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The relationship between birth weight and plasma lipoproteins is inconsistent.To assess the association between birth weight and (1) body mass index (BMI) at birth and (2) lipoproteins in young adults, and also to explore the possible effect of current obesity as a possible effect modifier.Two prospective studies based on representative samples of subjects born in the 1970s were carried out in Ribeirão Preto, Brazil (n=2063) and Limache, Chile (n=999). The surveys were carried out between 2001 and 2004.Mean birth weights were 3267 g and 3177 g and mean adult BMIs were 24.3 kg/m2 and 25.8 kg/m2 in the Brazilian and Chilean samples, respectively. Total adult cholesterol was 4.57 mmol/l in Chileans, 0.26 mmol/l higher than in Brazilians (p0.001). The main finding was an interaction between adult obesity (BMI 30 or over) and birth weight and also BMI at birth and low-density lipoprotein (LDL) and total cholesterol. A birth-weight increment of 1 kg was associated with a decrease in total cholesterol (-0.374 mmol/l, 95% CI -0.567 to -0.181) and LDL (-0.304 mmol/l (-0.479 to -0.129) in obese participants only. These associations persisted after allowing for gestational age in a smaller sample. This finding was consistent in separate analyses in the Brazilian and Chilean samples. No associations were found in relation to high-density lipoprotein and triglyceride concentrations.The results suggest that those who were of low birth weight and are obese are more likely to have high cholesterol and LDL concentrations. Thus preventing obesity may be especially rewarding in subjects with a low birth weight.

Aim: To evaluate whether the ventricular septal defect (VSD) size, along with the degree of preoperative growth impairment and age at repair, may influence postoperative growth, and if VSD size can be useful to identify children at risk for preoperative failure to thrive. Methods: Sixty-eight children submitted to VSD repair in a Brazilian tertiary-care institution were evaluated. Weight and height measurements were converted to Z-scores. Ventricular septal defect size was normalized by dividing it by the aortic root diameter (VSD/Ao ratio). Results: Twenty-six patients (38%) had significantly low weight-for-height, 10 patients (15%) had significantly low height-for-age and 13 patients (19%) had both conditions at repair. Catch-up growth occurred in 82% of patients for weight-for-age, in 75% of patients for height-for-age and in 89% of patients for weight-for-height. Weight-for-height Z-scores at surgery were significantly lower in patients who underwent repair before 9 months of age. The VSD/Ao ratio did not associate with any other data. On multivariate analysis, weight-for-age Z-scores and age at surgery were independent predictors of long-term weight and height respectively. Conclusion: The VSD/Ao ratio was not a good predictor of preoperative failure to thrive. Most patients had preoperative growth impairment and presented catch-up growth after repair. Preoperative growth status and age at surgery influenced long-term growth.

Low birth weight and preterm birth, and social disadvantage may negatively affect mental health of children, but findings have been inconsistent. To assess the influence of perinatal and social factors on mental health problems in children aged 7–9 years. A random sample of 805 births in Sao Luis, Brazil was studied in 1997/1998 and again in 2005/2006. Perinatal, socioeconomic and demographic variables were assessed within 24 h after delivery. The Strengths and Difficulties Questionnaire (SDQ) was used to assess mental health problems in the children. Simple and multiple Poisson regressions were used for statistical analysis. The overall prevalence of mental health problems in the total sample was 47.7%. The prevalences of emotional and conduct problems were 58.2 and 48.8%, respectively. Only paternal age (

Background/Aims: Aldosterone and the mineralocorticoid receptor (MR) play a major role in sodium balance and blood pressure control. They are also involved in adipocyte metabolism. The aim of this study was to analyze the association between the MR p.I180V polymorphism with hypertension and markers of cardiovascular risk. Design and methods: Case-control study nested within a cohort of 2063 subjects followed since birth to date. All subjects (age 23–25 yr old) from the entire cohort with systolic and diastolic hypertension (no.=126) were paired with 398 normotensive controls. MR p. I180V genotype association with anthropometric and biochemical markers of cardiometabolic risk was tested. Results: There was a significant association of the MR p. I180V genotype with body mass index (BMI) and LDL-cholesterol level (p

The interindividual variation in the activity of xenobiotic metabolizing enzymes and DNA repair genes could modify an individual's risk of recurrent malignancy and response to therapy. We investigated whether ALL outcome was related to polymorphisms in genes CYP2D6, MPO, EPHX1, NQO1, TS, XPD and XRCC1 in 95 consecutive ALL children by PCR or PCR-FRLP techniques. Polymorphisms in genes NQO1 and TS were associated with a significantly slow response to induction chemotherapy and NQO1 was also associated with a lower five-year event-free survival. This study suggests that polymorphisms of NQO1 and TS could be important for patient response to induction therapy and for treatment outcome.

Respiratory symptoms associated with smoking habit seem to be age dependent. However, there are few reports about the effect of tobacco in young populations. The objective of this study was to analyze the effect of smoking on respiratory symptoms and lung function in 23- to 25-year-old adults in Brazil. This study had a cross-sectional design and included 2063 young people in the city of Ribeirão Preto, São Paulo State.Subjects completed a questionnaire used by the European Community Respiratory Health Survey and underwent spirometry and bronchial challenge test with methacholine. Multiple logistic regression analysis and multiple linear regression analysis were carried out to assess the association between smoking and respiratory symptoms, bronchial hyperresponsiveness, forced expiratory volume in 1 second (FEV1), and forced vital capacity (FVC), adjusted for confounding variables.Prevalence of smoking habit was 17.2% with consumption (median) of 10 cigarettes per day (interquartile range 3-20). There was a significant association between smoking and respiratory symptoms. Smoking was associated to wheezing with odds ratio (95%CI) of 6.11 (4.03-9.28) among those smokingor=10 cigarettes per day and 3.36 (2.11-5.37) among those smoking10 cigarettes per day. Associations were found for other respiratory symptoms. Smoking was associated with lower FEV1/FVC ratio. No association was detected between smoking and FEV1 or bronchial hyperresponsiveness.These findings highlight the early health consequences of smoking among young adults. These results prompt the necessity to elaborate urgent programs to reduce tobacco habit in young populations.

OBJETIVO: Avaliar fatores associados ao aumento das taxas de peso insuficiente (PI) em duas coortes de recém-nascidos (RN) vivos e de parto único de Ribeirão Preto, São Paulo, separadas por 15 anos (1978/79 e 1994). MÉTODOS: Foram estudados 6.223 partos em 1978/79 e 2.522 em 1994, excluindo-se os RN de baixo peso. Associação entre PI e variáveis independentes (idade, trabalho, escolaridade e tabagismo maternos, abortos e natimortos prévios, número de filhos, situação conjugal, visitas de pré-natal, tipo de parto e hospital, categoria de internação, renda familiar, idade gestacional e sexo do RN) foi analisada por cálculo da Odds Ratio (OR) bruto e intervalo de confiança 95%, seguida de regressão logística múltipla. RESULTADOS: Em 1978/79, na análise ajustada, idade materna OBJECTIVE: To evaluate factors associated to the increase in insufficient birth weight (IBW) rates in two population-based-cohorts of singletons born alive in Ribeirão Preto, São Paulo, Brazil, separated by 15 years (1978/79 and 1994). METHODS: The first cohort (1978/79) comprised 6,223 newborns and the second (1994), 2,522, excluding low birth weight newborns. Independent variables association with IBW (maternal age, work, schooling and smoking; previous abortion, previous stillbirth, number of live births, maternal marital status, family income, occupation group, type of hospital, mode of insurance, number of antenatal visits, type of delivery; newborn gender and gestational age) were analyzed. The Odds Ratio (OR) was determined using a logistic regression model and 95% confidence limits were calculated. RESULTS: In 1978/79, maternal age

