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Sánchez-Luquez KY, Carpena MX, Karam SM, Martins-Silva T, Barros FC, de Oliveira IO, Santos IS, Barros AJD, Matijasevich A, Tovo-Rodrigues L. Evaluation of genomic factors and early childhood stimulation on intelligence in children from a Brazilian birth cohort: The primary role of independent factors. Prog Neuropsychopharmacol Biol Psychiatry 2024; 131:110932. [PMID: 38169242 DOI: 10.1016/j.pnpbp.2023.110932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 12/19/2023] [Accepted: 12/27/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Childhood cognitive abilities are a predictor of health outcomes and adult income potential. Identifying factors associated with childhood intelligence and their interactions is essential in behavioral research. We assessed the impact of genetic variants and early child stimulation (ECS) on child intelligence and examined their possible interaction as potential modifiers of IQ in a population-based longitudinal study. METHODS Participants of the 2004 Pelotas Birth Cohort study (N = 4231) underwent intelligent quotient (IQ) by WISC-III assessment at 6 years of age. At 24 and 48-months, mothers answered five ECS marker questions, whose sum was used to create a score. The polygenic score for intelligence (IQ-PGS) was constructed from the GWAS-weighted estimate of cognition. Association was assessed using multiple linear regression models adjusted for maternal, family, and child confounding variables. To explore the possible influence of skin color and ethnoracial classification, the regression models were stratified according to the skin color variable, as a sensitivity analysis. RESULTS In the adjusted analysis, IQ-PGS (β = 0.79, 95% confidence interval [95% CI] 0.26;1.31) as well as ECS (β = 2.34; 95% CI: 1.76;2.92) were associated with IQ in this sample. The association between IQ-PGS and IQ was significant only in the white Brazilian group in the sensitivity analysis. However, there was no interaction between IQ-PGS and ECS on IQ (p(IQ-PGS x ECS) = 0.46). CONCLUSIONS ECS did not modify the impact of genetic potential on intellectual development during childhood, suggesting that genetic factors and ECS exert independent effects on the IQ levels of children.
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Affiliation(s)
| | - Marina Xavier Carpena
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil; Human Development and Violence Research Centre (DOVE), Federal University of Pelotas, Postgraduate Program in Epidemiology, Pelotas, Brazil
| | - Simone M Karam
- Department of Pediatrics, Medicine Faculty, Federal University of Rio Grande, Rio Grande, Brazil
| | - Thais Martins-Silva
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil; Human Development and Violence Research Centre (DOVE), Federal University of Pelotas, Postgraduate Program in Epidemiology, Pelotas, Brazil
| | - Fernando C Barros
- Post Graduate Program in Health in the Vital Cycle, Catholic University of Pelotas, Pelotas, Brazil
| | - Isabel O de Oliveira
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Iná S Santos
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Aluísio J D Barros
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Alicia Matijasevich
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil; Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brasil
| | - Luciana Tovo-Rodrigues
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil; Human Development and Violence Research Centre (DOVE), Federal University of Pelotas, Postgraduate Program in Epidemiology, Pelotas, Brazil.
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Johns NE, Blumenberg C, Kirkby K, Allorant A, Costa FDS, Danovaro-Holliday MC, Lyons C, Yusuf N, Barros AJD, Hosseinpoor AR. Comparison of Wealth-Related Inequality in Tetanus Vaccination Coverage before and during Pregnancy: A Cross-Sectional Analysis of 72 Low- and Middle-Income Countries. Vaccines (Basel) 2024; 12:431. [PMID: 38675813 PMCID: PMC11054082 DOI: 10.3390/vaccines12040431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/21/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Immunization of pregnant women against tetanus is a key strategy for reducing tetanus morbidity and mortality while also achieving the goal of maternal and neonatal tetanus elimination. Despite substantial progress in improving newborn protection from tetanus at birth through maternal immunization, umbilical cord practices and sterilized and safe deliveries, inequitable gaps in protection remain. Notably, an infant's tetanus protection at birth is comprised of immunization received by the mother during and before the pregnancy (e.g., through childhood vaccination, booster doses, mass vaccination campaigns, or during prior pregnancies). In this work, we examine wealth-related inequalities in maternal tetanus toxoid containing vaccination coverage before pregnancy, during pregnancy, and at birth for 72 low- and middle-income countries with a recent Demographic and Health Survey or Multiple Indicator Cluster Survey (between 2013 and 2022). We summarize coverage levels and absolute and relative inequalities at each time point; compare the relative contributions of inequalities before and during pregnancy to inequalities at birth; and examine associations between inequalities and coverage levels. We present the findings for countries individually and on aggregate, by World Bank country income grouping, as well as by maternal and neonatal tetanus elimination status, finding that most of the inequality in tetanus immunization coverage at birth is introduced during pregnancy. Inequalities in coverage during pregnancy are most pronounced in low- and lower-middle-income countries, and even more so in countries which have not achieved maternal and neonatal tetanus elimination. These findings suggest that pregnancy is a key time of opportunity for equity-oriented interventions to improve maternal tetanus immunization coverage.
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Affiliation(s)
- Nicole E. Johns
- Department of Data and Analytics, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland; (N.E.J.)
| | - Cauane Blumenberg
- International Center for Equity in Health, Federal University of Pelotas, Rua Mal Deodoro 1160, Pelotas 96020-220, Brazil
- Causale Consulting, Avenida Adolfo Fetter 4331, Pelotas 96090-840, Brazil
| | - Katherine Kirkby
- Department of Data and Analytics, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland; (N.E.J.)
| | - Adrien Allorant
- Department of Data and Analytics, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland; (N.E.J.)
| | - Francine Dos Santos Costa
- International Center for Equity in Health, Federal University of Pelotas, Rua Mal Deodoro 1160, Pelotas 96020-220, Brazil
| | - M. Carolina Danovaro-Holliday
- Department of Immunization, Vaccines, and Biologicals, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
| | - Carrie Lyons
- Department of Data and Analytics, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland; (N.E.J.)
| | - Nasir Yusuf
- Department of Immunization, Vaccines, and Biologicals, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
| | - Aluísio J. D. Barros
- International Center for Equity in Health, Federal University of Pelotas, Rua Mal Deodoro 1160, Pelotas 96020-220, Brazil
| | - Ahmad Reza Hosseinpoor
- Department of Data and Analytics, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland; (N.E.J.)
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Tillmann TFF, de Camargo MBJ, Cascaes AM, Barros AJD, Santos IS, Corrêa MB, Matijasevich A, D'Ávila OP, Silva AER. Perception of parents and caregivers about the need for dental appointments for adolescents from a Brazilian birth cohort. Community Dent Oral Epidemiol 2024; 52:217-223. [PMID: 37861237 DOI: 10.1111/cdoe.12915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 09/01/2023] [Accepted: 09/25/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE To investigate the perception of parents or caregivers regarding the need for dental appointments for adolescents aged 12-13 years and associated factors. METHODS Data from the Pelotas 2004 Birth Cohort were used. The outcome variable was the need for dental appointments for young adolescents perceived by parents or caregivers. Demographic and economic exposure variables were obtained from the first (2004) and sixth general follow-up (2015), respectively. The exposure variables 'previous history of dental pain', 'self-rated oral health', clinical variables and the outcome variable were obtained from the second oral health follow-up (2017). Unadjusted and adjusted multivariate Poisson regression analyses provided prevalence ratios (PR) and respective 95% confidence intervals (CI). RESULTS At the first oral health follow-up (2009), 1303 five-year-old children were recruited, 996 of whom were reassessed and underwent oral health examinations at 12 and 13 years of age (response rate: 76.4%). The findings showed that 72.4% of parents/caregivers perceived that the adolescents needed dental appointments. No associations were found between the outcome and sociodemographic or economic variables. After adjustments, the outcome remained positively associated with previous history of toothache (PR 1.22; 95% CI 1.14-1.32), self-rated oral health as fair or poor (PR 1.26; 95% CI 1.15-1.39), the presence of dental caries (PR 1.27; 95% CI 1.20-1.38) and severe or disabling malocclusion (PR 1.14; 95% CI 1.05-1.25). CONCLUSIONS The perception of parents/caregivers regarding the need for dental appointments on the part of their adolescent sons and daughters was associated with oral health problems, and these findings can serve as the basis for creating and improving oral health programmes that seek a better understanding on the part of parents and caregivers regarding the importance of integral care for their adolescent children.
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Affiliation(s)
| | | | | | - Aluísio J D Barros
- Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Iná S Santos
- Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Marcos Britto Corrêa
- Postgraduate Programme in Dentistry, School of Dentistry, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Alicia Matijasevich
- Department of Preventive Medicine, Faculty of Medicine, Universidade de São Paulo, São Paulo, Brazil
| | - Otávio Pereira D'Ávila
- Postgraduate Programme in Dentistry, School of Dentistry, Universidade Federal de Pelotas, Pelotas, Brazil
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Martins-Silva T, Bauer A, Matijasevich A, Munhoz TN, Barros AJD, Santos IS, Tovo-Rodrigues L, Murray J. Early risk factors for conduct problem trajectories from childhood to adolescence: the 2004 Pelotas (BRAZIL) Birth Cohort. Eur Child Adolesc Psychiatry 2024; 33:881-895. [PMID: 37097345 PMCID: PMC10126565 DOI: 10.1007/s00787-023-02178-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 02/23/2023] [Indexed: 04/26/2023]
Abstract
Conduct problems are associated with an increased risk of a wide range of physical, mental, and social problems. However, there is still uncertainty about how early risk factors differentiate different developmental patterns of conduct problems and whether findings replicate across diverse social contexts. We aimed to identify developmental trajectories of conduct problems, and test early risk factors, in the 2004 Pelotas Birth Cohort in Brazil. Conduct problems were measured at ages 4, 6, 11, and 15 years from caregiver reports on the Child Behaviour Checklist (CBCL) and Strengths and Difficulties Questionnaire (SDQ). Conduct problem trajectories were estimated using group-based semi-parametric modeling (n = 3938). Multinomial logistic regression was used to examine associations between early risk factors and conduct problem trajectories. We identified four trajectories: three with elevated conduct problems, including early-onset persistent (n = 150; 3.8%), adolescence-onset (n = 286; 17.3%), and childhood-limited (n = 697; 17.7%), and one with low conduct problems (n = 2805; 71.2%). The three elevated conduct problem trajectories were associated with a wide range of sociodemographic risk factors, prenatal smoking, maternal mental health, harsh parenting, childhood trauma, and child neurodevelopmental risk factors. Early-onset persistent conduct problems were particularly associated with trauma, living without a father figure, and attention difficulties. The four trajectories of conduct problems from ages 4 to 15 years in this Brazilian cohort have similar longitudinal patterns to those identified in high-income countries. The results confirm previous longitudinal research and developmental taxonomic theories on the etiology of conduct problems in a Brazilian sample.
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Affiliation(s)
- Thais Martins-Silva
- Human Development and Violence Research Centre (DOVE), Federal University of Pelotas, Pelotas, Brazil
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Andreas Bauer
- Human Development and Violence Research Centre (DOVE), Federal University of Pelotas, Pelotas, Brazil
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Alicia Matijasevich
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Tiago N Munhoz
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Aluísio J D Barros
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Iná S Santos
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- Postgraduate Program in Pediatrics and Child Health, School of Medicine, Pontifical Catholic University of Rio Grande Do Sul, Porto Alegre, Brazil
| | - Luciana Tovo-Rodrigues
- Human Development and Violence Research Centre (DOVE), Federal University of Pelotas, Pelotas, Brazil
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Joseph Murray
- Human Development and Violence Research Centre (DOVE), Federal University of Pelotas, Pelotas, Brazil.
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.
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Tovo-Rodrigues L, Santos IS, Bierhals IO, Del-Ponte B, Murray J, Bielemann R, Munhoz TN, Crochemore-Silva I, de Oliveira IO, Barros FC, Barros AJD, Matijasevich A. Cohort Profile Update: 2004 Pelotas (Brazil) Birth Cohort Study follow-up during adolescent years. Int J Epidemiol 2024; 53:dyad156. [PMID: 37953504 PMCID: PMC10859134 DOI: 10.1093/ije/dyad156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 11/06/2023] [Indexed: 11/14/2023] Open
Affiliation(s)
- Luciana Tovo-Rodrigues
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
- Human Development and Violence Research Centre, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Iná S Santos
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | | | - Bianca Del-Ponte
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Joseph Murray
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
- Human Development and Violence Research Centre, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Renata Bielemann
- Postgraduate Program in Nutrition and Foods, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Tiago N Munhoz
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
- School of Psychology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Inácio Crochemore-Silva
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
- Postgraduate Program in Physical Education, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Isabel O de Oliveira
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Fernando C Barros
- Postgraduate Program in Health in the Life Cycle, Universidade Catolica de Pelotas, Pelotas, RS, Brazil
| | - Aluísio J D Barros
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Alicia Matijasevich
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brasil
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Maruyama JM, Bauer A, Hammerton G, Halligan SL, Santos IS, Munhoz TN, Barros AJD, Barros FC, Fairchild G, Matijasevich A. Pathways from maternal depression to child resilience: Socioeconomic, family, and individual factors in the 2004 Pelotas (Brazil) birth cohort. JCPP Adv 2023; 3:e12188. [PMID: 38054047 PMCID: PMC10694539 DOI: 10.1002/jcv2.12188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 06/16/2023] [Indexed: 12/07/2023] Open
Abstract
Background The negative impacts of maternal depression on child mental health outcomes are well-documented. However, some children show adaptive functioning following exposure to maternal depression, demonstrating resilience. In a large birth cohort from Brazil, a middle-income country, we examined direct and indirect pathways, considering socioeconomic, family, and individual factors, contributing to the development of resilience. Methods Using data from the 2004 Pelotas Birth Cohort (N = 4231), we restricted the sample to those exposed to maternal depression up to age 6 years (depression present at ≥2 out of 5 assessment waves; n = 1132; 50% boys). Resilience was defined as scoring below or equal to the mean of the unexposed group on all four problem subscales of the parent-report Strengths and Difficulties Questionnaire at age 11 years. We examined pathways from socioeconomic status (SES; measured at birth) to resilience via cognitive stimulation (CS) (at 24 and 48 months) and Intelligence quotient (IQ) (at 6 years), and from CS to resilience via IQ, using counterfactual mediation. Results A minority of children exposed to maternal depression showed resilience (12.4%). There was evidence of indirect pathways from SES to resilience via CS (odds ratio (OR) = 1.76, 95% confidence interval (CI) 1.02-3.38) and IQ (OR = 1.19, 95% CI 1.01-1.42), such that higher SES was associated with resilience via both higher levels of CS and higher IQ, which, in turn, were each positively associated with resilience. Furthermore, there was evidence of a direct (OR = 1.86, 95% CI 1.01-3.76) and total effect (OR = 1.94, 95% CI 1.05-3.89) of CS on resilience, even after controlling for SES. However, these effects varied depending on how persistent and severe depression was defined. Conclusions These findings suggest that CS in early childhood may represent a modifiable protective factor for children exposed to maternal depression and a promising intervention target to promote child resilience in the context of maternal depression exposure.
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Affiliation(s)
- Jessica Mayumi Maruyama
- Departamento de Medicina PreventivaFaculdade de Medicina FMUSPUniversidade de São PauloSão PauloBrazil
| | - Andreas Bauer
- Department of PsychologyUniversity of BathBathUK
- Human Development and Violence Research Centre (DOVE)Federal University of PelotasPelotasBrazil
- Postgraduate Program in EpidemiologyFederal University of PelotasPelotasBrazil
| | - Gemma Hammerton
- Population Health SciencesBristol Medical SchoolUniversity of BristolBristolUK
- MRC Integrative Epidemiology UnitUniversity of BristolBristolUK
| | - Sarah L. Halligan
- Department of PsychologyUniversity of BathBathUK
- Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa
| | - Ina S. Santos
- Postgraduate Program in EpidemiologyFederal University of PelotasPelotasBrazil
- Postgraduate Program in Paediatrics and Child HealthPontifical Catholic University of Rio Grande do SulPorto AlegreBrazil
| | - Tiago N. Munhoz
- Postgraduate Program in EpidemiologyFederal University of PelotasPelotasBrazil
- Faculty of PsychologyFederal University of PelotasPelotasBrazil
| | | | - Fernando C. Barros
- Postgraduate Program in Health and BehaviourCatholic University of PelotasPelotasBrazil
| | | | - Alicia Matijasevich
- Departamento de Medicina PreventivaFaculdade de Medicina FMUSPUniversidade de São PauloSão PauloBrazil
- Postgraduate Program in EpidemiologyFederal University of PelotasPelotasBrazil
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Maruyama JM, Valente JY, Tovo-Rodrigues L, Santos IS, Barros AJD, Munhoz TN, Barros FC, Murray J, Matijasevich A. Maternal depression trajectories in childhood, subsequent maltreatment, and adolescent emotion regulation and self-esteem: the 2004 Pelotas birth cohort. Eur Child Adolesc Psychiatry 2023; 32:1935-1945. [PMID: 35731302 PMCID: PMC9214189 DOI: 10.1007/s00787-022-02022-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 06/01/2022] [Indexed: 11/26/2022]
Abstract
This study aimed to examine the impact of maternal depressive symptoms trajectories on 15-year-old adolescents' self-esteem and emotion regulation and test the mediating role of child maltreatment in this association. The 2004 Pelotas Birth Cohort is an ongoing cohort study originally comprised of 4231 live births in a southern Brazilian city. We examined a subsample of 1949 adolescents at age 15 years. Maternal depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale. Trajectories of maternal depression from 3 months until the 11-year follow-up were calculated using a group-based modeling approach. Child maltreatment at age 11 years was measured using the parent-report version of the Parent-Child Conflict Tactics Scale. Adolescent outcomes at age 15 years were assessed by the self-report version of the Rosenberg Self-esteem Scale and the Emotion Regulation Index for Children and Adolescents. Path model analysis was conducted using a structural equation modeling framework in Mplus software. All maternal depression trajectories were negatively associated with offspring self-esteem and emotion regulation compared to the reference group (low depression trajectory). There was a significant indirect effect of maternal depression trajectories on emotion regulation mediated via child maltreatment. No evidence of moderation by sex was found for any pathway. The effects of maternal depression on adolescents' emotion regulation are partly mediated by child maltreatment at age 11.
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Affiliation(s)
- Jessica Mayumi Maruyama
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, Av. Dr. Arnaldo 455, 2nd Floor, São Paulo, SP, CEP 01246-903, Brazil.
| | - Juliana Y Valente
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Iná S Santos
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- Postgraduate Program in Pediatrics and Child Health, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Aluísio J D Barros
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Tiago N Munhoz
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- Faculty of Psychology, Federal University of Pelotas, Pelotas, Brazil
| | - Fernando C Barros
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- Programa de Pós-graduação em Saúde e Comportamento, Universidade Católica de, Pelotas, Brazil
| | - Joseph Murray
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- Human Development and Violence Research Centre, Federal University of Pelotas, Pelotas, Brazil
| | - Alicia Matijasevich
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, Av. Dr. Arnaldo 455, 2nd Floor, São Paulo, SP, CEP 01246-903, Brazil
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
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Hallal PC, Rocha ACCAD, Sardinha LMV, Barros AJD, Wehrmeister FC. [Telephone Survey of Risk Factors for Chronic Noncommunicable Diseases During the Pandemic (Covitel): methodological aspects]. CAD SAUDE PUBLICA 2023; 39:e00248922. [PMID: 37792820 PMCID: PMC10552799 DOI: 10.1590/0102-311xpt248922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 07/05/2023] [Accepted: 07/19/2023] [Indexed: 10/06/2023] Open
Abstract
This study describes the methodology of the Telephone Survey of Risk Factors for Chronic Noncommunicable Diseases During the Pandemic (Covitel), conducted in Brazil in 2022. Covitel is a population-based survey representing Brazil and its five macroregions (Central-West, Northeast, North, Southeast, and South) and providing information on the impact of the main risk factors for chronic noncommunicable diseases (NCDs) on the adult population aged 18 years or above who live in households served by fixed and mobile telephone lines. This study aims to contribute to the development and monitoring of public policies to promote the population's health and obtain results to contribute to the knowledge of the influence of COVID-19 on risk factors for NCDs in the country. We evaluated 9,000 individuals and collected information on their diet, physical activity, mental health, health status, hypertension, diabetes, depression, and alcohol and tobacco consumption, comparing the pre-pandemic moments and the first quarter of 2022. We also collected information about the population's vaccination schedule and COVID-19 infection history.
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Affiliation(s)
- Pedro Curi Hallal
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brasil
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Urbana, U.S.A
| | | | | | - Aluísio J D Barros
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brasil
| | - Fernando C Wehrmeister
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brasil
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Costa JC, Saad GE, Hellwig F, Maia MFS, Barros AJD. Measures of women's empowerment based on individual-level data: a literature review with a focus on the methodological approaches. Front Sociol 2023; 8:1231790. [PMID: 37780693 PMCID: PMC10538115 DOI: 10.3389/fsoc.2023.1231790] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/21/2023] [Indexed: 10/03/2023]
Abstract
Background Quantifying women's empowerment has become the focus of attention of many international organizations and scholars. We aimed to describe quantitative indicators of women's empowerment that are based on individual-level data. Methods In this scoping review, we searched PubMed, Scopus, Web of Science, Science Direct, Google, and Google Scholar for publications describing the operationalization of measures of women's empowerment. Results We identified 36 studies published since 2004, half of them since 2019, and most from low- and middle-income countries. Twelve studies were based on data from the Demographic and Health Surveys and used 56 different variables from the questionnaires (ranging from one to 25 per study) to measure the overall empowerment of women 15-49 years. One study focused on rural women, two included married and unmarried women, and one analyzed the couple's responses. Factor analysis and principal component analysis were the most common approaches used. Among the 24 studies based on other surveys, ten analyzed overall empowerment, while the others addressed sexual and reproductive health (4 studies), agriculture (3) and livestock (1), water and sanitation (2), nutrition (2), agency (1), and psychological empowerment (1). These measures were mainly based on data from single countries and factor analysis was the most frequently analytical method used. We observed a diversity of indicator definitions and domains and a lack of consensus in terms of what the proposed indicators measure. Conclusion The proposed women's empowerment indicators represent an advance in the field of gender and development monitoring. However, the empowerment definitions used vary widely in concept and in the domains/dimensions considered, which, in turn influence or are influenced by the adopted methodologies. It remains a challenge to find a balance between the need for a measure suitable for comparisons across populations and over time and the incorporation of country-specific elements.
