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Little is known about the effect of maternal immunological factors on the etiology of developmental defects of enamel (DDE). RANTES (Regulated on Activation Normal T Cell Expressed and Secreted) is a chemokine produced by fibroblasts, lymphoid and epithelial mucosa cells in response to various external stimuli. Despite its importance for embryogenesis, RANTES expression has been demonstrated in multiple diseases characterized by inflammation, tumor and immune response, and wound healing. We hypothesized that altered levels of RANTES during pregnancy are associated with the immune and inflammatory response in women, which could lead to the occurrence of DDE in utero (DDE-iu), directly or mediated by preterm birth. Therefore, this study aimed to evaluate the direct and indirect effects of serum levels of RANTES in pregnant women in the occurrence of DDE-iu in children. This is a longitudinal case-control study. The mothers and their children (327) were evaluated in three moments: prenatal care, post childbirth, and when the child was between 12.3 and 36 months of age. The analysis was performed with structural equation modeling, estimating the standardized coefficient (SC), adopting α = 5%. There was a direct and negative effect of RANTES on the outcome (SC = -0.137; p = 0.022). This association was not mediated by preterm birth (SC = 0.007; P = 0.551). When considering the specific types of DDE-iu, RANTES had a direct effect on hypoplasia (SC = -0.190; p = 0.007), but not on opacity (SC = 0.343; p = 0.074). Lower serum levels of RANTES may contribute to a higher number of teeth with DDE-iu, specifically hypoplasia. However, more evidence supported by clinical, laboratory and epidemiological studies is still needed.

Few studies have used structural equation modeling to analyze the effects of variables on violence against women. The present study analyzed the effects of socioeconomic status and social support on violence against pregnant women who used prenatal services. This was a cross-sectional study based on data from the Brazilian Ribeirão Preto and São Luís birth cohort studies (BRISA). The sample of the municipality of São Luís (Maranhão/Brazil) consisted of 1,446 pregnant women interviewed in 2010 and 2011. In the proposed model, socioeconomic status was the most distal predictor, followed by social support that determined general violence, psychological violence or physical/sexual violence, which were analyzed as latent variables. Violence was measured by the World Health Organization Violence against Women (WHO VAW) instrument. The São Luis model was estimated using structural equation modeling and validated with 1,378 pregnant women from Ribeirão Preto (São Paulo/Brazil). The proposed model showed good fit for general, psychological and physical/sexual violence for the São Luís sample. Socioeconomic status had no effect on general or psychological violence (p>0.05), but pregnant women with lower socioeconomic status reported more episodes of physical/sexual violence (standardized coefficient, SC = -0.136; p = 0.021). This effect of socioeconomic status was indirect and mediated by low social support (SC = -0.075; p<0.001). Low social support was associated with more episodes of general, psychological and physical/sexual violence (p<0.001). General and psychological violence indistinctly affected pregnant women of different socioeconomic status. Physical/sexual violence was more common for pregnant women with lower socioeconomic status and lower social support. Better social support contributed to reduction of all types of violence. Results were nearly the same for the validation sample of Ribeirão Preto except that SES was not associated with physical/sexual violence.

Psychosocial stress during pregnancy has long-lasting and important consequences in the following generations, as it can affect intrauterine development. The impact on the developing immune system is notoriously important due to the associated morbidity and mortality in the first years of life. Little attention has been given to the role of violence during pregnancy (VDP), especially its impact on infant infectious morbidity. We analyzed data from two Brazilian birth cohorts (  = 2,847) in two distinct cities (Ribeirão Preto and São Luís), collected during pregnancy and at the beginning of the second year of life. The association between VDP and infection in infancy was analyzed with structural equation modeling, using the WHO-VAW questionnaire as exposure and a latent variable for infection as the outcome. VDP was reported by 2.48% (sexual), 11.56% (physical), and 45.90% (psychological) of the mothers. The models presented an adequate fit. In the city of São Luís, VDP was significantly associated with the latent construct for infection (standardized beta = 0.182;  = 0.022), while that was not the case for the Ribeirão Preto sample (standardized beta = 0.113;  = 0.113). Further analyses showed a gradient effect for the different dimensions of the exposure, from psychological to physical and sexual violence. Our results suggest an association of VDP with infant morbidity in a poorer socioeconomic setting, and highlight the importance of considering the different dimensions of intimate partner violence. These findings may have important implications for the comprehension of global health inequalities and of the effects of gender-based violence.

