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Abstract: Brazil is characterized by an unfinished agenda of health inequalities, which impact health problems in the childhood. This study aimed to evaluate the socioeconomic inequalities of health problems in the early childhood. This is a prospective study, using data from the birth cohort carried out in the city of Pelotas (Rio Grande do Sul State, Brazil) in 2015. The outcomes were health problems presented at 12 and 24 months: cough, breathing difficulty, diarrhea, ear pain, pneumonia, urinary infection, hospitalization, and other health problems. Socioeconomic inequalities were measured applying the slope index of inequality (SII) and the concentration index (CIX), with wealth index and maternal schooling being the socioeconomic variables. The inequalities in the number of health problems were evaluated by Poisson regression. The perinatal sample comprised 4,275 children. At 12 months approximately 74% of the children presented 1 or more health problems, while at 24 months, approximately 44% presented 2 or more health problems. For all period, the mean number of health problems was 2.9 (standard deviation = 2.0). Higher frequencies were observed for children belonging to the poorest income quintile and with lower maternal education, except for 1 or more health problems at 24 months. The greatest absolute and relative inequality was observed for 2 or more health problems at 12 months (SII: -0.23, 95%CI: -0.29; -0.18 and CIX: -0.19, 95%CI: -0.25; -0.14). There is an opposite dose-response relation for the risk of accumulation of health problems according to maternal schooling (1.07, 95%CI: 1.04; 1.09) and wealth categories (1.03, 95%CI: 1.01; 1.04), in the full adjusted models. The study confirms inequalities due to health problems in Brazilian children, especially in the first year of life.

ABSTRACT Objective To analyze the association between intimate partner violence during pregnancy (IPVP) and quality of life (QOL). Methods A cross-sectional study was conducted with pregnant women receiving care in Primary Health Care in the municipality of Criciúma, Santa Catarina state, Brazil, in 2022; QOL was assessed in the physical, psychological, social relationship and environmental domains using WHOQOL-Bref instrument; IPVP was evaluated by means of the World Health Organization Violence Against Women; Crude and adjusted linear regression analyses were performed. Results A total of 389 pregnant women were evaluated; IPVP was observed in 13.6% of cases; in the adjusted analysis, IPVP remained associated with physical, psychological and social relationship domains; pregnant women who experienced IPVP had a reduction in their QOL score by 9.77, 11.07 and 8.95 points, respectively, when compared to those who did not experience IPVP. Conclusion IPVP was associated with poorer QOL in the physical, psychological and social relationships domains. Health services equipped to address and prevent violence against pregnant women are essential.

Abstract Background Maltreatment in childhood may leave people vulnerable to further experiences of violence and more severe effects of stress later in life. Longitudinal studies of risk for violent victimisation after maltreatment are lacking in low- and middle-income countries. The objective of this study was to quantify the risk for violent victimization in the family and community in young adulthood following experiences of childhood maltreatment (experiences of physical, emotional and sexual abuse and neglect) up to age 15 years in an urban Brazilian population. Methods 3246 participants in a prospective, population-based birth cohort study in Pelotas, Rio Grande do Sul, Brazil, were assessed at birth, 15 and 22 years. Sociodemographic factors were reported by mothers at birth and adolescents at age 15 years. Maltreatment and violent victimisation were self-reported in confidential questionnaires at 15 and 22, respectively. Multinomial logistic regression analyses estimated the association between having experienced any maltreatment and later experiences of family and community violence in young adulthood (no adult violence, violence only in the family context, only in the community, or both violence in the family and community), adjusting for sociodemographic factors. Results 39% of females and 27% of males reported any maltreatment up to age 15 years. At 22 years, rates of past year violence in the family or community were 17.6% for females and 20.2% for males. Maltreatment was strongly associated with community violence (Females: OR = 2.96, CI = 1.83–4.80; Males: OR = 2.01, 95%CI = 1.01-4.00) and its co-occurrence with family violence (Females: OR = 2.33, 95%CI = 1.34–4.04; Males: OR = 3.20, 95%CI = 1.82–5.65) in young adulthood, after adjustment for background sociodemographic factors. Conclusion Childhood maltreatment is an important risk factor for later violent victimisation in both the family and community context. The effects of repeated trauma through the life-course needs research and clinical attention.

