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ABSTRACT OBJECTIVE The COVID-19 pandemic has raised numerous concerns regarding its effects on individuals’ health and lifestyle. We aim to analyze potential changes in adolescent sleep patterns from before and during the pandemic and identify specific predictors of changes. METHODS A subgroup of adolescents from a population-based birth cohort from Pelotas, Brazil, was assessed pre-pandemic (T1, November-2019 to March-2020) and peri-pandemic (T2, August-2021 to December-2021) in in-person interviews (n = 1,949). Sleep parameters, including sleep duration and latency time on workdays and free days, as well as social jetlag (SJL), were assessed using the Munich ChronoType Questionnaire (MCTQ). Socio-demographic, pre-pandemic, and pandemic-related predictors were analyzed. Changes in sleep parameters from T1 to T2 were estimated by multivariate latent change score modeling. RESULTS The latent change factor shows a significant mean increase in workday sleep duration (M = 0.334, p < 0.001), workday sleep latency (M = 0.029, p = 0.002), and free day sleep latency (M = 0.021, p = 0.034), and a decreased in SJL (M = −0.758, p < 0.001) during the pandemic. Female adolescents presented higher increases in workday sleep duration. Adolescents who adopted a stricter social distancing level during the pandemic presented greater increases in workday sleep duration and smaller reductions in SJL. Self-evaluated insomnia during the pandemic predicted lower increases in workday and free day sleep duration and higher increases in workday and free day sleep latency. CONCLUSION The COVID-19 outbreak brought certain advantages regarding increased sleep duration and reduced SJL. However, the observed increase in sleep latency and the influence of self-reported insomnia could be related to psychological distress inherent to the pandemic.

BackgroundEnhancing the design of family planning interventions is crucial for promoting gender equality and improving maternal and child health outcomes. We identified, critically appraised, and synthesized policies and strategies from five selected countries that successfully increased family planning coverage.MethodsWe conducted a policy analysis through a scoping review and document search, focusing on documents published from 1950 to 2023 that examined or assessed policies aimed at enhancing family planning coverage in Brazil, Ecuador, Egypt, Ethiopia, and Rwanda. A search was conducted through PubMed, SCOPUS, and Web of Science. Government documents and conference proceedings were also critically analyzed. National health surveys were analyzed to estimate time trends in demand for family planning satisfied by modern methods (mDFPS) at the national level and by wealth. Changes in the method mix were also assessed. The findings of the studies were presented in a narrative synthesis.FindingsWe selected 231 studies, in which 196 policies were identified. All countries started to endorse family planning in the 1960s, with the number of identified policies ranging between 21 in Ecuador and 52 in Ethiopia. Most of the policies exclusively targeted women and were related to supplying contraceptives and enhancing the quality of the services. Little focus was found on monitoring and evaluation of the policies implemented.ConclusionAmong the five selected countries, a multitude of actions were happening simultaneously, each with its own vigor and enthusiasm. Our findings highlight that these five countries were successful in increasing family planning coverage by implementing broader multi-sectoral policies and considering the diverse needs of the population, as well as the specific contextual factors at play. Successful policies require a nuanced consideration of how these policies align with each culture’s framework, recognizing that both sociocultural norms and the impact of past public policies shape the current state of family planning.

Abstract Background Although most Latin American and the Caribbean (LAC) countries made important progress in maternal and child health indicators from the 1990s up to 2010, little is known about such progress in the last decade. This study aims at documenting progress for each country as a whole, and to assess how within-country socioeconomic inequalities are evolving over time. Methods We identified LAC countries for which a national survey was available between 2011–2015 and a second comparable survey in 2018–2020. These included Argentina, Costa Rica, Cuba, the Dominican Republic, Guyana, Honduras, Peru, and Suriname. The 16 surveys included in the analysis collected nationally representative data on 221,989 women and 152,983 children using multistage sampling. Twelve health-related outcomes were studied, seven of which related to intervention coverage: the composite coverage index, demand for family planning satisfied with modern methods, antenatal care (four or more visits and eight or more visits), skilled attendant at birth, postnatal care for the mother and full immunization coverage. Five additional impact indicators were also investigated: stunting prevalence among under-five children, tobacco use by women, adolescent fertility rate, and under-five and neonatal mortality rates. For each of these indicators, average annual relative change rates were calculated between the baseline and endline national level estimates, and changes in socioeconomic inequalities over time were assessed using the slope index of inequality. Results Progress over time and the magnitude of inequalities varied according to country and indicator. For countries and indicators where baseline levels were high, as Argentina, Costa Rica and Cuba, progress was slow and inequalities small for most indicators. Countries that still have room for improvements, such as Guyana, Honduras, Peru and Suriname, showed faster progress for some but not all indicators, although also had wider inequalities. Among the countries studied, Peru was the top performer in terms of increasing coverage and reducing inequalities over time, followed by Honduras. Declines in family planning and immunization coverage were observed in some countries, and the widest inequalities were present for adolescent fertility and antenatal care coverage with eight or more visits. Conclusions Although LAC countries are well placed in terms of current levels of health indicators compared to most low- and middle-income countries, important inequalities remain, and reversals are being observed in some areas. More targeted efforts and actions are needed in order to leave no one behind. Monitoring progress with an equity lens is essential, but this will require further investment in conducting surveys routinely.

Abstract Introduction Infant and neonatal mortality estimates are typically derived from retrospective birth histories collected through surveys in countries with unreliable civil registration and vital statistics systems. Yet such data are subject to biases, including under-reporting of deaths and age misreporting, which impact mortality estimates. Prospective population-based cohort studies are an underutilized data source for mortality estimation that may offer strengths that avoid biases. Methods We conducted a secondary analysis of data from the Child Health Epidemiology Reference Group, including 11 population-based pregnancy or birth cohort studies, to evaluate the appropriateness of vital event data for mortality estimation. Analyses were descriptive, summarizing study designs, populations, protocols, and internal checks to assess their impact on data quality. We calculated infant and neonatal morality rates and compared patterns with Demographic and Health Survey (DHS) data. Results Studies yielded 71,760 pregnant women and 85,095 live births. Specific field protocols, especially pregnancy enrollment, limited exclusion criteria, and frequent follow-up visits after delivery, led to higher birth outcome ascertainment and fewer missing deaths. Most studies had low follow-up loss in pregnancy and the first month with little evidence of date heaping. Among studies in Asia and Latin America, neonatal mortality rates (NMR) were similar to DHS, while several studies in Sub-Saharan Africa had lower NMRs than DHS. Infant mortality varied by study and region between sources. Conclusions Prospective, population-based cohort studies following rigorous protocols can yield high-quality vital event data to improve characterization of detailed mortality patterns of infants in low- and middle-income countries, especially in the early neonatal period where mortality risk is highest and changes rapidly.

Abstract Background The negative impacts of maternal depression on child mental health outcomes are well‐documented. However, some children show adaptive functioning following exposure to maternal depression, demonstrating resilience. In a large birth cohort from Brazil, a middle‐income country, we examined direct and indirect pathways, considering socioeconomic, family, and individual factors, contributing to the development of resilience. Methods Using data from the 2004 Pelotas Birth Cohort (N = 4231), we restricted the sample to those exposed to maternal depression up to age 6 years (depression present at ≥2 out of 5 assessment waves; n = 1132; 50% boys). Resilience was defined as scoring below or equal to the mean of the unexposed group on all four problem subscales of the parent‐report Strengths and Difficulties Questionnaire at age 11 years. We examined pathways from socioeconomic status (SES; measured at birth) to resilience via cognitive stimulation (CS) (at 24 and 48 months) and Intelligence quotient (IQ) (at 6 years), and from CS to resilience via IQ, using counterfactual mediation. Results A minority of children exposed to maternal depression showed resilience (12.4%). There was evidence of indirect pathways from SES to resilience via CS (odds ratio (OR) = 1.76, 95% confidence interval (CI) 1.02–3.38) and IQ (OR = 1.19, 95% CI 1.01–1.42), such that higher SES was associated with resilience via both higher levels of CS and higher IQ, which, in turn, were each positively associated with resilience. Furthermore, there was evidence of a direct (OR = 1.86, 95% CI 1.01–3.76) and total effect (OR = 1.94, 95% CI 1.05–3.89) of CS on resilience, even after controlling for SES. However, these effects varied depending on how persistent and severe depression was defined. Conclusions These findings suggest that CS in early childhood may represent a modifiable protective factor for children exposed to maternal depression and a promising intervention target to promote child resilience in the context of maternal depression exposure.

Abstract Although studies in low- and middle-income countries (LMICs) have examined the effects of c-sections on early initiation of breastfeeding (EIBF), the role of the place of birth has not yet been investigated. Therefore, we tested the association between EIBF and the type of delivery by place of birth. Data from 73 nationally representative surveys carried out in LMICs between 2010 and 2019 comprised 408,013 women aged 15 to 49 years. Type of delivery by place of birth was coded in four categories: home vaginal delivery, institutional vaginal delivery, c-section in public, and c-section in private health facilities. We calculated the weighted mean prevalence of place of birth and EIBF by World Bank country income groups. Adjusted Poisson regression (PR) was fitted taking institutional vaginal delivery as a reference. The overall prevalence of EIBF was significantly lower among c-section deliveries in public (PR = 38%; 95% CI 0.618–0.628) and private facilities (PR = 45%; 95% CI 0.54–0.566) compared to institutional vaginal deliveries. EIBF in c-sections in public facilities was slightly higher in lower-middle (PR = 0.650, 95% CI 0.635–0.665) compared to low (PR = 0.544, 95% CI 0.521–0.567) and upper-middle income countries (PR = 0.612, 95% CI 0.599–0.626). EIBF was inversely associated with c-section deliveries compared to institutional vaginal deliveries, especially in private facilities compared to public ones.

