[Show abstract][Hide abstract] ABSTRACT: Despite the availability of treatment and a vaccine, tuberculosis continues to be a public health problem worldwide. Mental disorders might contribute to the burden of the disease.
PLoS ONE 01/2014; 9(6):e99551. · 3.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Rural residence is protective against atopy and wheeze-rhinitis-eczema symptoms in developed countries, an effect attributed to farming and poor hygiene exposures. There are few data from developing countries addressing this question. We compared atopy and wheeze-rhinitis-eczema symptoms between urban and rural Ecuador, and explored the effects of farming and poor hygiene exposures.
We performed cross sectional studies of schoolchildren living in rural and urban Ecuador. Data on symptoms and farming/hygiene exposures were collected by parental questionnaire, atopy by allergen skin prick test reactivity and geohelminth infections by stool examinations.
Among 2526 urban and 4295 rural schoolchildren, prevalence was: atopy (10.0% vs 12.5%, p=0.06), wheeze (9.4% vs 10.1%, p=0.05), rhinitis (8.1% vs 6.4%, p=0.02) and eczema (5.9% vs 4.7%, p=0.06). A small proportion of symptoms were attributable to atopy (range 3.9-10.7%) with greater attributable fractions for respiratory symptoms observed in urban schoolchildren. Respiratory symptoms were associated with poor hygiene/farming exposures: wheeze with lack of access to potable water; and rhinitis with household pets, no bathroom facilities and contact with large farm animals. Birth order was inversely associated with respiratory symptoms. Area of residence and atopy had few effects on these associations.
Urban schoolchildren living in Ecuador have a similar prevalence of atopy, eczema and wheeze but a higher prevalence of rhinitis compared with rural children. Some farming and poor hygiene exposures were associated with an increase in the prevalence of wheeze or rhinitis while birth order was inversely associated with these symptoms.
[Show abstract][Hide abstract] ABSTRACT: Atopic and non-atopic asthma have distinct risk factors and immunological mechanisms, and few studies differentiate between the impacts of psychosocial factors on the prevalence of these disease phenotypes. The authors aimed to identify whether the effect of maternal mental health on prevalence of asthma symptoms differs between atopic and non-atopic children, taking into account family social support.
This is a cross-sectional study of 1013 children participating in the Social Change Allergy and Asthma in Latin America project. Psychosocial data were collected through a household survey utilising Self-Reporting Questionnaire and Medical Outcome Study Social Support Scale. Socioeconomic and wheezing information was obtained through the questionnaire of the International Study of Allergy and Asthma in Childhood, and level of allergen-specific IgE was measured to identify atopy. Polytomous logistic regression was used to estimate the association between maternal mental health, social support and atopic and non-atopic wheezing. Effect modification was evaluated through stratified polytomous regression according to social support level.
Maternal mental disorder had the same impact on atopic and non-atopic wheezing, even after adjusting for confounding variables. Affective, material and informational supports had protective effects on non-atopic asthma, and there is some evidence that social supports may act as a buffer for the impact of maternal mental disorder on non-atopic wheezing.
Poor maternal mental health is positively associated with wheezing, independent of whether asthma is atopic or non-atopic, but perception of high levels of social support appears to buffer this relationship in non-atopic wheezers only.
Journal of epidemiology and community health 04/2012; 66(11):1011-6. · 3.04 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study aimed to identify degrees of exposure to community violence reported by parents and guardians of children from four to 12 years of age and the association with childhood asthma symptoms. A cross-sectional study was conducted with 1,232 parents/guardians in 24 peripheral neighborhoods in Salvador, the capital of Bahia State, Brazil. The authors investigated asthma symptoms in children and acts of violence in the community. More than 75% of parents/guardians had been exposed to community violence in the previous year, with 20% reporting high levels of exposure. Children that were more exposed to violence showed higher asthma prevalence (28.4%) as compared to non-exposed children (16.4%). Children exposed to maximum levels of violence were nearly twice as likely to present asthma symptoms (adjusted OR = 1.94; 95%CI: 1.12-3.36). The study highlighted the relevance of community violence as a risk factor for asthma and the need for further research to elucidate methodological issues.
