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Abstract Background Noncommunicable diseases (NCDs) predominantly affect adults, but pathophysiological changes begin decades earlier, as a continuum, with initial events apparent in adolescence. Hence, early identification and intervention are crucial for the prevention and management of NCDs. We investigated the complex network of socioeconomic, behavioral, and metabolic factors associated with the presence of NCD in Brazilian adolescents. Methods We conducted a cross-sectional study nested within the São Luís segment of the Ribeirão Preto, Pelotas, and São Luís (RPS) cohort’s consortium, focusing on 18–19-year-olds (n = 2515). Data were collected prospectively, from which we constructed a complex network with NCD-related factors/indicators as nodes and their co-occurrences as edges. General and sex-based models analyzed: socioeconomic status, behavioral (smoking, alcohol, and other drugs use, unhealthy diet, poor sleep, physical inactivity), and metabolic factors (overweight/obesity, elevated blood pressure, poor lipid profile). We also looked for NCDs in adolescence like asthma, abnormal spirometry, depression, suicide risk, and poor oral health. The network was characterized by degree, betweenness, eigenvector, local transitivity, Shannon entropy, and cluster coefficient. Results The adolescents had an average age of 18.3 years, 52.3% were female and 47.7% male. 99.8% of them have a diet rich in free sugars, 15% are overweight/obese and 72.3% had an elevated TyG index. High free sugar emerged as the central hub, followed by high TyG index (an early marker of insulin resistance) and low socioeconomic class. In males, low fiber intake and a high triglycerides/HDL ratio highlighted cardiometabolic concerns; in females, sedentary behavior and poor sleep marked metabolic and psychological challenges, along with caries in both sexes. Conclusions Our findings provide insights into central health challenges during adolescence, such as high free sugars, insulin resistance, and low socioeconomic indicators, suggesting that interventions targeted at these central hubs could have a significant impact on their NCD network.

Abstract: This study aimed to analyze whether there is an association between intimate partner violence during pregnancy and time to return to sexual activity after childbirth in the BRISA cohort in São Luís, Maranhão State, Brazil, between 2010 and 2013. This is a longitudinal study conducted with 665 women. Intimate partner violence during pregnancy was measured using an instrument created and validated by the World Health Organization to measure violence against women. Time to return to sexual activity after childbirth was investigated using a structured questionnaire. Logistic regression models were used to analyze whether there is an association between intimate partner violence during pregnancy and time to return to sexual activity after childbirth. The prevalence of violence by an intimate partner during pregnancy was 24.06%. The prevalence of women who returned to sexual activity within 3 months after childbirth was 67.96%. When analyzing the association between exposure and outcome, no association was found in the crude model (OR = 0.88; 95%CI: 0.60-1.30), nor in the adjusted model (OR = 1.00; 95%CI: 0.61-1.63). The study results highlight the importance of providing comprehensive care to women, considering both physical and psychological aspects, since violence has a significant impact on several aspects of women’s lives.

There seems to be a consensus that adolescents worldwide are not getting enough sleep. This study aimed to evaluate the psychometric properties of the Epworth Sleepiness Scale (ESS) in adolescents using the item response theory. A psychometric study was conducted with 2206 adolescents aged 18 and 19 years in the city of São Luís, Maranhão, Brazil. The dimensionality of the ESS was assessed by principal component analysis. A Samejima’s graded response model (SGRM) was fitted to it. The findings of this study showed a good internal consistency and the unidimensionality of the ESS. Considering the latent trait continuum, we obtained three levels, with anchor items. For the item ‘Sitting still in a public place’, the adolescents presented a small possibility of dozing in level 1, and a medium and great possibility in level 2. The item ‘Sitting around talking to someone’ presented small, medium, and great possibilities of dozing in level 3. The ESS with five items showed satisfactory psychometric properties. In addition, the results from the SGRM showed that adolescents with high levels of sleepiness are likely to nod off or sleep sitting up while talking to someone. This study allows us to understand excessive daytime sleepiness in adolescents.

ABSTRACT OBJECTIVE To analyze the association between modifiable behavioral risk factors for non-communicable diseases and sleep parameters in Brazilian adolescents. METHODS This was a cross-sectional study that used data from the RPS Cohort Consortium, São Luís, Brazil for the follow-up of adolescents aged 18–19 years (n = 2,515). The outcomes were excessive daytime sleepiness (Epworth Sleepiness Scale – ESS) and sleep quality (Pittsburgh Sleep Quality Index – PSQI). The exposures of interest were the behavioral risk factors for non-communicable diseases (NCDs): screen time, physical inactivity, alcohol, smoking, illicit drugs, caffeine intake, and consumption of sugar-sweetened beverages. Excess weight was considered a possible mediator of this association between the exposures of interest and the outcomes. The models were analyzed by modeling with structural equations. RESULTS Physical inactivity (standardized coefficient, SC = 0.112; p = 0.001), higher consumption of alcohol (SC = 0.168; p = 0.019) and of sugar-sweetened beverages (SC = 0.128; p < 0.001) were associated with excessive daytime sleepiness in adolescents; better socioeconomic status was also associated with this outcome (SC = 0.128; p < 0.001). Physical inactivity (SC = 0.147; p < 0.001) and higher consumption of sugar-sweetened beverages (SC = 0.089; p = 0.003) were also associated with poor sleep quality. Overweight was neither a mediator nor associated with sleep quality or excessive daytime sleepiness. CONCLUSIONS The main modifiable behavioral risk factors for NCDs are associated with worse sleep parameters already in adolescence, which serves as a warning toward the accumulation of risks for sleep disorders in the future.

