Assessment of incompleteness of Mortality Information System records on deaths from external causes in the state of Rio Grande do Sul, Brazil, 2000-2019.

OBJECTIVE: to evaluate the incompleteness of Mortality Information System (Sistema de Informações sobre Mortalidade - SIM) data on deaths from external causes (ECs) in the state of Rio Grande do Sul, Brazil, 2000-2019. METHODS: This was an ecological study, using SIM data on all deaths from external causes and, specifically, from transport accident, homicides, suicides and falls; the analysis of the trend of incompleteness was performed by means of Prais-Winsten regression, with a 5% significance level. RESULTS: A total of 146,882 deaths were evaluated; sex (0.1%), place of death (0.1%) and age (0.4%) showed the lowest incompleteness in 2019; the proportion of incompleteness showed a decreasing trend for the place of death and schooling, an increasing trend for marital status and a stable trend for age and race/skin color, among all types of death evaluated. CONCLUSION: the variables analyzed reached a high degree of completion; with the exception of marital status and schooling, for which unsatisfactory scores persisted for deaths from ECs, both total and by subgroups.

Avaliação da incompletude dos registros de óbitos por causas externas do Sistema de Informações sobre Mortalidade no Rio Grande do Sul, 2000-2019 / Assessment of incompleteness of Mortality Information System records on deaths from external causes in the state of Rio Grande do Sul, Brazil, 2000-2019 / Evaluación de la incompletitud de los registros de defunción por causas externas del Sistema de Información de Mortalidad en Rio Grande do Sul, Brasil, 2000-2019

Objetivo: avaliar a incompletude dos dados do Sistema de Informações sobre Mortalidade (SIM) para óbitos por causas externas (CEs) no Rio Grande do Sul, Brasil, 2000-2019. Métodos: estudo ecológico, com dados do SIM para a totalidade das CEs e, especificamente, por acidentes de transporte, homicídios, suicídios e quedas; analisou-se a tendência da incompletude via regressão de Prais-Winsten, com nível de significância de 5%. Resultados: 146.882 óbitos foram avaliados; sexo (0,1%), local de ocorrência do óbito (0,1%) e idade (0,4%) mostraram as menores incompletudes, em 2019; a proporção de incompletude apresentou tendência decrescente para local de ocorrência do óbito e escolaridade, crescente para estado civil e estável para idade e raça/cor da pele, entre todos os tipos de óbito avaliados. Conclusão: as variáveis analisadas alcançaram alto grau de preenchimento; à exceção do estado civil e da escolaridade, para as quais persistiram escores insatisfatórios para óbitos por CEs, totais e por subgrupos.

Objective: to evaluate the incompleteness of Mortality Information System (Sistema de Informações sobre Mortalidade - SIM) data on deaths from external causes (ECs) in the state of Rio Grande do Sul, Brazil, 2000-2019. Methods: This was an ecological study, using SIM data on all deaths from external causes and, specifically, from transport accident, homicides, suicides and falls; the analysis of the trend of incompleteness was performed by means of Prais-Winsten regression, with a 5% significance level. Results: A total of 146,882 deaths were evaluated; sex (0.1%), place of death (0.1%) and age (0.4%) showed the lowest incompleteness in 2019; the proportion of incompleteness showed a decreasing trend for the place of death and schooling, an increasing trend for marital status and a stable trend for age and race/skin color, among all types of death evaluated. Conclusion: the variables analyzed reached a high degree of completion; with the exception of marital status and schooling, for which unsatisfactory scores persisted for deaths from ECs, both total and by subgroups.

Objetivo: evaluar la incompletitud de los datos del Sistema de Información de Mortalidad (SIM) para las defunciones por causas externas (CEs) en Rio Grande do Sul, Brasil, 2000-2019. Métodos: estudio ecológico con datos del SIM por causas externas, totales y por accidentes de tránsito, homicidios, suicidios y caídas; se utilizó la regresión de Prais-Winsten para evaluar la tendencia de incompletitud, con un nivel de significancia del 5%. Resultados: se evaluaron 146.882 muertes; sexo (0,1%), lugar de muerte (0,1%) y edad (0,4%) mostraron menos incompletitud en 2019; la tendencia de la proporción de incompletitud disminuyó para el lugar de ocurrencia y la educación, aumentó para el estado civil y se mantuvo estable para edad y raza/color del piel para todo tipo de muertes evaluadas. Conclusión: las variables analizadas lograron alta calidad de información, con excepción del estado civil y educación, que persistieron con incompletitud insatisfactoria para las muertes por CE (total y subgrupos).

Diminished insulin sensitivity is associated with altered brain activation to food cues and with risk for obesity - Implications for individuals born small for gestational age.

