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Background: The current techniques for determining carbon and nitrogen content to provide information about the nutritional status of plants are time-consuming and expensive. For this reason, the objective of this study was to develop an analytical method for the direct and simultaneous determination of nitrogen and carbon elemental content in soybean leaves using near-infrared spectroscopy and compare the performance of conventional (1100-2500 nm spectral range) and portable equipment (1100-1700 nm spectral range). Partial least-squares regression models were developed using 27 soybean leaf samples collected during the 2021 harvest and applied for the simultaneous determination of carbon and nitrogen in 13 samples collected during the 2022 harvest., Results: The root-mean-square error of prediction values for nitrogen and carbon were low (2.42 g kg -1 and 4.37 g kg -1 respectively) for the benchtop method yielded low but higher for the portable method (3.82 g kg -1 and 10.7 g kg -1 respectively). The benchtop method did not show significant differences when compared with the reference method for determining nitrogen and carbon. In contrast, the portable methodology showed potential as a screening method for determining nitrogen levels, particularly in fieldwork., Conclusion: The methodologies evaluated in this study were implemented and evaluated under real crop monitoring conditions, using independent sets of calibration and prediction samples. Their utilization enables the acquisition of cost-effective, safe analytical data aligning with the principles of green analytical chemistry. © 2023 Society of Chemical Industry., (© 2023 Society of Chemical Industry.)

Background: Regular physical activity (PA) is an important behavior in improving sleep health. However, the short-term effects of PA on sleep are still controversial. This study aimed to verify the effect of different intensities of PA practiced in different periods of the day on the subsequent sleep night in a population-based cohort of young adults., Methods: Prospective analyses were conducted for PA performed during the day and its effect on the following sleep night using data from the 22-year follow-up of the 1993 Pelotas Birth Cohort in Brazil (mean age of participants = 22.6 years). Wrist-worn accelerometry was used to measure both PA and sleep parameters. Regarding intensity, we analyzed the sleep effect of light PA (LPA), moderate PA, and vigorous PA, stratified by sex. Sleep variables were sleep time window (STW; the difference between sleep onset and sleep end), total sleep time (TST; the sum of minutes classified as sleep in STW), and sleep percent (SP; SP = (TST/STW); expressed in percentage). We performed generalized estimating equations using Stata software., Results: The means of STW, TST, and SP were 443.6 min/day, 371.1 min/day, and 84%, respectively. Time spent in moderate PA and vigorous PA in the morning and afternoon was not associated with sleep variables. Among men, 10 min/day of morning LPA increased TST by 2.56 min/day. Among women, 10 min/day of morning LPA increased SP by 0.15 percentage points. Afternoon LPA also increased SP by 0.09 percentage points for women. Night PA seems to have an inverse effect on sleep variables for any intensity and both sexes., Conclusion: The effect of PA on sleep health is intrinsically related to the period of the day in which it is performed. The effect magnitude is different between sexes. For better sleep health, it is preferable that PA be performed during the day., (Copyright © 2020. Production and hosting by Elsevier B.V.)

Objectives: Different screen time activities may be related to sleep, physical activity, and sedentary behavior. The objective was to examine the association between self-reported screen time activities and accelerometer-measured 24-h movement behaviors., Study Design: This was a cross-sectional study., Methods: Adolescents' (n = 718, 50.4% girls, 16 years) sleep duration, sedentary behavior, light-intensity physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) were estimated with wrist-worn accelerometry. Time spent on screen time activities related to studying, working, watching videos, playing video games, and using social media was self-reported. Multilevel linear regressions were used to test the association between screen time with sleep, sedentary behavior, and physical activity., Results: Boys and girls slept 6.4 and 6.7 h per night, spent 10.4 and 10.1 h/d in sedentary behavior, spent 4.0 and 4.4 h/d in LPA, and spent 34.7 and 29.2 min/d in MVPA, respectively. Studying was inversely related to LPA and MVPA. Working was inversely related to sleep and positively related to LPA. Watching videos was associated with lower LPA and MVPA. For boys, videogames were associated with increased sedentary behavior and lower LPA and MVPA. For girls, studying and/or using social media were associated with lower LPA and MVPA., Conclusions: Indicators of screen time were associated with different accelerometer-measured 24-h movement behaviors in this sample of Brazilian adolescents., (Copyright © 2021 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Background: Physical activity (PA) during pregnancy is associated with several benefits in maternal and child outcomes, and its relationship with preterm birth is still conflicting. This study aims to examine the associations between PA during pregnancy and occurrence of preterm birth., Methods: PA was assessed by questionnaire (for each trimester) and accelerometry (second trimester) in women enrolled in a birth cohort study that started during pregnancy and included births that occurred between January 1 and December 31, 2015. Gestational age was based on the last menstrual period and ultrasonography. All deliveries before 37 weeks of gestation were considered preterm births. A Poisson regression model was used to measure associations controlling for potential confounders., Results: PA information was available for 4163 women and 13.8% of births were preterm. A total of 15.8% of women were engaged in PA during pregnancy. Multivariate analysis showed that only PA performed in the third trimester of pregnancy (prevalence ratio = 0.58; 95% confidence interval, 0.36-0.96) was associated with the outcome., Conclusions: PA performed in the third trimester of pregnancy was associated with a protection to preterm birth. Pregnant women should be counseled to engage in PA to lower the risk of premature delivery.

