Abstract
Introduction
Birth weight is described as one of the main determinants of newborns’ chances of survival. Among the associated causes, or risk factors, the mother’s nutritional status ...strongly influences fetal growth and birth weight outcomes of the concept. This study evaluates the association between food deserts, small for gestational age (SGA), large for gestational age (LGA) and low birth weight (LBW) newborns.
Design
This is a cross-sectional population study, resulting from individual data from the Live Birth Information System (SINASC), and commune data from mapping food deserts (CAISAN) in Brazil. The newborn’s size was defined as follows: appropriate for gestational age (between 10 and 90
th
percentile), SGA (< 10
th
percentile), LGA (> 90
th
percentile), and low birth weight < 2,500 g. To characterize food environments, we used tertiles of the density of establishments which sell
in natura
and ultra-processed foods. Logistic regression modeling was conducted to investigate the associations of interest.
Results
We analyzed 2,632,314 live births in Brazil in 2016, after appropriate adjustments, women living in municipalities with limited availability of fresh foods had a higher chance of having newborns with SGA OR2nd tertile: 1.06 (1.05–1.07) and LBW OR2nd tertile: 1.11 (1.09–1.12). Conversely, municipalities with greater availability of ultra-processed foods had a higher chance of having newborns with SGA OR3rd tertile: 1.04 (1.02–1.06) and LBW OR2nd tertile: 1.13 (1.11–1.16). Stratification by race showed that Black and Mixed/Brown women had a higher chance of having newborns with SGA OR3rd tertile: 1.09 (1.01–1.18) and OR3rd tertile: 1.06 (1.04–1.09), respectively, while Mixed-race women also had a higher chance of having newborns with LBW OR3rd tertile: 1.17 (1.14–1.20). Indigenous women were associated with LGA OR3rd tertile: 1.20 (1.01–1.45).
Conclusion
The study found that living in areas with limited access to healthy foods was associated with an increased risk of SGA and low birth weight among newborns, particularly among Black and Mixed/Brown women. Therefore, urgent initiatives aimed at reducing social inequalities and mitigating the impact of poor food environments are needed in Brazil.
To evaluate the quality of information on gestational syphilis (GS) and congenital syphilis (CS) on the Sistema de Informação de Agravos de Notificação (SINAN-Syphilis Brazil - Notifiable Diseases ...Information System) by compiling and validating completeness indicators between 2007 and 2018.
Overall, care, and socioeconomic completeness scores were compiled based on selected variables, by using ad hoc weights assigned by experts. The completeness scores were analysed, considering the region and area of residence, the pregnant woman's race/colour, and the year of case notification. Pearson's correlation coefficients were used to validate the scores obtained by the weighted average method, compared with the values obtained by principal component analysis (PCA).
Most selected variables presented a good or excellent degree of completeness for GS and CS, except for clinical classification, pregnant woman's level of education, partner's treatment, and child's race/colour, which were classified as poor or very poor. The overall (89.93% versus 89.69%) and socioeconomic (88.71% versus 88.24%) completeness scores for GS and CS, respectively, were classified as regular, whereas the care score (GS-90.88%, and CS-90.72%) was good, despite improvements over time. Differences in the overall, care and socioeconomic completeness scores according to region, area of residence, and ethnic-racial groups were reported for syphilis notifications. The completeness scores estimated by the weighted average method and PCA showed a strong linear correlation (> 0.90).
The completeness of GS and CS notifications has been improving in recent years, highlighting the variables that form the care score, compared with the socioeconomic scores, despite differences between regions, area of residence, and ethnic-racial groups. The weighted average was a viable methodological alternative easily operationalised to estimate data completeness scores, allowing routine monitoring of the completeness of gestational and congenital syphilis records.
