Post-partum weight retention in Northeastern Brazilian women: a prospective NISAMI cohort study.

BACKGROUND: Weight retention during the post-partum period is associated with excessive weight gain. OBJECTIVES: To investigate factors associated with maternal weight retention at six months post-partum (PPWR). DESIGN AND SETTING: A prospective cohort study was conducted with 127 women monitored using prenatal services. METHODS: The outcome variable was represented by post-partum maternal weight retention and calculated as the difference between the mother's weight at sixth month post-partum and her pregestational weight. RESULTS: The mean age of the pregnant women was 26.7 ± 5.25 years old, and the post-partum maternal weight retention was 46.5%. The proximal determinants showed a direct association with PPWR after adjusting for the distal and intermediate variables: excessive gestational weight gain (odds ratio [OR]:3.34; confidence interval [CI]:1.16-9.59), greater adhesion to dietary intake pattern 2 (composed of red meats and derivatives, eggs, industrialized foods, and coffee) (OR:2.70; CI:1.16-6.32), and the absence of exclusive maternal breastfeeding in the first month (OR:3.40; CI:1.27-9.12), as well as primiparity (OR:2.36; CI:1.00-5.55), an intermediate determinant. Insufficient weight gain in pregnancy was inversely associated with the outcome (OR:0.35; CI:0.31-0.93). CONCLUSIONS: Among the hierarchical determinants, proximal factors were interrelated with maternal weight retention, indicating that excessive total weight gain, an inadequate dietary intake pattern, and the absence of exclusive maternal breastfeeding in the first month of life work as dampeners of the return to pre-gestational weight. Prepartum and post-partum care interventions can contribute to reducing excess weight in women.

Post-partum weight retention in Northeastern Brazilian women: a prospective NISAMI cohort study

ABSTRACT BACKGROUND: Weight retention during the post-partum period is associated with excessive weight gain. OBJECTIVES: To investigate factors associated with maternal weight retention at six months post-partum (PPWR). DESIGN AND SETTING: A prospective cohort study was conducted with 127 women monitored using prenatal services. METHODS: The outcome variable was represented by post-partum maternal weight retention and calculated as the difference between the mother's weight at sixth month post-partum and her pregestational weight. RESULTS: The mean age of the pregnant women was 26.7 ± 5.25 years old, and the post-partum maternal weight retention was 46.5%. The proximal determinants showed a direct association with PPWR after adjusting for the distal and intermediate variables: excessive gestational weight gain (odds ratio [OR]:3.34; confidence interval [CI]:1.16-9.59), greater adhesion to dietary intake pattern 2 (composed of red meats and derivatives, eggs, industrialized foods, and coffee) (OR:2.70; CI:1.16-6.32), and the absence of exclusive maternal breastfeeding in the first month (OR:3.40; CI:1.27-9.12), as well as primiparity (OR:2.36; CI:1.00-5.55), an intermediate determinant. Insufficient weight gain in pregnancy was inversely associated with the outcome (OR:0.35; CI:0.31-0.93). CONCLUSIONS: Among the hierarchical determinants, proximal factors were interrelated with maternal weight retention, indicating that excessive total weight gain, an inadequate dietary intake pattern, and the absence of exclusive maternal breastfeeding in the first month of life work as dampeners of the return to pre-gestational weight. Prepartum and post-partum care interventions can contribute to reducing excess weight in women.

Validation and calibration of the Food Consumption Frequency Questionnaire for pregnant women

ABSTRACT BACKGROUND: Few food frequency questionnaires (FFQ) have been validated for pregnant women, particularly those in small- and medium-sized cities in different regions of Brazil. OBJECTIVES: To validate and calibrate a semiquantitative FFQ for pregnant women. DESIGN AND SETTING: The study was validated with a sample of 50 pregnant women (≥ 18 years) enrolled in Brazilian prenatal services. METHODS: An FFQ and a 24-hour recall were used to evaluate dietary intake. Dietary variables were tested for normality and log-converted when asymmetrical. Pearson's Correlation Coefficient was used to validate the questionnaire. Linear regression was applied to extract calibration factors. All variables underlying the consumption analysis were adjusted for energy. RESULTS: The mean age of the pregnant women was 26 years ± 6.2 years; 58% were in their first trimester, and 30% were identified as overweight/obese. The Pearson correlation analysis results indicated that the FFQ overestimated energy and nutrient intake, whose coefficients ranged from −0.15 (monounsaturated fat) to 0.50 (carbohydrate). Adjusting for energy reduced the mean values of intake coefficients, which now ranged from −0.33 (sodium) to 0.96 (folate). The calibration analysis results indicated variation in the coefficients from −0.23 (sodium) to 1.00 (folate). Calibration produced satisfactory coefficients for the FFQ compared with the reference standard for energy, macronutrients, monounsaturated fat, cholesterol, vitamins B12/C, folate, sodium, iron, and calcium. CONCLUSIONS: After validating and calibrating tests, we observed that the FFQ was adequately accurate for assessing the food consumption of the pregnant women in this study.

Validation and calibration of the Food Consumption Frequency Questionnaire for pregnant women.

