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Heloisa Bettiol

Publications and source records attributed to Heloisa Bettiol.

At least 19 recordsLinked to original sources
PubMed2007

Does child labour affect final height?

BACKGROUND: Although the negative effects of child labour on health are well known, the impact of child labour on final height is still controversial. AIMS: To assess the effect of child labour on the final height of young adults. METHODS: The study included 2063 adults aged 23-25 years from a cohort study of all live births (6827) in Ribeirão Preto, Brazil (1978-79). Height was measured in centimetres. Information on work, physical activity and smoking was obtained retrospectively and the other variables were obtained at cohort baseline. Work was classified according to age at first job: <14 (child labour), 14-16 and >or=17 years. Analyses were performed separately for males and females. Multiple linear regression analysis followed bivariate and stratified analysis. RESULTS: The average height for males and females were respectively 176.0 cm [95% confidence interval (CI) 175.6-176.4] and 162.7 cm (95% CI 162.3-163.0). Labour before the age of 14 years was performed by 20% of males and 12% of females. In the bivariate analysis, child labour was statistically associated with final height for both males (P < 0.01) and females (P < 0.01). However, the association was not maintained after adjusting for confounders. CONCLUSION: We were not able to demonstrate significant height differences between those previously employed or not employed as a child, other than differences explained by other social and biological factors.

Adult↗
PubMed2006

Metabolic syndrome in young adults from two socioeconomic Latin American settings.

BACKGROUND AND AIM: Since little information on the metabolic syndrome (MS) is available in Latin America, the aim of this study was to explore whether and to what extent differing socioeconomic conditions influence the prevalence of MS and its associated factors among young adults from two towns in Latin America: semi-rural Limache (L), Chile, and urban Ribeirão Preto (RP), Brazil. METHODS AND RESULTS: A cross-sectional study based on two independent investigations of 22- to 28 year-old subjects using a common methodology. The prevalence of MS (according to the US National Cholesterol Education Program) and its risk factors (smoking habit, alcohol and caloric intake, obesity, physical activity and socioeconomic conditions) were assessed. The prevalence of MS was 10% in L and in RP men, but was lower (4.8%) in RP women. Hyperglycemia was very low (0.8% in L and 1.1% in RP), while the prevalence of low HDL cholesterol levels was high (66.7% and 42.2%, respectively). Intermediate prevalences of hypertriglyceridemia (17.9% and 12.9%), elevated blood pressure (15.5% and 23.1%) and abdominal obesity (19.3% versus 12.7%) were detected. RP subjects had a higher educational level and more qualified jobs, came from smaller families, and a higher proportion were car owners. In L, the smoking habit was more frequent, subjects had higher excess weight and caloric intake, and lower levels of physical activity. CONCLUSIONS: Metabolic changes possibly leading to cardiovascular diseases in later life were present in both populations at an early age, but were higher in the rural and less developed county. Our findings point to the existence of a cultural, educational and socioeconomic phenomenon that possibly influences the prevalence of the diagnostic components of MS through differences in lifestyles.

Adult↗
PubMed2006

Which factors could explain the low birth weight paradox?

OBJECTIVE: Low birth weight children are unusual among well-off families. However, in Brazil, low birth weight rate was higher in a more developed city than in a less developed one. The study objective was to find out the reasons to explain this paradox. METHODS: A study was carried out in two municipalities, Ribeirão Preto (Southeastern Brazil) and São Luís (Northeastern Brazil), which low birth weight rates were 10.7% and 7.6% respectively. Data from two birth cohorts were analyzed: 2,839 newborns in Ribeirão Preto in 1994 and 2,439 births in São Luís in 1997-1998. Multiple logistic regression analysis was performed, adjusted for confounders. RESULTS: Low birth weight risk factors in São Luís were primiparity, maternal smoking and maternal age less than 18 years. In Ribeirão Preto, the associated variables were family income between one and three minimum wages, maternal age less than 18 and equal to or more than 35 years, maternal smoking and cesarean section. In a combined model including both cohorts, Ribeirão Preto presented a 45% higher risk of low birth weight than São Luís. When adjusted for maternal smoking habit, the excess risk for low birth weight in Ribeirão Preto compared to São Luís was reduced by 49%, but the confidence interval was marginally significant. Differences in cesarean section rates between both cities contributed to partially explain the paradox. CONCLUSIONS: Maternal smoking was the most important risk factor for explaining the difference in low birth weight between both cities. The other factors contributed little to explain the difference in low birth weight rates.

