Cognitive outcome of 458 children over 25 years of neonatal screening for congenital hypothyroidism

Abstract Objectives: To describe the neurocognitive profile of 458 children with congenital hypothyroidism detected by neonatal screening, followed under the same treatment protocol over 25 years. To correlate estimated full-scale IQ (FSIQ) scores with age at the start of treatment, disease severity, and maternal education. Methods: Observational, analytical, retrospective, and longitudinal cohort study, that evaluated children detected between 1991 and 2014, who underwent at least one psychometric assessment (WPPSI- R and/or WISC-III). Estimated FSIQ scores are described and correlated with prognosis determinants. Results: Median T4 at diagnosis was 2.8 µg/dL (0.0-16.5), the median age at the start of treatment was 18.5 days (3-309). Maternal education (n = 445): 2.7% of illiteracy, 59.8% with basic education. Estimated FSIQ scores were 88.0 (±11.8) in WPPSI-R (age 5.6 ± 0.5 years) and 84.1 (±13.0) in WISC-III (age 9.1 ± 1.4 years). The intellectual deficit was identified in 11.6%. Correlation between age at the start of treatment and estimated FSIQ was found only in the WPPSI-R test (p = 0.02). Initial T4 and maternal education significantly correlated with estimated FSIQ scores in both tests, with the latter being the most important determining factor. Conclusions: In this large cohort of mainly low socioeconomic status children, most children achieved normal cognitive levels; however, a significant percentage presented with below-average estimated FSIQ scores and intellectual deficits. Maternal education was the main determining factor in cognitive level followed by hypothyroidism severity.

Sedentary Behavior and Physical Activity of Schoolchildren from a Low-income Region in Brazil: Associations with Maternal Variables / Comportamento Sedentário e Atividade Física de Escolares de uma Região de Baixa Renda no Brasil: Associações com Variáveis Maternas

INTRODUCTION: In the last decade, an increasing number of studies investigated markers of Sedentary Behavior (SB) and Physical Activity (PA) in school-age children since they lead to nutritional status changes in this groupOBJECTIVE: To analyze associations between maternal factors and SB and PA of schoolchildrenMETHODS: This is a cross-sectional study involving 410 mothers of children enrolled between the first and the fifth year in municipal schools of Santa Cruz, RN, Brazil. By applying questionnaires, socioeconomic variables of the family, maternal data, and habits related to SB and PA on weekdays and weekends were investigated. Pearson's chi-square test and Fisher's exact test were used to test associationsRESULTS: It was observed that income below one minimum wage and less maternal education were associated with greater active transportation among children (69.3%, p = 0.012 and 68.4%, p = 0.022, respectively). Children from low-income families (65.4%, p = 0.016) and who had six and seven siblings (8.2%, p = 0.023 and 7.6%, p = 0.037, respectively) presented lower SB at the weekend. Low level of maternal education was associated with reduced PA during the week (70.8%, p = 0.024CONCLUSION: Socioeconomic (i.e., family income and number of siblings) and maternal factors (i.e., level of education) are important indicators for time spent on sedentary behavior and physical activity of schoolchildren

INTRODUÇÃO: Na última década, um número crescente de estudos tem se preocupado em investigar marcadores de Comportamento Sedentário (CS) e Atividade Física (AF) em crianças na idade escolar, por serem reconhecidos como causadores de alterações do estado nutricional nesta faixa etáriaOBJETIVO: Analisar os fatores associados maternos sobre o CS e AF de escolaresMÉTODO: Trata-se de uma pesquisa com delineamento transversal, envolvendo 410 mães de crianças matriculadas entre o primeiro e quinto ano nas escolas municipais de Santa Cruz, RN, Brasil. Por meio da aplicação de questionários, foram investigadas variáveis socioeconômicas da família, dados maternos e hábitos relacionados ao CS e AF dos escolares, nos dias da semana e no final de semana. Para testar associações foi utilizado o teste Qui-quadrado de Pearson e Teste Exato de FisherRESULTADOS: Foi observado que uma renda inferior a um salário mínimo e menor escolaridade materna foram associados com maior deslocamento ativo das crianças (69,3%, p = 0,012 e 68,4% p = 0,022, respectivamente). As crianças de famílias com baixa renda (65,4%, p = 0,016) e que tinham seis e sete irmãos (8,2%, p = 0,023 e 7,6%, p = 0,037, respectivamente) apresentam menor CS no final de semana. Um menor grau de escolaridade materna foi associado com uma menor prática de AF durante a semana (70,8%, p = 0,024CONCLUSÃO: Conclui-se que os fatores socioeconômicos (i.e., renda familiar e número de irmãos) e maternos (i.e., nível de escolaridade) são importantes indicadores para o tempo dispendido em comportamento sedentário e atividade física de escolares

Student engagement in Higher Education, age and parental education level / Envolvimento dos estudantes no Ensino Superior, idade e habilitações acadêmicas dos pais

Within the scope of socio-cognitive theories, student engagement in school has been studied as a multidimensional construct. A four-dimensional perspective was adopted, with the dimensions: affective, cognitive, behavioural and agentic. The objective, to analyse how the variables age and parental education relate to student engagement in school. The sample consisted of 715 Portuguese public Higher Education students from the Lisbon area. The data was collected through an online survey, which included the Student Engagement in School: a Four-Dimensional Scale - Higher Education Version. Data analysis not only revealed that students of age 26 or older scored considerably higher results in engagement than younger colleagues, but also highlighted significant differences of engagement in the affective, behavioural and agentic dimensions, depending on parental education. The results, while partially corroborating the revised literature, suggest future in-depth studies.

