Potential Determinants of Thyroid Peroxidase Antibodies and Mortality Risk: Results From the ELSA-Brasil Study.

CONTEXT: The presence of thyroid peroxidase antibodies (TPOAbs) may be considered as an indicator of adverse health outcomes. OBJECTIVE: We aimed to investigate the potential determinants of TPOAb levels and to analyze the association between TPOAb titers and the risk of all- and specific-cause mortality. METHODS: Baseline and longitudinal data of 13 187 participants from the ELSA-Brasil Study were analyzed. We investigated the association of TPOAb, detectability, positivity, and persistent positivity with sociodemographic and lifestyle factors using logistic regressions. Cox proportional hazards and Fine-Gray subdistribution hazard regression analyses were used to verify the association of TPOAbs with mortality. RESULTS: The determinants of TPOAb detectability and positivity were younger age, higher body mass index, female sex, and former and current smoking status. Black, mixed, and other self-reported races, intermediate and higher education, and heavy drinking were determinants of detectable and positive TPOAb levels. Female sex, White race, and former smoking were determinants of persistent TPOAb positivity at 2 visits, although only the female sex maintained its association at 3 visits. Moreover, after multivariate adjustment, there were associations between higher levels of TPOAbs and higher risk of cancer-related mortality among men, and TPOAb detectability and mortality by other causes among women. CONCLUSION: Sociodemographic and lifestyle-related factors were determinants of multiple TPOAb categories. TPOAb levels were associated with mortality risk; however, the low mortality rate in this sample might have compromised this finding. We suggest further studies to explore the clinical importance of detectable TPOAb levels, not only its positivity, as a potential marker of inflammation.

Motor stereotypies in autism spectrum disorder: Clinical randomized study and classification proposal.

LAY ABSTRACT: Motor stereotypies are one of the most frequent features in children with a diagnosis of autism spectrum disorder. They may disrupt children's functioning and development and be a potential source of stress for families. Several factors, including sex, age, cognitive ability, and severity of autism spectrum disorder, may influence the presence and intensity of stereotypies. The present study aimed to identify the prevalence of motor stereotypies in a group of children with autism spectrum disorder. In addition, it sought to investigate whether sex, age, cognitive ability, verbal language, neurological comorbidities, and severity of autism spectrum disorder were associated with an increased probability and higher number, duration, and variability of stereotypies. A total of 134 participants aged 2.3-17.6 years underwent a clinical protocol with standardized video-recorded sessions. Stereotypies were identified and classified by two independent evaluators. The prevalence of stereotypies was 56.7%, and a total of 1198 motor stereotypies were captured. Children who were younger, nonverbal, and had higher severity of autism spectrum disorder had an increased probability of presenting stereotypies. Being nonverbal or having higher severity of autism spectrum disorder was also associated with presenting a higher number of stereotypies. Children with developmental delay, intellectual disability, or epilepsy displayed longer stereotypies, and children with developmental delay or intellectual disability additionally presented more diverse stereotypies. As part of the study, the authors present a clinical classification model, a glossary, and video samples of motor stereotypies. The findings of this study suggest that children who are younger, nonverbal, have lower cognitive ability, and have higher severity of autism spectrum disorder may have a higher burden of stereotypies. Earlier intervention and monitoring of these children have the potential to improve their long-term outcomes.

30-Year High Cardiovascular Risk Incidence and its Determinants: CUME Study / Incidencia del alto riesgo cardiovascular de 30 años y sus determinantes: Estudio CUME / Incidência do alto risco cardiovascular de 30 anos e seus determinantes: Estudo CUME

ABSTRACT Objective: Estimate the incidence of the 30-year high cardiovascular risk and its determinants among graduates of federal universities in Minas Gerais. Methods: This is a prospective cohort of 2,854 adults aged 20 to 59. The incidence of the outcome was calculated using the Framingham equation and its determinants were determined through multivariate Cox regression. Results: After an average of 2.62 years, the incidence of high cardiovascular risk was 8.09 and 20.1 cases per 1,000 person-years, for females and males respectively. Being male (HR: 2.34; 95% CI: 1.58 - 3.46), employment (HR: 2.13; 95% CI: 1.13 - 3.99), high consumption of processed foods (HR: 2.44; 95% CI: 1.21 - 4.90), and being physically active (HR: 0.63; 95% CI: 0.41 - 0.98) were associated with high cardiovascular risk. Conclusions: Among highly educated adults, being male, employment, and high consumption of processed foods are predictors of high cardiovascular risk, while being physically active acts as a protective factor.

