Prevalence and factors associated with adverse early childhood experiences: a population-based study in Ceará, Brazil.

OBJECTIVE: To estimate the prevalence of adverse childhood experiences and identify associated factors. METHODS: A population-based cross-sectional study comprised data from a sample of 3,200 households with 3,566 children under 6 years of age, representative of the state of Ceará, Brazil. A multistage sampling approach was used, with stratification among the state capital, Fortaleza, and the 28 countryside municipalities, in which 160 census tracts were randomly selected, each one with a cluster of 20 households. The outcome variable was structured based on adverse childhood experiences as suggested by the Center for Disease Control and Prevention, according to the number of situations to which the child was exposed: 0-2, 3-5, and 6-9. Ordinal logistic regression multivariate model was applied to assess associations. RESULTS: Among the 3,566 children studied, 89.7% (95%CI 88.7-90.7) were exposed to at least one adverse experience, of which the most prevalent were neglect, and emotional/physical abuse. The main factors associated were maternal advanced age and smoking, paternal absence, low education level of the head of the family, food insecurity and lack of a social support network. CONCLUSION: The study found a high occurrence of adverse early childhood experiences, particularly among preschool children born to mothers of older age, solo, who smoke and in a situation of social and economic vulnerability, including food insecurity, who should be target of control and prevention measures.

Correction: Vertical transmission of chikungunya virus: A systematic review.

[This corrects the article DOI: 10.1371/journal.pone.0249166.].

Positive Parenting Behaviors and Child Development in Ceará, Brazil: A Population-Based Study.

Parenting practices have been identified as a key determinant of children's developmental outcomes. The aim of this study was to evaluate the association of parenting practices with child development in a cross-sectional population-based study in a low-income state in northeastern Brazil. The study included data on 3566 caregiver−child pairs, and the children were aged 0−66 months. Positive parenting behaviors (PPBs) were conceptualized in areas of interactive play, social development, and speech and language interactions. Child development was evaluated using the Brazilian Ages and Stages Questionnaire. Linear regression analysis was used to assess the relationships. We found that a greater number of PPBs was associated with better child development domain scores. Among infants < 1 year, each additional PPB was associated with a 0.32 standardized mean difference (SMD) greater communication (95% CI: 0.24−0.41) and 0.38 SMD greater problem-solving scores (95% CI: 0.24−0.52). Among children aged 4−6 years old, each additional PPB was associated with improved communication (SMD: 0.22; 95% CI: 0.13−0.32), problem solving (SMD: 0.21; 95% CI: 0.10−0.32) and personal−social domain scores (SMD: 0.26; 95% CI: 0.17−0.36). Our findings indicate that PPB were robustly associated with better outcomes across developmental domains among Brazilian children. Programs and interventions that support PPB can contribute to improvements in development outcomes.

Breastfeeding Practices Before and During the COVID-19 Pandemic in Fortaleza, Northeastern Brazil.

BACKGROUND: Physical distancing associated with the COVID-19 pandemic may lead to suboptimal maternal mental health, social support after birth, and infant feeding practices. RESEARCH AIMS: To compare breastfeeding prevalence in participants who were pregnant at a time when strict physical distancing measures were imposed in Fortaleza, the capital of Ceará state, Brazil, with the pre-pandemic breastfeeding levels, and to assess the association of breastfeeding prevalence with maternal common mental disorders, and sociodemographic and health predictors. METHOD: A cross-sectional prospective two-group comparison design using two population-based surveys was carried out in Fortaleza before and after the pandemic. Participants (n = 351) who had a live birth in Fortaleza in July or August 2020, and participants (n = 222) who had a child younger than 12 months in 2017 were surveyed. Crude and adjusted multinomial logistic regressions with robust variance were used to estimate risk ratios and 95% confidence intervals (CI). RESULTS: Similar prevalence of exclusive breastfeeding were observed in 2021 (8.1%) and 2017 (8.5%; p = .790). An increase in predominant (2.2% vs. 13.4%; p < .001) and a decrease in complementary breastfeeding (64.0% vs. 48.4%; p = .037) was observed in 2021, compared to 2017. The prevalence of maternal common mental disorders also increased in 2021 (17.6% vs. 32.5%, p < .001). No statistically significant associations were found between breastfeeding patterns, maternal common mental disorders, and other predictors in 2017 or 2021. CONCLUSIONS: Participants who delivered during the COVID-19 pandemic delayed solid foods introduction and breastfed predominantly longer than participants during the pre-pandemic period. While common mental disorders significantly increased, they were not associated with differences in breastfeeding.