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Affiliation(s)
- Janaína Calu Costa
- International Center for Equity in Health, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Ghada E. Saad
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Franciele Hellwig
- International Center for Equity in Health, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Maria Fatima S. Maia
- International Center for Equity in Health, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Aluísio J. D. Barros
- International Center for Equity in Health, Universidade Federal de Pelotas, Pelotas, Brazil
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10
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Erchick DJ, Subedi S, Verhulst A, Guillot M, Adair LS, Barros AJD, Chasekwa B, Christian P, da Silva BGC, Silveira MF, Hallal PC, Humphrey JH, Huybregts L, Kariuki S, Khatry SK, Lachat C, Matijasevich A, McElroy PD, Menezes AMB, Mullany LC, Perez TLL, Phillips-Howard PA, Roberfroid D, Santos IS, ter Kuile FO, Ravilla TD, Tielsch JM, Wu LSF, Katz J. Quality of vital event data for infant mortality estimation in prospective, population-based studies: an analysis of secondary data from Asia, Africa, and Latin America. Popul Health Metr 2023; 21:10. [PMID: 37507749 PMCID: PMC10375772 DOI: 10.1186/s12963-023-00309-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION Infant and neonatal mortality estimates are typically derived from retrospective birth histories collected through surveys in countries with unreliable civil registration and vital statistics systems. Yet such data are subject to biases, including under-reporting of deaths and age misreporting, which impact mortality estimates. Prospective population-based cohort studies are an underutilized data source for mortality estimation that may offer strengths that avoid biases. METHODS We conducted a secondary analysis of data from the Child Health Epidemiology Reference Group, including 11 population-based pregnancy or birth cohort studies, to evaluate the appropriateness of vital event data for mortality estimation. Analyses were descriptive, summarizing study designs, populations, protocols, and internal checks to assess their impact on data quality. We calculated infant and neonatal morality rates and compared patterns with Demographic and Health Survey (DHS) data. RESULTS Studies yielded 71,760 pregnant women and 85,095 live births. Specific field protocols, especially pregnancy enrollment, limited exclusion criteria, and frequent follow-up visits after delivery, led to higher birth outcome ascertainment and fewer missing deaths. Most studies had low follow-up loss in pregnancy and the first month with little evidence of date heaping. Among studies in Asia and Latin America, neonatal mortality rates (NMR) were similar to DHS, while several studies in Sub-Saharan Africa had lower NMRs than DHS. Infant mortality varied by study and region between sources. CONCLUSIONS Prospective, population-based cohort studies following rigorous protocols can yield high-quality vital event data to improve characterization of detailed mortality patterns of infants in low- and middle-income countries, especially in the early neonatal period where mortality risk is highest and changes rapidly.
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Affiliation(s)
- Daniel J. Erchick
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Seema Subedi
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Andrea Verhulst
- Population Studies Center, University of Pennsylvania, Philadelphia, PA USA
| | - Michel Guillot
- Population Studies Center, University of Pennsylvania, Philadelphia, PA USA
- Department of Sociology, University of Pennsylvania, Philadelphia, PA USA
| | - Linda S. Adair
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Aluísio J. D. Barros
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Bernard Chasekwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Parul Christian
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | | | | | - Pedro C. Hallal
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Jean H. Humphrey
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Lieven Huybregts
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC USA
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Simon Kariuki
- Kenya Medical Research Institute/Centre for Global Health Research, Kisumu, Kenya
| | | | - Carl Lachat
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Alicia Matijasevich
- Department of Preventive Medicine, Faculty of Medicine FMUSP, University of São Paulo, São Paulo, Brazil
| | - Peter D. McElroy
- Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Ana Maria B. Menezes
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Luke C. Mullany
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Tita Lorna L. Perez
- USC-Office of Population Studies Foundation, University of San Carlos, Cebu City, Philippines
| | | | | | - Iná S. Santos
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Feiko O. ter Kuile
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | | | - James M. Tielsch
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC USA
| | - Lee S. F. Wu
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Joanne Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
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Botelho VH, Barros AJD, de Oliveira RG, Martins RC, Gonçalves H, Menezes AMB, Blumenberg C. Agreement between measured weight, height and BMI and Web-based self-reported data in participants of the 1993 Pelotas Birth Cohort, Brazil: a cross-sectional validation study. Epidemiol Serv Saude 2023; 32:e2022590. [PMID: 37531484 PMCID: PMC10379011 DOI: 10.1590/s2237-96222023000200013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/21/2023] [Indexed: 08/04/2023] Open
Abstract
OBJECTIVE to evaluate the agreement between measured height, weight, and body mass index (BMI) during the 22-year follow-up of the 1993 Pelotas Birth Cohort, state of Rio Grande do Sul, Brazil, and self-reported data during the online follow-up of the coortesnaweb. METHODS this was a cross-sectional validation study; agreement was assessed by means of Lin's concordance correlation coefficient for continuous measures and weighted Kappa for nutritional status; Spearman's rank correlation coefficient was used to estimate the correlation between measurements. RESULTS a total of 783 participants were included; it could be seen high correlation and high agreement between the measured height (r = 0.966; ρ = 0.966), weight (r = 0.934; ρ = 0.928), and BMI (r = 0.903; ρ = 0.910) and Web-based self-reported data; there was no correlation between mean difference and the time interval between measurements. CONCLUSION using the Internet to collect self-reported anthropometric measurements is as valid as the traditional method.
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Affiliation(s)
- Vivian Hernandez Botelho
- Universidade Federal de Pelotas, Programa de Pós-Graduação em Epidemiologia, Pelotas, RS, Brazil
| | - Aluísio J. D. Barros
- Universidade Federal de Pelotas, Programa de Pós-Graduação em Epidemiologia, Pelotas, RS, Brazil
| | | | - Rafaela Costa Martins
- Universidade Federal de Pelotas, Programa de Pós-Graduação em Epidemiologia, Pelotas, RS, Brazil
| | - Helen Gonçalves
- Universidade Federal de Pelotas, Programa de Pós-Graduação em Epidemiologia, Pelotas, RS, Brazil
| | - Ana M. B. Menezes
- Universidade Federal de Pelotas, Programa de Pós-Graduação em Epidemiologia, Pelotas, RS, Brazil
| | - Cauane Blumenberg
- Universidade Federal de Pelotas, Programa de Pós-Graduação em Epidemiologia, Pelotas, RS, Brazil
- Causale Consultoria, Pelotas, RS, Brazil
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12
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Mujica OJ, Sanhueza A, Carvajal-Velez L, Vidaletti LP, Costa JC, Barros AJD, Victora CG. Recent trends in maternal and child health inequalities in Latin America and the Caribbean: analysis of repeated national surveys. Int J Equity Health 2023; 22:125. [PMID: 37393277 PMCID: PMC10314462 DOI: 10.1186/s12939-023-01932-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 06/07/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND Although most Latin American and the Caribbean (LAC) countries made important progress in maternal and child health indicators from the 1990s up to 2010, little is known about such progress in the last decade. This study aims at documenting progress for each country as a whole, and to assess how within-country socioeconomic inequalities are evolving over time. METHODS We identified LAC countries for which a national survey was available between 2011-2015 and a second comparable survey in 2018-2020. These included Argentina, Costa Rica, Cuba, the Dominican Republic, Guyana, Honduras, Peru, and Suriname. The 16 surveys included in the analysis collected nationally representative data on 221,989 women and 152,983 children using multistage sampling. Twelve health-related outcomes were studied, seven of which related to intervention coverage: the composite coverage index, demand for family planning satisfied with modern methods, antenatal care (four or more visits and eight or more visits), skilled attendant at birth, postnatal care for the mother and full immunization coverage. Five additional impact indicators were also investigated: stunting prevalence among under-five children, tobacco use by women, adolescent fertility rate, and under-five and neonatal mortality rates. For each of these indicators, average annual relative change rates were calculated between the baseline and endline national level estimates, and changes in socioeconomic inequalities over time were assessed using the slope index of inequality. RESULTS Progress over time and the magnitude of inequalities varied according to country and indicator. For countries and indicators where baseline levels were high, as Argentina, Costa Rica and Cuba, progress was slow and inequalities small for most indicators. Countries that still have room for improvements, such as Guyana, Honduras, Peru and Suriname, showed faster progress for some but not all indicators, although also had wider inequalities. Among the countries studied, Peru was the top performer in terms of increasing coverage and reducing inequalities over time, followed by Honduras. Declines in family planning and immunization coverage were observed in some countries, and the widest inequalities were present for adolescent fertility and antenatal care coverage with eight or more visits. CONCLUSIONS Although LAC countries are well placed in terms of current levels of health indicators compared to most low- and middle-income countries, important inequalities remain, and reversals are being observed in some areas. More targeted efforts and actions are needed in order to leave no one behind. Monitoring progress with an equity lens is essential, but this will require further investment in conducting surveys routinely.
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Affiliation(s)
- Oscar J Mujica
- Pan American Health Organization (PAHO), 525 23Rd Street NW, Washington, DC, 20037, USA.
| | - Antonio Sanhueza
- Pan American Health Organization (PAHO), 525 23Rd Street NW, Washington, DC, 20037, USA
| | - Liliana Carvajal-Velez
- United Nations International Children Emergency Fund (UNICEF), New York City, USA
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Luis Paulo Vidaletti
- International Center for Equity in Health (ICEH), Federal University of Pelotas, Pelotas, Brazil
| | - Janaína C Costa
- International Center for Equity in Health (ICEH), Federal University of Pelotas, Pelotas, Brazil
| | - Aluísio J D Barros
- International Center for Equity in Health (ICEH), Federal University of Pelotas, Pelotas, Brazil
| | - Cesar G Victora
- International Center for Equity in Health (ICEH), Federal University of Pelotas, Pelotas, Brazil
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13
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Sanhueza A, Costa JC, Mújica OJ, Carvajal-Velez L, Caffe S, Victora C, Barros AJD. Trends and inequities in adolescent childbearing in Latin American and Caribbean countries across generations and over time: a population-based study. Lancet Child Adolesc Health 2023; 7:392-404. [PMID: 37208093 PMCID: PMC10191863 DOI: 10.1016/s2352-4642(23)00077-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 02/25/2023] [Accepted: 03/07/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND Latin America and the Caribbean present the second highest adolescent fertility rate in the world, only after sub-Saharan Africa, and have reached the third position globally in the incidence of motherhood in adolescence. We aimed to explore trends and inequities in adolescent childbearing in the region. METHODS We used nationally representative household surveys from Latin American and Caribbean countries to address trends in early childbearing (proportion of women having their first livebirth before age 18 years) over generations and in adolescent fertility rates (AFRs; livebirths per 1000 women aged 15-19 years) over time. For early childbearing, we analysed the most recent survey conducted since 2010 from 21 countries (2010-20); for AFR, we analysed nine countries with two or more surveys, with the most recent being conducted from 2010 onwards. For both indicators, variance-weighted least-square regression was used to estimate the average absolute changes (AACs) at the national level and by wealth (bottom 40% vs top 60%), urban versus rural residence, and ethnicity. FINDINGS Among 21 countries studied, we noted a decrease in early childbearing along generations in 13 of them, with declines varying from -0·6 percentage points (95% CI -1·1 to -0·1) in Haiti to -2·7 percentage points (-4·0 to -1·4) in Saint Lucia. We observed increases over generations in Colombia (1·2 percentage points [0·8 to 1·5]) and Mexico (1·3 percentage points [0·5 to 2·0]) and no changes in Bolivia and Honduras. The fastest early childbearing decline occurred among rural women, whereas no clear pattern was observed for wealth groups. Decreasing estimates from oldest to youngest generations were found among Afro-descendants and non-Afro-descendant and non-indigenous groups, but results were mixed for indigenous people. All nine countries with data for AFR presented reductions over time (-0·7 to -6·5 births per 1000 women per year), with the steepest declines observed in Ecuador, Guyana, Guatemala, and the Dominican Republic. In general, adolescents in rural areas and the poorest adolescents had the largest reductions in AFR. If current trends persist, by 2030 most countries will present AFR values ranging between 45 and 89 births per 1000 women, with notable wealth-related inequalities. INTERPRETATION Our results indicate a reduction in AFR in Latin American and Caribbean countries that was not necessarily accompanied by a decrease in early childbearing overall. Large inequalities both between countries and within countries were observed, with no clear reduction over time. Understanding trends in adolescent childbearing and its determinants is essential for planning and designing programmes to ensure the desired reductions in rates and gaps across population subgroups. FUNDING PAHO, Bill & Melinda Gates Foundation, and Wellcome Trust. TRANSLATIONS For the Spanish and Portuguese translations of the abstract see Supplementary Materials section.
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Affiliation(s)
| | - Janaína Calu Costa
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil.
| | | | - Liliana Carvajal-Velez
- United Nations Children's Fund, New York, NY, USA; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Sonja Caffe
- Pan-American Health Organization, Washington, DC, USA
| | - Cesar Victora
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Aluísio J D Barros
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
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14
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Santos IS, Tovo-Rodrigues L, Maruyama JM, Barros AJD, Bierhals I, Del Ponte B, Matijasevich A. Impact of covid-19 pandemic over depressive symptoms among mothers from a population-based birth cohort in southern brazil. Arch Womens Ment Health 2023:10.1007/s00737-023-01331-2. [PMID: 37225910 DOI: 10.1007/s00737-023-01331-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 05/19/2023] [Indexed: 05/26/2023]
Abstract
PURPOSE Our aim was to assess the impact of COVID-19 on depressive symptoms among mothers from a population-based birth cohort in Pelotas, Southern Brazil. METHODS A subgroup of mothers from the Pelotas 2004 Birth Cohort was assessed pre-pandemic (November,2019 to March,2020) and mid-pandemic (August-December,2021). In both follow-ups, depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS). Pre-pandemic (T1) and pandemic-related predictors (T2) were analyzed. Prevalence of depression (EPDS score ≥ 13) at T1 and T2 were compared with chi-square test. Changes in EPDS from T1 to T2 were estimated by multivariate latent change score modelling. RESULTS 1,550 women were assessed. Prevalence of depression increased 38.1% (from 18.9% at T1 to 26.1% at T2) (p < 0.001). At T1, higher schooling, higher family income and being employed or working were related to lower EPDS, whereas being beneficiary of a cash transfer program and a larger number of people living in the household predicted higher EPDS. The deterioration of ones' own perception of quality of overall health (β = 0.191; SE = 0.028; p < 0.001) and worst family financial situation due to the pandemic (β = 0.083; SE = 0.024; p = 0.001) predicted the increase in EPDS from T1 to T2. CONCLUSION Almost two years after the beginning of the pandemic, the prevalence of depressive symptoms among the women was higher than before the pandemic. The deterioration of ones' own perception of quality of overall health and worst family financial situation due to the pandemic are proxies for the effect of COVID-19 pandemic (the true exposure of interest) in the women mental health.
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Affiliation(s)
- Iná S Santos
- Programa de Pós-Graduação Em Epidemiologia, Faculdade de Medicina, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160, 3º Piso, Pelotas, RS, CEP 96020-220, Brazil.
| | - Luciana Tovo-Rodrigues
- Programa de Pós-Graduação Em Epidemiologia, Faculdade de Medicina, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160, 3º Piso, Pelotas, RS, CEP 96020-220, Brazil
| | - Jessica M Maruyama
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Aluísio J D Barros
- Programa de Pós-Graduação Em Epidemiologia, Faculdade de Medicina, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160, 3º Piso, Pelotas, RS, CEP 96020-220, Brazil
| | - Isabel Bierhals
- Programa de Pós-Graduação Em Epidemiologia, Faculdade de Medicina, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160, 3º Piso, Pelotas, RS, CEP 96020-220, Brazil
| | - Bianca Del Ponte
- Programa de Pós-Graduação Em Epidemiologia, Faculdade de Medicina, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160, 3º Piso, Pelotas, RS, CEP 96020-220, Brazil
| | - Alicia Matijasevich
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
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Vidaletti LP, Cata-Preta BO, Phillips DE, Shekhar S, Barros AJD, Victora CG. Time trends in ethnic inequalities in child health and nutrition: analysis of 59 low and middle-income countries. Int J Equity Health 2023; 22:76. [PMID: 37118789 PMCID: PMC10148503 DOI: 10.1186/s12939-023-01888-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/06/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Although ethnicity is a key social determinant of health, there are no global analyses aimed at identifying countries that succeeded in reducing ethnic gaps in child health and nutrition. METHODS We identified 59 low and middle-income countries with at least two surveys since 2010 providing information on ethnicity or language and on three outcomes: under-five mortality, child stunting prevalence and a composite index (CCI) based on coverage with eight maternal and child health interventions. Firstly, we calculated population-weighted and unweighted measures of inequality among ethnic or language groups within each country. These included the mean difference from the overall national mean (absolute inequality), mean ratio relative to the overall mean (relative inequality), and the difference and ratio between the best- and worst-performing ethnic groups. Second, we examined annual changes in these measures in terms of annual absolute and relative changes. Thirdly, we compared trends for each of the three outcome indicators and identified exemplar countries with marked progress in reducing inequalities. RESULTS For each outcome indicator, annual changes in summary measures tended to show moderate (Pearson correlation coefficients of 0.4 to 0.69) or strong correlations (0.7 or higher) among themselves, and we thus focused on four of the 12 measures: absolute and relative annual changes in mean differences and ratios from the overall national mean. On average, absolute ethnic or language group inequalities tended to decline slightly for the three outcomes, and relative inequality declined for stunting and CCI, but increased for mortality. Correlations for annual trends across the three outcomes were inconsistent, with several countries showing progress in terms of one outcome but not in others. Togo and Uganda showed with the most consistent progress in reducing inequality, whereas the worst performers were Nigeria, Moldova, Kyrgyzstan, Sao Tome and Principe, and Burkina Faso. CONCLUSIONS Although measures of annual changes in ethnic or language group inequalities in child health were consistently correlated within each outcome, analyses of such inequalities should rely upon multiple measures. Countries showing progress in one child health outcome did not necessarily show improvements in the remaining outcomes. In-depth analyses at country level are needed to understand the drivers of success in reducing ethnic gaps.
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Affiliation(s)
- Luis Paulo Vidaletti
- International Center for Equity in Health, Federal University of Pelotas, Rua Marechal Deodoro 1160, Pelotas, Pelotas, RS, 96020-220, Brazil
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro 1160, Pelotas, Pelotas, RS, 96020-220, Brazil
| | - Bianca O Cata-Preta
- International Center for Equity in Health, Federal University of Pelotas, Rua Marechal Deodoro 1160, Pelotas, Pelotas, RS, 96020-220, Brazil
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro 1160, Pelotas, Pelotas, RS, 96020-220, Brazil
| | - David E Phillips
- Gates Ventures, 4110 Carillon Pt, Kirkland, Seattle, WA, 98033-7463, USA
| | - Sonya Shekhar
- Gates Ventures, 4110 Carillon Pt, Kirkland, Seattle, WA, 98033-7463, USA
| | - Aluísio J D Barros
- International Center for Equity in Health, Federal University of Pelotas, Rua Marechal Deodoro 1160, Pelotas, Pelotas, RS, 96020-220, Brazil
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro 1160, Pelotas, Pelotas, RS, 96020-220, Brazil
| | - Cesar G Victora
- International Center for Equity in Health, Federal University of Pelotas, Rua Marechal Deodoro 1160, Pelotas, Pelotas, RS, 96020-220, Brazil.
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro 1160, Pelotas, Pelotas, RS, 96020-220, Brazil.
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16
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Peres KG, Feldens CA, Nascimento GG, Peres MA, Vitolo MR, Barros AJD. See Original Article here: See Original Article here. Community Dent Oral Epidemiol 2023; 51:583-584. [PMID: 37042495 DOI: 10.1111/cdoe.12857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 03/13/2023] [Indexed: 04/13/2023]
Affiliation(s)
- Karen Glazer Peres
- National Dental Research Institute Singapore, National Dental Centre Singapore, Oral Health ACP, Health Services and Systems Research Programme, Duke-NUS Medical School, Singapore, Singapore
| | | | - Gustavo Giacomelli Nascimento
- National Dental Research Institute Singapore, National Dental Centre Singapore, Oral Health ACP, Health Services and Systems Research Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Marco A Peres
- National Dental Research Institute Singapore, National Dental Centre Singapore, Oral Health ACP, Health Services and Systems Research Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Márcia Regina Vitolo
- Graduate Program in Pediatrics: Child and Adolescent Health Care, Universidade Federal de Ciências da Saúde, Porto Alegre, Brazil
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Johns NE, Cata-Preta BO, Kirkby K, Arroyave L, Bergen N, Danovaro-Holliday MC, Santos TM, Yusuf N, Barros AJD, Hosseinpoor AR. Inequalities in Immunization against Maternal and Neonatal Tetanus: A Cross-Sectional Analysis of Protection at Birth Coverage Using Household Health Survey Data from 76 Countries. Vaccines (Basel) 2023; 11:752. [PMID: 37112664 PMCID: PMC10146835 DOI: 10.3390/vaccines11040752] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 03/31/2023] Open
Abstract
Substantial progress in maternal and neonatal tetanus elimination has been made in the past 40 years, with dramatic reductions in neonatal tetanus incidence and mortality. However, twelve countries have still not achieved maternal and neonatal tetanus elimination, and many countries that have achieved elimination do not meet key sustainability thresholds to ensure long-lasting elimination. As maternal and neonatal tetanus is a vaccine-preventable disease (with coverage of the infant conferred by maternal immunization during and prior to pregnancy), maternal tetanus immunization coverage is a key metric for monitoring progress towards, equity in, and sustainability of tetanus elimination. In this study, we examine inequalities in tetanus protection at birth, a measure of maternal immunization coverage, across 76 countries and four dimensions of inequality via disaggregated data and summary measures of inequality. We find that substantial inequalities in coverage exist for wealth (with lower coverage among poorer wealth quintiles), maternal age (with lower coverage among younger mothers), maternal education (with lower coverage among less educated mothers), and place of residence (with lower coverage in rural areas). Inequalities existed for all dimensions across low- and lower-middle-income countries, and across maternal education and place of residence across upper-middle-income countries. Though global coverage changed little over the time period 2001-2020, this obscured substantial heterogeneity across countries. Notably, several countries had substantial increases in coverage accompanied by decreases in inequality, highlighting the need for equity considerations in maternal and neonatal tetanus elimination and sustainability efforts.
