Mental disorders in adults from Ribeirão Preto, Brazil: a cross-sectional analysis of two birth cohorts.

BACKGROUND: In Brazil, the prevalence of mental disorders is heterogeneous, with most studies conducted in large cities with high population density. This study aimed to assess the prevalence of mental disorders and psychiatric comorbidities among young adults (22-23 years old) and adults (37-38 years old) from Ribeirão Preto, a city located in the Northeast of the São Paulo state, with approximately 700,000 inhabitants, and to explore associations with sociodemographic variables, suicide risk, and health service usage. Second, we aimed to evaluate the performance of the Self-Report Questionnaire (SRQ-20) as a screening tool for mental disorders to be applied to the local population. METHODS: Participants from the 1978/1979 and 1994 Ribeirão Preto birth cohorts were evaluated using the Mini International Neuropsychiatric Interview (MINI) and the SRQ-20 at mean ages of 22-23, and 37-38 years, respectively. RESULTS: Our sample comprised 1,769 individuals from the 1978/1979 cohort and 1,037 from the 1994 cohort. The prevalence of mental disorders ranged from 28.6% (1978/79) to 31% (1994), with frequent comorbid diagnoses (42.7% and 43.3%, respectively). Men and women had a similar prevalence of mental disorders in the younger cohort, while women had a higher prevalence in the older cohort. Low educational attainment was associated with higher rates of diagnosis. In both cohorts, alcohol and other psychoactive substance use was higher among those with a psychiatric diagnosis. Although those with a psychiatric diagnosis were less satisfied with their own health, only one-fifth had seen a mental health professional in the previous year. A psychiatric diagnosis increased the suicide risk by 5.6 to 9.1 times. Regarding the SRQ-20, the best cutoff points were 5/6 for men and 7/8 for women, with satisfactory performance. CONCLUSIONS: The prevalence and comorbidity of mental disorders were high in both cohorts and comparable to those in larger Brazilian cities. However, few individuals with a diagnosis had sought specialized care. These data suggest that the mental health gap is still significant in Brazil.

Sociodemographic, Occupational, and Health Profile of Brazilian Housekeepers and House Cleaners-A Hypothesis-Generating Study.

For many women, house cleaning is an important way to participate in the labor market. In Brazil, there are 2 types of domestic workers: housekeepers have relatively secure employment and house cleaners are day laborers. The aim of this hypothesis-generating study was to describe the sociodemographic, occupational and health profile of a sample of domestic workers in Brazil. House cleaners received lower wages, had longer daily working hours and worked in a larger number of homes each week in comparison to housekeepers. About 51% of the domestic workers in this sample reported the use of pain medication and 34% reported spinal problems. Musculoskeletal symptoms were frequent in the lower back and upper limbs. Forty-seven percent reported high blood pressure. This study highlights the vulnerability of domestic workers, especially house cleaners, regarding workload, salary, and health conditions. Level of education is a contributing factor to this vulnerability.

Intravitreal Silicone Oil with a Silicone-free vs a Siliconized Syringe.

This randomized controlled trial compares incidence and quantity of presumed intravitreal silicone oil in diabetic patients receiving intravitreal injections using a silicone oil-free versus a siliconized syringe, highlighting the reduced contamination with silicone oil-free options.

Mid-pregnancy circulating cytokine levels, placental efficiency and their relationship with preterm birth.

Objective: To assess a panel of cytokines and placental insufficiency with the risk of preterm delivery (PTD). Methods: Nested case-control study into the BRISA birth cohort. Eighty-two mother-infant-placenta pairs were selected at 20+0 to 25+6 weeks. Circulating biomarker levels were performed using Luminex flowmetric xMAP technology. Cytokines classified as Th1, Th2 or Th17 and other biomarkers were selected. The ratio between birth weight and placental weight (BW/PW) was used as a proxy for placental efficiency. Spearman correlation, univariate analyses and logistic regression models were calculated. Sensitivity, specificity, positive and negative likelihood ratios were calculated using the Receiver Operating Characteristic curve. Results: Mean gestational age was 250 days, 14,6% were small for gestational age, 4,8% large for gestational age and 13,4% stunted. Placental efficiency was higher for term newborns (p<0,001), and 18/22 (81%) preterm biomarker values were higher than the control group. Th1 cytokines were highly correlated, while the weakest correlation was observed in other biomarkers. Less education was associated with a higher risk of PTD (p = 0.046), while there was no appreciable difference in the risk of PTD for placental insufficiency. Biomarkers showed negligible adjusted OR of PTD (0.90 to 1.02). IL-6, IL-8, IL-1ß, TNFß, IL-4, IL-13, GCSF, MIP1A, VEGF, EGF, and FGF2 presented a higher sensitivity ranging from 75.56% to 91.11%. Conclusion: IL-8, IL-12p40, IL-4, IL-13, GCSF, MIP1B, and GMSF in asymptomatic pregnant women were associated with PTD. This finding suggests an activation of maternal inflammatory response.

