The specific and combined role of domestic violence and mental health disorders during pregnancy on new-born health.

BACKGROUND: Addressing impaired foetal growth is recognized as a public health priority. Certain risk factors for this condition, such as poor nutritional status at birth, have been found to be highly correlated with poverty. However, the role of psychosocial factors, specifically the mother's mental health and exposure to violence during pregnancy, have yet to be further explored. Our objective was to determine if there is a measurable association between combined psychosocial factors, specifically domestic violence and mental disorders, and birth outcomes, specifically birth nutritional status and preterm delivery. METHODS: We followed 775 women from an underserved, urban area, beginning their 28th week of gestation. Diagnostic interviews were performed to determine if any of the mothers had any of the following disorders: mood disorder, anxiety, obsessive-compulsive disorder (OCD), substance dependence, psychotic disorder, or anti-social personality disorder. Physical, psychological, and sexual domestic violence were also assessed. RESULTS: Domestic violence and mental disorders were highly correlated in our sample. About 27.15% of the women in our study experienced domestic violence, and about 38.24% of them were diagnosed with mental disorders. The main association we found between combined psychosocial factors and neonate outcomes was between anxiety (IRR = 1.83; 95%CI = 1.06-3.17)/physical violence (IRR = 1.95; 95%CI = 1.11-3.42) and the rate of small-for-gestational age (SGA) in new-borns. More specifically, the combination of anxiety (beta = -0.48; 95%CI = -0.85/-0.10) and sexual violence (beta = -1.58; 95%CI = -2.61/-0.54) was also associated with birth length. Maternal risk behaviours such as smoking, drinking, inadequate prenatal care, and inadequate weight gain could not sufficiently explain these associations, suggesting that these psychosocial factors may be influencing underlying biological mechanisms. CONCLUSION: Domestic violence against women and mental disorders amongst pregnant women are extremely prevalent in under-resourced, urban areas and ultimately, have detrimental effects on birth outcomes. It is imperative that actions be taken to prevent violence and improve mental health during pregnancy.

Causal Pathways Between the Acute Experience of Violence During Pregnancy and Fetal Intrauterine Growth Restriction: A Cohort Study.

Introduction: Violence during pregnancy (VDP) is a prevalent global issue with dire consequences for the mother and the developing fetus. These consequences include prematurity, low birthweight, and intrauterine growth restriction (IUGR), but its pathways remain elusive. This study investigated the causal pathways between VDP and IUGR using mediation analysis. Methods: A prospective population-based birth cohort was followed from the beginning of the third gestational trimester to the second year of life. IUGR was defined by the Kramer index, and information on VDP was collected using the WHO-Violence Against Women (WHO VAW) questionnaire. Cases were considered positive only when no other life episodes were reported. Ten different mediators were analyzed as possible pathways based on previous research. Path analysis was conducted to evaluate these relationships. Results: The path analysis model included 755 dyads and presented an adequate fit. Violence during pregnancy showed a direct effect (ß = -0.195, p = 0.041) and a total effect (ß = -0.276, p = 0.003) on IUGR. Violence was associated with gestational depression or anxiety, tobacco and alcohol consumption, changes in blood pressure, and the need for emergency care, but these did not constitute mediators of its effect on IUGR. The sum of the indirect effects, however, showed a significant association with IUGR (ß = -0.081, p = 0.011). Conclusion: The acute experience of violence during pregnancy was associated with IUGR, primarily via a direct pathway. An indirect effect was also present but not mediated through the variables analyzed in this study. The robust strength of these associations underscores the negative health consequences of violence against women for the succeeding generation.

Mother-infant bonding and postpartum depression during the COVID-19 pandemic - a risk for nurturing care and child development.

