RESUMO
BACKGROUND AND AIMS: The first years of life are fundamental for the establishment of the gut microbiota, with diet being one of the main early exposures. During this period, the beneficial effect of breastfeeding on modulating the gut microbiota is well known; however, there are important gaps in the literature on the effects of ultra-processed food (UPF) consumption, particularly in longitudinal and large sample designs. Through a prospective birth cohort study, we investigated the effects of UPF consumption on the gut microbiota of children during the first year of life. METHODS: This study included children from the MINA-Brazil birth cohort with gut microbiota data (16S rRNA) available at the 1-year follow-up (n = 728). Data on breastfeeding practices were collected after childbirth and during follow-up visits. Complementary feeding was measured using a semi-structured questionnaire, referring to the day before the interview at the 1-year follow-up. A combined variable was generated according to breastfeeding practices and UPF consumption and was used as an independent variable in the adjusted median regression models, with alpha diversity parameters as the dependent variable. Beta diversity was analyzed using PERMANOVA according to Bray-Curtis dissimilarity and Distance-based Redundancy Analysis (db-RDA) adjusted for covariates. Relative abundance was analyzed using ANCOM-BC (corrected by FDR) and MaAsLin2 adjusted for covariates. RESULTS: Weaned children who consumed UPF showed a significant increase in alpha diversity for all parameters in the median regression models (Observed ASVs: p = 0.005; Shannon index: p = 0.036; Chao index: p = 0.026; Simpson index: p = 0.012) and in beta diversity (PERMANOVA: p = 0.006; db-RDA: p < 0.001) compared to breastfed children who did not consume UPF. Breastfed children who did not consume UPF had a higher relative abundance of Bifidobacterium than weaned children who consumed UPF (both p < 0.001 for ANCOM-BC and MaAsLin2) and a lower relative abundance of Firmicutes (p < 0.001 for MaAsLin2), Blautia (both p < 0.001 for ANCOM-BC and MaAsLin2), Sellimonas (p = 0.008 for ANCOM-BC) and Finegoldia (p = 0.045 for MaAsLin2) than weaned children who consumed UPF. CONCLUSION: These findings suggest that UPF consumption may negatively impact the diversity and abundance of the gut microbiota, with a more pronounced effect in children who have already been weaned.
Assuntos
Aleitamento Materno , Microbioma Gastrointestinal , Humanos , Microbioma Gastrointestinal/fisiologia , Lactente , Brasil , Feminino , Masculino , Estudos Prospectivos , Aleitamento Materno/estatística & dados numéricos , Coorte de Nascimento , Fast Foods , Fenômenos Fisiológicos da Nutrição do Lactente/fisiologia , Dieta/estatística & dados numéricos , Dieta/métodos , Recém-Nascido , Fezes/microbiologia , Estudos de Coortes , Manipulação de Alimentos/métodos , Alimento ProcessadoRESUMO
In this study, we examine the association between COVID-19 vaccination and antibody titer and whether this association varies by nutritional status and duration of school attendance using linear regression models applied to seven-year-old children from the 2015 Pelotas (Brazil) Birth Cohort (n = 2956). Antibody titers were 0.29 optical density (OD) titer units higher among vaccinated compared with unvaccinated children (95 % CI: 0.24, 0.34). Duration of school enrollment was associated with increased antibody titer, with each month being associated with a 0.15 unit increase in OD titer (95 % CI: 0.14, 0.16). Stunting was associated with lower COVID-19 titers among unvaccinated children (-0.10, 95 % CI: -0.21,0.004), but not among vaccinated children. Stunted children may have poorer immune responses to natural infection, but vaccination can overcome this deficit. Population-wide follow-up vaccination may be beneficial, particularly prior to school entry and for stunted children to reduce the risk of natural infection.
Assuntos
Anticorpos Antivirais , Vacinas contra COVID-19 , COVID-19 , Estado Nutricional , SARS-CoV-2 , Instituições Acadêmicas , Vacinação , Humanos , Brasil/epidemiologia , COVID-19/prevenção & controle , COVID-19/imunologia , COVID-19/epidemiologia , Anticorpos Antivirais/sangue , Criança , SARS-CoV-2/imunologia , Masculino , Feminino , Estudos Prospectivos , Vacinação/estatística & dados numéricos , Vacinas contra COVID-19/imunologia , Vacinas contra COVID-19/administração & dosagem , Coorte de NascimentoRESUMO
BACKGROUND: The mental health consequences of exposure to childhood trauma have been little studied among adolescents in low-income and-middle-income countries (LMICs), despite a relatively high burden of trauma in LMIC populations. We investigated associations between trauma and adolescent psychiatric disorders in the 2004 Pelotas Birth Cohort, Brazil. METHODS: In the 2004 Pelotas Birth Cohort, current psychiatric diagnoses (anxiety, mood, attention-hyperactivity, and conduct-oppositional disorders) were assessed at age 15 years (caregiver-report Development and Well-being Assessment), and age 18 years (self-report Mini-International Neuropsychiatric Interview). Lifetime cumulative trauma was assessed via caregiver report up to age 11 years and combined self-report and caregiver-report thereafter. Exposure to 12 trauma types