Low Physical Performance Could Be Associated with Adverse Health Outcomes over Time: Results from a Cohort of Older Adults.

A few studies on physical performance (PP) decline among community-dwelling older adults have simultaneously evaluated various outcomes in Brazil. This longitudinal cohort study aimed to verify the association between PP and health outcomes (negative health self-perception-NHSP; consultations with health professionals; disability; falls; and hospitalization) in older Brazilians (N = 476, 68 ± 6.7 years). PP assessments included Gait Speed (GS) and Timed Up and Go (TUG) tests, and changes were evaluated over time (2014 to 2019-2020). The association between the PP and the outcomes was estimated using Poisson's regression with robust variance. The physical tests were not associated with NSPH or with the number of consultations with health professionals. However, after adjustment (economic level, diet quality, physical activity, multimorbidity, depression, polypharmacy, and BMI), low PP at baseline (TUG and GS) was associated with disability at follow-up. A low TUG performance at baseline was also associated with subsequent falls (PR = 1.57, p = 0.007). A decline in GS was associated with hospitalization (PR = 1.86, p = 0.033). PP was associated with disability, falls, and hospitalization over a five- to six-year period in older Brazilians. Regular PP assessments should be conducted and low PP should be used as an indicator of the need for preventative measures to avoid poor health outcomes.

The effects of a large-scale home visiting programme for child development on use of health services in Brazil.

Partnership between early childhood development interventions and primary health care services can help catalyse health care uptake by socially vulnerable families. This study aimed to assess the real-life effects of a large-scale home visiting programme [Primeira Infância Melhor (PIM)] in Brazil on the use of preventive (prenatal visits, well child visits, dentist visits and vaccination) and recovery (emergency room visits and hospitalization) health services. A quasi-experiment nested in a population-based birth cohort study was conducted. The intervention group was firstly defined as all children enrolled in PIM up to age 6 months, and afterwards stratified between those enrolled during pregnancy or after birth up to 6 months. Children receiving PIM were matched with controls on propensity scores based on 27 confounders to estimate effects on health service use from prenatal to age 2 years. Double adjustment was applied in outcome Quasi-Poisson regressions. No evidence was found for effects of PIM starting anytime up to 6 months (262 pairs), or for the children enrolled only after birth (133 pairs), on outcomes occurring after age 6 months. When the programme started during pregnancy (129 pairs), there was a 13% higher prevalence of adequate prenatal visits (prevalence ratio = 1.13; 95% confidence interval 1.01-1.27), but no effect on use of any other health service. Sensitivity analyses suggested longer participation in the programme with reduced visitor turnover might improve its impact on prenatal visits. Integration between PIM and primary health care was not adequate to affect overall patterns of contacts with health services. Nevertheless, prenatal home visits showed potential to increase health service contact during a sensitive period of development, indicating the need to start such programmes before birth, when there is more time for maternal care, and family engagement in a network of services is facilitated.

Why are pregnant women physically inactive? A qualitative study on the beliefs and perceptions about physical activity during pregnancy.

This study aimed to describe the beliefs and perceptions of pregnant women and healthcare providers about physical activity during pregnancy. Using a qualitative approach, 30 pregnant women and the 14 healthcare providers caring for them were interviewed in the second trimester of pregnancy. We included women who maintained, decreased, or stopped physical activity since becoming pregnant. They were divided into low (≤ 8 years) and high schooling (> 8 years). Semi-structured, in-depth interviews were conducted and guided by three key questions: (1) When does physical activity during pregnancy start to be considered a wrong behavior?; (2) What are the main barriers (biological or others) to physical activity?; and (3) Do the actions of healthcare providers and people close to pregnant women reinforce barriers? Interviews were audio recorded, transcribed, and analyzed based on recurring themes. All women changed their physical activity behavior (decreased or stopped) when they discovered their pregnancy. Fear of miscarriage, contractions, bleeding, and of causing malformations in the baby were the most reported reasons for decreasing or stopping physical activity. Participants also lacked access to consistent information and healthcare providers' support on the benefits of physical activity. Despite the current international recommendations to regular physical activity during pregnancy, uncertainty regarding its benefits remains. Interventions to promote physical activity during this period should include the training of healthcare providers so they can advise and discard ideas contrary to mother-child health benefits.

