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Rogelio Perez-Padilla,1 Maria Montes de Oca,2 Ireri Thirion-Romero,1 Fernando C Wehrmeister,3 Maria Victorina Lopez,4 Gonzalo Valdivia,5 Jose R Jardim,6 Adriana Muino,4 Ana Maria B Menezes3 On behalf of the PLATINO Group1National Institute of Respiratory Diseases, Mexico City, Mexico; 2Pulmonary Division, Hospital Universitario de Caracas, Universidad Central de Venezuela, and Centro Medico de Caracas, Caracas, Venezuela; 3Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil; 4Universidad de la Republica. Hospital Maciel, Montevideo, Uruguay; 5Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; 6Paulista School of Medicine, Federal University of São Paulo, São Paulo, BrazilCorrespondence: Rogelio Perez-Padilla, Instituto Nacional de Enfermedades Respiratorias, Tlalpan 4502, Col. Sección XVI, 14080, CDMX, Mexico City, Mexico, Email perezpad@gmail.comBackground: Preserved ratio impaired spirometry (PRISm) has been associated with adverse outcomes and increased transition to other spirometric categories over time. We aimed to examine its prevalence, trajectories over time, and outcomes in a population-based sample from Latin America.Methods: Data were obtained from two population-based surveys of adults from three cities in Latin America (PLATINO study), conducted on the same individuals 5– 9 years after their baseline examination. We estimated the frequency of PRISm defined by FEV1/FVC≥ 0.70 with FEV1 < 80%, describing their clinical characteristics, longitudinal transition trajectories over time, factors associated with the transition.Results: At baseline, 2942 participants completed post-bronchodilator spirometry, and 2026 at both evaluations. The prevalence of normal spirometry was 78%, GOLD-stage 1 10.6%, GOLD 2– 4 6.5%, and PRISm was: 5.0% (95% CI 4.2– 5.8). PRISm was associated with less schooling, more reports of physician-diagnosis of COPD, wheezing, dyspnea, missing days at work, having ≥ 2 exacerbations in the previous year but without accelerated lung function decline. Mortality risk was significantly higher in PRISm (HR 1.97, 95% CI 1.2– 3.3) and COPD GOLD 1– 4 categories (HR 1.79, 95% CI 1.3– 2.4) compared with normal spirometry. PRISm at baseline most frequently transitioned to another category at follow-up (46.5%); 26.7% to normal spirometry and 19.8% to COPD. The best predictors of transition to COPD were closeness of FEV1/FVC to 0.70, older age, current smoking, and a longer FET in the second assessment.Conclusion: PRISm, is a heterogeneous and unstable condition prone to adverse outcomes that require adequate follow-up.Keywords: preserved ratio impaired spirometry PRISm, airflow obstruction, COPD, lung function decline

Ana Maria Baptista Menezes,1 Bruna Celestino Schneider,1 Vânia Pereira Oliveira,1 Fernanda Barros Prieto,1 Deisi Lane Rodrigues Silva,1 Beatriz Raffi Lerm,1 Thielen Borba da Costa,1 Roberta Bouilly,1 Fernando C Wehrmeister,1 Helen Gonçalves,1 Maria Cecília Formoso Assunção1,2 1Epidemiology Postgraduate Program, Federal University of Pelotas, Pelotas, Brazil; 2Public Health Postgraduate Program, Federal University of Rio Grande, Rio Grande, BrazilCorrespondence: Bruna Celestino SchneiderPostgraduate Program in Epidemiology, Federal University of Pelotas, Mal.Deodoro Street, 1160, 3rd Floor, Pelotas CEP: 96020- 220, RS, BrazilTel/Fax +55 53 3284 1300Email brucelsch@yahoo.com.brBackground: The role of diet in the etiology of asthma is still inconclusive. This paper evaluated the longitudinal association between diet quality and chest wheezing in young adults.Methods: This is a longitudinal study with follow-up information from 18- and 22-year-olds (18y and 22y) of the 1993 Pelotas (Brazil) Birth Cohort. Chest wheezing occurrence and number of events in the last year were reported at 22y. Diet quality was measured with a revised version of the Healthy Eating Index (IQD-R) for the Brazilian population at 18y and 22y by food frequency questionnaire referring to the last 12 months. The diet quality continuity was classified as good (always 1st IQD-R tertile), intermediate (always 2nd tertile/change tertile) and poor (always 3rd tertile).Results: A total of 2986 young individuals were evaluated; 51.4% were female. Prevalence of wheezing at 22y was 10.1% (95% CI: 9.1– 11.2), and of these patients, 10% reported at least one event in the past year. Better IQD-R score, both at 18y and at 22y, the lower the odds of wheezing in the past year. Regarding the diet quality continuity from 18y to 22y, staying on a poor diet increased by more than three-fold the odds of chest wheezing (OR=3.28; 95% CI: 1.84– 5.84) and of wheezing events (OR=3.32; 95% CI: 1.89– 5.85) compared to staying on a good diet, after adjustment for confounding variables.Conclusion: The overall quality of the diet seems to be more important than the individual components in the effect on asthma symptoms. Low-quality diet persistence increased the odds of chest wheezing and the number of events.Keywords: diet, wheezing, asthma, longitudinal studies

Maria Victorina Lopez Varela,1 Maria Montes de Oca,2 Fernando C Wehrmeister,3 Cecilia Rodriguez,1 Larissa Ramirez,4 Ana Menezes3 On behalf of the PLATINO team1Department of Pulmonary, Universidad de la República, Montevideo, Uruguay; 2Department of Pulmonary, Universidad Central de Venezuela, Caracas, Venezuela; 3Department of Pulmonary, Federal University of Pelotas, Pelotas, Brazil; 4Department of Pulmonary, AstraZeneca, San Jose, Costa RicaCorrespondence: Maria Victorina Lopez VarelaUniversidad de la República, Facultad de Medicina, Hospital Maciel, Montevideo 11200, UruguayTel +598 9 961 7256Email victorina.lopezvarela@gmail.comBackground: A seven-item prescreening questionnaire (gender, age, pack-years smoking, dyspnea, sputum, cough, previous spirometry data) was developed for COPD detection in the primary care setting (PUMA Study) of four Latin America countries.Objectives: To validate the PUMA prescreening COPD questionnaire externally in two different populations (primary care and general).Methods: The PUMA prescreening COPD questionnaire score was applied to subjects from the Hospital Maciel, Montevideo (primary care), case-finding program and the PLATINO population (general) using PUMA study inclusion criteria. Post-bronchodilator FEV1/FVC

Ana Maria Baptista Menezes,1 Paula Duarte de Oliveira,1 Cauane Blumenberg,1 Efrain Sanchez-Angarita,2 Gloria Isabel Niño-Cruz,1 Ignacio Zabert,3 Janaina Calu Costa,1 Luiza Isnardi Cardoso Ricardo,1 Rafaela Costa Martins,1 Fernando César Wehrmeister1 1Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil; 2Pulmonary Department, Hospital Universitario de Caracas, Universidad Central de Venezuela, Capital District, Venezuela; 3Facultad de Medicina, Universidad Nacional del Comahue, Neuquén, Argentina Purpose: Asthma is a highly prevalent noncommunicable lung disease. The aim of this study was to evaluate the longitudinal association of obesity/adiposity with wheezing and atopy.Methods: The population of the study was composed of participants from the 1993 Pelotas (Brazil) Birth Cohort. The following outcome variables were measured at 22 years: wheezing in the last 12 months, wheezing with atopy, wheezing without atopy, only atopy, and persistent wheezing at 18 and 22 years. Exposure variables were obesity body mass index, percent fat mass (FM), and fat mass index, which were obtained by precise methods (BOD POD and dual-energy X-ray absorptiometry [DXA]). Crude and adjusted logistic and multinomial logistic regressions were used in the analyses.Results: The prevalence of wheezing (with and without atopy), wheezing without atopy, only atopy, and persistent wheezing were 10.6%, 3.9%, 30.9%, and 4.0%, respectively. To be obese or to belong to the highest tertile of obesity/adiposity at two follow-ups showed a cumulative and positive association with wheezing in the adjusted analysis; for atopy there was no significant association. The odds ratio (OR) for wheezing according to the percentage of total FM measured by DXA in the highest tertile at both follow-ups was 1.58 (95% CI: 1.14–2.20) against an OR of 1.16 (95% CI: 0.92–1.47) for atopy. Persistent wheezing was also associated with adiposity, but without statistical significance.Conclusions: We found a positive longitudinal association between several measures of adiposity and wheezing at 22 years old. The effect was higher for cumulative adiposity; the results for atopy were not consistent. Keywords: asthma, BMI, fat mass, fat mass index