Objective: To investigate whether sub-Saharan African countries have succeeded in reducing wealth-related inequalities in the coverage of reproductive, maternal, newborn and child health interventions., Methods: We analysed survey data from 36 countries, grouped into Central, East, Southern and West Africa subregions, in which at least two surveys had been conducted since 1995. We calculated the composite coverage index, a function of essential maternal and child health intervention parameters. We adopted the wealth index, divided into quintiles from poorest to wealthiest, to investigate wealth-related inequalities in coverage. We quantified trends with time by calculating average annual change in index using a least-squares weighted regression. We calculated population attributable risk to measure the contribution of wealth to the coverage index., Findings: We noted large differences between the four regions, with a median composite coverage index ranging from 50.8% for West Africa to 75.3% for Southern Africa. Wealth-related inequalities were prevalent in all subregions, and were highest for West Africa and lowest for Southern Africa. Absolute income was not a predictor of coverage, as we observed a higher coverage in Southern (around 70%) compared with Central and West (around 40%) subregions for the same income. Wealth-related inequalities in coverage were reduced by the greatest amount in Southern Africa, and we found no evidence of inequality reduction in Central Africa., Conclusion: Our data show that most countries in sub-Saharan Africa have succeeded in reducing wealth-related inequalities in the coverage of essential health services, even in the presence of conflict, economic hardship or political instability., ((c) 2020 The authors; licensee World Health Organization.)

Background: The Sustainable Development Goals (SDGs) include specific targets for family planning (SDG 3.7) and birth attendance (SDG 3.1.2), and require analyses disaggregated by age and other dimensions of inequality (SDG 17.18). We aimed to describe coverage with demand for family planning satisfied with modern methods (DFPSm) and institutional delivery in low- and middle-income countries across the reproductive age spectrum. We attempted to identify a typology of patterns of coverage by age and compare their distribution according to geographic regions, World Bank income groups and intervention coverage levels., Methods: We used Demographic and Health Survey and Multiple Indicator Cluster Surveys. For DFPSm, we considered the woman's age at the time of the survey, whereas for institutional delivery we considered the woman's age at birth of the child. Both age variables were categorized into seven groups of 5 year-intervals, 15-19 up to 45-49. Five distinct patterns were identified: (a) increasing coverage with age; (b) similar coverage in all age groups; (c) U-shaped; (d) inverse U-shaped; and (e) declining coverage with age. The frequency of the five patterns was examined according to UNICEF regions, World Bank income groups, and coverage at national level of the given indicator., Results: We analyzed 91 countries. For DFPSm, the most frequent age patterns were inverse U-shaped (53%, 47 countries) and increasing coverage with age (41%, 36 countries). Inverse-U shaped patterns for DFPSm was the commonest pattern among lower-middle income countries, while low- and upper middle-income countries showed a more balanced distribution between increasing with age and U-shaped patterns. In the first and second tertiles of national coverage of DFPSm, inverse U-shaped was observed in more than half of countries. For institutional delivery, declining coverage with age was the prevailing pattern (44%, 39 countries), followed by similar coverage across age groups (39%, 35 countries). Most (79%) upper-middle income countries showed no variation by age group while most low-income countries showed declining coverage with age (71%)., Conclusion: Large inequalities in DFPSm and institutional delivery were identified by age, varying from one intervention to the other. Policy and programmatic approaches must be tailored to national patterns, and in most cases older women and adolescents will require special attention due to lower coverage and because they are at higher risk for maternal mortality and other poor obstetrical outcomes.

