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BACKGROUND: Adverse childhood experiences (ACEs) have long been associated with health risk behaviors, but they are poorly studied in Brazilian university students. OBJECTIVE: To estimate the prevalence of ACEs and investigate their association with sociodemographic data, health risk factors and self-related health in a sample of university students. PARTICIPANTS AND SETTING: A cross-sectional study conducted with 546 students from a Brazilian public university. METHOD: The self-reported 10-ACE Study questionnaire (ACE-Q) and sociodemographic information (age, sex, family income), health risk factors (body mass index, physical exercise, alcohol and tobacco use) and self-related health were assessed. Chi-square Test and multivariate logistic regression were used to evaluate the association between the cumulative occurrence of ACE (ACE ≥4) and the studied factors. RESULTS: Of the 546 participants, 464 responded to all ACE-Q questions; 74.4% reported at least one ACE, and 13.1 % reported four or more. Lower family income (OR = 2.02; 95%CI = 1.13-3.61; p = 0.01) and self-related poor health (OR = 2.29; 95%CI = 1.28-4.08; p = 0.00) were associated with the occurrence of ACE ≥4. CONCLUSION: Most students reported at least one ACE, while a minority reported ≥4 ACEs associated with lower family income and poor self-health. The data suggest that preventive actions should be considered to mitigate the problem, with lower-income students being treated as a priority.

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

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

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AIM: To assess the association between taking antibiotics in pregnancy and the occurrence of infections in children at four years of age. METHODS: We studied children who participated in the follow-up of the birth cohort Generation XXI, Porto-Portugal, at the age of four years. We evaluated the associations between the use of antibiotics by the mother at any time in pregnancy with the occurrence of infections. Data were analysed using logistic regression, controlling for potential confounding variables. RESULTS: We studied 7459 children (50.7% boys). The use of antibiotics at any stage of pregnancy, and not only in the third trimester, was associated with the occurrence of tonsillitis at four years, even after controlling for potential confounders (OR 1.19, 95% CI 1.03-1.38). Other infections did not show association. CONCLUSION: Maternal use of antibiotics during pregnancy was associated with an increased risk of tonsillitis reported at four years of age. Antibiotics could favour the potential transmission of an unfavourable microbiome from mother to child.

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

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OBJECTIVES: To determine the validity and reliability of the Brazilian Portuguese version of the Pediatric Confusion Assessment Method for the ICU for diagnosing delirium in patients with chronological and developmental ages from 5 to 17 years in Brazilian PICUs. DESIGN: Prospective, cross-sectional study. SETTINGS: Eight Brazilian PICUs (seven in Rio de Janeiro and one in São Paulo). PATIENTS: One-hundred sixteen patients, 5-17 years old, without developmental delay, submitted to mechanical ventilation or not. INTERVENTIONS: To assess the inter-observer reliability, two previously trained researchers concomitantly applied the Brazilian Portuguese version of the Pediatric Confusion Assessment Method for the ICU and independently rated the same patient. To assess the criterion validity, a pediatric neurologist or psychiatrist, blinded to the Brazilian Portuguese version of the Pediatric Confusion Assessment Method for the ICU assessments, evaluated the same patient within 30 minutes, using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, considered the reference standard. MEASUREMENTS AND MAIN RESULTS: One-hundred forty-nine paired assessments were included (some patients had more than one). Delirium was diagnosed in 11 of 149 assessments (7%), or eight of 116 patients (7%), using both the Brazilian Portuguese version of the Pediatric Confusion Assessment Method for the ICU and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. There was one false positive and one false negative diagnosis, which resulted in 90.9% sensitivity (95% CI, 58.7-99.8%) and 99.3% specificity (95% CI, 96-100%) for the Brazilian Portuguese version of the Pediatric Confusion Assessment Method for the ICU. The inter-rater reliability was considered almost perfect (κ = 1.0). CONCLUSIONS: The Brazilian Portuguese version of the Pediatric Confusion Assessment Method for the ICU is a valid and reliable tool for diagnosing delirium in pediatric patients 5-17 years old who are spontaneously breathing and not pharmacologically sedated in Brazilian PICUs. The implementation of this tool may be useful to reduce underdiagnosis, ensure monitoring and earlier intervention, provide a better prognosis, and improve research on delirium in this age group in Brazil. Further studies are necessary to test the psychometric properties of the Brazilian Portuguese version of the Pediatric Confusion Assessment Method for the ICU in sedated and mechanically ventilated children.

