Heloisa Bettiol

A century of trends in adult human height

Being taller is associated with enhanced longevity, and higher education and earnings. We reanalysed 1472 population-based studies, with measurement of height on more than 18.6 million participants to estimate mean height for people born between 1896 and 1996 in 200 countries. The largest gain in adult height over the past century has occurred in South Korean women and Iranian men, who became 20.2 cm (95% credible interval 17.5–22.7) and 16.5 cm (13.3–19.7) taller, respectively. In contrast, there was little change in adult height in some sub-Saharan African countries and in South Asia over the century of analysis. The tallest people over these 100 years are men born in the Netherlands in the last quarter of 20th century, whose average heights surpassed 182.5 cm, and the shortest were women born in Guatemala in 1896 (140.3 cm; 135.8–144.8). The height differential between the tallest and shortest populations was 19-20 cm a century ago, and has remained the same for women and increased for men a century later despite substantial changes in the ranking of countries. DOI: http://dx.doi.org/10.7554/eLife.13410.001

Factors associated with inadequacy of prenatal care utilization

OBJECTIVE To identify factors associated with inadequacy of prenatal care utilization in urban community. METHODS A cross-sectional study of a systematic sample stratified by maternity hospital, consisting of hospital births in the municipality of São Luís, Brazil, was carried out from March 1997 to February 1998. Socioeconomic and demographic factors, reproductive health, morbidity during pregnancy, and utilization of prenatal care services were studied. Mothers answered a standardized questionnaire before hospital discharge. The adequacy of prenatal care utilization was analyzed by means of two indexes: APNCU (Adequacy of Prenatal Care Utilization) and a new index based on the recommendations of the Brazilian Ministry of Health. RESULTS There were interviewed 2,831 women who delivered at 10 public and private maternity hospitals. The inadequacy of prenatal care utilization was 49.2% according to the APNCU index and 24.5% when determined by the Brazilian index. Prenatal care at public services, low maternal schooling, low income, having no partner, and absence of maternal diseases during pregnancy were associated with inadequacy of prenatal care use according to both indexes. High parity and maternal age of 35 years or more were also associated with inadequacy, whereas primiparity, morbidity, and young maternal age (<20 years) seemed to protect from inadequacy when the Brazilian index was used. CONCLUSIONS Prenatal care showed low coverage in the municipality of São Luís. The inadequacy of prenatal care utilization was associated with several factors linked to social inequality.

Clinical experience with infants with Robin sequence: a prospective study.

OBJECTIVE To study the clinical course of patients with Robin sequence (RS) during the first 6 months of life. DESIGN A longitudinal prospective study of children with RS. SETTING Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo, Bauru-SP, Brazil, 1997 and 1998. PATIENTS Sixty-two children were studied from hospital admission to 6 months of age. Thirty-three (53.2%) presented with probable isolated RS (PIRS), 25 (40.3%) presented with syndromes or other malformations associated with RS, and 4 (6.5%) presented with RS with neurological involvement. INTERVENTIONS The type of respiratory tract obstruction was defined by nasopharyngoscopy. The patients with type 1 and type 2 obstruction underwent nasopharyngeal intubation (NPI), and glossopexy was indicated in patients with type 1 obstruction who did not show clinical improvement with this procedure. Tracheostomy was indicated in patients with type 2 obstruction who did not show a good course after NPI, in patients with type 1 obstruction who did not show good course after glossopexy, and in patients with type 3 and type 4 obstruction. RESULTS Prone position treatment (PPT) or NPI was the definitive treatment in 25 cases (75.8%) of PIRS and in 13 cases (52%) of syndromes or other malformations. Among the children with type 1 obstruction, 24 (51.1%) were submitted exclusively to PPT and 12 (25.5%) to NPI. With the type 2 groups, only one (12.5%) received PPT, and three (37.5%) were treated exclusively with NPI. All 15 infants treated exclusively with NPI (24.4%) presented with good weight, length, and neuromotor development. CONCLUSIONS Most patients with PIRS and type 1 obstruction improved without surgical intervention. NPI should be the initial treatment in all patients with RS with type 1 and type 2 obstruction who present with important respiratory and feeding difficulties.