BACKGROUND: Few food frequency questionnaires (FFQ) have been validated for pregnant women, particularly those in small- and medium-sized cities in different regions of Brazil. OBJECTIVES: To validate and calibrate a semiquantitative FFQ for pregnant women. DESIGN AND SETTING: The study was validated with a sample of 50 pregnant women (≥ 18 years) enrolled in Brazilian prenatal services. METHODS: An FFQ and a 24-hour recall were used to evaluate dietary intake. Dietary variables were tested for normality and log-converted when asymmetrical. Pearson's Correlation Coefficient was used to validate the questionnaire. Linear regression was applied to extract calibration factors. All variables underlying the consumption analysis were adjusted for energy. RESULTS: The mean age of the pregnant women was 26 years ± 6.2 years; 58% were in their first trimester, and 30% were identified as overweight/obese. The Pearson correlation analysis results indicated that the FFQ overestimated energy and nutrient intake, whose coefficients ranged from -0.15 (monounsaturated fat) to 0.50 (carbohydrate). Adjusting for energy reduced the mean values of intake coefficients, which now ranged from -0.33 (sodium) to 0.96 (folate). The calibration analysis results indicated variation in the coefficients from -0.23 (sodium) to 1.00 (folate). Calibration produced satisfactory coefficients for the FFQ compared with the reference standard for energy, macronutrients, monounsaturated fat, cholesterol, vitamins B12/C, folate, sodium, iron, and calcium. CONCLUSIONS: After validating and calibrating tests, we observed that the FFQ was adequately accurate for assessing the food consumption of the pregnant women in this study.

[Hospital admissions due to neglected tropical diseases in Piauí, in the Northeast region of Brazil: costs, time trends, and spatial patterns, 2001-2018]. / Hospitalizações por doenças tropicais negligenciadas no Piauí, Nordeste do Brasil: custos, tendências temporais e padrões espaciais, 2001-2018.

To characterize the magnitude of hospital admissions and costs of patients with neglected tropical diseases, their time trends, and spatial patterns in Piauí, in the Northeast Region of Brazil, in 2001-2018. Ecological study of mixed designs, with calculation of relative risk (RR), time-trend analysis by Poisson regression, and inflection points, using data from neglected tropical diseases Hospital Admission Authorizations available in the Hospital Information System of the Brazilian Unified National Health System (SIH/SUS). Data showed 49,832 hospital admissions due to neglected tropical diseases in the period (rate: 86.70/100,000 inhabitants; 95%CI: 83.47; 89.93); of these, dengue (78.2%), leishmaniasis (8.6%), and leprosy (6.4%). The total cost was BRL 34,481,815.43, 42.8% of which referred to medium complexity cases. Higher risks of hospitalization occurred among people ≥ 60 years (RR = 1.8; 95%CI: 1.5; 2.2), mixed race/color (RR = 1.7; 95%CI: 1.1; 2.4), residents of municipalities presenting medium social vulnerability (RR = 1.5; 95% CI: 1.3; 1.6), and population size (RR = 1.6; 95%CI: 1.4; 1.9). The time trend showed a reduction in hospital admissions due to neglected tropical diseases, 2003-2018 (annual percent change - APC: -10.3; 95%CI: -14.7; -5.6). The spatial pattern showed clusters with higher rates of hospital admission in border municipalities located south of the Mid-north macroregion, north of the Semiarid macroregion, and south of the Cerrados macroregion. Piauí remains with high hospital admission rates and costs for neglected tropical diseases. Despite the reduction in time trends, knowledge burden, population groups, and municipalities at greater risk and vulnerability reinforce the importance of monitoring and strengthening control actions to maintain the reduction of the burden and costs of hospital admission due to neglected tropical diseases in the state.

Caracterizar a magnitude das internações hospitalares e custos por doenças tropicais negligenciadas, suas tendências temporais e padrões espaciais no Piauí, Nordeste do Brasil, 2001-2018. Estudo ecológico misto, com cálculo de risco relativo (RR) e análise de tendência temporal por regressão de Poisson, pontos de inflexão, utilizando-se dados de Autorizações de Internações Hospitalares por doenças tropicais negligenciadas via Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH/SUS). Verificaram-se 49.832 internações hospitalares por doenças tropicais negligenciadas (taxa: 86,70/100 mil habitantes; IC95%: 83,47; 89,93) no período, principalmente dengue (78,2%), leishmanioses (8,6%) e hanseníase (6,4%). O custo total foi de R$ 34.481.815,43, sendo 42,8% de média complexidade. Maiores riscos de hospitalizações ocorreram em: pessoas ≥ 60 anos (RR = 1,8; IC95%:1,5; 2,2), etnia/cor parda (RR = 1,7; IC95%: 1,1; 2,4), residentes em municípios de média vulnerabilidade social (RR = 1,5; IC95%: 1,3; 1,6) e porte populacional (RR = 1,6; IC95%: 1,4; 1,9). A tendência temporal foi de redução nas taxas de internações hospitalares por doenças tropicais negligenciadas, 2003-2018 (variação percentual anual - APC: -10,3; IC95%: -14,7; -5,6). O padrão espacial apresentou aglomerados com maiores taxas de internações hospitalares nos municípios limítrofes ao sul da macrorregião Meio-norte, norte do Semiárido e sul dos Cerrados. O Piauí persiste com elevadas taxas de hospitalizações e custos por doenças tropicais negligenciadas. Apesar da redução nas tendências temporais, o conhecimento de sua carga, seus grupos populacionais e municípios de maior risco e vulnerabilidade reforçam a importância do monitoramento e fortalecimento das ações de controle para manutenção na redução da carga e custos de internações hospitalares por doenças tropicais negligenciadas no estado.

