Birth weight and asthma in young adults of a Brazilian birth cohort.

This article aims to evaluate the association between birth weight and asthma in adulthood, estimated by employing structural equation modeling. Cohort study with 1,958 participants aged 23-25 years from Ribeirão Preto, São Paulo, Brazil. Standardized questionnaires were applied and pulmonary function evaluated, including bronchial reactivity with methacholine. A theoretical model was proposed to explore the effects of birth weight and asthma in adulthood. Asthma, socioeconomic status at birth (Birth SES), and current socioeconomic status (Adult SES) were obtained by constructs. Maternal age, sex, skin color, body mass index (BMI), smoking, parental asthma history, history of respiratory infection before five years old, history of hospitalization for lung disease before two years old, and atopy were the studied variables. 14.1% of participants were diagnosed with asthma. Birth weight was associated with asthma (Standardized Coefficient - SCtotal=-0.110; p=0.030), and an indirect effect was also observed (SCindirect=-0.220; p=0.037), mediated by hospitalization before two years and respiratory infection before five years. Lower birth weight showed an increased risk of asthma in adulthood and the SES Birth and Adult SES variables underlie this association.

Association between the Consumption of Ultra-Processed Foods and Asthma in Adults from Ribeirão Preto, São Paulo, Brazil.

BACKGROUND: Ultra-processed Food (UPF) consumption can play a role in the pathogenesis and progression of asthma. The aim of this study was to evaluate the association between the consumption of UPF and asthma. METHODS: This cross-sectional study included 1857 adults aged 23-25 years from the Ribeirão Preto-SP birth cohort (1978/1979). The exposure variable was the consumption of UPF (expressed as their percentage contribution to energy intake-% total caloric value [%TCV] and their percentage contribution to the amount of food ingested-%grams), which was assessed with a food frequency questionnaire. Asthma was the outcome and was defined based on a positive methacholine challenge test and the presence of wheezing, chest tightness, or shortness of breath over the last 12 months. Poisson regression with robust variance was used to estimate the association between these variables. Unadjusted analyses and analyses adjusted for sex, age, household income, smoking, and physical activity level were performed. RESULTS: The prevalence of asthma in the sample was 13.2%. The mean total consumption of UPF was 37.9 ± 11.2% TCV (corresponding to 35.1 ± 15.1% grams). There was no association between the consumption of UPF and asthma in adults. CONCLUSION: This study provides no evidence for an association between the consumption of UPF and asthma in young adults.

RANTES and developmental defects of enamel in children: A Brazilian prenatal cohort (BRISA).

OBJECTIVE: Little is known about the effect of maternal immunological factors on the etiology of developmental defects of enamel (DDE). RANTES (Regulated on Activation Normal T Cell Expressed and Secreted) is a chemokine produced by fibroblasts, lymphoid and epithelial mucosa cells in response to various external stimuli. Despite its importance for embryogenesis, RANTES expression has been demonstrated in multiple diseases characterized by inflammation, tumor and immune response, and wound healing. We hypothesized that altered levels of RANTES during pregnancy are associated with the immune and inflammatory response in women, which could lead to the occurrence of DDE in utero (DDE-iu), directly or mediated by preterm birth. Therefore, this study aimed to evaluate the direct and indirect effects of serum levels of RANTES in pregnant women in the occurrence of DDE-iu in children. METHODS: This is a longitudinal case-control study. The mothers and their children (327) were evaluated in three moments: prenatal care, post childbirth, and when the child was between 12.3 and 36 months of age. The analysis was performed with structural equation modeling, estimating the standardized coefficient (SC), adopting α = 5%. RESULTS: There was a direct and negative effect of RANTES on the outcome (SC = -0.137; p = 0.022). This association was not mediated by preterm birth (SC = 0.007; P = 0.551). When considering the specific types of DDE-iu, RANTES had a direct effect on hypoplasia (SC = -0.190; p = 0.007), but not on opacity (SC = 0.343; p = 0.074). CONCLUSION: Lower serum levels of RANTES may contribute to a higher number of teeth with DDE-iu, specifically hypoplasia. However, more evidence supported by clinical, laboratory and epidemiological studies is still needed.

High Consumption of Sugar-Sweetened Beverages Is Associated with Low Bone Mineral Density in Young People: The Brazilian Birth Cohort Consortium.

Sugar-sweetened beverages (SSB) consumption may be associated with a reduction in bone mineral density (BMD). The aim of this study was to evaluate the association between the consumption of SSB and BMD among young people. We performed a cross-sectional study that evaluated 6620 young people (18-23 years of age) from three Brazilian birth cohorts (Ribeirão Preto, Pelotas, and São Luís). We analyzed the daily frequency and the amount and energy contribution of the SSB, which were obtained through a food frequency questionnaire. Total body and lumbar spine BMD (g/cm2), measured by dual-energy X-ray absorptiometry, were the outcomes. Unadjusted linear regression models, adjusted for sex, socioeconomic class, physical activity, smoking, alcohol consumption, and body mass index were used. The highest tertile of SSB consumption frequency (2.1-16.7 times/day) was associated with a lower lumbar spine BMD (ß = -0.009; 95% CI: -0.017; -0.001; standardized ß = -0.03). This association persisted after adjustment for confounders (ß = -0.008; 95% CI: -0.016; -0.001; standardized ß = -0.03). No association was observed between SSB consumption frequency and total body BMD or between the amount and energy contribution of SSB and total body or lumbar spine BMD. A high frequency of SSB consumption was associated with a low lumbar spine BMD.

Sociodemographic and economic characteristics of families and health and education conditions of children in the BRISA cohort during the COVID-19 pandemic / Características sociodemográficas e econômicas das famílias e condições de saúde e educação das crianças da coorte BRISA durante a pandemia de COVID-19

ABSTRACT Objective: To describe changes in sociodemographic, economic and variables related to the characterization of family, health and education during the COVID-19 pandemic in a birth cohort evaluated at 10-11 years of age. Methods: Cross-sectional study involving 1,033 children from a cohort of children born in 2010/2011, in the city of Ribeirão Preto, SP, Brazil. Data were collected from July to October 2021 by telephone or video interview held with the person responsible for the child. The questionnaires discussed family organization, child behavior and health, school attendance, socioeconomic assessment and occurrence of COVID-19 during the period of social isolation due to the pandemic. Descriptive statistics were used to describe the data. The chi-square test was used to verify group differences by minimum wages (MW). Results: Of the respondents, 47.6% reported worsening of their financial situation during the pandemic, which was more frequent in the group with a household income <3 MW compared to the group with >6 MW (59.1 vs. 15.7%; p<0.001). According to the respondents, 62% of the children exhibited behavioral changes during the period and anxiety was the most frequently reported condition. In addition, 61.4% of the children had learning difficulties and these problems were more prevalent among children from households with lower incomes compared to those with higher incomes (74.7 vs. 45.1%; p<0.001). Conclusion: The COVID-19 pandemic has changed different economic aspects of families, as well as educational, health and behavioral indicators of children. Lower-income families were the most affected both economically and in terms of other indicators.