Rogelio Perez-Padilla,1 Fernando C Wehrmeister,2 Maria Montes de Oca,3 Maria Victorina Lopez,4 Jose R Jardim,5 Adriana Muiño,4 Gonzalo Valdivia,6 Ana Maria B Menezes,2 On behalf of the PLATINO group 1National Institute of Respiratory Diseases, Mexico City, Mexico; 2Federal University of Pelotas, Pelotas, Brazil; 3Pulmonary Division, Hospital Universitario de Caracas, Universidad Central de Venezuela, Caracas, Venezuela; 4Faculty of Medicine, University of the Republic, Montevideo, Uruguay; 5Federal University of Sao Paulo, Sao Paulo, Brazil; 6Pontificia Universidad Catolica de Chile, Santiago, Chile Background: We aimed to study the adverse outcomes of symptomatic and asymptomatic non-obstructed individuals and those with mild COPD longitudinally in participants from three Latin-American cities.Methods: Two population-based surveys of adults with spirometry were conducted for these same individuals with a 5- to 9-year interval. We evaluated the impact of respiratory symptoms (cough, phlegm, wheezing or dyspnea) in non-obstructed individuals, and among those classified as Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 1, COPD on exacerbation frequency, mortality and FEV1 decline, compared with asymptomatic individuals without airflow obstruction or restriction.Results: Non-obstructed symptomatic individuals had a marginal increased risk of mortality (HR 1.3; 95% CI 0.9–1.94), increased FEV1 decline (−4.5 mL/year; 95% CI −8.6, −0.4) and increased risk of 2+ exacerbations in the previous year (OR 2.6; 95% CI 1.2–6.5). Individuals with GOLD stage 1 had a marginal increase in mortality (HR 1.5; 95% CI 0.93–2.3) but a non-significant impact on FEV1 decline or exacerbations compared with non-obstructed individuals.Conclusions: The presence of respiratory symptoms in non-obstructed individuals was a predictor of mortality, lung-function decline and exacerbations, whereas the impact of GOLD stage 1 was mild and inconsistent. Respiratory symptoms were associated with asthma, current smoking, and the report of heart disease. Spirometric case-finding and treatment should target individuals with moderate-to-severe airflow obstruction and those with restriction, the groups with consistent increased mortality. Keywords: spirometry, airflow obstruction, COPD, mild COPD, lung function decline, COPD exacerbations, screening for COPD

Alejandro Casas,1 Maria Montes de Oca,2 Ana MB Menezes,3 Fernando C Wehrmeister,3 Maria Victorina Lopez Varela,4 Laura Mendoza,5 Larissa Ramírez,6 Marc Miravitlles7 On behalf of the LASSYC team 1Fundación Neumológica Colombiana, Universidad del Rosario, Bogotá, Colombia; 2Universidad Central de Venezuela, Caracas, Venezuela; 3Federal University of Pelotas, Pelotas, Brazil; 4Universidad de la República, Montevideo, Uruguay; 5Hospital Clínico Universidad de Chile, Santiago de Chile, Chile; 6AstraZeneca, San José, Costa Rica; 7Department of Pneumology, Hospital Universitari Vall d’Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain Background: Limited information is available regarding medication use in COPD patients from Latin America. This study evaluated the type of medication used and the adherence to different inhaled treatments in stable COPD patients from the Latin American region.Methods: This was an observational, cross-sectional, multinational, and multicenter study in COPD patients attended by specialist doctors from seven Latin American countries. Adherence to inhaled therapy was assessed using the Test of Adherence to Inhalers (TAI) questionnaire. The type of medication was assessed as: short-acting β-agonist (SABA) or short-acting muscarinic antagonist (SAMA) only, long-acting muscarinic antagonist (LAMA), long-acting β-agonist (LABA), LABA/LAMA, inhaled corticosteroid (ICS), ICS/LABA, ICS/LAMA/LABA, or other.Results: In total, 795 patients were included (59.6% male), with a mean age of 69.5±8.7 years and post-bronchodilator FEV1 of 50.0%±18.6%. The ICS/LAMA/LABA (32.9%) and ICS/LABA (27.7%) combinations were the most common medications used, followed by LABA/LAMA (11.3%), SABA or SAMA (7.9%), LABA (6.4%), LAMA (5.8%), and ICS (4.3%). The types of medication most commonly used in each Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2013 category were ICS/LABA (A: 32.7%; B: 19.8%; C: 25.7%; D: 28.2%) and ICS/LAMA/LABA (A: 17.3%; B: 30.2%; C: 33%; D: 41.1%). The use of long-acting bronchodilators showed the highest adherence (good or high adherence >50%) according to the TAI questionnaire.Conclusion: COPD management in specialist practice in Latin America does not follow the current guideline recommendations and there is an overuse of ICSs in patients with COPD from this region. Treatment regimens including the use of long-acting bronchodilators are associated with the highest adherence. Keywords: adherence, inhaled therapy, COPD, Latin America

Ana M Menezes,1 Fernando C Wehrmeister,1 Rogelio Perez-Padilla,2 Karynna P Viana,3 Claudia Soares,3 Hana Müllerova,4 Gonzalo Valdivia,5 José R Jardim,6 Maria Montes de Oca7 1Federal University of Pelotas, Pelotas, Brazil; 2National Institute of Respiratory Diseases, Mexico City, Mexico; 3GlaxoSmithKline, Rio de Janeiro, Brazil; 4GlaxoSmithKline R&D, Stockley Park, UK; 5Pontificia Universidad Catolica de Chile, Santiago, Republic of Chile; 6Federal University of São Paulo, São Paulo, Brazil; 7Pulmonary Division, Hospital Universitario de Caracas, Universidad Central de Venezuela, Caracas, Venezuela Background: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) report provides a framework for classifying COPD reflecting the impacts of disease on patients and for targeting treatment recommendations. The GOLD 2017 introduced a new classification with 16 subgroups based on a composite of spirometry and symptoms/exacerbations.Methods: Data from the population-based PLATINO study, collected at baseline and at follow-up, in three sites in Latin America were analyzed to compare the following: 1) the distribution of COPD patients according to GOLD 2007, 2013, and 2017; 2) the stability of the 2007 and 2013 classifications; and 3) the mortality rate over time stratified by GOLD 2007, 2013, and 2017.Results: Of the 524 COPD patients evaluated, most of them were classified as Grade I or II (GOLD 2007) and Group A or B (GOLD 2013), with ≈70% of those classified as Group A in GOLD 2013 also classified as Grade I in GOLD 2007 and the highest percentage (41%) in Group D (2013) classified as Grade III (2007). According to GOLD 2017, among patients with Grade I airflow limitation, 69% of them were categorized into Group A, whereas Grade IV patients were more evenly distributed among Groups A–D. Most of the patients classified by GOLD 2007 remained in the same airflow limitation group at the follow-up; a greater temporal variability was observed with GOLD 2013 classification. Incidence-mortality rate in patients classified by GOLD 2007 was positively associated with increasing severity of airflow obstruction; for GOLD 2013 and GOLD 2017 (Groups A–D), highest mortality rates were observed in Groups C and D. No clear pattern was observed for mortality across the GOLD 2017 subgroups.Conclusion: The PLATINO study data suggest that GOLD 2007 classification shows more stability over time compared with GOLD 2013. No clear patterns with respect to the distribution of patients or incidence-mortality rates were observed according to GOLD 2013/2017 classification. Keywords: chronic obstructive lung diseases, Latin America, GOLD classification

Casas A, Montes de Oca M, Menezes AMB, Wehrmeister FC, Lopez Varela MV, Mendoza L, Ramírez L, Miravitlles M. Int J Chron Obstruct Pulmon Dis. 2018;13:1545–1556.Page 1552, Disclosure, the text “AM has been paid for her work as a statistician for the LASSYC study. LR is an employee of AstraZeneca. The other authors report no conflicts of interest in this work” should read “AMM has been paid by AstraZeneca and GlaxoSmithKline for her work as a statistician for the LASSYC and PLATINIO studies, respectively. LR is an employee of AstraZeneca.MM has received speaker fees from Boehringer Ingelheim, Chiesi, Cipla, Menarini, Rovi, Bial, CSL Behring, Grifols and Novartis; consultancy fees from Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Bial, Gebro Pharma, CSL Behring, Laboratories Esteve, Mereo BioPharm, Verona Pharma, pHPharma, Novartis and Grifols; and research grants from GlaxoSmithKline and Grifols. The authors report no other conflicts of interest in this work”. Read the original article

Background: The objectives of this study were to investigate the relationship between perinatal risk factors and suicidal ideation and attempts in young adults in Pelotas, Brazil., Methods: The data were collected from the 1993 Pelotas Birth Cohort study. Every pregnant woman who gave birth in one of the hospitals in Pelotas Brazil in 1993 was invited to participate in the study. The current study uses perinatal data collected in 1993, and follow-ups at ages 18 and 22. The primary outcome was lifetime suicide attempts with past month suicide ideation a secondary outcome. The association between perinatal predictors and suicidal ideation or lifetime suicide attempts was investigated using hierarchical logistic regression., Findings: There was an analytic sample size of 3493. The perinatal factors association with lifetime suicide attempts were sex (OR = 2.25 CI: 1.76-2.89), paternal education at birth (OR = 0.60, 95%CI: 0.36-0.99), maternal education (9-11 years OR = 2.81, 95%CI: 1.41-5.59, & 0-8 years OR = 2.21, 95%CI: 1.07-4.58), support from friends or neighbors at birth (OR = 0.36 95%CI: 0.17-0.77), and maternal smoking during pregnancy (OR = 1.41, 95%CI: 1.10-1.79). Patterns of associations were broadly similar with suicidal ideation. Interactions between sex and the perinatal factors paternal education, maternal education, smoking and support from friends were assessed and found to be not significant., Conclusion: Several factors during the perinatal period are associated with risk of lifetime suicide attempts and ideation in young adults in Brazil. Early-life factors associated with suicide-related concerns in early adulthood were similar to those observed in studies from high-income settings.

