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To verify characteristics associated with drug resistant epilepsy in children up to 36 months of age with Congenital Zika Syndrome (CZS).This is a prospective cohort study with children aged up to 36 months diagnosed with CZS. Obstetric, demographic, phenotype and other clinical signs, cranial tomography, growth and motor development of the children were collected.Of a total of 109 children diagnosed with CZS, 100 (91.7%) had epilepsy and 68 (68%) with drug resistant seizures. The types of seizures associated with drug resistant epilepsy were focal seizures from the occipital lobe, generalized tonic and generalized tonic-clonic seizures. There was an association between drug resistant epilepsy and microcephaly at birth, severe microcephaly at birth, excess nuchal skin, ventriculomegaly, reduced brain parenchyma volume, and hypoplasia or malformation of the cerebellum. Difficulty sleeping, irritability, continuous crying, dysphagia and gross motor function were clinical signs associated with drug resistant epilepsy, as were the presence of ocular abnormalities, low head circumference in the first year of life and low weight in the first six months.The prevalence of drug resistant epilepsy in children up to 36 months with CZS was 62.4% and was associated with the severity of the child's neurological damage, with emphasis on the reduction of brain parenchyma volume and damage to the cerebellum.

Background Little information on gross motor function of congenital Zika syndrome (CZS) children is available. Objectives To evaluate gross motor function in CZS children aged up to 3 years, and its associated factors and changes in a minimum interval of 6 months. Methods One hundred children with CZS and cerebral palsy (36 with confirmed and 64 with presumed CZS) were evaluated with the Gross Motor Function Classification System (GMFCS) and Gross Motor Function Measure (GMFM-88/GMFM-66). Forty-six were reevaluated. Wilcoxon tests, Wilcoxon tests for paired samples, percentile scores, and score changes were performed. Results Clinical and socioeconomic characteristics (except maternal age), GMFM scores and GMFCS classification of confirmed and probable cases, which were analyzed together, were similar. The mean age was 25.6 months (±5.5); the median GMFM-88 score was 8.0 (5.4–10.8); and the median GMFM-66 score was 20.5 (14.8–23.1); 89% were classified as GMFCS level V. Low economic class, microcephaly at birth, epilepsy, and brain parenchymal volume loss were associated with low GMFM-66 scores. The median GMFM-66 percentile score was 40 (20–55). On the second assessment, the GMFM-66 scores in two GMFCS level I children and one GMFCS level IV child improved significantly. In one GMFCS level III child, one GMFCS level IV child, and the group of GMFCS level V children, no significant changes were observed. Conclusions Almost all CZS children had severe cerebral palsy; in the third year of life, most presented no improvement in gross motor function and were likely approaching their maximal gross motor function potential.

Objective To determine the prevalence of inadequate birth interval and its associated factors in the BRISA study. Methods Cross-sectional study using data from the BRISA cohort. Birth interval was categorized into “adequate” (≥ 2 years or < 5 years between births), “short interval” (< 2 years) and “long interval” (≥ 5 years). The analysis of the factors associated with short and long birth intervals used multinomial logistic regression. Results The prevalence of adequate birth intervals was 48.3%, of long intervals, 34.6%, and of short intervals, 17.1%. Skin color, age, education level, economic status, type of delivery, number of prenatal visits, parity, blood pressure, diabetes, and anemia (p-value was < 0.2 in the univariate analysis) proceeded to the final model. The variable ≥ 3 births (odds ratio [OR] = 1.29; confidence interval [CI]: 1.01–1.65) was associated with short intervals. Age < 20 years old (OR = 0.48; CI: 0.02–0.12) or ≥ 35 years old (OR = 2.43; CI: 1.82–3.25), ≥ 6 prenatal visits (OR = 0.58; CI: 0.47–0.72), ≥ 3 births (OR = 0.59; CI: 0.49–0.73), and gestational diabetes (OR = 0.38; CI: 0.20–0.75) were associated with long intervals. Conclusion Older mothers were more likely to have long birth intervals, and higher parity increases the chances of short birth intervals. Furthermore, gestational diabetes and adequate prenatal care presented higher chances of having adequate birth intervals, indicating that health assistance during pregnancy is important to encourage an adequate interval between gestations. Resumo Objetivo Determinar a prevalência de intervalo inadequado de nascimento e seus fatores associados no estudo BRISA. Métodos Estudo transversal com dados da coorte BRISA. O intervalo de nascimento foi categorizado em “adequado” (≥ 2 anos ou < 5 anos entre os nascimentos), “intervalo curto” (< 2 anos) e “intervalo longo” (≥ 5 anos). A análise dos fatores associados aos intervalos de nascimento curtos e longos utilizou regressão logística multinomial. Resultados A prevalência de intervalos adequados de nascimento foi de 48,3%, longa de 34,6% e curta de 17,1%. A cor da pele, idade, escolaridade, status econômico, tipo de parto, número de consultas pré-natais, paridade, pressão arterial, diabetes e anemia (valor-p < 0,2 na análise univariada) prosseguiram para o modelo final. A variável ≥ 3 nascimentos (odds ratio [OR] = 1,29; intervalo de confiança [IC]: 1,01–1,65) esteve associada a intervalos curtos. Idade < 20 anos (OR = 0.48; CI: 0.02–0.12) ou ≥ 35 anos (OR = 2.43; CI: 1.82–3.25), ≥ 6 consultas pré-natais (OR = 0.58; CI: 0.47–0.72), ≥ 3 nascimentos (OR = 0.59; CI: 0.49–0.73), e diabetes gestacional (OR = 0.38; CI: 0.20–0.75) foram associados a longos intervalos. Conclusão As mães mais velhas apresentaram maior probabilidade de ter longos intervalos de nascimento, e uma paridade maior aumenta as chances de intervalos curtos de nascimento. Além disso, o diabetes gestacional e o pré-natal adequado apresentaram maiores chances de ter um intervalo adequado ao nascimento, indicando que a assistência à saúde durante a gravidez é importante para incentivar um intervalo adequado entre as gestações.

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.

Little is known about the evolution of head circumference (HC) in children with congenital Zika syndrome (CZS). This study aims to evaluate HC growth in children with CZS in the first three years of life and identify associated factors. HC data obtained at birth and in neuropediatric consultations from 74 children with CZS were collected from the Child’s Health Handbook, parents’ reports, and medical records. Predictors of HC z-score were investigated using different mixed-effects models; Akaike’s information criterion was used for model selection. The HC z-score decreased from -2.7 ± 1.6 at birth to -5.5 ± 2.2 at 3 months of age, remaining relatively stable thereafter. In the selected adjusted model, the presence of severe brain parenchymal atrophy and maternal symptoms of infection in the first trimester of pregnancy were associated with a more pronounced reduction in the HC z-score in the first three years of life. The decrease of HC z-score in CZS children over the first three months demonstrated a reduced potential for growth and development of the central nervous system of these children. The prognosis of head growth in the first 3 years of life is worse when maternal infection occurs in the first gestational trimester and in children who have severe brain parenchymal atrophy.

