Search

Objective: To describe the prevalence of insufficient sleep duration, long sleep latency, terminal or maintenance insomnia, subjective sleep quality, and excessive daytime sleepiness among participants of birth cohorts conducted in three Brazilian cities, and to evaluate differences in prevalence rates within cohorts according to sociodemographic characteristics. Methods: Cross-sectional analyses involving adolescents and adults participating in four birth cohorts conducted in Ribeirão Preto (RP78 and RP94), Pelotas (PEL93) and São Luís (SL97/98). Sleep duration, latency, terminal or maintenance insomnia, and subjective sleep quality were obtained through the Pittsburgh Sleep Quality Index; and excessive daytime sleepiness was assessed using the Epworth Sleepiness Scale. Differences in the prevalence of the outcomes were analyzed in each cohort according to sociodemographic characteristics (skin color, marital status, socioeconomic status, study and working at the time of the interview) stratified by sex. Results: Insufficient sleep duration was the most common outcome at the four cohorts, with higher frequency among men. Long latency was more frequently reported by young adult women in RP94 and PEL93 cohorts, and insomnia by women of the four cohorts, when compared to men of the same age. Women generally suffered more from excessive daytime sleepiness and evaluated the quality of their sleep more negatively than men. In addition to sex, being a student and working were associated with the largest number of outcomes in both sexes. Conclusion: Sleep disorders are more prevalent in women, reinforcing the need for greater investment in sleep health in Brazil, without disregarding gender and socioeconomic determinants. RESUMO Objetivo: Descrever a prevalência de duração do sono, latência, insônia terminal, qualidade subjetiva do sono e sonolência diurna excessiva entre participantes de coortes de nascimentos realizadas em três cidades brasileiras, bem como avaliar as diferenças nas taxas de prevalência das coortes de acordo com características sociodemográficas. Métodos: Análises transversais envolvendo participantes de quatro coortes de nascimento realizadas em Ribeirão Preto (RP78 e RP94), Pelotas (PEL93) e São Luís (SL97). A duração, a latência, a insônia terminal e a qualidade subjetiva do sono foram obtidas por meio do Índice de Qualidade do Sono de Pittsburgh; e a sonolência diurna excessiva foi avaliada pela Escala de Sonolência de Epworth. As diferenças na prevalência dos desfechos foram analisadas em cada coorte segundo características sociodemográficas estratificadas por sexo. Resultados: A duração insuficiente do sono foi o desfecho mais comum nas quatro coortes, com maior frequência entre os homens. Latência longa foi mais frequentemente relatada por mulheres adultas jovens nas coortes RP94 e PEL93, e insônia por mulheres das quatro coortes, quando comparadas a homens da mesma idade. As mulheres geralmente sofriam mais com sonolência diurna excessiva e avaliavam a qualidade do sono de forma mais negativa do que os homens. Além do sexo, ser estudante e trabalhar estiveram associados ao maior número de desfechos em ambos os sexos. Conclusão: Os distúrbios do sono são mais prevalentes em mulheres, reforçando a necessidade de maior investimento na saúde do sono no Brasil, sem desconsiderar gênero e determinantes socioeconômicos.

BACKGROUND: As compared to full-term infants (39–41 weeks of gestation), early-term infants (37–38 wk) are at increased risk of adverse outcomes, including shorter exclusive breastfeeding (EB) duration and continued breastfeeding. OBJECTIVES: To compare early-term with full- and late-term infants regarding the prevalence of EB at 3 mo and any breastfeeding at 12 mo. METHODS: Data sets from two population-based birth cohorts conducted in the city of Pelotas, Brazil, were combined. Only term infants (37 0/7 through 41 6/7 weeks of gestation) were included in the analyses. Early-term infants (37 0/7 through 38 6/7 wk) were compared to the remaining term infants (39 0/7 through 41 6/7 wk). Information on breastfeeding was gathered through maternal interviews at the 3-mo and 12-mo follow-ups. The prevalence of EB at 3 mo and any breastfeeding at 12 mo with 95% CIs were calculated. Crude and adjusted prevalence ratios (PRs) were obtained through Poisson regression. RESULTS: A total of 6395 infants with information on gestational age and EB at 3 mo and 6401 infants with information on gestational age and any breastfeeding at 12 mo were analyzed. There was no difference between early-term infants and the remaining term infants regarding the prevalence of EB at 3 mo (29.2% and 27.9%, respectively) (P = 0.248). Prevalence of any breastfeeding at 12 mo was lower in early-term infants than among those born between 39 0/7 and 41 6/7 weeks of gestation (38.2% compared with 42.4%) (P = 0.001). In the adjusted analysis, the PR for any breastfeeding at 12 mo was 15% lower in the early-term group than in the remaining term infants (PR = 0.85; 95% CI: 0.76–0.95) (P = 0.004). CONCLUSIONS: The prevalence of EB at 3 mo was similar among term infants. Nonetheless, in comparison with the remaining infants born at term, early-term infants were at increased risk of having been weaned before reaching 12 mo of age. Curr Dev Nutr 2023;xx:xx.

We aimed to investigate the social inequalities in the fear of not having enough food for the household, a psychological domain of food insecurity, during the COVID-19 pandemic among mothers from the 2019 Rio Grande birth cohort. In 2019 we invited all mothers who gave birth to a singleton liveborn in the municipality of Rio Grande (southern Brazil) to respond to a standardized questionnaire. In 2020, we followed these mothers twice. In wave I we located 1,077 of all eligible mothers and 1,033 in wave II (follow-up rate of 52.1% and 50.4%). We estimated the absolute and relative inequalities of food insecurity according to the number of people living in the household, maternal education, family income, and income change during the pandemic using the slope index of inequalities (SII) and the concentration index (CIX), respectively. 1,021 mothers reported having food insecurity, and the prevalence was 42.8% and 44.7% for waves I and II, respectively. In wave I we observed inequities in the distribution of food insecurity, being higher among mothers living with ≥3 people (SII:-17.3; 95%CI[-29.6;-5.0]), with a lower education (SII:-36.7; 95%CI[-47.0;-26.4]), lower income (SII-48.9; 95%CI[-58.0;-39.7]), and with an income that decreased during the pandemic (SII:-47.1; 95%CI[-57.3;-36.9]). These inequities widened from wave I to wave II. This study describes the impact of the COVID-19 pandemic on maternal and family food insecurity and the increased social disparities during the pandemic, especially among the most vulnerable populations.

Objective: To describe and compare measures of maternal depression, anxiety, and posttraumatic stress symptoms before and during the coronavirus disease 2019 (COVID-19) pandemic in a Brazilian birth cohort. Methods: All hospital births occurring in the municipality of Rio Grande (southern Brazil) during 2019 were identified. Mothers were invited to complete a standardized questionnaire on sociodemographic and health-related characteristics. Between May and July 2020, we tried to contact all cohort mothers of singletons, living in urban areas, to answer a standardized web-based questionnaire. They completed the Edinburgh Postnatal Depression Scale (EPDS) and Generalized Anxiety Disorder 7-item (GAD-7) in both follow-ups, and the Impact of Event Scale (IES) in the online follow-up. Results: We located 1,136 eligible mothers (n=2,051). Of those, 40.5% had moderate to severe stress due to the current pandemic, 29.3% had depression, and 25.9% had GAD. Mothers reporting loss of income during the pandemic (57.2%) had the highest proportions of mental health problems. Compared to baseline, the prevalence of depression increased 5.7 fold and that of anxiety increased 2.4-fold during the pandemic (both p < 0.001). Conclusion: We found a high prevalence of personal distress due to the ongoing COVID-19 pandemic, and a clear rise in both maternal depression and anxiety.