Caracterizar la magnitud de las internaciones hospitalarias y los costos por las enfermedades tropicales desatendidas, sus tendencias temporales y patrones espaciales en Piauí, Nordeste de Brasil, 2001-2018. Estudio ecológico mixto, con cálculo de riesgo relativo (RR), y análisis de tendencia temporal por regresión de Poisson, puntos de inflexión, utilizando datos de Autorizaciones de Internaciones Hospitalarias por enfermedades tropicales desatendidas a través del Sistema de Informaciones Hospitalarias del Sistema Único de Salud (SIH/SUS). Se verificó 49.832 internaciones hospitalarias por enfermedades tropicales desatendidas (tasa: 86,70/100.000 habitantes; IC95%: 83,47; 89,93) en el periodo, las más frecuentes dengue (78,2 %), leishmaniasis (8,6%) y lepra (6,4%). El costo total fue de BRL 34.481.815,43, siendo 42,8 %, fueron de mediana complejidad. Los mayores riesgos de hospitalización se dieron en: personas ≥ 60 años (RR = 1,8; IC95%: 1,5; 2,2), etnia/color pardo (RR = 1,7; IC95%: 1,1; 2,4), residentes en municipios de vulnerabilidad social media (RR = 1,5; IC95%: 1,3; 1,6) y tamaño de la población (RR = 1,6; IC95%: 1,4; 1,9). La tendencia temporal fue de reducción en las tasas de internaciones hospitalarias por enfermedades tropicales desatendidas, 2003-2018 (cambio porcentual anual - APC: -10,3; IC95%: -14,7; -5,6). El patrón espacial presentó conglomerados con mayores tasas de internaciones hospitalarias en los municipios limítrofes al sur de la macrorregión del Medio-norte, el norte del Semiárido, y sur de los Cerrados. El Piauí persiste con elevadas tasas de hospitalizaciones y costos por enfermedades tropicales desatendidas. A pesar de la reducción de las tendencias temporales, el conocimiento de su carga, los grupos poblacionales y los municipios de mayor riesgo y vulnerabilidad refuerzan la importancia del monitoreo y fortalecimiento de las acciones de control para mantenimiento en la reducción de la carga y los costos de internaciones hospitalarias por enfermedades tropicales desatendidas en el estado.

Mortality from neglected tropical diseases in the state of Piauí, Northeast Brazil: temporal trend and spatial patterns, 2001-2018. / Mortalidade por doenças tropicais negligenciadas no Piauí, Nordeste do Brasil: tendência temporal e padrões espaciais, 2001-2018.

OBJETIVE: To analyze temporal trends and spatial patterns of mortality due to neglected tropical diseases (NTDs) in Piauí, Brazil, 2001-2018. METHODS: This was a mixed ecological study, with risk ratio (RR) calculation, spatiotemporal trend analysis, Poisson joinpoint regression, using data from the Mortality Information System. RESULTS: There were 2,609 deaths due to NTDs in the period (4.60/100,000 inhabitants), 55.2% were due to Chagas' disease. There was a higher risk of death in male (RR=1.76; 95%CI 1.25;2.46), being aged ≥60 years (RR=40.71; 95%CI 10.01;165.53), municipalities with medium vulnerability social (RR=1.76; 95%CI 1.09;2.84), smaller population size (RR=1.99; 95%CI 1.28;3.10) and the Cerrados macro-region (RR=4.51; 95%CI 2.51;8.11). There was an upward trend in mortality rates from 2001-2008 and a falling trend from 2009-2018. CONCLUSION: Mortality due to NTDs in Piauí remains high, particularly due to Chagas' disease, among groups with greater vulnerability, with concentration of higher rates in the southwest of the Semiarid macro-region and the northeast and south of the Cerrados macro-region.

Mortality from neglected tropical diseases in the state of Piauí, Northeast Brazil: temporal trend and spatial patterns, 2001-2018 / Mortalidad por enfermedades tropicales desatendidas en el estado de Piauí, Nordeste de Brasil: tendencia temporal y patrones espaciales, 2001-2018 / Mortalidade por doenças tropicais negligenciadas no Piauí, Nordeste do Brasil: tendência temporal e padrões espaciais, 2001-2018

Objective: To analyze temporal trends and spatial patterns of mortality from neglected tropical diseases (NTD) in Piauí, 2001-2018. Methods: Mixed ecological study, with hazard ratio (RR) calculation,spatio- temporal trend analysis, Poisson regression with inflection points, using data from the Mortality Information System. Results: There were 2,609 deaths due to NTD in the period (4.60/100,000 inhabitants), 55.2% due to Chagas disease. There was a higher risk of death in men (RR=1.76 ­ 95%CI 1.25;2.46), aged ≥60 years (RR=40.71 ­ 95%CI 10.01;165.53), municipalities with vulnerability average social (RR=1.76 ­ 95%CI 1.09;2.84), smaller population size (RR=1.99 ­ 95%CI 1.28;3.10) and Cerrados macro-region (RR=4.51-95%CI 2.51;8.11). There was an upward trend in mortality rates from 2001-2008 and a reduction from 2009- 2018. Conclusion: Mortality due to NTD in Piauí remains high, particularly due to Chagas disease, among groups with greater vulnerability, with concentration of higher rates in the southwest of the semi-arid macro-region, northeast and south of the Cerrados.

Objetivo: Analizar las tendencias temporales y patrones espaciales de mortalidad por enfermedades tropicales desatendidas (ETD) en Piauí, 2001-2018. Métodos: Estudio ecológico mixto, con cálculo de hazard ratio (RR), análisis de tendencias espacio-temporales, regresión de Poisson con puntos de inflexión, utilizando datos del Sistema de Información de Mortalidad. Resultados: Hubo 2.609 defunciones por ETD en el período (4,60/100.000 habitantes), 55,2% por enfermedad de Chagas. Hubo un mayor riesgo de muerte en hombres (RR=1,76 ­ IC95% 1,25;2,46), edad ≥60 años (RR=40,71 ­ IC95% 10,01;165,53), municipios con vulnerabilidad social media (RR=1,76 ­ IC95% 1,09;2,84), tamaño de población más pequeño (RR=1,99 ­ IC95% 1,28;3,10) y macrorregión de Cerrados (RR=4,51 ­ IC95% 2,51;8,11). Hubo tendencia al alza en las tasas de mortalidad de 2001-2008 y  reducción de 2009-2018. Conclusión: La mortalidad por ETD en Piauí sigue siendo alta, particularmente por la enfermedad de Chagas, entre los grupos con mayor vulnerabilidad, con concentración de tasas más altas en el suroeste de la macrorregión semiárida, noreste y sur de los Cerrados.

