Investigating changes in IQ scores over a decade in Brazil: factors at play.

PURPOSE: This study aimed to determine whether the factors underlying potential differences between two birth cohorts, born in 1982 and 1993, influence the changes in IQ over time. METHODS: Data from two Brazilian birth cohorts were used (1993 and 1982 Pelotas Birth Cohorts). The IQ scores were assessed using the WAIS-III test. RESULTS: Results showed that women born in 1993 had a higher average IQ score than those born in 1982, but no difference was found among men. The increase in IQ scores was only limited to participants from families with an income ranging from 1.1 to 3 times the minimum wage at the time of birth. The mean IQ score of participants born to mothers below the age of 20 remained stable over time, but increase for participants whose mothers were 20 years of age or older at the time of birth. CONCLUSIONS: This study emphasizes the importance of considering socio-economic and demographic factors when examining differences in IQ scores over time. Further research is needed to understand the underlying mechanisms of these findings.

Child maltreatment associates with violent victimization in young adulthood: a Brazilian birth cohort study.

BACKGROUND: Maltreatment in childhood may leave people vulnerable to further experiences of violence and more severe effects of stress later in life. Longitudinal studies of risk for violent victimisation after maltreatment are lacking in low- and middle-income countries. The objective of this study was to quantify the risk for violent victimization in the family and community in young adulthood following experiences of childhood maltreatment (experiences of physical, emotional and sexual abuse and neglect) up to age 15 years in an urban Brazilian population. METHODS: 3246 participants in a prospective, population-based birth cohort study in Pelotas, Rio Grande do Sul, Brazil, were assessed at birth, 15 and 22 years. Sociodemographic factors were reported by mothers at birth and adolescents at age 15 years. Maltreatment and violent victimisation were self-reported in confidential questionnaires at 15 and 22, respectively. Multinomial logistic regression analyses estimated the association between having experienced any maltreatment and later experiences of family and community violence in young adulthood (no adult violence, violence only in the family context, only in the community, or both violence in the family and community), adjusting for sociodemographic factors. RESULTS: 39% of females and 27% of males reported any maltreatment up to age 15 years. At 22 years, rates of past year violence in the family or community were 17.6% for females and 20.2% for males. Maltreatment was strongly associated with community violence (Females: OR = 2.96, CI = 1.83-4.80; Males: OR = 2.01, 95%CI = 1.01-4.00) and its co-occurrence with family violence (Females: OR = 2.33, 95%CI = 1.34-4.04; Males: OR = 3.20, 95%CI = 1.82-5.65) in young adulthood, after adjustment for background sociodemographic factors. CONCLUSION: Childhood maltreatment is an important risk factor for later violent victimisation in both the family and community context. The effects of repeated trauma through the life-course needs research and clinical attention.

Effect Modification of Cardiorespiratory Fitness, Obesity, and Physical Activity in Adults.

We investigated if cardiorespiratory fitness modifies the association between obesity and the level of physical activity. In this cross-sectional study, we analyzed data from 746 adults, free of diagnosed cardiorespiratory or locomotor diseases. We analyzed sociodemographic and clinical information, cardiovascular risk factors, cardiorespiratory fitness, anthropometry, and level of physical activity (time spent in moderate-to-vigorous physical activity). Those that spent more time in moderate-to-vigorous physical activity were younger, male, with lower body mass index, without self-reported arterial blood hypertension, diabetes and dyslipidemia, non-smokers, and presented with better cardiorespiratory fitness. The linear regression coefficients showed that cardiorespiratory fitness changes according to the level of physical activity and body mass index (obesity in low cardiorespiratory fitness: ß 6.0, p=0.213, 95%CI-3.5 to 15.6; in intermediate cardiorespiratory fitness: ß 6.3, p=0.114, 95%CI-1.5 to 14.2; in high cardiorespiratory fitness: ß-6.3, p=0.304, 95%CI-18.4 to 5.8). This effect modification trend was present after adjusting the model by covariates. Cardiorespiratory fitness potentially modifies the association between body mass index and the level of physical activity. It should be routinely assessed to identify persons with overweight/ obesity with low/ intermediate cardiorespiratory fitness to prescribe individualized training.