No âmbito das teorias sociocognitivas, o envolvimento do aluno na escola tem sido estudado como um constructo multidimensional. Para este estudo, optou-se por uma perspetiva quadridimensional a partir das dimensões afetiva, cognitiva, comportamental e agenciativa. Pretendeu-se analisar como as variáveis idade e escolaridade dos pais aparecem associadas ao envolvimento dos estudantes na escola. A amostra foi constituída em 715 estudantes portugueses do Ensino Superior Politécnico público da região de Lisboa. Os dados foram recolhidos através de um inquérito online que incluiu a escala, Envolvimento dos Alunos na Escola: uma Escala Quadri-Dimensional - Versão para Ensino Superior. A análise dos dados destacou que estudantes com 26 ou mais anos mostraram resultados no envolvimento significativamente superiores aos colegas mais jovens e salientou diferenças significativas no envolvimento deles nas dimensões afetiva, comportamental e agenciativa em função do nível de escolaridade dos pais. Os resultados corroboraram parcialmente a literatura revista e sugerem futuros estudos de aprofundamento.

Maternal periodontitis and its influence on duration of gestation and fetal birth weight

Background: There has been a lot of interest in knowing the effects of oral health on adverse pregnancy outcomes like preterm births and low birth weight. Studies have yielded contradicting results and there are lot of confounding issues that blur the picture.  Aim of the study is to determine the prevalence of periodontitis is pregnant population and determine the effect of periodontitis on preterm births and low birth weight.Methods: This was a cross sectional study of singleton pregnant women attending ante-natal checkups with oral interview and clinical examination. Oral examination was done at the beginning of third trimester of pregnancy. They were followed up to delivery to note the duration of gestation, birth weight of babies.Results: The prevalence of periodontitis was 22% with 90.9% having mild and 9.1% having moderate periodontitis. Maternal education (high school and above) was associated with lower prevalence of periodontitis (p=0.042). There was no difference in the birth weights between the group with and without periodontitis (2.9±0.41kgs vs 2.74±0.36kgs, p=0.11). The incidence of low birth weights was also similar (p=0.22). The average gestational age was slightly less in the group with periodontitis (38 weeks 3 days vs 37 weeks 5 days) but the rates of preterm births were similar between the two groups (p=0.61).Conclusions: Mild/moderate periodontitis does not appear to have a significant effect on pre-term births and low birth weight. Maternal education and awareness seem to mitigate development of periodontitis and adverse pregnancy outcomes.

A study on feeding practices among mothers with children aged less than two years in rural area of Kancheepuram District, Tamil Nadu

Background: Adequate nutrition in first 24 months through optimal Infant and Young Child feeding is fundamental for the development of the child. Hence assessment of Infant and Young child feeding practices rank among the most effective intervention is to meet the deficit improve the child health. Hence this study is conducted with the objective to assess the prevalence and factors influencing infant and young child feeding practices among the rural mothers of children aged less than two years. Methods: A cross sectional study was undertaken in the rural area of Kancheepuram district, Tamil Nadu from January 2017 to August 2017. 247 children of age less than two years were selected by two stage random sampling method. Data was collected house to house using pretested questionnaire and WHO infant and young child feeding questionnaire. Proportions were calculated and Chi square was applied. Results: The median age of the study participants were 9±7.1 months. 226 (91.5 %) were given colostrum and 163 (66%) were initiated breastfeeding within one hour after birth. 58.6% of children were introduced on soft/solid/semi solid food at the end of 6 to 8 months. In multiple logistic regression education of the mother, working status of the mother, number of antennal visits and place of delivery were associated with appropriate feeding practices. Conclusions: Maternal decision determines how an infant to be fed but it reflects the atmosphere by how they are influenced and adopted the decision.

Effect of maternal education on antenatal care utilization, maternal and perinatal outcome in a tertiary care hospital

Background: Antenatal Care (ANC) utilization facility is available but poorly utilized because of many factors which play indirect role in inadequate utilization of antenatal care facility: low social status of women in the society, less opportunity for basic education, less ability to make decisions. Therefore, the present study is an attempt to study the effect of maternal education on antenatal care utilization, maternal and perinatal outcome in a tertiary care hospital.Methods: A prospective study was carried out on 525 cases delivered during period of one year at Dayanand Medical College and Hospital, Ludhiana, Punjab, India; a tertiary care hospital catering both urban and rural population. All cases were categorized into two groups: booked and unbooked. The age, parity and education of each patient in booked and unbooked cases was noted. Further, its impact on antenatal care utilization, maternal and perinatal outcome was studied.Results: On studying education pattern, among illiterate subjects 50% were booked and 50% were unbooked; For graduate and above were 80.6% and 19.4%respectively. Among mothers who were illiterate 90.9% had low birth weight babies and 13.6% had stillborn. Among those graduates and above 38.7% had low birth weight babies,1.5 % stillborn and 1.2% neonatal deaths.Conclusions: The educational status of the women came out as a significantly important variable and predictor of perinatal outcome. Hence, whole hearted efforts should be directed in educating women population and also improving health care facilities in rural areas to provide early referral to higher centers.

