Factors associated with domestic violence in pregnant women during the COVID-19 pandemic: Araraquara Cohort study.

AIMS AND METHOD: This cross-sectional study, carried out from 2021 to 2022, investigated the factors associated with domestic violence in 400 Brazilian pregnant women during the COVID-19 pandemic. Violence was assessed with the World Health Organization's Violence Against Women questionnaire and the Abuse Assessment Screen. Demographic, socioeconomic, obstetric, lifestyle and mental health data were collected. RESULTS: Violence at any time in their lives was reported by 52.2% of the women, and psychological violence was the most prevalent type (19.5%). Violence was associated with being single and mental health changes. Pregnant women exposed to any lifetime violence and psychological violence were, respectively, 4.67 and 5.93 times more likely to show mental health changes compared with women with no reported violence. CLINICAL IMPLICATIONS: Training health professionals involved in prenatal care in the early detection of single women and women with mental health changes could be important in preventing domestic violence.

Obesity Induces an Impaired Placental Antiviral Immune Response in Pregnant Women Infected with Zika Virus.

Obesity is increasing in incidence worldwide, especially in women, which can affect the outcome of pregnancy. During this period, viral infections represent a risk to the mother, the placental unit, and the fetus. The Zika virus (ZIKV) outbreak in Brazil has been the cause of congenital Zika syndrome (CZS), with devastating consequences such as microcephaly in newborns. Herein, we analyzed the impact of maternal overweight/obesity on the antiviral factors' expression in the placental tissue of Zika-infected mothers. We accessed placentas from women with and without obesity from 34 public health units (São Paulo) and from Zika-infected mothers with and without obesity from the Clinical Cohort Study of ZIKV pregnant women (Rio de Janeiro, Brazil). We first verified that obesity, without infection, did not alter the constitutive transcriptional expression of antiviral factors or IFN type I/III expression. Interestingly, obesity, when associated with ZIKV infection, showed a decreased transcriptional expression of RIG-I and IFIH1 (MDA-5 protein precursor gene). At the protein level, we also verified a decreased RIG-I and IRF-3 expression in the decidual placenta from the Zika-infected obese group, regardless of microcephaly. This finding shows, for the first time, that obesity associated with ZIKV infection leads to an impaired type I IFN downstream signaling pathway in the maternal-fetal interface.

Screening for neuropsychomotor and social-emotional development in children under 24 months of age in the brazilian semi-arid region / Triagem do desenvolvimento neuropsicomotor e socioemocional em crianças menores de 24 meses na região do semiárido brasileiro

ABSTRACT Objective: To screen children under 24 months of age for neuropsychomotor and social-emotional development in a municipality of the Brazilian semi-arid region, using the Survey of Well-Being of Young Children (SWYC) scale. Methods: This is a quantitative cross-sectional study with a non-probabilistic sample, involving children aged 1 to 24 months and their respective mothers, recruited from primary care services in the municipality of Picos, Piauí, Northeastern Brazil. The screening for neuropsychomotor and social-emotional development using the SWYC scale also provided information about the family context. In addition, we administered a questionnaire to assess the children's demographic and socioeconomic factors. Descriptive data analysis was performed. Results: The sample consisted mostly of adult mothers (84.0%), with more than 8 years of schooling (83.3%), belonging to the C, D, and E socioeconomic classes (75.3%). The prevalence of suspected cases of delayed neuropsychomotor development and social-emotional changes was 12.7 and 42.2%, respectively. Conclusions: The results point to the existence of children at risk of delayed development, particularly in the social-emotional domain, reaffirming the need to adopt child development screening as a health service routine, with the implementation of appropriate intervention programs.

RESUMO Objetivo: Realizar a triagem para desenvolvimento neuropsicomotor e socioemocional em crianças menores de 24 meses, em município da região do semiárido brasileiro, utilizando a escala Survey of Wellbeing of Young Children (SWYC). Métodos: Estudo transversal, com abordagem quantitativa, amostra não proba­bilística, envolvendo crianças entre 1 e 24 meses e suas respectivas mães, selecionadas em serviços de saúde da atenção básica do município de Picos, Piauí. A triagem do desenvolvimento neuropsicomotor e socioemocional com uso da escala SWYC também forneceu informações sobre o contexto familiar. Além disso, utilizou-se questionário para avaliar fatores demográficos e socioeconômicos das crianças. Realizou-se a análise descritiva dos dados. Resultados: A amostra foi constituída de mães em sua maioria adultas (84,0%), com mais de oito anos de estudo (83,3%), pertencentes às classes socioeconômicas C, D e E (75,3%). A prevalência de casos suspeitos de atraso no desenvolvimento neuropsicomotor e de alterações socioemocionais foi de 12,7 e 42,2%, respectivamente. Conclusões: Os resultados apontam a existência de crianças em risco de desenvolvimento, sobretudo socioemocional, reafirmando a necessidade da adoção da triagem para desenvolvimento infantil como rotina nos serviços de saúde, com a implantação de programas de intervenção apropriados.