OBJECTIVE: The COVID-19 pandemic Increased the risk of impairing the mother-infant bonding. The objectives of this study were to evaluate the early bond established between mother and infant and postpartum depression (PPD) in pregnancies that occurred during the pandemic period, to identify the factors that may have influenced these outcomes and to verify if there was an association between bonding and probable PPD. METHODS: This is a cross-sectional study of postpartum women from a public maternity hospital in the city of São Paulo conducted from February to June 2021, involving 127 mother-baby dyads. The initial data were collected in the immediate postpartum period and between 21-45 days after birth, using a semi-structured questionnaire on sociodemographic characteristics, gestational and birth conditions, and baby characteristics; the Edinburgh Postnatal Depression Scale (EPDS) and Postpartum Bonding Questionnaire (PBQ) were used to evaluate PPD and bonding, respectively. RESULTS: The presence of probable PPD and unplanned pregnancies were associated with higher PBQ score and risk to impaired bonding (p = 0.001 and p = 0.004, respectively). EPDS showed a high prevalence of PPD (29.1%) and was not associated with any Studied variable. Probably, this high prevalence of probable PPD was due to the context of insecurity secondary to the pandemic. CONCLUSIONS: We observed an increase in the prevalence of probable PPD and unplanned pregnancies during the first 18 months of the pandemic, which were associated with worse scores in mother-infant bonding. The impaired bond can affect the future development of children born during this period.

Assessment of school readiness and the importance of executive functions for learning.

OBJECTIVE: Considering the importance of the beginning of the academic trajectory for children to reach their full development, this work aims to evaluate the school readiness of preschool-age children and identify which factors influence these results, in order to contribute to the proposition of strategies that allow improving the teaching-learning process and child development. METHODS: This is a cross-sectional, descriptive and analytical study with 443 preschool children belonging to the West Region Cohort (ROC Cohort), from the public school system of the city of São Paulo. School readiness was assessed by the International Development and Early Learning Assessment (IDELA) tool. Non-parametric techniques were used for the correlation analysis between IDELA scores and sociodemographic and socioeconomic conditions: Spearman's parametric correlation, Mann-Whitney and Kruskal-Wallis tests. RESULTS: The children's mean age was 69 months (standard deviation - SD=2.8; ranging from 55 to 72 months) and most of them came from families with low socioeconomic level. Most children showed adequate readiness in the overall score (65%) and in most domains, except for emergent literacy, in which most (56.9%) were classified as "emergent". The highest percentage of insufficiency was identified in executive functions (4.1%), which showed a correlation only with the caregiver's education. CONCLUSIONS: Children had adequate school readiness scores, except for emergent literacy, but the insufficiency in executive functions may compromise the future schooling of these children. Thus, pedagogical proposals should consider these aspects for learning and pediatricians need to reinforce the habit of reading and playing games to stimulate child development.

Non-communicable diseases, sociodemographic vulnerability and the risk of mortality in hospitalised children and adolescents with COVID-19 in Brazil: a cross-sectional observational study.

OBJECTIVES: To analyse how previous comorbidities, ethnicity, regionality and socioeconomic development are associated with COVID-19 mortality in hospitalised children and adolescents. DESIGN: Cross-sectional observational study using publicly available data from the Brazilian Ministry of Health. SETTING: Nationwide. PARTICIPANTS: 5857 patients younger than 20 years old, all of them hospitalised with laboratory-confirmed COVID-19, from 1 January 2020 to 7 December 2020. MAIN OUTCOME MEASURE: We used multilevel mixed-effects generalised linear models to study in-hospital mortality, stratifying the analysis by age, region of the country, presence of non-communicable diseases, ethnicity and socioeconomic development. RESULTS: Individually, most of the included comorbidities were risk factors for mortality. Notably, asthma was a protective factor (OR 0.4, 95% CI 0.24 to 0.67). Having more than one comorbidity increased almost tenfold the odds of death (OR 9.67, 95% CI 6.89 to 13.57). Compared with white children, Indigenous, Pardo (mixed) and East Asian had significantly higher odds of mortality (OR 5.83, 95% CI 2.43 to 14.02; OR 1.93, 95% CI 1.48 to 2.51; OR 2.98, 95% CI 1.02 to 8.71, respectively). We also found a regional influence (higher mortality in the North-OR 3.4, 95% CI 2.48 to 4.65) and a socioeconomic association (lower mortality among children from more socioeconomically developed municipalities-OR 0.26, 95% CI 0.17 to 0.38) CONCLUSIONS: Besides the association with comorbidities, we found ethnic, regional and socioeconomic factors shaping the mortality of children hospitalised with COVID-19 in Brazil. Our findings identify risk groups among children that should be prioritised for public health measures, such as vaccination.

PEDIATRICIANS AFTER RESIDENCY: A SURVEY OF PERSONAL/PROFESSIONAL DATA AND ISSUES.

