Socioeconomic inequalities in children's health-related quality of life according to weight status

OBJECTIVES

This study explores the association between socioeconomic position (SEP) and health-related quality of life (HRQoL) among Portuguese children according to their weight status.

METHODS

A total of 1215 primary school-aged children (mean age 8.78 years) from three Portuguese districts (Lisbon, Porto, Coimbra) were assessed during 2016/2017. Father and mother's education (low, medium, high) and work status (employed, unemployed/retired) were used as SEP indicators. Self-reported HRQoL was assessed with the KIDSCREEN-27. Height and weight were objectively measured and body mass index categorized in normal, overweight or obese. Age, sex, and district-adjusted linear regression models were fitted to estimate associations between SEP indicators and HRQoL dimensions, according to weight status.

RESULTS

We found that 24.9% of children were categorized as having overweight/obesity. The mean scores of the Physical Well-Being, and School Environment dimensions of HRQoL were lower among children classified with overweight/obesity compared to children with normal weight (57.21 vs 54.11, P < .001 and 57.85 vs 56.04, P = .010, respectively). Father's education was significantly associated with all HRQoL dimensions in children with a normal weight, but the same was not observed among children presenting overweight/obesity. An increase in the level of maternal education was also significantly associated with all HRQoL dimensions among children classified with a normal weight, and only for the School Environment dimension among children classified with overweight/obesity.

CONCLUSIONS

These results suggest the presence of socioeconomic inequalities in self-reported HRQoL from early age, particularly among children with normal weight.

Social inequalities in traditional and emerging screen devices among Portuguese children: a cross-sectional study

BACKGROUND

Children are often exposed to too much screen time but few studies have explored the use of old and new digital media among young children. This study assesses screen time, including traditional and mobile devices, in pre-school and elementary school-aged children, according to their gender, age, and socioeconomic position (SEP).

METHODS

A total of 8430 children (3 to 10 years; 50.8% boys) from the north, center and south-central Portugal were included in the present study. Data was collected by a parental questionnaire during 2016/2017. Children's screen time (by media device, weekdays and at the weekend; calculated by mean minutes per day) were reported by parents. Analysis were carried to compare screen time by children's age, gender and family SEP (classified using father's educational degree).

RESULTS

Daily screen time was high both in children aged 3 to 5 and 6 to 10 years - 154 min/day (95% CI: 149.51-158.91) and 200.79 min/day (95% CI: 197.08-204.50), respectively - and the majority of children, independently of their gender, exceed the recommended 2 h/day of screen viewing. Children are still primarily engaging in screen time through television but the use of mobile devices, particularly tablets, were already high among 3 year-old children and increased with age. SEP was a negative predictor of screen time in the linear regression analysis, including after adjustment.

CONCLUSIONS

Considering the negative health impacts of excessive screen time, recognizing subgroups at risk of excessive screen time and identifying how each device is used according to age is fundamental to enable appropriate future interventions. The screen time in children aged 3-10 years is longer than the recommended, particularly among boys and in those children from lower SEP. Parents and policymakers should have in mind that children spend most of their screen time watching television but mobile devices are becoming extremely popular starting at a young age.

Self-reported symptoms of depression, anxiety and stress in Portuguese primary school-aged children

BACKGROUND

Symptoms of depression, anxiety and stress experienced during childhood might have a negative impact on development. This study explores factors associated with such symptoms among Portuguese primary school-aged children.

METHODS

A sample of children (n = 1022, mean age = 8.77 years old) was recruited in public and private schools from the cities of Coimbra, Lisbon and Porto, Portugal. The children's version of the Depression, Anxiety and Stress Scale (DASS-C) was self-administered. Multivariate logistic regression models were fitted to measure associations (expressed as Odds Ratio, OR and 95% Confidence Intervals, CI) between each DASS-C subscale, dichotomized by its 4th vs. 3rd or less quartiles (symptoms increase with scores), and covariates: child sex, age, socioeconomic status (SES), sports activity beyond school, children self-assessed health status, child and mother's body mass index and mother's DASS scores.