While classically linked to memory, the hippocampus is also a feeding behavior modulator due to its multiple interconnected pathways with other brain regions and expression of receptors for metabolic hormones. Here we tested whether variations in insulin sensitivity would be correlated with differential brain activation following exposure to palatable food cues, as well as with variations in implicit food memory in a cohort of healthy adolescents, some of whom were born small for gestational age (SGA). Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) was positively correlated with activation in the cuneus, and negatively correlated with activation in the middle frontal lobe, superior frontal gyrus and precuneus when presented with palatable food images versus non-food images in healthy adolescents. Additionally, HOMA-IR and insulinemia were higher in participants with impaired food memory. SGA individuals had higher snack caloric density and greater chance for impaired food memory. There was also an interaction between the HOMA-IR and birth weight ratio influencing external eating behavior. We suggest that diminished insulin sensitivity correlates with activation in visual attention areas and inactivation in inhibitory control areas in healthy adolescents. Insulin resistance also associated with less consistency in implicit memory for a consumed meal, which may suggest lower ability to establish a dietary pattern, and can contribute to obesity. Differences in feeding behavior in SGA individuals were associated with insulin sensitivity and hippocampal alterations, suggesting that cognition and hormonal regulation are important components involved in their food intake modifications throughout life.

Fatores de risco aos desfechos obstétricos e neonatais de mães adolescentes / Factores de riesgo para los resultados obstétricos y neonatales de las madres adolescentes / Risk factors for obstetric and neonatal outcomes of adolescent mothers

Objetivo: comparar os desfechos obstétricos e neonatais entre mães adolescentes e adultas. Método: estudo transversal desenvolvido com base nos dados do Sistema de Informações de Nascidos Vivos, comparando variáveis sociodemográficas, obstétricas e neonatais de mães adolescentes e adultas do Rio Grande do Sul, no período de 2010-2016. O teste Qui-quadrado avaliou associação estatística e foi estimada a razão de prevalência. Resultados: houve diferenças significativas entre mães de 10-14 anos e as dos demais estratos: prevalência de raça/cor preta ou parda (RP=1,53; IC95% 1,46-1,60), pré-natal inadequado (RP=1,89; IC95% 1,84-1,94), prematuridade (RP=1,35; IC95% 1,27-1,43), baixo peso ao nascer (RP=1,34; IC95% 1,25-1,43) e desempenho inferior no Apgar do 1º minuto (RP=5,68; IC95% 5,49-5,88). Conclusão: a prevalência de fatores de risco aos desfechos obstétricos e neonatais de adolescentes de 10-14 anos demanda avaliação criteriosa da saúde. A gravidez precoce na adolescência requer o acionamento de equipes interdisciplinares, redes familiares, socioassistenciais e de proteção sociojurídica.

Objective: to compare obstetric and neonatal outcomes among adolescent and adult mothers. Method: cross-sectional study based on data from the Sistema de Informações de Nascidos Vivos (Live Birth Information System) comparing socio-demographic, obstetric, and neonatal variables of adolescent and adult mothers from Rio Grande do Sul in the period 2010-2016. The Chi-square test evaluated statistical association and the prevalence ratio was estimated. Results: there were significant differences between mothers aged 10-14 and those from other strata: prevalence of black or brown-skinned race/color (PR=1.53; CI95% 1.46-1.60), inadequate prenatal care (PR=1.89; IC95% 1.84-1.94), prematurity (PR=1.35; CI95% 1.27-1.43), low birth weight (PR=1.34; IC95% 1.25-1.43) and lower performance in the 1st minute Apgar score (PR=5.68; IC95% 5.49-5.88). Conclusion: prevalence of risk factors for obstetric and neonatal outcomes of adolescents aged 10-14 requires careful health evaluation. Early pregnancy in adolescence requires the activation of interdisciplinary teams, and family, social assistance and socio-legal protection networks.

Objetivo: comparar los resultados obstétricos y neonatales entre las madres adolescentes y adultas. Método: estudio transversal basado en datos del Sistema de Información de Nacimientos Vivos comparando las variables sociodemográficas, obstétricas y neonatales de madres adolescentes y adultas de Rio Grande do Sul en el período 2010-2016. Se estimó la prueba de Chi-cuadrado la asociación estadística y la relación de prevalencia. Resultados: hubo diferencias significativas entre las madres de 10 a 14 años y las de los otros estratos: prevalencia de raza/color negro o marrón (RP-1,53; IC95% 1,46-1,60), atención prenatal inadecuada (RP-1,89; IC95% 1,84-1,94), prematuridad (RP-1.35; IC95% 1,27-1,43), bajo peso al nacer (RP-1,34; IC95% 1,25-1,43) y menor rendimiento en el primer minuto de Apgar (RP-5.68; IC95% 5,49-5,88). Conclusión: la prevalencia de factores de riesgo para los resultados obstétricos y neonatales de adolescentes de 10 a 14 años requiere una evaluación cuidadosa de la salud. El embarazo precoz en la adolescencia requiere la activación de equipos interdisciplinarios y redes de familiares, de asistencia social y de protección socio-jurídica.