BackgroundQuantifying women's empowerment has become the focus of attention of many international organizations and scholars. We aimed to describe quantitative indicators of women's empowerment that are based on individual-level data.MethodsIn this scoping review, we searched PubMed, Scopus, Web of Science, Science Direct, Google, and Google Scholar for publications describing the operationalization of measures of women's empowerment.ResultsWe identified 36 studies published since 2004, half of them since 2019, and most from low- and middle-income countries. Twelve studies were based on data from the Demographic and Health Surveys and used 56 different variables from the questionnaires (ranging from one to 25 per study) to measure the overall empowerment of women 15–49 years. One study focused on rural women, two included married and unmarried women, and one analyzed the couple's responses. Factor analysis and principal component analysis were the most common approaches used. Among the 24 studies based on other surveys, ten analyzed overall empowerment, while the others addressed sexual and reproductive health (4 studies), agriculture (3) and livestock (1), water and sanitation (2), nutrition (2), agency (1), and psychological empowerment (1). These measures were mainly based on data from single countries and factor analysis was the most frequently analytical method used. We observed a diversity of indicator definitions and domains and a lack of consensus in terms of what the proposed indicators measure.ConclusionThe proposed women's empowerment indicators represent an advance in the field of gender and development monitoring. However, the empowerment definitions used vary widely in concept and in the domains/dimensions considered, which, in turn influence or are influenced by the adopted methodologies. It remains a challenge to find a balance between the need for a measure suitable for comparisons across populations and over time and the incorporation of country-specific elements.

Resumo: Este artigo descreve a metodologia utilizada na realização do Inquérito Telefônico de Fatores de Risco para Doenças Crônicas Não Transmissíveis em Tempos de Pandemia (Covitel), desenvolvido no Brasil em 2022. O Covitel é um inquérito de base populacional, com representatividade para o Brasil e suas cinco macrorregiões: Centro-oeste, Nordeste, Norte, Sudeste e Sul. O inquérito apresenta informações sobre o impacto dos principais fatores de risco para as doenças crônicas não transmissíveis (DCNT) na população adulta, com 18 anos ou mais, residente em domicílios servidos por linhas telefônicas fixas e móveis. O estudo tem por objetivo colaborar para o desenvolvimento e acompanhamento de políticas públicas voltadas para a promoção da saúde para a população, bem como obter resultados que visem contribuir para o conhecimento sobre a influência da COVID-19 nos fatores de risco para as DCNT no país. Foram avaliados 9 mil indivíduos e coletadas informações sobre alimentação, atividade física, saúde mental, estado de saúde, hipertensão arterial, diabetes e depressão, além do consumo de álcool e tabaco, comparando os momentos pré-pandemia e o primeiro trimestre de 2022. Além disso, o estudo coletou informações acerca do esquema vacinal da população e da infecção por COVID-19.

Immunization of pregnant women against tetanus is a key strategy for reducing tetanus morbidity and mortality while also achieving the goal of maternal and neonatal tetanus elimination. Despite substantial progress in improving newborn protection from tetanus at birth through maternal immunization, umbilical cord practices and sterilized and safe deliveries, inequitable gaps in protection remain. Notably, an infant’s tetanus protection at birth is comprised of immunization received by the mother during and before the pregnancy (e.g., through childhood vaccination, booster doses, mass vaccination campaigns, or during prior pregnancies). In this work, we examine wealth-related inequalities in maternal tetanus toxoid containing vaccination coverage before pregnancy, during pregnancy, and at birth for 72 low- and middle-income countries with a recent Demographic and Health Survey or Multiple Indicator Cluster Survey (between 2013 and 2022). We summarize coverage levels and absolute and relative inequalities at each time point; compare the relative contributions of inequalities before and during pregnancy to inequalities at birth; and examine associations between inequalities and coverage levels. We present the findings for countries individually and on aggregate, by World Bank country income grouping, as well as by maternal and neonatal tetanus elimination status, finding that most of the inequality in tetanus immunization coverage at birth is introduced during pregnancy. Inequalities in coverage during pregnancy are most pronounced in low- and lower-middle-income countries, and even more so in countries which have not achieved maternal and neonatal tetanus elimination. These findings suggest that pregnancy is a key time of opportunity for equity-oriented interventions to improve maternal tetanus immunization coverage.

ABSTRACT Objective: to evaluate the agreement between measured height, weight, and body mass index (BMI) during the 22-year follow-up of the 1993 Pelotas Birth Cohort, state of Rio Grande do Sul, Brazil, and self-reported data during the online follow-up of the coortesnaweb. Methods: this was a cross-sectional validation study; agreement was assessed by means of Lin’s concordance correlation coefficient for continuous measures and weighted Kappa for nutritional status; Spearman’s rank correlation coefficient was used to estimate the correlation between measurements. Results: a total of 783 participants were included; it could be seen high correlation and high agreement between the measured height (r = 0.966; ρ = 0.966), weight (r = 0.934; ρ = 0.928), and BMI (r = 0.903; ρ = 0.910) and Web-based self-reported data; there was no correlation between mean difference and the time interval between measurements. Conclusion: using the Internet to collect self-reported anthropometric measurements is as valid as the traditional method.

BackgroundDespite the efforts to promote universal coverage for family planning, inequalities are still high in several countries. Our aim was to identify which sources of contraceptives women mostly rely on in low- and middle-income countries (LMICs). We also explored the different sources according to age and marital status.MethodsWe used data from national health surveys carried out in 59 LMICs since 2010. Among all sexually active women at reproductive age, we explored inequalities in demand for family planning satisfied by modern methods (mDFPS) and in the source of modern contraceptives according to women's age, classified as: 15–19, 20–34, or 35–49 years of age. Among adolescents, mDFPS and source of method were explored by marital status, classified as married or in union and not married nor in a union.ResultsmDFPS was lower among adolescents than among adult women in 28 of the 59 countries. The lowest levels of mDFPS among adolescents were identified in Albania (6.1%) and Chad (8.2%). According to adolescents' marital status, the pattern of inequalities in mDFPS varied widely between regions, with married and unmarried adolescents showing similar levels of coverage in Latin America and the Caribbean, higher coverage among unmarried adolescents in Africa, and lower coverage among unmarried adolescents in Asia. Public and private health services were the main sources, with a lower share of the public sector among adolescents in almost all countries. The proportion of adolescents who obtained their contraceptives in the public sector was lower among unmarried girls than married ones in 31 of the 38 countries with data. Friends or relatives were a more significant source of contraceptives among unmarried compared to married adolescents in all regions.ConclusionsOur findings indicate lower levels of mDFPS and lower use of the public sector by adolescents, especially unmarried girls. More attention is needed to provide high-quality and affordable family planning services for adolescents, especially for those who are not married.

Objetivo. Evaluar la cobertura y las desigualdades en las intervenciones de salud maternoinfantil entre haitianos, migrantes haitianos en la República Dominicana y dominicanos. Métodos. Estudio transversal con datos de encuestas representativas en el nivel nacional realizadas en Haití en el 2012 y en la República Dominicana en el 2014. Se compararon nueve indicadores: la demanda de planificación familiar satisfecha con métodos modernos, la atención prenatal, la atención del parto (por personal de salud calificado), la vacunación infantil (con vacuna con la tuberculosis, el sarampión y tres dosis de la vacuna triple bacteriana), la gestión de casos de enfermedad en la infancia (administración de sales de rehidratación oral para la diarrea y búsqueda de atención sanitaria ante la sospecha de neumonía) e índice de cobertura compuesto. La riqueza se midió mediante un índice basado en los activos, dividido en terciles, y el lugar de residencia (urbano o rural) se determinó según la definición del país. Resultados. La población haitiana mostró la menor cobertura respecto de la demanda de planificación familiar satisfecha con métodos modernos (44,2%), atención prenatal (65,3%), asistencia calificada en el parto (39,5%) y búsqueda de atención sanitaria ante la sospecha de neumonía (37,9%), y la mayor cobertura respecto de la administración de sales de rehidratación oral para la diarrea (52,9%); los migrantes haitianos presentaron la menor cobertura en DPT3 (44,1%) y la administración de sales de rehidratación oral para la diarrea (38%) y la mayor cobertura en la búsqueda de atención sanitaria ante la sospecha de neumonía (80,7%). La población dominicana presentó la cobertura más alta en la mayoría de los indicadores, excepto en la administración de sales de rehidratación oral para la diarrea y en la búsqueda de atención sanitaria ante la sospecha de neumonía. El índice de cobertura compuesto fue de 79,2% para los dominicanos, 69,0% para los migrantes haitianos y 52,6% para los haitianos. Las desigualdades socioeconómicas tuvieron, en general, un patrón a favor de los ricos y de las zonas urbanas en todos los grupos analizados. Conclusión. Los migrantes haitianos en la República Dominicana presentaron una mayor cobertura que la población haitiana residente en Haití, pero menor que la población dominicana. Ambos países deberían planificar acciones y políticas para aumentar la cobertura y abordar las desigualdades existentes en las intervenciones de salud materna.

A utilização indiscriminada de antibacterianos no período gestacional pode aumentar a resistência antimicrobiana e colocar em risco a saúde da gestante e da criança. Atualmente, está em vigência no Brasil a Resolução da Diretoria Colegiada nº 20/2011, que controla a prescrição e fornecimento de antibacterianos. O objetivo deste estudo foi comparar o uso de antibacterianos pelas gestantes participantes das coortes de nascimentos de Pelotas, Rio Grande do Sul, Brasil, de 2004 e 2015, considerando a regulamentação implementada entre as duas coortes. Foram utilizados dados coletados no período perinatal dos dois estudos. O desfecho principal foi o uso de antibacterianos na gestação. As prevalências de uso foram descritas a partir de variáveis independentes e diferenças em pontos percentuais (p.p.) entre as duas coortes. A prevalência do uso de antibacterianos foi de 41,9% (IC95%: 40,4; 43,3) em 2004 e 39,2% (IC95%: 37,7; 40,6) em 2015. Considerando-se as gestantes que relataram ter infecção durante a gestação, observou-se maior redução de uso em 2015, quando comparado a 2004, nas gestantes mais pobres (-15,4p.p., IC95%: 9,59; 21,20) e naquelas que foram a menos consultas (-17,1p.p., IC95%: 2,81; 31,36). Houve redução na proporção de antibacterianos usados, considerando o total de medicamentos de 20,6% (IC95%: 19,9; 21,4) em 2004 para 12,6% (IC95%: 12,1; 13,1) em 2015. As reduções encontradas, tanto nas prevalências de uso quanto na proporção dos antibacterianos sobre o total de medicamentos utilizados, podem ser reflexo da política de regulamentação implementada em 2011.

