Geography, population, demography, socioeconomic, anthropometry, and environmental status in the MAL-ED cohort and case-control study Sites in Fortaleza, Ceará, Brazil.

The Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) cohort in the study's Fortaleza, Brazil, catchment area has a population of approximately 82 300 inhabitants. Most of the households (87%) have access to clean water, 98% have electricity, and 69% have access to improved toilet/sanitation. Most childbirths occur at the hospital, and the under-5 mortality rate is 20 per 1000 live births. The MAL-ED case-control study population, identified through the Institute for the Promotion of Nutrition and Human Development (IPREDE), serves 600 000 inhabitants from areas totaling about 42% of the city of Fortaleza. IPREDE receives referrals from throughout the state of Ceará for infant nutrition, and provides services including teaching activities and the training of graduate students and health professionals, while supporting research projects on child nutrition and health. In this article, we describe the geographic, demographic, socioeconomic, anthropometric, and environmental status of the MAL-ED cohort and case-control study populations in Fortaleza, Brazil.

The MAL-ED cohort study: methods and lessons learned when assessing early child development and caregiving mediators in infants and young children in 8 low- and middle-income countries.

More epidemiological data are needed on risk and protective factors for child development. In The Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) cohort study, we assessed child development in a harmonious manner across 8 sites in Bangladesh, Brazil, India, Nepal, Pakistan, Peru, South Africa, and Tanzania. From birth to 24 months, development and language acquisition were assessed via the Bayley Scales of Infant and Toddler Development and a modified MacArthur Communicative Development Inventory. Other measures were infant temperament, the child's environment, maternal psychological adjustment, and maternal reasoning abilities. We developed standard operating procedures and used multiple techniques to ensure appropriate adaptation and quality assurance across the sites. Test adaptation required significant time and human resources but is essential for data quality; funders should support this step in future studies. At the end of this study, we will have a portfolio of culturally adapted instruments for child development studies with examination of psychometric properties of each tool used.

Early-Life Enteric Pathogen Exposure, Socioeconomic Status, and School-Age Cognitive Outcomes.

Early-life experiences of enteric infections and diarrheal illness are common in low-resource settings and are hypothesized to affect child development. However, longer-term associations of enteric infections with school-age cognitive outcomes are difficult to estimate due to lack of long-term studies. The objective of this study was to examine the relationship between enteropathogen exposure in the first 2 years of life with school-age cognitive skills in a cohort of children followed from birth until 6 to 8 years in low-resource settings in Brazil, Tanzania, and South Africa. The study included participants from three sites from the Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health Study who were enrolled just after birth and followed for enteric infections, diarrheal illness, and cognitive development until 2 years of age. When the children were school-age, further data were collected on reasoning skills and semantic/phonemic fluency. We estimated associations between the burden of specific enteric pathogens and etiology-specific diarrhea from 0 to 2 years with cognitive test scores at 6 to 8 years using linear regression and adjusting for confounding variables. In this study, children who carried more enteric pathogens in the first 2 years of life showed overall decreases in school-age cognitive abilities, particularly children who carried protozoa, although this was not statistically significant in this sample. Socioeconomic factors such as maternal education and income were more closely associated with school-age cognitive abilities. Early-life enteric pathogens may have a small, lasting influence on school-age cognitive outcomes, although other socioeconomic factors likely contribute more significantly.

Impact of Shigella infections and inflammation early in life on child growth and school-aged cognitive outcomes: Findings from three birth cohorts over eight years.

BACKGROUND: Shigella infections cause inflammation, which has been hypothesized to mediate the associations between Shigella and child development outcomes among children in low-resource settings. We aimed to assess whether early life inflammation and Shigella infections affect school-aged growth and cognitive outcomes from 6-8 years of age. METHODOLOGY/PRINCIPAL FINDINGS: We conducted follow-up assessments of anthropometry, reasoning skills, and verbal fluency in 451 children at 6-8 years of age in the Brazil, Tanzania, and South Africa sites of MAL-ED, a longitudinal birth cohort study. We estimated the associations between Shigella burden and inflammation with linear growth at 2, 5, and 6-8 years of age, and with the cognitive test scores using linear regression and adjusting for potential confounding variables. We also assessed whether inflammation mediated the associations between Shigella and school-aged outcomes using a regression-based approach to mediation analysis. A high prevalence of Shigella was associated with a 0.32 (95% CI: 0.08, 0.56) z-score lower height-for-age z-score (HAZ) at 6-8 years compared to a low prevalence of Shigella. Intestinal inflammation had a smaller association with HAZ at 6-8 years. Shigella burden had small and consistently negative associations with cognitive outcomes in Brazil and Tanzania, but not South Africa, and the estimates were not statistically significant. Systemic inflammation was strongly associated with lower verbal fluency scores in Brazil (semantic fluency z-score difference: -0.57, 95% CI: -1.05, -0.10; phonemic fluency z-score difference: -0.48, 95% CI: -0.93, -0.03). There was no evidence that intestinal inflammation mediated the association between Shigella and HAZ or cognitive outcomes. CONCLUSIONS/SIGNIFICANCE: While Shigella infections were consistently associated with long-term deficits in linear growth, the estimates of the negative associations between Shigella and cognitive outcomes were imprecise and only observed in the Brazil and Tanzania sites. Systemic inflammation was strongly associated with lower semantic and phonemic fluency scores in Brazil only, highlighting the site-specificity of effects.