were assessed (serious accident, fire, other disaster, attack or threat, physical abuse, sexual abuse, witnessed domestic violence, witnessed attack, witnessed accident, heard about attack, heard about accident, and parental death). Due to the high prevalence of trauma exposure in the sample, the number of different types of trauma exposure reported was extracted as a proxy for cumulative trauma load. We assessed both cross-sectional and longitudinal associations between cumulative trauma load and psychiatric disorders during adolescence using logistic regression, adjusting for confounders and pre-existing child psychopathology at 48 months. We also computed population attributable fractions (PAFs) for trauma-mental health associations at age 18 years. FINDINGS: 4229 adolescents (51·9% male, 48·1% female) were included in logistic regression analyses based on imputed data. Trauma exposure affected 81·2% of adolescents by age 18 years. At age 15 years, the odds of any disorder (adjusted odds ratio [aOR] 1·19 [95% CI 1·03-1·38]), anxiety disorders (1·45 [1·21-1·75]), and conduct-oppositional disorders (1·60 [1·13-2·27]) increased for each category increase in cumulative trauma, but mood and attention-hyperactivity disorders were not related to cumulative trauma. At age 18 years, the odds of any disorder (1·34 [1·24-1·44]), anxiety disorders (1·23 [1·13-1·34]), mood disorders (1·33 [1·22-1·46]), attention-hyperactivity disorders (1·24 [1·09-1·41]), and conduct-oppositional disorders (1·59 [1·36-1·86]) all increased for each category increase in cumulative trauma. In longitudinal analyses, each category increase in cumulative trauma by age 11 years was associated with an increased odds of any disorder (aOR 1·26 [95% CI 1·11-1·44]), anxiety disorders (1·27 [1·04-1·56]), and conduct-oppositional disorders (1·43 [1·04-1·97]) at 15 years; and trauma up to age 15 years was associated with increased odds of any disorder (1·32 [1·21-1·45]), anxiety disorders (1·27 [1·14-1·40]), mood disorders (1·26 [1·12-1·41]), and conduct-oppositional disorders (1·52 [1·24-1·87]) at age 18 years. Trauma up to age 11 years was not predictive of disorders at age 18 years, and there were no longitudinal associations between trauma and attention-hyperactivity disorders. PAF estimates indicated that trauma exposure accounted for 30·6% (95% CI 21·2-38·7) of psychiatric disorders at age 18 years. INTERPRETATION: Increasing exposure to trauma is associated with mental disorders among Brazilian adolescents. Given the high prevalence of trauma in LMIC populations, strategies to reduce exposure, identify those at greatest risk of mental disorders following trauma, and mitigate the consequences are crucial. FUNDING: Wellcome Trust, WHO, National Support Program for Centers of Excellence, Brazilian National Research Council, Brazilian Ministry of Health, Children's Pastorate, São Paulo Research Foundation, Rio Grande do Sul Research Foundation, L'Oréal-Unesco-ABC Program for Women in Science in Brazil-2020, All for Health Institute, University of Bath, Economic and Social Sciences Research Council. TRANSLATION: For the Portuguese translation of the abstract see Supplementary Materials section.
Assuntos
Transtornos Mentais , Humanos , Brasil/epidemiologia , Adolescente , Masculino , Feminino , Estudos Longitudinais , Transtornos Mentais/epidemiologia , Criança , Coorte de Nascimento , Experiências Adversas da Infância/estatística & dados numéricos , Estudos TransversaisRESUMO
OBJECTIVE: To analyze measles, mumps, and rubella vaccination coverage among children up to 24 months old and factors associated with non-vaccination in a 2017-2018 live birth cohort, in state capitals and large interior region cities in Northeast Brazil. METHODS: Population-based survey analyzing vaccination coverage and sociodemographic factors through logistic regression. RESULTS: For 12,137 children, vaccination coverage was 79.3% (95%CI 76.5;81.8), and the dropout rate was 10.6%. Association with non-vaccination: socioeconomic stratum A (OR-a 1.29; 95%CI 1.10;1.50), living in the interior region (OR-a 1.22; 95%CI 1.07;1.39), no access to the Bolsa Família Program (OR-a 1.19, 95%CI 1.05;1.34), family income ≤BRL 1,000 (OR-a 1.17, 95%CI 1.03;1.31), mother not working (OR-a 1.28, 95%CI 1.15;1.42), >1 child per mother (OR-a 1.12, 95%CI 1.08;1.17), and no vaccination card (OR-a 10.69, 95%CI 6.27;18.20). CONCLUSION: Low vaccination coverage and a high dropout rate in state capitals and municipalities in the interior region of Northeast Brazil. MAIN RESULTS: 79.3% vaccination coverage with incomplete vaccination associated with living in higher socioeconomic strata and in interior region municipalities, and children without vaccination records. High dropout rates in the state capitals Natal and João Pessoa. IMPLICATIONS FOR SERVICES: Recognition of low coverage and factors associated with non-vaccination provides health services with relevant information with a view to planning strategic actions to increase measles, mumps and rubella vaccination coverage. PERSPECTIVES: Low coverage and identification of non-vaccination indicate the importance of targeting actions in the Brazilian National Health System to achieve the targets recommended by the National Immunization Program, for populations in Northeast Brazil.
