Different levels of cardiometabolic indicators in multiple vs. singleton children

Background We aimed to compare cardiometabolic indicators in singletons and multiples at age 7 and explore the birthweight mediation effect. Methods We studied 5431 singletons and 103 sets of multiples from Generation XXI birth cohort. Anthropometric measurements, body composition, and fasting blood samples were obtained. Age- and sex-specific z-scores were calculated (additionally height-specific for blood pressure). Adjusted regression coefficients and respective 95% confidence intervals [β (95%CI)] were computed using path analysis. Results Multiples had lower weight [− 0.419 (− 0.616;-0.223)], height [− 0.404 (− 0.594;-0.213)], BMI [− 0.470 (− 0.705;-0.234)], fat mass index [− 0.359 (− 0.565;-0.152)], waist circumference [− 0.342 (− 0.537;-0.147)], and waist-to-height ratio [− 0.165 (− 0.326;-0.003)] z-scores. These results were explained by the indirect effect via birthweight, which was also negative and significant for all the aforementioned cardiometabolic indicators, while no direct effect was present. There were also significant indirect effects regarding fat-free mass index, glucose, insulin, and blood pressure, though the total effects were not significant, due to the balance between direct and indirect effects. The only significant direct effect was regarding diastolic blood pressure [− 0.165 (− 0.302;-0.028)]. Conclusions At age 7, multiples presented better cardiometabolic indicators explained by lower weight at birth, except for the lower blood pressure which was independent of an effect via birthweight.Generation XXI was funded by Programa Operacional de Saúde – Saúde XXI, Quadro Comunitário de Apoio III and Administração Regional de Saúde Norte (Regional Department of Ministry of Health); FEDER through the Operational Programme Competitiveness and Internationalization and national funding from the Foundation for Science and Technology – FCT (Portuguese Ministry of Science, Technology and Higher Education) (POCI-01- 0145-FEDER-016837), under the project “PathMOB: Risco cardiometabólico na infância: desde o início da vida ao fim da infância” (Ref. FCT PTDC/DTP-EPI/3306/2014), the Unidade de Investigação em Epidemiologia - Instituto de Saúde Pública da Universidade do Porto (EPIUnit) (POCI-01-0145-FEDER-006862; Ref. UID/DTP/04750/2013), and ACS holds a FCT Investigator contract IF/01060/2015; and by the project DOCnet (NORTE-01-0145-FEDER-000003), supported by Norte Portugal Regional Operational Programme (NORTE 2020), under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund (ERDF) and by European Commission [project reference FP7-ENV-2013-603946]

Completeness of Retention Data and Determinants of Attrition in Birth Cohorts of Very Preterm Infants: A Systematic Review

Background: Birth cohorts provided essential knowledge for clinical and public health decision-making. However, little is known about retention and determinants of attrition in these specific longitudinal studies, although characterizing predictors of attrition sets the path to mitigate its occurrence and to promote valid inferences. We systematically reviewed retention in follow-ups of birth cohorts of very preterm or very low birth weight infants and the determinants of attrition. PROSPERO registration number: CRD42017082672. Methods: Publications were identified through PubMed®, Scopus, Web of Science, and Cochrane Library databases from inception to December 2017. Studies were included when reporting at least one of the following: retention at follow-ups, reasons for attrition, or characteristics of non-participants. Quality assessment was conducted using the completeness of the report of participation features in the articles. Non-participant's characteristics were presented using descriptive statistics. Local polynomial regression was used to describe overall retention trends over years of follow-up. Results: We identified 57 eligible publications, reporting on 39 birth cohorts and describing 83 follow-up evaluations. The overall median retention was 87% (p25–p75:75.8–93.6), ranging from 14.6 to 100%. Overall, retention showed a downward trend with increasing child age. Completeness of retention report was considered “enough” in only 36.8% of publications. Considering the 33 (57.9%) publications providing information on participants and non-participants, and although no formal meta-analysis was performed, it was evident that participants lost to follow-up were more often male, had foreign-born, multiparous, and younger mothers, and with a lower socioeconomic status. Conclusion: This systematic review evidenced a lack of detailed data on retention, which may threaten the potential use of evidence derived from cohort studies of very preterm infants for clinical and public health purpose. It supports the requirement for a standardized presentation of retention features responding to current guidelines.This work was supported by RECAP-Preterm project that is funded by the European Union's Horizon 2020 research and innovation program under Grant Agreement No. 733280. This study was also funded by Foundation for Science and Technology—FCT (Portuguese Ministry of Science, Technology and Higher Education), under the Unidade de Investigação em Epidemiologia—Instituto de Saúde Pública da Universidade do Porto (EPIUnit) (info:eu-repo/grantAgreement/FCT/6817 - DCRRNI ID/UIDB/04750/2020/PT); Ana Cristina Santos holds a FCT Investigator contract info:eu-repo/grantAgreement/FCT/Investigador FCT/IF/01060/2015/CP1319/CT0001/PT