OBJECTIVE: To assess personal, professional, medical, and scientific educational characteristics and issues reported by pediatricians. METHODS: Cross-sectional study based on an online survey including 614 pediatricians who graduated in the last 15 years at a University Pediatric Department in Brazil. RESULTS: The response rate was 331/614(54%). The majority were females (82%), the median age was 33 years (27-40) and median years of pediatric practice was 5 (1-13). High workload (>60 hours/week) occurred in 25% and 47% earned ≥15 minimum wages/month. The most work-related issues reported were long working hours, poor social life and a sedentary lifestyle (>50%). Pediatricians were further divided into two groups, according to years of pediatric clinical practice: group 1 (≤5 years) and group 2 (>5 years). The median of overall satisfaction with pediatric residency [8(0-10) vs. 9 (4-10); p=0.002] was significantly reduced in group 1. The frequencies of workload >60 hours, work on pediatric ward and pediatric intensive care were significantly higher in the first group (p<0.05). Regarding main issues related to clinical practice in the last year, long working hours (73 vs. 53%; p<0.001), poor social life (75 vs. 62%; p=0.018) and harassment (23 vs. 4%; p=0.003) were significantly higher in the first group. CONCLUSIONS: Very early career pediatricians (≤5 years) reported higher workload, lower income, work-related issues and different location of pediatric practice compared to early career pediatricians (>5 years). The overall satisfaction with pediatric residency was good, however, reduced in very early career pediatricians.

Profile of health professionals who completed a master's, doctoral, or post-doctoral degree in one Brazilian pediatric program.

OBJECTIVE: This study aimed to determine the personal and professional characteristics, and the physical, psychiatric/psychological, and professional issues that exist among master's-, doctoral-, and post-doctoral-level health professionals. METHODS: A cross-sectional, online, self-reported survey of 452 postgraduates who completed master's, doctoral, or post-doctoral degrees in one graduate program in pediatrics in São Paulo, Brazil, was conducted. RESULTS: The response rate was 47% (211/453). The majority of participants were women (78%) and physicians (74%), and the median age was 47 years (28-71). Master's, doctoral, and post-doctoral degrees were reported by 73%, 53%, and 3%, respectively. High workload (>40 hours/week) occurred in 59%, and 45% earned ≥15 minimum wages/month. At least one participation in scientific meeting in the past year was reported by 91%, and 79% had published their research. Thirty-nine percent served as a member of a faculty of an institution of higher learning. The data were analyzed by two age groups: participants aged ≤48 years (group 1) and participants aged >48 years (group 2). The median rating of overall satisfaction with the profession in the past year [8 (0-10) vs. 9 (1-10), p=0.0113]; workload >40 hours/week (53% vs. 68%, p=0.034); and ≥15 minimum wages/month (37% vs. 56%, p=0.0083) were significantly lower in group 1. Further analysis by gender revealed that the median rating of overall satisfaction with the profession in the past year [8 (0-10) vs. 9 (3-10), p=0.0015], workload >40 hours/week (53% vs. 83%, p=0.0002), and ≥15 minimum wages/month (37% vs. 74%, p=0.0001) were significantly lower in women compared with men. The median rating of overall satisfaction with the mentorship supervision provided was significantly higher among the women 10 (5-10) vs. 10 (2-10), p=0.0324]. CONCLUSIONS: The majority of master's-, doctoral-, and post-doctoral-level health professionals were women and physicians, and had published their thesis. Younger postgraduates and women reported low salaries, less likelihood of working >40 hours/week, and less overall satisfaction with their profession. Further longitudinal and qualitative studies are warranted to assess career trajectories after graduation.

Assessment of school readiness and the importance of executive functions for learning / Avaliação da prontidão escolar e a importância das funções executivas para o aprendizado

ABSTRACT Objective: Considering the importance of the beginning of the academic trajectory for children to reach their full development, this work aims to evaluate the school readiness of preschool-age children and identify which factors influence these results, in order to contribute to the proposition of strategies that allow improving the teaching-learning process and child development. Methods: This is a cross-sectional, descriptive and analytical study with 443 preschool children belonging to the West Region Cohort (ROC Cohort), from the public school system of the city of São Paulo. School readiness was assessed by the International Development and Early Learning Assessment (IDELA) tool. Non-parametric techniques were used for the correlation analysis between IDELA scores and sociodemographic and socioeconomic conditions: Spearman's parametric correlation, Mann-Whitney and Kruskal-Wallis tests. Results: The children's mean age was 69 months (standard deviation — SD=2.8; ranging from 55 to 72 months) and most of them came from families with low socioeconomic level. Most children showed adequate readiness in the overall score (65%) and in most domains, except for emergent literacy, in which most (56.9%) were classified as "emergent". The highest percentage of insufficiency was identified in executive functions (4.1%), which showed a correlation only with the caregiver's education. Conclusions: Children had adequate school readiness scores, except for emergent literacy, but the insufficiency in executive functions may compromise the future schooling of these children. Thus, pedagogical proposals should consider these aspects for learning and pediatricians need to reinforce the habit of reading and playing games to stimulate child development.