Assuntos
Programas de Imunização , Vacina contra Sarampo-Caxumba-Rubéola , Fatores Socioeconômicos , Cobertura Vacinal , Humanos , Brasil , Cobertura Vacinal/estatística & dados numéricos , Vacina contra Sarampo-Caxumba-Rubéola/administração & dosagem , Lactente , Feminino , Masculino , Programas de Imunização/estatística & dados numéricos , Vacinação/estatística & dados numéricos , Sarampo/prevenção & controle , Sarampo/epidemiologia , Estudos de Coortes , Rubéola (Sarampo Alemão)/prevenção & controle , Caxumba/prevenção & controle , Pré-Escolar , Modelos Logísticos , Cidades , Coorte de NascimentoRESUMO
OBJECTIVE: To analyze factors associated with full vaccination coverage with valid doses, in children from four state capitals and three other cities in Southeast Brazil. METHOD: Analysis of a population survey conducted in 2020-2021, with a sample stratified according to socioeconomic levels of children born in 2017-2018, with data collected through photographic records of their vaccination cards. Odds ratios (OR) and 95% confidence intervals (95%CI) for full vaccination coverage were estimated based on the characteristics of the family, mother and child. RESULTS: Among 8703 children, lowest coverage occurred in strata A and B (OR=0.39; 95%CI 0.23;0.67 and OR=0.38; 95%CI 0.25;0.58); in consumption level A/B (OR=0.38; 95CI% 0.28;0.52); among those with income >BRL8000/month (OR=0.23; 95%CI 0.12;0.42); in children of mothers with higher education (OR=0.47; 95%CI 0.32;0.71); in children not vaccinated exclusively in the public service (OR=0.37; 95%CI 0.26;0.51) and in children with a vaccination delay of up to 6 months (OR=0.28; 95%CI 0.22;0.37). CONCLUSION: Coverage did not reach the targets for controlling vaccine-preventable diseases and was negatively associated with higher socioeconomic status. MAIN RESULTS: Vaccination coverage for the full schedule with valid doses was very low, putting the control of vaccine-preventable diseases at risk in the four state capitals and three other cities in the interior region of Southeast Brazil. IMPLICATIONS FOR SERVICES: Brazilian National Health System managers and workers need to know the factors associated with low vaccination coverage and increased risk of abandoning the schedule, access problems and National Immunization Program difficulties. PERSPECTIVES: Understanding determinants of low vaccination coverage provides support for the discussion and design of effective public policies to address barriers and qualify health services for vaccination.
Assuntos
Programas de Imunização , Fatores Socioeconômicos , Cobertura Vacinal , Vacinação , Humanos , Brasil , Cobertura Vacinal/estatística & dados numéricos , Feminino , Lactente , Masculino , Vacinação/estatística & dados numéricos , Programas de Imunização/estatística & dados numéricos , Coorte de Nascimento , Vacinas/administração & dosagem , Pré-Escolar , Escolaridade , AdultoRESUMO
OBJECTIVE: To analyze vaccination coverage up to 24 months of age according to race/ skin color in the 2017-2018 live birth cohort in Natal, Rio Grande do Norte, Brazil. METHODS: Population-based survey conducted in 2020 and 2021. Vaccination coverage up to 24 months of age was estimated according to administered, valid and timely doses. Crude association of race/skin color was estimated by calculating the crude Prevalence Ratio and respective 95% Confidence Intervals, using Poisson regression. RESULTS: Of the 688 children in the selected cohort, there was greater coverage among Black children for administered doses (White 30.5%; Black 47.8%; 95%CI) and valid doses (White 25.8%; Black 40.1%; 95%CI), although without statistical significance, and lower coverage for timely doses, in the full schedule excluding yellow fever (PR = 0.21; 95%CI 0.04;0.90). CONCLUSION: There was lower timely coverage among Black children compared to White children. MAIN RESULTS: It was found that racial inequalities and social disparities were reflected in vaccination coverage of Black children in the state of Rio Grande do Norte, showing lower prevalence of timely and full vaccination schedules among those children. IMPLICATIONS FOR SERVICES: The results demonstrate the need to strengthen equitable public policies and the implementation of practices that seek to improve vaccination coverage, thus reducing racial inequalities in child immunization. PERSPECTIVES: Health service managers will be able to plan actions and strategies in childhood immunization services, in order to increase vaccination coverage and reduce vaccination hesitancy among Black people and people from lower socioeconomic strata.
Assuntos
População Negra , Cobertura Vacinal , Vacinação , População Branca , Humanos , Brasil , Cobertura Vacinal/estatística & dados numéricos , Lactente , Masculino , Feminino , População Branca/estatística & dados numéricos , População Negra/estatística & dados numéricos , Vacinação/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Pré-Escolar , Pigmentação da Pele , Recém-Nascido , Estudos de Coortes , Fatores Socioeconômicos , Coorte de NascimentoRESUMO
OBJECTIVES: To estimate the prevalence of allergic rhinitis (AR), atopic dermatitis (AD), and wheezing, and to describe their patterns of co-occurrence according to different characteristics in adolescence and early adulthood. METHODS: Cross-sectional analyses from the 15-year and 22-year follow-ups of the 1993 Pelotas (Brazil) Birth Cohort. The outcomes were assessed based on self-reported data, and the patterns of co-occurrence were determined using cluster analysis. The sample was described using absolute and relative frequencies according to the independent variables. Venn diagrams were generated to visualize the co-occurrence of AR, AD, and wheezing. RESULTS: Data on AR, AD, and wheezing were available for 4,286 participants at 15 years and 3,789 at 22 years. At 15 years, AR was reported by 20.9% of participants, AD by 25.2%, and wheezing by 33.4%. Meanwhile, at 22 years, AR was reported by 24.6%, AD by 14.2%, and wheezing by 30.7%. Notably, the overlap between AR and wheezing was greater than that of the other conditions (6.9% at 15 years and 8.3% at 22 years). Participants with lower maternal education and lower income were more likely to report having "no health condition". At 15 years, White individuals most frequently reported "three conditions" (4.1%; p<0.001), whereas at 22 years, they primarily reported "two conditions" (15.6%; p<0.001). The co-occurrence of all three health conditions was found to be greater than expected, with an observed rate 2.1 times higher (95% CI 1.4 - 3.0) at 22 years. CONCLUSIONS: This study highlights the social gradient in the diagnosis and reporting of co-occurrence of AR, AD, and wheezing.