Importance: There is no longitudinal evidence on risk factors for gang membership in low- and middle-income countries, despite organized crime groups posing major challenges, including high homicide rates in Latin America. Furthermore, adverse childhood experiences (ACEs) have been largely overlooked in gang-related research worldwide., Objectives: To examine the associations of ACEs up to 15 years of age with past-year gang membership at 18 years of age and to compare crime and criminal justice involvement between gang members and non-gang members., Design, Setting, and Participants: This cohort study assessed children from the 1993 Pelotas (Brazil) Birth Cohort-an ongoing population-based, prospective study. Assessments were undertaken perinatally (1993) and when the children were ages 11 (2004), 15 (2008), 18 (2011), and 22 (2015) years. All children born in 1993 were eligible (N = 5265), and 5249 (99.7%) were enrolled at birth. The study sample (N = 3794 [72.1%]) included those with complete data on ACEs. Data analyses were conducted from February to August 2024., Exposures: Twelve ACEs were assessed up to 15 years of age via child self-report and/or maternal report, including physical neglect, physical abuse, emotional abuse, sexual abuse, domestic violence, maternal mental illness, parental divorce, ever being separated from parents, parental death, poverty, discrimination, and neighborhood fear. These experiences were examined using a single adversity approach, cumulative risk, and latent classes., Main Outcomes and Measures: The main outcome was past-year gang membership at 18 years of age, assessed via self-report and analyzed using multivariate imputation., Results: Of 3794 participants, 1964 (51.8%) were female and 1830 (48.2%) were male, and 703 (18.5%) were Black, 2922 (77.0%) were White, and 169 (4.5%) were coded as "other" race or ethnicity (no additional details are available to further disaggregate the other category). On the basis of the imputed data, 1.6% (SE, 0.2 percentage points) of participants reported gang membership at 18 years of age. Physical abuse (odds ratio [OR], 2.76; 95% CI, 1.27-5.98), emotional abuse (OR, 2.76; 95% CI, 1.51-5.02), domestic violence (OR, 3.39; 95% CI, 1.77-6.48), parental divorce (OR, 2.04; 95% CI, 1.17-3.54), and separation from parents (OR, 3.13; 95% CI, 1.54-6.37) were associated with an increased risk of gang membership. A dose-response association was observed, with 4 or more ACEs increasing the risk (OR, 8.86; 95% CI, 2.24-35.08). In latent class analysis, the class with child maltreatment and household challenges was associated with a higher risk of gang membership than the low-adversities class (OR, 7.10; 95% CI, 2.37-21.28). There was no robust evidence that children exposed to household challenges and social risks were at increased risk of gang membership (OR, 2.28; 95% CI, 0.46-11.25)., Conclusions and Relevance: In this prospective cohort study, ACEs, particularly child maltreatment and family conflict, were associated with gang involvement when examined individually, cumulatively, and as clusters in a high-crime environment in Brazil. These findings underscore the value of integrating the ACE framework into gang-related research and the potential to reduce gang-related crime by reducing ACEs.

This study aimed to investigate the association between child maltreatment and human capital, measured by intelligence quotient (IQ) at age 18 years and schooling at age 22 years in 3,736 members from a population-based birth cohort in Southern Brazil. A multiple linear regression was used to assess the association between child maltreatment and human capital measurements. Physical and emotional abuse and physical neglect occurring up to 15 years of age were considered child maltreatment. Physical neglect was associated with lower IQ scores in women (β = -4.40; 95%CI: -6.82; -1.99) and men (β = -2.58; 95%CI: -5.17; -0.01) and lower schooling for all sexes: women (β = -1.19; 95%CI: -1.64; -0.74) and men (β = -0.82; 95%CI: -1.34; -0.30). Moreover, men who had experienced one type of child maltreatment and women who had experienced two or more types had lower years of schooling at 22 years (β = -0.41; 95%CI: -0.73; -0.89 and β = -0.57; 95%CI: -0.91; -0.22, respectively) than those who suffered no kind of maltreatment. Efforts to improve future educational and cognitive outcomes must include early prevention and intervention strategies for child maltreatment.

Background: The DSM Level 1 Cross-Cutting Symptom Measure (DSM-XC) allows for assessing multiple psychopathological domains. However, its capability to screen for mental disorders in a population-based sample and the impact of adverbial framings (intensity and frequency) on its performance are unknown., Methods: The study was based on cross-sectional data from the 1993 Pelotas birth cohort in Brazil. Participants with completed DSM-XC and structured diagnostic interviews ( n = 3578, aged 22, 53.6% females) were included. Sensitivity, specificity, positive (LR+), and negative (LR-) likelihood ratios for each of the 13 DSM-XC domains were estimated for detecting five internalizing disorders (bipolar, generalized anxiety, major depressive, post-traumatic stress, and social anxiety disorders) and three externalizing disorders (antisocial personality, attention-deficit/hyperactivity, and alcohol use disorders). Sensitivities and specificities >0.75, LR+ > 2 and LR- < 0.5 were considered meaningful. Values were calculated for the DSM-XC's original scoring and for adverbial framings., Results: Several DSM-XC domains demonstrated meaningful screening properties. The anxiety domain exhibited acceptable sensitivity and LR- values for all internalizing disorders. The suicidal ideation, psychosis, memory, repetitive thoughts and behaviors, and dissociation domains displayed acceptable specificity for all disorders. Domains also yielded small but meaningful LR+ values for internalizing disorders. However, LR+ and LR- values were not generally meaningful for externalizing disorders. Frequency-framed questions improved screening properties., Conclusions: The DSM-XC domains showed transdiagnostic screening properties, providing small but meaningful changes in the likelihood of internalizing disorders in the community, which can be improved by asking frequency of symptoms compared to intensity. The DSM-XC is currently lacking meaningful domains for externalizing disorders.

The place of residence is a major determinant of RMNCH outcomes, with rural areas often lagging in sub-Saharan Africa. This long-held pattern may be changing given differential progress across areas and increasing urbanization. We assessed inequalities in child mortality and RMNCH coverage across capital cities and other urban and rural areas. We analyzed mortality data from 163 DHS and MICS in 39 countries with the most recent survey conducted between 1990 and 2020 and RMNCH coverage data from 39 countries. We assessed inequality trends in neonatal and under-five mortality and in RMNCH coverage using multilevel linear regression models. Under-five mortality rates and RMNCH service coverage inequalities by place of residence have reduced substantially in sub-Saharan Africa, with rural areas experiencing faster progress than other areas. The absolute gap in child mortality between rural areas and capital cities and that between rural and other urban areas reduced respectively from 41 and 26 deaths per 1000 live births in 2000 to 23 and 15 by 2015. Capital cities are losing their primacy in child survival and RMNCH coverage over other urban areas and rural areas, especially in Eastern Africa where under-five mortality gap between capital cities and rural areas closed almost completely by 2015. While child mortality and RMNCH coverage inequalities are closing rapidly by place of residence, slower trends in capital cities and urban areas suggest gradual erosion of capital city and urban health advantage. Monitoring child mortality and RMNCH coverage trends in urban areas, especially among the urban poor, and addressing factors of within urban inequalities are urgently needed., (© 2024. The Author(s).)

Maternal mental health during different stages of life can have a significant impact on a child's cognitive development. This study aimed to investigate the association between maternal CMD at two distinct stages of the offspring's life (at 3 months and 11 years) and their IQ scores at 6 and 18 years across two birth cohorts. The study utilized data from two Brazilian birth cohorts: the 1993 cohort (full sample: N = 3719, subsample: N = 436), and the 2004 Pelotas Birth Cohort (N = 3440). IQ assessments were conducted at ages 18 and 6, employing the Wechsler Adult Intelligence Scale, third version (WAIS-III), and Wechsler Intelligence Scale for Children, third version (WISC-III), respectively. The presence of maternal CMD at 3 months and 11 years of age was evaluated using the Brazilian version of the Self-Reporting Questionnaire (SRQ-20). After adjustment, participants whose mothers experienced CMD at 3 months had average IQ scores 1.74 (95 % CI: -2.83 to -0.67) and 2.79 (95 % CI: -5.54 to -0.04) points lower at ages 6 (2004 cohort) and 18 (1993 cohort subsample), respectively. Furthermore, in the 1993 cohort (both full and subsample), maternal CMD at 11 years was associated with lower IQ scores at age 18. Understanding the mechanisms underlying this association, emphasized by these findings, is crucial for promoting children's cognitive development, educational achievement, and overall well-being., Competing Interests: Declaration of competing interest All authors contributed to study design, data analysis, data interpretation, and drafting and revision of the manuscript, and gave final approval of the version to be submitted for publication. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. The authors declare no conflicts of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Exposure to multiple risk factors is prevalent in low-and middle-income countries (LMICs), challenging one-directional strategies to address preventable under-5 mortality (U5M). This study aims to assess the associations between concurrence of multiple risk factors and U5M in LMICs., Methods: We extracted data from the Demographic and Health Surveys conducted between 2010 and 2021 across 61 LMICs. Our primary outcome was U5M, defined as deaths from birth to 59 months. Binary logistic regression model was applied to ascertain the association between U5M and a total of 20 critical risk factors. Upon identifying the risk factors demonstrating the strongest associations, we investigated the simultaneous presence of multiple risk factors in each individual and assessed their combined effects on U5M with logistic regression models., Findings: Of the 604,372 under-5 children, 18,166 (3.0%) died at the time of the survey. Unsatisfied family planning needs was the strongest risk factor for U5M (odds ratio [OR]: 2.0, 95% confidence interval [CI]: 1.9-2.1), followed by short birth interval (<18 months; OR: 2.0, 95% CI: 1.9-2.1), small birth size (OR: 2.0, 95% CI: 1.8-2.1), never breastfed or delayed breastfeeding (OR: 2.0, 95% CI: 1.9-2.0), and low maternal education (OR: 1.6, 95% CI: 1.4-1.8). 66.7% (66.6%-66.8%) of the children had 2 or more leading risk factors simultaneously. Simultaneous presence of multiple leading risk factors was significantly associated with elevated risk of U5M and children presenting with all 5 leading risk factors exhibited an exceedingly high risk of U5M (OR: 5.2, 95% CI: 4.3-6.3); a dose-response relationship between the number of risk factors and U5M was also observed-with the increment of numbers of leading risk factors, the U5M showed an increasing trend ( p-trend < 0.001)., Interpretation: Exposure to multiple risk factors is very common in LMICs and underscores the necessity of developing multisectoral and integrated approaches to accelerate progress in reducing U5M in line with the SDG 3.2., Funding: This research is funded by Research Fund, Vanke School of Public Health, Tsinghua University., Competing Interests: The authors declare no competing interests., (© 2024 The Author(s).)