Objective: To describe the sleep time window (STW), total sleep time (TST), and sleep percent [SP = (TST/STW) × 100] by accelerometry in a population-based young adult cohort in Brazil., Methods: Cross-sectional analysis with a 22-year sample (N = 2462). Sleep variables were measured using an accelerometer. The devices were worn on the non-dominant wrist for approximately seven days. A raw data analysis using the GGIR package was performed. The following sleep variables were extracted: TST, STW, and SP. Linear regression was used to adjust averages. All analyses were stratified according to sex. A comparison between weekday and weekend averages was also conducted., Results: The means of TST, STW, and SP for men were 5.9 h, 7.1 h, and 83.1%, respectively. For women, the means of TST, STW, and SP were 6.4 h, 7.6 h, and 84.6%, respectively. Women presented a higher means of all outcomes compared to men (p < 0.001). After adjusting for both sexes, white skin color and not working or studying were associated with higher TST. Individuals not working or studying presented higher means of STW and lower sleep SP. Women with children who were less than two years of age presented lower values of three evaluated outcomes. Regarding behavior and health condition variables, obesity was associated with lower STW only for men. Physical activity was associated with higher SP and risk drinking with lower TST and STW only for women., Conclusion: Differences between sexes were observed in TST, STW, and SP. In all outcomes women presented a higher means. Socioeconomic variables were associated with both sexes, but having children and behavior/health conditions differed between sexes., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Subnational inequalities have received limited attention in the monitoring of progress towards national and global health targets during the past two decades. Yet, such data are often a critical basis for health planning and monitoring in countries, in support of efforts to reach all with essential interventions. Household surveys provide a rich basis for interventions coverage indicators on reproductive, maternal, newborn and child health (RMNCH) at the country first administrative level (regions or provinces). In this paper, we show the large subnational inequalities that exist in RMNCH coverage within 39 countries in sub-Saharan Africa, using a composite coverage index which has been used extensively by Countdown to 2030 for Women's, Children's and Adolescent's Health. The analyses show the wide range of subnational inequality patterns such as low overall national coverage with very large top inequality involving the capital city, intermediate national coverage with bottom inequality in disadvantaged regions, and high coverage in all regions with little inequality. Even though nearly half of the 34 countries with surveys around 2004 and again around 2015 appear to have been successful in reducing subnational inequalities in RMNCH coverage, the general picture shows persistence of large inequalities between subnational units within many countries. Poor governance and conflict settings were identified as potential contributing factors. Major efforts to reduce within-country inequalities are required to reach all women and children with essential interventions., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Conflict adversely impacts health and health systems, yet its effect on health inequalities, particularly for women and children, has not been systematically studied. We examined wealth, education and urban/rural residence inequalities for child mortality and essential reproductive, maternal, newborn and child health interventions between conflict and non-conflict low-income and middle-income countries (LMICs)., Methods: We carried out a time-series multicountry ecological study using data for 137 LMICs between 1990 and 2017, as defined by the 2019 World Bank classification. The data set covers approximately 3.8 million surveyed mothers (15-49 years) and 1.1 million children under 5 years including newborns (<1 month), young children (1-59 months) and school-aged children and adolescents (5-14 years). Outcomes include annual maternal and child mortality rates and coverage (%) of family planning services, 1+antenatal care visit, skilled attendant at birth (SBA), exclusive breast feeding (0-5 months), early initiation of breast feeding (within 1 hour), neonatal protection against tetanus, newborn postnatal care within 2 days, 3 doses of diphtheria, pertussis and tetanus vaccine, measles vaccination, and careseeking for pneumonia and diarrhoea., Results: Conflict countries had consistently higher maternal and child mortality rates than non-conflict countries since 1990 and these gaps persist despite rates continually declining for both groups. Access to essential reproductive and maternal health services for poorer, less educated and rural-based families was several folds worse in conflict versus non-conflict countries., Conclusions: Inequalities in coverage of reproductive / maternal health and child vaccine interventions are significantly worse in conflict-affected countries. Efforts to protect maternal and child health interventions in conflict settings should target the most disadvantaged families including the poorest, least educated and those living in rural areas., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Universal Health Coverage (UHC) is a critical goal under the Sustainable Development Goals (SDGs) for health. Achieving this goal for reproductive, maternal, newborn and child health (RMNCH) service coverage will require an understanding of national progress and how socioeconomic and demographic subgroups of women and children are being reached by health interventions., Methods: We accessed coverage databases produced by the International Centre for Equity in Health, which were based on reanalysis of Demographic and Health Surveys, Multiple Indicator Cluster Surveys and Reproductive and Health Surveys. We limited the data to 58 countries with at least two surveys since 2008. We fitted multilevel linear regressions of coverage of RMNCH, divided into four main components-reproductive health, maternal health, child immunisation and child illness treatment-to estimate the average annual percentage point change (AAPPC) in coverage for the period 2008-2017 across these countries and for subgroups defined by maternal age, education, place of residence and wealth quintiles. We also assessed change in the pace of coverage progress between the periods 2000-2008 and 2008-2017., Results: Progress in RMNCH coverage has been modest over the past decade, with statistically significant AAPPC observed only for maternal health (1.25, 95% CI 0.90 to 1.61) and reproductive health (0.83, 95% CI 0.47 to 1.19). AAPPC was not statistically significant for child immunisation and illness treatment. Progress, however, varied largely across countries, with fast or slow progressors spread throughout the low-income and middle-income groups. For reproductive and maternal health, low-income and lower middle-income countries appear to have progressed faster than upper middle-income countries. For these two components, faster progress was also observed in older women and in traditionally less well-off groups such as non-educated women, those living in rural areas or belonging to the poorest or middle wealth quintiles than among groups that are well off. The latter groups however continue to maintain substantially higher coverage levels over the former. No acceleration in RMNCH coverage was observed when the periods 2000-2008 and 2008-2017 were compared., Conclusion: At the dawn of the SDGs, progress in coverage in RMNCH remains insufficient at the national level and across equity dimensions to accelerate towards UHC by 2030. Greater attention must be paid to child immunisation to sustain the past gains and to child illness treatment to substantially raise its coverage across all groups., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The aim of this study is to describe objectively measured physical activity (PA) and its correlates in one-year-old children., Methods: The current study includes participants from the 2015 Pelotas (Brazil) birth cohort. At age one, PA was assessed in a 24-h protocol during 4 days with a wrist-attached accelerometer (ActiGraph, wGT3X-BT), from which two complete days of data were analyzed, with 5-s epochs., Results: A total of 2974 individuals provided valid accelerometry data. Infants able to walk independently spent on average 19 h per day below 50 mg of acceleration (including sleep time), and those who could not walk spent on average 21 h in this intensity category. Girls spent approximately 10 min more than boys below 50 mg daily in both walking status categories, and less activity than boys on higher intensity categories. Boys and infants whose mothers were more physically active during pregnancy presented more acceleration, regardless of walking status. Among infants who could walk by themselves, those with mothers with one to eight schooling years; adequate length-for-age (z-score); not attending daycare; and more physically active fathers also showed higher levels of acceleration., Conclusions: Our findings demonstrate higher levels of PA among boys and those children with higher maternal PA during pregnancy, regardless of walking status. Also, among infants able to independently walk, 1-8 years of maternal schooling, adequate length-for-age (z-score), no daycare attendance and higher paternal PA are positive correlates of objectively measured PA early in life.