Consumo de substâncias psicoativas por adolescentes escolares de Ribeirão Preto, SP (Brasil). I - Prevalência do consumo por sexo, idade e tipo de substância

INTRODUCTION Concern over the consumption of psychoactive substances by teenagers has given rise to a great worldwide effort to produce information about this phenomenon. This study set out to investigate the prevalence of consumption of legal and illegal psychoactive substances, its distribution by age, sex and age at first experience of them, among teenage pupils in county, Ribeirão Preto, SP, Southeastern Brazil. MATERIAL AND METHOD A self-applicable questionnaire duly adapted and submitted to a reliability test was applied to a proportional sample of 1,025 teenagers enrolled in 8th, 9th, 10th and 11th grades at public and private city schools. The questionnaire contained questions about the use of ten classes of psychoactive substances, demographic questions and validation information, as well as questions about the perception and intrinsic behavior related to drug consumption. RESULTS The sample of 88.9% had consumed alcoholic beverages sometime in their lives, 37.7% had used tobacco, 31.1% solvents, 10.5% medicines, 6.8% marihuana, 2.7% cocaine, 1.6% hallucinogens, and 0.3% of the sample had consumed some opiate substance. The rates of consumption increased with age for all substances; however, the use of tobacco and of illegal substances was less intense during the later years of adolescence. As to sex distribution, boys consumed more than girls, except for medicines, with girls consuming barbiturates, amphetamines and tranquilizers in proportions similar to or higher than those observed among boys. Age at first experience showed that access to psychoactive substances occurred at very early ages. CONCLUSIONS Experimenting with psychoactive substances, whether legal or illegal, is a frequent phenomenon during adolescence, both among boys and girls, often at very early ages.INTRODUCTION: Concern over the consumption of psychoactive substances by teenagers has given rise to a great wordwide effort to produce information about this phenomenon. This study set out to investigate the prevalence of consumption of legal and illegal psychoactive substances, its distribution by age, sex and age at first experience of them, among teenage pupils in county, Ribeirao Preto, SP, Southeastern Brazil. MATERIAL AND METHOD: A self-applicable questionnaire duly adapted and submitted to a reliability test was applied to a proportional sample of 1,025 teenagers enrolled in 8th, 9th, 10th and 11th grads at public and private city schools. The questionnaire contained questions about the use of ten classes of psychoactive substances, demographic questions and validation information, as well as questions about the perception and intrinsic behavior related to drug consumption. RESULTS: The sample of 88.9% had consumed alcoholic beverages sometime in their lives, 37.7% had used tobacco, 31.1% solvents, 10.5% medicines, 6.8% marihuana, 2.7% cocaine, 1.6% hallucinogens, and 0.3% of the sample had consumed some opiate substance. The rates of consumption increased with age for all substances; however, the use of tobacco and of illegal substances was less intense during the later years of adolescence. As to sex distribution, boys consumed more than girls, except for medicines, with girls consuming barbiturates, amphetamines and tranquilizers in proportions similar to or higher than those observed among boys. Age at first experience showed that access to psychoactive substances occurred at very early ages. CONCLUSIONS: Experimenting with psychoactive substances, whether legal or illegal, is a frequent phenomenon during adolescence, both among boys and girls, often at very early ages.INTRODUCAO: A preocupacao suscitada quanto ao consumo de substâncias psicoativas pelos adolescentes tem mobilizado grandes esforcos em todo o mundo na producao de conhecimento sobre este fenomeno. Decidiu-se estudar as taxas de prevalencia de consumo de substâncias psicoativas de uso licito e ilicito, sua distribuicao por idade, sexo e a idade da primeira experiencia com essas substâncias, entre adolescentes escolares do Municipio de Ribeirao Preto, SP, Brasil. MATERIAL DE METODO: Um questionario devidamente adaptado e submetido a um teste de confiabilidade foi auto-aplicado a uma amostra proporcional de 1.025 adolescentes matriculados na oitava serie do primeiro grau e primeiro, segundo e terceiro anos do segundo grau, das escolas publicas e privadas do municipio estudado. O questionario continha questoes sobre o uso de dez classes de substâncias psicoativas, questoes demograficas e informacoes de validacao, alem de questoes de percepcao e comportamento intrinseco ao consumo de drogas. RESULTADOS: Da amostra 88,9% consumiram bebidas alcoolicas alguma vez na vida; 37,7% utilizaram o tabaco; 31,1% os solventes; 10,5% os medicamentos; 6,8% a maconha; 2,7% a cocaina; 1,6% os alucinogenos e 0,3% consumiu alguma substância a base de opiacios. As taxas de consumo cresceram com a idade, para todas as substâncias; no entanto, o uso de tabaco e de substâncias ilicitas mostrou uma desaceleracao nos anos que compreendem o final da adolescencia. Verificou-se que os meninos consumiram mais do que as meninas, exceto para os medicamentos, com as meninas consumindo barbituricos, anfetaminas e tranquilizantes em proporcoes semelhantes ou maiores que os meninos. A idade da primeira experiencia mostrou que o acesso as substâncias psicoativas ocorreu em idades bastante precoces. CONCLUSOES: As substâncias psicoativas, sejam licitas ou ilicitas, sao frequentemente experimentadas na adolescencia, tanto pelos meninos como pelas meninas, muitas vezes em idades bem precoces.