RESUMO Objetivo: Descrever as alterações nas características sociodemográficas, econômicas e variáveis relacionadas à caracterização da família, saúde e educação durante a pandemia da COVID-19, em uma coorte de nascimento avaliada aos 10-11 anos de idade. Métodos: Estudo transversal envolvendo 1.033 crianças de uma coorte de nascidos em 2010/2011, na cidade de Ribeirão Preto, SP, Brasil. Os dados foram obtidos por meio de entrevistas por telefone ou videochamada com o responsável pela criança, no período de julho a outubro de 2021. Os questionários abordaram informações sobre a organização familiar, comportamento e saúde da criança, acompanhamento escolar, avaliação socioeconômica e ocorrência da COVID-19 durante o período de isolamento social. Foi realizada estatística descritiva. O teste qui-quadrado foi utilizado para verificar diferenças de grupos por salários-mínimos (SM). Resultados: Dos entrevistados, 47,6% relataram piora na condição financeira durante a pandemia, sendo a piora econômica mais frequente no grupo de renda familiar <3 SM em comparação ao grupo de >6 SM (59,1 vs. 15,7%; p<0,001). Segundo os responsáveis, 62% das crianças apresentaram mudança de comportamento durante o período, sendo a ansiedade relatada com mais frequência. Ainda, 61,4% das crianças apresentaram dificuldades de aprendizagem, e o prejuízo foi mais acentuado naquelas de menor renda familiar em comparação às de maior renda (74,7 vs. 45,1%; p<0,001). Conclusão: A pandemia da COVID-19 alterou diferentes aspectos econômicos das famílias, assim como indicadores educacionais, de saúde e de comportamento das crianças. As famílias de menor renda foram as mais prejudicadas tanto do ponto de vista econômico como nos demais indicadores.

Nascer de cesariana e associação com quociente de inteligência em adolescentes: contribuição do Consórcio de Coortes RPS (Ribeirão Preto, Pelotas e São Luís), Brasil / Cesarean section and association with intelligence quotient in adolescents: contribution from the RPS Cohort Consortium (Ribeirão Preto, Pelotas and São Luís), Brazil / Parto por cesárea y asociación con cociente de inteligencia en adolescentes: contribución del Consorcio de Cohorte RPS (Ribeirão Preto, Pelotas y São Luís), Brasil

O objetivo do estudo foi avaliar a associação entre a cesariana e o quociente de inteligência (QI) em adolescentes do Município de São Luís, Maranhão, Brasil. Trata-se de um estudo longitudinal utilizando dados da coorte de nascimento em São Luís, iniciado no ano de 1997. A abordagem ocorreu na terceira fase da coorte, em 2016, com adolescente aos 18 e 19 anos de idade. A variável de exposição foi a via de nascimento e a variável de desfecho foi o QI, mensurada a partir da aplicação da terceira versão da Escala de Inteligência Wechsler para Adultos (WAIS-III). Na análise dos dados verificou-se a média do QI segundo as covariáveis e utilizou-se a regressão linear multivariada. Para controlar os fatores de confundimento foi elaborado um modelo teórico utilizando o gráfico acíclico dirigido. As variáveis confundidoras foram as socioeconômicas no momento do nascimento e as variáveis perinatais. A média do QI dos adolescentes foi 101,4. Na análise bruta, o QI dos adolescentes nascidos de cesariana foi 5,8 pontos maior em relação aos nascidos de parto vaginal (IC95%: 3,8; 7,7, p ≤ 0,001), com significância estatística. Na análise multivariada, o valor reduziu para 1,9 (IC95%: -0,5; 3,6, p = 0,141), sem significância estatística. O resultado do estudo mostrou que a cesariana não está associada ao QI dos adolescentes nessa amostra e reflete que as diferenças encontradas podem ser explicadas por outros fatores, como aspectos socioeconômicos e perinatais.

This study aimed to evaluate the association between cesarean section and intelligence quotient (IQ) in adolescents from the Municipality of São Luís, Maranhão State, Brazil. This is a longitudinal study using data from the São Luís birth cohort, started in 1997. The approach occurred in the third phase of the cohort, in 2016, with adolescents aged 18 and 19 years. The exposure variable was mode of delivery and the outcome variable was IQ, measured by applying the third version of the Wechsler Adult Intelligence Scale (WAIS-III). In the data analysis, the average IQ was verified according to the covariates and multivariate linear regression was used. To control confounding factors, a theoretical model was elaborated using the directed acyclic graph. The confounding variables were socioeconomic variables at birth and perinatal variables. Their average IQ was 101.4. In the crude analysis, the IQ of adolescents born by cesarean section was 5.8 points higher than those born by vaginal delivery (95%CI: 3.8; 7.7, p ≤ 0.001), with statistical significance. In the multivariate analysis, the value decreased to 1.9 (95%CI: -0.5; 3.6, p = 0.141), without statistical significance. The result of the study showed that cesarean section is not associated with the IQ of adolescents in this sample and reflects that the differences can be explained by other factors, such as socioeconomic and perinatal aspects.

El objetivo del estudio fue evaluar la asociación entre la cesárea y el cociente de inteligencia (CI) en adolescentes del Municipio de São Luís, Maranhão, Brasil. Este es un estudio longitudinal que utiliza datos de la cohorte de nacimiento en São Luís, que comenzó en 1997. El abordaje ocurrió en la tercera fase de la cohorte, en 2016, con adolescente a los 18 y 19 años de edad. La variable de exposición fue la vía de nacimiento y la variable de resultado fue el CI, medido a partir de la aplicación de la tercera versión de la Escala de Inteligencia para Adultos (WAIS-III). En el análisis de datos se verificó el CI medio según las covariables y se utilizó la regresión lineal multivariada. Para controlar los factores de confusión se elaboró un modelo teórico utilizando el gráfico acíclico dirigido. Las variables de confusión fueron las socioeconómicas en el momento del nacimiento y las variables perinatales. El coeficiente intelectual promedio de los adolescentes fue de 101,4. En el análisis bruto, el CI de los adolescentes nacidos de cesárea fue 5,8 puntos mayor en relación a los nacidos de parto vaginal (IC95%: 3,8; 7,7, p ≤ 0,001), con significancia estadística. En el análisis multivariado, el valor se redujo a 1,9 (IC95%: -0,5; 3,6, p = 0,141), sin significación estadística. El resultado del estudio mostró que la cesárea no está asociada con el coeficiente intelectual de los adolescentes en esta muestra y refleja que las diferencias encontradas pueden explicarse por otros factores, como los aspectos socioeconómicos y perinatales.

Why are pediatricians uncomfortable with prescribing emergency contraception for adolescents? / Por que os pediatras têm desconforto para prescrever contracepção de emergência para adolescentes?

Abstract Objective: Emergency contraception (EC) is an effective and safe method for preventing unplanned pregnancy after unprotected sexual intercourse among adolescents but is infrequently prescribed by pediatricians. Because of the scarcity of data on the discomfort with EC prescription among physicians in Brazil, this study aimed to identify associated factors with discomfort with EC prescription among pediatricians in the state of Amazonas. Methods: A web-based, cross-sectional study including sociodemographic data, knowledge, attitudes, and discomfort with EC prescription was used. Multivariate logistic regression and artificial intelligence methods such as decision tree and random forest analysis were used to identify factors associated with discomfort with EC prescriptions. Results: Among 151 physicians who responded to the survey, 53.0% were uncomfortable with prescribing EC, whereas only 33.1% had already prescribed it. Inexperience was significantly associated with discomfort with EC prescription (odds ratio 4.47, 95% confidence interval 1.71-11.66). Previous EC prescription was protective against discomfort with EC prescription in the three models. Conclusions: EC is still infrequently prescribed by pediatricians because of inexperience and misconceptions. Training these professionals needs to be implemented as part of public health policies to reduce unplanned adolescent pregnancy.