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Affiliation(s)
- Nicole E. Johns
- Department of Data and Analytics, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
| | - Bianca O. Cata-Preta
- International Center for Equity in Health, Federal University of Pelotas, Rua Mal Deodoro 1160, Pelotas 96020-220, Brazil
| | - Katherine Kirkby
- Department of Data and Analytics, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
| | - Luisa Arroyave
- International Center for Equity in Health, Federal University of Pelotas, Rua Mal Deodoro 1160, Pelotas 96020-220, Brazil
| | - Nicole Bergen
- Department of Data and Analytics, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
| | - M. Carolina Danovaro-Holliday
- Department of Immunization, Vaccines, and Biologicals, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
| | - Thiago M. Santos
- International Center for Equity in Health, Federal University of Pelotas, Rua Mal Deodoro 1160, Pelotas 96020-220, Brazil
| | - Nasir Yusuf
- Department of Immunization, Vaccines, and Biologicals, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
| | - Aluísio J. D. Barros
- International Center for Equity in Health, Federal University of Pelotas, Rua Mal Deodoro 1160, Pelotas 96020-220, Brazil
| | - Ahmad Reza Hosseinpoor
- Department of Data and Analytics, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
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18
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Hellwig F, Barros AJD. What are the sources of contraceptives for married and unmarried adolescents: Health services or friends? Analysis of 59 low- and middle-income countries. Front Public Health 2023; 11:1100129. [PMID: 36815169 PMCID: PMC9939762 DOI: 10.3389/fpubh.2023.1100129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/16/2023] [Indexed: 02/08/2023] Open
Abstract
Background Despite the efforts to promote universal coverage for family planning, inequalities are still high in several countries. Our aim was to identify which sources of contraceptives women mostly rely on in low- and middle-income countries (LMICs). We also explored the different sources according to age and marital status. Methods We used data from national health surveys carried out in 59 LMICs since 2010. Among all sexually active women at reproductive age, we explored inequalities in demand for family planning satisfied by modern methods (mDFPS) and in the source of modern contraceptives according to women's age, classified as: 15-19, 20-34, or 35-49 years of age. Among adolescents, mDFPS and source of method were explored by marital status, classified as married or in union and not married nor in a union. Results mDFPS was lower among adolescents than among adult women in 28 of the 59 countries. The lowest levels of mDFPS among adolescents were identified in Albania (6.1%) and Chad (8.2%). According to adolescents' marital status, the pattern of inequalities in mDFPS varied widely between regions, with married and unmarried adolescents showing similar levels of coverage in Latin America and the Caribbean, higher coverage among unmarried adolescents in Africa, and lower coverage among unmarried adolescents in Asia. Public and private health services were the main sources, with a lower share of the public sector among adolescents in almost all countries. The proportion of adolescents who obtained their contraceptives in the public sector was lower among unmarried girls than married ones in 31 of the 38 countries with data. Friends or relatives were a more significant source of contraceptives among unmarried compared to married adolescents in all regions. Conclusions Our findings indicate lower levels of mDFPS and lower use of the public sector by adolescents, especially unmarried girls. More attention is needed to provide high-quality and affordable family planning services for adolescents, especially for those who are not married.
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Affiliation(s)
- Franciele Hellwig
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil,Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil,*Correspondence: Franciele Hellwig ✉
| | - Aluísio J. D. Barros
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil,Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
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19
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López-Domínguez L, Bassani DG, Bourdon C, Massara P, Santos IS, Matijasevich A, Barros AJD, Comelli EM, Bandsma RHJ. A novel shape-based approach to identify gestational age-adjusted growth patterns from birth to 11 years of age. Sci Rep 2023; 13:1709. [PMID: 36720954 PMCID: PMC9889302 DOI: 10.1038/s41598-023-28485-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 01/19/2023] [Indexed: 02/01/2023] Open
Abstract
Child growth patterns assessment is critical to design public health interventions. However, current analytical approaches may overlook population heterogeneity. To overcome this limitation, we developed a growth trajectories clustering pipeline that incorporates a shape-respecting distance, baseline centering (i.e., birth-size normalized trajectories) and Gestational Age (GA)-correction to characterize shape-based child growth patterns. We used data from 3945 children (461 preterm) in the 2004 Pelotas Birth Cohort with at least 3 measurements between birth (included) and 11 years of age. Sex-adjusted weight-, length/height- and body mass index-for-age z-scores were derived at birth, 3 months, and at 1, 2, 4, 6 and 11 years of age (INTERGROWTH-21st and WHO growth standards). Growth trajectories clustering was conducted for each anthropometric index using k-means and a shape-respecting distance, accounting or not for birth size and/or GA-correction. We identified 3 trajectory patterns for each anthropometric index: increasing (High), stable (Middle) and decreasing (Low). Baseline centering resulted in pattern classification that considered early life growth traits. GA-correction increased the intercepts of preterm-born children trajectories, impacting their pattern classification. Incorporating shape-based clustering, baseline centering and GA-correction in growth patterns analysis improves the identification of subgroups meaningful for public health interventions.
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Affiliation(s)
- Lorena López-Domínguez
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Medical Sciences Building, Toronto, ON, M5S 1A8, Canada.,Translational Medicine Program, Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, ON, M5G 0A4, Canada
| | - Diego G Bassani
- Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Centre for Global Child Health, Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, ON, Canada.,Division of Paediatric Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Celine Bourdon
- Translational Medicine Program, Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, ON, M5G 0A4, Canada.,The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya
| | - Paraskevi Massara
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Medical Sciences Building, Toronto, ON, M5S 1A8, Canada.,Translational Medicine Program, Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, ON, M5G 0A4, Canada
| | - Iná S Santos
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Alicia Matijasevich
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil.,Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Aluísio J D Barros
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Elena M Comelli
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Medical Sciences Building, Toronto, ON, M5S 1A8, Canada. .,Joannah and Brian Lawson Center for Child Nutrition, University of Toronto, Toronto, ON, Canada.
| | - Robert H J Bandsma
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Medical Sciences Building, Toronto, ON, M5S 1A8, Canada. .,Translational Medicine Program, Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, ON, M5G 0A4, Canada. .,Centre for Global Child Health, Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, ON, Canada. .,Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, ON, Canada.
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20
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Bierhals IO, Vaz JDS, Matijasevich A, Barros AJD, Tovo-Rodrigues L, Barros FC, Santos IS. Linear growth and relative weight gain in childhood and bone mass in adolescence: findings from the Pelotas (Brazil) 2004 birth cohort. Arch Osteoporos 2022; 18:5. [PMID: 36482131 DOI: 10.1007/s11657-022-01189-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 11/10/2022] [Indexed: 12/13/2022]
Abstract
With the objective to investigate the relationship of weight and height growth with bone mass at 11 years, we found that boys who grew in weight and height, especially at 48 months, and girls, who grew in weight at 24 months and height at 11 years, gained more bone mass. PURPOSE To investigate independent relationships of linear growth and relative weight gain during defined periods of infancy, childhood, and early adolescence with areal bone mineral density (aBMD) of three sites at 11 years. METHODS Data on weight and length/height were obtained at birth, 3, 12, and 24 months, and the ages of 4, 6, and 11. The outcome was whole body, femoral neck, and lumbar spine aBMD (g/cm2) measured at 11 years using dual-energy X-ray absorptiometry. The effects of weight gain and linear growth were analyzed using conditional relative weight and conditional length/height. Associations between conditional growth and outcomes were analyzed using linear regression, adjusted for multiple confounders. RESULTS Individuals with data available for exposures and bone outcomes were 2875 and comprised the sample. For boys, the greatest magnitude of increase for whole body and height gain was at 48 months (β 0.014, 95% CI 0.010; 0.018). For girls, higher aBMD was observed for those with greater height gain at 11 years, representing for lumbar spine an increase of 0.056 g/cm2 (95% CI 0.050; 0.062). For body weight, among boys, the greatest magnitude in the whole body was also associated with weight gain at 48 months (β 0.014, 95% CI 0.010; 0.018). For girls, the highest coefficient was at 24 months, representing for lumbar spine an increase of 0.028 g/cm2, (95% CI 0.021; 0.035). CONCLUSION Positive associations were demonstrated between length/height and weight gain and aBMD in both sexes, with emphasis on girls' aBMD in response to the linear growth achieved mainly at 11 years.
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Affiliation(s)
- Isabel Oliveira Bierhals
- Postgraduate Program in Epidemiology, Faculty of Medicine, Federal University of Pelotas, Rua Marechal Deodoro, 1160, 3° Andar, Pelotas, RS, CEP 96020-220, Brazil.
| | - Juliana Dos Santos Vaz
- Postgraduate Program in Epidemiology, Faculty of Medicine, Federal University of Pelotas, Rua Marechal Deodoro, 1160, 3° Andar, Pelotas, RS, CEP 96020-220, Brazil
- Faculty of Nutrition, Federal University of Pelotas, Pelotas, Brazil
| | - Alicia Matijasevich
- Postgraduate Program in Epidemiology, Faculty of Medicine, Federal University of Pelotas, Rua Marechal Deodoro, 1160, 3° Andar, Pelotas, RS, CEP 96020-220, Brazil
- Faculdade de Medicina FMUSP, Departamento de Medicina Preventiva, Universidade de São Paulo, São Paulo, Brazil
| | - Aluísio J D Barros
- Postgraduate Program in Epidemiology, Faculty of Medicine, Federal University of Pelotas, Rua Marechal Deodoro, 1160, 3° Andar, Pelotas, RS, CEP 96020-220, Brazil
| | - Luciana Tovo-Rodrigues
- Postgraduate Program in Epidemiology, Faculty of Medicine, Federal University of Pelotas, Rua Marechal Deodoro, 1160, 3° Andar, Pelotas, RS, CEP 96020-220, Brazil
| | - Fernando C Barros
- Postgraduate Program in Epidemiology, Faculty of Medicine, Federal University of Pelotas, Rua Marechal Deodoro, 1160, 3° Andar, Pelotas, RS, CEP 96020-220, Brazil
- Postgraduation Program in Health and Behavior, Catholic University of Pelotas, Pelotas, RS, Brazil
| | - Iná S Santos
- Postgraduate Program in Epidemiology, Faculty of Medicine, Federal University of Pelotas, Rua Marechal Deodoro, 1160, 3° Andar, Pelotas, RS, CEP 96020-220, Brazil
- Postgraduate Program in Pediatrics and Child Health, School of Medicine, Pontifical Catholic University of Rio Grande Do Sul, Porto Alegre, RS, Brazil
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21
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Vaz JS, Gatica-Domínguez G, Neves PAR, Vidaletti LP, Barros AJD. Early initiation of breastfeeding is inversely associated with public and private c-sections in 73 lower- and middle-income countries. Sci Rep 2022; 12:21081. [PMID: 36473921 PMCID: PMC9727135 DOI: 10.1038/s41598-022-25564-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Although studies in low- and middle-income countries (LMICs) have examined the effects of c-sections on early initiation of breastfeeding (EIBF), the role of the place of birth has not yet been investigated. Therefore, we tested the association between EIBF and the type of delivery by place of birth. Data from 73 nationally representative surveys carried out in LMICs between 2010 and 2019 comprised 408,013 women aged 15 to 49 years. Type of delivery by place of birth was coded in four categories: home vaginal delivery, institutional vaginal delivery, c-section in public, and c-section in private health facilities. We calculated the weighted mean prevalence of place of birth and EIBF by World Bank country income groups. Adjusted Poisson regression (PR) was fitted taking institutional vaginal delivery as a reference. The overall prevalence of EIBF was significantly lower among c-section deliveries in public (PR = 38%; 95% CI 0.618-0.628) and private facilities (PR = 45%; 95% CI 0.54-0.566) compared to institutional vaginal deliveries. EIBF in c-sections in public facilities was slightly higher in lower-middle (PR = 0.650, 95% CI 0.635-0.665) compared to low (PR = 0.544, 95% CI 0.521-0.567) and upper-middle income countries (PR = 0.612, 95% CI 0.599-0.626). EIBF was inversely associated with c-section deliveries compared to institutional vaginal deliveries, especially in private facilities compared to public ones.
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Affiliation(s)
- Juliana S. Vaz
- grid.411221.50000 0001 2134 6519International Center for Equity in Health, Federal University of Pelotas, Rua Marechal Deodoro, 1160, 3rd Floor, Pelotas, RS 96020-220 Brazil ,grid.411221.50000 0001 2134 6519Faculty of Nutrition, Federal University of Pelotas, Pelotas, Brazil
| | - Giovanna Gatica-Domínguez
- grid.411221.50000 0001 2134 6519International Center for Equity in Health, Federal University of Pelotas, Rua Marechal Deodoro, 1160, 3rd Floor, Pelotas, RS 96020-220 Brazil
| | - Paulo A. R. Neves
- grid.411221.50000 0001 2134 6519International Center for Equity in Health, Federal University of Pelotas, Rua Marechal Deodoro, 1160, 3rd Floor, Pelotas, RS 96020-220 Brazil
| | - Luís Paulo Vidaletti
- grid.411221.50000 0001 2134 6519International Center for Equity in Health, Federal University of Pelotas, Rua Marechal Deodoro, 1160, 3rd Floor, Pelotas, RS 96020-220 Brazil
| | - Aluísio J. D. Barros
- grid.411221.50000 0001 2134 6519International Center for Equity in Health, Federal University of Pelotas, Rua Marechal Deodoro, 1160, 3rd Floor, Pelotas, RS 96020-220 Brazil
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22
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Bauer A, Fairchild G, Hammerton G, Murray J, Santos IS, Tovo Rodrigues L, Munhoz TN, Barros AJD, Matijasevich A, Halligan SL. Associations between childhood trauma and childhood psychiatric disorders in Brazil: a population-based, prospective birth cohort study. Lancet Psychiatry 2022; 9:969-977. [PMID: 36328032 DOI: 10.1016/s2215-0366(22)00337-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/08/2022] [Accepted: 09/14/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Childhood trauma is a proposed transdiagnostic risk factor for psychopathology, but epidemiological evidence from low-income and middle-income countries (LMICs) is scarce. We investigated associations between trauma and child psychiatric disorders in a birth cohort in Brazil. METHODS The 2004 Pelotas Birth Cohort is an ongoing, population-based, prospective birth cohort, including all hospital births occurring between Jan 1 and Dec 31, 2004, in the city of Pelotas, Brazil. When the children were aged 6 and 11 years, trained psychologists administered the Development and Well-Being Assessment clinical interview to caregivers to assess current child psychiatric disorders (anxiety disorders, mood disorders, ADHD and hyperactivity disorders, and conduct and oppositional disorders), and lifetime trauma exposure (ie, experiencing or witnessing life-threatening events) including interpersonal and non-interpersonal events. Analyses used multiple imputation and logistic regression models. OUTCOMES Of 4263 live births, 4231 children were included in the study sample, and 4229 (2195 [51·9%] boys and 2034 [48·1%] girls; 2581 [61·7%] with White mothers and 1600 [38·3%] with Black or mixed race mothers) were included in the imputed analyses. 1154 (34·3%) of 3367 children with complete data at age 11 years had been exposed to trauma by that age. After adjusting for confounders, at age 6 years, trauma was associated with increased odds of anxiety disorders (adjusted odds ratio 1·79 [95% CI 1·33-2·42]) and any psychiatric disorder (1·59 [1·22-2·06]), and at age 11 years, with any psychiatric disorder (1·45 [1·17-1·79]) and all four specific diagnostic classes of anxiety disorders (1·47 [1·04-2·09]), mood disorders (1·66 [1·08-2·55]), ADHD and hyperactivity disorders (1·47 [1·01-2·13]), and conduct and oppositional disorders (1·76 [1·19-2·61]). Interpersonal trauma and non-interpersonal trauma were each associated with increased odds of multiple psychiatric disorders, even when adjusting for their co-occurrence. INTERPRETATION A considerable mental health burden associated with childhood trauma is already evident by middle childhood in this sample from Brazil. Evidence-based efforts to reduce the incidence of childhood trauma in Brazil and address its consequences are urgently needed. FUNDING Children's Pastorate, WHO, National Support Program for Centres of Excellence, Brazilian National Research Council, Brazilian Ministry of Health, São Paulo Research Foundation, University of Bath, Wellcome Trust. TRANSLATION For the Portuguese translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Andreas Bauer
- Department of Psychology, University of Bath, Bath, UK; Centre for Epidemiological Research, Federal University of Pelotas, Pelotas, Brazil; Human Development and Violence Research Centre (DOVE), Federal University of Pelotas, Pelotas, Brazil.
| | | | - Gemma Hammerton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Joseph Murray
- Centre for Epidemiological Research, Federal University of Pelotas, Pelotas, Brazil; Human Development and Violence Research Centre (DOVE), Federal University of Pelotas, Pelotas, Brazil
| | - Ina S Santos
- Centre for Epidemiological Research, Federal University of Pelotas, Pelotas, Brazil
| | | | - Tiago N Munhoz
- Centre for Epidemiological Research, Federal University of Pelotas, Pelotas, Brazil; Faculty of Psychology, Federal University of Pelotas, Pelotas, Brazil
| | - Aluísio J D Barros
- Centre for Epidemiological Research, Federal University of Pelotas, Pelotas, Brazil
| | - Alicia Matijasevich
- Centre for Epidemiological Research, Federal University of Pelotas, Pelotas, Brazil; Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Sarah L Halligan
- Department of Psychology, University of Bath, Bath, UK; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
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23
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Neves PAR, Vaz JS, Ricardo LIC, Armenta-Paulino NN, Barros AJD, Richter L, Rollins N, Peréz-Escamilla R. Disparities in early initiation of breast feeding and prelacteal feeding: A study of low- and middle-income countries. Paediatr Perinat Epidemiol 2022; 36:741-749. [PMID: 35253935 DOI: 10.1111/ppe.12871] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 02/07/2022] [Accepted: 02/13/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Early initiation of breast feeding (EIBF) reduces the risk of neonatal mortality. However, only 45% of newborns are breast-fed within the first hour after birth and prelacteal feeding (PLF) is widely prevalent in low- and middle-income countries (LMICs). OBJECTIVE To assess within- and between-country disparities in EIBF and PLF practices by household wealth and place of birth and to investigate the national-level correlation between these feeding indicators in LMICs. METHODS Data from Demographic Health Surveys and Multiple Indicator Cluster Surveys (2010-2019) in 76 LMICs were used to investigate within-country disparities in EIBF, any PLF, milk-based prelacteal feeding (MPLF), and water-based prelacteal feeding (WPLF) by wealth quintiles and place of childbirth (institutional [private or public sector] or in-home) for children under two years. We examined the between-country Pearson's correlation between EIBF and types of PLF, later adjusted for per capita gross domestic product (GDP). RESULTS No clear wealth-related differences were found for EIBF and WPLF; however, any PLF and MPLF were significantly higher in children belonging to the richest 20% of households but are also prevalent among lower income groups. Prevalence of any PLF was higher among institutional births in all LMICs, but especially for MPLF in private sector deliveries in East Asia & the Pacific, Eastern Europe & Central Asia, and Latin America & the Caribbean. WPLF was more common in all African regions. EIBF was inversely correlated with any PLF (r = -0.59, 95% CI -0.72, -0.42), MPLF (r = -0.41, 95% CI -0.58, -0.21) and WPLF (r = -0.34, 95% CI -0.53, -0.13). Adjustment for log-GDP did not affect the magnitude and direction of the results. CONCLUSION Clear prorich disparities exist in the prevalence of PLF, especially MPLF. Children born in private sector facilities are more likely to receive MPLF. EIBF is negatively associated with PLF practices in LMICs. The promotion of better early feeding practices is urgent to achieve the Sustainable Development Goal to reduce neonatal mortality to 12 deaths per 1000 live births.
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Affiliation(s)
| | - Juliana S Vaz
- International Center for Equity in Health, Universidade Federal de Pelotas, Pelotas, Brazil.,Faculty of Nutrition, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Luiza I C Ricardo
- International Center for Equity in Health, Universidade Federal de Pelotas, Pelotas, Brazil
| | | | - Aluísio J D Barros
- International Center for Equity in Health, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Linda Richter
- DSI-NRF Centre of Excellence in Child Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Nigel Rollins
- Department of Maternal, Newborn, Child, and Adolescent Health, World Health Organization, Geneva, Switzerland
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Guimarães FS, Cata-Preta BO, Barros AJD, Matijasevich A, Santos IS, Silveira MF, Silveira MPT, Bertoldi AD. [Use of anti-bacterial agents in pregnant women before and after regulation in Brazil: Pelotas (Brazil) birth cohorts of 2004 and 2015]. CAD SAUDE PUBLICA 2022; 38:e00168021. [PMID: 35976345 DOI: 10.1590/0102-311xpt168021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 06/01/2022] [Indexed: 11/22/2022] Open
Abstract
Indiscriminate use of anti-bacterial agents during pregnancy can increase antimicrobial resistance and endanger both the mother's and the children's health. Currently, Brazil has the Collegiate Directive Resolution n. 20/2011, which controls prescription and dispensation of anti-bacterial agents. Given this scenario, this study compared the use of anti-bacterial agents by pregnant women participating in the 2004 and 2015 Pelotas (Brazil) birth cohorts, in Rio Grande do Sul, Brazil, considering the regulation issued between the two cohorts. Data were collected in the perinatal period of the two studies. The main outcome was the use of anti-bacterial agents during pregnancy. Prevalence scans were described based on independent variables and differences in percentage points (p.p.) between the two cohorts. The prevalence of anti-bacterial use was 41.9% (95%CI: 40.4; 43.3) in 2004 and 39.2% (95%CI: 37.7; 40.6) in 2015. Considering the pregnant women who reported having infection during pregnancy, a greater reduction in use was observed in 2015, when compared to 2004, in poor women (-15.4p.p., 95%CI: 9.59; 21.20) and in those who had less consultations (-17.1p.p., 95%CI: 2.81; 31.36). Considering total medications, the proportion of anti-bacterial used dropped from 20.6% (95%CI: 19.9; 21.4) in 2004 to 12.6% (95%CI: 12.1; 13.1) in 2015. The reductions found in both the prevalence of use and the proportion of anti-bacterial agents over total medications used may be a reflection of the regulatory policy implemented in 2011.
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Affiliation(s)
| | | | - Aluísio J D Barros
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brasil
| | | | - Iná S Santos
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brasil
| | | | | | - Andréa Dâmaso Bertoldi
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brasil
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25
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Jacques N, Silveira MFD, Hallal PC, Menezes AMB, Horta BL, Mesenburg MA, Hartwig FP, Barros AJD. [Mask use during the COVID-19 pandemic in Brazil: results of the EPICOVID19-BR study]. CAD SAUDE PUBLICA 2022; 38:e00271921. [PMID: 35857921 DOI: 10.1590/0102-311xpt271921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 04/14/2022] [Indexed: 11/21/2022] Open
Abstract
By March 3, 2022, the COVID-19 pandemic has caused more than 399 million infections and claimed the lives of more than five million people worldwide. To reduce infection rates, a series of prevention measures indicated by the World Health Organization (WHO) were adopted by countries, including the use of masks. This study aims to describe mask use in Brazil via data analysis from the EPICOVID19-BR, a population-based study conducted in 133 cities in the country in four phases between March and August 2020. The proportion of individuals who reported wearing a mask when they left their homes was 97.9% (95%CI: 97.8-98.0). The interviewer did not see interviewees' mask in 50% (95%CI: 49.9-51.1) of the cases at the time of the interview. However, between phase one and four of the survey, we observed a 4.4% decrease in the proportion of interviewees who failed to wear masks at the time of the interview. Mask non-visualization was more prominent in women, participants aged 10-19 and 20-29 years of indigenous, black, and brown skin color, and those with elementary and high school education and in the Central-West Region. The use of cloth masks showed a 91.4% predominance (95%CI: 91.2-1.5) with a 4.9% increase between phases 1 and 4. The results of the study bring important information to reinforce COVID-19 control policies in Brazil. The high percentage of people who failed to wear masks at the time of the interview suggests that it is still important to reinforce prevention and self-care, rather than relating mask wear to a mandatory measure.