Undernutrition and short duration of breastfeeding association with child development: a population-based study

Abstract Objective: To explore the relationship of undernutrition and the short duration of breastfeeding with child development of children 0-66 months of age residing in Ceará, Brazil. Methods: The authors of the present study utilized population-based data from children enrolled in the Study on Maternal and Child Health in Ceará, Brazi (PESMIC). Children's development was assessed with the Ages and Stages Questionnaire third version, validated in Brazil. Undernutrition was accessed through anthropometric measures obtained by trained staff. Breastfeeding information was obtained through the mothers' report and confirmed in the child's governmental booklet. The authors used logistic regressions adjusted for sample clusters used in PESMIC design in a theoretical model for known determinants of child development following the World Health Organization nurturing framework. Results: A total of 3,566 children were enrolled in the sixth PESMIC study and had their development assessed. The authors found that 8.2%, 3.0%, 2.1%, and 3.6% of children were stunted, underweight, or wasted, at the time of the interview, respectively. All studied factors were associated with a higher prevalence of child development impairment in at least one of the assessed domains. Underweight was the factor with the strongest effect, with an adjusted odds ratio (AOR) of 4,14 (2,26-7,58), p < 0.001. Breastfeeding for up to two months compared to more than six months (AOR2,08 (1,38-3,12)) was also associated. Conclusions: The authors found that undernutrition and short duration of breastfeeding are associated with development outcomes among Brazilian children. As a result, integrated nutritional programs may improve child development outcomes.

Undernutrition and short duration of breastfeeding association with child development: a population-based study.

OBJECTIVE: To explore the relationship of undernutrition and the short duration of breastfeeding with child development of children 0-66 months of age residing in Ceará, Brazil. METHODS: The authors of the present study utilized population-based data from children enrolled in the Study on Maternal and Child Health in Ceará, Brazil (PESMIC). Children's development was assessed with the Ages and Stages Questionnaire third version, validated in Brazil. Undernutrition was accessed through anthropometric measures obtained by trained staff. Breastfeeding information was obtained through the mothers' report and confirmed in the child's governmental booklet. The authors used logistic regressions adjusted for sample clusters used in PESMIC design in a theoretical model for known determinants of child development following the World Health Organization nurturing framework. RESULTS: A total of 3,566 children were enrolled in the sixth PESMIC study and had their development assessed. The authors found that 8.2%, 3.0%, 2.1%, and 3.6% of children were stunted, underweight, or wasted, at the time of the interview, respectively. All studied factors were associated with a higher prevalence of child development impairment in at least one of the assessed domains. Underweight was the factor with the strongest effect, with an adjusted odds ratio (AOR) of 4,14 (2,26-7,58), p < 0.001. Breastfeeding for up to two months compared to more than six months (AOR 2,08 (1,38-3,12)) was also associated. CONCLUSIONS: The authors found that undernutrition and short duration of breastfeeding are associated with development outcomes among Brazilian children. As a result, integrated nutritional programs may improve child development outcomes.

Prevalence and factors associated with adverse early childhood experiences: a population-based study in Ceará, Brazil / Prevalência e fatores associados a experiências adversas na primeira infância: um estudo de base populacional no Ceará, Brasil

ABSTRACT Objective: To estimate the prevalence of adverse childhood experiences and identify associated factors. Methods: A population-based cross-sectional study comprised data from a sample of 3,200 households with 3,566 children under 6 years of age, representative of the state of Ceará, Brazil. A multistage sampling approach was used, with stratification among the state capital, Fortaleza, and the 28 countryside municipalities, in which 160 census tracts were randomly selected, each one with a cluster of 20 households. The outcome variable was structured based on adverse childhood experiences as suggested by the Center for Disease Control and Prevention, according to the number of situations to which the child was exposed: 0-2, 3-5, and 6-9. Ordinal logistic regression multivariate model was applied to assess associations. Results: Among the 3,566 children studied, 89.7% (95%CI 88.7-90.7) were exposed to at least one adverse experience, of which the most prevalent were neglect, and emotional/physical abuse. The main factors associated were maternal advanced age and smoking, paternal absence, low education level of the head of the family, food insecurity and lack of a social support network. Conclusion: The study found a high occurrence of adverse early childhood experiences, particularly among preschool children born to mothers of older age, solo, who smoke and in a situation of social and economic vulnerability, including food insecurity, who should be target of control and prevention measures.

RESUMO Objetivo: Estimar a prevalência de experiências adversas na infância e identificar fatores associados. Métodos: O estudo transversal de base populacional compreendeu os dados de uma amostra de 3.200 domicílios com 3.566 crianças menores de seis anos, representativa do estado do Ceará, Brasil. Foi utilizado um processo de amostragem multiestágio, com estratificação entre a capital do estado, Fortaleza, e os 28 municípios do interior, nos quais foram sorteados 160 setores censitários, cada qual com um conglomerado de 20 domicílios. A variável desfecho foi estruturada com base nas situações de experiências adversas na infância sugeridas pelo grupo Centers for Disease Control and Prevention, de acordo com o número de situações a que a criança foi exposta: 0-2, 3-5 e 6-9. O modelo multivariado de regressão logística ordinal foi utilizado para avaliar as associações. Resultados: Das 3.566 crianças estudadas, 89,7% (intervalo de confiança — IC95% 88,7-90,7) foram expostas a pelo menos uma experiência adversa, sendo as mais prevalentes negligência e abuso emocional/físico. Os principais fatores associados às experiências adversas na infância foram a idade materna mais elevada e o tabagismo materno, a ausência paterna, a baixa escolaridade do chefe da família, a insegurança alimentar e a falta de rede de apoio social. Conclusão: O estudo encontrou alta ocorrência de experiências adversas na primeira infância, principalmente entre crianças nascidas de mães de idade mais elevada e tabagistas, sem a presença paterna, e em situação de vulnerabilidade social e econômica, como a insegurança alimentar, que deve ser alvo prioritário de medidas de prevenção e controle.