Participatory learning and action cycles with women’s groups have been recommended by the WHO to promote maternal and newborn health, but few studies have tested its feasibility and acceptability in mobile health (mHealth) interventions among mothers of toddlers. This was a mixed-method feasibility assessment of an 8-week WhatsApp-based maternal support group for mothers of toddlers (12–18 months of age) enrolled in a birth cohort study in Southern Brazil. Daily messages and weekly activities were sent by moderators to promote maternal–child outcomes: child nutrition, child sleep, nurturing care, and maternal psychosocial well-being (assessed pre- and post-intervention via self-reported questionnaire). The implementation and engagement of the mothers in the program were assessed by message extraction. Acceptability was evaluated through in-depth interviews (n = 5) and open-ended surveys (n = 10). 1481 messages were exchanged in 3 WhatsApp groups (n = 30 mothers). Mothers were most active on weekdays (68.6% of messages sent on Tuesdays and 72.6% on Thursdays), afternoons (2:00–4:00pm), and evenings (9:00–11:00 pm). Engagement was higher at weeks 1–4. Mothers enjoyed and considered topics relevant. Group interaction was perceived as low, which influenced their participation. The prevalence of depression symptoms decreased from pre- to post-intervention (9% to 5%; P = .04). A moderated mobile-based support group for mothers of toddlers was feasible. mHealth services to promote maternal support are a promising strategy to improve maternal–child outcomes, but engagement and use of the service remains a challenge. Program managers should work with community members to identify ways to support engagement and participation throughout the intervention.

Objective: We aimed to investigate the association between sleep in early life and ADHD in adolescence. As a secondary analysis, we tested whether the associations may be specific to ADHD. Method: Data from 3,467 participants of the 2004 Pelotas Birth Cohort were used. Information on their sleep duration and problems was collected at 12, 24, and 48 months of age. ADHD diagnosis and hyperactivity/inattention problems were assessed with the Development and Well-Being Assessment (DAWBA) and the Strengths and Difficulties Questionnaire (SDQ) among participants at 11 years of age. Results: Difficulty going to sleep at 24 months, nightmares at 24 months and at 48 months, and restless sleep at 48 months were consistently associated with ADHD as well as with other mental disorders. Conclusion: The results suggest that sleep disturbances may be more important ADHD predictors than sleep duration or sleep duration trajectories. However, it may also be considered early markers of other mental disorders.

To investigate the influence of maternal depression on child health-care services utilization.Data from The Pelotas 2004 Birth Cohort collected at birth and at 12- and 24-month follow-ups were used. Four outcomes occurring in the second year of life were investigated: number of well-baby visits, number of medical appointments, number of visits to emergency rooms, and number of hospitalizations. The main exposure was maternal depression symptoms at 12-month post-partum as assessed by the Edinburgh Postpartum Depression Scale (EPDS). Adjusted prevalence ratios (PR) with 95% confidence intervals (95% CI) were calculated by Poisson regression.The prevalence of mothers with depressive symptoms was 27.6% (95% CI: 26.2-29.0%). These mothers showed a 10% lower probability of taking their children to well-baby visits (0.90; 0.85-0.95; p = 0.001); 16% higher probability to seek medical consultations (1.16; 1.09-1.25, p = 0.001); and they sought emergency services for their children more often (1.30; 1.17-1.45, p 0.001) as compared to mothers who did not present depressive symptoms. Although the PR for hospitalizations was 26% higher for children from mothers with depressive symptoms, the association did not achieve statistical significance (1.26; 0.98-1.63; p = 0.072).Children from mothers with depressive symptoms attend fewer number of preventive consultations. In contrast, they are taken to medical and emergency care more often, suggesting that these children are given healthcare when they are at more advanced stages of their illnesses.

Highlights • The sucrose consumption was associated with the prevalence of ADHD only among boys at 6 years of age. • That persistence of high consumption or an increase in sugar consumption between 6 and 11 years of age was not associated with higher incidence of ADHD between 6 and 11 years of age. • The higher sugar consumption by children with ADHD is possibly a consequence rather than a determinant of the disorder., Background Attention-deficit/hyperactivity disorder (ADHD) is characterized by persistent symptoms of lack of attention, impulsivity and hyperactivity. The association between nutritional exposures and ADHD has been investigated and some studies have identified adverse effects from higher intake of sugar. The objective of the present study was to evaluate the association between change in sugar consumption between 6 and 11 years of age and incidence of attention-deficit/hyperactivity disorder (ADHD). Methods Pelotas 2004 Birth Cohort Study in Brazil. A food frequency questionnaire (FFQ) was used to estimate sugar consumption and the Development and Well-Being Assessment (DAWBA) was applied to mothers to assess the presence of ADHD. Results Only children without ADHD at 6 years and with complete information from FFQ and DAWBA at 6 and 11 years were included in the analyses (n = 2924). Odds ratios with 95% confidence intervals were calculated. Incidence of ADHD between 6 and 11 years was 4.6% (3.6–5.6%) among boys and 1.8% (1.2–2.5%) among girls. Adjusted analyses showed no association between always high sucrose consumption between 6 and 11 years and incidence of ADHD, compared with individuals who always presented low consumption, both among boys (OR = 0.66; 0.21–2.04) and girls (OR = 2.71; 0.24–30.35). Limitations Reflect those that are inherent to use of FFQs, such as memory bias and lack of precision in quantifying the diet. Conclusions The results suggest that there is no association between sucrose consumption between 6 and 11 years of age and incidence of ADHD.

This study used data from 2,222 mothers and infants participating in a population-based birth cohort to verify whether maternal depression in the perinatal period was associated with poor infant sleep. Mothers who scored ≥13 points on the Edinburgh Postnatal Depression Scale at 16-24 weeks of gestation and/or 3 months after delivery were considered perinatally depressed. The main outcome variable was poor infant sleep at 12 months of age, defined as3 night wakings, nocturnal wakefulness1 hr or total sleep duration9 hr. Infant sleep data were obtained with the Brief Infant Sleep Questionnaire (BISQ) and 24-hr actigraphy monitoring. Prevalence of perinatal depression in the sample was 22.3% (95% confidence interval [CI], 20.5-24.0). After Poisson regression, infants of depressed mothers showed an adjusted relative risk (RR) of 1.44 (95% CI, 1.00-2.08; p = .04) for3 night wakings with questionnaire-derived data. When actigraphy data were analysed, no association was found between perinatal depression and poor infant sleep (adjusted RR, 1.20; 95% CI, 0.82-1.74; p = .35). In conclusion, although mothers in the depressed group were more likely to report more night wakings, objective data from actigraphy did not replicate this finding. Dysfunctional cognition, maternal behavioural factors and sleep impairment associated with perinatal depression may affect the mother's impression of her infant's sleep.

Objective: To review the literature on interventions planned to prevent the incidence of injuries in childhood. Source of data: The PubMed, Web of Science, and Bireme databases were searched by two independent reviewers, employing the single terms accidents, accident, injuries, injury, clinical trial, intervention, educational intervention, and multiple interventions, and their combinations, present in the article title or abstract, with no limits except period of publication (2006–2016) and studies in human subjects. Synthesis of data: Initially, 11,097 titles were located. Fifteen articles were selected for the review. Eleven were randomized trials (four carried out at the children's households, five in pediatric healthcare services, and two at schools), and four were non-randomized trials carried out at the children's households. Four of the randomized trials were analyzed by intention-to-treat and a protective effect of the intervention was observed: decrease in the number of risk factors, decrease in the number of medical consultations due to injuries, decrease in the prevalence of risk behaviors, and increase of the parents’ knowledge regarding injury prevention in childhood. Conclusion: Traumatic injuries in childhood are amenable to primary prevention through strategies that consider the child's age and level of development, as well as structural aspects of the environment. Resumo: Objetivo: Revisar a literatura sobre intervenções voltadas à prevenção de acidentes na infância. Fonte dos dados: As bases PubMed, Web of Science e Bireme foram rastreadas por dois revisores independentes, utilizando os termos accidents, accident, injuries, injury, clinical trial, intervention, educational intervention e multiple interventions, e suas combinações, presentes no título ou resumo do artigo, sem limites, exceto o período de publicação (2006-2016) e estudos realizados em humanos. Síntese dos dados: Foram localizados inicialmente 11.097 títulos. Foram selecionados 15 artigos para esta revisão, dos quais 11 eram ensaios randomizados (quatro realizados em domicílios, cinco em serviços de saúde e dois em escolas) e quatro, ensaios não randomizados realizados em domicílios. Quatro dos estudos randomizados foram analisados por intenção de tratar e mostraram efeito favorável da intervenção: redução de fatores de risco para acidentes, diminuição do número de atendimentos médicos por acidentes, menor frequência de comportamentos de risco e maior conhecimento dos pais sobre prevenção de acidentes na infância. Conclusão: As lesões traumáticas na infância são passíveis de prevenção primária por meio de estratégias que levem em conta a idade e o nível de desenvolvimento da criança, bem como aspectos estruturais do ambiente. Keywords: Injuries, Accidental injuries, Childhood, Experimental studies, Palavras-chave: Acidentes, Lesões acidentais, Infância, Estudos experimentais