Breastfeeding, consumption of ultraprocessed foods, and dental caries at 4 years of age: A birth cohort study.

BACKGROUND: Cohort studies have demonstrated an association between prolonged and/or frequent breastfeeding and early childhood caries (ECC). AIM: To investigate the association between prolonged breastfeeding and ECC at 48 months, while considering the interaction between prolonged breastfeeding and ultraprocessed foods (UPF). DESIGN: Data from a birth cohort study conducted in southern Brazil were used (n = 3645). Poisson regression was used to evaluate the influence of breastfeeding and UPF consumption on the prevalence and experience of caries. To measure the interaction on the additive scale between breastfeeding and UPF consumption on the prevalence and experience of ECC, the relative excess risk due to interaction (RERI) was calculated. RESULTS: Prolonged breastfeeding was associated with higher prevalence (PR = 1.82; CI:1.59-2.08) and experience (RR = 2.47; CI:1.97-3.10) of ECC. Greater prevalence (PR = 1.16; CI: 1.04-1.30) and experience of ECC (RR = 1.22; CI: 1.00-1.48) were found in children who had high consumption of UPFs. Negative RERIs were observed for the prevalence and experience of ECC (-0.25 and -0.001). CONCLUSION: High UPF consumption and prolonged breastfeeding were associated with ECC. No interaction, however, was observed, showing that the two exposures have independent effects. To prevent ECC, policies and programs are needed to support breastfeeding until the age of 2 years and to limit the consumption of UPF.

Cross-sectional and prospective associations between screen time and childhood neurodevelopment in two Brazilian cohorts born 11 years apart.

BACKGROUND: The aim of this study was to investigate the associations between screen time from ages 2 to 4 years and child neurodevelopment at age 4. METHODS: The participants were from the 2004 (N = 3787) and 2015 (N = 3604) Pelotas (Brazil) birth cohort studies. Childhood neurodevelopment was assessed at age 4 using the Battelle Development Inventory. The time children spent on screen devices was reported by their guardians at ages 2 and 4 years. Linear regression models were used to investigate the association of: (i) time spent on television at ages 2 and 4 years; (ii) time spent on other screens at age 4; and (iii) total screen time at age 4 (television + other screens) with childhood neurodevelopment at age 4. RESULTS: Average daily screen time among children born in 2004 and those born in 2005 aged 4 years were 3.4 (SD: 2.4) and 4.4 h (SD: 2.9), respectively. Overall, few associations of very small magnitude between screen time and child neurodevelopment were observed. Television time at 2 years of age was statistically associated with lower neurodevelopment at 4 years of age in the 2015 cohort (ß = -0.30, 95%CI = -0.55; -0.05). Conversely, television time (ß = 0.17, 95%CI = 0.07, 0.26) and total screen time (ß = 0.22, 95%CI = 0.13, 0.31) at age 4 were associated with higher neurodevelopment at age 4 in the 2004 cohort. CONCLUSIONS: The findings of this study suggest that the amount of time spent on screen devices might not be associated with neurodevelopment of children under 5 years of age. The small magnitude and inconsistencies in the direction of associations did not find evidence to support the current guidelines for screen time at this age. Therefore, more studies, especially those with longitudinal data, are important to comprehend the true effect of screen time on neurodevelopment and other health outcomes.

Prepregnancy maternal BMI and trajectories of BMI-for-age in children up to four years of age: findings from the 2015 Pelotas (Brazil) birth cohort.