Resumo A avalição da efetividade de vacinas é feita com dados do mundo real e é essencial para monitorar o desempenho dos programas de vacinação ao longo do tempo bem como frente a novas variantes. ...Até o momento, a avaliação da efetividade das vacinas para COVID-19 tem sido baseada em métodos clássicos como estudos de coorte e caso controle teste-negativo, que muitas vezes podem não permitir o adequado controle dos vieses intrínsecos da alocação das campanhas de vacinação. O objetivo dessa revisão foi discutir os desenhos de estudo disponíveis para avaliação de efetividade das vacinas, enfatizando os estudos quase-experimentais, que buscam mimetizar os estudos aleatorizados ao introduzir um componente exógeno para atribuição ao tratamento, bem como suas vantagens, limitações e aplicabilidade no contexto dos dados brasileiros. O emprego de métodos quase-experimentais, incluindo as séries temporais interrompidas, o método de diferença em diferenças, escore de propensão, variáveis instrumentais e regressão descontínua, são relevantes pela possibilidade de gerar estimativas mais acuradas da efetividade de vacinas para COVID-19 em cenários como o brasileiro, que se caracteriza pelo uso de várias vacinas, com respectivos número e intervalos entre doses, aplicadas em diferentes faixas etárias e em diferentes momentos da pandemia.
Abstract The evaluation of vaccine effectiveness is conducted with real-world data. They are essential to monitor the performance of vaccination programmes over time, and in the context of the emergence of new variants. Until now, the effectiveness of COVID-19 vaccines has been assessed based on classic methods, such as cohort and test-negative case-control studies, which may often not allow for adequate control of inherent biases in the assignment of vaccination campaigns. The aim of this review was to discuss the study designs available to evaluate vaccine effectiveness, highlighting quasi-experimental studies, which seek to mimic randomized trials, by introducing an exogenous component to allocate to treatment, in addition to the advantages, limitations, and applicability in the context of Brazilian data. The use of quasi-experimental approaches, such as interrupted time series, difference-in-differences, propensity scores, instrumental variables, and regression discontinuity design, are relevant due to the possibility of providing more accurate estimates of COVID-19 vaccine effectiveness. This is especially important in scenarios such as the Brazilian, which characterized by the use of various vaccines, with the respective numbers and intervals between doses, applied to different age groups, and introduced at different times during the pandemic.
Women living in income-segregated areas are less likely to receive adequate breast cancer care and access community resources, which may heighten breast cancer mortality risk.
To investigate the ...association between income segregation and breast cancer mortality and whether this association is attenuated by receipt of the Bolsa Família program (BFP), the world's largest conditional cash-transfer program.
This cohort study was conducted using data from the 100 Million Brazilian Cohort, which were linked with nationwide mortality registries (2004-2015). Data were analyzed from December 2021 to June 2023. Study participants were women aged 18 to 100 years.
Women's income segregation (high, medium, or low) at the municipality level was obtained using income data from the 2010 Brazilian census and assessed using dissimilarity index values in tertiles (low 0.01-0.25, medium 0.26-0.32, and high 0.33-0.73).
The main outcome was breast cancer mortality. Mortality rate ratios (MRRs) for the association of segregation with breast cancer deaths were estimated using Poisson regression adjusted for age, race, education, municipality area size, population density, area of residence (rural or urban), and year of enrollment. Multiplicative interactions of segregation and BFP receipt (yes or no) in the association with mortality (2004-2015) were assessed.
Data on 21 680 930 women (mean SD age, 36.1 15.3 years) were analyzed. Breast cancer mortality was greater among women living in municipalities with high (adjusted MRR aMRR, 1.18; 95% CI, 1.13-1.24) and medium (aMRR, 1.08; 95% CI, 1.03-1.12) compared with low segregation. Women who did not receive BFP had higher breast cancer mortality than BFP recipients (aMRR, 1.17; 95% CI, 1.12-1.22). By BFP strata, women who did not receive BFP and lived in municipalities with high income segregation had a 24% greater risk of death from breast cancer compared with those living in municipalities with low income segregation (aMRR, 1.24: 95% CI, 1.14-1.34); women who received BFP and were living in areas with high income segregation had a 13% higher risk of death from breast cancer compared with those living in municipalities with low income segregation (aMRR, 1.13; 95% CI, 1.07-1.19; P for interaction = .008). Stratified by the amount of time receiving the benefit, segregation (high vs low) was associated with an increase in mortality risk for women receiving BFP for less time but not for those receiving it for more time (<4 years: aMRR, 1.16; 95% CI, 1.07-1.27; 4-11 years: aMRR, 1.09; 95% CI, 1.00-1.17; P for interaction <.001).
