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Objetivos.Investigar las desigualdades socioeconómicas y entre distintos grupos étnicos en la prevalencia de anticuerpos contra el SARS-CoV-2 en las 27 unidades federativas de Brasil.Métodos.En este estudio transversal, se realizaron tres encuestas de hogares los días 14-21 de mayo, 4-7 de junio y 21-24 de junio de 2020 en 133 áreas urbanas brasileñas. Se utilizó un muestreo de etapas múltiples para seleccionar 250 individuos en cada ciudad a fin de someterlos a una prueba rápida de anticuerpos. Los sujetos respondieron un cuestionario sobre los bienes del hogar, la escolaridad y el color de la piel y etnia (autodeclarado utilizando la clasificación brasileña estándar de cinco categorías: blanco, negro, pardo, asiático o indígena). Se utilizó el análisis de los componentes principales de los bienes para clasificar el estatus socioeconómico en cinco quintiles de riqueza. Se empleó la regresión de Poisson para los análisis.Resultados.Se analizaron 25 025 sujetos en la primera encuesta, 31 165 en la segunda y 33 207 en la tercera, que mostraron una prevalencia de resultados positivos de 1,4%, 2,4% y 2,9%; respectivamente. Los individuos del quintil más pobre tuvieron 2,16 veces más probabilidades de presentar un resultado positivo (intervalo de confianza del 95%: 1,86-2,51) que los del quintil más rico, y los que tenían 12 o más años de escolaridad tuvieron una prevalencia menor que los sujetos con menos educación. Las personas indígenas presentaron una prevalencia 4,71 (IC95%: 3,65-6,08) veces mayor que las blancas, al igual que las de piel negra o parda. El ajuste por región del país redujo los índices de prevalencia según la riqueza, la educación y el origen étnico, pero los resultados siguieron siendo estadísticamente significativos.Conclusiones.La prevalencia de anticuerpos contra el SARS-CoV-2 en Brasil muestra gradientes relacionados con la posición socioeconómica y la etnia muy pronunciados, con menor riesgo en las personas blancas, educadas y ricas.

Many observational studies and some randomized trials demonstrate how fetal growth can be influenced by environmental insults (for example, maternal infections)1 and preventive interventions (for example, multiple-micronutrient supplementation)2 that can have a long-lasting effect on health, growth, neurodevelopment and even educational attainment and income in adulthood3. In a cohort of pregnant women (n = 3,598), followed-up between 2012 and 2019 at six sites worldwide4, we studied the associations between ultrasound-derived fetal cranial growth trajectories, measured longitudinally from

In high-income countries, links between harsh and abusive parenting and child conduct and emotional problems are well-documented. However, less is known about these relationships in low- and middle-income countries, where harsh parenting may be more widely accepted and higher rates of conduct or emotional problems may exist which could influence the strength of these associations. We sought to investigate these relationships in a large population-based, prospective longitudinal study from Brazil, which also allowed us to test for sex differences. Using data from the 2004 Pelotas Birth Cohort Study (N = 4231) at ages 6 and 11 years, we applied cross-lagged path analysis to examine the relationships between harsh parenting (Conflict Tactics Scale Parent–Child version), and child conduct and emotional problems (Strengths and Difficulties Questionnaire). We found reciprocal relationships between harsh parenting and child conduct problems, with harsh parenting at age 6 predicting child conduct problems at age 11, and vice versa, even after adjusting for initial levels of conduct problems and harsh parenting, respectively. For child emotional problems, only unidirectional effects were found, with harsh parenting at age 6 predicting child emotional problems at age 11, after adjusting for initial levels of emotional problems, but not vice versa. No significant sex differences were observed in these relationships. These observations based on a middle-income country birth cohort highlight the potential universality of detrimental effects of harsh parenting on child conduct and emotional problems and affirm the importance of addressing parent- and child-effects in preventive and treatment interventions, especially those targeting conduct problems.

The first case of COVID-19 was reported in China in December 2019, and, as the virus has spread worldwide, the World Health Organization declared it a pandemic. Estimates on the number of COVID-19 cases do not reflect it real magnitude as testing is limited. Population based data on the proportion of the population with antibodies is relevant for planning public health policies. We aim to assess the prevalence of SARS-CoV-2 antibodies, presence of signs and symptoms of COVID-19, and adherence to isolation measures. A random sample comprising 133 sentinel cities from all states of the country will be selected. Three serological surveys, three weeks apart, will be conducted. The most populous municipality in each intermediate region of the country, defined by the Brazilian Institute of Geography and Statistics, was chosen as sentinel city. In each city, 25 census tracts will be selected, and 10 households will be systematically sampled in each tract, totaling 33,250 participants. In each household, one inhabitant will be randomly selected to be interviewed and tested for antibodies against SARS-CoV-2, using WONDFO SARS-CoV-2 Antibody Test. By evaluating a representative sample of Brazilian sentinel sites, this study will provide essential information for the design of health policies.

Objective: To investigate the incidence and homotypic and heterotypic continuity of psychiatric disorders between ages 6 and 11. Methods: In 2004, all live births in the city of Pelotas, Brazil, were recorded (n=4,231). Psychiatric disorders were assessed by the Strengths and Difficulties Questionnaire (SDQ). SDQ subscale scores (emotional symptoms, conduct problems, hyperactivity/inattention, and peer relationship problems) were categorized as normal or abnormal. To examine associations between problems over time, odds ratios were computed using logistic regression. Results: Any SDQ difficulty was observed in 350 children (10.4%, 95%CI 9.4-11.5) at age 6 and 476 (14.2%, 95%CI 13.0-15.4) at age 11, with a higher prevalence among boys at both ages. Between ages 6 and 11, there was a 50 and a 45% increase in the prevalence of emotional and hyperactivity/inattention symptoms, respectively. Among those who had any SDQ difficulty at age 6, that status persisted in 81% at age 11. We found homotypic continuity of emotional symptoms, conduct problems, hyperactivity/inattention, and peer relationship problems. Conclusions: Our results indicate an increasing incidence of psychiatric disorders in this age group, with rates of disorders and continuity patterns similar to those observed in other studies.

Objective:We aimed to assess the validity of maternal recall of exclusive breastfeeding (EBF) at 3 months obtained 12 months after childbirth.Design:A population-based birth cohort study. The gold standard is maternal report of EBF at the age of 3 months (yes or no) and age of introduction of other foods in the infant’s diet. EBF was considered when the mother reported that no liquid, semi-solid or solid food was introduced up to that moment. The variable to be validated was obtained at 12 months after childbirth when the mother was asked about the age of food introduction. The prevalence of EBF at 3 months, and sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and accuracy of 12-month recall with 95 % CI were calculated.Setting:Pelotas, Brazil.Participants:3700 mothers of participants of the Pelotas 2004 Birth Cohort.Results:The prevalence of EBF at 3 months was 27·8 % (95 % CI 26·4, 29·3) and 49·0 % (95 % CI 47·4, 50·6) according to gold standard and maternal recall, respectively. The sensitivity of maternal recall at 12 months was 98·3 % (95 % CI 97·4, 99·0), specificity 70·0 % (95 % CI 68·2, 71·7), PPV 55·8 % (95 % CI 53·4, 58·1), NPV 99·1 % (95 % CI 98·6, 99·5) and accuracy 77·9 % (95 % CI 76·6, 79·2). When the analyses were stratified by maternal and infant characteristics, the sensitivity remained around 98 %, and the specificity ranged from 64·4 to 81·8 %.Conclusions:EBF recalled at the end of the first year of infant’s life is a valid measure to be used in epidemiological investigations.

