Adverse childhood experiences and crime outcomes in early adulthood: A multi-method approach in a Brazilian birth cohort.

This study aimed to investigate alternative approaches to a cumulative risk score in the relationship between adverse childhood experiences (ACEs) and crime. Using data from the 1993 Pelotas (Brazil) Birth Cohort (n = 3236), we measured 12 ACEs up to 15 years, and past-year violent and non-violent crime at 22 years. We used four analytical approaches: single adversities, cumulative risk, latent class analysis, and network analysis. When examined individually, physical abuse, emotional abuse, and domestic violence were associated with both crime outcomes, whereas maternal mental illness and discrimination were associated with violent crime only, and parental divorce and poverty with non-violent crime only. There was a cumulative effect of ACEs on crime. The class with child maltreatment and household challenges was associated with both crime outcomes; exposure to household challenges and social risks was associated with violent crime only. In network models, crime showed conditional associations with physical abuse, maternal mental illness, and parental divorce. Although cumulative ACEs did associate with crime, some individual and combinations of ACEs showed particularly strong and robust effects, which were not captured by the cumulative score. Many ACEs are closely connected and/or cluster together, and the usefulness of the ACE score needs to be further evaluated.

The association between maternal fears about their infant/toddler during the COVID-19 pandemic and depression and anxiety: a birth cohort study

Objective: To assess the association between maternal fears about their infant/toddler and depression and anxiety during the COVID-19 pandemic. Methods: In 2019, all mothers who gave birth in hospitals in Rio Grande, RS, Brazil were asked to respond to a standardized questionnaire (baseline). We followed them between May-June 2020 (first follow-up point), August-December 2020 (second follow-up point), and from October 2021 to March 2022 (third follow-up point), and asked them if they were: (1) afraid that their infant/toddler would become infected with COVID or get sick (yes/no), (2) afraid that they would contaminate their own child with COVID, and/or (3) worried about the pandemic's effects on their child's future. At baseline and at all follow-up points, we assessed depressive symptoms using the Edinburgh Postnatal Depression Scale and anxiety symptoms using the Generalized Anxiety Disorder Scale, creating symptom trajectories using group-based trajectory modelling. We used multinomial logistic regression to calculate adjusted relative risk ratios (RRR). Results: A total of 1,296 mothers participated. Worrying about the pandemic's effects on their child's future and the fear of contaminating their own child with COVID-19 increased the risk of raising depressive symptoms to a clinical level (RRR = 4.97, 95%CI 2.32-10.64 and RRR = 3.87, 95%CI 1.58-9.47, respectively) and anxiety to a moderate level (RRR = 2.91, 95%CI 1.69-5.01 and RRR = 1.86, 95%CI 1.03-3.35, respectively). Conclusion: Fear for their children increased maternal depressive and anxiety symptoms during the pandemic.

The association between maternal fears about their infant/ toddler during the COVID-19 pandemic and depression and anxiety: a birth cohort study.

OBJECTIVE: To assess the association between maternal fears about their infant/toddler and depression and anxiety during the COVID-19 pandemic. METHODS: In 2019, all mothers who gave birth in hospitals in Rio Grande, RS, Brazil were asked to respond to a standardized questionnaire (baseline). We followed them between May-June 2020 (first follow-up point), August-December 2020 (second follow-up point), and from October 2021 to March 2022 (third follow-up point), and asked them if they were: (1) afraid that their infant/toddler would become infected with COVID or get sick (yes/no), (2) afraid that they would contaminate their own child with COVID, and/or (3) worried about the pandemic's effects on their child's future. At baseline and at all follow-up points, we assessed depressive symptoms using the Edinburgh Postnatal Depression Scale and anxiety symptoms using the Generalized Anxiety Disorder Scale, creating symptom trajectories using group-based trajectory modelling. We used multinomial logistic regression to calculate adjusted relative risk ratios (RRR). RESULTS: A total of 1,296 mothers participated. Worrying about the pandemic's effects on their child's future and the fear of contaminating their own child with COVID-19 increased the risk of raising depressive symptoms to a clinical level (RRR = 4.97, 95%CI 2.32-10.64 and RRR = 3.87, 95%CI 1.58-9.47, respectively) and anxiety to a moderate level (RRR = 2.91, 95%CI 1.69-5.01 and RRR = 1.86, 95%CI 1.03-3.35, respectively). CONCLUSION: Fear for their children increased maternal depressive and anxiety symptoms during the pandemic.

Agreement between measured weight, height and BMI and Web-based self-reported data in participants of the 1993 Pelotas Birth Cohort, Brazil: a cross-sectional validation study.