ObjectiveTo review the available literature on the association between consumption of ultra-processed foods and body fat during childhood and adolescence.DesignA systematic review was conducted in the PubMed, Web of Science and LILACS databases. Studies that evaluated the association between consumption of ultra-processed food (exposure) and body fat (outcome) during childhood and adolescence were eligible.SubjectsHealthy children and adolescents.ResultsTwenty-six studies that evaluated groups of ultra-processed foods (such as snacks, fast foods, junk foods and convenience foods) or specific ultra-processed foods (soft drinks/sweetened beverages, sweets, chocolate and ready-to-eat cereals) were selected. Most of the studies (n15) had a cohort design. Consumption was generally evaluated by means of FFQ or food records; and body composition, by means of double indirect methods (bioelectrical impedance analysis and skinfolds). Most of the studies that evaluated consumption of groups of ultra-processed foods and soft drinks/sweetened beverages found positive associations with body fat.ConclusionsOur review showed that most studies have found positive associations between consumption of ultra-processed food and body fat during childhood and adolescence. There is a need to use a standardized classification that considers the level of food processing to promote comparability between studies.

Social jetlag (SJL) is defined as the misalignment between the biological clocks and the social clock imposed by work and social constraints. In order to accomplish the workdays duties, people tend to not respect the internally sleep-wake cycle during the week, often using alarm clock to wake-up, which would lead to a chronic form of travel-induced jetlag. This circadian misalignment has been found to be associated with increased health risk and health-impairing behaviors. In this cross-sectional study, we aimed to explore whether the SJL is a valid concept for the travel-induced jetlag symptoms, as well as what is the cutoff point with best parameters for defining the presence of SJL, in a sample of undergraduate students of a university in Southern Brazil. We assessed SJL by the Munich ChronoType Questionnaire (MCTQ) and defined the concept as the difference between the midsleep point on free days and the midsleep point on classes days. The gold standard was defined as having at least one travel-induced jetlag symptom (fatigue, sleepiness or difficulty concentrating). Relative SJL, sensitivity and specificity were calculated for different cutoff points, plotted on ROC curves. A total of 452 students with complete sleep information were included in the analysis. The relative SJL mean was 2 h 23 min (SD = 1 h 24 min; range -3 h to 7 h 58 min) and 63.7% of the students had ≥2 h of relative SJL. All the tested cutoff points of the instrument had low sensitivity and specificity values, covering a small area under the ROC curve (0.487). The best parameters were for the cutoff point ≥2 h, with 63.4% sensitivity and 35.9% specificity. SJL did not revealed to be a valid concept for the studied sample comparing it to travel-induced jetlag symptomatology. One possible explanation for the lack of validity of our results regards the fact that SJL may not have the same apparent wide-term effects as the travel-induced jetlag. Then, the symptoms of SJL do not well represent the symptoms of travel-induced jetlag.

O objetivo foi investigar distúrbios do sono e fatores sociodemográficos e comportamentais associados. Foi realizado um censo com universitários. Perguntas extraídas do Munich Chronotype Questionnaire investigaram: duração insuficiente do sono (< 6 horas/dia para < 65 anos e < 5 horas/dia para os demais), latência longa (> 30 minutos), baixa qualidade autopercebida, despertares noturnos (involuntários, no meio da noite) e sonolência diurna (dificuldade de concentração). Variáveis independentes englobaram características sociodemográficas e comportamentais. Análises ajustadas foram feitas com regressão de Poisson. Dos 1.865 estudantes, 32% apresentaram sono insuficiente nos dias de aula, 8,2% sono insuficiente nos finais de semana, 18,6% latência longa nos dias de aula, 17,2% latência longa nos finais de semana, 30% baixa qualidade autopercebida, 12,7% despertares noturnos e 32,2% sonolência diurna. O maior consumo de álcool esteve associado à duração insuficiente e latência longa nos dias de aula, baixa qualidade, despertares e sonolência; tabagismo com duração insuficiente nos finais de semana, despertares e baixa qualidade; e cor da pele preta ou parda com duração insuficiente nos dias de aula, baixa qualidade e despertares. Ter aulas de manhã associou-se a sono insuficiente nos dias de aula e sonolência diurna, e o sexo feminino, sonolência, baixa qualidade e despertares. Os distúrbios de sono mais frequentes foram sono insuficiente nos dias de aula, baixa qualidade autopercebida e sonolência diurna. O consumo de álcool e cigarros e a cor preta ou parda foram os principais fatores associados aos distúrbios. The objective was to investigate sleep disorders and associated sociodemographic and behavioral factors. A census of university students was carried out. Questions extracted from the Munich Chronotype Questionnaire investigated: insufficient sleep duration (< 6 hours/day for < 65 years and < 5 hours/day for other ages), long latency (> 30 minutes), low self-rated sleep quality, nocturnal awakenings (involuntary, in the middle of the night), and daytime sleepiness (difficulty concentrating). Independent variables included sociodemographic and behavioral characteristics. Adjusted analyses were performed with Poisson regression. Of the 1,865 students, 32% exhibited insufficient sleep on class days, 8.2% insufficient sleep on weekends, 18.6% long latency on class days, 17.2% long latency on weekends, 30% low self-rated sleep quality, 12.7% nocturnal awakenings, and 32.2% daytime sleepiness. Higher alcohol consumption was associated with insufficient sleep duration and long latency on class days, low quality sleep, awakenings, and daytime sleepiness. Smoking was associated with insufficient sleep duration on weekends, awakenings, and low-quality sleep. Black and brown skin color were associated with insufficient sleep duration on class days, low-quality sleep, and awakenings. Morning classes were associated with insufficient sleep and daytime sleepiness. Female gender was associated with low-quality sleep and awakenings. The most frequent sleep disorders were insufficient sleep on class days, low self-rated quality of sleep, and daytime sleepiness. Alcohol consumption and smoking and black and brown skin color were the principal factors associated with sleep disorders. El objetivo fue investigar trastornos del sueño, factores sociodemográficos y de comportamiento asociados. Fue realizado un censo con los estudiantes universitarios. Las preguntas extraídas del Munich Chonotype Questionnaire investigaron: duración insuficiente del sueño (< 6 horas/día para < 65 años y < 5 horas/día para los demás), latencia prolongada (> 30 minutos), baja calidad autopercibida, vigilias (involuntarias, en medio de la noche) y somnolencia diurna (dificultad de concentración). Las variables independientes englobaron características sociodemográficas y de comportamiento. Se realizaron análisis ajustados con regresión de Poisson. De los 1.865 estudiantes, un 32% presentaron sueño insuficiente durante los días de clase, un 8,2% sueño insuficiente los fines de semana, un 18,6% latencia prolongada durante los días de clase, un 17,2% latencia prolongada durante los fines de semana, un 30% baja calidad autopercibida, un 12,7% vigilias y un 32,2% somnolencia diurna. El mayor consumo de alcohol se asoció a la duración insuficiente y latencia prolongada los días de clase, baja calidad de sueño, vigilias y somnolencia; el tabaquismo con duración insuficiente de sueño durante los fines de semana, vigilias y baja calidad de sueño, así como color de piel negro o mulato con una duración insuficiente de sueño durante los días de clase, baja calidad del mismo y vigilias. Tener clases por la mañana se asoció a sueño insuficiente durante los días de clase, somnolencia diurna, y el sexo femenino con somnolencia, baja calidad y vigilias. Los disturbios de sueño más frecuentes fueron sueño insuficiente durante los días de clase, baja calidad autopercibida y somnolencia diurna. El consumo de alcohol y cigarrillos, así como el color negro o mulato fueron los principales factores asociados a los disturbios.

