Publications by authors named "Janaína Vieira Dos Santos Motta"

26 Publications

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Brief cognitive behavioral therapy in pregnant women at risk of postpartum depression: Pre-post therapy study in a city in southern Brazil.

J Affect Disord 2021 Apr 30;290:15-22. Epub 2021 Apr 30.

Catholic University of Pelotas, Brazil; PQ CNPq, Brazil.

Background: Postpartum depression (PPD) affects a high number of women, often the first manifestation of a mood disorder that will occur later in life, bringing serious consequences for the patient and her offspring. Depression today is the leading cause of disability worldwide. The aim of this study was to evaluate the effectiveness of a preventive cognitive behavioral therapy (CBT) for PPD.

Methods: Pre-post therapy study, as part of a population-based cohort study. Pregnant women without a diagnosis of depression participated, who were divided into two groups: risk of depression (CBT) and a control group (without therapy). The preventive therapy consisted of six sessions of CBT, administered weekly. The Outcome Questionnaire (OQ-45) was used in all sessions. The Mini International Neuropsychiatric Interview and Beck Depression Inventory-II were used on three occasions. The final statistical analyses were performed by Poisson regression.

Results: The prevalence of PPD in the risk group was 5.5% and in the control group 2.2%, with no difference between the groups (PR 1.66 95% CI 0.44-6.18). The OQ-45 averages gradually reduced during the therapy sessions, indicating therapeutic progress. Schooling was an associated factor, both with the manifestation of PPD and with the greater effectiveness of the therapy.

Limitations: Rate of 40.5% refusal to preventive treatment and absence of a group with similar characteristics in another therapy model.

Conclusions: Brief cognitive behavioral therapy applied by mental health professionals with basic training was effective in preventing the manifestation of PPD.
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http://dx.doi.org/10.1016/j.jad.2021.04.031DOI Listing
April 2021

Children's eating behaviour traits and dental caries.

J Public Health Dent 2021 Mar 15. Epub 2021 Mar 15.

Department of Social and Preventive Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, Brazil.

Objectives: This cross-sectional study aimed to assess eating behavior traits in children with or without dental caries.

Methods: A sample of 580 children aged 8 years enrolled in 20 public schools in the city of Pelotas, Brazil were included. Parents/caregivers provided sociodemographic information and answered the Children's Eating Behavior Questionnaire (CEBQ) to assess eating behavior traits. This instrument possesses the subscales: food responsiveness, enjoyment of food, satiety responsiveness, slowness in eating, food fussiness, emotional overeating, emotional undereating, and desire to drink. To assess the presence of decayed, missing or filled teeth (DMFT/dmft), the World Health Organization (WHO) criteria were adopted. WHO criteria were used to evaluate presence of overweight and obesity. Analysis of variance (ANOVA) was used to compare the mean score in each CEBQ subscale according to the different exposure variables. Linear regression was used to assess the association between dental caries and CEBQ subscales means.

Results: Approximately half of the children were male (51.03 percent) and 66.73 percent had low/middle socioeconomic status. The mean DMFT/dmft was 2.41, ranging from 0 to 13, and 63 percent of the children showed DMFT/dmft > 0. After adjustments for potential confounders, children with dental caries showed higher scores on the subscales desire to drink (P = 0.03), and satiety responsiveness (P = 0.04).

Conclusion: The present study showed that some aspects of eating behaviors differ in children with or without caries. Such knowledge adds to the understanding of the multifactorial etiology of caries and may help in the development of nutritional interventions to promote healthy eating behaviors, with benefits for oral health.
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http://dx.doi.org/10.1111/jphd.12449DOI Listing
March 2021

Maternal-fetal attachment and perceived parental bonds of pregnant women.

Early Hum Dev 2021 Mar 22;154:105310. Epub 2021 Jan 22.

Postgraduate Program in Health and Behavior, Catholic University of Pelotas (UCPel), Gonçalves Chaves, 373 - 411 C, 96015-560 Pelotas, RS, Brazil. Electronic address:

Background: The parental bond is characterized by the perception of care and protection received by parental figures throughout human development. During the gestational period, the intensity in which the woman manifests behaviors and feelings for the fetus was denominated maternal-fetal attachment (MFA). In this perspective, the literature indicates that there is association between MFA and the pregnant woman's perception about the bond established with her parents.

Aims: This study aimed to evaluate the association between MFA and perceived parental bonds of pregnant women in the city of Pelotas/RS (Brazil).

Study Design: This is a cohort study with 839 women during their gestational period. All women answered to the Parental Bonding Instrument to investigate the perceived parental bonds, and the MFA was assessed through the Maternal-Fetal Attachment Scale.

Results: The main results showed that perceived paternal overprotection was associated with a higher MFA after adjustment (B 2.00 CI95% 0.30; 3.70). Additionally, the pregnant women who were in the first trimester of pregnancy (p < 0.001), who did not live with a partner (p = 0.018), and who did not feel supported by the baby's father during pregnancy (p = 0.014) presented lower scores of MFA.

Conclusion: This study showed the importance of the paternal role in the women's life, considering the perception of the bond with their father during their development, an adequate support by the father of the baby, and the presence of a partner during pregnancy. As a result, the paternal role may influence the feelings and behaviors of greater affection, care, and concern regarding the fetus.
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http://dx.doi.org/10.1016/j.earlhumdev.2021.105310DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7910275PMC
March 2021

Maternal-fetal attachment and perceived parental bonds of pregnant women.

