Análisis del desarrollo infantil temprano según el marco de cuidado cariñoso y sensible, por quintiles de riqueza y regiones de Argentina (2019-2020) / Analysis of early childhood development according to the nurturing care framework, by wealth quintiles and regions of Argentina (2019­2020)

Introducción. Uno de los principales desafíos para la primera infancia es brindar cuidados adecuados que reduzcan desigualdades y promuevan desarrollo infantil temprano (DIT). El objetivo del trabajo fue describir relaciones entre los cuidados que reciben niños y niñas de 3 y 4 años, según el marco para el cuidado cariñoso y sensible (NC, por sus siglas en inglés), y sus niveles de DIT en Argentina, considerando región y quintiles de riqueza. Población y métodos. Estudio analítico observacional de corte transversal, a partir de las bases de datos de la Encuesta Nacional de Niñas, Niños y Adolescentes (MICS) Argentina 2019-2020. Se seleccionaron 11 indicadores de NC y se estimó el nivel de DIT utilizando el Índice de Desarrollo Infantil Temprano (ECDI) para un análisis estadístico descriptivo. Resultados. En 2638 niños y niñas de 3 y 4 años evaluados, el promedio de acceso a indicadores de cuidados fue del 79,1 %; el acceso fue alto en 7 indicadores (entre el 84,2 % y el 97,9 %) y medio en 4 (entre el 46,9 % y el 65,1 %); la mayor frecuencia fue contar con registro de nacimiento (97,9 %) y la menor, la cobertura de seguro de salud (46,9 %). El 87,9 % alcanzó niveles adecuados de ECDI. Los resultados registran diferencias según quintiles de riqueza y regiones. Conclusiones. Los resultados evidencian desigualdades de acceso a cuidados y en DIT adecuado de niños y niñas de 3 y 4 años de áreas urbanas de Argentina según la región donde viven y el nivel de riqueza de sus hogares.

Introduction. One of the main challenges for early childhood is to provide adequate care to reduce inequalities and promote an early childhood development (ECD). The objective of this study was to describe the relationship between the care provided to children aged 3 and 4 years according to the nurturing care (NC) framework and their ECD levels in Argentina, considering the region and wealth quintiles. Population and methods. This was an observational, cross-sectional analytical study based on data from the National Survey of Children and Adolescents (MICS) of Argentina 2019­2020. A total of 11 NC indicators were selected; the level of ECD was estimated using the Early Childhood Development Index (ECDI) for a descriptive, statistical analysis. Results. In 2638 children aged 3 and 4 years assessed, the average access to care indicators was 79.1%; access was high for 7 indicators (between 84.2% and 97.9%) and middle for 4 indicators (between 46.9% and 65.1%); the highest and lowest frequency corresponded to having a birth certificate (97.9%) and health insurance coverage (46.9%), respectively. Adequate ECDI levels were observed in 87.9%. Results show differences by wealth quintile and region. Conclusions. The results evidence inequalities in terms of access to care and an adequate ECD of children aged 3 and 4 years from urban areas of Argentina, depending on the region where they live and their household wealth level.

Inclusão social pelo trabalho: percepções da primeira experiência de emprego em jovens de baixa renda / Social inclusion through work: perceptions of the first employment experience in low income young people / Inclusión social a través del trabajo: percepciones de la primera experiencia laboral en jóvenes de bajos ingresos

OBJETIVO: Este estudo teve como objetivo propor um modelo cognitivo/explicativo que represente as mudanças que podem ser incorporadas à vida de jovens de baixa renda, a partir de sua primeira experiência de emprego formal. MÉTODO: A amostra do estudo foi composta por 25 jovens beneficiários do Programa Primeiro Emprego/BA, que participaram de grupos focais on-line. Para a análise, as falas foram inicialmente categorizadas por meio da análise de conteúdo temática e, em seguida, visando uma sistematização e o estabelecimento de uma relação entre as categorias adotadas, foi utilizada a técnica do mapeamento cognitivo. RESULTADOS: A partir da análise das falas dos jovens, foram identificados 29 núcleos de sentidos, distribuídos em torno da tríade indivíduo- trabalho-sociedade. Entre as mudanças pessoais percebidas, destacam-se a valorização e o crescimento pessoal, assim como questões financeiras. Nas mudanças laborais, o aumento da empregabilidade como resultado da maior qualificação profissional e das novas habilidades técnicas adquiridas foi amplamente citado. Por fim, no que diz respeito às mudanças sociais, a percepção de alteração do status social ficou evidente. A maioria das mudanças observadas foram positivas e indicaram um aumento na qualidade de vida dos jovens de baixa renda. CONCLUSÃO: Conclui-se, portanto, que para uma modificação dos padrões de reprodução da força de trabalho juvenil, baseados na precarização e na subalternidade, é necessária uma transformação da realidade laboral dos seus atores.

OBJECTIVE: This study aimed to propose a cognitive/explanatory model that represents the changes that can be incorporated into the lives of low-income young people, from their first experience of formal employment. METHOD: The study sample consisted of 25 young beneficiaries of the First Employment Program/ BA, who participated in online focus groups. For the analysis, the speeches were initially categorized through thematic content analysis and, then, aiming at systematization and the establishment of a relationship between the adopted categories, the cognitive mapping technique was used. RESULTS: Based on the analysis of the young people's statements, 29 nuclei of meanings were identified, and distributed around the individual-work-society triad. Among the perceived personal changes, valorization and personal growth stand out, as well as financial issues. In terms of job changes, the increase in employability as a result of higher professional qualifications and new technical skills acquired was widely cited. Finally, with regard to social changes, the perception of change in social status was evident. Most of the changes observed were positive and indicated an increase in the quality of life of low-income youth. CONCLUSION: It is concluded, therefore, that for a change in the system, a transformation of the work reality of its actors is necessary.

OBJETIVO: Este estudio tuvo como objetivo proponer un modelo cognitivo/explicativo que represente los cambios que pueden incorporarse en la vida de jóvenes de bajos ingresos, a partir de su primera experiencia de empleo formal. MÉTODO: La muestra del estudio estuvo compuesta por 25 jóvenes beneficiarios del Programa Primeiro Emprego/BA, que participaron de grupos focales en línea. Para el análisis, los enunciados fueron inicialmente categorizados a través del análisis de contenido temático y luego, con el objetivo de sistematizar y establecer una relación entre las categorías adoptadas se utilizó la técnica del mapeo cognitivo. RESULTADOS: A partir del análisis de los enunciados de los jóvenes, se identificaron 29 centros de significado, distribuidos en torno a la tríada individuo-trabajo-sociedad. Entre los cambios personales percibidos se destacan la apreciación y el crecimiento personal, así como las cuestiones financieras. En los cambios laborales se citó ampliamente el aumento de la empleabilidad como consecuencia de una mayor cualificación profesional y de nuevas competencias técnicas adquiridas. Finalmente, en lo que respecta a los cambios sociales, se hizo evidente la percepción de cambios en el estatus social. La mayoría de los cambios observados fueron positivos e indicaron un aumento en la calidad de vida de los jóvenes de bajos ingresos. CONCLUSIÓN: Se concluye, por tanto, que para modificar los patrones de reproducción de la fuerza laboral juvenil, basados en la precariedad y la subalternidad, es necesaria una transformación de la realidad laboral de sus actores.