Introduction/Background* Endometrial cancer (EC) is the most common gynecologic malignancy in developed countries and the main treatment consists of surgery . Myometrial invasion is commonly used in guiding surgical extent and can be evaluated by intraoperative assessment (IOA). There are studies that show different reports regarding its adequacy and reliability. The aim of this study was to assess the diagnostic accuracy of IOA comparing with definitive histopathologic report surgically resected EC. Methodology We analysed retrospectively all patients submitted to surgical staging for presumed EC with a definitive diagnosis of endometrioid carcinoma grade 1 and 2 at a tertiary hospital in 2017-2020. Results of IOA were compared to the final pathology report. The accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the IOA were calculated. Result(s)* A total of 97 patients underwent surgical staging for EC. We had 41 women with histologically confirmed endometrioid carcinoma in which 39 were performed the IOA. The IOA had an accuracy of 82,1%, sensitivity of 64,3%, specificity of 92%, PPV of 81,8% and NPV of 82,1% in predicting miometrial invasion. In the definitive histopathological report 26 patients were classified with stage IA and 13 with stage IB. In the 27 cases identified as stage IA in IOA, the pathology reported stage IB in 4/39 (10,2%). 11/39 (28,2%) cases were identified as stage IB in IOA, and only 2/39 (5,1%) were in fact stage IA in the final pathology report. Surgery, based on the result of the IOA, caused undertreatment in 4/39 (10,2%) and overtreatment in 2/39 (5,1%) patients. Conclusion* Our IOA results have reasonable accuracy rates in predicting malignancy. However, the concordance of tumor myometrial invasion between IOA and pathology report was suboptimal, leading to the need of a secondary surgery in some patients.

Introduction/Background* Intraoperative frozen section (IFS) is considered a relevant procedure to categorize adnexal lesions as benign, borderline or malignant. The aim of this study is to determine the accuracy of IFS performed in our tertiary referral centre by assessing its correlation with definitive histopathologic diagnosis. Methodology This retrospective study included 89 patients with adnexal tumours, who consecutively underwent surgery and intraoperative histopathological examination in our Institution between 2017 and 2020. IFS was compared to definitive histopathological diagnosis and sensitivity, specificity, positive predictive value, negative predictive value and accuracy of IFS were determined according to malignancy status, with a 95% confidence interval (CI). Result(s)* Mean patient age was 56.3 years (SD 14.3) and 53.9% (48/89) were post-menopausal. IFS indicated benign tumours in 60 cases (67.4%), borderline in 12 (13.5%) and malignant in 17 (19.1%). Definitive histopathologic assessment diagnosed benign tumours in 58 cases (65.2%), borderline in 15 (16.9%) and malignant in 16 cases (18%). Concordance between IFS and definitive histopathologic diagnosis was found in 77 cases (86.5%). Overall accuracy of IFS was 92.1% for malignant tumours, 91.0% for benign and 89.9% for borderline. Conclusion* In our series of patients, in agreement with previously published data, IFS was an important tool in the assessment of adnexal masses, allowing an adequate surgical staging of invasive malignancies. With low positive predictive value, IFS presented limitations in the diagnosis of borderline tumours.

Bacterial meningitis (BM) is associated with a high morbidity and mortality. Cerebrospinal fluid (CSF) lactate may be used as a prognostic marker of this condition. We hypothesized that CSF lactate levels would remain elevated in participants who died of acute BM compared with those who recovered from this disease. Objective: To evaluate the potential use of lactate and other CSF biomarkers as prognostic markers of acute BM outcome. Methods: This retrospective, longitudinal study evaluated dynamic CSF biomarkers in 223 CSF samples from 49 patients who fulfilled the inclusion criteria of acute BM, with bacteria identified by CSF culturing. The participants were grouped according to outcome: death (n = 9; 18.37%) and survival (n = 40; 81.63%). All participants received appropriate antibiotic treatment. Results: In the logistic regression model, lactate concentration in the final CSF sample, xanthochromia, and CSF glucose variation between the first and last CSF samples were predictors of a poor outcome (death). In contrast, decrease in CSF white blood cell count and CSF percentage of neutrophils, increase in the percentage of lymphocytes, and normalization of the CSF lactate concentration in the last CSF sample were predictors of a good prognosis. Conclusion: The study confirmed the initial hypothesis. The longitudinal analysis of CSF lactate is an important predictor of prognosis in acute BM. RESUMO As meningites bacterianas (MB) estão associadas à alta morbidade e mortalidade. O lactato no líquido cefalorraquidiano (LCR) pode ser usado como biomarcador de prognóstico nas MB. A hipótese desse estudo é que os níveis de lactato no LCR se mantém elevados entre pacientes com MB aguda que evoluem para óbito, ao contrário do que ocorre em pacientes com bom prognóstico. Objetivo: Avaliar o uso potencial do lactato e outros marcadores no LCR como indicador de prognóstico na MB aguda. Métodos: Foi realizado um estudo retrospectivo longitudinal da dinâmica dos biomarcadores bioquímicos, celulares e físicos no LCR. Foram analisadas 223 amostras de 49 pacientes com MB aguda com bactérias identificadas por cultura do LCR. Os participantes foram divididos em dois grupos de acordo com o desfecho: óbito (n = 9; 18,37%) e não óbito (n = 40; 81,63%). Todos os participantes receberam antibioticoterapia adequada. Resultados: No modelo de regressão logística, as variáveis que diferiram significativamente entre os dois grupos foram concentração de lactato na amostra final de LCR, xantocromia e variação da concentração de glicose entre a primeira e a última amostra de LCR. A alteração desses fatores indicou desfechos negativos (óbito), enquanto a diminuição do número de leucócitos e da porcentagem de neutrófilos, assim como a normalização da concentração de lactato no LCR foram preditores de bom prognóstico. Conclusão: O estudo confirmou a hipótese inicial. A análise longitudinal do lactato no LCR é um importante preditor de prognóstico na MB aguda.

Introduction: Web-based epidemiologic surveys are being widely used, but still present lower response rates compared to traditional methods. Their design can influence survey response rates.Objecti...

To investigate the influence of maternal depression on child health-care services utilization.Data from The Pelotas 2004 Birth Cohort collected at birth and at 12- and 24-month follow-ups were used. Four outcomes occurring in the second year of life were investigated: number of well-baby visits, number of medical appointments, number of visits to emergency rooms, and number of hospitalizations. The main exposure was maternal depression symptoms at 12-month post-partum as assessed by the Edinburgh Postpartum Depression Scale (EPDS). Adjusted prevalence ratios (PR) with 95% confidence intervals (95% CI) were calculated by Poisson regression.The prevalence of mothers with depressive symptoms was 27.6% (95% CI: 26.2-29.0%). These mothers showed a 10% lower probability of taking their children to well-baby visits (0.90; 0.85-0.95; p = 0.001); 16% higher probability to seek medical consultations (1.16; 1.09-1.25, p = 0.001); and they sought emergency services for their children more often (1.30; 1.17-1.45, p 0.001) as compared to mothers who did not present depressive symptoms. Although the PR for hospitalizations was 26% higher for children from mothers with depressive symptoms, the association did not achieve statistical significance (1.26; 0.98-1.63; p = 0.072).Children from mothers with depressive symptoms attend fewer number of preventive consultations. In contrast, they are taken to medical and emergency care more often, suggesting that these children are given healthcare when they are at more advanced stages of their illnesses.

Background Non-supine infant sleep position is an important modifiable risk factor for sudden unexpected death in infancy. The aim of this study was to assess the prevalence of supine sleep position and associated factors among 3-month-old infants from a birth cohort in the city of Pelotas, southern Brazil. Methods The present study evaluated longitudinal data from the 2015 Pelotas Birth Cohort. Study outcome was supine infant sleep position, defined as the appropriate position, among 3-month-old children. Demographic, socioeconomic, behavioral, and health characteristics collected at birth and at the 3-month follow-up were investigated as possible associated factors. The prevalence of each associated factor was investigated, and crude and hierarchical adjusted analyses were performed using Poisson regression. Results Among the 4108 infants assessed in this study, 2274 (55.4%) slept in supine position at 3 months and only 66 (1.6%) in prone position. Maternal white skin color, higher family income and maternal schooling, advanced maternal age, maternal cohabiting with a partner, receiving counseling from health care professionals and non-bed-sharing were associated with higher prevalence of infants sleeping in supine position at 3 months. All these variables remained associated in our hierarchical adjusted analyses except maternal cohabitation with a partner. Participants with white mothers were more likely to sleep in supine position (PR: 1.23; 95%CI: 0.75–0.89) compared to participants with black mothers. Those belonging to the richest quintile were more likely to sleep in supine position (PR: 1.49; 95%CI: 1.35–1.65) compared to those who belong to the poorest. Mothers aged 31–36 years were more likely to choose supine sleep position (PR: 1.65; 95%CI: 1.42–1.92) compared to mothers younger than 19 years. Conclusions The findings of the present study showed the influence of maternal age, socioeconomic status, and counseling on infant sleep habits as predictors of choice of infant sleep position in a Brazilian population. It is recommended to implement informative campaigns and public policies to at-risk population and to improve recommendations from health care professionals.