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

Abstract Background We aimed to investigate the association between preterm birth and body composition at 6, 18, and 30 years of age using data from three population-based birth cohort studies. Methods Gestational age (GA), defined by the date of the last menstrual period (categorized in ≤33, 34–36, and ≥ 37 weeks), was gathered in the first 24-h after delivery for all live births occurring in the city of Pelotas, Brazil, in 2004, 1993 and 1982. Body composition was assessed by air-displacement plethysmography. Outcomes included fat mass (FM, kg), percent FM (%FM), FM index (FMI, kg/m2), fat-free mass (FFM, kg); percent FFM (%FFM), FFM index (FFMI, kg/m2), body mass index (BMI, kg/m2 at 18 years in the 1993 cohort and 30 years in the 1982 cohort), and BMI Z-score (at 6 years in the 2004 cohort). We further explored the association of birth weight for GA with body composition indicators and BMI. Crude and adjusted linear regressions provided beta coefficients with 95% confidence intervals (95%CI). Results A total of 3036, 3027, and 3369 participants, respectively, from the 2004, 1993, and 1982 cohorts were analyzed. At 6 years, preterm boys (born at 34–36 weeks) presented lower adjusted mean of FM (β = − 0.80 kg, − 1.45;-0.16, p = 0.046), %FM (β = − 2.39%, − 3.90;-0.88, p = 0.008), FMI (β = − 0.70 kg/m2, − 1.13;-0.27, p = 0.004) as well as lower FFM (β = − 0.4 kg, − 0.77; − 0.12, p = 0.010) and FFMI (β = − 0.3 kg/m2, − 0.46;-0.10, p

A pandemia de COVID-19 já causou mais de 399 milhões de infecções e custou a vida de mais de cinco milhões de pessoas no mundo, até 3 de março de 2022. Para reduzir a taxa de infecção, uma série de medidas de prevenção indicadas pela Organização Mundial da Saúde (OMS) foram adotadas pelos países, entre elas, o uso de máscara. O objetivo deste estudo é descrever a utilização de máscara na população brasileira, através da análise de dados do EPICOVID19-BR, um estudo de base populacional realizado em 133 cidades do país, em quatro fases entre março e agosto de 2020. A proporção de indivíduos que preferiram usar máscara quando saíam de casa foi de 97,9% (IC95%: 97,8-98,0). O entrevistador não visualizou a máscara do entrevistado em 50% (IC95%: 49,9-51,1) dos casos no momento da entrevista, no entanto, entre a fase uma e quatro da pesquisa, observou-se uma diminuição de 4,4 pontos percentuais na proporção de entrevistados que não usaram máscara no momento da entrevista. A não visualização da máscara foi mais observada em mulheres, participantes com idade entre 10-19 e 20-29 anos, de cor de pele indígena, preta, e parda, entre as pessoas com Ensinos Fundamental e Médio e na Região Centro-oeste. O uso de máscara de tecido foi predominante 91,4% (IC95%: 91,2-91,5) com um aumento de 4,9 pontos percentuais entre as fases 1 e 4. Os resultados do estudo trazem informações importantes para reforçar as políticas de controle de COVID-19 no Brasil. O alto percentual de pessoas sem máscara na hora da entrevista sugere que ainda é importante reforçar o aspecto preventivo e de autocuidado, não fazendo do uso da máscara algo apenas ligado à obrigatoriedade.

Abstract Background This longitudinal study explored the relationship between trajectories of maternal depressive symptoms and offspring’s risk behavior in adolescence contributing to an extremely scarce literature about the impacts of maternal depression trajectories on offspring risk behaviors. Methods We included 3437 11-year-old adolescents from the 2004 Pelotas Birth Cohort Study. Trajectories of maternal depressive symptoms were constructed using Edinburgh Postnatal Depression Scale (EDPS) from age 3 months to 11 years. We identified five trajectories of maternal depressive symptoms: “low” “moderate low”, “increasing”, “decreasing”, and “chronic high”. The following adolescent outcomes were identified via self-report questionnaire and analyzed as binary outcome –yes/no: involvement in fights and alcohol use at age 11. We used logistic regression models to examine the effects of trajectories of maternal depressive symptoms on offspring’s risk behavior adjusting for potential confounding variable. Results Alcohol use and/or abuse as well as involvement in fights during adolescence, were not significantly associated with any specific trajectory of maternal depressive symptoms neither in the crude nor in the adjusted analyses. Conclusion Alcohol use and involvement in fights at age 11 were not associated with any specific trajectory of maternal depression.

Objective. To assess coverage and inequalities in maternal and child health interventions among Haitians, Haitian migrants in the Dominican Republic and Dominicans. Methods. Cross-sectional study using data from nationally representative surveys carried out in Haiti in 2012 and in the Dominican Republic in 2014. Nine indicators were compared: demand for family planning satisfied with modern methods, antenatal care, delivery care (skilled birth attendance), child vaccination (BCG, measles and DPT3), child case management (oral rehydration salts for diarrhea and careseeking for suspected pneumonia), and the composite coverage index. Wealth was measured through an asset-based index, divided into tertiles, and place of residence (urban or rural) was established according to the country definition. Results. Haitians showed the lowest coverage for demand for family planning satisfied with modern methods (44.2%), antenatal care (65.3%), skilled birth attendance (39.5%) and careseeking for suspected pneumonia (37.9%), and the highest for oral rehydration salts for diarrhea (52.9%), whereas Haitian migrants had the lowest coverage in DPT3 (44.1%) and oral rehydration salts for diarrhea (38%) and the highest in careseeking for suspected pneumonia (80.7%). Dominicans presented the highest coverage for most indicators, except oral rehydration salts for diarrhea and careseeking for suspected pneumonia. The composite coverage index was 79.2% for Dominicans, 69.0% for Haitian migrants, and 52.6% for Haitians. Socioeconomic inequalities generally had pro-rich and pro-urban pattern in all analyzed groups. Conclusion. Haitian migrants presented higher coverage than Haitians, but lower than Dominicans. Both countries should plan actions and policies to increase coverage and address inequalities of maternal health interventions.

Abstract Background Contraception is a key component of sustainable development, empowering women, reducing the risk of maternal and child mortality and promoting economic growth. It is part of the Sustainable Development Goals agenda, where the aim is to achieve universal access to sexual and reproductive health. Our objective was to evaluate trends and inequalities in modern contraceptive prevalence, and according to the type of modern contraceptive, in 11 low- and middle-income countries that are partners of the Family Planning 2020 initiative. Methods Analyses were performed using 62 Performance Monitoring and Accountability 2020 (PMA2020) surveys from 11 countries. Forty surveys were nationally representative, while 22 had regional coverage. Regional surveys were analyzed separately, totalizing 15 geographies from 11 countries. We described trends on modern contraceptive prevalence, and its subtypes (short- and long-acting reversible contraceptives, and permanent methods), by calculating absolute average annual changes. Absolute inequalities on the prevalence of modern contraceptives were assessed for the most recent survey of each geography using the slope index of inequality, and according to wealth, education and age. Results The overall prevalence of modern contraception increased in most geographies analyzed, reaching a 7.2 percentage points increase per year in Lagos, Nigeria. This increase was mostly influenced by the long-acting reversible contraceptives, which increased in 73% of the geographies. Although the largest share of modern contraception is represented by short-acting reversible contraceptives, these are reducing and giving space for the long-acting methods. The exception was Rajasthan, India, where the permanent methods accounted for 70% of the modern contraception share, and their prevalence was almost 40%. Inequalities were identified in favor of richer, older and better educated women. Conclusions Out of the 15 geographies analyzed, 11 demonstrated an increase in overall modern contraceptive use – mainly driven by the uptake of long-acting reversible contraception. However, even in the groups with the highest prevalence, modern contraceptive use was at most 60% in most geographies. So, we are far from reaching the desired universal coverage proposed by the Sustainable Development Goals.

We aimed to assess the proportion of the population in 133 Brazilian municipalities who - from March to August 2020 - had a health problem but failed to seek care or failed to attend to a health service for routine appointment or examination. We conducted a household survey from August 24-27 in 133 Brazilian cities by asking the subjects if, since the beginning of the COVID-19 pandemic in March 2020, they had suffered from a health problem but did not seek care or failed to attend to a routine or screening examination. Poisson regression was used for the analyses. We interviewed 33,250 subjects and 11.8% (95%CI: 11.4-12.1) reported that, since March 2020, they failed to seek care despite being ill, 17.3% (95%CI: 16.9-17.7) failed to attend to a routine or screening examination and 23.9% (95%CI: 23.4-24.4) reported one or both outcomes. Health service closure and fear of the COVID-19 infection were the main reasons for not seeking care. Women and the poorest were more likely to not look for a health service, despite having a health problem or a scheduled routine appointment. On the other hand, those subjects who self-identified as white were less likely to not look for a health service. The COVID-19 pandemic is more critical for the indigenous people and the poorest, and these people are also more likely to not seek care for other health conditions during the pandemic.

