Cardiorespiratory fitness and socioeconomic influences in Chilean schoolchildren: a cross-sectional study.

OBJECTIVE: To compare the cardiovascular risk and physical fitness, according to type of school in a national sample of Chilean school students. METHODS: A total of 7,218 students participated, who completed all the national tests of the National System for Measuring the Quality of Education, which included physical fitness and anthropometric tests. The results were compared according to the type of educational establishment and anthropometric indicators were considered. Physical fitness was measured by lower extremity strength, abdominal strength, upper extremity strength, trunk flexibility, exertional heart rate, and cardiorespiratory fitness. Body mass index, heart rate, and waist-to-height ratio were analyzed as predictors of cardiovascular risk. RESULTS: There were differences according to the type of establishment in the predictors of cardiovascular risk (p < 0.05). Differences were also found in the physical fitness tests evaluated (p < 0.01). Students in private schools (PSC) and subsidized schools (SC) had lower levels of cardiovascular risk and higher levels of physical fitness than public schools (PS) and schools with delegated administration (DA). CONCLUSIONS: In conclusion, students in educational establishments with a higher socioeconomic level have lower levels of cardiovascular risk and better physical fitness than students in public establishments. The authors suggest considering specific school interventions to mitigate cardiovascular risk and improve physical fitness among this vulnerable population. To this end, future studies should analyze the characteristics of physical activity and nutritional habits in schools to determine the factors that affect the results.

Burden of metabolic syndrome on primary healthcare costs among older adults: A cross-sectional study.

BACKGROUND: The impact of metabolic syndrome (MetS) on healthcare costs remains unclear in the literature. OBJECTIVES: To determine the impact of MetS on primary healthcare costs of adults, as well as to identify the impact of physical activity and other covariates on this phenomenon. DESIGN AND SETTING: This cross-sectional study was conducted in the city of Presidente Prudente, State of São Paulo/Brazil, in 2016. METHODS: The sample comprised 159 older adults (> 50 years) of both sexes (110 women) who were identified from their medical records in the Brazilian National Health Service. Healthcare costs (US$) were assessed through medical records and divided into medical consultations, medications, laboratory tests, and total costs. MetS was assessed using medical records. RESULTS: The Brazilian National Health Service spent more on consultations (US$ 22.75 versus US$ 19.39; + 17.3%) and medication (US$ 19.65 versus US$ 8.32; + 136.1%) among adults with MetS than among those without MetS, but the costs for laboratory tests were similar (P = 0.343). Total costs were 53.9% higher in adults with MetS than in those without the diagnosis of the disease (P = 0.001). Regarding total costs, there was an increase of US$ 38.97 when five components of MetS were present (P = 0.015), representing an increase of approximately 700%, even after adjusting for sex, age, and physical activity. CONCLUSION: In conclusion, the presence of the MetS is responsible for increasing primary care costs among older adults, especially in those related to medicines.

Blood levels of 21 metals and metalloids in riverside villagers of the Brazilian Amazon: A human biomonitoring study with associations with sociodemographic, dietary, and lifestyle factors.

Human biomonitoring of toxic and essential trace elements is critically important for public health protection. Amazonian riverine communities exhibit distinctive dietary patterns, heavily reliant on locally sourced fish, fruits, and vegetables. These habits may result in unique exposure profiles compared to urban populations. However, comprehensive assessments of their exposure to toxic and essential metals are lacking, representing a critical gap in understanding the health risks faced by these communities. This study aimed to establish baseline levels of 21 metals and metalloids in human blood and explore the influence of sociodemographic factors, dietary habits, and lifestyle choices as potential sources of exposure to these elements. A cross-sectional biomonitoring investigation was conducted with 1,024 individuals from 13 communities in the Tapajós and Amazon Basins (Pará, Brazil). Most of the elements in study was determined for the first time in the region. Blood samples were analyzed using inductively coupled plasma mass spectrometry (ICP-MS). The levels of all elements were summarized by quantiles and compared with cutoff values from other Brazilian populations. Multiple linear regression was used to assess possible associations between element concentrations and sociodemographic characteristics, dietary habits, and lifestyle choices. High detection rates (64%-100%) were observed, indicating the widespread presence of these elements. Elevated blood concentrations were found for mercury (median 21.1 µg.L-1, interquartile range: 12-34 µg.L-1), selenium (median 166 µg.L-1, interquartile range: 137-208 µg.L-1), and lead (median 34 µg.L-1, interquartile range: 20.8-64 µg.L-1). Regression analysis revealed a positive association between mercury levels and fish consumption, while manioc flour intake showed no relationship to lead levels. In conclusion, our findings emphasize the need for continued monitoring and public policy development for these vulnerable populations. Further studies should assess long-term trends and investigate the health implications of prolonged exposure to diverse chemicals in Amazonian riverside communities.

