Ila Rocha Falcão

Introduction: Poverty amplifies the risk of malnutrition, which is particularly harmful to children as it can perpetuate a cycle of poverty and poor health. This study aims to assess the association of a conditional cash transfer programme (Bolsa Família Program (BFP)) with child nutrition nationwide in Brazil. Methods: We used the Centre for Data and Knowledge Integration for Health Birth Cohort (baseline data from the National Registry for Social Programmes (CadÚnico) linked with live births and nutrition registries) to conduct a longitudinal population-based study between 2008 and 2015. This cohort study followed children from birth until 5 years old between 1 January 2008 and 31 December 2015. Children exposed were those who received the BFP benefit at any time during follow-up and were compared with those who never received it. Malnutrition outcomes were assessed using height-for-age, weight-for-height and body mass index-for-age z-scores classified according to WHO cut-offs. Binary and multinomial logistic regressions and kernel-based matching were performed. Subgroup analyses considered maternal education and urban/rural areas of residence. Results: Our cohort included 3 116 138 children born in Brazil between 2008 and 2015. BFP participation was associated with a 17% lower chance of stunting (OR 0.83; 95% CI 0.81 to 0.85). Additionally, BFP was associated with a 19% higher chance of wasting (OR 1.19; 95% CI 1.16 to 1.22). The protective association with stunting was more pronounced in children from less-educated mothers (OR 0.75; 95% CI 0.70 to 0.81) and those living in rural areas (OR 0.77; 95% CI 0.73 to 0.81). BFP participation was associated with higher overweight/obesity among children from mothers with 8 or more years of education and living in urban areas, while those with 3 or fewer years of education and living in rural areas experienced protective effects. Conclusion: Our findings suggest a complex relationship between BFP participation and child malnutrition outcomes. The study underscores BFP participation’s benefits in child nutritional outcomes, emphasising the programme’s potential to reduce stunting in all children and to reduce overweight/obesity in the most vulnerable ones. However, BFP was also associated with an increased risk of overweight/obesity, which may be a consequence of overlapping stages of Brazil’s rapid nutrition transition, a scenario that contributes to the double burden of malnutrition. Further research is needed to understand this finding better.

Este estudo teve como objetivo investigar a associação entre padrões alimentares e excesso de peso e de obesidade abdominal em pescadoras artesanais. Estudo de delineamento transversal, a amostra foi composta de 201 mulheres, adultas de 18 a 65 anos, cadastradas na Associação das Marisqueiras de Saubara, Bahia, Brasil. Para avaliar o estado nutricional, foram utilizados o índice de massa corpórea e a circunferência da cintura. Foram coletados dados demográficos, socioeconômicos e referentes ao consumo alimentar. Os padrões alimentares foram identificados por meio da análise fatorial exploratória. As prevalências encontradas para o excesso de peso foram 70,6% (37,8 para o sobrepeso e 32,8% para a obesidade) e para a obesidade abdominal, 77,6%. Dois padrões alimentares foram identificados, o obesogênico, composto por massas, açúcares e doces, fast-foods, comidas gordurosas, embutidos e ultraprocessados, e o padrão saudável, caracterizado por hortaliças crucíferas folhosas, legumes não folhosos e sopas de legumes. O padrão alimentar saudável teve associação negativa com significância estatística com o excesso de peso e a obesidade abdominal com RP: 0,77 (IC: 0,61;0,99) e RP: 0,85 (IC: 0,74;0,98) respectivamente. Não foi encontrada associação entre o padrão obesogênico e o excesso de peso e a obesidade abdominal. O padrão saudável e a atividade física são fatores protetores para o excesso de peso. Já as mulheres que se autorrelataram como pretas ou pardas tiveram 18% mais obesidade abdominal comparadas às brancas.

Resumo Introdução Os(as) pescadores(as) artesanais foram diretamente afetados pelo derramamento de petróleo ocorrido na costa brasileira em 2019. Objetivo Identificar as vulnerabilidades socioambientais em pescadores(as) artesanais nos estados de Bahia e Sergipe, decorrentes do derramamento de petróleo, considerando as principais vias de exposição direta ao petróleo e as condições de vida, saúde e trabalho desta população. Métodos Estudo epidemiológico realizado em 2021 e 2022, com pescadores(as) artesanais residentes em áreas de proteção ambiental em dois estados da Região Nordeste do Brasil. Resultados Dos(as) 377 pescadores(as) entrevistados(as), 58,1% eram do sexo feminino, 73,7% relataram exposição ao petróleo pela via inalatória, 51,7% pela via dérmica e 8,2% pela via gástrica. Dentre os participantes, 81,7% relataram viver exclusivamente da pesca, 59,7% trabalhavam de cinco a sete dias/semana, 56,0% não interromperam o consumo de pescados/marisco. Conclusão As elevadas prevalências de exposições inalatórias e dérmicas, combinadas com as elevadas ocorrências do consumo do pescado e do trabalho no ambiente contaminado, revelaram prejuízos à saúde, à segurança alimentar e à renda das comunidades de pescadores(as) diante de um desastre socioambiental. Isso ressalta a importância da construção de estratégias para mitigar os danos nestas populações.