Diferencias en la evolución del sobrepeso y la obesidad infantil en España en el periodo 2011-2019 por sexo, edad y nivel socioeconómico: resultados del estudio ALADINO / Differences in the temporal trends of childhood overweight and obesity in Spain in the 2011-2019 period by sex, age and socioeconomic level: Results of the ALADINO study

Introducción: El exceso de peso infantil es un problema de salud pública creciente. El objetivo del trabajo es estudiar la evolución de la prevalencia de sobrepeso, de obesidad y de obesidad central en escolares de 6 a 9años en España entre 2011 y 2019 según características demográficas y socioeconómicas.MetodologíaSe incluyeron las rondas 2011, 2015 y 2019 del estudio observacional, descriptivo y transversal ALADINO en escolares de ambos sexos de 6 a 9años. Se realizó un análisis descriptivo de la evolución de la prevalencia de sobrepeso y de obesidad según los criterios de la Organización Mundial de la Salud (OMS) y la International Obesity Task Force (IOTF), así como obesidad central, y las variables demográficas y socioeconómicas asociadas.ResultadosEntre 2011 y 2019 se redujo la prevalencia de sobrepeso (criterios OMS) en niños de 6, 7 y 8años (−5,4, −5,7 y −5,3 puntos porcentuales, respectivamente) y niños cuyos progenitores tenían estudios superiores (−5,3 puntos porcentuales). Por renta, el sobrepeso en niños se redujo en todos los niveles de ingresos. Sin embargo, entre 2011 y 2019 se mantuvieron estables tanto la prevalencia de sobrepeso en niñas como la prevalencia de obesidad según las referencias OMS e IOTF y la de obesidad central en ambos sexos.ConclusionesLas prevalencias de sobrepeso y de obesidad en escolares de 6 a 9años en España siguen siendo altas. Entre 2011 y 2019 disminuyó la prevalencia de sobrepeso en niños de 6 a 8años y aquellos cuyos progenitores tienen estudios universitarios, mientras que la obesidad en niños, el sobrepeso y la obesidad en niñas, y la obesidad central en ambos sexos han permanecido estables. (AU)

Introduction: Childhood excess weight is a growing public health problem. The aim of this study was to assess temporal trends in the prevalence of overweight, obesity and central obesity in schoolchildren aged 6 to 9years in Spain between 2011 and 2019 based on demographic and socioeconomic characteristics.MethodologyThe analysis included data from the 2011, 2015 and 2019 rounds of the cross-sectional observational and descriptive ALADINO study in schoolchildren of both sexes aged 6 to 9years. We conducted a descriptive analysis of the trends in the prevalence of overweight and obesity (defined according to the criteria of the World Health Organization [WHO] and the International Obesity Task Force [IOTF]) and of central obesity, in addition to associated demographic and socioeconomic variables.ResultsBetween 2011 and 2019, the prevalence of overweight (WHO criteria) decreased in boys aged 6, 7 and 8years (by −5.4%, −5.7% and −5.3%, respectively) and boys whose parents had a higher educational attainment (by −5.3%). In relation to the socioeconomic level, overweight in boys declined at all income levels. However, between 2011 and 2019, both the prevalence of overweight in girls and the prevalence of obesity (applying the WHO and IOTF criteria) and the prevalence of central obesity in both sexes remained stable.ConclusionsThe prevalence of overweight and the prevalence of obesity in schoolchildren aged 6 to 9years in Spain remain high. Between 2011 and 2019, the prevalence of overweight in children aged 6 to 8years and in children whose parents had university degrees decreased, whereas obesity in boys, overweight and obesity in girls and central obesity in both sexes remained stable. (AU)

Differences in the temporal trends of childhood overweight and obesity in Spain in the 2011-2019 period by sex, age and socioeconomic level: results of the ALADINO study.

INTRODUCTION: Childhood excess weight is a growing public health problem. The aim of this study was to assess temporal trends in the prevalence of overweight, obesity and central obesity in schoolchildren aged 6-9 years in Spain between 2011 and 2019 based on demographic and socioeconomic characteristics. METHODOLOGY: The analysis included data from the 2011, 2015 and 2019 rounds of the cross-sectional observational and descriptive ALADINO study in schoolchildren of both sexes aged 6-9 years. We conducted a descriptive analysis of the trends in the prevalence of overweight and obesity (defined according to the criteria of the World Health Organization and the International Obesity Task Force) and of central obesity, in addition to associated demographic and socioeconomic variables. RESULTS: Between 2011 and 2019, the prevalence of overweight (WHO criteria) decreased in boys aged 6, 7 and 8 years (by -5.4%, -5.7% and -5.3%, respectively) and boys whose parents had a higher educational attainment (by -5.3%). In relation to the socioeconomic level, overweight in boys declined at all income levels. However, between 2011 and 2019, both the prevalence of overweight in girls and the prevalence of obesity (applying the WHO and IOTF criteria) and the prevalence of central obesity in both sexes remained stable. CONCLUSIONS: The prevalence of overweight and the prevalence of obesity in schoolchildren aged 6-9 years in Spain remain high. Between 2011 and 2019, the prevalence of overweight in children aged 6-8 years and in children whose parents had university degrees decreased, whereas obesity in boys, overweight and obesity in girls and central obesity in both sexes remained stable.

The effect of complex posttraumatic stress and poverty on quality of life among adult survivors of childhood institutional maltreatment: evidence from survivors of the 'Hyeongje Welfare Institution' in South Korea.

Background: Childhood institutional maltreatment (IM) is associated with both complex posttraumatic stress disorder (CTPSD) and poverty in adulthood life, each of which may impact an individual's quality of life (QoL). To find implications for clinical practice and policy making for adult survivors with childhood IM experiences, it is necessary to conduct research examining their current QoL and identifying related factors.Objective: By applying the model of the conservation of resources theory, we focused on how adulthood QoL can be indicated by childhood IM as well as the life outcomes of IM such as additional lifetime trauma, CPTSD, and poverty.Methods: In a cross-sectional study, self-report data were collected from 127 adults who were survivors of the 'Hyeongje' childhood IM in South Korea. We conducted regression analyses of childhood IM experiences, trauma experiences after escape from the institution, current CPTSD symptoms, and current poverty experiences on current QoL.Results: The duration of placement at the 'Hyeongje' (ß = .24, p = .009) was associated with trauma experiences after escape from the institution. Trauma experiences after escape from the institution (ß = .25, p = .007) were associated with CPTSD symptoms. CPTSD symptoms (ß = .26, p = .005) were associated with poverty, and both CPTSD symptoms (ß = -.52, p < .001) and poverty (ß = -.26, p = .003) were negatively associated with current QoL.Conclusions: Prolonged childhood IM brings about loss spirals by increasing an individual's exposure to experiences of further cumulative trauma, CPTSD, and poverty. There is a need for due diligence-based policy making and public support from the government to help create upward spirals for QoL. This may include the imminent detection and rescue of children as well as providing a safe environment, offering multidisciplinary interventions including evidence-based treatment for CPTSD, and considering economic support including collective reparations.

Duration of placement at the 'Hyeongje' institution was associated with additional trauma experience after escaping the institution.Cumulative trauma after escape was associated with CPTSD symptoms; CPTSD symptoms were associated with poverty; and both CPTSD symptoms and poverty were associated with poor current QoL.Multidisciplinary interventions including evidence-based treatment for CPTSD and considering economic resources for childhood IM survivors would be crucial in increasing QoL.