Objetivo: Analisar tendência temporal e padrões espaciais da mortalidade por doenças tropicais negligenciadas (DTNs) no Piauí, Brasil, 2001-2018. Métodos: Estudo ecológico misto, com cálculo de razão de risco (RR), análise de tendência  espaço-temporal e regressão de Poisson com pontos de inflexão, utilizando-se dados do Sistema de Informações sobre Mortalidade. Resultados: Verificou-se 2.609 óbitos por DTNs no período (4,60/100 mil habitantes), 55,2% por doença de Chagas. Houve maior risco de morte em homens (RR=1,76 ­IC95% 1,25;2,46), idade ≥60 anos (RR=40,71 ­IC95% 10,01;165,53), municípios com vulnerabilidade social média (RR=1,76 ­ IC95% 31,09;2,84), menor porte populacional (RR=1,99 ­ IC95% 1,28;3,10) e macrorregião dos Cerrados (RR=4,51 ­ IC95% 2,51;8,11). Verificou-se tendência de aumento nas taxas de mortalidade em 2001-2008 e redução em 2009-2018. Conclusão: A mortalidade por DTNs no Piauí persiste elevada, particularmente por doença de Chagas, entre grupos de maior vulnerabilidade, concentrando-se as maiores taxas no sudoeste da macrorregião do Semiárido, nordeste e sul dos Cerrados.

Mortalidade por doenças tropicais negligenciadas no Piauí, Nordeste do Brasil: tendência temporal e padrões espaciais, 2001-2018 / Mortalidad por enfermedades tropicales desatendidas en el estado de Piauí, Nordeste de Brasil: tendencia temporal y patrones espaciales, 2001-2018 / Mortality from neglected tropical diseases in the state of Piauí, Northeast Brazil: temporal trend and spatial patterns, 2001-2018

Objetivo: Analisar tendência temporal e padrões espaciais da mortalidade por doenças tropicais negligenciadas (DTNs) no Piauí, Brasil, 2001-2018. Métodos: Estudo ecológico misto, com cálculo de razão de risco (RR), análise de tendência espaço-temporal, regressão de Poisson com pontos de inflexão, utilizando-se dados do Sistema de Informações sobre Mortalidade. Resultados: Verificaram-se 2.609 óbitos por DTNs no período (4,60/100 mil habitantes), 55,2% por doença de Chagas. Houve maior risco de morte no sexo masculino (RR=1,76; IC95% 1,25;2,46), idade ≥60 anos (RR=40,71; IC95% 10,01;165,53), municípios com vulnerabilidade social média (RR=1,76; IC95% 1,09;2,84), menor porte populacional (RR=1,99; IC95% 1,28;3,10) e macrorregião dos Cerrados (RR=4,51; IC95% 2,51;8,11). Verificou-se tendência de aumento nas taxas de mortalidade em 2001-2008 e redução em 2009-2018. Conclusão: A mortalidade por DTNs no Piauí persiste elevada, particularmente por doença de Chagas, entre grupos de maior vulnerabilidade, concentrando-se as maiores taxas no sudoeste da macrorregião do Semiárido, nordeste e sul dos Cerrados.

Resumen Objetivo Analizar las tendencias temporales y patrones espaciales de mortalidad por enfermedades tropicales desatendidas (ETD) en Piauí, 2001-2018. Métodos Estudio ecológico mixto, con cálculo de razón de riesgo (RR), análisis de tendencias espacio-temporales, regresión de Poisson con puntos de inflexión, utilizando datos del Sistema de Información de Mortalidad. Resultados Hubo 2.609 defunciones por ETD en el período (4,60/100.000 habitantes), 55,2% por enfermedad de Chagas. Hubo un mayor riesgo de muerte el sexo masculino (RR=1,76; IC95% 1,25;2,46), edad ≥60 años (RR=40,71; IC95% 10,01;165,53), municipios con vulnerabilidad social mediana (RR=1,76; IC95% 1,09;2,84), con menor población (RR=1,99; IC95% 1,28;3,10) y la macrorregión de los Cerrados (RR=4,51; IC95% 2,51;8,11). Hubo tendencia al alta en las tasas de mortalidad de 2001-2008 y reducción de 2009-2018. Conclusión La mortalidad por ETD en Piauí sigue siendo alta, particularmente por la enfermedad de Chagas, entre los grupos con mayor vulnerabilidad, con concentración de tasas más altas en el Suroeste de la macrorregión del Semiárido, noreste y sur de los Cerrados.

Abstract Objetive To analyze temporal trends and spatial patterns of mortality due to neglected tropical diseases (NTDs) in Piauí, Brazil, 2001-2018. Methods This was a mixed ecological study, with risk ratio (RR) calculation, spatiotemporal trend analysis, Poisson joinpoint regression, using data from the Mortality Information System. Results There were 2,609 deaths due to NTDs in the period (4.60/100,000 inhabitants), 55.2% were due to Chagas' disease. There was a higher risk of death in male (RR=1.76; 95%CI 1.25;2.46), being aged ≥60 years (RR=40.71; 95%CI 10.01;165.53), municipalities with medium vulnerability social (RR=1.76; 95%CI 1.09;2.84), smaller population size (RR=1.99; 95%CI 1.28;3.10) and the Cerrados macro-region (RR=4.51; 95%CI 2.51;8.11). There was an upward trend in mortality rates from 2001-2008 and a falling trend from 2009-2018. Conclusion Mortality due to NTDs in Piauí remains high, particularly due to Chagas' disease, among groups with greater vulnerability, with concentration of higher rates in the southwest of the Semiarid macro-region and the northeast and south of the Cerrados macro-region.

Associations between Maternal Dietary Patterns and Infant Birth Weight in the NISAMI Cohort: A Structural Equation Modeling Analysis.