Enablers of vitamin A coverage among children under five years of age from multi-country analyses of global demographic and health surveys in selected LMIC and LIC countries in Africa and Asia: a random forest analysis

Background: Vitamin A deficiency is a common form of micronutrient malnutrition. The estimated relative risks associated with vitamin A deficiency in children were 1.86 (95% CI 1.32–2.59) for measles mortality, 2.15 (95% CI 1.83–2.58) for diarrhoea mortality, 1.78 (95% CI 1.43–2.19) for malaria mortality, 1.13 (95% CI 1.01–1.32) for other infectious disease mortality. Vitamin A supplementation reduces night blindness, child morbidity and mortality.Methods: This paper tries to explore the socio-demographic causes of receipt of vitamin A in selected lower-middle-income and low income countries by analysing the data of the demographic and health surveys from 2012 and 2016 using PASW 18.0 software. Multivariate binary logistic regressions were conducted to explore the role of socio-demographic covariates in the receipt of vitamin A supplementation. In addition, random forest (RF) analyses were conducted using Python 3.6.Results: After adjusting for related socio-economic and demographic factors, mother’s work status and education and among mass media channels, exposure to television seems to play an important role in predicting receipt of vitamin A in the selected countries in Asia, while education of the mother was significantly associated with the receipt of vitamin A in the selected countries of Africa. In all the selected countries, the RF analyses revealed mother’s education followed by wealth index and mass media (TV), as the variable of most importance.Conclusions: It can be concluded that mother’s education and mass media seems to be working well in making the mothers aware about the vitamin A campaign, especially, the exposure to television. It also figures in the variable importance matrix in addition to wealth index.

Modifying effect of maternal education level on association between the number of prenatal care visits and neonatal low birth weight / 西安交通大学学报(医学版)

Objective: To investigate the modifying effect of maternal education level on the association between the number of prenatal care visits and neonatal low birth weight (LBW). Methods: The information about women of childbearing age and their children was obtained through a survey on the status of birth defects and their risk factors in Shaanxi Province. Logistic regression model was used to explore the multiplied interaction between maternal education level or the number of prenatal care visits and neonatal low birth weight and the Excel table prepared by Andresson et al. was used to calculate the adding interaction. Results: With the increase of the number of prenatal care visits, the incidence of LBW and SGA in all the newborns and full-term infants gradually decreased. When the mother's education level was high school and above, the risk of incidence of LBW (OR=0.81, 95% CI 0.65-1.00) and SGA (OR=0.86, 95% CI 0.77-0.95) in all the newborns and full-term infants (OR=0.76, 95% CI 0.60-0.97) were reduced. Also there was a reduced risk of LBW and SGA in all the newborns and full-term infants with increased times of prenatal care visits. Interaction analysis showed that the level of maternal education and the number of prenatal care visits only had multiplied interaction on LBW (OR=0.78, 95% CI: 0.63-0.97) and SGA (OR=0.84, 95% CI: 0.76-0.94) in all the newborns and full-term infants (OR=0.72, 95% CI: 1.11-1.25). Conclusion: The lower education level of the mother and fewer antenatal care visits were the risk factors for the occurrence of neonatal LBW, and the level of maternal education had a modifying effect on the influence of prenatal examination on neonatal LBW. Higher maternal education can improve the effect of fewer prenatal care visits on neonates' LBW.

Background familiar e desempenho escolar: uma abordagem com variáveis binárias a partir dos resultados do Saresp / Family background and school performance: an approach with binary variables from SARESP results / Fondo familiar y desempeño escolar: Un enfoque con variables binarias a partir de los resultados del SARESP

No presente estudo investiga-se o impacto de fatores externos à escola sobre a escolarização do indivíduo. Renda e escolaridade materna são consideradas para medir o efeito de aspectos familiares no desempenho em matemática do aluno. Para tanto, foram utilizados dados referentes à nota em matemática dos alunos da 3ª série do ensino médio e as respostas dos pais ao questionário socioeconômico, aplicado pelo Sistema de Avaliação do Rendimento Escolar do Estado de São Paulo (Saresp) na edição de 2013. São propostos modelos com variáveis binárias e obtidas estimativas para os parâmetros por meio do software SPSS. Os resultados mostram que rendas mais altas proporcionam melhores desempenhos educacionais, porém há restrições. O nível de escolaridade materna atua positivamente sobre o desempenho do aluno, mas está limitado ao nível adequado de proficiência.

This study researches the impact of outside school factors on individuals' schooling. Income and maternal schooling are taken into consideration when measuring the effect of familiar aspects on students' performance in Mathematics. Therefore, we used data referring to the Mathematics grade of students in 3rd year High School, and the answers provided by their parents for the socioeconomic questionnaire, applied by SARESP in its 2013 edition. Models with binary variables are proposed and estimates for parameters are obtained with SPSS. Results show that students from families with higher incomes indicate better educational performance, but there are restrictions. The level of maternal education positively influences student's performance, but is limited to appropriate proficiency levels.