RESUMEN Objetivo: Estimar la incidencia del alto riesgo cardiovascular de 30 años y sus determinantes en graduados de universidades federales de Minas Gerais. Métodos: Cohorte prospectiva con 2.854 adultos de 20 a 59 años. Se calculó la incidencia del desenlace usando la ecuación de Framingham y sus determinantes a través de la regresión multivariante de Cox. Resultados: Después de un promedio de 2,62 años, la incidencia del alto riesgo cardiovascular fue de 8,09 y 20,1 casos por 1.000 personas-año, respectivamente, en los géneros femenino y masculino. Ser masculino (HR: 2,34; IC95%: 1,58 - 3,46), trabajar (HR: 2,13; IC95%: 1,13 - 3,99), un alto consumo de alimentos procesados (HR: 2,44; IC95%: 1,21 - 4,90) y ser activo físicamente (HR: 0,63; IC95%: 0,41 - 0,98) se asociaron con el alto riesgo cardiovascular. Conclusiones: En adultos con alta educación, ser masculino, trabajar y el alto consumo de alimentos procesados son predictores del alto riesgo cardiovascular, mientras que ser activo físicamente es un factor de protección.

RESUMO Objetivo: Estimar a incidência do alto risco cardiovascular de 30 anos e seus determinantes em egressos de universidades federais mineiras. Métodos: Coorte prospectiva com 2.854 adultos de 20 a 59 anos. Calculou-se a incidência do desfecho pela equação de Framingham e seus determinantes pela regressão de Cox multivariada. Resultados: Após uma média de 2,62 anos, a incidência do alto risco cardiovascular foi de 8,09 e 20,1 casos/1.000 pessoas-ano, respectivamente, nos sexos feminino e masculino. O sexo masculino (HR: 2,34; IC95%: 1,58 - 3,46), trabalhar (HR: 2,13; IC95%: 1,13 - 3,99), elevado consumo de alimentos processados (HR: 2,44; IC95%: 1,21 - 4,90) e ser ativo fisicamente (HR: 0,63; IC95%: 0,41 - 0,98) associaram-se ao alto risco cardiovascular. Conclusões: Em adultos com alta escolaridade, o sexo masculino, trabalhar e o elevado consumo de alimentos processados são preditivos do alto risco cardiovascular, enquanto ser ativo fisicamente é um fator de proteção.

Intergenerational Association of Short Maternal Stature with Stunting in Yanomami Indigenous Children from the Brazilian Amazon.

To describe the factors associated to stunting in <5-year-old Yanomami Brazilian children, and to evaluate the association of short maternal stature to their offspring's stunting. A cross-sectional study carried out in three villages in the Yanomami territory. We performed a census, in which all households with children < 5-years-old were included. The length/height-for-age z-score <-2 standard deviations was used to classify the children as stunted. Short maternal height was defined as <145 cm for adult women, and <-2 standard deviations of the height-for-age z-score for adolescent women. We used adjusted Poisson regression models to estimate prevalence ratios (PR) along the 90% confidence interval. We evaluated 298 children. 81.2% of children suffered from stunting and 71.9% of the mothers from short stature. In the bivariate analysis, a significant association of stunting with short maternal stature, gestational malaria and child's place of birth were observed. Considering the variables of the children under five years of age, there were significant associations with age group, the child's caregiver, history of malaria, pneumonia, and malnutrition treatment. In the adjusted hierarchical model, stunting was 1.22 times greater in the offspring of women with a short stature (90% CI: 1.07-1.38) compared to their counterparts. Brazilian Amazonian indigenous children living in a remote area displayed an alarming prevalence of stunting, and this was associated with short maternal height, reinforcing the hypothesis of intergenerational chronic malnutrition transmission in this population. In addition, children above 24 months of age, who were born in the village healthcare units and who had had previous treatment in the past for stunting presented higher rates of stunting in this study.

Assessing Dementia Prevalence in the Wisconsin Longitudinal Study: Cohort Profile, Protocol, and Preliminary Findings.