The mother's diet during pregnancy is associated with maternal and child health. However, there are few studies with moderation analysis on maternal dietary patterns and infant birth weight. We aim to analyse the association between dietary patterns during pregnancy and birth weight. A prospective cohort study was performed with pregnant women registered with the prenatal service (Bahia, Brazil). A food frequency questionnaire was used to evaluate dietary intake. Birth weight was measured by a prenatal service team. Statistical analyses were performed using factor analysis with a principal component extraction technique and structural equation modelling. The mean age of the pregnant women was 27 years old (SD: 5.5) and the mean birth weight was 3341.18 g. It was observed that alcohol consumption (p = 0.05) and weight-gain during pregnancy (p = 0.05) were associated with birth weight. Four patterns of dietary consumption were identified for each trimester of the pregnancy evaluated. Adherence to the "Meat, Eggs, Fried Snacks and Processed foods" dietary pattern (pattern 1) and the "Sugars and Sweets" dietary pattern (pattern 4) in the third trimester directly reduced birth weight, by 98.42 g (Confidence interval (CI) 95%: 24.26, 172.59) and 92.03 g (CI 95%: 39.88, 165.30), respectively. It was also observed that insufficient dietary consumption in the third trimester increases maternal complications during pregnancy, indirectly reducing birth weight by 145 g (CI 95%: -21.39, -211.45). Inadequate dietary intake in the third trimester appears to have negative results on birth weight, directly and indirectly, but more studies are needed to clarify these causal paths, especially investigations of the influence of the maternal dietary pattern on the infant gut microbiota and the impacts on perinatal outcomes.

Associação entre hipertensão arterial materna e peso inferior a 3000g em nascimentos a termo / Association between maternal arterial hypertension and weight below 3000g in full-term births

Introdução: A hipertensão arterial na gestação preditor de baixo peso ao nascer. Objetivo: Investigar a associação entre hipertensão arterial materna e o peso ao nascer inferior a 3.000g, entre indivíduos a termo. Método: Estudo tipo caso­controle, realizado em Juazeiro ­ Bahia e Petrolina ­ Pernambuco, entre 2009 e 2011. Calculou­se Odds Ratio e intervalos de confiança de 95% na análise de dados. Resultados: Gestantes com hipertensão tiveram 49% de chance a mais de ter filhos com peso inferior a 3.000g, quando comparadas às sem hipertensão arterial. Conclusão: A identificação precoce da hipertensão arterial na gestação evita danos desse agravo, especialmente baixo peso ao nascer.

Introduction: Hypertension in pregnancy predicting low birth weight. Objective: To investigate the association between maternal arterial hyper­tension and birth weight below 3,000g among full­term individuals. Method: Case­control study, carried out in Juazeiro ­ Bahia and Petrolina ­ Pernambuco, between 2009 and 2011. Odds Ratio and 95% confidence intervals were calculated in data analysis. Results: Pregnant women with hypertension were 49% more likely to have children weighing less than 3,000g when compared to those wi­thout hypertension. Conclusion: The early identification of hypertension during pregnancy prevents damage from this disease, especially low birth weight.

Prevalence of overweight and obesity and associated factors among women of childbearing age in Brazil.

OBJECTIVE: To assess the factors associated with overweight and obesity among women of childbearing age in Brazil. DESIGN: Cross-sectional study. SETTING: Using the National Health Survey (PNS) database, from the year 2013. The socio-economic and demographic factors analysed were age, race/skin colour, region, marital status, education level, employment and family income. Concerning health history, diagnoses of hypertension, diabetes mellitus, high cholesterol, heart attack, stroke, chronic kidney disease, menarche, parity and depression were evaluated. For lifestyle information, health status, alcoholic beverage consumption, smoking and physical activity were included. The outcomes were obesity and overweight. The association of excess weight with socio-economic and demographic factors, health history and lifestyle characteristics was investigated according to the appropriate theoretical-conceptual model for the topic. PARTICIPANTS: The sample size was 17 109 women aged 18-49 years. RESULTS: The prevalence of women with excess weight was 55·20 %, with 33·26 % being overweight and 21·94 % with obesity. The factors associated with excess weight were age, non-white skin colour, having a partner, family income of up to two minimum wages, menarche before the age of 12, multiparity, diabetes mellitus, depression, hypertension, high cholesterol, stroke and heart attack. CONCLUSION: The results showed an association between excess weight and socio-demographic factors, both determinants of general and reproductive health history. Implementation of effective public health policies is necessary to prevent unfavourable outcomes related to the health of women of childbearing age with excess weight.

An accuracy study of the clinical diagnosis of periodontitis in pregnant women.

BACKGROUND: There exists a diverse range of criteria used in epidemiological studies for the diagnosis of periodontitis. The results from these studies should be evaluated with consideration to the diagnostic criteria used, and this may account for differences between studies especially in some population groups such as pregnant females. The objective is to evaluate the diagnostic criteria used in a variety of epidemiologic studies of periodontitis in pregnant females. METHODS: An accuracy study with cross-sectional design was performed out from a database of 671 pregnant females, using six different sets of criteria for the diagnosis of periodontitis. Women were classified for periodontitis, as follows: Center for Disease Control and Prevention/American Academy of Periodontology (CDC/AAP, 2012 criterion), the gold standard, Gomes-Filho et al.(2018) criterion, Albandar et al.(2007) criterion, Bassani et al.(2007) criterion, López et al.(2002) criterion, and Nesse et al.(2008) criterion. For comparison amongst the gold standard and the other criteria, sensitivity, specificity, predictive values, and likelihood ratio were determined. RESULTS: The frequency of periodontitis ranged from 25.0% to 90.2%. The Bassani et al. (2007) criterion was found to be more sensitive among the studies, and thus more suitable for diagnostic screening studies. Gomes-Filho et al.(2018), Albandar et al. (2007), López et al. (2002), and Nesse et al. (2008) criteria were considered more specific, which makes them more useful for studies of periodontitis with the aim of using diagnosis for confirmation of disease. CONCLUSIONS: A variation in the occurrence of periodontitis was observed. The criterion must be chosen according to the research aims and population characteristics.