Changes in Use of Prenatal Dental Care After Brazil's Incentive Policy.

In 2020, the Brazilian federal government launched the "Prevent Brazil" program to incentivize cities to improve their performance across 7 health care indicators, including prenatal dental care. Our study examines the impact of this policy on the use of oral health care among pregnant women in Brazil. We used a series of cross-sectional data from the Brazilian Public Health System from 2018 to 2023. We linked publicly available data from the Brazilian Ministry of Health and the Brazilian Institute of Geography and Statistics. Our outcome was the proportion of pregnant women receiving prenatal care who had at least 1 dental visit during the past year. Covariates included city-level socioeconomic (income and literacy), demographic (gender, race, and urban areas), and workforce variables (number of dentists working in the public health system per city/year). We estimated the impact of the policy on prenatal dental visits nationwide and stratified by geographic region using interrupted time-series analysis. Our analyses included 99.9% of all Brazilian cities (n = 5,562). The use of oral health care among pregnant women increased from 15% in 2018 to 69% in 2023. Adjusted estimates show that, after initiation of the Prevent Brazil, dental care use among pregnant women increased nationally at a rate of 4.6 percentage points per 4-mo period (95% confidence interval [CI] 4.5; 4.7). The policy's largest impact was in the North and Northeast regions, which have the lowest socioeconomic profiles (adjusted time-series rate 5.7 [95% CI 5.3; 6.1] and 5.2 [5.0; 5.4] percent points, respectively). Our findings support the positive impact of the Prevent Brazil policy on prenatal dental care in Brazil. The policy was associated with a countrywide improvement in prenatal dental care use, with a greater impact in socioeconomically disadvantaged regions.

Validity and reliability of the Brazilian version of the Illness Perception Questionnaire-Revised for Dental.

This study aimed to test the validity and reliability of the Brazilian version of the "Illness Perception Questionnaire-Revised for Dental" (IPQ-RD) in parents/guardians of children aged six to 14 years. The sample consisted of 63 parents/guardians of schoolchildren from the municipal school system of Teófilo Otoni, MG. Remote and virtual data collection consisted of self-completion of personal data, socioeconomic questionnaire and the Brazilian short versions of the "Parental-Caregiver Perceptions Questionnaire" (16-P-CPQ) and the "Family Impact Scale" (4-FIS). The IPQ-RD was applied by telephone interview. Almost half of the sample belonged to socioeconomic classes C1 and C2. Approximately 1/3 classified their child's oral health as "regular" or "poor", while 11.1% reported "strong" or "very strong" impact on their child's well-being. The items most frequently cited as having an impact on the four domains of the 16-P-CPQ were: "bad breath" (23.8%), "mouth breathing" (20.7%), "feeling anxious or afraid" (20.7%), and "paying attention at school" (10%). In the 4-FIS, 11.1% "had little time for themselves or the family". There were higher IPQ-RD scores in the "disease coherence" domain for women and lower values of "emotional dimensions" for parents/guardians with incomplete education. The mean IPQ-RD score was 126.4 (±15.1), and domain scores were positively correlated. The internal consistency was "almost perfect" for the IPQ-RD total score, ranging from "moderate" to "almost perfect" for the "child-control" and "child-consequences" domains. The intraclass correlation coefficient ranged from 0.04 (poor) to 0.68 (substantial). The Brazilian Portuguese version of the IPQ-RD proved to be valid and reliable for assessing the cognitive and emotional perception of parents/guardians about childhood dental caries.

Biological, social, and healthcare factors for death due to influenza A(H1N1) during the 2009 epidemic in Brazil.

OBJECTIVE: To identify risk factors for death from influenza A(H1N1), including the effectiveness of the vaccine against influenza A(H1N1) concerning mortality. METHODS: A case-control of incident cases of influenza A(H1N1) reported in the epidemiological information systems of the states of São Paulo, Paraná, Pará, Amazonas, and Rio Grande do Sul was conducted. RESULTS: 305 participants were included, 70 of them cases and 235 controls, distributed as follows: Amazonas, 9 cases/10 controls; Pará, 22 cases/77 controls, São Paulo, 19 cases/49 controls; Paraná, 10 cases/54 controls; Rio Grande do Sul, 10 cases/45 controls. These participants had a mean age of 30 years, with 33 years among cases and 25 years among controls. There was a predominance of females both among the cases and controls. Biological (age), pre-existing diseases (congestive heart failure, respiratory disease, and diabetes mellitus), and care factors (ICU admission) associated with death from influenza A(H1N1) were identified. CONCLUSION: The risk factors identified in this investigation not only allowed subsidizing the elaboration of clinical conducts but also indicate important aspects for facing "new" influenza epidemics that are likely to occur in our country.