El presente estudio investiga el impacto de los factores externos a la escuela sobre la escolarización del individuo. Se consideran la renta y la escolaridad materna para medir el efecto de los aspectos familiares en el desempeño del alumno en Matemáticas. Para eso, se utilzaron datos sobre la nota en Matemáticas de los alumnos de la tercera serie de Enseñanza Media y las respuestas de los padres al cuestionario socioeconómico aplicado por la Secretaria da Educação do Estado de São Paulo (SARESP) en la edición de 2013. Se proponen modelos con variables binarias y estimativos para los parámetros que se obtienen con el SPSS. Los resultados muestran que las rentas más altas proporcionan mejores resultados educativos, a pesar de lo cual hay restricciones: el nivel de escolaridad materna actúa positivamente sobre el desempeño del alumno, pero está limitado al nivel adecuado de competencia.

Practicas alimentarias y factores asociados al estado nutricional de lactantes ingresados al Programa Alimentario Nutricional Integral en un servicio de salud

Introducción: Niño/as con desnutrición son usuarios del Programa Alimentario Nutricional Integral (PANI), poco se sabe de sus prácticas alimentarias o condiciones sociodemográficas. Objetivo: Evaluar la asociación de las prácticas alimentarias y variables sociodemográficas con el estado nutricional de lactantes de 6 a 23 meses usuarios al Programa Alimentario Nutricional Integral (PANI). Materiales y Métodos: Estudio de casos y controles, con niños de 6-23 meses del Hospital Materno Infantil de San Lorenzo asignados a 2 grupos: a)Gupo Estudio-GE: 25 niños del PANI (desnutridos(DNT) o riesgo de desnutrir(RD) b)Grupo Control-GC: 25 niños eutróficos E), pareados por edad y sexo. Se averiguó sobre alimentación y variables sociodemográficas. Fueron utilizados (2, Mann Whitney, T Student y regresión logística, p<0,05 fue significativo. Resultados: Previa aprobación de Comité de Ética, fueron evaluados 50 niños, la mediana de edad fue 13,9 meses, el 72% (18/25 por grupo) eran varones en ambos grupos, 46/50 (92%) pertenecían a zona urbana. En GE tenían RD 20/25(80%) niños, DNT 5/20(20%); en GC todos eutroficos. No hubo diferencias significativas entre grupos, acceso a agua y saneamiento, duración de lactancia materna (LM) exclusiva o inicio de alimentación complementaria. El GE presentó menor promedio de peso de nacimiento que el GC (2724,6 vs 3430,6 gramos; Mann-Whitney, p=0,001), menor duración de LM total (7,5 vs 10,7 meses, T Student p=0,04), menor escolaridad materna (8,68 vs 10,4años; T Student p=0,03). en el ingreso económico.) Conclusión: Menor peso de nacimiento, escolaridad materna y de tiempo de lactancia materna se asocian a peor estado nutricional del niño, pero ninguna es predictora.

Introduction: Children with malnutrition are users of the Comprehensive Nutritional Food Program (PANI). Little is known about their eating habits or sociodemographic conditions. Objective: To evaluate the association of eating habits and sociodemographic variables with the nutritional status of infants aged 6 to 23 months referred to the Comprehensive Nutritional Food Program (PANI). Materials and Methods: This was a case-control study of children from 6-23 months seen at the San Lorenzo Maternal and Child Hospital, who were assigned to one of two groups: a) Study Group-SG: 25 children of the PANI with malnutrition (MLN) or at risk of malnutrition (ROM) b) Control Group-CG: 25 healthy children (H), matched by age and sex. We reviewed eating and sociodemographic variables. Χ2, Mann Whitney, T Student and logistic regression were used, p <0.05 was significant. Results: After study approval by the Ethics Committee, 50 children were evaluated. The median age was 13.9 months, 72% (18/25 per group) were boys in both groups, 46/50 (92%) came from urban areas. In the SG, 20/25 (80%) children had MLN, 5/20 (20%) were at ROM; in CG all had normal nutritional status. There were no significant differences between groups regarding access to water and sanitation, exclusive breastfeeding duration (EBD) or start of solid feeding. The SG had a lower average birth weight than the CG (2724.6 vs. 3430.6 grams; Mann-Whitney, p = 0.001), shorter duration of total EBD (7.5 vs. 10.7 months, Student T p = 0.04), lower maternal education (8.68 vs 10.4 years; Student T p = 0.03) and in lower economic income groups. Conclusion: Lower birth weight, lower maternal education and shorter breastfeeding duration are associated with worsening of a child's nutritional status, but none of these is predictive.

Socioeconomic diversities and infant development at 6 to 9 months in a poverty area of São Paulo, Brazil / Diversidades socioeconômicas e o desenvolvimento infantil de 6 a 9 meses no estado de São Paulo, Brasil

Abstract Introduction The effects of socioeconomic disparities on cognitive development tend to emerge early in infancy and to widen throughout childhood, and may perpetuate later in life. Although the study of how poverty affects early childhood has increased in the last 20 years, many of the effects remain largely unknown, especially during the first year of life. Aim To investigate the influence of socioeconomic status (SES) and maternal education on infants' language, motor and cognitive development. Methods The cognitive, language and motor skills of 444 infants aged 6 to 9 months selected from a poor neighborhood in São Paulo, Brazil, were evaluated using the Bayley Scales of Infant Development. A questionnaire on socioeconomic background was administered to the participants' families. Results A positive association was found between SES and infants' performance on language and motor scales. Additionally, higher maternal education was associated with higher language and cognitive scores. Conclusion Our findings indicate that SES effects are detectable very early in infancy. This result has implications for the timing of both screening and intervention efforts to help children overcome the consequences of living in poverty.