This study aimed to analyze sociodemographic and reproductive factors associated with childbirth care in health services affiliated with the Stork Network in Brazil, from the users' perspective. The sample included 10,540 postpartum women from 606 services. The outcome was the latent variable reception of the patient, consisting of five indicators: healthcare staff members introducing themselves stating their names and roles, calling the pregnant woman by her name, the patient's understanding of the information provided, the patient feeling well treated and respected, and the patient having her needs met by the staff. The explanatory variables were maternal age, schooling, skin color, marital status, type of delivery, parity, and number of services visited before admission for childbirth. Most of the women were 20 to 34 years of age (68.31%), self-identified as brown (56.3%), had 9 to 11 years of schooling (56.1%), and were married or lived with the partner (78.8%). There was a predominance of vaginal delivery (56.6%), with one or two previous children (46%), and reports of not having gone to more than one maternity service to be admitted (91.9%). There was a direct positive effect on reception for childbirth from patient´s higher age (SC = 0.094; p0.001) and more schooling (SC = 0.096; p0.001). Cesarean delivery had a direct negative effect (SC = -0.059; p0.002), and black and brown skin color had direct and indirect negative effects (SC = -0.081; p0.001 and SC = -0.014; p0.001). Older postpartum women and those with more schooling and vaginal delivery had a more positive perception of their reception by maternity services.Este estudo objetivou analisar os fatores sociodemográficos e reprodutivos associados ao acolhimento ao parto em estabelecimentos de saúde vinculados à Rede Cegonha no Brasil, na perspectiva das usuárias. Foram selecionados 606 serviços com amostra de 10.540 puérperas. O desfecho foi a variável latente acolhimento da puérpera, composta por cinco indicadores: apresentação dos profissionais com nome e função, chamar a gestante pelo nome, compreensão das informações dadas, se sentir bem tratada e respeitada e ter as necessidades respondidas pela equipe. As variáveis explicativas foram: idade, escolaridade, cor da pele, situação conjugal, tipo de parto, paridade e peregrinação. Foi utilizada modelagem de equações estruturais. Observaram-se maiores percentuais de mulheres com idade de 20 a 34 anos (68,31%), que se autodeclararam como pardas (56,3%), com escolaridade entre 9 e 11 anos de estudo (56,1%) e que tinham companheiro (78,8%). Houve predominância de puérperas que tiveram parto vaginal (56,6%), com um a dois filhos (46%) e que relataram não peregrinar (91,9%). Apresentaram efeito direto positivo sobre o acolhimento mulheres com maior idade (CP = 0,094; p0,001) e maior escolaridade (CP = 0,096; p0,001). O parto cesáreo apresentou efeito direto negativo (CP = -0,059; p0,002) e cor da pele preta e parda apresentou efeitos direto e indireto negativos (CP = -0,081; p0,001 e CP = -0,014; p0,001). Puérpera com maior idade, maior escolaridade e que tiveram parto vaginal tiveram percepção mais positiva do acolhimento nos serviços de saúde.El objetivo de este estudio fue analizar los factores sociodemográficos y reproductivos, asociados a la acogida en el parto, en establecimientos de salud vinculados a la Red Cegonha en Brasil, desde la perspectiva de las usuarias. Se seleccionaron 606 servicios en una muestra de 10.540 puérperas. El resultado fue la variable latente de acogida de la puérpera, compuesta por cinco indicadores: presentación de los profesionales con nombre y función, llamar a la gestante por el nombre, comprensión de la información proporcionada, sentirse bien tratada y respetada y contar con las necesidades cubiertas por el equipo. Las variables explicativas fueron: edad, escolaridad, color de piel, situación conyugal, tipo de parto, paridad y desplazamientos largos. Se utilizó un modelado de ecuaciones estructurales. Se observaron mayores porcentajes de mujeres con una edad comprendida entre los 20 a los 34 años (68,31%), que se autodeclararon mestizas (56,3%), con una escolaridad entre 9 y 11 años de estudio (56,1%) y que tenían compañero (78,8%). Hubo una predominancia de puérperas que tuvieron un parto vaginal (56,6%), con de 1 a 2 hijos (46%) y que informaron no realizar grandes desplazamientos (91,9%). Presentaron un efecto directo positivo sobre la acogida mujeres con mayor edad (CP = 0,094; p0,001) y mayor escolaridad (CP = 0,096; p0,001). El parto por cesárea presentó un efecto directo negativo (CP = -0,059; p0,002) y color de la piel negra y mestiza presentó efectos directo e indirecto negativos (CP = -0,081; p0,001 e CP = -0,014; p0,001). Puérperas con mayor edad, mayor escolaridad y que tuvieran parto vaginal tuvieron una percepción más positiva de acogida en los servicios de salud.

This article aims to assess the prevalence and factors associated with self-medication in adolescents. Cross-sectional study, nested in cohort, with 2,515 adolescents aged 18-19 years born in São Luís-MA. The use of medication in the last 15 days without a medical prescription or by a qualified professional was considered self-medication. Factors associated with self-medication were evaluated using Poisson regression with robust variances and hierarchical selection of variables. Medicines were used in the last 15 days by 48.05% of adolescents. Among these, 70.09% use it without a prescription or indication from another health professional. The most used medications for self-medication were “over the counter” (93.68%). Self-medication was positively associated with female gender (PR: 1.41; 95%CI: 1.25-1.59), screen time ≥5h/day (PR: 1.32; 95%CI: 1.05-1.67) and self-reported diagnosis of allergic rhinitis (PR: 1.19; 95%CI: 1.02-1.39); however, negatively associated with self-satisfaction with health (PR: 0.79; 95%CI: 0.67-0.94) and hospitalization in the previous year (PR: 0.70; 95%CI: 0.50-0.97). Self-medication was common among adolescents and to reduce this practice, greater attention should be given to women, individuals with intense exposure to meshes and allergic diseases.

OBJECTIVES: To estimate the prevalence and factors associated with hesitancy in getting the vaccine against SARS-CoV-2 in Maranhão, Brazil. METHODS: This is a cross-sectional population-based study conducted from October 19 to 30, 2020. The estimates were calculated based on clustering, stratification, and non-response. A three-stage sampling was adopted, considering stratum, census tracts, and domicile. After systematic analysis, thirty sectors were selected in each stratum, totaling 150 sectors. Each sector contained a fixed number of 34 households, thus totaling 5,100 households. One individual within each household (resident for at least six months and aged one year or more) was selected by a simple random sampling. We questioned participants about their vaccination intention. Univariate association between independent variables and the outcome were verified using descriptive analysis (weighted frequencies) and Pearson's chi-square test (p < 0.05). Robust multivariate analysis was performed using a three-level hierarchical model. RESULTS: We found 17.5% (95%CI 16.1–19.1%) of the 4,630 individuals interviewed to report hesitancy to be vaccinated against covid-19. After final model adjustment, vaccination hesitancy was statistically higher among residents of the cities of Imperatriz (24.0%; RP = 1.48; IC95% 1.09–2.02) and municipalities of the Grande Ilha de São Luís (20.7%; RP = 1.34; 95%CI 1.02–1.76), female individuals (19.8%; RP = 1.44; 95%CI 1.20–1.75), older adults (22.8%; RP = 1.79; IC95% 1.30–2.46), evangelicals (24.1%; RP = 1.49; 95%CI 1.24–1.79), and those without reported symptoms (18.6%; RP = 1.24; 95%CI 1.02–1.51). We found no statistical differences for other socioeconomic and demographic characteristics, as well as variables related to the labor market, behaviors, and health conditions of the interviewees. CONCLUSION: The prevalence of vaccine hesitancy in Maranhão and its association with individual, contextual, and clinical factors enable us to identify the groups and contexts of greatest resistance, requiring special attention from public strategies to ensure wide vaccination.