BACKGROUND: There is growing consensus that non-genetic determinants of dementia can be linked to various risk- and resiliency-enhancing factors accumulating throughout the lifespan, including socioeconomic conditions, early life experiences, educational attainment, lifestyle behaviors, and physical/mental health. Yet, the causal impact of these diverse factors on dementia risk remain poorly understood due to few longitudinal studies prospectively characterizing these influences across the lifespan. OBJECTIVE: The Initial Lifespan's Impact on Alzheimer's Disease and Related Dementia (ILIAD) study aims to characterize dementia prevalence in the Wisconsin Longitudinal Study (WLS), a 60-year longitudinal study documenting life course trajectories of educational, family, occupational, psychological, cognitive, and health measures. METHODS: Participants are surveyed using the modified Telephone Interview for Cognitive Status (TICS-m) to identify dementia risk. Those scoring below cutoff undergo home-based neuropsychological, physical/neurological, and functional assessments. Dementia diagnosis is determined by consensus panel and merged with existing WLS data for combined analysis. RESULTS: Preliminary findings demonstrate the initial success of the ILIAD protocol in detecting dementia prevalence in the WLS. Increasing age, hearing issues, lower IQ, male sex, APOE4 positivity, and a steeper annualized rate of memory decline assessed in the prior two study waves, all increased likelihood of falling below the TICS-m cutoff for dementia risk. TICS-m scores significantly correlated with standard neuropsychological performance and functional outcomes. CONCLUSION: We provide an overview of the WLS study, describe existing key lifespan variables relevant to studies of dementia and cognitive aging, detail the current WLS-ILIAD study protocol, and provide a first glimpse of preliminary study findings.

A Predictive Model Has Identified Tick-Borne Encephalitis High-Risk Areas in Regions Where No Cases Were Reported Previously, Poland, 1999-2012.

During 1999­2012, 77% of the cases of tick-borne encephalitis (TBE) were recorded in two out of 16 Polish provinces. However, historical data, mostly from national serosurveys, suggest that the disease could be undetected in many areas. The aim of this study was to identify which routinely-measured meteorological, environmental, and socio-economic factors are associated to TBE human risk across Poland, with a particular focus on areas reporting few cases, but where serosurveys suggest higher incidence. We fitted a zero-inflated Poisson model using data on TBE incidence recorded in 108 NUTS-5 administrative units in high-risk areas over the period 1999­2012. Subsequently we applied the best fitting model to all Polish municipalities. Keeping the remaining variables constant, the predicted rate increased with the increase of air temperature over the previous 10­20 days, precipitation over the previous 20­30 days, in forestation, forest edge density, forest road density, and unemployment. The predicted rate decreased with increasing distance from forests. The map of predicted rates was consistent with the established risk areas. It predicted, however, high rates in provinces considered TBE-free. We recommend raising awareness among physicians working in the predicted high-risk areas and considering routine use of household animal surveys for risk mapping.

Spontaneous and induced abortion trends and determinants in the Northeast semiarid region of Brazil: a transversal series / Tendência de abortos espontâneos e induzidos na região semiárida do Nordeste do Brasil: uma série transversal

Abstract Objectives: this study intends to estimate the rates, associated factors and trends of selfreported abortion rates in the northeast of Brazil. Methods: series of population-based surveys realized in Ceará, northeast of Brazil, one of the poorest states in the country. A sample of about 27,000 women of reproductive age was used. Abortion was assessed according to women´s information and rates were calculated using official population estimates. The trends and the association among socioeconomic and reproductive factors were studied using regressive models. Results: a trend for reduction in rates was identified. For induced abortion, the determinants were: not having a partner, condom in the last sexual intercourse, first child up to 25years old (AOR= 5.21; ACI: 2.9 - 9.34) and having less than 13years old at first sexual intercourse (AOR= 5.88; ACI: 3.29 - 10.51). For spontaneous abortion were: having studied less than 8 years, knowledge and use of morning-after pill (AOR= 26.44; ACI: 17.9 - 39.05) and not having any children (AOR= 3.43). Conclusions: rates may have been low due to self-reporting. Young age and knowledge about contraceptive methods were associated to both kinds of abortion, while education level along with spontaneous and marital status with induced. Programs to reduce abortion rates should focus on single younger women with low education.