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26
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Hellwig F, Ewerling F, Coll CVN, Barros AJD. The role of female permanent contraception in meeting the demand for family planning in low- and middle-income countries. Contraception 2022; 114:41-48. [PMID: 35568087 DOI: 10.1016/j.contraception.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Our aim was to describe the reliance on female permanent contraception among women with demand for family planning satisfied with modern methods (mDFPS) in low- and middle-income countries (LMICs) and to describe socio-economic and demographic patterns of permanent contraception in countries with high use. METHODS Using data from the latest national health survey carried out in LMICs we estimated mDFPS and the share of each contraceptive method used. Countries with a share of more than 25% of female permanent contraception were further explored for differences by wealth, number of living children, woman's age, and by the intersection of woman's age and number of living children. RESULTS In the 20 countries studied, between 6% and 94% of the contracepting population used modern methods. Female permanent contraception accounted for more than half of women using modern contraceptives in India, Dominican Republic, El Salvador, Mexico, and Colombia. In India and Tonga, more than 20% of women using contraceptives with fewer than two living children were using female permanent contraception. Among women with two living children, countries with the highest reliance on permanent contraception were India (79%), El Salvador (61%), Cuba (55%), Colombia (52%), and Thailand (51%). Dominican Republic, El Salvador, India, and Mexico presented high levels of permanent contraception among younger women, with reliance higher than 30% among women aged 25 to 29 and 50% or more among women aged 30 to 34. CONCLUSIONS Reliance on permanent contraception was high in several countries and among women aged less than 35 years.
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Affiliation(s)
- Franciele Hellwig
- Federal University of Pelotas; International Center for Equity in Health; Pelotas Brazil; Federal University of Pelotas; Post-graduation Program in Epidemiology; Pelotas Brazil.
| | - Fernanda Ewerling
- Federal University of Pelotas; International Center for Equity in Health; Pelotas Brazil
| | - Carolina V N Coll
- Federal University of Pelotas; International Center for Equity in Health; Pelotas Brazil
| | - Aluísio J D Barros
- Federal University of Pelotas; International Center for Equity in Health; Pelotas Brazil; Federal University of Pelotas; Post-graduation Program in Epidemiology; Pelotas Brazil
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Horta BL, Silveira MF, Barros AJD, Hartwig FP, Dias MS, Menezes AMB, Hallal PC. COVID-19 and outpatient care: a nationwide household survey. CAD SAUDE PUBLICA 2022; 38:e00194121. [PMID: 35442261 DOI: 10.1590/0102-311x00194121] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 12/27/2021] [Indexed: 12/31/2022] Open
Abstract
We aimed to assess the proportion of the population in 133 Brazilian municipalities who - from March to August 2020 - had a health problem but failed to seek care or failed to attend to a health service for routine appointment or examination. We conducted a household survey from August 24-27 in 133 Brazilian cities by asking the subjects if, since the beginning of the COVID-19 pandemic in March 2020, they had suffered from a health problem but did not seek care or failed to attend to a routine or screening examination. Poisson regression was used for the analyses. We interviewed 33,250 subjects and 11.8% (95%CI: 11.4-12.1) reported that, since March 2020, they failed to seek care despite being ill, 17.3% (95%CI: 16.9-17.7) failed to attend to a routine or screening examination and 23.9% (95%CI: 23.4-24.4) reported one or both outcomes. Health service closure and fear of the COVID-19 infection were the main reasons for not seeking care. Women and the poorest were more likely to not look for a health service, despite having a health problem or a scheduled routine appointment. On the other hand, those subjects who self-identified as white were less likely to not look for a health service. The COVID-19 pandemic is more critical for the indigenous people and the poorest, and these people are also more likely to not seek care for other health conditions during the pandemic.
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Wendt A, Santos TM, Cata-Preta BO, Costa JC, Mengistu T, Hogan DR, Victora CG, Barros AJD. Children of more empowered women are less likely to be left without vaccination in low- and middle-income countries: A global analysis of 50 DHS surveys. J Glob Health 2022; 12:04022. [PMID: 35356658 PMCID: PMC8943525 DOI: 10.7189/jogh.12.04022] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background To help provide a global understanding of the role of gender-related barriers to vaccination, we have used a broad measure of women’s empowerment and explored its association with the prevalence of zero-dose children aged 12-23 months across many low- and middle-income countries, using data from standardized national household surveys. Methods We used data from Demographic and Health Surveys (DHS) of 50 countries with information on both women’s empowerment and child immunisation. Zero-dose was operationally defined as the proportion of children who failed to receive any doses of the diphtheria, pertussis, and tetanus containing vaccines (DPT). We measured women’s empowerment using the SWPER Global, an individual-level indicator estimated for women aged 15-49 years who are married or in union and with three domains: social independence, decision-making and attitude towards violence. We estimated two summary measures of inequality, the slope index of inequality (SII) and the concentration index (CIX). Results were presented for individual and pooled countries. Results In the country-level (ecological) analyses we found that the higher the proportion of women with high empowerment, the lower the zero-dose prevalence. In the individual level analyses, overall, children with highly-empowered mothers presented lower prevalence of zero-dose than those with less-empowered mothers. The social independence domain presented more consistent associations with zero-dose. In 42 countries, the lowest zero-dose prevalence was found in the high empowerment groups, with the slope index of inequality showing significant results in 28 countries. When we pooled all countries using a multilevel Poisson model, children from mothers in the low and medium levels of the social independence domain had respectively 3.3 (95% confidence interval (CI) = 2.3, 4.7) and 1.8 (95% CI = 1.5, 2.1) times higher prevalence of zero-dose compared to those in the high level. Conclusions Our country-level and individual-level analyses support the importance of women’s empowerment for child vaccination, especially in countries with weaker routine immunisation programs.
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Affiliation(s)
- Andrea Wendt
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Thiago M Santos
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Bianca O Cata-Preta
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Janaína C Costa
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | | | | | - Cesar G Victora
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Aluísio J D Barros
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
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Coll CVN, Santos TM, Devries K, Knaul F, Bustreo F, Gatuguta A, Houvessou GM, Barros AJD. Identifying the women most vulnerable to intimate partner violence: A decision tree analysis from 48 low and middle-income countries. EClinicalMedicine 2021; 42:101214. [PMID: 34988411 PMCID: PMC8712229 DOI: 10.1016/j.eclinm.2021.101214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/05/2021] [Accepted: 11/09/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Primary prevention strategies are needed to reduce high rates of intimate partner violence (IPV) in low- and middle-income countries (LMICs). The effectiveness of population-based approaches may be improved by adding initiatives targeted at the most vulnerable groups and tailored to context-specificities. METHODS We applied a decision-tree approach to identify subgroups of women at higher risk of IPV in 48 LMICs and in all countries combined. Data from the most recent Demographic and Health Survey carried out between 2010 and 2019 with available information on IPV and sociodemographic indicators was used. To create the trees, we selected 15 recognized risk factors for IPV in the literature which had a potential for targeting interventions. Exposure to IPV was defined as having experienced physical and/or sexual IPV in the past 12 months. FINDINGS In the pooled decision tree, witnessing IPV during childhood, a low or medium empowerment level and alcohol use by the partner were the strongest markers of IPV vulnerability. IPV prevalence amongst the most vulnerable women was 43% compared to 21% in the overall sample. This high-risk group included women who witnessed IPV during childhood and had lower empowerment levels. These were 12% of the population and 1 in 4 women who experienced IPV in the selected LMICs. Across the individual national trees, subnational regions emerged as the most frequent markers of IPV occurrence. INTERPRETATION Starting with well-known predictors of IPV, the decision-tree approach provides important insights about subpopulations of women where IPV prevalence is high. This information can help designing targeted interventions. For a large proportion of women who experienced IPV, however, no particular risk factors were identified, emphasizing the need for population wide approaches conducted in parallel, including changing social norms, strengthening laws and policies supporting gender equality and women´s rights as well as guaranteeing women´s access to justice systems and comprehensive health services. FUNDING Bill and Melinda Gates Foundation (Grant INV-010051/OPP1199234), Wellcome Trust (Grant Number: 101815/Z/13/Z) and Associação Brasileira de Saúde Coletiva (ABRASCO).
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Affiliation(s)
- Carolina V N Coll
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, RS, Brazil
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
- Corresponding author at: International Center for Equity in Health, Federal University of Pelotas, Pelotas, RS, Brazil.
| | - Thiago M Santos
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, RS, Brazil
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Karen Devries
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom
| | - Felicia Knaul
- Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL 33146, United States
| | | | - Anne Gatuguta
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | | | - Aluísio J D Barros
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, RS, Brazil
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
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Barros AJD, Victora CG, Menezes AMB, Horta BL, Barros FC, Hartwig FP, Victora GD, Vidaletti LP, Silveira MF, Mesenburg MA, Jacques N, Struchiner CJ, Brust FR, Dall'Agnol MM, Delamare APL, François CHR, Ikeda MLR, Pellegrini DCP, Reuter CP, Silva SGD, Dellagostin OA, Hallal PC. Population-level seropositivity trend for SARS-Cov-2 in Rio Grande do Sul, Brazil. Rev Saude Publica 2021; 55:78. [PMID: 34816981 PMCID: PMC8577540 DOI: 10.11606/s1518-8787.2021055004075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/02/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To describe the evolution of seropositivity in the State of Rio Grande do Sul, Brazil, through 10 consecutive surveys conducted between April 2020 and April 2021. METHODS Nine cities covering all regions of the State were studied, 500 households in each city. One resident in each household was randomly selected for testing. In survey rounds 1–8 we used the rapid WONDFO SARS-CoV-2 Antibody Test (Wondfo Biotech Co., Guangzhou, China). In rounds 9–10, we used a direct ELISA test that identifies IgG to the viral S protein (S-UFRJ). In terms of social distancing, individuals were asked three questions, from which we generated an exposure score using principal components analysis. RESULTS Antibody prevalence in early April 2020 was 0.07%, increasing to 10.0% in February 2021, and to 18.2% in April 2021. In round 10, self-reported whites showed the lowest seroprevalence (17.3%), while indigenous individuals presented the highest (44.4%). Seropositivity increased by 40% when comparing the most with the least exposed. CONCLUSIONS The proportion of the population already infected by SARS-Cov-2 in the state is still far from any perspective of herd immunity and the infection affects population groups in very different levels.
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Affiliation(s)
- Aluísio J D Barros
- Universidade Federal de Pelotas. Faculdade de Medicina. Programa de Pós-Graduação em Epidemiologia. Pelotas, RS, Brasil
| | - Cesar G Victora
- Universidade Federal de Pelotas. Faculdade de Medicina. Programa de Pós-Graduação em Epidemiologia. Pelotas, RS, Brasil
| | - Ana M B Menezes
- Universidade Federal de Pelotas. Faculdade de Medicina. Programa de Pós-Graduação em Epidemiologia. Pelotas, RS, Brasil
| | - Bernardo L Horta
- Universidade Federal de Pelotas. Faculdade de Medicina. Programa de Pós-Graduação em Epidemiologia. Pelotas, RS, Brasil
| | - Fernando C Barros
- Universidade Federal de Pelotas. Faculdade de Medicina. Programa de Pós-Graduação em Epidemiologia. Pelotas, RS, Brasil
| | - Fernando P Hartwig
- Universidade Federal de Pelotas. Faculdade de Medicina. Programa de Pós-Graduação em Epidemiologia. Pelotas, RS, Brasil
| | - Gabriel D Victora
- The Rockefeller University. Laboratory for Lymphocyte Dynamics. New York, NY, USA
| | - Luis Paulo Vidaletti
- Universidade Federal de Pelotas. Faculdade de Medicina. Programa de Pós-Graduação em Epidemiologia. Pelotas, RS, Brasil
| | - Mariângela F Silveira
- Universidade Federal de Pelotas. Faculdade de Medicina. Programa de Pós-Graduação em Epidemiologia. Pelotas, RS, Brasil
| | - Marilia A Mesenburg
- Universidade Federal de Pelotas. Faculdade de Medicina. Programa de Pós-Graduação em Epidemiologia. Pelotas, RS, Brasil.,Universidade Federal de Ciências da Saúde de Porto Alegre. Departamento de Saúde Coletiva. Porto Alegre, RS Brasil
| | - Nadège Jacques
- Universidade Federal de Pelotas. Faculdade de Medicina. Programa de Pós-Graduação em Epidemiologia. Pelotas, RS, Brasil
| | - Cláudio J Struchiner
- Fundação Getúlio Vargas. Escola de Matemática Aplicada. Rio de Janeiro, RJ, Brasil
| | - Flávia Roberta Brust
- Universidade Federal de Ciências da Saúde de Porto Alegre. Departamento de Saúde Coletiva. Porto Alegre, RS Brasil
| | - Marinel M Dall'Agnol
- Universidade Federal de Santa Maria. Centro de Ciências da Saúde. Departamento de Saúde Coletiva. Santa Maria, RS, Brasil
| | - Ana Paula Longaray Delamare
- Universidade de Caxias do Sul. Instituto de Biotecnologia. Programa de Pós-Graduação em Biotecnologia. Caxias do Sul, RS, Brasil
| | - Carlos Henrique R François
- Universidade Regional do Noroeste do Estado do Rio Grande do Sul. Faculdade de Medicina. Ijuí, RS, Brasil
| | - Maria Letícia R Ikeda
- Universidade do Vale do Rio dos Sinos. Curso de Enfermagem. Programa de Pós-Graduação em Saúde Coletiva. São Leopoldo, RS, Brasil
| | - Débora C P Pellegrini
- Universidade Federal do Pampa - Campus Uruguaiana. Programa de Pós-Graduação em Ciência Animal. Uruguaiana, RS, Brasil
| | - Cézane Priscila Reuter
- Universidade de Santa Cruz do Sul. Departamento de Ciências da Saúde. Programa de Pós-Graduação em Promoção da Saúde. Santa Cruz do Sul, RS, Brasil
| | - Shana G da Silva
- Universidade Federal da Fronteira Sul. Curso de Medicina. Programa de Pós-Graduação em Ciências Biomédicas. Passo Fundo, RS, Brasil
| | - Odir A Dellagostin
- Universidade Federal de Pelotas. Faculdade de Medicina. Programa de Pós-Graduação em Epidemiologia. Pelotas, RS, Brasil
| | - Pedro C Hallal
- Universidade Federal de Pelotas. Faculdade de Medicina. Programa de Pós-Graduação em Epidemiologia. Pelotas, RS, Brasil
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Mesenburg MA, Hallal PC, Menezes AMB, Barros AJD, Horta BL, Hartwig FP, Jacques N, Pellanda LC, Zelmanowicz ADM, Vergani DOP, Ries EF, Harter J, Martínez-Mesa J, Carneiro M, Estima SL, Heck TG, Silveira MFD. Prevalence of symptoms of COVID-19 in the state of Rio Grande do Sul: results of a population-based study with 18,000 participants. Rev Saude Publica 2021; 55:82. [PMID: 34816983 PMCID: PMC8601401 DOI: 10.11606/s1518-8787.2021055004030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 07/12/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the prevalence of reports of symptoms of COVID-19 among individuals with and without antibodies and identify those with greater capability to predict the presence of antibodies against SARS-CoV-2. METHODS The study uses data collected in phases 5 to 8 of Epicovid-19-RS. The presence of antibodies against SARS-CoV-2 was evaluated by a rapid test. The occurrence of cough, fever, palpitations, sore throat, difficulty breathing, changes in taste and smell, vomiting, diarrhea, body pain, shaking, and headache since March 2020 was also evaluated. Then, the capability to predict the evaluated symptoms concerning the presence of antibodies was calculated. RESULTS A total of 18,000 individuals were interviewed and 181 had antibodies against COVID-19 in phases 5 to 8. The proportion of asymptomatic individuals was 19.9% among participants with antibodies and 49.7% among those without antibodies. All symptoms were reported more frequently by individuals with antibodies. The division of the prevalence of symptoms among individuals with antibodies by the prevalence among individuals without antibodies showed the following prevalence ratios: for changes in smell or taste (9.1), fever (4.2), tremors (3.9), breathing difficulty (3.2) and cough (2.8 times). Anosmia and fever were the symptoms with a greater capability to predict the presence of antibodies. CONCLUSION The prevalence of symptoms was higher among individuals with antibodies against SARS-CoV-2. The proportion of asymptomatic individuals was low. Altered smell or taste and fever were the symptoms that most predict the presence of antibodies. These results can help to identify probable cases, contributing to the clinical diagnosis and screening of patients for testing and isolation guidance in positive cases, especially in scenarios of the scarcity of diagnostic COVID-19 tests.
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Affiliation(s)
- Marilia Arndt Mesenburg
- Universidade Federal de Pelotas. Faculdade de Medicina. Programa de Pós-Graduação em Epidemiologia. Pelotas, RS, Brasil.,Universidade Federal de Ciências da Saúde de Porto Alegre. Departamento de Saúde Coletiva. Porto Alegre, RS, Brasil
| | - Pedro Curi Hallal
- Universidade Federal de Pelotas. Faculdade de Medicina. Programa de Pós-Graduação em Epidemiologia. Pelotas, RS, Brasil
| | - Ana Maria Baptista Menezes
- Universidade Federal de Pelotas. Faculdade de Medicina. Programa de Pós-Graduação em Epidemiologia. Pelotas, RS, Brasil
| | - Aluísio J D Barros
- Universidade Federal de Pelotas. Faculdade de Medicina. Programa de Pós-Graduação em Epidemiologia. Pelotas, RS, Brasil
| | - Bernardo Lessa Horta
- Universidade Federal de Pelotas. Faculdade de Medicina. Programa de Pós-Graduação em Epidemiologia. Pelotas, RS, Brasil
| | - Fernando Pires Hartwig
- Universidade Federal de Pelotas. Faculdade de Medicina. Programa de Pós-Graduação em Epidemiologia. Pelotas, RS, Brasil
| | - Nadege Jacques
- Universidade Federal de Pelotas. Faculdade de Medicina. Programa de Pós-Graduação em Epidemiologia. Pelotas, RS, Brasil
| | - Lucia Campos Pellanda
- Universidade Federal de Ciências da Saúde de Porto Alegre. Departamento de Saúde Coletiva. Porto Alegre, RS, Brasil
| | | | | | - Edi Franciele Ries
- Universidade Federal de Santa Maria. Centro de Ciências da Saúde. Departamento de Saúde Coletiva. Santa Maria, RS, Brasil
| | - Jenifer Harter
- Universidade Federal do Pampa. Unidade Uruguaiana. Curso de Enfermagem. Uruguaiana, RS, Brasil
| | - Jeovany Martínez-Mesa
- Faculdade IMED Passo Fundo. Escola de Medicina. Programa de Pós-Graduação em Psicologia. Passo Fundo, RS, Brasil
| | - Marcelo Carneiro
- Universidade de Santa Cruz do Sul. Curso de Medicina. Programa de Pós-Graduação Promoção da Saúde. Santa Cruz, RS, Brasil
| | | | - Thiago Gomes Heck
- Universidade Regional do Noroeste do Estado do Rio Grande do Sul. Programa de Pós-Graduação em Atenção Integral à Saúde. Ijuí, RS, Brasil.,Universidade Regional do Noroeste do Estado do Rio Grande do Sul. Programa de Pós-Graduação em Modelagem Matemática e Computacional. Ijuí, RS, Brasil
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Horta BL, Silveira MF, Barros AJD, Barros FC, Hartwig FP, Dias MS, Menezes AMB, Hallal PC, Victora CG. [Prevalence of antibodies against SARS-CoV-2 according to socioeconomic and ethnic status in a nationwide Brazilian surveyPrevalência de anticorpos contra o SARS-CoV-2 de acordo com o status socioeconômico e étnico em uma pesquisa nacional no Brasil]. Rev Panam Salud Publica 2021; 45:e105. [PMID: 34703458 PMCID: PMC8530005 DOI: 10.26633/rpsp.2021.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To investigate socioeconomic and ethnic group inequalities in prevalence of antibodies against SARS-CoV-2 in the 27 federative units of Brazil. METHODS In this cross-sectional study, three household surveys were carried out on May 14-21, June 4-7, and June 21-24, 2020 in 133 Brazilian urban areas. Multi-stage sampling was used to select 250 individuals in each city to undergo a rapid antibody test. Subjects answered a questionnaire on household assets, schooling and self-reported skin color/ethnicity using the standard Brazilian classification in five categories: white, black, brown, Asian or indigenous. Principal component analyses of assets was used to classify socioeconomic position into five wealth quintiles. Poisson regression was used for the analyses. RESULTS 25 025 subjects were tested in the first, 31 165 in the second, and 33 207 in the third wave of the survey, with prevalence of positive results equal to 1.4%, 2.4%, and 2.9% respectively. Individuals in the poorest quintile were 2.16 times (95% confidence interval 1.86; 2.51) more likely to test positive than those in the wealthiest quintile, and those with 12 or more years of schooling had lower prevalence than subjects with less education. Indigenous individuals had 4.71 (3.65; 6.08) times higher prevalence than whites, as did those with black or brown skin color. Adjustment for region of the country reduced the prevalence ratios according to wealth, education and ethnicity, but results remained statistically significant. CONCLUSIONS The prevalence of antibodies against SARS-CoV-2 in Brazil shows steep class and ethnic gradients, with lowest risks among white, educated and wealthy individuals.