Substantial progress in maternal and neonatal tetanus elimination has been made in the past 40 years, with dramatic reductions in neonatal tetanus incidence and mortality. However, twelve countries have still not achieved maternal and neonatal tetanus elimination, and many countries that have achieved elimination do not meet key sustainability thresholds to ensure long-lasting elimination. As maternal and neonatal tetanus is a vaccine-preventable disease (with coverage of the infant conferred by maternal immunization during and prior to pregnancy), maternal tetanus immunization coverage is a key metric for monitoring progress towards, equity in, and sustainability of tetanus elimination. In this study, we examine inequalities in tetanus protection at birth, a measure of maternal immunization coverage, across 76 countries and four dimensions of inequality via disaggregated data and summary measures of inequality. We find that substantial inequalities in coverage exist for wealth (with lower coverage among poorer wealth quintiles), maternal age (with lower coverage among younger mothers), maternal education (with lower coverage among less educated mothers), and place of residence (with lower coverage in rural areas). Inequalities existed for all dimensions across low- and lower-middle-income countries, and across maternal education and place of residence across upper-middle-income countries. Though global coverage changed little over the time period 2001–2020, this obscured substantial heterogeneity across countries. Notably, several countries had substantial increases in coverage accompanied by decreases in inequality, highlighting the need for equity considerations in maternal and neonatal tetanus elimination and sustainability efforts.

To analyze how socio-economic factors and behavioural characteristics are related to the failure of academic progress. Data of the 1993 Birth Cohort of the city of Pelotas, Brazil, were analyzed using four follow-up waves. As a measure of the failure of academic progress, we used indicators of the age-grade gap. We analyzed the association of demographic, socio-economic, and behavioural characteristics. Factors associated with failure of academic progress were assessed through logistic regression. There are a higher odds of the age-grade gap when the adolescent is not white, man, of low socio-economic status, whose parents have low schooling and living in large families. In relation to risk behaviours, alcohol and tobacco consumption represent higher odds of the age-grade gap at age 18. The results show that socio-economic factors and behavioural characteristics are important predictors of academic progress. Public policies that seek to promote education should be targeted at the most vulnerable groups, decreasing the observed inequalities.

Abstract Background Unintentional child poisoning represents a significant public health problem across the globe, placing a substantial burden on health services emergency departments. Around the world, every year, thousands of children die as a result of physical injuries, most of which involve children under 5 years old. Medicines are the main products involved in poisoning, and children under 5 years old are the most vulnerable age group. The objective of this study was to measure the prevalence of unsafe storage of medicines in households with a 4-year-old child. Methods We used data from the follow-up of 4-year-old in the 2004 Pelotas Birth Cohort Study in Brazil (N = 3799). “Unsafe storage” was considered present when medicines were stored unlocked and within reach of children (at a height below the eye level of the average adult). Independent variables included maternal and family socioeconomic and demographic characteristics and the child’s health care. All information was collected during household interviews with the mothers using a standardized questionnaire. The overall prevalence rate with a 95% confidence interval (95% CI) and the prevalence associated with various independent variables were determined. Results The storage of medicines in unlocked areas was reported by 80.9% of the mothers, and, within reach of children for 26.5%. The overall prevalence rate of unsafe storage of medicines was 21.4% (20.1–22.7%). The main storage locations used were the kitchen (57.0%) and bedroom (53.3%). Conclusions The results indicate that medicines were unsafely stored in a 21.4% number of homes, which can contribute to the vulnerability of children to poisoning from medicines. To minimize this risk, education about the safe storage of medicines should be reinforced by health professionals.

Abstract Background The number of web-based E-epidemiologic studies using online recruitment methods is increasing. However, the optimal online recruitment method in terms of maximizing recruitment rates is still unknown. Our aim was to compare the recruitment rates of three online recruitment methods and to describe how these rates differ according to individual’s socioeconomic and demographic factors. Methods A total of 2394 members of the 1993 Pelotas birth cohort that provided an e-mail address, a Facebook name, and a WhatsApp number during a face-to-face follow-up were randomly allocated to be recruited by e-mail, Facebook or WhatsApp (798 individuals per method). This was a parallel randomised trial applying a block randomisation (block size = 3). Between January and February 2018, we sent messages inviting them to register into the web-based coortesnaweb platform. Recruitment rates were calculated for each method, and stratified according to the individual’s socioeconomic and demographic characteristics. We also analysed absolute and relative inequalities on recruitment according to schooling and socioeconomic position. Results Out of the 2394 individuals analysed, 642 registered into the platform. The overall recruitment rate was 26.8%. Recruitment rates for women were almost 10 percentage points higher compared to men. Facebook was the most effective recruitment method, as 30.6% of those invited through the social network were recruited. Recruitment rates of e-mail and WhatsApp were similar (recruitment rate = 24.9%). E-mail and Facebook were the most effective recruitment methods to invite highly educated and wealthier individuals. However, sending e-mails to recruit individuals also reflected in the highest inequalities according to schooling and socioeconomic position. In contrast, the lowest inequalities according to socioeconomic position were observed using Facebook. Conclusions Facebook was the most effective online recruitment method, also achieving the most equitable sample in terms of schooling and socioeconomic position. The effectiveness of online recruitment methods depends on the characteristics of the sample. It is important to know the profile of the target sample in order to decide which online recruitment method to use. Trial registration Brazilian Registry of Clinical Trials, identifier: RBR-3dv7gc, retrospectively registered in 10 April 2018.

Abstract: Interventions during prenatal care can mitigate negative outcomes of a sedentary lifestyle and unhealthy diet during pregnancy. We aimed to evaluate the effectiveness of an intervention that promoted healthy diet and leisure-time walking during antenatal care in a pragmatic, controlled, non-randomized intervention study. Physicians and nurses from all health care units of the Family Health Strategy model of health assistance participated in educational training to promote leisure-time walking and healthy diet during antenatal care visits. Pregnant women who received health care from these professionals constituted the intervention group (n = 181). The control group (n = 172) included pregnant women who received routine antenatal care, in health care units of the traditional model of health assistance. Data were collected in each trimester of pregnancy. Diet was investigated using a food frequency questionnaire adapted from Risk and Protective Factors Surveillance System for Chronic Non-Comunicable Diseases Through Telephone Interview (Vigitel). Leisure-time walking in a typical week was assessed using questions from the Physical Activity in Pregnancy Questionnaire. There were positive effects on leisure-time walking during the second trimester and the third trimester of pregnancy and on the women who achieved 150 minutes per week of walking during the third trimester. The intervention reduced the risk of pregnant women consuming soft drinks and/or commercially prepared cookies in the third trimester. This lifestyle intervention was partially effective, tripling the proportion of pregnant women who achieved the recommended walking time and reducing by half the proportion of women who had a high weekly consumption of soft drinks and industrially processed cookies.

Abstract: This paper describes the history, objectives and methods used by the nine Brazilian cohorts of the RPS Brazilian Birth Cohorts Consortium (Ribeirão Preto, Pelotas and São Luís) Common thematic axes are identified and the objectives, baseline periods, follow-up stages and representativity of the population studied are presented. The Consortium includes three birth cohorts from Ribeirão Preto, São Paulo State (1978/1979, 1994 and 2010), four from Pelotas, Rio Grande do Sul State (1982, 1993, 2004 and 2015), and two from São Luís, Maranhão State (1997 and 2010). The cohorts cover three regions of Brazil, from three distinct states, with marked socioeconomic, cultural and infrastructure differences. The cohorts were started at birth, except for the most recent one in each municipality, where mothers were recruited during pregnancy. The instruments for data collection have been refined in order to approach different exposures during the early phases of life and their long-term influence on the health-disease process. The investigators of the nine cohorts carried out perinatal studies and later studied human capital, mental health, nutrition and precursor signs of noncommunicable diseases. A total of 17,636 liveborns were recruited in Ribeirão Preto, 19,669 in Pelotas, and 7,659 in São Luís. In the studies starting during pregnancy, 1,400 pregnant women were interviewed in Ribeirão Preto, 3,199 in Pelotas, and 1,447 in São Luís. Different strategies were employed to reduce losses to follow-up. This research network allows the analysis of the incidence of diseases and the establishment of possible causal relations that might explain the health outcomes of these populations in order to contribute to the development of governmental actions and health policies more consistent with reality.

Gender-related barriers to immunization are key targets to improve immunization coverage and equity. We used individual-level demographic and health survey data from 52 low- and middle-income countries to examine the relationship between women’s social independence (measured by the Survey-based Women’s emPowERment (SWPER) Global Index) and childhood immunization. The primary outcome was receipt of three doses of the diphtheria-tetanus-pertussis vaccine (DTP3) among children aged 12–35 months; we secondarily examined failure to receive any doses of DTP-containing vaccines. We summarized immunization coverage indicators by social independence tertile and estimated crude and adjusted summary measures of absolute and relative inequality. We conducted all analyses at the country level using individual data; median results across the 52 examined countries are also presented. In crude comparisons, median DTP3 coverage was 12.3 (95% CI 7.9; 16.3) percentage points higher among children of women with the highest social independence compared with children of women with the lowest. Thirty countries (58%) had a difference in coverage between those with the highest and lowest social independence of at least 10 percentage points. In adjusted models, the median coverage was 7.4 (95% CI 5.0; 9.1) percentage points higher among children of women with the highest social independence. Most countries (41, 79%) had statistically significant relative inequality in DTP3 coverage by social independence. The findings suggest that greater social independence for women was associated with better childhood immunization outcomes, adding evidence in support of gender-transformative strategies to reduce childhood immunization inequities.