Sleep duration trajectories from adolescence to emerging adulthood: Findings from a population-based birth cohort.

This study aimed to describe longitudinal trajectories of sleep duration, among adolescents and adults from the Pelotas (Brazil) 1993 Birth Cohort, as well as characterize different trajectories groups according to socioeconomic, demographic and behavior characteristics. Sleep duration, hours per day (from Monday to Friday), bedtime and wake-up time were self-reported by participants at ages 11, 18 and 22 years. Covariables included socioeconomic, demographic, health and behavior characteristics. Trajectory analysis was performed using a semi-parametric, group-based modelling approach. Prevalence and 95% confidence interval were obtained to describe covariables and sleep trajectory groups. Chi-square test was employed in statistical analysis and all analyses were stratified by sex. A total of 3.395 individuals were included in the analysis. In both sexes, bedtime became later across years, while wake-up time presented little variation. Differences according sex were more pronounced from 18 years onwards. Three trajectories of sleep duration from 11 to 22 years were identified for males: "increase and maintenance" (3.4%), "fast reduction and maintenance" (45.0%) and "constant reduction" (51.6%). While in females the trajectories identified were: "increase and decrease" (2.4%), "fast reduction and maintenance" (25.6%) and "constant reduction" (72.0%). Men and women who belong to trajectories with longer sleep durations were more likely to present higher percentages of some risk behaviors and poor socioeconomic condition. Our results have provided longitudinal information regarding sleep duration trajectories in a medium-sized city in Brazil, aiming at filling an existing gap in literature from low- and middle-income countries.

How different online recruitment methods impact on recruitment rates for the web-based coortesnaweb project: a randomised trial.

BACKGROUND: The number of web-based E-epidemiologic studies using online recruitment methods is increasing. However, the optimal online recruitment method in terms of maximizing recruitment rates is still unknown. Our aim was to compare the recruitment rates of three online recruitment methods and to describe how these rates differ according to individual's socioeconomic and demographic factors. METHODS: A total of 2394 members of the 1993 Pelotas birth cohort that provided an e-mail address, a Facebook name, and a WhatsApp number during a face-to-face follow-up were randomly allocated to be recruited by e-mail, Facebook or WhatsApp (798 individuals per method). This was a parallel randomised trial applying a block randomisation (block size = 3). Between January and February 2018, we sent messages inviting them to register into the web-based coortesnaweb platform. Recruitment rates were calculated for each method, and stratified according to the individual's socioeconomic and demographic characteristics. We also analysed absolute and relative inequalities on recruitment according to schooling and socioeconomic position. RESULTS: Out of the 2394 individuals analysed, 642 registered into the platform. The overall recruitment rate was 26.8%. Recruitment rates for women were almost 10 percentage points higher compared to men. Facebook was the most effective recruitment method, as 30.6% of those invited through the social network were recruited. Recruitment rates of e-mail and WhatsApp were similar (recruitment rate = 24.9%). E-mail and Facebook were the most effective recruitment methods to invite highly educated and wealthier individuals. However, sending e-mails to recruit individuals also reflected in the highest inequalities according to schooling and socioeconomic position. In contrast, the lowest inequalities according to socioeconomic position were observed using Facebook. CONCLUSIONS: Facebook was the most effective online recruitment method, also achieving the most equitable sample in terms of schooling and socioeconomic position. The effectiveness of online recruitment methods depends on the characteristics of the sample. It is important to know the profile of the target sample in order to decide which online recruitment method to use. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials, identifier: RBR-3dv7gc , retrospectively registered in 10 April 2018.

Associations between body mass index, body composition and bone density in young adults: findings from a southern Brazilian cohort.

