The impact of the economic crisis on the mental health of Portuguese primary-school children

Objective

To measure the impact of the economic crisis on the mental health correlates of Portuguese children attending primary school during 2016.

Methods

Cross-sectional analysis of primary school-aged children and their parents (n = 1157), conducted in public and private schools of three Portuguese districts. Parent reports of children mental health symptoms (Strengths and Difficulties Questionnaire - SDQ) and children self-reports of health-related quality of life (KIDSCREEN-27) and depressive, anxiety and stress symptoms (Depression, Anxiety and Stress Scales, Children version - DASS-C), were compared according to a set of yes/no questions on how the economic crisis changed the normal aspects of routine life (e.g. During the financial crisis did you had to use savings? Started buying cheaper food?). Linear regression models were fitted for the SDQ, the KIDSCREEN-27 and the DASS-C as dependent variables adjusted for children sex, socioeconomic status and district of residence.

Results

Affirmative answers to the crisis impact questions were associated with more frequent psychosocial functioning problems in children, with poorer self-reported health-related quality of life and with more frequent symptoms of depression, anxiety and stress.

Conclusions

Portuguese children mental health correlates show significant worse scores for those whose parents declared having to change daily routine habits as a result of the recent macroeconomic financial crisis, compared to those who did not change habits. Public Health programs should be developed to mitigate the potential negative impact of the financial crisis to the mental health of children.

Key messages

A negative impact on children mental health was observed as a result of the economic crisis. Public health programs designed to mitigate the impact of the economic crisis should include primary-school aged children.

Overweight Risk and Food Habits in Portuguese Pre-school Children

The relationship between dietary intake and overweight-risk was assessed in 4349 children aged 3–5 years. Eating and sedentary behaviours were assessed by questionnaire. Logistic regressions were used. Children who consumed daily soft-drinks were 1.52 times more likely to be obese, and 72% more likely to be classified as overweight children.

Maternal smoking in pregnancy association with childhood adiposity and blood pressure

BACKGROUND

Maternal smoking during pregnancy has been associated with increased risk of childhood overweight/obesity defined by body mass index (BMI). We examined its association with a range of adiposity measures and cardiovascular indicators in children aged 3-10 years.

METHODS

We used data from a cross-sectional study of schoolchildren across mainland Portuguese districts (2009-2010). We applied quantile regressions to examine maternal smoking associations with adiposity (n = 17 286), blood pressure (BP) and resting pulse rate (RPR) (n ≈ 2500) measures across the age range, adjusting for prenatal and early life factors.

RESULTS

Maternal smoking during pregnancy was associated with increases in offspring adiposity levels. The difference in median BMI between children of smokers and non-smokers was 0.39 kg m(-2) (95% confidence interval: 0.25, 0.53) in boys and 0.46 kg m(-2) (0.31, 0.62) in girls; 0.55 cm (0.24, 0.87) and 0.82 cm (0.45, 1.19), respectively, in median waist circumference; and 0.94 mm (0.49, 1.40) and 1.47 mm (0.87, 2.07) in median sum of (triceps, subscapular, suprailiac) skin-folds. The associations appeared to be stronger with increasing age. The differences in the 90th centile tended to be greater than those in median. There was no consistent association of maternal smoking with BP and RPR.

CONCLUSIONS

Children whose mother smoked during pregnancy had higher adiposity levels than children of non-smokers, across several measures, particularly among older children. Although there was no consistent association with cardiovascular indicators, maternal smoking association with childhood obesity may have implications for cardiovascular risk factors over the life course.

Exposure to paracetamol and antibiotics in early life and elevated risk of asthma in childhood

