Avaliação do acompanhamento clínico de recém-nascidos pré-termo egressos da Unidade de Terapia Intensiva Neonatal de um Hospital Universitário no Sul do Brasil

Avaliar o tipo de agendamento recebido por recém-nascidos pré-termo egressos da Unidade de Terapia Intensiva Neonatal de um Hospital Universitário em Pelotas-RS A coleta de dados obteve informações sobre a atenção hospitalar, características clínicas do recém-nascido e sociodemográficas da mãe a partir de prontuários médicos e de entrevista com os familiares. Após a alta, o acompanhamento consistiu em uma ligação telefônica em 15, 30, 45, 60, 75 e 90 dias, ocorrendo durante junho e dezembro de 2019. Nas ligações, os familiares eram questionados sobre tipo de leite ofertado ao bebê e o local de acompanhamento médico. O estudo identificou que, no momento da alta, somente 53% dos recém-nascidos receberam agendamento, e este ao Ambulatório de pediatria da Faculdade de Medicina, enquanto os demais foram apenas encaminhados. Não houve agendamento para o Ambulatório de seguimento (follow-up). A média de peso ao nascer foi menor e o tempo de internação foi maior entre aqueles que tiveram consulta agendada. Conclui-se que a utilização do Ambulatório de seguimento necessita rever seus protocolos de oferta e agendamento, pois não contempla a demanda exigida. Sugere-se incentivo e informação aos familiares, para que façam uso deste serviço e aos profissionais de saúde, para que o referenciem

Socioeconomic changes and adolescent psychopathology in a brazilian birth cohort study

Purpose: To investigate the effects of socioeconomic changes from birth to 11 years of life on emotional, conduct, and attentional/hyperactivity problems in 15-year-old adolescents, from the 1993 Pelotas (Brazil) birth cohort study. Methods: The original cohort was composed of 5,249 hospital-born children whose mothers answered a questionnaire. We conducted interviews with 87.5% and 85.7% of the original cohort in 2004e2005 and 2008, respectively. We divided family income changes into nine possible categories based on two assessment points (birth and 11 years of age) and three income levels. To assess the psychopathology of the adolescents at 15 years of age, 4,423 mothers answered the Strengths and Difficulties Questionnaire. Results: Adolescents who were always poor or who became poor between birth and 11 years of age had greater conduct problems at 15 years of age. There was no consistent association between poverty and emotional and attentional/hyperactivity problems. Conclusions: The effects of income change were more specific to conduct problems than to emotional and attentional/hyperactivity problems, similar to what has been previously described in developed countries

The role of MIR9-2 in shared susceptibility of psychiatric disorders during childhood : a population-based birth cohort study

Background: It has been suggested that microRNAs (miRNAs; short non-protein-coding RNA molecules that mediate post-transcriptional regulation), including mir-9 and mir-34 families, are important for brain development. Current data suggest that mir-9 and mir-34 may have shared effects across psychiatric disorders. This study aims to explore the role of genetic polymorphisms in the MIR9-2 (rs4916723) and MIR34B/C (rs4938723) genes on the susceptibility of psychiatric disorders in children from the 2004 Pelotas Birth Cohort. Methods: Psychiatric disorders were assessed in 3585 individuals using Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), criteria through the application of standard semi-structured interviews (using the Development and Well-Being Assessment, DAWBA) at the six-years-of-age follow-up. The outcome was defined as the presence of any mental disorder. We also considered two broad groups of internalizing and externalizing disorders to further investigate the role of these variants in mental health. Results: We observed an association between rs4916723 (MIR9-2) and the presence of any psychiatric disorder (odds ratios (OR) = 0.820; 95% CI = 0.7130–0.944; p = 0.006) and a suggestive effect on internalizing disorders (OR = 0.830; 95% CI = 0.698–0.987; p = 0.035). rs4938723 (MIR34B/C) was not associated with any evaluated outcome. Conclusion: The study suggests that MIR9-2 may have an important role on a broad susceptibility for psychiatric disorders and may be important mainly for internalization problems

Changes in infant and neonatal mortality and associated factors in eight cohorts from three Brazilian cities

Stillbirth (SBR), perinatal (PMR), neonatal (NMR) and infant mortality rates (IMR) are declining in Brazil and the factors associated with these falls are still being investigated. The objective of the present study was to assess changes in SBR, PMR, NMR and IMR over time and to determine the factors associated with changes in NMR and IMR in eight Brazilian cohorts. All cohorts are population-based (Ribeirão Preto in 1978/79, 1994 and 2010; Pelotas in 1982, 1993 and 2004; and São Luís in 1997/98 and 2010). Were included data on 41440 children. All indicators were decreased, except in the city of Pelotas, from 1993 to 2004, and except SBR in São Luís. Sociodemographic variables seem to be able to explain reductions of NMR and IMR in Ribeirão Preto, from 1978/79 to 1994, and in São Luís. In Ribeirão Preto, from 1994 to 2010 declines in NMR and IMR seem to be explained by reductions in intrauterine growth restriction (IUGR). Newborn’s gestational age had diminished in all cohorts, preventing even greater reductions of NMR and IMR. Improved sociodemographic variables and reduction of IUGR, seem to be able to explain part of the decrease observed. NMR and IMR could have been reduced even more, were it not for the worsening in gestational age distribution

Identifying adolescents at risk for depression : a prediction score performance in cohorts based in 3 different continents