OBJECTIVE: to evaluate the agreement between measured height, weight, and body mass index (BMI) during the 22-year follow-up of the 1993 Pelotas Birth Cohort, state of Rio Grande do Sul, Brazil, and self-reported data during the online follow-up of the coortesnaweb. METHODS: this was a cross-sectional validation study; agreement was assessed by means of Lin's concordance correlation coefficient for continuous measures and weighted Kappa for nutritional status; Spearman's rank correlation coefficient was used to estimate the correlation between measurements. RESULTS: a total of 783 participants were included; it could be seen high correlation and high agreement between the measured height (r = 0.966; ρ = 0.966), weight (r = 0.934; ρ = 0.928), and BMI (r = 0.903; ρ = 0.910) and Web-based self-reported data; there was no correlation between mean difference and the time interval between measurements. CONCLUSION: using the Internet to collect self-reported anthropometric measurements is as valid as the traditional method.

Physical Activity and Chronic Stress in Early Life: Findings From the 2015 Pelotas (Brazil) Birth Cohort.

BACKGROUND: The association of physical activity through early childhood on children's chronic stress still is unclear. Therefore, the aim of the present study is to test the association of physical activity through early childhood (1-4 y) with chronic stress, measured by hair cortisol at age 4. METHODS: Longitudinal study including children from the 2015 Pelotas (Brazil) Birth Cohort. Cortisol at age 4 was measured using a hair sample, which provided cortisol concentration from the past months. Physical activity was measured using accelerometers at 1, 2, and 4 years. Linear regression models were used to assess the association between physical activity and chronic stress. Trajectory models were also applied to examine chronic stress in relation to physical activity patterns throughout early childhood. RESULTS: Children with valid physical activity and hair cortisol data were included in the analyses (N = 1475). Three groups of physical activity trajectories between 1 and 4 years were identified: low, medium, and high. No association between physical activity at 1, 2, and 4 years and chronic stress at age 4 was observed. However, children in the "high" physical activity trajectory presented low cortisol concentration; the magnitude of the regression coefficient was slightly larger in girls (ß = -0.125; 95% confidence interval, -0.326 to 0.074) than boys (ß = -0.051; 95% confidence interval, -0.196 to 0.09). CONCLUSION: There was no clear association between physical activity and chronic stress in early childhood. Trajectories models suggest that higher activity throughout early childhood may positively impact chronic stress; however, more studies are needed to confirm that hypothesis.

Physical Activity During Adolescence and Mental Health in Early Adulthood: Findings From the 1993 Pelotas Birth Cohort Study.

BACKGROUND: Low prevalence of physical activity (PA) and a high prevalence of mental health problems are common among youth. The aim of this study was to evaluate the association between PA during adolescence and depression and anxiety disorders in young adulthood. METHODS: Data from the 1993 Pelotas (Brazil) Birth Cohort Study were analyzed. Leisure-time PA and total PA (leisure plus commuting) were evaluated at 11, 15, and 18 years using self-reported data. PA was evaluated at each age separately and during adolescence, considering the number of times participants reached PA recommendations. Depression and anxiety were assessed through Mini International Neuropsychiatric Interview at 22 years. Crude and adjusted association analyses were performed using Poisson regression with robust error variance, providing prevalence ratios and 95% confidence intervals. RESULTS: Three thousand two hundred and forty-seven participants were included in the study. In the adjusted analyses, active participants in leisure-time PA (≥300 min/wk) and total PA at 11 years were less likely to be depressed at age 22 (prevalence ratios: 0.54; 95% confidence interval, 0.33-0.89; prevalence ratios: 0.63; 95% confidence interval, 0.41-0.97). For leisure-time PA, the more PA recommendations were met during adolescence, the lower the prevalence of depression. There was no association when PA variables were evaluated separately at 15 and 18 years and between PA and anxiety after controlling for potential confounders. CONCLUSIONS: Early adolescence appears to be a sensitive period for PA benefits on depression in early adulthood. The more timepoints reaching PA recommendations during adolescence, the lower the risk of depression. On the other hand, PA during adolescence was not associated with anxiety in young adults.

Determinants of hair cortisol in preschool children and their mothers: A Brazilian birth cohort study.