ABSTRACT OBJECTIVE To investigate the effects of depressive symptoms in childhood on the intellectual development of young adults. METHODS Study conducted with a birth cohort of São Luís, Maranhão, Brazil, composed of 339 participants evaluated between 7 and 9 years and between 18 and 19 years. Structural equation modeling (young adult education, sex, race/color) and childhood variables (nutritional status, depressive symptoms, cognitive function, head of household’s and mother’s education, family income) were used. In addition, head of household’s occupation, mother’s age, and presence of partner were tested as determinants of adults’ intelligence quotient (IQ). RESULTS Presence of depressive symptoms in childhood triggered a reduction of 0.342 in standard deviation (SD) and -3.83 points in the average IQ of adults (p-value < 0.001). Cognitive function in childhood had a total and direct positive effect (standardized coefficient [SC] = 0.701; p-value < 0.001) on IQ, increasing 7.84 points with each increase in level. A positive indirect effect of child nutritional status (SC = 0.194; p-value = 0.045), head of household’s (SC = 0.162; p-value = 0.036), and mother’s education was identified, the latter mediated by cognitive function in childhood (SC = 0.215; p-value = 0.012) on the IQ of young people. CONCLUSION Presence of depressive symptoms in childhood triggered a long-term negative effect on intelligence, reducing the IQ score in adulthood.

Abstract Objective To assess the direct, indirect, and total effects of violence during pregnancy on perinatal outcomes, and to evaluate the effect of violence as a moderator of the mediated relationship of depression with perinatal outcomes. Methods Data was collected from the prenatal study and follow-ups of the BRISA cohort, São Luís, Maranhão, Brazil. The perinatal outcomes investigated were: birth weight (BW), intrauterine growth restriction (IUGR) and gestational age (GA). Violence against women was evaluated using the World Health Organization Violence against Women instrument (Violence during pregnancy – regardless of the type of violence; Physical violence during pregnancy; Psychological violence during pregnancy). Depressive symptoms during pregnancy were evaluated as a mediating variable. Moderated mediation analysis was performed to estimate the effects of violence and depression on perinatal outcomes. Results Three types of violence analyzed by depression had an indirect effect in BW and GA. None of the types of violence showed an association with IUGR. All types of violence analyzed showed a moderated mediation effect with BW and GA. Only among women who experienced violence were birth weight and gestational age lower the higher the values of depressive symptoms. Conclusion Violence and depression are only associated with lower BW and GA when they occur simultaneously.

Abstract Background A nutrient-poor and hypocaloric diet may be associated with lower handgrip strength (HGS), whereas a high-quality or balanced diet may be associated with higher HGS. However, no study has used the NOVA system for classifying food by their degree of processing. Objective To analyze the association between food consumption according to the degree of food processing and HGS in Brazilian teenagers. Methods This cross-sectional study included teenagers aged 18 and 19 years old from the 1997/98 São Luís’ birth cohort, Maranhão, Brazil. HGS (kilogram-force) was measured via a Jamar Plus + dynamometer. Food consumption was assessed using a semiquantitative food frequency questionnaire. The energy intake of culinary preparations (unprocessed or minimally processed food and processed culinary ingredients), processed, and ultra-processed foods was evaluated in percentages and categorized in tertiles. The associations between each food group intake and HGS was estimated via crude and adjusted linear regression models. A directed acyclic graph was used to identify confounding factors. Results We evaluated 2,433 teenagers, 52.1% of which were girls. For boys, adjusted analysis showed an association between the highest HGS and the 3rd tertile of culinary preparation consumption (β: 1.95; 95%CI: 0.80; 3.10) and between the lowest HGS and the 3rd tertile of ultra-processed food consumption (β: -2.25; 95%CI: -3.40; -1.10). Among girls, the consumption of culinary preparations in the 3rd tertile was associated with higher HGS (β: 0.76; 95%CI: 0.05; 1.46). Conclusions Higher consumption of culinary preparations and lower consumption of ultra-processed foods can contribute to reduce the chance of lower HGS in adult life. Interventions to promote the development and preservation of muscle strength should include dietary recommendations.

ABSTRACT Objective: To describe the prevalence of insufficient sleep duration, long sleep latency, terminal or maintenance insomnia, subjective sleep quality, and excessive daytime sleepiness among participants of birth cohorts conducted in three Brazilian cities, and to evaluate differences in prevalence rates within cohorts according to sociodemographic characteristics. Methods: Cross-sectional analyses involving adolescents and adults participating in four birth cohorts conducted in Ribeirão Preto (RP78 and RP94), Pelotas (PEL93) and São Luís (SL97/98). Sleep duration, latency, terminal or maintenance insomnia, and subjective sleep quality were obtained through the Pittsburgh Sleep Quality Index; and excessive daytime sleepiness was assessed using the Epworth Sleepiness Scale. Differences in the prevalence of the outcomes were analyzed in each cohort according to sociodemographic characteristics (skin color, marital status, socioeconomic status, study and working at the time of the interview) stratified by sex. Results: Insufficient sleep duration was the most common outcome at the four cohorts, with higher frequency among men. Long latency was more frequently reported by young adult women in RP94 and PEL93 cohorts, and insomnia by women of the four cohorts, when compared to men of the same age. Women generally suffered more from excessive daytime sleepiness and evaluated the quality of their sleep more negatively than men. In addition to sex, being a student and working were associated with the largest number of outcomes in both sexes. Conclusion: Sleep disorders are more prevalent in women, reinforcing the need for greater investment in sleep health in Brazil, without disregarding gender and socioeconomic determinants.

Abstract Background The sleep reduction can change healthy people's hemodynamic control and cardiovascular regulation through increased inflammatory response and altered endothelial function. The objective the study to analyze the association between sleep duration and cardiometabolic risk factors in adolescents in the birth cohort of São Luís (1997/98). Methods This is a cross-sectional study with adolescents participating in the birth cohort of São Luís (1997/98). Sleep duration was evaluated using accelerometer data (Actigraph wGT3X-BT). Glycemia, systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol, low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c) and triglycerides were considered cardiometabolic factors. The Directed Acyclic Graph (DAG) was used to identify the minimum set of adjustment for confounding. Results Out of 1,268 adolescents, 50.3% of them were male. The prevalence of sleep duration of less than 6 h per day was 31.1%. The mean glycemia value was 91.8 mg/dL (± 15.9), DBP was 71.3 mmHg (± 7.5), SBP was 114.9 mmHg (± 12.3), HDL was 48.5 mg/dL (± 11.6), LDL was 89.0 mg/dL (± 25.7), the total cholesterol was 156.0 mg/dL (± 31.1), and triglycerides was 93.6 mg/dL (± 47.2). The crude analysis showed an association between sleep duration and SBP and LDL-c. In the adjusted analysis, the associations did not remain. Conclusion Our study showed no association between sleep duration and cardiometabolic outcomes in adolescents.