Brazil↗
PubMed2004

Infant mortality: comparison between two birth cohorts from Southeast and Northeast, Brazil.

OBJECTIVE: To obtain population estimates and profile risk factors for infant mortality in two birth cohorts and compare them among cities of different regions in Brazil. METHODS: In Ribeirão Preto, southeast Brazil, infant mortality was determined in a third of hospital live births (2,846 singleton deliveries) in 1994. In São Luís, northeast Brazil, data were obtained using systematic sampling of births stratified by maternity unit (2,443 singleton deliveries) in 1997-1998. Mothers answered standardized questionnaires shortly after delivery and information on infant deaths was retrieved from hospitals, registries and the States Health Secretarys' Office. The relative risk (RR) was estimated by Poisson regression. RESULTS: In São Luís, the infant mortality rate was 26.6/1,000 live births, the neonatal mortality rate was 18.4/1,000 and the post-neonatal mortality rate was 8.2/1,000, all higher than those observed in Ribeirão Preto (16.9, 10.9 and 6.0 per 1,000, respectively). Adjusted analysis revealed that previous stillbirths (RR=3.67 vs 4.13) and maternal age <18 years (RR=2.62 vs 2.59) were risk factors for infant mortality in the two cities. Inadequate prenatal care (RR=2.00) and male sex (RR=1.79) were risk factors in São Luís only, and a dwelling with 5 or more residents was a protective factor (RR=0.53). In Ribeirão Preto, maternal smoking was associated with infant mortality (RR=2.64). CONCLUSIONS: In addition to socioeconomic inequalities, differences in access to and quality of medical care between cities had an impact on infant mortality rates.

Adolescent↗
PubMed2004

Can we explain why Brazilian babies are becoming lighter?

BACKGROUND: We tried to explain why a marked decrease in birthweight of 122 g occurred over a 15-year period in Ribeirão Preto, Brazil. METHODS: Factors reflecting biological, social, and health care characteristics (infant gender, parity, maternal age, marital status, type of hospital, maternal smoking, preterm birth, small for gestational age [SGA], and prenatal care) were assessed on 6711 newborns in 1978/1979 and 2838 in 1994 using multiple linear regressions. RESULTS: The birthweight distribution shifted to the left and the residual distribution of small preterm babies increased from 1.9% to 3.4%. Only marital status and preterm delivery would have decreased the difference in birthweight over time, explaining for each of them around 30 g of the 122 g. Increasing levels of attendance at antenatal care over time might have decreased the birthweight difference by 40 g. Maternal age and SGA explained little of the decreasing trend. Reductions in maternal smoking would have increased mean birthweight slightly. In stratified analysis the downward trend was more marked among mothers with high education (-202 g) and those delivered by caesarean section (-194 g). After adjusting for all those significant variables mean birthweight was still 74 g (95% CI: -97, -50 g) lower in 1994 than in 1978/1979. CONCLUSION: The trend could be explained in part by factors related to marital status that might reflect dysfunctional families in the Brazilian context and the preterm increase that might be associated with advances in medical technology. The high attendance at antenatal clinics or factors associated with it might have prevented a further decrease in birthweight. Our results may be compatible with the high economic development of Ribeirão Preto within Brazil, together with factors associated with its unfavourable lifestyle.

Adolescent↗
PubMed2004

Increasing pre-term and low-birth-weight rates over time and their impact on infant mortality in south-east Brazil.

This study investigates the possible effects of pre-term births and low birth weight on infant mortality rates (IMRs) over a 15-year period in Ribeirão Preto, Brazil, based on surveys carried out in 1978/79 and 1994. The 1978/79 survey included 6750 births over a 12-month period and the 1994 survey 2846 births over a 4-month period. Infant deaths were retrieved monthly from the city register. Infant mortality rate decreased from 36.6 to 16.9 deaths per 1000 over 15 years. The decrease in IMR was larger in the 2500-2999 g group than in any other group. The observed falls in IMR were attributable to decreases in birth-weight-specific mortality rates. Likewise, there was a general decrease in IMR in mild, moderate and severe pre-term births. The incidence rate ratio of infant mortality between surveys was 0.46 (95% CI 0.34-0.63); it increased to 0.57 (95% CI 0.35-0.75) when adjusted for birth weight and other factors in the model and rose to 0.69 (95% CI 0.49-0.97) when adjusted for length of gestation and other variables. The increase in pre-term births and low birth weight may have had, at most, a marginal effect on the IMR. Progress in the care of newborns may have decreased the mortality risk, but even mild pre-term birth still has an impact on infant mortality. There is room for further improvement in IMR by tackling the high rates of pre-term birth.