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.

This article eevaluates delivery and birth care practices in maternity facilities in Brazil's North and Northeast regions. We conducted a qualitative evaluation of 91 facilities in the North and 181 facilities in the Northeast. The data was collected using systematic observation by a team of 44 previously trained evaluators and recorded in a field diary. A thematic analysis of the collected data was performed, resulting in three core themes: challenges of collegial management; challenges for coping with obstetric violence; and the potential of the evaluation process for driving change. Advances were made in the implementation of good labor and childbirth care practices; however, some maternity facilities still reproduce hierarchical models without spaces for collegial management and accounts of obstetric violence were common. Health professionals used the presence of risk to justify the low level of adoption of good practices. However, the findings reveal progress towards the humanization of care. The results also show the potential of the evaluation process for driving change. Although progress has been made towards the adoption of the good practices recommended by the Stork Network Program both in the area of management and care delivery, many challenges remain in view of the dominance of a hierarchical management model associated with an interventionist approach to health care.O objetivo deste artigo é avaliar práticas de atenção ao parto e nascimento em maternidades do Norte e Nordeste brasileiros. Avaliação qualitativa realizada em 91 maternidades no Norte e 181 no Nordeste do Brasil. A técnica de pesquisa foi a observação sistematizada, realizada por 44 avaliadores previamente treinados e registrada em diário de campo. Foi realizada análise de conteúdo na modalidade temática. Os núcleos temáticos encontrados foram: Desafios da Gestão Colegiada; Desafios para o enfrentamento da Violência Obstétrica; e Potencial do processo avaliativo na indução de mudanças. Foram identificados avanços na implantação de boas práticas na gestão do cuidado e atenção à saúde, embora algumas maternidades ainda reproduzam um modelo hierárquico, sem espaços colegiados de gestão e com práticas de violência obstétrica. Situações de risco em gestantes justificaram menor adesão dos profissionais de saúde às boas práticas, ainda que ações em direção à humanização também tenham sido visibilizadas. Identificou-se a potência do processo avaliativo na indução de mudanças. Foram evidenciadas mudanças em direção às boas práticas preconizadas pela Rede Cegonha, tanto na gestão quanto na atenção, mas são muitos os desafios frente ao predomínio de um modelo de gestão hierárquico associado a um modelo de atenção com práticas intervencionistas.

This study aimed to evaluate the racial inequality on childbirth care at the Rede Cegonha (Stork Network) using obstetric good practice and interventions indicators. Racial inequality, measured by the total effect of ethnicity/skin color in the crude model, was seen in many indicators. After adjusting for mediators, such as age, schooling, parity, high-risk hospital, and geographic macro-regions, the persistent direct effect suggests racial discrimination against black women with lower partograph completion (PR 0.88; 95% CI 0.80-0.95). Black women stayed less in lithotomy (PR 0.93; 95% CI 0.89-0.98), performed less episiotomy (PR 0.81; 95% CI 0.68 - 0.96), and had less episiotomy suturing pain (PR 0.66; 95% CI 0.51 - 0.87) when compared to white women, suggesting more good practice applied to black women. However, according to the interventionist care model still adopted by many professionals, these practices are routine, and lower achievement in black women would be better interpreted as evidence of racial discrimination against these women. For other outcomes, the ethnicity/skin color effect disappeared after adjusting for mediators, suggesting mitigation or disappearance of the skin color effect in some practices/interventions in childbirth.O objetivo do presente estudo foi avaliar desigualdade racial na atenção ao parto e ao nascimento na Rede Cegonha utilizando indicadores de boas práticas e intervenções obstétricas. Desigualdade racial, mensurada pelo efeito total da raça/cor no modelo sem ajuste, foi detectada em muitos indicadores. A persistência do efeito direto, após ajuste para os mediadores idade, escolaridade, paridade, hospital de alto risco e região geográfica, sugere discriminação racial contra as pretas, que tiveram menos partograma preenchido (RP 0,88; IC 95% 0,80-0,95). Comparadas às brancas, as pretas ficaram menos em litotomia (RP 0,93; IC95% 0,89-0,98), realizaram menos episiotomia (RP 0,81; IC95% 0,68-0,96) e tiveram menos dor na sutura da episiotomia (RP 0,66; IC95% 0,51-0,87), sugerindo que boas práticas estariam sendo mais realizadas nas pretas. Entretanto, pelo modelo intervencionista de assistência, ainda adotado por muitos profissionais, essas práticas são de rotina e a menor realização delas nas pretas seria melhor interpretada como evidência de discriminação racial a essas mulheres. Para outros desfechos, o efeito da raça/cor desapareceu após o ajuste para mediadores, sugerindo atenuação ou desaparecimento do efeito da cor da pele em algumas práticas/intervenções na assistência ao parto e nascimento.

This article compares the findings of "Avaliação da Rede Cegonha" (ARC - Stork Network Assessment), an evaluative study on the Rede Cegonha (RC - Stork Network) program, with Nascer no Brasil (NB - Born in Brazil), a national survey on labor and birth, conducted in 2011-12, before the start implementation of RC. ARC was conducted in 2017, in 606 maternity hospitals involved in RC and NB included a sample with national representation of 266 hospitals. In the current analysis, we included the 136 SUS hospitals that participated in both studies, totaling 3,790 and 12,227 puerperal women. We perform comparisons of best practices and interventions in the management of labor and delivery using Pearson's chi-square test for independent samples. The prevalence of best practices was, on average, 150% higher in ARC than in NB, with a greater relative increase in less developed regions, for older, brown and black women and less educated. Regarding interventions, there was an average reduction of 30% between NB and ARC, with a greater relative reduction in less developed regions and less educated women. There was a significant improvement in the scenario of care for labor and childbirth, with a reduction in regional, educational and racial inequalities in access to appropriate technologies, suggesting that the RC intervention was effective.Este artigo compara os achados da Avaliação da Rede Cegonha (ARC), estudo avaliativo sobre o programa Rede Cegonha (RC), com o Nascer no Brasil (NB), inquérito nacional sobre parto e nascimento, realizado em 2011-12, antes do início da implementação da RC. A ARC foi conduzida em 2017, em 606 maternidades envolvidas na RC e o NB e empregou uma amostra com representatividade nacional de 266 hospitais. Na análise atual, incluímos os 136 hospitais do SUS que participaram de ambos os estudos, totalizando 3.790 e 12.227 puérperas, respectivamente. Realizamos as comparações de boas práticas e intervenções no manejo do trabalho de parto e de parto utilizando o teste qui-quadrado para amostras independentes. A prevalência das boas práticas foi, em média, 150% maior na ARC que no NB, com maior aumento relativo nas regiões menos desenvolvidas, para mulheres mais velhas, pardas e pretas e menos escolarizadas. Com relação às intervenções, houve redução média de 30% entre o NB e a ARC, com maior redução relativa nas regiões menos desenvolvidas e nas mulheres menos escolarizadas. Houve melhoria significativa no cenário da atenção ao trabalho de parto e parto, com diminuição de iniquidades regionais, de nível de instrução e raciais no acesso às tecnologias apropriadas, sugerindo que a intervenção da RC foi efetiva.