Association between placental efficiency with anthropometry and nutritional phenotypes in full-term newborns from the 2010/2011 BRISA birth cohort

Abstract Objective: To study the association between placental efficiency with anthropometry and nutritional phenotypes in full-term newborns from a birth cohort. Method: This was a secondary cross-sectional analysis of data obtained in a cohort study (Brazilian RibeirãoPreto and São Luís Birth Cohort Studies - BRISA), whose deliveries were performed between 2010 and 2011. Standardized questionnaires were applied to mothers, and placentas and newborns were evaluated shortly after delivery. Placental efficiency was assessed using the ratio between birth weight and placental weight (BW/PW ratio); values below the lower quartile (25th percentile for gestational age) were considered to have low placental efficiency. Newborn phenotypes were small and large for gestational age, stunted and wasted, evaluated using the INTERGROWTH-21 growth standard. To identify the confounding variables theoretical model was constructed using Directed Acyclic Graphs, and unadjusted and adjusted logistic regression were performed. Placental measurements were obtained blindly from pregnancy and delivery data. Results: 723 mother-placenta-child triads were studied. 3.2 % of newborns were small-for-gestational-age (SGA), 6.5 %large-for-gestational-age (LGA), 5.7 %had stunting, and 0.27 % wasting. A significantly higher risk was found between low placental efficiency and SGA (OR 2.82;95 % CI 1.05-7.57), stunting (OR 2.23; 95 % CI 1.07-4.65), and wasting (OR 8.22; 95 % CI 1.96-34.37). No relationship was found between LGA and placental efficiency. Conclusions: Low placental efficiency was associated with increased risk for small-for-gestational-age, stunting, and wasting. Placental morphometry can provide valuable information on intrauterine conditions and neonatal health, helping to identify newborns at higher risk of future comorbidities.

Mobile Technologies for Monitoring Sleep Time: A Systematic Search of App Stores in Brazil.

Introduction Decreased sleep time is detrimental to physical and mental health, exerting negative impacts on daily functioning and quality of life. Mobile health (mHealth) applications can be useful for improving sleep quality. Objective To perform a systematic search of mHealth applications for monitoring sleep time at Brazilian online stores and evaluate the selected applications in terms of engagement, functionality, aesthetics, and quality of information. Methods A systematic search was performed at the Google Play Store and the App Store developed or updated between 2020 and 2022. The mobile app rating scale (MARS) was used to assess their quality. The characteristics and information of these applications were presented. Data were analyzed descriptively. Results Among the 2,264 relevant mHealth apps identified, 11 were eligible for inclusion. There was one app that offered only sleep time recordings, three offered sleep recordings and educational content, three monitored sleep time with audiovisual resources, two offered sleep time recordings with a focus on monitoring snoring, and two offered sleep time monitoring with individual content customizations. The apps scored fair on MARS, with a mean of 3.5 points (standard deviation: 0.8) on a scale of 1 to 5. Most apps scored low due to poor evidence-based information, aesthetics, and engagement. Conclusion Although the use of mHealth technologies for monitoring sleep time has considerable potential for investigation, it is a relatively new, underexplored topic. Collaboration between researchers, clinical professionals, patients, and application developers is necessary for the creation of new evidence-based mHealth applications focused on Brazilian users.

Sociodemographic and reproductive risk factors associated with metabolic syndrome in a population of Brazilian women from the city of Ribeirão Preto: a cross-sectional study.