BACKGROUND: The aims of the study were to: (a) describe BMI-for-age trajectories in children up to four years of age; (b) evaluate the association between prepregnancy maternal BMI and the BMI-for-age trajectories. METHODS: Data from 3218 (75.3% of the original cohort) children from the Pelotas 2015 Birth Cohort were analyzed. Prepregnancy BMI (kg/m2) was measured on the perinatal interview. Z-scores of BMI-for-age were calculated for children at three months, 1, 2 and 4 years. Trajectories were identified using a semi-parametric group-based modeling approach. Multinomial logistic regression was used to test the association between prepregnancy BMI (weight excess: BMI ≥ 25 kg/m2) and BMI-for-age trajectories. RESULTS: Four trajectories of the BMI-for-age, in z-score, were identified and represent children in the "increasing", "adequate", "stabilized" and "risk for weight excess" group. A total of 196 children (7.1%) belonged to the group that was at risk of weight excess. Adjusted analyses showed that children whose mothers presented prepregnancy weight excess had 2.36 (95%CI 1.71; 3.24) times more risk of belonging to group "risk for weight excess" when compared to those children whose mothers presented underweight/normal weight before pregnancy. CONCLUSION: The risk of weight excess in children up to 4 years of age were greater in mothers who presented prepregnancy weight excess.

Why are pregnant women physically inactive? A qualitative study on the beliefs and perceptions about physical activity during pregnancy / Por que as gestantes não são fisicamente ativas? Um estudo qualitativo sobre as crenças e percepções em relação à atividade física durante a gestação / ¿Por qué las mujeres embarazadas no hacen actividad física? Un estudio cualitativo sobre las creencias y percepciones relacionadas con la actividad física durante el embarazo

This study aimed to describe the beliefs and perceptions of pregnant women and healthcare providers about physical activity during pregnancy. Using a qualitative approach, 30 pregnant women and the 14 healthcare providers caring for them were interviewed in the second trimester of pregnancy. We included women who maintained, decreased, or stopped physical activity since becoming pregnant. They were divided into low (≤ 8 years) and high schooling (> 8 years). Semi-structured, in-depth interviews were conducted and guided by three key questions: (1) When does physical activity during pregnancy start to be considered a wrong behavior?; (2) What are the main barriers (biological or others) to physical activity?; and (3) Do the actions of healthcare providers and people close to pregnant women reinforce barriers? Interviews were audio recorded, transcribed, and analyzed based on recurring themes. All women changed their physical activity behavior (decreased or stopped) when they discovered their pregnancy. Fear of miscarriage, contractions, bleeding, and of causing malformations in the baby were the most reported reasons for decreasing or stopping physical activity. Participants also lacked access to consistent information and healthcare providers' support on the benefits of physical activity. Despite the current international recommendations to regular physical activity during pregnancy, uncertainty regarding its benefits remains. Interventions to promote physical activity during this period should include the training of healthcare providers so they can advise and discard ideas contrary to mother-child health benefits.

Este estudo objetivou descrever as crenças e percepções de gestantes e profissionais de saúde em relação a prática de atividade física durante a gestação. Usando uma abordagem qualitativa, 30 gestantes e 14 profissionais de saúde que atendiam essas mulheres foram entrevistados durante o segundo trimestre de gravidez. Foram incluídas mulheres que mantiveram, diminuíram ou pararam de praticar atividade física desde o início gravidez. Elas foram divididas em baixa (≤ 8 anos) e alta escolaridade (> 8 anos). Foram conduzidas entrevistas semiestruturadas e aprofundadas, orientadas por três perguntas-chave: (1) Quando a atividade física durante a gestação passa a ser considerada um comportamento errado? (2) Quais as principais barreiras (biológicas ou outras) para a prática de atividade física? (3) Estas barreiras são reforçadas pelas ações dos profissionais de saúde e das pessoas próximas à gestante? As entrevistas foram gravadas em áudio, transcritas e analisadas a partir de temas recorrentes. Todas as mulheres mudaram a prática de atividade física (diminuíram ou pararam) quando souberam da gravidez. O medo de aborto espontâneo, contrações e/ou sangramento e o medo de causar malformações no bebê foram os motivos mais relatados para diminuir ou parar a atividade física. Os participantes também não tiveram acesso a informações confiáveis e apoio dos profissionais de saúde sobre os benefícios da atividade física. Apesar das recomendações internacionais atuais para a prática regular de atividade física durante a gestação, a incerteza quanto aos seus benefícios continua sendo comum. As intervenções para promover a atividade física durante esse período devem incluir o treinamento de profissionais de saúde para que eles possam aconselhar e descartar ideias contrárias aos benefícios para a saúde materna e infantil.