Objective: Prediction models have become frequent in the medical literature, but most published studies are conducted in a single setting. Heterogeneity between development and validation samples has been posited as a major obstacle for the generalization of models. We aimed to develop a multivariable prognostic model using sociodemographic variables easily obtainable from adolescents at age 15 to predict a depressive disorder diagnosis at age 18 and to evaluate its generalizability in 2 samples from diverse socioeconomic and cultural settings. Method: Data from the 1993 Pelotas Birth Cohort were used to develop the prediction model, and its generalizability was evaluated in 2 representative cohort studies: the Environmental Risk (E-Risk) Longitudinal Twin Study and the Dunedin Multidisciplinary Health and Development Study. Results: At age 15, 2,192 adolescents with no evidence of current or previous depression were included (44.6% male). The apparent C-statistic of the models derived in Pelotas ranged from 0.76 to 0.79, and the model obtained from a penalized logistic regression was selected for subsequent external evaluation. Major discrepancies between the samples were identified, impacting the external prognostic performance of the model (Dunedin and E-Risk C-statistics of 0.63 and 0.59, respectively). The implementation of recommended strategies to account for this heterogeneity among samples improved the model’s calibration in both samples. Conclusion: An adolescent depression risk score comprising easily obtainable predictors was developed with good prognostic performance in a Brazilian sample. Heterogeneity among settings was not trivial, but strategies to deal with sample diversity were identified as pivotal for providing better risk stratification across samples. Future efforts should focus on developing better methodological approaches for incorporating heterogeneity in prognostic research

Pulse Wave Velocity at Early Adulthood: Breastfeeding and Nutrition during Pregnancy and Childhood.

BACKGROUND:Pulse wave velocity (PWV) is an early marker of arterial stiffness. Low birthweight, infant feeding and childhood nutrition have been associated with cardiovascular disease in adulthood. In this study, we evaluated the association of PWV at 30 years of age with birth condition and childhood nutrition, among participants of the 1982 Pelotas birth cohort. METHODS:In 1982, the hospital births in Pelotas, southern Brazil, were identified just after delivery. Those liveborn infants whose family lived in the urban area of the city were examined and have been prospectively followed. At 30 years of age, we tried to follow the whole cohort and PWV was assessed in 1576 participants. RESULTS:Relative weight gain from 2 to 4 years was positively associated with PWV. Regarding nutritional status in childhood, PWV was higher among those whose weight-for-age z-score at 4 years was >1 standard deviation above the mean. On the other hand, height gain, birthweight and duration of breastfeeding were not associated with PWV. CONCLUSION:Relative weight gain after 2 years of age is associated with increased PWV, while birthweight and growth in the first two years of life were not associated. These results suggest that the relative increase of weight later in childhood is associated with higher cardiovascular risk

Influence of body mass index and body weight perception on eating disorders symptoms

Objetivo: Estudar a associação entre a percepção do peso corporal, o índice de massa corporal e os comportamentos alimentares anormais. Métodos: Delineamento transversal, de base populacional, com mulheres de 12 a 29 anos, da zona urbana de Porto Alegre, RS (n=513). Para medir a prevalência de comportamentos alimentares anormais utilizou-se o Teste de Atitudes Alimentares 26 (EAT-26) e o Teste de Investigação Bulímica de Edimburgo (BITE), considerados separadamente e em conjunto, e a percepção do peso corporal por meio de 2 perguntas estruturadas: qual era o peso que a mulher julgava ideal e a auto-avaliação sobre seu peso. O índice de massa corporal (IMC) foi calculado por medida de peso e altura aferidos. Resultados: Considerando os instrumentos conjuntamente, 30,2% das mulheres tinham comportamento alimentar de risco, e 11,3% apresentaram comportamento alimentar anormal. Além disso, 82% das mulheres apresentaram IMC normal, sendo que 2% eram magras, e 16% apresentaram IMC de sobrepeso/obesidade. Das mulheres estudadas, 46% tinham o ideal de pesar menos, e 37,8% consideravam-se gordas. Entre as mulheres com IMC normal, 25,2% das que se achavam normais apresentavam comportamento alimentar de risco, e 5,7 % comportamento alimentar anormal. Das mulheres que se consideravam gordas, 47,2% apresentaram comportamento alimentar de risco, e 19,2% tinham comportamento alimentar anormal. Mulheres que se sentiam gordas apresentaram um risco quatro vezes maior de apresentar comportamentos alimentares anormais (razão de odds 4,50; IC 95% 2,88-7,01; p<0,001). Conclusão: A percepção do peso corporal – sentir-se gorda – mostrou um papel mais importante na determinação dos comportamentos alimentares anormais do que o índice de massa corporal (IMC sobrepeso/obesidade).Objective: To investigate the relationship between body mass index (BMI), body weight perception and eating disorder symptoms. Methods: A population-based cross-sectional study was conducted among women aged between 12 and 29 years old in Porto Alegre, Brazil (n=513). The prevalence of eating disorder symptoms was assessed by using two instruments: the Eating Attitudes Test - 26 (EAT-26) and the Bulimic Investigator Test (BITE). The results of the screening tests were evaluated separately and as a score combination of both instruments. Body weight perception was assessed using two questions: a) what was regarded as the ideal weight, and b) self-perception of body weight. The body mass index was calculated by dividing the square of the height (cm) by the weight (kg). Results: Regarding the results of the combined scores, 30.2% of the interviewed women were classified as having risk of eating disorder and 11.3% had abnormal eating behavior. The sample’s mean BMI was 21.9 (SD=3.8); 82.4% were classified as normal, 1.6% as thin and 16.1% as overweight/obese. Of the total of the study women, 46% had an ideal weight lower than their actual weight and 37.8% considered themselves fat. Among women with normal BMI, 25.2% that were classified as normal presented risk of abnormal eating behavior and 5.7% had eating disorder symptoms. Among women who considered themselves fat, 47.2% presented risk behaviors and 19.2% had eating disorder symptoms. The risk for eating disorder symptoms among women who saw themselves as fat was four times higher than among those who perceived their weight as normal (odds ratio 4.50; 95% CI 2.88-7.01; p<0.001)