Assuntos
Dermatite Atópica , Sons Respiratórios , Rinite Alérgica , Fatores Socioeconômicos , Humanos , Sons Respiratórios/etiologia , Brasil/epidemiologia , Dermatite Atópica/epidemiologia , Feminino , Masculino , Adolescente , Adulto Jovem , Prevalência , Rinite Alérgica/epidemiologia , Estudos Transversais , Coorte de Nascimento , Fatores de RiscoRESUMO
BACKGROUND: Paediatric tuberculosis leads to more than 200â000 deaths annually. We aimed to investigate the incidence of Mycobacterium tuberculosis infection and tuberculosis disease in the first decade of life in the Drakenstein Child Health Study (DCHS), a South African cohort in a community with high tuberculosis and HIV incidence. METHODS: In this prospective birth cohort study, we enrolled pregnant women aged 18 years or older who were between 20 and 28 weeks' of gestation in a peri-urban setting outside of Cape Town, South Africa. We followed up their children for tuberculosis until age 10 years. To measure M tuberculosis infection tuberculin skin tests were administered to children at age 6 months, 12 months, and then annually in children with a negative test, and at the time of a lower respiratory tract infection. Tuberculin skin test conversion was defined by an induration reaction of 10 mm or more. To measure tuberculosis disease, active surveillance was done throughout follow-up. Each episode of presumed tuberculosis disease was investigated using sputum induction, tested with Xpert MTB/RIF and liquid culture for M tuberculosis. Survival analyses were performed and multivariable Cox regression was used to measure factors associated with M tuberculosis infection or disease. FINDINGS: Between March 5, 2012, and March 31, 2015, 1137 women and their 1143 children (248 [21·7%] of 1143 children were HIV-exposed, two [0·2%] children with HIV) were included in the analysis. Children were followed up for 8870 person-years (median follow-up 9·1 years [IQR 8·2-10·2]). The annual risk of tuberculin conversion during follow-up was 6·6 infections per 100 person-years (95% CI 5·8-7·3) but ranged from 4-9 infections per 100 person-years over the follow-up period. 98 children developed tuberculosis (1105 cases per 100â000 person-years; 95% CI 906-1347). The cumulative hazard of tuberculin conversion was 36% (95% CI 32-41) at age 8 years and the cumulative hazard of tuberculosis disease was 10% (8-12) at age 10 years. Preventive treatment was associated with a reduction in tuberculosis disease among children who had tuberculin conversion (adjusted hazard ratio 0·23 [95% CI 0·12-0·47]). Most cases of tuberculosis disease (78 [79%; 95% CI 69-86] of 98 children) occurred among children who had tuberculin skin test conversion but were not administered preventive treatment. INTERPRETATION: In this prospective South African birth cohort, M tuberculosis transmission was consistently high throughout the first decade of life leading to approximately 10% of children developing tuberculosis disease. A multipronged approach to decrease paediatric tuberculosis is needed that combines preventive treatment for children at risk, reducing community M tuberculosis transmission, and active case finding. FUNDING: Bill & Melinda Gates Foundation, Medical Research Council South Africa, and National Research Foundation South Africa.
Assuntos
Mycobacterium tuberculosis , Tuberculose , Humanos , África do Sul/epidemiologia , Feminino , Pré-Escolar , Criança , Estudos Prospectivos , Lactente , Masculino , Incidência , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose/epidemiologia , Tuberculose/diagnóstico , Teste Tuberculínico , Coorte de Nascimento , Infecções por HIV/epidemiologia , Infecções por HIV/complicações , Gravidez , Adulto , AdolescenteRESUMO
BACKGROUND: Giardia lamblia is an intestinal protozoan estimated to cause ~200 million symptomatic infections annually, mainly in children in low- and middle-income countries associated with intestinal damage, increased permeability, and malabsorption. METHODS AND RESULTS: We describe here the epidemiology, incidence, clinical characteristics, and risk factors of acute gastroenteritis episodes (AGE) with G. lamblia detection (GAGE) using a birth cohort of 443 Nicaraguan children followed weekly until 36 months of life. From June 2017 to July 2021, 1385 AGE samples were tested by qPCR. G. lamblia was detected in 104 (7.5%) of AGE episodes. In all, 69 (15.6%) children experienced at least one GAGE episode, and 25 of them (36.2%) experienced more than one episode. The incidence rate of the first episode of GAGE was 6.8/100 child-years (95% CI, 4.5-9.1). During GAGE, bloody stools, vomiting, and fever were uncommon, and children were less likely to be treated at a primary care clinic, suggesting that GAGE is typically mild and most cases did not receive medical attention, which could facilitate higher parasite loads with increased possibilities of establishing chronic carriage. GAGE was more common in children 12-24 months of age (13.9/100 child-years [95% CI, 10.7-17.1]) as compared to other age groups. In our birth-cohort, children living in a home with an indoor toilet (aHR, 0.52 [95%CI, 0.29-0.92]), and being breastfed in the first year of life (aHR: 0.10 [95%IC, 0.02, 0.57]) had a lower incidence of GAGE. In contrast, being breastfed for ≤ 6 months was associated with a higher incidence if the children were living in houses without indoor toilets and earthen floors (HR, 7.79 [95% CI, 2.07, 29.3]). CONCLUSION: Taken together, GAGE is more frequent under poor household conditions. However, breastfeeding significantly reduces the incidence of GAGE in those children.