El objetivo de este estudio fue describir las creencias y percepciones de mujeres embarazadas y profesionales de la salud con respecto a la práctica de actividad física durante el embarazo. Utilizando un enfoque cualitativo, se entrevistaron 30 mujeres embarazadas y 14 profesionales de salud que cuidaban a estas mujeres durante el segundo trimestre del embarazo. Se incluyeron mujeres que mantuvieron, redujeron o dejaron de practicar actividad física desde el inicio del embarazo. Ellas se dividieron en baja (≤ 8 años) y alta escolaridad (> 8 años). Se realizaron entrevistas semiestructuradas y en profundidad, guiadas por tres preguntas clave: (1) ¿Cuándo se considera que la actividad física durante el embarazo es un comportamiento incorrecto? (2) ¿Cuáles son las barreras (biológicas u otras) principales para la práctica de actividad física? (3) ¿Estas barreras se refuerzan por las acciones de los profesionales de salud y de las personas cercanas a la mujer embarazada? Las entrevistas fueron grabadas en audio, transcritas y analizadas a partir de temas recurrentes. Todas las mujeres cambiaron la práctica de actividad física (redujeron o dejaron de practicarla) cuando descubrieron el embarazo. El miedo a sufrir un aborto espontáneo, contracciones y/o sangrado y el miedo a provocar malformaciones en el bebé fueron los motivos más relatados para reducir o dejar de practicar la actividad física. Los participantes también no han tenido acceso a informaciones confiables ni apoyo de los profesionales de salud sobre los beneficios de la actividad física. A pesar de las recomendaciones internacionales actuales para la práctica regular de actividad física durante el embarazo, la incertidumbre cuanto a sus beneficios sigue siendo común. Las intervenciones para promover la actividad física durante este periodo deben incluir la capacitación de profesionales de salud para que puedan aconsejar y descartar ideas contrarias a los beneficios para la salud materna e infantil.

Availability of emergency contraception in large Brazilian municipalities: a guaranteed right?

Introduction: Emergency Contraception (EC) is available in Brazil since 1996, when it was adopted as one if the family planning strategies and, in 1998, for use in services assisting victims of sexual violence. In the country, its use is regulated by guidelines. Its access through SUS (Unified Health System), however, does not seem to occur in a standardized manner. Methods: The aim of the study was to analyze the availability and barriers to accessing emergency contraception (levonorgestrel) in Brazilian municipalities with more than 500 thousand inhabitants. The survey was carried out by a form sent to the Municipal Health Departments (SMS) managers and a search on the list of standardized medicines by the hospitals in the same municipalities. Results: The Basic Health Units were identified as the standard access places to EC. However, one of the obstacles mentioned is the need for a prescription for dispensing in almost 80% of the analyzed cities. Access in emergency situations at night and on weekends is also uncertain, since although 67% of the places stated that they dispense at the hospital level, the item was only standardized in 21% of the hospital lists. Discussion: The difficult access this drug in the public system essentially tends to harm the poorest women, who are the ones who suffer most from the consequences of an unwanted pregnancy.

Folic acid supplementation during pregnancy and postpartum depressive symptoms.

OBJECTIVE: To verify whether folic acid supplementation during pregnancy is associated with the occurrence of maternal depressive symptoms at three months postpartum, in the 2015 Pelotas Birth Cohort. METHODS: This study included 4,046 women, who were classified into three groups: did not use folic acid supplementation during pregnancy; used during only one trimester of pregnancy; and used for two or three trimesters. Depressive symptoms were assessed at three months postpartum using the Edinburgh Postnatal Depression Scale (EPDS), at cutoff points ≥ 10 (mild symptoms) and ≥ 13 (moderate to severe intensity). RESULTS: The overall prevalence of mild symptoms was of 20.2% (95%CI 19.0-21.5), and moderate and severe was 11% (95%CI 10.0-12.0). The prevalence of EPDS ≥ 10 was of 26.8% (95%CI 24.0-29.5) among women who did not use folic acid and 18.1% for both those who used it during one trimester of pregnancy (95%CI 16.1-20.1) and those who used it for two or three trimesters (95%CI 16.0-20.2). The prevalence of EPDS ≥ 13 was of 15.7% (95%CI 13.5-17.9) in those who did not use folic acid, 9.1% (95%CI 7.5-10.6) in those who used it for one trimester, and 9.4% (95%CI 7.8-11.0) in those who used it for two or three trimesters. In the adjusted analyses, there was no statistically significant association between the use of folic acid during pregnancy and the occurrence of depressive symptoms at three months postpartum. CONCLUSION: There was no association between folic acid supplementation during pregnancy and postpartum depression at three months.