Background: The benefits of breast feeding may be associated with better formation of eating habits beyond childhood. This study was designed to verify the association between breast feeding and food consumption according to the degree of processing in four Brazilian birth cohorts., Methods: The duration of exclusive, predominant and total breast feeding was evaluated. The analysis of the energy contribution of fresh or minimally processed foods (FMPF) and ultra-processed foods (UPF) in the diet was evaluated during childhood (13-36 months), adolescence (11-18 years) and adulthood (22, 23 and 30 years)., Results: Those who were predominantly breastfed for less than 4 months had a higher UPF consumption (β 3.14, 95% CI 0.82 to 5.47) and a lower FMPF consumption (β -3.47, 95% CI -5.91 to -1.02) at age 22 years in the 1993 cohort. Exclusive breast feeding (EBF) for less than 6 months was associated with increased UPF consumption (β 1.75, 95% CI 0.25 to 3.24) and reduced FMPF consumption (β -1.49, 95% CI -2.93 to -0.04) at age 11 years in the 2004 cohort. In this same cohort, total breast feeding for less than 12 months was associated with increased UPF consumption (β 1.12, 95% CI 0.24 to 2.19) and decreased FMPF consumption (β -1.13, 95% CI -2 .07 to -0.19). Children who did not receive EBF for 6 months showed an increase in the energy contribution of UPF (β 2.36, 95% CI 0.53 to 4.18) and a decrease in FMPF (β -2.33, 95% CI -4 .19 to -0.48) in the diet at 13-36 months in the 2010 cohort. In this cohort, children who were breastfed for less than 12 months in total had higher UPF consumption (β 2.16, 95% CI 0.81 to 3.51) and lower FMPF consumption (β -1.79, 95% CI -3.09 to -0.48)., Conclusion: Exposure to breast feeding is associated with lower UPF consumption and higher FMPF consumption in childhood, adolescence and adulthood., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background and Objectives: Bipolar disorder is a chronic condition affecting millions of people worldwide. Currently, there is some evidence to suggest that cannabis use during adolescence may be an environmental risk factor for its onset, however inconsistencies have been observed across the literature. Considering this, we aimed to assess whether early lifetime cannabis is associated with subsequent bipolar disorder in young adults between 18 and 22 years of age., Methods: Using data from the 1993 Pelotas (Brazil) birth cohort (n = 5249), cannabis exposure was examined at age 18 by self-report, and bipolar disorder diagnosis was measured at age 22 using the Mini International Neuropsychiatric Interview (MINI). In order to control the analysis, we considered socioeconomic status index, sex, skin color, physical abuse by parents and lifetime cocaine use., Results: A total of 3781 individuals were evaluated in 2015 aged 22 years, of whom 87 were diagnosed with the bipolar disorder onset after the age of 18. Lifetime cannabis use predicted bipolar disorder onset at 22 years old (OR 1.82, 95% CI [1.10, 2.93]), and the effect remained after adjusting for socioeconomic status, sex, skin color, and physical abuse by parents (OR 2.00, 95% CI [1.20, 3.25]). However, this association was attenuated to statistically non-significant after further adjustment for all available covariates, including lifetime cocaine use (OR 1.79, 95% CI [0.95, 3.19]). We also found similar results for early cocaine use, where the association with bipolar disorder onset did not maintain significance in the multivariate model (OR 1.35, 95% CI [0.62, 2.86]). Otherwise, when we considered cannabis or cocaine lifetime use as a unique feature, our findings showed that the adolescent exposure to cannabis or cocaine increased the odds by 1.95 times of developing bipolar disorder at 22 years age, even when controlling for all other study variables (OR 2.14, 95% CI [1.30, 3.47]). Finally, our models suggest that cocaine use may potentially exert a major influence on the effect of lifetime cannabis use on bipolar disorder onset, and that physical abuse by parents and sex may modify the effect of cannabis use for later bipolar disorder onset., Conclusion: Based on our findings, early cannabis exposure predicted bipolar disorder onset in young adults, but this association was confounded by cocaine use. Contrary to schizophrenia, cannabis as a sole exposure was not associated with bipolar disorder onset after adjusting for control variables., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

This study assessed the association of birth weight, gestational age, and intrauterine growth with bone mineral density (BMD) at 22 and 30 years of age in the 1982 and 1993 birth cohorts in Pelotas, Rio Grande do Sul State, Brazil. BMD was measured by dual-energy X-ray absorptiometry (DXA) and the association was assessed using analysis of variance. Multiple linear regression was used to control for confounding factors: sex; household income at birth; maternal smoking during pregnancy; maternal schooling; maternal ethnicity/skin color; and pre-pregnancy body mass index. The study tested whether body fat in adulthood was a mediator of the association analyzed, using the G-computation Formula. A total of 6,803 participants from the 1982 and 1993 cohorts were evaluated at 30 and 22 years of age, respectively. Birth weight was associated with BMD at all sites, with a greater difference at the femoral neck. Individuals born weighing less than 2,000g had on average -0.036g/cm2 (95%CI: -0.064; -0.008) of BMD in the femoral neck than individuals weighing more than 3,500g. Individuals with an intrauterine growth z-score at least 1.28 standard deviation below the mean had an average of -0.013g/cm2 (95%CI: -0.024; -0.002) of BMD in the lumbar spine compared with individuals with an above-average z-score. The mediation analysis showed that body fat in adulthood did not mediate the association. Birth conditions have been associated with BMD in adulthood and the identification of early factors related to bone loss is essential due to the demographic inversion that has been taking place in low- and middle-income countries.

Living conditions and other factors in urban unplanned settlements present unique challenges for improving maternal and newborn health (MNH), yet MNH inequalities associated with such challenges are not well understood. This study examined trends and inequalities in coverage of MNH services in the last 20 years in unplanned and planned settlements of Lusaka City, Zambia. Geospatial information was used to map Lusaka's settlements and health facilities. Zambia Demographic Health Surveys (ZDHS 2001, 2007, 2013/2014, and 2018) were used to compare antenatal care (ANC), institutional delivery, and Cesarean section (C-section) coverage, and neonatal mortality rates between the poorer 60% and richer 40% households. Health Management Information System (HMIS) data from 2018 to 2021 were used to compute service volumes and coverage rates for ANC1 and ANC4, and institutional delivery and C-sections by facility level and type in planned and unplanned settlements. Although the correlation is not exact, our data analysis showed close alignment; and thus, we opted to use the 60% poorer and 40% richer groups as a proxy for households in unplanned versus planned settlements. Unplanned settlements were serviced by primary centers or first-level hospitals. ZDHS findings show that by 2018, at least one ANC visit and institutional delivery became nearly universal throughout Lusaka, but early and four or more ANC visits, C-sections, and neonatal mortality rates remained worse among poorer than richer women in ZDHS. In HMIS, ANC and institutional delivery volumes were highest in public facilities, especially in unplanned settlements. The volume of C-sections was much greater within facilities in planned than unplanned settlements. Our study exposed persistent gaps in timing and use of ANC and emergency obstetric care between unplanned and planned communities. Closing such gaps requires strengthening outreach early and consistently in pregnancy and increasing emergency obstetric care capacities and referrals to improve access to important MNH services for women and newborns in Lusaka's unplanned settlements., (© 2024. The Author(s).)

