Causal Pathways Between the Acute Experience of Violence During Pregnancy and Fetal Intrauterine Growth Restriction: A Cohort Study.

Introduction: Violence during pregnancy (VDP) is a prevalent global issue with dire consequences for the mother and the developing fetus. These consequences include prematurity, low birthweight, and intrauterine growth restriction (IUGR), but its pathways remain elusive. This study investigated the causal pathways between VDP and IUGR using mediation analysis. Methods: A prospective population-based birth cohort was followed from the beginning of the third gestational trimester to the second year of life. IUGR was defined by the Kramer index, and information on VDP was collected using the WHO-Violence Against Women (WHO VAW) questionnaire. Cases were considered positive only when no other life episodes were reported. Ten different mediators were analyzed as possible pathways based on previous research. Path analysis was conducted to evaluate these relationships. Results: The path analysis model included 755 dyads and presented an adequate fit. Violence during pregnancy showed a direct effect (ß = -0.195, p = 0.041) and a total effect (ß = -0.276, p = 0.003) on IUGR. Violence was associated with gestational depression or anxiety, tobacco and alcohol consumption, changes in blood pressure, and the need for emergency care, but these did not constitute mediators of its effect on IUGR. The sum of the indirect effects, however, showed a significant association with IUGR (ß = -0.081, p = 0.011). Conclusion: The acute experience of violence during pregnancy was associated with IUGR, primarily via a direct pathway. An indirect effect was also present but not mediated through the variables analyzed in this study. The robust strength of these associations underscores the negative health consequences of violence against women for the succeeding generation.

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.

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.

Inattention symptoms in early pregnancy predict parenting skills and infant maltreatment during the first year of life

Objective: Maternal attention-deficit/hyperactivity disorder has not been investigated in relation to parenting skills in adolescent mothers. This study investigated whether maternal inattention and hyperactivity/impulsivity symptoms early in pregnancy predict poorer parenting skills and infant maltreatment during the first year of life in adolescent mothers living in adverse environmental conditions. Methods: The participants in this study were 80 adolescent mothers aged 14-19 years and their babies who were taking part in a randomized controlled trial on the effects of a home-visiting program on infant development. Symptoms of maternal attention-deficit/hyperactivity disorder were assessed in the first trimester of pregnancy. Parenting skills (maternal competence, attachment to the baby, home environment) and child maltreatment were assessed when the infants were aged 6 and 12 months. Multilevel linear regression models were constructed to test the extent to which prenatal maternal inattention and hyperactivity/impulsivity symptoms predicted these parenting variables during the first year of the infant's life. Results: Prenatal inattention symptoms significantly predicted lower maternal competence and attachment, a poorer home environment, and greater maltreatment during the first year of life. Hyperactivity did not significantly predict parenting skills or maltreatment. Conclusions: Our findings suggest that inattention symptoms may interfere with parenting abilities in adolescent mothers and should be considered in early intervention programs.

Medical students with performance difficulties need wide support: Initial results of an academic tutoring program

BACKGROUND: Even students with previous academic success may face challenges that affect their academic performance. Many medical schools offer programs to students at the risk of academic failure, to ensure that they succeed in the course. OBJECTIVE AND METHODS: In this report we describe a pioneering academic tutoring program developed at a Brazilian medical school and discuss the initial results of the program based on the feedback from tutors and data regarding the progression of students in the medical course. RESULTS: In 2018, 33 students enrolled into the program. Students' performance difficulties were mainly associated with mental health problems and socioeconomic vulnerability. Of the 33 students, 27 (81.8%) were assisted by the Mental Health Support Service and 16 (48.5%) were assisted by the Social Assistance Service. In addition to the planning academic activity class load, tutors were able to assist students in solving socioeconomic issues, carrying out personal support interventions with the promotion of self-esteem, and presenting suggestions for behavioral changes in their routine. For most students (72%), the action plan proposed by the tutors was successful. Eight of the 14 (57%) students in the fourth year progressed to the final two years of in-hospital practical training (internship). CONCLUSIONS: The Academic Tutoring Program showed positive results for most of the students. Close monitoring and tutor intervention allowed students with poor academic performance to overcome the low performance cycle. These important tasks demand time and energy from tutors, and institutional recognition of these professionals is essential for the successful maintenance of the program.