OBJECTIVE To evaluate the prevalence of oral mucosal lesions (OML) and oral self-examination and their associated factors among pregnant women from the 2015 Pelotas Birth Cohort Study, Brazil. METHODS Pregnant women who would deliver babies in 2015 were included in the antenatal study. Data related to demographic, socio-economic and behavioural conditions were collected using questionnaires. Participants were also clinically assessed for oral health outcomes. The outcomes were the presence of OMLs and oral self-examination. Size, location, time of onset and symptomatology of the lesions were collected. Descriptive and bivariate analysis, and Poisson regression were performed. p-Value

Objective: To analyze early and late maternal complications associated with the mode of delivery in a birth cohort in Brazil, using the propensity score technique for analysis. Methods: This is a prospective cohort study, using data from the Pelotas Birth Cohort, RS, 2004. A total of 4,189 women were included and a descriptive analysis of the data and subsequent calculation of the propensity and pairing score of vaginal delivery women and cesarean delivery women with similar scores (1,366 pairs). We then assessed the difference in outcome risk between the groups. Results: Women in the cesarean group had 2.9 percentage points (pp) more risk of postpartum infection, 1.13 p.p. more risk of urinary infection, 1.10 p.p. more risk of anesthetic complications and 1.24 p.p. higher risk of headache compared to vaginal delivery, but less risk of anemia (-2.43 pp) and hemorrhoids (-1.24 p.p.). The use of propensity scores is extremely useful for reducing bias and increasing accuracy in observational studies when experimental studies cannot be performed. Conclusion: Cesarean sections have been associated with a higher prevalence of postpartum and urinary tract infections, anesthetic complications and headache and lower prevalence of anemia and hemorrhoids, so they should be performed with clear indications and when their benefits outweigh potential risks. RESUMO: Objetivo: Analisar as complicações maternas precoces e tardias, associadas à via de parto, em uma coorte de nascimentos no Brasil, utilizando para a análise a técnica de escores de propensão. Métodos: Trata-se de estudo do tipo coorte prospectiva, utilizando dados da Coorte de Nascimentos de Pelotas (RS), de 2004. Incluíram-se 4.189 mulheres, e realizaram-se análise descritiva dos dados e posterior cálculo do escore de propensão e pareamento das mulheres de parto vaginal com as mulheres de parto cesárea com escores semelhantes (1.366 pares), avaliando a diferença no risco do desfecho entre os grupos. Resultados: As mulheres do grupo cesárea apresentaram 2,9 pontos percentuais (p.p.) a mais de risco de infecção pós-parto, 1,13 p.p. a mais de risco de infecção urinária, 1,10 p.p. a mais de risco de complicações anestésicas e 1,24 p.p. a mais de risco de cefaleia que as de parto vaginal, porém apresentaram menor risco de anemia (-2,43 p.p.) e hemorroidas (-1,24 p.p.). A utilização de escores de propensão é extremamente útil para a redução de vieses e o aumento da precisão em estudos observacionais, quando estudos experimentais não podem ser realizados. Conclusão: As cesáreas associaram-se a maiores prevalências de infecções pós-parto e urinária, complicações anestésicas e cefaleia e menores prevalências de anemia e hemorroidas, portanto devem ser realizadas com indicações claras e quando seus benefícios superam potenciais riscos.

Evidence suggests that maternal prepregnancy body mass index (BMI) is associated with offspring cardiometabolic risk factors. This study was aimed at assessing the association of maternal prepregnancy BMI with offspring cardiometabolic risk factors in adolescence and adulthood. We also evaluated whether offspring BMI was a mediator in this association. The study included mother–offspring pairs from three Pelotas birth cohorts. Offspring cardiometabolic risk factors were collected in the last follow-up of each cohort [mean age (in years) 30.2, 22.6, 10.9]. Blood pressure was measured using an automatic device, cholesterol by using an enzymatic colorimetric method, and glucose from fingertip blood, using a portable glucose meter. In a pooled analysis of the cohorts, multiple linear regression was used to control for confounding. Mediation analysis was conducted using G-computation formula. In the adjusted model, mean systolic blood pressure of offspring from overweight and obese mothers was on average 1.25 (95% CI: 0.45; 2.05) and 2.13 (95% CI: 0.66; 3.59) mmHg higher than that of offspring from normal-weight mothers; for diastolic blood pressure, the means were 0.80 (95% CI: 0.26; 1.34) and 2.60 (95% CI: 1.62; 3.59) mmHg higher, respectively. Non-HDL cholesterol was positively associated with maternal BMI, whereas blood glucose was not associated. Mediation analyses showed that offspring BMI explained completely the association of maternal prepregnancy BMI with offspring systolic and diastolic blood pressure, and non-HDL cholesterol. Our findings suggest that maternal prepregnancy BMI is positively associated with offspring blood pressure, and blood lipids, and this association is explained by offspring BMI.

Background: Human growth is susceptible to damage from insults, particularly during periods of rapid growth. Identifying those periods and the normative limits that are compatible with adequate growth and development are the first key steps toward preventing impaired growth. Objective: This study aimed to construct international fetal growth velocity increment and conditional velocity standards from 14 to 40 weeks’ gestation based on the same cohort that contributed to the INTERGROWTH-21st Fetal Growth Standards. Study Design: This study was a prospective, longitudinal study of 4321 low-risk pregnancies from 8 geographically diverse populations in the INTERGROWTH-21st Project with rigorous standardization of all study procedures, equipment, and measurements that were performed by trained ultrasonographers. Gestational age was accurately determined clinically and confirmed by ultrasound measurement of crown-rump length at Results: Peak velocity was observed at a similar gestational age: 16 and 17 weeks’ gestation for head circumference (12.2 mm/wk), and 16 weeks’ gestation for abdominal circumference (11.8 mm/wk) and femur length (3.2 mm/wk). However, velocity growth slowed down rapidly for head circumference, biparietal diameter, occipitofrontal diameter, and femur length, with an almost linear reduction toward term that was more marked for femur length. Conversely, abdominal circumference velocity remained relatively steady throughout pregnancy. The change in velocity with gestational age was more evident for head circumference, biparietal diameter, occipitofrontal diameter, and femur length than for abdominal circumference when the change was expressed as a percentage of fetal size at 40 weeks’ gestation. We have also shown how to obtain accurate conditional fetal velocity based on our previous methodological work. Conclusion: The fetal skeleton and abdomen have different velocity growth patterns during intrauterine life. Accordingly, we have produced international Fetal Growth Velocity Increment Standards to complement the INTERGROWTH-21st Fetal Growth Standards so as to monitor fetal well-being comprehensively worldwide. Fetal growth velocity curves may be valuable if one wants to study the pathophysiology of fetal growth. We provide an application that can be used easily in clinical practice to evaluate changes in fetal size as conditional velocity for a more refined assessment of fetal growth than is possible at present (https://lxiao5.shinyapps.io/fetal_growth/). The application is freely available with the other INTERGROWTH-21st tools at https://intergrowth21.tghn.org/standards-tools/.