To estimate and assess pregnancy smoking trends since 1978, according to sociodemographic characteristics, in three Brazilian sites. We used cross-sectional data from the perinatal studies of nine birth cohorts, located in the southeast (Ribeirao Preto—1978/1979, 1994, and 2010), south (Pelotas—1982, 1993, 2004, and 2015), and northeast (Sao Luis—1997/1998 and 2010) regions of Brazil. We estimated the prevalence of pregnancy smoking at each time point according to age, education, and family income, in each cohort, and evaluated smoking trends. We analyzed data of 17,275 women in Ribeirao Preto, 19,819 in Pelotas, and 7753 in Sao Luis. Smoking decreased by 59% in Ribeirao Preto (p

The study aimed to estimate the prevalence of health indicators among adolescents in São Luís, Maranhão State, Brazil, in 2016. The analysis included sociodemographic conditions, life habits, body composition, sleep quality, physical activity, cognitive performance, and suicide risk in 2,515 adolescents 18 to 19 years of age. The adolescents belonged to the 1997/1998 birth cohort or were included retrospectively using the SINASC (Brazilian Information System on Live Births) database. The adolescents were mainly from economic class C (50.1%), 69.5% were in school, 40.3% were working, and 25.2% were neither studying nor working; 60.3% had been robbed, and 48.7% had parents who were separated or divorced; 19.4% showed harmful or excessive alcohol consumption or probable addiction, 19.1% had used or were using illicit drugs, 53.7% reported poor sleep quality, 40.8% reported frequent headaches, 34.3% reported more than five hours of daily screen time, and 4.1% showed high suicide risk. Prevalence of high blood pressure was 12%, and 6% were obese. Girls were more physically inactive (80.7%) and showed greater percentage of high (15.8%) and very high body fat (21.5%), while boys showed greater prevalence of high blood pressure (21.2%) and lower prevalence of physical inactivity (40.9%). High prevalence rates of health risk factors increase the adolescents' vulnerability, exposing these individuals earlier to factors leading to diseases and other health problems.

In 2015, there was an epidemic of microcephaly in Brazil that was associated with infection by the Zika virus. The condition of these children obliged the parents to embark on a quest in search of treatment. The scope of this study was to establish the therapeutic itinerary pursued in healthcare sectors by parents and/or caregivers of children with microcephaly due to the Zika virus. It involved qualitative research, conducted at a Center of Reference on Neurodevelopment between April 2017 and February 2018, with parents and/or caregivers of children with microcephaly caused by the Zika virus. The sample complied with the criteria of saturation. Twenty semi-structured interviews were conducted, recorded, and transcribed, and content analysis was applied. The results revealed disorientation and uncertainties in the search for care in the health sector. The most sought-after sector was the professional sector, followed by the informal sector. The information conveyed in the media and social networks, which constitute part of the informal sector, helped to clarify the significance of microcephaly and the Zika virus and assisted in the search for treatment. Care in the healthcare network was marked by difficulties and, faced with a new and emergency situation, the route between diagnosis and treatment was arduous.Em 2015, no Brasil, houve uma epidemia de microcefalia que foi associada à infecção pelo vírus Zika. A condição destas crianças impulsionou os pais a percorrerem um caminho em busca por tratamento. O objetivo deste estudo foi conhecer o itinerário terapêutico percorrido por pais e/ou cuidadores de crianças com microcefalia pelo vírus Zika nos setores de atenção à saúde. Pesquisa de abordagem qualitativa, realizada em um Centro de Referência em Neurodesenvolvimento, no período de abril de 2017 a fevereiro de 2018, com pais e/ou cuidadores de crianças com microcefalia pelo vírus Zika. A amostra obedeceu aos critérios de saturação de sentidos. Foram feitas 20 entrevistas semiestruturadas, gravadas e transcritas. Realizou-se análise de conteúdo, na modalidade temática. Os resultados demostraram desorientação e incertezas na busca pelo cuidado nos setores de saúde. O setor mais procurado foi o profissional, seguido pelo informal e popular. As informações veiculadas na mídia e redes sociais, que fazem parte do setor informal, contribuíram para esclarecer o significado da microcefalia e vírus Zika e auxiliou na busca por tratamento. O cuidado na rede de Atenção à Saúde foi marcado pela peregrinação. Diante de uma situação nova e emergencial, o caminho percorrido, entre o diagnóstico e o tratamento, foi árduo.

We report the early growth and neurologic findings of 48 infants in Brazil diagnosed with probable congenital Zika virus syndrome and followed to age 1-8 months. Most of these infants had microcephaly (86.7%) and craniofacial disproportion (95.8%). The clinical pattern included poor head growth with increasingly negative z-scores, pyramidal/extrapyramidal symptoms, and epilepsy.

The short duration of viremia, low blood viral load, inaccessibility to timely specific diagnostic tests, and cross-reactions with other flaviviruses have hindered laboratory confirmation of Congenital Zika Syndrome (CZS). This study analyzes the positivity of the plaque reduction neutralization test (PRNT) in children with clinical or imaging characteristics of CZS and its association with laboratory, clinical, and imaging characteristics. The 94 clinical cases of CZS submitted to the ZIKV PRNT90 test were followed from 2016 to 2018. The mean age of children at PRNT90 collection was 22 &plusmn, 6 months Standard Deviation. The ZIKV PRNT90 was positive (titer &ge, 10) in 40 (42.5%) children. ZIKV PRNT90 positivity was associated with severe microcephaly in newborns (p = 0.016), lower head circumference z-score at birth (p = 0.043) and 24 months of age (p = 0.031), and severe reduction of the cerebral parenchyma volume (p = 0.021), expressing greater disease severity. Negative PRNT90 in children with characteristic signs of CZS may be due to false-negative results, indicating that the diagnosis of CZS should be primarily syndromic.

This prospective study used data from the BRISA Cohort, São Luís, Brazil (n = 1140) and analyzed associations between environmental factors up to the first 1000 days of life and “Childhood Asthma Symptoms”. “Childhood Asthma Symptoms” was a latent variable based on the number of wheezing episodes, emergency care visit due to wheezing, diagnosis of asthma and diagnosis of rhinitis. A theoretical model that included prenatal factors (socioeconomic status, pregestational body mass index-BMI, soft drink and junk food consumption), birth factors (gestational age, smoking and diseases during pregnancy, birth weight and type of delivery), first year of life factors (breastfeeding, environmental aeroallergens and respiratory diseases) and BMI z-score in the second year of life, was analyzed by structural equation modeling. High pregestational BMI, high soft drink consumption, cesarean section without labor, chill in the first three months of life, carpeted floor and child’s exposure to tobacco were associated with higher values of “Childhood Asthma Symptoms”. In contrast, high birth weight, breastfeeding and infant’s age were associated with lower values of “Childhood Asthma Symptoms”. These findings support the hypothesis that environmental factors that are present before conception and up to the first 1000 days of life are associated with asthma.