The importance of viral load in the severity of acute bronchiolitis in hospitalized infants

OBJECTIVE: The relationship between viral load and the clinical evolution of bronchiolitis is controversial. Therefore, we aimed to analyze viral loads in infants hospitalized for bronchiolitis. METHODS: We tested for the presence of human respiratory syncytial virus (HRSV) or human rhinovirus (HRV) using quantitative molecular tests of nasopharyngeal secretions and recorded severity outcomes. RESULTS: We included 70 infants [49 (70%) HRSV, 9 (13%) HRV and 12 (17%) HRSV+HRV]. There were no differences among the groups according to the outcomes analyzed individually. Clinical scores showed greater severity in the isolated HRSV infection group. A higher isolated HRSV viral load was associated with more prolonged ventilatory support, oxygen therapy, and hospitalization days, even after adjustment for the age and period of nasopharyngeal secretion collection. In the co-infection groups, there was a longer duration of oxygen therapy when the HRSV viral load was predominant. Isolated HRV infection and co-infection with a predominance of HRV were not associated with severity. CONCLUSION: Higher HRSV viral load in isolated infections and the predominance of HRSV in co-infections, independent of viral load, were associated with greater severity. These results contribute to the development of therapeutic and prophylactic approaches and a greater understanding of the pathophysiology of bronchiolitis.

Modeling Pathways From the Perinatal Factors to the Vascular Risk Phenotype at the End of the Second Decade of Life: Birth Cohort, Brazil.

Risk factors act around birth increasing future vascular risk. In this study, we analysed the pathways from perinatal factors to the vascular risk phenotype (VRP) in adolescents including indirect pathways mediated by obesity in adolescence. Data from a Brazilian cohort were collected at birth and at 18 to 19 years (follow-up). A theoretical model was constructed to analyze the association between variables at birth (socioeconomic status, prepregnancy body mass index, mother's age, history of maternal hypertension, maternal smoking, gestational age at birth, birth weight, sex, delivery type) and at follow-up (smoking and excess weight) with the VRP, using structural equation modeling. VRP was a continuous latent variable, representing the shared variance of blood pressure indictors and carotid-femoral pulse wave velocity. Males had higher VRP (standardized coefficient [SC], 0.561; P<0.001). Higher prepregnancy body mass index was associated with higher VRP (SC, 0.140; P=0.032). Gestational age <34 weeks had a total (SC, 0.259; P=0.002) and direct effect (SC, 0.354; P=0.018) on VRP. Cesarean delivery had a total effect, albeit borderline, on VRP (SC, 0.159; P=0.066). Excess weight at follow-up was the main determinant of a high VRP (SC, 0.470; P<0.001). Male sex, cesarean section, gestational age <34 weeks, pregestational excess weight, and excess weight in adolescents were associated with increased VRP at 18 to 19 years of age.

Profile of health professionals who completed a master's, doctoral, or post-doctoral degree in one Brazilian pediatric program

OBJECTIVE: This study aimed to determine the personal and professional characteristics, and the physical, psychiatric/psychological, and professional issues that exist among master's-, doctoral-, and post-doctoral-level health professionals. METHODS: A cross-sectional, online, self-reported survey of 452 postgraduates who completed master's, doctoral, or post-doctoral degrees in one graduate program in pediatrics in São Paulo, Brazil, was conducted. RESULTS: The response rate was 47% (211/453). The majority of participants were women (78%) and physicians (74%), and the median age was 47 years (28-71). Master's, doctoral, and post-doctoral degrees were reported by 73%, 53%, and 3%, respectively. High workload (>40 hours/week) occurred in 59%, and 45% earned ≥15 minimum wages/month. At least one participation in scientific meeting in the past year was reported by 91%, and 79% had published their research. Thirty-nine percent served as a member of a faculty of an institution of higher learning. The data were analyzed by two age groups: participants aged ≤48 years (group 1) and participants aged >48 years (group 2). The median rating of overall satisfaction with the profession in the past year [8 (0-10) vs. 9 (1-10), p=0.0113]; workload >40 hours/week (53% vs. 68%, p=0.034); and ≥15 minimum wages/month (37% vs. 56%, p=0.0083) were significantly lower in group 1. Further analysis by gender revealed that the median rating of overall satisfaction with the profession in the past year [8 (0-10) vs. 9 (3-10), p=0.0015], workload >40 hours/week (53% vs. 83%, p=0.0002), and ≥15 minimum wages/month (37% vs. 74%, p=0.0001) were significantly lower in women compared with men. The median rating of overall satisfaction with the mentorship supervision provided was significantly higher among the women 10 (5-10) vs. 10 (2-10), p=0.0324]. CONCLUSIONS: The majority of master's-, doctoral-, and post-doctoral-level health professionals were women and physicians, and had published their thesis. Younger postgraduates and women reported low salaries, less likelihood of working >40 hours/week, and less overall satisfaction with their profession. Further longitudinal and qualitative studies are warranted to assess career trajectories after graduation.

