High pressures studies on bis(L-alaninate)copper(II) by Raman spectroscopy and synchrotron X-ray diffraction

The crystal of bis(L-alaninate)copper(II) [Cu(C3H6NO2)2] was studied by Raman spectroscopy and synchrotron X-ray diffraction as a function of hydrostatic pressure, and its vibrational and structural behavior were investigated to analyze its stability at high pressures. The Raman spectra of bis(L-alaninate)copper(II) show changes in vibrational modes that are associated with deformations and stretching of units involving the copper atom. These results indicate that molecular fragments involving the copper atom undergo rotations and discontinuities in bond lengths. The lattice parameters of bis(L-alaninate)copper(II) obtained from Le Bail fits also exhibit changes in the same pressure ranges as the Raman spectra. The discontinuities in the angular parameter beta are compatible with the rotations of the molecular fragments. Bis(L-alaninate)copper(II) undergoes changes, but maintains monoclinic symmetry in the range of 0-20.1 GPa.

Accelerometer-based sleep metrics and gut microbiota during adolescence: Association findings from a Brazilian population-based birth cohort

BACKGROUND

Sleep and gut microbiota are emerging putative risk factors for several physical, mental, and cognitive conditions. Sleep deprivation has been shown to be linked with unhealthy microbiome environments in animal studies. However, in humans, the results are mixed. Epidemiological studies evaluating the effect of accelerometer-based sleep measures on gut microbiome are scarce. This study aims to explore the relationship between sleep duration and efficiency with the gut microbiota in adolescence.

METHODS

A subsample of 352 participants from the 2004 Pelotas (Brazil) Birth Cohort Study with sleep and fecal microbiota data available were included in the study. Sleep duration and sleep efficiency were obtained from actigraphy information at 11 years old whereas microbiota information from fecal samples was collected at 12 years. The fecal microbiota was analyzed via Illumina MiSeq (16S rRNA V3-V4 region) and the UNOISE pipeline. Alpha was assessed in QIIME2. Association measures for sleep variables and microbial α-diversity, and bacterial relative abundance were assessed through generalized models (linear and logistic regression), adjusting for maternal and child variables confounders.

RESULTS

Adjusted models showed that sleep duration was positively associated with Simpson index of α-diversity (β = 0.003; CI95 %: 0.00004; 0.01). Both sleep duration (OR = 0.43; CI95 % 0.25; 0.74) and efficiency (OR = 0.55; CI95 % 0.38; 0.78) were associated with lower Bacteroidetes abundance.

CONCLUSION

Our results suggest that sleep duration and efficiency are linked to gut microbiota diversity and composition even with 1-2 years gap from exposure to outcome. The findings support the role of sleep in the gut-brain axis as well as provide insights on how to improve microbiota health.

[SDG3-related inequalities in women's, children's and adolescents' health: an SDG monitoring baseline for Latin America and the Caribbean using national cross-sectional surveysDesigualdades relacionadas ao ODS 3 na saúde da mulher, da criança e do adolescente: linha de base para o monitoramento do ODS na América Latina e no Caribe por meio de pesquisas transversais nacionais]

Objectives

Latin America and the Caribbean (LAC) countries have made important progress towards achieving the Sustainable Development Goal (SDG) targets related to health (SDG3) at the national level. However, vast within-country health inequalities remain. We present a baseline of health inequalities in the region, against which progress towards the SDGs can be monitored.

Setting

We studied 21 countries in LAC using data from Demographic and Health Surveys and Multiple Indicator Cluster Survey carried out from 2011 to 2016.

Participants

The surveys collect nationally representative data on women and children using multistage sampling. In total, 288 207 women and 195 092 children made part of the surveys in the 21 countries.

Outcome measures

Five health intervention indicators were studied, related to reproductive and maternal health, along with adolescent fertility and neonatal and under-five mortality rates. Inequalities in these indicators were assessed through absolute and relative measures.

Results

In most countries, subnational geographical health gradients were observed for nearly all women, child, and adolescent (WCA) indicators. Coverage of key interventions was higher in urban areas and among the richest, compared with rural areas and poorer quintiles. Analyses by woman's age showed that coverage was lower in adolescent girls than older women for family planning indicators. Pro-urban and pro-rich inequalities were also seen for mortality in most countries.