Maternal anemia and birth weight: A prospective cohort study.

OBJECTIVE: To investigate the association between maternal anemia and low/insufficient birth weight. DESIGN: A prospective cohort study of pregnant women who underwent prenatal care at the healthcare units in a municipality of northeast Brazil together with their newborn infants was carried out. The pregnant women were classified as having anemia when the hemoglobin level was below 11 g/dl. Infants who were born full term weighing less than 2500 grams were classified as low birth weight, and those weighing between 2500 and 2999 grams were classified as insufficient weight. The occurrence of maternal anemia and its association with birth weight was verified using crude and adjusted Relative Risk (RR) estimates with their corresponding 95% confidence intervals (95%CIs). RESULTS: The final sample was comprised of 622 women. Maternal anemia was considered a risk factor for low/insufficient birth weight, after adjusting the effect measurement for maternal age, family income, urinary infection, parity, alcoholic beverage consumption during pregnancy and gestational body mass index: RRadjusted = 1.38 [95% CI: 1.07 to 1.77]. CONCLUSIONS: Maternal anemia was associated with low/insufficient birth weight, representing a risk factor for the gestational outcomes studied.

Drought monitoring in the Brazilian Semiarid region.

Drought is a natural and recurrent phenomenon. It is considered 'a natural disaster' whenever it occurs in an intensive manner in highly populated regions, resulting in significant damage (material and human) and loss (socioeconomic). This paper presents the efforts developed to monitor the impact of drought in the semiarid region of Northeast Brazil. In this scope, information from different sources is compiled to support the evaluation and identification of impacted municipalities, with the main objective of supporting emergency actions to mitigate their impact. In the semiarid region of Brazil there are frequent occurrences of dry periods during the rainy season, which, depending on the intensity and duration, can cause significant damage to family-farmed crops, with a farming system characterized by low productivity indices. However, rain-fed agriculture has great economic expression and high social importance due to the region is densely occupied, and contributes to the establishment of communities in the countryside. Specifically, in the present study, the methodology adopted to monitor the impact of agricultural droughts, including an analysis of the hydrological year 2015-2016, is presented, considering different water stress indicators for the identification of the affected municipalities and assessment of the methods and tools developed.

Climatic characteristics of the 2010-2016 drought in the semiarid Northeast Brazil region.

This study discusses the climatological aspects of the most severe drought ever recorded in the semiarid region Northeast Brazil. Droughts are recurrent in the region and while El Nino has driven some of these events others are more dependent on the tropical North Atlantic sea surface temperature fields. The drought affecting this region during the last 5 years shows an intensity and impact not seen in several decades in the regional economy and society. The analysis of this event using drought indicators as well as meteorological fields shows that since the middle 1990s to 2016, 16 out of 25 years experienced rainfall below normal. This suggests that the recent drought may have in fact started in the middle-late 1990s, with the intense droughts of 1993 and 1998, and then the sequence of dry years (interrupted by relatively wet years in 2007, 2008, 2009 and 2011) after that may have affected the levels of reservoirs in the region, leading to a real water crisis that was magnified by the negative rainfall anomalies since 2010.

Consumo alimentar de gestantes atendidasem Unidades de Saúde / Food consumption of pregnant women assisted in Health Units

A alimentação exerce função indispensável para a saúde das gestantes. Devido ao período intenso de metabolismofaz-se necessário um consumo alimentar saudável que favoreça o desenvolvimento de uma gestação adequada.Diante dessas informações, o objetivo deste estudo foi analisar a adequação dos grupos alimentares consumidos pelasgestantes atendidas em consultas de pré-natal nas unidades de Saúde de um município do Recôncavo da Bahia. Trata-sede um estudo transversal, envolvendo gestantes atendidas no serviço de pré-natal da rede pública do ano 2010, 2011 e2012. Foi utilizado questionário estruturado com informações, obstétricas e de saúde. Para avaliar o consumo alimentarutilizou-se o Questionário de Frequência de Consumo de Alimentos (QFCA). As porções dos grupos alimentares foramdeterminadas e em seguida analisadas segundo a pirâmide alimentar adaptada para população brasileira. Analisaramsetambém as características socioeconômicas da amostra. Foram entrevistadas 70 gestantes, com idade de 20 a 45anos. Destas, 75,8% eram casadas ou com união estável, 78,6% com nível médio de escolaridade, 36,2% apresentaramrenda familiar menor que um salário mínimo e 41,5% autodeclaram-se negras. Observou-se que as característicassocioeconômicas podem influenciar diretamente no consumo alimentar das gestantes. Na análise dos grupos alimentaresnotou-se consumo insuficiente de leguminosas, leite e produtos lácteos, e consumo excessivo do grupo de açúcares/doces e carnes e ovos. Observou-se consumo alimentar inadequado em termos qualitativos (grupos alimentares),não atendendo às necessidades específicas do ciclo gestacional, podendo implicar em risco nutricional para mãe e oconcepto.