Study of the profile of behavioral problems and quality of life indexes in a pediatric cohort of monosymptomatic enuresis / Estudo do perfil dos problemas de comportamento e dos índices de qualidade de vida numa coorte pediátrica de enurese monossintomática

Abstract Objective: To evaluate and correlate, before and after the therapeutic intervention, the behavioral problem scores evaluated by the CBCL/6-18 questionnaire and the quality of life indexes evaluated by the PedsQL™ 4.0 in patients with monosymptomatic nocturnal enuresis. Method: After the initial evaluation and completion of the CBCL/6-18 questionnaire, a multidisciplinary evaluation and completion of the PedsQL™ 4.0 questionnaire was performed. Of the initially evaluated 140 children and adolescents aged 6-16 years, 58 were excluded due to non-monosymptomatic enuresis or associated comorbidities. Of the initially included 82 patients, who were randomized to three treatment groups, 59 completed the CBCL/6-18 and PedsQL™ 4.0 questionnaires at the end of the treatment and were included in this study. The α error was set at 5% for ruling out the null hypothesis. Results: Of the total of 59 participants, 45.8% responded with total success, 23.7% were partially successful, 23.7% did not reach the improvement criteria, and 6.8% gave up the treatment. There was a significant increase in quality of life indexes and a reduction of post-intervention behavioral problem scores, in the three proposed modalities, in patients who had a total or partial response to treatment. There was no correlation between higher scores of pre-treatment behavior problems and therapeutic failure. Conclusions: Only the participants who successfully responded to interventions showed improvement in quality of life and behavioral problems, which indicates that enuresis is a primary problem that has a negative impact on these parameters. The authors suggest that it is possible to achieve success in the treatment of monosymptomatic enuresis, even in patients with high pre-intervention behavioral problem scores.

Resumo Objetivo: Avaliar e relacionar, pré e pós-intervenção terapêutica, em pacientes com enurese noturna monossintomática, os escores de problemas de comportamento, avaliados pelo questionário CBCL/6-18, e os índices de qualidade de vida, avaliados pelo PedsQL™ 4.0. Método: Após avaliação inicial e preenchimento CBCL6/18, procedeu-se avaliação multidisciplinar e preenchimento do PedsQL™ 4.0. Das 140 crianças e adolescentes de 6 a 16 anos inicialmente avaliados, 58 foram excluídos por enurese não monossintomática ou comorbidades associadas. Dos 82 pacientes inicialmente incluídos e randomizados em três grupos de tratamento, 59 preencheram o CBCL/6-18 e PedsQL™ 4.0 no fim do tratamento e puderam ser incluídos neste trabalho. O erro alfa foi estabelecido em 5% para descarte da hipótese de nulidade. Resultados: Dos 59 participantes 45,8% responderam com sucesso total, 23,7% tiveram sucesso parcial, 23,7% não atingiram critério de melhoria e 6,8% desistiram do tratamento. Verificou-se aumento significativo dos índices de qualidade de vida e redução dos escores de problemas de comportamento pós-intervenção, nas três modalidades propostas, nos pacientes que obtiveram resposta total ou parcial ao tratamento. Não se demonstrou correlação entre maiores escores de problemas de comportamento pré-tratamento e insucesso terapêutico. Conclusões: Apenas os participantes que responderam com sucesso às intervenções melhoraram em sua qualidade de vida e problemas comportamentais, o que indica que a enurese é um problema primário que impacta negativamente esses parâmetros. Sugere-se que é viável obter sucesso no tratamento da enurese monossintomática, mesmo em pacientes com altos escores de problemas de comportamento pré-intervenção.

A influência da dança educativa no desenvolvimento motor de crianças / The influence of educational dance on the motor development of children

RESUMO Objetivo: A proposta deste estudo foi comparar o desenvolvimento motor de crianças que praticaram dança educativa com o desenvolvimento motor de crianças que não a praticaram e verificar a permanência dos resultados obtidos, após seis a oito meses do término da intervenção. Métodos: O estudo foi realizado com 85 crianças matriculadas no 1º ano do ensino fundamental de duas escolas da zona sul de São Paulo (SP), randomizadas por sorteio em dois grupos (intervenção e controle). Foram excluídas da análise as crianças com deficiência intelectual e/ou física e as prematuras. Os dois grupos tiveram seu desenvolvimento motor avaliado em três momentos: antes da intervenção, após a intervenção e depois de seis a oito meses do término da intervenção. O grupo intervenção participou de um programa de aulas de dança educativa por sete meses. Os grupos controle e intervenção foram comparados por teste qui-quadrado e teste t. Resultados: Os resultados indicaram que as crianças que participaram do programa de dança educativa obtiveram ganhos significativos em seu desenvolvimento motor geral e nas bases: equilíbrio, praxia fina e praxia global, em comparação às crianças que não participaram desse programa. Conclusões: A dança educativa auxiliou na evolução do desenvolvimento motor de crianças, e seus resultados mantiveram-se parcialmente meses após o término da intervenção.

