Ricardo Tavares Pinheiro

Association between breastfeeding and intelligence, educational attainment, and income at 30 years of age: a prospective birth cohort study from Brazil

Summary Background Breastfeeding has clear short-term benefits, but its long-term consequences on human capital are yet to be established. We aimed to assess whether breastfeeding duration was associated with intelligence quotient (IQ), years of schooling, and income at the age of 30 years, in a setting where no strong social patterning of breastfeeding exists. Methods A prospective, population-based birth cohort study of neonates was launched in 1982 in Pelotas, Brazil. Information about breastfeeding was recorded in early childhood. At 30 years of age, we studied the IQ (Wechsler Adult Intelligence Scale, 3rd version), educational attainment, and income of the participants. For the analyses, we used multiple linear regression with adjustment for ten confounding variables and the G-formula. Findings From June 4, 2012, to Feb 28, 2013, of the 5914 neonates enrolled, information about IQ and breastfeeding duration was available for 3493 participants. In the crude and adjusted analyses, the durations of total breastfeeding and predominant breastfeeding (breastfeeding as the main form of nutrition with some other foods) were positively associated with IQ, educational attainment, and income. We identified dose-response associations with breastfeeding duration for IQ and educational attainment. In the confounder-adjusted analysis, participants who were breastfed for 12 months or more had higher IQ scores (difference of 3·76 points, 95% CI 2·20–5·33), more years of education (0·91 years, 0·42–1·40), and higher monthly incomes (341·0 Brazilian reals, 93·8–588·3) than did those who were breastfed for less than 1 month. The results of our mediation analysis suggested that IQ was responsible for 72% of the effect on income. Interpretation Breastfeeding is associated with improved performance in intelligence tests 30 years later, and might have an important effect in real life, by increasing educational attainment and income in adulthood. Funding Wellcome Trust, International Development Research Center (Canada), CNPq, FAPERGS, and the Brazilian Ministry of Health.

Prevalência da depressão pós-parto e fatores associados

OBJETIVO: Avaliar a prevalencia e os fatores associados a depressao pos-parto. METODOS: O estudo foi realizado na cidade de Pelotas, entre outubro e novembro de 2000. As maes (n=410) foram entrevistadas no hospital, utilizando dois questionarios sobre informacoes obstetricas e psicossociais. Posteriormente, as puerperas foram visitadas em casa, entre 30 a 45 dias depois do parto, quando foi aplicada a Escala de Hamilton com o objetivo de medir e caracterizar a presenca de sintomas depressivos. O teste do qui-quadrado foi utilizado na comparacao entre proporcoes e a regressao logistica nao condicional, na analise multivariada. Os dados foram analisados hierarquicamente: no primeiro nivel as variaveis socioeconomicas, no segundo, as variaveis demograficas, no terceiro, estavam as variaveis obstetricas e no ultimo nivel, as variaveis psicossociais. RESULTADOS: A prevalencia de depressao pos-parto encontrada foi de 19,1%. As variaveis renda familiar (OR=5,24; IC 95%: 2,00-13,69), preferencia pelo sexo da crianca (meninos: OR=3,49; IC 95%: 1,76-6,93) e pensar em interromper a gestacao (OR=2,52; IC 95%: 1,33-4,76), apresentaram associacao com a ocorrencia de depressao. CONCLUSOES: Os achados sugerem que baixas condicoes socioeconomicas de vida da puerpera e a nao aceitacao da gravidez sao elementos-chave no desenvolvimento da depressao pos-parto.

Prevalência e fatores associados ao sedentarismo em adolescentes de área urbana

OBJETIVO: Determinar a prevalencia e fatores associados ao sedentarismo em adolescentes residentes em uma area urbana. METODOS: Realizou-se estudo transversal em uma amostra representativa de 960 adolescentes com idades entre 15 e 18 anos, em 2002, em Pelotas, Estado do Rio Grande do Sul. Os dados foram coletados por meio de um questionario anonimo e auto-aplicado. Foi definindo como sedentario o adolescente que participava de atividades fisicas por um tempo menor do que 20 minutos diarios e uma frequencia menor do que tres vezes por semana. Variaveis sociodemograficas e comportamentais foram avaliadas. Para as comparacoes entre proporcoes, utilizou-se o teste do qui-quadrado, e para a analise multivariada, a regressao de Poisson com ajuste robusto para as variâncias. Foi feito controle para efeito de delineamento. RESULTADOS: Foram entrevistados 960 adolescentes, dos quais 39% foram considerados sedentarios. As meninas foram mais sedentarias do que os meninos, 2,45 (IC 95% 2,06-2,92). Os adolescentes das classes sociais mais baixas foram mais sedentarios, 1,35 (IC 95% 1,06-1,72). Escolaridade inferior a quatro anos de estudo do adolescente 1,30 (IC 95% 1,01-1,68) e da mae 1,75 (IC 95% 1,31-2,23) apresentaram maior risco para o sedentarismo. Apos controle para possiveis fatores de confusao, mostrou-se tambem positiva a associacao entre o sedentarismo e a presenca de transtornos psiquiatricos menores e relacao inversa, fator de protecao para os sexualmente ativos 0,84 (IC 95% 0,71-0,99). CONCLUSOES: Ser do sexo feminino, pertencer a classe social baixa, ter uma baixa escolaridade e ser filho de mae com baixa escolaridade sao fatores associados ao sedentarismo.