Cadernos de saúde pública / Ministério da Saúde, Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública 01/2012; 28(1):86-94. · 0.83 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The Parent-Child Conflict Tactics Scale (CTSPC) is one of the most widely used instruments in the world for investigating domestic violence against children, but targeted use has proven inadequate given the phenomenon's complexity. This study focused on the factor structure of CTSPC scales in an urban population in Northeast Brazil. We conducted a cross-sectional study in a cohort of 1,370 children in Salvador, Bahia State. Factor analysis with promax oblique rotation was performed, and the Kuder-Richardson coefficient was calculated. Factor analysis showed a different distribution of items in the factors as compared to the original instrument. Violence showed a gradual profile in each factor. The Kuder-Richardson coefficient was 0.63 for factor 1, 0.59 for factor 2, and 0.42 for factor 3. The items behaved differently from the original instrument, corroborating international studies. These findings support proposing a resizing of the CTSPC.
Cadernos de saúde pública / Ministério da Saúde, Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública 11/2011; 27(11):2215-26. · 0.83 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Asthma is the most common chronic disease in childhood and has been designated a public health problem due to the increase in its prevalence in recent decades, the amount of health service expenditure it absorbs and an absence of consensus about its etiology. The relationships among psychosocial factors and the occurrence, symptomatology, and severity of asthma have recently been considered. There is still controversy about the association between asthma and a child's mental health, since the pathways through which this relationship is established are complex and not well researched. This study aims to investigate whether behavior problems are associated with the prevalence of asthma symptoms in a large urban center in Latin America.
It is a cross-section study of 869 children between 6 and 12 years old, residents of Salvador, Brazil. The International Study of Allergy and Asthma in Childhood (ISAAC) instrument was used to evaluate prevalence of asthma symptoms. The Child Behavior Checklist (CBCL) was employed to evaluate behavioral problems.
19.26% (n=212) of the children presented symptoms of asthma. 35% were classified as having clinical behavioral problems. Poisson's robust regression model demonstrated a statistically significant association between the presence of behavioral problems and asthma symptoms occurrence (PR: 1.43; 95% CI: 1.10-1.85).
These results suggest an association between behavioral problems and pediatric asthma, and support the inclusion of mental health care in the provision of services for asthma morbidity.
Journal of psychosomatic research 09/2011; 71(3):160-5. · 2.91 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Despite improvements in the nutritional status of Brazilian children, child malnutrition remains a public health issue. The objective of the present study was to analyse the effect of maternal common mental disorders (MCMD) on child malnutrition in a large Brazilian urban centre with low rates of child malnutrition. Furthermore, we explored the hypothesis that a reduction in the quality of maternal caregiving mediates the relationship between maternal mental health problems and child nutrition.
A case-control study including 294 children aged between 0 and 5 years, with 147 cases and 147 age- and sex-matched controls, was conducted in the city of Salvador, northeastern Brazil. Mothers completed the Self-Report Questionnaire (SRQ-20), the family's socio-economic status was evaluated and the Home Observation for Measurement of the Environment (HOME) Inventory was applied. Children were diagnosed as moderately or severely malnourished when the weight-for-height z-score was below -2 SD. Conditional logistic regression was used in the analysis, and the final model was created using the backward technique.
MCMD doubled the risk of moderate or severe malnutrition in children (OR = 2.04; 95% CI: 1.10-3.78). Maternal caregiving can be an important factor mediating the relationship between maternal mental health and child malnutrition.
MCMD must be taken into account in programmes for the treatment and prevention of malnutrition, especially in areas of low malnutrition prevalence.
Social Psychiatry 07/2011; 46(7):543-8. · 2.05 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of the ABC (Aberrant Behavior Checklist) is to evaluate the treatment response for aberrant behavior in patients with mental retardation. The aim of this study was to describe the partial cross-cultural adaptation of the ABC scale to Brazilian Portuguese. The process included conceptual and item equivalence, two translations (T1, T2) and their back-translations (R1, R2), evaluation of referential and general equivalence, expert evaluations, a pre-test, and elaboration of the final version. Conceptual and item equivalences of the ABC were considered pertinent to Brazilian culture. Semantic equivalence showed good correspondence between R1 items and ABC. Reasonable correspondence was obtained between ABC items and R2. All of the professors understood 94.8% of the items in the scale, while relatives understood 87.9%. The Brazilian Portuguese version of the ABC scale thus is available for use, with the appropriate conceptual, item, and semantic equivalence.
Cadernos de saúde pública / Ministério da Saúde, Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública 05/2011; 27(5):909-23. · 0.83 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Structural equation modeling (SEM) is an important statistical tool for evaluating complex relations in several research areas. In epidemiology, the use and discussion of SEM have been limited thus far. This article presents basic principles and concepts in SEM, including an application using epidemiological data analysis from a study on the determinants of cognitive development in young children, considering constructs related to organization of the child's home environment, parenting style, and the child's health status. The relations between the constructs and cognitive development were measured. The results showed a positive association between psychosocial stimulus at home and cognitive development in young children. The article presents the contributions by SEM to epidemiology, highlighting the need for an a priori theoretical model for improving the study of epidemiological questions from a new perspective.