Access to quality and affordable healthcare is central to the fulfilment of women's reproductive and sexual health needs and rights. For this reason, the World Health Organization declared access to appropriate healthcare services during pregnancy and childbirth a fundamental women's right. Prenatal care is a recognized human right to women's health in Brazil, as declared by the 1988 Constitution and many Brazilian policies. However, implementing the rights to health in Brazil presents a fundamental performance gap between legal rights and their delivery concerning reproductive health. Through extensive fieldwork including focus groups, interviews with women and participate observation in two municipalities in northeastern Brazil, this article addresses these issues and explores women's lived experience of access to and their fulfilment of the right to health regarding prenatal healthcare. We offer and account of the experience of women regarding what they identified as barriers that trample their right to health, that is: a) limited personnel and medical equipment as a perception of neglect; b) timely delivery of services: time matters for perception and experience of rights; c) misinformation as a barrier to the exercise of health rights; and d) socioeconomic barriers. These barriers particularly affect the right of women in rural communities, with lower socioeconomic levels and education, as well as brown and black women, from an intersectionality perspective, who are already at greater health risk and inadequate prenatal care. As such, we argue there is a performance gap between what the normative and legal frameworks encourage the health system to do and what the system actually provides in terms of access, equality, respect and continuity of treatment amongst certain groups in society whose right to health are denied while their health risks increase.

ABSTRACT Objective: To describe the prevalence of physical activity among subjects from birth cohorts of three cities located in different regions of Brazil according to sociodemographic characteristics and sex, comparing the relationships within and between cohorts. Methods: Cross-sectional study involving 12,724 adolescents and young adults who participated in five birth cohorts: Ribeirão Preto [1978/79 (37/39 years old in 2016) and 1994 (22 years in 2016)]; Pelotas [1982 (30 years in 2012) and 1993 (22 years in 2015)], and São Luís [1997/98 (18/19 years in 2016)]. Leisure-time physical activity was evaluated with questionnaires (insufficiently active:

Background: Little is known regarding the developmental consequences of congenital Zika syndrome (CZS) without microcephaly at birth. Most previously published clinical series were descriptive and they had small sample sizes. Study design: We conducted a cohort study to compare the growth, clinical, and motor development outcomes for 110 children with CZS born with and without microcephaly up to their third birthday. Ninety-three had their head circumference (HC) at birth abstracted and they did not have hypertensive hydrocephalus at birth, where 61 were born with microcephaly and 32 without. Results: The HC z-scores decreased steeply from birth to six months of age, i.e., from –3.77 to –6.39 among those with microcephaly at birth and from –1.03 to –3.84 among those without. Thus, at 6 months of age, the mean HC z-scores for children born without microcephaly were nearly the same as those for children born with microcephaly. Children born without microcephaly were less likely to have brain damage, ophthalmic abnormalities, and drug-resistant epilepsy, but the differences in many conditions were not statistically significant. Conclusions: Children born without microcephaly were only slightly less likely to present severe neurologic impairment and to develop postnatal-onset microcephaly, and some of the original differences between the groups tended to dissipate with age.

O objetivo do estudo foi avaliar a associação entre duração de sono e composição corporal em adolescentes. Estudo transversal, com 1.269 adolescentes de 18 e 19 anos da coorte de nascimentos de 1997/1998 de São Luís, Maranhão, Brasil. A duração do sono foi avaliada a partir dos dados registrados por acelerometria. A composição corporal foi avaliada pelo o índice de massa gorda (IMG), índice de massa muscular (IMM) e índice de massa corporal (IMC). Os fatores de confusão foram identificados em gráfico acíclico direcionado no programa DAGitty 3.0. Foram realizadas análises descritivas para todas as variáveis e, posteriormente, regressão linear, com estimativa dos coeficientes de regressão brutos e ajustados, com os respectivos intervalos de 95% de confiança (IC95%). Nos adolescentes do sexo masculino, cada hora a mais de sono associou-se a reduções de 0,30kg/m2 do IMM (IC95%: -0,45; -0,15), de 0,26kg/m2 do IMG (IC95%: -0,48; -0,03) e 0,61kg/m2 do IMC (IC95%: -0,93; -0,30). Nas adolescentes, cada hora a mais de sono associou-se à redução de 0,22kg/m2 do IMM (IC95%: -0,36; -0,07). A maior duração do sono associou-se a menor IMM em ambos os sexos e menor IMG e IMC no sexo masculino, o que evidencia a importância de ter adequadas horas de sono para melhorar os índices de composição corporal.

ABSTRACT Objectives: to analyze the sociodemographic and clinical variables related to the adherence to self-care activities in people with diabetes mellitus type 2. Methods: quantitative, cross-sectional study, carried out with 270 people with diabetes from December 2019 to October 2020, in São Luís, Maranhão. Results: the adherence to self-care was greater when it comes to medications (Md=7.0) and foot care (Md= 6.0), but lower in regard to blood sugar testing (Md=1.0), exercise (Md=2,0), and diet (general) (Md=4.0). The variables age group (p=0.007), educational level (p=0.015), body mass index (p=0.035), complications with diabetes (p=0.009), and nutritional follow-up (p=0.000) had associations with self-care activities. Conclusions: identifying the factors related to the adherence to self-care was found to be essential to strengthen the line of care in chronic diseases and to direct educational actions, aiming to improve the quality of life of people with diabetes.