RESUMO Objetivo: A contracepção de emergência (CE) é um método eficaz e seguro para prevenir gravidez não planejada após relação sexual desprotegida entre adolescentes, mas raramente prescrito por pediatras. Diante da escassez de dados sobre o desconforto com a prescrição de CE entre médicos no Brasil, o objetivo deste estudo foi identificar fatores associados a esse desconforto entre pediatras do estado do Amazonas. Métodos: Uma pesquisa do tipo e-survey coletou dados sociodemográficos, conhecimento, atitudes e desconforto com relação à prescrição de CE. Métodos de regressão logística multivariada e inteligência artificial, como árvore de decisão e random forest, foram usados para identificar fatores associados ao desconforto para a prescrição de CE. Resultados: Entre os 151 médicos que responderam à pesquisa, 53,0% sentiam-se desconfortáveis para prescrever CE e apenas 33,1% já a haviam prescrito. A inexperiência foi associada a esse desconforto (odds ratio — OR 4,47, intervalo de confiança — IC95% 1,71-11,66). A prescrição prévia de CE foi fator de proteção com relação ao desconforto nos três modelos. Conclusões: A CE ainda é pouco prescrita por pediatras. Apesar de sua segurança e eficácia, a inexperiência e conceitos equivocados foram associados ao desconforto para sua prescrição. Investigações sobre o assunto são importantes para subsidiar políticas públicas de saúde para a redução da gravidez não intencional na adolescência.

Sleep characteristics and excessive daytime sleepiness in adolescents and adults: results from the birth cohorts of three Brazilian cities — RPS Consortium / Características do sono e sonolência diurna excessiva em adolescentes e adultos: resultados das coortes de nascimento de três cidades brasileiras - Consórcio RPS

ABSTRACT Objective: To describe the prevalence of insufficient sleep duration, long sleep latency, terminal or maintenance insomnia, subjective sleep quality, and excessive daytime sleepiness among participants of birth cohorts conducted in three Brazilian cities, and to evaluate differences in prevalence rates within cohorts according to sociodemographic characteristics. Methods: Cross-sectional analyses involving adolescents and adults participating in four birth cohorts conducted in Ribeirão Preto (RP78 and RP94), Pelotas (PEL93) and São Luís (SL97/98). Sleep duration, latency, terminal or maintenance insomnia, and subjective sleep quality were obtained through the Pittsburgh Sleep Quality Index; and excessive daytime sleepiness was assessed using the Epworth Sleepiness Scale. Differences in the prevalence of the outcomes were analyzed in each cohort according to sociodemographic characteristics (skin color, marital status, socioeconomic status, study and working at the time of the interview) stratified by sex. Results: Insufficient sleep duration was the most common outcome at the four cohorts, with higher frequency among men. Long latency was more frequently reported by young adult women in RP94 and PEL93 cohorts, and insomnia by women of the four cohorts, when compared to men of the same age. Women generally suffered more from excessive daytime sleepiness and evaluated the quality of their sleep more negatively than men. In addition to sex, being a student and working were associated with the largest number of outcomes in both sexes. Conclusion: Sleep disorders are more prevalent in women, reinforcing the need for greater investment in sleep health in Brazil, without disregarding gender and socioeconomic determinants.

RESUMO Objetivo: Descrever a prevalência de duração do sono, latência, insônia terminal, qualidade subjetiva do sono e sonolência diurna excessiva entre participantes de coortes de nascimentos realizadas em três cidades brasileiras, bem como avaliar as diferenças nas taxas de prevalência das coortes de acordo com características sociodemográficas. Métodos: Análises transversais envolvendo participantes de quatro coortes de nascimento realizadas em Ribeirão Preto (RP78 e RP94), Pelotas (PEL93) e São Luís (SL97). A duração, a latência, a insônia terminal e a qualidade subjetiva do sono foram obtidas por meio do Índice de Qualidade do Sono de Pittsburgh; e a sonolência diurna excessiva foi avaliada pela Escala de Sonolência de Epworth. As diferenças na prevalência dos desfechos foram analisadas em cada coorte segundo características sociodemográficas estratificadas por sexo. Resultados: A duração insuficiente do sono foi o desfecho mais comum nas quatro coortes, com maior frequência entre os homens. Latência longa foi mais frequentemente relatada por mulheres adultas jovens nas coortes RP94 e PEL93, e insônia por mulheres das quatro coortes, quando comparadas a homens da mesma idade. As mulheres geralmente sofriam mais com sonolência diurna excessiva e avaliavam a qualidade do sono de forma mais negativa do que os homens. Além do sexo, ser estudante e trabalhar estiveram associados ao maior número de desfechos em ambos os sexos. Conclusão: Os distúrbios do sono são mais prevalentes em mulheres, reforçando a necessidade de maior investimento na saúde do sono no Brasil, sem desconsiderar gênero e determinantes socioeconômicos.

Validation of a food frequency questionnaire for assessing the intake of food groups and nutrients in adults / Validação de um questionário de frequência alimentar para avaliação do consumo de grupos de alimentos e nutrientes em adultos

ABSTRACT Objective: To validate a food frequency questionnaire used to assess food consumption among adults in a Brazilian cohort. Methods: Cross-sectional study conducted on 100 adults. Food intake was assessed by the food frequency questionnaire and by two 24-hour recalls. Validation was performed for nutrients (n=19) and food groups (n=21). Results: Moderate deattenuated Pearson's correlation coefficients (>0.4) were observed for the consumption of dairy products, breads and crackers, rice, pasta and tubers, leafy vegetables, other vegetables, fats, sweetened drinks, sandwiches and savory snacks, and nuts, and for the following nutrients (deattenuated and adjusted for energy intake): fiber, calcium, and vitamins A, B2, and C. Based on almost all food groups and nutrients assessed, ≥70% of the individuals were classified into the same or adjacent quartile for both methods, except for red and pork meat, snacks, nuts, phosphorus, potassium, and vitamin B3. The food groups and nutrients with fair kappa agreement (>0.2) were: dairy products, other vegetables, sweetened drinks, breakfast cereals, energy, carbohydrate, iron, and vitamin A. Conclusion: The food frequency questionnaire has proven useful for estimating the intake of some nutrients and food groups of the subjects evaluated. Only the intake of red and pork meat, snacks, nuts, vitamin B3, phosphorus and potassium were estimated with less accuracy.