Conclusions

Regional averages hide important health inequalities between countries, but national estimates hide still greater inequalities between subgroups of women, children and adolescents. To achieve the SDG3 targets and leave no one behind, it is essential to close health inequality gaps within as well as between countries.

SDG3-related inequalities in women's, children's and adolescents' health: an SDG monitoring baseline for Latin America and the Caribbean using national cross-sectional surveys

OBJECTIVES

Latin America and the Caribbean (LAC) countries have made important progress towards achieving the Sustainable Development Goal (SDG) targets related to health (SDG3) at the national level. However, vast within-country health inequalities remain. We present a baseline of health inequalities in the region, against which progress towards the SDGs can be monitored.

SETTING

We studied 21 countries in LAC using data from Demographic and Health Surveys and Multiple Indicator Cluster Survey carried out from 2011 to 2016 PARTICIPANTS: The surveys collect nationally representative data on women and children using multistage sampling. In total, 288 207 women and 195 092 children made part of the surveys in the 21 countries.

OUTCOME MEASURES

Five health intervention indicators were studied, related to reproductive and maternal health, along with adolescent fertility and neonatal and under-five mortality rates. Inequalities in these indicators were assessed through absolute and relative measures.

RESULTS

In most countries, subnational geographical health gradients were observed for nearly all women, child, and adolescent (WCA) indicators. Coverage of key interventions was higher in urban areas and among the richest, compared with rural areas and poorer quintiles. Analyses by woman's age showed that coverage was lower in adolescent girls than older women for family planning indicators. Pro-urban and pro-rich inequalities were also seen for mortality in most countries.

CONCLUSIONS

Regional averages hide important health inequalities between countries, but national estimates hide still greater inequalities between subgroups of women, children and adolescents. To achieve the SDG3 targets and leave no one behind, it is essential to close health inequality gaps within as well as between countries.

Time-dependent decay of detectable antibodies against SARS-CoV-2: A comparison of ELISA with two batches of a lateral-flow test

BACKGROUND

Large-scale epidemiological studies of seroprevalence of antibodies against SARS-CoV-2 often rely on point-of-care tests that provide immediate results to participants. Yet, little is known on how long rapid tests remain positive after the COVID-19 episode, or how much variability exists across different brands and even among batches of the same test.

METHODS

In November 2020, we assessed the sensitivity of three tests applied to 133 individuals with a previous positive PCR result between April and October. All subjects provided finger prick blood samples for two batches (A and B) of the Wondfo lateral-flow IgG/IgM test, and dried blood spot samples for the S-UFRJ ELISA test.

RESULTS

Overall sensitivity levels were 92.5% (95% CI 86.6-96.3), 63.2% (95% CI 54.4-71.4) and 33.8% (95% CI 25.9-42.5) for the S-UFRJ test, Wondfo A and Wondfo B tests, respectively. There was no evidence of a decline in the positivity of S-UFRJ with time since the diagnosis, but the two Wondfo batches showed sharp reductions to as low as 41.9% and 19.4%, respectively, for subjects with a positive PCR in June or earlier. Positive results for batch B of the rapid test were 35% to 54% lower than for batch A at any given month of diagnosis.

INTERPRETATION

Whereas the ELISA test showed high sensitivity and stability of results over the five months of the study, both batches of the rapid test showed substantial declines, with one of the batches consistently showing lower sensitivity levels than the other. ELISA tests based on dried-blood spots are an inexpensive alternative to rapid lateral-flow tests in large-scale epidemiological studies.

FUNDING

The study was funded by the "Todos Pela Saúde" initiative, Instituto Serrapilheira, Brazilian Ministry of Health, Brazilian Collective Health Association (ABRASCO) and the JBS S.A. initiative 'Fazer o Bem Faz Bem'.

SWPER Global: A survey-based women's empowerment index expanded from Africa to all low- and middle-income countries

Background In 2017, a survey-based women's empowerment index (SWPER) was proposed for African countries, including three domains: social independence, decision making and attitude to violence. External validity and predictive value of the SWPER has been demonstrated in terms of coverage of maternal and child interventions and use of modern contraception. To determine its value for global monitoring, we explored the applicability of the SWPER in national health surveys from low- and middle- income countries (LMICs) in other world regions.