Iron salt supplementation during gestation and gestational diabetes mellitus.

OBJETIVE: To evaluate the association between the use of iron salts during the first two trimesters of gestation in non-anemic women and the development of gestational diabetes mellitus. METHODS: The study used maternal data from the 2015 Pelotas Birth Cohort. All non-anemic women at the 24th week of gestation (n = 2,463) were eligible for this study. Gestational diabetes mellitus was self-reported by women. Crude and adjusted logistic regression were performed considering level of significance = 0.05. RESULTS: Among the women studied, 69.7% were exposed to prophylactic iron supplementation in the first two trimesters of gestation. The prevalence of gestational diabetes mellitus among those exposed was 8.7% (95%CI: 7.4­10.1) and 9.3% (95%CI: 7.4­11.6) among those who were not exposed. Iron supplementation was not associated with increased risk of gestational diabetes mellitus in crude (OR = 0.9; 95%CI: 0,7­1,3) and adjusted analysis (OR = 1.1; 95%CI :0,8­1,6). CONCLUSIONS: The results suggest that routine iron use in non-anemic pregnant women does not increase the risk of developing gestational diabetes. This evidence supports the existing national and international guidelines, in which prophylactic iron supplementation is recommended for all pregnant women as soon as they initiate antenatal care in order to prevent iron deficiency anemia.

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.

Bi-directional associations between physical activity and growth indicators of pre-school aged children.

Physical activity for young children provides a wealth of benefits for health and development. However, little is known about the inter-relationship of physical activity and growth indicators. The aim of this study was to test the bi-directional associations of physical activity and growth indicators in children under five years of age. This prospective study included 1,575 children with data on physical activity and growth indicators at ages 12, 24 and 48 months. Accelerometers were used to measure physical activity. Z-scores for length/height-for-age, weight-for-length/height, weight-for-age and body mass index (BMI)-for-age were calculated. Bi-directional associations between physical activity and growth indicators were evaluated using cross-lagged panels based on Generalized Estimating Equations and cross-lagged structural equation models. Physical activity was consistently associated with lower weight-related growth indicators: BMI-for-age: ß=-0.12; Weight-for-age: ß=-0.11; Weight-for-length/height: ß=-0.12. Higher BMI-for-age indicated lower physical activity (ß=-0.06). When the exposure was lagged, the association of physical activity on weight-related growth indicators remained, but weight-related growth indicators showed a negative association on physical activity. A bi-directional association between physical activity and weight-related growth indicators was observed. The magnitude of associations were stronger when physical activity was modelled as exposure. These results reinforce the importance of physical activity since early years.

[Prevalence of water intake among non-institutionalized elderly individuals in Southern Brazil]. / Prevalência de ingestão hídrica e fatores associados entre idosos não institucionalizados do Sul do Brasil.

The scope of this study was to determine the percentage of elderly individuals receiving an adequate water intake and associated factors among non-institutionalized elderly individuals in the urban area of Pelotas, Rio Grande do Sul. It involved a cross-sectional, population-based study carried out in 2014 with elderly participants (≥ 60 years) of the "COMO VAI?" survey. The amount of water ingested per day of the interviewees was investigated, considering the intake of at least eight glasses per day to be adequate. The independent variables were sociodemographic, behavioral, and health characteristics, and Poisson Regression was used to investigate associations. A total of 1,451 elderly people were interviewed, with only 12.6% (95%CI 10.8; 14.7) drinking a sufficient amount. A higher percentage of the elderly with adequate water consumption was observed in younger elderly individuals, those overweight, those with five or more diseases, and those who were more impaired. A low percentage of the elderly with an adequate water intake was observed among the elderly adults in the study. The decreasing trend of water intake in relation to age highlights the importance of developing actions for the higher risk population to stress adequate water intake and the possible consequences of the lack of adequate consumption.