OBJETIVO: Avaliar fatores associados ao aumento das taxas de peso insuficiente (PI) em duas coortes de recém-nascidos (RN) vivos e de parto único de Ribeirão Preto, São Paulo, separadas por 15 anos (1978/79 e 1994). MÉTODOS: Foram estudados 6.223 partos em 1978/79 e 2.522 em 1994, excluindo-se os RN de baixo peso. Associação entre PI e variáveis independentes (idade, trabalho, escolaridade e tabagismo maternos, abortos e natimortos prévios, número de filhos, situação conjugal, visitas de pré-natal, tipo de parto e hospital, categoria de internação, renda familiar, idade gestacional e sexo do RN) foi analisada por cálculo da Odds Ratio (OR) bruto e intervalo de confiança 95%, seguida de regressão logística múltipla. RESULTADOS: Em 1978/79, na análise ajustada, idade materna

Aim: To study the growth of infants with isolated Robin sequence (IRS) considered being severe cases during the first 6 months of life. Methods: Twenty infants with IRS, considered being severe cases were followed in a pure prospective longitudinal study. Feeding facilitating techniques were applied to all infants after airway disobstruction and a hypercaloric diet was offered. Weight and length were measured at birth and at 2-month intervals until 6 months of age. Results: The infants with severe IRS under study showed impaired weight and length growth from birth to 6 months of age when the values were compared to the NCHS2000 reference. Conclusions: Malnutrition persisted in infants with severe IRS during the first 6 months of life despite the use of special diet and techniques developed for clinical recovery of this anomaly.

Background Currently known risk factors explain only a small fraction of preterm birth (PTB). Previous PTB is one of the most important predictors. However, this information is not available in primiparous women. Few studies have looked at associations between regulatory cytokine expression (RCE) and PTB and the results are conflicting. Objective To investigate the association of RCE–Interleukin 10 (IL-10) and Transforming Growth Factor β (TGF-β)–with PTB, and to assess whether bacterial vaginosis (BV) is involved in this relationship. Methods This was a case-control study nested in a prospective cohort–called BRISA. Women with singleton pregnancies were interviewed from 22 to 25 weeks of gestational age (GA). Women were recruited from health services in São Luís, Brazil. A blood sample was collected and gynecological examination was performed. Serum IL-10 and TGF-β were determined using cytometric bead array. Nugent score >7 and/or the presence of clue cells were used for BV diagnosis. All PTB estimated by ultrasound dating performed before 20 weeks of gestational age were considered cases. Controls were selected by simple random sampling from the rest of the cohort, at a 2:1 ratio. Different models were tested, according to the main independent variable. Odds ratios (OR) and 95% confidence intervals (95%CI) were estimated by regression analyses. Results The study included 327 pregnant women, 109 cases and 218 controls. No associations were found between BV and PTB (P = 1.44; 95%CI: 0.51–3.77). Low levels of IL-10 (OR = 2.92 95%CI: 1.38–6.16) or TGF-β (OR = 16.90 95%CI: 6.42–44.51) or both simultaneously (OR = 77.16 95%CI: 7.99–744.88) were associated with increasing odds of PTB, even after adjustment for confounding. Conclusion Decreased RCE is a risk factor for PTB. This relationship, however, is not triggered by the presence of BV. Low IL-10/TGF-β levels from 22 to 25 weeks of GA could be used as early predictors of PTB. We suggest monitoring of these RCE, especially among primiparous women, for whom history of previous PTB is not available.

Few studies are available about racial inequalities in perinatal health in Brazil and little is known about whether the existing inequality is due to socioeconomic factors or to racial discrimination per se. Data regarding the Ribeirão Preto birth cohort, Brazil, whose mothers were interviewed from June 1, 1978 to May 31, 1979 were used to answer these questions. The perinatal factors were obtained from the birth questionnaire and the ethnic data were obtained from 2063 participants asked about self-reported skin color at early adulthood (23-25 years of age) in 2002/2004. Mothers of mulatto and black children had higher rates of low schooling (or = 4 years, 27.2 and 38.0%) and lower family income (or = 1 minimum wage, 28.6 and 30.4%). Mothers aged less than 20 years old predominated among mulattos (17.0%) and blacks (14.0%). Higher rates of low birth weight and smoking during pregnancy were observed among mulatto individuals (9.6 and 28.8%). Preterm birth rate was higher among mulattos (9.5%) and blacks (9.7%) than whites (5.5%). White individuals had higher rates of cesarean delivery (34.9%). Skin color remained as an independent risk factor for low birth weight (P0.001), preterm birth (P = 0.01), small for gestational age (P = 0.01), and lack of prenatal care (P = 0.02) after adjustment for family income and maternal schooling, suggesting that the racial inequalities regarding these indicators are explained by the socioeconomic disadvantage experienced by mulattos and blacks but are also influenced by other factors, possibly by racial discrimination and/or genetics.

Data for two birth cohorts from two Brazilian municipalities, Ribeirão Preto in 1994 and São Luís in 1997/1998, were used to identify and compare factors associated with inadequate utilization of prenatal care and to identify factors capable of explaining the differences observed between the two cities. Prenatal care was defined as adequate or inadequate according to the recommendations of the Brazilian Ministry of Health. The chi-square test and Poisson regression were used to compare differences in the inadequacy of prenatal care utilization. The percentage of inadequacy was higher in São Luís (34.6%) than in Ribeirão Preto (16.9%). Practically the same variables were associated with inadequacy in both cities. Puerperae with lower educational level, without a companion or cohabiting, who delivered in public health units, younger than 20 years, multiparae and smokers, with low family income presented higher percentages of inadequate prenatal care utilization. However, the effects of some variables differed between the two cities. The risk for inadequate use of prenatal care was higher for women attended in the public health sector in São Luís and for cohabiting women in Ribeirão Preto. The effect of the remaining factors studied did not differ between cities. The category of admission accounted for 57.0% of the difference in the inadequate use of prenatal care between cities and marital status accounted for 45.3% of the difference. Even after adjustment for all variables, part of the difference in the inadequacy of prenatal care utilization remained unexplained.

Background The present study aimed to evaluate the relationship between the functioning of the hypothalamic–pituitary–adrenal (HPA) axis and major depressive episodes in the remote postpartum period. Methods The sample (mean age, 28.0±5.3 years) consisted of 37 depressed postpartum women (DPP), 42 euthymic postpartum women (EPP) and 25 non-postpartum healthy women (HC). Salivary cortisol samples were collected immediately after awakening and 30 min, 3 and 12 h later, at approximately the sixth month postpartum (mean, 169.6±60.3 days). Results Differences in cortisol levels were observed at awakening (DPP EPP=HC). The relative increment in the cortisol awakening response (CARi%) was significantly higher in HC (113.5±94.3) than in EPP (63.1±69.8) and DPP (32.2±49.6). The relative reduction in diurnal variation (DVr%) was lower in DPP (56.5±41.8) than in EPP (75.6±22.4) and HC (75.1±13.0). Limitations The main limitation was cortisol collection on a single day and without measurement at midnight. Conclusions Our findings suggest that the remote postpartum period involves attenuation of HPA axis reactivity; this dysregulation is more pronounced in the presence of DPP, which is associated with a reduction in cortisol diurnal variation. Abnormalities in the neuroendocrine system related to stress processing, present even several months after delivery, can represent vulnerability to mental disorders. Thus, improvements in the mental health care of postpartum women are needed.