The objectives of this study were to estimate the involuntary pilgrimage by women in labor in search of childbirth care and to identify factors associated with this endeavor in two Brazilian cities. This was a cross-sectional study nested in the BRISA birth cohort, whose sample consisted of 10,475 women admitted to the selected maternity hospitals for delivery in São Luís (Maranhão State) and Ribeirão Preto (São Paulo State). Interviews were held with questionnaires that contained sociodemographic and obstetric variables. Hierarchical modeling was used, and relative risk was calculated with Poisson regression. Involuntary pilgrimage during labor was more frequent in São Luís (35.8%) than in Ribeirão Preto (5.8%). In São Luís, factors associated with pilgrimage were: first pregnancy (RR = 1.19; 95%CI: 1.08-1.31) and schooling less than 12 complete years. However, age 35 years or older (RR = 0.65; 95%CI: 0.54-0.84) was associated with less pilgrimage. In Ribeirão Preto, such trekking for obstetric care was more frequent in women with high-risk pregnancies (RR = 2.45; 95%CI: 1.81-3.32) and those with gestational age less than 37 weeks (RR = 1.93; 95%CI: 1.50-2.50). Meanwhile, delivery with gestational age equal to or greater than 42 weeks was associated with less pilgrimage (RR = 0.57; 95%CI: 0.33-0.98). In both cities, poor women had to trek more in search of childbirth care and had no guarantee of care, even for those who had received prenatal care. The study revealed the lack of guarantee of universal and equitable access and highlighted the unequal access to childbirth care between Brazil's major geographic regions.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.El objetivo de este trabajo fue estimar los desplazamientos largos de gestantes en el momento del parto e identificar los factores asociados a estos desplazamientos en dos ciudades brasileñas. Se trata de una investigación seccional, encajada en la cohorte de nacimiento BRISA, cuya muestra estuvo compuesta por 10.475 gestantes, admitidas en las maternidades seleccionadas para dar a luz en São Luís (Maranhão) y Ribeirão Preto (São Paulo). Las entrevistas se realizaron utilizando cuestionarios que contenían variables sociodemográficas y relacionadas con el parto. Se utilizó un modelado jerarquizado, y se calculó el riesgo relativo utilizando la regresión de Poisson. Los desplazamientos fueron más frecuentes en São Luís (35,8%) que en Ribeirão Preto (5,8%). En São Luís, los factores asociados a mayores desplazamientos fueron: ser primípara (RR = 1,19; IC95%: 1,08-1,31) y contar con una escolaridad menor a 12 o más años de estudio. Sin embargo, tener 35 años o más (RR = 0,65; IC95%: 0,54-0,84) fue un factor asociado a menores desplazamientos. En Ribeirão Preto, se desplazaron con mayor frecuencia las gestantes cuyos partos fueron de alto riesgo (RR = 2,45; IC95%: 1,81-3,32) y con una edad gestacional inferior a 37 semanas (RR = 1,93; IC95%: 1,50-2,50). Sin embargo, los partos con una edad gestacional igual o por encima de las 42 semanas fue un factor asociado a un menor desplazamiento (RR = 0,57; IC95%: 0,33-0,98). En las dos ciudades, las gestantes pobres se desplazaron con mayor frecuencia, y sin garantía de que serían atendidas, incluso entre quienes realizaron seguimiento prenatal. El estudio evidenció la inexistencia de garantías de acceso universal y ecuánime a la salud y reafirmó la desigualdad de acceso en la asistencia al parto entre regiones brasileñas.

OBJECTIVES: To estimate the baseline prevalence and risk factors for microcephaly at birth before the Zika virus epidemic in 2 Brazilian cities. METHODS: We used population-based data from the Brazilian Ribeirão Preto (RP) and São Luís (SL) birth cohort studies of 2010 that included hospital deliveries by resident mothers. The final sample was 7376 live births in RP and 4220 in SL. Gestational age was based on the date of the mother’s last normal menstrual period or obstetric ultrasonography, if available. Microcephaly at birth was classified according to the criteria of the International Fetal and Newborn Growth Consortium for the 21st Century and the Brazilian Ministry of Health. Risk factors for microcephaly, proportionate and disproportionate microcephaly, and severe microcephaly were estimated in a hierarchized logistic regression model. RESULTS: According to the International Fetal and Newborn Growth Consortium for the 21st Century definition, the prevalence of microcephaly (>2 SDs below the mean for gestational age and sex) was higher in SL (3.5%) than in RP (2.5%). The prevalence of severe microcephaly (>3 SDs below the mean) was higher in SL (0.7%) than in RP (0.5%). Low maternal schooling, living in consensual union or without a companion, maternal smoking during pregnancy, primiparity, vaginal delivery, and intrauterine growth restriction were consistently associated with microcephaly. The number of cases of microcephaly is grossly underestimated, with an underreporting rate of ∼90%. CONCLUSIONS: The prevalence of severe microcephaly was much higher than expected in both cities. Our findings suggest that microcephaly was endemic in both municipalities before the circulation of the Zika virus.

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 Ribeirao Preto and Sao Luis birth cohort studies (BRISA). The sample of the municipality of Sao Luis (Maranhao/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 Sao Luis model was estimated using structural equation modeling and validated with 1,378 pregnant women from Ribeirao Preto (Sao Paulo/Brazil). The proposed model showed good fit for general, psychological and physical/sexual violence for the Sao Luis 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 factors associated with physical violence against pregnant women were analyzed in a cross-sectional study of 1,446 pregnant women from a prenatal cohort who were interviewed in 2010 and 2011 in São Luís, Brazil. In the initial model, socioeconomic status occupied the most distal position, determining sociodemographic factors, social support and the behavioral factors that ultimately determined physical violence, which was investigated as a latent variable. Structural equation modeling was used in the analysis. Pregnant women who were from more disadvantaged backgrounds (p = 0.027), did not reside with intimate partners (p = 0.005), had low social support (p < 0.001) and had a high number of lifetime intimate partners (p = 0.001) reported more episodes of physical violence. Low social support was the primary mediator of the effect of socioeconomic status on physical violence. The effect of marital status was mainly mediated by a high number of lifetime intimate partners.

Breastfeeding plays an important role in child health. However, there are doubts about its influence on malocclusions. Systematic reviews have yielded contradictory results. Research aim: This study aimed to investigate whether the type and duration of breastfeeding are associated with malocclusions in primary teething.The review strategy included several electronic databases, lists of references, reviews, dissertation and thesis websites, experts, and other relevant documents. Published and unpublished observational studies ( N = 42) were reviewed using the Participants (children), Interventions (breastfeeding), Comparisons (bottle feeding), Outcomes (malocclusion), and Study design (observational) strategy, without restrictions on language or locale. Information about the authors, publication year, country of study, setting, study design, sample size, age, type and duration of exclusive and mixed breastfeeding, and malocclusions was recorded by two blinded evaluators. Quantitative meta-analysis ( N = 30) of the studies with available data was performed.Breastfeeding was a protective factor against malocclusions. The odds of association increased with breastfeeding duration. Irrespective of duration, breastfeeding had a protective association with open bite. For those who were breastfed for up to 6 months, breastfeeding protected against overjet, open bite, posterior crossbite, and crowding. Breastfeeding for 12 months or longer was associated with lower odds of overjet, open bite, and posterior crossbite. Breastfeeding exclusively for 6 months was also a protective factor against malocclusions. However, studies on this subject presented low quality, statistical heterogeneity, and only unadjusted measures of association in most of the cases.Breastfeeding beneficially affects primary occlusion when practiced for at least 6 months.