BACKGROUND: This study aimed to evaluate the association of body composition components and obesity with bone density. METHODS: Prospective study with data on 2968 members of the 1993 Pelotas Birth Cohort from follow-ups at 18 and 22 years of age. Areal bone mineral density (aBMD, g/cm2) was evaluated for whole body, lumbar spine, and femoral neck at 22 years using dual-energy X-ray absorptiometry. Simple and multiple linear regression, stratified by sex, were used to assess the effect of BMI, fat mass (FMI) and lean mass index (LMI), evaluated at 18 and 22 years, and obesity trajectories classified by FMI and categorized as "never", "only at 18 years", "only at 22 years" or "always" on aBMD. RESULTS: Among men, the largest coefficients were observed for BMI, followed by lean mass and fat mass. Compared to fat mass, lean mass presented the largest coefficients for all sites, with the strongest associations observed for the femoral neck (ß: 0.035 g/cm2; 95% CI: 0.031; 0.039 for both follow-ups), while the largest effect for FMI was observed for whole-body aBMD at 18 years (ß: 0.019 g/cm2; 95% CI: 0.014; 0.024). Among women, the strongest associations were observed for LMI. The largest coefficients for LMI and FMI were observed for femoral neck at age 18, presented ß: 0.030 g/cm2, 95% CI: 0.026, 0.034 for LMI and ß: 0.012 g/cm2; 95% CI: 0.009; 0.015) for FMI. Men who were "always obese" according to FMI had smallest aBMD for spine (ß: -0.014; 95%CI: - 0.029; - 0.001). Women who were obese "only at 18 years" had smallest aBMD for the whole-body (ß: -0.013; 95%CI: - 0.023; - 0.002), whereas those who were obese "only at 22 years" had larger whole-body and femoral neck aBMD (ß: 0.013; 95%CI: 0.009; 0.017 and ß: 0.027; 95%CI: 0.016; 0.038, respectively) and those "always obese" for whole-body aBMD (ß: 0.005; 95%CI: 0.001; 0.011) compared to the reference category. CONCLUSIONS: The indexes were positively associated with aBMD in this sample. Fat mass had smaller positive influence on these outcomes than lean mass, suggesting the most important body composition component for bone density is the lean mass.

Association between interleukin-6, C-reactive protein and adiponectin with adiposity: Findings from the 1993 pelotas (Brazil) birth cohort at 18 and 22 years.

BACKGROUND: Most of the literature has shown a direct association between adiposity, interleukin-6 (IL-6) and C-reactive protein (CRP), and an inverse association with adiponectin. The aim of this paper was to assess the association of obesity measurements and IL-6, CRP and adiponectin. METHODS: We performed cross-sectional/longitudinal analysis in the 1993 Birth Cohort in Brazil. Associations between IL-6 (pg/mL), CRP (mg/L) and adiponectin (µg/Ml) with body mass index (BMI), waist circumference (WC), percentage total fat mass (FM) (BODPOD) and trunk FM (DXA) were verified. Four trajectory variables were generated: (a) highest tertile/obesity according to BMI in both follow-ups; (b) highest tertile/obesity only at 18 years; (c) highest tertile/obesity only at 22 years; (d) not in the highest tertile/not obese at both ages. RESULTS: We found a direct association for IL-6 and CRP and an inverse association for adiponectin with measures of adiposity. For instance, for females, the highest mean IL-6 and CRP, respectively, was for those who had been in the obese category at 18-22 years (2.49; 3.75), in the highest tertile of WC (2.11; 3.08), in the highest % of FM (1.56; 3.30 l), and in the highest tertile of trunk FM (2.07; 3.26) (p < 0.001 for all these results in the adjusted analysis). Adiponectin showed an inverse association for the above variables, with lower mean values for males than females. CONCLUSION: There was a longitudinal and direct association between adiposity and IL-6 and CRP, and an inverse association with adiponectin at 22 years.

Lifelong robbery victimisation and mental disorders at age 18 years: Brazilian population-based study.