New Functionalized Macroparticles for Environmentally Sustainable Biofilm Control in Water Systems

Reverse osmosis (RO) depends on biocidal agents to control the operating costs associated to biofouling, although this implies the discharge of undesired chemicals into the aquatic environment. Therefore, a system providing pre-treated water free of biocides arises as an interesting solution to minimize the discharge of chemicals while enhancing RO filtration performance by inactivating bacteria that could form biofilms on the membrane system. This work proposes a pretreatment approach based on the immobilization of an industrially used antimicrobial agent (benzalkonium chloride-BAC) into millimetric aluminum oxide particles with prior surface activation with DA-dopamine. The antimicrobial efficacy of the functionalized particles was assessed against Escherichia coli planktonic cells through culturability and cell membrane integrity analysis. The results showed total inactivation of bacterial cells within five min for the highest particle concentration and 100% of cell membrane damage after 15 min for all concentrations. When reusing the same particles, a higher contact time was needed to reach the total inactivation, possibly due to partial blocking of immobilized biocide by dead bacteria adhering to the particles and to the residual leaching of biocide. The overall results support the use of Al2O3-DA-BAC particles as antimicrobial agents for sustainable biocidal applications in continuous water treatment systems

GJB2: Frequency of the less common variants in a sample of the Portuguese population

Introduction: Sequence variants in the GJB2 gene account for up to 50% of cases of non-syndromic sensorineural hearing loss in the Caucasian population. In this study, we report the frequency of the less common variants of the GJB2 gene in a Portuguese sample and compare these frequencies with those of a group of hearing-impaired patients. Material and Methods: In order to select the less common GJB2 variants, 147 hearing-impaired patients followed in Centro Hospitalar Universitário de São João were evaluated. Afterwards, the presence of those variants was tested in 360 individuals from Generation 21. Results: The patient assessment enabled the selection of 11 GJB2 variants. Of those, 10 were investigated in Generation 21 participants, with only four being detected, in heterozygosity: p.Phe83Leu, p.Arg127His, p.Val153Ile and p.Asn206Ser, with the allelic frequencies (95% confidence interval) of 0.14% (0.01% - 0.87%), 0.28% (0.01% - 1.08%), 0.97% (0.43% - 2.04%) and 0.14% (0.01% - 0.88%), respectively. Two variants, p.Val37Ile and p.Val95Met, were more frequent in the patients’ group with statistical significance. Discussion: Our results allow for the p.Arg127His and p.Val153Ile variants to comply with polymorphism criteria and support the pathogenicity of p.Val37Ile and p.Val95Met variants. Moreover, two cases of moderate hearing loss were explained by the p.Val37Ile/p. Asn206Ser genotype, substantiating both the pathogenicity of such variants and the hypothesis that compound heterozygosity with p.Ans206Ser is associated with mild-moderate genotypes. Conclusion: Understanding the role of the variants is essential in order to provide genetic counselling to patients and their families. We explored a set of uncommon GJB2 variants that comprised 12% of the hearing-impaired patients in this study, supporting the relevance of their description.Generation XXI was funded by Programa Operacional de Saúde – Saúde XXI, Quadro Comunitário de Apoio III and Administração Regional de Saúde Norte (Regional Department of Ministry of Health). This study was funded by FEDER through the Operational Programme Competitiveness and Internationalization and national funding from the Foundation for Science and Technology – FCT (Portuguese Ministry of Science, Technology and Higher Education) by the Unidade de Investigação em Epidemiologia – Instituto de Saúde Pública da Universidade do Porto (EPIUnit) (POCI-01-0145-FED-ER-006862; Ref. UID/DTP/ 04750/2013), and the Calouste Gulbenkian Foundation. Ana Cristina Santos holds an FCT Investigator contract IF/ 01060/2015. (POCI-01-0145-FEDER-016837)

Early socioeconomic circumstances and cardiometabolic health in 10-year-old children