Resumo Introdução Os efeitos das disparidades socioeconômicas no desenvolvimento cognitivo tendem a surgir no início da primeira infância e a se ampliar ao longo da infância, e podem perpetuar-se mais tardiamente. Embora estudos mostrando os efeitos deletérios de um menor nível socioeconômico (NSE) no desenvolvimento na primeira infância tenham aumentado nos últimos 20 anos, muitos desses efeitos ainda permanecem desconhecidos, especialmente durante o primeiro ano de vida. Objetivo Investigar a influência do NSE e da escolaridade materna no desenvolvimento linguístico, motor e cognitivo do bebê. Método Foram avaliadas as habilidades cognitivas, linguísticas e motoras de 444 lactentes com 6 a 9 meses de idade selecionados em um bairro de baixo NSE na zona oeste de São Paulo, Brasil, utilizando-se as Escalas Bayley de Desenvolvimento Infantil. Um questionário também foi administrado para coletar dados sobre o background socioeconômico das famílias das crianças participantes. Resultado Foi observada uma associação positiva entre NSE e o desempenho dos lactentes nas escalas de linguagem e desenvolvimento motor. Adicionalmente, maior educação materna esteve associada a escores mais altos nas escalas de desenvolvimento linguístico e cognitivo. Conclusão Os resultados deste estudo indicam que os efeitos do NSE são detectáveis muito cedo na primeira infância. Este resultado tem implicações para o timing de avaliações e intervenções que possam ajudar as crianças a superar as consequências de viver na pobreza.

Escolaridad materna y estrato socioeconómico según el estado nutricional de preescolares evaluados en guarderías

Introducción: La problemática del elevado índice de malnutrición a nivel mundial se relaciona con factores causales comunes relacionados con la escolaridad materna, que junto con el estrato socioeconómico, podrían influir en la nutrición de los niños/as sobre todo aquellos que se encuentran en edad preescolar. Objetivo: Evaluar la escolaridad y el estrato socioeconómico maternos según el estado nutricional de preescolares. Materiales y Métodos: Se llevó a cabo un estudio observacional analítico de corte transversal. Fueron evaluados por antropometría, según criterios de la OMS, 82 niños/as en edad preescolar y se aplicaron encuestas a sus respectivas madres. Resultados: Según el indicador de Peso/Talla, 57,31% de los preescolares presentó estado nutricional adecuado (entre -1 y+1 DE), 29,3% sobrepeso (entre +1 y+2 DE) y 7,31% obesidad (por encima de +2 DE). El 6,1% presentó riesgo de desnutrición (entre -1 DE y -2 DE). En cuanto al indicador Talla/Edad, el 87,8% presentó talla adecuada (por encima de -1 DE), 11% riesgo de talla baja (entre -1 DE y -2 DE) y 1,22% talla baja (por debajo de -2 DE). Al comparar las medianas de los años de escolaridad materna según el estado nutricional de los hijos/as (18, 15, 14 y 13,5), no se encontraron diferencias significativas entre los grupos (p=0,247 Kruskal Wallis) y al comparar las medianas de los puntajes de la estratificación socioeconómica según el estado nutricional de los preescolares (7, 15 y 10,5), se encontraron diferencias significativas entre los grupos (p=0,023 Kruskal Wallis). Conclusiones: Más de la mitad de los preescolares presentó estado nutricional adecuado y talla adecuada. No se encontraron diferencias entre los años de escolaridad materna según el estado nutricional de los preescolares pero sí entre los puntajes de estratificación económica.

Introduction: The problem of the high rate of malnutrition worldwide is related to common causal factors related to maternal education, along with socioeconomic status, they could influence the nutrition of children, especially those who are in preschool. Objective: To evaluate maternal education and socioeconomic status as the nutritional status of preschool children. Materials and Methods: An analytical observational cross-sectional study was conducted. 82 children were evaluated by anthropometry, according to WHO criteria and surveys were applied to their respective mothers. Results: According to the indicator Weight/Height, 57.31% of preschool children presented adequate nutritional status (between -1 y+1 SD), 29.3% overweight (between +1 y+2 SD) and 7.31% obesity (above +2SD). Moreover, 6.1% presented risk of malnutrition (between -1 DE y -2 SD). For the indicator Height/Age, 87.8% had adequate size (above - 1 SD), 11% risk of low height (between -1 DE y -2 SD) and 1.22% presented low height (under -2 SD). When comparing the medians of the years of maternal schooling according to the nutritional status of (18, 15, 14 and 13.5), no significant differences between groups were found (p=0.247 Kruskal Wallis) and comparing medians of the socioeconomic stratification scores according to the nutritional status of preschool children (7, 15 and 10.5), significant differences between groups were found (p=0.023 Kruskal Wallis). Conclusions: More than half of preschool children presented adequate nutritional status and adequate height. No differences between maternal schooling were found according to the nutritional status of preschoolers but it did among economic stratification scores.