Resumo Introdução O suicídio é uma das três causas de morte mais frequentes no mundo e varia conforme o sexo e a idade. Objetivo Analisar a tendência da mortalidade por suicídio nas regiões brasileiras no período de 1996 a 2015 e sua associação com o sexo e a faixa etária. Método Estudo ecológico de série temporal, utilizando os óbitos por suicídio analisados por regiões no período de 1996 a 2015 contidos no Sistema de Informações sobre Mortalidade. Para avaliação da tendência da mortalidade por suicídio, foi considerado o modelo de regressão de Prais-Winsten. Para comparar os percentuais de mortalidade por sexo e faixa etária, foi utilizado o teste qui-quadrado. Resultados Observou-se tendência crescente de óbitos por suicídio nas regiões Norte (1,73%, Coef = 0,007; p-valor < 0,001), Nordeste (2,30%, Coef = 0,010; p-valor = 0,006) e Sudeste (1,41%, Coef = 0,006; p-valor < 0,001) e decrescente no Sul (-0,57%, Coef = -0,002; p-valor = 0,001), além de predomínio de homens no percentual de óbitos (p < 0,001). Conclusão O suicídio é considerado importante problema de saúde pública, necessitando de ações para divulgação dos riscos e programas de prevenção.

Abstract Objective To describe caffeine consumption during pregnancy and its association with low birth weight (LBW) and preterm birth in the birth cohort of Ribeirão Preto, state of São Paulo, Brazil, in 2010. Methods Cohort study, with descriptive and analytical approach. Data included 7,607 women and their newborns in Ribeirão Preto, state of São Paulo, Brazil. The women answered standardized questionnaires about reproductive health, prenatal care, life habits, sociodemographic conditions, and information about coffee intake. The independent variable was high caffeine consumption (≥300 mg/day) from coffee during pregnancy, and the dependent variables were LBW (birth weight < 2,500 g) and preterm birth (< 37 weeks of gestational age). Four adjusted polytomous logistic regression models, relative risk (RR) and 95% confidence interval (CI) were fitted: biological and sociodemographic conditions; obstetric history; current gestational conditions; and all variables included in the previous models. Results A total of 4,908 (64.5%) mothers consumed caffeine, 143 (2.9%) of whom reported high consumption. High caffeine intake was significantly associated with reduced education and with the occupation of the head of the family, nonwhite skin color, not having a partner, higher parity, previous abortion and preterm birth, urinary tract infection, threatened abortion, alcohol consumption and smoking. No association was found between high caffeine consumption and LBW or preterm birth in both Conclusion In this cohort, high caffeine intake was lower than in other studies and no association with LBW or preterm birth was found.

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.

ABSTRACT OBJECTIVE: To analyze the effects of early determinants on adolescent fat-free mass. METHODS: A cohort study with 579 adolescents evaluated at birth and adolescence in a birth cohort in São Luís, Maranhão. In the proposed model, estimated by structural equation modeling, socioeconomic status (SES) at birth, maternal age, pregestational body mass index (BMI), gestational smoking, gestational weight gain, type of delivery, gestational age, sex of the newborn, length and weight at birth, adolescent socioeconomic status, “neither study/nor work” generation, adolescent physical activity level and alcohol consumption were tested as early determinants of adolescent fat-free mass (FFM). RESULTS: A higher pregestational BMI resulted in higher FFM in adolescence (Standardized Coefficient, SC = 0.152; p < 0.001). Being female implied a lower FFM in adolescence (SC = −0.633; p < 0.001). The negative effect of gender on FFM was direct (SC = −0.523; p < 0.001), but there was an indirect negative effect via physical activity level (SC = −0.085; p < 0.001). Women were less active (p < 0.001). An increase of 0.5 kg (1 Standard Deviation, SD) in birth weight led to a gain of 0.25 kg/m2 (0.106 SD) in adolescent FFM index (p = 0.034). Not studying or working had a negative effect on the adolescent's FFM (SC = −0.106; p = 0.015). Elevation of 1 SD in the adolescent's physical activity level represented an increase of 0.5 kg/m2 (0.207 SD) in FFM index (p < 0.001). CONCLUSIONS: The early determinants with the greatest effects on adolescent FFM are gender, adolescent physical activity level, pregestational BMI, birth weight and belonging to the “neither-nor” generation.

RESUMO Objetivo: analisar as prescrições de medicamentos potencialmente perigosos e identificar as práticas adotadas na dispensação em hospital universitário público de alta complexidade, propondo estratégias para prevenção de eventos adversos. Métodos: estudo transversal realizado com 566 prescrições, em três turnos, no período de abril a dezembro de 2016. A identificação de práticas para dispensação foi por observação direta com aplicação de checklist baseado no protocolo do Ministério da Saúde (MS) /Agência Nacional de Vigilância Sanitária (ANVISA). Utilizou-se teste não paramétrico do qui-quadrado de independência para avaliar a associação entre prescrições com e sem medicamentos potencialmente perigosos e unidades de internação. Resultados: mais da metade das prescrições (56,6%) continha dois ou mais medicamentos potencialmente perigosos e quase todos injetáveis (95,4%), principalmente analgésicos opioides (31,2%), glicose 50% (24,7%) e insulina NPH e regular (24,3%). A taxa dos prescritos correspondeu a 18,2%. As principais práticas que representaram riscos foram: distribuição coletiva de cloreto de potássio e insulina; falta de etiquetas de alerta; dupla conferência inexistente; uso de fontes de interrupção/distração em 43,9% das prescrições atendidas. Conclusão: apesar de serem frequentes em mais da metade das prescrições, as práticas adotadas na dispensação de medicamentos potencialmente perigosos foram insuficientes para uma dispensação segura, podendo comprometer a administração desses medicamentos e causar danos aos pacientes. É importante a implementação do protocolo do MS/ANVISA para prevenção de erros de medicação, em consonância com o terceiro desafio global da Organização Mundial da Saúde (OMS).