Background Gestational hypertensive and acute hypotensive disorders are associated with maternal morbidity and mortality worldwide. However, physiological blood pressure changes in pregnancy are insufficiently defined. We describe blood pressure changes across healthy pregnancies from the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) Fetal Growth Longitudinal Study (FGLS) to produce international, gestational age-specific, smoothed centiles (third, 10th, 50th, 90th, and 97th) for blood pressure. Methods and findings Secondary analysis of a prospective, longitudinal, observational cohort study (2009 to 2016) was conducted across 8 diverse urban areas in Brazil, China, India, Italy, Kenya, Oman, the United Kingdom, and the United States of America. We enrolled healthy women at low risk of pregnancy complications. We measured blood pressure using standardised methodology and validated equipment at enrolment at 14 mmHg or diastolic blood pressure by >11 mmHg in fewer than 10% of women at any gestational age. Fewer than 10% of women increased their systolic blood pressure by >24 mmHg or diastolic blood pressure by >18 mmHg at any gestational age. The study’s main limitations were the unavailability of prepregnancy blood pressure values and inability to explore circadian effects because time of day was not recorded for the blood pressure measurements. Conclusions Our findings provide international, gestational age-specific centiles and limits of acceptable change to facilitate earlier recognition of deteriorating health in pregnant women. These centiles challenge the idea of a clinically significant midpregnancy drop in blood pressure., Lauren Green and colleagues study blood pressure in pregnant women across a range of countries., Author summary Why was this study done? Internationally applicable gestational age-specific centiles for blood pressure are needed in clinical practice to determine when women have left the “normal” range. It is uncertain whether clinically significant decreases in blood pressure occur between early and midpregnancy. What did the researchers do and find? We estimated international gestational age-specific blood pressure centiles using longitudinal blood pressure data provided by women from 8 countries who took part in the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) Project. On average, systolic blood pressure rose by around 8 mmHg between 12 and 40 weeks’ gestation, with no decrease in midpregnancy. Diastolic blood pressure decreased slightly (by around 0.6 mmHg) between 12 and 19 weeks, rising thereafter until 40 weeks’ gestation. At any gestational age, systolic blood pressure fell by >14 mmHg and diastolic blood pressure by >11 mmHg from baseline in fewer than 10% of women. Fewer than 10% of women increased their systolic blood pressure by >24 mmHg or diastolic blood pressure by >18 mmHg at any gestational age. What do these findings mean? Our findings challenge the frequently quoted midpregnancy blood pressure decrease, advocating for a higher index of clinical suspicion when a woman presents with a “lower than booking” blood pressure, especially in late pregnancy. We show the limits for acceptable change in blood pressure during healthy pregnancy, which should help clinicians determine patients with abnormal blood pressure rises and falls.

BackgroundIntimate partner violence (IPV) against women and child maltreatment (CM) are major public health problems and human rights issues and may have shared causes. However, their overlap is understudied. We investigated the prevalence of IPV and CM, their co-occurrence in households and possible shared risk factors, in the general population of a Brazilian urban setting.MethodsProspective population-based birth cohort, including over 3500 mother–child dyads with maternal reports on both IPV and CM when children were 4 years old. Eleven neighbourhood, family and parental risk factors were measured between birth and age 4 years. Bivariate and multivariate Poisson regression models with robust variance were used to test which potential risk factors were associated with IPV, CM and their co-occurrence.ResultsThe prevalence of any IPV and CM were 22.8% and 10.9%, respectively; the co-occurrence of both types of violence was 5%. Multivariate analyses showed that the overlap of IPV and CM was strongly associated with neighbourhood violence, absence of the child’s biological father, paternal antisocial behaviour in general and a mother–partner relationship characterised by high levels of criticism, maternal depression and younger maternal age. A concentration of many risk factors among 10% of the population was associated with a sixfold increase in risk for overlapping IPV and CM compared with households with no risk factors.ConclusionIPV and CM share important risk factors in the family and neighbourhood environments and are particularly common in households with multiple social disadvantages and family difficulties. Integrated preventive interventions are needed.

OBJECTIVE: To construct international ultrasound-based standards for fetal cerebellar growth and Sylvian fissure maturation. METHODS: Healthy, well nourished pregnant women, enrolled at

Key Points Question Are specific phenotypes in preterm newborns associated with clinical, growth, and neurodevelopmental differences at age 2 years compared with term newborns? Findings In this cohort study of 6529 preterm and term newborns who were followed up from birth to age 2 years, 8 preterm-birth phenotypes were identified: no main maternal, fetal, or placental condition detected (35%); infections (21%); preeclampsia (12%); fetal distress (10%); intrauterine growth restriction (8%); severe maternal disease (6%); bleeding (5%); and congenital anomaly (4%). Each phenotype was associated with substantial differences in neonatal morbidity and infant outcomes. Meaning The study’s findings support the use of phenotypic classification for preterm births., Importance The etiologic complexities of preterm birth remain inadequately understood, which may impede the development of better preventative and treatment measures. Objective To examine the association between specific preterm-birth phenotypes and clinical, growth, and neurodevelopmental differences among preterm newborns compared with term newborns up to age 2 years. Design, Setting, and Participants The INTERBIO-21st study included a cohort of preterm and term newborn singletons enrolled between March 2012 and June 2018 from maternity hospitals in 6 countries worldwide who were followed up from birth to age 2 years. All pregnancies were dated by ultrasonography. Data were analyzed from November 2019 to October 2020. Exposures/Interventions Preterm-birth phenotypes. Main Outcomes and Measures Infant size, health, nutrition, and World Health Organization motor development milestones assessed at ages 1 and 2 years; neurodevelopment evaluated at age 2 years using the INTERGROWTH-21st Neurodevelopment Assessment (INTER-NDA) tool. Results A total of 6529 infants (3312 boys [50.7%]) were included in the analysis. Of those, 1381 were preterm births (mean [SD] gestational age at birth, 34.4 [0.1] weeks; 5148 were term births (mean [SD] gestational age at birth, 39.4 [0] weeks). Among 1381 preterm newborns, 8 phenotypes were identified: no main maternal, fetal, or placental condition detected (485 infants [35.1%]); infections (289 infants [20.9%]); preeclampsia (162 infants [11.7%]); fetal distress (131 infants [9.5%]); intrauterine growth restriction (110 infants [8.0%]); severe maternal disease (85 infants [6.2%]); bleeding (71 infants [5.1%]); and congenital anomaly (48 infants [3.5%]). For all phenotypes, a previous preterm birth was a risk factor for recurrence. Each phenotype displayed differences in neonatal morbidity and infant outcomes. For example, infants with the no main condition detected phenotype had low neonatal morbidity but increased morbidity and hospitalization incidence at age 1 year (odds ratio [OR], 2.2; 95% CI, 1.8-2.7). Compared with term newborns, the highest risk of scoring lower than the 10th centile of INTER-NDA normative values was observed in the fine motor development domain among newborns with the fetal distress (OR, 10.6; 95% CI, 5.1-22.2) phenotype. Conclusions and Relevance Results of this study suggest that phenotypic classification may provide a better understanding of the etiologic factors and mechanisms associated with preterm birth than continuing to consider it an exclusively time-based entity., This cohort study, part of the INTERBIO-21st Newborn Study, an extension of the INTERGROWTH-21st Project, examines the association between preterm-birth phenotypes and clinical, growth, and neurodevelopmental differences among preterm newborns compared with term newborns up to age 2 years.

Background West Nile virus (WNV) is a mosquito-borne pathogen with a globally expanding geographical range. Many European countries regularly report outbreaks affecting both human and equine populations, with an increase in epidemic activity in the past decade. Portugal, on the far west of Europe, has not yet experienced large outbreaks of WNV, despite its suitable Mediterranean climate. Objectives To provide a comprehensive, data-driven perspective on the past epidemiology, surveillance and transmission suitability of WNV in Portugal. Methods Literature and database reviews were performed, covering the period between 1966 and 2020 on existing evidence for WNV circulation. Climatic data was used to estimate the theoretical transmission potential of WNV, and to analyse long-term climate trends between 1981 and 2019. Results Existing data show that WNV-capable mosquito species are spread across the country, while WNV molecular and serological evidence is vastly concentrated in the south. Our analyses suggest that two different climate types, characteristic of the north and south of Portugal, contribute to quantitative differences in WNV theoretical transmission potential. This supports the north-south divide observed from previous molecular and serological evidence. Due to long-term changes in local climate, suitability for WNV transmission is shown to have been slowly increasing in the country. Discussion Data and theoretical analyses support the notion that the south of Portugal is more suitable for WNV transmission, while not rejecting the possibility of transmission in the north. Mosquito monitoring has been effective, but surveillance of key sentinel species remains passive, creating important knowledge gaps for epidemic control and public health. To date, evidence supports WNV circulation, but it remains unclear whether it is endemic or sporadically transmitted. This study supports a timely change towards WNV active surveillance, to avoid and mitigate potential public health emergencies as those recently observed in other European countries.