Background: Objective methods to measure physical activity (PA) can lead to better cross-cultural comparisons, monitoring temporal PA trends, and measuring the effect of interventions. However, when applying this technology in field-work, the accelerometer data processing is prone to methodological issues. One of the most challenging issues relates to standardizing total wear time to provide reliable data across participants. It is generally accepted that at least 4 complete days of accelerometer wear represent a week for adults. It is not known if this same assumption holds true for pregnant women., Aim: We assessed the optimal number of days needed to obtain reliable estimates of overall PA and moderate-to-vigorous physical activity (MVPA) during the 2nd trimester in pregnancy using a raw triaxial wrist-worn accelerometer., Methods: Cross-sectional analyses were carried out in the antenatal wave of the 2015 Pelotas (Brazil) Birth Cohort Study. Participants wore the wrist ActiGraph wGT3X-BT accelerometer for seven consecutive days. The daily average acceleration, which indicated overall PA, was measured as milli-g (mg), and time spent in MVPA (minutes/day) was analyzed in 5-minute bouts. ANOVA and Kruskal-Wallis tests were used to compare variability across days of the week. Bland-Altman plots and the Spearman-Brown Prophecy Formula were applied to determine the reliability coefficient associated with one to seven days of measurement., Results: Among 2,082 pregnant women who wore the accelerometer for seven complete days, overall and MVPA were lower on Sundays compared to other days of the week. Reliability of > = 0.80 to evaluate overall PA was reached with at least three monitoring days, whereas seven days were needed to estimate reliable measures of MVPA., Conclusions: Our findings indicate that obtaining one week of accelerometry in adults is appropriate for pregnant women, particularly to obtain differences on weekend days and reliably estimate overall PA and MVPA., Competing Interests: The authors have declared that no competing interests exist.

Importance: Interventions to reduce postpartum depression have mainly focused on enhancing screening to increase treatment rates among women. Preventive approaches are timely from a population health perspective, particularly in low- and middle-income countries where access to mental health services is limited., Objective: To assess the efficacy of regular exercise during pregnancy on the prevention of postpartum depression., Design, Setting, and Participants: This randomized clinical trial examines a prespecified secondary outcome of the Physical Activity for Mothers Enrolled in Longitudinal Analysis (PAMELA) Study, a parallel-group, randomized clinical trial. This trial was nested in the 2015 Pelotas (Brazil) Birth Cohort Study. Between August 27, 2014, and March 14, 2016, pregnant women between 16 and 20 weeks of gestation with no contraindications to exercise were randomized 1:2 to the intervention group or control group via computer-generated randomization using a block size of 9. Data were analyzed from March 7 to May 2, 2018., Interventions: Participants assigned to the intervention were engaged in a 16-week supervised exercise program including aerobic and resistance training delivered in 60-minute sessions 3 times per week., Main Outcomes and Measures: Postpartum depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale 3 months after birth. A score of 12 or greater was defined as screening positive for postpartum depression. Primary analysis was performed on a complete case basis (90% of participants who had the primary end point ascertained)., Results: A total of 639 participants (mean [SD] age, 27.1 [5.1] years; mean gestational age, 16.5 [1.5] weeks) were randomly assigned to the intervention group (n = 213) or control group (n = 426). Compliance with the protocol, defined as having engaged in at least 70% of exercise sessions, was low (40.4%). There was no significant difference in mean (SD) scores for postpartum depression between the intervention group (4.8 [3.7]) and the control group (5.4 [4.1]) (mean difference, -0.6; 95% CI, -1.3 to 0.1). There was also no significant difference in rates of postpartum depression between the intervention group (12 of 192 [6.3%]) and the control group (36 of 387 [9.3%]) (odds ratio, 0.65; 95% CI, 0.33-1.28). Instrumental variable analysis indicated that noncompliance may have attenuated the effect estimates obtained in the primary analysis., Conclusions and Relevance: Moderate-intensity exercise during pregnancy did not lead to significant reductions in postpartum depression. However, noncompliance to the intervention protocol was substantial and may have led to underestimations of the possible benefits of exercise. The point estimates for this study are in the same direction as the previous randomized clinical trial on this topic. Future studies on how to promote regular exercise during pregnancy to improve compliance, particularly targeting young and less educated women, are warranted before further trials are undertaken., Trial Registration: ClinicalTrials.gov Identifier: NCT02148965.

Introduction: Rapid urbanisation is one of the greatest challenges for Sustainable Development Goals. We compared socioeconomic inequalities in urban and rural women's access to skilled birth attendance (SBA) and to assess whether the poorest urban women have an advantage over the poorest rural women., Methods: The latest available surveys (DemographicHealth Survey, Multiple Indicators Cluster Surveys) of 88 countries since 2010 were analysed. SBA coverage was calculated for 10 subgroups of women according to wealth quintile and urban-rural residence. Poisson regression was used to test interactions between wealth quintile index and urban-rural residence on coverage. The slope index of inequality (SII) and concentration index were calculated for urban and rural women., Results: 37 countries had surveys with at least 25 women in each of the 10 cells. Average rural average coverage was 72.8 % (ranging from 17.2% % in South Sudan to 99.9 % in Jordan) and average urban coverage was 80.0% (from 23.6% in South Sudan to 99.7% in Guyana. In 33 countries, rural coverage was lower than urban coverage; the difference was significant (p<0.05) in 15 countries. The widest urban/rural coverage gap was in the Central African Republic (32.8% points; p<0.001). Most countries showed narrower socioeconomic inequalities in urban than in rural areas. The largest difference was observed in Panama, where the rural SII was 77.1% points larger than the urban SII (p<0.001). In 31 countries, the poorest rural women had lower coverage than the poorest urban women; in 20 countries, these differences were statistically significant (p<0.05)., Conclusion: In most countries studied, urban areas present a double advantage of higher SBA coverage and narrower wealth-related inequalities when compared with rural areas. Studies of the intersectionality of wealth and residence can support policy decisions about which subgroups require special efforts to reach universal coverage., Competing Interests: Competing interests: None declared.