Early Hum Dev 2021 Mar 22;154:105310. Epub 2021 Jan 22.

Postgraduate Program in Health and Behavior, Catholic University of Pelotas (UCPel), Gonçalves Chaves, 373 - 411 C, 96015-560 Pelotas, RS, Brazil. Electronic address:

Background: The parental bond is characterized by the perception of care and protection received by parental figures throughout human development. During the gestational period, the intensity in which the woman manifests behaviors and feelings for the fetus was denominated maternal-fetal attachment (MFA). In this perspective, the literature indicates that there is association between MFA and the pregnant woman's perception about the bond established with her parents.

Aims: This study aimed to evaluate the association between MFA and perceived parental bonds of pregnant women in the city of Pelotas/RS (Brazil).

Study Design: This is a cohort study with 839 women during their gestational period. All women answered to the Parental Bonding Instrument to investigate the perceived parental bonds, and the MFA was assessed through the Maternal-Fetal Attachment Scale.

Results: The main results showed that perceived paternal overprotection was associated with a higher MFA after adjustment (B 2.00 CI95% 0.30; 3.70). Additionally, the pregnant women who were in the first trimester of pregnancy (p < 0.001), who did not live with a partner (p = 0.018), and who did not feel supported by the baby's father during pregnancy (p = 0.014) presented lower scores of MFA.

Conclusion: This study showed the importance of the paternal role in the women's life, considering the perception of the bond with their father during their development, an adequate support by the father of the baby, and the presence of a partner during pregnancy. As a result, the paternal role may influence the feelings and behaviors of greater affection, care, and concern regarding the fetus.
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http://dx.doi.org/10.1016/j.earlhumdev.2021.105310DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7910275PMC
March 2021

How sex differences in schooling and income contribute to sex differences in depression, anxiety and common mental disorders: The mental health sex-gap in a birth cohort from Brazil.

J Affect Disord 2020 09 26;274:977-985. Epub 2020 May 26.

Postgraduate Program in Epidemiology, Federal University of Pelotas, Brazil. Rua Marechal Deodoro, 1160 - 3° Piso, Bairro Centro - Pelotas, RS. Cep: 96020-220 - Caixa Postal 464. Phone: +55 (53) 3284 - 1300. Electronic address:

Background: Reasons for the higher rates of depression, anxiety and common mental disorders among women are unclear. We investigated the mediating effect of schooling and personal income and the effect modification of maternal schooling and family income at baseline.

Methods: In 1982, the maternity hospitals of Pelotas (Southern Brazil) were daily visits and those livebirths whose family lived in the urban area of the city were examined and their mothers interviewed. At 30 years, the presence of major depression (MD) and generalized anxiety disorder (GAD) was assessed using the Mini-International Psychiatric Interview, and common mental disorders (CMD) with the self-rated questionnaire. We used Mantel-Haenszel test to assess effect modification and a counterfactual framework using inverse probability weights (IPW) and G-computation to analyze mediation.

Results: Income at 30 years captured part of the association of sex with MD (16.5%), GAD (14.2%), and CMD (18.0%). Schooling at 30 years was higher in women (p<0.001), and therefore inversely mediated the association with MD (-5.4%), GAD (-4.8%), and CMD (-6.7%). If we fixed the mediator to earning more than 3 minimum salaries, the effect of sex, was reduced in 64.9%, 56.7% and 31.4%, for MD, GAD and CMD, respectively, and 62.4%, 13.6% and 23.8%, if fixed to 12 or more years of schooling.

Limitations: We were not able to evaluate mental health and socioeconomic changes, or assess a bidirectional effect CONCLUSION: Personal income and schooling at 30 years, are important mediators and effect modifiers of the association between sex and MD, GAD, and CMD.
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http://dx.doi.org/10.1016/j.jad.2020.05.033DOI Listing
September 2020

Generalized Anxiety Disorder, Depressive Symptoms and the Occurrence of Stressors Events in a Probabilistic Sample of Pregnant Women.

Psychiatr Q 2021 Mar;92(1):123-133

Postgraduate Program in Health and Behavior, Catholic University of Pelotas (UCPel), Gonçalves Chaves, 377 - 411 C - 96015-560, Pelotas, RS, Brazil.

The aim of the study is to verify the association between GAD, the severity of depressive symptoms and stressors in pregnant women between the first and second trimester. Cross-sectional study, part of a cohort that followed 980 women during the gestational period of a city in southern Brazil. We performed bivariate analysis using the t-test and chi-square. The variables that presented p ≤ 0.20 were taken for multivariate analysis, through logistic regression, in order to control possible confounding factors. The Mini International Neuropsychiatric Interview Plus was used to evaluate GAD, the severity of depressive symptoms was investigated through the Beck Inventory of Depression II, and stress events according to the Social Readjustment Assessment Scale of Holmes e Rahe. The sample consisted of 980 women. Women with mild depression symptoms had 9.8 (IC95% 4.6;21.0) times more GAD, those with moderate symptoms had 27.5 (IC95% 12.5;60.0) times more GAD, and those with severe symptoms had 52.9 (IC95% 19.1;146.5) times more GAD when compared to pregnant women with no symptoms or minimal symptoms. Regarding the stressful events, the pregnant women who presented GAD had an increase of 1.0 (IC95% 1.0;1.1) point in the mean of occurrence of stressor events when compared to those without GAD. These findings highlight the need for prevention strategies and interventions to promote maternal mental health, which benefit the development of infants in the long term.
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http://dx.doi.org/10.1007/s11126-020-09763-0DOI Listing
March 2021

Common Mental Disorders and Contemporary Factors: 1982 Birth Cohort.