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Measles is a highly contagious disease that can be effectively prevented through vaccination. The recent increase in vaccination coverage was successful in reducing the mortality globally of the disease by 74%. As a whole, the Americas have been considered a disease-free zone. However, it is known that if an immunization programs fails, there will be an accumulation of susceptible people that can lead to disease outbreaks. Recently, both the United States and Brazil faced outbreaks of measles. The present study aims to identify the determining factors of non-vaccination in Brazil in two different vaccination coverage moments, to provide clues as to the causes of current outbreaks. Data were drawn from five population-based cross-sectional studies that surveyed a representative sample of preschool children from 1987 to 2007 (9585 children in total). To assess children's vaccination status, two different information sources were used: information provided by mothers and information from children's health cards. Multivariate analyses with logistic binary regression models were conducted. After adjustment for confounding factors, it was observed that in 1987, with 48.2% vaccination coverage, socioeconomic, maternal, nutritional factors and access to health facilities were important, while in 2007 (96.7% coverage), nutritional and maternal factors were important. Distinct patterns of determinants of non-vaccination were also found. In addition, the low coverage in 1987 resulted in a current pool of adults who were not immunized as children; this may have contributed to the beginning of the current Brazilian outbreak. Globally, there are two standards of vaccination coverage (low and high). Therefore, discussion of the determinants of non-vaccination is important. Our findings suggest vulnerable groups should receive special attention to ensure they are protected. It is also important to consider the possible impact of pools of adults not immunized.

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Objetivo: Avaliar o impacto da musicoterapia nos índices de aleitamento materno entre mães de recém-nascidos prematuros. Método: Neste ensaio clínico controlado, randomizado e aberto, mães de neonatos prematuros com peso ≤ 1.750 g foram submetidas a sessões de musicoterapia três vezes por semana durante 60 minutos. Os desfechos foram os índices de aleitamento materno na ocasião da alta hospitalar do bebê e em consultas de seguimento (7-15 dias, 30 e 60 dias após a alta). Resultados: Foram avaliadas 94 mães (48 no grupo da musicoterapia e 46 no grupo controle). O aleitamento materno foi significativamente mais frequente no grupo da musicoterapia na primeira consulta de seguimento [risco relativo (RR) = 1,26; intervalo de confiaba de 95% (IC95%) = 1,01-1,57; p = 0,03; número necessário para tratar (NNT) = 5,6]. Esse grupo também apresentou índices mais elevados de aleitamento materno na ocasião da alta do bebê (RR = 1,22; IC95% = 0,99-1,51; p = 0,06; NNT = 6,3), e 30 e 60 dias após a alta (RR = 1,21; IC95% = 0,73-5,66; p = 0,13 e RR = 1,28; IC95% = 0,95-1,71; p = 0,09, respectivamente), mas esses resultados não foram estatisticamente significativos. Conclusões: Este estudo demonstrou que a musicoterapia teve efeito significativo no aumento do índice de aleitamento materno entre mães de recém-nascidos prematuros na primeira consulta de seguimento, e uma influencia positiva (embora não significativa) que se estendeu até 60 dias depois da alta. A musicoterapia pode ser útil para elevar os índices de aleitamento materno entre mães de prematuros.

Objective: To evaluate the impact of music therapy on breastfeeding rates among mothers of premature newborns. Method: In this open randomized controlled trial, mothers of premature neonates weighting ≤ 1,750 g were submitted to music therapy sessions three times a week for 60 minutes. The endpoints were breastfeeding rates at the moment of infant hospital discharge and at follow-up visits (7-15 days, 30 and 60 days after discharge). Results: A total of 94 mothers (48 in the music therapy group and 46 in the comparison group) were studied. Breastfeeding was significantly more frequent in the music therapy group at the first followup visit [relative risk (RR) = 1.26; 95% confidence interval (95%CI) = 1.01-1.57; p = 0.03; number needed to treat (NNT) = 5.6]. Moreover, this group showed higher breastfeeding rates at the moment of infant discharge (RR = 1.22; 95%CI = 0.99-1.51; p = 0.06; NNT = 6.3) and at days 30 and 60 after discharge (RR = 1.21; 95%CI = 0.73-5.6; p = 0.13 and RR = 1.28; 95%CI = 0.95-1.71; p = 0.09, respectively), but those results were not statistically significant. Conclusions: This study demonstrated that music therapy had a significant effect in increasing breastfeeding rates among mothers of premature newborns at the first follow-up visit, and also a positive influence (although not significant) that lasted up to 60 days after infant discharge. Music therapy may be useful for increasing breastfeeding rates among mothers of premature newborns.