Resumo Objetivos: este estudo objetiva estimar as taxas, fatores associados e tendência das taxas de aborto no Nordeste do Brasil. Métodos: série de estudos transversais realizada no Ceará, um dos estados mais pobres do país. Uma amostra de cerca de 27000 mulheres em idade reprodutiva foi utilizada. A ocorrência de aborto foi aferida através de informação dada pela participante e taxas foram calculadas usando estimativas populacionais oficiais. As tendências e associações entre fatores socioeconômicos e reprodutivos foram estudadas através de modelos regressivos. Resultados: foi identificada tendência de redução nas taxas de abortamento. Para aborto induzido, os determinantes foram não ter um parceiro fixo, ter utilizado camisinha na última relação sexual, ter tido o primeiro filho com menos de 25 anos (AOR= 5,21; ACI: 2,9 - 9,34), e ter tido a primeira relação com menos de 13 anos (AOR= 5,88; ACI: 3,29 - 10,51). Para o espontâneo, ter estudado menos de oito anos, conhecimento sobre a pílula do dia seguinte (AOR= 26,44; ACI: 17,9 - 39,05), e não ter filhos (AOR= 3,43). Conclusões: as taxas podem ser subestimadas por serem auto relatadas. Estar na adolescência e ter conhecimento sobre métodos contraceptivos foram associados aos dois tipos de aborto, enquanto nível educacional com o espontâneo e estado conjugal com induzido. Programas para reduzir taxas de abortamento deveriam focar em mulheres solteiras e com baixa educação.

Socio-demographic, Epidemiological and Environmental Determinants of Acute Gastroenteritis in Western India.

INTRODUCTION: An outbreak of acute gastroenteritis had occurred in Rajpara village of Bhavnagar district. The objective of this study was to find out the socio-demographic, epidemiological and environmental determinants of this outbreak. METHODS: A case-control study was conducted in Rajpara village among 238 cases of acute gastroenteritis and an equal number of controls in January 2015. Multiple logistic regression was used for identifying the variables independently predicting acute gastroenteritis. RESULTS: Upper socio-economic status, occupation requiring travel outside village, source of drinking water from well of 'new' Rajpara village, change in taste of water, use of chlorine tablets, travel outside village in last week, another family member affected with acute gastroenteritis, using common utensil for hand washing, hand washing before eating, ate food from outside in last week, having sanitary latrine at house, waste disposal in a common dump (instead of at house), waste accumulation around house and flies inside house were significantly associated with occurrence of acute gastroenteritis. On multiple logistic regression, change in taste of water (P<0.001), waste disposal in a common dump (P=0.012), another family member been affected (P<0.001), waste accumulation around house (P<0.001), higher socio-economic status (P=0.002) and eating outside food (P=0.011) made a significant contribution to prediction. CONCLUSIONS: Socio-demographic factors (higher socio-economic status), epidemiological correlates (change in taste of water, another family member been affected with acute gastroenteritis and eating outside food) and environmental determinants (waste disposal in a common dump and waste accumulation around house) significantly determines the occurrence of cases of acute gastroenteritis.

Regional disparities in road traffic injuries and their determinants in Brazil, 2013.

BACKGROUND: In recent decades middle-income countries have experienced a rapid increase in the number of cars and motorcycles. Increased deaths and hospitalizations due to road traffic injuries (RTI) has been observed in several countries as a result. In this study we assessed the determinants of RTIs in Brazil by mode of transportation and compared differences in RTI rates among macro-regions. METHODS: We used data from the National Health Survey (NHS) conducted in 2013 by the Brazilian Institute of Geography and Statistics and the Ministry of Health. NHS is a comprehensive household survey which includes a representative sample (N = 60,198) of individuals aged 18 years or older. The prevalence and determinants of RTI were estimated according to different modes of transport (car/van, motorcycle, and other) and regions of the country. Bivariate and multivariable logistic regression models were applied to assess crude and adjusted odds ratios, respectively, and their 95 % CI for RTI determinants. RESULTS: The prevalence of RTI for the Southeast, South, Central-West, Northeast and North regions of Brazil was 2.4 %, 2.9 %, 4.4 %, 3.4 % and 4.8 %, respectively, pointing to important differences among regions. High percentages of motorcyclists were observed in the Northeast and North regions. For motorcyclists, factors associated with RTIs were being male (OR = 2.6;95 % CI:2.3;3.0), aged 18-29 (OR = 3.2; 95 % CI:2.7;3.8) and 30-39 years (OR = 2.0;95 % CI:1.7;2.5), black (OR = 1.4;95 % CI:1.1;1.7), having elementary educational (OR = 1.5;95 % CI:1.1;1.9), reporting binge drinking behavior (OR = 1.3;95 % CI:1.1;1.5), and living in the Central-West (OR = 2.0;95 % CI:1.6;2.5), Northeast (OR = 1.8;95 % CI:1.5;2.1) and North (OR = 2.0;95 % CI:1.6; 2.5) regions of the country. The independent variables associated with RTI for car/van occupants were being male (OR = 1.7;95 % CI:1.4;2.1), aged 18-29 (OR = 1.5;95 % CI:1.1;2.0) and 30-39 years (OR = 2.5;95 % CI:1.9;3.2), reporting binge drinking behavior (OR = 2.0;95 % CI:1.6;2.5) and living in the South region (OR = 1.6;95 % CI:1.3;2.1). CONCLUSIONS: There were considerable regional disparities in RTI rates across Brazil's regions. Motorcyclists contributed to the high RTI rates in these regions as did demographic factors and behaviors such as alcohol use. These findings can help guide interventions to reduce the burden of RTIs in Brazil.