PURPOSE: Urban violence is a major problem in Brazil and may contribute to mental disorders among victims. The aim of this study was to assess the association between robbery victimisation and mental health disorders in late adolescence. METHODS: At age 18 years, 4106 participants in the 1993 Pelotas Birth Cohort Study were assessed. A questionnaire about history of robbery victimisation was administered, the Self-Report Questionnaire was used to screen for common mental disorders, and the Mini International Neuropsychiatric Interview was used to assess major depressive disorder and generalised anxiety disorder. Cross-sectional prevalence ratios between lifetime robbery victimisation and mental disorders were estimated using Poisson regression with robust standard errors, adjusting for socioeconomic variables measured at birth and violence in the home and maltreatment measured at age 15. RESULTS: There was a dose-response relationship between frequency of lifetime robberies and risk of mental disorders. Adolescents who had been robbed three or more times had twice the risk (PR 2.04; 95% CI 1.64-2.56) for common mental disorders, over four times the risk for depression (PR 4.59; 95% CI 2.60-8.12), and twice the risk for anxiety (PR 1.93; 95% CI 1.06-3.50), compared with non-victims, adjusting for covariates. Experiencing frequent robberies had greater impact on common mental disorders than experiencing an armed robbery. Population attributable fractions with regard to robbery were 9% for common mental disorders, 13% for depression, and 8% for anxiety. CONCLUSIONS: Robberies are associated with common mental disorders in late adolescence, independently of violence between family members. Reducing urban violence could significantly help in preventing common mental illnesses.

Are cytokines (IL-6, CRP and adiponectin) associated with bone mineral density in a young adult birth cohort?

BACKGROUND: Studies have shown that cytokines play a role in bone remodeling. METHODS: In 1993, all hospital births occurred in Pelotas (Brazil) were identified and a total of 5249 newborns were included in the present cohort. Sub-samples of this cohort were visited during childhood and all members were traced at 11, 15, 18 and 22 years old. At 18 and 22 years the following biomarkers were measured: IL-6, CRP and adiponectin (the last one in a sub-sample) and bone mineral density (BMD-mg/cm2) was evaluated at 22 years. Crude regression analysis as well as adjusted for confounders (birth weight, pregnancy maternal smoking, gestational age, skin color, schooling, income, smoking, alcohol, physical activity, medical diagnosis of asthma, diabetes and hypertension, BMI, height, calcium intake, corticosteroid use, age at menarche, insulin and testosterone) were performed between the three biomarkers and the whole-body, lumbar spine and femoral BMD. RESULTS: No statistical significant association was found between IL-6 and CRP with BMD, in males. Significant inverse association in the adjusted analysis, among females, was found for the highest tertiles of CRP at 22 y (beta - 15.2 mg/cm2; 95% CI: -25.4; - 4.9; p = 004), of CRP and IL-6 at 22 years (beta - 20.0 mg/cm2; 95% CI: -31.7; - 8.3; p = 0.003), and of IL-6 and CRP at both ages (beta - 20.3 mg/cm2; 95% CI: -38.0; - 2.5; p = 0.001) with total body BMD. Significant association, among males, was also found between the highest tertile of adiponectin at 22 y (beta - 23.3 mg/cm2; 95% CI: -35.5; - 11.1; p = < 001; beta - 22.5 mg/cm2; 95% CI: -42.9; - 2.2; p = 0.03; and beta - 31.8 mg/cm2; 95% CI: -55.5; - 9.1; p = 0.006) and total body, lumbar spine and femur neck BMD, respectively; and, among females, - 17.8 mg/cm2; 95% CI: -34.9; - 0.9; p = 0.033, with lumbar spine BMD. CONCLUSION: CRP at 22 years, in females, seems to be a marker for total body BMD; adiponectin at 22 years is also a marker for BMD at the three sites, in males, and for lumbar spine BMD, in females.

[Breastfeeding and externalizing behaviors in childhood and adolescence in a birth cohort]. / Amamentação e comportamentos externalizantes na infância e adolescência em uma coorte de nascimentos.