Cadernos de saúde pública / Ministério da Saúde, Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública 12/2010; 26(12):2251-62. · 0.83 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: The causation of asthma is poorly understood. Risk factors for atopic and non-atopic asthma may be different. This study aimed to analyze the associations between markers of poverty, dirt and infections and wheezing in atopic and non-atopic children.
Respiratory Research 01/2010; 11(1). · 3.13 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Recent studies have shown that asthma represents a major health issue not only in children of developed countries but also in urban centers in some middle-income countries. Brazil has one of the highest prevalences of asthma worldwide. Recently, interest has grown in the relationship between psychosocial factors and asthma. This article examines the relationship between maternal mental disorders and the prevalence of asthma in low-income children from an inner city area of Salvador in the state of Bahia, Brazil, and is part of the SCAALA program (Social Change, Allergy and Asthma in Latin America).
A total of 1,087 children between the ages of 5 and 12 were investigated, together with their mothers. The mothers' mental health was evaluated using the SRQ-20, an instrument for the psychiatric screening of minor psychiatric disorders (depression, anxiety and somatic complaints). The prevalence of asthma was investigated using the ISAAC survey, a standardized, validated questionnaire for asthma and other allergic diseases. Cases were defined as asthma if the patient reported having had wheezing in the previous 12 months in addition to at least one of the following: having asthma, wheezing while exercising, waking during the night because of wheezing, or having had at least four episodes of wheezing in the previous 12 months. Atopy was defined as a positive skin prick test to allergens.
The presence of minor psychiatric disorders in the mothers was significantly associated with the presence of asthma in the children, and this association was consistent with all forms of asthma, irrespective of whether it was atopic or nonatopic. Future studies should be carried out to further investigate this association and the potential biological mechanisms involved. Programs for asthma control should include strategies for stress reduction and psychological support for the families of asthmatic children.
Social Psychiatry 11/2008; 44(5):416-20. · 2.05 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study aimed to provide an understanding of diagnosis, demographic characteristics, and treatment procedures for children and adolescents attending Psychosocial Care Centers (CAPSIS) in Brazil, 2003. It was a cross-sectional descriptive study using secondary data. The analysis considered three groups of variables related to: (a) the nature of the services; (b) patient profile; and (c) types of care. Seven CAPSIS that had recorded their procedures during all 12 months of 2003 participated in the study. The units involved treated 1,456 individuals, 62.8% of whom were males 11-13 years of age. Nearly half (49.3%) were treated in non-intensive care. The most frequent diagnoses were behavioral and emotional disorders (44.5%). There was no record of treatment related to use of psychoactive substances. The proportion of severe disorders was 19.4%. The CAPSIS operate in similar fashion to older outpatient units, but treat a variety of problems, creating a record according to types of activities. These services fill a historical gap in public mental health care for children and adolescents.
Cadernos de Saúde Pública 04/2008; 24(3):633-42. · 0.83 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The study describes the relationship between anthropometric status, socioeconomic conditions, and quality of home environment and child cognitive development in 320 children from 20 to 42 months of age, randomly selected from 20,000 households that represent the range of socioeconomic and environmental conditions in Salvador, Bahia, Northeast Brazil. The inclusion criterion was to be less than 42 months of age between January and July 1999. Child cognitive development was assessed using the Bayley Scales for Infant Development, and the Home Observation for Measurement of the Environment Inventory (HOME) was applied to assess quality of home environment. Anthropometric status was measured using the indicators weight/age and height/age ratios (z-scores), and socioeconomic data were collected through a standard questionnaire. Statistical analysis was conducted through univariate and hierarchical linear regression. Socioeconomic factors were found to have an indirect impact on early cognitive development mediated by the child's proximal environment factors, such as appropriate play materials and games available and school attendance. No independent association was seen between nutritional status and early cognitive development.
Cadernos de Saúde Pública 03/2008; 24(2):427-37. · 0.83 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: There is evidence that poverty, health and nutrition affect children's cognitive development. This study aimed to examine the relative contributions of both proximal and distal risk factors on child cognitive development, by breaking down the possible causal pathways through which poverty affects cognition.
This cohort study collected data on family socioeconomic status, household and neighbourhood environmental conditions, child health and nutritional status, psychosocial stimulation and nursery school attendance. The effect of these on Wechsler Pre-School and Primary Scale of Intelligence scores at five years of age was investigated using a multivariable hierarchical analysis, guided by the proposed conceptual framework.