This study analyzed the effects of gestational weight gain and breastfeeding on postpartum weight retention. The study followed 2,607 women from the BRISA cohort. The variables were age, socioeconomic status, parity, pre-gestational body mass index, gestational weight gain, duration of maternal breastfeeding, length of postpartum follow-up, and postpartum weight gain. Structural equation modeling was used to evaluate the total, direct, and indirect effects of the explanatory variables on postpartum weight retention. An increase of one standard deviation in gestational weight gain corresponded to a significant increase of 0.49 standard deviations in postpartum weight retention (p0.001). An increase of one standard deviation in duration of breastfeeding corresponded to mean decrease of 0.10 standard deviations in postpartum weight retention (p0.001). Independently of pre-gestational BMI, gestational weight gain is a risk factor and duration of breastfeeding is a protective factor against postpartum weight retention.

Se investigo la asociacion entre actividad fisica durante el segundo trimestre gestacional y los desenlaces perinatales adversos: bajo peso al nacer (BPN), nacimiento pretermino (NPT) y restriccion de crecimiento intrauterino (RCIU). Se utilizo una muestra de la cohorte BRISA, Sao Luis, Maranhao, Brasil, que incluyo mujeres con un embarazo unico, edad gestacional de 22 a 25 semanas, confirmada por ultrasonografia obstetrica realizada con < 20 semanas, reentrevistadas en las primeras 24 horas tras el parto (n = 1.380). El nivel de actividad fisica fue medido por el Cuestionario Internacional de Actividad Fisica (IPAQ), version corta, y categorizado en alto, moderado y bajo. El grafo aciclico dirigido (DAG) se utilizo para identificar un ajuste minimo para el control de confusores. Un nivel alto de actividad fisica no se asocio al BPN (RR = 0,94; IC95%: 0,54-1,63), NPT (RR = 0,86; IC95%: 0,48-1,54) o RCIU (RR = 0,80; IC95%: 0,55-1,15). Los resultados fortalecen la hipotesis de que la practica de actividad fisica en la gestacion no parece resultar en desenlaces adversos al nacimiento.

OBJECTIVE: To obtain population estimates and profile risk factors for infant mortality in two birth cohorts and compare them among cities of different regions in Brazil. METHODS: In Ribeirão Preto, southeast Brazil, infant mortality was determined in a third of hospital live births (2,846 singleton deliveries) in 1994. In São Luís, northeast Brazil, data were obtained using systematic sampling of births stratified by maternity unit (2,443 singleton deliveries) in 1997-1998. Mothers answered standardized questionnaires shortly after delivery and information on infant deaths was retrieved from hospitals, registries and the States Health Secretarys' Office. The relative risk (RR) was estimated by Poisson regression. RESULTS: In São Luís, the infant mortality rate was 26.6/1,000 live births, the neonatal mortality rate was 18.4/1,000 and the post-neonatal mortality rate was 8.2/1,000, all higher than those observed in Ribeirão Preto (16.9, 10.9 and 6.0 per 1,000, respectively). Adjusted analysis revealed that previous stillbirths (RR=3.67 vs 4.13) and maternal age

The association between young maternal age and preterm birth (PTB) remains controversial. In some studies the association disappeared after controlling for socio-economic and reproductive factors, thus indicating that social disadvantage rather than biological factors may be the explanation. However, in other studies the association persisted after adjustment. The relation between young maternal age and PTB was studied in a city located in Brazil, an underdeveloped country, where the prevalence of teenage pregnancy was high, 29%. A systematic sampling of 2541 hospital births, stratified by hospital, was performed in Sao Luis, Northeast Brazil, from March 1997 to February 1998. The risks of PTB for infants born to two groups of young mothers (

Background Over the last decades there has been a reduction of social inequalities in Brazil, as well as a strong expansion of health services, including prenatal care. The objective of the present study was to estimate the rate of inadequate prenatal care utilization and its associated factors in São Luís, Brazil, in 2010 and to determine whether there was a reduction of inequity in prenatal care use by comparing the present data to those obtained from a previous cohort started in 1997/98. Methods Data from the BRISA (Brazilian birth cohort studies of Ribeirão Preto and São Luís) population-based cohort, which started in 2010 (5067 women), were used. The outcome variable was the inadequate utilization of prenatal care, classified according to the recommendations of the Brazilian Ministry of Health. The explanatory variables were organized into three hierarchical levels based on the Andersen’s behavioral model of the use of health services: predisposing, enabling and need factors. Results Only 2.0% of the women did not attend at least one prenatal care visit. The rate of inadequate prenatal care utilization was 36.7%. Despite an improved adequacy of prenatal care use from 47.3% in 1997/98 to 58.2% in 2010, social inequality persisted: both low maternal schooling (prevalence ratio (PR) = 2.78; 95% confidence interval (95% CI) 2.23-3.47 for 0 to 4 years of study) and low family income, less than 0.5 monthly minimum wage per capita (PR = 1.37; 95% CI 1.22-1. 54), continued to be associated with higher rates of inadequate prenatal care utilization. Racial disparity regarding adequate utilization of prenatal services was detected, with black (PR = 1.19; 95% CI 1.04-1.36) and mulatto (PR = 1.14; 95% CI 1.02-1.26) women showing higher rates of inadequate use. On the other hand, women covered by the FHP - Family Health Program (PR = 0.92; 95% CI 0.85-0.98) showed a lower rate of inadequate prenatal care utilization. Conclusions Despite strong expansion of health services and expressive improvements in adequate prenatal care use and social indicators, inequalities in prenatal care use still persist. The FHP seems to be effective in reducing inadequate prenatal care utilization.