O objetivo deste estudo foi descrever a prevalência de idosos com uma ingestão adequada de água e seus fatores associados. Estudo transversal de base populacional realizado em 2014 com idosos (≥ 60 anos) participantes do estudo "COMO VAI?". Investigou-se o número de copos de água ingeridos/dia pelos entrevistados, considerando-se adequada a ingestão de pelo menos oito copos/dia. As variáveis independentes foram características sociodemográficas, comportamentais e de saúde. A regressão de Poisson foi utilizada para a investigação das associações. Foram entrevistados 1.451 idosos, sendo observado que uma baixa percentagem, 12,6% (IC95% 10,8; 14,7) referiu consumo adequado de água. Maior percentagem de consumo adequado de água foi observada nos idosos mais jovens, com excesso de peso, que apresentaram cinco ou mais doenças e que eram mais dependentes quanto à capacidade funcional. A tendência decrescente de ingestão de água em relação à idade torna essencial o desenvolvimento de ações voltadas para essa população de maior risco acerca da importância de uma ingestão hídrica adequada e das possíveis consequências do seu consumo inadequado.

Prevalência de ingestão hídrica e fatores associados entre idosos não institucionalizados do Sul do Brasil / Prevalence of water intake among non-institutionalized elderly individuals in Southern Brazil

Resumo O objetivo deste estudo foi descrever a prevalência de idosos com uma ingestão adequada de água e seus fatores associados. Estudo transversal de base populacional realizado em 2014 com idosos (≥ 60 anos) participantes do estudo "COMO VAI?". Investigou-se o número de copos de água ingeridos/dia pelos entrevistados, considerando-se adequada a ingestão de pelo menos oito copos/dia. As variáveis independentes foram características sociodemográficas, comportamentais e de saúde. A regressão de Poisson foi utilizada para a investigação das associações. Foram entrevistados 1.451 idosos, sendo observado que uma baixa percentagem, 12,6% (IC95% 10,8; 14,7) referiu consumo adequado de água. Maior percentagem de consumo adequado de água foi observada nos idosos mais jovens, com excesso de peso, que apresentaram cinco ou mais doenças e que eram mais dependentes quanto à capacidade funcional. A tendência decrescente de ingestão de água em relação à idade torna essencial o desenvolvimento de ações voltadas para essa população de maior risco acerca da importância de uma ingestão hídrica adequada e das possíveis consequências do seu consumo inadequado.

Abstract The scope of this study was to determine the percentage of elderly individuals receiving an adequate water intake and associated factors among non-institutionalized elderly individuals in the urban area of Pelotas, Rio Grande do Sul. It involved a cross-sectional, population-based study carried out in 2014 with elderly participants (≥ 60 years) of the "COMO VAI?" survey. The amount of water ingested per day of the interviewees was investigated, considering the intake of at least eight glasses per day to be adequate. The independent variables were sociodemographic, behavioral, and health characteristics, and Poisson Regression was used to investigate associations. A total of 1,451 elderly people were interviewed, with only 12.6% (95%CI 10.8; 14.7) drinking a sufficient amount. A higher percentage of the elderly with adequate water consumption was observed in younger elderly individuals, those overweight, those with five or more diseases, and those who were more impaired. A low percentage of the elderly with an adequate water intake was observed among the elderly adults in the study. The decreasing trend of water intake in relation to age highlights the importance of developing actions for the higher risk population to stress adequate water intake and the possible consequences of the lack of adequate consumption.

Functional dentition and edentulism associated with mortality: A cohort study of older adults in Southern Brazil.