[Quality of information systems on live births and mortality in Rio Grande do Sul, 2000 to 2014]. / Qualidade dos sistemas de informações sobre nascidos vivos e sobre mortalidade no Rio Grande do Sul, Brasil, 2000 a 2014.

This study assesses the quality of the SIM and SINASC information systems in coverage, incompleteness and consistency aspects, as well as the contribution of the linkage for data retrieval. It includes all live births and infant deaths in Rio Grande do Sul from 2000 to 2014. The records were paired by deterministic linkage through the DNV number and, in its absence, by probabilistic linkage. SINASC's coverage rose from 72.2% in 2000 to 98.9%, namely a 37% increase in the number of matched records. All variables in SINASC presented excellent incompleteness throughout the period, except for the number of dead children and maternal occupation. SIM presented poor or very poor incompleteness for most of the variables until 2003. Although it improved, in 2014, six variables still presented regular or poor incompleteness. The linkage procedure greatly reduced the incompleteness for most variables. There was a great variability in terms of consistency: while for gender this percentage was over 97% throughout the period, for another five variables it was still less than 75% in 2014. SINASC presented high coverage level and excellent incompleteness. Problems related to consistency persist. This study shows the linkage technic efficiency to retrieve missing information.

O estudo avalia a qualidade do SIM e do SINASC nos aspectos cobertura, incompletitude e consistência, bem como a contribuição do "linkage" para a recuperação de dados. Foram analisados nascimentos e óbitos de menores de um ano ocorridos no Rio Grande do Sul entre 2000 e 2014. Os registros foram pareados por "linkage" determinístico através do número da DNV e, na ausência deste, por "linkage" probabilístico. A cobertura do SINASC aumentou 37%, passando de 72,2% em 2000 para 98,9%. O grau de incompletitude do SINASC foi excelente para todas as variáveis, exceto quantidade de filhos mortos e ocupação materna. No SIM, até 2003 a maioria das variáveis apresentou preenchimento ruim ou muito ruim. Apesar da melhoria, seis delas ainda possuíam preenchimento regular ou ruim em 2014. Após o "linkage", a incompletitude reduziu-se para grande parte das variáveis. Houve alta variabilidade quanto à consistência: sexo apresentou percentual superior a 97% em todo período, enquanto para outras cinco variáveis essa fração segue inferior a 75% em 2014. Destaca-se a alta cobertura e a excelente incompletitude do SINASC. Persistem problemas relacionados à consistência de informações. Evidencia-se a relevância do "linkage" como método para recuperar informações.

Qualidade dos sistemas de informações sobre nascidos vivos e sobre mortalidade no Rio Grande do Sul, Brasil, 2000 a 2014 / Quality of information systems on live births and mortality in Rio Grande do Sul, 2000 to 2014

Resumo O estudo avalia a qualidade do SIM e do SINASC nos aspectos cobertura, incompletitude e consistência, bem como a contribuição do "linkage" para a recuperação de dados. Foram analisados nascimentos e óbitos de menores de um ano ocorridos no Rio Grande do Sul entre 2000 e 2014. Os registros foram pareados por "linkage" determinístico através do número da DNV e, na ausência deste, por "linkage" probabilístico. A cobertura do SINASC aumentou 37%, passando de 72,2% em 2000 para 98,9%. O grau de incompletitude do SINASC foi excelente para todas as variáveis, exceto quantidade de filhos mortos e ocupação materna. No SIM, até 2003 a maioria das variáveis apresentou preenchimento ruim ou muito ruim. Apesar da melhoria, seis delas ainda possuíam preenchimento regular ou ruim em 2014. Após o "linkage", a incompletitude reduziu-se para grande parte das variáveis. Houve alta variabilidade quanto à consistência: sexo apresentou percentual superior a 97% em todo período, enquanto para outras cinco variáveis essa fração segue inferior a 75% em 2014. Destaca-se a alta cobertura e a excelente incompletitude do SINASC. Persistem problemas relacionados à consistência de informações. Evidencia-se a relevância do "linkage" como método para recuperar informações.

Abstract This study assesses the quality of the SIM and SINASC information systems in coverage, incompleteness and consistency aspects, as well as the contribution of the linkage for data retrieval. It includes all live births and infant deaths in Rio Grande do Sul from 2000 to 2014. The records were paired by deterministic linkage through the DNV number and, in its absence, by probabilistic linkage. SINASC's coverage rose from 72.2% in 2000 to 98.9%, namely a 37% increase in the number of matched records. All variables in SINASC presented excellent incompleteness throughout the period, except for the number of dead children and maternal occupation. SIM presented poor or very poor incompleteness for most of the variables until 2003. Although it improved, in 2014, six variables still presented regular or poor incompleteness. The linkage procedure greatly reduced the incompleteness for most variables. There was a great variability in terms of consistency: while for gender this percentage was over 97% throughout the period, for another five variables it was still less than 75% in 2014. SINASC presented high coverage level and excellent incompleteness. Problems related to consistency persist. This study shows the linkage technic efficiency to retrieve missing information.

