Fatores de risco comportamentais modificáveis para DNT e sono em adolescentes brasileiros

OBJETIVO: Analisar a associação entre fatores de risco comportamentais modificáveis para doenças não transmissíveis e parâmetros do sono em adolescentes brasileiros. MÉTODOS: Estudo transversal que utilizou dados do Consórcio de Coortes RPS, São Luís, Brasil para o seguimento de adolescentes de 18-19 anos (n = 2.515). Os desfechos foram a sonolência diurna excessiva (Escala de Sonolência de Epworth – ESE) e a qualidade do sono (Índice de Qualidade do Sono de Pittsburgh – IQSP). As exposições de interesse foram os fatores de risco comportamentais para doenças não transmissíveis (DNT): tempo de tela, inatividade física, álcool, cigarro, drogas ilícitas, consumo de cafeína, consumo de bebidas adoçadas com açúcar. O excesso de peso foi considerado um possível mediador dessa associação entre as exposições de interesse e os desfechos. Os modelos foram analisados por modelagem com equações estruturais. RESULTADOS: A inatividade física (Coeficiente padronizado, CP = 0,112; p = 0,001), maior consumo de álcool (CP = 0,168; p = 0,019) e de bebidas adoçadas com açúcar (CP = 0,128; p < 0,001) foram associados a sonolência diurna excessiva nos adolescentes; a melhor situação socioeconômica também foi associada a este desfecho (CP = 0,128; p < 0,001). A inatividade física (CP = 0,147; p < 0,001) e o maior consumo de bebidas adoçadas com açúcar (CP = 0,089; p = 0,003) também se associaram com a qualidade do sono ruim. O excesso de peso não foi mediador e nem associado à qualidade do sono ou à sonolência diurna excessiva. CONCLUSÕES: Os principais fatores de risco comportamentais modificáveis para DNT estão associados a piores parâmetros do sono já na adolescência; alertando para um quadro de acúmulos de riscos para distúrbios de sono no futuro.OBJECTIVE: To analyze the association between modifiable behavioral risk factors for non-communicable diseases and sleep parameters in Brazilian adolescents. METHODS: This was a cross-sectional study that used data from the RPS Cohort Consortium, São Luís, Brazil for the follow-up of adolescents aged 18–19 years (n = 2,515). The outcomes were excessive daytime sleepiness (Epworth Sleepiness Scale – ESS) and sleep quality (Pittsburgh Sleep Quality Index – PSQI). The exposures of interest were the behavioral risk factors for non-communicable diseases (NCDs): screen time, physical inactivity, alcohol, smoking, illicit drugs, caffeine intake, and consumption of sugar-sweetened beverages. Excess weight was considered a possible mediator of this association between the exposures of interest and the outcomes. The models were analyzed by modeling with structural equations. RESULTS: Physical inactivity (standardized coefficient, SC = 0.112; p = 0.001), higher consumption of alcohol (SC = 0.168; p = 0.019) and of sugar-sweetened beverages (SC = 0.128; p < 0.001) were associated with excessive daytime sleepiness in adolescents; better socioeconomic status was also associated with this outcome (SC = 0.128; p < 0.001). Physical inactivity (SC = 0.147; p < 0.001) and higher consumption of sugar-sweetened beverages (SC = 0.089; p = 0.003) were also associated with poor sleep quality. Overweight was neither a mediator nor associated with sleep quality or excessive daytime sleepiness. CONCLUSIONS: T he m ain m odifiable b ehavioral r isk f actors f or N CDs a re a ssociated with worse sleep parameters already in adolescence, which serves as a warning toward the accumulation of risks for sleep disorders in the future

AMPLIAÇÃO DO ACESSO AO ATENDIMENTO ANTIRRÁBICO HUMANO EM SÃO LUÍS, MARANHÃO: RELATO DE EXPERIÊNCIA / INCREASING ACCESS OF HUMAN ANTI-RABIES CARE IN SÃO LUÍS, MARANHÃO, BRAZIL: CASE REPORT