Access to medicines, the Unified Health System, and intersectional injustices.

OBJECTIVE: To estimate the prevalence of general and public access to prescription drugs in the Brazilian population aged 15 or older in 2019, and to identify inequities in access, according to intersections of gender, color/race, socioeconomic level, and territory. METHODS: We analyzed data from the 2019 National Health Survey with respondents aged 15 years or older who had been prescribed a medication in a healthcare service in the two weeks prior to the interview (n = 19,819). The outcome variable was access to medicines, subdivided into general access (public, private and mixed), public access (via the Unified Health System - SUS) for those treated by the SUS, and public access (via the SUS) for those not treated by the SUS. The study's independent variables were used to represent axes of marginalization: gender, color/race, socioeconomic level, and territory. The prevalence of general and public access in the different groups analyzed was calculated and the association of the outcomes with the aforementioned axes was estimated with odds ratios (OR) using logistic regression models. RESULTS: There was a high prevalence of general access (84.9%), when all sources of access were considered, favoring more privileged segments of the population, such as men, white, and those of high socioeconomic status. When only the medicines prescribed in the SUS were considered, there was a low prevalence (30.4% access) that otherwise benefited marginalized population segments, such as women, black, and people from low socioeconomic backgrounds. CONCLUSIONS: Access to medicines through the SUS proves to be an instrument for combating intersectional inequities, lending credence to the idea that the SUS is an efficient public policy for promoting social justice.

Socioeconomic and environmental factors associated with dengue fever incidence in Guatemala: Rising temperatures increase dengue risk.

Dengue fever is a mosquito-borne illness that infects 390 million people annually. Dengue outbreaks in Guatemala have been occurring more often and at increased rates since the first dengue outbreak in Guatemala in the 1970s. This study will examine environmental and socioeconomic factors associated with dengue in Guatemala at the municipality (county) level. Socioeconomic factors included population density, Mayan population, economic activity, and attending school. Environmental factors included average minimum annual temperature and annual precipitation. The relationship between environmental and socioeconomic variables and dengue fever incidence was initially evaluated through univariate zero-inflated negative binomial models, and then again through three zero-inflated multivariate negative binomial regression models. For all three models, elevation was considered a predictor of zero-inflation. In the combined model, there was a positive relationship between minimum temperature, economic activity and dengue fever incidence, and a negative relationship between population density, Mayan population and dengue fever. Predicted rates of dengue fever incidence and adjusted confidence intervals were calculated after increasing minimum yearly temperature by 1°C and 2°C. The three municipalities with the highest minimum yearly temperature (El Estor, Iztapa, and Panzós) and the municipality of Guatemala, all had an increase in the magnitude of the risk of dengue fever incidence following 1°C and 2°C increase in temperature. This research suggests that these socioeconomic and environmental factors are associated with risk of dengue in Guatemala. The predicted rates of dengue fever also highlight the potential effect that climate change in the form of increasing temperature can have on dengue in Guatemala.

Spatial clusters and social inequities in COVID-19 vaccine coverage among children in Brazil.

This study examined the spatial distribution and social inequalities in COVID-19 vaccine coverage among children aged 5-11 in Brazil. First and second dose vaccine coverage was calculated for all Brazilian municipalities and analyzed by geographic region and deciles based on human development index (HDI-M) and expected years of schooling at 18 years of age. Multilevel models were used to determine the variance partition coefficient, and bivariate local Moran's I statistic was used to assess spatial association. Results showed significant differences in vaccine coverage rates among Brazilian municipalities, with lower coverage in the North and Midwest regions. Municipalities with lower HDI and expected years of schooling had consistently lower vaccine coverage rates. Bivariate clustering analysis identified extensive concentrations of municipalities in the Northern and Northeastern regions with low vaccine coverage and low human development, while some clusters of municipalities in the Southeast and South regions with low coverage were located in areas with high HDI-M. These findings highlight the persistent municipal-level inequalities in vaccine coverage among children in Brazil and the need for targeted interventions to improve vaccine access and coverage in underserved areas.