ABSTRACT This study analyzed possible associations between the trimester of maternal Zika virus infection (ZIKV) in pregnancy, severity of brain computed tomography (CT) findings and the presence of microcephaly at birth in children with Congenital Zika Syndrome (CZS). It was an analytical study in a cohort of children with CZS. Symptoms of maternal infection were dichotomized into the 1st trimester of pregnancy and other trimesters. Head circumference (HC) at birth was used to calculate the z-score. Mild microcephaly was defined as HC between 2 and ≥3 standard deviations (SD) below the mean for each gestational age and sex, and severe microcephaly when HC

Resumo: O objetivo foi estimar a prevalência de indicadores de saúde de adolescentes em São Luís, Maranhão, Brasil, em 2016. Foram estudadas condições sociodemográficas, hábitos de vida, composição corporal, qualidade do sono, atividade física, habilidade cognitiva e risco de suicídio de 2.515 adolescentes com 18 e 19 anos. Os adolescentes pertencem à coorte de nascimento 1997/1998 ou foram incluídos, retrospectivamente, utilizando-se o banco do SINASC (Sistema de Informações sobre Nascidos Vivos). Os adolescentes eram, principalmente, da classe econômica C (50,1%), 69,5% estudavam, 40,3% trabalhavam e 25,2% não estudavam nem trabalhavam; 60,3% já foram vítimas de assalto e 48,7% tinham pais separados. Apresentaram padrão de consumo nocivo, excessivo ou provável dependência de álcool 19,4%, 19,1% usaram ou estavam usando drogas ilícitas, 53,7% tinham qualidade de sono ruim, 40,8% referiram dor de cabeça frequente, 34,3% declararam tempo de tela por dia maior que cinco horas e 4,1% apresentaram alto risco para suicídio. A prevalência de hipertensão arterial foi de 12% e de obesidade, 6%. As meninas eram mais inativas (80,7%) e apresentaram maior percentual de gordura corporal alto (15,8%) e muito alto (21,5%), já os meninos tiveram maior prevalência de hipertensão arterial (21,2%) e menor prevalência de inatividade física (40,9%). As elevadas prevalências de fatores de risco à saúde aumentam a vulnerabilidade dos adolescentes, expondo estes indivíduos precocemente a fatores que levam ao acometimento cada vez mais cedo de doenças e agravos à saúde.

Objetivo: identificar tipos de erros na dispensação de medicamentos (ED), analisar fatores associados e propor medidas para prevenção de acidentes. Método: estudo transversal realizado com 5.604 medicamentos dispensados em hospital universitário brasileiro, em 2016/2017. Após obtenção dos dados, pela aplicação de checklist e abertura dos kits de dispensação, utilizou-se regressão hierarquizada ajustada para identificação dos fatores associados ao ED. Resultados: os ED ocorreram em 236 medicamentos e os métodos de cálculo mostraram as taxas: 4,2%, 7,3% e 24,9%. Os principais erros foram de conteúdo por desvio de qualidade e de omissão. No modelo final da regressão, permaneceram associadas ao aumento da chance de ED as variáveis: turno da noite e presença de fonte de interrupção/distração. Conclusão: a frequência de ED foi mais baixa quando se utilizou o método de cálculo do Ministério da Saúde. Os fatores relacionados ao turno noturno e ao uso de fontes de interrupção/distração podem estar associados a ED, especialmente a omissão. ABSTRACT Objective: to identify types of medication dispensing (DE) errors, to analyze its associated factors and to propose action for preventing accidents. Method: a cross-sectional study was performed with 5,604 drugs dispensed in a Brazilian teaching hospital, in 2016/2017. After data collection, by applying a checklist and opening dispensing kits, adjusted hierarchical regression was applied to identify factors associated with DE. Results: DE occurred in 236 medications and calculation methods led to the rates: 4.2%, 7.3%. and 24.9%. The main dispensing errors were related to content, due to quality deviation, and omission. In the final regression model, the following variables remained associated with an increased chance of DE: overnight shift and the presence of interruption/distraction sources. Conclusion: the frequency of DE was low when using the calculation method of the Brazilian Ministry of Health. Factors related to the night shift and the use of interruption/distraction sources can be associated with DE, especially those related to omission. RESUMEN Objetivo: identificar los tipos de errores en la dispensación de medicamentos (ED), analizar los factores asociados y proponer medidas de prevención de accidentes. Método: estudio transversal realizado con 5,604 medicamentos dispensados en un hospital universitario brasileño, en 2016/2017. Después de obtidos los datos, aplicando un checklist y abriendo los kits de dispensación, se utilizó la regresión jerárquica ajustada para identificar los factores asociados con la DE. Resultados: ocurrió ED en 236 medicamentos y los métodos de cálculo mostraron las tasas: 4.2%, 7.3% y 24.9%. Los principales errores fueron de contenido debido a la desviación de calidad y la omisión. En el modelo de regresión final, las variables: turno nocturno y presencia de fuentes de interrupción/distracción permanecieron asociadas con mayor probabilidad de ED. Conclusión: la frecuencia de DE fue menor cuando se utilizó el método de cálculo del Ministerio de Salud. Los factores relacionados con el turno nocturno y el uso de fuentes de interrupción/distracción pueden estar asociados con DE, especialmente la omisión.

RESUMO: Estudos vêm mostrando uma possível associação das doenças bucais no período gestacional com o nascimento pré-termo (NPT) e o baixo peso ao nascer (BPN). Esses desfechos perinatais parecem se associar com defeitos de desenvolvimento do esmalte (DDE) na dentição decídua, que, por sua vez, parecem predispor ao desenvolvimento futuro de lesões de cárie nas crianças. Assim, é relevante a inclusão de variáveis de saúde bucal do binômio mãe/filho nos estudos de coorte para a compreensão de como esses fatores se associam. Os objetivos deste estudo são: 1) verificar se existe associação entre doenças da cavidade bucal da gestante e o NPT; 2) testar a hipótese de associação entre desfechos perinatais e defeitos de esmalte/cárie dentária nas crianças; 3) analisar se existem associações entre desfechos perinatais e distúrbios de erupção dentária nas crianças; 4) construir modelos teóricos para estudo das iniquidades sociais como fator comum entre os desfechos perinatais e condições bucais. Utilizou-se abordagem integrada e colaborativa entre duas cidades brasileiras com condições socioeconômicas contrastantes: São Luís, MA; e Ribeirão Preto, SP - estudo BRISA (Brazilian Birth Cohort Studies, Ribeirão Preto-São Luís ). Duas coortes foram avaliadas: uma iniciada ao nascimento, representativa da população de nascidos vivos; e outra iniciada no pré-natal. Os participantes foram reavaliados a partir do início do segundo ano de vida. Espera-se que estas coortes contribuam para fomentar o desenvolvimento e consolidação de pesquisas de seguimento, de base populacional, no Brasil.