ABSTRACT Objective: The purpose of this study was to compare the motor development of children who practiced educational dance with the motor development of children who did not practice it and to verify the results obtained after six to eight months after the end of the intervention. Methods: The study was carried out with 85 children enrolled in the first year of elementary school in two schools located in the south of São Paulo city (São Paulo, Brazil). Children were randomized by lot in two groups (intervention and control). Children with intellectual and/or physical disabilities and the premature ones were excluded from the analysis. The two groups had their motor development evaluated in three moments: before the intervention, after the intervention and six to eight months after the end of the intervention. The intervention group participated in an educational dance class program for seven months. Control and intervention groups were compared by chi-square and t-test. Results: Children who participated in the educational dance program, compared to children who did not, achieved significant gains in their general motor development and on the following bases: balance, fine motor and overall praxis. Conclusions: Educational dance helped the children's motor development, and the results were partially maintained months after the end of the intervention.

Socioeconomic diversities and infant development at 6 to 9 months in a poverty area of São Paulo, Brazil / Diversidades socioeconômicas e o desenvolvimento infantil de 6 a 9 meses no estado de São Paulo, Brasil

Abstract Introduction The effects of socioeconomic disparities on cognitive development tend to emerge early in infancy and to widen throughout childhood, and may perpetuate later in life. Although the study of how poverty affects early childhood has increased in the last 20 years, many of the effects remain largely unknown, especially during the first year of life. Aim To investigate the influence of socioeconomic status (SES) and maternal education on infants' language, motor and cognitive development. Methods The cognitive, language and motor skills of 444 infants aged 6 to 9 months selected from a poor neighborhood in São Paulo, Brazil, were evaluated using the Bayley Scales of Infant Development. A questionnaire on socioeconomic background was administered to the participants' families. Results A positive association was found between SES and infants' performance on language and motor scales. Additionally, higher maternal education was associated with higher language and cognitive scores. Conclusion Our findings indicate that SES effects are detectable very early in infancy. This result has implications for the timing of both screening and intervention efforts to help children overcome the consequences of living in poverty.

Resumo Introdução Os efeitos das disparidades socioeconômicas no desenvolvimento cognitivo tendem a surgir no início da primeira infância e a se ampliar ao longo da infância, e podem perpetuar-se mais tardiamente. Embora estudos mostrando os efeitos deletérios de um menor nível socioeconômico (NSE) no desenvolvimento na primeira infância tenham aumentado nos últimos 20 anos, muitos desses efeitos ainda permanecem desconhecidos, especialmente durante o primeiro ano de vida. Objetivo Investigar a influência do NSE e da escolaridade materna no desenvolvimento linguístico, motor e cognitivo do bebê. Método Foram avaliadas as habilidades cognitivas, linguísticas e motoras de 444 lactentes com 6 a 9 meses de idade selecionados em um bairro de baixo NSE na zona oeste de São Paulo, Brasil, utilizando-se as Escalas Bayley de Desenvolvimento Infantil. Um questionário também foi administrado para coletar dados sobre o background socioeconômico das famílias das crianças participantes. Resultado Foi observada uma associação positiva entre NSE e o desempenho dos lactentes nas escalas de linguagem e desenvolvimento motor. Adicionalmente, maior educação materna esteve associada a escores mais altos nas escalas de desenvolvimento linguístico e cognitivo. Conclusão Os resultados deste estudo indicam que os efeitos do NSE são detectáveis muito cedo na primeira infância. Este resultado tem implicações para o timing de avaliações e intervenções que possam ajudar as crianças a superar as consequências de viver na pobreza.

The specific and combined role of domestic violence and mental health disorders during pregnancy on new-born health.

BACKGROUND: Addressing impaired foetal growth is recognized as a public health priority. Certain risk factors for this condition, such as poor nutritional status at birth, have been found to be highly correlated with poverty. However, the role of psychosocial factors, specifically the mother's mental health and exposure to violence during pregnancy, have yet to be further explored. Our objective was to determine if there is a measurable association between combined psychosocial factors, specifically domestic violence and mental disorders, and birth outcomes, specifically birth nutritional status and preterm delivery. METHODS: We followed 775 women from an underserved, urban area, beginning their 28th week of gestation. Diagnostic interviews were performed to determine if any of the mothers had any of the following disorders: mood disorder, anxiety, obsessive-compulsive disorder (OCD), substance dependence, psychotic disorder, or anti-social personality disorder. Physical, psychological, and sexual domestic violence were also assessed. RESULTS: Domestic violence and mental disorders were highly correlated in our sample. About 27.15% of the women in our study experienced domestic violence, and about 38.24% of them were diagnosed with mental disorders. The main association we found between combined psychosocial factors and neonate outcomes was between anxiety (IRR = 1.83; 95%CI = 1.06-3.17)/physical violence (IRR = 1.95; 95%CI = 1.11-3.42) and the rate of small-for-gestational age (SGA) in new-borns. More specifically, the combination of anxiety (beta = -0.48; 95%CI = -0.85/-0.10) and sexual violence (beta = -1.58; 95%CI = -2.61/-0.54) was also associated with birth length. Maternal risk behaviours such as smoking, drinking, inadequate prenatal care, and inadequate weight gain could not sufficiently explain these associations, suggesting that these psychosocial factors may be influencing underlying biological mechanisms. CONCLUSION: Domestic violence against women and mental disorders amongst pregnant women are extremely prevalent in under-resourced, urban areas and ultimately, have detrimental effects on birth outcomes. It is imperative that actions be taken to prevent violence and improve mental health during pregnancy.