Abstract Background Longitudinal studies have consistently reported that prenatal exposure to acetaminophen can to lead to an increased risk of attention deficit-hyperactivity disorder during childhood. This study aimed to investigate the association between intrauterine exposure to acetaminophen and the presence of emotional and behavioral problems at the ages of 6 and 11 years in a low-middle income country. Methods We performed a prospective longitudinal population-based study using data from the 2004 Pelotas birth cohort. From the 4231 initial cohort participants, 3722 and 3566 children were assessed at 6 and 11 years of age, respectively. The outcomes were assessed using the parent version of Strengths and Difficulties Questionnaire (SDQ). The cut-off points established for the Brazilian population were used to categorize the outcomes. Crude and adjusted odds ratio were obtained through logistic regression. Results Acetaminophen was used by 27.5% (95% confidence interval [CI]: 26.1–28.9) of the mothers at least once during pregnancy. The prevalence of emotional problems at 6 and 11 years was 13.6 and 19.9%, respectively. For hyperactivity problems, prevalence was 13.9 and 16.1%, respectively. Intrauterine exposure to acetaminophen increased the odds of having emotional (odds ratio [OR] = 1.47; 95% CI: 1.07–2.02) and hyperactivity/inattention (OR = 1.42; 95% CI: 1.06–1.92) problems in 6-year-old boys. At the age of 11, a small decrease in the effect was observed for both outcomes after adjustment: OR = 1.31 (95% CI: 0.99–1.73) for emotional problems and OR = 1.25 (95% CI: 0.95–1.65) for hyperactivity/inattention in boys. No association for any phenotypes at both ages was observed for girls. Conclusion The effect of intrauterine exposure to acetaminophen in emotional and hyperactivity symptoms was dependent on sex in a Brazilian cohort. While it seemed to be important for boys, mainly at 6 years of age, for girls, no association was observed.

Abstract Background Postmenstrual and/or gestational age-corrected age (CA) is required to apply child growth standards to children born preterm (

Abstract Background Birth registration, and the possession of a birth certificate as proof of registration, has long been recognized as a fundamental human right. Data from a functioning civil registration and vital statistics (CRVS) system allows governments to benefit from accurate and universal data on birth and death rates. However, access to birth certificates remains challenging and unequal in many low and middle-income countries. This paper examines wealth, urban/rural and gender inequalities in birth certificate coverage. Methods We analyzed nationally representative household surveys from 94 countries between 2000 and 2014 using Demographic Health Surveys and Multiple Indicator Cluster Surveys. Birth certificate coverage among children under five was examined at the national and regional level. Absolute measures of inequality were used to measure inequalities in birth certificate coverage by wealth quintile, urban/rural residence and sex of the child. Results Over four million children were included in the analysis. Birth certificate coverage was over 90% in 29 countries and below 50% in 36 countries, indicating that more than half the children under five surveyed in these countries did not have a birth certificate. Eastern & Southern Africa had the lowest average birth certificate coverage (26.9%) with important variability among countries. Significant wealth inequalities in birth certificate coverage were observed in 74 countries and in most UNICEF regions, and urban/rural inequalities were present in 60 countries. Differences in birth certificate coverage between girls and boys tended to be small. Conclusions We show that wealth and urban/rural inequalities in birth certificate coverage persist in most low and middle income countries, including countries where national birth certificate coverage is between 60 and 80%. Weak CRVS systems, particularly in South Asia and Africa lead rural and poor children to be systematically excluded from the benefits tied to a birth certificate, and prevent these children from being counted in national health data. Greater funding and attention is needed to strengthen CRVS systems and equity analyses should inform such efforts, especially as data needs for the Sustainable Development Goals expand. Monitoring disaggregated data on birth certificate coverage is essential to reducing inequalities in who is counted and registered. Strengthening CRVS systems can enable a child’s right to identity, improve health data and promote equity.

Abstract: More than one in four Brazilians have private health insurance (PHI), even thought it covers mostly the same procedures as the Brazilian Unified National Health System (SUS). This literature review included articles and monographs published since 1990 about the utilization of SUS by privately insured individuals. Considering outpatient care and hospitalization, privately insured people in Brazil use SUS in approximately 13% of the times they receive health care, and approximately 7% of people receiving care paid by SUS are privately insured; these findings vary depending on the type of service studied and on study methods. Utilization of SUS is more frequent in less developed regions, by people with more restricted PHI plans and by people with worse health status. Privately insured people report the limitations of PHI plans as their reasons for resorting to SUS. Sometimes, beneficiaries of PHI plans owned by nonprofit hospitals (which also provide health care financed by SUS) have easier access to care than uninsured people financed by SUS. Anecdotally, privately insured people are satisfied with SUS, but not to the point of adopting SUS as their preferred source of care. In short, for privately insured people, SUS only plays a secondary role in their health care. Despite PHI taking over part of the SUS’s health care demand, PHI represents a restriction of the universal, equitable character of the SUS.

Abstract Background Dietary intake patterns of children from the 2004 Pelotas birth cohort study have been described at 12, 24 and 48 months of age, but there is no information about dietary patterns of these children at 6 years. Then, we aimed to identify and describe dietary intake patterns of children aged 6 years as well as to assess their association with socioeconomic and demographic characteristics, early feeding practices and BMI z-score at 6 years. Methods We used principal components analysis to identify dietary intake patterns of 3,427 children from the 2004 Pelotas (Brazil) birth cohort study. We used multiple linear regression models to evaluate whether socioeconomic and demographic characteristics (socioeconomic position, mother’s age at birth, and child’s sex and skin colour), early feeding practices (exclusive breastfeeding duration and age of introduction of complementary foods), and BMI z-score at 6 years were associated with dietary intake patterns. Results We identified seven dietary components of children’s dietary intake patterns, namely: fruits and vegetables, snacks and treats, coffee and bread, milk, cheese and processed meats, rice and beans and carbohydrates. Dietary patterns were socially patterned, since six dietary components were associated with socioeconomic position. Moreover, high intake of snacks and treats and less fruits and vegetables were associated with children born to teenage mothers, with those exclusively breastfed for less than one month, and with those who started on complementary feeding before 4 months. Finally, overweight and obese children at 6 years presented lower intake of four out of seven dietary components, but we need to be cautious in interpretation due to limitations on food consumption reporting and due to possible reverse causality. Conclusion Dietary intake patterns in children are strongly influenced by socioeconomic characteristics. Other factors such as younger maternal age at birth, and both early weaning and early introduction of complementary feeding appear to be related with ‘unhealthier’ patterns. Overweight and obese children presented lower intake of four out of seven dietary components, but further studies would be interesting to understand the longitudinal effect of children’s feeding practices on BMI and adiposity.

Background: An estimated 23 million infants are still not being benefitted from routine immunization services. We assessed how many children failed to be fully immunized even though they or their mothers were in contact with health services to receive other interventions. Design: Fourteen countries with Demographic and Health Surveys and Multiple Indicator Cluster Surveys carried out after 2000 and with coverage for DPT (Diphtheria-tetanus-pertussis) vaccine below 70% were selected. We defined full immunization coverage (FIC) as having received one dose of BCG (bacille Calmette-Guérin), one dose of measles, three doses of polio, and three doses of DPT vaccines. We tabulated FIC against: antenatal care (ANC), skilled birth attendance (SBA), postnatal care for the mother (PNC), vitamin A supplementation (VitA) for the child, and sleeping under an insecticide-treated bed-net (ITN). Missed opportunities were defined as the percentage of children who failed to be fully immunized among those receiving one or more other interventions. Results: Children who received other health interventions were also more likely to be fully immunized. In nearly all countries, FIC was lowest among children born to mothers who failed to attend ANC, and highest when the mother had four or more ANC visits Côte d'Ivoire presented the largest difference in FIC: 54 percentage points (pp) between having four or more ANC visits and lack of ANC. SBA was also related with higher FIC. For instance, the coverage in children without SBA was 36 pp lower than for those with SBA in Nigeria. The largest absolute difference on FIC in relation to PNC was observed for Ethiopia: 31 pp between those without and with PNC. FIC was also positively related with having received VitA. The largest absolute difference was observed in DR Congo: 41 pp. The differences in FIC among whether or not children slept under ITN were much smaller than for other interventions. Haiti presented the largest absolute difference: 16 pp. Conclusions: Our results show the need to develop and implement strategies to vaccinate all children who contact health services in order to receive other interventions.

O objetivo foi investigar as desigualdades no comprometimento da renda domiciliar com gastos privados em assistência odontológica no Brasil. Foram analisados dados de 55.970 domicílios brasileiros que participaram da Pesquisa de Orçamentos Familiares, de abrangência nacional, no período de 2008-2009. O comprometimento dos gastos privados com assistência odontológica na renda familiar foi calculado pela divisão do gasto médio domiciliar per capita anual pela renda familiar per capita anual e estimado segundo quatro categorias: > 0%, ≥ 5%, ≥ 10% e ≥ 20%. A análise do comprometimento na renda foi realizada apenas para os domicílios com gasto positivo. Apenas 2.961 (7%) dos domicílios reportaram gastos positivos com assistência em odontologia. No geral, o gasto médio per capita anual foi de R$ 42,19 e, de R$ 602,47 entre aqueles com gasto positivo. Os domicílios que possuem os maiores gastos absolutos com assistência odontológica são aquelas pertencentes à área urbana e ao quinto mais rico. Em contrapartida, os domicílios com maior comprometimento na renda pertencem à área rural e ao quinto mais pobre. Entre os que informaram gasto positivo, 55% dos domicílios do quinto mais pobre comprometeram ≥ 20% de sua renda com assistência odontológica. O percentual é de apenas 6% no grupo mais rico da população. Os domicílios mais pobres das regiões mais ricas (Centro-oeste, Sul e Sudeste) apresentaram os maiores comprometimentos de renda. As desigualdades socioeconômicas nos gastos e no comprometimento de renda com assistência odontológica são evidentes. A avaliação dessas desigualdades torna-se relevante para avaliação e orientação de políticas públicas em saúde.