Introduction Artisanal fishers were directly affected by the oil spill that occurred off the Brazilian coast in 2019. Objective To identify the socio-environmental vulnerabilities among artisanal fishers in the states of Bahia and Sergipe, resulting from the oil spill, considering the main direct exposure pathways to oil and the lifestyle, health, and working conditions of this population. Methods An epidemiological study conducted between 2021 and 2022 with artisanal fishers residing in Environmental Protection Areas in two states of the Northeastern region in Brazil. Results Of the 377 fishers interviewed, 58.1% were female, 73.7% reported exposure to oil through inhalation, 51.7% through dermal contact, and 8.2% through the gastric route. Among the participants, 81.7% reported depending exclusively on fishing, 59.7% worked 5-7 days/week, and 56.0% did not stop consuming fishing products. Conclusion The high prevalence of inhalation and dermal exposures, combined with the continued consumption of seafood and working in the contaminated environment, revealed significant harms to the health, food security, and income of these communities in the context of a socio-environmental disaster. This highlights the importance of developing strategies to mitigate the damage to these populations.

Introduction Musculoskeletal disorders (MSD) are one of the leading causes of pain and disability at work, affecting various professional categories, including multipurpose/artisanal fishing workers . Objective To analyse the factors associated with the prevalence of musculoskeletal disorders, characterized according to occupation, and to draw up a profile of fishermen and shellfish gatherers. Methods Cross-sectional study with a probabilistic sample of artisanal fishing workers from the municipality of Cachoeira (BA). The Nordic Musculoskeletal Questionnaire was used, in addition to a structured questionnaire. Multiple correspondence analysis and Poisson regression were used. Results 248 workers participated, n = 78 fishermen and n = 170 shellfish gatherers. The prevalence of MSD was 89.7% among fishermen and 95.3% among shellfish gatherers, with no differences between these groups (prevalence ratio = 1.06). Among the shellfish gatherers, were predominant women aged ≤ 37 years, with children under two years old, incomplete secondary education, who had another activity, with long hours in a squatting position, walking while handling loads and pushing fish. Among the fishermen, the profile was the opposite, they reported taking pain medication and long hours in a sitting position. Conclusion There was a high prevalence of generalized MSD among multipurpose/artisanal fishers, regardless of gender. This could be explained by the high exposure of both groups to adverse occupational factors and by the sociodemographic profile of the community studied.

Resumo Introdução Distúrbios musculoesqueléticos (DME) são uma das principais causas de dor e incapacidade no trabalho, afetando diversas categorias profissionais, incluindo pescadores polivalentes/artesanais. Objetivo Analisar os fatores associados à prevalência de DME, conforme a ocupação de pescadores e marisqueiras. Métodos: Estudo transversal, com amostra probabilística de pescadores do município de Cachoeira (BA). Utilizou-se o Questionário Nórdico de Sintomas Osteomusculares, além de questionário estruturado. Empregou-se análise de correspondência múltipla e regressão de Poisson. Resultados Participaram 248 trabalhadores, n = 78 pescadores e n = 170 marisqueiras. A prevalência de DME foi de 89,7% entre pescadores e de 95,3% entre marisqueiras, sem diferenças entre esses grupos (razão de prevalência = 1,06). Entre as marisqueiras, predominaram mulheres com idade ≤ 37 anos, com filhos menores de dois anos, ensino médio incompleto, que tinham outra atividade, com longas jornadas na postura agachada, deambulando com manuseio de carga e empurrando o pescado. Entre os pescadores, o perfil foi oposto, eles referiram medicamento para dor e longas jornadas na posição sentada. Conclusão Houve elevada prevalência de DME generalizado entre os pescadores polivalentes/artesanais, independentemente do gênero, isto pode ser explicado pela alta exposição de ambos os grupos aos fatores ocupacionais adversos e pelo perfil sociodemográfico da comunidade estudada.

Resumo O objetivo foi mapear evidências sobre a qualidade dos registros do Sistema de Informação sobre Mortalidade (SIM) por meio de revisão de escopo nacional com artigos publicados até abril de 2023 em cinco bases (PubMed, Embase, scopus, LILACS e SciELO). Excluíram-se estudos focados em causas específicas de óbito. Foram avaliadas dimensões como acessibilidade, clareza metodologica, cobertura, completitude, confiabilidade, consistencia, nao-duplicidade, oportunidade, validade e estudos de causas mal definidas/garbage codes.. Dos 33 artigos incluídos, observou-se melhoria geral da qualidade do SIM, com redução de 68,5% nos garbage codes (2000-2015). Contudo, persistem desigualdades regionais no SIM, com cobertura abaixo de 90% no Acre e Maranhão e pior desempenho nas regiões Norte e Nordeste. Um SIM robusto é essencial para estratégias de saúde pública voltadas à prevenção de mortes evitáveis.