Distribuição de óbitos devido ao câncer do colo do útero nos municípios de extrema pobreza, Brasil, 2000 a 2018 / Distribution of deaths due to cervical cancer in extreme poverty municipalities, Brazil, from 2000 to 2018

Resumo Introdução: O câncer do colo uterino (CCU) permanece uma importante causa de morte nas regiões mais pobres do mundo. Objetivo: Analisar tendências da distribuição relativa de óbitos por CCU ocorridos nos municípios de extrema pobreza (EP) do Brasil, de 2000 a 2018. Método: A distribuição relativa de óbitos por CCU nos municípios de EP foi avaliada em relação ao total de óbitos observados em cada Unidade Federativa (UF). Uma modelagem autorregressiva foi usada para avaliar as tendências temporais da distribuição relativa de óbitos de 2000 a 2018. Resultados: De 2000 a 2018, houve 94.065 óbitos por CCU no Brasil, e 10,7% deles ocorreram nos municípios de EP. Seis estados (Amazonas, Roraima, Pará, Amapá, Tocantins e Mato Grosso do Sul) tiveram 100% dos seus municípios de EP reportando a ocorrência desses óbitos. As tendências na distribuição de óbitos nos municípios de EP em relação ao total de óbitos de cada UF seguiram em elevação em onze estados brasileiros. Conclusões: O CCU é doença prioritária das políticas públicas do Brasil, e as tendências desses óbitos observadas nos municípios mais pobres apontam que mais atenção deve ser dada a estas unidades de análise, a fim de melhorar a saúde das pessoas mais pobres.

Abstract Background: Cervical cancer (CC) remains a major cause of death in the poorest regions of the world. Objective: To analyze trends in relative distribution of CC deaths occurred in extreme poverty municipalities, Brazil, from 2000 to 2018. Method: The relative distribution of CC deaths occurred in extreme poverty municipalities was evaluated in relation to total number of CC deaths observed in each Federative Unit (FU). An autoregressive modeling was used to assess the temporal trends in the death distribution, 2000-2018. Results: From 2000 to 2018, there were 94,065 CC deaths, and 10.7% of them were recorded in extreme poverty municipalities. There were six states (Amazonas, Roraima, Pará, Amapá, Tocantins, and Mato Grosso do Sul) with 100.0% of extreme poverty municipalities reporting the occurrence of these deaths. The trends of death distribution in extreme poverty municipalities in relation to the total of deaths in each FU followed in increasing trends in eleven Brazilian FU. Conclusions: CC is a disease prioritized by public policies in Brazil, and the trends of these deaths observed in the poorest municipalities point out that more attention should be given to these units of analysis, in order to improve the health of the poorest people.

[Energy poverty and self-rated health among Roma population and general population in Spain]. / Pobreza energética y salud en población gitana y en población general de España.

OBJECTIVE: To quantify energy poverty in Roma population and in general population in Spain, in 2016, as well as to observe the association of this phenomenon with self-rated health, adjusted according to the main socio-economic determinants. METHOD: Energy poverty has been defined as the financial inability to keep a home warm, the presence of dampness in the dwelling and falling into arrears in utility bills, using data from two European surveys from Spain in 2016: the Survey on Income and Living Conditions (EU-SILC) and the Second Survey on Minorities and Discrimination (EU-MIDIS II). Hierarchical logistic regression models were estimated with self-rated health as the outcome variable, progressively adjusted according to demographic (gender and age), environmental (household temperature, humidity and arrears in utility bills) and socio-economic (level of education, marital status and employment status) variables. RESULTS: Our results show that 45% of the Roma population had moderate or high levels of energy poverty. The odds ratio (OR) of poor self-rated health was higher in the Roma population (OR: 3.11; 95% confidence interval [95% CI]: 2.59-3.74). The inability to maintain an adequate indoor temperature significantly increased the risk of poor health (OR: 2.10; 95% CI: 1.90-2.32). After adjusting according to demographic, environmental and socio-economic variables, no association was observed between the population of ascription and self-rated health. CONCLUSIONS: Taking into account the main social determinants, including energy poverty indicators, being Roma is not associated with reporting poor health. This result points to the importance of tackling socio-economic factors, including energy poverty, to reduce health inequalities.

Acesso físico às feiras de orgânicos municipais em favelas de Belo Horizonte, Minas Gerais / Physical access to municipal organic food fairs in favelas in Belo Horizonte, Minas Gerais

Introdução: Favelas são regiões que não foram priorizadas pelas políticas públicas, e isso se reflete no ambiente alimentar e, consequentemente, na dificuldade de acesso aos alimentos, sobretudo aqueles produzidos de forma sustentável. Objetivo: Caracterizar o acesso físico às feiras de orgânicos municipais em favelas de Belo Horizonte, Minas Gerais, identificando desertos e pântanos alimentares e realizando uma comparação com a disponibilidade, distância e tempo de deslocamento de estabelecimentos que ofertam alimentos convencionais nessas áreas. Métodos: Foi analisada a distribuição das feiras de orgânicos municipais, dos equipamentos públicos de segurança alimentar e nutricional e dos estabelecimentos que ofertam alimentos cadastrados na Secretaria da Fazenda do Estado de Minas Gerais para o ano de 2019, nos 192 setores censitários localizados em favelas de Belo Horizonte. Para as análises closestfacility e distância de deslocamento, foi utilizado o buffer network de 500 metros. Também foi realizada a análise do tempo de deslocamento utilizando transporte público. Resultados: As feiras de orgânicos municipais estão em menor número e mais distantes dos centroides das favelas. E, além da maior distância para acessar as feiras caminhando, acessá-las por meio de transporte público leva, em geral, um tempo maior de deslocamento. Conclusões: São necessários programas e políticas públicas que incentivem a abertura de feiras de orgânicos e outros tipos de estabelecimentos que ofertam alimentos in natura e minimamente processados que adotem modelos de produção sustentáveis em áreas de favelas, a fim de reduzir as iniquidades de acesso aos alimentos saudáveis e sustentáveis nesse território.Introdução: Favelas são regiões que não foram priorizadas pelas políticas públicas, e isso se reflete no ambiente alimentar e, consequentemente, na dificuldade de acesso aos alimentos, sobretudo aqueles produzidos de forma sustentável. Objetivo: Caracterizar o acesso físico às feiras de orgânicos municipais em favelas de Belo Horizonte, Minas Gerais, identificando desertos e pântanos alimentares e realizando uma comparação com a disponibilidade, distância e tempo de deslocamento de estabelecimentos que ofertam alimentos convencionais nessas áreas. Métodos: Foi analisada a distribuição das feiras de orgânicos municipais, dos equipamentos públicos de segurança alimentar e nutricional e dos estabelecimentos que ofertam alimentos cadastrados na Secretaria da Fazenda do Estado de Minas Gerais para o ano de 2019, nos 192 setores censitários localizados em favelas de Belo Horizonte. Para as análises closestfacility e distância de deslocamento, foi utilizado o buffer network de 500 metros. Também foi realizada a análise do tempo de deslocamento utilizando transporte público. Resultados: As feiras de orgânicos municipais estão em menor número e mais distantes dos centroides das favelas. E, além da maior distância para acessar as feiras caminhando, acessá-las por meio de transporte público leva, em geral, um tempo maior de deslocamento. Conclusões: São necessários programas e políticas públicas que incentivem a abertura de feiras de orgânicos e outros tipos de estabelecimentos que ofertam alimentos in natura e minimamente processados que adotem modelos de produção sustentáveis em áreas de favelas, a fim de reduzir as iniquidades de acesso aos alimentos saudáveis e sustentáveis nesse território.