Objective This study investigated the role of oral health self-perception as mediator of association between dental caries and depression among pregnant women from the 2015 Pelotas Birth Cohort Study, Brazil. Materials and methods Overall, 2,496 pregnant women participated of this oral health sub-study. Data related to demographic and socioeconomic conditions, lifetime and current depression, and oral health self-perception were collected. Participants were also assessed for dental caries (DMF-T index). Depression was assessed using the Edinburgh Postnatal Depression Scale. For analysis, six outcomes related to dental caries experience were considered. Causal mediation analysis was performed using parametric regression models. Results When it was assumed that all subjects had poor perception about oral health, it was observed that the presence of moderate/severe depressive signals and symptoms was higher in subjects with dental caries experience (OR 1.13; CI 95% 1.06-1.20), with severity of untreated dental caries (OR 2.08; CI 95% 1.16-3.78), untreated dental caries (OR 1.18; 95% CI 1.07-1.29), tooth loss (OR 1.08; 95% CI 1.02-1.14), and filled tooth (OR 1.07; 95% CI 1.02-1.16). Conclusions Our findings show the effect of dental caries on depression is mediated by self-perception about oral health in pregnant women.

IntroductionAsymptomatic carriers (AC) of the new SARS-CoV-2 represent an important source of spread for COVID-19. Early diagnosis of these cases is a powerful tool to control the pandemic. Our objective was to characterise patients with AC status and identify associated sociodemographic factors.MethodsUsing a cross-sectional design and the national database of daily occurrence of COVID-19, we characterised both socially and demographically all ACs. Additional correspondence analysis and logistic regression model were performed to identify characteristics associated with AC state (OR, 95% CI).Results76.162 ACs (12.1%; 95% CI 12.0% to 12.2%) were identified, mainly before epidemiological week 35. Age≤26 years (1.18; 1.09 to 1.28), male sex (1.51; 1.40 to 1.62), cases imported from Venezuela, Argentina, Brazil, Germany, Puerto Rico, Spain, USA or Mexico (12.6; 3.03 to 52.5) and autochthonous cases (22.6; 5.62 to 91.4) increased the risk of identifying ACs. We also identified groups of departments with moderate (1.23; 1.13 to 1.34) and strong (19.8; 18.6 to 21.0) association with ACs.ConclusionSociodemographic characteristics strongly associated with AC were identified, which may explain its epidemiological relevance and usefulness to optimise mass screening strategies and prevent person-to-person transmission.

Background Anaemia in pregnancy is a global health problem with associated morbidity and mortality. Methods A secondary analysis of prospective, population-based study from 2009 to 2016 to generate maternal haemoglobin normative centiles in uncomplicated pregnancies in women receiving optimal antenatal care. Pregnant women were enrolled Findings A total of 3502 (81%) of 4321 women who delivered a live, singleton newborn with no visible congenital anomalies, contributed at least one haemoglobin value. Median haemoglobin concentrations ranged from 114.6 to 121.4 g/L, 94 to 103 g/L at the 3rd centile, and from 135 to 141 g/L at the 97th centile. The lowest values were seen between 31 and 32 weeks’ gestation, representing a mean drop of 6.8 g/L compared to 14 weeks’ gestation. The percentage variation in maternal haemoglobin within-site was 47% of the total variance compared to 13% between sites. Interpretation We have generated International, gestational age-specific, smoothed centiles for maternal haemoglobin concentration compatible with better pregnancy outcomes, as well as adequate neonatal and early childhood morbidity, growth and development up to 2 years of age. Funding Bill & Melinda Gates Foundation Grant number 49038.

Highlights • ACT and DBS were well accepted by participants in a middle-income country (Brazil). • Attendance rates of the interventions were high (ACT = 64.2%; DBS = 76.6%). • Few variables predicted attendance rates in this study., Parent training programmes have significant potential to improve the quality of children's early environments and thereby their development and life-course outcomes. The aim of this study was to identify and explain the extent to which parents engaged in two group-based training programmes, offered to high-risk families enrolled in a randomized controlled trial study called PIÁ in Southern Brazil. The programmes were: (1) ACT: Raising Safe Kids, a 9-week programme aiming to reduce harsh parenting and maltreatment and improve positive parenting practices; (2) Dialogic book-sharing (DBS), an 8-week programme aiming to promote parental sensitivity and improve child cognitive development and social understanding. Of the 123 mothers randomly allocated to the ACT programme, 64.2% (n = 79) completed the course, and of 124 mothers allocated to DBS, 76.6% (n = 95) completed the course. After the interventions, mothers were very positive about the experience of both programmes but highlighted practical difficulties in attending. In adjusted regression analyses, only two variables significantly predicted ACT course completion (maternal age and distance between the intervention site and household); no significant predictor was found for DBS attendance. We conclude that although high completion rates are possible, there are important challenges to engaging parents of young children in training programmes, and practical difficulties occurring during training courses may be more important for attendance than baseline participant characteristics.

OBJECTIVES To verify the association between periodontal conditions and preterm birth. MATERIALS AND METHODS This study used data from the 2015 Pelotas Birth Cohort Study, Brazil. Pregnant women expected to give birth in 2015 were interviewed and dentally examined by a trained dentist, with periodontal measures collected in all teeth, six sites per tooth. Exposure was periodontal disease. Outcomes were preterm birth (all births

Objective We set forth to build a prediction model of individuals who would develop bipolar disorder (BD) using machine learning techniques in a large birth cohort. Methods A total of 3748 subjects were studied at birth, 11, 15, 18, and 22 years of age in a community birth cohort. We used the elastic net algorithm with 10-fold cross-validation to predict which individuals would develop BD at endpoint (22 years) at each follow-up visit before diagnosis (from birth up to 18 years). Afterward, we used the best model to calculate the subgroups of subjects at higher and lower risk of developing BD and analyzed the clinical differences among them. Results A total of 107 (2.8%) individuals within the cohort presented with BD type I, 26 (0.6%) with BD type II, and 87 (2.3%) with BD not otherwise specified. Frequency of female individuals was 58.82% (n = 150) in the BD sample and 53.02% (n = 1868) among the unaffected population. The model with variables assessed at the 18-year follow-up visit achieved the best performance: AUC 0.82 (CI 0.75-0.88), balanced accuracy 0.75, sensitivity 0.72, and specificity 0.77. The most important variables to detect BD at the 18-year follow-up visit were suicide risk, generalized anxiety disorder, parental physical abuse, and financial problems. Additionally, the high-risk subgroup of BD showed a high frequency of drug use and depressive symptoms. Conclusions We developed a risk calculator for BD incorporating both demographic and clinical variables from a 22-year birth cohort. Our findings support previous studies in high-risk samples showing the significance of suicide risk and generalized anxiety disorder prior to the onset of BD, and highlight the role of social factors and adverse life events.

Since the beginning of the pandemic of COVID-19, there has been a widespread assumption that most infected persons are asymptomatic. Using data from the recent wave of the EPICOVID19 study, a nationwide household-based survey including 133 cities from all states of Brazil, we estimated the proportion of people with and without antibodies for SARS-CoV-2 who were asymptomatic, which symptoms were most frequently reported, number of symptoms and the association with socio-demographic characteristics. We tested 33,205 subjects using a rapid antibody test previously validated. Information was collected before participants received the test result. Out of 849 (2.7%) participants positive for SARS-CoV-2 antibodies, only 12.1% (95% CI 10.1–14.5) reported no symptoms, compared to 42.2% (95% CI 41.7–42.8) among those negative. The largest difference between the two groups was observed for changes in smell/taste (56.5% versus 9.1%, a 6.2-fold difference). Changes in smell/taste, fever and body aches were most likely to predict positive tests as suggested by recursive partitioning tree analysis. Among individuals without any of these three symptoms, only 0.8% tested positive, compared to 18.3% of those with both fever and changes in smell or taste. Most subjects with antibodies against SARS-CoV-2 are symptomatic, even though most present only mild symptoms.