I-determinants for a successful PhD or postdoctoral outcome.

Many resources are invested in research training, but very little literature exists on predictors for a successful PhD and postdoctoral training outcome. A PhD program has two overall objectives: to extend knowledge about a hopefully important health topic and to provide extensive training to improve the PhD student's skills through learning research methods and collaboration. A substantial number of PhD students may run into some kind of problem in the course of their PhD program. In this article, some determinants all starting with an "I" and indicative of a good PhD outcome are reported. The successful PhD student can be described as having an Interest in the PhD program, an Incentive for the program, and an Idea of what he or she wants to investigate, showing Initiative, and having high personal Integrity and good Interpersonal relationships. When these so-called I-determinants are present, the likelihood of success in a PhD program is high. More evidence is available for selection of candidates for postdoctoral appointments since it is known that the postdoctoral candidate has completed a PhD program, published papers in peer-reviewed journals, and received awarded grants. However, other characteristics determine a successful transition of the postdoctoral candidate into a research leader. These determinants are Identity, Independence and Image, Implementation ability in terms of being able to implement decisions and projects, working with Innovative and Important topics, having In-depth knowledge of the research topic, being Interactive and Integrated with the scientific community, and Internationally oriented. In conclusion, regardless of the framework of research, the personal characteristics of a researcher play a very important role in the quality of research. Application of some of the principles mentioned in this article might allow decision to reach a more evidence-based way to recruit PhD students and postdoctorals.

The Natural History of Human Polyomaviruses and Herpesviruses in Early Life--The Rhea Birth Cohort in Greece.

Sparse data exist on the patterns and determinants of acquisition of polyomaviruses and herpesviruses in childhood. We measured immunoglobulin G seroreactivity against 10 polyomaviruses (BKPyV, JCPyV, KIPyV, WUPyV, MCPyV, HPyV6, HPyV7, TSPyV, HPyV9, HPyV10) and 5 herpesviruses (Epstein Barr virus (EBV), cytomegalovirus (CMV), herpes simplex virus types 1 and 2, human herpesvirus 8) using multiplex serology on blood samples collected at birth (cord blood, n = 626) and at follow-up at 3 years (n = 81) and 4 years (n = 690) of age among the Rhea birth cohort recruited in Greece from pregnant women in 2007-2008. We used Poisson regression with robust variance to identify determinants of seropositivity at age 4. Seroprevalence of polyomaviruses ranged from 38.5% to 99.8% in cord blood and from 20.9% to 82.3% at age 4. Seroprevalence of EBV, CMV, herpes simplex virus types 1 and 2, and human herpesvirus 8 was 99.4%, 74.9%, 26.2%, 8.0%, and 1.6% in cord blood and 52.5%, 25.8%, 3.6%, 1.4%, and 0% at age 4, respectively. Determinants of seropositivity at age 4 were cord seropositivity (JCPyV, HPyV7, HPyV10, CMV), vaginal delivery (HPyV10), breastfeeding (CMV), younger age at day-care entry (BKPyV, KIPyV, WUPyV, TSPyV, HPyV10, HPyV9, EBV, CMV), and swimming pool attendance (BKPyV, KIPyV, WUPyV, HPyV10). Television viewing, parental stress, and hygiene practices were inversely associated with the seroprevalence of polyomaviruses and herpesviruses.