Decreased comfort food intake and allostatic load in adolescents carrying the A3669G variant of the glucocorticoid receptor gene.

BACKGROUND: The A3669G single nucleotide polymorphism (SNP) of the glucocorticoid receptor (GR) gene NR3C1 is associated with altered tissue sensitivity to glucocorticoids (GCs). GCs modulate the food reward circuitry and are implicated in increased intake of palatable foods, which can lead to the metabolic syndrome and obesity. We hypothesized that presence of the G variant of the A3669G SNP would affect preferences for palatable foods and alter metabolic, behavioural, and neural outcomes. METHODS: One hundred thirty-one adolescents were genotyped for the A3669G polymorphism, underwent anthropometric assessment and nutritional evaluations, and completed behavioural measures. A subsample of 74 subjects was followed for 5 years and performed a brain functional magnetic resonance imaging (fMRI) paradigm to verify brain activity in response to food cues. RESULTS: Sugar and total energy consumption were lower in A3669G G allele variant carriers. On follow-up, this group also had reduced serum insulin concentrations, increased insulin sensitivity, and lower anxiety scores. Because of our unbalanced sample sizes (31/37 participants non-G allele carriers/total), our imaging data analysis failed to find whole brain-corrected significant results in between-group t-tests. CONCLUSION: These results highlight that a genetic variation in the GR gene is associated, at the cellular level, with significant reduction in GC sensitivity, which, at cognitive and behavioural levels, translates to altered food intake and emotional stress response. This genetic variant might play a major role in decreasing risk for metabolic and psychiatric diseases.

Attention, memory, visuoconstructive, and executive task performance in adolescents with anxiety disorders: a case-control community study.

OBJECTIVE:: The aim of the present study was to assess children and adolescents with mild and severe anxiety disorders for their performance in attention, verbal episodic memory, working memory, visuoconstructive skills, executive functions, and cognitive global functioning and conduct comparative analyses with the performance of children free from anxiety disorders. METHODS:: Our sample comprised 68 children and adolescents aged 10 to 17 years (41 with current diagnoses of anxiety disorders and 27 controls) selected from a larger cross-sectional community sample of adolescents. Children and adolescents with anxiety disorders were categorized into two groups on the basis of anxiety severity (mild or severe). All participants underwent a neuropsychological assessment battery to evaluate attention, verbal episodic memory, working memory, visuoconstructive skills, and executive and cognitive functions. RESULTS:: No differences were found in any neuropsychological tests, with the single exception that the group with mild anxiety had better performance on the Digit Span backward test compared to subjects with severe anxiety and to controls (p = 0.041; η2 = 0.11). CONCLUSIONS:: Not only might anxiety disorders spare main cognitive functions during adolescence, they may even enhance certain working memory processes.

Attention, memory, visuoconstructive, and executive task performance in adolescents with anxiety disorders: a case-control community study / Desempenho em tarefas de atenção, memória, habilidades visuoconstrutivas e funções executivas em adolescentes com transtornos de ansiedade: um estudo comunitário caso-controle

Abstract Objective: The aim of the present study was to assess children and adolescents with mild and severe anxiety disorders for their performance in attention, verbal episodic memory, working memory, visuoconstructive skills, executive functions, and cognitive global functioning and conduct comparative analyses with the performance of children free from anxiety disorders. Methods: Our sample comprised 68 children and adolescents aged 10 to 17 years (41 with current diagnoses of anxiety disorders and 27 controls) selected from a larger cross-sectional community sample of adolescents. Children and adolescents with anxiety disorders were categorized into two groups on the basis of anxiety severity (mild or severe). All participants underwent a neuropsychological assessment battery to evaluate attention, verbal episodic memory, working memory, visuoconstructive skills, and executive and cognitive functions. Results: No differences were found in any neuropsychological tests, with the single exception that the group with mild anxiety had better performance on the Digit Span backward test compared to subjects with severe anxiety and to controls (p = 0.041; η2 = 0.11). Conclusions: Not only might anxiety disorders spare main cognitive functions during adolescence, they may even enhance certain working memory processes.