Association between maternal lifestyle and preschool nutrition.

INTRODUCTION:: Many of the health behaviors involved in the emergence of chronic non-communicable diseases (CNCD) are originated in childhood under parental influence. Mothers are the ones most involved in the education and health care of children. Lifestyle (LS) is a social determinant of health. Very few studies tried to understand the influence of maternal LS on child nutrition. OBJECTIVE:: To verify the association between maternal behavioral and non-behavioral LS and nutritional aspects in preschool children. METHOD:: From January 2010 to December 2010, we performed a cross-sectional study with 255 mothers of preschool children who were residents of five different sub-districts in southwestern São Paulo. A proportional stratified random sample was selected using two layers ("schools" and "children"). From the mother, sociodemographic and LS information were collected. From the child, data on anthropometry, sedentary behavior and food intake were collected. The association was calculated using chi-square test and logistic regression. RESULTS:: Children who ate minimally processed food were born from mothers with more socially aware non-behavioral LS, while children that ate more processed food were born from mothers with more consumerist non-behavioral LS. No association was found between nutritional characteristics of preschoolers and types of maternal behavioral LS. Children presenting "sedentary behavior" and the habit of eating "ultra-processed foods" had 113% and 84% higher chances, respectively, of being born to mothers that belonged to the "consumerist" cluster. CONCLUSION:: Mothers living a consumerist lifestyle can promote negative influences on child nutrition.

Randomized controlled trial comparing nasal intermittent positive pressure ventilation and nasal continuous positive airway pressure in premature infants after tracheal extubation / Estudo controlado e randomizado entre uso de ventilação positiva intermitente e pressão positiva contínua em vias aéreas em recém-nascidos prematuros após a extubação traqueal

Summary Objective: To analyze the frequency of extubation failure in premature infants using conventional mechanical ventilation (MV) after extubation in groups subjected to nasal intermittent positive pressure ventilation (nIPPV) and continuous positive airway pressure (nCPAP). Method: Seventy-two premature infants with respiratory failure were studied, with a gestational age (GA) ≤ 36 weeks and birth weight (BW) > 750 g, who required tracheal intubation and mechanical ventilation. The study was controlled and randomized in order to ensure that the members of the groups used in the research were chosen at random. Randomization was performed at the time of extubation using sealed envelopes. Extubation failure was defined as the need for re-intubation and mechanical ventilation during the first 72 hours after extubation. Results: Among the 36 premature infants randomized to nIPPV, six (16.6%) presented extubation failure in comparison to 11 (30.5%) of the 36 premature infants randomized to nCPAP. There was no statistical difference between the two study groups regarding BW, GA, classification of the premature infant, and MV time. The main cause of extubation failure was the occurrence of apnea. Gastrointestinal and neurological complications did not occur in the premature infants participating in the study. Conclusion: We found that, despite the extubation failure of the group of premature infants submitted to nIPPV being numerically smaller than in premature infants submitted to nCPAP, there was no statistically significant difference between the two modes of ventilatory support after extubation.

Resumo Objetivo: analisar a frequência de falha da extubação em recém-nascidos pré-termo (RNPT) em uso de ventilação mecânica (VM) convencional após a extubação traqueal nos grupos submetidos à ventilação por pressão positiva intermitente por via nasal (nIPPV) e pressão positiva contínua em vias aéreas (nCPAP). Método: foram estudados 72 RNPT portadores de insuficiência respiratória, com idade gestacional (IG) ≤ 36 semanas e peso de nascimento (PN) > 750 g, que necessitaram de entubação traqueal e ventilação mecânica. O estudo foi controlado e randomizado a fim de garantir a aleatoriedade na escolha dos integrantes dos grupos. A randomização foi realizada no momento da extubação por meio de envelopes selados. Falha da extubação foi definida como necessidade de reentubação e ventilação mecânica durante as primeiras 72 horas após a extubação. Resultados: entre os 36 RN randomizados para nIPPV, seis (16,6%) apresentaram falha de extubação em comparação a 11 (30,5%) dos 36 RN randomizados para nCPAP. Não houve diferença estatística entre os dois grupos de estudo em relação a PN, IG, classificação do RN e tempo de VM. A principal causa de falha da extubação foi a ocorrência de apneia. Complicações gastrointestinais e neurológicas não ocorreram nos RNPT participantes do estudo. Conclusão: constatamos que no grupo dos RNPT submetidos à nIPPV, apesar da falha da extubação ser numericamente menor que nos RNPT submetidos à nCPAP, não houve diferença estatisticamente significante entre os dois modos de suporte ventilatório após a extubação.