OBJECTIVE: To assess the association between breastfeeding duration and externalizing behaviors in childhood and adolescence. METHODS: Data from the 1993 Pelotas Birth Cohort was used. Information on breastfeeding was assessed at 12 months of age. Behavior was assessed at 4 years of age using the Child Behavior Checklist (CBCL), and at ages 11 and 15 years using the Strengths and Difficulties Questionnaire (SDQ), both administered to the mother or caretaker. Of 5 249 cohort participants, those with complete data on breastfeeding and externalizing behaviors were included: 630 children at 4 years of age, 1 277 adolescents at 11 years, and 1 199 at 15 years. Poisson regression with robust variance was used to assess the association between breastfeeding duration and externalizing behaviors. RESULTS: After adjustment for confounders, children who were breastfed for least 6 months had lower risk of hyperactivity (RR = 0.54; 95%CI: 0.32-0.91) at age 11 compared to those breastfed for less than 1 month. However, no association was observed between breastfeeding duration and externalizing behaviors at ages 4 and 15. CONCLUSIONS: Although breastfeeding for at least 6 months was inversely associated with hyperactivity at 11 years of age no association was observed at 4 and 15 years of age. Further longitudinal studies should focus on other aspects influencing externalizing behaviors, such as presence of the father in the family, domestic violence and abuse, and the quality of mother-child relationship.

Social inequalities in care for the elderly with diabetes in Brazil.

OBJECTIVE: To measure the prevalence of various care services offered to the elderly with diabetes mellitus in Brazil, and to assess the social inequalities in these services. METHODS: This cross-sectional, population-based study was carried out in 2013. The care services offered were evaluated in terms of the following eight indicators: recommendations to lower carbohydrates, to measure blood glucose, and to examine the feet; requests made for blood tests, for glycated hemoglobin tests, and for glycemic curve tests; and whether service users had had their eyes or feet examined in the previous year. We used the slope index of inequality and the concentration index to assess the inequalities among wealth quintiles. RESULTS: A total of 1 685 elderly persons with diabetes were evaluated. Overall, 41.7% of them had had their eyes examined in the preceding year, 35.4% had had their feet examined in the preceding year, and 10.9% had been offered all eight of the care services. The largest absolute differences (in percentage points) between the first (poorest) and fifth (richest) wealth quintiles in terms of the care services that were offered to the users were for: a recommendation to measure blood glucose (25.8), a glycated hemoglobin test request (27.4), a glycemic curve test request (31.9), having the eyes examined in the preceding year (29.3), and having the feet examined in the preceding year (27.0). CONCLUSION: There were notable inequalities in the prevalences of the care services. In the future, measurement of blood glucose and examination of the feet should be emphasized, especially for elderly persons in a lower socioeconomic level.

Physical activity levels objectively measured among older adults: a population-based study in a Southern city of Brazil.

BACKGROUND: Low levels of physical activity are currently observed in all age groups around the world. Among older adults physical activity is even lower, potentially influencing quality of life, incidence of diseases and premature mortality. The aim of this study was to describe objectively measured physical activity levels among older adults residents in a Southern city of Brazil. METHODS: A population-based study was carried out including people aged 60+ years living in the urban area of Pelotas. Face-to-face interviews, anthropometric measures and triaxial accelerometry (non-dominant wrist) were used to collect sociodemographic, anthropometric and physical activity, respectively. For descriptive purposes, overall physical activity was expressed as daily averages of acceleration. Time spent in light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) using different bout criteria (non-bouted, and in 1-, 5- and 10-min bouts) were calculated. Crude and adjusted analyses were performed using simple linear regression to examine the association between physical activity and exposure variables. RESULTS: Overall, 971 individuals provided valid accelerometry data. Women spent on average more time on LPA (136.2 vs. 127.6 min per day). Men and women respectively accumulated, in average, 64.5 and 56.7 min per day of non-bouted MVPA, while these daily averages were 14.9 and 9.46 min using 5-min, and 8.1 and 4.5 min using 10-min bout MVPA. In adjusted analyses, men aged 80 years or more spent in average 45 min less LPA per day when compared to men 60-69 years and, among women, this difference was 65 min. Considering time in 5-min MVPA bouts, the youngest age group and those with a better self-perceived health accumulated more MVPA. Specifically among men, socioeconomic status was inversely associated with 5-min bout MVPA. CONCLUSION: The present study showed low levels of physical activity among Brazilian older adults, even lower in more advanced ages, and a different pattern for physical activity intensity between men and women.