Objective methods to measure physical activity (PA) have become available and widely used given the high degree of precision to evaluate PA. However, few studies have used accelerometers to measure PA during pregnancy, especially in low- and middle-income countries. We assessed overall PA, moderate, vigorous, and moderate-to-vigorous physical activity (MVPA) objectively measured among pregnant women and their correlates in a population-based study. PA was assessed for seven consecutive days using a raw triaxial wrist-worn accelerometer in women interviewed around 16 and 24 weeks of gestation in the 2015 Pelotas (Brazil) Birth Cohort Study. The average acceleration, which expresses overall PA, was presented in milli-g (1 mg = 0.001 g), and average time (min/day) spent in MVPA (>100 mg) was also analyzed in 5- and 10-min bouts. Analyses were performed using linear regression. In total, 2317 women were included in the analyses. Overall PA was 27.6 mg. Pregnant women spent on average 14 min/day in MVPA and 0.4 min in vigorous PA. Time spent in MVPA and total PA were inversely associated with years in school and income, and were lower among women receiving advice to not exercise. MVPA was also inversely associated with age, lower among women living with a partner, and higher among non-white women. The study indicated low levels of PA among pregnant women. The identified correlates may provide a framework to better understand factors influencing PA during pregnancy and thus inform future interventions., (© 2018 The Authors. Scandinavian Journal of Medicine & Science In Sports published by John Wiley & Sons Ltd.)

Background: Maternal physical activity (PA) during pregnancy could affect offspring's neurodevelopment. However, studies in humans in early childhood are scarce and show inconsistent results. We aimed to review the literature on the association between physical activity during pregnancy and offspring neurodevelopment., Methods: LILACS, MEDLINE and Web of Science were searched for studies published since 1977. Original studies conducted in humans, without language, country, or study type restriction, were eligible. Information on the study methodology like study design, sample size, PA exposure and neurodevelopment assessment, covariates, and the effect measure were extracted from the selected articles., Results: From 802 non-duplicated titles initially located, 6 articles were selected and included (one randomised clinical trial and 5 cohort studies). The instruments used to measure PA during pregnancy and neurodevelopment varied between the studies. PA was self-reported at different gestational ages and neurodevelopment was assessed prospectively in offspring aged 1-8 years old. Only the randomised clinical trial found no effect of PA over offspring neurodevelopment. Cohort studies found a positive association between PA practice during pregnancy and offspring neurodevelopment., Conclusions: These findings suggest that leisure-time physical activity practice may have positive association with language offspring's neurodevelopment in the age range of 18 from 60 months., (© 2018 John Wiley & Sons Ltd.)

Purpose: This study aimed to evaluate methods for infants' physical activity measurement based on accelerometry, including the minimum number of measurement days and placement of a wrist or ankle device. We also evaluated the acceptability of the device among infants and mothers., Methods: A cross-sectional mixed-methods study was conducted on a convenience sample of 90 infants. Physical activity was measured using the Actigraph GT3X+ accelerometer placed on the wrist and/or ankle for 7 consecutive days (worn for 24 h), and a qualitative interview was performed to verify acceptability. The intraclass correlation coefficient (ICC) method and the Bland and Altman's dispersion diagram were used to verify the minimum number of measurement days. All analyses were stratified by walking status., Results: The mean (SD) age was 12.9 (1.70) months; the mean acceleration varied between 25.8 mg (95% confidence interval (CI), 14.3-52.7) and 27.3 mg (95% CI, 17.9-44.5) using the wrist placement, and between 24.9 mg (95% CI, 10.6-48.4) and 26.2 mg (95% CI, 11.7-65.6) using the ankle placement. The ICC results showed a lower acceleration variability between days among infants incapable of walking; they achieved an ICC of 0.80 with 1 d of measurement in both placements. Among those capable of walking, the minimum number of days to achieve an ICC of 0.80 was 2 d measured at the wrist (0.85; 95% CI, 0.71-0.93) and 3 d measured at the ankle (0.92; 95% CI, 0.84-0.96). The qualitative results pointed to the wrist placement as the preferred placement among the overall sample., Conclusions: Two and three measurement days with the accelerometer placed on the wrist and ankle, respectively, seemed to adequately represent a week of measurement. The accelerometer placed on the wrist had better acceptance by the infants and mothers.

Background: Having high-quality data available by 2020, disaggregated by income, is one of the Sustainable Development Goals (SGD). We explored how well coverage with skilled birth attendance (SBA) is predicted by asset-based wealth quintiles and by absolute income., Methods: We used data from 293 national surveys conducted in 100 low and middle-income countries (LMICs) from 1991 to 2014. Data on household income were computed using national income levels and income inequality data available from the World Bank and the Standardized World Income Inequality Database. Multivariate regression was used to explore the predictive capacity of absolute income compared to the traditional measure of quintiles of wealth index., Results: The mean SBA coverage was 68.9% (SD: 24.2), compared to 64.7% (SD: 26.6) for institutional delivery coverage. Median daily family income in the same period was US$ 6.4 (IQR: 3.5-14.0). In cross-country analyses, log absolute income predicts 51.5% of the variability in SBA coverage compared to 22.0% predicted by the wealth index. For within-country analysis, use of absolute income improved the understanding of the gap in SBA coverage among the richest and poorest families. Information on income allowed identification of countries - such as Burkina Faso, Cambodia, Egypt, Nepal and Rwanda - which were well above what would be expected solely from changes in income., Conclusion: Absolute income is a better predictor of SBA and institutional delivery coverage than the relative measure of quintiles of wealth index and may help identify countries where increased coverage is likely due to interventions other than increased income.