Screening for violence during pregnancy is one of the strategies for the prevention of abuse against women. Since violence is difficult to measure, it is necessary to validate questionnaires that can provide a good measure of the phenomenon. The present study analyzed the psychometric properties of the World Health Organization Violence Against Women (WHO VAW) instrument for the measurement of violence against pregnant women. Data from the Brazilian Ribeirão Preto and São Luís birth cohort studies (BRISA) were used. The sample consisted of 1,446 pregnant women from São Luís and 1,378 from Ribeirão Preto, interviewed in 2010 and 2011. Thirteen variables were selected from a self-applied questionnaire. Confirmatory factor analysis was used to investigate whether violence is a uni-or-multidimensional construct consisting of psychological, physical and sexual dimensions. The mean-and-variance-adjusted weighted least squares estimator was used. Models were fitted separately for each city and a third model combining data from the two settings was also tested. Models suggested from modification indices were tested to determine whether changes in the WHO VAW model would produce a better fit. The unidimensional model did not show good fit (Root mean square error of approximation [RMSEA]  = 0.060, p < 0.001 for the combined model). The multidimensional WHO VAW model showed good fit (RMSEA = 0.036, p = 0.999 for the combined model) and standardized factor loadings higher than 0.70, except for the sexual dimension for SL (0.65). The models suggested by the modification indices with cross loadings measuring simultaneously physical and psychological violence showed a significantly better fit compared to the original WHO model (p < 0.001 for the difference between the model chi-squares). Violence is a multidimensional second-order construct consisting of psychological, physical and sexual dimensions. The WHO VAW model and the modified models are suitable for measuring violence against pregnant women.

While birth weight and weight gain have been associated with hypertension (HT), the association of linear growth, independently of weight gains, has been less well studied. We assessed the independent association of body mass index (BMI) and length at birth and changes in BMI and height during the first two decades of life with adult blood pressure (BP). A birth cohort (n = 1141) was assembled in 1978–79, and followed up at school-age and adulthood. We used conditional length and BMI measures. BMI at birth was inversely associated with HT; c-BMI from school age to adulthood and c-height from birth to school age were positively associated with hypertension. Early adiposity accretion from birth to 9 years and late linear growth from 9 to 24 years were not associated with increased HT. Regarding BP, systolic and diastolic BP presented similar partterns: the lower the BMI at birth the higher the adult BP; the higher the BMI gains in the first 2 decades of life the higher the adult BP; linear accretion only in the first decade of life was associated with adult BP. Linear growth in the first decade of life and fat accretion in the second decade are associated with adults HT.

Background Little is known about the interaction between gender and low birth weight (LBW) and lifelong social mobility as an explanation of the etiology of obesity. The aim of the present study was to evaluate total and central obesity according to gender, LBW and social mobility, within the context of the epidemiological transition in middle-income countries. We hypothesize that there are more pronounced metabolic consequences of social mobility for women born with LBW. Methods We used data from a birth cohort study conducted in Ribeirão Preto, São Paulo, Brazil. Data regarding anthropometric measurements, schooling and smoking status were collected at 23-25 years of age. Social mobility was determined based on maternal and adult offspring schooling and categorized as Low-Low, Low-High and High-High. Analysis of covariance was performed to assess the association between social mobility and body mass index (BMI) or waist circumference (WC) in adulthood, stratified by LBW and gender. Results Data on 6827 singleton pregnancies were collected at birth in 1978/79 and a sample was followed up in 2002/04. A total of 2063 subjects were included in the study. Mean age was 23.9 ± 0.7 years, 51.8% ( n  = 1068) were female and the LBW was 6.2% ( n  = 128). There was a triple interaction between social mobility, LBW and gender. Among women born without LBW, BMI and WC were higher in the Low-Low group compared to High-High schooling group. Among LBW women, BMI and WC were higher in the Low-Low group compared to the Low-High group. Conclusions Women born with LBW belonging to the low schooling group in early adulthood had high BMI and WC, compared to the Low-High social mobility group.

The aim of this study was to estimate the incidence of metabolic syndrome (MetS) in individuals with a healthy weight (HWI), normal weight obesity (NWO), or overweight/obesity (OWO). In all, 787 adults belonging to a 1978/1979 birth cohort from Ribeirão Preto were placed into one of three groups: HWI (body mass index [BMI] ≥18.5 and <25 kg/m2 + ∑skinfolds ≤90th percentile); NWO (BMI ≥18.5 and <25 kg/m2 +∑skinfolds >90th percentile); and OWO (BMI ≥25 kg/m2 +∑skinfolds >90th percentile). Those diagnosed with MetS at the 23 to 25 y of age were excluded according to Joint Interim Statement criteria. The incidence of MetS and its components in individuals 37 to 39 y of age was evaluated by Poisson regression with robust estimation of variance, which was adjusted for family income; physical activity level; and daily intake of calories, lipids, and added sugar. MetS was detected in 279 adults at 37 to 39 y of age. NWO and OWO individuals showed higher risk ratios (RRs) for the development of MetS (RR,1.87; 95% confidence interval [CI], 1.36–2.57; RR, 1.61; 95% CI, 1.29–2.03), increased blood glucose levels (RR, 1.77; 95% CI, 1.12–2.79; RR, 1.51; 95% CI, 1.12–2.04), and increased waist circumferences (RR, 1.46; 95% CI, 1.32–1.61; RR, 1.50; 95% CI, 1.38–1.62). There was a higher risk for increased blood pressure (RR, 1.72; 95% CI, 1.35–2.19) among OWO individuals, but not among those with NWO. Individuals with NWO have a risk ratio for MetS similar to individuals with OWO. This demonstrates the need to assess body fat percentages, even in BMI-designated normal weight individuals, both for prevention and management of obesity. •Normal weight obesity individuals showed a higher risk for metabolic syndrome than healthy weight individuals.•Normal weight obesity individuals showed a higher risk for high blood glucose levels than healthy weight individuals.•Of the healthy weight individuals studied, 63.4% increased their waist circumference over the 15 years of study•Normal weight obesity individuals have a similar risk ratio for metabolic syndrome than overweight/obese individuals. [Display omitted]

