This three-essay dissertation examines racial disparities in infant health outcomes and exposure to air pollution in Texas. It also asks whether the EPA's Risk-Screening Environmental Indicators Geographic Microdata (RSEI-GM) might be used to assess the effects of little-studied toxic air pollutants on infant health outcomes. Chapter 1 contributes to the ``weathering'' literature, which has shown that disparities in infant health outcomes between non-Hispanic black and non-Hispanic white women tend to widen with age. In this study, we ask whether the same patterns are observed in Texas and among Hispanic women, since other studies have focused on black and white women from other regions. We find that black and Hispanic women in Texas do ``weather'' earlier than white mothers with respect to rates of low birthweight and preterm birth. This differential weathering appears to be mediated by racial disparities in the distribution and response to socioeconomic risk factors, though a large gap between black and white mothers across all ages remains unexplained. Chapter 2 extends the statistical environmental justice literature by examining the distribution of toxic air pollution across infants in Texas. We find that, within Texas cities, being black or Hispanic is a significant predictor of how much pollution one is exposed to at birth. We further find that, among mothers who move between births, white mothers tend to move to significantly cleaner areas than black or Hispanic mothers. In Chapter 3, we use geocoded birth records matched to square-kilometer pollution concentration estimates from the RSEI-GM to ask whether the pollution-outcome relationships that emerge through regression analysis are similar to the effects found in previous research. If so, the RSEI-GM might be used to study the health effects of nearly 600 chemicals tracked in that dataset. We conclude, based on instability of results across various specifications and lack of correspondence to previous results, that the merged birth record-RSEI data are not appropriate for statistical epidemiology research.

No description available.

Ambient air pollution has been associated with restricted fetal growth, which is linked with adverse respiratory health in childhood. We assessed the effect of maternal exposure to low concentrations of ambient air pollution on birthweight. We pooled data from 14 population-based mother-child cohort studies in 12 European countries. Overall, the study population included 74-178 women who had singleton deliveries between Feb 11, 1994, and June 2, 2011, and for whom information about infant birthweight, gestational age, and sex was available. The primary outcome of interest was low birthweight at term (weight <2500 g at birth after 37 weeks of gestation). Mean concentrations of particulate matter with an aerodynamic diameter of less than 2·5 μm (PM2·5), less than 10 μm (PM10), and between 2·5 μm and 10 μm during pregnancy were estimated at maternal home addresses with temporally adjusted land-use regression models, as was PM2·5 absorbance and concentrations of nitrogen dioxide (NO2) and nitrogen oxides. We also investigated traffic density on the nearest road and total traffic load. We calculated pooled effect estimates with random-effects models. A 5 μg/m3 increase in concentration of PM2·5 during pregnancy was associated with an increased risk of low birthweight at term (adjusted odds ratio [OR] 1·18, 95% CI 1·06-1·33). An increased risk was also recorded for pregnancy concentrations lower than the present European Union annual PM2·5 limit of 25 μg/m3 (OR for 5 μg/m3 increase in participants exposed to concentrations of less than 20 μg/m3 1·41, 95% CI 1·20-1·65). PM10 (OR for 10 μg/m3 increase 1·16, 95% CI 1·00-1·35), NO2 (OR for 10 μg/m3 increase 1·09, 1·00-1·19), and traffic density on nearest street (OR for increase of 5000 vehicles per day 1·06, 1·01-1·11) were also associated with increased risk of low birthweight at term. The population attributable risk estimated for a reduction in PM2·5 concentration to 10 μg/m3 during pregnancy corresponded to a decrease of 22% (95% CI 8-33%) in cases of low birthweight at term. Exposure to ambient air pollutants and traffic during pregnancy is associated with restricted fetal growth. A substantial proportion of cases of low birthweight at term could be prevented in Europe if urban air pollution was reduced. / The European Union