Trends of Social Inequalities in the Specific Causes of Infant Mortality in a Nationwide Birth Cohort in Korea, 1995–2009

The relationship between social disparity and specific causes of infant mortality has rarely been studied. The present study analyzed infant mortality trends according to the causes of death and the inequalities in specific causes of infant mortality between different parental social classes. We analyzed 8,209,836 births from the Statistics Korea between 1995 and 2009. The trends of disparity for cause-specific infant mortality according to parental education and employment were examined using the Cox proportional hazard model for the birth-year intervals of 1995–1999, 2000–2004, and 2005–2009. Adjusted hazard ratios were calculated after adjusting for infants' gender, parents' age, maternal obstetrical history, gestational age, and birth weight. An increasing trend in social inequalities in all-cause infant mortality according to paternal education was evident. Social inequalities in infant mortality were greater for “Not classified symptoms, signs and findings” (International Classification of Diseases 10th revision [ICD-10]: R00–R99) and “Injury, poisoning and of external causes” (S00–T98), particularly for “Ill-defined and unspecified causes” (R990) and “Sudden infant death syndrome (SIDS)” (R950); and increased overtime for “Not classified symptoms, signs and findings” (R00–R99), “Injury, poisoning and of external causes” (S00–T98) and “Conditions in perinatal period” (P00–P96), particularly for “SIDS” (R950) and “Respiratory distress syndrome of newborns (RDS)” (P220). The specific causes of infant mortality, in particular the “Not classified causes” (R00–R99 coded deaths) should be investigated more thoroughly to reduce inequality in health.

Does Maternal Education Affect Maternal and Child Health Care Utilization?: A Community Based Study in a Urban Slum Area of Western India.

In order to examine the relationship between maternal education and maternal and child mortality a survey was carried out in urban slum area of Surat city. The sample for this survey was designed to provide estimates on a large number of indicators on the situation of children and women living in the area where RCH services are provided by the Health Department of Surat Municipal Corporation. We included the mothers who had delivered in the past 1 year and their babies.Various variables with respect to maternal care and child care were investigated. A logistic regression was applied for variables found significantly associated with maternal education. This study showed that maternal education was independently associated with various aspects of maternal health care and child health care services. It is recommended that the local authorities should make effort to increase the maternal education for the betterment of the society.

Spatial distribution of C-sections within the state of São Paulo / Distribuição espacial das cesarianas no Estado de São Paulo

Objective: to identify spacial patterns for cesarean deliveries per microregion in the state of São Paulo. Methods: this is an ecological and exploratory study with data on live births occurred between 2003 and 2007 in 63 microregions in the state of São Paulo. Variables analyzed included cesarean delivery rates, teenage mothers, mothers with high levels of education and who had at least seven prenatal consultations. Moran's index (I), a measure of spatial autocorrelation of rates related to the variables described above and which identifies the presence of spatial clusters, was calculated. The distributions of the variables' rates in this study were visualized using thematic maps. The Moran map was used to identify microregions with high priority need for attention. Pearson correlation coefficients among the variables were also obtained. Results: there were 3,045,293 births, being 1,636,009 (53.7 %) cesarean deliveries. It was possible to identify spatial clusters of C-sections (I = 0.58 and p < 0.01) in the microregions located on the north and northwest of the state of São Paulo, as well as in Guaratinguetá; the values found for Moran index were, I = 0.32, I = 0.30 and I = 0.24, for the rates of teenage mothers, schooling and number of consultations, respectively, being all significant results (p <0.01). Micro-regions with high-priority need for attention were identified. Cesarean rates were significantly correlated with high rates of maternal education and number of prenatal consultations. Conclusion: the identification of these microregion clusters with high rates of cesarean delivery allows health managers to implement policies in order to minimize these rates. .

Objetivo: identificar padrões espaciais para partos cesarianos por microrregião do Estado de São Paulo. Métodos: estudo ecológico e exploratório com dados de nascidos vivos entre 2003 e 2007 de 63 microrregiões do Estado de São Paulo. As variáveis analisadas neste estudo foram, além de taxas de parto cesariano, taxas de mães adolescentes, de mães com alta escolaridade e de mães que realizaram pelo menos 7 consultas no pré-natal. Foram calculados os índices de Moran (I), que estimam autocorrelação espacial das taxas das variáveis acima descritas e identificam a presença de aglomerados espaciais. Essas taxas foram visualizadas pelos mapas temáticos; microrregiões com alta prioridade de atenção foram identificadas pelo mapa de Moran. Foram calculados os coeficientes de correlação de Pearson entre as variáveis. Resultados: houve 3.045.293 partos, sendo 1.636.009 (53,72%) partos cesarianos. Foi possível identificar aglomerados espaciais de cesarianas (I = 0,58 e p < 0,01) nas microrregiões ao norte e noroeste do Estado, além de Guaratinguetá. Os valores dos índices de Moran foram, para as taxas de mães adolescentes, I = 0,32; para as taxas de alta escolaridade, I = 0,30; e para as taxas do número de consultas, I = 0,24, todos significativos (p<0,01). Foram identificadas microrregiões com alta prioridade de intervenção. As taxas de cesarianas estiveram correlacionadas significativamente com as taxas de alta escolaridade materna e com número de consultas. Conclusão: a identificação desses aglomerados de microrregiões com altas taxas de cesarianas permite aos gestores de saúde implantar políticas para minimizar tais taxas. .