Objetivo: Avaliar o conhecimento dos acadêmicos de enfermagem antes e após capacitação sobre prevenção e tratamento de lesão por pressão. Método: Estudo quase-experimental com pré e pós-teste, realizado com acadêmicos de enfermagem de uma universidade federal, no período de maio a agosto de 2022. A amostra foi intencional, com 66 sujeitos, os quais foram recrutados por e-mail. A intervenção constitui-se de capacitação online e assíncrona. Para avaliar o conhecimento utilizou-se um instrumento construído pela autora baseado no Teste de Conhecimento de Caliri-Pieper, o qual considera conhecimento adequado quando o percentual de acertos é maior do que 90%. A coleta de dados foi online e os dados foram analisados com estatística descritiva e com Teste T para amostras dependentes e teste não paramétrico de Wilcoxon. Resultado: A idade média foi de 24,8±3,7 anos, com predominancia do sexo feminino (60; 90,9%) e de indivíduos solteiros (60; 90,9%). O percentual médio de acertos antes da capacitação foi de 68,3± 9,8% e de desconhecimento de 19,3±10,8%. Após a capacitação houve 86,1±7,5% (p

ABSTRACT OBJETIVE To evaluate the association between the use of iron salts during the first two trimesters of gestation in non-anemic women and the development of gestational diabetes mellitus. METHODS The study used maternal data from the 2015 Pelotas Birth Cohort. All non-anemic women at the 24th week of gestation (n = 2,463) were eligible for this study. Gestational diabetes mellitus was self-reported by women. Crude and adjusted logistic regression were performed considering level of significance = 0.05. RESULTS Among the women studied, 69.7% were exposed to prophylactic iron supplementation in the first two trimesters of gestation. The prevalence of gestational diabetes mellitus among those exposed was 8.7% (95%CI: 7.4–10.1) and 9.3% (95%CI: 7.4–11.6) among those who were not exposed. Iron supplementation was not associated with increased risk of gestational diabetes mellitus in crude (OR = 0.9; 95%CI: 0,7–1,3) and adjusted analysis (OR = 1.1; 95%CI :0,8–1,6). CONCLUSIONS The results suggest that routine iron use in non-anemic pregnant women does not increase the risk of developing gestational diabetes. This evidence supports the existing national and international guidelines, in which prophylactic iron supplementation is recommended for all pregnant women as soon as they initiate antenatal care in order to prevent iron deficiency anemia.

Abstract Objective The aim of this study was to systematically review literature on the use of iron supplements (not including iron derived from diet), increased levels of hemoglobin and/or ferritin, and the risk of developing gestational diabetes mellitus (GDM). Data source The following databases were searched, from the study's inception to April 2021: PUBMED, Cochrane, Web of Science, Scopus, Embase, Cinahl and Lilacs. Selection of studies A total of 6,956 titles and abstracts were reviewed, 9 of which met the final inclusion criteria, with 7,560 women in total. Data collection Data extraction was performed by two independent reviewers and disagreements were resolved by a third researcher. Data synthesis Methodological quality in controlled trials were assessed according to the Cochrane Collaboration tools (ROB-2 and ROBINS-1) and for the observational studies, the National Institutes of Health's (NIH) quality assessment tool was used. Among the 5 observational studies, women with a higher hemoglobin or ferritin level were more likely to develop GDM when compared with those with lower levels of these parameters. Among the 3 randomized clinical trials, none found a significant difference in the incidence of GDM among women in the intervention and control groups. However, we identified many risks of bias and great methodological differences among them. Conclusion Based on the studies included in this review, and due to the important methodological problems pointed out, more studies of good methodological quality are needed to better establish the association between iron supplementation and GDM.

Resumo O objetivo deste estudo é identificar e descrever disciplinas em que são abordadas as temáticas segurança do paciente e ética em saúde em cursos de graduação em enfermagem. Trata-se de pesquisa documental, com foco em projetos político-pedagógicos e matrizes curriculares de instituições de ensino superior que oferecem cursos de enfermagem na região metropolitana de Porto Alegre. Foram examinados 12 documentos, a partir dos quais emergiram dois tópicos analíticos: 1) ensino da ética, abrangendo conteúdos como ética profissional, bioética e legislação profissional em enfermagem; e 2) ensino da segurança do paciente, abrangendo conteúdos como biossegurança, educação e comunicação em saúde e controle de infecção. O tema ética foi majoritariamente mencionado quando comparado a segurança do paciente. Novos estudos são necessários para entender melhor como esses conceitos estão sendo desenvolvidos na formação de enfermeiros.