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Affiliation(s)
- Bernardo L Horta
- Universidad Federal de PelotasPelotasBrasilUniversidad Federal de Pelotas, Pelotas, Brasil.
| | - Mariângela F Silveira
- Universidad Federal de PelotasPelotasBrasilUniversidad Federal de Pelotas, Pelotas, Brasil.
| | - Aluísio J D Barros
- Universidad Federal de PelotasPelotasBrasilUniversidad Federal de Pelotas, Pelotas, Brasil.
| | - Fernando C Barros
- Universidad Federal de PelotasPelotasBrasilUniversidad Federal de Pelotas, Pelotas, Brasil.
| | - Fernando P Hartwig
- Universidad Federal de PelotasPelotasBrasilUniversidad Federal de Pelotas, Pelotas, Brasil.
| | - Mariane S Dias
- Universidad Federal de PelotasPelotasBrasilUniversidad Federal de Pelotas, Pelotas, Brasil.
| | - Ana M B Menezes
- Universidad Federal de PelotasPelotasBrasilUniversidad Federal de Pelotas, Pelotas, Brasil.
| | - Pedro C Hallal
- Universidad Federal de PelotasPelotasBrasilUniversidad Federal de Pelotas, Pelotas, Brasil.
| | - Cesar G Victora
- Universidad Federal de PelotasPelotasBrasilUniversidad Federal de Pelotas, Pelotas, Brasil.
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Bouilly R, Gatica-Domínguez G, Mesenburg M, Cáceres Ureña FI, Leventhal DGP, Barros AJD, Victora CG, Wehrmeister FC. [Maternal and child health inequalities among migrants: the case of Haiti and the Dominican RepublicDesigualdades na saúde materno-infantil entre migrantes: o caso do Haiti e da República Dominicana]. Rev Panam Salud Publica 2021; 45:e100. [PMID: 34539764 PMCID: PMC8442708 DOI: 10.26633/rpsp.2021.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/19/2020] [Indexed: 11/24/2022] Open
Abstract
Objective To assess coverage and inequalities in maternal and child health interventions among Haitians, Haitian migrants in the Dominican Republic and Dominicans. Methods Cross-sectional study using data from nationally representative surveys carried out in Haiti in 2012 and in the Dominican Republic in 2014. Nine indicators were compared: demand for family planning satisfied with modern methods, antenatal care, delivery care (skilled birth attendance), child vaccination (BCG, measles and DPT3), child case management (oral rehydration salts for diarrhea and careseeking for suspected pneumonia), and the composite coverage index. Wealth was measured through an asset-based index, divided into tertiles, and place of residence (urban or rural) was established according to the country definition. Results Haitians showed the lowest coverage for demand for family planning satisfied with modern methods (44.2%), antenatal care (65.3%), skilled birth attendance (39.5%) and careseeking for suspected pneumonia (37.9%), and the highest for oral rehydration salts for diarrhea (52.9%), whereas Haitian migrants had the lowest coverage in DPT3 (44.1%) and oral rehydration salts for diarrhea (38%) and the highest in careseeking for suspected pneumonia (80.7%). Dominicans presented the highest coverage for most indicators, except oral rehydration salts for diarrhea and careseeking for suspected pneumonia. The composite coverage index was 79.2% for Dominicans, 69.0% for Haitian migrants, and 52.6% for Haitians. Socioeconomic inequalities generally had pro-rich and pro-urban pattern in all analyzed groups. Conclusion Haitian migrants presented higher coverage than Haitians, but lower than Dominicans. Both countries should plan actions and policies to increase coverage and address inequalities of maternal health interventions.
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Affiliation(s)
- Roberta Bouilly
- Universidad Federal de Pelotas Pelotas Brasil Universidad Federal de Pelotas, Pelotas, Brasil
| | | | - Marilia Mesenburg
- Universidad Federal de Pelotas Pelotas Brasil Universidad Federal de Pelotas, Pelotas, Brasil.,Universidad Federal de Ciencias de la Salud Porto Alegre Brasil Universidad Federal de Ciencias de la Salud, Porto Alegre, Brasil
| | - Francisco I Cáceres Ureña
- Universidad Autónoma de Santo Domingo Santo Domingo República Dominicana Universidad Autónoma de Santo Domingo, Santo Domingo, República Dominicana.,Oficina Nacional de Estadística Santo Domingo República Dominicana Oficina Nacional de Estadística, Santo Domingo, República Dominicana
| | - Daniel G P Leventhal
- Universidad Federal de Pelotas Pelotas Brasil Universidad Federal de Pelotas, Pelotas, Brasil
| | - Aluísio J D Barros
- Universidad Federal de Pelotas Pelotas Brasil Universidad Federal de Pelotas, Pelotas, Brasil
| | - Cesar G Victora
- Universidad Federal de Pelotas Pelotas Brasil Universidad Federal de Pelotas, Pelotas, Brasil
| | - Fernando C Wehrmeister
- Universidad Federal de Pelotas Pelotas Brasil Universidad Federal de Pelotas, Pelotas, Brasil
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Hallal PC, Victora CG, Silveira MF, Barros AJD, Menezes AMB, Horta BL, Struchiner CJ, Hartwig FP, Victora GD, Pellanda LC, Burattini MN, Dellagostin OA, Barros FC. The challenge of conducting epidemiological research in times of pandemic and denialism: 1-year anniversary of the EPICOVID-19 project in Brazil. Int J Epidemiol 2021; 50:1049-1052. [PMID: 34215876 DOI: 10.1093/ije/dyab129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Pedro C Hallal
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Cesar G Victora
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Mariângela F Silveira
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Aluísio J D Barros
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Ana M B Menezes
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Bernardo L Horta
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | | | - Fernando P Hartwig
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Gabriel D Victora
- Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, USA
| | - Lúcia C Pellanda
- Universidade Federal de Ciências de Saúde de Porto Alegre, Porto Alegre, Brazil
| | | | - Odir A Dellagostin
- Postgraduate Program in Biotechnology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Fernando C Barros
- Postgraduate Program in Health and Behavior, Universidade Católica de Pelotas, Pelotas, Brazil
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Giugliani ERJ, Gomes E, Santos IS, Matijasevich A, Camargo-Figuera FA, Barros AJD. All day-long pacifier use and intelligence quotient in childhood: A birth cohort study. Paediatr Perinat Epidemiol 2021; 35:511-518. [PMID: 33570810 DOI: 10.1111/ppe.12752] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 11/23/2020] [Accepted: 12/19/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Literature on pacifier use remains controversial, but mostly suggests an inverse association with childhood intelligence. OBJECTIVES The objective of this study was to assess the association between pacifier use and intelligence quotient (IQ) in six-year-old children from a birth cohort. METHODS Data from 3532 children from the 2004 Pelotas (Brazil) Birth Cohort were analysed. Children were recruited and assessed at birth and followed up at 3 months, and 1, 2, 4, and 6 years. Data on pacifier use duration and intensity were obtained via interviews with mothers in all six follow-up visits. IQ was estimated at 6 years using the Wechsler Intelligence Scale for Children and standardised for the analyses. Crude and adjusted coefficients were calculated (linear regression) for all the data collected in follow-up assessments for pacifier use. RESULTS IQ was inversely associated with all pacifier use indicators. Children who used a pacifier all day long (ADL) at any follow-up showed an IQ 0.18 (95% confidence interval [CI] 0.11, 0.24) standard deviations below those who never used it ADL, after adjusting for confounders. The strength of association increased with number of assessments reporting ADL pacifier use, from a reduction in IQ of 0.13 (95% CI 0.06, 0.21) to 0.34 (95% CI 0.15, 0.52) standard deviations for ADL use in one and in all four follow-up visits, respectively. CONCLUSIONS We found a strong association between intense pacifier use up to 4 years of age and lower IQ at 6 years. A dose-response gradient was observed, with greater IQ deficits in children who used a ADL pacifier for longer durations. The mechanisms underlying this association need to be clarified. One hypothesis is that children using a pacifier, especially those who use it more intensely, are less stimulated.
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Affiliation(s)
- Elsa R J Giugliani
- Faculdade de Medicina, Departamento de Pediatria, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Erissandra Gomes
- Faculdade de Odontologia, Departamento de Cirurgia e Ortopedia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Iná S Santos
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brazil.,Programa de Pós-Graduação em Pediatria e Saúde da Criança, Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Alicia Matijasevich
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brazil.,Faculdade de Medicina, Departamento de Medicina Preventiva, Universidade de São Paulo, São Paulo, Brazil
| | - Fabio A Camargo-Figuera
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brazil.,Escuela de Enfermería, Universidad Industrial de Santander, Bucaramanga, Colombia
| | - Aluísio J D Barros
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brazil
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36
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Hallal PC, Silveira MF, Menezes AMB, Horta BL, Barros AJD, Pellanda LC, Victora GD, Dellagostin OA, Struchiner CJ, Burattini MN, Mesenburg MA, Jacques N, Vidaletti LP, Ambros EL, Berlezi EM, Schirmer H, Renner JDP, Collares K, Ikeda MLR, Ardenghi TM, Gasperi PD, Hartwig FP, Barros FC, Victora CG. Slow Spread of SARS-CoV-2 in Southern Brazil Over a 6-Month Period: Report on 8 Sequential Statewide Serological Surveys Including 35 611 Participants. Am J Public Health 2021; 111:1542-1550. [PMID: 34185552 DOI: 10.2105/ajph.2021.306351] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To evaluate the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) over 6 months in the Brazilian State of Rio Grande do Sul (population 11.3 million), based on 8 serological surveys. Methods. In each survey, 4151 participants in round 1 and 4460 participants in round 2 were randomly sampled from all state regions. We assessed presence of antibodies against SARS-CoV-2 using a validated lateral flow point-of-care test; we adjusted figures for the time-dependent decay of antibodies. Results. The SARS-CoV-2 antibody prevalence increased from 0.03% (95% confidence interval [CI] = 0.00%, 0.34%; 1 in every 3333 individuals) in mid-April to 1.89% (95% CI = 1.36%, 2.54%; 1 in every 53 individuals) in early September. Prevalence was similar across gender and skin color categories. Older adults were less likely to be infected than younger participants. The proportion of the population who reported leaving home daily increased from 21.4% (95% CI = 20.2%, 22.7%) to 33.2% (95% CI = 31.8%, 34.5%). Conclusions. SARS-CoV-2 infection increased slowly during the first 6 months in the state, differently from what was observed in other Brazilian regions. Future survey rounds will continue to document the spread of the pandemic.
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Affiliation(s)
- Pedro C Hallal
- Pedro C. Hallal, Mariângela F. Silveira, Ana M. B. Menezes, Bernardo L. Horta, Aluísio J. D. Barros, Nadege Jacques, Luís Paulo Vidaletti, Fernando P. Hartwig, Fernando C. Barros, and Cesar G. Victora are with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Brazil. Lúcia C. Pellanda and Helena Schirmer are with the Universidade Federal de Ciências de Saúde de Porto Alegre, Brazil. Gabriel D. Victora is with the Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, NY. Odir A. Dellagostin is with the Postgraduate Program in Biotechnology, Universidade Federal de Pelotas. Claudio J. Struchiner is with the Fundação Getúlio Vargas, Rio de Janeiro, Brazil. Marcelo N. Burattini is with the Universidade Federal de São Paulo, Brazil. Marilia A. Mesenburg is with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, and the Universidade Federal de Ciências de Saúde de Porto Alegre. Emanuele L. Ambros is with the Secretaria Municipal de Saúde de Uruguaiana, Brazil. Evelise M. Berlezi is with the Universidade de Ijuí, Brazil. Jane D. P. Renner is with the Universidade de Santa Cruz do Sul, Brazil. Kaue Collares is with the Universidade de Passo Fundo, Brazil. Maria Letícia R. Ikeda is with the Universidade do Vale do Rio dos Sinos, Sao Leopoldo, Brazil. Thiago M. Ardenghi is with the Universidade Federal de Santa Maria, Brazil. Patricia de Gasperi is with the Universidade de Caxias do Sul, Brazil
| | - Mariângela F Silveira
- Pedro C. Hallal, Mariângela F. Silveira, Ana M. B. Menezes, Bernardo L. Horta, Aluísio J. D. Barros, Nadege Jacques, Luís Paulo Vidaletti, Fernando P. Hartwig, Fernando C. Barros, and Cesar G. Victora are with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Brazil. Lúcia C. Pellanda and Helena Schirmer are with the Universidade Federal de Ciências de Saúde de Porto Alegre, Brazil. Gabriel D. Victora is with the Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, NY. Odir A. Dellagostin is with the Postgraduate Program in Biotechnology, Universidade Federal de Pelotas. Claudio J. Struchiner is with the Fundação Getúlio Vargas, Rio de Janeiro, Brazil. Marcelo N. Burattini is with the Universidade Federal de São Paulo, Brazil. Marilia A. Mesenburg is with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, and the Universidade Federal de Ciências de Saúde de Porto Alegre. Emanuele L. Ambros is with the Secretaria Municipal de Saúde de Uruguaiana, Brazil. Evelise M. Berlezi is with the Universidade de Ijuí, Brazil. Jane D. P. Renner is with the Universidade de Santa Cruz do Sul, Brazil. Kaue Collares is with the Universidade de Passo Fundo, Brazil. Maria Letícia R. Ikeda is with the Universidade do Vale do Rio dos Sinos, Sao Leopoldo, Brazil. Thiago M. Ardenghi is with the Universidade Federal de Santa Maria, Brazil. Patricia de Gasperi is with the Universidade de Caxias do Sul, Brazil
| | - Ana M B Menezes
- Pedro C. Hallal, Mariângela F. Silveira, Ana M. B. Menezes, Bernardo L. Horta, Aluísio J. D. Barros, Nadege Jacques, Luís Paulo Vidaletti, Fernando P. Hartwig, Fernando C. Barros, and Cesar G. Victora are with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Brazil. Lúcia C. Pellanda and Helena Schirmer are with the Universidade Federal de Ciências de Saúde de Porto Alegre, Brazil. Gabriel D. Victora is with the Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, NY. Odir A. Dellagostin is with the Postgraduate Program in Biotechnology, Universidade Federal de Pelotas. Claudio J. Struchiner is with the Fundação Getúlio Vargas, Rio de Janeiro, Brazil. Marcelo N. Burattini is with the Universidade Federal de São Paulo, Brazil. Marilia A. Mesenburg is with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, and the Universidade Federal de Ciências de Saúde de Porto Alegre. Emanuele L. Ambros is with the Secretaria Municipal de Saúde de Uruguaiana, Brazil. Evelise M. Berlezi is with the Universidade de Ijuí, Brazil. Jane D. P. Renner is with the Universidade de Santa Cruz do Sul, Brazil. Kaue Collares is with the Universidade de Passo Fundo, Brazil. Maria Letícia R. Ikeda is with the Universidade do Vale do Rio dos Sinos, Sao Leopoldo, Brazil. Thiago M. Ardenghi is with the Universidade Federal de Santa Maria, Brazil. Patricia de Gasperi is with the Universidade de Caxias do Sul, Brazil
| | - Bernardo L Horta
- Pedro C. Hallal, Mariângela F. Silveira, Ana M. B. Menezes, Bernardo L. Horta, Aluísio J. D. Barros, Nadege Jacques, Luís Paulo Vidaletti, Fernando P. Hartwig, Fernando C. Barros, and Cesar G. Victora are with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Brazil. Lúcia C. Pellanda and Helena Schirmer are with the Universidade Federal de Ciências de Saúde de Porto Alegre, Brazil. Gabriel D. Victora is with the Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, NY. Odir A. Dellagostin is with the Postgraduate Program in Biotechnology, Universidade Federal de Pelotas. Claudio J. Struchiner is with the Fundação Getúlio Vargas, Rio de Janeiro, Brazil. Marcelo N. Burattini is with the Universidade Federal de São Paulo, Brazil. Marilia A. Mesenburg is with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, and the Universidade Federal de Ciências de Saúde de Porto Alegre. Emanuele L. Ambros is with the Secretaria Municipal de Saúde de Uruguaiana, Brazil. Evelise M. Berlezi is with the Universidade de Ijuí, Brazil. Jane D. P. Renner is with the Universidade de Santa Cruz do Sul, Brazil. Kaue Collares is with the Universidade de Passo Fundo, Brazil. Maria Letícia R. Ikeda is with the Universidade do Vale do Rio dos Sinos, Sao Leopoldo, Brazil. Thiago M. Ardenghi is with the Universidade Federal de Santa Maria, Brazil. Patricia de Gasperi is with the Universidade de Caxias do Sul, Brazil
| | - Aluísio J D Barros
- Pedro C. Hallal, Mariângela F. Silveira, Ana M. B. Menezes, Bernardo L. Horta, Aluísio J. D. Barros, Nadege Jacques, Luís Paulo Vidaletti, Fernando P. Hartwig, Fernando C. Barros, and Cesar G. Victora are with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Brazil. Lúcia C. Pellanda and Helena Schirmer are with the Universidade Federal de Ciências de Saúde de Porto Alegre, Brazil. Gabriel D. Victora is with the Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, NY. Odir A. Dellagostin is with the Postgraduate Program in Biotechnology, Universidade Federal de Pelotas. Claudio J. Struchiner is with the Fundação Getúlio Vargas, Rio de Janeiro, Brazil. Marcelo N. Burattini is with the Universidade Federal de São Paulo, Brazil. Marilia A. Mesenburg is with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, and the Universidade Federal de Ciências de Saúde de Porto Alegre. Emanuele L. Ambros is with the Secretaria Municipal de Saúde de Uruguaiana, Brazil. Evelise M. Berlezi is with the Universidade de Ijuí, Brazil. Jane D. P. Renner is with the Universidade de Santa Cruz do Sul, Brazil. Kaue Collares is with the Universidade de Passo Fundo, Brazil. Maria Letícia R. Ikeda is with the Universidade do Vale do Rio dos Sinos, Sao Leopoldo, Brazil. Thiago M. Ardenghi is with the Universidade Federal de Santa Maria, Brazil. Patricia de Gasperi is with the Universidade de Caxias do Sul, Brazil
| | - Lúcia C Pellanda
- Pedro C. Hallal, Mariângela F. Silveira, Ana M. B. Menezes, Bernardo L. Horta, Aluísio J. D. Barros, Nadege Jacques, Luís Paulo Vidaletti, Fernando P. Hartwig, Fernando C. Barros, and Cesar G. Victora are with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Brazil. Lúcia C. Pellanda and Helena Schirmer are with the Universidade Federal de Ciências de Saúde de Porto Alegre, Brazil. Gabriel D. Victora is with the Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, NY. Odir A. Dellagostin is with the Postgraduate Program in Biotechnology, Universidade Federal de Pelotas. Claudio J. Struchiner is with the Fundação Getúlio Vargas, Rio de Janeiro, Brazil. Marcelo N. Burattini is with the Universidade Federal de São Paulo, Brazil. Marilia A. Mesenburg is with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, and the Universidade Federal de Ciências de Saúde de Porto Alegre. Emanuele L. Ambros is with the Secretaria Municipal de Saúde de Uruguaiana, Brazil. Evelise M. Berlezi is with the Universidade de Ijuí, Brazil. Jane D. P. Renner is with the Universidade de Santa Cruz do Sul, Brazil. Kaue Collares is with the Universidade de Passo Fundo, Brazil. Maria Letícia R. Ikeda is with the Universidade do Vale do Rio dos Sinos, Sao Leopoldo, Brazil. Thiago M. Ardenghi is with the Universidade Federal de Santa Maria, Brazil. Patricia de Gasperi is with the Universidade de Caxias do Sul, Brazil
| | - Gabriel D Victora
- Pedro C. Hallal, Mariângela F. Silveira, Ana M. B. Menezes, Bernardo L. Horta, Aluísio J. D. Barros, Nadege Jacques, Luís Paulo Vidaletti, Fernando P. Hartwig, Fernando C. Barros, and Cesar G. Victora are with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Brazil. Lúcia C. Pellanda and Helena Schirmer are with the Universidade Federal de Ciências de Saúde de Porto Alegre, Brazil. Gabriel D. Victora is with the Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, NY. Odir A. Dellagostin is with the Postgraduate Program in Biotechnology, Universidade Federal de Pelotas. Claudio J. Struchiner is with the Fundação Getúlio Vargas, Rio de Janeiro, Brazil. Marcelo N. Burattini is with the Universidade Federal de São Paulo, Brazil. Marilia A. Mesenburg is with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, and the Universidade Federal de Ciências de Saúde de Porto Alegre. Emanuele L. Ambros is with the Secretaria Municipal de Saúde de Uruguaiana, Brazil. Evelise M. Berlezi is with the Universidade de Ijuí, Brazil. Jane D. P. Renner is with the Universidade de Santa Cruz do Sul, Brazil. Kaue Collares is with the Universidade de Passo Fundo, Brazil. Maria Letícia R. Ikeda is with the Universidade do Vale do Rio dos Sinos, Sao Leopoldo, Brazil. Thiago M. Ardenghi is with the Universidade Federal de Santa Maria, Brazil. Patricia de Gasperi is with the Universidade de Caxias do Sul, Brazil
| | - Odir A Dellagostin
- Pedro C. Hallal, Mariângela F. Silveira, Ana M. B. Menezes, Bernardo L. Horta, Aluísio J. D. Barros, Nadege Jacques, Luís Paulo Vidaletti, Fernando P. Hartwig, Fernando C. Barros, and Cesar G. Victora are with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Brazil. Lúcia C. Pellanda and Helena Schirmer are with the Universidade Federal de Ciências de Saúde de Porto Alegre, Brazil. Gabriel D. Victora is with the Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, NY. Odir A. Dellagostin is with the Postgraduate Program in Biotechnology, Universidade Federal de Pelotas. Claudio J. Struchiner is with the Fundação Getúlio Vargas, Rio de Janeiro, Brazil. Marcelo N. Burattini is with the Universidade Federal de São Paulo, Brazil. Marilia A. Mesenburg is with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, and the Universidade Federal de Ciências de Saúde de Porto Alegre. Emanuele L. Ambros is with the Secretaria Municipal de Saúde de Uruguaiana, Brazil. Evelise M. Berlezi is with the Universidade de Ijuí, Brazil. Jane D. P. Renner is with the Universidade de Santa Cruz do Sul, Brazil. Kaue Collares is with the Universidade de Passo Fundo, Brazil. Maria Letícia R. Ikeda is with the Universidade do Vale do Rio dos Sinos, Sao Leopoldo, Brazil. Thiago M. Ardenghi is with the Universidade Federal de Santa Maria, Brazil. Patricia de Gasperi is with the Universidade de Caxias do Sul, Brazil
| | - Claudio J Struchiner
- Pedro C. Hallal, Mariângela F. Silveira, Ana M. B. Menezes, Bernardo L. Horta, Aluísio J. D. Barros, Nadege Jacques, Luís Paulo Vidaletti, Fernando P. Hartwig, Fernando C. Barros, and Cesar G. Victora are with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Brazil. Lúcia C. Pellanda and Helena Schirmer are with the Universidade Federal de Ciências de Saúde de Porto Alegre, Brazil. Gabriel D. Victora is with the Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, NY. Odir A. Dellagostin is with the Postgraduate Program in Biotechnology, Universidade Federal de Pelotas. Claudio J. Struchiner is with the Fundação Getúlio Vargas, Rio de Janeiro, Brazil. Marcelo N. Burattini is with the Universidade Federal de São Paulo, Brazil. Marilia A. Mesenburg is with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, and the Universidade Federal de Ciências de Saúde de Porto Alegre. Emanuele L. Ambros is with the Secretaria Municipal de Saúde de Uruguaiana, Brazil. Evelise M. Berlezi is with the Universidade de Ijuí, Brazil. Jane D. P. Renner is with the Universidade de Santa Cruz do Sul, Brazil. Kaue Collares is with the Universidade de Passo Fundo, Brazil. Maria Letícia R. Ikeda is with the Universidade do Vale do Rio dos Sinos, Sao Leopoldo, Brazil. Thiago M. Ardenghi is with the Universidade Federal de Santa Maria, Brazil. Patricia de Gasperi is with the Universidade de Caxias do Sul, Brazil