OBJECTIVE: Few large-scale studies have provided population-based estimates of hair cortisol levels and its determinants. Hair cortisol and potential determinants were measured in children and their mothers in a population-based sample in a Brazilian city with large variations in socioeconomic conditions. METHODS: We used data from the 4-year follow-up of the 2015 Pelotas (Brazil) Birth Cohort Study. Hair samples were collected by trained fieldworkers to analyze average levels of cortisol over a 3-month period. Four groups of variables were tested as potential determinants: hair characteristics (natural color, treatment, type, and frequency of wash), use of corticosteroids and oral contraceptives, sociodemographic factors (sex, age, skin color, socioeconomic level, maternal relationship, pregnancy, daycare enrollment), maternal perceived stress, and substance exposure (smoking and illicit drug use). Linear regression with log transformation was used to test associations. RESULTS: 3235 children and 3102 mothers were analyzed (80.7% and 77.4% of those interviewed when children were 4 years of age, respectively), for whom sufficient hair was collected for cortisol analysis. The median of hair cortisol concentration was 7.8 pg/mg (IQR = 5.6 - 11.0) for children, and 5.6 pg/mg (IQR = 4.2 - 7.8) for mothers. In adjusted models, sex and socioeconomic level were associated with child cortisol levels. For mothers, hair cortisol levels were associated with socioeconomic level, skin color, age, hair treatment and hair natural color. CONCLUSION: This study provides estimates of hair cortisol levels in a diverse population in a upper-middle income country. Although just a few predictors were associated with maternal/child cortisol levels, socioeconomic level was the key variable that should be incorporated in studies using hair cortisol to measure biological manifestations of stress, but other variables, such as some hair and sociodemographic characteristics are important to consider when using hair cortisol.

Child and Maternal Mental Health Before and During the COVID-19 Pandemic: Longitudinal Social Inequalities in a Brazilian Birth Cohort.

OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic has caused major stress for families and children, particularly in the context of prolonged school closures. Few longitudinal studies are available on young children's mental health, including data both before and during the pandemic. This study examined experiences that might increase risk for mental health problems among caregivers and young children during the COVID-19 pandemic and inequalities driven by pre-pandemic disadvantage. METHOD: This prospective, population-based birth cohort study in Pelotas, Brazil, analyzed 2,083 children and caregivers with data from before the pandemic in 2019, when children were 4 years old, and again in 2020, when schools were closed for a long period during the pandemic. Child conduct problems, emotional problems, and hyperactivity-inattention problems were assessed using the Strengths and Difficulties Questionnaire. Family financial hardship, relationship difficulties, caregiver mental health, parenting practices, and child fears and isolation were considered as potential risk factors. RESULTS: Across the whole population, the only significant increase in mental health problems from before to during the pandemic was found for maternal depression. However, poorer families were at far greater risk of experiencing serious financial problems, food shortages, increased conflict in adult relationships, parenting problems, and child worries about food availability during the pandemic. In turn, these difficulties were associated with increases in multiple mental health problems for both caregivers and children. Increased child mental health problems were most strongly associated with concurrent maternal anxiety (ß > 0.20, p < .001, for each of child conduct, emotional, and hyperactivity problems), maternal depression (ß = 0.26, p < .001, for child emotional problems), partner criticism (ß = 0.21, p < .001, for child conduct problems), and harsh parenting (ß > 0.20, p < .001, for both child conduct and hyperactivity problems). Child worry about COVID-19 was associated with increased emotional problems (ß = 0.14, p < .001), but children's isolation was not associated with their mental health. CONCLUSION: Overall, the impact of the COVID-19 pandemic on mental health is a mixed picture, but for families in poverty, marked material and interpersonal difficulties were associated with increases in mental health problems among children and caregivers.

Concordância entre as medidas aferidas de peso, altura e IMC e autorrelatadas pela internet em participantes da coorte de nascimentos de Pelotas de 1993: estudo transversal de validação / Concordancia entre medidas de peso, talla e IMC autoinformadas en internet en participantes de la Cohorte de Nascimiento de Pelotas de 1993, Brasil: estudio de validación transversal / Agreement between measured weight, height and BMI and Web-based self-reported data in participants of the 1993 Pelotas Birth Cohort, Brazil: a cross-sectional validation study

Objective: to evaluate the agreement between measured height, weight, and body mass index (BMI) during the 22-year follow-up of the 1993 Pelotas Birth Cohort, state of Rio Grande do Sul, Brazil, and self-reported data during the online follow-up of the coortesnaweb. Methods: this was a cross-sectional validation study; agreement was assessed by means of Lin's concordance correlation coefficient for continuous measures and weighted Kappa for nutritional status; Spearman's rank correlation coefficient was used to estimate the correlation between measurements. Results: a total of 783 participants were included; it could be seen high correlation and high agreement between the measured height (r = 0.966; ρ = 0.966), weight (r = 0.934; ρ = 0.928), and BMI (r = 0.903; ρ = 0.910) and Web-based self-reported data; there was no correlation between mean difference and the time interval between measurements. Conclusion: using the Internet to collect self-reported anthropometric measurements is as valid as the traditional method.

Objetivo: evaluar la concordancia entre la altura, el peso y el índice de masa corporal (IMC) medidos durante el acompañamiento de 22 años de la cohorte de nacimientos de Pelotas de 1993 y autoinformado durante el seguimiento en línea de la coortesnaweb. Métodos: estudio metodológico de validación. Se utilizó el coeficiente de correlación de Lin para medidas continuas, y de Kappa ponderado para el estado nutricional y la correlación de Spearman para la correlación entre medidas. Resultados: se incluyeron 783 participantes, con alta correlación y concordancia entre las medidas de talla (r = 0,966; ρ = 0,966), peso (r = 0,934; ρ = 0,928) e IMC (r = 0,903; ρ = 0,910) medidos y autoinformados vía web. No hubo correlación entre las diferencias de medidas y el intervalo de tiempo entre las mediciones. Conclusión: el uso de internet para recopilar variables antropométricas autoinformadas es válido en comparación con el método tradicional.