Objetivo: Mapear e sumarizar evidências científicas sobre a terapia do coágulo sanguíneo autólogo na cicatrização das lesões. Método: Trata-se de uma revisão de escopo construída em cinco etapas, realizada nas bases/motores de busca Biblioteca Virtual em Saúde (BVS), PubMed, Google Acadêmico, Biblioteca Scientific Electronic Library Online (SCIELO) e no Portal de Teses e Dissertações da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES). Os descritores controlados foram “cicatrização” e “ferimentos e lesões” e o não controlado Terapia do Coágulo Sanguíneo Autólogo”, com suas derivações em inglês e espanhol. Foram incluídos artigos publicados nos últimos 10 anos, e excluídos os duplicados ou que não estivessem disponíveis na íntegra. Para a extração foi construído um quadro sinóptico e os dados foram analisados de forma descritiva. Resultados: Foram identificadas 246 publicações e a amostra final foi composta por 16 publicações. O ano de 2022 foi o que apresentou maior número de publicações (5;33,4%), 15(93,7%) estudos estavam em inglês e 12(75,0%) em revistas dos Estados Unidos. Não foram localizados estudos no Brasil sobre o tema. Verificou-se que 11(68,7%) estudos avaliaram o efeito da terapia, dos quais 6(37,5%) tiveram delineamento quase-experimental, três (18,7%) foram estudo de caso e dois (12,5%) estudo de série de casos. Conclusões: O artigo atingiu os objetivos ao mapear as evidências científicas sobre a temática, demostrando que a terapia possui boa efetividade no tratamento de lesões por pressão. Contudo, há limitações pela falta de pesquisas com métodos com maior nível de evidência e com amostras maiores.

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Abstract Background To guarantee prevention and adequate treatment, as required for the population to have access to health services and technologies, including medicines. The purpose of this study is to analyse the economic and regional inequalities in access to medicines for diabetes and hypertension among the adult population in Brazil. Methods This was a cross-sectional study with adults aged 18 and over from the VIGITEL study conducted in 2019 in all Brazilian regions. Non-access to antidiabetic and antihypertensive drugs was assessed according to formal education and housing macro-region. The slope index of inequality (SII) was used to analyse absolute inequalities. Results The total number of individuals interviewed was 52,443. Approximately 10.0% of the people with diabetes and/or hypertension reported not having access to drug treatment. The major means for having access to antihypertensive drugs, in all regions, was private pharmacies; for antidiabetics, in the North region, people had greater access through private pharmacies, while in the Northeast, Southeast and South, they had greater access through the public sector. Inequalities were found in the lack of access to medicines according to the region of residence, especially in the North region. Conclusion The lack of access to medicines showed regional disparities, particularly in the most economically vulnerable regions.

Background Homicide is the leading cause of death among young people in Latin America, one of the world's most violent regions. Poverty is widely considered a key cause of violence, but theories suggest different effects of poverty, depending on when it is experienced in the life-course. Longitudinal studies of violence are scarce in Latin America, and very few prospective data are available worldwide to test different life-course influences on homicide. Methods In a prospective birth cohort study following 5914 children born in southern Brazil, we examined the role of poverty at birth, in early childhood, and in early adulthood on violence and homicide perpetration, in criminal records up to age 30 years. A novel Structured Life Course Modelling Approach was used to test competing life-course hypotheses about 'sensitive periods', 'accumulation of risk', and 'downward mobility' regarding the influence of poverty on violence and homicide. Results Cumulative poverty and poverty in early adulthood were the most important influences on violence and homicide perpetration. This supports the hypothesis that early adulthood is a sensitive period for the influence of poverty on lethal and non-lethal violence. Results were replicable using different definitions of poverty and an alternative outcome of self-reported fights. Conclusion Cumulative poverty from childhood to adulthood was an important driver of violence and homicide in this population. However, poverty experienced in early adulthood was especially influential, suggesting the importance of proximal mechanisms for violence in this context, such as unemployment, organized crime, drug trafficking, and ineffective policing and justice systems. [ABSTRACT FROM AUTHOR]