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. O objetivo deste estudo foi analisar as mudanças na saúde perinatal em duas coortes de nascimento realizadas em 1997/1998 e 2010, em São Luís, Maranhão, Brasil. Um total de 2.493 nascidos vivos foi incluído em 1997/1998 e 5.166 em 2010. A taxa de baixo peso ao nascer (BPN) não se modificou (8,5% em 1997/1998 e 8,6% em 2010). A taxa de nascimento pré-termo (NPT) também permaneceu estável (13,2% em 1997/1998 e 13% em 2010). Nascimentos em adolescentes e em mulheres sem companheiro decresceram. A escolaridade materna e a cobertura do pré-natal aumentaram. A taxa de restrição de crescimento intrauterino (RCIU) diminuiu de 13,3% para 10,6% (p < 0,001). A taxa de mortalidade perinatal foi reduzida de 36,6 para 20,7 por mil (p < 0,001) e a taxa de mortalidade infantil diminuiu de 28,5 para 12,8 por mil (p < 0,001). A taxa de cesárea (TC) aumentou de 34,1% para 47,5% (p < 0,001). Apesar das mudanças favoráveis nas variáveis sociodemográficas, comportamentais e de serviços de saúde e da redução nas taxas de RCIU, mortalidade perinatal e infantil, as taxas de BPN e NPT permaneceram estáveis, enquanto a TC aumentou. El objetivo de este estudio fue analizar los cambios de la salud perinatal en dos cohortes de nacimiento realizadas en 1997/1998 y 2010 en São Luís, Maranhão, Brasil. Un total de 2.493 niños nacidos vivos fueron incluidos en 1997/1998 y 5.166 en 2010. La tasa de bajo peso al nacer (BPN) no cambió (8,5% y 8,6%). La tasa del nacimiento prematuro (TNP) también se mantuvo estable (13,2% y 13%). Los nacimientos entre adolescentes y madres solteras disminuyeron. La escolaridad de la madre y la cobertura de atención prenatal aumentaron. La tasa de restricción del crecimiento intrauterino (RCIU) se redujo de un 13,3% a un 10,6% (p < 0,001). La tasa de mortalidad perinatal disminuyó de 36,6 a 20,7 por mil (p < 0,001), y la tasa de mortalidad infantil (TMI) se redujo de 28,5 a 12,8 por mil (p < 0,001). La tasa de cesárea (TC) aumentó de 34,1% a 47,5% (p < 0,001). A pesar de los cambios favorables en factores sociodemográficos, de conducta y de servicios de salud, y de la reducción de RCIU, mortalidad perinatal e infantil, las tasas de BPN y el PTB se mantuvieron estables, mientras que la TC aumentó.

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:56:55Z No. of bitstreams: 1 S0102-311X2001000600038.pdf: 36305 bytes, checksum: 0402e38950f904bc754d3296754db2fc (MD5) Made available in DSpace on 2013-08-22T18:56:55Z (GMT). No. of bitstreams: 1 S0102-311X2001000600038.pdf: 36305 bytes, checksum: 0402e38950f904bc754d3296754db2fc (MD5) Previous issue date: 2001-12-01 Made available in DSpace on 2013-09-30T19:51:13Z (GMT). No. of bitstreams: 2 S0102-311X2001000600038.pdf: 36305 bytes, checksum: 0402e38950f904bc754d3296754db2fc (MD5) S0102-311X2001000600038.pdf.txt: 26368 bytes, checksum: 95bcaa66b317b52434083b1a1eb5cebb (MD5) Previous issue date: 2001-12-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T15:13:17Z No. of bitstreams: 2 S0102-311X2001000600038.pdf: 36305 bytes, checksum: 0402e38950f904bc754d3296754db2fc (MD5) S0102-311X2001000600038.pdf.txt: 26368 bytes, checksum: 95bcaa66b317b52434083b1a1eb5cebb (MD5) Made available in DSpace on 2014-05-20T15:13:17Z (GMT). No. of bitstreams: 2 S0102-311X2001000600038.pdf: 36305 bytes, checksum: 0402e38950f904bc754d3296754db2fc (MD5) S0102-311X2001000600038.pdf.txt: 26368 bytes, checksum: 95bcaa66b317b52434083b1a1eb5cebb (MD5) Previous issue date: 2001-12-01 Agressões de morcegos a pessoas vêm sendo notificadas em várias comunidades amazônicas nesta última década. Isto constitui um risco potencial para a raiva humana transmitida por morcegos. O objetivo deste estudo foi de analisar fatores associados a estas agressões em uma destas comunidades. Foi realizado um estudo transversal em um povoado de garimpeiros na Região Amazônica brasileira (160 habitantes). Foi realizada a captura de morcegos junto às casas e foram enviadas amostras para o laboratório. Das 129 pessoas entrevistas, 41% foram agredidas por morcegos pelo menos uma vez, com 92% das mordidas localizadas nos dedos dos pés. Por meio de regressão logística, encontrou-se que adultos eram agredidos ao redor de quatro vezes mais do que crianças (OR = 3,75, IC: 1,46-9,62, p = 0,036). Homens foram agredidos com maior freqüência do que mulheres (OR = 2,08, IC: 0,90-4,76, p = 0,067). Nove Desmodus rotundus e três morcegos frugívoros foram capturados e resultaram negativos para a raiva. O estudo sugere que, em áreas de garimpo, adultos do sexo masculino têm maior probabilidade de serem agredidos por morcegos. As ações de controle para a raiva humana a serem desenvolvidas nestes lugares devem dar ênfase especial a adultos homens. Recomendam-se mais investigações sobre o modo como o garimpo na Região Amazônica está colocando em risco as pessoas e o ambiente. Many people in Amazonian communities have reported bat bites in the last decade. Bites by vampire bats can potentially transmit rabies to humans. The objective of this study was to analyze factors associated with bat biting in one of these communities. A cross-sectional survey was conducted in a village of gold miners in the Amazonian region of Brazil (160 inhabitants). Bats were captured near people's houses and sent to a lab. of 129 people interviewed, 41% had been attacked by a bat at least once, with 92% of the bites located on the lower limbs. A logistic regression found that adults were bitten around four times more often than children (OR = 3.75, CI 95%: 1.46-9.62, p = 0.036). Males were bitten more frequently than females (OR = 2.08, CI 95%: 0.90-4.76, p = 0.067). Nine Desmodus rotundus and three frugivorous bats were captured and tested negative for rabies. The study suggests that, in an area of gold miners, common vampire bats are more likely to attack adults and males. The control strategy for human rabies developed in this region should therefore place special emphasis on adult males. There should also be more research on how the search for gold in the Amazonian region places people and the environment at risk. Pan American Health Organization Science Communication Studies Instituto de Salud Ambiente y Trabajo Universidade Estadual Paulista Instituto de Biociências Departamento de Zoologia Universidad Nacional Autonóma de México Universidade Estadual Paulista Instituto de Biociências Departamento de Zoologia

This study analyzes the prevalence of illicit drug use and associated factors during pregnancy. This was a cross-sectional study of participants in the BRISA prenatal care cohort. Frequencies and hierarchical logistic regression were used. Estimated prevalence rates were 1.45% for illicit drug use, 22.32% for alcohol consumption, and 4.22% for smoking. The study population was mostly young (81% in the 20-34-year bracket), with 9 to 11 years of schooling (75.55%), with more than half of the women outside the workforce (52.18%), and in economic class "C" (67.61%). Pregnant women showed a high level of stress (24.46%), moderate to intense anxiety (40.84%), and severe depressive symptoms (28.8%). Approximately half (49.72%) of the pregnant women reported some type of violence, and they had wide networks (72.77%) and low social support (65.21%). Use of legal drugs, high stress levels, and single parenthood were independently associated with illicit drug use in pregnancy.

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.