Prospective studies on increased risk of childhood asthma due to exposure to paracetamol and antibiotics in early life have yielded contradictory results. Therefore, the aim of the present study was to investigate the association between administration of paracetamol and antibiotics in the first 12 months of life and delayed asthma symptoms later in childhood. This is a cross-sectional study that included 1,063 children from the primary schools in Coimbra, Portugal. ISAAC-based environmental and core asthma and rhinitis questionnaires were used to obtain information about children's respiratory health and administration of paracetamol and antibiotics. We found that early paracetamol use significantly increased the risk of asthma ever (at least one episode in life) (OR = 2.9; 95 %CI:1.8-4.5), current asthma (OR = 2.4; 95 %CI:1.5-3.6), wheezing ever (OR = 2.5; 95 %CI:1.8-3.4), rhinitis ever (OR = 2.4; 95 %CI:1.7-3.3), and current rhinitis (OR = 2.8; 95 %CI:2.0-3.9). Antibiotic exposure showed a similar effect with the risk for current asthma (OR = 1.6; 95 %CI:1.0-2.5), asthma ever (OR = 2.0; 95 %CI:1.3-3.1), wheeze ever (OR = 2.3; 95 %CI:1.7-3.2), and rhinitis symptoms (OR = 1.8; 95 %CI:1.3-2.6, OR = 1.8; 95 %CI:1.3-2.6, OR = 1.9; 95 %CI:1.2-3.0 for rhinitis ever, current rhinitis, and tearing, respectively). We further found that increased frequency of paracetamol use during the last 12 months preceding the study facilitated the appearance of allergic symptoms, suggesting a dose-dependent associations. In conclusion, the study shows a significant association between exposure to paracetamol and antibiotics in the first 12 months of life and both prevalence and severity of asthma and rhinitis symptoms in children 5-9 years old.

Maternal weight gain during pregnancy and overweight in Portuguese children

OBJECTIVE

The objective of our study was to assess the association between maternal weight gain during pregnancy and childhood overweight.

DESIGN

This study was a cross-sectional analysis.

SETTING

The data were derived from a community-based survey of children from primary schools of Portugal.

SUBJECTS

The study was performed in a sample of 6-12-year-old Portuguese school children (2445 girls and 2400 boys; age was 8.5+/-0.91 years).

MEASUREMENTS

Height and weight were measured according to international standards, and body mass index (BMI) was calculated. The definition of overweight was based on average centiles according to the International Obesity Task Force cutoffs. Children's parents completed a self-administered questionnaire, which provided information on general family background characteristics, maternal weight gain during pregnancy and children's physical activity. The response rate was 70.6%. Children's dietary intake was measured using a 24-h dietary recall. Logistic regression models were fitted to estimate the magnitude of the association between maternal weight gain during pregnancy and overweight in their children, adjusting for confounders (gender, age, birthweight, order of birth, breastfeeding, smoking during pregnancy, physical activity, parental BMI, parental education, calcium to protein ratio and energy intake).

RESULTS

The prevalence of overweight (including obesity) was 29% in boys and 33% in girls. The odds favouring overweight (including obesity) increased significantly for those women who gained > or =16 kg during pregnancy, compared to those with <9 kg , even after adjustment for confounders (crude odds ratio (OR)=1.53, confidence interval (CI) 95% 1.27-1.84, P-trend <0.001; Adjusted OR=1.27, CI 95% 1.01-1.61, P-trend=0.038).

CONCLUSION

Large maternal weight gain during pregnancy (> or =16 kg) was significantly associated with higher risk of overweight in Portuguese children.

Dietary calcium and body mass index in Portuguese children

OBJECTIVE

The objective of our study was to assess nutritional intake in school children (7-9-y-old) and relate calcium intake to body mass index (BMI).

DESIGN

This study was a cross-sectional analysis.

SETTING

The data were derived from a community-based survey of children from primary schools of Portugal.

SUBJECTS

In all, 3044 Portuguese children (1503 girls and 1541 boys) from a community-based sample of 7-9-y-olds.

METHODS

Height and weight were measured according to international standards, and BMI was calculated. Children's parents completed a self-administered questionnaire that provided information on general family background characteristics and children's physical activity. Children's dietary intake was measured using a 24-h dietary recall. Calcium intake was expressed as the calcium-to-protein ratio, and regression analysis was used to estimate the association between calcium intake and BMI, adjusting for energy intake and confounders.

RESULTS

The prevalence of children with calcium intake below the Dietary Reference Intake was higher in girls (36.4 vs 33.0%, P = 0.053). Calcium-to-protein ratio predicts BMI only in girls (beta = -0.052, P = 0.002), even after adjusting for age, energy intake, parental education, and physical activity.

CONCLUSION

We found an inverse relationship between calcium intake and BMI only in girls. These data reinforce the need for controlled trials to assess the effects of dietary calcium on body mass in each gender.