Introduction Venezuela and Colombia both adopted measures of containment early in response to the COVID-19 pandemic. However, Venezuela's ongoing humanitarian crisis has decimated its health care system, and forced millions of Venezuelans to flee through its porous border with Colombia. The extensive shared border, and illegal cross-border transit through improvised trails between the two countries are major challenges for public health authorities. We report the first SARS-CoV-2 genomes from Venezuela, and present a snapshot of the SARS-CoV-2 epidemiologic landscape in the Colombian-Venezuelan border region. Methods We sequenced and assembled viral genomes from total RNA extracted from nasopharyngeal (NP) clinical specimens using a custom reference-based analysis pipeline. Three assemblies obtained were subjected to typing using the Phylogenetic Assignment of Named Global Outbreak LINeages ‘Pangolin’ tool. A total of 376 publicly available SARS-CoV-2 genomes from South America were obtained from the GISAID database to perform comparative genomic analyses. Additionally, the Wuhan-1 strain was used as reference. Results We found that two of the SARS-CoV-2 genomes from Venezuela belonged to the B1 lineage, and the third to the B.1.13 lineage. We observed a point mutation in the Spike protein gene (D614G substitution), previously reported to be associated with increased infectivity, in all three Venezuelan genomes. Additionally, three mutations (R203K/G204R substitution) were present in the nucleocapsid (N) gene of one Venezuelan genome. Conclusions Genomic sequencing demonstrates similarity between SARS-CoV-2 lineages from Venezuela and viruses collected from patients in bordering areas in Colombia and from Brazil, consistent with cross-border transit despite administrative measures including lockdowns. The presence of mutations associated with increased infectivity in the 3 Venezuelan genomes we report and Colombian SARS-CoV-2 genomes from neighboring borders areas may pose additional challenges for control of SARS-CoV-2 spread in the complex epidemiological landscape in Latin American countries. Public health authorities should carefully follow the progress of the pandemic and its impact on displaced populations within the region., Highlights • SARS-CoV-2 genomes obtained from Venezuela reveal the presence of B1 and B.1.13 lineages, suggesting two separate introductions. • All Venezuelan genomes carried a D614G substitution in the spike (S) protein, which has been linked to increased infectivity. • Three substitutions in the nucleocapsid (N) gene were additionally identified in one of the examined genomes.

Objectives Neck and low back pains are the leading causes of years lived with disability, and using computers or mobile devices in excess could be risk factors for back pain. Our aim was to evaluate the association of the length of time using computers and mobile devices with neck, mid-back and low back pains and the number of regions with pain. Study design Cross-sectional study nested in the 1993 Pelotas birth cohort with young adults aged 22 years. Methods Outcomes analyzed were neck, mid-back and low back pains and the number of regions with pain. Exposures were the number of daily hours using computers and mobile devices. Crude and adjusted analyses were performed to estimate prevalence ratios using Poisson regression. Results Almost half of the sample reported having back pain, the low back pain being the most prevalent. Compared with individuals using mobile devices for less than one hour, the prevalence of neck pain was 1.41 and 1.81 times higher among individuals using mobile devices from three to seven hours and for seven or more hours per day, respectively. Neck pain prevalence was 1.47 times higher among individuals using computers for more than two hours than among those not using computers. Using mobile devices for seven hours or more was associated to 1.19 times higher prevalence of low back pain. Conclusion Using mobile devices in excess was associated to neck and low back pains, while the use of computers in excess was associated only to neck pain. It is important that guidelines are developed to recommend the adequate length of time that computers and mobile devices should be used to prevent back pain.

ObjectiveAsymptomatic carriers (AC) of the new Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) represent an important source of spread for Coronavirus Disease 2019 (COVID-19). Early diagnosis of these cases is a powerful tool to control the pandemic. Our objective was to characterize patients with AC status and identify associated sociodemographic factors.MethodsUsing a cross-sectional design and the national database of daily occurrence of COVID-19, we characterized both socially and demographically all ACs. Additional Correspondence Analysis and Logistic Regression Model were performed to identify characteristics associated with AC state (OR, 95% CI).Results2338 ACs (11.8%; 95% CI, 11.3-12.2%) were identified, mainly in epidemiological week 18 [EW] (3.98; 3.24-4.90). Age ≤ 39 years (1.56; 1.42-1.72). Male sex (1.39; 1.26-1.53), cases imported from Argentina, Spain, Peru, Brazil, Costa Rica or Mexico (3.37; 1.47-7.71) and autochthonous cases (4.35; 2.12-8.93) increased the risk of identifying AC. We also identified groups of departments with moderate (3.68; 3.13-4.33) and strong (8.31; 6.10-7.46) association with AC.DiscussionSociodemographic characteristics strongly associated with AC were identified, which may explain its epidemiological relevance and usefulness to optimize mass screening strategies and prevent person-to-person transmission.

Background: Reference values for umbilical artery Doppler indices are used clinically to assess fetal well-being. However, many studies that have produced reference charts have important methodologic limitations, and these result in significant heterogeneity of reported reference ranges. Objectives: To produce international gestational age-specific centiles for umbilical artery Doppler indices based on longitudinal data and the same rigorous methodology used in the original Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project. Study Design: In Phase II of the INTERGROWTH-21st Project (the INTERBIO-21st Study), we prospectively continued enrolling pregnant women according to the same protocol from 3 of the original populations in Pelotas (Brazil), Nairobi (Kenya), and Oxford (United Kingdom) that had participated in the Fetal Growth Longitudinal Study. Women with a singleton pregnancy were recruited at Results: Of the women enrolled at the 3 sites, 1629 were eligible for this study; 431 (27%) met the entry criteria for the construction of normative centiles, similar to the proportion seen in the original fetal growth longitudinal study. They contributed a total of 1243 Doppler measures to the analysis; 74% had 3 measures or more. The healthy low-risk status of the population was confirmed by the low rates of preterm birth (4.9%) and preeclampsia (0.7%). There were no neonatal deaths and satisfactory growth, health, and motor development of the infants at 1 and 2 years of age were documented. Only a very small proportion (2.8%–6.5%) of the variance of Doppler indices was due to between-site differences; in addition, standardized site difference estimates were marginally outside this threshold in only 1 of 27 comparisons, and this supported the decision to pool data from the 3 study sites. All 3 Doppler indices decreased with advancing gestational age. The 3rd, 5th 10th, 50th, 90th, 95th, and 97th centiles according to gestational age for each of the 3 indices are provided, as well as equations to allow calculation of any value as a centile and z scores. The mean pulsatility index according to gestational age = 1.02944 + 77.7456*(gestational age)–2 – 0.000004455*gestational age3. Conclusion: We present here international gestational age-specific normative centiles for umbilical artery Doppler indices produced by studying healthy, low-risk pregnant women living in environments with minimal constraints on fetal growth. The centiles complement the existing INTERGROWTH-21st Standards for assessment of fetal well-being.