Screen time and early childhood development in Ceará, Brazil: a population-based study.

BACKGROUND: Globally, children's exposure to digital screens continues to increase and is associated with adverse effects on child health. We aimed to evaluate the association of screen exposure with child communication, gross-motor, fine-motor, problem-solving, and personal-social development scores. METHODS: We conducted a population-based, cross-sectional study with cluster sampling among children 0-60 months of age living in the state of Ceará, Brazil. Child screen time was assessed by maternal report and the World Health Organization (WHO) recommendations were used to define excessive screen time exposure. Child development was assessed with the Brazilian Ages and Stages Questionnaire. Generalized linear regression was used to determine the association of screen exposure with developmental outcomes. We also examined the potential non-linear relationship of screen time with development scores using spline analyses. RESULTS: A total of 3155 children 0-60 months of age had screen time exposure evaluated and 69% percent were identified as exposed to excessive screen time. This percentage of excess screen time increased with child age from 41.7% for children 0-12 months to 85.2% for children 49-60 months. Each additional hour of screen time was associated with lower child communication (standardized mean difference (SMD): -0.03; 95% CI: - 0.04, - 0.02), problem solving (SMD: -0.03; 95% CI: - 0.05, - 0.02) and personal-social (SMD: -0.04; 95% CI: - 0.06, - 0.03) domain scores. CONCLUSIONS: Excess screen time exposure was highly prevalent and independently associated with poorer development outcomes among children under 5 years of age in Ceará, Brazil.

Prevalence, socioeconomic factors and obstetric outcomes associated with adolescent motherhood in Ceará, Brazil: a population-based study.

BACKGROUND: Adolescent motherhood (AM) remains a public health problem, especially in low and middle income countries, where approximately 95% of these births occur. Evidence from studies with population representativeness about events associated with AM is limited. We assessed the prevalence of AM, as well as its association with Socioeconomic Factors and Obstetric Outcomes. METHODS: A population-based cross-sectional study on maternal and child health of women aged 10 to 49 years, living in the state of Ceará, in northeastern Brazil was carried out to assess the prevalence of AM, as well as its association with Socioeconomic Factors and Obstetric Outcomes. The definition of adolescence used in the study was the one utilized by the WHO. In addition to the interview, data were double-checked according to the information in the government's pregnancy health booklet. Sample-adjusted logistic models to determine the association of socioeconomic factors and AM, as well as the association of AM with obstetric outcomes, with a causal approach to multivariate analyses, were used. RESULTS: The prevalence of adolescent motherhood was 18.6%. Poverty and household crowding were associated with greater chances of AM (p values of 0.038 and <  0.001, respectively), as well as not being in a stable relationship (OR 2.26 (95%CI: 1.67, 3.07), p <  0.001). AM showed a greater chance of not using community health services (p <  0.001), had fewer prenatal consultations (ß - 0.432 (95%CI: - 0.75, - 0.10)) and started prenatal care at a later date (ß 0.38 (95%CI: 0.21, 0.55), p <  0.001)). AM are also less likely to be tested for HIV and more likely to have urinary tract infections. CONCLUSIONS: Interventions aimed at socially-vulnerable adolescents are suggested. However, if pregnant, adolescents should receive proactive and differentiated prenatal care.

Vertical transmission of chikungunya virus: A systematic review.

OBJECTIVES: To describe and estimate the frequency of pregnancy outcomes, clinical and laboratory characteristics of vertical transmission of CHIKV in the neonate. STUDY DESIGN: We performed a systematic review evaluating the clinical presentation of perinatally-acquired CHIKV infection in neonates. The search was performed using Medline (via PubMed), LILACS, Web of Science, Scielo, Google Scholar and Open grey to identify studies assessing vertical transmission of CHIKV up to November 3, 2020. There were no search restrictions regarding the study type, the publication date or language. Studies with no documented evidence of CHIKV infection in neonates (negative RT-PCR or absence of IgM) were excluded. RESULTS: From the 227 studies initially identified, 42 were selected as follows: 28 case reports, 7 case series, 2 cross-sectional studies and 5 cohort studies, for a total of 266 CHIKV infected neonates confirmed by serological and/or molecular tests. The vertical transmission rate was 50% in the Reunion Island outbreak, which was the subject of the majority of the studies; the premature delivery were reported in 19 (45.2%) studies; the rate of fetal distress was 19.6% of infected babies and fetal loss occurred in 2% of the cases. Approximately 68.7% of newborns were diagnosed with encephalopathy or encephalitis after perinatally acquired CHIKV. Most of the infected neonates were born healthy, developing CHIKV sepsis clinical syndrome within the first week of life. CONCLUSIONS: We alert neonatologists to the late manifestations of neonatal CHIKV infection, relevant to the management and reduction of morbidity. A limitation of our review was that it was not possible to carry out meta-analysis due to differences in study design and the small number of participants.