Food plays essential role for the health of pregnant women. Due to the intense metabolism period, it is necessaryhealthy food consumption which ensures the development of an adequate pregnancy. Due to this information, the aimof this study is to analyze the adequacy of food groups consumed by pregnant women attending prenatal consultationsin the health units of the municipality Reconcavo in Bahia. It is a cross sectional study involving pregnant women inprenatal service of the public network over the years 2010, 2011 and 2012. It was used structured questionnaire withsocio-demographic information, obstetric and health. To assess food consumption it was used the Survey of FoodConsumption Frequency (FFQ). The portions of the food groups were determined then analyzed according to the foodpyramid adapted to the Brazilian population. It was also analyzed the socioeconomic characteristics of the sample. Theyinterviewed 70 pregnant women aged between 20 and 45 years. Among these women, 75.8% were married or in astable relationship, 78.6% with high school degree, 36.2% had family income lower than the minimum wage and 41.5%declare themselves as black. It was observed that the socioeconomic characteristics can influence directly on the diet ofpregnant women. In the analysis of food groups was noted insufficient intake of legumes, milk and dairy products, andexcessive consumption of the group of sugar/sweets and meats and eggs. There was inadequate food consumption interms of qualitative (food groups), not taking into account the specific needs of the gestational cycle, which may resultin nutritional risk to mother and fetus.

FOOD CONSUMPTION PATTERNS DURING PREGNANCY: A LONGITUDINAL STUDY IN A REGION OF THE NORTH EAST OF BRAZIL.

INTRODUCTION: the nutritional panorama in Brazil indicates that the dietary patterns of the population is characterized by the increasing inclusion of saturated and trans fats, sodium, sugars, soft drinks. This epidemiological and nutritional challenges reflects in the patterns of illness and death. OBJECTIVE: this study aims to identify patterns of food consumption and dietary changes in the first and third trimester of pregnancy. METHODOLOGY: this is a prospective cohort study involving 185 pregnant women in the State of Bahia, from 2012 to 2013. We used a food frequency questionnaire to assess dietary intakes. To identify the dietary pattern, the principal components factor analysis was adopted. We used the Pearson correlation test to identify the correlation between the patterns extracted in each trimester. RESULTS: four patterns of food consumption during pregnancy were identified. We observed changes in the eating patterns over the trimesters evaluated, especially for the food groups of fruit, coffee, fats, fried snacks, sugar and sweets. DISCUSSION: these dietary changes throughout the pregnancy accompany the physiological changes of each period of the pregnancy. In the first trimester, symptoms of nausea and vomiting are common, whereas in the same period cravings is reported, which may justify the consumption of a larger quantity of food deemed unhealthy. CONCLUSION: it was observed that there were changes in the adoption of dietary pattern throughout the evaluated trimesters of pregnancy, especially for the groups of fruit, coffee, fats, fried snacks and sugar and sweets.

Introducción: las perspectivas de crecimiento en Brasil indican que los patrones dietéticos de la población se caracterizan por el aumento del consumo de grasas saturadas y trans, sodio, azúcares y refrescos. Este punto de vista epidemiológico y nutricional refleja el cambio en el patrón de la enfermedad y la muerte. Objetivo: este estudio tiene como objetivo identificar los patrones de consumo de alimentos y los cambios en la dieta en el primer y tercer trimestres del embarazo. Metodología: se trata de un estudio de cohorte prospectivo de 185 mujeres embarazadas del Estado de Bahía, a partir de 2012 a 2013. Se utilizó el cuestionario de frecuencia de alimentos para evaluar la ingesta alimentaria. Para identificar la norma alimentaria se adoptó el análisis factorial de componentes principales. Se utilizó la prueba de correlación de Pearson para identificar la correlación entre los patrones extraídos en cada trimestre. Resultados: se identificaron cuatro patrones de consumo de alimentos durante el embarazo. Hemos observado cambios en los patrones de alimentación durante los trimestres evaluados, especialmente para los grupos de frutas, café, grasas, frituras, azúcar y dulces. Discusión: estos cambios en la dieta durante el embarazo acompañan a los cambios fisiológicos de cada embarazo. En el primer trimestre son síntomas comunes las náuseas y los vómitos; por otro lado, también se manifiesta antojos en el mismo periodo, lo cual puede justificar el consumo de mayor cantidad de alimentos considerados saludables. Conclusión: se observaron cambios en el patrón alimentario a lo largo de los diversos trimestres del embarazo examinados, especialmente para los grupos de frutas, café, grasas, frituras, azúcar y dulces.

Food consumption patterns during pregnancy: a longitudinal study in a region of the North East of Brazil / Patrones de consumo de alimentos durante el embarazo: un estudio longitudinal

Introduction: the nutritional panorama in Brazil indicates that the dietary patterns of the population is characterized by the increasing inclusion of saturated and trans fats, sodium, sugars, soft drinks. This epidemiological and nutritional challenges reflects in the patterns of illness and death. Objective: this study aims to identify patterns of food consumption and dietary changes in the first and third trimester of pregnancy. Methodology: this is a prospective cohort study involving 185 pregnant women in the State of Bahia, from 2012 to 2013. We used a food frequency questionnaire to assess dietary intakes. To identify the dietary pattern, the principal components factor analysis was adopted. We used the Pearson correlation test to identify the correlation between the patterns extracted in each trimester. Results: four patterns of food consumption during pregnancy were identified. We observed changes in the eating patterns over the trimesters evaluated, especially for the food groups of fruit, coffee, fats, fried snacks, sugar and sweets. Discussion: these dietary changes throughout the pregnancy accompany the physiological changes of each period of the pregnancy. In the first trimester, symptoms of nausea and vomiting are common, whereas in the same period cravings is reported, which may justify the consumption of a larger quantity of food deemed unhealthy. Conclusion: it was observed that there were changes in the adoption of dietary pattern throughout the evaluated trimesters of pregnancy, especially for the groups of fruit, coffee, fats, fried snacks and sugar and sweets (AU)