Assuntos
Gastroenterite , Giardia lamblia , Giardíase , Humanos , Nicarágua/epidemiologia , Giardíase/epidemiologia , Giardia lamblia/isolamento & purificação , Lactente , Masculino , Feminino , Pré-Escolar , Fatores de Risco , Gastroenterite/epidemiologia , Gastroenterite/parasitologia , Incidência , Coorte de Nascimento , Recém-Nascido , Fezes/parasitologia , Doença Aguda/epidemiologiaRESUMO
Importance: There is no longitudinal evidence on risk factors for gang membership in low- and middle-income countries, despite organized crime groups posing major challenges, including high homicide rates in Latin America. Furthermore, adverse childhood experiences (ACEs) have been largely overlooked in gang-related research worldwide. Objectives: To examine the associations of ACEs up to 15 years of age with past-year gang membership at 18 years of age and to compare crime and criminal justice involvement between gang members and non-gang members. Design, Setting, and Participants: This cohort study assessed children from the 1993 Pelotas (Brazil) Birth Cohort-an ongoing population-based, prospective study. Assessments were undertaken perinatally (1993) and when the children were ages 11 (2004), 15 (2008), 18 (2011), and 22 (2015) years. All children born in 1993 were eligible (N = 5265), and 5249 (99.7%) were enrolled at birth. The study sample (N = 3794 [72.1%]) included those with complete data on ACEs. Data analyses were conducted from February to August 2024. Exposures: Twelve ACEs were assessed up to 15 years of age via child self-report and/or maternal report, including physical neglect, physical abuse, emotional abuse, sexual abuse, domestic violence, maternal mental illness, parental divorce, ever being separated from parents, parental death, poverty, discrimination, and neighborhood fear. These experiences were examined using a single adversity approach, cumulative risk, and latent classes. Main Outcomes and Measures: The main outcome was past-year gang membership at 18 years of age, assessed via self-report and analyzed using multivariate imputation. Results: Of 3794 participants, 1964 (51.8%) were female and 1830 (48.2%) were male, and 703 (18.5%) were Black, 2922 (77.0%) were White, and 169 (4.5%) were coded as "other" race or ethnicity (no additional details are available to further disaggregate the other category). On the basis of the imputed data, 1.6% (SE, 0.2 percentage points) of participants reported gang membership at 18 years of age. Physical abuse (odds ratio [OR], 2.76; 95% CI, 1.27-5.98), emotional abuse (OR, 2.76; 95% CI, 1.51-5.02), domestic violence (OR, 3.39; 95% CI, 1.77-6.48), parental divorce (OR, 2.04; 95% CI, 1.17-3.54), and separation from parents (OR, 3.13; 95% CI, 1.54-6.37) were associated with an increased risk of gang membership. A dose-response association was observed, with 4 or more ACEs increasing the risk (OR, 8.86; 95% CI, 2.24-35.08). In latent class analysis, the class with child maltreatment and household challenges was associated with a higher risk of gang membership than the low-adversities class (OR, 7.10; 95% CI, 2.37-21.28). There was no robust evidence that children exposed to household challenges and social risks were at increased risk of gang membership (OR, 2.28; 95% CI, 0.46-11.25). Conclusions and Relevance: In this prospective cohort study, ACEs, particularly child maltreatment and family conflict, were associated with gang involvement when examined individually, cumulatively, and as clusters in a high-crime environment in Brazil. These findings underscore the value of integrating the ACE framework into gang-related research and the potential to reduce gang-related crime by reducing ACEs.
Assuntos
Experiências Adversas da Infância , Humanos , Brasil/epidemiologia , Feminino , Masculino , Fatores de Risco , Prevalência , Experiências Adversas da Infância/estatística & dados numéricos , Criança , Adolescente , Estudos Prospectivos , Coorte de Nascimento , Grupo Associado , Crime/estatística & dados numéricos , Delinquência Juvenil/estatística & dados numéricos , Estudos de CoortesRESUMO
BACKGROUND: Continued breastfeeding reduces infant mortality and provides nutritional, immunological, and developmental benefits for the child. OBJECTIVES: A prospective cohort study conducted in 2015 followed 608 children who were breastfed between 6 and 24 months. The study assessed the risk of breastfeeding interruption at 12, 18, and 24 months, as well as the factors associated with this outcome, in a cohort of newborns in Rio Branco, using the life table method. METHODS: The factors associated with breastfeeding cessation and their 95% confidence intervals (CI95%) were analyzed using both crude and adjusted Cox proportional hazards regression in a hierarchical model. The risks of breastfeeding cessation at 12, 18, and 24 months were 19%, 65%, and 71%, respectively. RESULTS: Factors positively associated with the risk of breastfeeding cessation include the use of a pacifier before 6 weeks of age (HR = 1.62; CI: 95% 1.24-2.11) and the use of a bottle during the first year of life (HR = 1.41; CI: 95% 1.11-1.78). Maternal return to work after the birth of the baby (HR = 0.78; CI: 95% 0.62-0.97) was found to be negatively associated with the risk of breastfeeding interruption. CONCLUSIONS: Early pacifier use before 6 weeks and the introduction of a bottle in the first year affect continued breastfeeding. Maternal employment was associated with reduced risk of breastfeeding cessation, contrary to most studies.