Objective The objective of the present study was to investigate the associated factors with short and long sleep duration at ages 11 (pre-adolescence) and 22 years old (early adulthood). Methods Participants of the 1993 Pelotas birth cohort with self-reported sleep records at 11 (n = 4442) and 22 (n = 3800) years were included. The total sleep time duration was categorised as short ( 11 for 11 years and >9 for 22 years) and recommended according to the National Sleep Foundation criteria. Multinomial regression analyses were applied according to a hierarchical approach in order to investigate the associated factors with sleep duration patterns. All analyses were stratified by sex. Results Higher income was associated with higher odds of short sleep duration in 11-year-old boys [OR = 1.54 (CI95%: 1.08; 2.19)] and girls [OR = 1.45 (CI95%: 1.03; 2.06)] and also with lower odds of long sleep duration in both ages. At 22 years, common mental health disorders were associated with higher odds of short sleep duration in both men [OR = 1.56 (CI95%: 1.18; 2.06)] and women [OR = 1.48 (CI95%: 1.11; 1.99)]. Sleep duration was also related to screen time and physical activity showing different association patterns according to sex and age. Conclusions Different factors may be associated with sleep duration patterns in pre-adolescence and early adulthood. Our results emphasise the importance of considering stratification analyses to identify associated factors with sleep duration since they may vary according to age and sex.

Background Immunization has been held as a major achievement for global health, however, still exist many children who are not completely vaccinated. Knowledge about factors contributing to the incomplete immunization is important to develop effective strategies and interventions to achieve universal coverage to control or eradicate vaccine-preventable diseases. This study aimed to describe immunization coverage within the first year of life and associated factors with incompleteness among participants of the 2015 Pelotas Birth Cohort, Brazil. Methods Cross-sectional analyses were performed using data from a population-based cohort. Information on vaccination status was collected from immunization cards and verbal mother’s reports from 4014 children aged 24 months. Coverage was described for each vaccine, for the basic and the complete national schedule. Incomplete vaccination was defined as failure to receive the recommended number of doses by the National Immunization Program in 2015. Bivariate and multivariate Poisson regressions with robust variance were conducted to identify factors associated with incompleteness. Results Vaccine coverage of individual vaccines varied from 81% (Hepatitis A) to 97% (BCG). Full immunization coverage were 77% (95% CI: 75.8; 78.4) and 66.1% (95% CI: 64.6; 67.5), for basic and expanded indicators, relatively. Multivariate analyses showed that factors associated with incompleteness (for both basic and expanded coverage) were high family income, high parity, low number of prenatal consultations, not have done the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine during pregnancy, not have breastfeed the child until at age 12 months and not have used public health care services for child’s vaccination. Conclusion Findings of our study show the need to develop and implement policies and programs to achieve complete immunization during the first year of life. Some strategies would include an increase in the primary health care services networks, improving their quality and access, the dissemination of scientific-based evidence about the benefits of vaccination, through communication campaigns and guidance provided by health professionals, especially those responsible for prenatal care.

Prenatal and birth cohort studies, including those that start before conception, are an epidemiologic study design that best allows for the investigation of early-life origins of adult disease. This article reviews the definition and methodology of a cohort study. We also identify the worldwide locations of the most important preconception, prenatal, and birth cohorts that have been studied, as well as describe their characteristics. Finally, we examine the importance of these studies in the context of life-course epidemiology research and discuss why new studies of this type are needed. Preconception, prenatal, and birth cohorts provide insights into the mechanism of risk and protection across the life course and between generations, and have contributed significantly to what is known today regarding the developmental origins of health and disease hypothesis.

Avaliar o conhecimento de profissionais de saúde sobre a existência ou não de associação entre inatividade física e oito morbidades (diabetes, hipertensão arterial, aids, osteoporose, câncer de pulmão, depressão, cirrose hepática e infarto agudo do miocárdio). Foi realizado um estudo transversal em uma amostra representativa de 1.600 unidades básicas de saúde do Brasil; a população elegível incluía 1/3 de médicos, 1/3 de enfermeiros e 1/3 de agentes comunitários de saúde. A média de acertos observada foi de 6,3 questões. A proporção de profissionais que acertaram sete ou oito questões foi de 68% (IC95%: 60-75) entre os médicos, 54% (IC95%: 48-59) entre enfermeiros e 43% (IC95%: 40-55) entre agentes comunitários de saúde. O percentual de acertos dos médicos foi estatisticamente superior (p

To evaluate the pathophysiology of catheter-associated candiduria, the bladders of female mice were infected with Candida tropicalis. One group was implanted with a catheter fragment with preformed biofilm by cystotomy technique, while another group received, in separate, a sterile catheter fragment and a correspondent yeast suspension. The bladder tissues were examined by histopathology and the quantity of colony forming units was evaluated. All the animals presented inflammation and the presence of C. tropicalis was observed in the tissue within 72 h of the introduction of biofilm, while 75% of the mice remained infected after 144 h. However, only 50% of animals from the group infected with C. tropicalis in suspension (planktonic yeasts), exhibited such signs of infection over time. The cystotomy technique is therefore viable in mice, and is an effective model for evaluating the pathogenesis of candiduria from catheter biofilms. The model revealed the potential of C. tropicalis infectivity and demonstrated more effective evasion of the host response in biofilm form than the planktonic yeast.

IntroductionInjuries during childhood, which mostly consist of falls, burns, drowning, poisonings and car crashes, are among the main causes of death among children and young adults in several countries.ObjectivesTo investigate the association between maternal depression and the incidence of injuries during childhood.MethodsIn 2004, children who were born in the municipality of Pelotas, Brazil, were enrolled in a population-based birth cohort, with evaluations at birth and at 3, 12, 24 and 48 months of age. Maternal depression during pregnancy was evaluated at the time of delivery. At 12 and 24 months post partum, the Edinburgh Postnatal Depression Scale (EPDS) was used. The injuries incidence rates at ages of 24–48 months and the crude and adjusted IRRs were calculated with 95% CI through Poisson’s regression.ResultsA total of 3533 children were analysed. The incidence of injuries was higher among children whose mothers presented depressive symptoms during pregnancy and at 12 and 24 months compared with those whose mothers did not present any symptoms. In the adjusted analysis, the IRR among girls whose mothers presented depressive symptoms during pregnancy and EPDS ≥13 at 12 and 24 months was 1.31 (1.15–1.50); and, among boys, 1.18 (1.03–1.36).InterpretationMaternal depression is associated with higher incidence of injuries between 24 and 48 months of age, in both sexes.

Background Non-communicable diseases are the leading cause of death, worldwide. Obesity is one of the factors that is associated with the development of such diseases. The role of reproductive factors on women body composition has been evaluated, but the findings are controversial. This study was aimed at assessing the association of parity with body composition among women. Methods In 1982, the maternity hospital of Pelotas, a southern Brazilian city, were visited daily and all deliveries were identified. Those livebirths whose family lived in the urban area of the city have been prospectively followed (n = 5914). In 2012–13, we tried to follow the whole cohort, the subjects were interviewed and examined. We evaluated the association of parity with the following body composition variables: body mass index, waist circumference and fat mass %. Estimates were adjusted for family income, skin color, maternal schooling, occupational status, alcohol, smoking, physical activity, and consumption of processed and ultraprocessed foods. All these analyses were replicated among the cohort men as a comparison. We also assessed whether duration of breastfeeding moderated the association. Results In the 2012–13 visit, 3701 subjects were evaluated (mean age of 30.2 years). In the present analysis, we included 1620 women and 1653 men. 33% of women were nulliparous and 48% of men were without children. Even after controlling for confounding, parous women had a BMI 0.96 kg/m2 (95% CI: 0.30; 1.62) higher than nulliparous and for men the regression coefficient was 0.79 kg/m2 (95% CI: 0.29; 1.29). Waist circumference was also higher among parous women. Among men, the association was not linear and the regression coefficients were lower than that observed among women [3.41 cm (95% CI: -0.91; 7.73) among men and 4.83 cm (95% CI: 2.43; 7.24) among women with more than 3 children when compared with those without children], but this difference was not statistically significant (interaction p value = 0.58). Fat mass % was not associated with parity. Breastfeeding did not modify the association between parity and body composition. Conclusions Parity was positively associated with body mass index and waist circumference among women. However, similar results among men suggest that there is no causal effect of parity. Electronic supplementary material The online version of this article (10.1186/s12889-018-5089-2) contains supplementary material, which is available to authorized users.