Introduction: Favelas are usually in regions forgotten by public policies, and it reflects on their residents' food environment, as well as on their tough time accessing food, mainly produced through sustainable ways. Objective: Featuring the physical access to municipal organic-food fairs in Belo Horizonte City, Minas Gerais State, based on identifying food deserts and swamps and comparing food availability to distance and displacement time from shops that sell conventional food in these places. Methods: The distribution of organic food municipal fairs, as well as of both food security and nutrition public equipment, and shops selling food that was registered at Minas Gerais State Treasure Secretariat in 2019, located in the 192 census sectors set in Belo Horizonte favelas. The closest facility and displacement distance analyses were based on the 500m buffer network. Displacement time linked to public transportation usage was also analyzed. Results: The number of organic food municipal fairs in favelas is smaller, and favelas are located farther from fairs' centroids. The distance to be crossed to get to fairs on foot in favelas is also longer, and getting to them by public transportation often demands longer displacements. Conclusions: Public programs and policies are needed to encourage new organic fairs and other establishment types capable of providing fresh and minimally processed food in favela areas based on sustainable production models. It must be done to reduce inequities in access to healthy and sustainable food in these territories.

Percepções de chefes de famílias de baixa renda sobre os efeitos da pandemia de Covid-19 em suas vidas cotidianas / Perceptions of heads of low-income families on the effects of the Covid-19 pandemic on their daily lives

Resumo A pandemia de Covid-19 produziu uma série de agravos sociais, como crescimento exponencial da pobreza e da fome, aumento nas taxas de desemprego, interrupção de atividades de trabalhadores informais, piora das condições de moradia da população de baixa renda e transtornos psíquicos. No Brasil, essa realidade foi enfrentada de forma insuficiente no que se refere às ações minimizadoras do governo, incluindo programas de transferência de renda. Ainda assim, apenas no primeiro ano de pandemia, a concessão dos chamados benefícios eventuais passou de 3 para 7,8 milhões de pessoas. Apesar da existência de muitos estudos estatísticos sobre a piora das condições socioeconômicas da população, ainda são raros os estudos que investigam o problema na perspectiva das pessoas socioeconomicamente mais atingidas. A pesquisa ouviu 27 chefes de família de baixa renda, atendidos em um CRAS do DF, sobre os efeitos da pandemia em suas vidas. Os resultados permitiram compreender, em profundidade, os sofrimentos e dificuldades vividas em aspectos como: trabalho e renda; alimentação; educação de crianças; sofrimentos psíquicos; obtenção e uso de benefícios eventuais e apontam para novas estratégias, programas e políticas capazes de mitigar os efeitos da pandemia que perdurarão ainda por longo tempo.

Abstract The Covid-19 pandemic produced a series of social problems, such as the exponential growth of poverty and hunger, an increase in unemployment rates, interruption of activities of informal workers, worsening of the housing conditions of the low-income population and psychological disorders. In Brazil, this reality has been insufficiently addressed in terms of minimizing government actions, including income transfer programs. Even so, only in the first year of the pandemic, the granting of so-called occasional benefits went from 3 to 7.8 million people. Despite the existence of many statistical studies on the worsening of the socioeconomic conditions of the population, studies that investigate the problem from the perspective of the most socioeconomically affected people are still rare. The research heard 27 low-income family heads, assisted at a CRAS in the DF, Brazil, about the effects of the pandemic on their daily lives. The results made it possible to understand, in depth, the sufferings and difficulties experienced in aspects such as: work and income; food; children's education; psychic sufferings; obtaining and using eventual benefits and point to new strategies, programs and policies capable of mitigating the effects of the pandemic that will last for a long time.Resumo: A pandemia de Covid-19 produziu uma série de agravos sociais, como crescimento exponencial da pobreza e da fome, aumento nas taxas de desemprego, interrupção de atividades de trabalhadores informais, piora das condições de moradia da população de baixa renda e transtornos psíquicos. No Brasil, essa realidade foi enfrentada de forma insuficiente no que se refere às ações minimizadoras do governo, incluindo programas de transferência de renda. Ainda assim, apenas no primeiro ano de pandemia, a concessão dos chamados benefícios eventuais passou de 3 para 7,8 milhões de pessoas. Apesar da existência de muitos estudos estatísticos sobre a piora das condições socioeconômicas da população, ainda são raros os estudos que investigam o problema na perspectiva das pessoas socioeconomicamente mais atingidas. A pesquisa ouviu 27 chefes de família de baixa renda, atendidos em um CRAS do DF, sobre os efeitos da pandemia em suas vidas. Os resultados permitiram compreender, em profundidade, os sofrimentos e dificuldades vividas em aspectos como: trabalho e renda; alimentação; educação de crianças; sofrimentos psíquicos; obtenção e uso de benefícios eventuais e apontam para novas estratégias, programas e políticas capazes de mitigar os efeitos da pandemia que perdurarão ainda por longo tempo.

Vulnerabilidade socioeconômica e microcefalia relacionada ao Zika vírus no Brasil / Socioeconomic vulnerability and microcephaly related to Zika virus in Brazil

Resumo Objetivo: Realizar uma análise descritiva dos gastos privados diretos domiciliares em saúde e da vulnerabilidade socioeconômica associados à condição de microcefalia, uma das manifestações mais evidentes da síndrome congênita do Zika vírus (SCZ). O surto de microcefalia e outros distúrbios neurológicos em crianças menores de um ano de idade foi associado à infecção pelo vírus Zika, durante a epidemia ocorrida no período de 2015-2016 no Brasil. Método: Noventa e seis entrevistas foram realizadas em dois centros especializados de atendimento às crianças acometidas por microcefalia nas cidades do Rio de Janeiro e Fortaleza. O questionário estruturado abrangeu características sociodemográficas, gastos com desembolso direto associados com a doença e estratégias adotadas pelas famílias para lidarem com os desafios financeiros impostos pela anomalia congênita. Resultados: Os domicílios eram majoritariamente chefiados por não-brancos e pertenciam às classes C e D-E. Os gastos com medicamentos contabilizaram 78% dos gastos médicos, enquanto as despesas com transporte representaram 46% do gasto privado não-médico. A maioria dos domicílios enfrentaram endividamento e redução do consumo doméstico, inclusive de alimentos, a fim de fazer face às despesas incorridas pela doença. Conclusão: A microcefalia parece reforçar a vulnerabilidade socioeconômica das famílias, reforçando o círculo vicioso característico da abordagem conceitual da armadilha saúde-pobreza.