Assuntos
Aleitamento Materno , Chupetas , Humanos , Aleitamento Materno/estatística & dados numéricos , Brasil/epidemiologia , Feminino , Lactente , Estudos Prospectivos , Chupetas/estatística & dados numéricos , Masculino , Recém-Nascido , Adulto , Fatores de Risco , Coorte de Nascimento , Alimentação com Mamadeira/estatística & dados numéricos , Modelos de Riscos Proporcionais , Pré-Escolar , Adulto Jovem , Estudos de CoortesRESUMO
OBJECTIVES: Diabetes prevalence has increased markedly in Mexico. We examined the individual and joint contributions of economic disadvantage during childhood (EDDC) and elevated body weight on diabetes prevalence in 3 cohorts of Mexican adults. METHODS: Data on those 60-69 years old from the 1930-1939, 1940-1949, and 1950-1959 birth cohorts in Waves 1 (2001), 3 (2012), and 5 (2018) of the Mexican Health and Aging Study were used. EDDC was defined as the absence of a toilet in the household before age 10. Body mass status was defined using self-reported perceived body image at age 50. Diabetes was based on respondent reports. Supplementary analyses using HbA1c as a criterion for diabetes were conducted. A regression-decomposition approach was implemented. Logistic regression models included adjustments for sociodemographic characteristics and access to medical care. RESULTS: Diabetes prevalence was 23% overall and 11%, 25%, and 26% in the 1930-1939, 1940-1949, and 1950-1959 cohorts, respectively. EDDC declined across successive cohorts, whereas the prevalence of overweight/obesity at age 50 increased. EDDC and overweight/obesity were associated with higher odds of reporting diabetes. A scenario that eliminates disadvantaged EDDC reduced diabetes prevalence by 11% in a pooled sample, while eliminating overweight/obesity reduced it by 30%. Overweight/obesity explained 42% of the rise in diabetes prevalence between the 1930-1939 and 1950-1959 cohorts. Improvement in EDDC explained 18% of the rise in diabetes prevalence between 1930-1939 and 1950-1959 cohorts. DISCUSSION: High body weight across Mexican birth cohorts seemed to offset the potential benefits from improvements in childhood conditions on adult diabetes risk.
Assuntos
Diabetes Mellitus , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Idoso , México/epidemiologia , Diabetes Mellitus/epidemiologia , Prevalência , Obesidade/epidemiologia , Coorte de Nascimento , Índice de Massa Corporal , Experiências Adversas da Infância/estatística & dados numéricos , Sobrepeso/epidemiologia , Pobreza/estatística & dados numéricos , População Norte-AmericanaRESUMO
BACKGROUND: In Brazil, the prevalence of mental disorders is heterogeneous, with most studies conducted in large cities with high population density. This study aimed to assess the prevalence of mental disorders and psychiatric comorbidities among young adults (22-23 years old) and adults (37-38 years old) from Ribeirão Preto, a city located in the Northeast of the São Paulo state, with approximately 700,000 inhabitants, and to explore associations with sociodemographic variables, suicide risk, and health service usage. Second, we aimed to evaluate the performance of the Self-Report Questionnaire (SRQ-20) as a screening tool for mental disorders to be applied to the local population. METHODS: Participants from the 1978/1979 and 1994 Ribeirão Preto birth cohorts were evaluated using the Mini International Neuropsychiatric Interview (MINI) and the SRQ-20 at mean ages of 22-23, and 37-38 years, respectively. RESULTS: Our sample comprised 1,769 individuals from the 1978/1979 cohort and 1,037 from the 1994 cohort. The prevalence of mental disorders ranged from 28.6% (1978/79) to 31% (1994), with frequent comorbid diagnoses (42.7% and 43.3%, respectively). Men and women had a similar prevalence of mental disorders in the younger cohort, while women had a higher prevalence in the older cohort. Low educational attainment was associated with higher rates of diagnosis. In both cohorts, alcohol and other psychoactive substance use was higher among those with a psychiatric diagnosis. Although those with a psychiatric diagnosis were less satisfied with their own health, only one-fifth had seen a mental health professional in the previous year. A psychiatric diagnosis increased the suicide risk by 5.6 to 9.1 times. Regarding the SRQ-20, the best cutoff points were 5/6 for men and 7/8 for women, with satisfactory performance. CONCLUSIONS: The prevalence and comorbidity of mental disorders were high in both cohorts and comparable to those in larger Brazilian cities. However, few individuals with a diagnosis had sought specialized care. These data suggest that the mental health gap is still significant in Brazil.
Assuntos
Transtornos Mentais , Humanos , Brasil/epidemiologia , Feminino , Adulto , Masculino , Transtornos Mentais/epidemiologia , Estudos Transversais , Adulto Jovem , Prevalência , Coorte de Nascimento , Comorbidade , Inquéritos e QuestionáriosRESUMO
This study aimed to investigate the association between child maltreatment and human capital, measured by intelligence quotient (IQ) at age 18 years and schooling at age 22 years in 3,736 members from a population-based birth cohort in Southern Brazil. A multiple linear regression was used to assess the association between child maltreatment and human capital measurements. Physical and emotional abuse and physical neglect occurring up to 15 years of age were considered child maltreatment. Physical neglect was associated with lower IQ scores in women (ß = -4.40; 95%CI: -6.82; -1.99) and men (ß = -2.58; 95%CI: -5.17; -0.01) and lower schooling for all sexes: women (ß = -1.19; 95%CI: -1.64; -0.74) and men (ß = -0.82; 95%CI: -1.34; -0.30). Moreover, men who had experienced one type of child maltreatment and women who had experienced two or more types had lower years of schooling at 22 years (ß = -0.41; 95%CI: -0.73; -0.89 and ß = -0.57; 95%CI: -0.91; -0.22, respectively) than those who suffered no kind of maltreatment. Efforts to improve future educational and cognitive outcomes must include early prevention and intervention strategies for child maltreatment.