Association between maternal lifestyle and preschool nutrition / Associação do estilo de vida materno com a nutrição de pré-escolares

Summary Introduction: Many of the health behaviors involved in the emergence of chronic non-communicable diseases (CNCD) are originated in childhood under parental influence. Mothers are the ones most involved in the education and health care of children. Lifestyle (LS) is a social determinant of health. Very few studies tried to understand the influence of maternal LS on child nutrition. Objective: To verify the association between maternal behavioral and non-behavioral LS and nutritional aspects in preschool children. Method: From January 2010 to December 2010, we performed a cross-sectional study with 255 mothers of preschool children who were residents of five different sub-districts in southwestern São Paulo. A proportional stratified random sample was selected using two layers (“schools” and “children”). From the mother, sociodemographic and LS information were collected. From the child, data on anthropometry, sedentary behavior and food intake were collected. The association was calculated using chi-square test and logistic regression. Results: Children who ate minimally processed food were born from mothers with more socially aware non-behavioral LS, while children that ate more processed food were born from mothers with more consumerist non-behavioral LS. No association was found between nutritional characteristics of preschoolers and types of maternal behavioral LS. Children presenting “sedentary behavior” and the habit of eating “ultra-processed foods” had 113% and 84% higher chances, respectively, of being born to mothers that belonged to the “consumerist” cluster. Conclusion: Mothers living a consumerist lifestyle can promote negative influences on child nutrition.

Resumo Introdução: muitos dos comportamentos de saúde envolvidos no aparecimento das doenças crônicas não comunicáveis são originados na infância sob influência dos pais. A mãe é a pessoa mais envolvida na educação e nos cuidados de saúde da criança. O estilo de vida (EdV) é um determinante social da saúde. Poucos estudos compreenderam a influência do EdV materno na nutrição infantil. Objetivo: verificar a associação do EdV materno comportamental e não comportamental com aspectos nutricionais do pré-escolar. Método: entre janeiro e dezembro de 2010, realizou-se um estudo transversal com 255 pares de mães-pré-escolares moradoras de cinco subdistritos da região sudoeste, do município de São Paulo. Selecionou-se uma amostra probabilística aleatória estratificada proporcional, com dois estratos (“escola” e “criança”). Da mãe, foram coletadas informações sociodemográficas e de EdV. Da criança, foram coletadas informações antropométricas, de comportamento sedentário e consumo alimentar. As associações foram calculadas por meio do teste do qui-quadrado e por regressão logística. Resultados: as crianças com alimentação “minimamente processada” eram filhas de mães com EdV não comportamental mais “socioconsciente”, enquanto as crianças com alimentação “ultraprocessada” eram filhas de mães com EdV não comportamental mais do tipo “consumista”. Nenhuma associação foi encontrada entre as características nutricionais do pré-escolar e os tipos de EdV materno comportamental. As crianças com “comportamento sedentário presente” e alimentação “ultraprocessada” tiveram chances 113 e 84% maiores, respectivamente, de serem filhas de mães pertencentes ao cluster “consumista”. Conclusão: mães com EdV do tipo “consumista” podem proporcionar influências negativas na nutrição infantil.

Mother's lifestyle: development of a questionnaire to assess a determinant of children's health. A cross-sectional study / Estilo de vida materno: desenvolvimento de um questionário para avaliar um determinante da saúde da criança. Um estudo transversal

CONTEXT AND OBJECTIVE: Lifestyle includes the personal attitudes or behavioral patterns that result in risks or benefits to the individual's own health or that of others. Children's health is particularly determined by their mother's lifestyle. The objective here was to develop and evaluate the reliability of a questionnaire capable of describing the lifestyles of preschoolers' mothers in terms of their activities, interests, opinions and values. DESIGN AND SETTING: Cross-sectional study conducted in a public university. METHODS: This study was conducted between January 2010 and March 2011, among 255 mothers of preschoolers living in the southeastern region of the municipality of São Paulo. A proportional stratified random probabilistic sample with two strata was selected: schools were drawn and then the children. Three instruments found in the literature were used to create the lifestyle questionnaire. The questionnaire was developed in eight stages: preliminary pretest, cultural adaptation, second pretest, pilot study, semantic correction and adaptation, third pretest, final research and final retest. Cronbach's alpha and pairwise correlation coefficients were used. RESULTS: The Cronbach's alpha value in the final version was 0.83 and the pre and post-test pairwise correlation coefficients were greater than 0.5. Factor analysis identified five factors that explained 73.51% of the correlation variance. As a result, seven variables were eliminated from the questionnaire. CONCLUSIONS: The questionnaire described five lifestyle domains, with good reliability, and can be used in combination with preschoolers' health and nutritional outcomes.