To investigate the validity of the Brief Infant Sleep Questionnaire (BISQ), in assessing sleep quality in childhood.This was a validation study with children from the Pelotas 2015 Birth Cohort. BISQ was applied to mothers when their children were 3, 6, 12, and 24 months of age. The poor sleep indicators analysed, as defined by BISQ, were3 wakings per night, nocturnal wakefulness1 h and total sleep duration9/24 h, compared to number of wakings per night and nocturnal and total sleep duration defined by actigraphy taken as the gold standard. The Actiwatch wGT3X-BT device was used by the child consecutively during five days at three and six months and for three days at 12 and 24 months. At each age the prevalence, sensitivity, specificity, accuracy, and positive (PPV) and negative predictive values (NPV) of each sleep indicator was calculated.A total of 586 children were enrolled in the study. Nocturnal wakefulness1 h was the most frequent indicator at all ages, with higher sensitivity (varying from 27.5% at six months to 54.8% at three) and lower specificity (53.4% at three months to 79.4% at six months), in comparison to the other sleep indicators. Specificity for3 wakings and total sleep duration9 h was greater than 85.0% at all the ages. Higher accuracies were observed for total sleep9 h at 3 (85.6%), 6 (88.2%) and 12 months (73.6%) and for 3 wakings at 24 months (84.5%). The sensitivity for the presence of at least one indicator decreased with age from 56.0% at three months to 35.8% at 24 months, whereas the specificity increased from 50.6% at three months to 63.8% at 24 months.The high specificity of the BISQ sleep parameters supports the validity of parents' reports on sleep-related problems in childhood for use in epidemiological studies.

to evaluate maternal intention to breastfeed, duration of breastfeeding up to 24 months-of-age and reasons for weaning in the first year of life.this was a cohort study conducted in Pelotas, RS, Brazil, with participants from the Multi-Center Body Composition Study; a life table was used to analyze duration of breastfeeding.of the 1377 mothers screened, 74.3% reported intending to exclusively breastfeed up until 6 months, while 91.1% intended to prolong breastfeeding until at least 12 months; 58.0% of children were breastfed up to at least 6 months; median breastfeeding duration was 10.8 months (IQR: 5.8 - 23.0); the main reasons reported for weaning were insufficient breast milk (57.3%), return to work/school (45.5%), and unexplained refusal by the baby (40.1%).the results show that despite the intention to breastfeed, there are still structural and social barriers that interfere with successful breastfeeding, especially those related to working mothers.

The objective was to investigate sleep disorders and associated sociodemographic and behavioral factors. A census of university students was carried out. Questions extracted from the Munich Chronotype Questionnaire investigated: insufficient sleep duration (6 hours/day for65 years and5 hours/day for other ages), long latency (30 minutes), low self-rated sleep quality, nocturnal awakenings (involuntary, in the middle of the night), and daytime sleepiness (difficulty concentrating). Independent variables included sociodemographic and behavioral characteristics. Adjusted analyses were performed with Poisson regression. Of the 1,865 students, 32% exhibited insufficient sleep on class days, 8.2% insufficient sleep on weekends, 18.6% long latency on class days, 17.2% long latency on weekends, 30% low self-rated sleep quality, 12.7% nocturnal awakenings, and 32.2% daytime sleepiness. Higher alcohol consumption was associated with insufficient sleep duration and long latency on class days, low quality sleep, awakenings, and daytime sleepiness. Smoking was associated with insufficient sleep duration on weekends, awakenings, and low-quality sleep. Black and brown skin color were associated with insufficient sleep duration on class days, low-quality sleep, and awakenings. Morning classes were associated with insufficient sleep and daytime sleepiness. Female gender was associated with low-quality sleep and awakenings. The most frequent sleep disorders were insufficient sleep on class days, low self-rated quality of sleep, and daytime sleepiness. Alcohol consumption and smoking and black and brown skin color were the principal factors associated with sleep disorders.O objetivo foi investigar distúrbios do sono e fatores sociodemográficos e comportamentais associados. Foi realizado um censo com universitários. Perguntas extraídas do Munich Chronotype Questionnaire investigaram: duração insuficiente do sono (6 horas/dia para65 anos e5 horas/dia para os demais), latência longa (30 minutos), baixa qualidade autopercebida, despertares noturnos (involuntários, no meio da noite) e sonolência diurna (dificuldade de concentração). Variáveis independentes englobaram características sociodemográficas e comportamentais. Análises ajustadas foram feitas com regressão de Poisson. Dos 1.865 estudantes, 32% apresentaram sono insuficiente nos dias de aula, 8,2% sono insuficiente nos finais de semana, 18,6% latência longa nos dias de aula, 17,2% latência longa nos finais de semana, 30% baixa qualidade autopercebida, 12,7% despertares noturnos e 32,2% sonolência diurna. O maior consumo de álcool esteve associado à duração insuficiente e latência longa nos dias de aula, baixa qualidade, despertares e sonolência; tabagismo com duração insuficiente nos finais de semana, despertares e baixa qualidade; e cor da pele preta ou parda com duração insuficiente nos dias de aula, baixa qualidade e despertares. Ter aulas de manhã associou-se a sono insuficiente nos dias de aula e sonolência diurna, e o sexo feminino, sonolência, baixa qualidade e despertares. Os distúrbios de sono mais frequentes foram sono insuficiente nos dias de aula, baixa qualidade autopercebida e sonolência diurna. O consumo de álcool e cigarros e a cor preta ou parda foram os principais fatores associados aos distúrbios.El objetivo fue investigar trastornos del sueño, factores sociodemográficos y de comportamiento asociados. Fue realizado un censo con los estudiantes universitarios. Las preguntas extraídas del Munich Chonotype Questionnaire investigaron: duración insuficiente del sueño (6 horas/día para65 años y5 horas/día para los demás), latencia prolongada (30 minutos), baja calidad autopercibida, vigilias (involuntarias, en medio de la noche) y somnolencia diurna (dificultad de concentración). Las variables independientes englobaron características sociodemográficas y de comportamiento. Se realizaron análisis ajustados con regresión de Poisson. De los 1.865 estudiantes, un 32% presentaron sueño insuficiente durante los días de clase, un 8,2% sueño insuficiente los fines de semana, un 18,6% latencia prolongada durante los días de clase, un 17,2% latencia prolongada durante los fines de semana, un 30% baja calidad autopercibida, un 12,7% vigilias y un 32,2% somnolencia diurna. El mayor consumo de alcohol se asoció a la duración insuficiente y latencia prolongada los días de clase, baja calidad de sueño, vigilias y somnolencia; el tabaquismo con duración insuficiente de sueño durante los fines de semana, vigilias y baja calidad de sueño, así como color de piel negro o mulato con una duración insuficiente de sueño durante los días de clase, baja calidad del mismo y vigilias. Tener clases por la mañana se asoció a sueño insuficiente durante los días de clase, somnolencia diurna, y el sexo femenino con somnolencia, baja calidad y vigilias. Los disturbios de sueño más frecuentes fueron sueño insuficiente durante los días de clase, baja calidad autopercibida y somnolencia diurna. El consumo de alcohol y cigarrillos, así como el color negro o mulato fueron los principales factores asociados a los disturbios.

Background The Attention Deficit Hyperactivity Disorder (ADHD) is a neurobiological disorder characterized by persistent symptoms of inattention, impulsivity and hyperactivity. The diet during childhood has been investigated as a factor potentially involved in the ADHD etiology. Objective To review systematically the evidence of the association between dietary patterns and ADHD. Methods Two independent literature searches were carried out in PubMed, LILACS and PsycINFO databases. The studies included were only those that assessed dietary patterns and ADHD in children and adolescents. Due to heterogeneity between the studies random-effects models were used to pool the estimates. Results We included fourteen observational studies (four cohorts, five case-control and five cross-sectional studies). In the pooled analysis, healthy dietary patterns were protective against ADHD (OR: 0.65; 95% CI: 044 – 0.97), while unhealthy dietary patterns were found as risk to ADHD (OR: 1.41; 95% CI: 1.15–1.74). After stratifying the studies by design (cohort/case control or cross-sectional), continent (Europe or Asia/Oceania) and sample size (≥1000 or Limitations Absence of randomized controlled trials at the literature on this subject and scarce evidence from more robust designs, such as cohort and case-control studies. Conclusion This study suggests that a diet high in refined sugar and saturated fat can increase the risk, whereas a healthy diet, characterized by high consumption of fruits and vegetables, would protect against ADHD or hyperactivity. Nevertheless, giving the number and the design of most of the studies available in the literature, the current evidence is weak. More studies using longitudinal design need to be performed to reinforce this evidence.