Purpose: This study aimed to determine whether the factors underlying potential differences between two birth cohorts, born in 1982 and 1993, influence the changes in IQ over time., Methods: Data from two Brazilian birth cohorts were used (1993 and 1982 Pelotas Birth Cohorts). The IQ scores were assessed using the WAIS-III test., Results: Results showed that women born in 1993 had a higher average IQ score than those born in 1982, but no difference was found among men. The increase in IQ scores was only limited to participants from families with an income ranging from 1.1 to 3 times the minimum wage at the time of birth. The mean IQ score of participants born to mothers below the age of 20 remained stable over time, but increase for participants whose mothers were 20 years of age or older at the time of birth., Conclusions: This study emphasizes the importance of considering socio-economic and demographic factors when examining differences in IQ scores over time. Further research is needed to understand the underlying mechanisms of these findings., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Objective: This study aims to test the association of rest-activity rhythm (intradaily variability and interdaily stability) with all-cause mortality in an older adult cohort in Brazil. It also assesses whether the amount of time spent at each intensity level (i.e., physical activity and nocturnal sleep) interferes with this association., Methods: This cohort study started in 2014 with older adults (≥60 years). We investigated deaths from all causes that occurred until April 2017. Rest-activity rhythm variables were obtained using accelerometry at baseline. Intradaily variability indicates higher rhythm fragmentation, while interdaily stability indicates higher rhythm stability. Cox proportional-hazard models were used to test the associations controlling for confounders., Results: Among the 1451 older adults interviewed in 2014, 965 presented valid accelerometry data. During the follow-up period, 80 individuals died. After adjusting the analysis for sociodemographic, smoking, morbidity score, and number of medicines, an increase of one standard deviation in interdaily stability decreased 26% the risk of death. The adjustment for total sleep time and inactivity did not change this association. On the other hand, the association was no longer significant after adjusting for overall physical activity and moderate to vigorous physical activity., Conclusion: Rest-activity rhythm pattern was not associated with mortality when physical activity was considered, possibly because this pattern could be driven by regular exercise. Promoting physical activity remains a relevant strategy to improve population health., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Wendt et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: To examine inequalities in the coverage of reproductive and maternal health interventions in low- and middle-income countries and territories using a composite index of socioeconomic deprivation status., Methods: We obtained data on education and living standards from national household surveys conducted between 2015 and 2019 to calculate socioeconomic deprivation status. We assessed the coverage of reproductive and maternal health interventions, using three indicators: (i) demand for family planning satisfied with modern methods; (ii) women who received antenatal care in at least four visits; and (iii) the presence of a skilled attendant at delivery. Absolute and relative inequalities were evaluated both directly and using the slope index of inequality and the concentration index., Findings: In the 73 countries and territories with available data, the median proportions of deprivation were 41% in the low-income category, 11% in the lower-middle-income category and less than 1% in the upper-middle-income category. The coverage analysis, conducted for 48 countries with sufficient data, showed consistently lower median coverage among deprived households across all health indicators. The coverage of skilled attendant at delivery showed the largest inequalities, where coverage among the socioeconomically deprived was substantially lower in almost all countries. Antenatal care visits and demand for family planning satisfied with modern methods also showed significant disparities, favouring the less deprived population., Conclusion: The findings highlight persistent disparities in the coverage of reproductive and maternal health interventions, requiring efforts to reduce those disparities and improve coverage, particularly for skilled attendant at delivery., ((c) 2024 The authors; licensee World Health Organization.)

Identifying and classifying poor and rich groups in cities depends on several factors. Using data from available nationally representative surveys from 38 sub-Saharan African countries, we aimed to identify, through different poverty classifications, the best classification in urban and large city contexts. Additionally, we characterized the poor and rich groups in terms of living standards and schooling. We relied on absolute and relative measures in the identification process. For absolute ones, we selected people living below the poverty line, socioeconomic deprivation status and the UN-Habitat slum definition. We used different cut-off points for relative measures based on wealth distribution: 30%, 40%, 50%, and 60%. We analyzed all these measures according to the absence of electricity, improved drinking water and sanitation facilities, the proportion of children out-of-school, and any household member aged 10 or more with less than 6 years of education. We used the sample size, the gap between the poorest and richest groups, and the observed agreement between absolute and relative measures to identify the best measure. The best classification was based on 40% of the wealth since it has good discriminatory power between groups and median observed agreement higher than 60% in all selected cities. Using this measure, the median prevalence of absence of improved sanitation facilities was 82% among the poorer, and this indicator presented the highest inequalities. Educational indicators presented the lower prevalence and inequalities. Luanda, Ouagadougou, and N'Djaména were considered the worst performers, while Lagos, Douala, and Nairobi were the best performers. The higher the human development index, the lower the observed inequalities. When analyzing cities using nationally representative surveys, we recommend using the relative measure of 40% of wealth to characterize the poorest group. This classification presented large gaps in the selected outcomes and good agreement with absolute measures., (© 2023. The Author(s).)

Objective: Bipolar disorder (BD) is a major cause of disability-adjusted life years in young adults. Pregnancy complications have previously been associated with BD. The current study aimed to examine the association between perinatal factors and BD., Methods: We included 3,794 subjects from the 1993 Pelotas population-based birth cohort study. We assessed 27 variables at birth and modeled BD onset at 18 and 22 years. Bivariate analysis was performed by means of binomial logistic regression models. The variables with p-values less than 0.05 were included in a multiple regression with confounders., Results: Maternal smoking was associated with a 1.42-fold increased risk of BD at 18 or 22 years old (95%CI 1.091-1.841), and maternal passive exposure to tobacco with a 1.43-fold increased risk (95%CI 1.086-1.875). No association was found between other perinatal factors and BD after controlling for confounders., Conclusion: The results of the present cohort study corroborate previous reports in the literature indicating a negative effects of maternal smoking during pregnancy. These findings can be further tested and support the development of strategies to prevent the onset development of BD., Competing Interests: ICP receives authorship royalties from Springer Nature and ArtMed; has served as consultant, advisor, or continuing medical education speaker for Janssen, LundBeck, Libbs, Daiichi Sankyo, EMS, and Pfizer. The other authors report no conflicts of interest.

Mood disorders significantly impact global health, with MDD ranking as the second leading cause of disability in the United States and BD ranking 18th. Despite their prevalence and impact, the relationship between premorbid intelligence and the subsequent development of BD and MDD remains inconclusive. This study investigates the potential of premorbid Intelligence Quotient (IQ) and school failure frequency as risk factors for Bipolar Disorder (BD) and Major Depressive Disorder (MDD) in a birth cohort setting. We analyze data from the Pelotas population-based birth cohort study, comprising 3580 participants aged 22, who had no prior mood disorder diagnoses. Utilizing regression models and accounting for potential confounders, we assess the impact of IQ and school failure, measured at age 18, on the emergence of BD and MDD diagnoses at age 22, using individuals without mood disorders as comparators. Results reveal that lower IQ (below 70) at 18 is associated with an increased risk of BD (Adjusted Odds Ratio [AOR] 1.75, 95%CI: 1.00-3.09, p < 0.05), while higher IQ (above 120) is linked to MDD (AOR 2.16, 95%CI: 1.24-3.75, p < 0.001). Moreover, an elevated number of school failures is associated with increased BD risk (AOR 1.23, 95%CI: 1.11-1.41, p < 0.001), particularly for BD type 1 (AOR 1.36, 95% CI: 1.17-1.58, p < 0.001). These findings offer insights into the distinct premorbid intellectual characteristics of BD and MDD and contribute to a deeper understanding of their developmental trajectories, potentially informing the development of risk assessment tools for mood disorders., Competing Interests: Declaration of competing interest Flávio Kapczinski reports personal fees from Daiichi Sankyo and Janssen-Cilag, grants from Stanley Medical Research Institute (07TGF/1148), grants from National Institute for Science and Technology (INCT - CNPq 465458/2014–9), and from the Canada Foundation for Innovation - CFI. Ives Cavalcante Passos has received research support from or served as consultant, adviser or speaker for Lundbeck, EMS, Libbs, and receives authorship royalties from Springer Nature and ArtMed. Furthermore, Ives Cavalcante Passos’ research is supported by National Council for Scientific and Technological Development (CNPq) and by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil Mauricio Kunz reports personal fees from Daiichi Sankyo. Francisco Diego Rabelo-da-Ponte receives authorship royalties from Springer Nature. Silvia Amoretti has been supported by a Sara Borrell contract (CD20/00177), funded by Instituto de Salud Carlos III (ISCIII) and co-funded by European Social Fund “Investing in your future”. The remaining authors do not have competing interests to declare., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: Preterm birth has been associated with increased risk of hypertension and cardiovascular disease later in adulthood, attributed to cardiovascular and metabolic alterations in early life. However, there is paucity of evidence from low- and middle-income countries (LMICs)., Methods: We investigated the differences between preterm (<37 weeks gestational age) and term-born individuals in birth length and weight as well as adult (18 and 20 years) height, weight and blood pressure in the Brazilian 1993 Pelotas birth cohort using linear regressions. Analyses were adjusted for the maternal weight at the beginning of pregnancy and maternal education and family income at childbirth. Additional models were adjusted for body mass index (BMI) and birthweight. Separate analyses were run for males and females. The complete sample was analysed with an interaction term for sex., Results: Of the 3585 babies included at birth, 3010 were followed up in adulthood at 22 years. Preterm participants had lower length and weight at birth. This difference remained for male participants in adulthood, but female participants were no shorter than their term counterparts by 18 years of age. At 22 years, females born preterm had lower blood pressures (systolic blood pressure -1.00 mmHg, 95%CI -2.7, 0.7 mmHg; diastolic blood pressure -1.1 mmHg, 95%CI -2.4, 0.3 mmHg) than females born at term. These differences were not found in male participants., Conclusions: In this Brazilian cohort we found contrasting results regarding the association of preterm birth with blood pressure in young adulthood, which may be unique to an LMIC., (© The Author(s) 2023. Published by Oxford University Press on behalf of the International Epidemiological Association.)