SCREENING FOR NEUROPSYCHOMOTOR AND SOCIAL-EMOTIONAL DEVELOPMENT IN CHILDREN UNDER 24 MONTHS OF AGE IN THE BRAZILIAN SEMI-ARID REGION.

OBJECTIVE: To screen children under 24 months of age for neuropsychomotor and social-emotional development in a municipality of the Brazilian semi-arid region, using the Survey of Well-Being of Young Children (SWYC) scale. METHODS: This is a quantitative cross-sectional study with a non-probabilistic sample, involving children aged 1 to 24 months and their respective mothers, recruited from primary care services in the municipality of Picos, Piauí, Northeastern Brazil. The screening for neuropsychomotor and social-emotional development using the SWYC scale also provided information about the family context. In addition, we administered a questionnaire to assess the children's demographic and socioeconomic factors. Descriptive data analysis was performed. RESULTS: The sample consisted mostly of adult mothers (84.0%), with more than 8 years of schooling (83.3%), belonging to the C, D, and E socioeconomic classes (75.3%). The prevalence of suspected cases of delayed neuropsychomotor development and social-emotional changes was 12.7 and 42.2%, respectively. CONCLUSIONS: The results point to the existence of children at risk of delayed development, particularly in the social-emotional domain, reaffirming the need to adopt child development screening as a health service routine, with the implementation of appropriate intervention programs.

Association between weight at birth and body composition in childhood: A Brazilian cohort study.

BACKGROUND AND AIM: Previous studies have shown that the association between birth weight and obesity later in life apparently follows a U-shaped curve. However, due to the continuous increase of mean birth weight in several countries worldwide, it is expected that higher birth weight will play a more important role as a risk factor for further obesity than low birth weight. This study investigated the association between birth weight and body composition of children in order to establish their relationship in an earlier period of life. STUDY DESIGN AND SUBJECTS: Prospective cohort study carried out from 1997 to 2006 in Jundiai city, Brazil, involving 486 children at birth and from 5 to 8 years of age. The following anthropometric measurements were determined: birth weight, weight, height, waist circumference and triceps skinfold thickness. Fat mass percentage, fat mass and fat-free mass were measured by electrical bioimpedance analysis by the 310 Body Composition Analyzer, Biodynamics(®). Five multiple linear regression models were developed considering waist circumference, triceps skinfold thickness, fat mass percentage, fat mass and fat-free mass as markers of body composition, and outcomes. RESULTS: Significant positive associations were observed between birth weight and waist circumference (p<0.001), triceps skinfold thickness (p=0.006), fat mass (p=0.007) and fat-free mass (p<0.001). Approximately 10% of the children presented excess body fat assessed by bioimpedance, and 27.6% of them had central adiposity (waist circumference ≥95th percentile). CONCLUSIONS: Intrauterine growth, assessed by weight at birth, was positively associated with body composition of children aged 5-8 years, indicating that those with the highest birth weight are more at risk for obesity, and probably to chronic diseases in adulthood.

Lipid profile of HIV-infected patients in relation to antiretroviral therapy: a review.