Maternal and neonatal factors associated with child development in Ceará, Brazil: a population-based study.

BACKGROUND: The first 1000 days of life are a critical period when the foundations of child development and growth are established. Few studies in Latin America have examined the relationship of birth outcomes and neonatal care factors with development outcomes in young children. We aimed to assess the association between pregnancy and neonatal factors with children's developmental scores in a cross-sectional, population-based study of children in Ceará, Brazil. METHODS: Population-based, cross-sectional study of children aged 0-66 months (0-5.5 years) living in Ceará, Brazil. We examined the relationship of pregnancy (iron and folic acid supplementation, smoking and alcohol consumption) and neonatal (low birth weight (LBW) gestational age, neonatal care interventions, and breastfeeding in the first hour) factors with child development. Children's development was assessed with the Ages and Stages Questionnaire (ASQ-BR). We used multivariate generalized linear models that accounted for clustering sampling to evaluate the relationship of pregnancy and neonatal factors with development domain scores. FINDINGS: A total of 3566 children were enrolled. Among pregnancy factors, children whose mothers did not receive folic acid supplementation during pregnancy had lower fine motor and problem-solving scores (p-values< 0.05). As for neonatal factors, LBW was associated with 0.14 standard deviations (SD) lower (CI 95% -0.26, - 0.02) communication, 0.24 SD lower (95% CI: - 0.44, - 0.04) fine motor and 0.31 SD lower (CI 95% -0.45, - 0.16) problem-solving domain scores as compared to non-LBW children (p values < 0.05). In terms of care, newborns that required resuscitation, antibiotics for infection, or extended in-patient stay after birth had lower development scores in selected domains. Further, not initiating breastfeeding within the first hour after birth was associated with lower gross motor and person-social development scores (p-values < 0.05). CONCLUSION: Pregnancy and neonatal care factors were associated with later child development outcomes. Infants at increased risk of suboptimal development, like LBW or newborns requiring extended in-patient care, may represent groups to target for supplemental intervention. Further, early integrated interventions to prevent adverse pregnancy and newborn outcomes may improve child development outcomes.

Coronavirus disease 2019, food security and maternal mental health in Ceará, Brazil: a repeated cross-sectional survey.

OBJECTIVE: To quantify the change in the risk of food insecurity and maternal mental disorder (MMD) before and during the coronavirus disease 2019 (COVID-19) pandemic. DESIGN: Repeated cross-sectional survey. Between 17 July and 10 September 2020, mother-child pairs who were enrolled in a population-based survey in 2017 were re-contacted by telephone for consent and to complete a telephonic COVID-19 survey. We used the Brazilian Food Insecurity Scale to assess food security and the Self Reporting Questionnaire-20 to assess MMD. McNemar's test for paired data that also accounted for clustering was used. Logistic regression was used to assess the relationship of unemployment and receipt of government assistance with food insecurity and MMD in 2020. SETTING: Ceará, Brazil. PARTICIPANTS: Five hundred and seventy-seven mother-child pairs completed the 2017 and 2020 surveys. At the time of the 2020 interview, the child cohort was 36-108 months of age. RESULTS: The proportion of mothers reporting food insecurity was 15·5 % higher (95 % CI 5·9, 25·1, P value < 0·001) during the pandemic in July-August 2020 as compared with November 2017, while the prevalence of MMD was 40·2 % higher during the pandemic (95 % CI 32·6, 47·8, P value < 0·001). Loss of formal employment was associated with increased risk of food insecurity, but not with the risk of MMD. CONCLUSIONS: The risk of food insecurity and MMD in Ceará increased during the COVID-19 pandemic. These findings highlight the need for policies and interventions to reduce the impact of the COVID-19 pandemic on maternal and child health, nutrition and well-being in Brazil.

Adverse Childhood Experiences and Child Development Outcomes in Ceará, Brazil: A Population-based Study.