These findings suggest that place-based inequities in breast cancer mortality associated with income segregation may be mitigated with BFP receipt, possibly via improved income and access to preventive cancer care services among women, which may be associated with early detection and treatment and ultimately reduced mortality.
The literature contains scarce data on inequalities in growth trajectories among children born to mothers of diverse ethnoracial background in the first 5 years of life.
We aimed to investigate child ...growth according to maternal ethnoracial group using a nationwide Brazilian database.
A population-based retrospective cohort study employed linked data from the CIDACS Birth Cohort and the Brazilian Food and Nutrition Surveillance System (SISVAN). Children born at term, aged 5 years or younger who presented two or more measurements of length/height (cm) and weight (kg) were followed up between 2008 and 2017. Prevalence of stunting, underweight, wasting, and thinness were estimated. Nonlinear mixed effect models were used to estimate childhood growth trajectories, among different maternal ethnoracial groups (White, Asian descent, Black, Pardo, and Indigenous), using the raw measures of weight (kg) and height (cm) and the length/height-for-age (L/HAZ) and weight-for-age z-scores (WAZ). The analyses were also adjusted for mother's age, educational level, and marital status.
A total of 4,090,271 children were included in the study. Children of Indigenous mothers exhibited higher rates of stunting (26.74%) and underweight (5.90%). Wasting and thinness were more prevalent among children of Pardo, Asian, Black, and Indigenous mothers than those of White mothers. Regarding children's weight (kg) and length/height (cm), those of Indigenous, Pardo, Black, and Asian descent mothers were on average shorter and weighted less than White ones. Regarding WAZ and L/HAZ growth trajectories, a sharp decline in average z-scores was evidenced in the first weeks of life, followed by a period of recovery. Over time, z-scores for most of the subgroups analyzed trended below zero. Children of mother in greater social vulnerability showed less favorable growth.
We observed racial disparities in nutritional status and childhood growth trajectories, with children of Indigenous mothers presenting less favorable outcomes compared to their White counterparts. The strengthening of policies aimed at protecting Indigenous children should be urgently undertaken to address systematic ethnoracial health inequalities.
This article aims to propose and discuss a set of criteria for conceptual research in clinical behavior analysis. The existing lack of consensus on such criteria hinders advances in conceptual ...research that is needed for the advancement of clinical treatments. The research criteria proposed here are mindful of and try to manage some of the practical problems inherent in this type of research (e.g., dealing with psychotherapy goals and the potential disadvantages of using middle-level terms). In particular, the article, (1) offers a definition of conceptual research that is consistent with relevant theory and philosophy; and (2) explores five criteria currently used in clinical behavior analysis regarding conceptual developments. These criteria include coherence with basic research; coherence with applied research; coherence with philosophy and the theory of clinical behavior analysis; conceptual precision; and the potential to provide the practitioner with the means to develop and use technology. These five criteria are discussed and offered as a potentially useful basis for conceptual developments in clinical behavior analysis.
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•Urban and peri-urban Atlantic forest remnants are affected by air pollution deposition.•Air pollution emissions from diversified land uses have caused nutritional imbalances.•Clay ...soils provided the high buffering capacity against anthropic deposition.•Agriculture activities have increased P, K, Ca, and Mg deposition in forests.•Industrial activities contributed to enhance N, S and Mn in forests.
This study was conducted with the purpose to evaluate the hypothesis that the air pollution deposition in the remaining Brazilian Atlantic Forest surrounded by diversified land uses, has altered the nutritional status of its tree species. The leaf concentrations of macronutrients and micronutrients were determined to estimate Concentration Factors – CF (plant/soil concentration ratios) and leaf nutrient ratios (N/P, N/K, N/Ca, N/Mg, N/S, S/K, S/Ca, S/Mg) of the most abundant tree species found in four remnants at the Metropolitan Region of Campinas, SE Brazil: Cosmopolis, Holambra, Paulínia and Campinas. The leaf samplings occurred during three dry and wet seasons. Multivariate analysis of variance (MANOVA) determined if CF for nutrients and ratios varied between forest remnants and seasons. Variations in CF values indicated that the nutritional status of the forest remnants is defined by both physical/chemical soil attributes and atmospheric deposition. The clay soils of the Campinas forest appeared to provide the highest buffering capacity against acidic deposition and nutritional imbalances induced by the anthropic activities. The air pollution emissions from diversified land uses has increased the CF medians above a reliable baseline of the nutritional plant/soil relationship in the forest remnants studied. Agriculture activities seemed to be responsible for increasing P, K, Ca, and Mg depositions; industries for N, S and Mn depositions; soil resuspension for Ca, Fe and Mg. Considering these sources, Paulínia and Campinas seemed to be the most and least forest remnants affected by air pollution, respectively.