The objective of this study is to evaluate the association between the consumption of ultra-processed foods (UPF) and the mental health of pregnant women from the South of Brazil. This is a cross-sectional study carried out in Criciúma, Brazil, through face-to-face interviews, from April to December 2022. Pregnant women aged 18 or older who underwent prenatal care in the forty-eight basic health care units of the municipality and who were in their third trimester of pregnancy were included. High consumption of UPF was considered as six or more items or subgroups of UPF consumed on the day before the interview, using the Nova-UPF screener. The mental health variables were depressive symptoms, stress, sadness and anxiety. Crude and adjusted analyses were conducted using the Fisher's exact test and the Poisson regression with robust variance. In total, 428 pregnant women were studied; most of them were aged between 20 and 25 years and were white. Pregnant women who presented high consumption of UPF were 1·42-fold (95 % CI 1·06, 1·92) more likely to experience anxiety and presented a prevalence 56 % (95 % CI 1·18, 2·07) higher of stress when compared with those who did not present high consumption of UPF. The prevalence of depressive symptoms and feelings of sadness was 1·31-fold (95 % CI 1·08, 1·60) and 3·41-fold (95 % CI 1·77, 6·58) higher among those with high consumption of UPF, respectively. The results suggest that diet quality is associated with the mental health of pregnant women. Promoting joint actions focused on food and nutritional education, and mental health, for pregnant women, is necessary. [ABSTRACT FROM AUTHOR]

Extensive ecosystem restoration is increasingly seen as being central to conserving biodiversity.sup.1 and stabilizing the climate of the Earth.sup.2. Although ambitious national and global targets have been set, global priority areas that account for spatial variation in benefits and costs have yet to be identified. Here we develop and apply a multicriteria optimization approach that identifies priority areas for restoration across all terrestrial biomes, and estimates their benefits and costs. We find that restoring 15% of converted lands in priority areas could avoid 60% of expected extinctions while sequestering 299 gigatonnes of CO.sub.2--30% of the total CO.sub.2 increase in the atmosphere since the Industrial Revolution. The inclusion of several biomes is key to achieving multiple benefits. Cost effectiveness can increase up to 13-fold when spatial allocation is optimized using our multicriteria approach, which highlights the importance of spatial planning. Our results confirm the vast potential contributions of restoration to addressing global challenges, while underscoring the necessity of pursuing these goals synergistically. Multicriteria optimization identifies global priority areas for ecosystem restoration and estimates their benefits for biodiversity and climate, providing cost-benefit analyses that highlight the importance of optimizing spatial planning and incorporating several biomes in restoration strategies., Author(s): Bernardo B. N. Strassburg [sup.1] [sup.2] [sup.3] [sup.4] , Alvaro Iribarrem [sup.1] [sup.2] , Hawthorne L. Beyer [sup.5] , Carlos Leandro Cordeiro [sup.1] [sup.2] , Renato Crouzeilles [sup.1] [sup.2] [...]

Resumo Objetivo: Analisar desigualdades regionais e sociais na realização de mamografia e exame citopatológico. Métodos: Estudo transversal, com dados da Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel), de 2019. As variáveis de desfecho foram realização de mamografia e exame citopatológico; e as variáveis de exposição, raça/cor da pele, escolaridade e macrorregião nacional de residência. Medidas de desigualdades absolutas foram apresentadas por meio do slope index of inequality (SII) e equiplots. Resultados: Foram incluídas 23.339 mulheres. A realização de mamografia foi 5,2 pontos percentuais maior naquelas com maior escolaridade, e de exame citopatológico, 5,3 pontos percentuais menor nas mulheres de raça/cor da pele preta. A realização de mamografia e exame citopatológico foram 3,9 e 11,2 pontos percentuais maiores na região Sul, respectivamente. Conclusão: Desigualdades sociais e regionais persistem no país e afetam, principalmente, mulheres de raça/cor da pele preta, de baixa escolaridade e residentes no Nordeste brasileiro.