Methods

We used data from the latest Demographic and Health Survey for 62 LMICs since 2000. 14 pre-selected questions (items) were considered during the validation process. Content adaptations included the exclusion of women's working status and recategorization of the decision-making related items. We compared the loading patterns obtained from principal components analysis performed for each country separately with those obtained in a pooled data set with all countries combined. Country rankings based on the score of each SWPER domain were correlated with their rankings in the Gender Development Index (GDI) and the Gender Inequality Index (GII) for external validation.

Results

Consistency regarding item loadings for the three SWPER empowerment domains was observed for most countries. Correlations between the scores generated for each country and global score obtained from the combined data were 0.89 or higher for all countries. Correlations between the country rankings according to SWPER and GDI were, respectively, 0.74, 0.72 and 0.67 for social independence, decision-making, and attitude to violence domains. The correlations were equal to 0.81, 0.67, and 0.44, respectively, with GII.

Conclusions

The indicator we propose, named SWPER Global, is a suitable common measure of women's empowerment for LMICs, addressing the need for a single consistent survey-based indicator of women´s empowerment that allows for tracking of progress over time and across countries at the individual and country levels.

Early childhood suspected developmental delay in 63 low- and middle-income countries: Large within- and between-country inequalities documented using national health surveys

²Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.

Background

The Sustainable Development Goals call for inclusive, equitable and quality learning opportunities for all. This is especially important for children, to ensure they all develop to their full potential. We studied the prevalence and inequalities of suspected delay in child development in 63 low- and middle-income countries.

Methods

We used the early child development module from national health surveys, which covers four developmental domains (physical, social-emotional, learning, literacy-numeracy) and provides a combined indicator (early child development index, ECDI) of whether children are on track. We calculated the age-adjusted prevalence of suspected delay at the country level and stratifying by wealth, urban/rural residence, sex of the child and maternal education. We also calculated measures of absolute and relative inequality.

Results

We studied 330 613 children from 63 countries. Prevalence of suspected delay for the ECDI ranged from 3% in Barbados to 67% in Chad. For all countries together, 25% of the children were suspected of developmental delay. At regional level, prevalence of delay ranged from 10% in Europe and Central Asia to 42% in West and Central Africa. The literacy-numeracy domain was by far the most challenging, with the highest proportions of delay. We observed very large inequalities, and most markedly for the literacy-numeracy domain.

Conclusions

To date, our study presents the most comprehensive analysis of child development using an instrument especially developed for national health surveys. With a quarter of the children globally suspected of developmental delay, we face an immense challenge. The multifactorial aspect of early child development and the large gaps we found only add to the challenge of not leaving these children behind.

The impact of women's empowerment on their children's early development in 26 African countries

BACKGROUND

Every year more than 200 million children under-five years fail to achieve their full developmental potential in low- and middle-income countries (LMICs). Although women´s empowerment has been associated with improved child health and development outcomes, this is a topic little studied in LMICs. We investigated the associations between women´s empowerment and early childhood development among a sample population of 84537 children aged 36-59 months from national health surveys of 26 African countries.

METHODS

We used data from Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) ranging from 2010 to 2018. Four developmental domains were assessed among children using the Early Childhood Development Index: literacy-numeracy, physical, learning and socioemotional. Women's empowerment in attitude to violence, social independence and decision-making was evaluated using the SWPER global, a validated survey-based index. We reported effect sizes for each country and a combined estimate of the association. The study covers all countries with surveys in the region and uses a novel approach for measuring women's empowerment, the SWPER.

RESULTS

Across all countries, 15.1% of the children were on track in the literacy-numeracy domain, 92.3% in physical, 81.3% in learning and 67.8% in socio-emotional. The odds of a child being on track in literacy-numeracy increased by 34% (odds ratio (OR) = 1.34; 95% confidence interval (CI) = 1.31-1.37), 88% (OR = 1.88; 95% CI = 1.85-1.91) and 34% (OR = 1.34; 95% CI = 1.29-1.39), with a one standard deviation increase in the scores of attitudes to violence, social independence and decision-making domains of empowerment, respectively. No effect of empowerment was observed for the other domains of child development.