| | - Marcelo N Burattini
- Pedro C. Hallal, Mariângela F. Silveira, Ana M. B. Menezes, Bernardo L. Horta, Aluísio J. D. Barros, Nadege Jacques, Luís Paulo Vidaletti, Fernando P. Hartwig, Fernando C. Barros, and Cesar G. Victora are with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Brazil. Lúcia C. Pellanda and Helena Schirmer are with the Universidade Federal de Ciências de Saúde de Porto Alegre, Brazil. Gabriel D. Victora is with the Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, NY. Odir A. Dellagostin is with the Postgraduate Program in Biotechnology, Universidade Federal de Pelotas. Claudio J. Struchiner is with the Fundação Getúlio Vargas, Rio de Janeiro, Brazil. Marcelo N. Burattini is with the Universidade Federal de São Paulo, Brazil. Marilia A. Mesenburg is with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, and the Universidade Federal de Ciências de Saúde de Porto Alegre. Emanuele L. Ambros is with the Secretaria Municipal de Saúde de Uruguaiana, Brazil. Evelise M. Berlezi is with the Universidade de Ijuí, Brazil. Jane D. P. Renner is with the Universidade de Santa Cruz do Sul, Brazil. Kaue Collares is with the Universidade de Passo Fundo, Brazil. Maria Letícia R. Ikeda is with the Universidade do Vale do Rio dos Sinos, Sao Leopoldo, Brazil. Thiago M. Ardenghi is with the Universidade Federal de Santa Maria, Brazil. Patricia de Gasperi is with the Universidade de Caxias do Sul, Brazil
| | - Marilia A Mesenburg
- Pedro C. Hallal, Mariângela F. Silveira, Ana M. B. Menezes, Bernardo L. Horta, Aluísio J. D. Barros, Nadege Jacques, Luís Paulo Vidaletti, Fernando P. Hartwig, Fernando C. Barros, and Cesar G. Victora are with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Brazil. Lúcia C. Pellanda and Helena Schirmer are with the Universidade Federal de Ciências de Saúde de Porto Alegre, Brazil. Gabriel D. Victora is with the Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, NY. Odir A. Dellagostin is with the Postgraduate Program in Biotechnology, Universidade Federal de Pelotas. Claudio J. Struchiner is with the Fundação Getúlio Vargas, Rio de Janeiro, Brazil. Marcelo N. Burattini is with the Universidade Federal de São Paulo, Brazil. Marilia A. Mesenburg is with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, and the Universidade Federal de Ciências de Saúde de Porto Alegre. Emanuele L. Ambros is with the Secretaria Municipal de Saúde de Uruguaiana, Brazil. Evelise M. Berlezi is with the Universidade de Ijuí, Brazil. Jane D. P. Renner is with the Universidade de Santa Cruz do Sul, Brazil. Kaue Collares is with the Universidade de Passo Fundo, Brazil. Maria Letícia R. Ikeda is with the Universidade do Vale do Rio dos Sinos, Sao Leopoldo, Brazil. Thiago M. Ardenghi is with the Universidade Federal de Santa Maria, Brazil. Patricia de Gasperi is with the Universidade de Caxias do Sul, Brazil
| | - Nadege Jacques
- Pedro C. Hallal, Mariângela F. Silveira, Ana M. B. Menezes, Bernardo L. Horta, Aluísio J. D. Barros, Nadege Jacques, Luís Paulo Vidaletti, Fernando P. Hartwig, Fernando C. Barros, and Cesar G. Victora are with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Brazil. Lúcia C. Pellanda and Helena Schirmer are with the Universidade Federal de Ciências de Saúde de Porto Alegre, Brazil. Gabriel D. Victora is with the Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, NY. Odir A. Dellagostin is with the Postgraduate Program in Biotechnology, Universidade Federal de Pelotas. Claudio J. Struchiner is with the Fundação Getúlio Vargas, Rio de Janeiro, Brazil. Marcelo N. Burattini is with the Universidade Federal de São Paulo, Brazil. Marilia A. Mesenburg is with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, and the Universidade Federal de Ciências de Saúde de Porto Alegre. Emanuele L. Ambros is with the Secretaria Municipal de Saúde de Uruguaiana, Brazil. Evelise M. Berlezi is with the Universidade de Ijuí, Brazil. Jane D. P. Renner is with the Universidade de Santa Cruz do Sul, Brazil. Kaue Collares is with the Universidade de Passo Fundo, Brazil. Maria Letícia R. Ikeda is with the Universidade do Vale do Rio dos Sinos, Sao Leopoldo, Brazil. Thiago M. Ardenghi is with the Universidade Federal de Santa Maria, Brazil. Patricia de Gasperi is with the Universidade de Caxias do Sul, Brazil
| | - Luís Paulo Vidaletti
- Pedro C. Hallal, Mariângela F. Silveira, Ana M. B. Menezes, Bernardo L. Horta, Aluísio J. D. Barros, Nadege Jacques, Luís Paulo Vidaletti, Fernando P. Hartwig, Fernando C. Barros, and Cesar G. Victora are with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Brazil. Lúcia C. Pellanda and Helena Schirmer are with the Universidade Federal de Ciências de Saúde de Porto Alegre, Brazil. Gabriel D. Victora is with the Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, NY. Odir A. Dellagostin is with the Postgraduate Program in Biotechnology, Universidade Federal de Pelotas. Claudio J. Struchiner is with the Fundação Getúlio Vargas, Rio de Janeiro, Brazil. Marcelo N. Burattini is with the Universidade Federal de São Paulo, Brazil. Marilia A. Mesenburg is with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, and the Universidade Federal de Ciências de Saúde de Porto Alegre. Emanuele L. Ambros is with the Secretaria Municipal de Saúde de Uruguaiana, Brazil. Evelise M. Berlezi is with the Universidade de Ijuí, Brazil. Jane D. P. Renner is with the Universidade de Santa Cruz do Sul, Brazil. Kaue Collares is with the Universidade de Passo Fundo, Brazil. Maria Letícia R. Ikeda is with the Universidade do Vale do Rio dos Sinos, Sao Leopoldo, Brazil. Thiago M. Ardenghi is with the Universidade Federal de Santa Maria, Brazil. Patricia de Gasperi is with the Universidade de Caxias do Sul, Brazil
| | - Emanuele L Ambros
- Pedro C. Hallal, Mariângela F. Silveira, Ana M. B. Menezes, Bernardo L. Horta, Aluísio J. D. Barros, Nadege Jacques, Luís Paulo Vidaletti, Fernando P. Hartwig, Fernando C. Barros, and Cesar G. Victora are with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Brazil. Lúcia C. Pellanda and Helena Schirmer are with the Universidade Federal de Ciências de Saúde de Porto Alegre, Brazil. Gabriel D. Victora is with the Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, NY. Odir A. Dellagostin is with the Postgraduate Program in Biotechnology, Universidade Federal de Pelotas. Claudio J. Struchiner is with the Fundação Getúlio Vargas, Rio de Janeiro, Brazil. Marcelo N. Burattini is with the Universidade Federal de São Paulo, Brazil. Marilia A. Mesenburg is with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, and the Universidade Federal de Ciências de Saúde de Porto Alegre. Emanuele L. Ambros is with the Secretaria Municipal de Saúde de Uruguaiana, Brazil. Evelise M. Berlezi is with the Universidade de Ijuí, Brazil. Jane D. P. Renner is with the Universidade de Santa Cruz do Sul, Brazil. Kaue Collares is with the Universidade de Passo Fundo, Brazil. Maria Letícia R. Ikeda is with the Universidade do Vale do Rio dos Sinos, Sao Leopoldo, Brazil. Thiago M. Ardenghi is with the Universidade Federal de Santa Maria, Brazil. Patricia de Gasperi is with the Universidade de Caxias do Sul, Brazil
| | - Evelise M Berlezi
- Pedro C. Hallal, Mariângela F. Silveira, Ana M. B. Menezes, Bernardo L. Horta, Aluísio J. D. Barros, Nadege Jacques, Luís Paulo Vidaletti, Fernando P. Hartwig, Fernando C. Barros, and Cesar G. Victora are with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Brazil. Lúcia C. Pellanda and Helena Schirmer are with the Universidade Federal de Ciências de Saúde de Porto Alegre, Brazil. Gabriel D. Victora is with the Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, NY. Odir A. Dellagostin is with the Postgraduate Program in Biotechnology, Universidade Federal de Pelotas. Claudio J. Struchiner is with the Fundação Getúlio Vargas, Rio de Janeiro, Brazil. Marcelo N. Burattini is with the Universidade Federal de São Paulo, Brazil. Marilia A. Mesenburg is with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, and the Universidade Federal de Ciências de Saúde de Porto Alegre. Emanuele L. Ambros is with the Secretaria Municipal de Saúde de Uruguaiana, Brazil. Evelise M. Berlezi is with the Universidade de Ijuí, Brazil. Jane D. P. Renner is with the Universidade de Santa Cruz do Sul, Brazil. Kaue Collares is with the Universidade de Passo Fundo, Brazil. Maria Letícia R. Ikeda is with the Universidade do Vale do Rio dos Sinos, Sao Leopoldo, Brazil. Thiago M. Ardenghi is with the Universidade Federal de Santa Maria, Brazil. Patricia de Gasperi is with the Universidade de Caxias do Sul, Brazil
| | - Helena Schirmer
- Pedro C. Hallal, Mariângela F. Silveira, Ana M. B. Menezes, Bernardo L. Horta, Aluísio J. D. Barros, Nadege Jacques, Luís Paulo Vidaletti, Fernando P. Hartwig, Fernando C. Barros, and Cesar G. Victora are with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Brazil. Lúcia C. Pellanda and Helena Schirmer are with the Universidade Federal de Ciências de Saúde de Porto Alegre, Brazil. Gabriel D. Victora is with the Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, NY. Odir A. Dellagostin is with the Postgraduate Program in Biotechnology, Universidade Federal de Pelotas. Claudio J. Struchiner is with the Fundação Getúlio Vargas, Rio de Janeiro, Brazil. Marcelo N. Burattini is with the Universidade Federal de São Paulo, Brazil. Marilia A. Mesenburg is with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, and the Universidade Federal de Ciências de Saúde de Porto Alegre. Emanuele L. Ambros is with the Secretaria Municipal de Saúde de Uruguaiana, Brazil. Evelise M. Berlezi is with the Universidade de Ijuí, Brazil. Jane D. P. Renner is with the Universidade de Santa Cruz do Sul, Brazil. Kaue Collares is with the Universidade de Passo Fundo, Brazil. Maria Letícia R. Ikeda is with the Universidade do Vale do Rio dos Sinos, Sao Leopoldo, Brazil. Thiago M. Ardenghi is with the Universidade Federal de Santa Maria, Brazil. Patricia de Gasperi is with the Universidade de Caxias do Sul, Brazil
| | - Jane D P Renner
- Pedro C. Hallal, Mariângela F. Silveira, Ana M. B. Menezes, Bernardo L. Horta, Aluísio J. D. Barros, Nadege Jacques, Luís Paulo Vidaletti, Fernando P. Hartwig, Fernando C. Barros, and Cesar G. Victora are with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Brazil. Lúcia C. Pellanda and Helena Schirmer are with the Universidade Federal de Ciências de Saúde de Porto Alegre, Brazil. Gabriel D. Victora is with the Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, NY. Odir A. Dellagostin is with the Postgraduate Program in Biotechnology, Universidade Federal de Pelotas. Claudio J. Struchiner is with the Fundação Getúlio Vargas, Rio de Janeiro, Brazil. Marcelo N. Burattini is with the Universidade Federal de São Paulo, Brazil. Marilia A. Mesenburg is with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, and the Universidade Federal de Ciências de Saúde de Porto Alegre. Emanuele L. Ambros is with the Secretaria Municipal de Saúde de Uruguaiana, Brazil. Evelise M. Berlezi is with the Universidade de Ijuí, Brazil. Jane D. P. Renner is with the Universidade de Santa Cruz do Sul, Brazil. Kaue Collares is with the Universidade de Passo Fundo, Brazil. Maria Letícia R. Ikeda is with the Universidade do Vale do Rio dos Sinos, Sao Leopoldo, Brazil. Thiago M. Ardenghi is with the Universidade Federal de Santa Maria, Brazil. Patricia de Gasperi is with the Universidade de Caxias do Sul, Brazil
| | - Kaue Collares
- Pedro C. Hallal, Mariângela F. Silveira, Ana M. B. Menezes, Bernardo L. Horta, Aluísio J. D. Barros, Nadege Jacques, Luís Paulo Vidaletti, Fernando P. Hartwig, Fernando C. Barros, and Cesar G. Victora are with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Brazil. Lúcia C. Pellanda and Helena Schirmer are with the Universidade Federal de Ciências de Saúde de Porto Alegre, Brazil. Gabriel D. Victora is with the Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, NY. Odir A. Dellagostin is with the Postgraduate Program in Biotechnology, Universidade Federal de Pelotas. Claudio J. Struchiner is with the Fundação Getúlio Vargas, Rio de Janeiro, Brazil. Marcelo N. Burattini is with the Universidade Federal de São Paulo, Brazil. Marilia A. Mesenburg is with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, and the Universidade Federal de Ciências de Saúde de Porto Alegre. Emanuele L. Ambros is with the Secretaria Municipal de Saúde de Uruguaiana, Brazil. Evelise M. Berlezi is with the Universidade de Ijuí, Brazil. Jane D. P. Renner is with the Universidade de Santa Cruz do Sul, Brazil. Kaue Collares is with the Universidade de Passo Fundo, Brazil. Maria Letícia R. Ikeda is with the Universidade do Vale do Rio dos Sinos, Sao Leopoldo, Brazil. Thiago M. Ardenghi is with the Universidade Federal de Santa Maria, Brazil. Patricia de Gasperi is with the Universidade de Caxias do Sul, Brazil
| | - Maria Letícia R Ikeda
- Pedro C. Hallal, Mariângela F. Silveira, Ana M. B. Menezes, Bernardo L. Horta, Aluísio J. D. Barros, Nadege Jacques, Luís Paulo Vidaletti, Fernando P. Hartwig, Fernando C. Barros, and Cesar G. Victora are with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Brazil. Lúcia C. Pellanda and Helena Schirmer are with the Universidade Federal de Ciências de Saúde de Porto Alegre, Brazil. Gabriel D. Victora is with the Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, NY. Odir A. Dellagostin is with the Postgraduate Program in Biotechnology, Universidade Federal de Pelotas. Claudio J. Struchiner is with the Fundação Getúlio Vargas, Rio de Janeiro, Brazil. Marcelo N. Burattini is with the Universidade Federal de São Paulo, Brazil. Marilia A. Mesenburg is with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, and the Universidade Federal de Ciências de Saúde de Porto Alegre. Emanuele L. Ambros is with the Secretaria Municipal de Saúde de Uruguaiana, Brazil. Evelise M. Berlezi is with the Universidade de Ijuí, Brazil. Jane D. P. Renner is with the Universidade de Santa Cruz do Sul, Brazil. Kaue Collares is with the Universidade de Passo Fundo, Brazil. Maria Letícia R. Ikeda is with the Universidade do Vale do Rio dos Sinos, Sao Leopoldo, Brazil. Thiago M. Ardenghi is with the Universidade Federal de Santa Maria, Brazil. Patricia de Gasperi is with the Universidade de Caxias do Sul, Brazil
| | - Thiago M Ardenghi
- Pedro C. Hallal, Mariângela F. Silveira, Ana M. B. Menezes, Bernardo L. Horta, Aluísio J. D. Barros, Nadege Jacques, Luís Paulo Vidaletti, Fernando P. Hartwig, Fernando C. Barros, and Cesar G. Victora are with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Brazil. Lúcia C. Pellanda and Helena Schirmer are with the Universidade Federal de Ciências de Saúde de Porto Alegre, Brazil. Gabriel D. Victora is with the Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, NY. Odir A. Dellagostin is with the Postgraduate Program in Biotechnology, Universidade Federal de Pelotas. Claudio J. Struchiner is with the Fundação Getúlio Vargas, Rio de Janeiro, Brazil. Marcelo N. Burattini is with the Universidade Federal de São Paulo, Brazil. Marilia A. Mesenburg is with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, and the Universidade Federal de Ciências de Saúde de Porto Alegre. Emanuele L. Ambros is with the Secretaria Municipal de Saúde de Uruguaiana, Brazil. Evelise M. Berlezi is with the Universidade de Ijuí, Brazil. Jane D. P. Renner is with the Universidade de Santa Cruz do Sul, Brazil. Kaue Collares is with the Universidade de Passo Fundo, Brazil. Maria Letícia R. Ikeda is with the Universidade do Vale do Rio dos Sinos, Sao Leopoldo, Brazil. Thiago M. Ardenghi is with the Universidade Federal de Santa Maria, Brazil. Patricia de Gasperi is with the Universidade de Caxias do Sul, Brazil
| | - Patricia de Gasperi
- Pedro C. Hallal, Mariângela F. Silveira, Ana M. B. Menezes, Bernardo L. Horta, Aluísio J. D. Barros, Nadege Jacques, Luís Paulo Vidaletti, Fernando P. Hartwig, Fernando C. Barros, and Cesar G. Victora are with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Brazil. Lúcia C. Pellanda and Helena Schirmer are with the Universidade Federal de Ciências de Saúde de Porto Alegre, Brazil. Gabriel D. Victora is with the Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, NY. Odir A. Dellagostin is with the Postgraduate Program in Biotechnology, Universidade Federal de Pelotas. Claudio J. Struchiner is with the Fundação Getúlio Vargas, Rio de Janeiro, Brazil. Marcelo N. Burattini is with the Universidade Federal de São Paulo, Brazil. Marilia A. Mesenburg is with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, and the Universidade Federal de Ciências de Saúde de Porto Alegre. Emanuele L. Ambros is with the Secretaria Municipal de Saúde de Uruguaiana, Brazil. Evelise M. Berlezi is with the Universidade de Ijuí, Brazil. Jane D. P. Renner is with the Universidade de Santa Cruz do Sul, Brazil. Kaue Collares is with the Universidade de Passo Fundo, Brazil. Maria Letícia R. Ikeda is with the Universidade do Vale do Rio dos Sinos, Sao Leopoldo, Brazil. Thiago M. Ardenghi is with the Universidade Federal de Santa Maria, Brazil. Patricia de Gasperi is with the Universidade de Caxias do Sul, Brazil
| | - Fernando P Hartwig
- Pedro C. Hallal, Mariângela F. Silveira, Ana M. B. Menezes, Bernardo L. Horta, Aluísio J. D. Barros, Nadege Jacques, Luís Paulo Vidaletti, Fernando P. Hartwig, Fernando C. Barros, and Cesar G. Victora are with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Brazil. Lúcia C. Pellanda and Helena Schirmer are with the Universidade Federal de Ciências de Saúde de Porto Alegre, Brazil. Gabriel D. Victora is with the Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, NY. Odir A. Dellagostin is with the Postgraduate Program in Biotechnology, Universidade Federal de Pelotas. Claudio J. Struchiner is with the Fundação Getúlio Vargas, Rio de Janeiro, Brazil. Marcelo N. Burattini is with the Universidade Federal de São Paulo, Brazil. Marilia A. Mesenburg is with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, and the Universidade Federal de Ciências de Saúde de Porto Alegre. Emanuele L. Ambros is with the Secretaria Municipal de Saúde de Uruguaiana, Brazil. Evelise M. Berlezi is with the Universidade de Ijuí, Brazil. Jane D. P. Renner is with the Universidade de Santa Cruz do Sul, Brazil. Kaue Collares is with the Universidade de Passo Fundo, Brazil. Maria Letícia R. Ikeda is with the Universidade do Vale do Rio dos Sinos, Sao Leopoldo, Brazil. Thiago M. Ardenghi is with the Universidade Federal de Santa Maria, Brazil. Patricia de Gasperi is with the Universidade de Caxias do Sul, Brazil
| | - Fernando C Barros
- Pedro C. Hallal, Mariângela F. Silveira, Ana M. B. Menezes, Bernardo L. Horta, Aluísio J. D. Barros, Nadege Jacques, Luís Paulo Vidaletti, Fernando P. Hartwig, Fernando C. Barros, and Cesar G. Victora are with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Brazil. Lúcia C. Pellanda and Helena Schirmer are with the Universidade Federal de Ciências de Saúde de Porto Alegre, Brazil. Gabriel D. Victora is with the Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, NY. Odir A. Dellagostin is with the Postgraduate Program in Biotechnology, Universidade Federal de Pelotas. Claudio J. Struchiner is with the Fundação Getúlio Vargas, Rio de Janeiro, Brazil. Marcelo N. Burattini is with the Universidade Federal de São Paulo, Brazil. Marilia A. Mesenburg is with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, and the Universidade Federal de Ciências de Saúde de Porto Alegre. Emanuele L. Ambros is with the Secretaria Municipal de Saúde de Uruguaiana, Brazil. Evelise M. Berlezi is with the Universidade de Ijuí, Brazil. Jane D. P. Renner is with the Universidade de Santa Cruz do Sul, Brazil. Kaue Collares is with the Universidade de Passo Fundo, Brazil. Maria Letícia R. Ikeda is with the Universidade do Vale do Rio dos Sinos, Sao Leopoldo, Brazil. Thiago M. Ardenghi is with the Universidade Federal de Santa Maria, Brazil. Patricia de Gasperi is with the Universidade de Caxias do Sul, Brazil
| | - Cesar G Victora
- Pedro C. Hallal, Mariângela F. Silveira, Ana M. B. Menezes, Bernardo L. Horta, Aluísio J. D. Barros, Nadege Jacques, Luís Paulo Vidaletti, Fernando P. Hartwig, Fernando C. Barros, and Cesar G. Victora are with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Brazil. Lúcia C. Pellanda and Helena Schirmer are with the Universidade Federal de Ciências de Saúde de Porto Alegre, Brazil. Gabriel D. Victora is with the Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, NY. Odir A. Dellagostin is with the Postgraduate Program in Biotechnology, Universidade Federal de Pelotas. Claudio J. Struchiner is with the Fundação Getúlio Vargas, Rio de Janeiro, Brazil. Marcelo N. Burattini is with the Universidade Federal de São Paulo, Brazil. Marilia A. Mesenburg is with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, and the Universidade Federal de Ciências de Saúde de Porto Alegre. Emanuele L. Ambros is with the Secretaria Municipal de Saúde de Uruguaiana, Brazil. Evelise M. Berlezi is with the Universidade de Ijuí, Brazil. Jane D. P. Renner is with the Universidade de Santa Cruz do Sul, Brazil. Kaue Collares is with the Universidade de Passo Fundo, Brazil. Maria Letícia R. Ikeda is with the Universidade do Vale do Rio dos Sinos, Sao Leopoldo, Brazil. Thiago M. Ardenghi is with the Universidade Federal de Santa Maria, Brazil. Patricia de Gasperi is with the Universidade de Caxias do Sul, Brazil
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Barros FC, Hartwig FP, Barros AJD, Menezes AMB, Horta BL, Struchiner CJ, Vidaletti LP, Silveira MF, Mesenburg MA, Delagostin OA, Hallal PC, Victora CG. COVID-19 and social distancing among children and adolescents in Brazil. Rev Saude Publica 2021; 55:42. [PMID: 34190899 PMCID: PMC8225319 DOI: 10.11606/s1518-8787.2021055003832] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of SARS-CoV-2 antibodies and the adherence to measures of social distancing in children and adolescents studied in three national surveys conducted in Brazil between May-June 2020. METHODS Three national serological surveys were conducted in 133 sentinel cities located in all 27 Federative Units. Multistage probability sampling was used to select 250 individuals per city. The total sample size in age ranges 0-9 and 10-19 years old are of 4,263 and 8,024 individuals, respectively. Information on children or adolescents was gathered with a data collection app, and a rapid point-of-case test for SARS-CoV-2 was conducted on a finger prick blood sample. RESULTS The adjusted prevalence of antibodies was 2.9% (2.2-3.6) among children 0-9 years, 2.2% (1.8-2.6) among adolescents 10-19 years, and 3.0% (2.7-3.3) among adults 20+years. Prevalence of antibodies was higher among poor children and adolescents compared to those of rich families. Adherence to social distancing measures was seen in 72.4% (71.9-73.8) of families with children, 60.8% (59.6-61.9) for adolescents, and 57.4% (56.9-57.8) for adults. For not leaving the house except for essential matters the proportions were 81.7% (80.5-82.9), 70.6% (69.6-61.9), and 65.1% (64.7-65.5), respectively. Among children and adolescents, social distancing was strongly associated with socioeconomic status, being much higher in the better-off families. CONCLUSIONS The prevalence of antibodies against SARS-CoV-2 showed comparable levels among children, adolescents, and adults. Adherence to social distancing measures was more prevalent in children, followed by adolescents. There were important socioeconomic differences in the adherence to social distancing among children and adolescents.