Sociocultural Determinants of Tobacco Smoking Initiation among University Students in Bucaramanga, Colombia, 2012.

BACKGROUND: Tobacco smoking is the leading cause of preventable mortality. The prevalence of smoking in adolescents in high schools ranges from 23.5% to 41%, respectively. In Colombia, these figures are similar and students entering the University are exposed to initiate smoking. The purpose of this study was to establish the determinants associated with the initiation of tobacco smoking among university students. METHODS: A case-control paired by sex and age study design was used. The study population was the students of a private university of Bucaramanga, Santander, Colombia. The final sample consisted of 167 cases and 314 controls randomly select undergraduate university students. Data analysis was performed using a Logistic regression model adjusted by gender and age; using the initiation of tobacco smoking as the dependent variable, and as independent variables relationship with parents, history of parental smoking, university social environment, being away from hometown, steady girlfriend/boyfriend who smokes, alcohol consumption, physical activity, and Francis Score. RESULTS: THE SOCIAL ENVIRONMENT (ODDS RATIO [OR]: 32.70, 7.40-144.55), being away from hometown (OR: 3.06, 1.55-6.07), history of steady girlfriend/boyfriend who smoke (OR: 2.87, 1.43-5.76), a bad relationship with the father (OR: 8.01, 2.01-31.83), history of tobacco consumption of the mother (OR: 2.66, 1.37-5.17) and alcohol consumption (OR: 4.79, 1.91-12.00) appeared as determinants of initiation of tobacco smoking. As protector factors we found media advertisement (OR: 0.19, 0.05-0.71), light physical activity 2-3 times a week (OR: 0.33, 0.12-0.88), and a high result in Francis score (OR: 0.95, 0.919-0.99). CONCLUSIONS: University efforts for tobacco-free policies should focus on preventive advertisement, promoting physical activity and awareness among young students of social environmental factors that could influence their decision to start smoking tobacco.

Do Performance-based Health Measures Reflect Differences in Frailty Among Immigrants Age 50+ in Europe?

BACKGROUND: Life course influences, including country of residence and country of birth, are associated with frailty index scores. We investigated these associations using performance-based health measures. METHODS: Among 33,745 participants age 50+ (mean age 64.8 ± 10.1; 55% women) in the Survey of Health, Ageing, and Retirement in Europe, grip strength, delayed word recall, and semantic verbal fluency were assessed. Participants were grouped by country of residence (Northern/Western Europe or Southern/Eastern Europe), and by country of birth (native-born, immigrants born in low- and middle-income countries [LMICs], or immigrants born in high-income countries [HICs]). RESULTS: Participants in Southern/Eastern Europe had lower mean test scores than those in Northern/Western Europe, and their scores did not differ by country of birth group. In Northern/Western Europe, compared with native-born participants, LMIC-born immigrants demonstrated lower mean grip strength (32.8 ± 7.6 kg vs. 35.7 ± 7.7 kg), delayed recall (2.9 ± 1.9 vs. 3.6 ± 1.9), and verbal fluency scores (16.0 ± 6.9 vs. 20.3 ± 7.0). HIC-born immigrants had mean scores higher than LMIC-born immigrants, but lower than native-born participants (all p<.001). CONCLUSIONS: Cognitive and motor performance, measured from late middle age, were associated with national income levels of both country of residence and country of birth. This was similar to previously observed differences in frailty index scores.

Risk factors for high and low placental weight.

BACKGROUND: Placental weight is an independent predictor of adverse perinatal outcome. However, risk factors for high and low placental weight are poorly understood. The objective of this study was to identify maternal, placental, and umbilical cord determinants of placental weight, before and after accounting for birthweight. METHODS: This cohort study of 87,600 singleton births at the Royal Victoria Hospital in Montreal, Canada assessed the relationship between maternal, placental, and umbilical cord characteristics and placental weight (standardised for sex and gestational age). We separately examined risk factors for high (z-score >+1) and low (z-score <-1) placental weight. Multivariable logistic regression was used to study associations after adjusting for confounders and further adjusting for birthweight. RESULTS: Chronic hypertension was associated with low placental weight {relative risk (RR) 2.1 [95% confidence interval (CI) 1.8, 2.4] and 1.8 [95% CI 1.5, 2.1] before and after accounting for birthweight}, while pre-eclampsia was associated with low placenta weight before, but not after adjustment for birthweight. Anaemia and gestational diabetes were linked with high placental weight (RRs 1.2-1.4, respectively) before and after adjustment for birthweight, while smoking was linked with high placental weight only after adjustment for birthweight (RR 1.4 [95% CI 1.3, 1.5]). Placental and cord determinants of high placental weight included chorioamnionitis, chorangioma/chorangiosis, circumvallate placenta, marginal cord insertion, and other cord abnormalities. CONCLUSIONS: The broad range of risk factors for high placental weight suggests multiple aetiologic pathways. Future work should seek to understand the pathways by which the placenta adapts to unfavourable intrauterine conditions, which may provide insights into potential therapies.