Rev Bras Enferm 2020 10;73(1):e20180162. Epub 2020 Feb 10.

Universidade Federal de Pelotas. Pelotas, Rio Grande do Sul, Brazil.

Objective: To describe the association between common mental disorders and socio-demographic variables, smoking habits and stressful events among the 30-year-old members of a 1982 cohort.

Method: Mental disorder was analyzed by the Self-Reporting Questionnaire (SRQ-20). Poisson regression was used to analyze the unadjusted and adjusted associations.

Results: Low level of education and stressful events increased the prevalence of mental disorders for both genders. Lower income for women and unemployment for men also remained associated with CMD.

Conclusion: It was possible to describe the association between contemporary factors and mental disorders in a young population, to which prevention and control measures, through public policies proposed to the areas of Primary Care, Mental Health and Education, can represent a better quality of life and health.
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http://dx.doi.org/10.1590/0034-7167-2018-0162DOI Listing
November 2020

People living with HIV/AIDS: body image and its important associations with mental health and BMI.

Psychol Health Med 2020 09 18;25(8):1020-1028. Epub 2019 Nov 18.

Postgraduate Program in Health and Behavior, Catholic University of Pelotas , Pelotas, Brazil.

Patients on antiretroviral therapy face new challenges, such as bodily changes. We conducted a cross-sectional study with people living with HIV/AIDS. We investigate the self-perception of body image and its associations. Most of the patients reported negative self-perception of body image (NSPBI), being mostly women, up to 40 years old and with changes in BMI. NSPBI was associated with depressive symptoms and punctual alterations in the redistribution of body fat: face, abdomen and legs, subjects still little elucidated. Assessing neglected aspects can improve the way these patients see themselves, and come to understand the disease as only a part of their lives.
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http://dx.doi.org/10.1080/13548506.2019.1691244DOI Listing
September 2020

Emotional and behavioral problems: a school-based study in southern Brazil.

Trends Psychiatry Psychother 2019 1;41(3):211-217. Epub 2019 Aug 1.

Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, Pelotas, RS, Brazil.

Introduction: Mental health assessment in childhood needs to be carried out within a broader context that includes different factors.

Objective: To assess the prevalence of emotional and behavioral problems in schoolchildren and associated factors.

Method: A cross-sectional study was conducted with a school-based sample at 20 schools selected by systematic random sampling. Participants consisted of children aged 7-8 year old and their parents or primary caregivers. The Strengths and Difficulties Questionnaire (SDQ) was used to screen for the presence of emotional and behavioral problems in children.

Results: A total of 596 dyads were evaluated. The prevalence of emotional and behavioral problems was 30.0% among boys and 28.2% among girls. Hyperactivity/inattention were more prevalent among boys (p=0.015). Belonging to economically disadvantaged strata increased the likelihood of emotional and behavioral problems among schoolchildren by 71% (p=0.001), while having parents or caregivers with mental disorder increased by 2.2 times that probability (p<0.001). Conclusion: Our findings showed a high prevalence of emotional and behavioral problems among schoolchildren, as well as the influence of economic conditions and of the mental health of parents and caregivers on child mental health.
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http://dx.doi.org/10.1590/2237-6089-2017-0119DOI Listing
March 2020

Overweight trajectory and cardio metabolic risk factors in young adults.

BMC Pediatr 2019 03 11;19(1):75. Epub 2019 Mar 11.

Postgraduate Program in Epidemiology, Federal University of Pelotas, Caixa postal 354, Marechal Deodoro, 1160, Pelotas, RS, 96020-220, Brazil.

Background: Obesity is one of the conditions that increases the risk of cardiovascular disease. Studies about obesity trajectory and cardio metabolic outcomes at adulthood are still scarce. Therefore, we aimed to assess the association between patterns of overweight over the life-course and cardio metabolic risk factors in young adults.

Methods: In 1982, the maternity hospitals in Pelotas were visited daily and those newborns whose family lived in the urban area of the city were identified (n = 5914), and have prospectively followed for several occasions. Weight and height were measured at every visit. BMI-for-age z-score was calculated using the WHO Child Growth Standards. Overweight and obesity were defined as a BMI greater than or equal to 25 kg/m2 and 30 kg/m2 respectively. This was the definition adopted for evaluations overweight and obesity at 30 years. The participants were divided into eight groups according to the presence of overweight or obesity in childhood, adolescence and adulthood. Blood pressure, random blood glucose, HDL cholesterol, LDL cholesterol triglycerides and fat mass were measured.

Results: From 2219 participants with anthropometric data in childhood, adolescence and adulthood, 25% never had been overweight, whereas 11.6% were overweight in the three periods. Random blood glucose, SBP and DBP were higher among those subjects who were always overweight/ obese or only overweight/obese during adolescence and adulthood. The participants who were never overweight/obese or only in childhood or adolescence had a lower cardiovascular risk profile (higher HDL cholesterol, lower blood pressure, lower random glucose, lower LDL cholesterol) at 30 years. Fat mass captured from 25 to 100% of the association of overweight and obesity trajectory with cardiometabolic risk factors.

