Aluísio Jardim Dornellas de Barros

Cohort Profile: The 2004 Pelotas (Brazil) Birth Cohort Study

The last decades of the 20th century witnessed a major epidemiological and nutritional transition in Latin America. Mortality due to infectious diseases and malnutrition declined in most countries and neonatal deaths now account for a growing proportion of infant deaths. In Brazil, infant mortality fell from 82.8 per 1000 live births in 1980 to 27.4 per 1000 in 2000. There were also marked improvements in undernutrition: 37.1% of Brazilian children <5 years of age were stunted in 1974 compared with 10.5% in 1996. Because of the speed of epidemiological and nutritional changes, and motivated by the successful implementation and follow-up of two previous population-based birth cohorts in 1982 and 1993, the research team decided to start a new cohort in 2004 to assess the magnitude of changes in maternal and child health status and their determinants. The existence of three prospective birth cohorts in the same population would provide a unique opportunity to study time trends over a 22-year span.

The relation between family socioeconomic trajectories from childhood to adolescence and dental caries and associated oral behaviours

Objectives: To investigate the influence of family socioeconomic trajectories from childhood to adolescence on dental caries and associated behaviours. Design: Population-based birth cohort. Setting: Representative sample of the population of subjects born in 1982 in Pelotas, Brazil. Participants: Adolescents (n = 888) aged 15 years old were dentally examined and interviewed. Main outcome measures: Dental caries index (DMFT), care index (F/DMFT), tooth brushing, flossing and pattern of dental services use. Main results: Adolescents who were always poor showed, in general, a worse pattern of dental caries, whereas adolescents who never were poor had a better pattern of dental caries. Adolescents who had moved from poverty in childhood to non-poverty in adolescence and those who had moved from non-poverty in childhood to poverty in adolescence had similar dental pattern to those who were always poor except for the pattern of dental services use, which was higher in the first group. In all groups girls had fewer carious teeth, better oral hygiene habits and higher dental services use than boys. Conclusion: Poverty in at least one stage of the lifespan has a harmful effect on dental caries, oral behaviours and dental services use. Belonging to upwardly mobile families between childhood and adolescence only contributed to improved dental care.

Cesarean section and risk of obesity in childhood, adolescence, and early adulthood: evidence from 3 Brazilian birth cohorts

Background: The number of cesarean sections (CSs) is increasing in many countries, and there are concerns about their short- and long-term effects. A recent Brazilian study showed a 58% higher prevalence of obesity in young adults born by CS than in young adults born vaginally. Because CS-born individuals do not make contact at birth with maternal vaginal and intestinal bacteria, the authors proposed that this could lead to long-term changes in the gut microbiota that could contribute to obesity. Objective: We assessed whether CS births lead to increased obesity during childhood, adolescence, and early adulthood in 3 birth cohorts. Design: We analyzed data from 3 birth-cohort studies started in 1982, 1993, and 2004 in Southern Brazil. Subjects were assessed at different ages until 23 y of age. Poisson regression was used to estimate prevalence ratios with adjustment for ≤15 socioeconomic, demographic, maternal, anthropometric, and behavioral covariates. Results: In the crude analyses, subjects born by CS had ∼50% higher prevalence of obesity at 4, 11, and 15 y of age but not at 23 y of age. After adjustment for covariates, prevalence ratios were markedly reduced and no longer significant for men or women. The only exception was an association for 4-y-old boys in the 1993 cohort, which was not observed in the other 2 cohorts or for girls. Conclusion: In these 3 birth cohorts, CSs do not seem to lead to an important increased risk of obesity during childhood, adolescence, or early adulthood.

Uso regular de serviços odontológicos entre adultos: padrões de utilização e tipos de serviços

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

Anemia em menores de seis anos: estudo de base populacional em Pelotas, RS

OBJETIVO: Analisar a prevalencia de anemia em criancas menores de seis anos, em uma amostra probabilistica de area urbana. METODOS: Foi realizado estudo com criancas de zero a cinco anos de idade, na cidade de Pelotas, RS, em 2004. Foram coletadas informacoes sobre caracteristicas demograficas, socioeconomicas, antropometricas, de morbidade e sobre alimentacao, por meio de questionario aplicado as maes ou responsaveis. As criancas foram pesadas e medidas. A concentracao de hemoglobina foi medida com hemoglobinometro portatil, HemoCue e anemia foi definida como valores de hemoglobina <11 g/dL. A associacao entre anemia e preditores foi expressa como razao de prevalencia. Foi realizada analise multivariada por regressao de Poisson a partir de um modelo conceitual, considerando o efeito do delineamento do estudo. RESULTADOS: Foram identificadas 534 criancas e as perdas e recusas totalizaram 27 criancas (5,1%). A prevalencia de anemia foi 30,2% (IC 95%: 23,5%;37,0%). Na analise multivariada, somente idade e renda familiar permaneceram significativamente associadas com anemia. CONCLUSOES: A anemia foi, em grande parte, socialmente determinada na populacao estudada. Intervencoes com o objetivo de combate-la devem ser delineadas para amenizar esta condicao em curto prazo e direcionadas para populacoes menos favorecidas economicamente.