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Affiliation(s)
- Fernando C Barros
- Universidade Católica de PelotasPelotasRSBrasilUniversidade Católica de Pelotas. Curso de Pós-Graduação em Saúde no Ciclo Vital. Pelotas, RS, Brasil
- Universidade Federal de PelotasFaculdade de MedicinaDepartamento de Medicina SocialPelotasRSBrasilUniversidade Federal de Pelotas. Faculdade de Medicina. Departamento de Medicina Social. Pelotas, RS, Brasil
| | - Fernando P Hartwig
- Universidade Federal de PelotasFaculdade de MedicinaDepartamento de Medicina SocialPelotasRSBrasilUniversidade Federal de Pelotas. Faculdade de Medicina. Departamento de Medicina Social. Pelotas, RS, Brasil
| | - Aluísio J D Barros
- Universidade Federal de PelotasFaculdade de MedicinaDepartamento de Medicina SocialPelotasRSBrasilUniversidade Federal de Pelotas. Faculdade de Medicina. Departamento de Medicina Social. Pelotas, RS, Brasil
| | - Ana M B Menezes
- Universidade Federal de PelotasFaculdade de MedicinaDepartamento de Medicina SocialPelotasRSBrasilUniversidade Federal de Pelotas. Faculdade de Medicina. Departamento de Medicina Social. Pelotas, RS, Brasil
| | - Bernardo L Horta
- Universidade Federal de PelotasFaculdade de MedicinaDepartamento de Medicina SocialPelotasRSBrasilUniversidade Federal de Pelotas. Faculdade de Medicina. Departamento de Medicina Social. Pelotas, RS, Brasil
| | - Cláudio J Struchiner
- Fundação Getúlio VargasEscola de Matemática AplicadaRio de JaneiroRJBrasilFundação Getúlio Vargas. Escola de Matemática Aplicada. Rio de Janeiro, RJ, Brasil
| | - Luis Paulo Vidaletti
- Universidade Federal de PelotasFaculdade de MedicinaDepartamento de Medicina SocialPelotasRSBrasilUniversidade Federal de Pelotas. Faculdade de Medicina. Departamento de Medicina Social. Pelotas, RS, Brasil
| | - Mariangela F Silveira
- Universidade Federal de PelotasFaculdade de MedicinaDepartamento de Medicina SocialPelotasRSBrasilUniversidade Federal de Pelotas. Faculdade de Medicina. Departamento de Medicina Social. Pelotas, RS, Brasil
| | - Marilia A Mesenburg
- Universidade Federal de PelotasFaculdade de MedicinaDepartamento de Medicina SocialPelotasRSBrasilUniversidade Federal de Pelotas. Faculdade de Medicina. Departamento de Medicina Social. Pelotas, RS, Brasil
- Universidade Federal de Ciências da Saúde de Porto AlegreFaculdade de MedicinaPorto AlegreRSBrasilUniversidade Federal de Ciências da Saúde de Porto Alegre. Faculdade de Medicina. Porto Alegre, RS, Brasil
| | - Odir A Delagostin
- Universidade Federal de PelotasFaculdade de MedicinaDepartamento de Medicina SocialPelotasRSBrasilUniversidade Federal de Pelotas. Faculdade de Medicina. Departamento de Medicina Social. Pelotas, RS, Brasil
| | - Pedro C Hallal
- Universidade Federal de PelotasFaculdade de MedicinaDepartamento de Medicina SocialPelotasRSBrasilUniversidade Federal de Pelotas. Faculdade de Medicina. Departamento de Medicina Social. Pelotas, RS, Brasil
| | - Cesar G Victora
- Universidade Federal de PelotasFaculdade de MedicinaDepartamento de Medicina SocialPelotasRSBrasilUniversidade Federal de Pelotas. Faculdade de Medicina. Departamento de Medicina Social. Pelotas, RS, Brasil
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Menezes AMB, Victora CG, Hartwig FP, Silveira MF, Horta BL, Barros AJD, Mesenburg MA, Wehrmeister FC, Pellanda LC, Dellagostin OA, Struchiner CJ, Burattini MN, Barros FC, Hallal PC. High prevalence of symptoms among Brazilian subjects with antibodies against SARS-CoV-2. Sci Rep 2021; 11:13279. [PMID: 34168250 PMCID: PMC8225900 DOI: 10.1038/s41598-021-92775-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 06/15/2021] [Indexed: 12/13/2022] Open
Abstract
Since the beginning of the pandemic of COVID-19, there has been a widespread assumption that most infected persons are asymptomatic. Using data from the recent wave of the EPICOVID19 study, a nationwide household-based survey including 133 cities from all states of Brazil, we estimated the proportion of people with and without antibodies for SARS-CoV-2 who were asymptomatic, which symptoms were most frequently reported, number of symptoms and the association with socio-demographic characteristics. We tested 33,205 subjects using a rapid antibody test previously validated. Information was collected before participants received the test result. Out of 849 (2.7%) participants positive for SARS-CoV-2 antibodies, only 12.1% (95% CI 10.1-14.5) reported no symptoms, compared to 42.2% (95% CI 41.7-42.8) among those negative. The largest difference between the two groups was observed for changes in smell/taste (56.5% versus 9.1%, a 6.2-fold difference). Changes in smell/taste, fever and body aches were most likely to predict positive tests as suggested by recursive partitioning tree analysis. Among individuals without any of these three symptoms, only 0.8% tested positive, compared to 18.3% of those with both fever and changes in smell or taste. Most subjects with antibodies against SARS-CoV-2 are symptomatic, even though most present only mild symptoms.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Lúcia C Pellanda
- Fundação Universidade Federal de Ciências de Saúde de Porto Alegre, Porto Alegre, Brazil
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Mesenburg MA, Hallal PC, Menezes AMB, Barros AJD, Horta BL, de Barros FC, Hartwig FP, Jacques N, da Silveira MF. Chronic non-communicable diseases and COVID-19: EPICOVID-19 Brazil results. Rev Saude Publica 2021; 55:38. [PMID: 34105606 PMCID: PMC8139841 DOI: 10.11606/s1518-8787.2021055003673] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 03/23/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Describing the prevalence of chronic diseases and associated socioeconomic and demographic factors, evaluating the patterns of social distancing and the antibodies prevalence against SARS-CoV-2 and COVID-19 symptoms in carriers and non-carriers of chronic diseases. METHODS Data from 77,075 individuals aged 20 to 59 from three steps of the EPICOVID-19 Brazil (a nationwide serological survey conducted between May and June, 2021) were assessed. The presence of antibodies against SARS-CoV-2 was examined by rapid tests. Self-reported prevalence of hypertension, diabetes, asthma, cancer, chronic kidney disease and heart disease were investigated. The prevalence of mask use, adherence to isolation measures and antibodies were evaluated separately amid carriers and non-carriers of chronic diseases. The prevalence of symptoms was analyzed among carriers and non-carriers of chronic diseases with antibodies. RESULTS The prevalence of at least one chronic disease was 43%, higher in the Southeast region, among white and indigenous individuals, women, less schooled and in lower socioeconomic position. The use of masks when leaving home was similar among carriers and non-carriers of chronic diseases (98%). The proportion of participants who reported adherence to isolation measures was higher amid carriers (15.9%) than non-carriers (24.9%) of chronic diseases. The prevalence of antibodies to SARS-CoV-2 was similar amongst carriers and non-carriers (2.4% and 2.3%). The prevalence of cough, dyspnea, palpitations and myalgia was significantly higher among carriers, but the proportion of symptomatic patients was similar between groups. CONCLUSION The prevalence of chronic diseases in Brazil is high and the COVID-19 pandemic affects carriers and non-carriers of chronic diseases similarly. Carriers present more severe forms of COVID-19 and higher prevalence of symptoms. Greater adherence to social distancing measures among chronic patients is disassociated from a lower incidence of COVID-19 in this group.
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Affiliation(s)
- Marilia Arndt Mesenburg
- Universidade Federal de PelotasPrograma de Pós-Graduação em EpidemiologiaPelotasRSBrasilUniversidade Federal de Pelotas. Programa de Pós-Graduação em Epidemiologia. Pelotas, RS, Brasil.
- Universidade Federal de Ciências da Saúde de Porto AlegreDepartamento de Saúde ColetivaPorto AlegreRSBrasilUniversidade Federal de Ciências da Saúde de Porto Alegre. Departamento de Saúde Coletiva. Porto Alegre, RS, Brasil.
| | - Pedro Curi Hallal
- Universidade Federal de PelotasPrograma de Pós-Graduação em EpidemiologiaPelotasRSBrasilUniversidade Federal de Pelotas. Programa de Pós-Graduação em Epidemiologia. Pelotas, RS, Brasil.
| | - Ana Maria Baptista Menezes
- Universidade Federal de PelotasPrograma de Pós-Graduação em EpidemiologiaPelotasRSBrasilUniversidade Federal de Pelotas. Programa de Pós-Graduação em Epidemiologia. Pelotas, RS, Brasil.
| | - Aluísio J D Barros
- Universidade Federal de PelotasPrograma de Pós-Graduação em EpidemiologiaPelotasRSBrasilUniversidade Federal de Pelotas. Programa de Pós-Graduação em Epidemiologia. Pelotas, RS, Brasil.
| | - Bernardo Lessa Horta
- Universidade Federal de PelotasPrograma de Pós-Graduação em EpidemiologiaPelotasRSBrasilUniversidade Federal de Pelotas. Programa de Pós-Graduação em Epidemiologia. Pelotas, RS, Brasil.
| | - Fernando Celso de Barros
- Universidade Federal de PelotasPrograma de Pós-Graduação em EpidemiologiaPelotasRSBrasilUniversidade Federal de Pelotas. Programa de Pós-Graduação em Epidemiologia. Pelotas, RS, Brasil.
| | - Fernando Pires Hartwig
- Universidade Federal de PelotasPrograma de Pós-Graduação em EpidemiologiaPelotasRSBrasilUniversidade Federal de Pelotas. Programa de Pós-Graduação em Epidemiologia. Pelotas, RS, Brasil.
| | - Nadège Jacques
- Universidade Federal de PelotasPrograma de Pós-Graduação em EpidemiologiaPelotasRSBrasilUniversidade Federal de Pelotas. Programa de Pós-Graduação em Epidemiologia. Pelotas, RS, Brasil.
| | - Mariangela Freitas da Silveira
- Universidade Federal de PelotasPrograma de Pós-Graduação em EpidemiologiaPelotasRSBrasilUniversidade Federal de Pelotas. Programa de Pós-Graduação em Epidemiologia. Pelotas, RS, Brasil.
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Leventhal DGP, Crochemore-Silva I, Vidaletti LP, Armenta-Paulino N, Barros AJD, Victora CG. Delivery channels and socioeconomic inequalities in coverage of reproductive, maternal, newborn, and child health interventions: analysis of 36 cross-sectional surveys in low-income and middle-income countries. Lancet Glob Health 2021; 9:e1101-e1109. [PMID: 34051180 PMCID: PMC8295042 DOI: 10.1016/s2214-109x(21)00204-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/26/2021] [Accepted: 04/12/2021] [Indexed: 01/13/2023]
Abstract
Background Global reports have described inequalities in coverage of reproductive, maternal, newborn, and child health (RMNCH) interventions, but little is known about how socioeconomic inequality in intervention coverage varies across multiple low-income and middle-income countries (LMICs). We aimed to assess the association between wealth-related inequalities in coverage of RMNCH interventions. Methods In this cross-sectional study, we identified publicly available Demographic Health Surveys and Multiple Indicator Cluster Surveys from LMICs containing information on household characteristics, reproductive health, women's and children's health, nutrition, and mortality. We identified the most recent survey from the period 2010–19 for 36 countries that contained data for our preselected set of 18 RMNCH interventions. 21 countries also had information on two common malaria interventions. We classified interventions into four groups according to their predominant delivery channels: health facility based, community based, environmental, and culturally driven (including breastfeeding practices). Within each country, we derived wealth quintiles from information on household asset indices. We studied two summary measures of within-country wealth-related inequality: absolute inequalities (akin to coverage differences among children from wealthy and poor households) using the slope index of inequality (SII), and relative inequalities (akin to the ratio of coverage levels for wealthy and poor children) using the concentration index (CIX). Pro-poor inequalities are present when intervention coverage decreased with increasing household wealth, and pro-rich inequalities are present when intervention coverage increased as household wealth increased. Findings Across the 36 LMICs included in our analyses, coverage of most interventions had pro-rich patterns in most countries, except for two breastfeeding indicators that mostly had higher coverage among poor women, children and households than wealthy women, children, and households. Environmental interventions were the most unequal, particularly use of clean fuels, which had median levels of SII of 48·8 (8·6–85·7) and CIX of 67·0 (45·0–85·8). Interventions primarily delivered in health facilities—namely institutional childbirth (median SII 46·7 [23·1–63·3] and CIX 11·4 [4·5–23·4]) and antenatal care (median SII 26·7 [17·0–47·2] and CIX 10·0 [4·2–17·1])—also usually had pro-rich patterns. By comparison, primarily community-based interventions, including those against malaria, were more equitably distributed—eg, oral rehydration therapy (median SII 9·4 [2·9–19·0] and CIX 3·4 [1·3–25·0]) and polio immunisation (SII 12·1 [2·3–25·0] and CIX 3·1 [0·5–7·1]). Differences across the four types of delivery channels in terms of both inequality indices were significant (SII p=0·0052; CIX p=0·0048). Interpretation Interventions that are often delivered at community level are usually more equitably distributed than those primarily delivered in fixed facilities or those that require changes in the home environment. Policy makers need to learn from community delivery channels to promote more equitable access to all RMNCH interventions. Funding Bill & Melinda Gates Foundation and Wellcome Trust. Translations For the French, Portuguese and Spanish translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Daniel G P Leventhal
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Inácio Crochemore-Silva
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Luis P Vidaletti
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Nancy Armenta-Paulino
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Aluísio J D Barros
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Cesar G Victora
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, RS, Brazil.
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Malta MB, Gomes CDB, Barros AJD, Baraldi LG, Takito MY, Benício MHD, Carvalhaes MADBL. Effectiveness of an intervention focusing on diet and walking during pregnancy in the primary health care service. CAD SAUDE PUBLICA 2021; 37:e00010320. [PMID: 34037070 DOI: 10.1590/0102-311x00010320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 08/17/2020] [Indexed: 11/22/2022] Open
Abstract
Interventions during prenatal care can mitigate negative outcomes of a sedentary lifestyle and unhealthy diet during pregnancy. We aimed to evaluate the effectiveness of an intervention that promoted healthy diet and leisure-time walking during antenatal care in a pragmatic, controlled, non-randomized intervention study. Physicians and nurses from all health care units of the Family Health Strategy model of health assistance participated in educational training to promote leisure-time walking and healthy diet during antenatal care visits. Pregnant women who received health care from these professionals constituted the intervention group (n = 181). The control group (n = 172) included pregnant women who received routine antenatal care, in health care units of the traditional model of health assistance. Data were collected in each trimester of pregnancy. Diet was investigated using a food frequency questionnaire adapted from Risk and Protective Factors Surveillance System for Chronic Non-Comunicable Diseases Through Telephone Interview (Vigitel). Leisure-time walking in a typical week was assessed using questions from the Physical Activity in Pregnancy Questionnaire. There were positive effects on leisure-time walking during the second trimester and the third trimester of pregnancy and on the women who achieved 150 minutes per week of walking during the third trimester. The intervention reduced the risk of pregnant women consuming soft drinks and/or commercially prepared cookies in the third trimester. This lifestyle intervention was partially effective, tripling the proportion of pregnant women who achieved the recommended walking time and reducing by half the proportion of women who had a high weekly consumption of soft drinks and industrially processed cookies.
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Affiliation(s)
- Maíra Barreto Malta
- Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brasil.,Programa de Pós-graduação em Saúde Coletiva, Universidade Católica de Santos, Santos, Brasil
| | - Caroline de Barros Gomes
- Faculdade de Medicina de Botucatu, Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, Brasil
| | - Aluísio J D Barros
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brasil
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Confortin SC, Ribeiro MRC, Barros AJD, Menezes AMB, Horta BL, Victora CG, Barros FC, Gonçalves H, Bettiol H, Santos ISD, Barbieri MA, Saraiva MDCP, Alves MTSSDBE, Silveira MFD, Domingues MR, Lima NP, Rocha PRH, Cavalli RC, Batista RFL, Cardoso VC, Simões VMF, Silva AAMD. RPS Brazilian Birth Cohorts Consortium (Ribeirão Preto, Pelotas and São Luís): history, objectives and methods. CAD SAUDE PUBLICA 2021; 37:e00093320. [PMID: 33950086 DOI: 10.1590/0102-311x00093320] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 08/20/2020] [Indexed: 01/11/2023] Open
Abstract
This paper describes the history, objectives and methods used by the nine Brazilian cohorts of the RPS Brazilian Birth Cohorts Consortium (Ribeirão Preto, Pelotas and São Luís) Common thematic axes are identified and the objectives, baseline periods, follow-up stages and representativity of the population studied are presented. The Consortium includes three birth cohorts from Ribeirão Preto, São Paulo State (1978/1979, 1994 and 2010), four from Pelotas, Rio Grande do Sul State (1982, 1993, 2004 and 2015), and two from São Luís, Maranhão State (1997 and 2010). The cohorts cover three regions of Brazil, from three distinct states, with marked socioeconomic, cultural and infrastructure differences. The cohorts were started at birth, except for the most recent one in each municipality, where mothers were recruited during pregnancy. The instruments for data collection have been refined in order to approach different exposures during the early phases of life and their long-term influence on the health-disease process. The investigators of the nine cohorts carried out perinatal studies and later studied human capital, mental health, nutrition and precursor signs of noncommunicable diseases. A total of 17,636 liveborns were recruited in Ribeirão Preto, 19,669 in Pelotas, and 7,659 in São Luís. In the studies starting during pregnancy, 1,400 pregnant women were interviewed in Ribeirão Preto, 3,199 in Pelotas, and 1,447 in São Luís. Different strategies were employed to reduce losses to follow-up. This research network allows the analysis of the incidence of diseases and the establishment of possible causal relations that might explain the health outcomes of these populations in order to contribute to the development of governmental actions and health policies more consistent with reality.
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Gatica-Domínguez G, Neves PAR, Barros AJD, Victora CG. Complementary Feeding Practices in 80 Low- and Middle-Income Countries: Prevalence of and Socioeconomic Inequalities in Dietary Diversity, Meal Frequency, and Dietary Adequacy. J Nutr 2021; 151:1956-1964. [PMID: 33847352 PMCID: PMC8245881 DOI: 10.1093/jn/nxab088] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/02/2021] [Accepted: 03/09/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Adequate complementary feeding practices in early childhood contribute to better food preferences and health outcomes throughout the life course. OBJECTIVES The aim of this study was to describe patterns and socioeconomic inequalities in complementary feeding practices among children aged 6-23 mo in 80 low- and middle-income countries. METHODS We analyzed national surveys carried out since 2010. Complementary feeding indicators for children aged 6-23 mo included minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD). Between- and within-country inequalities were documented using relative (wealth deciles), gross domestic product (GDP) per capita, and absolute (estimated household income) socioeconomic indicators. Statistical analyses included calculation of the slope index of inequality, Pearson correlation and linear regression, and scatter diagrams. RESULTS Only 21.3%, 56.2%, and 10.1% of the 80 countries showed prevalence levels >50% for MDD, MMF, and MAD, respectively. Western & Central Africa showed the lowest prevalence for all indicators, whereas the highest for MDD and MAD was Latin America & Caribbean, and for MMF it was East Asia & the Pacific. Log GDP per capita was positively associated with MDD (R2 = 48.5%), MMF (28.2%), and MAD (41.4%). Pro-rich within-country inequalities were observed in most countries for the 3 indicators; pro-poor inequalities were observed in 2 countries for MMF, and in none for the other 2 indicators. Breast milk was the only type of food with a pro-poor distribution, whereas animal-source foods (dairy products, flesh foods, and eggs) showed the most pronounced pro-rich inequality. Dietary diversity improved sharply when absolute annual household incomes exceeded ∼US$20,000. All 3 dietary indicators improved by age and no consistent differences were observed between boys and girls. CONCLUSIONS Monitoring complementary feeding indicators across the world and implementing policies and programs to reduce wealth-related inequalities are essential to achieve optimal child nutrition.