RESUMO Objetivo: Considerando-se a importância do início da trajetória acadêmica para as crianças alcançarem o seu pleno potencial de desenvolvimento, este trabalho tem como objetivo avaliar a prontidão escolar de crianças em idade pré-escolar e identificar que fatores influenciam esses resultados, com a finalidade de propor estratégias que possam melhorar o processo de ensino-aprendizagem e o desenvolvimento da criança. Métodos: Trata-se de um estudo transversal, descritivo e analítico, com 443 pré-escolares pertencentes à Coorte da Região Oeste (Coorte ROC) da rede pública de ensino da cidade de São Paulo. A prontidão escolar foi avaliada pela ferramenta International Development and Early Learning Assessment (IDELA). Técnicas não paramétricas foram utilizadas para a análise de correlação entre escores de IDELA e as condições sociodemográficas e socioeconômicas: correlação paramétrica de Spearman, testes de Mann-Whitney e Kruskal-Wallis. Resultados: A média de idade das crianças foi de 69 meses (desvio padrão — DP=2,8; variando de 55 a 72 meses) e maioria era proveniente de famílias com baixo nível socioeconômico. A maioria das crianças apresentou prontidão adequada na pontuação geral (65%) e na maior parte dos domínios, com exceção da pré-escrita, na qual as crianças foram predominantemente (56,9%) classificadas como "emergentes". O maior percentual de insuficiência foi identificado nas funções executivas (4,1%), apresentando correlação apenas com a formação do cuidador. Conclusões: As crianças apresentaram escores adequados de prontidão escolar, exceto para a pré-escrita, mas a insuficiência nas funções executivas pode comprometer a escolaridade futura dessas crianças. Assim, as propostas pedagógicas devem considerar esses aspectos para a aprendizagem, e os pediatras precisam reforçar o hábito de ler e dos jogos e brincadeiras para estimular o desenvolvimento infantil.

Clinical indicators of child development in the capitals of nine Brazilian states: the influence of regional cultural factors.

OBJECTIVE: Evaluating the interaction between mother or caregiver and infant through the Clinical Indicators of Risks in Infant Development and investigating whether local and cultural influences during infant development affect these clinical indicators. INTRODUCTION: The Clinical Indicators of Risks in Infant Development was created in order to fully assess infants' development and the subjective relationship between the babies and their caregivers. The absence of two or more Clinical Indicators of Risks in Infant Developments suggests a possibly inadequate mental development. Given the continental size of Brazil and its accentuated cultural differences, one might question how trustworthy these indicators can be when applied to each of the geographical regions of the country. METHODS: This was a cross-sectional study with 737 infants from the capitals of 9 Brazilian states. The size of the initial sample population was based on a pilot study carried out in the cities of São Paulo and Brasília. The ages of children were grouped: 0-3 months, 4-7 months, 8-11 months and 12-18 months. The chi-square test was used together with analyses by the statistical software SPSS 13.0. RESULTS: Statistical analysis of results from the different municipalities against the total sample did not reveal any statistically significant differences. Municipalities represented were Belém (p=0.486), Brasília (p=0.371), Porto Alegre (p=0.987), Fortaleza (p=0.259), Recife (p=0.630), Salvador (0.370), São Paulo (p=0.238), Curitiba (p=0.870), and Rio de Janeiro (p= 0.06). DISCUSSION: Care for mental development should be considered a public health issue. Its evaluation and follow-up should be part of the already available mother-child assistance programs, which would then be considered to provide "full" care to children. CONCLUSIONS: Local habits and culture did not affect the results of the Clinical Indicators of Risks in Infant Development indicators. Clinical Indicators of Risks in Infant Development proved to be robust despite the specificities of each region.