CONTEXTO E OBJETIVO: Estilo de vida compreende as atitudes pessoais ou padrões de comportamento que trazem riscos ou benefícios para a própria saúde ou de outros. A saúde das crianças é principalmente determinada pelo estilo de vida da mãe. O objetivo foi desenvolver e avaliar a confiabilidade de um questionário capaz de descrever o estilo de vida de mães de pré-escolares em termos de atividades, interesses, opiniões e valores. TIPO DE ESTUDO E LOCAL: Estudo transversal conduzido em uma universidade pública. MÉTODOS: Estudo realizado entre janeiro de 2010 e março de 2011 com 255 mães de pré-escolares residentes na Região Sudoeste do Município de São Paulo. Selecionou-se uma amostra probabilística aleatória estratificada proporcional com dois estratos, sendo sorteadas as escolas e depois as crianças. Três instrumentos foram encontrados na literatura e utilizados para compor o questionário de estilo de vida. O desenvolvimento do questionário cumpriu oito etapas: pré-teste preliminar, adaptação cultural, segundo pré-teste, estudo piloto, correção e adaptação semântica, terceiro pré-teste, pesquisa final e reteste. Foram utilizados o alfa de Cronbach e coeficiente de correlação pairwise. RESULTADOS: O valor do alfa de Cronbach na versão final foi de 0,83 e o coeficiente de correlação pairwise pré e pós-teste foram maiores que 0,5. A análise fatorial identificou cinco fatores, os quais explicaram 73,51% da variância de correlação. Como resultado, sete variáveis foram eliminadas do questionário. CONCLUSÃO: O questionário descreveu cinco domínios de estilo de vida, com boa confiabilidade, e pode ser utilizado em associações com aspectos nutricionais e de saúde de pré-escolares.

Mother's lifestyle: development of a questionnaire to assess a determinant of children's health. A cross-sectional study.

CONTEXT AND OBJECTIVE: Lifestyle includes the personal attitudes or behavioral patterns that result in risks or benefits to the individual's own health or that of others. Children's health is particularly determined by their mother's lifestyle. The objective here was to develop and evaluate the reliability of a questionnaire capable of describing the lifestyles of preschoolers' mothers in terms of their activities, interests, opinions and values. DESIGN AND SETTING: Cross-sectional study conducted in a public university. METHODS: This study was conducted between January 2010 and March 2011, among 255 mothers of preschoolers living in the southeastern region of the municipality of São Paulo. A proportional stratified random probabilistic sample with two strata was selected: schools were drawn and then the children. Three instruments found in the literature were used to create the lifestyle questionnaire. The questionnaire was developed in eight stages: preliminary pretest, cultural adaptation, second pretest, pilot study, semantic correction and adaptation, third pretest, final research and final retest. Cronbach's alpha and pairwise correlation coefficients were used. RESULTS: The Cronbach's alpha value in the final version was 0.83 and the pre and post-test pairwise correlation coefficients were greater than 0.5. Factor analysis identified five factors that explained 73.51% of the correlation variance. As a result, seven variables were eliminated from the questionnaire. CONCLUSIONS: The questionnaire described five lifestyle domains, with good reliability, and can be used in combination with preschoolers' health and nutritional outcomes.

Confiabilidade da tradução da versão brasileira do questionário PedsQL - DREA para avaliação da qualidade de vida de crianças e adolescentes / Reliability of the Brazilian version of the PedsQL - ESDR questionnaire to evaluate quality of life of children and adolescents