OBJECTIVE: The aim of this study was to evaluate the association between the lack of a functional dentition and edentulism with mortality in a cohort of older adults in a Southern Brazilian city. MATERIALS AND METHODS: This is a longitudinal study carried out with community-dwelling older adults (≥60 years old) from Pelotas, Brazil, using data from the baseline (2014) and the first follow-up (2017). Main exposures were functional dentition (20+ teeth present) and edentulism (absence of all teeth), derived from self-reported number of teeth. All-causes mortality was evaluated according to the city's Epidemiological Surveillance Department. Potential confounders were age, sex, socioeconomic position, smoking, diabetes, hypertension, and body mass index (BMI). To test the association between functional dentition and edentulism with mortality, Poisson regression models with robust variance were used, to estimate Relative Risks and 95% confidence intervals. RESULTS: A total of 1289 older adults had information on all variables of interest and comprise the analytical sample (from 1451 at baseline). When analysing the presence of functional dentition, only 222 individuals (17.2%) had 20 or more teeth in their mouth, while 490 older adults were edentulous (38.0%). Crude analysis showed an association between tooth loss indicators and mortality. Models adjusted for sociodemographic variables and health conditions and behaviours revelled no association between the exposures and mortality. CONCLUSIONS: With the findings of this study, we did not identify an association between edentulism and functional dentition with mortality, after considering important shared risk factors.

Difficulties in the use of medications by elderly people followed up in a cohort study in Southern Brazil. / Dificuldades no uso de medicamentos por idosos acompanhados em uma coorte do Sul do Brasil.

OBJECTIVE: This study aimed to assess the need for help by elderly people to take their medications, the difficulties related to this activity, the frequency of forgotten doses, and factors associated. METHODS: Cross-sectional study conducted with a cohort of elderly people (60 years and over - "COMO VAI?" [How do you do?] study), where the need for help to properly take medication and the difficulties faced in using them were evaluated. The Poisson regression model was used to estimate the crude and adjusted prevalence ratios (PR) of the outcomes and respective 95% confidence intervals according to the characteristics of the sample. RESULTS: In total, 1,161 elderly people were followed up. The prevalence of participants who reported requiring help with medication was 15.5% (95%CI 13.5-17.8), and the oldest subjects, with lower educational levels, in worse economic situations, on four or more medications and in bad self-rated health were the ones who needed help the most. Continuous use of medication was reported by 83.0% (95%CI 80.7-85.1) of the sample and most participants (74.9%; 95%CI 72.0-77.5) never forgot to take their medications. CONCLUSION: The need for help to use medications was shown to be influenced by social and economic determinants. Studies assessing the difficulties in medication use by the elderly are important to support policies and practices to improve adherence to treatment and the rational use of medications.

OBJETIVO: Este estudo visou avaliar a necessidade de ajuda dos idosos para tomar seus medicamentos, bem como as dificuldades relacionadas com a sua utilização, e a frequência de esquecimento de doses. Ainda, avaliar fatores associados à necessidade de ajuda dos idosos com os medicamentos. MÉTODOS: Corte transversal em uma coorte de idosos (60 anos ou mais ­ estudo "COMO VAI?"), em que foi avaliada a necessidade de ajuda para tomar medicamentos de forma adequada e as dificuldades apresentadas na sua utilização. Utilizou-se regressão de Poisson para estimar as razões de prevalência (RP) brutas e ajustadas dos desfechos e seus intervalos de confiança de 95% (IC95%) de acordo com as características da amostra. RESULTADOS: Participaram 1.161 idosos. A prevalência de idosos que relataram necessidade de ajuda com os medicamentos foi de 15,5% (IC95% 13,5­17,8), sendo que os mais idosos, com menor escolaridade e em pior situação econômica, em uso de quatro medicamentos ou mais e com pior autoavaliação de saúde foram os que mais necessitaram de ajuda. O uso contínuo de medicamentos foi referido por 83,0% (IC95% 80,7­85,1) e a maioria (74,9%; IC95% 72,0­77,5) nunca se esqueceu de tomar seus medicamentos. CONCLUSÃO: Observou-se a influência de determinantes sociais e econômicos e de saúde sobre a necessidade de ajuda para a utilização dos medicamentos. Estudos que estimem as dificuldades no uso de medicamentos por idosos são importantes para subsidiar políticas e práticas norteadoras de ações para melhorar a adesão e o uso racional de medicamentos.