Most of calibration studies based on accelerometry were developed using count-based analyses. In contrast, calibration studies based on raw acceleration signals are relatively recent and their evidences are incipient. The aim of the current study was to systematically review the literature in order to summarize methodological characteristics and results from raw data calibration studies. The review was conducted up to May 2017 using four databases: PubMed, Scopus, SPORTDiscus and Web of Science. Methodological quality of the included studies was evaluated using the Landis and Koch's guidelines. Initially, 1669 titles were identified and, after assessing titles, abstracts and full-articles, 20 studies were included. All studies were conducted in high-income countries, most of them with relatively small samples and specific population groups. Physical activity protocols were different among studies and the indirect calorimetry was the criterion measure mostly used. High mean values of sensitivity, specificity and accuracy from the intensity thresholds of cut-point-based studies were observed (93.7%, 91.9% and 95.8%, respectively). The most frequent statistical approach applied was machine learning-based modelling, in which the mean coefficient of determination was 0.70 to predict physical activity energy expenditure. Regarding the recognition of physical activity types, the mean values of accuracy for sedentary, household and locomotive activities were 82.9%, 55.4% and 89.7%, respectively. In conclusion, considering the construct of physical activity that each approach assesses, linear regression, machine-learning and cut-point-based approaches presented promising validity parameters., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background: To describe overall physical activity prevalence measured by the Global Physical Activity Questionnaire as well as inequalities in leisure-time physical activity among Brazilian adults (15 y and older)., Methods: Data from the Brazilian Survey on Medicine Access, Utilization, and Rational Use of Medicines were analyzed. The study was carried out between September 2013 and February 2014. Physical activity was measured through Global Physical Activity Questionnaire and classified according to the recommendations of the World Health Organization. Additional analysis determined the contribution of each physical activity domain to the total amount of physical activity. Inequalities in terms of sex, age, and socioeconomic position were explored., Results: About one-third of the participants (37.1%; 95% confidence interval, 35.5-38.8) were physically inactive. Work-based activities were responsible for 75.7% of the overall physical activity. The prevalence of participants achieving physical activity guidelines considering only leisure-time activities was 17.8% (95% confidence interval, 16.7-19.2). Females and older participants were less active than their counterparts for both overall and leisure-time physical activity; socioeconomic status was positively associated to leisure-time physical activity., Conclusions: Major overall physical activity is attributed to work-related physical activity. Leisure-time physical activity, a key domain for public health, presents important gender and socioeconomic inequalities.

Purpose: The aims of this study were to (i) examine gender differences in physical inactivity in countries with different levels of Human Development Index (HDI); and (ii) assess whether small changes in the prevalence of inactivity in women could achieve the World Health Organization's (WHO) global inactivity target., Methods: Data on inactivity were extracted for 142 countries for the year 2010 from the WHO Data Repository. Data for HDI were obtained for the year 2010 from the United Nations Development Program. Absolute and relative gender differences were calculated for countries according to four HDI categories. The potential effects of increasing women's activity levels on achievement of the WHO physical inactivity target were computed., Results: Overall inactivity prevalence was higher in women (27%) than in men (20%). Women were more inactive than men in all except eight countries. Absolute gender differences [median 7.5% (range -10.1 to 33.2)] did not vary by HDI category, but there was a small negative correlation between relative gender difference in inactivity and HDI (rho -0.19; p = 0.02), which was mostly influenced by three outlier countries with low HDI. A decrease in inactivity levels of 4.8% points among women across the world would achieve the WHO target of reducing global levels of inactivity by 10%., Conclusion: Gender differences in the prevalence of physical inactivity were highly variable, both within and across categories of HDI. Interventions which result in small changes in inactivity prevalence in women would achieve the 2025 WHO global target for inactivity, without any change to the prevalence in men.

Background: Global stunting prevalence has been nearly halved between 1990 and 2016, but it remains unclear whether this decline has benefited poor and rural populations within low- and middle-income countries (LMICs)., Objective: We assessed time trends in stunting among children <5 y of age (under-5) according to household wealth and place of residence in 67 LMICs., Methods: Stunting prevalence was analyzed in 217 nationally representative Demographic and Health Surveys and Multiple Indicator Cluster Surveys from 67 countries with ≥2 surveys between 1993 and 2014. National estimates were stratified by wealth and area of residence, comparing the poorest 40% with the wealthiest 60%, and those residing in urban and rural areas. Time trends were calculated for LMICs by using multilevel regression models weighted by under-5 population, with stratification by wealth and by residence. Trends in absolute (slope index of inequality; SII) and relative (concentration index; CIX) inequalities were calculated., Results: Mean prevalences in 1993 were 53.7% in low-income and 48.2% in middle-income countries, with annual average linear declines of 0.76 and 0.72 percentage points (pp), respectively. Although similar slopes of declines were observed for the poorest 40% and wealthiest 60% groups in all countries (0.78 and 0.74 pp, respectively), absolute and relative inequalities increased over time in low-income countries (SII increased from -19.3% in 1993 to -23.7% in 2014 and CIX increased from -6.2% to -10.8% in the same period). In middle-income countries, socioeconomic inequalities remained stable. Overall, stunting prevalence decreased more rapidly among rural than for urban children (0.78 and 0.55 pp, respectively)., Conclusions: The prevalence of stunting is decreasing. Poor-rich gaps are stable in middle-income countries and slightly increasing in low-income countries. Rural-urban inequalities are decreasing over time.