Orientadores: Jose Dirceu Ribeiro, Maria Aparecida Marques dos Santos Mezzacappa / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-07T08:58:42Z (GMT). No. of bitstreams: 1 Mendes_ThaisdeBarros_M.pdf: 697160 bytes, checksum: 683a02d47dfa9c24c4f1e7ea7b12f590 (MD5) Previous issue date: 2006 / Resumo: A doença pelo refluxo gastroesofágico (DRGE) é a enfermidade esofágica mais comum no período neonatal, e tem sido implicada como um fator contribuinte para as doenças respiratórias. Entretanto, muitos de seus aspectos são controversos e não são adequadamente conhecidos em recém-nascidos prematuros. A displasia broncopulmonar (DBP) é a doença pulmonar crônica mais freqüente em recém-nascidos de muito baixo peso (RNMBP). Em virtude da escassez de informações sobre o diagnóstico de DRGE em pacientes com DBP e dadas às conseqüências sobre a sua morbidade, pareceu-nos importante conhecer os fatores de risco para a associação, podendo colaborar com a melhora da qualidade da assistência prestada. Este estudo teve o objetivo de conhecer os fatores de risco para a DRGE em RNMBP com DBP, investigados por meio da monitorização prolongada do pH esofágico distal. Verificar se o corticóide pré-natal é fator de risco para a DRGE, bem como identificar os fatores de risco demográficos do RN, definir os fatores de risco referentes à evolução pós-natal do RN e determinar se alguns dos procedimentos e os medicamentos administrados ao RN são fatores de risco para a DRGE. Foi realizado um estudo observacional, retrospectivo, de caso-controle. O diagnóstico de DRGE foi estabelecido pelas manifestações clínicas e pelo índice de refluxo = 10%. Foram estudados todos os RN com DBP que receberam diagnóstico de DRGE por meio da monitorização do pH esofágico, em condições padronizadas, no período janeiro de 2001 a outubro de 2005, no Centro de Atenção Integral à Saúde da Mulher. O tamanho da amostra foi de 23 casos e igual número de controles, não emparelhados, que foram comparados quanto à idade gestacional, peso ao nascimento, gênero, uso de corticóide pré-natal, tempo de ventilação assistida, oxigenoterapia, tempo de uso de sonda gástrica, xantinas, idade pós-conceptual e peso à monitorização do pH esofágico. Para a análise estatística foram empregados, inicialmente, os testes de Qui-quadrado e o teste Exato de Fisher, para as variáveis categóricas e para as variáveis numéricas a comparação entre os grupos foi realizada pelo teste U de Mann-Whitney. Em seguida, para analisar a influência dos fatores de risco para a DRGE foi realizada análise por regressão logística univariada e múltipla para estabelecer o odds-ratio (OR) e o seu respectivo intervalo de confiança de 95% (IC). Foram considerados como significativos os valores de p< 0,05. Os dois grupos (com e sem DRGE) não apresentaram diferenças significativas em relação às variáveis demográficas, as de evolução pós-natal, ao uso de corticóide pré e pós-natal, bem como ao tempo de uso de cafeína, ventilação mecânica e oxigenoterapia. Entretanto, as variáveis: intolerância alimentar (OR 6,55; IC 1,05 - 40,8) e tempo de uso de sonda gástrica (OR 1,67; IC 1,11 - 2,51) associaram-se independentemente à DRGE. A maior idade pós-conceptual ao exame (OR 0,02; IC <0,001 - 0,38) foi identificada como fator protetor para a DRGE. O presente estudo permite inferir que o tempo prolongado de uso de sonda gástrica e a ocorrência de intolerância alimentar aumentam a probabilidade para a DRGE, em RNPT menores de 1500 gramas com DBP. Já a maior idade pós-conceptual ao exame diminui a chance para a DRGE. Estes achados merecem atenção e outros estudos, para maximizar a correlação dos fatores de risco para a DRGE em neonatos com DBP / Abstract: Gastroesophageal reflux disease (GERD) is the most common illness in neonatal period, and is considered an associated factor for respiratory diseases. However, several aspects of GERD are controversy and not appropriately known in premature. Bronchopulmonary dysplasia (BPD) is the most common chronic lung disease in very low birth weight (VLBW) infants. Due to shortage of information¿s about diagnosis of GERD in patients with BPD and considering the consequences about his morbidity, seems to us important to know the risk factors for the association, be able to collaborate with the improvement of quality of treatment. The objective of this study was to determine the risk factors for GERD in extremely low birth weight infants with BPD. A retrospective case-control study was realized, including 23 patients and 23 control subjects who were diagnosed by clinical manifestations and 24 hours esophageal pH monitoring presenting reflux index = 10%. All newborn with BPD were studied from January 2001 to October 2005 at the Center for Women¿s Integral Health Care. Cases and controls were compared for gestational age, birth weight, gender, antenatal steroid use, assisted ventilation time, oxygen therapy and time of feed tube use, xanthine, post conceptual age and weight on esophageal pH monitoring. For the statistic analysis were utilized, initially, the square¿ test and the Fisher¿s exact test for the numerical variables, and Mann-Whitney¿s test for category variables. Multiple logistic regression was made for to establish odds-ratio (OR) with confidence interval of 95% (CI). Were considered significant p< 0.05. Both groups (with and without GERD) didn¿t show significant differences on variables: demographics, postnatal evolution, prenatal and postnatal steroids use, caffeine utilization, mechanical ventilation and oxygen therapy. The variables feeding intolerance (OR 6.55; CI 1.05; 40.8) and time of gastric tube use (OR 1.67; CI 1.11; 2.51) showed be risk factors for GERD. The major post conceptual age on esophageal Ph monitoring (OR 0.02; CI <0.001; 0.38) showed be protector factor for GERD. The obtained data showed that a prolonged gastric tubes use and the feeding intolerance increase probability for GERD. While the major post conceptual age on esophageal pH monitoring decrease likelihood for GERD in premature neonates with BPD / Mestrado / Saude da Criança e do Adolescente / Mestre em Saude da Criança e do Adolescente