Indicators of social inequalities associated with cancer mortality in Brazilian adults: scoping review. / Indicadores de desigualdades sociais associados à mortalidade por neoplasias nos adultos brasileiros: revisão de escopo.

The objective of this study was to identify indicators of social inequalities associated with mortality from neoplasms in the Brazilian adult population. A scoping review method was used, establishing the guiding question: What is the effect of social inequalities on mortality from neoplasms in the Brazilian adult population? A total of 567 papers were identified, 22 of which were considered eligible. A variety of indicators were identified, such as the Human Development Index and the Gini Index, which primarily assessed differences in income, schooling, human development and vulnerability. A single pattern of association between the indicators and the different neoplasms was not established, nor was a single indicator capable of explaining the effect of social inequality at all levels of territorial area and by deaths from all types of neoplasms identified. It is known that mortality is influenced by social inequalities and that the study of indicators provides an opportunity to define which best explains deaths. This review highlights important gaps regarding the use of non-modifiable social indicators, analysis of small geographical areas, and limited use of multidimensional indicators.

O objetivo deste estudo foi identificar indicadores de desigualdades sociais associados à mortalidade por neoplasias na população adulta brasileira. Utilizou-se como método a revisão de escopo, estabelecendo-se a pergunta norteadora: qual o efeito das desigualdades sociais na mortalidade por neoplasias na população adulta brasileira? Foram identificados 567 trabalhos, sendo 22 considerados elegíveis. Identificou-se uma diversidade de indicadores, como o Índice de Desenvolvimento Humano e o Índice de Gini, entre outros, que avaliaram primordialmente diferenças de renda, escolarização, desenvolvimento humano e vulnerabilidade. Não foi estabelecido um único padrão de associação entre os indicadores e as diferentes neoplasias, assim como não se identificou um indicador único capaz de explicar o efeito da desigualdade social em todos os níveis de área e por óbitos por todos os tipos de neoplasias, mas identificou-se que a mortalidade é influenciada pelas desigualdades sociais e que o estudo dos indicadores proporciona definir qual melhor explica os óbitos. Essa revisão destaca importantes lacunas referentes ao uso de indicadores sociais não modificáveis, à análise de pequenas áreas e ao uso limitado de indicadores multidimensionais.

Maternal perception of factors that interfere with breastfeeding of preterm newborns. / Percepção materna sobre os fatores que interferem na amamentação de prematuros.

PURPOSE: to verify the association between the perception of mothers of premature infants regarding the features that may interfere with breastfeeding and the mother's socioeconomic data, pregnancy and the baby's clinical data. METHODS: observational, descriptive and analytical quali-quantitative cross-sectional study. One hundred and fourteen mothers of premature infants were included and data were collected through questionnaires, applied at hospital discharge, and analysis of medical records. Maternal responses about the interference observed in the breastfeeding process were categorized by content analysis and associated with socioeconomic, pregnancy and baby data. RESULTS: the mothers' perceptions regarding the factors that interfere with the baby's feeding at the mother's breast were divided into four semantic categories: clinical and/or physical conditions of the baby; clinical, physical and/or psycho-emotional conditions of the mother; support network; and strategies for initiating and/or maintaining breastfeeding. Education, paternal presence, having other children and having breastfed them were associated with the maternal perception that their clinical, physical and/or psycho-emotional conditions interfere with breastfeeding. In addition, the support network was associated with exclusive breastfeeding at discharge. CONCLUSION: education, paternal presence, multiparity and having breastfed previous children influenced the maternal perception that their clinical, physical and/or psycho-emotional conditions interfere with breastfeeding. In addition, mention of the support network was associated with exclusive breastfeeding at discharge.

OBJETIVO: verificar a associação entre a percepção das mães de prematuros a respeito dos fatores que podem interferir no aleitamento e as características socioeconômicas da mãe, da gestação e clínicas do recém-nascido. MÉTODO: estudo qualiquantitativo observacional, descritivo e analítico do tipo transversal. Foram incluídas 114 mães de prematuros. Os dados foram coletados por meio de questionários, aplicados à alta hospitalar e análise dos prontuários. As respostas maternas sobre as interferências observadas no processo do aleitamento foram categorizadas por análise de conteúdo e associadas aos dados socioeconômicos, da gestação e do recém-nascido (RN). RESULTADOS: as percepções das mães quanto aos fatores que interferem na alimentação do RN ao seio materno foram divididas em quatro categorias semânticas: condições clínicas e/ou físicas do RN; condições clínicas, físicas e/ou psicoemocionais da mãe; rede de apoio; e estratégias para iniciar e/ou manter o aleitamento materno. Escolaridade, presença paterna, possuir outros filhos e tê-los amamentado apresentaram associação com a percepção materna de que suas condições clínicas, físicas e ou psicoemocionais interferem no aleitamento. Além disso, a rede de apoio esteve associada ao aleitamento materno exclusivo à alta. CONCLUSÃO: escolaridade, presença paterna, multiparidade e ter amamentado filhos anteriores influenciaram a percepção materna de que suas condições clínicas, físicas e ou psicoemocionais apresentam interferência no aleitamento. Além disso, a menção à rede de apoio esteve associada com o aleitamento materno exclusivo à alta.