Abstract Objective: To carry out a descriptive analysis of direct private household health expenditures and socioeconomic vulnerability associated with the condition of Microcephaly, one of the most evidence manifestations of Congenital Zika Syndrome (CZS). The outbreak of microcephaly and other neurological disorders in children under one year of age was linked to Zika virus infection during the 2015-2016 epidemic in Brazil. Method: Ninety-six interviews were carried out in two specialized care centers for children with microcephaly in the cities of Rio de Janeiro and Fortaleza, Brazil. The structured questionnaire covered sociodemographic characteristics, out-of-pocket expenditures associated with the disease, and strategies adopted by families to deal with the financial challenges imposed by the congenital anomaly. Results: The households were mostly headed by non-whites and belonged to classes C and D-E. Expenditures on medicines accounted for 78% of medical expenses, while transportation represented 46% of private non-medical expenses. Most households faced debt and reduced domestic consumption, including food, to meet the expenses incurred by the disease. Conclusion: Microcephaly appears to reinforce the socioeconomic vulnerability of families, reinforcing the vicious circle characteristic of the health-poverty trap conceptual approach.

Breastfeeding and factors associated with the neuropsychomotor development of children living in social vulnerability / Aleitamento materno e fatores associados ao desenvolvimento neuropsicomotor de crianças em vulnerabilidade social

Abstract Objective: to determine the association between breastfeeding and associated factors with neuropsychomotor development of children living in social vulnerability. Methods: cross-sectional study within a socially vulnerable community. Households with children aged seven to 72 months, and their biological mothers were included. Sociodemographic, anthropometric and breastfeeding variables were collected using questionnaires, and neuropsychomotor development was assessed using the Denver II screening test. Adjusted prevalence ratios were calculated using multivariable models, oriented by directed acyclic graphs. Results: from the 654 households visited, 224 mother-child binomials were included. The mean age of children was 28 (18.7) months, and 143 (63.8%) of them presented suspected delay in neuropsychomotor development. Mothers presented a median of 8 years of formal schooling and 64 (28.6%) had performed exclusive breastfeeding for 6 months. Exclusive breastfeeding was not associated with neuropsychomotor development (PR=0.92; CI95%=0.84-1.00). A significant association was observed only with years of formal maternal education (PR=0.98; CI95%=0.97-0.99). A mediation analysis did not show any clear mediator between maternal education and neuropsychomotor development. Conclusions: children living in social vulnerability presented a high prevalence of suspected delay in neuropsychomotor development. Maternal education was the only variable associated with such condition.

Resumo Objetivos: determinar a associação entre o aleitamento materno e fatores associados ao desenvolvimento neuropsicomotor de crianças em extrema vulnerabilidade social. Métodos: estudo transversal conduzido em uma comunidade em vulnerabilidade social, envolvendo crianças de sete a 72 meses, e suas mães biológicas. Variáveis sociodemográficas, antropométricas e de amamentação foram coletadas por meio de questionários e o desenvolvimento neuropsicomotor foi avaliado por meio do teste de triagem Denver II. Razões de prevalência ajustadas foram calculadas usando modelos multivariáveis, orientados por grafos acíclicos direcionados. Resultados: dos 654 domicílios visitados, foram incluídos 224 binômios mãe-filho, com média de idade de 28,8 (18,7) meses, em que 143 (63,8%) crianças apresentavam suspeita de atraso no desenvolvimento neuropsicomotor e 64 (28,6%) haviam realizado aleitamento materno exclusivo até o sexto mês. Aleitamento materno exclusivo por 6 meses não se associou ao desenvolvimento neuropsicomotor (RP= 0,91; IC95%=0,83-1,00). Houve associação significativa observada apenas com anos de escolaridade materna formal (RP=0,97; IC95%=0,96-0,99). Análise de mediação não mostrou nenhum mediador entre escolaridade materna e desenvolvimento neuropsicomotor. Conclusões: destaca-se a alta prevalência de crianças com suspeita de atraso no desenvolvimento neuropsicomotor. A escolaridade materna foi a única variável associada à esta condição.

Pobreza energética y salud en población gitana y en población general de España / Energy poverty and self-rated health among Roma population and general population in Spain

Objetivo: Cuantificar la pobreza energética en población gitana y población general de España, en 2016, y observar la asociación de este fenómeno con la salud autopercibida, ajustando por los principales determinantes socioeconómicos. Método: La pobreza energética fue definida como la incapacidad económica para mantener el calor dentro del hogar, la presencia de humedad en la vivienda y tener retrasos en el pago de facturas de suministros, con datos de dos encuestas europeas para España en 2016: la Encuesta sobre Ingresos y Condiciones de Vida (EU-SILC) y la Segunda Encuesta sobre Minorías y Discriminación (EU-MIDIS II). Se calcularon modelos de regresión logística jerárquica con la salud autopercibida como variable resultado, ajustando progresivamente por variables demográficas (género y edad), ambientales (temperatura del hogar, humedad y retrasos en las facturas) y socioeconómicas (nivel educativo, estado civil y situación ocupacional). Resultados: El 45% de la población gitana mostró niveles moderados o altos de pobreza energética. La odds ratio (OR) de mala salud autopercibida era mayor en la población gitana (OR: 3,11; intervalo de confianza del 95% [IC95%]: 2,59-3,74). No poder mantener una temperatura adecuada en el interior del hogar incrementó considerablemente el riesgo de mala salud (OR: 2,10; IC95%: 1,90-2,32). Tras ajustar por variables demográficas, ambientales y socioeconómicas, no observamos asociación entre población de adscripción y salud autopercibida. Conclusiones: Considerando los principales determinantes sociales, indicadores de pobreza energética incluidos, ser una persona gitana no se asocia con declarar mala salud. Este resultado señala la relevancia de abordar los factores socioeconómicos, la pobreza energética entre ellos, para reducir las desigualdades en salud.(AU)

Objective: To quantify energy poverty in Roma population and in general population in Spain, in 2016, as well as to observe the association of this phenomenon with self-rated health, adjusted according to the main socio-economic determinants. Method: Energy poverty has been defined as the financial inability to keep a home warm, the presence of dampness in the dwelling and falling into arrears in utility bills, using data from two European surveys from Spain in 2016: the Survey on Income and Living Conditions (EU-SILC) and the Second Survey on Minorities and Discrimination (EU-MIDIS II). Hierarchical logistic regression models were estimated with self-rated health as the outcome variable, progressively adjusted according to demographic (gender and age), environmental (household temperature, humidity and arrears in utility bills) and socio-economic (level of education, marital status and employment status) variables. Results: Our results show that 45% of the Roma population had moderate or high levels of energy poverty. The odds ratio (OR) of poor self-rated health was higher in the Roma population (OR: 3.11; 95% confidence interval [95% CI]: 2.59–3.74). The inability to maintain an adequate indoor temperature significantly increased the risk of poor health (OR: 2.10; 95% CI: 1.90–2.32). After adjusting according to demographic, environmental and socio-economic variables, no association was observed between the population of ascription and self-rated health. Conclusions: Taking into account the main social determinants, including energy poverty indicators, being Roma is not associated with reporting poor health. This result points to the importance of tackling socio-economic factors, including energy poverty, to reduce health inequalities.(AU)

Attitudes towards childcare practices in rural and urban caregivers with high rates of multidimensional poverty

Objective: To analyse the relationship between poverty and attitudes towards childcare practices in rural and urban areas of Colombia. Method: This article presents a cross-sectional correlational study conducted in the department of Atlántico, northern Colombia. Attitudes towards childcare and living conditions were assessed among 1189 caregivers of preschool children. The multidimensional poverty index and the participants' area of origin (urban or rural) were considered. Results: No direct relationship was found between attitudes towards childcare and the multidimensional poverty index. However, it was observed that urban participants from deprived areas had a higher poverty index and less positive attitudes towards childcare, especially regarding cognitive, sleep and health care. There was a moderating effect of area on attitudes towards childcare. Conclusions: The study highlights the influence of poverty and social vulnerability on attitudes towards childcare, particularly in urban areas. These findings underline the importance of considering socio-economic and geographical conditions when addressing childcare practices. It also highlights the need to implement specific strategies to promote positive childcare practices in more vulnerable contexts to improve early childhood development in Colombia.