O objetivo do presente estudo foi avaliar, mediante revisão sistemática da literatura, as evidências acerca da associação entre consumo materno de cafeína durante a gestação e transtorno de déficit de atenção e hiperatividade (TDAH) na infância. A busca na literatura ocorreu de forma sistemática, em múltiplas etapas, nas bases PubMed, LILACS, BIREME e PsycINFO, com limites para artigos publicados em português, inglês e espanhol, realizados em humanos. Foram encontradas 373 referências. Dessas, somente cinco foram mantidas, por atenderem ao objetivo deste estudo. Os cinco trabalhos foram realizados em países desenvolvidos; a maioria utilizou delineamento longitudinal e foi publicada nos últimos cinco anos. Apenas um estudo encontrou associação positiva. Estudos sobre o consumo de cafeína na gestação e TDAH são escassos, com resultados controversos e se deparam com várias dificuldades metodológicas, como falta de padronização na definição do desfecho

OBJECTIVE To estimate the prevalence of smoking and associated factors among rural residents. METHODS This is a population-based, cross-sectional study of 1,519 individuals carried out in 2016. We randomly selected 24 of the 50 census tracts that make up the eight rural districts of the city of Pelotas, State of Rio Grande do Sul, Brazil. All individuals aged 18 years or more living in the randomly selected households were eligible. Smokers were all those who smoked ≥ 1 cigarette/day for at least one month or declared that they had stopped smoking for less than one month. The independent variables included socioeconomic, demographic, behavioral, and health characteristics. We investigated age of onset, duration of addiction, number of cigarettes smoked/day, pack-years, and types of cigarettes consumed. Poisson regression was performed to calculate the adjusted prevalence ratios (PR) and 95% confidence intervals (95%CI). RESULTS The prevalence of smoking was 16.6% (95%CI 13.6–20.0), and it was twice as high in men in relation to women (PR = 1.99, 95%CI 1.44–2.74), in socioeconomic class D or E in relation to class A or B (PR = 2.23, 95%CI 1.37–3.62), and in those who considered their health poor or very poor in relation those with good or very good health (PR = 2.02, 95%CI 1.33–3.08). It was also higher in persons aged 30–59 years (compared to those aged < 30 years), with 5–8 years of education level (compared to those with ≥ 9 years), and with positive screening for alcohol-related disorder. Prevalence was lower among individuals who were overweight or obese than in those with normal weight. Smoking began on average at 16.9 years, with an average consumption of approximately 14 cigarettes/day and mean pack-years of 22 packs/year. The paper hand-rolled cigarette was the most consumed (57.6%). CONCLUSIONS Approximately one in six adults in rural Pelotas is a current smoker. The findings show the existence of social inequalities related to smoking addiction. Actions to prevent and control smoking should continue to be stimulated, especially in the most vulnerable subgroups. RESUMO OBJETIVO Estimar a prevalência de tabagismo e fatores associados entre moradores de zona rural. MÉTODOS Estudo transversal de base populacional realizado com 1.519 indivíduos, em 2016. Foram aleatoriamente selecionados 24 dos 50 setores censitários que compõem os oito distritos rurais do município de Pelotas, RS. Indivíduos ≥ 18 anos residentes nos domicílios aleatoriamente selecionados eram elegíveis. Foram considerados tabagistas aqueles que fumavam ≥ 1 cigarro/dia há pelo menos um mês ou que declararam haver parado de fumar há menos de um mês. As variáveis independentes incluíram características socioeconômicas, demográficas, comportamentais e de saúde. Foram investigados: idade de início, duração da adição, número de cigarros fumados/dia, carga tabágica e tipos de cigarros consumidos. Foi realizada regressão de Poisson para cálculo das razões de prevalências (RP) ajustadas e intervalos de confiança de 95% (IC95%). RESULTADOS A prevalência de tabagismo foi 16,6% (IC95% 13,6–20,0), sendo duas vezes maior nos homens do que nas mulheres (RP = 1,99; IC95% 1,44–2,74), na classe econômica D ou E do que na A ou B (RP = 2,23; IC95% 1,37–3,62) e naqueles que consideraram sua saúde ruim ou muito ruim, comparados àqueles que a consideraram muito boa ou boa (RP = 2,02; IC95% 1,33–3,08). Também foi superior em pessoas com 30–59 anos (comparadas àquelas com < 30 anos), com 5–8 anos de escolaridade (comparados às pessoas com ≥ 9 anos), e com rastreio positivo para transtorno relacionado ao consumo de álcool. A prevalência foi menor entre indivíduos com sobrepeso ou obesidade, em comparação aos eutróficos. O tabagismo iniciou em média aos 16,9 anos, com consumo médio de cerca de 14 cigarros/dia e carga tabágica média de 22 maços/ano. O cigarro de papel enrolado à mão foi o mais consumido (57,6%). CONCLUSÕES Aproximadamente um em cada seis adultos da zona rural de Pelotas é fumante atual. Os achados evidenciam a existência de desigualdades sociais relacionadas à adição tabágica. Ações de prevenção e controle do tabagismo devem continuar sendo estimuladas, sobretudo nos subgrupos mais vulneráveis.

This randomized clinical trial examines the effect of parental counseling on bedtime routines and behaviors on infants’ sleep habits from ages 3 months to 2 years., Key Points Question Can an educational intervention improve infants’ nighttime sleep duration and sleep habits? Results In this randomized clinical trial with 586 children assessed at ages 3 (baseline), 6, 12, and 24 months, mean nighttime sleep duration was 19 minutes longer in intervention group than the control group at age 6 months but 5 minutes shorter in intervention group than the control group at age 12 months. There were no statistically significant differences in the sleep parameters between the intervention group and control group at any age. Meaning This randomized clinical trial found that the educational intervention did not achieve longer nighttime sleep duration among infants in the intervention group., Importance Poor sleep during early childhood is associated with adverse outcomes, including obesity, cognitive impairment, and mental and behavioral disorders. Objective To assess the efficacy of an educational intervention in the promotion of nighttime sleep duration. Design, Setting, and Participants This single-blind, intent-to-treat randomized clinical trial included participants in Pelotas, Brazil, aged 3 months who were followed up until age 24 months. Eligibility criteria included healthy infants aged approximately 3 months who slept less than 15 hours per 24 hours. Infants were randomized to the intervention group or control group. Interventions Information on sleep characteristics, improvements in the environment, establishment of a nighttime sleep routine, and waiting before attending nocturnal awakenings was delivered to mothers in the intervention group by trained home-visitors at baseline. The intervention group received a telephone call on the first and second day after the intervention and a home visit on the third day after the intervention. The intervention’s content was reinforced at health care visits for ages 6 months and 12 months. Mothers allocated to the control group were counseled on the benefits of breastfeeding for the mother’s and child’s health and given written material with content on breastfeeding. Main Outcomes and Measures Nighttime sleep duration was measured by interview and actigraphy at baseline and ages 6, 12, and 24 months and diaries at baseline and age 6 months. At ages 3 and 6 months, nighttime sleep self-regulation was calculated by subtracting nighttime sleep duration recorded by actigraphy from nighttime sleep duration recorded in the diaries and at ages 12 and 24 months by subtracting nighttime sleep duration recorded by actigraphy from nighttime sleep duration obtained by interview. Results Among 1812 mother-infant dyads invited to participate, 798 met the inclusion criteria and 586 agreed to participate. The intervention group included 298 infants (154 [52.9%] boys), and the control group included 288 infants (164 [58.2%] boys). At age 6 months, mean (SD) nighttime sleep duration recorded in diaries was 9.80 (1.85) hours in the intervention group and 9.49 (2.07) hours in the control group, a difference of 19 minutes longer for the intervention group. At age 12 months, mean (SD) nighttime sleep duration based on the Brief Infant Sleep Questionnaire was 8.43 (1.35) hours in the intervention group and 8.52 (1.35) hours in the control group, a difference of 5 minutes shorter for the intervention group. At age 24 months, compared with information from the interview, actigraphy records showed that children in the intervention group stayed awake at night without signalizing for a mean (SD) of 0.52 (2.52) hours, whereas children in the control group stayed awake at night without signalizing for a mean (SD) of 0.23 (2.43) hours. There were no statistically significant difference between groups in any of the sleep parameters investigated. Conclusions and Relevance This randomized clinical trial found that the educational intervention did not achieve longer nighttime sleep duration among infants in the intervention group. Trial Registration ClinicalTrials.gov identifier: NCT02788630