Resumo Objetivo: Este estudo objetivou avaliar crianças e adolescentes com transtornos de ansiedade leve e moderada nas funções neuropsicológicas de atenção, memória episódica verbal, memória de trabalho, habilidades visuoconstrutivas, funções executivas e cognição global, comparando o seu desempenho ao de crianças com desenvolvimento típico. Métodos: Participaram do estudo 68 crianças e adolescentes com idade de 10 a 17 anos (41 com diagnósticos clínicos atuais de transtornos de ansiedade e 27 controles), selecionados de uma amostra transversal mais ampla de adolescentes da comunidade. Os adolescentes com diagnóstico foram divididos ainda em dois grupos com base na gravidade dos transtornos (leve ou moderado). Todos os participantes realizaram uma avaliação neuropsicológica individual das funções de atenção, memória episódica verbal, memória de trabalho, habilidades visuoconstrutivas, funções executivas e cognição global. Resultados: Nenhum dos testes neuropsicológicas demonstrou diferenças significativas, sendo a única exceção a tarefa de span de dígitos ordem inversa, na qual o grupo com ansiedade leve apresentou desempenho superior ao do grupo com ansiedade moderada e também ao dos controles (p = 0.041; η2 = 0.11). Conclusão: Os resultados sugerem que não só os transtornos de ansiedade podem preservar as principais funções cognitivas durante a adolescência, mas que podem até melhorar certos processos de memória de trabalho.

Musical intervention and food preferences in girls born with lower birth weight.

BACKGROUND: Children born after intrauterine growth restriction (IUGR), especially girls, show an increased intake of palatable foods in several developmental stages, which likely contributes to their increased risk for obesity later. Recently, neuroimaging studies suggested that musical exposure activates the mesolimbic region, which is also involved in the processing of food rewards. AIMS: We evaluated the impact of musical intervention in mother/infant pairs on feeding behavior during childhood with regard to birth weight. STUDY DESIGN: Cohort study. SUBJECTS: A total of 28 children exposed to a structured musical intervention in early life were invited for an anthropometric and nutritional evaluation, and were compared to a communitarian age-matched sample. OUTCOME MEASURES: A series of general linear models adjusted for socioeconomic status and maternal education were constructed to evaluate the interaction between music exposure, birth weight, and sex on the consumption of different types of foods, measured using a food frequency questionnaire. RESULTS: There was an interaction between birth weight, sex, and musical intervention on the consumption of sugar during childhood (Wald=7.87, df=2, p=0.02); control participants consumed more sugar as birth weight decreased (B=-8.673, p<0.0001). No such effect was found for the girls exposed to musical intervention (B=3.352, p=0.15) or for boys (exposed B=2.870, p=0.44; non-exposed B=3.706, p=0.236). The absence of other effects suggests that this finding is specific for sweet foods. CONCLUSION: Early music intervention in mother/infant pairs may moderate the effects of IUGR on palatable food preference in girls.

Brazilian version of the Quality of Care Scale: the perspective of people with disabilities.

OBJECTIVE: To analyze evidence of the validity and reliability of a Brazilian Portuguese version of the Quality of Care Scale from the perspective of people with physical and intellectual disabilities. METHODS: There were 162 people with physical disabilities and 156 with intellectual disabilities from Porto Alegre and metropolitan region, who participated in the study in 2008. Classical psychometrics was used to independently analyze the two samples. Hypotheses for evidence of criterion validity (concurrent type) were tested with the Mann-Whitney test for non-normal distributions. Principal components analysis was used to explore factorial models. Evidence of reliability was calculated with Cronbach alpha for the scales and subscales. Test-retest reliability was analyzed for individuals with intellectual disabilities through intra-class correlation coefficient and the Willcoxon test. RESULTS: The principal components in the group with physical disabilities replicated the original model presented as a solution to the international project data. Evidence of discriminant validity and test-retest reliability was found. CONCLUSIONS: The transcultural factor model found within the international sample project seems appropriate for the samples investigated in this study, especially the physical disabilities group. Depression, pain, satisfaction with life and disability may play a mediating role in the evaluation of quality of care. Additional research is needed to add to evidence of the validity of the instruments.

Brazilian version of the Quality of Care Scale: the perspective of people with disabilities / Versão brasileira do Quality of Care Scale: qualidade de cuidado na perspectiva de pessoas com incapacidades

OBJECTIVE To analyze evidence of the validity and reliability of a Brazilian Portuguese version of the Quality of Care Scale from the perspective of people with physical and intellectual disabilities. METHODS There were 162 people with physical disabilities and 156 with intellectual disabilities from Porto Alegre and metropolitan region, who participated in the study in 2008. Classical psychometrics was used to independently analyze the two samples. Hypotheses for evidence of criterion validity (concurrent type) were tested with the Mann-Whitney test for non-normal distributions. Principal components analysis was used to explore factorial models. Evidence of reliability was calculated with Cronbach alpha for the scales and subscales. Test-retest reliability was analyzed for individuals with intellectual disabilities through intra-class correlation coefficient and the Willcoxon test. RESULTS The principal components in the group with physical disabilities replicated the original model presented as a solution to the international project data. Evidence of discriminant validity and test-retest reliability was found. CONCLUSIONS The transcultural factor model found within the international sample project seems appropriate for the samples investigated in this study, especially the physical disabilities group. Depression, pain, satisfaction with life and disability may play a mediating role in the evaluation of quality of care. Additional research is needed to add to evidence of the validity of the instruments. .