Secular trends in age at menarche among Caboclo populations from Pará, Amazonia, Brazil: 1930-1980

The present study is part of a large research project on growth, development, nutrition, and health of Caboclo populations from the Brazilian Amazon. The aim of this paper is to analyze the age of menarche in adolescents (N=164) and adult women (219) in the studied populations. Caboclo are admixed rural, peasant groups that live along the Amazon river and its tributaries, and there are few previous studies about them. Probit analysis of the status quo data yielded a median age at menarche of 12.29+/-1.76 years. The retrospective method was applied to recall data of the 77 post-menarcheal adolescents, yielding an average of 13.06+/-1.27 years. Number of children in the family did not show any statistical influence on age at menarche in any age group. In adult women, age at menarche decreased from 14.50 in those born in 1930 to 12.88 for those born in 1980 (F=4.371, P=0.001). The downward trend found was, on average, 0.237 year per decade in the study period. The median age at menarche in the adolescents (12.29 years) is one of the lowest values found for Central and South American populations. In the ecological context, a low age at menarche could be an adaptive advantage because it provides a greater chance for reproduction at a young age in an environment where, until recently, life expectancy was low. As has been reported for other developing countries, the change found in age at menarche in the women born from the 1930s to the 1980s is likely to be related to changes in health and nutritional factors that occurred in Brazil because this country experienced significant improvement in living standards related to education, vaccination, and health conditions, which, although not equally, reached all regions after the 1960s.

Age at menarche in Coimbra (Portugal) school girls: a note on the secular changes

The age at menarche and several menstrual symptoms were reported by 516 Portuguese school girls who took part in a cross-sectional anthropometric study in Coimbra, Portugal. The mean ages of menarche calculated using the recall method and also using probit analysis were 12.53 +/-1.27 and 12.03 +/- 1.26 years, respectively. Parents'educational level, place of residence and size of the family did not have any significant effect on the mean age at menarche in this sample of adolescents. The order of birth was the only variable that indicated a significative effect: the first borns reported a lower mean age at menarche (12.34 years) than the later borns (12.6 years). In this sample, 47% of the girls had a cycle length of >or = 29 days, 23.4% had irregular cycles, 59% reported that the duration of bleeding was 3-5 days and the majority, 49%, did not report any pain during the bleeding days. However, 14.3% and 24.45% reported severe and medium pain. The age at menarche has declined from 15.0 (girls born in 1880-1890) to 12.03 (girls born in 1970-1980) years in the Portuguese population. This decrease in age, and also the lack of influence of the family characteristics, appear as a result of the great improvements in the social and economic living conditions that occurred in Portugal, especially after the 1970s. These improvements are mainly related to better nutrition and better health care along with many other environmental factors.

Age at menarche of schoolgirls in Maputo, Mozambique

Age at menarche was analysed in 753 Mozambican schoolgirls taking part in across-sectional anthropometric study in Maputo, Mozambique, in 2000. The probit analysis of the status quo data yielded an median age at menarche of 13.20 +/- 1.18 years. The retrospective method was applied only to recall data of the 396 post-menarcheal girls and it yielded an average of 13.91 +/- 1.29 years. Mean age at menarche in girls living in the urban centre of Maputo was 13.35 and 12.96 years, for recall age and probit analysis, respectively, and 14.51 and 13.68 years for girls living in the slums surrounding the centre. The differences in age at menarche, calculated by recall method, between girls from central Maputo and girls from the slums were statistically significant (p = 0.000). Parent's educational level also revealed a significant effect on age at menarche. Girls whose parents had a lower educational level showed a later age at menarche. For the size of the family, girls who were later borne had a higher age at menarche. In the 1960s, the age at menarche was 13.55 and 13.83 years in urban and rural girls, respectively. In this study, we found a lack of decrease in the mean age at menarche (13.9 years), which could be due to the poor living conditions in Mozambique between 1960 and 2000 as a result of the civil war from 1976 to 1990. Despite the economic growth of the country in the last decade, Mozambique is still in the group of the poorest countries in the world; in spite of this fact, the mean menarcheal age in these girls are amongst the lowest values presented for African countries.