Abstract: This study aimed to evaluate the medium-term effects that hospitalization in the first 48 months of life has on the development of psychiatric disorders at 6 and 11 years of age among individuals in a birth cohort in a middle-income country. We analyzed data from a 2004 birth cohort (N = 4,231) in the city of Pelotas, Rio Grande do Sul State, Brazil. The frequency of hospitalization was investigated at 12, 24 and 48 months of life. When the children were 6 and 11 years old, psychiatric disorders were investigated with the Development and Well-Being Assessment. We used logistic regression to adjust for potential confounders. The overall frequency of hospitalization during the first 48 months of life was 33.1% (95%CI: 31.4; 34.7). Among the hospitalized children 25.6% (95%CI: 24.1; 27.1), 4.7% (95%CI: 4.0; 5.5) and 2.8% (95%CI: 2.3; 3.5) were hospitalized 1, 2 or ≥ 3 times during this period, respectively. After adjustment for potential confounders, the chance of presenting any psychiatric disorder at 6 and 11 years of age was higher for the children who had been hospitalized during the first 48 months of life than for those who had not, with OR of 1.50 (95%CI: 1.19; 1.88) and 1.63 (95%CI: 1.28; 2.07), respectively. Our results support the hypothesis that hospitalization in the early stages of life has an effect on the subsequent mental health of children. Preventive measures are needed in order to minimize the negative experiences of children who are hospitalized during infancy.

Resumo O objetivo deste artigo é apresentar os principais métodos de mensuração e monitoramento das desigualdades sociais em saúde e ilustrar suas aplicações. Foram revisadas as medidas mais frequentemente empregadas na literatura. Dados de cobertura e qualidade do cuidado pré-natal no Brasil, provenientes da Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher (PNDS-2006) e da Pesquisa Nacional de Saúde (PNS-2013), foram utilizados para exemplificar as aplicações. Medidas de desigualdade absoluta e relativa foram apresentadas, destacando-se sua complementaridade. Apesar dos avanços evidenciados nos indicadores nacionais de pré-natal, importantes desigualdades foram identificadas entre subgrupos da população, sem que houvesse redução da magnitude dessas diferenças no período estudado. O Brasil apresenta importantes desigualdades sociais, que ainda se refletem em persistentes desigualdades em saúde. A descrição e monitoramento dessas desigualdades são fundamentais para o direcionamento de políticas de saúde, com foco em grupos mais vulneráveis que vêm sendo deixados para trás.

O Brasil é apontado como um dos países com as menores mobilidades intergeracionais de renda do mundo. O principal objetivo do artigo é analisar a mobilidade intergeracional de renda na coorte de nascimentos de 1982 em Pelotas, Rio Grande do Sul. São utilizados dois métodos de estimação: elasticidade intergeracional de renda e regressões quantílicas para mensuração de possíveis heterogeneidades na mobilidade intergeracional em função dos diferentes níveis de renda dos pais no passado. Os resultados mostram uma mobilidade intergeracional de renda relativamente alta para os padrões brasileiros. A explicação reside, sobretudo, no fato de terem sido usados dados de renda dos filhos em idade jovem, em torno de 23 anos. As análises das regressões quantílicas indicam que a maior mobilidade social acontece nas camadas sociais intermediárias. Os resultados encontrados reforçam a existência de dois polos opostos de armadilhas: armadilha da pobreza e da riqueza.

Resumo: Este estudo foi desenhado para avaliar a cobertura por plano de saúde e seus motivos em uma população coberta pela Estratégia Saúde da Família. Nesta análise, descrevemos a cobertura por plano de saúde, total e por tipos, e analisamos sua associação com características de saúde e sociodemográficas. Entre os 31,3% (IC95%: 23,8-39,9) de pessoas que relatavam cobertura por “plano de saúde”, 57,0% (IC95%: 45,2-68,0) estavam cobertos por cartões de desconto, que não oferecem qualquer tipo de cobertura para assistência médica, apenas descontos em farmácias, clínicas e hospitais. Tanto no caso dos planos de saúde quanto no dos cartões de desconto, os motivos para cobertura mais frequentemente relatados foram “para a segurança” e “para ter melhor atendimento”. Ambas as coberturas se associaram à idade (65+ versus 15-24 anos: odds ratio ajustada, ORa = 2,98; IC95%: 1,28-6,90; e ORa = 3,67; IC95%: 2,22-6,07, respectivamente) e ao nível econômico (desvio padrão adicional: ORa = 2,25; IC95%: 1,62-3,14; e ORa = 1,96; IC95%: 1,34-2,97). Além disso, a cobertura por plano de saúde se associou à escolaridade (ORa = 7,59; IC95%: 4,44-13,00) para Ensino Superior completo e ORa = 3,74 (IC95%: 1,61-8,68) para Ensino Médio completo, em comparação a menos do que o Ensino Fundamental completo. Por outro lado, nem a cobertura por plano de saúde nem a por cartão de desconto se mostraram associadas ao estado de saúde ou ao número de doenças diagnosticadas. Em conclusão, estudos que pretendam avaliar a cobertura por saúde suplementar deveriam ser planejados de forma a poderem distinguir entre cartões de desconto e planos de saúde formais.

The aim of this study was to describe fat (FM) and lean body mass (LBM) in six-year-old children from the 2004 Pelotas Birth Cohort, stratified by gender. Dual-Energy X-ray Absorptiometry was used to measure FM and LBM, FM and LBM indexes, and percentage (%) of FM and LBM. Mean measures of adiposity were higher among girls (6.3kg, 4.2kg/m2 and 23.4% vs. 5kg, 3.3kg/m2 and 18%) while LBM measures were higher among boys (19.3kg, 13kg/m2 and 78.5% vs. 17.7kg, 12.2kg/m2 and 73.2%). In both boys and girls mean measures of adiposity increased with socioeconomic status and maternal education. Mean measures of adiposity were higher among white-skinned children while %LBM was higher among black-skinned children. Preterm compared to full-term children showed lower mean measures of adiposity and LBM. Female sex, white skin color and higher socioeconomic conditions are associated with higher adiposity in childhood.

O estudo teve como objetivos descrever padrões alimentares e investigar a associação com fatores demográficos e socioeconômicos entre crianças de um a seis anos na cidade de Pelotas, Rio Grande do Sul, Brasil. Foi utilizada a correlação de Pearson para agrupar os alimentos. Os padrões alimentares foram construídos por meio da análise de componentes principais. As associações foram verificadas usando-se o teste de KruskalWallis (α = 0,05). Foram avaliadas 667 crianças. Identificou-se cinco padrões alimentares: "vegetais", "tradicional" (pão, margarina/margarina, arroz/massa, café, açúcar), "guloseimas e embutidos", "lanches" (laticínios, achocolatados, biscoitos e sucos) e "frutas". Os padrões "vegetais" e "frutas"tiveram maior adesão entre as crianças cujas mães tinham maior escolaridade e renda familiar. O padrão "tradicional" foi o mais observado entre crianças cujas mães tinham menor escolaridade e renda familiar. Os padrões "vegetais" e "tradicional" apresentaram o maior percentual de variância. As condições socioeconômicas das famílias exercem um papel fundamental na determinação do padrão alimentar das crianças.

O objetivo deste trabalho é caracterizar a metodologia de coleta de atividade física por meio de acelerometria nas coortes de nascidos em 2004 e 1993 em Pelotas, Rio Grande do Sul, Brasil, nos acompanhamentos dos 6-7 e 18 anos, respectivamente. Ao visitarem a sede para um amplo estudo de saúde, esses indivíduos receberam o acelerômetro e a posterior busca foi realizada no domicílio por meio de motociclistas da equipe de pesquisa. Os modelos utilizados foram o GENEA e GENEActiv, estimadores triaxiais da aceleração da gravidade (g), utilizados no punho de crianças e adolescentes por um período de 5 a 8 dias. O número de indivíduos com dados de acelerometria nas coortes foi de 3.331 crianças (93,7% do acompanhamento) e 3.816 jovens (92,9% do acompanhamento). Ao caracterizarmos a coleta de acelerometria em mais de 7.000 indivíduos, apresenta-se um arcabouço metodológico para o planejamento de novos estudos populacionais no tema, descrevendo situações específicas dessa experiência e qualificando a compreensão da atividade física no contexto de estudos epidemiológicos.El objetivo de este estudio es caracterizar la metodología de recolección de la actividad física por acelerometría en las cohortes de nacidos en 2004 y 1993 en Pelotas, Río Grande do Sul, Brasil, en un seguimiento de 6-7 y 18, respectivamente. Al visitar la sede de un centro de salud general, estos sujetos recibieron el acelerómetro y la posterior encuesta en el domicilio se llevó a cabo por los responsables del equipo de investigación. Los modelos utilizados fueron el Genea y GENEActiv, estimadores triaxiales de la aceleración de la gravedad (g), que se utilizaron en niños y adolescentes durante un período de 5 a 8 días. El número de individuos con datos de acelerometría en las cohortes fue de 3.331 niños (93,7% de seguimiento) y 3.816 jóvenes (92,9% de seguimiento). Con el fin de caracterizar la recolección de acelerometría en más de 7.000 individuos, se presenta un marco metodológico para el diseño de nuevos estudios de población sobre el tema, describiendo situaciones específicas de la experiencia y calificando la comprensión de la actividad física en el contexto de los estudios epidemiológicos.The aim of this study was to characterize the methodology of data collection on physical activity using accelerometry in two birth cohorts (2004 and 1993) in Pelotas, Rio Grande do Sul State, Brazil, at the 6-7 and 18-year follow-up visits, respectively. During visits to the study headquarters for a health evaluation, cohort subjects received the accelerometer to be worn on the wrist for 5 to 8 days, after which the device was retrieved at their homes. Genea and GENEActiv triaxial estimators of gravity (g) acceleration were employed. Accelerometry data were collected from 3,331 children (93.7% of those included in follow-up) and 3,816 adolescents (99% of those in follow-up). The study characterizes the data collection methodology in more than 7,000 individuals and discusses issues in its implementation. It thus provides a methodological framework aimed at helping to plan future population-based studies with the use of such technology and to improve understanding of physical activity in the context of epidemiological studies.