Assuntos
Maus-Tratos Infantis , Escolaridade , Humanos , Feminino , Masculino , Maus-Tratos Infantis/estatística & dados numéricos , Brasil/epidemiologia , Adolescente , Criança , Adulto Jovem , Coorte de Nascimento , Fatores Socioeconômicos , Inteligência , Pré-Escolar , Fatores Sexuais , Lactente , Estudos de Coortes , Fatores de RiscoRESUMO
BACKGROUND: Limited research has explored the course of harsh parenting practices throughout childhood and adolescence and its impact on socioemotional competences from a longitudinal perspective. This study examined the association between harsh parenting trajectories and socioemotional competences at age 18. METHODS: Data from the 2004 Pelotas (Brazil) Birth Cohort study, originally comprising 4231 live births, were used. Harsh parenting was measured using the parent-report version of the Parent-Child Conflict Tactics Scale at ages 6, 11, 15 and 17 years, and trajectories were identified using a group-based modelling approach. Socioemotional competences were emotion regulation, assessed by the Emotional Regulation Index for Children and Adolescents; self-esteem, measured by the self-report Rosenberg Self-esteem Scale; prosocial behaviour and peer relationship problems, both assessed by the Strengths and Difficulties Questionnaire. Multivariate linear and Poisson regression models were applied to examine the effects of harsh parenting trajectories on socioemotional competences, adjusting for confounding variables. RESULTS: We identified three trajectories: a "low harsh parenting" trajectory (49.7 %), a "moderate harsh parenting" (44.7 %), and a "high harsh parenting" trajectory (5.6 %). Compared to those belonging to the low harsh parenting trajectory group, adolescents who experienced either a moderate or high harsh parenting trajectory exhibited lower scores in emotion regulation, self-esteem, and prosocial behaviour scales, along with higher scores of peer relationships problems. LIMITATIONS: Data on harsh parenting at 15 and 17 years were available only for a sub-sample. CONCLUSIONS: Our study extends the evidence of the adverse effects of persistent harsh parenting on socioemotional competences during adolescence.
Assuntos
Poder Familiar , Autoimagem , Humanos , Poder Familiar/psicologia , Adolescente , Feminino , Masculino , Criança , Brasil , Relações Pais-Filho , Coorte de Nascimento , Regulação Emocional , Estudos Longitudinais , Comportamento Social , Estudos de Coortes , Habilidades Sociais , Grupo AssociadoRESUMO
Background: Women's health and well-being (WHW) have been receiving growing attention, but limited progress has been made on how to measure its different domains in low- and middle-income countries (LMICs). We used data from five long-term birth cohorts in Brazil, Guatemala, the Philippines and South Africa to explore different domains of adult WHW, and how these domains relate to early life exposures. Methods: Based upon an a priori conceptualisation of eight postulated WHW outcomes available in the data, we grouped them as follows: human capital (intelligence quotient, schooling, height, and teenage childbearing), metabolic health (body mass index and metabolic syndrome score), and psychological (happiness and Self-Reported Questionnaire (SRQ) scores). Correlation analyses confirmed the variables theoretically belonging to the same dimension of WHW were statistically related. We then applied principal component analysis to each group of variables separately and used the first principal component as a summary quantitative measure of the corresponding WHW dimension. Finally, we assessed the association of each domain with a range of early-life factors: wealth, maternal education, maternal height, water, and sanitation, birthweight, length at two years and development quotient in mid-childhood. Results: The three domains were largely uncorrelated. Early determinants were positively associated with human capital, while birth order was negatively associated. Fewer associations were found for the metabolic or psychological components. Birthweight and weight at age two years were inversely associated with metabolic health. Maternal education was associated with better psychological health. Conclusions: Our findings indicate that WHW is multidimensional, with most women in the cohorts being compromised in one or more domains while few women scored highly in all three domains. Our analyses are limited by lack of data on adolescent exposures and on other relevant WHW dimensions such as safety, agency, empowerment, and violence. Further research is needed in LMICs for identifying and measuring the multiple domains of WHW.
Assuntos
Países em Desenvolvimento , Saúde da Mulher , Humanos , Feminino , Adulto , Filipinas/epidemiologia , Brasil/epidemiologia , Guatemala , África do Sul , Coorte de Nascimento , Adolescente , Adulto Jovem , Estudos de Coortes , Fatores SocioeconômicosRESUMO
BACKGROUND: Homicide is the leading cause of death among young people in Latin America, one of the world's most violent regions. Poverty is widely considered a key cause of violence, but theories suggest different effects of poverty, depending on when it is experienced in the life-course. Longitudinal studies of violence are scarce in Latin America, and very few prospective data are available worldwide to test different life-course influences on homicide. METHODS: In a prospective birth cohort study following 5914 children born in southern Brazil, we examined the role of poverty at birth, in early childhood, and in early adulthood on violence and homicide perpetration, in criminal records up to age 30 years. A novel Structured Life Course Modelling Approach was used to test competing life-course hypotheses about 'sensitive periods', 'accumulation of risk', and 'downward mobility' regarding the influence of poverty on violence and homicide. RESULTS: Cumulative poverty and poverty in early adulthood were the most important influences on violence and homicide perpetration. This supports the hypothesis that early adulthood is a sensitive period for the influence of poverty on lethal and non-lethal violence. Results were replicable using different definitions of poverty and an alternative outcome of self-reported fights. CONCLUSION: Cumulative poverty from childhood to adulthood was an important driver of violence and homicide in this population. However, poverty experienced in early adulthood was especially influential, suggesting the importance of proximal mechanisms for violence in this context, such as unemployment, organized crime, drug trafficking, and ineffective policing and justice systems.