Background Social adversity is thought to become biologically embedded during sensitive periods of development, setting children on a trajectory of increased risk for later chronic diseases. Thus, social differences are expected to be expressed as biological alterations and might have their origins in early life. Therefore, we aim to estimate the association between early socioeconomic position (SEP) and cardiometabolic health during childhood. Methods Data from 2962 participants in the population-based birth cohort Generation XXI, from Porto, Portugal, was collected following standardized procedures at all study waves. Early SEP definition included household income, parental education and occupation at child’s birth. Cardiometabolic health was characterized at the age of 7 and 10, considering the triglycerides, cholesterol, fasting glucose, body mass index, systolic and diastolic blood pressure. Logistic regression was used to estimate the association between early SEP and a favorable cardiometabolic health profile. Results A favorable cardiometabolic profile was observed in almost half of participants at both ages, particularly among high SEP children who remain more frequently without alterations. For girls, higher paternal education at 7 years (OR:1.49;95%CI:1.03-2.15) and higher SEP at 10 were associated with better cardiometabolic health profile. In boys, a better cardiometabolic health profile was observed with increasing levels in maternal and paternal education and occupation, but at the age of 10, social differences were more evident according to parental education. Conclusions We provide evidence that children from more advantaged SEP at birth have an increased likelihood of presenting better cardiometabolic health at early ages. Social differences in cardiometabolic health biomarkers are already found in childhood, suggesting that the short-term impact of early life SEP on the physiology dysregulation takes place already in the first decade of life

Effect of maternal country of birth on breastfeeding practices: results from Portuguese GXXI birth cohort

Background: Maternal country of birth has been associated with perinatal health outcomes but less is known regarding breastfeeding practices in contemporary European settings. This study investigated effect of maternal country of birth on breastfeeding initiation and duration by comparing native Portuguese and migrant mothers. Methods: We analyzed data of 7065 children of the Generation XXI (GXXI) birth cohort recruited at birth (2005-06) and followed-up 4 years later. Logistic regression was used to assess the effect of maternal country of birth on breastfeeding initiation. Kaplan-Meier estimate was used to compare breastfeeding duration by maternal country of birth and length of residence by migrant mothers in Portugal. Results: Breastfeeding initiation and the type of breastfeeding practice were similar for native Portuguese and migrant mothers. The migrants had significantly higher median duration in months of any breastfeeding (Odds Ratio [OR] 6.0, 95% Confidence Interval [CI] 5.4,6.6) and exclusive breastfeeding (OR 4.0, 95% CI 3.8,4.2) than native Portuguese mothers (OR 4.0, 95% CI 3.8,4.2 and OR 3.0, 95% CI 2.9,3.0). Migrant mothers who resided in Portugal for either 5 years (OR 6.0, 95% CI 5.5,6.5 and OR 4.0, 95% CI 3.7,4.3) years had similar duration of any breastfeeding or exclusive breastfeeding, in both cases higher than the native Portuguese mothers. No significant differences were found when world regions were compared. Conclusions: Maternal country of birth does not influence breastfeeding initiation and type of feeding practice. However, migrant mothers have longer breastfeeding duration of either exclusive or any breastfeeding, which was not changed by length of residence in Portugal.GXXI was funded by Programa Operacional de Saude-Saude XXI, Quadro Comunitario de Apoio III and Administracao Regional de Saude Norte (Regional Department of Ministry of Health). It has support from Calouste Gulbenkian Foundation and Portuguese Foundation for Science and Technology. Precisely, EPIUnit-Instituto de Saude Publica da Universidade do Porto (POCI-01-0145-FEDER-006862; Ref. UID/DTP/04750/2013); PhD Grant SFRH/BD/111794/2015 (Carina Rodrigues) as well as the individual grants IF/01060/2015 (Ana Cristina Santos) and SFRH/BSAB/113778/2015 (Henrique Barros), co-funded by the FCT and the POCH/FSE Program

Early socioeconomic circumstances and adverse childhood experiences in 10-year-old children

Background Evidence showed that adverse childhood experiences (ACEs) are associated with the development of disease later in life and premature death. Examining the occurrence of these experiences at early ages would contribute to intervene and therefore to reduce health inequalities. This study aimed to assess the prevalence of ACEs among 10-year-children and to examine its association with early socioeconomic circumstances. Methods At the fourth wave of the population-based birth cohort Generation XXI, from Porto, Portugal, 5153 children completed a self-report questionnaire on 9 experiences related to household dysfunction and physical and emotional abuse. Socioeconomic circumstances included household income, maternal and paternal education, and history of parental unemployment. Logistic regression was performed to calculate the Odds Ratios (OR) and 95% Confidence Intervals (95%CI). Results A high prevalence of physical and emotional abuse was reported by children from low socioeconomic circumstances. A graded relationship between socioeconomic circumstances and cumulative ACEs was observed, for instance, low household income was associated with increased number of ACEs (one event [OR = 1.10; 95%CI: 0.89-1.36], two events [OR = 1.41; 95%CI: 1.15-1.73], three events [OR = 1.67; 95%CI: 1.34-2.06], and four or more events [OR = 2.05; 95%CI: 1.64-2.55]). Also, living with one parent or none of them increased the likelihood of reporting multiple ACEs (OR = 5.50; 95%CI: 4.23-7.13). Conclusions Children from low socioeconomic circumstances were more likely to report multiple adverse experiences in the first decade of life. These findings support that children from less advantaged environments might be at a higher risk of co-occurrence of adverse experiences during their childhood