Prevalência e fatores associados ao sobrepeso e à obesidade em adolescentes

OBJETIVO: Determinar a prevalencia e os fatores associados ao sobrepeso e a obesidade em adolescentes de zona urbana. METODOS: Estudo transversal de base populacional, realizado no municipio de Pelotas, Rio Grande do Sul, de 2001 a 2002. Adolescentes entre 15 e 18 anos de idade foram medidos, pesados e responderam a questionario auto-aplicavel. De 90 setores sorteados, foram visitados 86 domicilios em cada setor, totalizando 960 adolescentes. A prevalencia de sobrepeso e obesidade foi definida a partir do indice de massa corporal, mediante a utilizacao dos pontos de corte, ajustados a idade e ao sexo. Realizou-se analise multivariada com regressao de Poisson, considerando um modelo hierarquico das variaveis associadas ao sobrepeso e a obesidade. RESULTADOS: A prevalencia de sobrepeso e de obesidade foi 20,9% e 5%, respectivamente. A relacao entre a obesidade e idade e escolaridade do adolescente foi inversa. Verificou-se associacao de sobrepeso e obesidade com o relato de obesidade dos pais (p=0,03) e maturacao sexual do adolescente (p=0,01). Os habitos de fazer dieta e omitir refeicoes foram associados a obesidade, com riscos de 3,98 (IC 95%: 1,83-8,67) e 2,54 (IC 95%: 1,22-5,29), respectivamente. CONCLUSOES: A prevalencia de sobrepeso e obesidade na regiao sao preocupantes a despeito do comportamento dos adolescentes para prevenir a obesidade. E necessaria a implantacao de campanhas mais eficazes, direcionadas a orientar melhor os adolescentes.

Is paternal postpartum depression associated with maternal postpartum depression? Population-based study in Brazil

Objective:  To describe the prevalence of paternal postpartum depression (PPD) as well as its association with maternal PPD.

Tabaco, álcool e outras drogas entre adolescentes em Pelotas, Rio Grande do Sul, Brasil: uma perspectiva de gênero

This study assesses the relationship between gender and use of psychoactive substances (alcohol, nicotine, and illicit drugs) by teenagers. In 2002, a cross-sectional study was carried out in the urban area of Pelotas, southern Brazil. Multi-stage sampling was used to obtain a sample of adolescents, 15 to 18 years of age. Subjects were interviewed using a self-applied confidential questionnaire. Smoking was more prevalent among girls, while alcohol consumption in the previous month was more common among boys. Meanwhile, the proportion of adolescents that reported drug use in the previous month was unrelated to gender. Higher cigarette consumption by girls suggests an increase in smoking by women in the future, which highlights the need for a special focus on this area.

Tabagismo em adolescentes de área urbana na região Sul do Brasil

OBJECTIVE: To evaluate the prevalence of tobacco smoking and its determinants among adolescents. METHODS: A cross-sectional study, using a multiple stage sampling, was carried out in 1997 and a sample of adolescents aged between 12 and 18 years who were living in the urban area of Pelotas, Brazil, was studied. Those who reported having smoked at least one cigarette per week during the last month were considered smokers. Chi-square test was used to compare proportions and conditional logistic regression was applied in the multivariate analysis. RESULTS/ CONCLUSIONS: Six hundred and thirty-two adolescents were interviewed, among which 38 were non-respondents. Of those interviewed, 11.1% were smokers at time of the study, 6.8% were former smokers and 82.1% had never smoked. Prevalence of tobacco smoking was directly related to the age. Even after adjusting for confounding factors, those who had left or failed at school, their parents were divorced or reported alcohol abuse in the last month showed a higher odds ratio for smoking.OBJECTIVE To evaluate the prevalence of tobacco smoking and its determinants among adolescents. METHODS A cross-sectional study, using a multiple stage sampling, was carried out in 1997 and a sample of adolescents aged between 12 and 18 years who were living in the urban area of Pelotas, Brazil, was studied. Those who reported having smoked at least one cigarette per week during the last month were considered smokers. Chi-square test was used to compare proportions and conditional logistic regression was applied in the multivariate analysis. RESULTS/ CONCLUSIONS: Six hundred and thirty-two adolescents were interviewed, among which 38 were non-respondents. Of those interviewed, 11.1% were smokers at time of the study, 6.8% were former smokers and 82.1% had never smoked. Prevalence of tobacco smoking was directly related to the age. Even after adjusting for confounding factors, those who had left or failed at school, their parents were divorced or reported alcohol abuse in the last month showed a higher odds ratio for smoking.