Objetivo: avaliar a concordância entre altura, peso e índice de massa corporal (IMC) aferidos durante o acompanhamento dos 22 anos da coorte de nascimentos de Pelotas, Rio Grande do Sul, Brasil, de 1993, e dados autorrelatados durante o acompanhamento online da coortesnaweb. Métodos: estudo transversal de validação; a concordância foi avaliada pelos coeficientes de correlação de Lin para medidas contínuas e de Kappa ponderado para o estado nutricional; utilizou-se a correlação de Spearman para estimar a correlação entre as medidas. Resultados: 783 participantes foram incluídos; observou-se alta correlação e alta concordância entre as medidas de altura (r = 0,966; ρ = 0,966), peso (r = 0,934; ρ = 0,928) e IMC (r = 0,903; ρ = 0,910) aferidas e as autorrelatadas via internet; não houve correlação entre as diferenças médias e o intervalo de tempo entre as medidas. Conclusão: utilizar a internet para coletar medidas antropométricas autorrelatadas é um método válido, comparado ao método tradicional.

Effects of Regular Exercise During Pregnancy on Early Childhood Neurodevelopment: The Physical Activity for Mothers Enrolled in Longitudinal Analysis Randomized Controlled Trial.

BACKGROUND: The aim of this study was to investigate the effect of exercise during pregnancy on early childhood neurodevelopment (cognitive, motor, and language domains). METHODS: A randomized controlled trial nested into the 2015 Pelotas (Brazil) Birth Cohort was conducted. Healthy pregnant women were enrolled between 16 and 20 weeks of gestation; 424 women and their children (intervention [n = 141]; control [n = 283]) were analyzed. An exercise-based intervention 3 times per week was delivered over 16 weeks. Child neurodevelopment and its domains were assessed at 1, 2, and 4 years. Standardized mean differences and 95% confidence intervals are presented. RESULTS: No effects of exercise during pregnancy on child neurodevelopment and its domains at age 1 year were observed. Compared with the control group, children from women in the exercise group had higher language score at age 2 years (standardized mean differences = 0.23; 95% confidence intervals, 0.02 to 0.44) and higher cognitive score (standardized mean differences = 0.22; 95% confidence intervals, 0.03 to 0.41) at age 4 years. No effects of exercise during pregnancy were observed in the motor domain at 1, 2, and 4 years. CONCLUSIONS: No detrimental effects of exercise during pregnancy on child neurodevelopment were observed. In addition, these findings suggest that exercise during pregnancy can result in small benefits for language and cognitive development.

School Performance and Young Adult Crime in a Brazilian Birth Cohort.

Poor school performance may increase the risk of crime and violence via effects on self-esteem, risky behaviours, peer networks, and perceived stakes in society. Despite very high rates of violence in Latin America, no longitudinal research has addressed this issue in the region. Two aspects of educational performance (grade repetition and school completion) were examined during adolescence in a population-based Brazilian birth cohort study (n = 3584). Violent and non-violent crime were measured at age 22 years in confidential self-reports; sociodemographic, family, and individual confounders were measured between birth and age 11 years, and potential mediators were measured at age 18 years. The prevalence of violent and non-violent crimes at 22 years was 8.2% and 3.3%, respectively, referring to acts in the previous twelve months. For youth repeating school grades three times or more, the odds of violent crime were 2.4 (95%CI: 1.6-3.6) times higher than for those who had not repeated any school grade. Youth completing school had a lower risk for both violent (OR = 0.5; 95%CI: 0.4-0.7) and non-violent crime (OR = 0.3; 95%CI: 0.2-0.5), compared to those who did not finish school by the expected age. The protective effect of completing school was independent of the number of grades previously repeated. In conclusion, repeating school grades was associated with increased risk for crime; however, successfully managing to complete school by the expected age was an important protective factor against crime, even after multiple grade repetitions. Supplementary Information: The online version contains supplementary material available at 10.1007/s40865-022-00214-x.

[Child abuse and sexual risk behavior in adulthood: a systematic review]. / Maus-tratos infantis e comportamentos sexuais de risco na idade adulta: uma revisão sistemática.