Introdução: A raiva é um agravo de altíssima letalidade e afeta particularmente populações que apresentam um acesso desigual aos serviços de saúde. Objetivo: Relatar a utilização de estratégias para a ampliação do atendimento antirrábico humano, a partir das ações do setor de Vigilância em Saúde no município de São Luís, Maranhão, em 2013. Métodos: Estudo do tipo Relato de Experiência. Foi desenvolvido ações para a capacitação dos profissionais e gestores das unidades de saúde buscando a ampliação da oferta da terapia antirrábica em unidades de saúde. Resultados: Foram capacitados 169 profissionais. A vacina passou a ser ofertada em 46 unidades, e o soro em 05 unidades. Conclusão: Houve melhora no acesso ao atendimento antirrábico, o que contribui para minimizar iniquidades em saúde.Palavras-chave: Raiva. Vacinas Antirrábicas. Vigilância em Saúde Pública. Capacitação Profissional.AbstractIntroduction: Rabies is a highly lethal injury particularly affecting populations with unequal access to health services. Objective: To report the use of strategies aimed at improving human anti-rabies service from the Health Surveillance sector in São Luís, Maranhão, Brazil in 2013. Methods: Health professionals were trained and the rabies therapy supply was expanded in health facilities. Results: 169 professionals were trained. The vaccine became available in 46 units and the serum became available in 05 units. Conclusion: There was anti-rabies therapy access improvement, which helps to minimize health inequities.Keywords: Rabies. Rabies Vaccines. Public Health Surveillance. Professional Training

Processed and ultra-processed food consumption among children aged 13 to 35 months and associated factors

Abstract: The aim of this study was to evaluate the consumption of processed and ultra-processed foods among children aged 13-35 months and its associated factors. We studied 1,185 children within the BRISA cohort in São Luís, Maranhão State, Brazil. The food consumption was investigated using a 24-hour recall, and the percentages of daily caloric intake and nutrients were estimated by food groups according to “NOVA” classification. We chose to categorize children belonging to the upper tertile of the distribution as having a high consumption of processed and ultra-processed food products. The Poisson regression model with robust variance estimation using a hierarchical modeling approach was used to calculate the prevalence ratios (PRs) of variables associated with high consumption of processed and ultra-processed food products. The mean energy intake was 1,226Kcal/day. After adjustments, there was a higher proportion of high consumption of processed and ultra-processed food products among children whose mothers had < 12 years of education and among children who were older than 16 months. Mothers with low schooling and children older than 16 months should be the targets of interventions aimed at reducing consumption of these food products and preventing adverse health outcomes in later life

Maternal Mental Health in Late Pregnancy and Longitudinal Changes in Postpartum Serum Vitamin B-12, Homocysteine, and Milk B-12 Concentration Among Brazilian Women

BackgroundLittle is known regarding the association between mental health distress during pregnancy and postpartum maternal serum biomarkers of vitamin B-12 status and milk B-12 concentration.ObjectiveTo evaluate the association between depressive and anxiety symptoms in the third trimester of pregnancy and changes in postpartum serum B-12, homocysteine, and B-12 milk concentration.MethodsA total of 101 women (18-40 years) were studied in a prospective cohort with data at the third trimester of pregnancy (baseline) and three postpartum time-points (TPs): 2-8 days (TP1), 28-50 days (TP2), and 88-119 days (TP3) postpartum. B-12 concentrations in milk were measured by competitive chemiluminescent enzyme immunoassay at TP1, TP2, and TP3. Serum B-12 and homocysteine concentrations were evaluated at baseline, TP1, TP2, and TP3 by chemiluminescent immunoassays. Depressive and anxiety symptoms were measured with the Edinburgh Postnatal Depression Scale and the State-Trait Anxiety Inventory at baseline. Spearman's correlation test and multiple linear mixed-effect models were performed.ResultsThe prevalence of depressive and anxiety state symptoms was 35.6 and 39.6% at baseline. High prevalence of low milk B-12 concentration (&lt;310 pmol/L) were observed at TP1 (53.2%), TP2 (71.4%), and TP3 (71.1%). Women with anxiety symptoms at baseline presented higher median concentrations of serum homocysteine at TP1 and lower concentrations of serum and milk B-12 at TP2 compared with women without anxiety symptoms [8 (7; 9) vs. 6 (5; 8) and 266 (188; 369) vs. 332 (272; 413)]. Milk B-12 concentrations were positively and significantly correlated with maternal serum B-12 concentrations at different TP. Women with anxiety symptoms at baseline exhibited a decrease in daily postpartum homocysteine concentrations compared to women without anxiety symptoms (β = -0.002, SE = 0.001, p = 0.024).ConclusionAnxiety symptoms at the end of pregnancy were associated with longitudinal changes in maternal serum homocysteine concentrations during the first 3 months postpartum