Conclusions: The tracking of overweight/obesity is associated with an adverse cardio metabolic profile and this association is largely mediated by fat mass in adulthood.
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http://dx.doi.org/10.1186/s12887-019-1445-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6410517PMC
March 2019

Adolescence and Later Life Disease Burden: Quantifying the Contribution of Adolescent Tobacco Initiation From Longitudinal Cohorts.

J Adolesc Health 2017 Aug;61(2):171-178

Centre for Adolescent Health, Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Melbourne, Victoria, Australia.

Purpose: Adolescence is a time of initiation of behaviors leading to noncommunicable diseases (NCDs). We use tobacco to illustrate a novel method for assessing the contribution of adolescence to later burden.

Methods: Data on initiation of regular smoking during adolescence (10-19 years) and current adult smoking were obtained from the 1958 British Birth Cohort, the U.S. National Longitudinal Study of Adolescent Health (Add Health), the Pelotas 1982 Birth Cohort, and the Victorian Adolescent Health Cohort Study. We estimated an "adolescent attributable fraction" (AAF) by calculating the proportion of persisting adult daily smoking initiated < age 20 years. We used findings to estimate AAFs for >155 countries using contemporary surveillance data.

Results: In the 1958 British Birth Cohort, 81.6% of daily smokers at age 50 years initiated < age 20 years, with a risk ratio of 6.1 for adult smoking related to adolescent initiation. The adjusted AAF was 69.1. Proportions of smokers initiating <20 years, risk ratio, and AAFs were 83.3%, 7.0%, and 70.4% for Add Health; 75.5%, 3.7%, and 50.2% in Victorian Adolescent Health Cohort Study; and 70.9%, 5.8%, and 56.9% in Pelotas males and 89.9%, 6.4%, and 75.9% in females. Initiation <16 years resulted in the highest AAFs. Estimated AAFs globally ranged from 35% in China to 76% in Argentina.

Conclusions: The contribution of adolescent smoking initiation to adult smoking burden is high, suggesting a need to formulate and implement effective actions to reduce smoking initiation in adolescents. Similar trends in other NCD risks suggest that adolescents will be central to future efforts to control NCDs.
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http://dx.doi.org/10.1016/j.jadohealth.2017.02.011DOI Listing
August 2017

Caesarean section and adiposity at 6, 18 and 30 years of age: results from three Pelotas (Brazil) birth cohorts.

BMC Public Health 2017 03 14;17(1):256. Epub 2017 Mar 14.

Post-graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160 - 3o piso, 96020-220, Pelotas, Brazil.

Background: Association between caesarian section (C-section) and obesity is controversial and mostly based on body mass index (BMI), which has inherent limitations. Using direct estimates of body fat mass, we aimed to assess the association between C-section and adiposity using fat mass index and BMI z-score in three birth cohort studies from Pelotas, Brazil.

Methods: We measured weight, height and fat mass (using dual X-ray absorptiometry (DXA)) at ages 6, 18 and 30 years among participants in the 2004, 1993 and 1982 population-based Pelotas Birth Cohort Studies, respectively. We used multiple linear regression analysis to examine the crude and adjusted association between C-section and the body composition indicators. We also modelled height as an outcome to explore the presence of residual confounding.

Results: We observed that fat mass index and BMI z-score were strongly and positively associated with C-section in the crude analysis. However, when we adjusted for socioeconomic characteristics, maternal BMI, parity, age and smoking during pregnancy, effect estimates were attenuated towards the null, except for 30-year-old women. In those women from the 1982 cohort, C-section remained associated with fat mass index (β = 0.82; CI95% 0.32;1.32) and BMI z-score (β = 0.15; CI95% 0.03;0.28), even after adjusting for all potential confounders, suggesting an increase in fat mass index and BMI at 30 years among those born by C-section.

Conclusion: We found no consistent association of C-section with fat mass index measured by DXA and BMI z-score in individuals aged 6, 18 and 30 years, except for women in the latter group, which might be explained by residual confounding. Confounding by socioeconomic and maternal characteristics accounted for all the other associations.
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http://dx.doi.org/10.1186/s12889-017-4165-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5351260PMC
March 2017

Associations of Linear Growth and Relative Weight Gain in Early Life with Human Capital at 30 Years of Age.

J Pediatr 2017 03 4;182:85-91.e3. Epub 2017 Jan 4.

Postgraduate Program in Health and Behavior, Universidade Católica de Pelotas, Brazil.

Objective: To assess the associations of birthweight, nutritional status and growth in childhood with IQ, years of schooling, and monthly income at 30 years of age.

Study Design: In 1982, the 5 maternity hospitals in Pelotas, Brazil, were visited daily and 5914 live births were identified. At 30 years of age, 3701 subjects were interviewed. IQ, years of schooling, and income were measured.

Results: On average, their IQ was 98 points, they had 11.4 years of schooling, and the mean income was 1593 reais. After controlling for several confounders, birthweight and attained weight and length/height for age at 2 and 4 years of age were associated positively with IQ, years of years of schooling, and income, except for the association between length at 2 years of age and income. Conditional growth analyses were used to disentangle linear growth from relative weight gain. Conditional length at 2 years of age ≥1 SD score above the expected value, compared with ≥1 SD below the expected, was associated with an increase in IQ (4.28 points; 95% CI, 2.66-5.90), years of schooling (1.58 years; 95% CI, 1.08-2.08), and monthly income (303 Brazilian reais; 95% CI, 44-563). Relative weight gain, above what would be expected from linear growth, was not associated with the outcomes.