Objective: To identify sociodemographic and reproductive risk factors associated with MetS in women in their fourth decade of life. Methods: Cohort study conducted on women born from June 1978 to May 1979 in Ribeirão Preto, Brazil. Sociodemographic, clinical, and obstetric data were collected by interview and clinical evaluation. Univariable and multivariable binomial logistic regression models were constructed to identify the risk factors of metabolic syndrome and the adjusted relative risk (RR) was calculated. Results: The cohort included 916 women, and 286 (31.2%) of them have metabolic syndrome. MetS was associated with lack of paid work (RR 1.49; 95% CI 1.14-1.95), marital status of without a partner (RR 1.33; 95% CI 1.03-1.72), low educational level (less than 8 years of schooling [RR 1.72; 95% CI 1.23-2.41], 8 to 12 years of schooling [RR 1.37; 95% CI 1.06-1.76], when compared with more than 12 years of schooling), and teenage pregnancy (RR 2.00; 95% CI 1.45-2.77). There was no association between MetS, and the other covariates studied. Conclusion: Metabolic syndrome in a population of women in the fourth decade of life was associated with lack of employment, lack of a partner, low educational level, and teenage pregnancy.

Birth weight and asthma in young adults of a Brazilian birth cohort.

This article aims to evaluate the association between birth weight and asthma in adulthood, estimated by employing structural equation modeling. Cohort study with 1,958 participants aged 23-25 years from Ribeirão Preto, São Paulo, Brazil. Standardized questionnaires were applied and pulmonary function evaluated, including bronchial reactivity with methacholine. A theoretical model was proposed to explore the effects of birth weight and asthma in adulthood. Asthma, socioeconomic status at birth (Birth SES), and current socioeconomic status (Adult SES) were obtained by constructs. Maternal age, sex, skin color, body mass index (BMI), smoking, parental asthma history, history of respiratory infection before five years old, history of hospitalization for lung disease before two years old, and atopy were the studied variables. 14.1% of participants were diagnosed with asthma. Birth weight was associated with asthma (Standardized Coefficient - SCtotal=-0.110; p=0.030), and an indirect effect was also observed (SCindirect=-0.220; p=0.037), mediated by hospitalization before two years and respiratory infection before five years. Lower birth weight showed an increased risk of asthma in adulthood and the SES Birth and Adult SES variables underlie this association.

Synchronous Diagnosis of Diabetic Retinopathy by a Handheld Retinal Camera, Artificial Intelligence, and Simultaneous Specialist Confirmation.

PURPOSE: Diabetic retinopathy (DR) is a leading cause of preventable blindness, particularly in underserved regions where access to ophthalmic care is limited. This study presents a proof of concept for utilizing a portable handheld retinal camera with an embedded artificial intelligence (AI) platform, complemented by a synchronous remote confirmation by retina specialists, for DR screening in an underserved rural area. DESIGN: Retrospective cohort study. SUBJECTS: A total of 1115 individuals with diabetes. METHODS: A retrospective analysis of a screening initiative conducted in 4 municipalities in Northeastern Brazil, targeting the diabetic population. A portable handheld retinal camera captured macula-centered and disc-centered images, which were analyzed by the AI system. Immediate push notifications were sent out to retina specialists upon the detection of significant abnormalities, enabling synchronous verification and confirmation, with on-site patient feedback within minutes. Referral criteria were established, and all referred patients underwent a complete ophthalmic work-up and subsequent treatment. MAIN OUTCOME MEASURES: Proof-of-concept implementation success. RESULTS: Out of 2052 invited individuals, 1115 participated, with a mean age of 60.93 years and diabetes duration of 7.52 years; 66.03% were women. The screening covered 2222 eyes, revealing various retinal conditions. Referable eyes for DR were 11.84%, with an additional 13% for other conditions (diagnoses included various stages of DR, media opacity, nevus, drusen, enlarged cup-to-disc ratio, pigmentary changes, and other). Artificial intelligence performance for overall detection of referable cases (both DR and other conditions) was as follows: sensitivity 84.23% (95% confidence interval (CI), 82.63-85.84), specificity 80.79% (95% CI, 79.05-82.53). When we assessed whether AI matched any clinical diagnosis, be it referable or not, sensitivity was 85.67% (95% CI, 84.12-87.22), specificity was 98.86 (95% CI, 98.39-99.33), and area under the curve was 0.92 (95% CI, 0.91-0.94). CONCLUSIONS: The integration of a portable device, AI analysis, and synchronous medical validation has the potential to play a crucial role in preventing blindness from DR, especially in socially unequal scenarios. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Association between placental efficiency with anthropometry and nutritional phenotypes in full-term newborns from the 2010/2011 BRISA birth cohort.