RESUMO Objetivo: Validar um questionário de frequência alimentar para avaliar o consumo alimentar de adultos em uma coorte brasileira. Métodos: Estudo transversal realizado com 100 adultos. A ingestão alimentar foi avaliada pelo questionário de frequência alimentar e por dois recordatórios de 24 horas. A validação foi realizada para nutrientes (n=19) e grupos de alimentos (n=21). Resultados: Coeficientes de correlação de Pearson deatenuados moderados (>0,4) foram observados para o consumo de laticínios, pães e biscoitos, arroz, macarrão e tubérculos, vegetais folhosos, outros vegetais, gorduras, bebidas adoçadas, sanduíches e salgadinhos, e nozes, e para os seguintes nutrientes (deatenuados e ajustados para ingestão de energia): fibra, cálcio e vitaminas A, B2 e C. Com base em quase todos os grupos de alimentos e nutrientes avaliados, ≥70% dos indivíduos foram classificados no mesmo quartil ou quartil adjacente para ambos os métodos, exceto para carnes vermelhas e suínas, salgadinhos, nozes, fósforo, potássio e vitamina B3. Os grupos de alimentos e nutrientes com concordância kappa justa (>0,2) foram: laticínios, outras verduras, bebidas açucaradas, cereais matinais, energia, carboidratos, ferro e vitamina A. Conclusão: O questionário de frequência alimentar mostrou-se útil para estimar a ingestão de alguns nutrientes e grupos de alimentos dos sujeitos avaliados. Apenas o consumo de carnes vermelhas e suínas, salgadinhos, nozes, vitamina B3, fósforo e potássio foi estimado com menor precisão.

Factors associated with allergy traits around the 2nd year of life: a brazilian cohort study.

BACKGROUND: Allergic status has been strongly influenced by early exposures; however, allergic diseases are hard to measure in early life. Thus, this study proposed a latent variable allergy traits around the second year of life and analyzed pre- and perinatal factors associated with this phenomenon. METHODS: The study used data from the BRISA birth cohort, Ribeirão Preto, Brazil (n = 3644). The theoretical model included: family allergy (history of allergic rhinitis, atopic dermatitis, and asthma); gestational period variables (socioeconomic status, mother's skin color, pregestational body mass index - BMI, smoking, gestational diabetes, and hypertension); birth variables (gestational age, 5-minute Apgar score, birth weight, type of delivery), and early life factor (exclusive breast feeding). The outcome was allergy traits around the 2nd year of life, a latent variable deduced from the shared variance among medical diagnosis of allergic rhinitis, atopic dermatitis, and food allergy. The model was analyzed by structural equation modeling. RESULTS: Higher socioeconomic status (SC = 0.256; p < 0.001) and higher family allergy values (SC = 1.224; p < 0.001) were associated with higher allergy trait values. Hypertension during pregnancy was associated with higher values (SC = 0.170; p = 0.022) and exclusive breast feeding (SC = -0.192; p < 0.001) with low allergy trait values. CONCLUSION: Although socioeconomic and environmental factors were associated with allergy traits around the 2nd year of life, the family component of allergy was the exposure that best explained this outcome.

Behavioral risk factors for noncommunicable diseases associated with depression and suicide risk in adolescence.

Noncommunicable diseases (NCDs) and mental disorders cooccur in adulthood, which is why their determinants and common risk factors should be addressed at an early age. Therefore, we estimated the association of the major risk factors for NCDs with depression and suicide risk by structural equation modeling considering pathways triggered by social vulnerability or mediated by obesity. This population-based study included 2,515 Brazilian adolescents. The following exposures were the major risk factors for NCDs: substance use behaviors (variable deduced from alcohol, tobacco, and drug use), physical inactivity, and components of unhealthy eating markers (added sugar and saturated fat). Obesity was assessed using the fat mass index. The outcomes were depression and suicide risk. Depression was associated with substance use behaviors (SC = 0.304; p < 0.001), added sugar (SC = 0.094; p = 0.005), and females (SC = 0.310; p < 0.001). Suicide risk was also associated with substance use behaviors (SC = 0.356; p < 0.001), added sugar (SC = 0.100; p = 0.012), and females (SC = 0.207; p < 0.001). In adolescents, these associations may help explain the cluster of NCDs and mental disorders in adulthood.

Behavioral risk factors for noncommunicable diseases associated with depression and suicide risk in adolescence / Fatores de risco comportamentais para doenças não transmissíveis associados à depressão e ao risco de suicídio em adolescentes / Factores de riesgo comportamentales para las enfermedades no comunicables asociadas con la depresión y el riesgo de suicidio en la adolescencia

Noncommunicable diseases (NCDs) and mental disorders cooccur in adulthood, which is why their determinants and common risk factors should be addressed at an early age. Therefore, we estimated the association of the major risk factors for NCDs with depression and suicide risk by structural equation modeling considering pathways triggered by social vulnerability or mediated by obesity. This population-based study included 2,515 Brazilian adolescents. The following exposures were the major risk factors for NCDs: substance use behaviors (variable deduced from alcohol, tobacco, and drug use), physical inactivity, and components of unhealthy eating markers (added sugar and saturated fat). Obesity was assessed using the fat mass index. The outcomes were depression and suicide risk. Depression was associated with substance use behaviors (SC = 0.304; p < 0.001), added sugar (SC = 0.094; p = 0.005), and females (SC = 0.310; p < 0.001). Suicide risk was also associated with substance use behaviors (SC = 0.356; p < 0.001), added sugar (SC = 0.100; p = 0.012), and females (SC = 0.207; p < 0.001). In adolescents, these associations may help explain the cluster of NCDs and mental disorders in adulthood.

As doenças não transmissíveis (DNT) e transtornos mentais podem ocorrer simultaneamente na vida adulta, razão pela qual seus determinantes e fatores de risco comuns devem ser abordados em idade precoce. Portanto, estimamos a associação entre os principais fatores de risco para DNT e a depressão e risco de suicídio através da modelagem de equações estruturais, considerando os caminhos desencadeados pela vulnerabilidade social ou mediados pela obesidade. Este estudo de base populacional incluiu 2.515 adolescentes brasileiros. As exposições foram os principais fatores de risco para DNT: comportamento de risco viciante (variável latente deduzida a partir do uso de álcool, tabaco e drogas), inatividade física e componentes da dieta não saudável (açúcar de adição e gordura saturada). A obesidade foi avaliada pelo índice de massa gorda. Os desfechos foram depressão e risco de suicídio. Comportamento de risco viciante (CP = 0,304; p < 0,001), açúcar de adição (CP = 0,094; p = 0,005) e sexo feminino (CP = 0,310; p < 0,001) estiveram associados à depressão. Comportamento de risco viciante (CP = 0,356; p < 0,001), açúcar de adição (CP = 0,100; p = 0,012) e sexo feminino (CP = 0,207; p < 0,001) também estiveram associados ao risco de suicídio. Comportamento de risco viciante e açúcar de adição estiveram associados à depressão e ao risco de suicídio em adolescentes, fato este que pode ajudar a explicar o agrupamento de DNT e transtornos mentais na vida adulta.

Las enfermedades no comunicables (ENTs) y los desórdenes mentales ocurren en la etapa adulta, un hecho que da impulso para dirigirse a sus determinantes y factores de riesgo comunes a una edad temprana. Por ello estimamos la asociación de los mayores factores de riesgo para ENTs con la depresión y riesgo de suicidio mediante un modelo de ecuación estructural, considerando trayectorias derivadas de la vulnerabilidad social o mediadas por la obesidad. Este estudio basado en población incluyó a 2.515 adolescentes brasileños. Las exposiciones fueron los mayores factores de riesgo para las ENTs: comportamiento en el uso de sustancias (variable latente deducida del alcohol, tabaco y consumo de drogas), inactividad física y componentes de marcadores de consumo de comida insana (azúcar añadido y grasas saturadas). La obesidad fue evaluada usando el índice de masa grasa. Los resultados fueron depresión y riesgo de suicidio. Los comportamientos en el uso de sustancias (CE = 0,304; p < 0,001), azúcar añadido (CE = 0,094; p = 0,005), y sexo femenino (CE = 0,310; p < 0,001) estuvieron asociados con depresión. Comportamientos en el consumo de sustancias (CE = 0,356; p < 0,001) y azúcar añadido (CE = 0,100; p = 0,012) y el sexo femenino (CE = 0,207; p < 0,001) estuvieron también asociados con el riesgo de suicidio. Los comportamientos en el consumo de sustancias y de azúcar añadido, estuvieron asociados con la depresión y el riesgo de suicidio en adolescentes, un hecho que puede ayudar a explicar la concentración de ENTs y desórdenes mentales en la etapa adulta.