Introducción: las perspectivas de crecimiento en Brasil indican que los patrones dietéticos de la población se caracterizan por el aumento del consumo de grasas saturadas y trans, sodio, azúcares y refrescos. Este punto de vista epidemiológico y nutricional refleja el cambio en el patrón de la enfermedad y la muerte. Objetivo: este estudio tiene como objetivo identificar los patrones de consumo de alimentos y los cambios en la dieta en el primer y tercer trimestres del embarazo. Metodología: se trata de un estudio de cohorte prospectivo de 185 mujeres embarazadas del Estado de Bahía, a partir de 2012 a 2013. Se utilizó el cuestionario de frecuencia de alimentos para evaluar la ingesta alimentaria. Para identificar la norma alimentaria se adoptó el análisis factorial de componentes principales. Se utilizó la prueba de correlación de Pearson para identificar la correlación entre los patrones extraídos en cada trimestre. Resultados: se identificaron cuatro patrones de consumo de alimentos durante el embarazo. Hemos observado cambios en los patrones de alimentación durante los trimestres evaluados, especialmente para los grupos de frutas, café, grasas, frituras, azúcar y dulces. Discusión: estos cambios en la dieta durante el embarazo acompañan a los cambios fisiológicos de cada embarazo. En el primer trimestre son síntomas comunes las náuseas y los vómitos; por otro lado, también se manifiesta antojos en el mismo periodo, lo cual puede justificar el consumo de mayor cantidad de alimentos considerados saludables. Conclusión: se observaron cambios en el patrón alimentario a lo largo de los diversos trimestres del embarazo examinados, especialmente para los grupos de frutas, café, grasas, frituras, azúcar y dulces (AU)

Amamentação: conhecimento e prática de gestantes / Breast Feeding: knowledge and practice of pregnancy

O leite materno contribui positivamente para o crescimento e desenvolvimento da criança e apresenta vantagens imunológicas,psicológicas e nutricionais. Adicionalmente, leva a considerável redução na mortalidade infantil por todas ascausas e também é importante para a saúde da mulher. Considerando as informações apresentadas, o objetivo do presenteestudo foi identificar os conhecimentos e a prática do aleitamento materno de gestantes atendidas em unidades de saúdeem um município do Recôncavo Baiano. Estudo transversal, envolvendo gestantes atendidas em pré-natal em unidades desaúde em município do Recôncavo da Bahia, de Outubro de 2010 a Maio de 2011. Foram excluídas do estudo gestantescom HIV/AIDS ou que se recusaram a participar. Foi utilizado um questionário estruturado sobre aleitamento materno etécnica da mamada, contendo 34 questões, sendo 19 destinadas às multíparas, sobre a experiência prévia com amamentação.Foram entrevistadas 50 gestantes, sendo 68% primigestas. Cerca de 76% das mulheres consideraram que as criançasdeveriam mamar exclusivamente ao seio até os 6 meses, e 80% consideraram o leite materno forte. No que tange aosbenefícios do aleitamento materno para a saúde da mulher, 88% reconheceram a importância dessa prática e apontaramcomo principal benefício a redução do câncer de mama (68%). Apesar da maioria das mães apresentarem conhecimentosobre a importância do aleitamento materno, este ainda não é aplicado satisfatoriamente na prática da amamentação.Deve-se salientar a importância de ações de educação e apoio à amamentação desde o pré-natal até a fase de introduçãode novos alimentos para otimização da prática do aleitamento materno.

Breastfeeding contributes positively to the growth and development of children and presents advantages immunological,psychological and nutritional. Additionally, it leads to considerable reduction in mortality from all causes and is alsoimportant for women’s health. Considering the information presented, there is the objective of this study was to identifythe knowledge and practice of breast-feeding of pregnant women attending health facilities in one district of ReconcavoBaiano. It is a cross-sectional study involving pregnant women attending antenatal care in health facilities in the municipalityReconcavo of Bahia, October/2010 to May/2011. The study excluded women with HIV / AIDS or who refused toparticipate. We used a structured questionnaire on breastfeeding and breastfeeding technique, containing 34 questions,19 aimed at multiparous on previous experience with breastfeeding. We interviewed 50 pregnant women, 68% primiparous.About 76% of women felt that children should breastfeed exclusively breastfed until 6 months, and 80% consideredstrong breast milk. Regarding the benefits of breastfeeding for the health of women, 88% recognized the importance ofthis practice and pointed as the main benefit to reducing breast cancer (68%). Although most mothers present knowledgeabout the importance of breastfeeding, it is not yet satisfactorily applied in the practice of breastfeeding. Must stress theimportance of education initiatives and support breastfeeding from antenatal and even the phase of introduction of newfoods for optimal breastfeeding.

Surto alimentar por Salmonella enterica sorotipo Enteritidis em restaurante, São Paulo, SP - dezembro de 2006 / Foodborne disease outbreak caused by Salmonella enterica serotype Enteritidis at restaurant, in the city of São Paulo, SP - December 2006

Salmonella é um grupo bacteriano que pode causar gastrenterites, sendo encontrada, em geral, em alimentos de origem animal, como carnes, ovos, leite e outros. Salmonella Enteritidis é um dos mais comuns sorotipos no mundo, transmitido principalmente por ovos consumidos crus ou mal cozidos. O presente trabalho tem como objetivo apresentar os achados da investigação de surto alimentar ocorrido entre freqüentadores de um restaurante, em 22 e 23 de dezembro de 2006, no município de São Paulo. Dos 29 entrevistados, 24 adoeceram (TA=82,8%). A idade mediana foi de 27 anos (variação de cinco a 62 anos); 83% eram do sexo feminino. Mais de 50% dos doentes desenvolveram diarréia, febre, cólicas, vômitos, náuseas e cefaléia, sendo três deles internados, e nenhum óbito. Foi isolada S. Enteritidis nas fezes dos doentes expostos nos dias 22 e 23, e no copo do liquidificador utilizado para preparar o patê de ricota, alimento de risco associado ao surto (RR=1,5; IC 95% = 1,05-2,14; p< 0,05). Medidas sanitárias administrativas e de orientação técnica foram desencadeadas para prevenção de novos casos ou surtos.