OBJECTIVE: To study the association between placental efficiency with anthropometry and nutritional phenotypes in full-term newborns from a birth cohort. METHOD: This was a secondary cross-sectional analysis of data obtained in a cohort study (Brazilian RibeirãoPreto and São Luís Birth Cohort Studies - BRISA), whose deliveries were performed between 2010 and 2011. Standardized questionnaires were applied to mothers, and placentas and newborns were evaluated shortly after delivery. Placental efficiency was assessed using the ratio between birth weight and placental weight (BW/PW ratio); values below the lower quartile (25th percentile for gestational age) were considered to have low placental efficiency. Newborn phenotypes were small and large for gestational age, stunted and wasted, evaluated using the INTERGROWTH-21 growth standard. To identify the confounding variables theoretical model was constructed using Directed Acyclic Graphs, and unadjusted and adjusted logistic regression were performed. Placental measurements were obtained blindly from pregnancy and delivery data. RESULTS: 723 mother-placenta-child triads were studied. 3.2 % of newborns were small-for-gestational-age (SGA), 6.5 %large-for-gestational-age (LGA), 5.7 %had stunting, and 0.27 % wasting. A significantly higher risk was found between low placental efficiency and SGA (OR 2.82;95 % CI 1.05-7.57), stunting (OR 2.23; 95 % CI 1.07-4.65), and wasting (OR 8.22; 95 % CI 1.96-34.37). No relationship was found between LGA and placental efficiency. CONCLUSIONS: Low placental efficiency was associated with increased risk for small-for-gestational-age, stunting, and wasting. Placental morphometry can provide valuable information on intrauterine conditions and neonatal health, helping to identify newborns at higher risk of future comorbidities.

Birth weight and asthma in young adults of a Brazilian birth cohort / Peso ao nascer e asma em adultos jovens de um coorte brasileiro de nascimentos

Abstract This article aims to evaluate the association between birth weight and asthma in adulthood, estimated by employing structural equation modeling. Cohort study with 1,958 participants aged 23-25 years from Ribeirão Preto, São Paulo, Brazil. Standardized questionnaires were applied and pulmonary function evaluated, including bronchial reactivity with methacholine. A theoretical model was proposed to explore the effects of birth weight and asthma in adulthood. Asthma, socioeconomic status at birth (Birth SES), and current socioeconomic status (Adult SES) were obtained by constructs. Maternal age, sex, skin color, body mass index (BMI), smoking, parental asthma history, history of respiratory infection before five years old, history of hospitalization for lung disease before two years old, and atopy were the studied variables. 14.1% of participants were diagnosed with asthma. Birth weight was associated with asthma (Standardized Coefficient - SCtotal=-0.110; p=0.030), and an indirect effect was also observed (SCindirect=-0.220; p=0.037), mediated by hospitalization before two years and respiratory infection before five years. Lower birth weight showed an increased risk of asthma in adulthood and the SES Birth and Adult SES variables underlie this association.

Resumo O objetivo deste artigo é avaliar associação entre peso ao nascer e asma na vida adulta pela análise de equações estruturais. Estudo de coorte com 1.958 participantes de 23-25 anos, residentes em Ribeirão Preto, São Paulo, Brasil. Foram aplicados questionários padronizados e avaliado a função pulmonar, incluindo hiper-reatividade brônquica com metacolina. O modelo teórico foi proposto para explorar os efeitos do peso ao nascer e asma na vida adulta. Asma, status socioeconômico ao nascimento (SES Nascimento) e status socioeconômico adulto (SES adulto) foram obtidos por um construto. Variáveis estudadas: idade materna, idade, sexo, cor da pele, índice de massa corporal (IMC), tabagismo, história de asma dos pais, história de infecção respiratória antes dos cinco anos, história de internação por doença pulmonar antes dos dois anos e atopia. 14,1% dos participantes foram diagnosticados com asma. Peso ao nascer foi associado com asma (Coeficiente Padronizado - CPtotal=-0,110; p=0,030), e foi observado efeito indireto (CPindireto=-0,220; p=0,037), mediado por internação antes dos dois anos e infecção respiratória antes dos 5 anos. Menor peso ao nascer aumentou o risco para asma na vida adulta e as variáveis SES Nascimento e SES adulto foram subjacentes a esta associação.