Child abuse is a public health problem and can lead to serious consequences, such as involvement in sexual risk behavior (SRB). The scope of this article is to identify the studies that evaluated the association between different types of child maltreatment and SRB in adulthood through a systematic review. The search was conducted in the PubMed, Web of Science, PsycNET and Lilacs databases. The inclusion criteria were: cross-sectional, cohort or case-control design; assessment of individuals who have been exposed to maltreatment before the age of 18; evaluation of SRB in adulthood. The search identified 18,951 articles, 34 of which were included in this study. The selection process was performed by two researchers independently. Studies have generally shown that sexual abuse is a risk factor for the tendency of SRB in adulthood, however there is less evidence of this association for other forms of child abuse, such as domestic violence, emotional abuse and neglect. Child maltreatment negatively influences SRB in early adulthood. Further studies are needed to evaluate this relationship longitudinally, including the different types of abuse and the possible mechanisms of this relationship.

Os maus-tratos infantis são um problema de saúde pública e podem gerar graves consequências, como envolvimento em comportamentos sexuais de risco (CSR). O objetivo deste artigo é identificar os estudos que avaliaram a associação entre diferentes tipos de maus-tratos infantis e CSR na idade adulta, por meio de uma revisão sistemática da literatura. A busca foi realizada nas bases de dados PubMed, Web of Science, PsycNET e Lilacs. Os critérios de inclusão foram: delineamento transversal, coorte ou caso-controle; avaliação de indivíduos que foram expostos a maus-tratos até os 18 anos e avaliação de CSR na idade adulta. A busca identificou 18.951 artigos, sendo 34 incluídos neste estudo. O processo de seleção foi realizado por duas pesquisadoras de maneira independente. Em geral os estudos mostraram que o abuso sexual é um fator de risco para a adoção de CSR na vida adulta, no entanto há menos evidências dessa associação para as outras formas de maus-tratos, como violência doméstica, abuso emocional e negligência. Os maus-tratos infantis influenciam de maneira negativa os CSR da vida adulta. São necessários novos estudos que avaliem essa relação de maneira longitudinal, incluindo os diferentes tipos de maus-tratos e os possíveis mecanismos dessa relação.

A WhatsApp-Based Intervention to Improve Maternal Social Support and Maternal-Child Health in Southern Brazil: The Text-Message Intervention to Enhance Social Support (TIES) Feasibility Study.

Participatory learning and action cycles with women's groups have been recommended by the WHO to promote maternal and newborn health, but few studies have tested its feasibility and acceptability in mobile health (mHealth) interventions among mothers of toddlers. This was a mixed-method feasibility assessment of an 8-week WhatsApp-based maternal support group for mothers of toddlers (12-18 months of age) enrolled in a birth cohort study in Southern Brazil. Daily messages and weekly activities were sent by moderators to promote maternal-child outcomes: child nutrition, child sleep, nurturing care, and maternal psychosocial well-being (assessed pre- and post-intervention via self-reported questionnaire). The implementation and engagement of the mothers in the program were assessed by message extraction. Acceptability was evaluated through in-depth interviews (n = 5) and open-ended surveys (n = 10). 1481 messages were exchanged in 3 WhatsApp groups (n = 30 mothers). Mothers were most active on weekdays (68.6% of messages sent on Tuesdays and 72.6% on Thursdays), afternoons (2:00-4:00pm), and evenings (9:00-11:00 pm). Engagement was higher at weeks 1-4. Mothers enjoyed and considered topics relevant. Group interaction was perceived as low, which influenced their participation. The prevalence of depression symptoms decreased from pre- to post-intervention (9% to 5%; P = .04). A moderated mobile-based support group for mothers of toddlers was feasible. mHealth services to promote maternal support are a promising strategy to improve maternal-child outcomes, but engagement and use of the service remains a challenge. Program managers should work with community members to identify ways to support engagement and participation throughout the intervention.

Maus-tratos infantis e comportamentos sexuais de risco na idade adulta: uma revisão sistemática / Child abuse and sexual risk behavior in adulthood: a systematic review

Resumo Os maus-tratos infantis são um problema de saúde pública e podem gerar graves consequências, como envolvimento em comportamentos sexuais de risco (CSR). O objetivo deste artigo é identificar os estudos que avaliaram a associação entre diferentes tipos de maus-tratos infantis e CSR na idade adulta, por meio de uma revisão sistemática da literatura. A busca foi realizada nas bases de dados PubMed, Web of Science, PsycNET e Lilacs. Os critérios de inclusão foram: delineamento transversal, coorte ou caso-controle; avaliação de indivíduos que foram expostos a maus-tratos até os 18 anos e avaliação de CSR na idade adulta. A busca identificou 18.951 artigos, sendo 34 incluídos neste estudo. O processo de seleção foi realizado por duas pesquisadoras de maneira independente. Em geral os estudos mostraram que o abuso sexual é um fator de risco para a adoção de CSR na vida adulta, no entanto há menos evidências dessa associação para as outras formas de maus-tratos, como violência doméstica, abuso emocional e negligência. Os maus-tratos infantis influenciam de maneira negativa os CSR da vida adulta. São necessários novos estudos que avaliem essa relação de maneira longitudinal, incluindo os diferentes tipos de maus-tratos e os possíveis mecanismos dessa relação.