Factors Affecting Nutritional Status of Children below 24 Months in Pekan District, Pahang, Malaysia

Introduction: This study aimed to assess the nutritional status of children below 24 months in the district of Pekan, Pahang, and identify the contributing factors. Methods: Using a cross-sectional methodology, a total of 910 children was selected by random sampling from four public health clinics. Anthropometric measurements were taken and weight-for-age, height-for-age, and weight-forheight were calculated in Z scores. Immediate caregivers of children were interviewed by using a pretested validated questionnaire to assess their socioeconomic, demographic, educational and occupational status. Results: Of the 910 children who participated in the study, the majority were Malay (70.1%), while the remaining comprised indigenous or Orang-Asli (OA) children. Prevalence of wasting, stunting and underweight were 28.7 %, 15.6 % and 19.0% respectively. There were more underweight males than females. Wasting was most common among children aged below 6 months. Stunting was more prevalent in children between 12 to 24 months. Obesity was seen in 7.3% of the sample. Maternal education, employment and socio-economic status had a significant influence on wasting and underweight. Children were vulnerable to stunting as age advanced, whereas prevalence of wasting tended to decrease. Conclusion: Malnutrition exists in significant proportions among children below 24 months in the Pekan district. This study identified low birth weight along with age, race, gender, large family size and socio-economic status as important risk factors of malnutrition.

El inicio precoz de la lactancia materna se ve favorecido por la realización de la educación maternal / Early initiation of breastfeeding is benefited by maternal education program

OBJETIVO: Determinar la influencia de la educación maternal (EM) sobre el inicio precoz de la lactancia materna (LM) y su mantenimiento hasta los dos meses de vida del recién nacido. Conocer la influencia de la EM sobre los motivos que argumenta la mujer para abandonar la LM. MÉTODO: Estudio multicéntrico observacional llevado a cabo en cuatro hospitales de Andalucía en 2011 sobre mujeres primíparas. Los datos se recogieron a través de una entrevista y la historia clínica. En el análisis se estimaron odds ratios crudas y ajustadas. RESULTADOS: La realización de EM por parte de la madre se asoció con el inicio precoz de la LM (ORa = 1.78, IC 95% = 1.14-2.78) y el mantenimiento de esta (ORa = 1.73, IC 95% = 1.15-2.61). No hubo diferencias en los motivos que las mujeres argumentaron para abandonar la LM. CONCLUSIONES: La EM favorece el inicio y mantenimiento de la LM.

OBJECTIVE: To determine the influence of maternal education (ME) on early initiation of breastfeeding (BF) and its maintenance during the first two months of the infant's life, as well as to understand the influence of ME on the reasons for BF discontinuation. METHOD: This was a multicenter observational study carried out with primiparous women in four hospitals of Andalucía during 2011. Data was collected through interviews and from clinical charts. Raw and adjusted odds ratios were estimated during the analysis. RESULTS: Mothers who attended ME classes showed early initiation of BF (aOR = 1.78, 95% CI = 1.14-2.78) and maintenance of BF (aOR = 1.73, 95% CI = 1.15-2.61). There were no differences related to women's reasons to discontinue BF. CONCLUSIONS: ME positively impacts the initiation and maintenance of BF.

Nivel de dolor y elección de analgesia en el parto determinada por la realización de educación maternal / Influence of maternal education on the level of pain expressed by women during the delivery process

Objetivo: Conocer la influencia de la educación maternal sobre el nivel de dolor que manifiesta la mujer durante el proceso de parto, la utilización de analgesia epidural y el uso de medidas analgésicas alternativas. Método: Estudio multicéntrico observacional, realizado en cuatro hospitales de Andalucía desde enero de 2011 a enero de 2012. La población estudio fueron mujeres primíparas que tuvieron su parto en alguno de estos centros. Se estudiaron diferentes variables sociodemográficas, nivel de dolor y uso de medidas analgésicas. Los datos se recogieron a través de una entrevista y de la historia clínica. En el análisis se estimaron Odds Ratios (OR) y comparación de medias, crudas y ajustadas. Resultados: Participaron en el estudio 520 mujeres. No se detectó asociación entre la realización de educación maternal por parte de la mujer y el nivel de dolor que esta padeció durante el proceso de parto (p>0,05). Tampoco se detectó influencia con la utilización de medidas analgésicas alternativas (ORa= 1,14; IC95 por ciento: 0,70-1,83), ni de la analgesia epidural (ORa= 1,58; IC95 por ciento: 0,96-2,63). Conclusión: La educación maternal no es eficaz para el control del dolor que produce el proceso de parto, ni determina el uso de otras medidas analgésicas...

Objective: To determine the influence of maternal education on the level of pain expressed by women during the delivery process, the use of epidural analgesia and analgesic use of alternative measures. Methods: A multicenter observational conducted in four hospitals in Andalusia from January 2011 to January 2012. The study population consisted of primiparous women who gave birth in one of these centers. Sociodemographic variables were studied, level of pain and use of analgesic measures. The data were collected through an interview and medical history. The analysis estimated the Odds Ratios (OR) and mean, crude and adjusted. Results: The study involved 520 women. No association was found between maternal education being carried out by women and that this level of pain endured during the delivery process (p>0.05). Nor influence was detected with the use of alternative analgesic measures (aOR= 1.14; 95 percent CI: 0.70-1.83), or epidural analgesia (aOR= 1.58; 95 percent CI: 0.96-2.63). Conclusion: The maternal education is not effective for pain control that produces the delivery process, or determine the use of other analgesic measures...