Factors influencing adherence in long-term use of statins.

PURPOSE: To assess the factors influencing adherence in long-term medication use as exemplified by statins. METHODS: Data from an in-depth survey of Australians aged 45 years and over were linked to national prescription reimbursement data to assess medication possession ratio (MPR) for statins for the middle two years of a four-year period of statin possession. Poisson regression was used to calculate the relative risk (RR) for adherence (MPR ≥ 80%) for patient characteristics and factors related to access to and need for health care services. Separate models were fit for patients receiving healthcare concession subsidies and those who do not ('general beneficiaries'). RESULTS: In the analysis, 42 492 concessional and 16 110 general beneficiary patients were included, with 80.1% and 56.7% showing MPR ≥ 80%, respectively. In both models, RR for adherence was significantly elevated for older (age 65+) and less healthy (worse self-rated health, pre-existing heart condition or obese) individuals, and for those who had private health insurance. Significantly lower RR (i.e. more non-adherence) was found for individuals reporting speaking a language other than English at home, who were smokers, were employed, and had higher levels of education, and for those who reported psychological distress. Income had no significant relationship with adherence, and the pattern of adherence by remoteness of area of residence was inconsistent. CONCLUSIONS: Poor adherence in long-term use of statins is commonplace, but a number of key predictors-including age, language other than English spoken at home, smoking status and psychological distress-are readily assessable by the prescribing practice.

Estereótipos de gênero e sexismo ambivalente em adolescentes masculinos de 12 a 16 anos / Ambivalent sexism and gender stereotyping in male adolescents aged 12 to 16 years

A discriminação e a violência contra o gênero feminino associam-se a representações distorcidas da mulher. Este trabalho tem o objetivo de mensurar a existência de preconceitos nas manifestações dos estereótipos de gênero e sexismo ambivalente, em adolescentes masculinos de 12 a 16 anos. Em um estudo transversal, aplicaram-se três questionários (sociodemográfico, Gender stereotyping, Inventário do Sexismo Ambivalente) a 787 estudantes de 11 escolas públicas. Nos resultados, detectou-se a presença de estereótipos de gênero. Houve diferença significante entre alunos de escolas estaduais e municipais e também nos alunos que estudavam em bairros de poder aquisitivo elevado em relação aos demais. O sexismo, também presente, apresentou-se significantemente mais benévolo que hostil. O escore para o componente benévolo variou conforme a escola cursada. O hostil não foi influenciado pelas variáveis estudadas. Os achados corroboram a existência de estereótipos de gênero e sexismo ambivalente nos adolescentes masculinos e a necessidade de desenvolvimento de ações e políticas para sua erradicação.

Prevalência de barreiras para a prática de atividade física em adolescentes / Prevalence of barriers for physical activity in adolescents