Summarize the literature on the relationship between composite socioeconomic indicators and mortality in different geographical areas of Brazil.
This scoping review included articles published ...between January 1, 2000, and August 31, 2020, retrieved by means of a bibliographic search carried out in the Medline, Scopus, Web of Science, and Lilacs databases. Studies reporting on the association between composite socioeconomic indicators and all-cause, or specific cause of death in any age group in different geographical areas were selected. The review summarized the measures constructed, their associations with the outcomes, and potential study limitations.
Of the 77 full texts that met the inclusion criteria, the study reviewed 24. The area level of composite socioeconomic indicators analyzed comprised municipalities (n = 6), districts (n = 5), census tracts (n = 4), state (n = 2), country (n = 2), and other areas (n = 5). Six studies used composite socioeconomic indicators such as the Human Development Index, Gross Domestic Product, and the Gini Index; the remaining 18 papers created their own socioeconomic measures based on sociodemographic and health indicators. Socioeconomic status was inversely associated with higher rates of all-cause mortality, external cause mortality, suicide, homicide, fetal and infant mortality, respiratory and circulatory diseases, stroke, infectious and parasitic diseases, malnutrition, gastroenteritis, and oropharyngeal cancer. Higher mortality rates due to colorectal cancer, leukemia, a general group of neoplasms, traffic accident, and suicide, in turn, were observed in less deprived areas and/or those with more significant socioeconomic development. Underreporting of death and differences in mortality coverage in Brazilian areas were cited as the main limitation.
Studies analyzed mortality inequalities in different geographical areas by means of composite socioeconomic indicators, showing that the association directions vary according to the mortality outcome. But studies on all-cause mortality and at the census tract level remain scarce. The results may guide the development of new composite socioeconomic indicators for use in mortality inequality analysis.
Industrialization in developing countries associated with urban growth results in a number of economic benefits, especially in small or medium-sized cities, but leads to a number of environmental and ...public health consequences. This problem is further aggravated when adequate infrastructure is lacking to monitor the environmental impacts left by industries and refineries. In this study, a new protocol was designed combining biomonitoring and geostatistics to evaluate the possible effects of shale industry emissions on human health and wellbeing. Futhermore, the traditional and expensive air quality method based on PM
measuring was also used to validate the low-cost geostatistical approach. Chemical analysis was performed using Energy Dispersive X-ray Fluorescence Spectrometer (EDXRF) to measure inorganic elements in tree bark and shale retorted samples in São Mateus do Sul city, Southern Brazil. Fe, S, and Si were considered potential pollutants in the study area. Distribution maps of element concentrations were generated from the dataset and used to estimate the spatial behavior of Fe, S, and Si and the range from their hot spot(s), highlighting the regions sorrounding the shale refinery. This evidence was also demonstrated in the measurements of PM
concentrations, which are in agreement with the information obtained from the biomonitoring and geostatistical model. Factor and descriptive analyses performed on the concentrations of tree bark contaminants suggest that Fe, S, and Si might be used as indicators of industrial emissions. The number of cases of respiratory diseases obtained from local basic health unit were used to assess a possible correlation between shale refinery emissions and cases of repiratory disease. These data are public and may be accessed on the website of the the Brazilian Ministry of Health. Significant associations were found between the health data and refinery activities. The combination of the spatial characterization of air pollution and clinical health data revealed that adverse effects were significant for individuals over 38 years of age. These results also suggest that a protocol designed to monitor urban air quality may be an effective and low-cost strategy in environmentally contaminated cities, especially in low- and middle-income countries.
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