To evaluate the frequency of maternal smoking in successive pregnancies and its association with repetition of low birthweight, a study was conducted of a subsample of mothers from the 2004 Pelotas Birth Cohort in Brazil. Only women with previous histories of low birthweight newborns were included. Women with ≥ 2 previous births were eligible only if at least one of the two births immediately preceding the 2004 birth had low birthweight. From 4,458 births, 565 were included in this study. Frequency of smoking was 32.4%. Considering past pregnancies, 67.1% of mothers never smoked, 21.4% smoked during all pregnancies, 6.5% were ex-smokers, and 5% smoked only during the current pregnancy. In the adjusted analyses, when compared to mothers who never smoked, those who smoked during all pregnancies had 2.5 times greater probability of low birthweight recurrence in 2004 (PR = 2.5; 95%CI: 1.32-4.80). Smoking persistence is an important factor for the recurrence of low birthweight in successive pregnancies.Este estudio fue realizado en una submuestra de madres de la cohorte de nacimientos de Pelotas, Río Grande do Sul, Brasil, de 2004 para evaluar la frecuencia y asociación del tabaquismo en sucesivas gestaciones con el fenómeno de repetición del bajo peso al nacer. Se incluyeron solamente mujeres con antecedentes en el historial médico de recién nacidos con bajo peso al nacer. Se elegían a mujeres con ≥ 2 partos anteriores, solamente, si por lo menos uno de los dos partos inmediatamente anteriores al de 2004 hubiera sido de bajo peso al nacer. De los 4.458 nacimientos, 565 fueron incluidos en la muestra. La frecuencia de tabaquismo fue de un 32,4% y, teniendo en consideración las gestaciones anteriores, un 67,1% nunca fumaron; un 21,4% siempre fumaron; un 6,5% eran ex-fumadoras; y un 5,0% fumaron solamente en la gestación actual. En el análisis multivariable, las madres que fumaron en todas las gestaciones tuvieron una probabilidad 2,5 veces mayor de recurrencia de bajo peso al nacer en 2004, en comparación con las que nunca fumaron (RP = 2,5; IC95%: 1,32-4,80). La persistencia del tabaquismo es un factor importante para la recurrencia del bajo peso al nacer en sucesivas gestaciones.Este estudo foi realizado em uma subamostra de mães da coorte de nascimentos de Pelotas, Rio Grande do Sul, Brasil, de 2004, para avaliar a frequência e associação do tabagismo em sucessivas gestações com repetição de baixo peso ao nascer. Foram incluídas somente mulheres com história pregressa de recém-nascido com baixo peso ao nascer. Mulheres com ≥ 2 partos anteriores eram elegíveis somente se, pelo menos, um dos dois partos imediatamente anteriores ao de 2004 tivesse sido de baixo peso ao nascer. Dos 4.458 nascimentos, 565 foram incluídos. A frequência de tabagismo foi de 32,4%; e, levando em conta as gestações anteriores, 67,1% nunca fumaram; 21,4% sempre fumaram; 6,5% eram ex-fumantes; e 5% fumaram somente na gestação atual. Na análise multivariável, as mães que fumaram em todas as gestações tiveram uma probabilidade 2,5 vezes maior de recorrência de baixo peso ao nascer em 2004, em comparação às que nunca fumaram (RP = 2,5; IC95%: 1,32-4,80). A persistência do tabagismo é um importante fator para a recorrência do baixo peso ao nascer em sucessivas gestações.

Prematurity is a leading cause of neonatal mortality and a global health problem that affects high, middle and low-income countries. Several factors may increase the risk of preterm birth. In this article, we test the hypothesis that different risk factors determine preterm birth in different income groups by investigating whether risk factors for preterm deliveries in the 2004 Pelotas (Rio Grande do Sul State, Brazil) birth cohort vary among those groups. A total of 4,142 women were included in the analysis. Preterm births were equally common among women who had spontaneous vaginal deliveries as for those with induced or operative births. In the multivariate analysis the factors that remained significantly associated with preterm birth were black skin color, low education, poverty, young maternal age, primiparity, previous preterm birth, inadequacy of prenatal care and reported hypertension. In the analyses repeated after stratification by family income terciles, there was no evidence of effect modification by income and no clear difference between the socioeconomic groups. No association between cesarean section and preterm delivery was found. Further studies are required to understand the causes of the epidemic of preterm births in Brazil.A prematuridade é uma grande causa de morte neonatal e um problema de saúde global, afetando países de alta, média e baixa renda. Vários fatores podem aumentar o risco de parto pré-termo. Neste artigo, testamos a hipótese de que diferentes fatores de risco determinem o parto pré-termo em diferentes grupos de renda, investigando como fatores de risco para prematuridade na coorte de nascimentos de 2004 de Pelotas, Rio Grande do Sul, Brasil, variam entre estes grupos. Foram incluídas na análise 4.142 mulheres. Os nascimentos pretermo foram igualmente comuns entre mulheres com partos vaginais e com partos induzidos ou cesáreas. Na análise multivariada, a cor negra, baixa educação, baixa renda, idade materna jovem, primiparidade, parto pré-termo anterior, cuidado pré-natal inadequado, e relato de hipertensão na gestação permaneceram significativamente associados com prematuridade. Nas análises estratificadas por tercis de renda familiar não houve evidência de modificação de efeito por renda, não sendo identificados diferentes padrões de risco entre os grupos sócio-econômicos. Não foi encontrada associação entre o parto cesáreo e prematuridade. Mais estudos são necessários para entender as causas da epidemia de partos pré-termo no Brazil.

This study assessed the associations between female interviewers' self-classified "color/race" and participants' self- and interviewer-classified "color/race". A cross-sectional study was carried out among adult individuals living in Pelotas, southern Brazil. Associations were examined by means of contingency tables and multinomial regression models, adjusting for interviewees' socioeconomic and demographic factors. Individuals aged > 40 years were 2.1 times more likely to classify themselves as brown (versus white) when interviewed by black (as compared to white) interviewers. Participants in the same age group were 2.5 times less likely to classify themselves as black (versus white), when interviewed by black interviewers. These differences were even greater among men 40 years or older. Compared to white interviewers, black female interviewers were 2.5 times less likely to classify men aged > 40 years as black. These results highlight the complexity of racial classification, indicating the influence of the interviewer's physical characteristics on the interviewee's "color/race".Avaliou-se a relação entre "cor/raça" de entrevistadoras, auto e heteroclassificação de "cor/raça" dos entrevistados. Foi realizado um estudo com indivíduos adultos de Pelotas, Rio Grande do Sul, Brasil. As associações foram verificadas com tabelas de contingência e modelos multinomiais, ajustando-se para variáveis sócio-econômicas e demográficas dos entrevistados. Indivíduos com > 40 anos tiveram uma chance 2,1 vezes maior de se classificarem como pardos do que como brancos, quando abordados por entrevistadoras pretas, em relação às brancas. Entrevistados dessa mesma faixa etária apresentaram 2,5 vezes menos chances de se classificarem como pretos do que como brancos, ao serem abordados por entrevistadoras pretas. Essas diferenças foram mais expressivas entre homens de > 40 anos. Entrevistadoras pretas tiveram chance 2,5 vezes menor de classificar homens de > 40 anos como pretos do que como brancos, em comparação com as brancas. Os resultados indicam o caráter complexo da classificação racial, sugerindo a influência de características pessoais das entrevistadoras sobre a "cor/raça" dos entrevistados.

O objetivo deste estudo foi avaliar o uso regular de serviços odontológicos entre adultos, identificando grupos nos quais esse comportamento é mais freqüente. O estudo foi realizado em Pelotas, Rio Grande do Sul, Brasil, com desenho transversal de base populacional, envolvendo 2.961 indivíduos, que responderam um questionário estruturado. A prevalência de uso regular encontrada foi de 32,8%. Estiveram positivamente associadas ao uso de forma regular as seguintes características: ser do sexo feminino, ter idade < 60 anos, não ter companheiro, ter alta escolaridade, ter maior nível econômico, usar serviços privados, ter autopercepção de saúde bucal boa/ótima, não ter autopercepção de necessidade de tratamento, ter recebido orientação sobre prevenção e ter manifestado opinião favorável ao profissional. O uso regular foi pouco freqüente, especialmente entre os menos favorecidos (15%). Restringindo a análise apenas para usuários do serviço público, observou-se maior utilização regular entre os mais escolarizados. Os serviços de saúde, em especial o público, devem trabalhar a fim de incrementar o uso regular e preventivo.The aim of this study was to estimate the prevalence of regular use of dental services by adults and identify groups where this behavior is more frequent. A cross-sectional population-based study was carried out in Pelotas, southern Brazil, including 2,961 individuals who answered a standardized questionnaire. Overall prevalence of regular use of dental services was 32.8%. The following variables were positively associated with regular use: female gender, age > 60 years, no partner, high educational level, high economic status, private service user, good/excellent self-rated oral health, and no perceived need for dental treatment. Those who had received orientation on prevention and expressed a favorable view towards the dentist had higher odds of being regular users. Especially among lower-income individuals, regular use was infrequent (15%). When restricting the analysis to users of public dental services, schooling was still positively associated with the outcome. Dental services, especially in the public sector, should develop strategies to increase regular and preventive use.