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OBJETIVO: Avaliar o impacto da musicoterapia nos índices de aleitamento materno entre mães de recém-nascidos prematuros. MÉTODO: Neste ensaio clínico controlado, randomizado e aberto, mães de neonatos prematuros com peso < 1.750 g foram submetidas a sessões de musicoterapia três vezes por semana durante 60 minutos. Os desfechos foram os índices de aleitamento materno na ocasião da alta hospitalar do bebê e em consultas de seguimento (7-15 dias, 30 e 60 dias após a alta). RESULTADOS: Foram avaliadas 94 mães (48 no grupo da musicoterapia e 46 no grupo controle). O aleitamento materno foi significativamente mais frequente no grupo da musicoterapia na primeira consulta de seguimento [risco relativo (RR) = 1,26; intervalo de confiança de 95 por cento (IC95 por cento) = 1,01-1,57; p = 0,03; número necessário para tratar (NNT) = 5,6]. Esse grupo também apresentou índices mais elevados de aleitamento materno na ocasião da alta do bebê (RR = 1,22; IC95 por cento = 0,99-1,51; p = 0,06; NNT = 6,3), e 30 e 60 dias após a alta (RR = 1,21; IC95 por cento = 0,73-5,66; p = 0,13 e RR = 1,28; IC95 por cento = 0,95-1,71; p = 0,09, respectivamente), mas esses resultados não foram estatisticamente significativos. CONCLUSÕES: Este estudo demonstrou que a musicoterapia teve efeito significativo no aumento do índice de aleitamento materno entre mães de recém-nascidos prematuros na primeira consulta de seguimento, e uma influência positiva (embora não significativa) que se estendeu até 60 dias depois da alta. A musicoterapia pode ser útil para elevar os índices de aleitamento materno entre mães de prematuros.

OBJECTIVE: To evaluate the impact of music therapy on breastfeeding rates among mothers of premature newborns. METHOD: In this open randomized controlled trial, mothers of premature neonates weighting < 1,750 g were submitted to music therapy sessions three times a week for 60 minutes. The endpoints were breastfeeding rates at the moment of infant hospital discharge and at follow-up visits (7-15 days, 30 and 60 days after discharge). RESULTS: A total of 94 mothers (48 in the music therapy group and 46 in the comparison group) were studied. Breastfeeding was significantly more frequent in the music therapy group at the first follow-up visit [relative risk (RR) = 1.26; 95 percent confidence interval (95 percentCI) = 1.01-1.57; p = 0.03; number needed to treat (NNT) = 5.6]. Moreover, this group showed higher breastfeeding rates at the moment of infant discharge (RR = 1.22; 95 percentCI = 0.99-1.51; p = 0.06; NNT = 6.3) and at days 30 and 60 after discharge (RR = 1.21; 95 percentCI = 0.73-5.6; p = 0.13 and RR = 1.28; 95 percentCI = 0.95-1.71; p = 0.09, respectively), but those results were not statistically significant. CONCLUSIONS: This study demonstrated that music therapy had a significant effect in increasing breastfeeding rates among mothers of premature newborns at the first follow-up visit, and also a positive influence (although not significant) that lasted up to 60 days after infant discharge. Music therapy may be useful for increasing breastfeeding rates among mothers of premature newborns.

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OBJECTIVE: To evaluate the impact of music therapy on breastfeeding rates among mothers of premature newborns. METHOD: In this open randomized controlled trial, mothers of premature neonates weighting ≤ 1,750 g were submitted to music therapy sessions three times a week for 60 minutes. The endpoints were breastfeeding rates at the moment of infant hospital discharge and at follow-up visits (7-15 days, 30 and 60 days after discharge). RESULTS: A total of 94 mothers (48 in the music therapy group and 46 in the comparison group) were studied. Breastfeeding was significantly more frequent in the music therapy group at the first follow-up visit [relative risk (RR) = 1.26; 95% confidence interval (95%CI) = 1.01-1.57; p = 0.03; number needed to treat (NNT) = 5.6]. Moreover, this group showed higher breastfeeding rates at the moment of infant discharge (RR = 1.22; 95%CI = 0.99-1.51; p = 0.06; NNT = 6.3) and at days 30 and 60 after discharge (RR = 1.21; 95%CI = 0.73-5.6; p = 0.13 and RR = 1.28; 95%CI = 0.95-1.71; p = 0.09, respectively), but those results were not statistically significant. CONCLUSIONS: This study demonstrated that music therapy had a significant effect in increasing breastfeeding rates among mothers of premature newborns at the first follow-up visit, and also a positive influence (although not significant) that lasted up to 60 days after infant discharge. Music therapy may be useful for increasing breastfeeding rates among mothers of premature newborns.

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