Background Sleep problems in childhood have been found to be associated with memory and learning impairments, irritability, difficulties in mood modulation, attention and behavioral problems, hyperactivity and impulsivity. Short sleep duration has been found to be associated with overweight and obesity in childhood. This paper describes the protocol of a behavioral intervention planned to promote healthier sleep in infants. Methods The study is a 1:1 parallel group single-blinded randomized controlled trial enrolling a total of 552 infants at 3 months of age. The main eligibility criterion is maternal report of the infant’s sleep lasting on average less than 15 h per 24 h (daytime and nighttime sleep). Following block randomization, trained fieldworkers conduct home visits of the intervention group mothers and provide standardized advice on general practices that promote infant’s self-regulated sleep. A booklet with the intervention content to aid the mother in implementing the intervention was developed and is given to the mothers in the intervention arm. In the two days following the home visit the intervention mothers receive daily telephone calls for intervention reinforcement and at day 3 the fieldworkers conduct a reinforcement visit to support mothers’ compliance with the intervention. The main outcome assessed is the between group difference in average nighttime self-regulated sleep duration (the maximum amount of time the child stays asleep or awake without awakening the parents), at ages 6, 12 and 24 months, evaluated by means of actigraphy, activity diary records and questionnaires. The secondary outcomes are conditional linear growth between age 3–12 and 12–24 months and neurocognitive development at ages 12 and 24 months. Discussion The negative impact of inadequate and insufficient sleep on children’s physical and mental health are unquestionable, as well as its impact on cognitive function, academic performance and behavior, all of these being factors to which children in low- and middle-income countries are at higher risk. Behavioral interventions targeting mothers and young children that can be delivered inexpensively and not requiring specialized training can help prevent future issues by reducing the risk to which these children are exposed. Trial registration ClinicalTrial.gov NCT02788630 registered on 14 June 2016 (retrospectively registered).

O objetivo do presente estudo foi avaliar, mediante revisão sistemática da literatura, as evidências acerca da associação entre consumo materno de cafeína durante a gestação e transtorno de déficit de atenção e hiperatividade (TDAH) na infância. A busca na literatura ocorreu de forma sistemática, em múltiplas etapas, nas bases PubMed, LILACS, BIREME e PsycINFO, com limites para artigos publicados em português, inglês e espanhol, realizados em humanos. Foram encontradas 373 referências. Dessas, somente cinco foram mantidas, por atenderem ao objetivo deste estudo. Os cinco trabalhos foram realizados em países desenvolvidos; a maioria utilizou delineamento longitudinal e foi publicada nos últimos cinco anos. Apenas um estudo encontrou associação positiva. Estudos sobre o consumo de cafeína na gestação e TDAH são escassos, com resultados controversos e se deparam com várias dificuldades metodológicas, como falta de padronização na definição do desfecho This aim of this study was to conduct a systematic literature review on the association between maternal caffeine intake during pregnancy and attention deficit hyperactivity disorder (ADHD) in childhood. The systematic multiple-stage literature search in PubMed, LILACS, BIREME, and PsycINFO was limited to research in human subjects and published in Portuguese, English, and Spanish. A total of 373 references were retrieved. Of these, only five met the study's objectives and were kept in the review. Most of the studies employed a longitudinal design, were conducted in developed countries, and were published in the last five years. Only one study found a positive association. Studies on caffeine consumption during pregnancy and ADHD are scarce, with conflicting results and several methodological difficulties such as lack of standardized outcome measures El objetivo de este estudio fue evaluar, a través de una revisión sistemática de la literatura, evidencias sobre la asociación entre el consumo de cafeína durante el embarazo y el trastorno por déficit de atención e hiperactividad (TDAH) en la infancia. Se realizó una búsqueda sistemática en la literatura, por etapas múltiples, en PubMed, LILACS BIREME y PsycINFO, limitándose a artículos publicados en portugués, inglés y español, realizados en estudios sobre humanos. Fueron localizadas 373 referencias. De ellas, apenas se mantuvieron cinco, por cumplir el objetivo de este estudio. Los estudios se realizaron en países desarrollados; el diseño longitudinal fue el más utilizado y se trata de publicaciones de los últimos cinco años. Sólo un estudio encontró asociación positiva. Los estudios sobre el consumo de cafeína durante el embarazo y el TDAH son escasos, con resultados controvertidos, y enfrentan varias dificultades metodológicas, como la no estandarización de la evaluación del resultado

This aim of this study was to conduct a systematic literature review on the association between maternal caffeine intake during pregnancy and attention deficit hyperactivity disorder (ADHD) in childhood. The systematic multiple-stage literature search in PubMed, LILACS, BIREME, and PsycINFO was limited to research in human subjects and published in Portuguese, English, and Spanish. A total of 373 references were retrieved. Of these, only five met the study's objectives and were kept in the review. Most of the studies employed a longitudinal design, were conducted in developed countries, and were published in the last five years. Only one study found a positive association. Studies on caffeine consumption during pregnancy and ADHD are scarce, with conflicting results and several methodological difficulties such as lack of standardized outcome measures.

This study investigated the association between dietary pattern and hypertension using the rank reduced regression (RRR). It was a cross-sectional population-based study with a representative sample of 1,026 women living in the city of São Leopoldo, Rio Grande do Sul State, Brazil. In order to identify dietary patterns, dietary variables from a dietary frequency questionnaire were used as predictors and sodium, potassium and saturated fat consumption were selected as response variables. The RRR identified three dietary patterns: Factor 1, Factor 2 and Factor 3. The association between hypertension and factors 1, 2 and 3, after adjustment for socio-demographic, behavioral and obesity variables, was not significant. After stratification by age, the association between hypertension and factor 2 was present in 40-60 year-old women (tertile 2 compared to 3 RP = 0.62, 95%CI: 0.43-0.91; p = 0,05). The new statistical method (RRR), proved to be a useful tool for identifying dietary patterns. In this study, healthier dietary pattern was directly associated with hypertension in women between 40 and 60 years of age. O estudo investigou a associação entre os padrões alimentares, obtidos usando-se a regressão de posto reduzido (RRR), e hipertensão arterial. Foi um estudo transversal de base populacional com 1.026 mulheres residentes na cidade de São Leopoldo, Rio Grande do Sul, Brasil. Para a identificação dos padrões alimentares foram utilizadas como preditores as variáveis alimentares de um questionário de frequência alimentar e como variáveis respostas o consumo de sódio, potássio e gordura. Foram identificados três padrões alimentares: o Fator 1, o Fator 2, e o Fator 3. Em uma análise ajustada para fatores sociodemográficos, comportamentais e obesidade não houve associação entre a hipertensão e os padrões alimentares. Em uma análise estratificada para idade, houve associação entre hipertensão e o Fator 2 nas mulheres com 40 anos ou mais (tercil 2 comparado ao 3 RP = 0.62; IC95%: 0.43-0.91; p = 0,050). O método estatístico (RRR), mostrou-se uma ferramenta útil para a identificação de padrões alimentares. Neste estudo, o padrão alimentar saudável esteve diretamente associado à hipertensão nas mulheres entre 40 e 60 anos. El estudio investigó la asociación entre los hábitos alimentarios, obtenidos por la regresión con rango reducido (RRR) y la hipertensión. Fue un corte transversal de 1.026 mujeres, basado en la población que vive en São Leopoldo, Río Grande do Sul, Brasil. Para identificar los hábitos alimentarios se utilizó como predictor de variables de la dieta un cuestionario de frecuencia alimentaria y las variables de respuesta fueron: consumo de potasio, sodio y grasa. Se identificaron tres patrones alimenticios: Factor 1; Factor 2 y Factor 3. En un análisis ajustado sociodemográfico, de conducta y obesidad no hay asociación entre la hipertensión y los hábitos alimentarios. En un análisis estratificado por edad, se observó una asociación entre la hipertensión y el Factor 2 en las mujeres de 40 años o más (tercil 2, en comparación con el 3 RP = 0,62, IC95%: 0,43-0,91; p = 0,05). El método estadístico (RRR) fue una herramienta útil para la identificación de los patrones dietéticos. En este estudio, el patrón de dieta saludable está directamente asociado con la hipertensión en las mujeres entre 40 y 60 años.