Resumo: O objetivo deste trabalho foi estimar a peregrinação de gestantes no momento do parto e identificar os fatores associados a essa peregrinação em duas cidades brasileiras. Estudo seccional, aninhado à coorte de nascimento BRISA, cuja amostra foi composta por 10.475 gestantes admitidas nas maternidades selecionadas por ocasião do parto em São Luís (Maranhão) e Ribeirão Preto (São Paulo). Entrevistas foram realizadas utilizando-se questionários que continham variáveis sociodemográficas e relacionadas ao parto. Utilizou-se modelagem hierarquizada, e calculou-se o risco relativo utilizando regressão de Poisson. A peregrinação foi mais frequente em São Luís (35,8%) que em Ribeirão Preto (5,8%). Em São Luís, foram fatores associados à maior peregrinação: ser primípara (RR = 1,19; IC95%: 1,08-1,31) e ter escolaridade menor que 12 ou mais anos de estudo. Entretanto, ter 35 anos ou mais (RR = 0,65; IC95%: 0,54-0,84) foi fator associado à menor peregrinação. Em Ribeirão Preto, peregrinaram com maior frequência as gestantes cujos partos foram de alto risco (RR = 2,45; IC95%: 1,81-3,32) e com idade gestacional inferior a 37 semanas (RR = 1,93; IC95%: 1,50-2,50). No entanto, partos com idade gestacional igual ou acima de 42 semanas foi um fator associado à menor peregrinação (RR = 0,57; IC95%: 0,33-0,98). Nas duas cidades, gestantes pobres peregrinaram com maior frequência, e sem garantia de que seriam atendidas, mesmo dentre as que realizaram o pré-natal. O estudo evidenciou ausência da garantia de acesso universal e equânime e reafirmou a desigualdade de acesso à assistência ao parto entre as regiões brasileiras.

ABSTRACT OBJECTIVE To analyze the effects of maternal pre-pregnancy body mass index and weight gain during pregnancy on the baby's birth weight. METHODS We conducted a cross-sectional study with 5,024 mothers and their newborns using a Brazilian birth cohort study. In the proposed model, estimated by structural equation modeling, we tested socioeconomic status, age, marital status, pre-pregnancy body mass index, smoking habit and alcohol consumption during pregnancy, hypertension and gestational diabetes, gestational weight gain, and type of delivery as determinants of the baby's birth weight. RESULTS For a gain of 4 kg/m2 (1 Standard Deviation [SD]) in pre-pregnancy body mass index, there was a 0.126 SD increase in birth weight, corresponding to 68 grams (p < 0.001). A 6 kg increase (1 SD) in gestational weight gain represented a 0.280 SD increase in newborn weight, correponding to 151.2 grams (p < 0.001). The positive effect of pre-pregnancy body mass index on birth weight was direct (standardized coefficient [SC] = 0.202; p < 0.001), but the negative indirect effect was small (SC = -0.076, p < 0.001) and partially mediated by the lower weight gain during pregnancy (SC = -0.070, p < 0.001). The positive effect of weight gain during pregnany on birth weight was predominantly direct (SC = 0.269, p < 0.001), with a small indirect effect of cesarean delivery (SC = 0.011; p < 0.001). Women with a higher pre-pregnancy body mass index gained less weight during pregnancy (p < 0.001). CONCLUSIONS The effect of gestational weight gain on the increase in birth weight was greater than that of pre-pregnancy body mass index.

The objective of this study was to analyze changes in perinatal health in two birth cohorts started in 1997/1998 and 2010, respectively, in São Luís, Maranhão State, Brazil. A total of 2,493 live born infants were included in 1997/1998 and 5,166 in 2010. Low birth weight (LBW) rate did not change (8.5% in 1997/1998 and 8.6% in 2010). Preterm birth (PTB) rate also remained stable (13.2% in 1997/1998 and 13% in 2010). Teenage deliveries and births to single mothers decreased. Maternal schooling and prenatal care coverage increased. Intrauterine growth restriction (IUGR) decreased from 13.3% to 10.6% (p < 0.001). The perinatal mortality rate decreased from 36.6 to 20.7 per 1,000 (p < 0.001) and the infant mortality rate (IMR) dropped from 28.5 to 12.8 per 1,000 (p < 0.001). The cesarean rate increased from 34.1% to 47.5% (p < 0.001). In conclusion, despite favorable changes in socio-demographic, behavioral, and health service factors and decreasing rates of IUGR and perinatal and infant mortality, LBW and PTB remained stable, while the cesarean rate increased.

Few studies have used structural equation modeling to analyze the effects of variables on violence against women. The present study analyzed the effects of socioeconomic status and social support on violence against pregnant women who used prenatal services. This was a cross-sectional study based on data from the Brazilian Ribeirão Preto and São Luís birth cohort studies (BRISA). The sample of the municipality of São Luís (Maranhão/Brazil) consisted of 1,446 pregnant women interviewed in 2010 and 2011. In the proposed model, socioeconomic status was the most distal predictor, followed by social support that determined general violence, psychological violence or physical/sexual violence, which were analyzed as latent variables. Violence was measured by the World Health Organization Violence against Women (WHO VAW) instrument. The São Luis model was estimated using structural equation modeling and validated with 1,378 pregnant women from Ribeirão Preto (São Paulo/Brazil). The proposed model showed good fit for general, psychological and physical/sexual violence for the São Luís sample. Socioeconomic status had no effect on general or psychological violence (p>0.05), but pregnant women with lower socioeconomic status reported more episodes of physical/sexual violence (standardized coefficient, SC = -0.136; p = 0.021). This effect of socioeconomic status was indirect and mediated by low social support (SC = -0.075; p

The aim of this study was to investigate the association between mental health and physical inactivity in 1,447 pregnant women in the second trimester of pregnancy. Subjects answered the short version of the International Physical Activity Questionnaire. Symptoms of depression and anxiety, and stress levels were assessed using the Center for Epidemiological Studies Depression Scale, the Beck Anxiety Inventory and the Perceived Stress Scale, respectively. The rate of physical inactivity was low (39.8%). The prevalence rates of symptoms of severe depression and severe levels of anxiety were 28.8% and 16.9%, respectively. The average perceived stress score was 24.9. An association was found between physical inactivity and not living with a partner (OR = 1.28), having a manual occupation (OR = 0.71) and, unexpectedly, normal and low levels of anxiety (OR = 1.46 and OR = 1.44, respectively). No association was observed between physical inactivity and symptoms of severe depression and perceived stress. It is plausible to assume that the majority of physical activity practiced by these women was attributable to housework or occupation which may in turn be associated with high levels of anxiety.