Social background and age at menarche in Portuguese university students: a note on the secular changes in Portugal

Menarcheal age of a sample of Portuguese university students (n = 3366), born between 1972 and 1983, age 18-23 years, was analyzed. The influence of parents' educational level and occupation, family size, birth order, and degree of urbanization of girl's locality of residence during childhood and adolescence were analyzed as well as secular trend in the Portuguese population. Mean age at menarche for girls born in 1983 was 12.32 years. Parents' educational level and occupation did not show any significant influence on mean age at menarche. Place of residence during childhood years and adolescence showed a significant effect on mean age at menarche, with girls from rural places with a later age at menarche than those who spent their childhood or adolescence in urban areas (P <or= 0.01 and P <or= 0.05 for childhood and adolescence, respectively). Family size and birth order showed the highest effect. Girls born in small families, with one child, matured earlier (12.32 years) than those born in large families with four or more children (12.67 years), (P <or= 0.01). Also, girls that were first-born had an earlier menarche (12.41 years) than those who were third or later (12.58 years, P <or= 0.01). Regression analysis selected family size and place of residence in childhood as the most important determinants of mean age at menarche in our university students. In this sample, from 1972 to 1983, mean age at menarche remained stable. When we considered published data from all the Portuguese population we found a decrease in mean age at menarche from 15 years for girls born in 1880 to 12.44 for those born in the 1980s. This decrease was the result of great improvements in the social and economic living conditions that occurred in Portugal especially after the 1970s concerning nutrition and health care, among many other environmental factors.

Secular trend in stature in the Portuguese population (1904-2000)

The records of height of 995 101 18-year-old Portuguese males were analysed as well as the relation between localities of the subject's residence (districts) and final height. The sample includes all the Portuguese 18-year-old males born between 1966 and 1982 and examined between 1985 and 2000, in the north, centre and south of Portugal, representing all the social strata. Statistically significant differences (p <or= 0.001) among the districts were found: males from Lisboa (172.79 cm) and Braga (172.67 cm), the most developed districts, are the tallest, and those from Madeira (170.67 cm), Castelo Branco, Leiria and Coimbra (171.31 cm) are the shortest. Comparing to published data from 1904, a positive secular trend in height was found. The average increase was 8.93 cm, which yields a rate of 0.99 cm per decade. This positive trend must be related to the general improvement in the population's standard living conditions that took place in Portugal mainly after the 1960s and 1970s, especially in terms of nutrition and the health system. However, taking into account the differences that still exist in mean height values between the districts, these results suggest that there are still great social inequalities in Portugal and the secular trend in height will continue for the Portuguese population in future decades.

Secular trends in male adult height 1904-1996 in relation to place of residence and parent's educational level in Portugal

The records of height of 22841 18-year-old Portuguese males were analysed as well as their parents educational level and localities of subject's residence (districts). The sample includes all the Portuguese 18-year-old males, born in 1978 and examined in 1996, in central and southern Portugal, representing all the social strata. Statistically significant differences (p < or = 0.001) among the districts were found: males from Setúbal (172.75 cm) and Lisboa (172.64 cm), the most developed districts, are the tallest, and those from C. Branco (170.79cm) and Coimbra (171.19 cm) are the shortest. Comparing to published data from 1904, a positive secular trend in height was found. The average increase was 8.99 cm, which yields a rate of 0.99 cm per decade. This positive trend must be related to the general improvement in the population's standard living conditions, as the striking drop of post-neonatal mortality rate shows after the 1960s and 1970s. Despite this positive trend, great social difference still exists: the gap between the two extremes of parents' educational level is almost 4 cm for height. Analysis of variance (ANOVA) showed significant effects of father's and mother's educational level as well as subject's locality of residence, but the influence of parents' educational level was stronger than that of geographic residence. These results suggest that the secular trend in height will continue for the Portuguese population in the future decade.

Influence of industrialisation on marital behaviour in Beduído (Estarreja), Portugal

From marriage records of a Northern Portuguese parish for 1900-80, endogamy and exogamy rates were calculated for birthplace and residence in order to analyse the effect of industrialisation on the population structure after 1940. Marriages that were endogamous relative to birthplace decreased between 1940-49 (58.9%) and 1988 (20.5%), while exogamy increased. Exogamous marriages in which people came from outside the municipality (51.92%) were greater than those of the surrounding region (42.04%). After industrialisation, the pattern of marriages changed for residence, with an increase in the number of individuals who came from the district to work in the factories and married. Industrialisation advanced the start of exogamy which, for most Portuguese populations, began later, in the 1960s.