Early Sugar Introduction Associated with Early Childhood Caries Occurrence.

Consensus has yet to be reached on the impact of early sugar introduction on early childhood dental caries (ECC). This study aimed to evaluate the association between the time of introduction of sugar in the infant's diet and ECC at 48 months, using data from the 2015 Pelotas Birth Cohort Study. This cohort comprises 4,275 children. At 48 months, 3,654 (91.1%) children had their oral health clinically evaluated by a team of 12 trained and calibrated dentists and their dental caries experience and cavitated lesions were assessed. The period of life in which sugar was first introduced into the child's diet was considered the primary exposure of the study, collected through questionnaires at 3, 12, 24, and 48 months of age. Analyses were conducted using Stata, version 15.0. Descriptive analyses were initially performed. Poisson regression with robust variance adjustment for the crude and adjusted analysis was used to estimate the effect of the sugar introduction on ECC. The highest prevalence of caries experience (43.3%) was in children in which sugar was introduced into the infant's diet before 12 months of age. A higher prevalence of caries experience was found for less educated (49.8%) and younger (51.7%) mothers, and in poorer families (48.3%). In the adjusted analysis, the experience of caries was 48% greater in the group with sugar introduction before 12 months of age, compared to those where sugar was introduced after 24 months of age In conclusion, our results support the adoption of preventive measures to delay the supply of sugar in early life in order to reduce the caries experience in children.

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.

Desempenho das Unidades Básicas de Saúde e uso do Programa Farmácia Popular / Performance of Basic Health Unitsand use ofthe Popular PharmacyProgram

Resumo Introdução O Brasil conta com dois programas de financiamento governamental para a provisão de medicamentos, o Programa Farmácia Popular do Brasil (PFPB) e a provisão em Unidades do Sistema Único de Saúde, ambos possuindo itens em comum. Objetivo Explorar a relação entre o uso do PFPB por hipertensos e diabéticos com fatores relacionados ao atendimento nas Unidades Básicas de Saúde, à estrutura da farmácia destas Unidades e à disponibilidade dos anti-hipertensivos e antidiabéticos comuns ao PFPB e ao SUS em municípios brasileiros de médio e grande porte populacional. Método Delineamento ecológico transversal utilizando dados secundários do PFPB e do Programa Nacional de Melhoria do Acesso e Qualidade na Atenção Básica (PMAQ-AB), com dados referentes ao ano de 2012. Resultados Municípios de médio porte apresentaram uma proporção de Unidades de Saúde com disponibilidade de anti-hipertensivos e antidiabéticos superior aos de grande porte. A maioria dos respondentes do PMAQ-AB relataram disponibilidade dos anti-hipertensivos e antidiabéticos nos serviços públicos. A análise multivariada mostrou que o uso da Farmácia Popular pela população está mais relacionado às situações emergenciais e ocasionais. Conclusão Na ausência do SUS, o PFPB supre a necessidade da população para obter medicamentos, evidenciando o seu importante papel para a continuidade do tratamento de muitos indivíduos com hipertensão e diabetes.

Abstract Background Brazil has two government-funded drug supply programs, the Popular Pharmacy Program of Brazil (PFPB), and the provision in Unified Health System (SUS) units, which have items in common. Objective To explore the relationship between the use of PFPB by hypertensive and diabetic patients and factors related to care in basic health units, the pharmacy structure of units, and the availability of antihypertensive and antidiabetic agents common to PFPB and SUS in Brazilian municipalities of medium and large population sizes. Method A cross-sectional ecological study was carried out using secondary data from PFPB and the National Program for Improving Access and Quality in Primary Care (PMAQ-AB) for 2012. Results Municipalities of medium population showed a greater proportion of health units with antihypertensive and antidiabetic availability than those of large size. Most respondents at PMAQ-AB affirmed that hypertension and diabetes medications are available in public health services. The multivariate analysis showed that the use of Popular Pharmacy by the population is more related to emergency and occasional situations. Conclusion PFPB supplies the need for the population to obtain medications in the absence of SUS, evidencing an important role in the continuity of drug treatment for many individuals suffering from hypertension and diabetes.