Características da gravidez na adolescência em São Luís, Maranhão

OBJECTIVE: To identify the main socioeconomic, demographic, anthropometric and behavioral characteristics, and pregnancy outcomes of adolescent pregnancy and to assess health services used by pregnant adolescents. METHODS: Data were collected from a cross-section of 2,429 deliveries by women residing in the municipality of Sao Luis, Brazil, of which 94% were hospital births. Women were categorized into six age groups. The two groups of teenagers (under 18 and 18-19 years) were compared to four groups of older women. Comparison was also made between the two teenage groups. The chi-square test was used to compare proportions and prevalence ratio was used as an effect measure. RESULTS: Of 2,429 women, 714 (29.4%) were adolescents. Their specific fertility coefficient was higher than in other regions of the country. Adolescents showed lower socioeconomic and reproductive conditions than older women and a higher proportion of inadequate prenatal care. The majority had no partner. They had the lowest percentages of caesarean section and smokers. CONCLUSIONS: Despite their equally unfavorable socioeconomic situation, 18-19 year-old adolescents had pregnancy outcomes comparable to the age group 25-29, whereas those under 18 had the highest proportions of low birth weight, preterm birth, and infant mortality rate. This suggests that biologic immaturity may be associated with adverse pregnancy outcomes.OBJETIVO: Identificar as principais caracteristicas socioeconomicas, demograficas, antropometricas e comportamentais, bem como os resultados perinatais da gravidez na adolescencia. Conhecer os tipos de servicos de saude utilizados pelas gestantes adolescentes. METODOS: A amostra de 2.429 partos de mulheres residentes em Sao Luis, MA, abrangeu 94% dos nascimentos hospitalares. As mulheres foram separadas em seis grupos de idade para melhor avaliacao do comportamento das variaveis entre os dois grupos de adolescentes (abaixo de 18 anos; 18 a 19 anos) e entre as adolescentes e as demais mulheres. O teste do qui-quadrado foi utilizado para a comparacao de proporcoes e a razao de prevalencias foi empregada como medida de efeito. RESULTADOS: Das 2.429 mulheres, 714 eram adolescentes (29,4%). Seu coeficiente especifico de fecundidade, 72,2 por mil, foi mais elevado que em outras regioes do Pais. As adolescentes apresentaram piores condicoes socioeconomicas e reprodutivas que as demais mulheres, maior proporcao de pre-natal inadequado (39,2%) e muitas nao tinham companheiro (34,5%). Por outro lado, tiveram menor proporcao de parto cesareo (23,0%) e de fumantes (3.5%). CONCLUSOES: Apesar da situacao socioeconomica igualmente desfavoravel, as adolescentes de 18 a 19 anos apresentaram resultados perinatais semelhantes as mulheres de 25 a 29 anos. Ja as menores de 18 anos tiveram maiores proporcoes de filhos com baixo peso ao nascer, prematuros e com maior risco de mortalidade infantil. Isto sugere que a imaturidade biologica possa estar associada a maiores taxas de prematuridade, baixo peso ao nascer e mortalidade infantil.OBJECTIVE To identify the main socioeconomic, demographic, anthropometric and behavioral characteristics, and pregnancy outcomes of adolescent pregnancy and to assess health services used by pregnant adolescents. METHODS Data were collected from a cross-section of 2,429 deliveries by women residing in the municipality of São Luís, Brazil, of which 94% were hospital births. Women were categorized into six age groups. The two groups of teenagers (under 18 and 18-19 years) were compared to four groups of older women. Comparison was also made between the two teenage groups. The chi-square test was used to compare proportions and prevalence ratio was used as an effect measure. RESULTS Of 2,429 women, 714 (29.4%) were adolescents. Their specific fertility coefficient was higher than in other regions of the country. Adolescents showed lower socioeconomic and reproductive conditions than older women and a higher proportion of inadequate prenatal care. The majority had no partner. They had the lowest percentages of caesarean section and smokers. CONCLUSIONS Despite their equally unfavorable socioeconomic situation, 18-19 year-old adolescents had pregnancy outcomes comparable to the age group 25-29, whereas those under 18 had the highest proportions of low birth weight, preterm birth, and infant mortality rate. This suggests that biologic immaturity may be associated with adverse pregnancy outcomes.