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.

The increase in non-communicable chronic diseases of adults is due to demographic changes and changes in the risk factors related to physical activity, smoking habits and nutrition. We describe the methodology for the evaluation of persons at 23/25 years of age of a cohort of individuals born in Ribeirão Preto in 1978/79. We present their socioeconomic characteristics and the profile of some risk factors for chronic diseases. A total of 2063 participants were evaluated by means of blood collection, standardized questionnaires, anthropometric and blood pressure measurements, and methacholine bronchoprovocation tests. The sexes were compared by the chi-square test, with alpha = 0.05. Obesity was similar among men and women (12.8 and 11.1%); overweight was almost double in men (30.3 vs 17.7%). Weight deficit was higher among women than among men (8.6 and 2.6%). Women were more sedentary and consumed less alcohol and tobacco. Dietary fat consumption was similar between sexes, with 63% consuming large amounts (30 to 39.9 g/day). Metabolic syndrome was twice more frequent among men than women (10.7 vs 4.8%), hypertension was six times more frequent (40.9 vs 6.4%); altered triglyceride (16.1 vs 9.8%) and LDL proportions (5.4 vs 2.7%) were also higher in men, while women had a higher percentage of low HDL (44.7 vs 39.5%). Asthma and bronchial hyper-responsiveness were 1.7 and 1.5 times more frequent, respectively, among women. The high prevalence of some risk factors for chronic diseases among young adults supports the need for investments in their prevention.

In Brazil, similar intrauterine growth restriction (IUGR) rates were observed between cities with distinct levels of socioeconomic development, challenging the current knowledge that higher rates of IUGR would necessarily be observed in poorer areas than in wealthier ones. Ribeirão Preto, a city located in the most developed area in Brazil, showed an IUGR rate of 18% in 1994, whereas this rate was 18.5% in 1997/1998 in São Luis, located in one of the poorest areas in the country. The objective of this study was to compare risk factors for IUGR in these two cities and to identify factors that are responsible for this unexpected lack of difference between the rates. Using data from two birth cohorts, including 2839 neonates who were from Ribeirão Preto and born in 1994 and 2439 neonates who were from São Luis and born in 1997/1998, a multivariable analysis was conducted to assess changes in the risk for IUGR in the poorer city compared with the wealthier one in a combined model, adjusting for some risk factors for IUGR. The wealthier city showed higher rates of maternal smoking, attendance in the private sector, and obstetric interventions than the less developed one. Differences in maternal smoking and obstetric interventions were possibly responsible for the similarity of the rates between cities. It seems that early detection of IUGR followed by cesarean section in the wealthier city is associated with increased low birth weight and IUGR rates but reduced stillbirth and infant mortality rates.

OBJETIVO: Apresentar protocolo único que possa atender tanto às dificuldades respiratórias como às dificuldades alimentares dos neonatos e lactentes com seqüência de Robin. FONTE DE DADOS: O artigo foi desenvolvido tomando como base as publicações mais recentes disponíveis em bancos de dados bibliográficos e livros que discutem o tratamento da seqüência de Robin, em especial os estudos realizados no Hospital de Reabilitação de Anomalias Craniofaciais da Universidade de São Paulo (HRAC/USP). SÍNTESE DE DADOS: O artigo apresenta os aspectos morfológicos e genéticos da seqüência de Robin e conceitos sobre nasofaringoscopia e suas implicações clínicas, discute o tratamento das dificuldades respiratórias e alimentares e apresenta um protocolo único para atender a todos os casos de seqüência de Robin, independentemente de sua gravidade e complexidade. CONCLUSÕES: A seqüência de Robin não é somente uma patologia obstrutiva anatômica para ser resolvida com procedimentos cirúrgicos, mas os conhecimentos sobre crescimento e desenvolvimento devem ser aplicados por uma equipe multidisciplinar, porque possibilitam a rápida recuperação da permeabilidade das vias aéreas e da capacidade de alimentação oral, evitando-se, muitas vezes, os procedimentos cirúrgicos e seus riscos, principalmente quando realizados em neonatos e lactentes pequenos. OBJECTIVE: To present a single protocol that might cover both the respiratory and feeding difficulties of neonates and infants with Robin sequence. SOURCES OF DATA: The article was prepared on the basis of the most recent publications available in bibliographic databases and in books that discuss the treatment of Robin sequence, especially the studies conducted at the Hospital for Rehabilitation of Craniofacial Anomalies of Universidade de São Paulo (HRAC/USP). SUMMARY OF THE FINDINGS: We present the morphological and genetic aspects of Robin sequence and concepts about nasopharyngoscopy and its clinical implications; we discuss the treatment of respiratory and feeding difficulties, and we present a single protocol for the treatment of all Robin sequence cases regardless of their severity and complexity. CONCLUSIONS: Robin sequence is not only an anatomic obstructive disorder to be treated with surgical procedures, but knowledge about children's growth and development must be applied by a multidisciplinary team, since this permits the maintenance of airway permeability and of the ability to feed orally, often without the need of surgical procedures and their risks, especially when applied to neonates and small infants.

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

BACKGROUND: We tried to explain why a marked decrease in birthweight of 122 g occurred over a 15-year period in Ribeirao Preto, Brazil. METHODS: Factors reflecting biological, social, and health care characteristics (infant gender, parity, maternal age, marital status, type of hospital, maternal smoking, preterm birth, small for gestational age [SGA], and prenatal care) were assessed on 6711 newborns in 1978/1979 and 2838 in 1994 using multiple linear regressions. RESULTS: The birthweight distribution shifted to the left and the residual distribution of small preterm babies increased from 1.9% to 3.4%. Only marital status and preterm delivery would have decreased the difference in birthweight over time, explaining for each of them around 30 g of the 122 g. Increasing levels of attendance at antenatal care over time might have decreased the birthweight difference by 40 g. Maternal age and SGA explained little of the decreasing trend. Reductions in maternal smoking would have increased mean birthweight slightly. In stratified analysis the downward trend was more marked among mothers with high education (-202 g) and those delivered by caesarean section (-194 g). After adjusting for all those significant variables mean birthweight was still 74 g (95% CI: -97, -50 g) lower in 1994 than in 1978/1979. CONCLUSION: The trend could be explained in part by factors related to marital status that might reflect dysfunctional families in the Brazilian context and the preterm increase that might be associated with advances in medical technology. The high attendance at antenatal clinics or factors associated with it might have prevented a further decrease in birthweight. Our results may be compatible with the high economic development of Ribeirao Preto within Brazil, together with factors associated with its unfavourable lifestyle.