Concentração de vitamina A no leite humano maduro / Vitamin A concentration in mature human milk

OBJETIVO: Quantificar a concentração de vitamina A no leite maduro de nutrizes assistidas em maternidade pública no município do Rio de Janeiro e avaliar a sua relação com variáveis sociodemográficas e grau de conhecimento de nutrição. MÉTODOS: Para a quantificação do retinol, foram coletadas amostras de 10 mL de leite maduro. Os pontos de corte adotados para identificação da deficiência de vitamina A e constituição de reserva hepática foram de < 1,05 µmol/L e > 2,3 µmol/L, respectivamente. Foram avaliadas, ainda, as variáveis: grau de conhecimento de nutrição, sexo, idade, renda familiar, escolaridade, condições de saneamento básico, número de moradores na residência, idade materna e assistência pré-natal. Resultados: Participaram do estudo 196 nutrizes, com concentração média de vitamina A no leite maduro de 1,76±0,85 µmol/L e prevalência de 20,5% de deficiência de vitamina A. Não houve diferença na concentração de vitamina A no leite das nutrizes segundo as variáveis sociodemográficas e conhecimento de nutrição. Apenas 38,9% das nutrizes apresentavam concentração de vitamina A no leite suficiente para constituição de reserva hepática dos lactentes. RESULTADOS: Participaram do estudo 196 nutrizes, com concentração média de vitamina A no leite maduro de 1,76±0,85 µmol/L e prevalência de 20,5% de deficiência de vitamina A. Não houve diferença na concentração de vitamina A no leite das nutrizes segundo as variáveis sociodemográficas e conhecimento de nutrição. Apenas 38,9% das nutrizes apresentavam concentração de vitamina A no leite suficiente para constituição de reserva hepática dos lactentes. CONCLUSÕES: Os achados aqui apresentados revelam alta prevalência de inadequação do estado nutricional de vitamina A materno e do lactente, concordante com a prevalência nacional descrita em mulheres em idade fértil e crianças brasileiras, e que as medidas de intervenção para combate à carência devem ser estendidas a todas as gestantes e puérperas, independentemente das condições sociodemográficas e do grau de conhecimento de nutrição, visando melhorar a saúde do binômio mãe/filho.

OBJECTIVE: To quantify vitamin A levels in mature milk of 196 nursing women who were treated at the Maternity School of Rio de Janeiro and to evaluate its correlation with sociodemographic variables and degree of nutrition knowledge. METHODS: To quantify retinol concentrations, 10 mL of mature milk were collected by manual expression of one breast, 2 hours after the last feed, in the morning period. Values below 1.05 µmol/L and 2.3 µmol/L were considered inadequate to meet satisfactory intake and to constitute vitamin A liver reserve, respectively. The following variables were also assessed: sex, age, familiar income, maternal education, basic sanitation conditions, number of people in the household, maternal age, prenatal care, and degree of nutrition knowledge. RESULTS: Among the 196 lactating mothers analyzed, the average vitamin A concentration observed in mature milk was 1.76±0.85 µmol/L and prevalence of vitamin A deficiency was observed in 20.5% mothers. There was no significant difference between vitamin A levels in maternal milk and the variables socioeconomic status and nutrition knowledge. Only 38.9% of lactating women presented enough vitamin A concentrations in milk for the infants' liver reserves (2.3 µmol/L). CONCLUSIONS: These findings reveal high prevalence of inadequate vitamin A nutritional status of mothers and infants, consistent with the national prevalence reported in women of childbearing age and Brazilian children, and that the intervention measures to fight this shortage should be extended to all pregnant and postpartum women, regardless of sociodemographic conditions and degree of nutrition knowledge, in order to improve the health of mother and child.

Effect of Maternal Education and Outreach Services on Child Mortality in a Zambian Village / 国際保健医療

<b>Objective</b><br> To examine the effects of the educational status of mothers and outreach services on childhood mortality in a Zambian village<br><b>Methods</b><br> The study design was a cross-sectional descriptive study. A survey was carried out in a village of Zambia in 2007. Five Japanese medical and nursing students interviewed mothers who had children under five years old. A structured questionnaire was used to collect information on social and educational factors and their experience of child deaths. In total, 73 mothers were interviewed, but three subjects were excluded because their records were inadequate. Information on the remaining 70 subjects was analyzed. The relationship between the dependent variable (child death rate per household) and independent variables (mother's characteristics, community circumstances) was examined. In this study, we used “the numbers of babies or young children who had died without defining age by care takers in a household” (child death rate per household) as a measure of child mortality.<br><b>Results</b><br> Of the 70 mothers, 30 were literate (42.9%). 33 mothers received health information from an outreach program and 22 from community health workers (CHWs).<br> The mother's education and the availability of health information from the outreach program were significantly related to lower child death rate per household (p=0.015 and p=0.019 respectively). The relationship between the mother's literacy and child death rate per household also showed an inverse tendency. Mothers with some education who received health information from the outreach program had reduced child death rate per household.<br> After stratification by maternal age (younger or older than 30 years), greater education, literacy and outreach program of the younger mothers were more strongly associated with decreased child death rate per household.<br><b>Conclusions</b><br> Education and community learning are important for the health of children. Maternal educational level and a community-based approach have strong impacts on child survival.