O estudo objetivou avaliar a cobertura vacinal e os fatores associados ao esquema vacinal básico incompleto aos 12 meses de idade, em 427 crianças de 12 a 59 meses, em São Luís, Maranhão, Brasil, 2006. Trata-se de inquérito domiciliar transversal, de base populacional, com amostragem complexa por conglomerados. Empregou-se regressão de Poisson com ajuste robusto da variância. A cobertura para o esquema básico completo foi de 71,9% segundo doses aplicadas, 61,8% para doses válidas e 23,6% para doses corretas. As vacinas contra hepatite B e tetravalente apresentaram maiores percentuais de doses aplicadas em datas ou intervalos inferiores aos recomendados. Os percentuais de atraso vacinal foram elevados, exceto para a BCG. Percentuais mais elevados de esquema vacinal básico incompleto foram encontrados em crianças das classes econômicas D e E, do sexo feminino e de chefes de família de cor da pele preta. As desigualdades raciais, de gênero e socioeconômicas representaram barreiras à vacinação completa, indicando necessidade de reforçar as políticas equitativas que eliminem essas desigualdades.

O estudo objetivou avaliar a cobertura vacinal e os fatores associados ao esquema vacinal básico incompleto aos 12 meses de idade, em 427 crianças de 12 a 59 meses, em São Luís, Maranhão, Brasil, 2006. Trata-se de inquérito domiciliar transversal, de base populacional, com amostragem complexa por conglomerados. Empregou-se regressão de Poisson com ajuste robusto da variância. A cobertura para o esquema básico completo foi de 71,9% segundo doses aplicadas, 61,8% para doses válidas e 23,6% para doses corretas. As vacinas contra hepatite B e tetravalente apresentaram maiores percentuais de doses aplicadas em datas ou intervalos inferiores aos recomendados. Os percentuais de atraso vacinal foram elevados, exceto para a BCG. Percentuais mais elevados de esquema vacinal básico incompleto foram encontrados em crianças das classes econômicas D e E, do sexo feminino e de chefes de família de cor da pele preta. As desigualdades raciais, de gênero e socioeconômicas representaram barreiras à vacinação completa, indicando necessidade de reforçar as políticas equitativas que eliminem essas desigualdades.El estudio tiene como objetivo evaluar la cobertura de vacunación y los factores asociados al esquema incompleto de vacunación básico a los 12 meses de edad, realizado en 427 niños de 12 a 59 meses, en São Luis, Maranhão, Brasil, 2006. Se trata de una encuesta domiciliaria transversal, de base poblacional, con muestreo complejo por conglomerados. Se empleó la regresión de Poisson con un ajuste robusto de variancia. La cobertura para el esquema básico completo fue de un 71,9% según las dosis aplicadas, un 61,8% para dosis válidas y un 23,6% para dosis correctas. Las vacunas contra la hepatitis B y tetravalente presentaron mayores porcentajes de dosis aplicadas en fechas o intervalos inferiores a los recomendados. Los porcentajes de atraso en la vacunación fueron elevados, excepto para la vacuna BCG. Los porcentajes más elevados de esquema incompleto de vacunación básico se encontraron en niños de clases económicas D y E, de sexo femenino y con jefes de familia afrobrasileños. Las desigualdades raciales, de género y socioeconómicas representaron barreras a la vacunación completa, indicando la necesidad de reforzar las políticas equitativas que eliminen esas desigualdades.The study aimed to evaluate vaccination coverage and factors associated with incomplete basic vaccination schedule at 12 months of age in 427 children aged 12-59 months in São Luis, Maranhão State, Brazil, 2006. This cross-sectional, population-based household survey used complex cluster sampling. Poisson regression with robust adjustment of variance was applied. Complete basic vaccination coverage was 71.9% for applied doses, 61.8% for valid doses, and 23.6% for correct doses. Hepatitis B and tetravalent vaccines showed higher percentages of doses on dates or at intervals lower than recommended. Percentages of delayed vaccination were high, except for BCG. Incomplete basic vaccination was more frequent in girls and children from low-income and black families. Racial, gender, and socioeconomic factors posed barriers to complete vaccination, thus emphasizing the need for policies to address such inequalities.

Secular trends in rates of low birth weight in Brazilian state capital cities were evaluated for the period 1996 to 2010 using joinpoint regression models. The rates were calculated using data from the Live Births Information System. Newborns weighing less than 500g were excluded. Only data for capital cities was included since under-registration of births in these cities is lower and new trends can be detected earlier. There was a significant increase in the rate of low birth weight in the Brazilian capitals of the North Region, Northeast Region, South Region and Southeast Region up to 2003/2004, stabilizing thereafter. In the capitals of the Center-west Region the rate increased throughout the whole study period. The rate of low birth weight was higher in the capitals of the more developed regions. The rate of multiple births increased significantly in all Brazilian capitals, while the stillbirth rate decreased and showed a negative correlation with the rate of low birth weight. The increase in the rate of low birth weight may be partially explained by the increase in multiple births, an increase in the birth of infants weighing 500 to 999g and by the reduction in the stillbirth rate.