O objetivo deste estudo foi investigar padrões de utilização de serviços odontológicos na população de um município de porte médio. Realizou-se um inquérito de base populacional em Pelotas, Rio Grande do Sul, Brasil, com uma amostra de 4.226 indivíduos de dez anos ou mais. Empregou-se a regressão de Poisson para analisar os fatores associados; 50,9% (IC95%: 49,3-52,4) dos entrevistados consultaram com dentista no último ano. A proporção da população que realizou consultas, no último ano, entre adolescentes, adultos e idosos, foi de 52,2%, 53,6% e 37,2%, respectivamente. Após ajuste para fatores de confusão, os determinantes da utilização de serviços para essas três faixas etárias foram: escolaridade > 9 anos, maior nível econômico e auto-referência à existência de problemas bucais. Ademais, adolescentes e adultos que avaliaram sua saúde bucal como boa apresentaram uma prevalência de utilização 10% e 40% maiores em relação àqueles que avaliaram sua saúde bucal como ruim. A determinação da prevalência de utilização dos serviços odontológicos e das características de seus usuários pode auxiliar no planejamento de futuras ações em saúde que priorizem grupos populacionais com maiores dificuldades na utilização desses serviços.The aim of this study was to estimate patterns of dental services use in a medium-sized city in southern Brazil. A population-based cross-sectional study was conducted in a sample of 4,226 individuals aged 10 years and older. Poisson regression analysis was used to identify associated factors; 50.9% (95%CI: 49.3-52.4) of the sample had consulted a dentist in the previous year. Dental care attendance rates among adolescents, adults, and elders were 52.2%, 53.6%, and 37.2%, respectively. After adjusting for various confounders, the most important determinants of dental services use were: schooling > 9 years, high socioeconomic status, and self-reported oral health problems. In addition, adolescents and adults that rated their oral health as good showed 10% and 40% higher prevalence dental services use, respectively, when compared with those who rated their oral health as bad. Determining the prevalence of dental services use and users' characteristics can help policymakers plan future measures to make dental care available to population groups with low rates of dental services use.

O Programa de Pós-graduação em Epidemiologia da UFPel realizou um intenso trabalho de auto-avaliação para resolver problemas identificados com seu curso de mestrado. O resultado foi a introdução de uma estrutura curricular baseada em dois pilares. De um lado, disciplinas de cunho teórico, fornecendo a base da formação do mestrando; de outro, disciplinas de cunho prático, onde os alunos trabalham coletivamente a construção de seu projeto de pesquisa, passando pela escolha de um tema, revisão da literatura, definição de objetivos e da metodologia. Esse esforço conjunto culmina na realização de um trabalho de campo único, na forma de um estudo transversal de base populacional, em que todos os mestrandos participam de maneira integral, obtendo dados para sua dissertação. Essa estratégia tem garantido a formação de mestres em epidemiologia com forte base teórica e com experiência de preparação e condução de um trabalho de campo. Além disso, tem sido possível manter um tempo de titulação abaixo de 24 meses. Cerca de 80% dos egressos têm publicado pelo menos um artigo baseado em seu mestrado. Destas publicações, quase 90% têm se dado em periódicos classificados como Internacional-A no Qualis da Capes.The postgraduate program in epidemiology of the Federal University of Pelotas, Brazil, went through an intense self-assessment process to solve problems related to its Master's course. The result was the introduction of a curricular structure based on two pillars. The first one: theoretical courses to offer students the bases of epidemiology. The other, practical training in which students work in groups to design their research projects, from the choice of a research question, to literature review, definition of objectives and methods. This joint effort leads to shared fieldwork, a cross-sectional population-based study, where all students have full participation and get data for their dissertations. This strategy has provided students with strong theoretical background and experience in preparing and conducting fieldwork. Besides, a median completion time below 24 months has been achieved. About 80% of the students who complete the course published at least one paper based on their dissertations; and almost 90% of these papers were published in journals classified as A-International by the Qualis criteria established by Capes.

OBJETIVO: Avaliar a influência de fatores socioeconômicos, reprodutivos e comportamentais sobre a evolução do peso durante a gestação. MÉTODOS: O peso corporal foi mensurado prospectivamente em uma coorte de 215 gestantes saudáveis atendidas por um serviço público de pré-natal do Município de São Paulo, no período de 1997 a 1998. Os critérios de inclusão foram: idade > 18 anos e início do pré-natal com idade gestacional < 16 semanas. A relação entre as variáveis independentes com a evolução do peso durante a gestação foi avaliada mediante análise multinível linear hierarquizada, analisada pelo teste de máxima verossimilhança. RESULTADOS: Na análise multinível, os fatores significantemente associados ao ganho de peso gestacional foram IMC inicial, escolaridade, situação marital e paridade. As equações obtidas permitiram identificar o efeito individualizado de cada uma das características: IMC inicial eutrófico, escolaridade >4 anos, ausência de companheiro e primiparidade proporcionam acréscimos de 3,0 kg, 1,9 kg, 2,3 kg e 2,4 kg, respectivamente, no ganho de peso total durante a gestação. CONCLUSÕES: O IMC inicial, escolaridade e paridade são características maternas que, com o estado marital, devem ser consideradas no desenvolvimento de estratégias para a promoção de um ganho de peso adequado durante a gestação.OBJECTIVE: To assess the influence of socioeconomic, reproductive, and behavioral factors on the evolution of weight during pregnancy. METHODS: Body weight was measured prospectively in a cohort of 215 healthy pregnant women attended to by a public prenatal service in the city of São Paulo, between 1997 and 1998. The criteria for inclusion were the following: aged 18 or older and with the beginning of prenatal care at a gestational age 4 years, lack of partner, and primiparity cause increases of 3.0 kg, 1.9 kg, 2.3 kg and 2.4 kg in the total weight gain during pregnancy, respectively. CONCLUSIONS: Initial BMI, level of education and parity are the maternal characteristics that, along with the marital status, must be taken into consideration in the development of strategies to promote adequate weight gain during pregnancy.

The aim of this study was to evaluate the Edinburgh Postnatal Depression Scale (EPDS) for screening and diagnosis of postpartum depression. Three months after delivery, EPDS was administered to 378 mothers from the 2004 Pelotas Birth Cohort Study, Rio Grande do Sul State, Brazil. Up to 15 days later, mothers were re-interviewed by mental health care professionals using a semi-structured interview based on ICD-10 (gold standard). We calculated the sensitivity and specificity of each cutoff point, and values were plotted as a receiver operator characteristic curve. The best cutoff point for screening postpartum depression was > 10, with 82.6% (75.3-89.9%) sensitivity and 65.4% (59.8-71.1%) specificity. For screening moderate and severe cases, the best cutoff point was > 11, with 83.8% (73.4-91.3%) sensitivity and 74.7% (69.4-79.5%) specificity. For diagnosis, EPDS was valid only for prevalence of postpartum depression in the 20-25% range, with 60% PPV for the > 13 cutoff point (59.5% sensitivity; 88.4% specificity). The specificities and PPVs for all cutoff points were below those reported by other authors. Small numbers and the calculation of PPV in samples with overrepresentation of cases in the majority of studies appear to account for these differences.Avaliar a validade da Escala de Depressão Pós-natal de Edimburgo (EPDS) para rastreamento e diagnóstico de depressão pós-parto. Três meses pós-parto, a EPDS foi aplicada a 378 mães da Coorte de Nascimentos de Pelotas, Rio Grande do Sul, Brasil, em 2004. Até 15 dias após, as mães foram reentrevistadas por profissionais de saúde mental utilizando-se questionário semi-estruturado baseado na CID-10 (padrão-ouro). Calculamos sensibilidade e especificidade de cada ponto de corte e construiu-se curva ROC. Melhor ponto de corte para rastreamento foi > 10 (sensibilidade 82,6%, 75,3%-89,9%; especificidade 65,4%, 59,8%-71,1%). Para rastrear casos moderados e graves, melhor ponto de corte foi > 11, com sensibilidade 83,8% (73,4%-91,3%) e especificidade 74,7% (69,4%-79,5%). Para diagnóstico, a EDPS foi válida somente para prevalências em torno de 20%-25%, com valor preditivo positivo de 60% para o ponto de corte > 13 (sensibilidade 59,5%; especificidade 88,4%). As especificidades e valores preditivos positivos de todos os pontos de corte foram inferiores aos relatados na literatura. Possivelmente, o uso de amostras pequenas e o cálculo de valores preditivos positivos em amostras com super-representação de casos, sejam responsáveis por essas diferenças.

This study evaluated knowledge and use of generic drugs in a population-based sample of adults from a southern Brazilian city. The outcomes were: the proportion of generics in total medicines used; theoretical and practical knowledge about generics; and strategies used to buy medicines on medical prescriptions. The recall period for drug utilization was 15 days. The proportion of generics in total medicines was 3.9%. While 86.0% knew that generics cost less and 70.0% that the quality is similar to brand name medicines, only 57.0% knew any packaging characteristics that distinguish generics from other medicines. The highest proportion of generic drug utilization was in the antimicrobial pharmacological group. A brand name medicine (with a brand similar to the generic name) was mistakenly classified as a generic through photos by 48.0% of the interviewees. Among subjects who bought medicines in the 15-day period, 18.9% reported buying a generic, but this result should be interpreted with caution, because the population frequently fails to differentiate between generics and other medicines.Este estudo avaliou o conhecimento e utilização de medicamentos genéricos em uma amostra populacional de adultos de uma cidade no sul do Brasil. Os desfechos foram: proporção de genéricos sobre o total de medicamentos usados; conhecimento teórico e prático sobre medicamentos genéricos; estratégias usadas para compra de medicamentos com prescrição médica. O período recordatório para uso de medicamentos foi de 15 dias. A proporção de genéricos no total de medicamentos foi de 3,9%. Enquanto 86,0% sabiam que o preço dos genéricos era menor e 70,0% que a qualidade era equivalente aos medicamentos de marca, apenas 57,0% conheciam alguma característica da embalagem que diferencia os genéricos de outros medicamentos. A maior proporção de uso de genéricos foi encontrada no grupo farmacológico dos antimicrobianos. Um medicamento de marca (com nome comercial semelhante ao genérico) foi erroneamente classificado como genérico através de fotos por 48,0% das pessoas. Entre os indivíduos que compraram medicamentos no período de 15 dias, 18,9% relataram comprar um genérico, mas esse resultado deve ser interpretado com cautela, pois freqüentemente a população não consegue diferenciar os genéricos dos demais medicamentos.