Objective: We aimed to compare the prevalence and neonatal mortality associated with large for gestational age (LGA) and macrosomia among 115.6 million live births in 15 countries, between 2000 and 2020. Design: Population‐based, multi‐country study. Setting: National healthcare systems. Population: Liveborn infants. Methods: We used individual‐level data identified for the Vulnerable Newborn Measurement Collaboration. We calculated the prevalence and relative risk (RR) of neonatal mortality among live births born at term + LGA (>90th centile, and also >95th and >97th centiles when the data were available) versus term + appropriate for gestational age (AGA, 10th–90th centiles) and macrosomic (≥4000, ≥4500 and ≥5000 g, regardless of gestational age) versus 2500–3999 g. INTERGROWTH 21st served as the reference population. Main outcome measures: Prevalence and neonatal mortality risks. Results: Large for gestational age was common (median prevalence 18.2%; interquartile range, IQR, 13.5%–22.0%), and overall was associated with a lower neonatal mortality risk compared with AGA (RR 0.83, 95% CI 0.77–0.89). Around one in ten babies were ≥4000 g (median prevalence 9.6% (IQR 6.4%–13.3%), with 1.2% (IQR 0.7%–2.0%) ≥4500 g and with 0.2% (IQR 0.1%–0.2%) ≥5000 g). Overall, macrosomia of ≥4000 g was not associated with increased neonatal mortality risk (RR 0.80, 95% CI 0.69–0.94); however, a higher risk was observed for birthweights of ≥4500 g (RR 1.52, 95% CI 1.10–2.11) and ≥5000 g (RR 4.54, 95% CI 2.58–7.99), compared with birthweights of 2500–3999 g, with the highest risk observed in the first 7 days of life. Conclusions: In this population, birthweight of ≥4500 g was the most useful marker for early mortality risk in big babies and could be used to guide clinical management decisions.

Importance: There is limited evidence of the association of conditional cash transfers, an important strategy to reduce poverty, with prevention of adverse birth-related outcomes.Objective: To investigate the association between receiving benefits from the Bolsa Família Program (BFP) and birth weight indicators.Design, Setting, and Participants: This cohort study used a linked data resource, the Centro de Integracao de Dados e Conhecimentos Para Saude (CIDACS) birth cohort. All live-born singleton infants born to mothers registered in the cohort between January 2012 and December 2015 were included. Each analysis was conducted for the overall population and separately by level of education, self-reported maternal race, and number of prenatal appointments. Data were analyzed from January 3 to April 24, 2023.Exposure: Live births of mothers who had received BFP until delivery (for a minimum of 9 months) were classified as exposed and compared with live births from mothers who did not receive the benefit prior to delivery.Main Outcomes and Measures: Low birth weight (LBW), birth weight in grams, and small for gestational age (SGA) were evaluated. Analytical methods used included propensity score estimation, kernel matching, and weighted logistic and linear regressions. Race categories included Parda, which translates from Portuguese as “brown” and is used to denote individuals whose racial background is predominantly Black and those with multiracial or multiethnic ancestry, including European, African, and Indigenous origins.Results: A total of 4 277 523 live births (2 085 737 females [48.8%]; 15 207 among Asian [0.4%], 334 225 among Black [7.8%], 29 115 among Indigenous [0.7%], 2 588 363 among Parda [60.5%], and 1 310 613 among White [30.6%] mothers) were assessed. BFP was associated with an increase of 17.76 g (95% CI, 16.52-19.01 g) in birth weight. Beneficiaries had an 11% lower chance of LBW (odds ratio [OR], 0.89; 95% CI, 0.88-0.90). BFP was associated with a greater decrease in odds of LBW among subgroups of mothers who attended fewer than 7 appointments (OR, 0.85; 95% CI, 0.84-0.87), were Indigenous (OR, 0.73; 95% CI, 0.61-0.88), and had 3 or less years of education (OR, 0.76; 95% CI, 0.72-0.81). There was no association between BFP and SGA, except among less educated mothers, who had a reduced risk of SGA (OR, 0.83; 95% CI, 0.79-0.88).Conclusions and Relevance: This study found that BFP was associated with increased birth weight and reduced odds of LBW, with a greater decrease in odds of LBW among higher-risk groups. These findings suggest the importance of maintaining financial support for mothers at increased risk of birth weight–related outcomes.