Health in early adulthood: the contribution of the 1978/79 Ribeirão Preto birth cohort.

The increase in non-communicable chronic diseases of adults is due to demographic changes and changes in the risk factors related to physical activity, smoking habits and nutrition. We describe the methodology for the evaluation of persons at 23/25 years of age of a cohort of individuals born in Ribeirão Preto in 1978/79. We present their socioeconomic characteristics and the profile of some risk factors for chronic diseases. A total of 2063 participants were evaluated by means of blood collection, standardized questionnaires, anthropometric and blood pressure measurements, and methacholine bronchoprovocation tests. The sexes were compared by the chi-square test, with alpha = 0.05. Obesity was similar among men and women (12.8 and 11.1%); overweight was almost double in men (30.3 vs 17.7%). Weight deficit was higher among women than among men (8.6 and 2.6%). Women were more sedentary and consumed less alcohol and tobacco. Dietary fat consumption was similar between sexes, with 63% consuming large amounts (30 to 39.9 g/day). Metabolic syndrome was twice more frequent among men than women (10.7 vs 4.8%), hypertension was six times more frequent (40.9 vs 6.4%); altered triglyceride (16.1 vs 9.8%) and LDL proportions (5.4 vs 2.7%) were also higher in men, while women had a higher percentage of low HDL (44.7 vs 39.5%). Asthma and bronchial hyper-responsiveness were 1.7 and 1.5 times more frequent, respectively, among women. The high prevalence of some risk factors for chronic diseases among young adults supports the need for investments in their prevention.

Severe intrauterine growth restriction is associated with higher spontaneous carbohydrate intake in young women.

Intrauterine growth restriction (IUGR) is associated with metabolic disorders in adulthood. In rats, an early adverse environment alters food preferences in adult life. We investigated whether IUGR is associated with spontaneous macronutrient preferences in humans. Two thousand sixty-three participants from a Brazilian birth cohort were evaluated at 24 y of age using a food frequency questionnaire, physical examination, anthropometric measurements, and biochemical assays (glucose, insulin, cholesterol, and triglycerides). IUGR was defined by the birth weight ratio (BWR = birth weight/mean weight for gestational age). Individuals were classified as non growth restricted (BWR ≥0.85), moderately growth restricted (0.85 > BWR ≥ 0.75), and severely growth restricted (BWR <0.75). Severe IUGR women consumed a greater carbohydrate to protein ratio, even after controlling for social variables. There was a continuous association between growth restriction and later carbohydrate to protein ratio consumption in women. Women from both IUGR groups had a larger waist to hip ratio (WHR). The prevalence of metabolic syndrome was comparable between the groups. IUGR women preferred carbohydrates to protein in their regular diet, suggesting that spontaneous food choices may precede the appearance and contribute to the risk for metabolic diseases in this group.