Physical activity in birth cohorts of three Brazilian cities (Ribeirão Preto, Pelotas, and São Luís): A cross-sectional study / Atividade física em coortes de nascimento de três cidades brasileiras (Ribeirão Preto, Pelotas e São Luís): estudo transversal

ABSTRACT Objective: To describe the prevalence of physical activity among subjects from birth cohorts of three cities located in different regions of Brazil according to sociodemographic characteristics and sex, comparing the relationships within and between cohorts. Methods: Cross-sectional study involving 12,724 adolescents and young adults who participated in five birth cohorts: Ribeirão Preto [1978/79 (37/39 years old in 2016) and 1994 (22 years in 2016)]; Pelotas [1982 (30 years in 2012) and 1993 (22 years in 2015)], and São Luís [1997/98 (18/19 years in 2016)]. Leisure-time physical activity was evaluated with questionnaires (insufficiently active: <150 min/week and active: ≥150 min/week) and moderate and vigorous physical activity (MVPA) was objectively measured by accelerometry. Those, in each city, were evaluated accordingly to skin color, socioeconomic classification, and study/work activities. Results: The prevalence of leisure-time physical activity ranged from 29.2% at 30 years old in Pelotas to 54.6% among adolescents from São Luís. The prevalence of leisure-time physical activity was higher among younger people (54.6% in São Luís 1997), while the same was not observed for total physical activity. MVPA (3rd tercile) was higher in the cohorts from Pelotas and São Luís. The prevalence of leisure-time physical activity and MVPA was higher in men. The data showed that the variation in physical activity was associated with sex and sociodemographic conditions in all cohorts. Conclusion: Sociodemographic characteristics should be considered when promoting leisure-time physical activity and actions aimed at young people, and adults who are more socioeconomically vulnerable should be encouraged.

RESUMO Objetivo: Descrever a prevalência de atividade física entre sujeitos de coortes de nascimento de três cidades localizadas em diferentes regiões do Brasil segundo características sociodemográficas e sexo, comparando relações intra e intercoortes. Métodos: Estudo transversal com 12.724 adolescentes e adultos jovens que participaram de cinco coortes de nascimento: Ribeirão Preto [1978/79 (37/39 anos em 2016) e 1994 (22 anos em 2016)]; Pelotas [1982 (30 anos em 2012) e 1993 (22 anos em 2015)] e São Luís [1997/98 (18/19 anos em 2016)]. A atividade física no lazer foi avaliada com questionários (insuficientemente ativo: <150 min/semana; ativo: ≥150 min/semana) e a atividade física moderada e vigorosa (AFMV) foi medida objetivamente por acelerometria. Foram avaliadas a cor da pele, a classificação socioeconômica e as atividades de estudo/trabalho. Resultados: A prevalência de ativos no lazer variou de 29,2% aos 30 anos em Pelotas a 54,6% entre os adolescentes de São Luís. A prevalência de ativos no lazer foi maior entre os mais jovens (54,6% em São Luís/1997), o que não foi observado para a atividade física total. A AFMV (3o tercil) foi maior nas coortes de Pelotas e São Luís. A prevalência de ativos no lazer e a AFMV foi maior nos homens. Os dados mostraram que a variação da atividade física foi associada ao sexo e às condições sociodemográficas em todas as coortes. Conclusão: As características sociodemográficas devem ser consideradas na promoção da atividade física no lazer e as ações voltadas para jovens e adultos mais vulneráveis socioeconomicamente devem ser incentivadas.

Factors associated with neonatal-near miss: birth cohorts in three Brazilian cities - Ribeirão Preto, Pelotas and São Luís, Brazil / Fatores associados ao near miss neonatal: coortes de nascimentos de três cidades brasileiras - Ribeirão Preto, Pelotas e São Luís, Brasil

Abstract The aim of this study was to investigate the association of sociodemographic factors, lifestyle, maternal reproductive profile and prenatal and childbirth care with neonatal near miss (NNM) morbidity in four birth cohorts. This study involved four population-based birth cohorts: Ribeirão Preto (RP) and São Luís (SL) (2010), Pelotas 2004 (PEL04) and 2015 (PEL15). NNM was defined when one or more of the following conditions were present: birthweight <1,500 g, 5-minute Apgar score <7, gestational age <32 weeks, and report of congenital malformations. The covariates were obtained with questionnaires applied to the puerperal women. Some particularities between cohorts were identified. In the RP and SL cohorts, factors of the more distal levels (sociodemographic, lifestyle, and reproductive profile) were associated with NNM. On the other hand, proximal factors related to healthcare were more significant for the occurrence of NNM in PEL. Only the absence of prenatal care was associated with NNM in all cohorts: RP (OR=4.27, 95%CI 2.16-8.45), SL (OR=2.32, 95%CI 1.09-4.94), PEL04 (OR=4.79, 95%CI 1.59-14.46), and PEL15 (OR=5.10, 95%CI 2.60-9.97).

Resumo O objetivo deste estudo foi investigar a associação entre fatores sociodemográficos, estilo de vida, perfil reprodutivo maternos e atenção pré-natal e ao parto com a morbidade near miss neonatal (NMN), em quatro coortes de nascimento. Este estudo envolveu quatro coortes de nascimento: Ribeirão Preto (RP) e São Luís (SL) (2010), Pelotas 2004 (PEL04) e 2015 (PEL15). Foi considerado NMN quando presente uma ou mais das seguintes condições: peso ao nascer <1.500g, índice de Apgar <7 no quinto minuto de vida, idade gestacional <32 semanas e relato de malformações congênitas. As covariáveis foram obtidas por meio de questionários aplicados às puérperas. Para análise, foi utilizada regressão logística múltipla com abordagem hierarquizada. Algumas particularidades entre as coortes foram verificadas. Nas coortes de RP e SL foram observadas associações dos fatores dos níveis mais distais (sociodemográficas, estilo de vida e perfil reprodutivo) com o NMN. Por outro lado, em PEL os fatores proximais relacionados à atenção à saúde foram mais significativos para ocorrência de NMN. Apenas a não realização do pré-natal associou-se ao NMN em todas as coortes: RP (OR=4,27, IC95% 2,16-8,45), SL (OR=2,32, IC95% 1,09-4,94), PEL04 (OR=4,79, IC95% 1,59-14,46) e PEL15 (OR=5,10, IC95% 2,60-9,97).

Comparison of body composition parameters in the study of the association between body composition and pulmonary function.