Factors associated with the anxiety score of deaf and hearing mothers. / Fatores associados ao escore de ansiedade de mães surdas e ouvintes.

PURPOSE: To associate maternal anxiety with sociodemographic factors, breastfeeding practices, oral habits, and the child's entry into daycare among deaf and hearing (non-deaf) mothers. METHODS: This retrospective comparative cross-sectional study included 116 mothers (29 deaf and 87 hearing) of children aged between two and five years. Deaf mothers belonged to a reference center in the city, while hearing mothers were contacted in public daycares where their children were enrolled. Mothers underwent interviews covering socio-economic factors and child development-related aspects. Additionally, they completed the Brazilian Beck Anxiety Inventory, adapted for both deaf and hearing individuals, serving as instruments to assess anxiety. The Kolmogorov-Smirnov normality test, Kruskal Wallis test, Mann-Whitney test, and Poisson Regression were employed for statistical analyses (p<0.05). RESULTS: Deaf mothers exhibited anxiety scores one and a half times higher than hearing mothers. Moreover, mothers of children with thumb-sucking habits showed higher anxiety scores, while mothers whose children started attending daycare as infants demonstrated lower anxiety scores compared to mothers of children without such habits and who did not attend daycare. CONCLUSION: Deaf mothers displayed higher anxiety levels when compared to hearing mothers. Children's behaviors, such as thumb-sucking habits, and early enrollment in daycare during the first year of life influenced maternal anxiety.

OBJETIVO: Associar a ansiedade materna aos fatores sociodemográficos, pratica de aleitamento, hábitos bucais e ingresso da criança em creche entre mulheres surdas e ouvintes. MÉTODO: Participaram deste estudo transversal retrospectivo comparativo, 116 mães (29 surdas e 87 ouvintes) de crianças na faixa etária entre dois e cinco anos. As mães surdas pertenciam a um centro de referência da cidade e as mães ouvintes foram contatadas em creches públicas, onde seus filhos estavam matriculados. As mães foram submetidas a entrevista sobre fatores socioeconômicos e relacionados ao desenvolvimento dos filhos, além de realizarem o preenchimento do Inventário Brasileiro de Ansiedade de Beck, nas versões para surdos e ouvintes, que foram instrumentos usados para avaliar a ansiedade. O teste de normalidade de Kolmogorov-Smirnov, os testes de Kruskal Wallis, Mann-Whitney e Regressão de Poisson foram utilizados para análises estatísticas (p <0,05). RESULTADOS: Mães surdas apresentaram escore de ansiedade uma vez e meia maior que mães ouvintes. Além disso, mães de crianças com hábito de sucção de dedo apresentaram maior escore de ansiedade e mães cujos filhos começaram a frequentar a creche ainda bebês apresentaram menor escore de ansiedade, quando comparados a crianças sem o hábito e que não frequentavam a creche. CONCLUSÃO: Mães surdas apresentaram maior ansiedade quando comparadas às ouvintes. Comportamento dos filhos com hábitos de sucção de dedo e o ingresso em creches no primeiro ano de vida influenciaram a ansiedade materna.

Factors related to early weaning in babies born at term in a public maternity. / Fatores relacionados ao desmame precoce em bebês nascidos a termo em uma maternidade pública.

PURPOSE: to analyze how socioeconomic, pregnancy and childbirth factors relate to the feeding situation in the sixth month of life of full-term babies. METHODS: longitudinal observational study, with 98 mothers of full-term babies. Data collection was structured by capturing information regarding the clinical history and moment of birth in the babies' medical records, followed by the application of two questionnaires to the postpartum women, with questions regarding sociodemographic data, pre- and post-pregnancy data and the baby's nutrition. baby, the first being answered during hospital stay and the second, by telephone, in the 6th month of life. A descriptive analysis of the data was performed, using the frequency distribution of categorical variables, inferential analysis using Pearson's Chi-square test and multivariate analysis using binary logistic regression, adopting, for inclusion in the final model, the significance level of 5%. RESULTS: there was an association between exclusive breastfeeding in the 6th month and maternal education and between the period of food introduction and family income. Mothers with higher education were 4.82 times more likely to breastfeed their children exclusively until the sixth month. Families with lower income (up to one minimum wage) were 2.54 times more likely to start food introduction before the sixth month than families with higher income. CONCLUSION: higher maternal education was a predictive factor for exclusive breastfeeding at the 6th month and higher military income was a predictive factor for introducing food after the 6th month.