RESULTS

Age was negatively associated with anxiety symptoms (adjusted OR, 95% CI: 0.70, 0.57-0.87) and girls, compared to boys, presented lower odds of depressive and stress symptoms (adjusted OR, 95% CI: 0.65, 0.47-0.92 and 0.57, 0.41-0.80, respectively). A low socioeconomic status was associated with more frequent symptoms of stress (adjusted OR, 95%CI for low compared to high SES: 1.61, 1.01-2.56). Children with poorer self-assessed health status and whose mothers scored higher in the DASS also presented significantly higher odds of scoring in the 4th quartile (vs. 3rd or less) of the three DASS-C subscales.

CONCLUSIONS

These results suggest the need to tailor preventive efforts targeting childhood mental health symptoms.

Influence of parental perceived environment on physical activity, TV viewing, active play and Body Mass Index among Portuguese children: A mediation analysis

OBJECTIVES

The environment is believed to be key in obesity prevention, yet it is unclear how factors in the neighborhood influence weight-related behaviors. The present study aimed to investigate the influence of parental perceived environment on physical activity (PA), television (TV) time, active play and Body Mass Index (BMI) z score, and the mediating role of these weight-related behaviors on the relationship between neighborhood characteristics and children's BMI.

METHODS

Data of 8472 Portuguese preschool (aged 3-6, n = 3819) and school-aged children (aged 7-11 years, n = 4653) were collected during 2016/2017. Structural equation modeling was used to estimate the associations between parents perceived neighborhood characteristics (latent variables: unsafety and built/physical environment) and child's BMI z score, PA and TV time.

RESULTS

Among preschoolers, the latent variables of the perceived environment were not associated with the BMI, TV time, extracurricular PA, and active play. Among schoolchildren, the unsafety environment was positively associated with both the BMI (SC = 0.050, P = .008) and the time spent watching TV (SC = 0.052, P = .031) and negatively associated with extracurricular PA (SC = -0.125, P < .001). The latent variable Favorable Built Environment for PA (ie, environmental facilitating elements) was positively associated with active play (SC = 0.041, P = .031). Moreover, the TV time was a marginally significant mediator of the relationship between the perceived unsafe environment and the BMI of school-aged children (B = 0.002, P = .096).

CONCLUSIONS

In conclusion, changes in the environment to targeting parental perception of neighborhood safety could have positive effects on the promotion of healthy weight and the adoption of a healthy lifestyle in school-aged children.

Impacts of plastic products used in daily life on the environment and human health: What is known?

Plastics are indispensable and persistent materials used in daily life that can be fragmented into micro- or nanoplastics. They are long polymer chains mixed with additives that can be toxic when in contact with distinct species. The toxicity can result from polymer matrix, additives, degradation products and adsorbed contaminants. Notwithstanding, there is still an immense gap of information concerning the individual and mixed impacts of plastics. Hence, in this study, we characterize the most common plastic materials widely used in our daily life by its polymer type and compile the environmental and human health hazards of these polymers including the impacts of monomers, additives, degradation products and adsorbed contaminants based on literature review. In summary, polyvinyl chloride is the most toxic polymer type used daily (monomer and additives); additives are more toxic than monomers to wildlife and humans; and the most toxic additives are benzene, phthalates and lead stabilisers.

The impact of the economic crisis on the mental health of Portuguese primary-school children

Objective

To measure the impact of the economic crisis on the mental health correlates of Portuguese children attending primary school during 2016.

Methods

Cross-sectional analysis of primary school-aged children and their parents (n = 1157), conducted in public and private schools of three Portuguese districts. Parent reports of children mental health symptoms (Strengths and Difficulties Questionnaire - SDQ) and children self-reports of health-related quality of life (KIDSCREEN-27) and depressive, anxiety and stress symptoms (Depression, Anxiety and Stress Scales, Children version - DASS-C), were compared according to a set of yes/no questions on how the economic crisis changed the normal aspects of routine life (e.g. During the financial crisis did you had to use savings? Started buying cheaper food?). Linear regression models were fitted for the SDQ, the KIDSCREEN-27 and the DASS-C as dependent variables adjusted for children sex, socioeconomic status and district of residence.

Results

Affirmative answers to the crisis impact questions were associated with more frequent psychosocial functioning problems in children, with poorer self-reported health-related quality of life and with more frequent symptoms of depression, anxiety and stress.

Conclusions

Portuguese children mental health correlates show significant worse scores for those whose parents declared having to change daily routine habits as a result of the recent macroeconomic financial crisis, compared to those who did not change habits. Public Health programs should be developed to mitigate the potential negative impact of the financial crisis to the mental health of children.