Resumo Objetivo: Avaliar a confiabilidade da tradução e adaptação cultural do questionário Pediatric Quality of Life Inventory (Peds- QLTM) - Doença Renal em Estágio Avançado (DREA) - versão 3.0 - relato das crianças/adolescentes e relato dos pais para avaliação da Qualidade de Vida Relacionada à Saúde (QRVS) de crianças brasileiras portadoras de DREA. Método: Utilizou-se a metodologia proposta pelos autores da versão original dos questionários, por meio da administração dos mesmos a um grupo de 24 crianças e adolescentes portadores de DREA em acompanhamento na Unidade de Nefrologia Pediátrica do Instituto da Criança - HCFMUSP e 32 cuidadores primários (CP). Resultados: A análise estatística inicial dos sete domínios do questionário resultou em alfa de Cronbach entre 0,39 e 0,89. Os domínios que apresentaram valores inferiores a 0,5 foram recalculados separando-os por faixas etárias, o que resultou em elevação do alfa de Cronbach, demonstrando a influência da faixa etária na percepção da qualidade de vida, no paciente portador de DREA. A avaliação geral do alfa de Cronbach, todavia, apontou 0,81 e 0,71 para os questionários destinados aos relatos dos pacientes e dos CP, respectivamente, demonstrando uma boa consistência interna. Conclusão: A versão brasileira do questionário é válida, confiável e útil na mensuração da QVRS das crianças e dos adolescentes com DREA, segundo os relatos dos pacientes e dos CP. .

Abstract Objective: To evaluate the reliability of the translation and cultural adaptation of the Pediatric Quality of Life Inventory (PedsQLTM) - End Stage Renal Disease (ESRD) - version 3.0 - children/adolescents and parents reports in Brazilian children with ESRD. Methods: A group of 24 children and adolescents with ESRD, followed at Unidade de Nefrologia Pediátrica do Instituto da Criança - HCFMUSP and 32 primary caregivers were interviewed according to the me methodology proposed by the creator of the original questionnaire. Results: Statistical analysis using Cronbach's alpha resulted in values between 0.39 and 0.89 for all domains in initial statistical analysis. The domains that presented values lower than 0.5 were recalculated by age group, resulting in higher Cronbach's alpha values demonstrating the influence of the age in the perception of quality of life in ESRD patients. The overall rating of Cronbach's alpha values resulted in values of 0.81 and 0.71 in patients and PC reports, respectively, demonstrating good internal consistency. Conclusions: Ours results show that the Brazilian version of the questionnaires is valid, reliable and useful for measure HRQoL of children and adolescents ESRD, according to patients and PC reports. .

Longitudinal electrophysiological study of auditory pathway in small for gestational age infants / Estudo eletrofisiológico longitudinal da via auditiva em crianças nascidas a termo e pequenas para a idade gestacional

PURPOSE: To follow the maturation of the auditory pathway of infants born small for gestational age term, by studying absolute and interpeak latencies of Auditory Brainstem Response (ABR) in the first six months of life. METHODS: Multicentric prospective longitudinal study. The ABR was carried out in the neonatal period in 96 newborn infants, 49 small for gestational age (SGA) and 47 appropriate for gestational age (AGA). Of these, 77 infants (39 SGA and 38 AGA) returned for a second evaluation. In the third evaluation, 70 infants (35 SGA and 35 AGA) returned. RESULTS: SGA and AGA did not present significant differences in the neonatal period and at three months of life. However, at six months, there was statistical significant difference between SGA and AGA groups for the latencies of wave III and interpeak I-III. Latencies of ABR waves decreased more rapidly in the first three months than the third to the sixth month of life for the SGA. AGA group showed progressive decrease in latency of ABR waves during the six months. CONCLUSION: The findings suggest that, for SGA infants, the maturational process of the auditory pathway occurs in different rate when compared to AGA infants. The SGA infants have faster maturation especially at the first three months of life, while in infants AGA, this process occurred in a constant and gradual way throughout the six months studied. .

OBJETIVO: Acompanhar a maturação da via auditiva de lactentes nascidos a termo pequenos para a idade gestacional, por meio do estudo das latências absolutas e interpicos do Potencial Evocado Auditivo de Tronco Encefálico (PEATE) nos primeiros seis meses de vida. MÉTODOS: Estudo multicêntrico prospectivo longitudinal. PEATE realizado no período neonatal em 96 recém-nascidos, 49 pequenos para a idade gestacional (PIG) e 47 adequados para a idade gestacional (AIG). Destes, 77 lactentes (39 PIG e 38 AIG) retornaram para a segunda avaliação. Na terceira avaliação, retornaram 70 lactentes (35 PIG e 35 AIG). RESULTADOS: PIG e AIG não apresentaram diferenças significativas no período neonatal e aos três meses de vida. Aos seis meses, houve diferença estatística entre os grupos PIG e AIG para a onda III e interpico I-III. Latências das ondas do PEATE diminuíram mais rapidamente nos primeiros três meses que do terceiro para o sexto mês de vida para o grupo PIG. O grupo AIG mostrou diminuição progressiva da latência das ondas do PEATE durante os seis meses. CONCLUSÃO: Os resultados sugerem que a maturação da via auditiva nos PIG ocorre em ritmo diferente quando comparada aos AIG. Os PIG têm maturação mais rápida, especialmente nos três primeiros meses de vida; nas crianças AIG, esse processo ocorreu de modo constante e gradual ao longo dos seis meses estudados. .