Conclusion: In a middle-income setting, promotion of linear growth in the first 1000 days of life is likely to increase adult IQ, years of schooling, and income. Weight gain in excess of what is expected from linear growth does not seem to improve human capital.
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http://dx.doi.org/10.1016/j.jpeds.2016.12.020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5323242PMC
March 2017

Aging, neurocognitive impairment and adherence to antiretroviral therapy in human immunodeficiency virus-infected individuals.

Braz J Infect Dis 2016 Nov - Dec;20(6):599-604. Epub 2016 Oct 24.

Universidade Católica de Pelotas, Programa de Pós-Graduação em Saúde e Comportamento, Pelotas, RS, Brazil.

Background/objective: There is an increasing number of older patients with human immunodeficiency virus infection due to the success of antiretroviral therapy, the improved prognosis and life expectancy of patients, and the higher number of new infections among older individuals. The main objective of the present study was to compare the characteristics of older human immunodeficiency virus patients with those of younger patients.

Materials And Methods: We conducted a cross-sectional study with human immunodeficiency virus-infected patients who were treated at the Specialized Care Service (Serviço de Assistência Especializada) for human immunodeficiency virus/AIDS in the city of Pelotas, South Brazil. Sociodemographic information as well as data on human immunodeficiency virus infection and treatment were collected. All participants underwent psychiatric and neurocognitive assessments, and their adherence to antiretroviral therapy was evaluated.

Results: A total of 392 patients participated in the study, with 114 patients aged 50 years and older. The characteristics showing significant differences between older and younger human immunodeficiency virus-infected patients included race/ethnicity, comorbidities, duration and adherence to antiretroviral therapy, currently undetectable viral load, and cognitive impairment. Compared to younger patients, older patients were at higher risk of exhibiting cognitive impairment [OR 2.28 (95% CI: 1.35-3.82, p=0.002)] and of having increased adherence to antiretroviral therapy [OR 3.11 (95% CI: 1.67-5.79, p<0.001)].

Conclusions: The prevalence of neurocognitive impairment remained high in human immunodeficiency virus-infected patients despite antiretroviral therapy. In the present study, the prevalence of this type of impairment was significantly higher in patients aged ≥50 years, most likely due to aging, human immunodeficiency virus infection, and a possible synergistic effect between these factors. Despite this higher prevalence, older patients exhibited higher rates of adherence to antiretroviral therapy and of undetectable human immunodeficiency virus viral load.
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http://dx.doi.org/10.1016/j.bjid.2016.09.006DOI Listing
July 2017

[Social impact of literacy in the household: analysis of the association with smoking in illiterate co-residents in Brazil].

Rev Panam Salud Publica 2016 Jun;39(6):316-321

Objective To investigate the social impact of literacy on the smoking behavior of illiterate individuals who share the household with literate individuals. Method This cross-sectional study employed data from the 2008 Brazilian National Household Survey (Pesquisa Nacional por Amostra de Domicílios, PNAD). Smokers were defined as individuals reporting use of any tobacco product daily or less than daily. The literacy profiles of residents were identified. Poisson regressions adjusted for skin color, age, and maximum level of literacy in the household were performed. Four groups were analyzed: men living in rural areas, men living in urban areas, women living in rural areas, and women living in urban areas. Results For urban men, the presence of literate women only in the household was a protection factor against smoking (prevalence ratio, PR: 0.77; 95%CI: 0.71-0.82) vs. households in which all the males were illiterate. The same protective effect was found for rural men (PR: 0.79; 95%CI: 0.73-0.85). In turn, the presence of literate men only living in the same household with illiterate men did not provide protection against smoking in any case (PR: 0.93; 95%CI: 0.83-1.03 for the urban subsample; and PR: 0.99; 95%CI: 0.88-1.11 for the rural subsample). Illiterate women benefited from the presence of both literate men (PR: 0.77; 95%CI: 0.71-0.84 for the urban sample; and PR: 0.78; 95%CI: 0.69-0.89 for the rural subsample) and literate women (PR: 0.81; 95%CI: 0.72-0.92 for the urban subsample; and PR: 0.75; IC95%: 0.60-0.93 for the rural subsample). Conclusions Literate women seem to have positively affected illiterate co-residents of both sexes. This result is in agreement with reports showing broad advantages of female schooling.
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June 2016

Genomic ancestry and the social pathways leading to major depression in adulthood: the mediating effect of socioeconomic position and discrimination.

BMC Psychiatry 2016 09 5;16(1):308. Epub 2016 Sep 5.

Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160 - 3° Piso, Bairro Centro. Cep: 96020-220, Caixa Postal 464, Pelotas, RS, Brazil.

Background: Evidence suggests that there is an association between ethnicity/skin color and depression; however, many contextual and individual variables, like sense of discrimination and socioeconomic position (SEP), might influence the direction of this association. We assessed the association between African ancestry and major depression among young adults that have been followed-up since birth in a Southern Brazilian city, and the mediating effect of SEP and discrimination.