Mid-pregnancy circulating cytokine levels, placental efficiency and their relationship with preterm birth

Abstract Objective To assess a panel of cytokines and placental insufficiency with the risk of preterm delivery (PTD). Methods Nested case-control study into the BRISA birth cohort. Eighty-two mother-infant-placenta pairs were selected at 20+0 to 25+6 weeks. Circulating biomarker levels were performed using Luminex flowmetric xMAP technology. Cytokines classified as Th1, Th2 or Th17 and other biomarkers were selected. The ratio between birth weight and placental weight (BW/PW) was used as a proxy for placental efficiency. Spearman correlation, univariate analyses and logistic regression models were calculated. Sensitivity, specificity, positive and negative likelihood ratios were calculated using the Receiver Operating Characteristic curve. Results Mean gestational age was 250 days, 14,6% were small for gestational age, 4,8% large for gestational age and 13,4% stunted. Placental efficiency was higher for term newborns (p<0,001), and 18/22 (81%) preterm biomarker values were higher than the control group. Th1 cytokines were highly correlated, while the weakest correlation was observed in other biomarkers. Less education was associated with a higher risk of PTD (p = 0.046), while there was no appreciable difference in the risk of PTD for placental insufficiency. Biomarkers showed negligible adjusted OR of PTD (0.90 to 1.02). IL-6, IL-8, IL-1β, TNFβ, IL-4, IL-13, GCSF, MIP1A, VEGF, EGF, and FGF2 presented a higher sensitivity ranging from 75.56% to 91.11%. Conclusion IL-8, IL-12p40, IL-4, IL-13, GCSF, MIP1B, and GMSF in asymptomatic pregnant women were associated with PTD. This finding suggests an activation of maternal inflammatory response.

Sociodemographic and reproductive risk factors associated with metabolic syndrome in a population of Brazilian women from the city of Ribeirão Preto: a cross-sectional study

Abstract Objective: To identify sociodemographic and reproductive risk factors associated with MetS in women in their fourth decade of life. Methods: Cohort study conducted on women born from June 1978 to May 1979 in Ribeirão Preto, Brazil. Sociodemographic, clinical, and obstetric data were collected by interview and clinical evaluation. Univariable and multivariable binomial logistic regression models were constructed to identify the risk factors of metabolic syndrome and the adjusted relative risk (RR) was calculated. Results: The cohort included 916 women, and 286 (31.2%) of them have metabolic syndrome. MetS was associated with lack of paid work (RR 1.49; 95% CI 1.14-1.95), marital status of without a partner (RR 1.33; 95% CI 1.03-1.72), low educational level (less than 8 years of schooling [RR 1.72; 95% CI 1.23-2.41], 8 to 12 years of schooling [RR 1.37; 95% CI 1.06-1.76], when compared with more than 12 years of schooling), and teenage pregnancy (RR 2.00; 95% CI 1.45-2.77). There was no association between MetS, and the other covariates studied. Conclusion: Metabolic syndrome in a population of women in the fourth decade of life was associated with lack of employment, lack of a partner, low educational level, and teenage pregnancy.

Sociodemographic and economic characteristics of families and health and education conditions of children in the BRISA cohort during the COVID-19 pandemic.

OBJECTIVE: To describe changes in sociodemographic, economic and variables related to the characterization of family, health and education during the COVID-19 pandemic in a birth cohort evaluated at 10-11 years of age. METHODS: Cross-sectional study involving 1,033 children from a cohort of children born in 2010/2011, in the city of Ribeirão Preto, SP, Brazil. Data were collected from July to October 2021 by telephone or video interview held with the person responsible for the child. The questionnaires discussed family organization, child behavior and health, school attendance, socioeconomic assessment and occurrence of COVID-19 during the period of social isolation due to the pandemic. Descriptive statistics were used to describe the data. The chi-square test was used to verify group differences by minimum wages (MW). RESULTS: Of the respondents, 47.6% reported worsening of their financial situation during the pandemic, which was more frequent in the group with a household income <3 MW compared to the group with >6 MW (59.1 vs. 15.7%; p<0.001). According to the respondents, 62% of the children exhibited behavioral changes during the period and anxiety was the most frequently reported condition. In addition, 61.4% of the children had learning difficulties and these problems were more prevalent among children from households with lower incomes compared to those with higher incomes (74.7 vs. 45.1%; p<0.001). CONCLUSION: The COVID-19 pandemic has changed different economic aspects of families, as well as educational, health and behavioral indicators of children. Lower-income families were the most affected both economically and in terms of other indicators.