Objetivo: Analizar la relación entre la pobreza y las actitudes hacia las prácticas de cuidado infantil en áreas rurales y urbanas de Colombia. Método: El presente artículo es un estudio transversal correlacional en el departamento del Atlántico, al norte de Colombia. Se indagó sobre las actitudes hacia el cuidado infantil y las condiciones de vida en 1189 cuidadores de niños en edad preescolar. Se tuvo en cuenta el índice de pobreza multidimensional y el área de procedencia de los participantes (urbana o rural). Resultados: No se encontró una relación directa entre las actitudes hacia el cuidado infantil y el índice de pobreza multidimensional. Sin embargo, se observó que los participantes de áreas urbanas provenientes de zonas vulnerables presentaron un mayor índice de pobreza y mostraron actitudes menos positivas hacia el cuidado infantil, especialmente en el cuidado cognitivo, del sueño y de la salud. Se evidenció un efecto moderador del área sobre las actitudes de cuidado. Conclusiones: El estudio destaca la influencia de la pobreza y la vulnerabilidad social en las actitudes de cuidado infantil, especialmente en áreas urbanas. Estos hallazgos subrayan la importancia de considerar las condiciones socioeconómicas y geográficas al abordar el cuidado infantil. Además, se resalta la necesidad de implementar estrategias específicas para promover prácticas de cuidado positivas en contextos más vulnerables, con el fin de mejorar el desarrollo de la primera infancia en Colombia.

Práticas Avançadas de Enfermagem em cuidados paliativos na comunidade compassiva de favela: relato de experiência / Advanced Practice Nursing in palliative care within the compassionate favela community: an experience report

OBJETIVO: descrever a prática avançada do enfermeiro em cuidados paliativos que atua com a equipe Interdisciplinar em um projeto de extensão universitária nas favelas da Rocinha e Vidigal no Rio de Janeiro, Brasil. MÉTODO: Trata-se de um estudo descritivo do tipo relato de experiência, sobre a aplicabilidade de práticas avançadas de enfermagem, no contexto de cuidados paliativos em comunidades vulneráveis, Rocinha e Vidigal, 2019 e 2020. RESULTADOS: Enfermeiros líderes, por meio da micropolítica, buscam o alívio do sofrimento humano, mediante o controle de sinais e sintomas físicos, psicossociais e espirituais, através de raciocínio clínico, habilidade de resolução de problemas por intermédio da consulta de enfermagem e articulação junto a equipe interdisciplinar. CONCLUSÃO: A abordagem de cuidados paliativos sob a ótica do projeto de comunidade compassiva tem mostrado uma forte prática da autonomia do enfermeiro, assim como proporciona visibilidade para a vulnerabilidade social e fortalecimento da prática avançada do enfermeiro no Brasil.

OBJECTIVE: to describe the advanced practice of nurses in palliative care who work with the Interdisciplinary team in a university extension project in the favelas of Rocinha and Vidigal in Rio de Janeiro, Brazil. METHOD: This descriptive research shows an experience report on the applicability of advanced practice nursing in palliative care in vulnerable communities, Rocinha and Vidigal, 2019 and 2020. RESULTS: Through micropolitics, leading nurses seek to relieve human suffering by controlling physical, psychosocial, and spiritual signs and symptoms through clinical reasoning, problem-solving skills in nursing appointments, and articulation with the interdisciplinary team. COONCLUSION: From the perspective of the compassionate community project, the palliative care approach has shown a strong practice of nurse autonomy, provided visibility for social vulnerability, and strengthened the advanced practice of nurses in Brazil.

Redes sociales de apoyo formales e informales para la reducción de pobreza del adulto mayor y su familia

Introducción: El aumento en la esperanza de vida se ha convertido en una realidad, en una problemática y en un reto para los países en desarrollo como Colombia, marcado por determinantes sociales dentro de los cuales la población adulta mayor se ve ampliamente afectada. Objetivo: Describir la percepción del adulto mayor y su familia acerca de las redes sociales de apoyo formales e informales, que contribuyen en la reducción de la pobreza. Materiales y métodos: Se realizó un estudio cualitativo con enfoque fenomenológico. Participaron 22 adultos mayores, 3 hombres y 19 mujeres entre los 60 y 89 años, dos cuidadores y un empleado administrativo de la institución en Neiva (Huila). Resultados: Los hallazgos se enmarcaron bajo tres cuatro categorías instauradas previa revisión teórica: precepción de envejecimiento, estructura de las redes sociales de apoyo, dinámica familiar y percepción de redes sociales de apoyo; además, se obtuvieron durante el estudio emergieron tres categorías emergentes: la pobreza más allá del concepto económico, entre lo espiritual y emocional como red de apoyo y la resignificación del trabajo en el adulto mayor como una opción. Conclusiones: Los adultos mayores perciben las redes sociales de apoyo formales e informales como necesarias para su bienestar físico, espiritual y emocional, además, identifican la resignificación del trabajo como una opción de vida desde sus capacidades instrumentales, junto con la espiritualidad, la cual se fortalece a lo largo de sus vidas y al interior de sus familias.

Introduction: The increase in life expectancy has become a reality, a problem, and a challenge for developing countries such as Colombia, marked by social determinants in which the elderly population is largely affected. Objective: Describe the perception of older adults and their families regarding formal and informal social support networks that contribute to poverty reduction. Materials and methods: A qualitative study using a phenomenological approach was conducted. Twenty-two older adults, three men and 19 women, between 60 and 89 years old; two caregivers, and an administrative employee at the institution in Neiva (Huila) participated. Results: The findings were framed under four categories established after a theoretical review: perception of aging, structure of social support networks, family dynamics, and perception of social support networks. Three categories emerged during the study: Poverty beyond the economic concept, between the spiritual and emotional as a support network, and the resignification of work in the elderly as an option. Conclusions: Older adults perceive formal and informal social support networks as something necessary for their physical, spiritual, and emotional well-being. In addition, they identify the resignification of work as a life option based on their instrumental capabilities, along with spirituality, which is strengthened throughout their lives and within their families.