INTRODUCTION: More than 200 million children fail to reach their full developmental potential in low- and middle-income countries. Adverse childhood experiences, maternal mental health, and intimate partner violence are negatively associated with child development outcomes. The relationship of these risk factors with child communication, gross motor, fine motor, problem-solving, and personal-social development scores in Brazil are assessed. METHODS: A population-based, cross-sectional study of preschool children living in the state of Ceará, Brazil, in 2017 was conducted. Child development was assessed with the Ages and Stages Questionnaire. Adverse childhood experiences for children were self-reported by the participants' mothers using the Centers for Disease Control and Prevention Adverse Childhood Experiences Study‒adapted metric. Maternal mental health and intimate partner violence were evaluated using validated questionnaires. Sample-adjusted multivariable generalized linear models with interaction terms were used to determine the association of intimate partner violence, maternal mental health, and adverse childhood experiences with developmental outcomes and identify possible moderators. Data were analyzed between 2019 and 2020. RESULTS: Children exposed to ≥3 adverse childhood experiences had -0.12 (95% CI= -0.24, 0) lower communication, -0.25 (95% CI= -0.46, -0.03) lower gross motor, -0.27 (95% CI= -0.47, -0.07) lower fine motor, and -0.17 (95% CI= -0.3, -0.03) lower personal-social domain scores than children with no adverse childhood experiences. Furthermore, the greater number of adverse childhood experiences was linearly associated with lower developmental scores. Maternal mental health and intimate partner violence were also associated with lower development scores. CONCLUSIONS: Adverse childhood experiences were independently associated with developmental outcomes in Brazilian children. Community-based interventions to reduce the impact of adverse childhood experiences, intimate partner violence, and maternal mental health may benefits child development outcomes.

Attitudes and perceptions of teachers and medical students regarding suicide / Atitudes e percepções de professores e estudantes de medicina em relação ao suicídio

Abstract: Introduction: The World Health Organization (WHO) estimates that there are around one million deaths by suicide a year worldwide, more than the total sum of deaths caused by wars and homicides, which results in one death every 40 seconds. Despite the existence of several scientific publications on suicide prevention, there have been studies showing that health professionals are not trained to adequately care for individuals at risk of suicide. Objective: This study aimed to understand the attitudes and perceptions of medical school students and teachers regarding suicide. Methods: This is a cross-sectional, descriptive study, with a quantitative and qualitative approach, approved by the Research Ethics Committee, which assessed a sample of 180 students attending the 8th and 11th semesters and 57 teachers from different semesters of the evaluated medical courses. The data were obtained by applying the Suicide Behavior Attitude Questionnaire (SBAQ), in addition to a sociodemographic questionnaire. The data were submitted to descriptive and analytical statistics. Results: Regarding professional capacity, the scores were low for both students (median 5.5) and teachers (median 5.25). Students who had seen someone exhibiting suicidal behavior (p = 0.002) and those attending the more advanced semesters (p = 0.04) felt more confident when treating patients at risk of suicide. There was a significant difference regarding the Right to Suicide factor among students who said they were religious (p = 0.001), as also among the teachers who attended religious services with a higher frequency (p = 0.02). Conclusions: We conclude that students and teachers have had little experience with suicide in the assessed medical courses, which contributes to low level of training and the feeling of insecurity, indicating the need to give more importance to the subject in the undergraduate medical school, aiming to allow the acquisition of knowledge and skills for a competent and preventive medical practice regarding suicide.

Resumo: Introdução: A estimativa da Organização Mundial da Saúde (OMS) é que haja cerca de um milhão de mortes por suicídio por ano no mundo, mais do que a soma total de mortes em guerras e homicídios, que resulta em uma morte a cada 40 segundos. Apesar da existência de diversas publicações científicas sobre a prevenção do suicídio, existem estudos que mostram que os profissionais de saúde não são capacitados para cuidar adequadamente de pessoas em risco de suicídio. Objetivo: Este estudo teve como objetivo compreender as atitudes e percepções de alunos e professores do curso de medicina em relação ao suicídio. Métodos: Trata-se de um estudo transversal, descritivo, com abordagem quantitativa e qualitativa, aprovado pelo Comitê de Ética em Pesquisa, que avaliou uma amostra de 180 alunos do 8º e 11º semestres e 57 professores de diferentes semestres dos cursos médicos avaliados. Os dados foram obtidos por meio da aplicação do Suicide Behavior Attitude Questionnaire (SBAQ), além de um questionário sociodemográfico. Os dados foram submetidos à estatística descritiva e analítica. Resultados: Em relação à capacidade profissional, as pontuações foram baixas tanto para alunos (mediana 5,5) quanto para professores (mediana 5,25). Alunos que viram alguém apresentando comportamento suicida (p = 0,002) e os que frequentavam o semestre mais avançado (p = 0,04) sentiram-se mais confiantes no atendimento de pacientes com risco de suicídio. Houve diferença significativa quanto ao fator Direito ao Suicídio entre os alunos que se disseram religiosos (p = 0,001), assim como entre os professores que frequentavam serviços religiosos com maior frequência (p = 0,02). Conclusões: Concluímos que alunos e professores tiveram pouca experiência com suicídio nos cursos de medicina avaliados, o que contribui para o baixo nível de formação e o sentimento de insegurança, indicando a necessidade de dar mais importância ao assunto na graduação em medicina, visando permitir a aquisição de conhecimentos e habilidades para uma prática médica preventiva e competente em relação ao suicídio.