This study investigates the possible effects of pre-term births and low birth weight on infant mortality rates (IMRs) over a 15-year period in Ribeirão Preto, Brazil, based on surveys carried out in 1978/79 and 1994. The 1978/79 survey included 6750 births over a 12-month period and the 1994 survey 2846 births over a 4-month period. Infant deaths were retrieved monthly from the city register. Infant mortality rate decreased from 36·6 to 16·9 deaths per 1000 over 15 years. The decrease in IMR was larger in the 2500–2999 g group than in any other group. The observed falls in IMR were attributable to decreases in birth-weight-specific mortality rates. Likewise, there was a general decrease in IMR in mild, moderate and severe pre-term births. The incidence rate ratio of infant mortality between surveys was 0·46 (95% CI 0·34–0·63); it increased to 0·57 (95% CI 0·35–0·75) when adjusted for birth weight and other factors in the model and rose to 0·69 (95% CI 0·49–0·97) when adjusted for length of gestation and other variables. The increase in pre-term births and low birth weight may have had, at most, a marginal effect on the IMR. Progress in the care of newborns may have decreased the mortality risk, but even mild pre-term birth still has an impact on infant mortality. There is room for further improvement in IMR by tackling the high rates of pre-term birth.

Preterm birth continues to be one of the main causes of neonatal morbidity and mortality. The objective of the present study was to identify risk factors for preterm birth in São Luís, Maranhão, Brazil. The sample consisted of hospital births at 10 public and private hospitals from March 1, 1997 to February 28, 1998. A total of 2,443 live births were randomly selected, excluding multiple deliveries and stillbirths. Preterm birth rate in São Luís was 12.7%. Risk factors for preterm delivery were maternal age below 18 years, family income equal to or less than one minimum wage/ month, primiparity, vaginal delivery at a public hospital, single mothers (or living without a partner), and absence of prenatal care. The following factors remained associated with preterm birth after multivariate analysis to control for confounding: maternal age below 18 years (OR = 1.9), primiparity (OR = 1.5), and failure to appear for scheduled prenatal care visits (OR = 1.5). A prematuridade continua sendo uma das principais causas de morbidade e mortalidade neonatal. O presente estudo tem como objetivo identificar os fatores de risco para a prematuridade em São Luís, Maranhão, Brasil. Foi estudada uma amostra de partos hospitalares ocorridos em dez hospitais públicos e privados no período de 1º de março de 1997 a 28 de fevereiro de 1998. Foram selecionados 2.443 nascidos vivos de forma aleatória, sendo excluídos os nascimentos de partos múltiplos e os natimortos. A incidência de nascimentos pré-termo em São Luís foi de 12,7%. Os fatores de risco para a prematuridade foram: idade materna menor de 18 anos, renda familiar menor ou igual a um salário mínimo, primiparidade, nascer em hospital público e de parto vaginal, viver sem companheiro, e não ter feito pré-natal. Após análise multivariável para controle dos fatores de confundimento, permaneceram associados ao nascimento prematuro: idade materna menor de 18 anos (OR = 1,9), primiparidade (OR = 1,5) e o não comparecimento ao pré-natal (OR = 1,5).

Objective To compare the growth curves (weight and length) of two groups of infants with isolated Robin sequence (RS) treated with nasopharyngeal intubation (NPI), one group receiving a hypercaloric diet and the other receiving a normal diet for age, and compare the growth rates and duration of NPI between the two groups. Design Prospective longitudinal study. Setting Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo, Bauru, Brazil, 1998 to 2000. Patients Twenty-three children with isolated RS treated by prolonged NPI. Interventions Nine children received a milk formula supplemented with 5% to 7% glucose polymers and 3% to 5% medium chain triglycerides (group 1), and 14 children received a milk formula only (group 2). Weight and length were measured at birth and every month up to 6 months of life for the construction of weight and length growth curves. The time of use of the nasogastric tube, age at the beginning of NPI, and duration of NPI were also determined. Results No significant difference in length was observed between the two groups. The mean weight curves obtained for the two groups were below the 50th percentile of the National Center for Health Statistics, but weight gain was higher in group 1. The duration of NPI was shorter in this group. Conclusions The hypercaloric diet led to an improvement in nutritional status, which in turn contributed to improved respiratory conditions in isolated RS.

Vertical HIV transmission rates and associated factors among mother-infant pairs cared for at a Brazilian reference centre from 1988 to 1993 (period 1), and from 1996 to 1999 (period 2) were evaluated. A total of 150 and 239 infants born to HIV+ mothers were enrolled at birth during these periods. No zidovudine prophylaxis was available in period 1. In period 2, 92.4% of the infants were exposed to zidovudine (54% started at delivery or in the post-natal period). During period 1, 25 of 129 infants were found to be infected (19.4%; 95% confidence interval [CI]=13-27) vs 20 of 232 (8.6%; 95% CI=5-13) during period 2 ( P

Objective To correlate nasopharyngoscopic findings with clinical manifestations during the first month of life and study the course of respiratory obstruction during the first year in infants with Robin sequence (RS). Design A longitudinal prospective study of children with RS. Setting Hospital de Reabilitação de Anomalias Craniofaciais, University of São Paulo, Bauru-SP, Brazil, 1998 to 2000. Patients Fifty-six children were studied from the age of 1 month to 12 months. Interventions The type of respiratory obstruction was defined by nasopharyngoscopy. Patients for whom glossoptosis was the only mechanism of respiratory obstruction were classified as having mild, moderate, or severe glossoptosis by nasopharyngoscopy and as mild, moderate, or severe cases with respect to the clinical manifestations. Results Forty-two (75%) patients showed respiratory obstruction caused by glossoptosis; seven (43.7%) of these infants with mild clinical manifestations showed moderate glossoptosis during the first month of life and five (31.3%) presented severe glossoptosis; 10 (45.5%) of the infants with severe clinical manifestations showed moderate and 11 (50.0%) severe glossoptosis. At 12 months of age, glossoptosis was mild or absent in 83.3% of the patients, moderate in 14.3% and severe in 2.4%. Conclusions A poor correlation between the severity of glossoptosis and the severity of clinical manifestations was observed for patients with respiratory obstruction caused by glossoptosis during the first month of life, but the correlation between glossoptosis and respiratory distress according to age was statistically significant. Nasopharyngoscopy is not a good method for predicting the severity of the clinical course of respiratory obstruction caused by glossoptosis.

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 (

We studied the monthly distribution of menarche among schoolgirls from Barrinha, Brazil, a municipality of rural characteristics in the process of transition to urbanization, economically dependent on sugar cane culture and processing. The association between season of the year, month of the year, and birth month and the occurrence of menarche was evaluated. The schoolgirls who provided the date of menarche (month and year) by the recall method and who had menarche up to 36 months before the interview were selected for analysis (460 girls). The correlations between month of occurrence of menarche and month of birth and between menarche and seasons of the year were determined by the chi-square test and the mean monthly ages at menarche were compared by Student's t-test, with a significance level of 0.05. There was a correlation between month of birth and month at menarche, with a peak of occurrence of menarche in December not affected by the menstruating patterns of maturation, but no correlation between menarche and seasons of the year. The difference between mean age at menarche in December (spring–summer transition) and in June (autumn–winter transition) was not significant. Mean age at menarche during the month following school vacations was lower. We conclude that situations of stress–relaxation transition, such as end of the school year, beginning of school vacation, and, perhaps most important, the socioeconomic factor—the end of the sugar cane harvest, when rural workers receive their final payments—favor the occurrence of the peak of menarche in December. Am. J. Hum. Biol. 16:17–23, 2004. © 2003 Wiley-Liss, Inc.

