Bernardo Lessa Horta

Background: Formula feeding and having a mother with overweight are associated with overweight during infancy. Objectives: We sought to pilot test calibrated formula feeding guidance using age and weight specific intake recommendations to improve weight outcomes amongst at‐risk infants. Methods: Exclusively formula fed newborns with birthweight ≥ 50th percentile delivered to mothers with pre‐pregnancy body mass index (BMI) ≥ 25 kg/m ² were randomised to intervention and usual care groups. At monthly visits from 1 to 5 months, mothers of intervention group infants with weight‐for‐length (WFL) ≥ 75th percentile were advised to give 10% less daily formula than required based upon sex, age and weight. The primary outcome was conditional weight gain (CWG) between birth and 6 months. Secondary outcomes included WFL z ‐score and overweight (WFL ≥ 95th percentile) at 6 months, as well as growth trajectory. Results: Sixty infants were enrolled; 36 mothers (66.7%) had pre‐pregnancy BMI ≥ 30. Seventeen (28.3%) withdrew before 6 months. At each assessment, a minority had WFL ≥ 75th percentile required to receive calibrated formula guidance. There were no group differences in CWG (intervention mean 0.27, 95% CI −0.20 to 0.75 vs. control mean −0.12, 95% CI −0.62 to 0.37; p = 0.25) or for secondary outcomes. Conclusions: Calibrated infant formula recommendations were not associated with growth outcomes. Trial Registration: Clinicaltrials.gov identifier: NCT05104073 (registered October 11, 2021)

Resumo Introdução: As notificações de sífilis congênita têm aumentado no Brasil. As regiões metropolitanas e do norte do Espírito Santo também apresentam elavadas taxas da doença, evidenciando o desafio persistente à saúde materno-infantil. Objetivo: Analisar os fatores associados à sífilis congênita nas regiões Metropolitana e Norte do Espírito Santo entre mulheres que tiveram sífilis durante a gestação. Método: Estudo transversal realizado nos 34 municípios que compõem as regiões de saúde Metropolitana (2016 a 2017) e Norte (2015 a 2017). O desfecho de interesse foi representado pelas mães com diagnóstico de sífilis gestacional cujos recém-nascidos, natimortos ou abortos foram notificados para sífilis congênita. Utilizaram-se dados de notificações de sífilis em gestantes e congênita do Sistema de Informações de Agravos de Notificação (Sinan); e para dados das características obstétricas e do recém-nascido, o Sistema de Informações sobre Nascidos Vivos (Sinasc). Utilizou-se o programa Stata 13.0 para proceder análises descritivas, bruta e ajustada com base em modelo hierárquico, obtendo Razão de Prevalência (RP) e Intervalo de Confiança de 95% (IC95%) pela regressão de Poisson. Resultados: Maior risco para sífilis congênita entre as mulheres com sífilis gestacional foi identificado nas não brancas (RPajustada=1,38; IC95% 1,15–1,66), que iniciaram o pré-natal no 3o trimestre (1,88; 1,28–2,77), notificadas no 3o trimestre (2,98; 1,83–4,85), com sífilis primária (1,92; 1,34–2,76), com tratamento inadequado (2,12; 1,18–3,81), bem como seus parceiros (2,18; 1,29–3,68). Conclusões: Faz-se relevante a manutenção da educação em saúde, melhoria na vigilância em saúde e qualidade da assistência pré-natal, bem como a redução das iniquidades sociais relativas à doença.