Abstract Background Many low- and middle-income countries recommend micronutrient supplements for pregnant women to improve their nutritional status, prevent possible deficiencies and avoid fetal healgth consequences. This study evaluated the influence of socioeconomic status on the use of folic acid, iron salts and other vitamins and minerals among pregnant women in the 2015 Pelotas Birth Cohort. Methods This population-based birth cohort study was carried out with 4270 women. Participants were interviewed during pregnancy and at the maternity hospital about the antenatal period; including the use of iron salts, vitamins and other minerals. Descriptive analyses were performed to characterize the sample. The analyses were adjusted according to socioeconomic variables (maternal education, ethnicity, household income). Results The overall prevalence of the use of folic acid, iron salts or other vitamins and minerals was 91.0% (95% CI: 90.1–91.8). Specifically, 70.9% (95% CI: 69.5–72.3) used folic acid, 72.9% (95% CI: 71.5–74.3) used iron compounds, and 31.8% (95% CI: 30.3–33.2) used other vitamins or minerals. In the adjusted analysis, the use of iron salts was associated with nonwhite mothers, with ≤4 years of education and whose family income was less than or equal to the monthly minimum wage. The use of folic acid and other vitamins and minerals was associated with white mothers who were more highly educated and had a higher family income. Conclusion Although folic acid and other vitamins and minerals were more frequently used in white, richer and more educated mothers, which indicates inequality, iron supplements were more frequently used in the poorer, less educated nonwhite mothers, suggesting the opposite association for this supplement.

Objective: To describe the inequalities in the double burden of malnutrition (DBM) in the adult population.Methods: Study carried out with data from the VIGITEL study, conducted in 2019 in all Brazilian capitals. Underweight and excess weight were evaluated on the basis of years of schooling and age. Multi-level analysis was performed including Human Development Index of each capital and individual-level variables. The inequality slope index was used to assess the magnitude of the inequalities found. All analyses considered the svy command owing to the complexity of the sampling process.Results: 47.119 individuals were studied. Men with no education had 6 percentage points more underweight compared to those with higher education. Higher prevalence of excess weight was found among men with higher education and women with no education. In women, the difference was 18 percentage points between extreme categories. Elderly people with no education had 10 percentage points more excess weight than those with higher education.Conclusions: The findings suggest the need for intersectoral actions that can cope with the social inequalities and help confronting with the DBM in Brazil.

O objetivo foi descrever a prevalência de ganho de peso gestacional e a retenção de peso após 3 e 12 meses do parto, e identificar possíveis desigualdades socioeconômicas no ganho de peso gestacional adequado. Realizou-se um estudo longitudinal com dados da coorte de nascimentos de Pelotas, Rio Grande do Sul, Brasil, 2015. O ganho de peso gestacional foi classificado segundo o Instituto de Medicina dos Estados Unidos. A retenção de peso aos 3 e 12 meses foi calculada considerando-se o peso da mãe em cada período, subtraído do peso pré-gestacional. Para identificar as possíveis desigualdades, utilizou-se o Slope Index (SII) e o Concentration Index (CIX). A amostra analítica incluiu as mães com informações para o desfecho em estudo (n = 4.102). A prevalência de ganho de peso gestacional adequado foi de 33,5% (IC95%: 32,1; 35,0). Foram encontradas desigualdades discretas na prevalência de ganho de peso adequado entre as menos escolarizadas [CIX = 1,88 (IC95%: -0,76; 4,52); SII = 4,27 (IC95%: -0,87; 9,41)] e entre as mães pertencentes ao quinto mais pobre - 1º quinto - [CIX = 1,04 (IC95%: -1,60; 3,67); SII = 2,93 (IC95%: -2,06; 7,92)], porém, estas diferenças não foram estatisticamente significativas. A média de retenção de peso pós-parto foi de 2,3kg (DP = 6,4) e de 1,4kg (DP = 8,8) após 3 e 12 meses do parto, respectivamente. Um terço das mulheres apresentou ganho de peso considerado adequado. As desigualdades observadas na prevalência de ganho de peso gestacional adequado com relação à menor escolaridade materna e quinto mais pobre de renda não foram estatisticamente significativas.