Abstract Child abuse is a public health problem and can lead to serious consequences, such as involvement in sexual risk behavior (SRB). The scope of this article is to identify the studies that evaluated the association between different types of child maltreatment and SRB in adulthood through a systematic review. The search was conducted in the PubMed, Web of Science, PsycNET and Lilacs databases. The inclusion criteria were: cross-sectional, cohort or case-control design; assessment of individuals who have been exposed to maltreatment before the age of 18; evaluation of SRB in adulthood. The search identified 18,951 articles, 34 of which were included in this study. The selection process was performed by two researchers independently. Studies have generally shown that sexual abuse is a risk factor for the tendency of SRB in adulthood, however there is less evidence of this association for other forms of child abuse, such as domestic violence, emotional abuse and neglect. Child maltreatment negatively influences SRB in early adulthood. Further studies are needed to evaluate this relationship longitudinally, including the different types of abuse and the possible mechanisms of this relationship.

Influence of parental physical activity on offspring's nutritional status: an intergenerational study in the 1993 Pelotas birth cohort.

OBJECTIVE: To investigate the influence of parental physical activity on offspring's nutritional status in the 1993 Pelotas (Brazil) birth cohort. DESIGN: Birth cohort study. SETTING: The main outcomes were overweight and obesity status of children. The main exposure was parental physical activity over time, measured during the 11, 15 and 18 years of age follow-ups. The exposure was operationalised as cumulative, and the most recent measure before the birth of child. We adjusted Poisson regression models with robust variance to evaluate crude and adjusted associations between parental physical activity and offspring's nutritional status. All analyses were stratified according to the sex of the parent. PARTICIPANTS: A total of 874 members from the 1993 Pelotas (Brazil) birth cohort followed-up at 22 years of age with their first-born child were analysed. RESULTS: Children were, on average, 3·1 years old. Crude analyses showed that the mother's cumulative physical activity measure had an indirect association with the prevalence of children's obesity. The most recent maternal physical activity measure before the birth of the child was associated with 41 % lower prevalence of obesity in children, even after adjustment for confounders. CONCLUSIONS: The most recent maternal physical activity measure was indirectly associated with the prevalence of obesity in children. No associations were found for fathers, reinforcing the hypothesis of a biological effect of maternal physical activity on offspring's nutritional status.

Multiple imputation to deal with missing objectively-measured physical activity data: findings from two cohorts / Imputação múltipla para lidar com dados faltantes em acelerometria: resultados de duas coortes

The objective of this article was to describe patterns of losses of information regarding accelerometer data and to assess the use of multiple imputation to generate physical activity estimates for individu-als without accelerometry data. Two birth cohort studies from Pelotas (Brazil) with participants aged 22 and 11-years old assessed objectively measured physical activity differences between complete and imputed cases. Mean values of overall physical activity for complete cases (n1993 = 2,985 and n2004 = 3,348) and for complete cases plus imputed cases (n1993 = 760 and n2004 = 79) were described accord-ing to predictors. Male individuals, participants with black skin color, and less schooled individuals presented higher averages of overall physical activity than their counterparts. Almost all imputed estimates were comparable to the complete cases, and the highest difference found was 0.7 mg for the first quintile of socioeconomic status of the 1993 birth cohort. Multiple imputation is a positive technique to deal with missing data from objectively measured physical activity. It provides a set of relevant variables to be used in order to efficiently predict accelerometer data

O objetivo desse artigo foi descrever os padrões de perda de informação em dados de acelerometria, além de avaliar o processo de imputação múltipla para estimar o nível de atividade física para indivíduos sem dados de acelerometria. Participantes de duas coortes de nascimentos de Pelotas (Brasil) com 22 e 11 anos participaram do estudo e diferenças entre casos completos e imputados foram avaliadas. A média geral de atividade física para os casos completos (n1993 = 2.985 e n2004 = 3.348) e para casos completos mais imputados (n1993 = 760 e n2004 = 79) foi descrita de acordo com os preditores. Indivíduos do sexo masculino, de cor da pele preta e com menor escolaridade apresentaram maiores médias de atividade física geral. Quase todas as estimativas imputadas foram comparáveis com os valores de casos completos, e a maior diferença encontrada foi 0,7 mg para o primeiro quintil de renda na coorte de 1993. Imputação múltipla é uma boa técnica para lidar com dados faltantes de atividade física medida por acelerometria. Essa técnica fornece um gama relevante de variáveis para serem usadas a fim de predizer valores de acelerometria eficientemente

Sources of access to medication and its use in the rural area of Pelotas, Rio Grande do Sul, Brazil, in 2016: a cross-sectional population-based study. / Fontes de acesso e utilização de medicamentos na zona rural de Pelotas, Rio Grande do Sul, em 2016: estudo transversal de base populacional.