The aim of the present study was to identify the prevalence of metabolic syndrome at 22 and 30 years of age, determine inequalities by sex, skin color, and socioeconomic status, and investigate the intersections of these variables. A cross-sectional analysis was conducted using data from the 1993 (22 years of age) and 1982 (22 and 30 years of age) Pelotas (Brazil) birth cohort. Metabolic syndrome was defined based on the criteria of the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) and the International Diabetes Federation (IDF). Inequalities in terms of sex, skin color, and socioeconomic status were described in Equiplots and analyzed by absolute measures (prevalence ratio and slope index of inequality - SII]) and relative measures (difference in prevalence and concentration index - CIX]). At 22 years of age, the prevalence of metabolic syndrome was 18.2% (IDF) and 13.5% (NCEP-ATP III) in the 1993 cohort, and 11.3% (IDF) and 8.6% (NCEP-ATP III) in the 1982 cohort. At 30 years of age (1982 cohort), the prevalence was 15.5% (IDF) and 10.7% (NCEP-ATP III). The greatest inequality in terms of socioeconomic status occurred in the 1982 cohort at 22 years of age based on the NCEP-ATP III criteria among women (SII: -8.7p.p. [95%CI: -13.2; -4.2]; CIX: -20.1% [95%CI: -29.7; -10.5]) and men (SII: 6.5p.p. [95%CI: 0.1; 12.9]; CIX: 7.9% [95%CI: 0.6; 15.3]). The most affected subgroups were White women with a lower socioeconomic status and Black/Mixed-race men (1993 cohort) and White men (1982 cohort) with a higher socioesconomic status. Our results demonstrate that metabolic syndrome is not evenly distributed in this population and that its occurrence may be influenced by intersections between socioeconomic status, sex, and skin color.

Este estudo buscou identificar a prevalência de síndrome metabólica aos 22 e 30 anos abordando desigualdades por sexo, cor da pele e posição socioeconômica, e suas intersecções. Análise transversal utilizando dados das coortes de nascimento de Pelotas, Rio Grande do Sul, Brasil, de 1993 (22 anos) e de 1982 (22 e 30 anos). A síndrome metabólica foi definida pelos critérios da National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) e da Federação Internacional de Diabetes (IDF). As desigualdades entre sexo, cor da pele e posição socioeconômica foram descritas em Equiplots e analisadas por medidas absolutas (diferença de prevalência e índice de inclinação da desigualdade – SII]) e relativas (razão de prevalência e índice de concentração – CIX]). Aos 22 anos, a prevalência de síndrome metabólica foi de 18,2% (IDF) e 13,5% (NCEP-ATP III) (coorte de 1993), e de 11,3% (IDF) e 8,6% (NCEP-ATP III) (coorte de 1982). Aos 30 anos (coorte de 1982), foi de 15,5% (IDF) e 10,7% (NCEP-ATP III). A maior desigualdade por posição socioeconômica ocorreu na coorte de 1982 aos 22 anos, pelo NCEP-ATP III: entre mulheres (SII: -8,7p.p.; [IC95%: -13,2; -4,2]; CIX: -20,1%; [IC95%: -29,7; -10,5]) e homens (SII: 6,5p.p.; [IC95%: 0,1; 12,9]; CIX: 7,9%; [IC95%: 0,6; 15,3]). Os subgrupos mais acometidos foram: mulheres brancas de posição socioeconômica inferior, homens pretos/pardos (coorte de 1993) e homens brancos (coorte de 1982) de posição socioeconômica superior. Nossos resultados reforçam que a síndrome metabólica não está distribuída de forma homogênea nesta população e que sua ocorrência pode ser influenciada por intersecções entre posição socioeconômica, sexo e cor da pele.

Background: The COVID-19 pandemic imposed a substantial disease burden, yet few population-based studies assessed its long-term impacts on families. This study estimated the pandemic’s impact on family income, employment, school interruption, food insecurity, and death of family members in Brazil. Methods: Population-based household survey with 33.250 participants from 133 large cities in Brazil during May and June 2024. Households were selected using a multistage probability sampling design in each city. Results: Among respondents, 14.7% [95% confidence interval (CI):13.8%; 15.6%] reported the death of a family member due to COVID-19; 48.6% (95% CI: 47.1%; 50.1%) experienced reductions in family income; 34.9% (95% CI: 33.4%; 36.4%) reported that at least one family member stopped working; in 21.5% (95% CI: 20.1%; 22.9%) of families, at least one member interrupted studies; and 47.4% (95% CI: 45.9%; 48.8%) experienced food insecurity during the pandemic. These outcomes were more frequent among families with low income and with six or more members, except for the death of a family member, which was more commonly reported in households with higher incomes and educational levels. Job losses, interruption of studies, and food insecurity were more common in families led by women. Indigenous people experienced a high prevalence of food insecurity. Conclusion: The COVID-19 pandemic exacerbated social and economic inequalities, with most impacts disproportionately affecting the poorest families, those led by women, and indigenous people. Conversely, the death of a relative was more commonly reported among the wealthiest families that include a larger number of older members.