Enfermedades emergentes, pobreza y hambre / Emerging diseases, poverty and hunger

La pobreza y el hambre son elementos significativos para la prevalencia de las enfermedades emergentes, además de la ignorancia, la indigencia, las falencias sanitarias y los cambios ambientales debidos al calentamiento global. La desnutrición es consecuencia de la pobreza y ésta es causa de desnutrición. Los niños que viven en condiciones de mayor vulnerabilidad tienen un riesgo alto de morir por diarrea, neumonía y enfermedades emergentes. La mayoría son desnutridos. Su futuro en la adultez guarda relación con la desnutrición en la infancia. En el mundo 820 millones de niños padecen hambre y mueren anualmente 3 millones de menores de 5 años, según datos del Fondo de las Naciones Unidas para la Infancia. En Argentina, según datos del segundo semestre de 2022, un 39,2% de la población es pobre (Instituto Nacional de Estadísticas y Censos). El 15,5% de niños y adolescentes padecen inseguridad alimentaria y 2 millones de niños padecen hambre (Médicos sin Fronteras). La tasa de mortalidad infantil en menores de 5 años tiene una prevalencia del 0,4%. Los cambios climáticos ejercen influencia sobre la salud, produciendo cambios en la epidemiologia de las enfermedades emergentes, mientras que la insuficiente alimentación ocasiona efectos negativos sobre la salud. El calentamiento global aumenta las inundaciones y las sequías, incidiendo en la escasez de alimentos e incrementando las enfermedades emergentes. La situación debe ser revertida mediante el desarrollo sostenido de la educación, el bienestar social y los proyectos sanitarios. (AU)

Poverty and hunger are significant elements for the prevalence of emerging diseases, in addition to ignorance, indigence, sanitary deficiencies and environmental changes due to global warming. Malnutrition is a consequence of poverty and poverty is a cause of malnutrition. Children living in more vulnerable conditions are at greater risk of dying from diarrhea, pneumonia and emerging diseases. Most are malnourished. Their future in adulthood is related to malnutrition in childhood. Worldwide, 820 million children suffer from hunger and 3 million children under 5 die annually (United Nations Children's Fund). In Argentina, according to data from the second half of 2022, 39.2% of the population is poor (Instituto Nacional de Estadísticas y Censos). 15.5% of children and adolescents are food insecure and 2 million children are hungry (Médecins Sans Frontières). The infant mortality rate in children under 5 years of age has a prevalence of 0.4%. Climate change influences health, producing changes in the epidemiology of emerging diseases, while insufficient food has negative effects on health. Global warming increases floods and droughts, leading to food shortages and increasing emerging diseases. The situation must be reversed through sustained development of education, social welfare and health projects. (AU)

Problemas sociales: mucha frecuencia, poca formación / Social problems: high frequency, low training

Introducción: la patología social pediátrica en relación con inequidades socioeconómicas, relaciones disfuncionales familiares, inmigración, adicciones, violencia hacia la infancia, etc. va en aumento. El objetivo de este trabajo es analizar su peso en la labor asistencial del pediatra, la descripción de la formación y los conocimientos en ese ámbito, y las razones que dificultan su implicación en estos temas. Metodología: estudio multicéntrico a través de encuesta online cumplimentada por 407 profesionales médicos. Se analizaron 11 problemas en relación con el entorno familiar, escolar, pobreza, inmigración, adicciones y violencia. Resultados: los problemas del entorno familiar o escolar fueron señalados como frecuentes o muy frecuentes por alrededor del 50% de los profesionales; los relacionados con inmigración, acoso y pobreza, por el 20-30%; y los referidos a violencia o adicciones, por menos del 10%. Sin embargo, los porcentajes de formación recibida (y de conocimientos) fueron muy bajos en todos los temas (la mayor formación se aprecia en violencia de género y abuso). Se desglosan los resultados según el ámbito profesional de trabajo (hospitalario o Atención Primaria), el entorno (urbano o rural) y la edad. La mayor dificultad que alegan los profesionales para el abordaje de estos problemas es precisamente la falta de formación. Conclusiones: la patología social infantil está muy presente en la labor diaria del pediatra. Por ello, se precisa una adecuada formación y actualización en esta materia que permita detectar y atender esta patología como el resto de los problemas de la infancia. Se proponen acciones de mejora. (AU)

Introduction: paediatric social disease in relation to socioeconomic inequities, dysfunctional family relationships, immigration, addiction, violence towards children, etc has been increasing. The aim of this paper is to analyse the importance of social disease in paediatric practice and describe the training and knowledge of providers on this subject and the perceived barriers to their involvement in these issues. Methodology: multicentre study by means of an online survey with participation by 407 medical professionals. We analysed 11 social problems related to the family and school environment, poverty, immigration, substance use and violence. Results: problems in the family or school environment were reported as frequent or highly frequent by approximately 50% of the respondents; problems related to immigration, bullying and poverty, by 20-30%; and problems related to violence or addiction by less than 10%. However, the percentage of respondents that reported receiving training (and having knowledge) were very low for all topics (the frequency of training was highest for gender violence and abuse). We analysed the results based on the care setting (hospital or primary care), geographical setting (urban or rural) and age of the provider. The greatest barrier reported by professionals in tackling these problems was precisely the lack of training. Conclusions: paediatricians encounter social disease frequently in their everyday practice. For this reason, adequate and up-to-date training on the subject is required to detect and treat social disease like any other childhood problems. Some improvement strategies are proposed. (AU)

Does the Brazilian cash transfer program (bolsa familia): Protect nutritional deviations among infants and breastfeeding practices in a capital of the Central Region of Brazil?

Cash transfer programs are strategies used by countries, intended for impoverished families, which play an essential role in promoting access to public services such as health, education, and social protection. Programs may also promote food and nutrition security. The Brazilian Cash Transfer Program ("Bolsa Familia") (BFP) aims to alleviate immediate poverty and combat hunger. The aim of this study is to characterize the nutritional and breastfeeding status of children under two years old among both beneficiaries and non-beneficiaries of BFP. Data from the Brazilian Food and Nutritional Surveillance System, available in the primary healthcare service system of Goiania, Brazil, in 2013 were collected. The following variables were evaluated: sex, weight, height/length, age, and breastfeeding status. Data from 4,567 children under 24 months old were assessed, of which 2.72% (n= 124) were BFP beneficiaries. Beneficiaries had a lower odd of receiving breast milk compared to non-beneficiaries (OR= 0.46, 95% CI:0.31; 0.66, p= 0.0001). Regarding nutritional status, 18.14% (n= 790) of children were diagnosed with nutritional deviation, and overweight was the most prevalent (n=352, 8.04%). Beneficiaries presented a lower odd of developing stunting when compared to non-beneficiaries of BFP (OR= 0.44, 95% CI:0.25; 0.77, p= 0.006). Being a BFP beneficiary was a protective factor for the stunting in children under 24 months old in Goiania, Brazil. However, measures to promote and support breastfeeding should be intensified in primary healthcare service, aimed primarily at children in social vulnerability.

Los programas de transferencias en efectivo son estrategias utilizadas por los países, destinadas a familias en situación de pobreza y pobreza extrema, que juegan un papel fundamental en la promoción del acceso a los servicios públicos como salud, educación y protección social, además de promover la seguridad alimentaria y nutricional. El Programa Brasileño de Transferencias en Efectivo ("Bolsa Familia") (BFP) tiene como objetivo aliviar la pobreza inmediata y combatir el hambre. El objetivo de este estudio es caracterizar el estado nutricional y de lactancia de los niños menores de dos años, tanto beneficiarios como no beneficiarios del BFP. Se recogieron datos del Sistema de Vigilancia Alimentaria y Nutricional Brasileña, disponibles en el sistema de atención primaria de salud de Goiânia, Brasil, en 2013. Se evaluaron las siguientes variables, sexo, peso, talla, edad y estado de lactancia. Se evaluaron datos de 4.567 menores de 24 meses, de los cuales el 2.72% (n=124) eran beneficiarios del BFP. Las beneficiarias presentaron menos posibilidades de recibir leche materna en comparación con las no beneficiarias (OR= 0.46, IC95%:0,31; 0,66, p= 0,0001). En cuanto al estado nutricional, el 18,14% (n= 790) de los niños fueron diagnosticado con desviación nutricional, siendo el sobrepeso el más prevalente (n= 352, 8, 04%). Los beneficiarios presentaron menos probabilidad de desarrollar talla baja en comparación con los no beneficiarios del BFP (OR= 0.44, IC95%: 0.25; 0.77, p= 0.006). Ser beneficiario del BFP fue un factor de protección para la baja talla en menores de 24 meses en Goiania, Brasil. Sin embargo, se deben intensificar las medidas de promoción y apoyo a la lactancia materna en los servicios de atención primaria de salud, dirigidas principalmente a los niños en situación de vulnerabilidad social.