BACKGROUND: The excess adiposity, even in the absence of diseases, is responsible for a decline in pulmonary function, which is considered a predictor of mortality and a risk factor for diseases in several epidemiological studies. However, studies on the association between obesity and pulmonary function have found only few associations or inconclusive results. The aim of the study is to evaluate the association between body composition and spirometric parameters, comparing simple obesity measures such as body mass index (BMI) and waist circumference with more precise body composition measurements such as dual-energy X-ray absorptiometry (DXA) and air-displacement plethysmography (BOD POD). METHODS: This is an observational, cross-sectional study that used data from the 1978/79 Ribeirão Preto birth cohort (São Paulo, Brazil). The study included 1746 participants from the 5th follow-up of the cohort. Linear regressions were calculated to evaluate the association between BMI, waist circumference, waist-height ratio (WHtR), BOD POD- and DXA-measured fat mass percentage, and spirometric parameters FEV1, and FVC. RESULTS: For every 1-kg/m2 BMI increase, FVC decreased by 13 ml in males and by 6 ml in females and FEV1 decreased by 11 ml and 5 ml, respectively. Regarding body composition measurements, for a 1% increase in fat mass assessed by BOD POD, FVC decreased by 16 ml in males and by 8 ml in females and FEV1 decreased by 13 ml and 7 ml, respectively. Hence, negative associations between body measurements and FEV1 and FVC were observed in both genders, especially when using the fat mass measurement and were more expressive in men. CONCLUSION: The anthropometric and body composition parameters were negatively associated with the spirometric variables FVC and FEV1. We have also observed that simple measures such as waist-height ratio were sufficient to detect the association of body composition with pulmonary function reduction.

Previous preeclampsia and its association with the future development of cardiovascular diseases: a systematic review and meta-analysis

Preeclampsia is a multifactorial disease. Among these factors, untreated hypertension during pregnancy can result in high morbidity and mortality rates and may also be related to the future development of cardiovascular diseases.Therefore, this systematic review aimed to determine the association of previous preeclampsia with the future development of cardiovascular diseases. Studies on the association between preeclampsia and future cardiovascular diseases published in the last 10 years (2009-2019) were identified from the PubMed/Medline (207 articles), Embase (nine articles), and Cochrane (three articles) databases using the keywords "preeclampsia" and "future cardiovascular diseases", "preeclampsia" and "future heart attack", and "preeclampsia" and "future cardiac disease". After applying the inclusion and exclusion criteria, 15 articles were analyzed by systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The meta-analysis and the determination of the quality of the articles were conducted using RevMan software, version 5.3. Statistically significant differences were observed between the control and previous preeclampsia groups with respect to systolic blood pressure (mean difference [MD] 4.32; 95% confidence interval [95%CI] 3.65, 4.99; p<0.001), diastolic blood pressure (MD): 2.11; 95%CI: 1.68, 2.55; p<0.0001), and insulin level (MD: 2.80; 95% CI: 0.50, 5.11; p<0.001). Body mass index (MD: 2.57, 95%CI: 2.06, 3.07; p=0.0001), total cholesterol (MD: 10.39; 95%CI: 8.91, 11.87; p=0.0001), HDL (MD: 2.83; 95%CI: 2.20, 3.46; p=0.0001), and LDL (MD: 1.77; 95%CI: 0.42, 3.13; p=0.0001) also differed significantly between groups. Thus, the results of the present study showed that women with a history of preeclampsia were more likely to develop cardiovascular disease.

RPS Brazilian Birth Cohorts Consortium (Ribeirão Preto, Pelotas and São Luís): history, objectives and methods / Consórcio RPS (Ribeirão Preto, Pelotas e São Luís) de coortes de nascimento brasileiras: história, objetivos e métodos / Consorcio RPS (Ribeirão Preto, Pelotas y São Luís) cohortes brasileñas de nacimiento: historia, objetivos y métodos

Abstract: This paper describes the history, objectives and methods used by the nine Brazilian cohorts of the RPS Brazilian Birth Cohorts Consortium (Ribeirão Preto, Pelotas and São Luís) Common thematic axes are identified and the objectives, baseline periods, follow-up stages and representativity of the population studied are presented. The Consortium includes three birth cohorts from Ribeirão Preto, São Paulo State (1978/1979, 1994 and 2010), four from Pelotas, Rio Grande do Sul State (1982, 1993, 2004 and 2015), and two from São Luís, Maranhão State (1997 and 2010). The cohorts cover three regions of Brazil, from three distinct states, with marked socioeconomic, cultural and infrastructure differences. The cohorts were started at birth, except for the most recent one in each municipality, where mothers were recruited during pregnancy. The instruments for data collection have been refined in order to approach different exposures during the early phases of life and their long-term influence on the health-disease process. The investigators of the nine cohorts carried out perinatal studies and later studied human capital, mental health, nutrition and precursor signs of noncommunicable diseases. A total of 17,636 liveborns were recruited in Ribeirão Preto, 19,669 in Pelotas, and 7,659 in São Luís. In the studies starting during pregnancy, 1,400 pregnant women were interviewed in Ribeirão Preto, 3,199 in Pelotas, and 1,447 in São Luís. Different strategies were employed to reduce losses to follow-up. This research network allows the analysis of the incidence of diseases and the establishment of possible causal relations that might explain the health outcomes of these populations in order to contribute to the development of governmental actions and health policies more consistent with reality.

Resumo: O artigo descreve a história, objetivos e métodos utilizados pelas nove coortes do Consórcio RPS de Coortes de Nascimento. São identificados eixos temáticos comuns, com apresentação dos objetivos, anos de linha de base, fases de seguimento e representatividade das populações de estudo. O Consórcio inclui três coortes de nascimento de Ribeirão Preto, Estado de São Paulo (1978/1979, 1994 e 2010), quatro de Pelotas, Estado do Rio Grande do Sul (1982, 1993, 2004 e 2015) e duas de São Luís, Estado do Maranhão (1997 e 2010). As coortes provêm de três regiões do Brasil, de três estados diferentes, com importantes diferenças socioeconômicas, culturais e de infraestrutura. As coortes foram iniciadas ao nascer dos participantes, exceto a mais recente em cada município, onde as mães foram recrutadas durante a gestação. Os instrumentos para a coleta de dados foram refinados para aproximar diferentes exposições na primeira infância e a influência, a longo prazo, no processo saúde-doença. Os investigadores das nove coortes realizaram estudos perinatais e depois examinaram o capital humano, saúde mental, nutrição e sinais percursores de doenças crônicas. Um total de 17.636 nascidos vivos foram recrutados em Ribeirão Preto, 19.669 em Pelotas e 7.659 em São Luís. Nas coortes que foram iniciadas durante a gestação, foram entrevistadas 1.400 gestantes em Ribeirão Preto, 3.199 em Pelotas e 1.447 em São Luís. Foram utilizadas diferentes estratégias para reduzir as perdas de seguimento. A rede de pesquisa do Consórcio permite analisar a incidência de doenças e identificar possíveis relações causais que podem explicar os desfechos de saúde nessas populações e contribuir para o desenvolvimento de medidas públicas e políticas de saúde que estejam mais de acordo com as respectivas realidades.