[Childhood Mental Health Problems in Primary Care]. / Prevalência de problemas de saúde mental na infância na atenção primária.

The present population study aimed at identifying the prevalence of mental health problems (MHP) and describing health services use in a sample of children attending Primary Healthcare Units (PHU) in the city of Sao Paulo. Caregivers of 825 6-11 years old children were assessed. MHP were assessed with the Strength and Difficulties Questionnaire and health services use with an adapted version of the Client Receipt Inventory Children`s version. Prevalence of internalizing and externalizing MHP was 30.7% and 18.3%, respectively. Pediatricians were the most consulted health professional (56.7%) and psychologists the most consulted mental health professional (7.9%). Only 3 children were under medication treatment for MHP. The high prevalence of MHP among children in the primary care setting and the low rate of treatment constitute a public health problem. Training programs for health professionals are relevant to help identify and refer MHP cases.

O presente estudo populacional de corte transversal teve como objetivo verificar a prevalência de problemas de saúde mental (PSM) e descrever o uso de serviços de saúde numa amostra de crianças atendidas em unidades de saúde (UBS) do município de São Paulo. Responsáveis de 825 crianças de 6-11 anos de idade foram entrevistados. PSM das crianças foram avaliados pelo "Strength and Difficulties Questionnaire" e uso de serviços por uma versão adaptada do "Client Service Receipt Inventory Children's version". A prevalência de PSM internalizantes e externalizantes foi de 30,7% e 18,3%, respectivamente. O pediatra foi o profissional de saúde mais consultado (56,7%), o psicólogo foi o profissional da saúde mental mais consultado (7,9%). Apenas 3 crianças estavam em tratamento medicamentoso para PSM. A alta prevalência de PSM em crianças atendidas na AP e o baixo número de atendimentos em serviços configuram um importante problema de saúde pública. Programas de capacitação para profissionais são importantes para aprimorar a identificação e o encaminhamento de casos de PSM.

Mother-infant bonding and postpartum depression during the COVID-19 pandemic — a risk for nurturing care and child development / Vínculo mãe-bebê e depressão pós-parto durante a pandemia de COVID-19 — um risco para o nurturing care e o desenvolvimento da criança

ABSTRACT Objective: The COVID-19 pandemic Increased the risk of impairing the mother-infant bonding. The objectives of this study were to evaluate the early bond established between mother and infant and postpartum depression (PPD) in pregnancies that occurred during the pandemic period, to identify the factors that may have influenced these outcomes and to verify if there was an association between bonding and probable PPD. Methods: This is a cross-sectional study of postpartum women from a public maternity hospital in the city of São Paulo conducted from February to June 2021, involving 127 mother-baby dyads. The initial data were collected in the immediate postpartum period and between 21-45 days after birth, using a semi-structured questionnaire on sociodemographic characteristics, gestational and birth conditions, and baby characteristics; the Edinburgh Postnatal Depression Scale (EPDS) and Postpartum Bonding Questionnaire (PBQ) were used to evaluate PPD and bonding, respectively. Results: The presence of probable PPD and unplanned pregnancies were associated with higher PBQ score and risk to impaired bonding (p = 0.001 and p = 0.004, respectively). EPDS showed a high prevalence of PPD (29.1%) and was not associated with any Studied variable. Probably, this high prevalence of probable PPD was due to the context of insecurity secondary to the pandemic. Conclusions: We observed an increase in the prevalence of probable PPD and unplanned pregnancies during the first 18 months of the pandemic, which were associated with worse scores in mother-infant bonding. The impaired bond can affect the future development of children born during this period.