Medicine access and utilization in a population covered by primary health care in Brazil

OBJECTIVES To describe medicine utilization and access in a population covered by the Family Health Program (PSF) in Brazil. METHODS Cross-sectional study with a random sample of 2988 individuals living in areas covered by 45 PSF clinics. Medicine utilization in the 15 days prior to the interview was assessed, as well as lack of access to medicines (proportion of people with medicines needed but not used), and lack of free access through the PSF (proportion of medicines used which had to be purchased). RESULTS Overall, 54.5% (95% CI 50.6; 58.4) of individuals used at least one medicine in the 15-day period and 3.6% reported failing to use a needed medicine. Of all medicines used, 41.5% were paid for out-of-pocket (25.5% among the poorest families), and 51.0% were obtained for free from the PSF. Almost 90% of the medicines prescribed by PSF physicians were provided for free by the PSF. CONCLUSION Although medicine access was high, individuals paid out-of-pocket for a substantial proportion of the medicines used. Lack of availability in PSF facilities and prescribing by non-PSF providers seem to contribute to the need for out-of-pocket purchases, and thus can be targeted for improvement through PSF policies.

Caries Is the Main Cause for Dental Pain in Childhood: Findings from a Birth Cohort

Aim: The aim of the study was to evaluate the prevalence of dental pain in preschool children and its association with socioeconomic, demographic, clinical, and behavior variables. Subjects and Methods: The study was nested in a population-based birth cohort from Pelotas, Brazil, started in 2004. A sample of 1,129 children aged 5 years was dentally examined, and their mothers were interviewed. Exploratory variables included demographics, socioeconomic status, mothers’ oral health status and associated behaviors, and caries in primary teeth. Data were analyzed using multivariable Poisson regression. Results: The prevalence of dental pain was 16.5% (95% CI: 14.4–18.8). Multivariate analysis showed that dark-skinned children (prevalence ratio, PR = 1.6, 95% CI: 1.1–2.4) from low socioeconomic level (PR 1.9, 1.2–3.0) whose mothers had less than 4 years of education (PR 1.9, 1.0–3.6), from mothers with less than 10 teeth in at least one arch (PR 1.7, 1.2–2.5) and less than 10 in two arches (PR 1.6, 1.0–2.6), and those with high caries prevalence at the age of 5 years (PR 4.8, 3.3–7.1) were more likely to experience dental pain. Conclusions: Unrestored caries is the main factor associated with dental pain in childhood. Socioeconomic aspects and family context in which dental pain occurs should also be taken into account when dental pain preventive measures are implemented.

Avaliação nutricional subjetiva: Parte 2 - Revisão de suas adaptações e utilizações nas diversas especialidades clínicas

BACKGROUND The subjective global assessment is a clinical method for nutritional assessment that considers not only body composition alterations but also changes in physiological function. The method is simple, inexpensive and non-invasive, and it can be performed at bedside. Although the subjective global assessment was developed to assess surgical patients, many studies have showed its use in other clinical situations, evaluating patients with renal failure patients, cancer, liver diseases, as well as elderly and HIV-infected patients. AIM To review the use of subjective global assessment in other clinical situations and intervention studies. METHODS It was performed a systematic review in MEDLINE, using subjective global assessment as search term and the most relevant papers were selected. RESULTS It was found the subjective global assessment modifications to be applied in renal failure patients, cancer and liver diseases, with good results. In patients with cancer, the subjective global assessment has been used to identify patients who are at higher nutritional risk and would need an aggressive nutritional support. Few intervention studies in surgical patients used subjective global assessment to identify nutritional risk patients. CONCLUSIONS The subjective global assessment has been a good option in nutritional assessment in surgical patients and some modifications have been suggested to adjust the method to other clinical situations. The observer experience is of extreme importance, since the precision of the method depends on it.

Caesarean sections and risk of wheezing in childhood and adolescence: data from two birth cohort studies in Brazil

Cite this as: A. M. B. Menezes,P. C. Hallal, A. M. Matijasevich,A. J. D. Barros, B. L. Horta, C. L. P. Araujo,D. P. Gigante, I. S. Santos, G. Minten,M. R. Domingues, S. C. Dumith and F. C. Barros, Clinical & Experimental Allergy, 2011 (41) 218–223.

Cohort Profile Update: 2004 Pelotas (Brazil) Birth Cohort Study. Body composition, mental health and genetic assessment at the 6 years follow-up

This is an update of the 2004 Pelotas Birth Cohort profile, originally published in 2011. In view of the high prevalence of overweight and mental health problems among Brazilian children, together with the availability of state-of-the-art equipment to assess body composition and diagnostic tests for mental health in childhood, the main outcomes measured in the fifth follow-up (mean age 6.8 years) included child body composition, mental health and cognitive ability. A total of 3722 (90.2%) of the original mothers/carers were interviewed and their children examined in a clinic where they underwent whole-body dual X-ray absorptiometry (DXA), air displacement plethysmography and a 3D photonic scan. Saliva samples for DNA were obtained. Clinical psychologists applied the Development and Well-Being Assessment questionnaire and the Wechsler Intelligence Scale for Children to all children. Results are being compared with those of the two earlier cohorts to assess the health effects of economic growth and full implementation of public policies aimed at reducing social inequalities in the past 30 years. For further information visit the programme website at [http://www.epidemio-ufpel.org.br/site/content/coorte_2004/questionarios.php]. Applications to use the data should be made by contacting 2004 cohort researchers and filling in the application form available at [http://www.epidemio-ufpel.org.br/site/content/estudos/formularios.php].