Methods: In 1982, all hospital deliveries in Pelotas (Southern Brazil) were identified; liveborns were examined and their mothers interviewed (n = 5914). In 2012-13, at 30 years of age, we used the Mini International Neuropsychiatric Interview (MINI) for major depression diagnosis. In addition, DNA samples were genotyped for approximately 2.5 million single nucleotide polymorphisms (SNPs) using Illumina (CA, USA) HumanOmni2.5-8v1 array. Genomic ancestry estimation was based on approximately 370 000 single nucleotide polymorphisms (SNPs) mutually available for the Pelotas cohort and selected samples (used as reference panels) of the HapMap and Human Genome Diversity (HGDP). We estimated prevalence ratios (PR) using Poisson regression models and evaluated the association between percentage of African ancestry and major depression. We used G-computation for mediation analysis.

Results: At 30 years, 3576 individuals were evaluated for major depression (prevalence = 7.9 %). Only individuals in the highest SEP, who had a percentage of African ancestry between >5-30 % and >30 % had a prevalence of major depression 2.16 (PR = 2.16 95 % CI [1.05-4.45]) and 2.74 (PR = 2.74 95 % CI [1.06-7.06]) times higher, than those with 5 % or less, respectively. Among these subjects, sense of discrimination by skin color, captured 84 % of the association between African ancestry and major depression.

Conclusion: SEP is an important effect modifier of the positive association between African ancestry and major depression. In addition, this association is predominantly mediated by the sense of feeling discriminated by skin color.
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http://dx.doi.org/10.1186/s12888-016-1015-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5011949PMC
September 2016

Design of a digital and self-reported food frequency questionnaire to estimate food consumption in adolescents and young adults: birth cohorts at Pelotas, Rio Grande do Sul, Brazil.

Rev Bras Epidemiol 2016 Apr-Jun;19(2):419-32

Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas - Pelotas (RS), Brasil.

Purpose: Methodological paper aiming to describe the development of a digital and self-reported food frequency questionnaire (FFQ), created to the 1982 and 1993 Pelotas Birth Cohorts.

Methods: The instrument was created based on FFQs previously applied to subjects belonging to both cohorts in the 2004 and 2008 follow-ups. The FFQ was developed including 88 foods and/or meals where frequencies were clustered from a minimum of never or once/month to a maximum of greater than or equal to 5 times/day. The closed options related to portions were based on a 24-hour recall previously asked to a subsample from the 1993 cohort. Three options for portions were created: equal to, less than or greater than. Equal to portion was described based on the 50 percentile of each food consumed reported in a 24-hour recall. Photographs of portions related to the 50 percentile for each food were also included in the software.

Results: This digital FFQ included food and meals based on the needs of current researches. The layout of the software was attractive to the staff members as well as to the cohort members. The responding time was 12 minutes and the software allowed several individuals to use it at the same time. Moreover, this instrument dismissed interviewers and double data entry.

Conclusion: It is recommended the use of the same strategy in other studies, adapted to different contexts and situations.
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http://dx.doi.org/10.1590/1980-5497201600020017DOI Listing
October 2017

Breastfeeding and mental health in adulthood: A birth cohort study in Brazil.

J Affect Disord 2016 Sep 26;202:115-9. Epub 2016 May 26.

Postgraduate Program in Epidemiology, Federal University of Pelotas, Brazil; Health and Behavior Postgraduate Program, Universidade Católica de Pelotas - UCPEL, Pelotas, RS, Brazil.

Background: Breastfeeding is negatively associate with behavioral and internalization problems, psychological stress, and depressive/anxiety symptoms. However, studies evaluating specific mental health disorders are scarce. We aimed to assess the association between breastfeeding and mental health outcomes in young adults.

Methods: In 1982, hospital deliveries in Pelotas (Southern Brazil) were identified; liveborns were examined and their mothers interviewed (n=5914). Information on breastfeeding was collected in early childhood. In 2012-13, at 30 years of age, we used the Mini International Neuropsychiatric Interview (MINI) for the diagnosis of major depression (MD), generalized anxiety disorder (GAD) and social anxiety disorder (SAD). In addition, we used the Beck Depression Inventory (BDI-II) and the Self-reported Questionnaire (SRQ-20), to evaluate depressive symptoms severity and common mental disorders (CMD), respectively. We used multivariable regression models to evaluate the association between breastfeeding and mental health outcomes.

Results: We evaluated 3657 individuals. Prevalence of CMD, MD, GAD and SAD was 24.3%, 7.9%, 12.7% and 3.6%, respectively. In multivariable models the odds of having a more severe case of depression (BDI-II) was smaller among those breastfed for 6 or more months (OR=0.69 95%CI [0.53-0.89]). We observed a similar pattern for MD and CMD, however, confidence intervals included the reference.

Limitations: We had no information on home environment characteristics during childhood. Lack of power and a small effect size could explain why we did not detect an association between breastfeeding and MD.

Conclusion: Breastfeeding reduced the odds of having more severe depressive symptoms.
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http://dx.doi.org/10.1016/j.jad.2016.05.055DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4957542PMC
September 2016

[Evolution of overweight and obesity into adulthood, Pelotas, Rio Grande do Sul State, Brazil, 1982-2012].

Cad Saude Publica 2015 Sep;31(9):2017-25

Universidade Federal de Pelotas, Pelotas, Brasil.