RESUMO Objetivo: A pandemia do COVID-19 aumentou o risco de o vínculo entre mãe-bebê ser prejudicado. Os objetivos deste estudo foram avaliar o vínculo mãe-bebê estabelecido precocemente e a depressão puerperal (DP) em gestações que ocorreram durante a pandemia, identificar os fatores que podem ter influenciado esses resultados e verificar se houve associação entre o vínculo e a provável depressão puerperal. Métodos: Foi realizado um estudo transversal com puérperas de uma maternidade pública da cidade de São Paulo, no período de fevereiro a junho de 2021, envolvendo 127 díades mãe-bebê. Os dados foram obtidos no puerpério imediato e 21 a 45 dias após o parto, utilizando-se um questionário semiestruturado sobre as características sociodemográficas, as condições de gestação e nascimento e características do recém-nascido; a escala de depressão puerperal de Edimburgo (EPDS) e o questionário de vínculo pós-parto (PBQ) foram utilizados para avaliar a presença de provável DP e o vínculo mãe-bebê, respectivamente. Resultados: A presença de provável DP e as gestações não planejadas foram associadas a maiores escores no PBQ e no risco de vínculo prejudicado (p = 0,001 e p = 0,004, respectivamente). A escala de Edimburgo mostrou alta prevalência de risco de depressão puerperal (29,1%) e não foi associada a nenhuma variável estudada. Provavelmente, a alta prevalência de provável DP foi secundária ao contexto de insegurança decorrente da pandemia. Conclusões: Observamos aumento na prevalência da provável DP e das gestações não planejadas durante os primeiros 18 meses da pandemia, os quais estiveram associados a piores escores no vínculo mãe-bebê. O prejuízo no vínculo pode afetar o desenvolvimento futuro das crianças geradas durante esse período.

Socioeconomic diversities and infant development at 6 to 9 months in a poverty area of São Paulo, Brazil.

INTRODUCTION: The effects of socioeconomic disparities on cognitive development tend to emerge early in infancy and to widen throughout childhood, and may perpetuate later in life. Although the study of how poverty affects early childhood has increased in the last 20 years, many of the effects remain largely unknown, especially during the first year of life. AIM: To investigate the influence of socioeconomic status (SES) and maternal education on infants' language, motor and cognitive development. METHODS: The cognitive, language and motor skills of 444 infants aged 6 to 9 months selected from a poor neighborhood in São Paulo, Brazil, were evaluated using the Bayley Scales of Infant Development. A questionnaire on socioeconomic background was administered to the participants' families. RESULTS: A positive association was found between SES and infants' performance on language and motor scales. Additionally, higher maternal education was associated with higher language and cognitive scores. CONCLUSION: Our findings indicate that SES effects are detectable very early in infancy. This result has implications for the timing of both screening and intervention efforts to help children overcome the consequences of living in poverty.

Sex differences in DNA methylation of the cord blood are related to sex-bias psychiatric diseases.

Sex differences in the prevalence of psychiatric disorders are well documented, with exposure to stress during gestation differentially impacting females and males. We explored sex-specific DNA methylation in the cord blood of 39 females and 32 males born at term and with appropriate weight at birth regarding their potential connection to psychiatric outcomes. Mothers were interviewed to gather information about environmental factors (gestational exposure) that could interfere with the methylation profiles in the newborns. Bisulphite converted DNA was hybridized to Illumina HumanMethylation450 BeadChips. Excluding XYS probes, there were 2,332 differentially methylated CpG sites (DMSs) between sexes, which were enriched within brain modules of co-methylated CpGs during brain development and also differentially methylated in the brains of boys and girls. Genes associated with the DMSs were enriched for neurodevelopmental disorders, particularly for CpG sites found differentially methylated in brain tissue between patients with schizophrenia and controls. Moreover, the DMS had an overlap of 890 (38%) CpG sites with a cohort submitted to toxic exposition during gestation. This study supports the evidences that sex differences in DNA methylation of autosomes act as a primary driver of sex differences that are found in psychiatric outcomes.

Assessment of access to primary health care among children and adolescents hospitalized due to avoidable conditions.

INTRODUCTION:: Hospitalizations for ambulatory care-sensitive conditions (HACSC) are considered an indicator of the effectiveness of primary health care (PHC). High rates of HACSC represent problems in the access or the quality of health care. In Brazil, HACSC rates are high and there are few studies on the factors associated with it. OBJECTIVE:: To evaluate the access to PHC offered to children and adolescents hospitalized due to ACSC and analyze the conditioning factors. METHOD:: Cross-sectional study with a quantitative and qualitative approach. Five hundred and one (501) users (guardians/caregivers) and 42 professionals of PHC units were interviewed over one year. Quantitative data were obtained using Primary Care Assessment Tool validated in Brazil (PCATool-Brazil), while qualitative data were collected by semi-structured interview. The independent variables were: age, maternal education, family income, type of diagnosis, and model of care offered, and the dependent variables were access and its components (accessibility and use of services). RESULTS:: Sixty-five percent (65.2%) of hospitalizations were ACSC. From the perspective of both users and professionals, access and its components presented low scores. Age, type of diagnosis, and model of care affected the results. CONCLUSION:: The proportion of HACSC was high in this population. Access to services is inappropriate due to: barriers to access, appreciation of the emergency services, and attitude towards health needs. Professional attitudes and opinions reinforce inadequate ideas of users reflecting on the pattern of service use.