Resumen: El trabajo describe la historia, objetivos y métodos usados por nueve cohortes brasileñas del RPS Consorcio de Cohortes de Nacimiento. Se identificaron los ejes temáticos comunes y los objetivos, así como los periodos de referencia, la presentación del estadio de seguimiento y representatividad de la población estudiada. El consorcio incluye tres cohortes de nacimiento de Ribeirão Preto, Estado de São Paulo (1978/1979, 1994 y 2010), cuatro de Pelotas, Estado del Rio Grande do Sul (1982, 1993, 2004 y 2015), y dos de São Luís, Estado del Maranhão (1997 y 2010). Las cohortes cubren tres regiones de Brasil, de tres estados distintos, con marcadas diferencias socioeconómicas, culturales y de infraestructura. Las cohortes comenzaron con el nacimiento, excepto para la más reciente en cada municipio, donde las madres fueron reclutadas durante la gestación. Los instrumentos para la recogida de datos han sido depurados, con el fin de realizar una aproximación a diferentes exposiciones durante las fases tempranas de la vida y su influencia a largo plazo en el proceso de salud-enfermedad. Se incluyeron a los investigadores de las nueve cohortes, donde se llevaron a cabo estudios perinatales, así como los recursos humanos analizados posteriormente, al igual que la salud mental, nutrición y signos precursores de enfermedades no comunicables. Un total de 17.636 nacidos vivos fueron reclutados en Ribeirão Preto, 19.669 en Pelotas, y 7.659 en São Luís. En los estudios que comenzaron durante el embarazo, 1.400 mujeres embarazadas fueron entrevistadas en Ribeirão Preto, 3.199 en Pelotas, y 1.447 en São Luís. Se usaron diferentes estrategias para reducir pérdidas, con el fin de realizar el seguimiento. Esta red de investigación permite el análisis de la incidencia de enfermedades y el establecimiento de posibles relaciones causales que podrían explicar los resultados de salud de estas poblaciones, con el fin de contribuir al desarrollo de acciones gubernamentales y políticas de salud más consistentes con la realidad.

Excess weight and obesity prevalence in the RPS Brazilian Birth Cohort Consortium (Ribeirão Preto, Pelotas and São Luís) / Prevalências de excesso de peso e obesidade no Consórcio RPS (Ribeirão Preto, Pelotas e São Luís) de coortes de nascimentos brasileiras, Brasil / Prevalencias de sobrepeso y obesidad en el Consorcio RPS (Ribeirão Preto, Pelotas y São Luís) cohortes brasileñas de nascimientos

Our objective was to estimate the prevalence of excess weight and obesity, according to sex and income in the RPS Brazilian Birth Cohort Consortium (Ribeirão Preto, Pelotas, and São Luís). Participants in the Ribeirão Preto (1978/1979 and 1994), Pelotas (1982, 1993 and 2004) and São Luís (1997/1998) birth cohorts were included in different follow-ups from 7 years old onwards. Excess weight (overweight and obesity) were assessed by body mass index. The highest prevalences were observed in Ribeirão Preto (excess weight: 27.7% at 9-11 and 47.1% at 22-23 years; obesity: 8.6% at 9-11 and 19.8% at 22-23 years) while the smallest was in São Luís (excess weight: 5.4 to 7-9 and 17.2% at 18-19 years; obesity: 1.8% at 7-9 and 3.6% at 18-19 years). The younger the cohort, the greater the prevalence of excess weight and obesity when comparing similar age groups. Increases in obesity prevalence were greater than in excess weight prevalence. Women had lower excess weight prevalence in older cohorts and higher obesity prevalence in younger cohorts. Higher excess weight and obesity prevalence were observed in higher income children and adolescents, and in poorer adults. Differences in the prevalence of excess weight and obesity evidenced that individuals from younger cohorts are more exposed to this morbidity, as well as those who were born in the most developed city, low-income adults as well as children and adolescents belonging to families of the highest income tertile. Therefore, the results of this study indicate the need to prioritize actions aimed at younger individuals.

O estudo teve como objetivo estimar as prevalências de excesso de peso e de obesidade, de acordo com sexo e renda, no Consórcio RPS (Ribeirão Preto, Pelotas e São Luís) de coorte de nascimentos brasileiros. Os participantes nas coortes de Ribeirão Preto (1978/1979 e 1994), Pelotas (1982, 1993 e 2004) e São Luís (1997/1998) foram incluídos em diferentes seguimentos a partir dos sete anos de idade. O excesso de peso (sobrepeso e obesidade) e a obesidade foram avaliados pelo índice de massa corporal. As maiores prevalências foram observadas em Ribeirão Preto (excesso de peso: 27,7% aos 9-11 e 47,1% aos 22-23 anos; obesidade: 8,6% aos 9-11 e 19,8% aos 22-23 anos) e as menores taxas em São Luís (excesso de peso: 5,4% aos 7-9 e 17,2% aos 18-19 anos; obesidade: 1,8% aos 7-9 e 3,6% aos 18-19 anos). Quanto mais jovem a coorte, maior a prevalência de excesso de peso e de obesidade, na comparação entre grupos etários semelhantes. O aumento na prevalência de obesidade foi maior que na prevalência de excesso de peso. As mulheres tiveram menor prevalência de excesso de peso nas coortes mais velhas e maior prevalência de obesidade nas coortes mais jovens. Maiores prevalências de excesso de peso e de obesidade foram observadas nas crianças e adolescentes com renda familiar mais alta e em adultos de renda mais baixa. As diferenças nas prevalências de excesso de peso e de obesidade evidenciaram que os indivíduos das coortes mais jovens estão mais expostos a essa morbidade, assim como, aqueles nascidos na cidade mais desenvolvida, os adultos de baixa renda e crianças e adolescentes pertencentes a família do tercil de maior renda. Portanto, os resultados indicam a necessidade de priorizar medidas dirigidas aos indivíduos mais jovens.

El objetivo de este estudio fue estimar la prevalencia de sobrepeso y obesidad, según sexo e ingresos en el Consorcio RPS (Ribeirão Preto, Pelotas and São Luís) cohortes brasileñas de nascimientos. Los participantes en las cohortes de nacimiento de Ribeirão Preto (1978/1979 y 1994), Pelotas (1982, 1993 y 2004) y São Luís (1997/1998) fueron incluidos en diferentes seguimientos desde los 7 años de edad. El exceso de peso (sobrepeso y obesidad) fueron evaluados por el índice de masa corporal. Las prevalencias más altas se observaron en Ribeirão Preto (exceso de peso: 27,7% a los 9-11 y 47,1% a los 22-23 años; obesidad: 8,6% a los 9-11 y 19,8% a los 22-23 años) y los más pequeños en São Luís (exceso de peso: 5,4 a los 7-9 y 17,2% a los 18-19 años; obesidad: 1,8% a los 7-9 y 3,6% a los 18-19 años). Cuanto más joven fuera la cohorte, mayor era la prevalencia de exceso de peso y obesidad, cuando se comparan con grupos de edad similares. El incremento en la prevalencia de obesidad fue mayor que en la prevalencia de exceso de peso. Las mujeres tenían una prevalencia de exceso de peso más baja en las cohortes más viejas y una mayor prevalencia de obesidad en las cohortes más jóvenes. Se observaron prevalencias más altas de exceso de peso y obesidad en los niños y adolescentes con mayores ingresos, y en los adultos más pobres. Las diferencias en las prevalencias de exceso de peso y obesidad evidenciaron que las personas de las cohortes más jóvenes estaban más expuestas a esta morbilidad, al igual que aquellas que habían nacido en las ciudades más desarrolladas, adultos con bajos ingresos, además de niños y adolescentes pertenecientes a las familias del tercil de ingresos más altos. Por eso, los resultados de este estudio indican la necesidad de priorizar acciones dirigidas a las personas más jóvenes.