Background Violence against pregnant women has been associated with gestational and perinatal disorders. Psychological violence is the type least investigated and its associated factors have been little studied. The present study was conducted in order to estimate prevalence rates and analyze the factors associated with exclusive and recurrent psychological violence in the municipality of São Luís, Brazil. Methods Data regarding 982 pregnant women, aged from 14 to 45 years, interviewed in 2010 and 2011 in a prenatal cohort were used. A self-applied questionnaire was used to screen for violence. Pregnant women submitted to physical and sexual violence were excluded from the analysis of factors associated with exclusive psychological violence. Prevalence ratios and 95% confidence intervals were estimated by a Poisson regression model with a hierarchical approach at three levels. At level 1 of the theoretical-conceptual model, we analyzed demographic and socioeconomic characteristics and variables that express gender inequalities; at level 2, we analyzed social support received by the women, and at level 3, the life experiences of the pregnant women. Results Prevalence rate of exclusive psychological violence was 41.6% and of recurrent violence was 32.6%. Exclusive psychological violence was associated with pregnant women’s age of 14 to 18 years (PR: 1.32 95% CI: 1.04 – 1.70), pregnant women’s schooling superior to that of her intimate partner (PR: 1.54 95% CI: 1.09 – 2.16), inadequate social affective support/positive social interaction (PR: 1.34 95% CI: 1.11 – 1.62), use of illicit drugs by the pregnant women (PR: 1.80 95% CI: 1.16 – 2.81) and having had six or more intimate partners in life (PR: 1.52 95% CI: 1.18 – 1.96). Recurrent exclusive psychological violence was associated with inadequate social affective support/positive social interaction (PR: 1.47 95% CI: 1.15 – 1.87), use of illicit drugs by the pregnant women (PR: 2,28 95% CI: 1,40 - 3,71) and having had six or more intimate partners in life (PR: 1.47 95% CI: 1.06 – 2.03). Conclusions Psychological violence was a common phenomenon in this population of pregnant women that was associated with gender inequalities, inadequate social support and illicit drug use and should be routinely investigated during prenatal visits at health care services.

The scope of this study was to evaluate the use of oral health services (OHS) and related factors in municipalities with more than 100,000 inhabitants in Maranhão, Brazil. It was a population-based sample including 1214 children and 1059 adults. Prevalence ratios (PR) were estimated by hierarchical Poisson regression in accordance with Andersen's theoretical model. Over 91% of children and 71.9% of adults had not used the OHS in the six months prior to the interview. Of those who did, 48.5% were attended in the Unified Health System (SUS). Preventive were more frequent than curative procedures. In children and adults, predisposing, facilitating and need-based factors explained the use of OHS. Children aged2 years (PR=5.29), with greater schooling of the head of the household (PR=2.37), e"6 prenatal visits (PR=1.69) and dental treatment needs (PR=9.54) were associated with greater use of the OHS. In adults, use was associated with greater schooling (PR=2.26), economic class A/B (PR=1.38), self-perceived health as good/very good (PR=1.72) and need for treatment (PR=18.25). The use of the OHS is neither universal nor equitable and there are deficiencies in comprehensive care, as few people use the more complex services. Fewer prenatal visits appear to be a predictor of non-use of the OHS by children.

We used body mass index (BMI) and waist circumference (WC) as fat indicators to assess whether perinatal and early adulthood factors are associated with adiposity in early adulthood. We hypothesized that risk factors differ between men and women and are also different when WC is used for measuring adiposity as opposed to BMI. We conducted a longitudinal study based on a sample of 2,063 adults from the 1978/1979 Ribeirão Preto birth cohort. Adjustment was performed using four sequential multiple linear regression models stratified by sex. Both perinatal and early adulthood variables influenced adulthood BMI and WC. The associations differed between men and women and depending on the measure of abdominal adiposity (BMI or WC). Living with a partner, for both men and women, and high fat and alcohol intake in men were factors that were consistently associated with higher adulthood BMI and WC levels. The differences observed between sexes may point to different lifestyles of men and women, suggesting that prevention policies should consider gender specific strategies. Utilizou-se o índice de massa corporal (IMC) e a circunferência de cintura (CC) para avaliar se alguns fatores perinatais e da vida adulta se associam com adiposidade na vida adulta jovem. Trabalhou-se com a hipótese de que os fatores de risco diferem entre homens e mulheres e também são diferentes quando a CC é utilizada como medida de adiposidade em vez do IMC. Realizou-se estudo longitudinal baseado em 2.063 pessoas da coorte de nascimentos de 1978/1979 de Ribeirão Preto, São Paulo, Brasil. Foi feito ajuste sequencial em quatro modelos de regressão linear múltipla, estratificados por sexo. Tanto variáveis do início da vida como atuais interferiram no IMC e na CC. As associações foram diferentes para homens e mulheres, e também quando se considerou o IMC ou a CC. Homens e mulheres que vivem com companheira(o) e homens que têm consumo elevado de gordura e álcool apresentam maiores valores de IMC e de CC. As diferenças encontradas podem apontar para estilos de vida diferentes de homens e mulheres, sugerindo que as políticas de prevenção também precisam traçar estratégias diferenciadas segundo gênero.

Prevalences of malnutrition and overweight among children under five years and its association with socioeconomic, demographic and health indicators were estimated for the six largest municipalities of Maranhão, in 2006/2007. By means of a household survey, a sample of 1214 children under five years of age was randomly selected. Two-stage cluster sampling was used, representing the six municipalities of Maranhão with over one hundred thousand inhabitants. Standardized questionnaire was administered to mothers or guardians and trained personnel measured weight and height or length. For classification of malnutrition cutoff points of-2z scores for weight-for-age, weight-for-length/height and length/height-for-age were used. Overweight was considered when weight for height was+2 z score, following World Health Organization guidelines. By weight-for-age malnutrition prevalence was 4.5, by length/height-for-age 8.5% were stunted and by the weight-for-length/height 3.9% were malnourished (wasting), while 6.7% were overweight. Children of families headed by women had lower prevalence of malnutrition (prevalence ratio=0.4). Socioeconomic variables were not associated with malnutrition or overweight. Participation in money transfer programs from the government was not associated with malnutrition or overweight. The prevalence of malnutrition was low, but being overweight was more prevalent than malnutrition. Social inequality was not detected in relation to malnutrition in children under five years of age, suggesting a favorable trend towards greater equity.

Caesarean section (CS) delivery is associated with low birthweight (LBW) in south-east Brazil. A hospital-based study was conducted on singleton infants from mothers residing in São Luís, to assess if an association between CS and LBW was found in the northern part of the country, where the CS rate is lower than in the south-east. A standardised questionnaire was administered to a sample of 2541 mothers in 10 hospitals, representing 94% of all deliveries, from March 1997 to February 1998. In a logistic model, type of delivery was the independent variable, the other variables were treated as confounders, and interaction terms were added between type of delivery and all other factors. LBW was associated with low maternal height, maternal smoking, primiparity, previous LBW, public insurance, preterm birth and CS. The CS rate was 33.7%. The risk of CS was higher for primiparous and married mothers, those with high level of schooling and attended by the same physician during prenatal and delivery care, deliveries held in private hospitals, daylight hours or evenings, and for those mothers who had adequate prenatal care. Because it appears unlikely that only medical reasons are operative, it is a possibility that CS could cause LBW, reflecting abusive indications for elective CS.