CONCLUSIONS

Our results show a consistent positive effect of empowerment on the literacy-numeracy domain of child development cross-nationally in Africa and this was particularly evident for the social independence domain of the SWPER. Programs and interventions may also consider addressing the reduction of gender inequalities to improve child development.

Time trends in demand for family planning satisfied: analysis of 73 countries using national health surveys over a 24-year period

Background

Universal access to family planning is key to extend its health and economic benefits worldwide. Our aim was to track progress in demand for family planning satisfied with modern methods (mDFPS) and its inequalities in low- and middle-income countries (LMICs).

Methods

Analyses were based on Demographic and Health Surveys and Multiple Indicator Cluster Surveys carried out between 1993 and 2017 in 73 LMICs, using data for married women aged 15-49 years. We estimated trends in mDFPS coverage by country and world region and evaluated trends in wealth-based inequalities. The analyses pooling all countries together were stratified by wealth quintiles, area of residence and woman’s age. mDFPS coverage in 2030 for each country was predicted using a linear model.

Results

Overall, mDFPS increased and poor-rich gaps narrowed. Eastern & Southern Africa showed an average increase of 1.5 percentage points (p.p.) a year, being the region with the fastest progress. West & Central Africa had an increase in mDFPS of 1 p.p. a year but current coverage is still below 40%. Generally, inequalities were reduced, except for West & Central Africa and Europe & Central Asia where almost no change was observed. The country with the fastest progress in mDFPS was Rwanda, with an increase of 5 p.p./y, while Timor Leste had the fastest reduction in absolute inequality, less 3.8 p.p./y. Inequalities by area of residence were reduced, but large gaps remain. A similar trend was observed for different age groups. If the current trend is not accelerated, 44 countries will not achieve universal coverage in mDFPS by 2030.

Conclusions

Generally, mDFPS is increasing and inequalities are decreasing. However, progress is slow in some regions, especially West & Central Africa, where low coverage is combined with high levels of inequalities. Efforts to increase family planning coverage must be prioritized in countries where progress is slow or inexistent.

P5596Something is moving in acute aortic syndrome management and mortality. Results of Spanish registry of acute aortic syndrome (RESA-III)

Background

The impact of recent advances on the management of acute aortic syndrome (AAS) is usually reported by centres with great experience in aortic diseases. Current data on the management of this specific disease in Spain remains unknown.

Purpose

The Spanish Registry of Acute Aortic Syndrome (RESA-III) was established to assess current results in the management of AAS in a large cohort of hospitals from the same geographical area.

Methods

All patients admitted for AAS to 29 Spanish tertiary hospitals were enroled over 18 months (2017/2018).

Results

574 patients, (68% men; mean age 64±14y; range 18–99) were prospectively and consecutively included. Aortic dissection was the underlying disease in 474 (82.6%) (375 type A, 99 type B), aortic haematoma in 76 (13.2%) (43 type A and 33 type B) and penetrating ulcer in 24 (4.2%) (7 type A and 17 type B). From the subgroup of type A AAS (74% n=425), 81% underwent surgical treatment and medical management was chosen in the remaining 19%. 78 patients did not undergo surgery principally because of severe comorbidities (n=34) or advanced age (n=24), patient refusal (n=7), or presence of an intramural haematoma (n=2). Regarding the cohort of patients with type B AAS (26% n=149), 52% were managed only medically, 37% with endovascular treatment, and 11% underwent open surgery. Endovascular treatment was indicated owing to recurrent pain (n=19), progressive vessel dilation (n=9), dissection expansion (n=5), peripheral (n=5) or visceral ischaemia (n=4), high blood pressure (n=18), peripheral bleeding (n=17) or haemodynamical instability (n=8).

Overall type A mortality during hospitalisation was 36.4%; 26.4% in surgically treated and 79.4% in medically-treated patients (p=0.001). In type B AAS, overall mortality was 19.1%; 21.9% in the treated medically subgroup, 43.8% in those treated with open surgery and 7.8% in the endovascular treatment cohort (p=0.004).

Conclusion

Despite significant advances in acute aortic syndrome diagnosis and management, in-hospital mortality remains high. In type A AAS, medical management rate was too high (19%); however, in type B AAS, endovascular treatment yielded excellent results with less mortality than medical management (7.8% vs 19.1%, respectively). Our data support the need for continued improvement in the management of acute aortic syndrome.