OBJETIVO: analisar como os fatores socioeconômicos, da gestação e do parto se relacionam com a situação da alimentação no sexto mês de vida de bebês nascidos a termo. MÉTODO: estudo observacional longitudinal, com 98 mães de bebês termos. A coleta de dados foi estruturada pela captação das informações referentes à história clínica e ao momento do parto nos prontuários dos bebês, seguida da aplicação de dois questionários, com questões referentes a dados sociodemográficos, dados pré e pós-gestacionais e da alimentação do bebê, sendo o primeiro respondido durante a internação hospitalar e o segundo, por contato telefônico, no 6° mês de vida. Foi realizada análise descritiva dos dados, por meio da distribuição de frequência das variáveis categóricas, análise inferencial utilizando o teste Qui-quadrado de Pearson e análise multivariada por regressão logística binária, adotando-se, para inclusão no modelo final, o nível de significância de 5%. RESULTADOS: houve associação entre aleitamento materno exclusivo no 6º mês e escolaridade materna e entre o início da introdução alimentar e a renda familiar. Mães com ensino superior apresentaram 4,82 vezes mais chances de amamentarem os filhos de forma exclusiva até o sexto mês. Famílias de menor renda (até um salário mínimo) tiveram 2,54 vezes mais chances de iniciarem a introdução alimentar antes do sexto mês do que as famílias de maior renda. CONCLUSÃO: maior escolaridade materna foi fator preditor para o aleitamento materno exclusivo ao 6º mês e maior renda familiar foi fator preditor para introdução alimentar após o 6º mês.

Women's health and well-being in five birth cohorts from low- and middle-income countries: Domains and their associations with early-life conditions.

Background: Women's health and well-being (WHW) have been receiving growing attention, but limited progress has been made on how to measure its different domains in low- and middle-income countries (LMICs). We used data from five long-term birth cohorts in Brazil, Guatemala, the Philippines and South Africa to explore different domains of adult WHW, and how these domains relate to early life exposures. Methods: Based upon an a priori conceptualisation of eight postulated WHW outcomes available in the data, we grouped them as follows: human capital (intelligence quotient, schooling, height, and teenage childbearing), metabolic health (body mass index and metabolic syndrome score), and psychological (happiness and Self-Reported Questionnaire (SRQ) scores). Correlation analyses confirmed the variables theoretically belonging to the same dimension of WHW were statistically related. We then applied principal component analysis to each group of variables separately and used the first principal component as a summary quantitative measure of the corresponding WHW dimension. Finally, we assessed the association of each domain with a range of early-life factors: wealth, maternal education, maternal height, water, and sanitation, birthweight, length at two years and development quotient in mid-childhood. Results: The three domains were largely uncorrelated. Early determinants were positively associated with human capital, while birth order was negatively associated. Fewer associations were found for the metabolic or psychological components. Birthweight and weight at age two years were inversely associated with metabolic health. Maternal education was associated with better psychological health. Conclusions: Our findings indicate that WHW is multidimensional, with most women in the cohorts being compromised in one or more domains while few women scored highly in all three domains. Our analyses are limited by lack of data on adolescent exposures and on other relevant WHW dimensions such as safety, agency, empowerment, and violence. Further research is needed in LMICs for identifying and measuring the multiple domains of WHW.

Life-course influences of poverty on violence and homicide: 30-year Brazilian birth cohort study.