Background Maternal depression impacts on several detrimental outcomes during a child's life course, and could increase their risk of victimization. This longitudinal study examined the association between antenatal maternal depression, postnatal trajectories, and current maternal depression and offspring bullying victimization at 11 years. Methods We included 3,441 11-year-old adolescents from the 2004 Pelotas Cohort Study. Antenatal maternal depression, postnatal trajectories, and current maternal depression data were assessed during the follow-up waves. Bullying victimization was self-reported by the adolescents. We used ordinal logistic regression to estimate the odds ratio (OR) and 95% confidence intervals (CIs), for the association between maternal depression and offspring bullying victimization. Results The most prevalent type of bullying was verbal victimization (37.9%). We observed a positive association between antenatal maternal depression, postnatal trajectories, and current maternal depression and physical bullying victimization. Maternal mood symptoms during pregnancy were associated with physical (OR = 1.30, 95%CI = 1.11–1.53), verbal (OR = 1.29, 95%CI = 1.12–1.49), and any victimization (OR = 1.22, 95%CI = 1.05–1.41). Severe current maternal depression was associated with physical (OR = 1.34, 95%CI = 1.10–1.62), social manipulation (OR = 1.29, 95%CI = 1.08–1.53), attacks on property (OR = 1.30, 95%CI = 1.08–1.57) and any victimization (OR = 1.32, 95%CI = 1.12–1.56). Regarding maternal depression trajectories, the “chronic-high” group was associated with higher risk of social manipulation, attacks on property and any victimization, than the “low” group. Conclusions Our results strengthen the evidence of association between maternal depression and offspring bullying victimization, and physical victimization appears to be the main component. Further studies are warranted to confirm our findings and to elucidate the theoretical pathways for this longitudinal association.

Background:Physical inactivity is responsible for 7% of diabetes deaths worldwide, but little is known whether low levels of physical activity (PA) during adolescence increase the risk of diabetes in early adulthood. We evaluated the cross-sectional and longitudinal associations between PA throughout adolescence and HbA1c concentration in early adulthood.Methods:HbA1c was measured by high performance liquid chromatography. PA was assessed by self-report at the ages of 11, 15, and 18 years and by accelerometry at the ages of 13 (subsample) and 18 years. The loss percentages of follow up were 12.5% at 11 years, 14.4% at 15 years, and 18.7% at 18 years.Results:At 18 years, boys showed higher HbA1c than girls. At age 18 years, accelerometrybased PA at 18 years was inversely related to HbA1c levels in boys. Self-reported leisure-time PA at ages 11, 15, and 18 were unrelated to HbA1c in both genders. PA at 13 years of age was unrelated to HbA1c among both genders. In trajectory analysis, PA and accelerometer PA trajectories were not associated with later HbA1c.Conclusions:Objectively measured PA at 18 years was cross-sectionally inversely associated with HbA1c in boys only. No prospective associations were identified.

This study used data from 2,222 mothers and infants participating in a population-based birth cohort to verify whether maternal depression in the perinatal period was associated with poor infant sleep. Mothers who scored ≥13 points on the Edinburgh Postnatal Depression Scale at 16-24 weeks of gestation and/or 3 months after delivery were considered perinatally depressed. The main outcome variable was poor infant sleep at 12 months of age, defined as3 night wakings, nocturnal wakefulness1 hr or total sleep duration9 hr. Infant sleep data were obtained with the Brief Infant Sleep Questionnaire (BISQ) and 24-hr actigraphy monitoring. Prevalence of perinatal depression in the sample was 22.3% (95% confidence interval [CI], 20.5-24.0). After Poisson regression, infants of depressed mothers showed an adjusted relative risk (RR) of 1.44 (95% CI, 1.00-2.08; p = .04) for3 night wakings with questionnaire-derived data. When actigraphy data were analysed, no association was found between perinatal depression and poor infant sleep (adjusted RR, 1.20; 95% CI, 0.82-1.74; p = .35). In conclusion, although mothers in the depressed group were more likely to report more night wakings, objective data from actigraphy did not replicate this finding. Dysfunctional cognition, maternal behavioural factors and sleep impairment associated with perinatal depression may affect the mother's impression of her infant's sleep.

Background: Large-scale epidemiological studies of seroprevalence of antibodies against SARS-CoV-2 often rely on point-of-care tests that provide immediate results to participants. Yet, little is known on how long rapid tests remain positive after the COVID-19 episode, or how much variability exists across different brands and even among batches of the same test. Methods: In November 2020, we assessed the sensitivity of three tests applied to 133 individuals with a previous positive PCR result between April and October. All subjects provided finger prick blood samples for two batches (A and B) of the Wondfo lateral-flow IgG/IgM test, and dried blood spot samples for the S-UFRJ ELISA test. Results: Overall sensitivity levels were 92.5% (95% CI 86.6;96.3), 63.2% (54.4;71.4) and 33.8% (25.9;42.5) for the S-UFRJ test, Wondfo A and Wondfo B tests. There was no evidence of a decline in the positivity of S-UFRJ with time since the diagnosis, but the two Wondfo batches showed sharp reductions to as low as 41.9% and 19.4%, respectively, for subjects with a positive PCR in June or earlier. Positive results for batch B of the rapid test were 35% to 54% lower than for batch A at any given month of diagnosis. Interpretation: Whereas the ELISA test showed high sensitivity and stability of results over the five months of the study, both batches of the rapid test showed substantial declines, with one of the batches consistently showing lower sensitivity levels than the other. ELISA tests based on dried-blood spots are an inexpensive alternative to rapid lateral-flow tests in large-scale epidemiological studies. Funding: The study was funded by the “Todos Pela Saude” initiative, Instituto Serrapilheira, Brazilian Ministry of Health, Brazilian Collective Health Association (ABRASCO) and the JBS S.A. initiative ‘Fazer o Bem Faz Bem’. Declaration of Interests: None to Declare Ethics Approval Statement: Ethical approval by the Brazilian National Ethics Committee (process number 30415520.2.0000.5313).

Background: Bipolar disorder (BD) is the sixth leading cause of disability worldwide. Early detection of BD may help clinicians to intervene early and to prevent illness progression. We aimed to build a BD prediction model using machine learning techniques in a large population-based birth cohort at the individual level. Methods: A total of 3,748 subjects were studied from birth up to the age of 22 years in a prospective population-based birth cohort. We used the Elastic Net algorithm with 10-fold cross-validation to predict who would develop BD by the age 22-years assessment using clinical and demographic variables at each follow-up visit before diagnosis (perinatal, 11 years, 15 years, and 18 years). After that, we used the best predictive model to calculate the subgroups of subjects at higher and lower risk of developing BD and analyzed the clinical differences among them. Findings: A total of 107 (2∙8%) individuals within the cohort presented with BD type I, 26 (0∙6%) presented with BD type II, and 87 (2∙3%) presented with BD not otherwise specified. The model with variables assessed at the 18-years follow-up visit achieved the best performance: an AUC of 0∙82 (CI 0∙75–0∙88), balanced accuracy of 0∙75, sensitivity of 0∙72, and specificity of 0∙77. The most important variables to predict BD at the 18-years follow-up visit were suicide risk, a diagnosis of generalized anxiety disorder, parental physical abuse, and financial problems. Additionally, the high-risk subgroup of BD showed a high frequency of drug use and depressive symptoms. Interpretation: We developed a machine learning-based risk calculator for BD at the age of 22 years, which may be used as a tool to clinical decision making, incorporating both demographic and clinical variables. Future studies integrating data from different biological levels, such as genetics and metabolomics, could potentially help to build more accurate models. Furthermore, other researches should determine whether the features selected by the model as the most important have a causal relation with BD or whether they are prodromal symptoms. Funding Statement: This article is based on data from the study "Pelotas Birth Cohort − 1993" conducted by Graduate Program in Epidemiology at Universidade Federal de Pelotas with the collaboration of the Brazilian Public Health Association (ABRASCO). Furthermore, the 1993 birth cohort study was supported by the Wellcome Trust and Brazilian National Research Council (CNPq) with Brazilian Ministry of Health (DECIT – CNPq). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The 1993 Pelotas Birth Cohort study was approved by the local ethics committee. All participants provided written informed consent.