Association between availability of children's book and the literacy-numeracy skills of children aged 36 to 59 months: secondary analysis of the UNICEF Multiple-Indicator Cluster Surveys covering 35 countries

Background

Stimulating home environments that have children's books, pictures and play toys facilitate caregiver-child interactions and enhance children's development. Although this has been demonstrated in small-scale intervention studies, it is important to document whether book ownership is beneficial at large scale in low and middle-income settings.

Methods

We conducted a secondary analysis using data from the multiple-indicator cluster survey, covering 100 012 children aged 36-59 months, from 35 countries. The outcome was children being on-track for a literacy-numeracy index (LNI) constructed from three questions assessing children's ability to identify/name at least 10 letters of the alphabet, read at least four simple popular words and know the names and symbols of all numbers from 1-10. The main exposure was availability of children's book to the child within household. Analysis considered the survey design, assessed and ranked risk ratios of being on track, adjusting for potential confounders such as child's age (in months), maternal education, household wealth index quintile and area of residence (rural/urban). Ecological analysis was performed using meta-regression after grouping countries by World Bank income groups (low- to high-income).

Results

Only half (51.8%) of children from all the countries analysed have at least one children's book at home and less than one-third (29.9%; 95% confidence interval (CI) = 23.5%, 36.3%) are on track for literacy-numeracy. After adjusting for confounders, the likelihood of being on track in literacy-numeracy almost doubled if at least one book was available at home compared to when there was none: RR = 1.89 (95% CI = 1.75, 2.03). There was an economic gradient showing that the likelihood of children being on track for LNI decreased with the country's income group: adjusted-RR ranged from 1.65 in upper middle income to 2.23 in LIC (F-test P-value <0.0001). Only three high-income countries were included, and children's books were universally available resulting in wide confidence intervals for the effect.

Conclusions

These findings are policy-relevant, as they corroborate the results from small scale experiments. Making children's book available to children is a cheap and feasible intervention that could change home dynamics to improve the future economic fortunes of children especially in the poorest countries.

Comparison of risk factors and outcomes of daptomycin-susceptible and -nonsusceptible vancomycin-resistant Enterococcus faecium infections in liver transplant recipients

BACKGROUND

Vancomycin-resistant Enterococcus faecium (VRE) infections are common in liver transplant recipients (LTRs). Daptomycin (DAP) is an important treatment for such infections; however, DAP-nonsusceptible VRE (DNS-VRE) are increasingly frequent. The purpose of this study was to compare clinical characteristics and outcomes of LTRs with infections due to DNS-VRE and DAP-susceptible VRE (DS-VRE).

METHODS

A single center, retrospective review of patients who underwent liver transplantation between January 1, 2010 and December 31, 2015 and developed infections due to DS-VRE or DNS-VRE post transplant was performed. Patients with DNS-VRE and DS-VRE infections were compared using univariate and logistic regression analysis.

RESULTS

Fourteen LTRs developed DNS-VRE and 20 LTRs developed DS-VRE infection post-transplantation. No significant differences were observed in demographics, model for end-stage liver disease (MELD) scores, causes of end-stage liver disease, or rate of pre-transplant perirectal VRE colonization between groups. Bleeding complications and renal replacement therapy were more common in the DNS-VRE group than in the DS-VRE group. The duration of transplant hospitalization and post-transplant intensive care unit (ICU) admission was longer in the DNS-VRE group than in the DS-VRE group. The 30-day and 6-month mortality rate associated with DNS-VRE infection was similar to that associated with DS-VRE infection.

CONCLUSIONS

Liver transplant recipients who develop DNS-VRE infection have higher bleeding complications and longer, more complex hospitalizations compared to those who develop DS-VRE infection post transplantation; however, mortality at 30 days and 6 months is not significantly worse. Further study is needed to determine optimal strategies for the prevention and treatment of DNS-VRE infections in LTRs.