BACKGROUND: Homicide is the leading cause of death among young people in Latin America, one of the world's most violent regions. Poverty is widely considered a key cause of violence, but theories suggest different effects of poverty, depending on when it is experienced in the life-course. Longitudinal studies of violence are scarce in Latin America, and very few prospective data are available worldwide to test different life-course influences on homicide. METHODS: In a prospective birth cohort study following 5914 children born in southern Brazil, we examined the role of poverty at birth, in early childhood, and in early adulthood on violence and homicide perpetration, in criminal records up to age 30 years. A novel Structured Life Course Modelling Approach was used to test competing life-course hypotheses about 'sensitive periods', 'accumulation of risk', and 'downward mobility' regarding the influence of poverty on violence and homicide. RESULTS: Cumulative poverty and poverty in early adulthood were the most important influences on violence and homicide perpetration. This supports the hypothesis that early adulthood is a sensitive period for the influence of poverty on lethal and non-lethal violence. Results were replicable using different definitions of poverty and an alternative outcome of self-reported fights. CONCLUSION: Cumulative poverty from childhood to adulthood was an important driver of violence and homicide in this population. However, poverty experienced in early adulthood was especially influential, suggesting the importance of proximal mechanisms for violence in this context, such as unemployment, organized crime, drug trafficking, and ineffective policing and justice systems.

Association between cognitive impairment and socioeconomic and sociodemographic factors in Colombian older adults.

INTRODUCTION: Worldwide, because of the demographic transition, the proportion of older adults has increased, which has been reflected in an increase in the prevalence of major neurocognitive disorder (MND). This phenomenon is especially important in low- and middle-income countries such as Colombia, given the high economic and social costs it entails. The objective was to analyse the association between socioeconomic variables with the presence of cognitive impairment in Colombian older adults. METHODS: The records of 23,694 adults over 60 years-of-age surveyed for SABE Colombia 2015, that took a stratified sample by conglomerates and were representative of the adult population over 60 years-of-age. This instrument assessed cognitive impairment using the abbreviated version of the Minimental (AMMSE) and collected information on multiple socioeconomic variables. RESULTS: 19.7% of the older adults included in the survey were reviewed with cognitive impairment by presenting a score <13 in the AMMSE. There was a higher prevalence of cognitive impairment in women (21.5%) than in men (17.5%). The socioeconomic variables were shown to impact the prevalence of deterioration, especially being currently working (OR = 2.74; 95%CI, 2.43-3.09) as a risk factor and having attended primary school as a protective factor (OR = 0.30; 95%CI, 0.28-0.32), differentially according to gender. CONCLUSIONS: An association between socioeconomic and sociodemographic factors with cognitive impairment in Colombian older adults was evidenced. Despite the above, a differential impact dependent on sex is suggested.

Do socioeconomic factors and local human preference determine the hybridization of knowledge in local medical systems?

BACKGROUND: Hybridization between the local medical systems (LMSs) and biomedicine has been the focus of different studies in ethnobiology, primarily due to the increasing access to biomedicine by indigenous peoples and local communities. Studies on hybridization allow for an understanding of the process of developing and evolving local knowledge systems. In this study, we propose a hybridization score to determine how individuals' socioeconomic characteristics and preference between LMS and biomedicine determine the complementarity of therapeutic options. METHODS: We conducted semistructured interviews and applied free listing technique in a rural community in Northeast Brazil to assess the treatments the local population sought and which were preferred. RESULTS: Our analyses showed that the level of schooling was the socioeconomic factor that negatively affected the hybridization process. Individuals with higher levels of schooling tended to prefer LMS strategies less and, consequently, showed a lower probability of hybridizing the two systems. Additionally, older people who preferred LMS strategies showed a greater tendency to adopt hybridization in human health-seeking behavior. CONCLUSIONS: Our findings provide further evidence of the complementarity between different medical systems and demonstrate that socioeconomic factors can affect local knowledge and are responsible for differences in individual propensity to hybridize distinct medical systems.

Leisure Time Physical Activity and Incidence of Arterial Hypertension in ELSA-Brasil Participants. / Atividade Física no Tempo Livre e Incidência de Hipertensão Arterial em Participantes do ELSA-Brasil.

BACKGROUND: Evidence indicates that physical activity (PA) has a protective effect against chronic diseases, including high arterial hypertension (AH). OBJECTIVE: This study investigated, longitudinally, the association between changes in leisure time physical activity (LTPA) and the incidence of hypertension in ELSA-Brasil participants. METHODS: Data from 8,968 participants were analyzed at two different times (2008-2010 and 2012-2014). The International Physical Activity Questionnaire (IPAQ), long version, was used to assess LTPA. The association between LTPA and AH was tested using Poisson regression with relative risk (RR) estimation, with a significance level of 5% and a 95% confidence interval. RESULTS: When the LTPA level variable was categorized as sufficient and insufficient, no statistically significant associations were found between LTPA and AH incidence as a function of changes in PA during follow-up. However, when the LTPA variable was categorized as inactive, little active, active, and very active, a statistically significant association was observed between LTPA and AH in participants classified as very physically active. The risk of AH was reduced by 35% among men RR 0.65 (95% CI 0.50-0.86) and by 66% among women RR 0.34 (95% CI 0.20-0.58) who maintained high levels of LTPA at both moments of follow-up. CONCLUSION: These results suggest that maintaining high levels of PA over time is associated with a lower risk of developing AH, highlighting the importance of PA in preventing this condition, for both men and women.