OBJETIVO Analisar as evidências de validade e fidedignidade da versão para o português brasileiro da Quality of Care Scale na perspectiva de pessoas com incapacidades físicas e intelectuais. MÉTODOS Participaram do estudo 162 pessoas com incapacidades físicas e 156 com incapacidades intelectuais em Porto Alegre e região metropolitana, 2008. A psicometria clássica foi utilizada para analisar as duas amostras independentemente. As hipóteses para evidências de validade de critério do tipo concorrente foram avaliadas com teste de Mann-Whitney. A análise de componentes principais foi utilizada para exploração dos modelos fatoriais. Evidências de fidedignidade foram calculadas com α de Cronbach para escalas e subescalas. A fidedignidade teste-reteste para pessoas com incapacidades intelectuais foi analisada pelo coeficiente de correlação intraclasse e teste de Willcoxon. RESULTADOS Os componentes principais no grupo de pessoas com incapacidades físicas replicou o modelo original apresentado em solução aos dados internacionais do projeto. Foram encontradas evidências de validade discriminante e de fidedignidade teste-reteste. CONCLUSÕES O modelo fatorial transcultural encontrado na amostra internacional do projeto parece adequado para as amostras testadas neste estudo, especialmente a de incapacidades físicas. Depressão, dor, satisfação com a vida e incapacidade parecem ter papel mediador na avaliação da qualidade de cuidado. Pesquisas adicionais são necessárias para o acréscimo de evidências às validades dos instrumentos. .

The World Health Organization Quality of Life instrument for people with intellectual and physical disabilities (WHOQOL-Dis): evidence of validity of the Brazilian version.

BACKGROUND: The number of people with disabilities in Brazil and worldwide has grown substantially in recent decades. Cross-cultural quality of life instruments can be helpful in the development of interventions designed to meet the needs of this population and contribute to rational allocation of resources. This study sought to provide evidence of validity and reliability the Brazilian Portuguese version of WHOQOL-Dis-D (a cross-cultural, multicentre instrument developed by the WHOQOL-Group for the assessment of quality of life in persons with physical disability - PD) and WHOQOL-Dis-ID (for persons with intellectual disability - ID). METHODS: Classical psychometric methods were used to conduct independent analyses of the PD and ID samples. Criterion groups were established for analysis of construct validity. Concurrent validity was assessed in relation to SWLS and BDI-II scores; discriminant validity, in relation to WHODAS-II. Cronbach alpha was used to test the instrument scales and subscales for reliability. The ID subgroup was retested, and test-retest reliability assessed by means of intraclass correlation coefficients and paired Student's t-test. RESULTS: A total of 162 (98 females) people with PD and 156 (55 females) people with ID participated in the study. Cronbach alpha was satisfactory across practically all domains and factors in the PD subsample. In IDs, most factors or domains had coefficients higher than 0.70, but four subscales exhibited less satisfactory performance. Evidence of construct and concurrent validity and reliability were obtained. CONCLUSIONS: The analyses presented herein provide satisfactory evidence of the validity and reliability of the instrument and corroborated the factor structure revealed during cross-cultural research. Further studies with larger sample sizes are required to obtain additional evidence of validity and reliability.

Transgenerational effects of maternal care interact with fetal growth and influence attention skills at 18 months of age.

BACKGROUND: Evidence suggests that there is an association between being born small for gestational age (SGA) and an increased risk of internalizing and externalizing problems, such as ADHD. Additionally, individuals who report having received a lower quality of maternal care show an increased prevalence of depression and anxiety, and they are generally worse caregivers of their offspring. Therefore, an interaction between the birth weight status and the quality of maternal care perceived by the mother could affect behavioral outcomes of the children. AIMS: Evaluate the influence of being born SGA and parental bonding, as perceived by the mother during her infancy, on the children's behavior at 18 months of age. STUDY DESIGN: Nested cross-sectional study within a Canadian prenatal cohort (MAVAN, Maternal Adversity, Vulnerability and Neurodevelopment) recruited from 2003 to 2010. SUBJECTS: Data from 305 children who were evaluated at 18 months of age. OUTCOME MEASURES: Early Childhood Behavior Questionnaire--ECBQ and Infant-Toddler Social and Emotional Assessment--ITSEA) were included. RESULTS: Children born SGA whose mothers reported low maternal care during her infancy (using the Parental Bonding Instrument--PBI) showed lower scores in the attentional set shifting trait (ECBQ, p=0.002) and attention construct (ITSEA, p=0.05) at 18 months of age. We also found that SGA increases decreases cuddliness (p=0.011) and poor perceived maternal care decreases low intensity pleasure (p=0.016) on the ECBQ. CONCLUSIONS: These findings suggest a complex transgenerational transmission whereby mother's own care interacts with the fetal growth of her offspring to predict its attentional skills at 18 months of age.