Setting research priorities to improve global newborn health and prevent stillbirths by 2025

Background

In 2013, an estimated 2.8 million newborns died and 2.7 million were stillborn. A much greater number suffer from long term impairment associated with preterm birth, intrauterine growth restriction, congenital anomalies, and perinatal or infectious causes. With the approaching deadline for the achievement of the Millennium Development Goals (MDGs) in 2015, there was a need to set the new research priorities on newborns and stillbirth with a focus not only on survival but also on health, growth and development. We therefore carried out a systematic exercise to set newborn health research priorities for 2013–2025.

Methods

We used adapted Child Health and Nutrition Research Initiative (CHNRI) methods for this prioritization exercise. We identified and approached the 200 most productive researchers and 400 program experts, and 132 of them submitted research questions online. These were collated into a set of 205 research questions, sent for scoring to the 600 identified experts, and were assessed and scored by 91 experts.

Results

Nine out of top ten identified priorities were in the domain of research on improving delivery of known interventions, with simplified neonatal resuscitation program and clinical algorithms and improved skills of community health workers leading the list. The top 10 priorities in the domain of development were led by ideas on improved Kangaroo Mother Care at community level, how to improve the accuracy of diagnosis by community health workers, and perinatal audits. The 10 leading priorities for discovery research focused on stable surfactant with novel modes of administration for preterm babies, ability to diagnose fetal distress and novel tocolytic agents to delay or stop preterm labour.

Conclusion

These findings will assist both donors and researchers in supporting and conducting research to close the knowledge gaps for reducing neonatal mortality, morbidity and long term impairment. WHO, SNL and other partners will work to generate interest among key national stakeholders, governments, NGOs, and research institutes in these priorities, while encouraging research funders to support them. We will track research funding, relevant requests for proposals and trial registers to monitor if the priorities identified by this exercise are being addressed.

[Oral contraceptive and breast cancer: a case-control study]

OBJECTIVE

To investigate the association between breast cancer and the duration of use of oral contraceptives (OC), and age it started to be used in a population of Pelotas, Southern Brazil.

METHODS

There were identified 250 incident cases of breast cancer in patients aged 20 to 60 years from records of pathology laboratories and there were enrolled 1,020 controls drawn from hospital and neighbourhood population. For 90 cases identified in Pelotas, 270 hospital controls and 270 neighbourhood controls were selected, for another 78 cases in Pelotas, 234 controls were selected, and for 82 cases from other municipalities, 246 hospital controls were selected. Controls were matched by age. Adjusted analysis was performed using conditional logistic regression.

RESULTS

No association between oral contraceptive use and breast cancer was found (OR=1.1;CI95% 0.7 - 1.6 for hospital controls, and OR=0.9;CI95% 0.6 - 1.6 for neighbourhood controls) neither for different duration of use or starting age. To increase the test power, 250 cases and all 1020 controls were analyzed together, and an odds ratio of 1.6 (CI95% 1.0 - 2.4) was found for women older than 45 years of age who had been using oral contraceptives for five years or more.

CONCLUSIONS

No evidence was found of a general association between oral contraceptive use and breast cancer. When analyzing the whole date set, with all neighbourhood and hospital controls together, for women older than 45 years of age who had been using oral contraceptives for more than 5 years, it was found an increased risk almost statistically significant (p=0.05).

Relationship of mercury with aluminum, iron and manganese oxy-hydroxides in sediments from the Alto Pantanal, Brazil

Sediments from nine floodplain lakes in Pantanal were analyzed for a large-scale (300 km) survey of mercury (Hg) load in sediments and soils of the Alto Pantanal and to study the relationship between Hg and reactive aluminum, iron, and manganese oxy-hydroxides. The results were compared with the Hg content in river and stream sediments from the Poconé gold mining area, where Hg has been extensively used and still is in use. The results indicate that the Hg concentrations were elevated in river sediment close to the mining area in Bento Gomes river basin (average in the < 74-microm fraction 88.9 ng Hg g(-1) dry wt.; interquartile range 50.3-119.5), but there was no clear indication that the local Hg emissions have contaminated the remote floodplain lakes, where concentrations were surprisingly low (average in the < 74-microm fraction 33.2 ng Hg g(-1) dry wt. sediment; interquartile range 18.4-46.8), in particular when considering geochemical characteristics of the sediment. The sediment from the floodplain lakes contained less Hg-tot and more reactive iron oxy-hydroxides than soils from the Tapajós area in the Amazon basin. This resulted in a mass ratio between Hg and amorphous oxy-hydroxides of only 5 x 10(-6) for Hg-tot/Fe-oxa (interquartile range 3-7 x 10(-6).