Stakeholders' perceptions of humanized birth practices and obstetric violence in Chile: A scoping review. / Stakeholders' perceptions of humanized birth practices and obstetric violence in Chile: A scoping review.

INTRODUCTION: Chile has an incipient policy regarding humanized birth practices. Obstetric violence is becoming an issue in the public discussion, as brought up by women. Despite this advancement, no initiatives were observed to overcome the conflict. Questions arise from the different points of view of the main stakeholders involved. These questions help identify strategies contributing to the development of health policies that consider influencing actors. OBJECTIVES: To identify stakeholders' perceptions of humanized care in childbirth and obstetric violence. METHODS: We conducted a scoping review that included articles and analysis of texts reflecting the scientific communities' point of view. We included statements from governmental, social, professional, and political actors as expressed in institutional websites. Moreover, we performed a qualitative inductive, thematic content analysis. RESULTS: We included seventy documents. The scientific community is visualized as aligned with ministerial recommendations for personalized childbirth. Several researchers analyze the difficulties for its improvement due to the historical, socio-cultural, and economic construction of the predominantly biomedical model for birthing. Convergence is observed among the scientific community and other stakeholders in recognition of humanized birth benefits and the need to overcome institutional obstacles within the health sector. However, the progress of the proposed change is slow, and health professionals' resistance to address women's complaints towards obstetric violence and claim of quality care is observed. This discussion finds its reflection in a parliamentary discussion. CONCLUSIONS: The stakeholders' analysis reflects areas of conflict and consensus, as well as the diverse interacting dimensions that hinder the advance of humanized care in childbirth. This broad analysis strategy contributes to identifying critical aspects to be addressed in the development of integral and effective health policies.

Percepción de actores involucrados acerca del parto humanizado y la violencia obstétrica en Chile: una revisión panorámica / Stakeholders' perceptions of humanized birth practices and obstetric violence in Chile: a scoping review

INTRODUCCIÓN: Chile tiene una política incipiente en relación con prácticas de parto humanizado y la violencia obstétrica es una materia de creciente discusión pública levantada por las mujeres. A pesar de este avance, no se han observado iniciativas para superar el conflicto. Surge la pregunta acerca de los diferentes puntos de vista de los principales actores involucrados, con el fin de identificar estrategias que contribuyan al desarrollo de políticas públicas de salud que consideren a los actores influyentes. OBJETIVO: Identificar la percepción de actores acerca del parto humanizado y la violencia obstétrica. MÉTODO: Se condujo una revisión panorámica (scoping review) que incluyó la descripción y el análisis de artículos y textos de análisis que reflejaran la visión de la comunidad científica y declaraciones de actores del sector gubernamental, social, profesional y político expresados en sitios web institucionales. Se desarrolló un análisis de contenido temático cualitativo, de naturaleza inductiva. RESULTADOS: Se incluyeron setenta documentos. La comunidad científica se visualiza alineada con las recomendaciones ministeriales de parto personalizado. Varios investigadores analizan las dificultades de implementación debido a la construcción histórica, sociocultural y económica del modelo biomédico de atención del parto predominante. Se observa convergencia entre la comunidad científica y otros actores en torno al reconocimiento de los beneficios del parto humanizado, así como acerca de la necesidad de superar obstáculos institucionales del sector de salud. No obstante, el proceso de cambio propuesto es lento y se observan resistencias entre profesionales de la salud para abordar las quejas de las mujeres frente a la violencia obstétrica y su demanda de atención de calidad. Esta situación se refleja a nivel parlamentario. CONCLUSIONES: El análisis de actores identifica áreas de conflicto y de consenso, así como diversas dimensiones interactuantes que obstaculizan el avance hacia la humanización de la atención del parto. Esta estrategia amplia de análisis contribuye a la identificación de aspectos críticos a ser abordados para un desarrollo de políticas sanitarias integrales y efectivas.

INTRODUCTION: Chile has an incipient policy regarding humanized birth practices. Obstetric violence is becoming an issue in the public discussion, as brought up by women. Despite this advancement, no initiatives were observed to overcome the conflict. Questions arise from the different points of view of the main stakeholders involved. These questions help identify strategies contributing to the development of health policies that consider influencing actors. OBJECTIVES: To identify stakeholders' perceptions of humanized care in childbirth and obstetric violence. METHODS: We conducted a scoping review that included articles and analysis of texts reflecting the scientific communities' point of view. We included statements from governmental, social, professional, and political actors as expressed in institutional websites. Moreover, we performed a qualitative inductive, thematic content analysis. RESULTS: We included seventy documents. The scientific community is visualized as aligned with ministerial recommendations for personalized childbirth. Several researchers analyze the difficulties for its improvement due to the historical, socio-cultural, and economic construction of the predominantly biomedical model for birthing. Convergence is observed among the scientific community and other stakeholders in recognition of humanized birth benefits and the need to overcome institutional obstacles within the health sector. However, the progress of the proposed change is slow, and health professionals' resistance to address women's complaints towards obstetric violence and claim of quality care is observed. This discussion finds its reflection in a parliamentary discussion. CONCLUSIONS: The stakeholders' analysis reflects areas of conflict and consensus, as well as the diverse interacting dimensions that hinder the advance of humanized care in childbirth. This broad analysis strategy contributes to identifying critical aspects to be addressed in the development of integral and effective health policies.