Intrauterine growth restriction and the fetal programming of the hedonic response to sweet taste in newborn infants.

Intrauterine growth restriction is associated with increased risk for adult metabolic syndrome and cardiovascular disease, which seems to be related to altered food preferences in these individuals later in life. In this study, we sought to understand whether intrauterine growth leads to fetal programming of the hedonic responses to sweet. Sixteen 1-day-old preterm infants received 24% sucrose solution or water and the taste reactivity was filmed and analyzed. Spearman correlation demonstrated a positive correlation between fetal growth and the hedonic response to the sweet solution in the first 15 seconds after the offer (r = 0.864, P = 0.001), without correlation when the solution given is water (r = 0.314, P = 0.455). In fact, the more intense the intrauterine growth restriction, the lower the frequency of the hedonic response observed. IUGR is strongly correlated with the hedonic response to a sweet solution in the first day of life in preterm infants. This is the first evidence in humans to demonstrate that the hedonic response to sweet taste is programmed very early during the fetal life by the degree of intrauterine growth. The altered hedonic response at birth and subsequent differential food preference may contribute to the increased risk of obesity and related disorders in adulthood in intrauterine growth-restricted individuals.

Características clínicas e demográficas de pacientes pediátricos com fibrose cística acompanhados no Hospital de Clínicas de Porto Alegre no ano de 2009 / Clinical and demography characteristics of cystic fibrosis patients attending at the Hospital de Clínicas de Porto Alegre during 2009

INTRODUÇÃO: O diagnóstico precoce, o acompanhamento e o tratamento dos fibrocísticos têm levado o crescente aumento da sobrevida. O objetivo deste estudo é descrever os pacientes pediátricos com FC em acompanhamento no HCPA em 2009. MÉTODOS: As variáveis analisadas foram: idade, gênero, idade ao diagnóstico, número de consultas e internações, resultado de cultura de escarro, swab ou aspirado de orofaringe, estado nutricional, comprometimento hepático, provas de função pulmonar, tratamento realizado e óbitos constatados. RESULTADOS: A idade média foi de 10,8 anos (DP=4,28). Cinquenta e cinco pacientes eram do gênero masculino (49,1%). A mediana de idade no diagnóstico foi de 0,48 anos. Cento e sete (54,2%) compareceram entre três a quatro consultas ambulatoriais (média 3,4 consultas/ano). Setenta e um pacientes não internaram (64%), 33 pacientes internaram uma vez (29,7%), cinco pacientes (4,55%) duas vezes e os demais internaram mais de três vezes ao ano. A prevalência de Staphylococcus aureus meticilino-sensível na via aérea foi 74,6%, Staphylococcus aureus meticilino-reistente 8,41%, Pseudomonas aeruginosa 42,99% e a de Complexo Burkholderia cepacia 24,29%. Oitenta e três pacientes (74,1 %) eram eutróficos. A solução salina hipertônica foi administrada em 79,43% dos pacientes, dornase alfa em 57%, colomicina em 42,99%, tobramicina em 30,84%, enzimas pancreáticas em 90,65%, azitromicina 33.6%, ácido ursodesoxicólico em 42,11% dos pacientes. A função pulmonar foi estudada em 78 pacientes, não havendo diferença significativa dos resultados entre os grupos etários avaliados nos anos de 2005 (p=0,670) e 2009 (p=0,482). Constatados dois óbitos durante 2009 por insuficiência respiratória. CONCLUSÃO: Nossos resultados são semelhantes aos demais centros de fibrose cística

INTRODUCTION: Early diagnosis, monitoring and treatment of cystic fibrosis has led to increasing survival. Aim: To describe pediatric patients with CF followed at the HCPA in 2009. METHODS: The variables analyzed were age, gender, age at diagnosis, number of visits and hospitalizations, results of sputum culture, throat swab or aspirate, nutritional status, liver condition, pulmonary function tests, treatment given, and recorded deaths. RESULTS: The mean age was 10.8 years (SD=4.28). Fifty-five patients were males (49.1%). The median age at diagnosis was 0.48 years. One hundred and seven (54.2%) paid three or four medical visits (mean 3.4 visits/year). Seventy-one patients were not hospitalized (64%), 33 patients were hospitalized once (29.7%), five patients (4.55%) twice, and the others were hospitalized more than three times a year. The prevalence of methicillin-sensitive Staphylococcus aureus in the airways was 74.6%, methicillinresistant Staphylococcus aureus, 8.41%, Pseudomonas aeruginosa, 42.99%, and Burkholderia cepacia complex, 24.29%. Eighty-three patients (74.1%) were eutrophic. Hypertonic saline solution was administered to 79.43% of patients; dornase alfa to 57%, colomicine, 42.99%; tobramycin, 30.84%; pancreatic enzymes, 90.65%; azithromycin 33.6%; and ursodeoxycholic acid to 42.11% of patients. Pulmonary function was studied in 78 patients, and there was no significant difference in results between age groups tested in 2005 (p=0.670) and 2009 (p=0.482). Two deaths were recorded in 2009 due to respiratory failure. CONCLUSION: Our results are similar to those of other cystic fibrosis centers

Preliminary evidence for an impulsivity-based thrifty eating phenotype.