Mother's lifestyle: development of a questionnaire to assess a determinant of children's health. A cross-sectional study.

CONTEXT AND OBJECTIVE: Lifestyle includes the personal attitudes or behavioral patterns that result in risks or benefits to the individual's own health or that of others. Children's health is particularly determined by their mother's lifestyle. The objective here was to develop and evaluate the reliability of a questionnaire capable of describing the lifestyles of preschoolers' mothers in terms of their activities, interests, opinions and values. DESIGN AND SETTING: Cross-sectional study conducted in a public university. METHODS: This study was conducted between January 2010 and March 2011, among 255 mothers of preschoolers living in the southeastern region of the municipality of São Paulo. A proportional stratified random probabilistic sample with two strata was selected: schools were drawn and then the children. Three instruments found in the literature were used to create the lifestyle questionnaire. The questionnaire was developed in eight stages: preliminary pretest, cultural adaptation, second pretest, pilot study, semantic correction and adaptation, third pretest, final research and final retest. Cronbach's alpha and pairwise correlation coefficients were used. RESULTS: The Cronbach's alpha value in the final version was 0.83 and the pre and post-test pairwise correlation coefficients were greater than 0.5. Factor analysis identified five factors that explained 73.51% of the correlation variance. As a result, seven variables were eliminated from the questionnaire. CONCLUSIONS: The questionnaire described five lifestyle domains, with good reliability, and can be used in combination with preschoolers' health and nutritional outcomes.

Rollout of community-based family health strategy (programa de saude de familia) is associated with large reductions in neonatal mortality in São Paulo, Brazil.

RATIONALE: Several recent studies suggest that Brazil's Estratégia Saude de Familia (Family Health Strategy-FHS) has contributed to declines in mortality at the national and regional level. Comparatively little is known whether this approach is effective in urban populations with relatively easy access to health services. OBJECTIVES: To use detailed medical data collected as part of São Paulo's Western Region project to examine whether the FHS program had an impact on child health in São Paulo, Brazil. RESULTS: No associations were found between FHS and birth weight (OR 1.03, 95% CI 0.93-1.29), gestational length (OR 0.98, 95% CI 0.83-1.15) or stillbirth (OR 1.51, 95% CI 0.75-3.03). FHS eligibility was associated with a 42% reduction in the odds of child mortality (OR 0.58, 95% CI 0.34, 0.91), with largest effect sizes for the early neonatal period (OR 0.18, 95% CI 0.04-0.79). CONCLUSIONS: Community based health delivery platforms may be a highly effective way to reduce neonatal mortality in urban areas of low and middle income countries, even when access to general health services is almost universal.

Pediatricians after residency: a survey of personal/professional data and issues / Pediatras após a residência médica: um questionário sobre dados e problemas pessoais/profissionais

ABSTRACT Objective: To assess personal, professional, medical, and scientific educational characteristics and issues reported by pediatricians. Methods: Cross-sectional study based on an online survey including 614 pediatricians who graduated in the last 15 years at a University Pediatric Department in Brazil. Results: The response rate was 331/614(54%). The majority were females (82%), the median age was 33 years (27-40) and median years of pediatric practice was 5 (1-13). High workload (>60 hours/week) occurred in 25% and 47% earned ≥15 minimum wages/month. The most work-related issues reported were long working hours, poor social life and a sedentary lifestyle (>50%). Pediatricians were further divided into two groups, according to years of pediatric clinical practice: group 1 (≤5 years) and group 2 (>5 years). The median of overall satisfaction with pediatric residency [8(0-10) vs. 9 (4-10); p=0.002] was significantly reduced in group 1. The frequencies of workload >60 hours, work on pediatric ward and pediatric intensive care were significantly higher in the first group (p<0.05). Regarding main issues related to clinical practice in the last year, long working hours (73 vs. 53%; p<0.001), poor social life (75 vs. 62%; p=0.018) and harassment (23 vs. 4%; p=0.003) were significantly higher in the first group. Conclusions: Very early career pediatricians (≤5 years) reported higher workload, lower income, work-related issues and different location of pediatric practice compared to early career pediatricians (>5 years). The overall satisfaction with pediatric residency was good, however, reduced in very early career pediatricians.