Visceral and subcutaneous abdominal adiposity and pulmonary function in 30-year-old adults: a cross-sectional analysis nested in a birth cohort.

BACKGROUND: Several studies have verified body fat distribution in association with pulmonary function (PF), mainly waist circumference, but few have used measures able to distinguish abdominal fat compartments. The present study aims to verify the association of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) with PF measures. METHODS: In 1982, all hospital births occurring in Pelotas, Brazil, were identified and those livebirths have been followed. In 2012-13, the cohort participants were evaluated and VAT and SAT measured using ultrasound; forced expiratory volume in the first second (FEV1) or forced vital capacity (FVC) were patronized in z-scores stratified by sex. The associations were verified using crude and adjusted linear regressions. RESULTS: The present analyses comprised 3438 individuals (1721 women). VAT was inversely associated with spirometric parameters, in both crude and adjusted models. SAT showed inverse associations in the crude analyzes in males and a positive trend after adjustment, except for SAT and FVC in males. To each centimeter of VAT, mean adjusted FEV1 z-scores decreased 0.072 (95% CI -0.107; -0.036) in men and 0.127 (95% CI -0.164; -0.090) in women, and FVC z-scores decreased -0.075 (95% CI -0.111; -0.039) and 0.121 (95% CI -0.158; -0.083), in men and women, respectively. CONCLUSIONS: VAT has a consistent inverse association with FEV1 and FVC in both sexes. On the other hand, SAT showed inconsistent results with PF parameters.

Physical activity throughout adolescence and body composition at 18 years: 1993 Pelotas (Brazil) birth cohort study.

BACKGROUND: Adolescence is a period of accelerated development and increases in body composition. Physical activity (PA) practice has been associated with the development of major components of body composition (bone, muscle and fat). However, the longitudinal effects of PA of different intensities during adolescence are still not well understood. Thus, the main goal this study has investigate the association between practice of moderate- and vigorous-intensity physical activity throughout adolescence and body composition, specifically lean mass (LM) and fat mass (FM), at age 18. METHODS: In this cohort study, physical activity was measured at 11, 15 and 18 years, using questionnaires. Thresholds of 300, 150 and 75 min per week, were used for MVPA, moderate- and vigorous-intensity physical activity, respectively. Consistent physical activity was defined as reaching the thresholds at the three follow-ups. FM and LM at age 18 were assessed by DXA and expressed as fat mass (FMI) and lean mass (LMI) indexes. To verify the association between the trajectories of MVPA, moderate- and vigorous-intensity physical activity in adolescence and FM and LM at 18, multivariate analyses were performed through multiple linear regressions adjusted for co-variables. RESULTS: A total of 3,176 adolescents were evaluated. The consistent practice of moderate- and vigorous-intensity physical activity according to thresholds during adolescence were directly related to the LMI in boys (moderate-intensity - ß = 0.40 and CI95 % 0.13; 0.68 and vigorous-intensity - ß = 0.95 and CI95 % 0.69; 1.21) and girls (Moderate-intensity - ß = 0.23 and CI95 % 0.02; 0.45 and vigorous-intensity - ß = 0.80 and CI95 % 0.29; 1.32). Practice of vigorous-intensity physical activity alone showed to be inversely associated with the FMI in boys (ß = -0.53 and CI95 % -0.96;-0.10). CONCLUSION: Consistent physical activity practice during adolescence was associated with greater lean mass in both sexes. In boys, vigorous-intensity physical activity was associated with less fat mass.

Impact of the age at menarche on body composition in adulthood: results from two birth cohort studies.