Newborn weight change and childhood cardio-metabolic traits - a prospective cohort study

Background: Newborn weight change (NWC) in the first 4 days represents short-term adaptations to external environment. It may be a key developmental period for future cardio-metabolic health, but this has not been explored. We aimed to determine the associations of NWC with childhood cardio-metabolic traits. Methods: As part of Generation XXI birth cohort, children were recruited in 2005/2006 at all public units providing obstetrical and neonatal care in Porto. Birthweight was abstracted from clinical records and postnatal anthropometry was obtained by trained examiners during hospital stay. NWC was calculated as ((minimum weight - birthweight)/birthweight) x 100. At age 4 and 7, children were measured and had a fasting blood sample collected. Fasting glucose, LDL-cholesterol, triglycerides, waist circumference, systolic and diastolic blood pressure were evaluated. This study included 312 children with detailed information on growth in very early life and subsequent cardio-metabolic measures. Path analysis was used to compute adjusted regression coefficients and 95% confidence intervals. Results: NWC was not associated with any cardio-metabolic traits at ages 4 or 7. Strong associations were observed between each cardio-metabolic trait at 4 with the same trait at 7 years. The strongest associations were found for waist circumference [0.725 (0.657; 0.793)] and LDL-cholesterol [0.655 (0.575; 0.735)]. Conclusions: No evidence that NWC is related to childhood cardio-metabolic traits was found, suggesting that NWC should be faced in clinical practice as a short-term phenomenon, with no medium/long term consequences, at least in cardio-metabolic health. Our results show strong tracking correlations in cardio-metabolic traits during childhood.This work was supported by Programa Operacional de Saude - Saude XXI, Quadro Comunitario de Apoio III and Administracao Regional de Saude Norte (Regional Department of Ministry of Health); FEDER through the Operational Programme Competitiveness and Internationalization and national funding from the Foundation for Science and Technology - FCT (Portuguese Ministry of Science, Technology and Higher Education) [POCI-01-0145-FEDER-016837], under the project PathMOB.: Risco cardiometabolico na infancia: desde o inicio da vida ao fim da infancia [Ref. FCT PTDC/DTP-EPI/3306/2014], and FCT Investigator contract [IF/01060/2015] - ACS; Unidade de Investigacao em Epidemiologia - Instituto de Saude Publica da Universidade do Porto (EPIUnit) [POCI-01-0145-FEDER-006862; Ref. UID/DTP/04750/2013]; Norte Portugal Regional Operational Programme (NORTE 2020), under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund (ERDF) - DOCnet (NORTE-01-0145-FEDER-000003); UK Medical Research Council [MC_UU_12013/5] and UK National Institute of Health Research Senior Investigator [NF-SI-0611-10196] - DAL

Accessibility and integration of HIV, TB and harm reduction services for people who inject drugs in Portugal: a rapid assessment