Comparison between two cohorts of adolescent mothers in Southeastern Brazil

OBJECTIVE To compare the prevalence of pregnancy among adolescents and analyze trends in some social and biological variables among two cohorts of adolescent mothers in Ribeirão Preto, Brazil, during 1978/79 and 1994. METHODS Two cohorts of adolescent mothers were interviewed shortly after delivery, comprising 943 women in the first survey (1978/79) and 499 in the second (1994). Both surveys covered more than 98% of births in all childbirth clinics. Only singleton livebirths from adolescent mothers living in the municipality were included in the analysis. The Chi-square test was used for statistical analysis, with a 0.05 significance level. RESULTS The percentage of adolescent mothers increased from 14.1% in 1978/79 to 17.5% in 1994 (p<0.05), mainly due to an increase in deliveries in the 13-17 years age group. There was a reduction in the number of smokers and mothers with lower schooling. The number of prenatal care visits increased. There was also an increase in the proportion of single mothers, of those who were employed and got private delivery care. Low birth weight and preterm birth rates remained unchanged for all of them. Cesarean section and forceps delivery rates increased substantially. Mothers in the 13-17 years age group however showed twice as much premature and low birth weight children, a higher proportion of single mothers with lower schooling, and higher rate of forceps delivery. CONCLUSIONS Some characteristics of the adolescent mothers in the 13-17 years age group were more unfavorable when compared to the 18-19 years age group. The characteristics of adolescent age groups need to be better understood and taken into account in the prenatal and delivery care planning.OBJETIVO: Comparar a prevalencia de gravidez na adolescencia e analisar variaveis sociobiologicas relacionadas ao binomio mae-filho entre duas coortes de maes adolescentes de nascidos vivos em Ribeirao Preto (1978-1979 e 1994). METODOS: Foram entrevistadas maes adolescentes logo apos o parto, sendo 943 em 1978/79 e 499 em 1994, abrangendo nascidos vivos de parto unico, de familias residentes em Ribeirao Preto, SP. Foi utilizado o teste do qui-quadrado, com nivel de significância de 0,05. RESULTADOS: O percentual de maes adolescentes aumentou de 14,1% em 1978/79 para 17,5% em 1994 (p<0,05), devido ao crescimento dos partos entre as jovens de 13 a 17 anos. Observou-se incremento da escolaridade, reducao do habito de fumar e aumento no numero de consultas de pre-natal. Elevou-se a proporcao de adolescentes sem companheiro, exercendo atividade remunerada e tendo atendimento privado no parto. As taxas de baixo peso ao nascer e da prematuridade nao se alteraram no grupo de adolescentes como um todo. Houve maior taxa de cesarianas e uso do forceps no parto das adolescentes. Contudo, maes de 13 a 17 anos tiveram o dobro de filhos prematuros e de baixo peso, maior proporcao de solteiras, de baixa escolaridade, e de uso do forceps no parto. CONCLUSOES: Muitas caracteristicas das maes adolescentes de 13 a 17 anos foram mais desfavoraveis do que daquelas com 18 e 19 anos. Estas especificidades no grupo de adolescentes necessitam ser melhor estudadas e compreendidas e levadas em conta no planejamento da oferta de servicos de atencao ao pre-natal e ao parto.

Cesarean delivery is associated with an increased risk of obesity in adulthood in a Brazilian birth cohort study

BACKGROUND Obesity is epidemic worldwide, and increases in cesarean delivery rates have occurred in parallel. OBJECTIVE This study aimed to determine whether cesarean delivery is a risk factor for obesity in adulthood in a birth cohort of Brazilian subjects. DESIGN We initiated a birth cohort study in Ribeirão Preto, southeastern Brazil, in 1978. A randomly selected sample of 2057 subjects from the original cohort was reassessed in 2002-2004. Type of delivery, birth weight, maternal smoking, and schooling were obtained after birth. The following data from subjects were collected at 23-25 y of age: body mass index (BMI; in kg/m(2)), physical activity, smoking, and income. Obesity was defined as a BMI ≥30. A Poisson multivariable model was performed to determine the association between cesarean delivery and BMI. RESULTS The obesity rate in adults born by cesarean delivery was 15.2% and in those born by vaginal delivery was 10.4% (P = 0.002). Adults born by cesarean delivery had an increased risk (prevalence ratio: 1.58; 95% CI: 1.23, 2.02) of obesity at adulthood after adjustments. CONCLUSION We hypothesize that increasing rates of cesarean delivery may play a role in the obesity epidemic worldwide.

Acompanhamento do crescimento

OBJECTIVE: to present concepts related to growth assessment, with emphasis on aspects concerning the evaluation of individuals. SOURCES OF DATA: the present paper is based on reports published by the WHO regarding the use anthropometry for the assessment of nutritional status; on original articles; and on book chapters about the same topic, as well as on the criticisms of auxologists of this type of assessment when employed at the individual level. SUMMARY OF THE FINDINGS: concepts concerning reference, skeletal maturity, mid-parental target height, z score, short stature, growth rate, body mass index, and their assumptions and limitations are presented. CONCLUSIONS: the assessment of the nutritional status of a population is based on cut-off points, taking into consideration that whoever is below or above that point presents a nutritional problem. Clinical evaluation is based on the idea of variability, which can be both biological and social, and on the idea that it is the clinicians task to establish whether a child within or outside given parameters presents normal growth and nutritional status. When monitoring the growth of a child or adolescent, the most important parameter to be considered is growth rate.