INTRODUCTION: Low birth weight is associated with obesity and an increased risk for metabolic/cardiovascular diseases in later life. RESULTS: The results of the snack delay test, which encompassed four distinct trials, indicated that the gender × intrauterine growth restriction (IUGR) × trial interaction was a predictor of the ability to delay the food reward (P = 0.002). Among children with normal birth weights, girls showed a greater ability to delay food rewards than did boys (P = 0.014).In contrast, among children with IUGR, there was no such differential ability between girls and boys. Furthermore, in girls, impulsive responding predicted both increased consumption of palatable fat (P = 0.007) and higher BMIs (P = 0.020) at 48 mo of age, although there was no such association with BMI at 36 mo. DISCUSSION: In girls, the quality of fetal growth may contribute to impulsive eating, which may promote an increased intake of fats and consequently higher BMIs. As with the original thrifty phenotype, such a mechanism would be adaptive when food supplies are sparse, but would be problematic in societies with ample access to calorically rich foods. METHODS: We examined whether the quality of intrauterine growth programs obesogenic eating behaviors, by investigating (i) the relationship between birth weight and impulsive eating in 3-year-old children (using the snack delay test), and (ii) whether impulsive eating predicts fat intake and/or BMI at 4 years of age (using a laboratory-based test meal).

[Analysis of infant mortality trends and risk factors in Porto Alegre, Rio Grande do Sul State, Brazil, 1996-2008]. / Análise de tendências das taxas de mortalidade infantil e de seus fatores de risco na cidade de Porto Alegre, Rio Grande do Sul, Brasil, no período de 1996 a 2008.

The aim of this article was to determine trends in infant mortality and related risk factors in Porto Alegre, Rio Grande do Sul State, Brazil. The study was based on data from a live birth and infant death registry for the years 1996 to 2008. Times trends were analyzed for overall and partial infant mortality rates according to maternal schooling, number of prenatal visits, maternal age, number of live and dead children, sex of the newborn, type of delivery, birth weight, and type of hospital. Poisson regression was used to estimate the influence of socioeconomic status and other risk factors. The infant mortality rate dropped among mothers with less than 11 years of schooling. There were no significant changes among newborns of mothers with 12 or more years of schooling. Maternal socioeconomic status was the factor most closely associated with the reduction in infant mortality. Still, the downward trend failed to achieve its full potential, due to the increase in low birth weight.

Análise de tendências das taxas de mortalidade infantil e de seus fatores de risco na cidade de Porto Alegre, Rio Grande do Sul, Brasil, no período de 1996 a 2008 / Analysis of infant mortality trends and risk factors in Porto Alegre, Rio Grande do Sul State, Brazil, 1996-2008

Objetiva-se determinar as tendências de mortalidade infantil e de seus fatores de risco em Porto Alegre. Este é um estudo baseado nas informações do registro de nascidos vivos e de óbitos infantis no período de 1996-2008. Foi analisada a tendência temporal das taxas de mortalidade infantil (TMI) e de seus componentes, de acordo com a escolaridade materna, o número de consultas de pré-natal, idade materna, número de filhos vivos e mortos, sexo do recém-nascido, o tipo de parto, a idade gestacional, o peso de nascimento e o tipo de hospital. Foi utilizada a regressão sequencial de Poisson para estimar a influência da condição socioeconômica e os demais fatores de risco. A TMI decaiu entre os nascidos de mães com escolaridade inferior a 11 anos. Entre os nascidos de mães com 12 ou mais anos de escolaridade, não houve alterações significativas. A condição socioeconômica materna foi o fator que mais se associou à redução da mortalidade infantil. Contudo, a tendência de redução não atingiu todo o potencial devido ao aumento do baixo peso ao nascer.

The aim of this article was to determine trends in infant mortality and related risk factors in Porto Alegre, Rio Grande do Sul State, Brazil. The study was based on data from a live birth and infant death registry for the years 1996 to 2008. Times trends were analyzed for overall and partial infant mortality rates according to maternal schooling, number of prenatal visits, maternal age, number of live and dead children, sex of the newborn, type of delivery, birth weight, and type of hospital. Poisson regression was used to estimate the influence of socioeconomic status and other risk factors. The infant mortality rate dropped among mothers with less than 11 years of schooling. There were no significant changes among newborns of mothers with 12 or more years of schooling. Maternal socioeconomic status was the factor most closely associated with the reduction in infant mortality. Still, the downward trend failed to achieve its full potential, due to the increase in low birth weight.