Key messages

A negative impact on children mental health was observed as a result of the economic crisis. Public health programs designed to mitigate the impact of the economic crisis should include primary-school aged children.

Overweight Risk and Food Habits in Portuguese Pre-school Children

The relationship between dietary intake and overweight-risk was assessed in 4349 children aged 3–5 years. Eating and sedentary behaviours were assessed by questionnaire. Logistic regressions were used. Children who consumed daily soft-drinks were 1.52 times more likely to be obese, and 72% more likely to be classified as overweight children.

The role of urban design in childhood obesity: A case study in Lisbon, Portugal

OBJECTIVE

We hypothesize that physical features of the urban environment might enhance or prevent childhood obesity. Thus, this study's main goal was to verify if there is an association between the neighborhood urban design and childhood obesity-independent of well-known childhood obesity determinants, such as, father's level of schooling (as a proxy for socioeconomic status), and parent's weight status.

METHODS

This study classifies neighborhoods according to land use and building features using hierarchical clusters analysis and examines their association with childhood obesity through logistic regression models.

RESULTS

Four clusters resulted from the analysis: Cluster 1 represents areas with older buildings and mixed land use, cluster 2 is an area with small rented buildings and urban areas, cluster 3 comprises newer buildings with parking and urban green space, and cluster 4 is a forest area. Living in cluster 3 protects from childhood obesity, even when adjusting for father's level of schooling or parent's weight status.

CONCLUSIONS

There are distinct urban configurations in Lisbon's municipality and children who live in Cluster 3 (more recent and greener neighborhoods) seem to be protected from obesity. Therefore, public policy should focus on healthy urban planning at the neighborhood level, to promote positive impacts on peoples' health.

Spatial and temporal distribution of microplastics in water and sediments of a freshwater system (Antuã River, Portugal)

Microplastics (particles with a size<5mm), one of the most emerging aquatic pollutants, are of particular concern since they can reach high densities and interact with biotic and abiotic environment. The occurrence of microplastics in freshwater systems is less understood than in marine environment. Hence, the present study aims to provide new insights into microplastics abundances and distribution in Antuã River (Portugal) by applying the isolation method of wet peroxide oxidation with addition of zinc chloride to water and sediment samples collected in March and October 2016, in three sampling sites. The abundance of microplastics in water ranged from 5 to 8.3mgm^-3 or 58-193itemsm^-3 in March and from 5.8-51.7mgm^-3 or 71-1265itemsm^-3 in October. In sediments, the abundance ranged from 13.5-52.7mgkg^-1 or 100-629itemskg^-1 in March and from 2.6-71.4mgkg^-1 or 18-514itemskg^-1 in October. The water and sediment samples with the greatest abundances were from São João da Madeira and Aguincheira, respectively. Spatio-temporal distribution showed different pattern according to methodological approaches, seasonal and hydrodynamic conditions and the proximity to urban/industry areas. Analysis of plastics by Fourier transform infrared spectroscopy underline polyethylene and polypropylene as the most common polymer types identified in this work. The low medium high oxidation ratio was 56:22:22 (%) in March and 61:31:8 (%) in October. Foams and fibers were the most abundant type in São João da Madeira, while fibers and fragments were the most abundant in Aguincheira and Estarreja in water and sediment samples, respectively. This study emphasizes the importance of rivers as carriage systems of microplastics. Further studies should be performed to identify point sources in order to mitigate the microplastics contamination in aquatic systems.

Hedgehog-shaped {Mo368} cluster: unique electronic/structural properties, surfactant encapsulation and related self-assembly into vesicles and films

The hedgehog-shaped {Mo368} cluster shows unique electronic (extremely high extinction coefficient) and structural features, especially regarding its size, the high number of delocalized electrons which allows to measure the surface enhanced Raman scattering (SERS) spectrum and the option for coordination chemistry inside the cavity. Its relative instability in aqueous solution can be overcome by embedment in a hydrophobic shell of dimethyldioctadecylammonium cations. The resulting hybrid self-assembles into spherical vesicles in acetone-water mixtures, according to a process directed by hydrophobic-hydrophilic interactions. It also forms rather stable Langmuir monolayers while a second layer evolves under higher surface pressure, in accordance with a rather low alkyl surface density.