BACKGROUND: Evidence suggests that early menarche is positively associated with adiposity in adulthood. However, it is important to assess whether this association is due to early menarche or to the association of adiposity in late childhood with age at menarche. We evaluated the association between age at menarche and body composition in adolescence and adulthood, among subjects who have been prospectively followed in two Brazilian birth cohort studies. METHODS: In 1982 and 1993, the hospitals births in Pelotas were identified, and these subjects have been followed for several times. Information on age at menarche was obtained from the women (1982 cohort) and their mothers (1993 cohort). At 30 and 18 years, the following body composition measures were evaluated: body mass index, waist circumference, fat-free mass index and fat mass index measured by dual-energy x-ray absorptiometry, and thickness of the abdominal visceral fat layer measured by ultrasound. The analyses were adjusted for: birth weight, maternal pregestational weight, gestational age, family income, household score index, maternal schooling, weight-for-height z-score at 4 years (1982), and body mass index at 11 years (1993). RESULTS: At 30 and 18 years, 2045 and 2092 women were evaluated, respectively. The prevalence of early menarche (≤11 years of age) was 24.7 % in the 1982 and 27.6 % in the 1993 cohort. In the 1982 cohort, early menarche was positively associated with all body composition variables compared to those with late menarche (≥14 years of age) even after adjusting for confounders (fat mass index: 2.33 kg/m2, 95 % Confidence interval: 1.64; 3.02). However, in the 1993 cohort, after adjusting for body mass index at 11 years, the regression coefficient for the association with fat mass index decreased from 2.2 kg/m2 (95 % Confidence interval: 1.7; 2.6) to 0.26 (95 % Confidence interval: -0.08; 0.60). CONCLUSIONS: The association between age at menarche and body composition in adulthood is strongly explained by pre-pubertal adiposity.

Body mass index at 11 years and bone mass at age 18: path analysis within the 1993 Pelotas (Brazil) birth cohort study.

BACKGROUND: We investigated whether Body Mass Index (BMI) at 11 years old has a direct effect on bone mass at age 18 operating through alterations to bone growth and development, or whether the association is mediated by concurrent BMI, fat mass (FM), and fat free mass (FFM). METHODS: Path analysis was used to explore the association between BMI at age 11 and whole-body bone mineral content (BMC) and bone mineral density (BMD) assessed by dual-energy x-ray absorptiometry (DXA) at age 18 in a prospective birth cohort study comprising 3,307 adolescents; we also evaluated the degree to which this association was mediated by BMI, FM (kg) and FFM (kg) assessed by plethysmography (BOD POD) at age 18. RESULTS: We found a positive association between BMI at age 11 and BMC (males [ß = 179.7 g, 95% CI 161.4; 198.0]; females [ß = 179.9 g, 95% CI 165.3; 194.6]) and BMD (males [ß = 0.030 g/cm2, 95% CI 0.024; 0.035]; females [ß = 0.029 g/cm2, 95% CI 0.025; 0.033]) at age 18. This association was largely mediated by BMI and FFM at age 18 in both female and male adolescents. FM at age 18 was not an important mediator. CONCLUSIONS: Concurrent BMI and FFM were the main mediators of the association between BMC/BMD in late adolescence and BMI in early adolescence.

Maternal mental health and offspring's IQ: Evidence from two Brazilian birth cohorts.

Maternal mental health during different stages of life can have a significant impact on a child's cognitive development. This study aimed to investigate the association between maternal CMD at two distinct stages of the offspring's life (at 3 months and 11 years) and their IQ scores at 6 and 18 years across two birth cohorts. The study utilized data from two Brazilian birth cohorts: the 1993 cohort (full sample: N = 3719, subsample: N = 436), and the 2004 Pelotas Birth Cohort (N = 3440). IQ assessments were conducted at ages 18 and 6, employing the Wechsler Adult Intelligence Scale, third version (WAIS-III), and Wechsler Intelligence Scale for Children, third version (WISC-III), respectively. The presence of maternal CMD at 3 months and 11 years of age was evaluated using the Brazilian version of the Self-Reporting Questionnaire (SRQ-20). After adjustment, participants whose mothers experienced CMD at 3 months had average IQ scores 1.74 (95 % CI: -2.83 to -0.67) and 2.79 (95 % CI: -5.54 to -0.04) points lower at ages 6 (2004 cohort) and 18 (1993 cohort subsample), respectively. Furthermore, in the 1993 cohort (both full and subsample), maternal CMD at 11 years was associated with lower IQ scores at age 18. Understanding the mechanisms underlying this association, emphasized by these findings, is crucial for promoting children's cognitive development, educational achievement, and overall well-being.