RESUMO: Objetivo: Classificar os medicamentos usados durante o parto quanto aos riscos na amamentação, utilizando diferentes fontes e verificando suas discordâncias. Métodos: Estudo transversal inserido na coorte de nascimentos de Pelotas de 2015. Coletaram-se informações sobre o uso de medicamentos, classificando-os quanto ao risco de acordo com: manual do Ministério da Saúde (MS), Organização Mundial da Saúde (OMS), classificação de Newton e Hale e Academia Americana de Pediatria (AAP). Resultados: Participaram 1.409 mães, utilizando 14.673 medicamentos, sendo 143 fármacos diferentes, dos quais 28 tiveram classificação de risco na amamentação discordante. Entre aqueles com classificação discordante estão morfina (64%), classificada pela AAP e OMS como compatível e pelo MS e por Newton e Hale como criterioso; hioscina (23%), criterioso pelo MS e compatível (A) pela AAP; e metoclopramida (18%), compatível pelo MS, de efeitos desconhecidos (D) pela AAP e evitado de acordo com a OMS. Do total de medicamentos, 49,7% foi classificado como compatível com a amamentação. Quase a totalidade das mulheres utilizou ocitocina (97,4%), seguida de lidocaína (75%), cetoprofeno (69%), cefalotina (66%) e diclofenaco (65%), classificados como compatíveis. Conclusão: Houve amplo uso de medicamentos pelas mães durante a internação para o parto, a maioria deles classificada no mesmo grau de risco, e quase a metade classificada como compatível com a amamentação, porém houve discordância entre as fontes para 19,6% dos medicamentos analisados, o que pode colocar em risco a saúde do lactente ou deixar dúvida quanto ao uso do medicamento ou à prática da amamentação.

RESUMO: Objetivo: Verificar a prevalência e os fatores associados à recomendação de uso de ferro a crianças aos 12 e aos 24 meses de idade. Metodologia: Todas as crianças nascidas nas maternidades de Pelotas em 2015 foram elegíveis para a coorte. Os desfechos foram a recomendação de uso de sulfato ferroso por profissional de saúde e a respectiva utilização. Resultados: A coorte acompanhou 4.275 crianças. Aproximadamente 65% receberam recomendação de suplementação de ferro até 12 meses. Destas, 68,8% fizeram a utilização recomendada. Dos 12 aos 24 meses, 39,4% das crianças receberam recomendação de suplementação de ferro e 26,2% fizeram o uso recomendado. Aos 12 meses, após ajuste, permaneceram associadas com recomendação de uso de ferro: maior escolaridade, maior renda, menor paridade e baixo peso ao nascer. Aos 24 meses, após ajuste, observou-se maior recomendação às mães com menor paridade e às crianças com baixo peso ao nascer. Conclusão: Houve baixa recomendação e baixa utilização de ferro. Esses achados são preocupantes diante da alta prevalência de anemia em crianças na faixa etária estudada. A baixa recomendação de profilaxia de ferro a crianças até 24 meses de idade, assim como a baixa utilização entre aquelas que receberam a orientação de uso refletem a necessidade de ações coordenadas entre profissionais de saúde e de ampliação do conhecimento entre as mães para possibilitar maior alcance dessa importante política pública.

O adenocarcinoma ovariano representa 1,2 % de todas as neoplasias diagnosticadas em cadelas, afeta um ou ambos os ovários e pode ser encontrado como achado durante ováriohisterectomias eletivas. Em cães, este neoplasma surge a partir de invaginações das estruturas de subsuperfícies epiteliais na cápsula do ovário. Porém, essa enfermidade apresenta-se pobremente descrita na literatura. Desse modo, objetiva-se relatar o caso de uma cadela com 13 anos de idade, apresentando anemia, azotemia, secreção vaginal sanguinolenta e diagnóstico presuntivo de hematometra/ piometra por meio de ecografia abdominal. A paciente foi estabilizada e submetida a ovariohisterectomia terapêutica. O diagnóstico histopatológico revelou adenomiose uterina, hiperplasia glandular não cística e adenocarcinoma ovariano subtipo papilar. Após o procedimento cirúrgico a paciente foi acompanhada por cinco meses e apresentou completa remissão dos sinais clínicos sem evidências de metástase.