Factors associated with trachoma treatment and control treatment in schools of municipality of the Northeast Region, Brazil. / Fatores associados ao tratamento e ao controle do tratamento do tracoma em escolares de município da Região Nordeste, Brasil.

INTRODUCTION: Trachoma maintains itself as a public health problem and an important cause of morbidity, visual impairment and preventable blindness in Brazil. OBJECTIVE: To analyze factors associated with treatment and control of trachoma treatment in schoolchildren diagnosed during the national campaign in 2014, in the town of Russas, Ceará. METHODOLOGY: A cross-sectional study was brought out from January to April 2016. Social, demographic, economic and follow-up data were collected for 390 schoolchildren aged five to 14 years old, diagnosed with trachoma in the campaign in 2014. They were defined dependent variables: trachoma treatment and control of trachoma disease, categorized as adequate and inadequate, and multivariate analyzes were performed. RESULTS: Treatment was considered adequate in 56.7% of schoolchildren and in only 5.9% treatment control was classified as adequate. In the multivariate analysis, they have got an association with the trachoma treatment result: rural residence zone and waste destination in a non-public space. The last control of the treatment of trachoma remained associated to the variables: rural residence zone; family income less than a minimum wage and school not examined by the physician. CONCLUSION: Inadequate treatment and control of trachoma treatment showed an association with socioeconomic variables and follow-up of primary care. Health education activities were not accessible to the entire community, indicating the need for more involvement by primary care professionals.

INTRODUÇÃO: O tracoma mantém-se como problema de saúde pública e importante causa de morbidade, deficiência visual e cegueira evitável no Brasil. OBJETIVO: Analisar fatores associados ao tratamento e ao controle do tratamento do tracoma em escolares diagnosticados durante Campanha Nacional de Hanseníase, Verminoses, Tracoma e Esquistossomose, em 2014, no município de Russas, Ceará. METODOLOGIA: Estudo transversal desenvolvido de janeiro a abril de 2016. Foram coletados dados sociais, demográficos, econômicos e de acompanhamento pela atenção básica de 390 escolares de 5 a 14 anos de idade diagnosticados com tracoma, na campanha em 2014. Definiram-se as variáveis dependentes: tratamento do tracoma e controle do tratamento do tracoma, categorizadas em adequado e inadequado, realizando-se análises bi e multivariada. RESULTADOS: O tratamento foi considerado adequado em 56,7% dos escolares, e em apenas 5,9% o controle do tratamento foi classificado como adequado. Na análise multivariada, mantiveram associação com o desfecho tratamento do tracoma as variáveis zona de residência rural e destino dos dejetos em rede não pública. O desfecho controle do tratamento do tracoma permaneceu associado às variáveis: zona de residência rural, renda familiar menor que um salário mínimo e escolar não examinado pelo médico. CONCLUSÃO: O tratamento e controle do tratamento inadequados do tracoma mostraram associação com variáveis socioeconômicas e de acompanhamento pela atenção básica. As atividades de educação em saúde não foram acessíveis a toda a comunidade, indicando a necessidade de maior envolvimento dos profissionais da atenção básica.

Environmental, Socioeconomic, Maternal, and Breastfeeding Factors Associated with Childhood Overweight and Obesity in Ceará, Brazil: A Population-Based Study.

Childhood obesity is now an epidemic in many countries worldwide and is known to be a multifactorial condition. We aimed to examine the relationship of environmental, socioeconomic, and nutritional factors with childhood overweight and obesity. We conducted a population-based cross-sectional study of children from 2 to 6 years of age in Ceará, Brazil. Children's nutritional status was assessed by body mass index (BMI) Z scores categorized as overweight and obesity. Ordinal logistic regression models were used to assess the relationship between the factors with overweight and obesity. A total of 2059 children participated, of which 50.4% were male. The mean age was 46 ± 17 months, with a prevalence of overweight and obesity of 12.0% (95% CI 10.7-13.6) and 8.0% (6.7-9.5), respectively. In multivariate analysis, the probability of childhood obesity increased as family income increased (adjusted hazard ratio (aHR) 0.6 (95% CI 0.37-0.95), p-value = 0.03). Moreover, families with fewer children had more than 30% fewer overweight children (aHR 0.68; 95% CI 0.48-0.96). Environmental, socioeconomic, and child nutritional factors were associated with overweight and obesity. The results provided could be used to design integrated interventions spanning from conception, or earlier, through the first years of life and may improve child nutritional outcomes.