Brazil↗
PubMed2004

Growth of children with isolated Robin sequence treated by nasopharyngeal intubation: importance of a hypercaloric diet.

OBJECTIVE: To compare the growth curves (weight and length) of two groups of infants with isolated Robin sequence (RS) treated with nasopharyngeal intubation (NPI), one group receiving a hypercaloric diet and the other receiving a normal diet for age, and compare the growth rates and duration of NPI between the two groups. DESIGN: Prospective longitudinal study. SETTING: Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo, Bauru, Brazil, 1998 to 2000. PATIENTS: Twenty-three children with isolated RS treated by prolonged NPI. INTERVENTIONS: Nine children received a milk formula supplemented with 5% to 7% glucose polymers and 3% to 5% medium chain triglycerides (group 1), and 14 children received a milk formula only (group 2). Weight and length were measured at birth and every month up to 6 months of life for the construction of weight and length growth curves. The time of use of the nasogastric tube, age at the beginning of NPI, and duration of NPI were also determined. RESULTS: No significant difference in length was observed between the two groups. The mean weight curves obtained for the two groups were below the 50th percentile of the National Center for Health Statistics, but weight gain was higher in group 1. The duration of NPI was shorter in this group. CONCLUSIONS: The hypercaloric diet led to an improvement in nutritional status, which in turn contributed to improved respiratory conditions in isolated RS.

Airway Obstruction↗
PubMed2004

Trends in prenatal care use and low birthweight in southeast Brazil.

OBJECTIVES: We investigated trends in prenatal care use and its association with low birthweight in a developing country. METHODS: We examined data from 2 southeast Brazilian cohort surveys, 1 conducted in 1978-1979 and the other in 1994. RESULTS: Socioeconomic inequalities in prenatal care use increased during the 15-year period of 1979-1994. Although prenatal care use increases paralleled increases in low birthweight rate during this period, having no prenatal care was associated with higher risk of low birthweight in both surveys. Inadequate prenatal care use was also associated with higher risk of low birthweight in 1978-1979 only. CONCLUSIONS: Increasing low birthweight rates among women who adequately used prenatal care may be causing a bias by reducing the estimates of the effect of inadequate prenatal care use on low birthweight rates.

Bias↗
PubMed2003

[Characteristics of adolescent pregnancy in São Luís, Maranhão, Brazil].

OBJECTIVE: To identify the main socioeconomic, demographic, anthropometric and behavioral characteristics, and pregnancy outcomes of adolescent pregnancy and to assess health services used by pregnant adolescents. METHODS: Data were collected from a cross-section of 2,429 deliveries by women residing in the municipality of São Luís, Brazil, of which 94% were hospital births. Women were categorized into six age groups. The two groups of teenagers (under 18 and 18-19 years) were compared to four groups of older women. Comparison was also made between the two teenage groups. The chi-square test was used to compare proportions and prevalence ratio was used as an effect measure. RESULTS: Of 2,429 women, 714 (29.4%) were adolescents. Their specific fertility coefficient was higher than in other regions of the country. Adolescents showed lower socioeconomic and reproductive conditions than older women and a higher proportion of inadequate prenatal care. The majority had no partner. They had the lowest percentages of caesarean section and smokers. CONCLUSIONS: Despite their equally unfavorable socioeconomic situation, 18-19 year-old adolescents had pregnancy outcomes comparable to the age group 25-29, whereas those under 18 had the highest proportions of low birth weight, preterm birth, and infant mortality rate. This suggests that biologic immaturity may be associated with adverse pregnancy outcomes.

Adolescent↗
PubMed2003

[Factors associated with inadequacy of prenatal care utilization].

OBJECTIVE: To identify factors associated with inadequacy of prenatal care utilization in urban community. METHODS: A cross-sectional study of a systematic sample stratified by maternity hospital, consisting of hospital births in the municipality of São Luís, Brazil, was carried out from March 1997 to February 1998. Socioeconomic and demographic factors, reproductive health, morbidity during pregnancy, and utilization of prenatal care services were studied. Mothers answered a standardized questionnaire before hospital discharge. The adequacy of prenatal care utilization was analyzed by means of two indexes: APNCU (Adequacy of Prenatal Care Utilization) and a new index based on the recommendations of the Brazilian Ministry of Health. RESULTS: There were interviewed 2,831 women who delivered at 10 public and private maternity hospitals. The inadequacy of prenatal care utilization was 49.2% according to the APNCU index and 24.5% when determined by the Brazilian index. Prenatal care at public services, low maternal schooling, low income, having no partner, and absence of maternal diseases during pregnancy were associated with inadequacy of prenatal care use according to both indexes. High parity and maternal age of 35 years or more were also associated with inadequacy, whereas primiparity, morbidity, and young maternal age (<20 years) seemed to protect from inadequacy when the Brazilian index was used. CONCLUSIONS: Prenatal care showed low coverage in the municipality of São Luís. The inadequacy of prenatal care utilization was associated with several factors linked to social inequality.