This study reviewed the lipid profile of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients in relation to use of antiretroviral therapy (ART), and its different classes of drugs. A total of 190 articles published in peer-reviewed journals were retrieved from PubMed and LILACS databases; 88 of them met the selection criteria and were included in the review. Patients with HIV/AIDS without ART presented an increase of triglycerides and decreases of total cholesterol, low density lipoprotein (LDL-c), and high density lipoprotein (HDL-c) levels. Distinct ART regimens appear to promote different alterations in lipid metabolism. Protease inhibitors, particularly indinavir and lopinavir, were commonly associated with hypercholesterolemia, high LDL-c, low HDL-c, and hypertriglyceridemia. The protease inhibitor atazanavir is apparently associated with a more advantageous lipid profile. Some nucleoside reverse-transcriptase inhibitors (didanosine, stavudine, and zidovudine) induced lipoatrophy and hypertriglyceridemia, whereas abacavir increased the risk of cardiovascular diseases even in the absence of apparent lipid disorders, and tenofovir resulted in lower levels of cholesterol and triglycerides. Although non-nucleoside reverse-transcriptase inhibitors predisposed to hypertriglyceridemia and hypercholesterolemia, nevirapine was particularly associated with high HDL-c levels, a protective factor against cardiovascular diseases. Therefore, the infection itself, different classes of drugs, and some drugs from the same class of ART appear to exert distinct alterations in lipid metabolism.

Lipid profile of HIV-infected patients in relation to antiretroviral therapy: a review / Perfil lipídico de pacientes infectados pelo HIV em relação à terapia antirretroviral: uma revisão

This study reviewed the lipid profile of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients in relation to use of antiretroviral therapy (ART), and its different classes of drugs. A total of 190 articles published in peer-reviewed journals were retrieved from PubMed and LILACS databases; 88 of them met the selection criteria and were included in the review. Patients with HIV/AIDS without ART presented an increase of triglycerides and decreases of total cholesterol, low density lipoprotein (LDL-c), and high density lipoprotein (HDL-c) levels. Distinct ART regimens appear to promote different alterations in lipid metabolism. Protease inhibitors, particularly indinavir and lopinavir, were commonly associated with hypercholesterolemia, high LDL-c, low HDL-c, and hypertriglyceridemia. The protease inhibitor atazanavir is apparently associated with a more advantageous lipid profile. Some nucleoside reverse-transcriptase inhibitors (didanosine, stavudine, and zidovudine) induced lipoatrophy and hypertriglyceridemia, whereas abacavir increased the risk of cardiovascular diseases even in the absence of apparent lipid disorders, and tenofovir resulted in lower levels of cholesterol and triglycerides. Although non-nucleoside reverse-transcriptase inhibitors predisposed to hypertriglyceridemia and hypercholesterolemia, nevirapine was particularly associated with high HDL-c levels, a protective factor against cardiovascular diseases. Therefore, the infection itself, different classes of drugs, and some drugs from the same class of ART appear to exert distinct alterations in lipid metabolism.

Este estudo faz uma revisão sobre o perfil lipídico de pacientes com vírus da imunodeficiência humana/síndrome da imunodeficiência adquirida (HIV/AIDS) em relação ao uso da terapia antirretroviral (TARV), e suas diferentes classes de fármacos. Um total de 190 artigos publicados em revistas indexadas foram selecionados das bases de dados PubMed e LILACS; 88 deles preencheram os critérios de seleção e foram incluídos nesta revisão. Pacientes com HIV/AIDS sem uso de TARV apresentaram aumento de triglicérides e diminuição dos níveis de colesterol total, lipoproteína de baixa densidade (LDL-c) e lipoproteína de alta densidade (HDL-c). Distintos regimes de TARV promoveram diferentes alterações no metabolismo lipídico. Inibidores de protease, particularmente indinavir e lopinavir, foram comumente associados com hipercolesterolemia, aumento de LDL-c, diminuição de HDL-c e hipertrigliceridemia. O inibidor de protease atazanavir aparentemente está associado a menores alterações do perfil lipídico. Alguns inibidores da transcripitase reversa análogos de nucleosídeos (didanosina, estavudina e zidovudina), induziram lipoatrofia e hipertrigliceridemia, enquanto o abacavir aumentou o risco cardiovascular mesmo na ausência de aparentes distúrbios lipídicos, e o tenofovir resultou em menores níveis de colesterol e triglicérides. Embora os inibidores da transcriptase reversa não análogos de nucleosídeos possam predispor a hipertrigliceridemia e hipercolesterolemia, a nevirapina, particularmente, foi associada a maiores níveis de HDL-c, um fator de proteção contra doenças cardiovasculares. Portanto, a própria infecção, diferentes classes de fármacos e alguns fármacos da mesma classe de TARV podem exercer distintas alterações no metabolismo lipídico.

Nutritional status and lipid profile of young children in Brazil.