Background Chronic obstructive pulmonary disease (COPD) is a disease with a high socioeconomic burden for the global population. Identifying those individuals with a higher potential to develop the disease is essential for reducing its incidence. Methods This is an observational, longitudinal study that uses data from the 1978/1979 Ribeirão Preto City birth cohort (São Paulo State, Brazil). The study included 895 individuals who participated at the age of 23–25 and 37–38 years. Asthmatics were diagnosed by methacholine bronchial challenge test and were excluded from the analysis. A multiple linear regression was performed to evaluate the association of active smoking, passive smoking, body mass index (BMI), C-reactive protein (CRP) levels, and respiratory symptoms with FEV1 variation between ages. Results The analysis showed an association between BMI, CRP levels, and active smoking with FEV1 fall. Active smoking increased FEV1 decline by 1.95%. For each 1 kg/m² increase in BMI, there was a 0.28% loss in FEV1, while an increase in CRP level of 1 mg/dL was associated to a 0.76% additional FEV1 decline. Conclusion In addition to the well-known relationship between smoking and pulmonary function decline, there was also an association with BMI and CRP levels, suggesting the hypothesis that a metabolic process may contribute to the development of COPD.

Background In Brazil, the prevalence of mental disorders is heterogeneous, with most studies conducted in large cities with high population density. This study aimed to assess the prevalence of mental disorders and psychiatric comorbidities among young adults (22–23 years old) and adults (37–38 years old) from Ribeirão Preto, a city located in the Northeast of the São Paulo state, with approximately 700,000 inhabitants, and to explore associations with sociodemographic variables, suicide risk, and health service usage. Second, we aimed to evaluate the performance of the Self-Report Questionnaire (SRQ-20) as a screening tool for mental disorders to be applied to the local population. Methods Participants from the 1978/1979 and 1994 Ribeirão Preto birth cohorts were evaluated using the Mini International Neuropsychiatric Interview (MINI) and the SRQ-20 at mean ages of 22–23, and 37–38 years, respectively. Results Our sample comprised 1,769 individuals from the 1978/1979 cohort and 1,037 from the 1994 cohort. The prevalence of mental disorders ranged from 28.6% (1978/79) to 31% (1994), with frequent comorbid diagnoses (42.7% and 43.3%, respectively). Men and women had a similar prevalence of mental disorders in the younger cohort, while women had a higher prevalence in the older cohort. Low educational attainment was associated with higher rates of diagnosis. In both cohorts, alcohol and other psychoactive substance use was higher among those with a psychiatric diagnosis. Although those with a psychiatric diagnosis were less satisfied with their own health, only one-fifth had seen a mental health professional in the previous year. A psychiatric diagnosis increased the suicide risk by 5.6 to 9.1 times. Regarding the SRQ-20, the best cutoff points were 5/6 for men and 7/8 for women, with satisfactory performance. Conclusions The prevalence and comorbidity of mental disorders were high in both cohorts and comparable to those in larger Brazilian cities. However, few individuals with a diagnosis had sought specialized care. These data suggest that the mental health gap is still significant in Brazil.

To investigate the association of sociodemographic characteristics, gestational factors, and birth outcomes with developmental delay from the second year of life in late preterm (LPT) infants. This study included 327 LPT infants from a cohort started in 2010. Developmental performance was assessed using the Bayley-III screening test. The covariates were obtained with questionnaires and from the maternity records. Hierarchical multiple logistic regression was used for analysis. Smoking during pregnancy was associated with fine motor and cognitive delays (OR = 2.27, 95 %CI 1.05–4.93 and OR = 2.22, 95 %CI 1.05–4.68, respectively). Living without a partner (OR = 2.98, 95 %CI 1.36–6.52) and intrauterine growth restriction of the child (OR = 2.63, 95 %CI 1.32–5.24) were associated with fine motor delay and neonatal intensive care unit admission with cognitive delay (OR = 2.11, 95 %CI 1.01–4.44). These factors must be considered when implementing strategies for the diagnosis of possible developmental delays and when designing interventions for LPT children.