RESUMO Objetivo: Avaliar características e problemas pessoais, profissionais, médicos e de educação científica reportados por pediatras. Métodos: Estudo transversal com base em uma pesquisa online, incluindo 614 pediatras formados nos últimos 15 anos no Departamento de Pediatria de uma universidade brasileira. Resultados: A taxa de resposta foi de 331/614 (54%). A maioria dos participantes era do sexo feminino (82%), a mediana de idade foi de 33 anos (27-40 anos) e a mediana de tempo de prática pediátrica foi de 5 anos (1-13). Jornada de trabalho elevada (>60 horas/semana) foi relatada por 25% dos entrevistados e 47% recebiam ≥15 salários mínimos/mês. Os problemas relacionados ao trabalho mais frequentes foram jornadas longas de trabalho, vida social insatisfatória e sedentarismo (>50%). Os pediatras foram divididos em dois grupos de acordo com os anos de prática clínica pediátrica: grupo 1 (≤5 anos) e grupo 2 (>5 anos). A mediana de satisfação geral com a residência pediátrica [8 (0-10) versus 9 (4-10); p=0,002] foi significativamente menor no grupo 1. As frequências de jornada de trabalho >60 horas, trabalho na enfermaria pediátrica e na terapia intensiva pediátrica foram significativamente maiores no primeiro grupo (p<0,05). Quanto aos principais problemas relacionados à prática clínica no ano anterior, jornadas longas de trabalho (73 versus 53%; p<0,001), vida social insatisfatória (75 versus 62%; p=0,018) e assédio (23 versus 4%; p=0,003) foram significativamente mais elevados no grupo 1. Conclusões: Pediatras em início de carreira (≤5 anos) relataram maior jornada de trabalho, menor renda, problemas relacionados ao trabalho e diferentes locais de trabalho em comparação com pediatras mais experientes (>5 anos). A satisfação geral com a residência pediátrica foi boa, porém menor em pediatras do primeiro grupo.

Profile of health professionals who completed a master's, doctoral, or post-doctoral degree in one Brazilian pediatric program

OBJECTIVE: This study aimed to determine the personal and professional characteristics, and the physical, psychiatric/psychological, and professional issues that exist among master's-, doctoral-, and post-doctoral-level health professionals. METHODS: A cross-sectional, online, self-reported survey of 452 postgraduates who completed master's, doctoral, or post-doctoral degrees in one graduate program in pediatrics in São Paulo, Brazil, was conducted. RESULTS: The response rate was 47% (211/453). The majority of participants were women (78%) and physicians (74%), and the median age was 47 years (28-71). Master's, doctoral, and post-doctoral degrees were reported by 73%, 53%, and 3%, respectively. High workload (>40 hours/week) occurred in 59%, and 45% earned ≥15 minimum wages/month. At least one participation in scientific meeting in the past year was reported by 91%, and 79% had published their research. Thirty-nine percent served as a member of a faculty of an institution of higher learning. The data were analyzed by two age groups: participants aged ≤48 years (group 1) and participants aged >48 years (group 2). The median rating of overall satisfaction with the profession in the past year [8 (0-10) vs. 9 (1-10), p=0.0113]; workload >40 hours/week (53% vs. 68%, p=0.034); and ≥15 minimum wages/month (37% vs. 56%, p=0.0083) were significantly lower in group 1. Further analysis by gender revealed that the median rating of overall satisfaction with the profession in the past year [8 (0-10) vs. 9 (3-10), p=0.0015], workload >40 hours/week (53% vs. 83%, p=0.0002), and ≥15 minimum wages/month (37% vs. 74%, p=0.0001) were significantly lower in women compared with men. The median rating of overall satisfaction with the mentorship supervision provided was significantly higher among the women 10 (5-10) vs. 10 (2-10), p=0.0324]. CONCLUSIONS: The majority of master's-, doctoral-, and post-doctoral-level health professionals were women and physicians, and had published their thesis. Younger postgraduates and women reported low salaries, less likelihood of working >40 hours/week, and less overall satisfaction with their profession. Further longitudinal and qualitative studies are warranted to assess career trajectories after graduation.