OBJECTIVE: To evaluate the nutritional status and lipid profile of young children from an urban Brazilian region. METHODS: Cross-sectional study involving a representative sample of 472 children aged 5-8 years from Jundiai city. The nutritional status was assessed by the body mass index for age. Total cholesterol and fractions (low-density lipoprotein cholesterol, high density lipoprotein cholesterol) and triglycerides concentrations were determined by automated enzymatic methods. The results were analyzed by the student t-test and Fisher exact test. RESULTS: Overweight/obesity was observed in 22% of the children and thinness in 3.2%. Girls presented a higher prevalence of overweight/obesity (24.0%) and lower levels of high-density lipoprotein cholesterol (22.8%) compared with boys (19.7% and 10.6%), respectively (p < 0.001). The prevalence of children with elevated and borderline total cholesterol was 32.8% and 26.7%, respectively, although 82.8% had desirable levels of high-density lipoprotein cholesterol. CONCLUSION: The prevalence of overweight/obesity and dyslipidaemia observed in these children is a matter of concern considering the age group evaluated.

Iron supplementation in pregnancy and breastfeeding and iron, copper and zinc status of lactating women from a human milk bank.

This study evaluated the influence of iron supplementation in pregnancy and breastfeeding on iron status of lactating women from a Brazilian Human Milk Bank. Blood and mature breast milk samples were collected from 145 women for assessment of iron status, as well as copper and zinc status. Haemoglobin, serum iron and ferritin were determined, respectively, by electronic counting, colorimetry and chemiluminescence. Transferrin and ceruloplasmin were analysed by nephelometry. Serum copper and zinc were measured by atomic absorption spectrophotometry, and serum alkaline phosphatase was measured by a colorimetric method. Iron, zinc and copper in breast milk were determined by spectrometry. Mean values of iron, copper and zinc (blood and breast milk) were compared by ANOVA, followed by Tukey's test. Iron supplementation was beneficial to prevent anaemia in pregnancy but not effective to treat anaemia. During breastfeeding, iron supplementation had a negative effect on maternal copper status, confirming an interaction between these micronutrients.

Vitamin A and beta-carotene concentrations in adults with HIV/AIDS on highly active antiretroviral therapy.

Micronutrient deficiency is a common condition in HIV-infected individuals and may occur in all stages of the disease. The objective of this cross-sectional study was to compare the concentrations of vitamin A and beta-carotene, micronutrients related to immunity and oxidative stress, in 182 adults with HIV/AIDS, under different highly active antiretroviral therapy (HAART) regimens. Patients were divided into 3 groups according to their HAART regimen: combination of nucleoside analog reverse transcriptase inhibitors (NRTIs) and non-NRTIs; combination of NRTIs, protease inhibitors, and ritonavir; combination of NRTIs and other classes. Multiple linear regression analysis determined the effect of the treatment regimen, time of use, and compliance with the regimen, on vitamin A and beta-carotene concentrations, controlling for the following variables: gender, age, educational level, smoking, physical activity, body mass index, time of infection with HIV, presence of comorbidities, CD4(+) T lymphocyte count, total cholesterol and fractions, and triglyceride levels. There was no significant difference in vitamin A or beta-carotene concentrations in patients under the different HAART regimens. However, approximately 4% of the patients had deficient/low concentrations of vitamin A (<0.70 µmol/L), and 98% showed concentrations of beta-carotene <1.0 µmol/L. In conclusion, HIV/AIDS patients in this region will not benefit from vitamin A supplementation, independently of the HAART regimen utilized, but beta-carotene may be of importance, considering its antioxidant effect.

Iron deficiency anaemia and blood lead concentrations in Brazilian children.

This study investigated the relationship between iron deficiency/iron deficiency anaemia, assessed by several parameters, and blood lead concentration in children. This cross-sectional study involved 384 Brazilian children, aged 2-11 years, who lived near a lead-manipulating industry. Complete blood counts were obtained by an automated cell counter. Serum iron, total iron binding capacity (TIBC) and ferritin were determined respectively, by colorimetric, turbidimetric methods and chemiluminescence. Blood lead was measured by atomic absorption spectrophotometry. The impact of several parameters for assessment of iron status (haemoglobin, serum iron, TIBC, transferrin saturation, ferritin, red cell indices and red cell distribution width) and variables (gender, age, mother's education, income, body mass index, iron intake, and distance from home to lead-manipulating industry) on blood lead concentration was determined by multiple linear regression. There were significant negative associations between blood lead and the distance from home to the lead-manipulating industry (P<0.001), Hb (P=0.019), and ferritin (P=0.023) (R(2)=0.14). Based on these results, further epidemiological studies are necessary to investigate the impact of interventions like iron supplementation or fortification, as an attempt to decrease blood lead in children.