FUNDAMENTO: Evidências apontam que a atividade física (AF) apresenta efeito protetor para as doenças crônicas, incluindo a hipertensão arterial (HA). OBJETIVO: Este estudo investigou, de forma longitudinal, a associação entre as mudanças na atividade física no tempo livre (AFTL) e a incidência de HA em participantes do ELSA-Brasil. MÉTODOS: Foram analisados dados de 8.968 participantes em dois momentos distintos (2008-2010 e 2012-2014). Foi utilizado o Questionário Internacional de Atividade Física (IPAQ), versão longa, para avaliação da AFTL. A associação entre AFTL e HA foi testada por regressão de Poisson com estimativa do risco relativo (RR), com nível de significância de 5% e intervalo de confiança de 95%. RESULTADOS: Quando a variável nível de AFTL foi categorizada em suficiente e insuficiente, não foram encontradas associações estatisticamente significantes entre AFTL e a incidência HA em função das mudanças na AF durante o seguimento. No entanto, a variável AFTL quando categorizada em inativo, pouco ativo, ativo e muito ativo, observou-se associação estatisticamente significante entre AFTL e HA em participantes classificados como muito ativos fisicamente. O risco de HA foi reduzido em 35% entre homens RR 0,65 (IC 95% 0,50-0,86) e em 66% entre as mulheres RR 0,34 (IC 95% 0,20-0,58) que mantiveram altos níveis de AFTL em ambos os momentos do seguimento. CONCLUSÃO: Esses resultados sugerem que a manutenção de altos níveis de AF ao longo do tempo está associada a um menor risco de desenvolver HA, destacando a importância da AF na prevenção dessa condição, tanto para homens quanto para mulheres.

Investigating factors affecting the development of contract farming. Case study: tomatoes in Kermanshah Province.

The escalating demands of a growing population and rising living standards strain the efficiency of traditional agricultural methods in fulfilling consumer nutritional needs. Technological advancements, particularly the introduction of contract farming models, offer a potential path towards addressing these challenges. However, in Iran, contract farming remains an underdeveloped and under-researched agricultural practice. This study delves into the factors influencing the development of contract farming in Iran. Employing a two-level multinomial logit model and data collected through 380 questionnaires administered to farmers in the Kermanshah region, the research reveals income (measured by the number of employed household members) as the primary driver of contract farming adoption. Additionally, factors such as reduced agricultural risk, higher education levels among farmers, improved product sales prices, and proximity to processing facilities positively impact the expansion of contract farming. Interestingly, "push factors" like land scarcity significantly influence non-contract farming participation, with 30.8% of surveyed households relying on these alternative methods. Geographical factors also contribute, explaining 23% of the observed variance in farming activity choices. These findings inform key policy interventions for sustainable contract farming development in Iran: robust legal frameworks and transparent contracts, contract-specific insurance schemes, training for agricultural extension workers, and farmer awareness campaigns.

Knowledge, behavior and practices of the population during the pandemic against the transmission of SARS-CoV-2 in the state of Alagoas, Brazil.

The World Health Organization (WHO) declared an international state of emergency in order to contain the rapid spread of COVID-19. To ensure that there is adherence to preventive measures by the population aimed at controlling the pandemic in Alagoas, it is expected that knowledge, behavior and practices play an important role in preventing and controlling the disease. In this sense, it becomes relevant to understand the knowledge of the population about the disease. To evaluate the knowledge, behavior and practices of social media users during social isolation to prevent the transmission of the SARS-CoV-2 in the state of Alagoas, Northeast, Brazil. A probabilistic sample was carried out across the entire territory of the state of Alagoas with those who have access to a device that accesses the internet and a cross-sectional study was carried out using an online questionnaire applied to a convenience sample, recruited between August 2021 and July 2022 by snowball sampling. The questionnaire consisted of seven sessions, the first collecting data on the socioeconomic and sociodemographic profile of the participants, and the other sessions involving knowledge, attitudes and practices, including topics related to the vaccination that had to be administered at that time. High popular knowledge about signs and symptoms, means of transmission and risk groups. Low knowledge about seeking health services. Based on the results obtained, information from official channels became relevant to better teach the population in order to reduce the impact of COVID-19.