Inequalities in Pap smear screening for cervical cancer in Brazil.

OBJECTIVE: To examine the risk factors associated with never being screened for cervical cancer (CC) in Brazil. METHODS: Using the National Household Sample Survey 2008 (PNAD), we analyzed data from 102,108 Brazilian women ages 25-64years. The patients were analyzed as having been or never having been screened with a Pap smear (Yes/No). Age-adjusted prevalence of never-screening was analyzed using a Chi-squared test. Crude and adjusted models using Poisson regression were performed. RESULTS: The prevalence of never-screened women for CC was 12.9%, 11.5% and 22.2% in Brazil in general, urban and rural areas, respectively. The Brazilian region with the highest prevalence of never-screening was the North (17.4%, 14.7% and 27.3% in general, urban and rural areas, respectively). The factors associated with a higher risk for never being screened were the following: poverty, younger age, lower educational level, non-white skin color, a greater number of children, no supplemental health insurance and not having visited a doctor in the past 12months. CONCLUSION: Socioeconomic and demographic conditions lead to inequalities in access to Pap smear screening in Brazil. Public health policy addressing these risk groups is necessary.

Effect of Adolescent Body Mass Index Trajectories on Working Memory: A Prospective Birth Cohort in Brazil.

Most research on the association between high body mass index (BMI) and working memory (WM) has been cross-sectional in design, limiting conclusions about long-term effects of overweight and obesity on WM. The aim of this study was to examine the association of BMI trajectory from 11 to 22 years with WM at 22 years of age. Data from the 1993 Pelotas (Brazil) Birth Cohort Study were analyzed (N = 3,010). Information on BMI was collected at ages 11, 15, 18, and 22 years. Group-based trajectory modeling was used separately for each sex to identify BMI trajectories. Working Memory performance (Digit Span backward score) was examined at age 22. Multiple linear regression was used to assess the association between BMI trajectory from 11 to 22 years and WM at age 22. In both sexes, the trajectory groups were: stable normal weight, stable overweight, and stable obesity. In the adjusted analyses, women in the stable-obesity group had lower WM at 22 years (ß = -.49; 95% CI: -0.75, -0.23; p < .001) than those in the stable-normal weight group. No associations were found between BMI trajectories and WM in men. This study may contribute to future investigations of possible explanatory avenues for the association between high BMI and WM.

Treatments used by chronic obstructive pulmonary disease patients in Brazil: National Survey of Health, 2013.

OBJECTIVE: To estimate the prevalence of treatments used for the management of chronic obstructive pulmonary disease (COPD) in the Brazilian adult population. METHODS: A population-based cross-sectional study with data from the 2013 Brazilian National Survey of Health, including individuals aged 40 years or older, with a self-reported medical diagnosis of COPD, chronic bronchitis and/or emphysema, who were asked about treatments used for disease management. RESULTS: A total of 60,202 adults were interviewed, of which 636 were 40 years of age or older and had reported a medical diagnosis of COPD, emphysema, or chronic bronchitis. Less than half (49.4%) of the diagnosed population reported using some type of treatment, with differences regarding the macro-region of the country (South 53.8% - Northeast 41.2%, p = 0.007). Pharmacological treatment was the most reported, and emphysema patients had the highest proportion of those undergoing more than one type of treatment. Among the individuals who reported having only chronic bronchitis, 55.1% (95%CI: 48.7-61.4) used medication, 4.7% (95%CI: 2.6-8.3) underwent physical therapy, and 6.0% (95%CI: 3.6-9.9) oxygen therapy. On the other hand, among the emphysema patients, 44.1% (95%CI: 36.8-51.7) underwent drug treatment, 8.8% (95%CI: 5.4-14.2) physical therapy, and 10.0% (95%CI: 6.3-15.6) oxygen therapy. CONCLUSION: The prevalence of treatments for COPD management was below ideal in 2013. The pharmacological treatment was the main type of treatment, followed by oxygen therapy and physical therapy.