The effects of lipoic acid and α-tocopherol supplementation on the lipid profile and insulin sensitivity of patients with type 2 diabetes mellitus: a randomized, double-blind, placebo-controlled trial.

Antioxidants probably play an important role in the etiology of type 2 diabetes (DM2). This study evaluated the effects of supplementation with lipoic acid (LA) and α-tocopherol on the lipid profile and insulin sensitivity of DM2 patients. A randomized, double-blind, placebo-controlled trial involving 102 DM2 patients divided into four groups to receive daily supplementation for 4 months with: 600 mg LA (n = 26); 800 mg α-tocopherol (n = 25); 800 mg α-tocopherol + 600 mg LA (n = 25); placebo (n = 26). Plasma α-tocopherol, lipid profile, glucose, insulin, and the HOMA index were determined before and after supplementation. Differences within and between groups were compared by ANOVA using Bonferroni correction. Student's t-test was used to compare means of two independent variables. The vitamin E/total cholesterol ratio improved significantly in patients supplemented with vitamin E+LA and vitamin E alone (p ≤ 0.001). There were improvements of the lipid fractions in the groups receiving LA and vitamin E alone or in combination, and on the HOMA index in the LA group, but not significant. The results suggest that LA and vitamin E supplementation alone or in combination did not affect the lipid profile or insulin sensitivity of DM2 patients.

The nutritional status of children and adolescents with HIV/AIDS on antiretroviral therapy.

The objective of this cross-sectional study was to assess the nutritional status of children and adolescents with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) receiving highly active antiretroviral therapy (HAART). One hundred and eighteen subjects aged 6-19 years attending an outpatient clinic in São Paulo city were involved in the study. The following anthropometric measurements were assessed: weight, height, waist circumference and triceps and subscapular skinfold thickness. One (0.9%) adolescent was diagnosed with abdominal obesity based on waist circumference measurement; three (2.5%) adolescents were obese based on subscapular skinfold thickness. According to the body mass index, the population studied was mainly eutrophic. The prevalence of fat redistribution, a characteristic of patients with HIV/AIDS under HAART, was low. We advise the development of further studies to assess the nutritional status of children and adolescents with HIV/AIDS using anthropometric measurements as well as computed tomography to detect fat redistribution.

The relationship between arterial elasticity and lipid profile in people with type 1 diabetes mellitus.

A cross-sectional study was carried out to assess small (SAEI) and large (LAEI) arterial elasticity indexes of individuals with T1DM, and its relationship with their lipid profile. There were associations between SAEI and total cholesterol and waist-hip ratio (R(2)=0.29). Most of the individuals investigated showed low measures of SAEI.

The relationship between cortisol concentrations in pregnancy and systemic vascular resistance in childhood.

OBJECTIVE: To assess the relationship between cortisol concentrations in the last trimester of pregnancy and systemic vascular resistance - SVR in childhood. MATERIALS AND METHODS: This study is part of a cohort involving 130 Brazilian pregnant women and their children, ages 5 to 7years. Maternal cortisol was determined in saliva by an enzyme immunoassay utilizing the mean concentration of 9 samples of saliva (3 in each different day), collected at the same time, early in the morning. SVR was assessed by the HDI/PulseWave CR-2000 Cardiovascular Profiling System(R). Socioeconomic and demographic characteristics and life style factors were determined by a questionnaire. The nutritional status of the women and children was assessed by the body mass index - BMI. The association between maternal cortisol and SVR in childhood was calculated by multivariate linear regression analysis. RESULTS: There were statistically significant associations between maternal cortisol and SVR (p=0.043) and BMI-z score of the children (p=0.027), controlling for maternal BMI, birth weight, age, and gender of the children. CONCLUSION: As far as we know this is the first study in the literature assessing the association between cortisol concentrations in pregnancy and SVR in childhood. Overall, the data suggest that exposure to excess glucocorticoid in the prenatal period is associated to vascular complications in childhood, predisposing to cardiovascular diseases in later life.