This study assessed the prevalence of overweight and obesity in adolescence and adulthood among subjects enrolled in the 1982 Pelotas Birth Cohort, Rio Grande do Sul State, Brazil, according to social and demographic characteristics. In 1982, hospital births in Pelotas were identified and all live born infants (n = 5,914) were examined and have been followed since. The data were collected at 15, 18, 23, and 30 years of age. In women, prevalence of overweight increased from 23.6% at 15 years to 52.4% at 30 years of age, while obesity increased from 6.6% to 23.8%. In men, overweight increased from 22.9% to 62.9%, and obesity from 7.5% to 22.1%. Overweight and obesity increased more among individuals of both sexes with lower socioeconomic status, which can lead to more inequality in the occurrence of chronic diseases.
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http://dx.doi.org/10.1590/0102-311X00173814DOI Listing
September 2015

The Effect of Fetal and Childhood Growth over Depression in Early Adulthood in a Southern Brazilian Birth Cohort.

PLoS One 2015 15;10(10):e0140621. Epub 2015 Oct 15.

Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.

Background: Poor nutrition and growth during fetal life and childhood might be associated with depression in adulthood; however, studies evaluating these associations present controversial results, especially when comparing studies using different proxies for fetal growth. We evaluated the association of fetal and childhood growth/nutrition with depression, in adulthood, using different approaches and measurement methods.

Method: In 1982, hospital births (n = 5914) in Pelotas, southern Brazil, were examined and have been prospectively followed. At 30 years, the presence of major depression and depressive symptoms severity was evaluated using the Mini International Neuropsychiatric Interview (MINI) and Beck Depression Inventory (BDI-II). The present study assessed their association with birth weight, premature birth, small for gestational age (SGA), stunting and conditional growth during childhood.

Results: At 30 years, 3576 individuals were evaluated and 7.9% had major depression. Low birth weight (PR = 1.01 95%CI [0.64-1.60]), having been born SGA (PR = 0.87 95%CI [0.64-1.19]) and premature birth (PR = 1.22 95%CI [0.72-2.07]) were not associated with major depression in multivariable models. However, those born SGA who were also stunted in childhood had a higher prevalence of major depression (PR = 1.87 95%CI [1.06-3.29]) and greater odds of scoring a higher level of depression in the BDI-II (OR = 2.18 95%CI [1.34-3.53]).

Conclusion: In this Brazilian cohort of young adults, those born SGA who were also stunted during childhood had a higher risk of depression in adulthood. Our results show that the effect of growth impairment on depression is cumulative.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0140621PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607416PMC
June 2016

Social Mobility and Mental Disorders at 30 Years of Age in Participants of the 1982 Cohort, Pelotas, Rio Grande Do Sul - RS.

PLoS One 2015 8;10(10):e0136886. Epub 2015 Oct 8.

Graduate Program in Epidemiology, Federal University of Pelotas (Universidade Federal de Pelotas - UFPEL), Rio Grande do Sul, Brazil.

This study aimed to evaluate the relationship between mental disorders at 30 years of age and social mobility by formally testing three hypotheses: Risk Accumulation; Critical Period; and Social Mobility. The study was performed using data from the 30-year follow-up of the Pelotas Birth Cohort Study, conducted in 1982, and data from previous follow-ups. The tool used to evaluate mental health was the Self Report Questionnaire (SRQ-20). For the statistical analysis, the chi-square test with the Yates correction was used to estimate the prevalence of mental disorder, and the Poisson regression with robust variance was used to formally test the hypotheses according to the Risk Accumulation, Critical Period and Social Mobility Models. The analyses were stratified by gender. The prevalence of Common Mental Disorders (CMDs) was 24.3% (95% CI 22.9-25.7) when the whole sample was considered. The highest prevalence, 27.1% (95% CI 25.1-29.2), was found in women, and the difference between genders was significant (p < 0.001). CMDs were more frequent in participants who remained "poor" in the three follow-ups. In both men and women, the best fit was obtained with the Risk Accumulation Model, with p = 0.6348 and p = 0.2105, respectively. The results indicate the need to rethink public income maintenance policies. Finally, we suggest further studies to investigate the role of different public policies in decreasing the prevalence of mental disorders and thus contribute proposals of new policies that may contribute to the prevention of these disorders.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0136886PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4598184PMC
June 2016

[Poor dad, poor child? An investigation of intergenerational income mobility in the 1982 Birth Cohort in Pelotas, Rio Grande do Sul State, Brazil].

Cad Saude Publica 2015 Jun 1;31(6):1225-33. Epub 2015 Jun 1.

Universidade Federal de Pelotas, Pelotas, Brasil.

Brazil is one of the countries with the lowest intergenerational income mobility. This article aimed to analyze intergenerational income mobility in the 1982 Birth Cohort in Pelotas, Rio Grande do Sul State. Two methods were used, intergenerational income elasticity and quantile regressions, in order to measure heterogeneity in income mobility as a function of different levels of parents' past income. The results show relatively high income mobility for Brazilian standards. The main explanation is that the data cover the children's income at a younger age (about 23 years). Quantile regressions show higher social mobility in the intermediary social stratum. The results reinforce the notion of two opposite "traps", poverty and wealth.
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http://dx.doi.org/10.1590/0102-311X00067714DOI Listing
June 2015

Social mobility and smoking: a systematic review.

Cien Saude Colet 2015 May;20(5):1515-20

Universidade Federal de Pelotas, Brasil.