OBJECTIVE: To analyze the prevalence of medication use, sources of access, and associated factors among rural residents in Pelotas, RS, Brazil. METHODS: This was a cross-sectional study conducted in 2016 with adults ≥18 years old. Participants reported on medication use and sources of access to medication in the month prior to the interview. Poisson regression was used. RESULTS: Among the 1,519 respondents, 54.7% (95%CI 48.7;60.5) used some form of medication and 3.3% (95%CI 2.4;4.5) stopped taking necessary medication. Higher prevalence of use occurred in: women (PR=1.23 - 95%CI 1.12;1.34), the elderly (PR=2.36 - 95%CI 2.05;2.73), people with poorer self-perceived health (PR=1.29 - 95%CI 1.14;1.46) and people with a higher number of diseases (PR=2.37 - 95%CI 2.03;2.77). A total of 14.0% (95%CI 11.2;17.4) obtained medication exclusively from the Brazilian National Health System, prevalence of which was higher among those who self-reported themselves to be non-white and from lower economic classification. CONCLUSION: A low number stopped taking medication they needed to take. Use of free-of-charge medication was greater in groups with lower income.

Fontes de acesso e utilização de medicamentos na zona rural de Pelotas, Rio Grande do Sul, em 2016: estudo transversal de base populacional / Fuentes de acceso y uso de medicamentos en la zona rural de Pelotas, Rio Grande do Sul, Brasil, en 2016: estudio transversal de base poblacional / Sources of access to medication and its use in the rural area of Pelotas, Rio Grande do Sul, Brazil, in 2016: a cross-sectional population-based study

Objetivo: Analisar a prevalência do uso de medicamentos, fontes de acesso e fatores associados, em residentes da zona rural de Pelotas, RS, Brasil. Métodos: Estudo transversal com adultos ≥18 anos, realizado em 2016. Questionou-se o uso e fontes de acesso aos medicamentos no mês anterior à entrevista. Empregou-se regressão de Poisson. Resultados: Dos 1.519 entrevistados, 54,7% (IC95% 48,7;60,5) utilizaram algum medicamento e 3,3% (IC95% 2,4;4,5) deixaram de utilizar medicamento necessário. Exibiram maiores prevalências de utilização: mulheres (RP=1,23 - IC95% 1,12;1,34), idosos (RP=2,36 - IC95% 2,05;2,73), pessoas com pior autopercepção de saúde (RP=1,29 - IC95% 1,14;1,46), com maior número de doenças (RP=2,37 - IC95% 2,03;2,77). Obtiveram medicamentos exclusivamente pelo Sistema Único de Saúde (SUS) 14,0% (IC95% 11,2;17,4), com prevalências maiores entre pessoas de cor da pele autodeclarada não branca e classificação econômica inferior. Conclusão: Pequena parcela deixou de usar medicamentos de que necessitava. A obtenção gratuita de medicamentos foi maior nos grupos de menor poder aquisitivo.

Objetivo: Analizar la prevalencia del uso de medicamentos, las fuentes de acceso y los factores asociados en habitantes rurales de Pelotas, RS, Brasil. Métodos: Estudio transversal con adultos ≥18 años, en 2016. Se preguntó sobre el uso y fuentes de acceso a los medicamentos en el mes anterior a la entrevista. Se utilizó la regresión de Poisson. Resultados: De los 1.519 entrevistados, 54,7% (IC95% 48,7; 60,5) usó algún medicamento y 3,3% (IC95% 2,4; 4,5) dejó de usar un medicamento necesario. Las prevalencias de uso fueron mayores en mujeres (RP=1,23 - IC95% 1,12;1,34), adultos mayores (RP=2,36 - IC95% 2,05;2,73), personas con peor autopercepción de salud (RP=1,29 - IC95% 1,14;1,46) y con más enfermedades (RP=2,37 - IC95% 2,03;2,77). En total, 14,0% (IC95% 11,2;17,4) obtuvo medicamentos exclusivamente por el Sistema Único de Salud (SUS) y la prevalencia fue mayor en los de color de piel no blanca (autodeclarada) y clase económica más baja. Conclusión: Pequeña parcela indicó que dejó de usar medicamentos necesarios. La obtención gratuita fue mayor en grupos de menor poder adquisitivo.