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Affiliation(s)
| | - Paulo A R Neves
- International Center for Equity in Health, Post-graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Aluísio J D Barros
- International Center for Equity in Health, Post-graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Cesar G Victora
- International Center for Equity in Health, Post-graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
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Costa CDS, Assunção MCF, Loret de Mola C, Cardoso JDS, Matijasevich A, Barros AJD, Santos IS. Role of ultra-processed food in fat mass index between 6 and 11 years of age: a cohort study. Int J Epidemiol 2021; 50:256-265. [PMID: 32888008 PMCID: PMC7938497 DOI: 10.1093/ije/dyaa141] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Ultra-processed food consumption and obesity have been highlighted as an important relationship to public health. We aimed to evaluate the association between ultra-processed food consumption and body fat from 6 to 11 years of age. METHODS We assessed the association between ultra-processed food consumption (from food frequency questionnaires) and body fat (measured by air displacement plethysmography) between 6 and 11 years of age among participants of the Pelotas-Brazil 2004 Birth Cohort. The NOVA classification was used to classify foods according to the processing degree. Body fat was evaluated relative to the height using fat mass index (FMI). Generalized estimating equations were used to answer the main research question and mediation analyses were run to assess the direct and indirect effect of ultra-processed food in body fat. RESULTS At fully adjusted analysis, an increase of 100 g in contribution from ultra-processed food to daily food intake at between 6 and 11 years of age was associated with a gain of 0.14 kg/m² in FMI in the same period; 58% of the total effect of ultra-processed food intake at 6 years (in grams) over the change in FMI from 6 to 11 years was mediated by its calorie content. CONCLUSIONS Ultra-processed food consumption was associated with an increase in body fat from childhood to early adolescence, and this association was not just due to the effect of ultra-processed food on calorie content.
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Affiliation(s)
- Caroline dos Santos Costa
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
- Center for Epidemiological Research in Nutrition and Health, Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
| | | | - Christian Loret de Mola
- Post-Graduate Program in Public Health, Federal University of Rio Grande, Rio Grande, Rio Grande do Sul, Brazil
| | - Juliane de Souza Cardoso
- Post-Graduate Program in Biochemistry and Bioprospecting, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Alicia Matijasevich
- Department of Preventive Medicine, Faculty of Medicine FMUSP, University of São Paulo, São Paulo, Brazil
| | - Aluísio J D Barros
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Iná S Santos
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
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Bortolotto CC, Santos IS, Dos Santos Vaz J, Matijasevich A, Barros AJD, Barros FC, Santos LP, Munhoz TN. Prematurity and body composition at 6, 18, and 30 years of age: Pelotas (Brazil) 2004, 1993, and 1982 birth cohorts. BMC Public Health 2021; 21:321. [PMID: 33563247 PMCID: PMC7871570 DOI: 10.1186/s12889-021-10368-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/31/2021] [Indexed: 11/24/2022] Open
Abstract
Background We aimed to investigate the association between preterm birth and body composition at 6, 18, and 30 years of age using data from three population-based birth cohort studies. Methods Gestational age (GA), defined by the date of the last menstrual period (categorized in ≤33, 34–36, and ≥ 37 weeks), was gathered in the first 24-h after delivery for all live births occurring in the city of Pelotas, Brazil, in 2004, 1993 and 1982. Body composition was assessed by air-displacement plethysmography. Outcomes included fat mass (FM, kg), percent FM (%FM), FM index (FMI, kg/m2), fat-free mass (FFM, kg); percent FFM (%FFM), FFM index (FFMI, kg/m2), body mass index (BMI, kg/m2 at 18 years in the 1993 cohort and 30 years in the 1982 cohort), and BMI Z-score (at 6 years in the 2004 cohort). We further explored the association of birth weight for GA with body composition indicators and BMI. Crude and adjusted linear regressions provided beta coefficients with 95% confidence intervals (95%CI). Results A total of 3036, 3027, and 3369 participants, respectively, from the 2004, 1993, and 1982 cohorts were analyzed. At 6 years, preterm boys (born at 34–36 weeks) presented lower adjusted mean of FM (β = − 0.80 kg, − 1.45;-0.16, p = 0.046), %FM (β = − 2.39%, − 3.90;-0.88, p = 0.008), FMI (β = − 0.70 kg/m2, − 1.13;-0.27, p = 0.004) as well as lower FFM (β = − 0.4 kg, − 0.77; − 0.12, p = 0.010) and FFMI (β = − 0.3 kg/m2, − 0.46;-0.10, p < 0.001), and BMI Z-score (β = − 0.69,; − 0.99;-0.40, p < 0.001); but higher %FFM (β = 2.4%, 0.87;-3.90, p = 0.008), when compared to boys born at term (≥37). At 30 years, FM (15.7 kg, 0.25;31.1, p = 0.102) was higher among males born at ≤33 weeks. No association was observed for females from the three cohorts and for 18-year-old males. The association of birth weight for GA with body composition and BMI was not significant in any cohort. At 6 years, SGA boys had lower FFMI than boys AGA. Conclusions Our results suggest that preterm birth is associated with decreased body fat and fat-free mass in childhood but higher fat mass in adulthood. Nevertheless, results were only significant for males. SGA boys also showed lower FFMI. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10368-w.
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Affiliation(s)
- Caroline Cardozo Bortolotto
- Federal University of Pelotas (UFPel). Postgraduate Program in Epidemiology, Rua Marechal Deodoro, 1160 - 3° Piso. Bairro Centro, Cep: 96020-220, Pelotas, RS, Caixa Postal 464, Brazil.
| | - Iná S Santos
- Federal University of Pelotas (UFPel). Postgraduate Program in Epidemiology, Rua Marechal Deodoro, 1160 - 3° Piso. Bairro Centro, Cep: 96020-220, Pelotas, RS, Caixa Postal 464, Brazil.,Pontifical Catholic University of Rio Grande do Sul, Program of Pediatrics and Child Health, Porto Alegre, Brazil
| | - Juliana Dos Santos Vaz
- Federal University of Pelotas (UFPel). Postgraduate Program in Epidemiology, Rua Marechal Deodoro, 1160 - 3° Piso. Bairro Centro, Cep: 96020-220, Pelotas, RS, Caixa Postal 464, Brazil.,Federal University of Pelotas, Faculty of Nutrition, Pelotas, 96010610, Brazil
| | - Alicia Matijasevich
- Federal University of Pelotas (UFPel). Postgraduate Program in Epidemiology, Rua Marechal Deodoro, 1160 - 3° Piso. Bairro Centro, Cep: 96020-220, Pelotas, RS, Caixa Postal 464, Brazil.,Faculdade de Medicina FMUSP, Departamento de Medicina Preventiva, Universidade de São Paulo, São Paulo, 01246-903, Brazil
| | - Aluísio J D Barros
- Federal University of Pelotas (UFPel). Postgraduate Program in Epidemiology, Rua Marechal Deodoro, 1160 - 3° Piso. Bairro Centro, Cep: 96020-220, Pelotas, RS, Caixa Postal 464, Brazil.,Federal University of Pelotas, International Center for Equity in Health, Graduate Program in Epidemiology, Pelotas, 96020220, Brazil
| | - Fernando C Barros
- Federal University of Pelotas (UFPel). Postgraduate Program in Epidemiology, Rua Marechal Deodoro, 1160 - 3° Piso. Bairro Centro, Cep: 96020-220, Pelotas, RS, Caixa Postal 464, Brazil.,Catholic University of Pelotas, Medicine School, 96010-280, Pelotas, Brazil
| | - Leonardo Pozza Santos
- Federal University of Pampa (Unipampa), Nutrition College, Itaqui, 97650-000, Brazil
| | - Tiago Neuenfeld Munhoz
- Federal University of Pelotas (UFPel). Postgraduate Program in Epidemiology, Rua Marechal Deodoro, 1160 - 3° Piso. Bairro Centro, Cep: 96020-220, Pelotas, RS, Caixa Postal 464, Brazil.,Federal University of Pelotas, Faculty of Psychology, Pelotas, 96030-001, Brazil
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Laporte PP, Matijasevich A, Munhoz TN, Santos IS, Barros AJD, Pine DS, Rohde LA, Leibenluft E, Salum GA. Disruptive Mood Dysregulation Disorder: Symptomatic and Syndromic Thresholds and Diagnostic Operationalization. J Am Acad Child Adolesc Psychiatry 2021; 60:286-295. [PMID: 32004697 PMCID: PMC9073144 DOI: 10.1016/j.jaac.2019.12.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 12/18/2019] [Accepted: 01/22/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To identify the most appropriate threshold for disruptive mood dysregulation disorder (DMDD) diagnosis and the impact of potential changes in diagnostic rules on prevalence levels in the community. METHOD Trained psychologists evaluated 3,562 preadolescents/early adolescents from the 2004 Pelotas Birth Cohort with the Development and Well-Being Behavior Assessment (DAWBA). The clinical threshold was assessed in 3 stages: symptomatic, syndromic, and clinical operationalization. The symptomatic threshold identified the response category in each DAWBA item, which separates normative misbehavior from a clinical indicator. The syndromic threshold identified the number of irritable mood and outbursts needed to capture preadolescents/early adolescents with high symptom levels. Clinical operationalization compared the impact of AND/OR rules for combining irritable mood and outbursts on impairment and levels of psychopathology. RESULTS At the symptomatic threshold, most irritable mood items were normative in their lowest response categories and clinically significant in their highest response categories. For outbursts, some indicated a symptom even when present at only a mild level, while others did not indicate symptoms at any level. At the syndromic level, a combination of 2 out of 7 irritable mood and 3 out of 8 outburst indicators accurately captured a cluster of individuals with high level of symptoms. Analysis combining irritable mood and outbursts delineated nonoverlapping aspects of DMDD, providing support for the OR rule in clinical operationalization. The best DMDD criteria resulted in a prevalence of 3%. CONCLUSION Results provide information for initiatives aiming to provide data-driven and clinically oriented operationalized criteria for DMDD.
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Affiliation(s)
- Paola Paganella Laporte
- Universidade Federal do Rio Grande do Sul, Graduate Program in Psychiatry and Behavioral Sciences, Brazil; Section on Negative Affect and Social Processes, Hospital de Clínicas de Porto Alegre, Brazil; National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, Brazil.
| | - Alicia Matijasevich
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Brazil; Faculty of Medicine FMUSP, University of São Paulo, Brazil
| | - Tiago N Munhoz
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Brazil; Faculty of Psychology, Federal University of Pelotas, Brazil
| | - Iná S Santos
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Brazil
| | - Aluísio J D Barros
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Brazil
| | - Daniel Samuel Pine
- Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland
| | - Luis Augusto Rohde
- Universidade Federal do Rio Grande do Sul, Graduate Program in Psychiatry and Behavioral Sciences, Brazil; Section on Negative Affect and Social Processes, Hospital de Clínicas de Porto Alegre, Brazil; National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, Brazil
| | - Ellen Leibenluft
- Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland
| | - Giovanni Abrahão Salum
- Universidade Federal do Rio Grande do Sul, Graduate Program in Psychiatry and Behavioral Sciences, Brazil; Section on Negative Affect and Social Processes, Hospital de Clínicas de Porto Alegre, Brazil; National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, Brazil
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Silveira Schuch H, Venâncio Fernandes Dantas R, Menezes Seerig L, S Santos I, Matijasevich A, J D Barros A, Glazer Peres K, Peres MA, Demarco FF. Socioeconomic inequalities explain the association between source of drinking water and dental caries in primary dentition. J Dent 2021; 106:103584. [PMID: 33465449 DOI: 10.1016/j.jdent.2021.103584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/06/2021] [Accepted: 01/11/2021] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To evaluate the association between source of drinking water and dental caries at age 5 and to test whether socioeconomic conditions act as confounding factors in such association. METHODS The study was carried out in a sub-sample of the 2004 Pelotas Birth Cohort, which comprised the application of a questionnaire and clinical oral examination. The exposure was source of drinking water, collected through a question to the primary caregiver. The outcome was dental caries in primary dentition, measured through several standardized indicators of the decayed, missing and filled teeth index (dmft), assessing past and present dental caries. Socioeconomic indicators (family income and maternal education) were identified as potential confounding factors. After descriptive analysis, the association between source of water and measures of dental caries was assessed by Regression models. RESULTS 1,084 children were evaluated and had complete information in all variables (83.2 % of the targeted sample). Dental caries experience was observed in 48.7 % of the children, with a mean of 1.9 decayed, missing or filled teeth. Most children consumed water from public water supply (76.0 %), and a socioeconomic pattern was observed, with children from lower income more likely to drink water from public supply. In crude analysis, children who consumed bottled water had a lower risk of decayed teeth, lower experience of dental caries and less severe disease. No associations were observed after adjustments for socioeconomic conditions. CONCLUSION Underlying socioeconomic inequalities explained the association between prevalence and severity of dental caries in primary dentition and source of drinking water. CLINICAL SIGNIFICANCE Drinking fluoridated tap water is as effective in dental caries prevention as bottled water with acceptable levels of fluoride, with the advantage of being accessible to all. Oral health prevention and treatment should be implemented as early in life as possible and should take into consideration the family's socioeconomic context.
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Affiliation(s)
- Helena Silveira Schuch
- Graduate Program in Dentistry, Federal University of Pelotas, Rua Gonçalves Chaves, 457 - Centro, CEP 96015-560, Pelotas, Rio Grande do Sul, Brazil.
| | - Raquel Venâncio Fernandes Dantas
- Operative Dentistry Department, Federal University of Paraíba, Campus I - Cidade Universitária, CEP 58051-900, João Pessoa, Paraíba, Brazil.
| | - Lenise Menezes Seerig
- Graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160 - Centro, CEP 96020-220, Pelotas, Rio Grande do Sul, Brazil.
| | - Iná S Santos
- Graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160 - Centro, CEP 96020-220, Pelotas, Rio Grande do Sul, Brazil.
| | - Alícia Matijasevich
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, Av. Dr Arnaldo, 455, 2ºandar, CEP 01246-903, São Paulo, São Paulo, Brazil.
| | - Aluísio J D Barros
- Graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160 - Centro, CEP 96020-220, Pelotas, Rio Grande do Sul, Brazil; International Center for Equity in Health, Federal University of Pelotas, Rua Marechal Deodoro, 1160 - Centro, CEP 96020-220, Pelotas, Rio Grande do Sul, Brazil.
| | - Karen Glazer Peres
- National Dental Research Institute Singapore, National Dental Centre Singapore, Oral Health ACP, Health Services and Systems Research Programme, Duke-NUS Medical School, 8 College Road, 169857, Singapore.
| | - Marco Aurélio Peres
- National Dental Research Institute Singapore, National Dental Centre Singapore, Oral Health ACP, Health Services and Systems Research Programme, Duke-NUS Medical School, 8 College Road, 169857, Singapore.
| | - Flávio Fernando Demarco
- Graduate Program in Dentistry, Federal University of Pelotas, Rua Gonçalves Chaves, 457 - Centro, CEP 96015-560, Pelotas, Rio Grande do Sul, Brazil; Graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160 - Centro, CEP 96020-220, Pelotas, Rio Grande do Sul, Brazil.
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Bozzini AB, Maruyama JM, Munhoz TN, Barros AJD, Barros FC, Santos IS, Matijasevich A. Trajectories of maternal depressive symptoms and offspring's risk behavior in early adolescence: data from the 2004 Pelotas birth cohort study. BMC Psychiatry 2021; 21:18. [PMID: 33413253 PMCID: PMC7792177 DOI: 10.1186/s12888-020-03026-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 12/22/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND This longitudinal study explored the relationship between trajectories of maternal depressive symptoms and offspring's risk behavior in adolescence contributing to an extremely scarce literature about the impacts of maternal depression trajectories on offspring risk behaviors. METHODS We included 3437 11-year-old adolescents from the 2004 Pelotas Birth Cohort Study. Trajectories of maternal depressive symptoms were constructed using Edinburgh Postnatal Depression Scale (EDPS) from age 3 months to 11 years. We identified five trajectories of maternal depressive symptoms: "low" "moderate low", "increasing", "decreasing", and "chronic high". The following adolescent outcomes were identified via self-report questionnaire and analyzed as binary outcome -yes/no: involvement in fights and alcohol use at age 11. We used logistic regression models to examine the effects of trajectories of maternal depressive symptoms on offspring's risk behavior adjusting for potential confounding variable. RESULTS Alcohol use and/or abuse as well as involvement in fights during adolescence, were not significantly associated with any specific trajectory of maternal depressive symptoms neither in the crude nor in the adjusted analyses. CONCLUSION Alcohol use and involvement in fights at age 11 were not associated with any specific trajectory of maternal depression.
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Affiliation(s)
- Ana Beatriz Bozzini
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil.
| | - Jessica Mayumi Maruyama
- grid.11899.380000 0004 1937 0722Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Tiago N. Munhoz
- grid.411221.50000 0001 2134 6519Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil ,grid.411221.50000 0001 2134 6519Faculty of Psychology, Federal University of Pelotas, Pelotas, Brazil
| | - Aluísio J. D. Barros
- grid.411221.50000 0001 2134 6519Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Fernando C. Barros
- grid.411965.e0000 0001 2296 8774Post-graduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil
| | - Iná S. Santos
- grid.412519.a0000 0001 2166 9094Postgraduate Program in Pediatrics and Child Health, School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Alicia Matijasevich
- grid.11899.380000 0004 1937 0722Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil ,grid.411221.50000 0001 2134 6519Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
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Cata-Preta BDO, Wehrmeister FC, Santos TM, Barros AJD, Victora CG. Patterns in Wealth-related Inequalities in 86 Low- and Middle-Income Countries: Global Evidence on the Emergence of Vaccine Hesitancy. Am J Prev Med 2021; 60:S24-S33. [PMID: 33131990 PMCID: PMC7613086 DOI: 10.1016/j.amepre.2020.07.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/03/2020] [Accepted: 07/06/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Coverage of health interventions usually shows social gradients with higher levels among wealthy than among poor individuals. Owing to the upsurge of vaccine hesitancy in high-income countries, the authors hypothesized that the social gradient may also be changing over time in the low- and middle-income countries and set out to test this hypothesis. METHODS In January 2020, surveys conducted from 2010 to 2018 in 86 low- and middle-income countries were analyzed to assess full immunization coverage in children aged 12-23 months. The authors calculated full immunization coverage point estimates and 95% CIs for each country and wealth quintile. To explore wealth-related inequalities, the authors estimated the slope index of inequality and calculated the Pearson correlation coefficient between these values and per capita gross domestic product. Time trends were analyzed in 10 countries with recent evidence of hesitancy. RESULTS Pro-poor patterns were defined as significant slope index of inequality values with higher coverage among poor children, and pro-rich patterns were defined as the reverse pattern. A total of 11 countries showed pro-poor patterns in the most recent survey, accounting for 20% of upper middle- and 7% of low-income countries. The correlation between the slope index of inequality and log per capita gross domestic product was -0.38 (p<0.001). Among the 10 countries with recent evidence of hesitancy, 5 showed full immunization coverage declines over time in the wealthiest quintiles, and 4 switched from pro-rich to pro-poor patterns throughout the years. CONCLUSIONS Lower full immunization coverage was found among the wealthy than among the poor in 10 countries, especially in the upper middle-income group, consistent with the emergence of vaccine hesitancy. SUPPLEMENT INFORMATION This article is part of a supplement entitled Global Vaccination Equity, which is sponsored by the Global Institute for Vaccine Equity at the University of Michigan School of Public Health.
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Affiliation(s)
- Bianca de O Cata-Preta
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil.
| | - Fernando C Wehrmeister
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Thiago M Santos
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Aluísio J D Barros
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Cesar G Victora
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
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Bouilly R, Gatica-Domínguez G, Mesenburg M, Cáceres Ureña FI, Leventhal DGP, Barros AJD, Victora CG, Wehrmeister FC. Maternal and child health inequalities among migrants: the case of Haiti and the Dominican Republic. Rev Panam Salud Publica 2020; 44:e144. [PMID: 33245298 PMCID: PMC7679047 DOI: 10.26633/rpsp.2020.144] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/19/2020] [Indexed: 11/24/2022] Open
Abstract
Objective. To assess coverage and inequalities in maternal and child health interventions among Haitians, Haitian migrants in the Dominican Republic and Dominicans. Methods. Cross-sectional study using data from nationally representative surveys carried out in Haiti in 2012 and in the Dominican Republic in 2014. Nine indicators were compared: demand for family planning satisfied with modern methods, antenatal care, delivery care (skilled birth attendance), child vaccination (BCG, measles and DPT3), child case management (oral rehydration salts for diarrhea and careseeking for suspected pneumonia), and the composite coverage index. Wealth was measured through an asset-based index, divided into tertiles, and place of residence (urban or rural) was established according to the country definition. Results. Haitians showed the lowest coverage for demand for family planning satisfied with modern methods (44.2%), antenatal care (65.3%), skilled birth attendance (39.5%) and careseeking for suspected pneumonia (37.9%), and the highest for oral rehydration salts for diarrhea (52.9%), whereas Haitian migrants had the lowest coverage in DPT3 (44.1%) and oral rehydration salts for diarrhea (38%) and the highest in careseeking for suspected pneumonia (80.7%). Dominicans presented the highest coverage for most indicators, except oral rehydration salts for diarrhea and careseeking for suspected pneumonia. The composite coverage index was 79.2% for Dominicans, 69.0% for Haitian migrants, and 52.6% for Haitians. Socioeconomic inequalities generally had pro-rich and pro-urban pattern in all analyzed groups. Conclusion. Haitian migrants presented higher coverage than Haitians, but lower than Dominicans. Both countries should plan actions and policies to increase coverage and address inequalities of maternal health interventions.
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Affiliation(s)
| | | | - Marilia Mesenburg
- Federal University of Pelotas, Pelotas, Brazil
- Federal University of Health Science, Porto Alegre, Brazil
| | - Francisco I. Cáceres Ureña
- Autonomous University of Santo Domingo, Santo Domingo, Dominican Republic
- National Statistics Office, Censuses and Surveys, Santo Domingo, Dominican Republic
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