Objective Studies evaluating caffeine intake during pregnancy and long-term outcomes, such as the child9s neurobehaviour, are still scarce and their results are inconsistent. The objective of the present study was to evaluate the association between maternal consumption of caffeine during pregnancy and attention deficit hyperactivity disorder (ADHD) at the age of 11 years. Methodology All children born in the city of Pelotas, Brazil, during the year 2004, were selected for a cohort study. The mothers were interviewed at birth to obtain information on coffee and yerba mate consumption during pregnancy, among other matters. At the age of 11 years, presence of ADHD was evaluated using the Development and Well-Being Assessment (DAWBA) questionnaire, applied to the mothers. The prevalence of ADHD was calculated, with 95% CIs. The association between caffeine consumption and ADHD was tested by means of logistic regression. Results 3485 children were included in the analyses. The prevalence of ADHD was 4.1% (95% CI 3.4% to 4.7%): 5.8% (95% CI 4.7% to 6.9%) among boys and 2.3% (95% CI 1.5% to 3.0%) among girls. The prevalence of caffeine consumption during the entire pregnancy and in the first, second and third trimesters was 88.7% (87.7% to 89.7%), 86.5% (85.4% to 87.5%), 83.0% (81.8% to 84.2%) and 92.3% (91.4% to 93.1%), respectively. Caffeine consumption during the entire pregnancy and the first, second and third trimesters were not associated with ADHD in the crude or adjusted analysis. Conclusions The present study did not show any association between maternal caffeine consumption during pregnancy and ADHD at the age of 11 years.

Introdução: A regressão por redução de posto (RRR) é uma técnica que vem sendo empregada na epidemiologia nutricional desde 2004. O objetivo dela é encontrar padrões alimentares associados a algum desfecho. Assim, ela é considerada uma técnica que combina informações a priori e a posteriori. A informação a priori é um conhecimento prévio da associação entre as variáveis intermediárias (biomarcadores, nutrientes) e o desfecho (doença), e a posteriori é a combinação entre as variáveis intermediárias e o consumo alimentar (variáveis preditoras). A RRR tenta explicar o máximo possível da variação das variáveis intermediárias através das variáveis preditoras. Objetivos: Fornecer uma breve revisão teórica da técnica e descrever as rotinas computacionais em SAS. Métodos: Análise ilustrativa utilizando-se dados do estudo “Condições de saúde das mulheres: estudo de base populacional na região do Vale do Rio dos Sinos”. Foram utilizadas como variáveis intermediárias o consumo dos nutrientes sódio, potássio e gordura saturada; as variáveis preditoras foram a frequência de consumo de 70 tipos de alimentos. Conclusão: A RRR é uma poderosa ferramenta para detectar padrões alimentares que podem estar associados a alguma doença de interesse.

Muitos fatores influenciam na elevação da pressão arterial. Entre eles tem destaque os fatores genéticos e os comportamentais como atividade física e dieta. A dieta é considerada um componente indispensável para o controle da Hipertensão Arterial, mesmo entre os indivíduos que fazem tratamento medicamentoso adequado. O objetivo do presente estudo foi identificar padrões alimentares por meio da Regressão de Posto Reduzido (RRR – do inglês Reduced Rank Regression) e verificar sua associação com hipertensão, em mulheres adultas. Foi um estudo transversal de base populacional com uma amostra representativa de 1026 mulheres de 20 a 60 anos residentes na zona urbana de uma cidade no Sul do Brasil. O consumo alimentar foi obtido por meio de um Questionário de Frequência Alimentar (QFA- 70). Para a construção dos padrões alimentares utilizou-se a RRR, tendo-se como variáveis respostas nutrientes fortemente associados à hipertensão arterial como o sódio, o potássio e a gordura saturada. Os principais padrões alimentares obtidos pela RRR foram: fator 1 com forte contribuição do queijo, do presunto e da linguiça; e o fator 2 com maior contribuição do leite desnatado, mamão, maça, banana, laranja, abóbora, agrião, couve e suco natural. Na análise bruta, verificou-se que o fator 2 esteve positivamente associado com a hipertensão. Quando a análise foi ajustada para fatores sócio-demográficos, comportamentais (fumo e atividade física) e estado nutricional a associação com hipertensão não se manteve. Com o fator 1 não foram observadas associações significativas. Após a estratificação por idade em

Resumo Objetivo: avaliar a intenção materna de amamentar, duração do aleitamento materno até os 24 meses e os motivos para o desmame no primeiro ano de vida. Métodos: trata-se de estudo de coorte realizado em Pelotas, RS, Brasil, com participantes do Multi-Centre Body Composition Study; para a análise da duração da amamentação, utilizou-se tábua de vida. Resultados: das 1.377 mães rastreadas, 74,3% relataram intenção de amamentar exclusivamente até os 6 meses, enquanto 91,1% pretendiam prolongar o aleitamento materno até pelo menos os 12 meses; até pelo menos 6 meses, 58,0% das crianças foram amamentadas; a mediana da amamentação foi de 10,8 meses (IIQ: 5,8 a 23,0); os principais motivos relatados para desmame foram leite insuficiente (57,3%), retorno ao trabalho/escola (45,5%) e recusa inexplicável do bebê (40,1%). Conclusão: apesar da intenção de amamentar, persistem barreiras estruturais e sociais que interferem no sucesso da amamentação, especialmente as relacionadas ao trabalho materno. Resumen Objetivo: evaluar la intención materna de amamantar, la duración de la lactancia materna hasta los 24 meses de edad y los motivos para la ablactación en el primer año de vida. Métodos: se trata de un estudio de cohorte realizado en Pelotas, RS, Brasil, con participantes del Multi-Centre Body Composition Study; para el análisis de la duración de la lactancia, se utilizó la tabla de vida. Resultados: de las 1.377 madres rastreadas, el 74,3% tenía intención de amamantar exclusivamente hasta los 6 meses, mientras que el 91,1% pretendía prolongarla hasta por lo menos los 12 meses; el 58,0% de los niños fueron amamantados hasta, al menos, los 6 meses; la mediana de la lactancia fue de 10,8 meses (IIQ: 5,8 a 23,0); los principales motivos para el destete fueron: leche insuficiente (57,3%), retorno al trabajo/escuela (45,5%) y la negativa inexplicable del bebé (40,1%). Conclusión: los resultados muestran que, a pesar de la intención de amamantar, todavía hay barreras estructurales y sociales que interfieren en el éxito de la lactancia, especialmente los relacionados con el trabajo materno. Abstract Objective: to evaluate maternal intention to breastfeed, duration of breastfeeding up to 24 months-of-age and reasons for weaning in the first year of life. Methods: this was a cohort study conducted in Pelotas, RS, Brazil, with participants from the Multi-Center Body Composition Study; a life table was used to analyze duration of breastfeeding. Results: of the 1377 mothers screened, 74.3% reported intending to exclusively breastfeed up until 6 months, while 91.1% intended to prolong breastfeeding until at least 12 months; 58.0% of children were breastfed up to at least 6 months; median breastfeeding duration was 10.8 months (IQR: 5.8 - 23.0); the main reasons reported for weaning were insufficient breast milk (57.3%), return to work/school (45.5%), and unexplained refusal by the baby (40.1%). Conclusion: the results show that despite the intention to breastfeed, there are still structural and social barriers that interfere with successful breastfeeding, especially those related to working mothers.