Assessing development across cultures: Invariance of the Bayley-III Scales Across Seven International MAL-ED sites.

The Bayley's Scales of Infant and Toddler Development-Third Edition (Bayley-III) were used to measure the development of 24-month-old children (N = 1,452) in the Interactions of Malnutrition and Enteric Infections: Consequences for Child Health and Development (MAL-ED) study (an international, multisite study on many aspects of child development). This study examined the factor structure and measurement equivalence/invariance of Bayley-III scores across 7 international research sites located in Bangladesh, Brazil, India, Nepal, Pakistan, Peru, and South Africa. Exploratory and confirmatory factor analyses were used to identify the factor structure of Bayley-III scores. Subsequently, reliability analyses and item response theory analyses were applied, and invariance was examined using multiple-indicator, multiple-cause modeling. The findings supported the validity, but not invariance, of Bayley-III language scores at all seven sites and of the cognitive and motor scores at six sites. These findings provide support for the use of scores for research purposes, but mean comparison between sites is not recommended. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Emotional intelligence and self-efficacy: effects on psychological well-being in college students.

The present paper examined the role of perceived emotional intelligence-EI- (measured by adaptations of the Trait Meta-Mood Scale - TMMS, Salovey, Mayer, Goldman, Turvey, & Palfai, 1995) as a predictor of life satisfaction and mental health. We explored the unique contribution of EI dimensions (Attention, Clarity and Repair) on individuals' psychological well-being, after controlling for the influence of general self-efficacy and socio-demographic variables (age, gender and culture). Data was collected from a sample of 1078 Spanish, Mexican, Portuguese and Brazilian undergraduate students (M(age) = 22.98; SD = 6.73) and analyzed using hierarchical multiple regressions. Results indicated that overall EI dimensions (especially Clarity and Repair) accounted for unique variance on psychological well-being above and beyond general self-efficacy and socio-demographic characteristics. These findings provide additional support for the validity of perceived EI, and suggests that EI components contribute to important well-being criteria independently from well-known constructs such as self-efficacy.

Sexualidade na visão da adolescente grávida: mitos e tabus / Sexuality in the view of the pregnant adolescent: myths and taboos

Estudo exploratório-descritivo desenvolvido com 10 gestantes adolescentes entre 16 e 19 anos, em atendimento de pré-natal no Núcleo de Assistência Médica Integrada (NAM) em Fortaleza-CE, no período de agosto e setembro de 2004. Objetivamos identificar dificuldades enfrentadas pela adolescente em relação à prática sexual neste período; estabelecer uma co-relação entre o nível sócio-econômico e as dificuldades encontradas e a atuação da enfermeira quanto às orientações acerca da prática sexual durante a consulta pré-natal da adolescente grávida. Constatamos que a prática sexual é realizada durante a gravidez, só que as dificuldades emocionais e anatômicas tornam esta prática menos prazerosa, o que dificulta o relacionamento do casal. Em relação às orientações durante a consulta, percebemos que são insuficientes e que o assunto ainda é motivo de vergonha entre a gestante e o profissional que a atende, o que gera dúvidas e medo à gestante.

Radiofármacos utilizados en cardiología nuclear: revisión bibliográfica / Radiopharmaceuticals used in nuclear cardiology

Se informa que se han experimentado en los últimos años, con un notable auge, las exploraciones con radionúclidos en Cardiología, desde que se comenzaron a utilizar radionúclidos de vida media física corta. Se señala que existen equipos detectores, los cuales conjuntamente con equipos de cálculo, permiten obtener múltiples imágenes por segundo en forma de series gammagráficas rápidasm ya sea para obtener datos hemodinámicos globales, o para generar imágenes funcionales que no representan una estructura anatómica y que informan de la dinámica cardíaca al nivel regional. Se utilizan en estas técnicas, empleadas en Cardiología Nuclear los siguientes radionúclidos y radiofármacos: albúmina radiomarcada, 99mTc hematíes, 113mIn-transferrina, radionúclidos de vida media física supercorta tales como 195mAu, 178Ta, 191Ir. Además, para mediciones del flujo coronario, 113Xe; para angiogammagrafía, microesferas y macropartículas radiomarcadas. Para gammagrafía miocárdica 129Cs, 43K, 81Rb, 82Rb y el 201TI que es el más ampliamente utilizado. Se señala que más novedosos aún son los ácidos grasos fundamentalmente radioyodados y de algunos hidrocarburos de largas cadenas marcados con 99mTc. Se expresa que el 99mTc-Sn-pirosfosfato se ha usado en gammagrafías del infarto del miocardio. Se trabaja en el desarrollo de nuevos radiofármacos, fundamentalmente ácidos grasos y agentes quelantes del 99mTc, que perfeccionen estas técnicas