[Understanding the low prevalence of weight-for-height deficit in lower-income Brazilian children: correlations among anthropometric values]

The sample for this study consisted of 386 children from six to 59 months of age. The objective was to study the association between wasting and abdominal circumference. Thirteen anthropometric measurements were taken: weight, height or length, crown-rump length, 4 circumferences, 4 skin fold thicknesses, and 2 breadths. Muscle, fat, and total upper arm areas and leg length were calculated. Indices of body proportionality were obtained by dividing the anthropometric variables by height. Height-for-age, weight-for-age, and weight-for-height deficits were 25.9%, 14.4%, and 3.5%, respectively. The smallest and lightest children were those with the highest abdominal circumferences divided by height. According to this study, abdominal circumference for Brazilian children without height-for-age deficit is, on average, 1.2 cm larger than for US children. Using this as a basis, the study calculated that prevalence of weight-for-height deficit would increase from 3.5% to 7.0% by increasing 2 cm in the abdominal circumference. The low prevalence of wasting and the high prevalence of stunting as indicated by several Brazilian studies could be explained partially by larger mean abdominal circumference values.

[Low prevalence of bodyweight-for-height deficit: comparison of stunned and no-stunned Brazilian children]

OBJECTIVES

The aim of this study was to investigate the relationship between abdominal circumference and weight-for-height in children. The average of 18 anthropometric and body proportionality indexes were compared among four groups of children: stunted and non-stunted Brazilians, Peruvians and North-Americans.

METHODS

There were studied 386 children aged 6-59 months living in a poor neighborhood in Pelotas, Brazil. Anthropometric measurements (weight, recumbent length or height, sitting height or crown-rump length; head, chest, upper arm and abdominal circumferences; triceps, biceps, subescapular and suprailiac skinfold thickness; biacromial and biiliac breadths) were obtained. Muscle, fat, total upper arm areas, leg length and body proportionality indexes were calculated.

RESULTS AND CONCLUSIONS

The study sample showed high levels of morbidity, low parental educational levels, poor access to health services and poor housing conditions. Stunted Brazilian children had lower means for most of the anthropometric measurements when compared to non-stunted Brazilians and North-American children. However, stunted children showed larger abdominal, head and thoracic circumference in relation to their stature than non-stunted children. The low prevalence of weight-for-height among the children of this study is not a result of excess of fat or muscle tissue, and may be partly explained by an increase in head and trunk dimensions (including abdominal circumference) relative to the child's stature.

Preventing acute respiratory infections and diarrhoea in child care centres

This study was designed to explore the physical characteristics and child care practices of child care centres as potential risk factors for respiratory infections and diarrhoea in children 3-35 mo of age. A dynamic cohort averaging 667 children from 40 child care centres in Campinas (Brazil) was followed up for 8 mo. Direct structured observations were made to collect information on the centres' physical structure, child activities and child care practices. Despite their good infrastructures, hand washing in the centres was infrequent, and nearly 30% of diaper changes were unhygienic. Risk factors for diarrhoea included the presence of flies during meals, infrequent child hand washing before meals, and infrequent child hand washing after defecation, with relative risks of 1.33, 1.73 and 1.63, respectively. There was 33% less diarrhoea in classes where soap was frequently used during diapering. Contrary to our hypotheses, ventilation, group size and child density were not associated with respiratory infections, as was the case for most other factors studied. Only mixing of groups and a larger classroom area were found to be negatively associated with lower and upper respiratory infections, respectively. The results indicate that improving hygiene practices is the only intervention in child care centre characteristics with good potential to reduce diarrhoea among attendees. For respiratory infections, no modifiable characteristic with intervention potential was identified.