Objective: To analyze the prevalence of medication use, sources of access, and associated factors among rural residents in Pelotas, RS, Brazil. Methods: This was a cross-sectional study conducted in 2016 with adults ≥18 years old. Participants reported on medication use and sources of access to medication in the month prior to the interview. Poisson regression was used. Results: Among the 1,519 respondents, 54.7% (95%CI 48.7;60.5) used some form of medication and 3.3% (95%CI 2.4;4.5) stopped taking necessary medication. Higher prevalence of use occurred in: women (PR=1.23 - 95%CI 1.12;1.34), the elderly (PR=2.36 - 95%CI 2.05;2.73), people with poorer self-perceived health (PR=1.29 - 95%CI 1.14;1.46) and people with a higher number of diseases (PR=2.37 - 95%CI 2.03;2.77). A total of 14.0% (95%CI 11.2;17.4) obtained medication exclusively from the Brazilian National Health System, prevalence of which was higher among those who self-reported themselves to be non-white and from lower economic classification. Conclusion: A low number stopped taking medication they needed to take. Use of free-of-charge medication was greater in groups with lower income.

Parental attendance in two early-childhood training programmes to improve nurturing care: A randomized controlled trial.

Parent training programmes have significant potential to improve the quality of children's early environments and thereby their development and life-course outcomes. The aim of this study was to identify and explain the extent to which parents engaged in two group-based training programmes, offered to high-risk families enrolled in a randomized controlled trial study called PIÁ in Southern Brazil. The programmes were: (1) ACT: Raising Safe Kids, a 9-week programme aiming to reduce harsh parenting and maltreatment and improve positive parenting practices; (2) Dialogic book-sharing (DBS), an 8-week programme aiming to promote parental sensitivity and improve child cognitive development and social understanding. Of the 123 mothers randomly allocated to the ACT programme, 64.2% (n = 79) completed the course, and of 124 mothers allocated to DBS, 76.6% (n = 95) completed the course. After the interventions, mothers were very positive about the experience of both programmes but highlighted practical difficulties in attending. In adjusted regression analyses, only two variables significantly predicted ACT course completion (maternal age and distance between the intervention site and household); no significant predictor was found for DBS attendance. We conclude that although high completion rates are possible, there are important challenges to engaging parents of young children in training programmes, and practical difficulties occurring during training courses may be more important for attendance than baseline participant characteristics.

Sources of access and medication use in rural area of Pelotas, Rio Grande do Sul, Brazil, in 2016: cross-sectional population-based study / Fuentes de acceso y uso de medicamentos en la zona rural de Pelotas, Rio Grande do Sul, Brasil, en 2016: estudio transversal de base poblacional / Fontes de acesso e utilização de medicamentos na zona rural de Pelotas, Rio Grande do Sul, em 2016: estudo transversal de base populacional

Objective. To analyze the prevalence of medication use, sources of access, and associated factors among rural residents in Pelotas, RS, Brazil. Methods. Cross-sectional study with adults ≥18 years, in 2016. Participants reported on the use and sources of access to medication used in the month prior to the interview. Poisson regression was used. Results. Among the 1,519 respondents, 54.7% (95%CI 48.7;60.5) used some medication and 3.3% (95%CI 2.4;4.5) didn't use some necessary medication. Higher prevalence of use occurred in: women (PR=1.23 ­ 95%CI 1.12;1.34), the elderly (PR=2.36 ­ 95%CI 2.05;2.73), worse self-perception of health (PR=1.29 ­ 95%CI 1.14;1.46) and higher number of diseases (PR=2.37 ­ 95%CI 2.03;2.77). A total of 14.0% (95%CI 11.2;17.4) obtained medications exclusively from Health System and the prevalence was higher among those who self-declared non-white and from lower economic classes. Conclusion. A small portion indicated that they didn't use necessary medications. Free obtaining was higher in groups with lower income.

Objetivo. Analisar a prevalência do uso de medicamentos, fontes de acesso e fatores associados, em residentes da zona rural de Pelotas, RS, Brasil. Métodos. Estudo transversal com adultos ≥18 anos, realizado em 2016. Questionou-se o uso e fontes de acesso aos medicamentos no mês anterior à entrevista. Empregou-se regressão de Poisson. Resultados. Dos 1.519 entrevistados, 54,7% (IC95% 48,7;60,5) utilizaram algum medicamento e 3,3% (IC95% 2,4;4,5) deixaram de utilizar medicamento necessário. Exibiram maiores prevalências de utilização: mulheres (RP=1,23 ­ IC95% 1,12;1,34), idosos (RP=2,36 ­ IC95% 2,05;2,73), pessoas com pior autopercepção de saúde (RP=1,29 ­ IC95% 1,14;1,46), com maior número de doenças (RP=2,37 ­ IC95% 2,03;2,77). Obtiveram medicamentos exclusivamente pelo Sistema Único de Saúde (SUS) 14,0% (IC95% 11,2;17,4), com prevalências maiores entre pessoas de cor da pele autodeclarada não branca e classe econômica inferior. Conclusão. Pequena parcela deixou de usar medicamentos que necessitava. A obtenção gratuita de medicamentos foi maior nos grupos de menor poder aquisitivo.