The purpose of this study is to review the literature on longitudinal studies that have evaluated the effect of social mobility on the occurrence of smoking in various populations. Articles were selected from the web databases PubMed and Web of Science using the words: follow up, cohort longitudinal prospective, social mobility, social change life, course socioeconomic, smoking, and tobacco. Of the six studies identified in this review, four used occupational classification to measure social mobility. All six were carried out on the continent of Europe. The results indicate higher proportions of tobacco users among those with lower socioeconomic level during the whole period of observation (for all variables analyzed); and that people who suffered downward mobility, that is to say people who were classified as having a higher socioeconomic level at the beginning of life, tended to mimic habits of the new group when they migrated to a lower social group.
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http://dx.doi.org/10.1590/1413-81232015205.01642014DOI Listing
May 2015

Comparison of two instruments to track depression symptoms during pregnancy in a sample of pregnant teenagers in Southern Brazil.

J Affect Disord 2015 May 3;177:95-100. Epub 2015 Feb 3.

Programa de Pós-Graduação em Saúde & Comportamento, Centro de Ciências da Vida e da Saúde, Universidade Católica de Pelotas. Electronic address:

Introduction: Depression during pregnancy in adolescents is increasing significantly. However, instruments for early depression screening during prenatal care are scarce. Faced this fact, the objective of this research is to identify the best cutoff points for the Edinburgh Postnatal Depression Scale (EPDS) and Beck Depression Inventory (BDI) in a sample of pregnant adolescents.

Method: 807 pregnant adolescents, with a mean age of 17 years, met in public antenatal services were evaluated. Two screening scales for depression were analyzed, EPDS and the BDI. These scales had their accuracy measured by AUC of their ROC curve, as well as their respective sensitivity and specificity.

Results: In the analysis, the best cutoff for the EPDS was≥10, in which the sensitivity was 81.1% and specificity 82.7%. For the BDI, it was with recognized the cutoff ≥11, sensitivity 86.7% and specificity 73.8%. In the analysis of the ROC AUC, values of 0.89 (CI 0.87-0.92) for the EPDS and BDI for 0.87 (CI 0.84-0.89) were identified compared to the MINI.

Limitations: The sample was composed majority by middle and low income adolescent and the study was performed only with pregnant women in the second trimester.

Conclusions: The results indicate that both scales have good accuracy in screening of depression in adolescent mothers. However, the EPDS scale shows higher AUC ROC and also better sensitivity and specificity values, the latter being more precise and effective for screening for depression in this population.
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http://dx.doi.org/10.1016/j.jad.2015.01.051DOI Listing
May 2015

Proposal of a short-form version of the Brazilian food insecurity scale.

Rev Saude Publica 2014 Oct;48(5):783-9

Objective: To propose a short version of the Brazilian Food Insecurity Scale.

Methods: Two samples were used to test the results obtained in the analyses in two distinct scenarios. One of the studies was composed of 230 low income families from Pelotas, RS, Southern Brazil, and the other was composed of 15,575 women, whose data were obtained from the 2006 National Survey on Demography and Health. Two models were tested, the first containing seven questions, and the second, the five questions that were considered the most relevant ones in the concordance analysis. The models were compared to the Brazilian Food Insecurity Scale, and the sensitivity, specificity and accuracy parameters were calculated, as well as the kappa agreement test.

Results: Comparing the prevalence of food insecurity between the Brazilian Food Insecurity Scale and the two models, the differences were around 2 percentage points. In the sensitivity analysis, the short version of seven questions obtained 97.8% and 99.5% in the Pelotas sample and in the National Survey on Demography and Health sample, respectively, while specificity was 100% in both studies. The five-question model showed similar results (sensitivity of 95.7% and 99.5% in the Pelotas sample and in the National Survey on Demography and Health sample, respectively). In the Pelotas sample, the kappa test of the seven-question version totaled 97.0% and that of the five-question version, 95.0%. In the National Survey on Demography and Health sample, the two models presented a 99.0% kappa.

Conclusions: We suggest that the model with five questions should be used as the short version of the Brazilian Food Insecurity Scale, as its results were similar to the original scale with a lower number of questions. This version needs to be administered to other populations in Brazil in order to allow for the adequate assessment of the validity parameters.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4211573PMC
http://dx.doi.org/10.1590/s0034-8910.2014048005195DOI Listing
October 2014

[Food insecurity in the Northeast and South of Brazil: magnitude, associated factors, and per capita income patterns for reducing inequities].

Cad Saude Publica 2014 Jan;30(1):161-74

This article addresses food insecurity among urban Brazilian families with children under seven years. A cross-sectional study in areas covered by primary health care centers identified 5,419 families in the Northeast and 5,081 in the South of the country. Food insecurity was assessed by the Brazilian Food Insecurity Scale. Prevalence of moderate or severe food insecurity was 22.9% in the Northeast and 7.5% in the South. According to the adjusted analysis, increased likelihood of moderate or severe food insecurity was associated with families headed by women, black or brown maternal skin color, low maternal education, low family income, and enrollment in the Bolsa Família program (conditional income transfer). Moderate or severe food insecurity would be reduced by 59.5% in the Northeast and 45.4% in the South with a per capita income of at least BRL 175.00 per month. Increased family income for the poorest families and better targeting of Bolsa Família are essential for reducing food insecurity in the country.
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http://dx.doi.org/10.1590/0102-311x00036013DOI Listing
January 2014