Executive summary Background: Injecting drug use is associated with high risk of tuberculosis (TB) and reduced retention in treatment. Provision of opioid substitution therapy (OST) improves HIV and TB treatment outcomes among people who inject drugs (PWID) but there is a lack of documented strategies for the effective delivery of integrated HIV, TB and drug dependency treatment. Within a harm reduction framework, Portugal has made concerted efforts to move towards integrated service delivery. We aimed to document existing models of integrated TB and HIV care for PWID in Porto, Portugal. Methods: We undertook a rapid assessment combining the following methods and data sources: a mapping of existing HIV, TB, hepatitis C virus (HCV) and drug dependency treatment services in Porto; a review of existing data on HIV, TB and drug treatment service use and integration; semi-structured interviews with 30 PWID with experience of HIV and/or TB, and with seven providers representing HIV, TB, drug treatment, outreach and prison health services. We analysed quantitative data descriptively and qualitative data thematically, triangulating findings throughout data collection and analysis. Findings: The assessment documented two models of integrated HIV, TB and drug dependency care for PWID. The first ‘combined’ model provides all services within a designated centre staffed by a co-located team of specialists with shared case management protocols. This approach facilitates multidisciplinary care but is resource-intensive, limited to a specific location and offers reduced scope for community/home-based care. The second ‘collaborative’ model is a less formalised, client-centred approach in which multiple and existing health programmes work together to achieve co-located treatment delivery in a location convenient to the patient, with outreach teams often acting as mediators between services. This model allows prompt access and adaptability to clients’ circumstances but is highly dependent on the participation of multiple services. The relative success of integration was shaped by four key factors: the extent of collaborative networks and shared protocols; the central involvement of outreach teams; provision of uninterrupted OST; and flexibility over treatment location. Engagement in services more broadly was shaped by social network and outreach support; recognition of patient autonomy; patient-provider relationships; timing of testing and treatment provision; treatment literacy; and the availability of social care. Few quantitative data were available to assess service integration. Targeted rapid HIV testing in drug treatment centres has achieved high coverage among PWID but rates of TB and HCV screening were low and incompletely reported. Most TB patients knew their HIV status but no equivalent data were available on TB among patients receiving HIV care. Recommendations: Guidelines on integration of HIV, TB and drug dependency care should reflect the importance of: multi-agency collaboration, use of existing professional networks to develop mechanisms for expedited access to integrated care; uninterrupted provision of drug dependency treatment accounting for interactions with anti-TB and anti-retroviral therapy; a client-centred approach recognising service users’ autonomy; and the key role outreach programmes can play in facilitating access. Recommendations specific to Porto include expansion of TB and HCV screening among PWID; improved health information systems; streamlined referral mechanisms; increased user involvement; renewed focus on HCV; tackling stigma in primary care; and addressing PWIDs’ broader social care needs

Maternal smoking: a life course blood pressure determinant?

Introduction: Exposure to maternal smoking early in life may affect blood pressure (BP) control mechanisms. We examined the association between maternal smoking (before conception, during pregnancy, and 4 years after delivery) and BP in preschool children. Methods: We evaluated 4295 of Generation XXI children, recruited at birth in 2005–2006 and reevaluated at the age of 4. At birth, information was collected by face-to-face interview and additionally abstracted from clinical records. At 4-year follow-up, interviews were performed and children’s BP measured. Linear regression models were fitted to estimate the association between maternal smoking and children’s BP. Results: Children of smoking mothers presented significantly higher BP levels. After adjustment for maternal education, gestational hypertensive disorders, and child’s body mass index, children exposed during pregnancy to maternal smoking presented a higher systolic BP (SBP) z-score (β = 0.08, 95% confidence interval [CI] 0.04 to 0.14). In crude models, maternal smoking was associated with higher SBP z-score at every assessed period. However, after adjustment, an attenuation of the association estimates occurred (β = 0.08, 95% CI 0.03 to 0.13 before conception; β = 0.07, 95%CI 0.02 to 0.12; β = 0.04, 95%CI −0.02 to 0.10; and β = 0.06, 95%CI 0.00 to 0.13 for the first, second, and third pregnancy trimesters, respectively; and β = 0.07, 95%CI 0.02 to 0.12 for current maternal smoking). No significant association was observed for diastolic BP z-score levels. Conclusion: Maternal smoking before, during, and after pregnancy was independently associated with systolic BP z-score in preschool children. This study provides additional evidence to the public health relevance of maternal smoking cessation programs if early cardiovascular health of children is envisaged. Implications: Using observational longitudinal data from the birth cohort Generation XXI, this study showed that exposure to maternal smoking—before pregnancy, during pregnancy, and 4 years after delivery—was associated with a systolic BP-raising effect in children at the age of 4. The findings of this study add an important insight into the need to support maternal smoke-free environments in order to provide long-term cardiovascular benefit, starting as early as possible in life.Generation XXI has been funded by the Operational Health Programme XXI Health, Community support framework III (co-funded by Feder), Administração Regional de Saúde do Norte, Fundação Calouste Gulbenkian and Fundação para a Ciência e Tecnologia (SFRH/BSAB/113778/2015; PD/BD/105824/2014; PD/BD/105827/2014; F-COMP-01-0124-FEDER-011008; FCT—PTDC/SAU-ESA/105033/2008). Also, the Portuguese Foundation for Science and Technology funds the Epidemiology Research Unit of the Institute of Public Health of the University of Porto (UID/DTP/04750/2013). This article is a result of the project DOCnet (NORTE-01-0145-FEDER-000003), supported by Norte Portugal Regional Operational Programme (NORTE 2020), under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund (ERDF)