Polycystic ovary syndrome (PCOS) is a multifactorial disorder that arises from interactions between genetic, environmental and intra-uterine factors. Small-for-gestational-age (SGA) babies and the daughters of mothers with PCOS represent possible postnatal clinical targets for developmental programming by steroid excess. The presence of excess glucocorticoids and/or androgens during foetal organogenesis and growth might promote changes in gene expression, and these changes might be related to an increase in the risk of PCOS-like reproductive and metabolic disorders in postnatal life, such as rapid growth and weight gain during the first 2 years of life (only in SGA babies), hyperinsulinaemia, adipocyte dysfunction and childhood visceral obesity, premature pubarche and adrenarche (only in SGA babies) and PCOS. In the fourth decade of life, women who have PCOS may be at higher risk for type 2 diabetes mellitus, dyslipidaemia and systemic arterial hypertension, which suggests that these women are also at higher risk for cardiovascular disease during menopause. However, PCOS can also occur in women who were born at appropriate weight for GA or in newborns of women without PCOS, which suggests that genetic variation and environmental factors play important roles in the development and maintenance of PCOS in a population. Genome-wide association studies based on adequate population samples have shown a higher frequency of genetic polymorphisms of the LHCGR, THADA and DENND1A genes in women with PCOS. Genetic studies of PCOS have also included analyses of structural changes in the chromosome based on an assessment of telomere length in single, cross-sectional evaluations, and these studies have produced controversial results. The present narrative review assesses the multifactorial origins of PCOS (including environmental, genetic and intra-uterine factors) and the development of conditions associated with this disorder. It is concluded that although PCOS might originate in the intra-uterine environment through developmental programming by steroid excess, the interaction between genetic and environmental factors is crucial for its appearance. Follow-up studies should be conducted to assess the same populations over their entire lifespans while taking into account different aspects of the pathogenesis of PCOS.

Objective It has been suggested that a greater dairy consumption is a contributing factor to a lower prevalence of metabolic syndrome (MetS) as a result of the possible actions of some milk nutrients. However, results remain controversial. The aim of this study was to examine the association between dairy consumption and MetS and its components. Methods Dairy consumption and biochemical and anthropometric parameters were determined in 2031 young adults ages 23 to 25 y. Food consumption was assessed using a food frequency questionnaire. The estimated habitual portion of dairy products consumed daily was divided into quintiles. The criteria of the International Diabetes Federation (IDF) and of the Joint Interim Statement (JIS) were used for the classification of MetS. Nonadjusted and adjusted odds ratios (ORs) were estimated by logistic regression. Results The prevalence of MetS was 11.9% by the IDF criteria and 9% by the JIS criteria. A greater dairy consumption was associated with a lower prevalence of MetS according to both IDF (OR, 0.61; 95% confidence interval [CI], 0.38–0.97) and JIS (OR, 0.62; 95% CI, 0.39–0.98) criteria when the last quintile was compared with the first. The association persisted in the model adjusted for demographic, socioeconomic, dietary, and lifestyle variables according to the IDF (OR, 0.53; 95% CI, 0.30–0.93) and was borderline according to the JIS (OR, 0.59; 95% CI, 0.34–1.00), but lost significance when data were adjusted for calcium in both models. Conclusions A greater dairy consumption is associated with a lower prevalence of MetS, with calcium probably being the nutrient responsible for this association.

Introduction: patients with low stature normal variant growth have peculiar evolutionary patterns making it difficult to precisely define when final stature will be reached, since prediction methods are based on parameters of difficult quantification, such as bone age. Objective: To assess the agreement between two methods for prediction of final height based on family target range regarding the final height reached by adolescents with a diagnosis of normal variant short stature. Methods: Thirty-three subjects were evaluated using height of parents for the calculation of family target range and Bayley-Pinneau and Tanner-Whitehouse methods for prediction of final height. Spearman correlation coefficient was calculated to correlate final height with the mean of the family target range, and the St. Laurent concordance coefficient was used to assess concordance between final stature and predictive methods. Results: 87.9% (29/33) subjects kept short stature at the end of growth and 90.9% (30/33) had a final height within family target range. A very strong positive correlation (Cs = 0.77; p < 0.01) was observed between parental mean and final height. Bayley-Pinneau method showed a 0.47 concordance coefficient with final height (95% CI: 0.34; 0.57), and Tanner-Whitehouse 3 method showed a concordance coefficient of 0.58 (95% CI: 0.41; 0.75). Conclusion: The strong positive correlation observed demonstrates the significant influence of parental height on final height. Neither method showed good concordance when used as a predictor of final height, with height values being overestimated.

There is scarce information on the relative importance of measurements at birth and social factors in determining adult height.To assess the relative contribution of length and weight at birth, and social factors to height at 18 years.A total of 3470 boys born in Ribeirão Preto, Brazil, in 1978/1979 were reassessed at the time of military conscription. Anthropometric, demographic and social variables were collected concurrently and used in a multiple regression analysis.A total of 2029 (61.3%) of the target population were assessed at 18 years. In the adjusted analysis, birth length, birth weight, social class, neighbourhood wealth of subject, maternal age and birth order were highly associated with height at 18 years. The results were similar when birth weight and length at birth were included as continuous or categorical variables. The differences in height due to length at birth were greater than those due to social factors.This study has demonstrated the lasting and greater effect of length and weight at birth on height in comparison to social factors, but social factors are still meaningful in their effects on height. Birth length has a marginal greater effect on final height than birth weight.

The objective of the present study was to investigate whether dietary patterns are associated with excess weight and abdominal obesity among young adults (23–25 years). A cross-sectional study was conducted on 2061 participants of a birth cohort from Ribeirao Preto, Brazil, started in 1978–1979. Twenty-seven subjects with caloric intake outside ±3 standard deviation range were excluded, leaving 2034 individuals. Excess weight was defined as body mass index (BMI ≥ 25 kg/m2), abdominal obesity as waist circumference (WC > 80 cm for women; >90 cm for men) and waist/hip ratio (WHR > 0.85 for women; >0.90 for men). Poisson regression with robust variance adjustment was used to estimate the prevalence ratio (PR) adjusted for socio-demographic and lifestyle variables. Four dietary patterns were identified by principal component analysis: healthy, traditional Brazilian, bar and energy dense. In the adjusted analysis, the bar pattern was associated with a higher prevalence of excess weight (PR 1.46; 95 % CI 1.23–1.73) and abdominal obesity based on WHR (PR 2.19; 95 % CI 1.59–3.01). The energy-dense pattern was associated with a lower prevalence of excess weight (PR 0.73; 95 % CI 0.61–0.88). Men with greater adherence to the traditional Brazilian pattern showed a lower prevalence of excess weight (PR 0.65; 95 % CI 0.51–0.82), but no association was found for women. There was no association between the healthy pattern and excess weight/abdominal obesity. In this sample, the bar pattern was associated with higher prevalences of excess weight and abdominal obesity, while the energy-dense (for both genders) and traditional Brazilian (only for men) patterns were associated with lower prevalences of excess weight.

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.