Performance of Body Fat Percentage, Fat Mass Index and Body Mass Index for Detecting Cardiometabolic Outcomes in Brazilian Adults.

Obesity is a recognized risk factor for the development of cardiometabolic outcomes. Therefore, it is essential to evaluate anthropometric and body composition indicators used for its diagnosis. This study aimed to assess the diagnostic performance of body fat percentage (BF%), fat mass index (FMI) and body mass index (BMI) for detecting cardiometabolic outcomes in adults. A cross-sectional study was conducted involving adults at 30 years of age from Pelotas, RS (n = 3517) and at 37-39 years from Ribeirão Preto, SP (n = 1696). Receiver operating characteristic (ROC) curves were used to determine the cut-off points for predicting cardiometabolic risk factors, including altered blood pressure, blood glucose, triglycerides, total cholesterol, low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDDL-c), C-reactive protein and glycated hemoglobin. The cut-off points of BF% ranged from 25.2 to 27.8 in men and from 37.4 to 39.7 in women at 30 years, and from 26.1 to 27.8 in men and from 38.5 to 42.2 in women at 37-39 years. For FMI (kg/m2), the cut-off points ranged from 6.3 to 7.5 in men and from 9.5 to 10.8 in women at 30 years, and from 7.3 to 7.8 in men and from 10.2 to 12.2 in women at 37-39 years. The BMI cut-off points (kg/m2) ranged from 26.3 to 27.3 in men and from 25.4 to 27.2 in women at 30 years, and from 28.3 to 29.0 in men and from 27.2 to 29.6 in women at 37-39 years. The areas under the curve were similar for the three indicators, ranging from 0.523 to 0.746. BMI showed a performance similar to that of the body fat-based indicators in identifying cardiometabolic outcomes. The cut-off points of the three indicators showed acceptable discriminatory power in subjects with cardiometabolic risk factors.

Sociodemographic and reproductive risk factors associated with obesity in a population of brazilian women from the city of Ribeirão Preto: a cross-sectional study.

BACKGROUND: Obesity is a highly prevalent chronic disease that is associated with the development of other metabolic comorbidities. Its etiology is complex and multiple risk factors have been reported. In women, weight gain during pregnancy and the effect of pregnancy on subsequent weight gain are important events in women's history. Both pregnancy and postpartum are critical periods for the development of obesity. OBJECTIVES: To identify sociodemographic and reproductive risk factors associated with obesity in women in their fourth decade of life. METHODS: Cohort study conducted on women born from June 1978 to May 1979 in Ribeirão Preto, Brazil. Sociodemographic, clinical, and obstetric data were collected by interview and clinical evaluation. Univariable and multivariable binomial logistic regression models were constructed to identify the risk factors of obesity and the adjusted relative risk (RR) was calculated. RESULTS: The cohort included 916 women and 309 (33.7%) of them were obese. Obesity was associated with low educational level (RR 1.77, 95%CI 1.33-2.35) and teenage pregnancy (RR 1.46, 95%CI 1.10-1.93). There was no association of obesity with the other covariates studied. CONCLUSION: Obesity is associated with years of schooling and teenage pregnancy.

Prediction of Perinatal and Neurodevelopmental Outcomes in Newborns with a Birth Weight below the 3rd Percentile: Performance of Two International Curves - Prospective Cohort from a Brazilian City.