Fatores associados ao tratamento e ao controle do tratamento do tracoma em escolares de município da Região Nordeste, Brasil / Factors associated with trachoma treatment and control treatment in schools of municipality of the Northeast Region, Brazil

RESUMO: Introdução: O tracoma mantém-se como problema de saúde pública e importante causa de morbidade, deficiência visual e cegueira evitável no Brasil. Objetivo: Analisar fatores associados ao tratamento e ao controle do tratamento do tracoma em escolares diagnosticados durante Campanha Nacional de Hanseníase, Verminoses, Tracoma e Esquistossomose, em 2014, no município de Russas, Ceará. Metodologia: Estudo transversal desenvolvido de janeiro a abril de 2016. Foram coletados dados sociais, demográficos, econômicos e de acompanhamento pela atenção básica de 390 escolares de 5 a 14 anos de idade diagnosticados com tracoma, na campanha em 2014. Definiram-se as variáveis dependentes: tratamento do tracoma e controle do tratamento do tracoma, categorizadas em adequado e inadequado, realizando-se análises bi e multivariada. Resultados: O tratamento foi considerado adequado em 56,7% dos escolares, e em apenas 5,9% o controle do tratamento foi classificado como adequado. Na análise multivariada, mantiveram associação com o desfecho tratamento do tracoma as variáveis zona de residência rural e destino dos dejetos em rede não pública. O desfecho controle do tratamento do tracoma permaneceu associado às variáveis: zona de residência rural, renda familiar menor que um salário mínimo e escolar não examinado pelo médico. Conclusão: O tratamento e controle do tratamento inadequados do tracoma mostraram associação com variáveis socioeconômicas e de acompanhamento pela atenção básica. As atividades de educação em saúde não foram acessíveis a toda a comunidade, indicando a necessidade de maior envolvimento dos profissionais da atenção básica.

ABSTRACT: Introduction: Trachoma maintains itself as a public health problem and an important cause of morbidity, visual impairment and preventable blindness in Brazil. Objective: To analyze factors associated with treatment and control of trachoma treatment in schoolchildren diagnosed during the national campaign in 2014, in the town of Russas, Ceará. Methodology: A cross-sectional study was brought out from January to April 2016. Social, demographic, economic and follow-up data were collected for 390 schoolchildren aged five to 14 years old, diagnosed with trachoma in the campaign in 2014. They were defined dependent variables: trachoma treatment and control of trachoma disease, categorized as adequate and inadequate, and multivariate analyzes were performed. Results: Treatment was considered adequate in 56.7% of schoolchildren and in only 5.9% treatment control was classified as adequate. In the multivariate analysis, they have got an association with the trachoma treatment result: rural residence zone and waste destination in a non-public space. The last control of the treatment of trachoma remained associated to the variables: rural residence zone; family income less than a minimum wage and school not examined by the physician. Conclusion: Inadequate treatment and control of trachoma treatment showed an association with socioeconomic variables and follow-up of primary care. Health education activities were not accessible to the entire community, indicating the need for more involvement by primary care professionals.

Prevalence and socioeconomic determinants of development delay among children in Ceará, Brazil: A population-based study.

OBJECTIVE: To assess the prevalence of child development delay and to identify socioeconomic determinants. STUDY DESIGN: We conducted a population-based cross-sectional study of children 2 to 72 months of age residing in the state of Ceará, Brazil. In total, 3200 households were randomly selected for participation in the study and had child development assessed with the Ages and Stages Questionnaire (ASQ) version 3. Development delay was defined as a score of less than -2 standard deviations below the median of the Brazilian ASQ standard. We present population-level prevalence of delay in five development domains and assess socioeconomic determinants. RESULTS: A total of 3566 children completed the ASQ development assessment of which 9.2% (95% CI: 8.1-10.5) had at least one domain with development delay. The prevalence of delay increased with age in all domains and males were at higher risk for communication, gross motor and personal-social development delays as compared to females (p-values <0.05). We found robust associations of indicators of socioeconomic status with risk of development delay; increasing monthly income and higher social class were associated with reduced risk of delay across all domains (28,2% in the poorest and 21,2% in richest for any delay, p-values <0.05 for all domains). In addition, children in poor households that participated in conditional cash transfer (CCT) programs appeared to have reduced risk of delay as compared to children from households that were eligible, but did not participate, in CCT programs. CONCLUSIONS: There is a relatively high population-level prevalence of development delay in at least one domain among children 0-6 years of age in Ceará, Brazil. Integrated child development, social support, and poverty reduction interventions may reduce the population-level prevalence of development delay in Ceará and similar settings.