Background The aim of the present study was to identify the main dietary patterns among young adults and to investigate the association of socioeconomic and demographic factors, and social mobility with dietary patterns. Methods Data from the fourth follow-up of the 1978/79 Ribeirão Preto birth cohort study, Brazil, were used. A total of 2,061 young adults, whose mothers gave sociodemographic information at birth in 1978–79, provided sociodemographic and dietary data through a validated food frequency questionnaire in 2002–2004, when they were aged 23–25 years. Those whose caloric intake was outside of the ±3 standard deviation range were excluded, leaving 2,034 individuals. The dietary patterns were identified by principal component analysis followed by varimax orthogonal rotation. Poisson regression with robust estimation of variance was used to derive prevalence ratios (PR). Results Four dietary patterns were identified: healthy, traditional Brazilian, energy-dense and bar. In the adjusted analysis, individuals with higher schooling (≥12 years) in adult life (PR = 1.51, 95% CI: 1.07-2.14) showed greater adherence whilst men (PR = 0.79, 95% CI: 0.68-0.93) had lower adherence to the healthy pattern. The highest adherence to the traditional Brazilian pattern was found for men (PR = 2.39, 95% CI: 2.04-2.80), mullatos (PR = 1.41, 95% CI: 1.21-1.64), households with ≥2 members, and for those with children (PR = 1.28, 95% CI: 1.07-1.55) while individuals with higher schooling in adulthood (≥12 years) (PR = 0.47, 95% CI: 0.34-0.65), higher family income in adulthood (≥20 MW) (PR = 0.57, 95% CI: 0.33-0.99) and higher family income at birth (≥6.1 MW) showed lower adherence. The bar pattern was positively associated with male sex (PR = 2.96, 95% CI: 2.47-3.55) and low schooling (≤8 years). The energy-dense pattern was not associated with any of the variables investigated. Social mobility was associated with the traditional Brazilian pattern. Men and women who were not poor at birth and remained so in adulthood showed lower adherence to this pattern (PR = 0.70, 95% CI: 0.53-0.94 for men and PR = 0.40, 95% CI: 0.20-0.80 for women). Conclusions Four different dietary patterns were identified among young adults. Socioeconomic and demographic factors, and social mobility were associated with food choices.

This study aimed to identify possible variables associated with cognitive, behavioral and emotional development in a cohort of school children, based on biological (sex, gestational age and birth weight) and socioeconomic variables (marital status, maternal and paternal education, occupation of head of household, socioeconomic status, and number of household members). We evaluated 790 children born in a cohort of Ribeirão Preto (SP), Brazil, with 10/11 years of age. The Raven Test was used for cognitive assessment and the Strengths and Difficulties Questionnaire was utilized for emotional and behavioral assessment. By means of multivariate logistic regression analysis (CI 95%) we found that: 1) low maternal schooling was associated with behavioral and emotional problems and poor cognitive function, 2) being female was considered as a protective factor against behavioral problems and 3) low birth weight and prematurity were not associated with the outcomes investigated. O presente trabalho objetivou identificar possíveis variáveis associadas com o desenvolvimento cognitivo, comportamental e emocional de uma coorte de crianças em idade escolar, com base em variáveis biológicas (idade, sexo e peso ao nascer) e socioeconômicas (estado civil, educação materna e paterna, ocupação do chefe de família, status socioeconômico e número de membros da família). Foram avaliadas 790 crianças nascidas em uma coorte de Ribeirão Preto (SP), Brasil, aos 10/11 anos de idade. Para a avaliação cognitiva utilizou-se o Teste de Raven e para a avaliação emocional e comportamental usou-se o Questionário de Capacidades e Dificuldades. Por meio de análise de regressão logística multivariada (IC 95%), verificou-se que: 1) baixa escolaridade materna foi associada a problemas comportamentais, emocionais e baixo desempenho cognitivo; 2) sexo feminino foi um fator de proteção contra problemas de comportamento e 3) baixo peso ao nascer e prematuridade não foram associados com as variáveis investigadas. Este estudio objetivó identificar las posibles variables asociadas con el desarrollo cognitivo, comportamental y emocional de una cohorte de niños en edad escolar basado en variables biológicas (edad, sexo y peso al nacer) y socioeconómicas (estado civil, nivel educacional materno y paterno, ocupación del jefe del hogar, estatus socioeconómico y número de miembros de la familia). Fueron evaluados 790 niños nacidos en una cohorte de Ribeirão Preto (SP-Brasil), a los 10/11 años de edad. Para la evaluación cognitiva se utilizó el Test de Raven, y para la evaluación emocional y comportamental se usó el Cuestionario de Capacidades y Dificultades. Por medio del análisis de regresión multivariada (IC 95%) se verificó que: 1) baja escolaridad materna fue asociada a problemas comportamentales, emocionales y bajo desempeño cognitivo; 2) el sexo femenino fue un factor de protección contra problemas de comportamiento y 3) el bajo peso al nacer y la prematuridad no fueron asociados con las variables investigadas.

Studies have shown a possible association of oral diseases during pregnancy with preterm birth (PTB) and low birth weight (LBW). These perinatal outcomes appear to be associated with enamel defects in the primary dentition, which, in turn, seem to predispose to future development of caries in children. Therefore it is relevant to include oral health variables of the mother/child dyad in cohort studies to understand how these factors are associated. The objectives of this study are: 1) check if there is an association between diseases of the oral cavity of pregnant women and PTB, 2) test the hypothesis of association between perinatal outcomes and enamel defects/dental caries in children, 3) examine whether there are associations between perinatal outcomes and disorders of tooth eruption in children; 4) build theoretical models to study social inequities as a common factor between oral conditions and perinatal outcomes. We used an integrated, collaborative approach between two Brazilian cities with contrasting socioeconomic conditions: Sao Luis , MA, and Ribeirão Preto, SP - British Birth Cohort Studies study (BRISA Ribeirão Preto, São Luís). Two cohorts were evaluated: one initiated at birth, representative of the population of live births, and another, initiated prenatally. Participants were reassessed from the beginning of the second year of life. It is expected that these cohorts will contribute to foster the development and consolidation of population-based follow-up studies in Brazil.

Objective To study the clinical course of patients with Robin sequence (RS) during the first 6 months of life. Design A longitudinal prospective study of children with RS. Setting Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo, Bauru-SP, Brazil, 1997 and 1998. Patients Sixty-two children were studied from hospital admission to 6 months of age. Thirty-three (53.2%) presented with probable isolated RS (PIRS), 25 (40.3%) presented with syndromes or other malformations associated with RS, and 4 (6.5%) presented with RS with neurological involvement. Interventions The type of respiratory tract obstruction was defined by nasopharyngoscopy. The patients with type 1 and type 2 obstruction underwent nasopharyngeal intubation (NPI), and glossopexy was indicated in patients with type 1 obstruction who did not show clinical improvement with this procedure. Tracheostomy was indicated in patients with type 2 obstruction who did not show a good course after NPI, in patients with type 1 obstruction who did not show good course after glossopexy, and in patients with type 3 and type 4 obstruction. Results Prone position treatment (PPT) or NPI was the definitive treatment in 25 cases (75.8%) of PIRS and in 13 cases (52%) of syndromes or other malformations. Among the children with type 1 obstruction, 24 (51.1%) were submitted exclusively to PPT and 12 (25.5%) to NPI. With the type 2 groups, only one (12.5%) received PPT, and three (37.5%) were treated exclusively with NPI. All 15 infants treated exclusively with NPI (24.4%) presented with good weight, length, and neuromotor development. Conclusions Most patients with PIRS and type 1 obstruction improved without surgical intervention. NPI should be the initial treatment in all patients with RS with type 1 and type 2 obstruction who present with important respiratory and feeding difficulties.