Adolescent↗
PubMed2003

Young maternal age and preterm birth.

The association between young maternal age and preterm birth (PTB) remains controversial. In some studies the association disappeared after controlling for socio-economic and reproductive factors, thus indicating that social disadvantage rather than biological factors may be the explanation. However, in other studies the association persisted after adjustment. The relation between young maternal age and PTB was studied in a city located in Brazil, an underdeveloped country, where the prevalence of teenage pregnancy was high, 29%. A systematic sampling of 2541 hospital births, stratified by hospital, was performed in São Luís, Northeast Brazil, from March 1997 to February 1998. The risks of PTB for infants born to two groups of young mothers (<18 and 18-19 years) were calculated with and without adjustment for confounding factors (family income, marital status, mode of delivery, parity, health insurance, and short maternal stature) in a logistic regression model, using mothers 25-29 years of age as the reference group. In the unadjusted analysis, the risk of PTB was higher for mothers < 18 years [odds ratio (OR) = 2.42, 95% confidence interval (CI) 1.64, 3.57]. Those aged 18 or 19 years were not at a higher risk of PTB (OR = 0.89, 95% CI 0.58, 1.38). After adjustment, the risk of PTB for mothers < 18 years was lower but remained significant after controlling for confounding (OR = 1.70, 95% CI 1.11, 2.60). After performing a stratified analysis according to parity, the risk of PTB among very young primiparae (<18 years) remained significant (OR = 1.77, 95% CI 1.02, 3.08), whereas the risk among non-primiparous adolescents was not significantly higher than the risk among mothers in the reference group. This suggests that the association between young maternal age and PTB may have a biological basis or an artifactual explanation (errors in gestational age estimation may be more common among very young mothers) or may be due to residual confounding.

Adolescent↗
PubMed2003

Nasopharyngoscopy in Robin sequence: clinical and predictive value.

OBJECTIVE: To correlate nasopharyngoscopic findings with clinical manifestations during the first month of life and study the course of respiratory obstruction during the first year in infants with Robin sequence (RS). DESIGN: A longitudinal prospective study of children with RS. SETTING: Hospital de Reabilitação de Anomalias Craniofaciais, University of São Paulo, Bauru-SP, Brazil, 1998 to 2000. PATIENTS: Fifty-six children were studied from the age of 1 month to 12 months. INTERVENTIONS: The type of respiratory obstruction was defined by nasopharyngoscopy. Patients for whom glossoptosis was the only mechanism of respiratory obstruction were classified as having mild, moderate, or severe glossoptosis by nasopharyngoscopy and as mild, moderate, or severe cases with respect to the clinical manifestations. RESULTS: Forty-two (75%) patients showed respiratory obstruction caused by glossoptosis; seven (43.7%) of these infants with mild clinical manifestations showed moderate glossoptosis during the first month of life and five (31.3%) presented severe glossoptosis; 10 (45.5%) of the infants with severe clinical manifestations showed moderate and 11 (50.0%) severe glossoptosis. At 12 months of age, glossoptosis was mild or absent in 83.3% of the patients, moderate in 14.3% and severe in 2.4%. CONCLUSIONS: A poor correlation between the severity of glossoptosis and the severity of clinical manifestations was observed for patients with respiratory obstruction caused by glossoptosis during the first month of life, but the correlation between glossoptosis and respiratory distress according to age was statistically significant. Nasopharyngoscopy is not a good method for predicting the severity of the clinical course of respiratory obstruction caused by glossoptosis.

Age Factors↗
PubMed2003

[Monitoring growth].

OBJECTIVE: To present concepts related to growth assessment, with emphasis on aspects concerning the evaluation of individuals. SOURCES: The present paper is based on reports published by the WHO regarding the use anthropometry for the assessment of nutritional status; on original articles; and on book chapters about the same topic, as well as on the criticisms of auxologists of this type of assessment when employed at the individual level. SUMMARY OF THE FINDINGS: Concepts concerning reference, skeletal maturity, mid-parental target height, z score, short stature, growth rate, body mass index, and their assumptions and limitations are presented. CONCLUSIONS: The assessment of the nutritional status of a population is based on cut-off points, taking into consideration that whoever is below or above that point presents a nutritional problem. Clinical evaluation is based on the idea of variability, which can be both biological and social, and on the idea that it is the clinician's task to establish whether a child within or outside given parameters presents normal growth and nutritional status. When monitoring the growth of a child or adolescent, the most important parameter to be considered is growth rate.