Background: Violence against women has a negative impact on multiple dimensions of women's health. During the Covid-19 pandemic, intimate partner violence against women has continued, and in some contexts has intensified. The aim of this study was to identify the prevalence of intimate partner violence against women during covid-19 pandemic and its association with socioeconomic, behavioral, and life-experience factors., Methods and Findings: Cross-sectional, population-based study conducted in the municipality of Vitória, state of Espírito Santo, from January to May 2022, where 1,086 women aged 18 years and over were interviewed. The World Health Organization (WHO) instrument on violence against women was used to screen outcomes. The prevalence of violence during the pandemic (psychological, physical, and sexual) and bivariate analysis with sociodemographic, behavioral, family, and life history characteristics of women were estimated. The multivariate analysis was carried out for each type of violence, the Poisson regression model was performed with an estimate of robust variance, inserting the variables of interest with (p<0.20). Those with p<0.05 remained in the adjusted model., Results: The prevalence of violence psychological against women perpetrated by an intimate partner during the pandemic was the most frequent (20.2%), followed by physical (9.0%) and sexual violence (6.5%). Women with less schooling and who were single had a higher prevalence of physical and psychological violence, as did those with a history of sexual abuse in childhood and whose mothers had been beaten by their intimate partners. Sexual violence was more prevalent among non-white, with up to eight years of schooling, whose mothers had a history of intimate partner violence, and who consumed alcohol during four days or more (p<0.01)., Conclusion: Psychological, physical, and sexual violence perpetrated by the intimate partner during the pandemic presented high magnitude among women living in Vitória. Sociodemographic, behavioral factors, and personal and maternal experiences of violence were associated with the phenomenon., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Leite et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Rapid urbanization is likely to be associated with suboptimal access to essential health services. This is especially true in cities from sub-Saharan Africa (SSA), where urbanization is outpacing improvements in infrastructure. We assessed the current situation in regard to several markers of maternal, newborn, and child health, including indicators of coverage of health interventions (demand for family planning satisfied with modern methods, at least four antenatal care visits (ANC4+), institutional birth, and three doses of DPT vaccine[diphtheria, pertussis and tetanus]) and health status (stunting in children under 5 years, neonatal and under-5 mortality rates) among the poor and non-poor in the most populous cities from 38 SSA countries. We analyzed 136 population-based surveys (year range 2000-2019), contrasting the poorest 40% of households (referred to as poor) with the richest 60% (non-poor). Coverage in the most recent survey was higher for the city non-poor compared to the poor for all interventions in virtually all cities, with the largest median gap observed for ANC4+ (13.5 percentage points higher for the non-poor). Stunting, neonatal, and under-5 mortality rates were higher among the poor (7.6 percentage points, 21.2 and 10.3 deaths per 1000 live births, respectively). The gaps in coverage between the two groups were reducing, except for ANC4, with similar median average annual rate of change in both groups. Similar rates of change were also observed for stunting and the mortality indicators. Continuation of these positive trends is needed to eliminate inequalities in essential health services and child survival in SSA cities., (© 2023. The Author(s).)

Background: In low-income and middle-income countries (LMICs), intimate partner violence poses a substantial barrier to accomplishing target 5.2 of the Sustainable Development Goals: to eliminate all forms of violence against women and girls. Our study aimed to assess the prevalence and changes of intimate partner violence against women in LMICs. We also explored the association between women's empowerment and intimate partner violence., Methods: In this secondary analysis of population-based surveys, we obtained data from the nationally representative Demographic and Health Surveys conducted in LMICs between 2000 and 2021. We selected countries with available data on the domestic violence module, and women aged 15 to 49 years who currently or formerly had a husband or partner, and who had provided information about intimate partner violence, were included in the analysis. We first estimated the weighted prevalence of intimate partner violence in LMICs with available data, and then we assessed the average annual rate of change using Poisson regression with robust error variance in a subset of countries with at least two surveys. We used multilevel analysis to investigate the association between intimate partner violence and women's empowerment measured at both the country and individual levels. Country-level empowerment was measured by gender inequality index, while individual-level empowerment considered social independence, decision making, and attitude to violence., Findings: A total of 359 479 women aged 15 to 49 years were included from 53 LMICs. 336 811 women from 21 countries with two surveys provided data for assessing the trends of intimate partner violence. The weighted prevalence of any type of intimate partner violence was 37·2% (95% CI 36·6 to 37·8). A significant overall decline in the prevalence of any type of intimate partner violence was observed with an average annual rate of change of -0·2% (95% CI -0·4 to -0·03); however six countries showed significant increasing trends, with average annual rates of change ranging from 1·2% (95% CI 0·7 to 1·7) in Nigeria to 6·6% (5·3 to 7·8) in Sierra Leone. Notably, the prevalence of psychological intimate partner violence has risen (average annual rate of change, 2·3% [95% CI 2·1 to 2·6]), reflected in increased rates across eight countries. Higher levels of country-level women's empowerment were associated with a lower risk of intimate partner violence: women from countries with the highest tertile of gender inequality index had an increased odds of any type of intimate partner violence (odds ratio 1·58 [95% CI 1·12 to 2·23]). Similarly, better individual-level women's empowerment also showed significant associations with a lower risk of intimate partner violence., Interpretation: The prevalence of intimate partner violence remains high, and some countries have shown an increasing trend. The strong relationship between both country-level and individual-level women's empowerment and the prevalence of intimate partner violence suggests that accelerating women's empowerment could be one strategy to further reduce intimate partner violence against women., Funding: National Natural Science Foundation; Vanke School of Public Health, Tsinghua University; and Sanming Project of Medicine in Shenzhen., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

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., (© 2023. The Author(s).)

Objectives: To investigate smoking trajectories and their association with pulmonary function (PF) and respiratory symptoms at age 22., Methods: Data from a population-based cohort study of 3350 individuals and their spirometries were analysed. The outcomes were: forced expiratory volume in the first second (FEV 1 ), forced vital capacity (FVC), forced expiratory flow at the mid expiratory phase (FEF 25-75 % ), FEV 1 /FVC and FEF 25-75 /FVC ratio. Smoking data were collected at perinatal follow-up (gestational exposure) and 15, 18 and 22 years. Group-based trajectory model was applied., Results: Four groups were identified: no exposure (NE), gestational (GE), gestational and adulthood (GAE) and continuous (CE) exposure. Both CE and GAE trajectories were associated with lower values of FEV 1 /FVC (-1.77pp; p = 0.01 and -1.58 pp; p<0.001 respectively) and FEF 25-75 /FVC ratio (-7.27pp; p = 0.019 and -6.04pp; p<0.001 respectively) compared to the NE trajectory. Lower FEV 1 and FEF 25-75 % values were also related to the GAE trajectory (-68 ml; p = 0.03 and -253 ml/s ; p<0.001 respectively). Compared to those who never smoked, individuals who smoked 10 or more cigarettes daily presented a reduction in the FEV 1 /FVC ratio by 1.37pp (p<0.001), FEF 25-75 % by 126 ml (p = 0.012) and FEF 25-75 % /FVC ratio by 3.62pp (p = 0.011). CE trajectory showed higher odds of wheezing (OR 4.14; p<0.001) and cough (OR 2.39; p = 0.002) compared to the non-exposed group., Conclusions: The in-uterus exposure to maternal smoking reduces PF later in life. However, the perpetuation of smoking behaviour throughout adolescence and early adulthood is determinant for PF main reduction and the emergence of respiratory-related symptoms., Competing Interests: Conflicts of interest Priscila Weber reports personal fees from Coordination for the Improvement of Higher Education Personnel (CAPES), during the conduct of the study., (Copyright © 2023 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.)

Background: Suicide is the second most common cause of death among young individuals (10-25 years). The risk of first occurrence of suicidal behavior increases significantly at the start of adolescence, highlighting the importance of research regarding the association between early life factors, such as adverse childhood experiences (ACEs), and suicidal behaviors., Objective: To assess if ACEs are prospectively associated with lifetime suicide attempt and suicidal thoughts at young adulthood., Participants and Setting: Data from 3050 young adults from the 1993 Pelotas Birth Cohort., Methods: Discrimination (of any type), financial hardship, maternal common mental disorders (CMD - SRQ-20), parental death, parental divorce and physical abuse were assessed at the 11-year follow-up. Data regarding suicidal thoughts and suicide attempt was assessed at 22 years with Mini International Neuropsychiatric Interview (MINI), version 5.0. Crude and adjusted logistic regression models were estimated., Results: In the adjusted model, those who suffered financial hardship (OR 2.51; 95 % CI 1.66-3.79), parental divorce (OR 1.44; 95 % CI 1.02-2.04) and maternal CMD (OR 1.72; 95 % CI 1.21-2.46) at 11 years were more likely to report suicidal thoughts at 22 years. Also, those who experienced financial hardship (OR 1.71; 95 % CI 1.13-2.58), physical abuse (OR 1.48; 95 % CI 1.08-2.04), discrimination (OR 1.74; 95 % CI 1.20-2.51), maternal CMD (OR 1.67; 95 % CI 1.20-2.32), or parental divorce (OR 1.41; 95 % CI 1.02-1.94) were more likely to report a lifetime suicide attempt., Conclusion: There was a strong association between financial hardship, maternal CMD and divorce during childhood, and suicidal thoughts, such as suicidal ideation or planning, at the beginning of adulthood. Financial hardship, discrimination, divorce, maternal CMD and physical abuse were associated with suicide attempt. These findings demonstrate that mental health support must be available following certain ACEs during childhood, alongside with ACEs prevention. More research is needed on the association between discrimination and suicide attempts, differentiating the nature and impact of each type of discrimination., Competing Interests: Declaration of competing interest No conflict of interests., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

This study evaluates the association of birth conditions with attention deficit/hyperactivity disorders (ADHD) in adults using data from two birth cohorts in the city of Pelotas Rio Grande do Sul State, Brazil. In 1982 and 1993 all births in the city were identified and have been prospectively monitored. In the follow-ups at 30 and 22 years of the 1982 (n = 3,574) and 1993 (n = 3,780) cohorts, respectively, participants were examined, and trained psychologists applied the Mini-International Neuropsychiatric Interview (M.I.N.I.). Those individuals who met the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnostic criteria were defined as positive for ADHD. Poisson regression with robust variance adjustment was used to estimate the prevalence ratio (PR) adjusted for sex, maternal skin color, family income, maternal age, maternal schooling during pregnancy, maternal marital status, parity, and maternal smoking during pregnancy. The prevalence of adult ADHD was 4.4% and 4.5% in the 1982 and 1993 cohorts, respectively. The prevalence of ADHD was higher in those born with lower weight, but no linear trend was observed, and those born with weight between 3,000 and 3,499 grams (PR = 1.40; 95%CI: 1.05-1.86) had the highest risk. For gestational age, we observed an inversely proportional relationship for the presence of ADHD: preterm infants had a 33% higher risk (95%CI: 0.90-1.96) of being considered as having ADHD than those born at 39 or more weeks, but as the confidence interval included nullity, this association may have occurred at random. These results indicate that birth weight and gestational age may be associated with adult ADHD.