OBJECTIVES: To evaluate the performance of Intergrowth-21 st (INT) and Fetal Medicine Foundation (FMF) curves in predicting perinatal and neurodevelopmental outcomes in newborns weighing below the 3rd percentile. METHODS: Pregnant women with a single fetus aged less than 20 weeks from a general population in non-hospital health units were included. Their children were evaluated at birth and in the second or third years of life. Newborns (NB) had their weight percentiles calculated for both curves. Sensitivity, specificity, positive (PPV) and negative predictive value (NPV), and area under the ROC curve (ROC-AUC) for perinatal outcomes and neurodevelopmental delay were calculated using birth weight < 3rd percentile as the cutoff. RESULTS: A total of 967 children were evaluated. Gestational age at birth was 39.3 (±3.6) weeks and birth weight was 3,215.0 (±588.0) g. INT and FMF classified 19 (2.4%) and 49 (5.7%) newborns below the 3rd percentile, respectively. The prevalence of preterm birth, tracheal intubation >24 hours in the first three months of life, 5th minute Apgar <7, admission to a neonatal care unit (NICU admission), cesarean section rate, and the neurodevelopmental delay was 9.3%, 3.3%, 1.3%, 5.9%, 38.9%, and 7.3% respectively. In general, the 3rd percentile of both curves showed low sensitivity and PPV and high specificity and NPV. The 3rd percentile of FMF showed superior sensitivity for preterm birth, NICU admission, and cesarean section rate. INT was more specific for all outcomes and presented a higher PPV for the neurodevelopmental delay. However, except for a slight difference in the prediction of preterm birth in favor of INT, the ROC curves showed no differences in the prediction of perinatal and neurodevelopmental outcomes. CONCLUSION: Birth weight below the 3rd percentile according to INT or FMF alone was insufficient for a good diagnostic performance of perinatal and neurodevelopmental outcomes. The analyzes performed could not show that one curve is better than the other in our population. INT may have an advantage in resource contingency scenarios as it discriminates fewer NB below the 3rd percentile without increasing adverse outcomes.

OBJETIVOS: Avaliar o desempenho das curvas de Intergrowth-21 st (INT) e Fetal Medicine Foundation (FMF) na predição de resultados perinatais e de neurodesenvolvimento de recém-nascidos com peso abaixo do percentil 3. MéTODOS: Foram incluídas gestantes de feto único com idade inferior a 20 semanas de uma população geral em unidades de saúde não hospitalares. Seus filhos foram avaliados ao nascimento e no segundo ou terceiro anos de vida. Os recém-nascidos tiveram seus percentis de peso calculados para ambas as curvas. Sensibilidade, especificidade, valor preditivo positivo (VPP) e negativo (VPN) e área sob a curva ROC (ROC-AUC) foram calculados para desfechos perinatais e atraso de neurodesenvolvimento considerando o peso ao nascimento menor que o percentil 3 como ponto de corte. RESULTADOS: Um total de 967 crianças foram avaliadas ao nascimento e no segundo ou terceiro anos de vida. A idade gestacional ao nascer foi de 39,3 (±3,6) semanas e o peso ao nascimento foi de 3.215,0 (±588,0) g. INT e FMF classificaram 19 (2,4%) e 49 (5,7%) recém-nascidos abaixo do percentil 3, respectivamente. A prevalência de parto pré-termo, intubação traqueal > 24 horas nos primeiros três meses de vida, Apgar de 5° minuto < 7, internação em unidade de terapia intensiva neonatal (internação em UTIN), taxa de cesariana e atraso de neurodesenvolvimento foi 9,3%, 3,3%, 1,3%, 5,9%, 38,9% e 7,3% respectivamente. Em geral, o percentil 3 de ambas as curvas apresentou baixa sensibilidade e VPP e alta especificidade e VPN. O percentil 3 de FMF mostrou sensibilidade superior para parto prematuro, internação em UTIN e taxa de cesariana. INT foi mais específico para todos os desfechos e apresentou maior VPP para o atraso do neurodesenvolvimento. Entretanto, exceto por uma pequena diferença na predição de parto pré-termo em favor de INT, as curvas ROC não mostraram diferenças na predição de resultados perinatais e de desenvolvimento neurológico. CONCLUSãO: O peso ao nascer abaixo do percentil 3 segundo INT ou FMF isoladamente foi insuficiente para um bom desempenho diagnóstico de desfechos perinatais e de neurodesenvolvimento. As análises realizadas não puderam mostrar que uma curva é melhor que a outra em nossa população. INT pode ter vantagem em cenários de contingência de recursos, pois discrimina menos recém-nascidos abaixo do percentil 3 sem aumentar os desfechos adversos.

Cytokine quantification and association with cervical length in a prospective cohort of pregnant women.