O objetivo deste estudo foi analisar a prevalência de barreiras e sua associação com a prática de atividades físicas em adolescentes. O presente estudo, transversal, avaliou uma amostra representativa de escolares do ensino médio da rede pública da cidade de Curitiba-PR, Brasil. Um total de 1.609 escolares (59,7 por cento do gênero feminino) entre 14 e 18 anos de idade reportou, por meio de um questionário, o nível de atividade física e as barreiras para a prática de atividades físicas. Para verificar a associação entre a prevalência de barreiras e a atividade física foi realizada uma análise de regressão logística para cada barreira investigada ajustando para variáveis de confusão (idade e nível socioeconômico). As análises foram realizadas separadamente para meninos e meninas. Apenas 22 por cento dos meninos e 9 por cento das meninas atingiram a atual recomendação para atividade física. Entre as 12 barreiras investigadas, apenas "não ter alguém para levar" não diferiu entre os gêneros. Para todas as outras, a percepção de barreiras foi maior entre as meninas (p < 0,05). "Não ter a companhia dos amigos" e "ter preguiça" foram as barreiras mais reportadas pelos meninos (30,4 por cento) e meninas (51,8 por cento), respectivamente; no entanto a barreira mais fortemente associada com maior prevalência de níveis insuficientes de atividade física foi "preferir fazer outras coisas" para meninos (OR = 5.02 (2,69 - 9,37); p < 0,05) e meninas (OR = 7.10 (3,71 - 13,60); p < 0,05). As barreiras percebidas para a prática de atividades físicas foram mais prevalentes entre as meninas e diferiram em grau de importância entre os gêneros.

The aim of this study was to analyze the prevalence and association of barriers to physical activity among adolescents. This cross-sectional study evaluated a representative sample of public high school students in Curitiba-PR, Brazil. A total of 1,609 school adolescents (59.7 percent male) between 14 and 18 years of age answered a questionnaire on physical activity status and barriers to physical activity. Logistic regressions were conducted for each barrier investigated to verify the association between the prevalence of barriers and physical activity, adjusting for confounding variables (age and socioeconomic status). Analyses were done separately for boys and girls. Only 22 percent of boys and 9 percent of girls achieved the current physical activity recommendation. Among the 12 barriers investigated, only "there is nobody to take" did not differ between boys and girls. The perception of barriers was higher for girls than boys (p < 0.05) for all other barriers. "Lack of friends company" and "feel lazy" were the barriers most often reported by boys (30.4 percent) and girls (51.8 percent) respectively; however, the barrier most strongly associated with prevalence of physical inactivity was "prefer to do other things" for both boys (OR = 5.02 (2.69 - 9.37); p < 0.05) and girls (OR = 7.10 (3.71 - 13.60); p < 0.05). Perceived barriers for the practice of physical activity were more prevalent in girls and differed as to the extent of importance between genders.

Ganho de peso gestacional: determinantes e suas repercussões clínicas e perinatais / Weight gain in pregnancy: determinant factors, clinical and perinatal outcomes

O conhecimento do estado nutricional materno antes e durante a gravidez, é fator fundamental para a saúde da mãe e de seu filho. No Brasil, a preocupação com a persistência do baixo peso e com o crescente aumento da prevalência da obesidade feminina é premente, particularmente em mulheres em idade reprodutiva, devido aos riscos para desfechos gestacionais e neonatais desfavoráveis e seus respectivos efeitos imediatos e em longo prazo. Pretende-se revisar o que a literatura traz de mais relevante sobre ganho ponderal em gestantes, seus fatores determinantes e consequências. Para tanto, foram consultadas as bases de dados Medline/Pubmed, Lilacs, Cochrane e Scielo, sendo examinados os trabalhos mais adequados ao propósito da revisão. Observa-se que a deposição variável de tecido adiposo durante a gestação ocorre em função dos fatores genéticos, nutricionais, sociodemográficos e comportamentais, e que estes fatores determinarão, em última instância, o ganho de peso gestacional e consequentes desfechos gestacionais e neonatais. A adequada atenção à saúde nutricional materna, portanto, perpassa pelo conhecimento do perfil epidemiológico nutricional da população gestante, bem como de seus fatores associados.

Knowledge of maternal nutritional status prior to and during pregnancy is a fundamental factor in determining the health of the mother and her infant. In Brazil, there is concern with respect to the persistence of low birth weight and the increasing prevalence of female obesity, particularly in women of reprocutive age in view of the risks of unfavorable gestational and neonatal outcome and the respective immediate and long-term effects. The objective of this study was to review the literature to identify the most relevant papers on weight gain in pregnant women, its determining factors and consequences. Therefore, the Medline/Pubmed, Lilacs, Cochrane and Scielo databases were consulted and the most pertinent studies, reviewed. Adipose tissue deposition during pregnancy was found to be associated with genetic, nutritional, sociodemographic and behavioral factors and these factors were found to determine gestational weight gain in the first instance and consequently gestational and neonatal outcome. Adequate attention to maternal nutritional health; therefore, must include epidemiological data on the nutritional profile of the population of pregnant women, as well as its associated factors.