Vaccination services and incomplete vaccine coverage for children: a comparative spatial analysis of the BRISA cohorts, São Luís (Maranhão State) and Ribeirão Preto (São Paulo State), Brazil / Serviços de vacinação e cobertura vacinal incompleta em crianças: uma análise espacial comparativa das coortes BRISA, São Luís (Maranhão) e Ribeirão Preto (São Paulo), Brasil / Servicios de vacunación y niños con su cobertura de vacunación incompleta: un análisis comparativo espacial de las cohortes BRISA, São Luís (Maranhão) y Ribeirão Preto (São Paulo), Brasil

We analyzed the spatial relation between incomplete vaccine coverage for children and the distance from vaccination services. This was a cross-sectional study of children from 13 to 35 months of age from the cities of São Luís (Maranhão State) and Ribeirão Preto (São Paulo State), Brazil, and from basic health units (UBS, in Portuguese). The sample consisted of 2,744 children from São Luís and 3,325 from Ribeirão Preto. Data about incomplete vaccine coverage for children were obtained from the BRISA birth cohorts. Data about the quality of UBS vaccination services were obtained from the first cycle of the Brazilian National Program for Improvement of Access and Quality of Basic Care (PMAQ-AB, in Portuguese). For the spatial analysis, we determined the distance between the residence of the children (with and without a complete vaccine calendar) and the vaccination services of the UBS (classified according to number of structural items). Incomplete vaccine coverage was more pronounced in São Luís, with greater percentages for human rotavirus and triple viral vaccines, with the latter being the least available. In Ribeirão Preto, incomplete BCG vaccine coverage was more pronounced, with the tetravalent vaccine being the least available. Children from the two cities showed similarities: most of them had adult mothers with 9 to 11 years of schooling and did not reside with siblings in the household. They also showed differences: in São Luís, most mothers belonged to the economic class C, while in Ribeirão Preto they belong to the A and B classes. In the two cities with different socioeconomic conditions, complete vaccine coverage seemed not to depend on the location or quality of the vaccination service. Although São Luís showed a better structure of the services, incomplete vaccine coverage was higher compared to Ribeirão Preto.

Analisamos a relação espacial entre cobertura vacinal incompleta em crianças e a distância da residência até os serviços de vacinação. Este foi um estudo transversal de crianças entre 13 e 35 meses de idade nas cidades de São Luís (Maranhão) e Ribeirão Preto (São Paulo), Brasil, e das unidades básicas de saúde (UBS). A amostra consistia em 2.744 crianças de São Luís e 3.325 de Ribeirão Preto. Os dados sobre a cobertura vacinal incompleta foram obtidos das coortes de nascimento BRISA. Os dados sobre a qualidade dos serviços de vacinação das UBS foram obtidos do primeiro ciclo do Programa de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB). Para a análise espacial, determinamos a distância da residência das crianças (com e sem calendário vacinal completo) até os serviços de vacinação da UBS (classificados de acordo com o número de itens estruturais). A cobertura vacinal incompleta era mais marcante em São Luís, com percentuais mais altos para as vacinas do rotavírus humano e tríplice viral, sendo que esta era menos disponível. Em Ribeirão Preto, a cobertura vacinal incompleta para BCG era mais evidente, enquanto a vacina tetravalente era a menos disponível. As crianças das duas cidades mostraram semelhanças: a maioria tinha mães adultas com 9 a 11 anos de escolaridade e não residia com irmãos no domicílio. Também mostravam diferenças: em São Luís, a maioria das mães pertencia à classe econômica C, enquanto as mães em Ribeirão Preto pertenciam mais às classes A e B. Nas duas cidades, com condições socioeconômicas diferentes, a cobertura vacinal completa parecia não depender da localização ou da qualidade do serviço de vacinação. Embora São Luís tenha demonstrado melhor estrutura dos serviços, a cobertura vacinal incompleta foi mais alta em São Luís quando comparada à de Ribeirão Preto.

Analizamos la relación espacial entre los niños con una cobertura de vacunación incompleta y la distancia que los separa de los servicios de vacunación. Se trata de un estudio transversal con niños desde los 13 a los 35 meses de edad en las ciudades de São Luís (Maranhão) y Ribeirão Preto (São Paulo), Brasil, y en unidades básicas de salud (UBS por sus siglas en portugués). La muestra consistió en 2.744 niños de São Luís y 3.325 de Ribeirão Preto. Los datos sobre la cobertura de vacunación incompleta de los niños proceden de las cohortes de nacimiento BRISA. Los datos sobre la calidad de los servicios de vacunación en los servicios UBS se obtuvieron del 1er ciclo del Programa Nacional de Mejoría de Acceso y Calidad de la Atención Básica (PMAQ-AB). Para el análisis espacial, determinamos la distancia entre la residencia de los niños (con y sin un calendario de vacunas completo) y los servicios de vacunación de las UBS (clasificados según el número de ítems estructurales). Se destacó una cobertura incompleta de vacunación en São Luís, con porcentajes de vacunas contra rotavirus humano y triple vírica, siendo esta última la menos disponible. En Ribeirão Preto, la cobertura incompleta de la vacuna BCG fue la más destacable y la vacuna tetravalente fue la menos disponible. Los niños de las dos ciudades mostraron similitudes: la mayoría de ellos tenían madres adultas con una escolaridad que oscilaba entre los 9 y los 11 años de edad y no residían con hermanos en el hogar. Asimismo, mostraron también diferencias: en São Luís, la mayoría de las madres pertenecían a la clase económica C, mientras que en Ribeirão Preto pertenecían las clases A y B. En las dos ciudades con condiciones diferentes socioeconómicas, la cobertura completa de vacunación parecía no depender de la localización o la calidad del servicio de vacunación. Sin embargo, São Luís mostró una mejor estructura de los servicios, aunque la cobertura incompleta de vacunación fue más alta comparada con Ribeirão Preto.

Sociodemographic factors and prenatal care behaviors associated with unplanned pregnancy in a Brazilian birth cohort study.

OBJECTIVE: To identify the sociodemographic factors and prenatal behavior characteristics associated with unplanned pregnancy. METHODS: A cross-sectional survey was conducted of mothers of newborns enrolled in a birth cohort in Ribeirão Preto, Brazil. Questionnaires were administered to postpartum women. Multiple logistic regression was used to identify sociodemographic predictors of unplanned pregnancy and to evaluate the association with adherence to prenatal care recommendations. RESULTS: The cohort included 7608 mothers: 7541 (99.1%) answered the interview and 4056 (53.8%) had an unplanned pregnancy. Adolescents were more likely to have an unplanned pregnancy (odds ratio [OR] 1.87; 95% confidence interval [CI] 1.50-2.34) as were women over 40 (OR 1.74; 95% CI 1.22-2.47). Pregnancy during adolescence (OR 1.27; 95% CI 1.09-1.48), being single (OR 7.56; 95% CI 5.98-9.56), having two or more previous births (OR 1.73; 95% CI 1.52-1.97), and being of a lower socioeconomic status were also predictors. Lack or late initiation of prenatal care, attendance at less than six prenatal visits, drinking alcohol, and smoking during pregnancy were associated with unplanned pregnancy. CONCLUSION: Unplanned pregnancies disproportionately affect women at extremes of age, single, and of low socioeconomic status. These women are less likely to adhere to prenatal care.