BACKGROUND: Preterm birth is a leading cause of infant morbidity and mortality; its multifactorial causes are an obstacle to understanding etiology and pathogenesis. The importance of cytokines and inflammation in its etiology and association with the short cervix is nowadays well-proven. To date, there are no reliable biological or biochemical markers to predict preterm birth; even though the length of the cervix has high specificity, its sensitivity with the cervix below 2.5 cm is low. OBJECTIVE: We study the association of plasma cytokine levels and cervical length in search of predictors of preterm birth. STUDY DESIGN: We evaluated a total of 1400 pregnant women carrying a single fetus between 20 and 25 weeks of gestation, and 1370 of them after childbirth in a nested case-control study of a prenatal cohort. Eligible pregnant women were interviewed and submitted to obstetric morphological and transvaginal ultrasound with cervical length measurement, gynecological examination, and blood collection. Preterm birth occurred in 133 women, 129 included in the study, and a control group randomly selected at a 2:1 ratio. A total of 41 cytokines with a higher probability of being associated with preterm birth or being of significance during labor were determined. RESULTS: Cytokine and cervical length analysis by multivariate analysis of the conditional interference tree revealed that growth-related oncogene values of less than 2293 pg/mL were significantly associated with a cervical length of less than 2.5 cm. CONCLUSIONS: As well as a cervical length shorter than 2.5 cm, growth-related oncogene levels of less than 2293 pg/ml may be associated with an increased risk of PB. Analysis based on the association of biomarkers and of the interaction between cytokines is a promising pathway in search of a predictor of preterm birth.

Serum cytokines in second trimester pregnancy and their relationship with spontaneous preterm births in the Ribeirão Preto and São Luiz cohorts.

OBJECTIVE: To evaluate the association between second trimester plasma cytokine levels in asymptomatic pregnant women and preterm births (PTB) in an attempt to identify a possible predictor of preterm birth. METHODS: The study design was a nested case-control study including women with singleton a gestational age between 20-25(+ 6) weeks from two Brazilian cities. The patients were interviewed, Venous blood samples were collected. The participants were again evaluated at birth. A total of 197 women with PTB comprised the case group. The control group was selected among term births (426 patients). Forty-one cytokines were compared between groups. RESULTS: When only spontaneous PTB were analyzed, GRO, sCD40L and MCP-1 levels were lower in the case group (p < 0.05). Logarithmic transformation was performed for cytokines with discrepant results, which showed increased levels of IL-2 in the group of spontaneous PTB (p < 0.05). In both analyses, the incidence of maternal smoking and of a history of preterm delivery differed significantly between the case and control groups. In multivariate analysis, only serum GRO levels differed between the case and control groups. CONCLUSION: Lower second trimester serum levels of GRO in asymptomatic women are associated with a larger number of PTB. This finding may reflect a deficient maternal inflammatory response.

Sleep characteristics and excessive daytime sleepiness in adolescents and adults: results from the birth cohorts of three Brazilian cities - RPS Consortium.

OBJECTIVE: To describe the prevalence of insufficient sleep duration, long sleep latency, terminal or maintenance insomnia, subjective sleep quality, and excessive daytime sleepiness among participants of birth cohorts conducted in three Brazilian cities, and to evaluate differences in prevalence rates within cohorts according to sociodemographic characteristics. METHODS: Cross-sectional analyses involving adolescents and adults participating in four birth cohorts conducted in Ribeirão Preto (RP78 and RP94), Pelotas (PEL93) and São Luís (SL97/98). Sleep duration, latency, terminal or maintenance insomnia, and subjective sleep quality were obtained through the Pittsburgh Sleep Quality Index; and excessive daytime sleepiness was assessed using the Epworth Sleepiness Scale. Differences in the prevalence of the outcomes were analyzed in each cohort according to sociodemographic characteristics (skin color, marital status, socioeconomic status, study and working at the time of the interview) stratified by sex. RESULTS: Insufficient sleep duration was the most common outcome at the four cohorts, with higher frequency among men. Long latency was more frequently reported by young adult women in RP94 and PEL93 cohorts, and insomnia by women of the four cohorts, when compared to men of the same age. Women generally suffered more from excessive daytime sleepiness and evaluated the quality of their sleep more negatively than men. In addition to sex, being a student and working were associated with the largest number of outcomes in both sexes. CONCLUSION: Sleep disorders are more prevalent in women, reinforcing the need for greater investment in sleep health in Brazil, without disregarding gender and socioeconomic determinants.