This study describes the methodology of the Telephone Survey of Risk Factors for Chronic Noncommunicable Diseases During the Pandemic (Covitel), conducted in Brazil in 2022. Covitel is a population-based survey representing Brazil and its five macroregions (Central-West, Northeast, North, Southeast, and South) and providing information on the impact of the main risk factors for chronic noncommunicable diseases (NCDs) on the adult population aged 18 years or above who live in households served by fixed and mobile telephone lines. This study aims to contribute to the development and monitoring of public policies to promote the population's health and obtain results to contribute to the knowledge of the influence of COVID-19 on risk factors for NCDs in the country. We evaluated 9,000 individuals and collected information on their diet, physical activity, mental health, health status, hypertension, diabetes, depression, and alcohol and tobacco consumption, comparing the pre-pandemic moments and the first quarter of 2022. We also collected information about the population's vaccination schedule and COVID-19 infection history.

The objective of this study is to examine the association between preterm infants' size at 1 year and attention-deficit/hyperactivity disorder (ADHD) assessed categorically and dimensionally in childhood and adolescence. We studied infants born < 37 weeks' gestation from two Brazilian birth cohorts (n = 653). ADHD was evaluated using the Development and Well-Being Assessment (DAWBA) interview at the age of 6 years in one cohort and by a structured interview according to DSM-5 criteria at 18 years in the other one. The presence of child attention difficulties was measured by the Strengths and Difficulties Questionnaire (SDQ) at 6 and 11 years in the 2004 and 1993 cohorts, respectively. We estimated associations of weight, length, head circumference, and BMI z-scores at 1-year chronological age with ADHD using Poisson Regression Model; and with attention difficulties using Linear Regression, adjusting for covariates. Mean birth weight was 2500 g and gestational age was 34.5 weeks. The aggregated ADHD prevalence in the two cohorts was 2.7%, and the median score for attention difficulties was 3.0. We found that increased head circumference at 1 year was associated with a lower risk of ADHD diagnosis (RR = 0.7, 95% CI 0.4, 0.9; p = 0.04 per standard deviation difference) and with fewer dimensional attention symptoms. In sensitivity analysis with other mental disorders, head circumference was associated with depression, but not with anxiety. Our findings emphasize poor head growth in the first year of life as a potential determinant of attentional difficulties in the preterm infant population., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Background: Low prevalence of physical activity (PA) and a high prevalence of mental health problems are common among youth. The aim of this study was to evaluate the association between PA during adolescence and depression and anxiety disorders in young adulthood., Methods: Data from the 1993 Pelotas (Brazil) Birth Cohort Study were analyzed. Leisure-time PA and total PA (leisure plus commuting) were evaluated at 11, 15, and 18 years using self-reported data. PA was evaluated at each age separately and during adolescence, considering the number of times participants reached PA recommendations. Depression and anxiety were assessed through Mini International Neuropsychiatric Interview at 22 years. Crude and adjusted association analyses were performed using Poisson regression with robust error variance, providing prevalence ratios and 95% confidence intervals., Results: Three thousand two hundred and forty-seven participants were included in the study. In the adjusted analyses, active participants in leisure-time PA (≥300 min/wk) and total PA at 11 years were less likely to be depressed at age 22 (prevalence ratios: 0.54; 95% confidence interval, 0.33-0.89; prevalence ratios: 0.63; 95% confidence interval, 0.41-0.97). For leisure-time PA, the more PA recommendations were met during adolescence, the lower the prevalence of depression. There was no association when PA variables were evaluated separately at 15 and 18 years and between PA and anxiety after controlling for potential confounders., Conclusions: Early adolescence appears to be a sensitive period for PA benefits on depression in early adulthood. The more timepoints reaching PA recommendations during adolescence, the lower the risk of depression. On the other hand, PA during adolescence was not associated with anxiety in young adults.

Background: Although Zambia has achieved notable improvements in reproductive, maternal, newborn and child health (RMNCH), continued efforts to address gaps are essential to reach the Sustainable Development Goals by 2030. Research to better uncover who is being most left behind with poor health outcomes is crucial. This study aimed to understand how much more demographic health surveys can reveal about Zambia's progress in reducing inequalities in under-five mortality rates and RMNCH intervention coverage., Methods: Using four nationally-representative Zambia Demographic Health Surveys (2001/2, 2007, 2013/14, 2018), we estimated under-five mortality rates (U5MR) and RMNCH composite coverage indices (CCI) comparing wealth quintiles, urban-rural residence and provinces. We further used multi-tier measures including wealth deciles and double disaggregation between wealth and region (urban residence, then provinces). These were summarised using slope indices of inequality, weighted mean differences from overall mean, Theil and concentration indices., Results: Inequalities in RMNCH coverage and under-five mortality narrowed between wealth groups, residence and provinces over time, but in different ways. Comparing measures of inequalities over time, disaggregation with multiple socio-economic and geographic stratifiers was often valuable and provided additional insights compared to conventional measures. Wealth quintiles were sufficient in revealing mortality inequalities compared to deciles, but comparing CCI by deciles provided more nuance by showing that the poorest 10% were left behind by 2018. Examining wealth in only urban areas helped reveal closing gaps in under-five mortality and CCI between the poorest and richest quintiles. Though challenged by lower precision, wealth gaps appeared to close in every province for both mortality and CCI. Still, inequalities remained higher in provinces with worse outcomes., Conclusions: Multi-tier equity measures provided similarly plausible and precise estimates as conventional measures for most comparisons, except mortality among some wealth deciles, and wealth tertiles by province. This suggests that related research could readily use these multi-tier measures to gain deeper insights on inequality patterns for both health coverage and impact indicators, given sufficient samples. Future household survey analyses using fit-for-purpose equity measures are needed to uncover intersecting inequalities and target efforts towards effective coverage that will leave no woman or child behind in Zambia and beyond., (© 2023. The Author(s).)

Objectives: To determine sleep clusters among young adults and describe the prevalence of modifiable risk behaviors for noncommunicable diseases (NCDs) according to these clusters., Methods: A cross-sectional analysis was carried out with the 1993 Pelotas Birth Cohort participants at the 22-year follow-up. Sleep onset, sleep offset, total sleep time (TST), TST variability, and sleep efficiency were evaluated by a triaxial accelerometer. We asked participants to wear the devices for 7 days on a nondominant wrist. Excessive daytime sleepiness was assessed by the Epworth sleep scale and sleep quality by the Pittsburgh Sleep Quality Index. Sleep clusters of 2738 individuals were determined using k-means cluster analysis. Crude and adjusted prevalence of modifiable risk behaviors for NCDs (smoking, harmful alcohol intake, leisure physical inactivity, overweight, screen time, and ultra-processed food consumption) were presented according to the sleep clusters. Adjustments included wealth index, skin color, years of schooling, current occupation, shift work, and having children under 2 years. All analyses were stratified according to sex., Results: We identified 3 sleep clusters for men (Healthy sleepers, Late and variant sleepers, and Shorter and poorer sleepers) and 3 for women (Healthy sleepers, Late and poor-quality sleepers, and Shorter, variant, and inefficient sleepers). Both males and females classified as Healthy sleepers presented a lower prevalence of modifiable risk behaviors for NCDs compared to individuals from other sleep clusters., Conclusions: Poor sleep health is associated with higher prevalence of modifiable risk behaviors for NCDs. Prevention strategies for NCDs should also focus on sleep health., (Copyright © 2023 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)

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.