Child Development↗
PubMed2002

Narrowing inequalities in infant mortality in Southern Brazil.

OBJECTIVE: To determine the trends of infant mortality from 1995 to 1999 according to a geographic area-based measure of maternal education in Porto Alegre, Brazil. METHODS: A registry-based study was carried out and a municipal database created in 1994 was used. All live births (n=119,170) and infant deaths (n=1,934) were considered. Five different geographic areas were defined according to quintiles of the percentage of low maternal educational level (<8 years of schooling): high, medium high, medium, medium low, and low [corrected]. The chi-square test for trend was used to compare rates between years. Incidence rate ratio was calculated using Poisson regression to identify excess infant mortality in poorer areas compared to higher schooling areas. RESULTS: The infant mortality rate (IMR) decreased steadily from 18.38 deaths per 1,000 live births in 1995 to 12.21 in 1999 (chi-square for trend p<0.001). Both neonatal and post-neonatal mortality rates decreased although the drop seemed to be steeper for the post-neonatal component. The higher decline was seen in poorer areas. CONCLUSION: Inequalities in IMR seem to have decreased due to a steeper reduction in both neonatal and post-neonatal components of infant mortality in lower maternal schooling area.

Brazil↗
PubMedDate not supplied

Monthly distribution of menarche among schoolgirls from a municipality in Southeastern Brazil.

We studied the monthly distribution of menarche among schoolgirls from Barrinha, Brazil, a municipality of rural characteristics in the process of transition to urbanization, economically dependent on sugar cane culture and processing. The association between season of the year, month of the year, and birth month and the occurrence of menarche was evaluated. The schoolgirls who provided the date of menarche (month and year) by the recall method and who had menarche up to 36 months before the interview were selected for analysis (460 girls). The correlations between month of occurrence of menarche and month of birth and between menarche and seasons of the year were determined by the chi-square test and the mean monthly ages at menarche were compared by Student's t-test, with a significance level of 0.05. There was a correlation between month of birth and month at menarche, with a peak of occurrence of menarche in December not affected by the menstruating patterns of maturation, but no correlation between menarche and seasons of the year. The difference between mean age at menarche in December (spring-summer transition) and in June (autumn-winter transition) was not significant. Mean age at menarche during the month following school vacations was lower. We conclude that situations of stress-relaxation transition, such as end of the school year, beginning of school vacation, and, perhaps most important, the socioeconomic factor-the end of the sugar cane harvest, when rural workers receive their final payments-favor the occurrence of the peak of menarche in December.

Adolescent↗
PubMedDate not supplied

Growth impairment of children with different types of lip and palate clefts in the first 2 years of life: a cross-sectional study.

OBJECTIVE: To analyze the differences in growth impairment according to sex in the 2 first years of life in children with three types of clefts. METHODS: This was a cross-sectional study of 881 children (58.9% boys and 41.1% girls) with cleft lip and palate treated at the Craniofacial Anomaly Rehabilitation Hospital, (University of São Paulo, Bauru, SP), Brazil. Age ranged from 1 to 24 months. Three types of clefts were evaluated: isolated cleft lip (181/20.5%), isolated cleft palate (157/17.8%) and cleft lip + palate (543/61.6%). Weight and length measurements and data regarding breast-feeding and socioeconomic level were obtained. Children with weight and length below the 10th percentile of the NCHS reference were considered to have impaired growth. RESULTS: Sample distribution according to cleft type and sex was similar to that observed in other epidemiological studies. Breast-feeding was more frequent in the isolated cleft lip group (45.9%) then in the isolated cleft palate (12.1%) or cleft lip + palate group (10.5%). Isolated cleft lip children showed less marked impairment of weight (23.8%) and length (19.3%) compared to the cleft lip + palate group (35.7% and 33.1%, respectively). In the latter group, the proportion of children with weight and length below the 10th percentile was very close to that of the isolated cleft palate group (34.4% and 38.9%). CONCLUSIONS: The impairment in weight and length was more severe in cleft lip + palate and isolated cleft palate children and may be attributed to feeding difficulties compared to the isolated cleft lip group.

Body Height↗