Unfavourable socioeconomic conditions, poorly educated mother, absent father, poor sanitary conditions at home and in the neighbourhood and low birth weight were negatively associated with cognitive performance at five years of age, while strong positive associations were found with high levels of domestic stimulation and nursery school attendance.
Children's cognitive development in urban contexts in developing countries could be substantially increased by interventions promoting early psychosocial stimulation and preschool experience, together with efforts to prevent low birth weight and promote adequate nutritional status.
BMC Public Health 02/2008; 8:202. · 2.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A city-wide sanitation intervention was started in Salvador, Brazil, in 1997 to improve sewerage coverage from 26% of households to 80%. Our aim was to investigate the epidemiological effect of this city-wide sanitation programme on diarrhoea morbidity in children less than 3 years of age.
The investigation was composed of two longitudinal studies done in 1997-98 before the intervention (the sanitation programme) and in 2003-04 after the intervention had been completed. Each study consisted of a cohort of children (841 in the preintervention study and 1007 in the postintervention study; age 0-36 months at baseline) who were followed up for a maximum of 8 months. Children were sampled from 24 sentinel areas that were randomly chosen to represent the range of environmental conditions in the study site. At the start of each study an individual or household questionnaire was applied by trained fieldworkers; an environmental survey was done in each area before and after introduction of the sanitation programme to assess basic neighbourhood and household sanitation conditions. Daily diarrhoea data were obtained during home visits twice per week. The effect of the intervention was estimated by a hierarchical modelling approach fitting a sequence of multivariate regression models.
Diarrhoea prevalence fell by 21% (95% CI 18-25%)-from 9.2 (9.0-9.5) days per child-year before the intervention to 7.3 (7.0-7.5) days per child-year afterwards. After adjustment for baseline sewerage coverage and potential confounding variables, we estimated an overall prevalence reduction of 22% (19-26%).
Our results show that urban sanitation is a highly effective health measure that can no longer be ignored, and they provide a timely support for the launch of 2008 as the International Year of Sanitation.
The Lancet 12/2007; 370(9599):1622-8. · 39.06 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The caregiver-child relationship is important for child development. The prevalence of mental disorders was assessed in a female caregiver group and associated with socioenvironmental factors.
A cross sectional study was conducted in 326 caregivers whose children have been participating in a cohort study on mental development since 1999.
The overall prevalence of mental disorders assessed according to the CIDI version 2.1 was 47.5% (95% CI 0.42-0.53). They were predominantly anxiety disorders (32.8%; 95%CI 0.27-0.38), followed by mood disorders (26.1%; 95%CI 0.21-0.31) and psychoactive substance abuse (10.1%; 95%CI 0.07-0.13). Anxiety and mood disorders were less likely in younger caregivers and substance abuse disorder was less likely among those better educated.
The overall prevalence was similar to previous estimates, although 32.8% of anxiety disorders exceeded previous findings, which is unsurprising in a female sample.
Younger caregivers with higher schooling were more likely to have better mental health, which favors child development.
Revista Brasileira de Psiquiatria 07/2006; 28(2):111-7. · 1.86 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To assess the association between quality of stimulation in the family environment and child's cognitive development considering the impact of mother's schooling on the quality of stimulation.
A cross-sectional study comprising 350 children aged 17-42 months was carried out in central and peripheral areas of Salvador, Northeastern Brazil, in 1999. A socio-economic questionnaire was used, along with the Home Observation for Measurement of the Environment Scale (HOME Inventory), and the Bayley Scale for Infant Development. Bivariate and multivariate analyses were carried out through linear regression at 5% level of significance.
There was a positive (beta=0.66) and statistically significant association between quality of stimulation in the family environment and child's cognitive development. Part of the effect was mediated by the mother's working circumstances and educational level. It was verified that a better quality of stimulation is provided for those who come early in the birth order in family, and live with only a few others under five years of age. This pattern of stimulation is better among children who live with their parents and whose mothers have better education, have a job and a partner involved in the family environment.
Quality of stimulation in the family environment is crucial for child's cognitive development, besides the significant role of the available resources and family dynamics. The study findings show the pertinence to cognitive development of interventions which improve the quality of the environment and the child-caregiver relationship.
Revista de Saúde Pública 09/2005; 39(4):606-11. · 1.07 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective To assess the association between quality of stimulation in the family environment and child's cognitive development considering the impact of mother's schooling on the quality of stimulation.
Revista De Saude Publica - REV SAUDE PUBL. 01/2005; 39(4).