Assuntos
Homicídio , Pobreza , Violência , Humanos , Homicídio/estatística & dados numéricos , Brasil/epidemiologia , Pobreza/estatística & dados numéricos , Masculino , Feminino , Violência/estatística & dados numéricos , Adulto , Estudos Prospectivos , Adolescente , Criança , Adulto Jovem , Pré-Escolar , Coorte de Nascimento , Fatores de Risco , Fatores Socioeconômicos , Lactente , Estudos LongitudinaisRESUMO
OBJECTIVE: To evaluate in a rural Tanzanian birth cohort the association between birth timing in relation to the preharvest lean season and early-life growth and cognitive development. STUDY DESIGN: Children were enrolled within 14 days of birth and followed up for 18 months. Child anthropometry was measured every 3 months. The Malawi Developmental Assessment Test was administered at the end of follow-up. We estimated the association between timing of birth in the context of other early childhood risk factors and both growth and Malawi Developmental Assessment Test scores. RESULTS: Children born in the preharvest months September and October had the lowest cognitive scores at 18 months, compared with birth in July and August (-1.05 change in overall Malawi Developmental Assessment Test development-for-age Z score, 95% CI: -1.23, -0.86). This association was observed for the language (-1.67 change in development-for-age Z score; 95% CI: -1.93, -1.40) and fine motor subcomponent scores (-1.67; 95% CI: -1.96, -1.38) but not for gross motor (-0.07; 95% CI: -0.23, 0.10) or social subcomponents (-0.07; 95% CI: -0.23, 0.10). Children born in September and October were the longest at birth but had the largest declines in growth Z scores during the first 6 months. CONCLUSIONS: There was a strong association between birth at the beginning of the preharvest season and poor growth and cognitive development. If these associations were mediated by the preharvest postnatal environment, targeted maternal and child interventions for children born during high-risk periods may improve these outcomes. TRIAL REGISTRATION: NCT03268902 (https://clinicaltrials.gov/study/NCT03268902).
Assuntos
Desenvolvimento Infantil , Cognição , Estações do Ano , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Coorte de Nascimento , Desenvolvimento Infantil/fisiologia , Cognição/fisiologia , Seguimentos , Desnutrição , Fatores de Risco , Tanzânia/epidemiologiaRESUMO
OBJECTIVE: To analyze COVID-19 vaccine uptake in children and to investigate factors associated with two outcomes variables: (a) not even beginning; (b) not completing the COVID-19 vaccine series. METHODS: We used data of children aged 6-7 years from the 2015 Pelotas c Birth Cohort Study. COVID-19 vaccination status was collected from immunization cards and National Immunization Program Information System. Adjusted analyses were performed using a hierarchical model to identify factors associated with the two study outcomes. RESULTS: Among 3867 children, 20.7 % (95 % CI, 19.5 %-22.0 %) did not even begin the 2-dose primary COVID-19 vaccine series, and 28.2 % (95 % CI, 26.6 %-29.8 %) did not complete the series with the second dose. Children not even beginning the COVID-19 vaccine series were more likely to have a White mother, not to have obesity, to have a history of COVID-19 infection, to have received non-recommended drugs for COVID-19, to be afraid of needles, and to have an incomplete diphtheria-tetanus-pertussis (DTP) and poliovirus immunization schedule. Not completing the 2-dose series was associated with lower maternal age and education, mother's self-identification as White or Brown, lower household income, lack of access to health services, not having completed the DTP and poliovirus immunization schedule and living with a person with a history of infection with COVID-19. CONCLUSION: The results highlight a vaccine-hesitant parents' group who chose not beginning the COVID-19 vaccine series of their children and, another group of parents who failure to complete the child's series due to difficulty accessing health services.
Assuntos
Coorte de Nascimento , Vacinas contra COVID-19 , COVID-19 , Humanos , Criança , Feminino , COVID-19/prevenção & controle , COVID-19/epidemiologia , Vacinas contra COVID-19/administração & dosagem , Masculino , Brasil/epidemiologia , Vacinação/estatística & dados numéricos , SARS-CoV-2/imunologia , Programas de Imunização/estatística & dados numéricos , Esquemas de Imunização , Cobertura Vacinal/estatística & dados numéricos , Estudos de CoortesRESUMO
Birth cohort studies across the world have yielded information that has been used to inform policy and programme decisions that have improved the health and well-being of populations. A few such studies have been conducted in low- and middle-income countries due to funding, methodological and other challenges. This paper briefly reviews the methods of comprehensive birth cohort studies with extensive follow-up of participants through the life course conducted in low- and middle-income countries. It then reviews the first Jamaican birth cohort study of 1986 and discusses the methodological advances in implementing JA KIDS, the second Jamaican birth cohort study conducted in 2011. The aims and methods of JA KIDS are described in detail.