The purpose of this research is to investigate whether grandmother's smoking during pregnancy reduces the grandchildren's birthweight and whether maternal smoking during pregnancy modified this association. We also evaluated the effect of duration and intensity of smoking. This study included data from three generations from two birth cohorts carried out in Pelotas, a southern Brazilian city: women enrolled in the perinatal study in the 1982 and 1993 cohorts (G1); daughters (G2) of those G1 mothers who were followed to adulthood; and first children (G3) born from G2 women. Information on maternal smoking during pregnancy was obtained from women (G1) shortly after delivery of the two cohorts and from G2 in the follow-up in adulthood of the 1993 cohort. Mothers (G2) reported G3 birthweight during the follow-up visit at adulthood. Multiple linear regression was used to obtain effect measures adjusted for confounders. The study included 1602 grandmothers (G1), mothers (G2), and grandchildren (G3). Prevalence of maternal (G1) smoking during pregnancy was 43% and mean G3 birthweight was 3118.9 g (SD: 608.8). Grandmother's smoking in the pregnancy was not associated with grandchild's birthweight. However, offspring of both G1 and G2 smokers had lower mean birthweight than those whose mother and grandmother did not smoke (adjusted β: - 223.05; 95% CI: - 415.16, - 32.76)., Conclusion: No significant association was observed between grandmother's smoking in the pregnancy and grandchild's birthweight. But it seems that grandmother's smoking in pregnancy has an effect on grandchild's birthweight when the mother also smoked in the pregnancy. ., What Is Known: • Most studies on the association of maternal tobacco smoking in pregnancy with offspring birthweight have been restricted to two generations, and an inverse association is well known., What Is New: • Besides to investigate whether grandmother's smoking during pregnancy reduces the grandchildren's birthweight, we examined whether this association varied according to maternal smoking during pregnancy., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Aims: Previous epidemiological evidence identified a concerning increase in behavioural problems among young children from 1997 to 2008 in Brazil. However, it is unclear whether behavioural problems have continued to increase, if secular changes vary between sociodemographic groups and what might explain changes over time. We aimed to monitor changes in child behavioural problems over a 22-year period from 1997 to 2019, examine changing social inequalities and explore potential explanations for recent changes in behavioural problems between 2008 and 2019., Methods: The Child Behaviour Checklist was used to compare parent-reported behavioural problems in 4-year-old children across three Brazilian birth cohorts assessed in 1997 (1993 cohort, n  = 633), 2008 (2004 cohort, n  = 3750) and 2019 (2015 cohort, n  = 577). Response rates across all three population-based cohorts were over 90%. Moderation analyses tested if cross-cohort changes differed by social inequalities (demographic and socioeconomic position), while explanatory models explored whether changes in hypothesized risk and protective factors in prenatal development (e.g., smoking during pregnancy) and family life (e.g., maternal depression and harsh parenting) accounted for changes in child behavioural problems from 2008 to 2019., Results: Initial increases in child behavioural problems from 1997 to 2008 were followed by declines in conduct problems (mean change = -2.75; 95% confidence interval [CI]: -3.56, -1.94; P  < 0.001), aggression (mean change = -1.84; 95% CI: -2.51, -1.17; P  < 0.001) and rule-breaking behaviour (mean change = -0.91; 95% CI: -1.13, -0.69 P  < 0.001) from 2008 to 2019. Sex differences in rule-breaking behaviour diminished during this 22-year period, whereas socioeconomic inequalities in behavioural problems emerged in 2008 and then remained relatively stable. Consequently, children from poorer and less educated families had higher behavioural problems, compared to more socially advantaged children, in the two more recent cohorts. Changes in measured risk and protective factors partly explained the reduction in behavioural problems from 2008 to 2019., Conclusions: Following a rise in child behavioural problems, there was a subsequent reduction in behavioural problems from 2008 to 2019. However, social inequalities increased and remained high. Continued monitoring of behavioural problems by subgroups is critical for closing the gap between socially advantaged and disadvantaged children and achieving health equity for the next generation.

Objective: We examined associations among serial measures of linear growth and relative weight with adult body composition., Design: Secondary data analysis of prospective birth cohort studies., Settings: Six birth cohorts from Brazil, Guatemala, India, the Philippines and South Africa., Participants: 4173 individuals followed from birth to ages 22-46 years with complete and valid weight and height at birth, infancy, childhood and adolescence, and body composition in adult life., Exposures: Birth weight and conditional size (standardised residuals of height representing linear growth and of relative weight representing weight increments independent of linear size) in infancy, childhood and adolescence., Primary Outcome Measures: Body mass index, fat mass index (FMI), fat-free mass index (FFMI), fat mass/fat-free mass ratio (FM/FFM), and waist circumference in young and mid-adulthood., Results: In pooled analyses, a higher birth weight and relative weight gains in infancy, childhood and adolescence were positively associated with all adult outcomes. Relative weight gains in childhood and adolescence were the strongest predictors of adult body composition (β (95% CI) among men: FMI (childhood: 0.41 (0.26 to 0.55); adolescence: 0.39 (0.27 to 0.50)), FFMI (childhood: 0.50 (0.34 to 0.66); adolescence: 0.43 (0.32 to 0.55)), FM/FFM (childhood: 0.31 (0.16 to 0.47); adolescence: 0.31 (0.19 to 0.43))). Among women, similar patterns were observed, but, effect sizes in adolescence were slightly stronger than in childhood. Conditional height in infancy was positively associated with FMI (men: 0.08 (0.03 to 0.14); women: 0.11 (0.07 to 0.16)). Conditional height in childhood was positively but weakly associated with women's adiposity. Site-specific and sex-stratified analyses showed consistency in the direction of estimates, although there were differences in their magnitude., Conclusions: Prenatal and postnatal relative weight gains were positive predictors of larger body size and increased adiposity in adulthood. A faster linear growth in infancy was a significant but weak predictor of higher adult adiposity., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)

Most research on the association between high body mass index (BMI) and working memory (WM) has been cross-sectional in design, limiting conclusions about long-term effects of overweight and obesity on WM. The aim of this study was to examine the association of BMI trajectory from 11 to 22 years with WM at 22 years of age. Data from the 1993 Pelotas (Brazil) Birth Cohort Study were analyzed ( N = 3,010). Information on BMI was collected at ages 11, 15, 18, and 22 years. Group-based trajectory modeling was used separately for each sex to identify BMI trajectories. Working Memory performance (Digit Span backward score) was examined at age 22. Multiple linear regression was used to assess the association between BMI trajectory from 11 to 22 years and WM at age 22. In both sexes, the trajectory groups were: stable normal weight, stable overweight, and stable obesity. In the adjusted analyses, women in the stable-obesity group had lower WM at 22 years (β = -.49; 95% CI: -0.75, -0.23; p < .001) than those in the stable-normal weight group. No associations were found between BMI trajectories and WM in men. This study may contribute to future investigations of possible explanatory avenues for the association between high BMI and WM.

Background: Zambia experienced a major decline in under-five mortality rates (U5MR), with one of the fastest declines in socio-economic disparities in sub-Saharan Africa in the last two decades. We aimed to understand the extent to which, and how, Zambia has reduced socio-economic inequalities in U5MR since 2000., Methods: Using nationally-representative data from Zambia Demographic Health Surveys (2001/2, 2007, 2013/14 and 2018), we examined trends and levels of inequalities in under-five mortality, intervention coverage, household water and sanitation, and fertility. This analysis was integrated with an in-depth review of key policy and program documents relevant to improving child survival in Zambia between 1990 and 2020., Results: The under-five mortality rate (U5MR) declined from 168 to 64 deaths per 1000 live births between 2001/2 and 2018 ZDHS rounds, particularly in the post-neonatal period. There were major reductions in U5MR inequalities between wealth, education and urban-rural residence groups. Yet reduced gaps between wealth groups in estimated absolute income or education levels did not simultaneously occur. Inequalities reduced markedly for coverage of reproductive, maternal, newborn and child health (RMNCH), malaria and human immunodeficiency virus interventions, but less so for water or sanitation and fertility levels. Several policy and health systems drivers were identified for reducing RMNCH inequalities: policy commitment to equity in RMNCH; financing with a focus on disadvantaged groups; multisectoral partnerships and horizontal programming; expansion of infrastructure and human resources for health; and involvement of community stakeholders and service providers., Conclusion: Zambia's major progress in reducing inequalities in child survival between the poorest and richest people appeared to be notably driven by government policies and programs that centrally valued equity, despite ongoing gaps in absolute income and education levels. Future work should focus on sustaining these gains, while targeting families that have been left behind to achieve the sustainable development goal targets., (© 2023. The Author(s).)

Introduction: No multi-country analysis described patterns and inequalities for the brand-new feeding indicators proposed by WHO/UNICEF: zero consumption of vegetables and fruits (ZVF) and consumption of eggs and/or flesh (EFF). Our aim was to describe patterns in the prevalence and social inequalities of ZVF and EFF among children aged 6-23 months in low-and middle-income countries., Methods: Data from nationally representative surveys (2010-2019) in 91 low-and middle-income countries were used to investigate within-country disparities in ZVF and EFF by place of residence, wealth quintiles, child sex and child age. The slope index of inequality was used to assess socioeconomic inequalities. Analyses were also pooled by World Bank income groups., Results: The prevalence of ZVF was 44.8% and it was lowest in children from upper-middle income countries, from urban areas, and those 18-23 months. The slope index of inequality showed that socioeconomic inequalities in the prevalence of ZVF were higher among poor children in comparison to richest children (mean SII = -15.3; 95%CI: -18.5; -12.1). Overall, 42.1% of children consumed egg and/or flesh foods. Being a favorable indicator, findings for EFF were generally in the opposite direction than for ZVF. The prevalence was highest in children from upper-middle income countries, from urban areas, and those 18-23 months of age. The slope index of inequality showed pro-rich patterns in most countries (mean SII = 15.4; 95%CI: 12.2; 18.6)., Discussion: Our findings demonstrate that inequalities exist in terms of household wealth, place of residence, and age of the child in the prevalence of the new complementary feeding indicators. Moreover, children from low-and lower-middle countries had the lowest consumption of fruits, vegetables, eggs, and flesh foods. Such findings provide new insights towards effective approaches to tackle the malnutrition burden through optimal feeding practices., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Ricardo, Gatica-Domínguez, Neves, Vaz, Barros and Wehrmeister.)