BACKGROUND: Screening for violence during pregnancy is one of the strategies for the prevention of abuse against women. Since violence is difficult to measure, it is necessary to validate questionnaires that can provide a good measure of the phenomenon. The present study analyzed the psychometric properties of the World Health Organization Violence Against Women (WHO VAW) instrument for the measurement of violence against pregnant women. METHODS: Data from the Brazilian Ribeirão Preto and São Luís birth cohort studies (BRISA) were used. The sample consisted of 1,446 pregnant women from São Luís and 1,378 from Ribeirão Preto, interviewed in 2010 and 2011. Thirteen variables were selected from a self-applied questionnaire. Confirmatory factor analysis was used to investigate whether violence is a uni-or-multidimensional construct consisting of psychological, physical and sexual dimensions. The mean-and-variance-adjusted weighted least squares estimator was used. Models were fitted separately for each city and a third model combining data from the two settings was also tested. Models suggested from modification indices were tested to determine whether changes in the WHO VAW model would produce a better fit. RESULTS: The unidimensional model did not show good fit (Root mean square error of approximation [RMSEA] = 0.060, p < 0.001 for the combined model). The multidimensional WHO VAW model showed good fit (RMSEA = 0.036, p = 0.999 for the combined model) and standardized factor loadings higher than 0.70, except for the sexual dimension for SL (0.65). The models suggested by the modification indices with cross loadings measuring simultaneously physical and psychological violence showed a significantly better fit compared to the original WHO model (p < 0.001 for the difference between the model chi-squares). CONCLUSIONS: Violence is a multidimensional second-order construct consisting of psychological, physical and sexual dimensions. The WHO VAW model and the modified models are suitable for measuring violence against pregnant women.

O parto pré-termo, segundo a OMS, é aquele que ocorre após a 20ª e antes da 37ª semana de gestação, e constitui-se um problema de Saúde Pública. Buscou-se caracterizar o recém nascido pré-termo entre mulheres residentes em São Luís - MA entre os anos 2006 a 2010. Trata-se de estudo descritivo utilizando os dados do SINASC coletados do banco de dados DATA SUS. A população foi constituída por 87.274 nascidos vivos, sendo 4.570 pré-termos. Houve aumento do número de recém-nascidos prétermos entre os anos estudados. Observou-se que idade materna entre 20 e 34 anos, mães solteiras, com escolaridade de 8 a 11 anos, de gravidez única, com 4 a 6 consultas pré-natal, recém-nascido de raça/cor parda relacionaram-se com o nascimento pré-termo. Partos cesarianos, recém-nascidos do sexo masculino, nenhum filho morto e nenhum filho vivo, também relacionaram-se à prematuridade, assim como, a influência da situação socioeconômica. Os percentuais de prematuridade em São Luis - MA apresentaram aumento no período estudado. Os recém-nascidos pré-termos caracterizaram-se principalmente por serem de 32 a 36 semanas, sexo masculino, pardos e baixo peso ao nascer. Assim, os dados obtidos permitem concluir que o conhecimento e a avaliação do perfil das mães e o número e a situação do nascimento dessas crianças é importante no planejamento de estratégias de saúde eficazes na atenção maternoinfantil, objetivando aprimorar políticas públicas para a sobrevivência do recém-nascido e a consequente redução da ocorrência da prematuridade. Palavras-chave: Recém Nascido Pré-termo. Declaração de Nascimento. Sistemas de Saúde. CHARACTERIZATION OF NEWLYBORN PRETERMS ARE BORN IN SÃO LUIS-MA IN THE PERIOD 2006 TO 2010: analysis of SINASC Abstract: The preterm birth, according to WHO, is one that occurs after the 20th and before the 37th week of gestation, and constitutes a public health problem. It was sought to characterize the newly born preterm birth among women living in Sao Luis - MA between the years 2006 to 2010. descriptive study using data collected SINASC database DATA SUS. The study population consisted of 87,274 live births, of which 4570 were preterms. There was an increase in the number of preterm newborns between the years studied. It was observed that maternal age between 20 and 34 years, single mothers with education from 8 to 11 years, single pregnancy, with 4-6 prenatal visits, newborn mixed race were related to preterm birth. Cesarean deliveries, newborn male, no dead son and no living children, also were related to prematurity as well as the influence of socioeconomic status. The percentage of preterm births in São Luis - MA showed an increase during the study period. The newly born preterm were characterized mainly by being 32 to 36 weeks, male, brown and low birthweight. Thus the data obtained indicate that the knowledge and evaluation of the profile of mothers and the numbers and situation of the birth of those children is important in planning effective health strategies in maternal and child care, aiming to improve public policies for the survival of the newborn and the consequent reduction in the incidence of prematurity. Keywords: Premature Newborn. Birth Certificates. Health Systems. CARACTERIZACIÓN DE LOS RECIÉN NACIDOS PREMATUROS NACIDOS EN SÃO LUÍS - MA EN EL PERÍODO 2006 A 2010: análisis de SINASC Resumen: El parto prematuro, según la OMS, es aquella que ocurre después del 20ª y antes de la semana 37ª de gestación, y constituye un problema de salud Pública.Se busca caracterizar al recién nacido prematuro entre las mujeres que viven en São Luís entre los años 2006 a 2010.Se trata de un estudio descriptivo utilizando datos obtenidos de la base de datos SINASC .colectados del banco de dados de DATA SUS. La población de estudio consistió de 87,274 nacidos vivos, siendo que 4.570 fueron prematuros. Hubo un aumento en el número de recién nacidos prematuros entre los años estudiados. Se observó que la edad materna entre 20 y 34 años, madres solteras con la educación de 8 a 11 años . Embarazo simple, con 4-6 visitas prenatales y el recién nacido de raza / parda estaban relacionadas con el parto prematuro. Los partos por cesárea, los niños varones recién nacidos, ningún caso de muerte fetal y sin ningún hijo vivo, también se relacionaron con la prematuridad, así como la influencia de factores socioeconómicos. El porcentaje de nacimientos prematuros en São Luis - MA mostró un aumento durante el período de estudio. El recién nacido prematuro se caracteriza principalmente por ser de 32 a 36 semanas, varón, de color pardo y bajo peso al nacer. Por lo tanto, los datos obtenidos permiten concluir que el conocimiento y la evaluación del perfil de las madres y el número y la situación del nacimiento de estos niños es importante en la planificación de estrategias eficaces de salud en la atención materno-infantil, con el objetivo de mejorar las políticas públicas para la supervivencia del recién nacido y la consiguiente reducción de la incidencia de la prematuridad. Palabras clave: Recién nacidos prematuros. Certificados de nacimiento. Sistemas de Salud.