An increase in preterm deliveries in Ribeirao Preto stimulated an analysis of possible explanatory factors. Two cohorts of singleton livebirths were studied, the first based on 6746 births in 1978-9 and the second based on 2846 births in 1994. A logistic regression was carried out to assess the association of preterm birth with several sociodemographic, behavioural and clinical variables, including year of survey. Delivery in private settings compared with a public setting, maternal age of < or = 17 compared with any other age group, and mothers who had had previous abortions and previous stillbirths were associated with greater rates of preterm birth. Although there was an increase in preterm birth rates regardless of mode of delivery, the increase was greater in the caesarean section group than in the vaginal delivery group. Over the study period, deliveries in private hospitals and caesarean section operations increased markedly (from 4% to 36% and from 30% to 51% respectively). Caesarean section may be the main contributor to the increase of preterm birth rate in this study. It is essential to ensure that health-care staff, especially those in private facilities, are properly educated and audited.

Objective To investigate the etiopathogenesis of isolated Robin sequence. Design A longitudinal and prospective study of children with isolated Robin sequence and no other associated syndromes or malformations. Setting The study was carried out at the Hospital de Reabilitacao de Anomalias Craniofaciais (formerly the Hospital for Research and Rehabilitation of Cleft Lip/Palate), University of São Paulo, Bauru, SP, Brazil, which provides care for patients with lip/palate lesions throughout Brazil. Patients Forty-three children were initially included in the study, seven of whom were later found to be cases of Stickler syndrome and excluded. The remaining 36 children presenting only the anomaly triad of microretrognathia, glossoptosis, and cleft palate were followed up from the first month of life to 4 years of age with repetitive clinical and ophthalmological examination. Main outcome Measure A family history of cleft lip/palate was determined on the basis of information provided by the parents and, when possible, the affected relative was submitted to physical examination. Results A family history of cleft lip/palate was observed in 27.7% of cases, one case having a younger brother with only cleft palate but no microretrognathia or glossoptosis. Six cases of isolated cleft palate and three cases of cleft lip with or without cleft palate were present in distant relatives. Complete U-shaped cleft palate (wide cleft) was the most frequent type of cleft, which was present in 75% of cases. Only one case of incomplete cleft palate was observed, but U-shaped; 25% of the patients presented complete V-shaped cleft palate. Conclusions We conclude that heredity could be a factor in the etiopathogenesis of isolated Robin sequence and suggest that cleft palate (usually complete and U-shaped) is the primary event in the determination of the triad of anomalies.

The objective of this study was to evaluate the impact of a feeding supplementation program on the growth of undernourished children younger than 5 years in the city of Guariba, state of Sao Paulo, Brazil. The sample consisted of 469 malnourished children enrolled in a feeding supplementation program sponsored by the State Health Secretariat. The children were divided into four groups according to how long they had been enrolled in the program: in group 1, the children had been enrolled for up to 12 months; in group 2, from 12 to 24 months; in group 3 from 24 to 36 months; and in group 4 the children had been enrolled for more than 35 months. Percentiles for weight/age, height/age and weight/height were calculated for each child. To assess the impact of the program, reference curves for the anthropometric profile were constructed based on expected variations in population percentiles. The changes observed in each group were analyzed statistically (McNemar). Groups 1 and 2 presented weight recovery and gains in the weight/height ratios for the most severely malnourished children; in group 3, the weight/height ratio was maintained and there was a discrete tendency towards weight recovery, which was reversed in group 4, in which the weight was again low in relation to height. The feeding supplementation program temporarily minimized severe nutritional deficiencies but was not sufficient to recover and maintain normal growth.

The phenotypic effects of ADIPOQ mutations early in life, prior to type 2 diabetes onset, have not been studied.The objective of the study was to characterize the impact of a novel ADIPOQ mutation in vitro and in vivo.The design of the study was ADIPOQ screening, adiponectin oligomerization, and cardiometabolic phenotype assessment.Fourteen hypoadiponectinemic (3 μg/mL) and 686 normoadiponectinemic young adults (23-25 y) were prospectively followed up since birth.Human and recombinant murine mutant adiponectin oligomerization, the proband's ADIPOQ and ADIPOR1/R2 adipose tissue (AT) expression, and cardiometabolic profile were measured.The heterozygous ADIPOQ p.M40K mutation was identified in one hypoadiponectinemic male (2.4 μg/mL) and three other family members. Carriers presented a marked reduction of serum high-molecular weight to total adiponectin ratio when compared with controls (9.4% ± 1% vs 56.6% ± 13%; P.05) and family noncarriers (9.4% ± 1% vs 42% ± 0.5%; P = .05). Both mRNA and protein levels of adiponectin were increased in the AT of the proband (2.3- and 1.6-fold, respectively). However, the high-molecular weight to total adiponectin ratio of adiponectin was decreased (3.3-fold). Moreover, the expressions of ADIPOR1 and ADIPOR2 were significantly down-regulated in the AT of the proband (6- and 1.2-fold, respectively). The results were confirmed by in vitro studies on the recombinant murine homologous mutation (p.M43K). The proband's cardiometabolic phenotype progression was further characterized: born small for gestational age and adolescence-onset obesity; insulin resistance (homeostasis assessment model of insulin resistance of 4.7), and dyslipidemia at 25 years; decreased high-molecular weight adiponectin (0.24 μg/mL = 10%), hypertension (180/120 mm Hg), steatosis (fat liver = 40% ± 6%), increased carotid intima-media thickness at 31 years, and type 2 diabetes (glycosylated hemoglobin = 6.6%) at 34 years of age. Of note, all of the affected family members presented features of metabolic syndrome.The newly identified ADIPOQ p.M40K mutation associates with severe cardiometabolic dysfunction due to the impairment of high-molecular weight adiponectin complex formation.

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.

Context The GHR polymorphisms contribution to the interindividual variability in prenatal and postnatal growth as well as to metabolic traits is controversial. Objective The aim of this study is to analyze the association of the GHRfl / d3 polymorphism with prenatal and postnatal growth and metabolic outcomes in adult life and to compare the genotype distribution in different populations. Design 385 community healthy subjects followed from birth to adult life (23–25years old) were grouped according to birth size: small—SGA ( n =130, 62 males), appropriate—AGA ( n =162, 75 males) and large for gestational age—LGA ( n =93, 48 males). GHRfl / d3 genotype distribution and its potential association with anthropometric (at birth, childhood and adult life) and metabolic features (in adult life) were analyzed and compared with data obtained from a systematic review of GHRfl / d3 association studies (31 articles). Results The frequency of the GHR d3 / d3 genotype was lower in the LGA ( χ 2 p =0.01); SGA and AGA subjects exhibited an increased chance of the d3 / d3 genotype (OR=3.58; 95%CI: 1.55; 8.24) and (OR=2.39; 95%CI: 1.02; 5.62), respectively. Despite the different prevalence among different birth size groups, in adults, GHRfl / d3 genotype was not associated with height, plasma IGF1 levels or metabolic phenotype and cardiovascular risk. GHRfl / d3 genotype distributions in AGA, SGA and LGA groups were comparable with those found in subjects of European origin but not with those of Asian ancestry. Conclusions The GHRd3 genotype was negatively associated with birth size but it was not associated with adult height or weight, plasma IGF1, metabolic phenotype or any marker of increased cardiovascular risk in young adults.