Análisis espacio-temporal de la tuberculosis pulmonar para el periodo 2016-2020 en la Región Metropolitana, Chile / Spatio-temporal analysis of pulmonary tuberculosis in the Metropolitan Region of Chile since 2016 to 2020

INTRODUCCIÓN: El año 2020, la tuberculosis (TB) fue responsable por 9,9 millones de nuevos casos y 1,5 millones de muertes en el mundo. En Chile, se ha reportado aumento en las tasas de incidencia en los últimos años, con gran concentración de casos en la Región Metropolitana (RM). OBJETIVO: Evaluar la relación espacio-temporal de la TB pulmonar con variables socioeconómicas en la RM de Chile. MATERIAL Y MÉTODO: Estudio ecológico desarrollado entre los años 2016 y 2020. Los casos se obtuvieron desde el Ministerio de Salud (n = 4.370), describiéndose según: sexo, edad, año de confirmación diagnóstica, servicio de salud y comuna de residencia. Se utilizó análisis de componentes principales para la construcción de factores socioeconómicos comunales. La asociación entre factores y TB pulmonar se evaluó con un modelo binominal negativo multinivel. RESULTADOS: Se observó aumento en la tasa de incidencia (9,97 a 10,74 casos por 100 mil), disminución de la incidencia en personas ≥ 65 años (17,56 a 13,38) y en el promedio de edad (46,03 a 41,77 años). El factor caracterizado por mayor inmigración, hacinamiento y población urbana se asoció con mayores tasas de incidencia (RTI: 1,29; IC95: 1,23-134) y el factor con mayor escolaridad, menor pobreza y menor hacinamiento con menores tasas (RTI: 0,94; IC95: 0,89-0,98) en el periodo. CONCLUSIONES: La disminución en la edad de los casos junto a la concentración de casos en comunas urbanas y céntricas, asociadas con variables socioeconómicas desfavorables, confirman que la TB pulmonar continúa siendo un problema de relevancia a considerar.

BACKGROUND: In 2020, tuberculosis (TB) was responsible for 9.9 million new cases and 1.5 million deaths worldwide. In Chile, an increase in incidence rates has been reported in recent years, with a concentration of cases in the Metropolitan Region (MR). AIM: To evaluate the spatio-temporal relationship of pulmonary TB with socioeconomic variables in the MR of Chile. METHODS: Ecological study developed between 2016 and 2020. Cases were obtained from the Ministry of Health (n = 4,370) and described by: sex, age, year of confirmation, health service, and commune of residence. Principal component analysis was used to construct community socioeconomic factors, and the association between factors and pulmonary TB was evaluated with a multilevel negative binomial model. RESULTS: There was an increase in the incidence rate (9.97 to 10.74 cases per 100,000), a decrease in the incidence in people ≥ 65 years (17.56 to 13.38), and the average age (46.03 to 41.77 years). The factor characterized by greater immigration, overcrowding, and the urban population was associated with more elevated incidence rates (RTI: 1.29; IC95: 1.23-134), and the factor with higher education, less poverty, and less overcrowding with lower rates (RTI: 0.94; CI 95: 0.89-0.98) in the period. CONCLUSIONS: The decrease in the age of the cases together and the concentration of cases in urban and central communes, associated with unfavorable socioeconomic variables, confirm that pulmonary TB continues to be a relevant problem to consider.

Desigualdades socioeconómicas y de género en la obesidad infantil en España / Socioeconomic and gender inequalities in childhood obesity in Spain

Introducción: La obesidad infantil se asocia inversamente con el nivel socioeconómico familiar en países desarrollados. El objetivo es evaluar la asociación entre la situación ponderal infantil y el nivel socioeconómico familiar, según características familiares, percepciones, hábitos de vida y entorno escolar. Metodología: Análisis descriptivo de la situación ponderal infantil según factores socioeconómicos familiares y variables mediadoras en el estudio ALADINO 2019, en una muestra de 16.665 escolares representativa de la población escolar de seis a nueve años en España. Resultados: La prevalencia de obesidad infantil en hogares de bajo nivel socioeconómico (26,8% niños; 20,4% niñas) era, en ambos sexos, el doble de la de los de mayor nivel (12,1% niños; 8,7% niñas). En escolares de familias de baja renta eran más frecuentes hábitos alimentarios poco saludables, el sedentarismo (principalmente en niñas) y la presencia de pantallas en la habitación (más en niños). Por el contrario, en hogares más desfavorecidos eran menos frecuentes el antecedente de lactancia materna y la práctica de actividad física (especialmente en niñas). La disponibilidad de cocina propia, actividades deportivas y gimnasio cubierto en los centros era también menos habitual para los escolares de familias de menor renta. Conclusiones: Un menor nivel socioeconómico del hogar se asocia con peores hábitos alimentarios y de actividad física y ciertas características del entorno familiar y el escolar, que a su vez median la asociación inversa que existe entre el nivel socioeconómico y la prevalencia de obesidad infantil. Las niñas realizan menos actividad física y presentan más sedentarismo, mientras que los niños tienen más acceso a pantallas. Las intervenciones para combatir la obesidad infantil deben contemplar las desigualdades identificadas. (AU)

Introduction: Childhood obesity is inversely associated with household socioeconomic status in high-income countries. Our aim was to explore the association between childhood weight status and household socioeconomic status in Spain in relation to family characteristics, perceptions and lifestyle habits and the school environment. Methods: We performed a descriptive analysis of child weight status according to family socioeconomic factors and mediating variables based on data from the ALADINO 2019 study in a sample of 16 665 schoolchildren representative of the population aged 6–9 years in Spain. Results: The prevalence of childhood obesity in households with low socioeconomic status (26.8% boys; 20.4% girls) was, in both sexes, twice as high as in those with higher socioeconomic status (12.1% boys; 8.7% girls). Unhealthy eating habits, sedentary lifestyles (mainly in girls) and the presence of screens in the bedroom (more prevalent in boys) were more frequent in school-aged children from low-income households. On the other hand, in the most disadvantaged households, a history of breastfeeding and physical activity (especially in girls) were less frequent. Similarly, schools attended by children from low-income households were less likely to have their own kitchens and indoor gymnasiums or offer sports activities. Conclusions: A lower household socioeconomic status was associated with poorer dietary and physical activity habits and certain characteristics of the family and school environments that mediate the inverse association between household socioeconomic status and the prevalence of childhood obesity. Girls were less physically active and reported more sedentary lifestyles, while boys had greater access to screens. Interventions to combat childhood obesity should address the identified inequalities. (AU)