[Daycare centers in a medium-sized Brazilian city: operations, child-care practices, infrastructure, and safety]

Ninety-two daycare centers (23 public, 10 charitable, and 59 private) were identified in the municipality of Pelotas, RS, Southern Brazil. These centers were studied in relation to their organization, services, child-care practices, and infrastructure. All public centers worked full-time, while most private centers operated in the afternoon and received a smaller proportion of children under the age of two. The child-to-attendant ratio was similar in both types of centers, and the nurseries were the classes most frequently above the recommended maximum. Group and center sizes were larger in the public centers. Attendant schooling was higher in the private centers, but task specificity was lower. The infrastructure deficiencies most commonly observed in the public centers were lack of an internal recreational area and playground equipment. Private centers lacked adequate diapering facilities and exclusive toilets for the children. A small proportion of centers had staff trained to handle fire emergencies and administer first aid, revealing insufficient concern over safety issues.

Child-care attendance and common morbidity: evidence of association in the literature and questions of design

Papers on child-care attendance as a risk factor for acute respiratory infections and diarrhea were reviewed. There was great variety among the studies with regard to the design, definition of exposure and definition of outcomes. All the traditional epidemiological study designs have been used. The studies varied in terms of how child-care attendance in general was defined, and for different settings. These definitions differed especially in relation to the minimum time of attendance required. The outcomes were also defined and measured in several different ways. The analyses performed were not always appropriate, leading to sets of results of uneven quality, and composed of different measures of association relating different exposures and outcomes, that made summarizing difficult. Despite that, the results reported were remarkably consistent. Only two of the papers reviewed failed to show some association between child-care attendance and increased acute respiratory infections, or diarrhea. On the other hand, the magnitude of the associations reported varied widely, especially for lower respiratory infections. Taken together, the studies so far published provide evidence that children attending child-care centers, especially those under three years of age, are at a higher risk of upper respiratory infections, lower respiratory infections, and diarrhea. The studies were not consistent, however, in relation to attendance at child-care homes. Children in such settings were sometimes similar to those in child-care centers, sometimes similar to those cared for at home, and sometimes presented an intermediate risk.

[Public and private day-care centers in Pelotas, RS: compliance with the regulations]

OBJECTIVES: Seventy-seven day-care centers were evaluated in Pelotas, RS, Brazil, in 1996, in order to assess compliance with current service regulations. METHODS: Information about physical structure, facilities, equipment, hygiene practices, and day-care staff was collected through a structured questionnaire. RESULTS: The median number of children in public day-care centers was 89 children per center, while in the private centers the median was 29 children per center (p<0.001). A nursery was available in 88% of public day-care centers, and in 36% of the private centers (p<0.001). Concerning the physical structure, the majority of the public centers had exclusive toilet facilities for the children (91%), while this was the case in only 66% of the private centers (p<0.001). Fire extinguishers were found in public centers in a proportion three times higher than in the private centers. Proper bottle washing and refrigeration was done in 95% of the day-care centers studied, while sterilization of the bottles was reported in only 47% of the centers. Despite the fact of 85% of the centers kept records with health information on the children, 93% of the centers did not have the required health license provided by the municipal authority. CONCLUSIONS: There is a good deal of work to do in both private and public day-care centers in order for them to comply with the current service regulations.

[Estimating the prevalence of height for age deficits based on the prevalence of weight for age deficits among Brazilian children]

INTRODUCTION

Anthropometry is frequently used for evaluating nutritional status of individuals and populations. In recent years, community surveys have been conducted by health professionals in various regions of Brazil with the objective of complementing the data obtained through nutritional surveillance programs. One important difficulty in conducting these assessments has been measuring height during visits to the homes of survey participants.

METHODS

Thirty-eight anthropometric surveys of Brazilian children aged up to 5 years using the National Center for Health Statistics (NCHS) reference were identified. The percentage of children with a Z-score below standard deviations was used to define deficits of weight for age and height for age.

RESULTS

Correlation between prevalences of height for age and weight for age deficits were examined. Due to the low prevalence of deficits in weight for height in all surveys, there was a strong correlation between weight for age and height for age at the population level. Approximately 90% of the height for age (H/A) variation was accounted for by that of weight for age (W/A).

CONCLUSIONS

Using the equation, (Prevalence H/A) = 0.74 + 2.34 (Prevalence W/A) -0.03 (Prevalence W/A)2 it is possible to estimate the prevalence of height deficits on the basis of prevalence of weight deficits. These results suggest that anthropometric surveys as conducted in Brazil, in the context of health services, can be simplified by measuring weight only, instead of both weight and height.