Submitted by Aline Batista (alinehb.ufpel@gmail.com) on 2021-05-28T18:20:19Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_Alice_Guimaraes_de_Faria.pdf: 608076 bytes, checksum: 7c7ecf472a384b842551bf59bf05ea84 (MD5) Approved for entry into archive by Aline Batista (alinehb.ufpel@gmail.com) on 2021-05-29T00:53:46Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_Alice_Guimaraes_de_Faria.pdf: 608076 bytes, checksum: 7c7ecf472a384b842551bf59bf05ea84 (MD5) Approved for entry into archive by Aline Batista (alinehb.ufpel@gmail.com) on 2021-05-29T00:53:58Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_Alice_Guimaraes_de_Faria.pdf: 608076 bytes, checksum: 7c7ecf472a384b842551bf59bf05ea84 (MD5) Made available in DSpace on 2021-05-29T00:54:06Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_Alice_Guimaraes_de_Faria.pdf: 608076 bytes, checksum: 7c7ecf472a384b842551bf59bf05ea84 (MD5) Previous issue date: 2019-08-22 Sem bolsa A inversão nos padrões alimentares observada nos últimos anos, principalmente na faixa etária mais jovem, além de um estilo de vida mais sedentário, são alguns dos fatores responsáveis pela crescente prevalência de excesso de peso e obesidade entre adolescentes. Porém, a literatura ainda é escassa quando trata-se de adolescentes da zona rural. Assim, este trabalho teve como objetivo avaliar o consumo de alimentos ultraprocessados entre adolescentes da zona rural de Pelotas, RS e identificar os seus fatores associados. Foi realizado um estudo transversal, do tipo censo de base escolar, com os escolares matriculados do 6º ao 9º ano do ensino fundamental das 21 escolas municipais da zona rural de Pelotas, RS. Para avaliação do consumo alimentar foi utilizado um recordatório alimentar de 24 horas, sendo os alimentos ultraprocessados classificados de acordo com a classificação NOVA. As variáveis independentes avaliadas foram sexo, idade, cor da pele, escolaridade dos pais/responsáveis, excesso de peso, inatividade física no lazer, se realizava as principais refeições acompanhada dos pais/responsáveis e se realizava as refeições em frente a televisão, celular ou computador. Todos os dados referentes aos alunos e seus pais/responsáveis foram coletados através de um questionário auto aplicado. Observou-se que os alimentos ultraprocessados contribuíram com cerca de um terço do consumo médio calórico diário dos adolescentes. O consumo de doces mostrou-se mais elevado nas meninas e o consumo de carnes processadas e embutidos foi mais elevado nos meninos. Além disso, a elevada contribuição calórica dos alimentos ultraprocessados, após análises ajustadas, manteve-se inversamente relacionada com a escolaridade dos pais/responsáveis e foi associada ao fato de não realizar as principais refeições em família, entre as meninas. Nesse sentido, os resultados indicam que os alimentos ultraprocessados tiveram elevada contribuição na alimentação dos adolescentes residentes da zona rural e que esse consumo é influenciado por fatores sociodemográficos e comportamentais. The inversion in eating patterns observed in recent years, especially in the younger age group, in addition to a more sedentary lifestyle, are some of the factors responsible for the increasing prevalence of overweight and obesity among adolescents. However, the literature is still scarce when it comes to rural adolescents. Thus, this study aimed to assess the consumption of ultra-processed foods among adolescents in the rural area of Pelotas, RS and to identify its associated factors. A cross-sectional, school-based census type study was carried out with students enrolled from the 6th to the 9th grade of elementary school in the 21 municipal schools in the rural area of Pelotas, RS. A 24-hour food record was used to assess food consumption, with ultra-processed foods classified according to the NOVA classification. The independent variables evaluated were sex, age, skin color, education of parents / guardians, overweight, physical inactivity at leisure, the main meals were accompanied by parents / guardians and meals were performed in front of television, cell phones or computer. All data regarding students and their parents / guardians were collected through a self-applied questionnaire. It was observed that ultra-processed foods contributed about a third of the average daily caloric intake of adolescents. The consumption of sweets was higher in girls and the consumption of processed meats and sausages was higher in boys. In addition, the high caloric contribution of ultra-processed foods, after adjusted analyzes, remained inversely related to the education of parents / guardians and was associated with the fact of not having the main family meals, among the girls. In this sense, the results indicate that ultra-processed foods had a high contribution to the diet of adolescents living in rural areas and that this consumption is influenced by sociodemographic and behavioral factors.

Submitted by Aline Batista (alinehb.ufpel@gmail.com) on 2019-11-14T13:44:08Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_Sheila_Amaral.pdf: 1854802 bytes, checksum: ab7c72b53dbb0affb5620d8b55bc2714 (MD5) Approved for entry into archive by Aline Batista (alinehb.ufpel@gmail.com) on 2019-11-14T14:10:52Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_Sheila_Amaral.pdf: 1854802 bytes, checksum: ab7c72b53dbb0affb5620d8b55bc2714 (MD5) Approved for entry into archive by Aline Batista (alinehb.ufpel@gmail.com) on 2019-11-14T14:10:58Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_Sheila_Amaral.pdf: 1854802 bytes, checksum: ab7c72b53dbb0affb5620d8b55bc2714 (MD5) Made available in DSpace on 2019-11-14T14:11:04Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_Sheila_Amaral.pdf: 1854802 bytes, checksum: ab7c72b53dbb0affb5620d8b55bc2714 (MD5) Previous issue date: 2018-07-03 Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq O objetivo do estudo foi avaliar a intenção materna de amamentar, duração do aleitamento materno e os motivos para o desmame entre mães e bebês do sul do Brasil participantes de um estudo multicêntrico. Trata-se de estudo de coorte realizado em Pelotas, RS, com participantes do Multi-Centre Body Composition Study. Mães e bebês foram selecionados no hospital do parto e acompanhados aos 3, 6, 9, 12, 18 e 24 meses de idade. Foram investigados os motivos para o desmame antes dos 12 meses. Mediana e intervalo interquartil da duração do aleitamento materno foram calculados. Das 1377 mães rastreadas, 74% tinham intenção de amamentar exclusivamente até os 6 meses e 91%, de prolongar a amamentação até pelo menos os 12 meses. Ao todo, 168 duplas de mães e bebês atenderam os critérios de elegibilidade e aceitaram participar do acompanhamento. A mediana de aleitamento materno foi de 11 meses (IIQ:5,8-23,0 meses), sendo que 52% das crianças foram desmamadas antes dos 12 meses. Os principais motivos relatados para o desmame foram leite insuficiente (57%), retorno ao trabalho/escola (45%) e a recusa inexplicada do bebê (40%). Os resultados mostraram que, apesar da intenção de amamentar, existe a necessidade de esclarecimento das mães e famílias sobre questões relacionadas à amamentação. The objective of the study was to evaluate the maternal intention to breastfeed, duration of the breastfeeding and reasons for weaning among mothers and babies from southern Brazil participating in a multi center study. This is a cohort study conducted in Pelotas, RS, with participants from the Multi-Centre Body Composition Study. Mothers and babies were enrolledat the hospital of delivery and were followed-up at 3, 6, 9, 12, 18 and 24 months of age. The reasons for weaning before 12 months were investigated. Median and interquartile intervals of breastfeeding duration were calculated. Of the 1377 mothers screened, 74% intended to exclusively breastfeed until 6 months and 91% to prolong the breastfeeding until at least 12 months. A total of 168 mother-child pairsmetall eligibility criteria and agreed to participate in the follow-up. The median of the breastfeeding duration was 11 months (IQR: 5.8-23.0 months), and 52% of the infants were weaned before 12 months. The main reasons for weaning were insufficient milk (57%), return to work/school (45%) and unexplained refusal of the baby (40%). The results showed that despite the intention to breastfeed, there is a need to clarify the mothers and families about issues related to breastfeeding.