Aim: Development of functionalized nanocomposites containing AgNPs-PVP-Glucantime ® to evaluate their leishmanicidal activity as a novel method for improving the pharmacological properties of the drug Glucantime ® against extracellular promastigotes and intracellular amastigotes of Leishmania amazonensis in vitro to treat cutaneous leishmaniasis., Materials & Methods: The silver nanoparticles and nanocomposites prepared containing silver nanoparticles, polyvinylpyrrolidone and different amounts of Glucantime were characterized using transmission electron microscopy, x-ray diffraction, energy-dispersive x-ray spectroscopy and ζ potential analysis; in addition, the in vitro cytotoxicity was evaluated., Results: The nanocomposites showed an inhibitory effect on the cellular viability of promastigote forms, with values of 47.06, 51.71 and 65.67% for nanocomposite 1 , nanocomposite 2 and nanocomposite 3 , respectively, as well as a dose-dependent decrease in the infectivity index, with values of 33.33 and 23% for nanocomposite 2 and nanocomposite 3 , respectively., Conclusion: The proposed nanocomposite reveals leishmanial activity and the absence of cytotoxicity in macrophages. Further investigations will be conducted in vivo.

Background: Women are encouraged to be physically active during pregnancy. Despite available evidence supporting antenatal physical activity to bring health benefits for both the mother and child, the most effective way to prevent some maternal and fetal outcomes is still unclear. The purpose of this study was to evaluate the efficacy of an exercise intervention to prevent negative maternal and newborn health outcomes., Methods: A randomized controlled trial (RCT) nested into the 2015 Pelotas (Brazil) Birth Cohort Study was carried-out with 639 healthy pregnant women, 213 in the intervention group (IG) and 426 in the control (CG) group. An exercise-based intervention was conducted three times/week for 16 weeks from 16-20 to 32-36 weeks' gestation. The main outcomes were preterm birth and pre-eclampsia. Gestational age was calculated based on several parameters, including routine ultrassounds and/or last menstrual period and categorized as < 37 weeks and ≥ 37 weeks for evaluation of preterm birth. Pre-eclampsia was self-reported. Secondary outcomes were gestational weight gain, gestational diabetes, birth weight, infant length, and head circumference. Analyses were performed by intention-to-treat (ITT) and per protocol (70% of the 48 planned exercise sessions). Odds ratio were derived using unconditional logistic regression., Results: The IG and CG did not differ at baseline regarding their mean age (27.2 years ± 5.3 vs. 27.1 years ± 5.7) and mean pre-pregnancy body mass index (25.1 ± 3.9 vs. 25.2 ± 4.1 kg/m 2 ). The mean adherence to the exercise intervention was 27 ± 17.2 sessions (out of a potential 48) with 40.4% attending > = 70% of the recommended exercise sessions. A total of 594 participants (IG:198; CG: 396) were included in the ITT and 479 (IG: 83; CG: 396) were included in the per protocol analyses. There were no significant differences in the incidence of preterm birth and pre-eclampsia between groups in the ITT and per protocol analysis. There were also no differences between the two groups in mean gestational weight gain, gestational diabetes, birth weight, infant length, and head circumference., Conclusions: While the RCT did not support the benefits of exercise performed during pregnancy on preeclampsia and preterm birth, the exercise program also did not present adverse impacts on newborn health. Our findings may contribute to promote intervention strategies that motivate health providers to encourage pregnant women to be more physically active., Trial Registration: Clinicaltrials.gov identifier: NCT02148965 , registered on 22 May 2014.

Objective: To assess associations between national characteristics, including governance indicators, with a proxy for universal health coverage in reproductive, maternal, newborn and child health (RMNCH)., Design: Ecological analysis based on data from national standardised cross-sectional surveys., Setting: Low-income and middle-income countries with a Demographic and Health Survey or a Multiple Indicator Cluster Survey since 2005., Participants: 1 246 710 mothers and 2 129 212 children from 80 national surveys., Exposures of Interest: Gross domestic product (GDP), country surface area, population, Gini index and six governance indicators (control of corruption, political stability and absence of violence, government effectiveness, regulatory quality, rule of law, and voice and accountability)., Main Outcomes: Levels and inequality in the composite coverage index (CCI), a weighted average of eight RMNCH interventions. Relative and absolute inequalities were measured through the concentration index (CIX) and slope index of inequality (SII) for CCI, respectively., Results: The average values of CCI (70.5% (SD=13.3)), CIX (5.3 (SD=5.1)) and mean slope index (19.8 (SD=14.7)) were calculated. In the unadjusted analysis, all governance variables and GDP were positively associated with the CCI and negatively with inequalities. Country surface showed inverse associations with both inequality indices. After adjustment, among the governance indicators, only political stability and absence of violence was directly related to CCI (β=6.3; 95% CI 3.6 to 9.1; p<0.001) and inversely associated with relative (CIX; β=-1.4; 95% CI -2.4 to -0.4; p=0.007) and absolute (SII; β=-5.3; 95% CI -8.9 to -1.7; p=0.005) inequalities. The strongest associations with governance indicators were found in the poorest wealth quintile. Similar patterns were observed for GDP. Country surface area was inversely related to inequalities on CCI., Conclusions: Levels and equity in RMNCH interventions are positively associated with political stability and absence of violence, and with GDP, and inversely associated with country surface area., Competing Interests: Competing interests: None declared.