INTRODUÇÃO: Vários estudos epidemiológicos sobre o consumo de substâncias psicoativas têm incluído em suas análises a avaliação da influência do contexto social nos níveis de prevalência desse consumo. Analisa-se a distribuição do consumo dessas substâncias segundo as classes sociais, numa amostra de adolescentes escolares de Ribeirão Preto, SP, Brasil. MATERIAL E MÉTODO: Um questionário auto-aplicável, adaptado e submetido a um teste de confiabilidade, foi aplicado a uma amostra proporcional de 1.025 adolescentes matriculados na oitava série do primeiro grau e primeiro, segundo e terceiro anos do segundo grau, das escolas públicas e privadas da cidade. O questionário continha questões sobre o uso de dez classes de drogas. Utilizou-se a adaptação de um modelo que identifica 5 frações de classe social (burguesias empresarial, gerencial e pequena burguesia, proletariado e subproletariado), a partir de indicadores que situam os indivíduos dentro das relações sociais de produção. RESULTADOS: As três frações da burguesia foram mais representadas que as outras na população de adolescentes escolares do que na população geral. Não houve diferenças na distribuição do consumo de álcool e tabaco pelas classes sociais, embora se observe uma tendência de maior prevalência nos extremos da escala social. Já o consumo de substâncias ilícitas foi maior nas burguesias e menor no proletariado. CONCLUSÕES: Embora o consumo de substâncias lícitas não tenha diferido entre as classes sociais, o maior consumo de substâncias ilícitas pelos mais ricos provavelmente se deveu ao maior custo desses produtos do que o álcool e o tabaco. INTRODUCTION: Many of the epidemiological studies on the consumption of legal and illegal psychoactive substances have included the evaluation of the influence of social context on the levels of prevalence of this consumption using indirect social indicators such as family income, and educational and housing levels in an attempt to identify individuals or groups in different social contexts. The present study investigates the distribution of consumpition of psychoactive substances according to social class in a sample of teenage pupils in Ribeirão Preto, SP, Southeastern Brazil. MATERIAL AND METHOD: A self-applicable questionnaire duly adapted and submitted to a reliability test was applied to a proportional sample of 1,025 teenagers enrolled in the 8th, 9th, 10th and 12th grades in public and private city schools. The questionnaires contained questions about the use of ten classes of psychoactive substances, demographic questions and validation information, as well as questions about the perception and intrinsic behavior related to drug consumption. The adaptation of a model that identifies 5 social class strata (business middle class, managerial middle class, lower middle class, proletariat and subproletariat) on the basis of indicators that situate the individuals within the social relations of production, was used. RESULTS: The 3 middle class strata were more often represented, whereas the proletariat and subproletariat were less frequently represented in this teenage pupil population than in the population in general. There was no difference in alcohol or tobacco consumption according to social class, although prevalence tended to be higher at the two extremes of the social ladder. In contrast, the consumption of illegal substances was higher in the middle class and lower in the proletariat. CONCLUSION: Although the consumption of legal substances did not differ among social classes, the higher consumption of illegal substances by the wealthier teenagers was probably due to the higher cost of these products as compared those of alcohol and tobacco.

OBJETIVO Estimar a prevalência de nascimentos pré-termo por faixas de peso ao nascer e obter uma equação para correção de estimativas. MÉTODOS Revisão sistemática da literatura nacional, de 1990 a 2012, para identificar estudos com coleta primária de informações sobre peso ao nascer e idade gestacional. Foram selecionados 12 que contribuíram com tabulações da prevalência de nascimentos pré-termo para faixas de 100 g de peso ao nascer. Os resultados desses estudos foram combinados pelo método de polinômios fracionais, sendo obtidas curvas separadas para meninos e meninas, comparadas com os resultados do Sistema de Informações sobre Nascidos Vivos para os anos 2000, 2005, 2010 e 2011. RESULTADOS As estimativas da prevalência de nascimentos pré-termo, obtidas a partir dos estudos primários, foram superiores às do Sistema de Informações sobre Nascidos Vivos para praticamente todas as faixas de peso ao nascer. A prevalência relatada pelo Sistema de Informações sobre Nascidos Vivos foi de 7,1% em 2010, cerca de 38% menor do que a estimativa de 11,7% obtida com a equação de correção. CONCLUSÕES Os dados do Sistema de Informações sobre Nascidos Vivos quanto à prevalência de nascimento pré-termo não refletem a verdadeira dimensão da prematuridade no Brasil. Assim sendo, para sua utilização, será necessária a aplicação do fator de correção, conforme proposto. OBJETIVO Estimar la prevalencia de nacimientos pre-término por rangos de peso al nacer y obtener una ecuación para corrección de estimaciones. MÉTODOS Revisión sistemática de la literatura nacional, de 1990 a 2012, para identificar estudios con colecta primaria de informaciones sobre peso al nacer y edad de gestación. Se seleccionaron 12 que contribuyeron con tabulaciones de la prevalencia de nacimientos pre-término para grupos de 100 g de peso al nacer. Los resultados de estos estudios fueron combinados por el método de polinomios fraccionales siendo obtenidas curvas separadas para niños y niñas, comparadas con los resultados del Sistema de Informaciones sobre Nacidos Vivos para los años 2000, 2005, 2010 y 2011. RESULTADOS Las estimaciones de la prevalencia de nacimientos pre-término, obtenidas a partir de los estudios primarios, fueron superiores a las del Sistema de Informaciones sobre Nacidos Vivos para prácticamente todos los grupos de peso al nacer. La prevalencia relatada por el Sistema de Informaciones sobre Nacidos Vivos fue de 7,1% en 2010, cerca de 38% menor que la estimativa de 11,7% obtenida con la ecuación de corrección. CONCLUSIONES Los datos del Sistema de Informaciones sobre Nacidos Vivos sobre prevalencia de nacimiento pre-término no reflejan la verdadera dimensión de la prematuridad en Brasil. Siendo así, para su utilización, será necesaria la aplicación del factor de corrección, conforme propuesto. OBJECTIVE To estimate the prevalence of preterm birth by categories of birth weight, and to obtain an equation to correct the estimates. METHODS Systematic review of the Brazilian literature published from 1990 to 2012, to identify studies with primary collection of data on birth weight and gestational age. Twelve studies were selected and contributed for tabulations of preterm prevalence according to 100 g birth weight categories. These results were combined using sex-specific fractional polynomial equations and the resulting curves were compared with results from the Live Birth Information System for the years 2000, 2005, 2010 and 2011. RESULTS For all birth weight categories, preterm prevalence estimates based on primary studies had a higher prevalence than those of the the Live Birth Information System. The prevalence reported by the Live Birth Information System was of 7.2% in 2010, about 38.0% lower than the estimated prevalence of 11.7% obtained with the correctional equation. CONCLUSIONS Information reported by the Live Birth Information System on preterm prevalence does not reflect the true magnitude of the problem in Brazil, and should not be used without the correction factors proposed in the present analyses.

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.

To estimate the prevalence of preterm birth by categories of birth weight, and to obtain an equation to correct the estimates.Systematic review of the Brazilian literature published from 1990 to 2012, to identify studies with primary collection of data on birth weight and gestational age. Twelve studies were selected and contributed for tabulations of preterm prevalence according to 100 g birth weight categories. These results were combined using sex-specific fractional polynomial equations and the resulting curves were compared with results from the Live Birth Information System for the years 2000, 2005, 2010 and 2011.For all birth weight categories, preterm prevalence estimates based on primary studies had a higher prevalence than those of the the Live Birth Information System. The prevalence reported by the Live Birth Information System was of 7.2% in 2010, about 38.0% lower than the estimated prevalence of 11.7% obtained with the correctional equation.Information reported by the Live Birth Information System on preterm prevalence does not reflect the true magnitude of the problem in Brazil, and should not be used without the correction factors proposed in the present analyses.