Uso de álcool por adolescentes: estudo de base populacional

OBJETIVO: Estimar la prevalencia y los factores asociados al uso de alcohol por adolescentes. METODOS: Estudio transversal de base poblacional realizado entre 2005 y 2006, en Pelotas (Sur de Brasil), con 1.056 adolescentes entre 11 y 15 anos de edad. Fue aplicado un cuestionario de auto-llenado anonimo, basado en el modelo de la Organizacion Mundial de la Salud para uso de drogas. Para analisis de los datos, fue utilizada la regresion de Poisson. RESULTADOS: La prevalencia de adolescentes que refirieron el consumo de bebidas alcoholicas en el ultimo mes fue de 23,0% (IC 95%: 20,4; 25,4), la prevalencia fue de 21,7% entre el sexo femenino y 24,2% entre el masculino. La prevalencia de consumo de alcohol a los 11 anos fue de 11,9%. En el analisis de regresion multiple, entre adolescentes del sexo masculino, el uso de bebidas alcoholicas fue mayor en aquellos que relataron el uso de tabaco en el ultimo mes, en los mas viejos y en aquellos que ya habian tenido relacion sexual. En las adolescentes del sexo femenino la edad fue la unica variable asociada al uso de bebidas alcoholicas. CONCLUSIONES: El uso de bebidas alcoholicas fue prevalerte en ambos sexos y con inicio extremadamente precoz. Tabaquismo y el haber tenido relaciones sexuales tambien estuvieron asociados al uso de bebidas alcoholicas. Hay necesidad de medidas preventivas con mayor precocidad, visando controlar el uso de alcohol en el intervalo de edad de 11 a los 15 anos.OBJECTIVE To estimate the prevalence and factors associated with alcohol use among adolescents. METHODS Population-based, cross-sectional study performed from 2005 to 2006, in the city of Pelotas, Southern Brazil, with 1,056 adolescents aged between 11 and 15 years. An anonymous, self-applied questionnaire was used, based on the World Health Organization model for drug use. Poisson regression was employed to analyze data. RESULTS Prevalence of adolescents who reported alcoholic beverage consumption in the last month was 23.0% (95% CI: 20.4;25.4), prevalence was 21.7% among females and 24.2% among males. Prevalence of alcohol consumption at 11 years of age was 11.9%. In the multiple regression analysis, alcoholic beverage use by male adolescents was higher among those who reported tobacco use in the last month, those who were older, and those who had already had sexual intercourse. Among female adolescents, age was the only variable associated with alcoholic beverage use. CONCLUSIONS Alcoholic beverage use was prevalent in both sexes and began at a very early age. Smoking and previous sexual intercourse were also associated with this use. Preventive measures need to begin earlier, aiming to control alcohol use in the 11-to-15-year age group.

The impact of maternal post-partum depression on the language development of children at 12 months

BACKGROUND Language is one of the most important acquisitions made during childhood. Before verbal language, a child develops a range of skills and behaviours that allow the child to acquire all communication skills. Factors such as environmental factors, socio-economic status and interaction with parents can affect the acquisition of vocabulary in children. Post-partum depression can negatively affect the first interactions with the child and, consequently, the emotional, social and cognitive development of the child. OBJECTIVE To analyse the effect of the duration of the mothers depression on the language development of children at 12 months old. METHODS This was a longitudinal study. The participants of this study were mothers who had received prenatal care from the Brazilian National System of Public Health in Pelotas city, State of Rio Grande do Sul, Brazil. The mothers were interviewed at two different time points: from 30 to 90 days after delivery and at 12 months after delivery; the children were also evaluated at this later time point. To diagnose maternal depression, we used the Mini International Neuropsychiatric Interview, and to assess child development, we used the language scale of the Bayley Scales of Infant Development III. RESULTS We followed 296 dyads. Maternal depression at both time points (post partum and at 12 months) was significantly associated with the language development of infants at 12 months of age. This impact was accentuated when related to the duration of the disorder. Older women and women with more than two children were more likely to have children with poorer language development, while women who were the primary caregiver had children with higher scores on the language test. CONCLUSION The findings indicate that maternal age, parity, primary caregiver status and duration of post-partum depression are associated with the language development of the child.

Peripheral oxidative damage in early-stage mood disorders: a nested population-based case-control study

Systemic toxicity is a relevant dimension of pathophysiology in bipolar disorder, and oxidative damage is one potential link between central and peripheral pathology. Although there is mounting evidence that chronic bipolar disorder is associated with oxidative stress, studies in the early stages of bipolar disorder are scarce, and heavily reliant on clinical in lieu of population studies. The objective of this study was to confirm leading hypotheses about the role of oxidative damage in bipolar disorder. To that end, we nested a case-control study in a population-based study of young adults aged 18-24 yr. After an initial psychopathology screen, all people with a lifetime history of (hypo)mania and matched controls underwent a structured diagnostic interview. This yielded a sample of 231 participants, in whom we measured serum protein carbonyl content (PCC) and thiobarbituric acid reactive substances (TBARS). People with bipolar disorder had higher PCC levels than healthy subjects. Those with major depression were not different from control subjects in either PCC or TBARS levels. Both bipolar disorder and major depression were associated with higher PCC levels in the a priori regression model controlling for possible confounders. These findings indicate that protein oxidative damage is present from early stages and can be seen as a sign of early illness activity in mood disorders.