Introduction: Due to biological reasons, boys are more likely to die than girls. The detection of gender bias requires knowing the expected relation between male and female mortality rates at different levels of overall mortality, in the absence of discrimination. Our objective was to compare two approaches aimed at assessing excess female under-five mortality rate (U5MR) in low/middle-income countries., Methods: We compared the two approaches using data from 60 Demographic and Health Surveys (2005-2014). The prescriptive approach compares observed mortality rates with historical patterns in Western societies where gender discrimination was assumed to be low or absent. The descriptive approach is derived from global estimates of all countries with available data, including those affected by gender bias., Results: The prescriptive approach showed significant excess female U5MR in 20 countries, compared with only one country according to the descriptive approach. Nevertheless, both models showed similar country rankings. The 13 countries with the highest and the 10 countries with the lowest rankings were the same according to both approaches. Differences in excess female mortality among world regions were significant, but not among country income groups., Conclusion: Both methods are useful for monitoring time trends, detecting gender-based inequalities and identifying and addressing its causes. The prescriptive approach seems to be more sensitive in the identification of gender bias, but needs to be updated using data from populations with current-day structures of causes of death., Competing Interests: Competing interests: None declared.

Background: Physical activity is likely to be determined as a complex interplay between personal, interpersonal, and environmental factors. Studying the built environment involves expanding the focus from the individual perspective to a public health one. Therefore, the objetive of this study was to examine the association between the built environment and objectively-measured physical activity among youth., Methods: Cross-sectional analysis of data from of a Brazilian birth cohort during adolescence. Physical activity was measured using accelerometers (GENEActiv) and self-report (International Physical Activity Questionnaire, long version). Participants' home addresses were geocoded and built environment characteristics such as streets' pattern and quality, and public open spaces attributes for physical activity practice were evaluated in a 500-m circular buffer surrounding their homes., Results: A total of 3379 participants were included. Street lighting (β = 2.2; 95%CI: 0.5; 3.9) was positively associated with objectively-measured moderate-vigorous physical activity (MVPA) and proportion of paved streets and buffer's average family income were associated with lower MVPA. Living near the beach increased the odds of leisure-time MVPA practice by 3.3 (95%CI: 1.37; 8.02) times. There was a built environment-by-socioeconomic status (SES) interaction for the associations with commuting physical activity; street lighting [Odds ratio (OR) = 1.22; 95%CI: 1.01; 1.47] and presence of cycle lanes (OR = 1.77; 95%CI: 1.05; 2.96) were positively associated with commuting physical activity only among the intermediate SES tertile., Conclusion: Beachfront, street lighting, paved streets and cycle lanes were associated with physical activity patterns. This suggests that infrastructure interventions may influence physical activity levels of Brazilian adolescents.

Brazilian pig production spans over a large territory encompassing regions of different climatic and socio-economic realities. Production, physical, socio-economic, and environmental data were used to characterize pig production in the country. Multivariate analysis evaluated indices including number productivity, production levels, and income from pigs, together with the average area of pig farm and socio-economic variables such as municipal human development index, technical guidance received from agricultural cooperatives and industrial companies, number of family farms, and offtake; and finally, environmental variables: latitude, longitude, annual temperature range, solar radiation index, as well as temperature and humidity index. The Southern region has the largest herd, number of pigs sold/sow, and offtake rate (p < 0.05), followed by the Midwest and Southeast. No significant correlations were seen between production rates and productivity with the socio-economic and environmental variables in the regions of Brazil. Production indexes, productivity, and offtake rate discriminated Northeast and Midwest and Northeast and Southeast regions. The Northern region, with a large area, has few and far-between farms that rear pigs for subsistence. The Northeast region has large herds, but low productivity. Number of slaughtered pigs has been variable over the past three decades, with few states responsible for maintaining high production in Brazil. However, the activity can be effective in any region of the country with technology and technical assistance adapted to regional characteristics.

Background: Coverage levels for essential interventions aimed at reducing deaths of mothers and children are increasing steadily in most low-income and middle-income countries. We assessed how much poor and rural populations in these countries are benefiting from national-level progress., Methods: We analysed trends in a composite coverage indicator (CCI) based on eight reproductive, maternal, newborn, and child health interventions in 209 national surveys in 64 countries, from Jan 1, 1994, to Dec 31, 2014. Trends by wealth quintile and urban or rural residence were fitted with multilevel modelling. We used an approach akin to the calculation of population attributable risk to quantify the contribution of poor and rural populations to national trends., Findings: From 1994 to 2014, the CCI increased by 0·82 percent points a year across all countries; households in the two poorest quintiles had an increase of 0·99 percent points a year, which was faster than that for the three wealthiest quintiles (0·68 percent points). Gains among poor populations were faster in lower-middle-income and upper-middle-income countries than in low-income countries. Globally, national level increases in CCI were 17·5% faster than they would have been without the contribution of the two poorest quintiles. Coverage increased more rapidly annually in rural (0·93 percent points) than urban (0·52 percent points) areas., Interpretation: National coverage gains were accelerated by important increases among poor and rural mothers and children. Despite progress, important inequalities persist, and need to be addressed to achieve the Sustainable Development Goals., Funding: UNICEF, Wellcome Trust., (Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license. Published by Elsevier Ltd.. All rights reserved.)