京都大学 / 新制・論文博士 / 博士(医学) / 乙第13438号 / 論医博第2237号 / 新制||医||1054(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 川上 浩司, 教授 滝田 順子, 教授 万代 昌紀 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

O presente estudo teve por objetivo: a) avaliar os indicadores de ansiedade, disforia e depressão em um grupo de mães de bebês nascidos pré-termo de muito baixo peso (GPT) e comparar esses indicadores com os de um grupo de mães de bebês nascidos a termo (GAT); b) comparar indicadores de ansiedade, disforia e depressão de mães de bebês nascidos prétermo de muito baixo peso avaliados em dois momentos distintos, durante o período de hospitalização do bebê e após a sua alta hospitalar; c) comparar os conteúdos verbais acerca do bebê, da amamentação e da maternidade expressos pelo grupo de mães de bebês pré-termo de muito baixo peso e pelo grupo de mães de bebês a termo. O GPT foi formado por 50 mães de bebês nascidos pré-termo de muito baixo peso (?1.500 gramas), enquanto que o GAT foi composto por 25 mães de bebês nascidos a termo com peso de nascimento igual ou superior a 2.500g. Foram utilizados os seguintes instrumentos e materiais: Entrevista Clínica Estruturada para DSM III?R (SCID/NP), Inventário de Ansiedade Traço-Estado (IDATE), Inventário de Depressão de Beck (BDI), Roteiro de Entrevista, Escala de Eventos Vitais e Prontuários médicos dos bebês. Primeiramente, aplicou-se a SCID/NP para a identificação das mães com antecedentes psiquiátricos, as quais foram excluídas da amostra final. Em seguida, para o GPT foram realizadas duas sessões, durante o período de hospitalização do bebê (1a avaliação): na primeira, aplicou-se o Roteiro de Entrevista e a Escala de Eventos Vitais e na segunda, foram aplicados os instrumentos IDATE e BDI. Após a alta hospitalar do bebê, foi realizada mais uma sessão com o GPT para reaplicação do IDATE e do BDI (2a avaliação). Para o GAT, os instrumentos de avaliação foram aplicados em uma única sessão, nos primeiros dias de vida do bebê. Em relação à análise de dados, os instrumentos de avaliação de ansiedade e disforia/depressão foram corrigidos de acordo com as normas dos testes e foram realizadas as análises comparativas entre os grupos (GPT X GAT) e intra-grupo (GPT ? 1a avaliação X GPT ? 2a avaliação). As respostas maternas ao Roteiro de Entrevista foram submetidas à análise de conteúdo temático e quantificadas em termos de freqüência e porcentagem. Os resultados mostraram uma incidência de 32% das mães do GPT e 4% das mães do GAT com escores indicativos de sintomas clínicos de ansiedade do tipo estado. A análise comparativa entre os grupos mostrou diferença estatisticamente significativa entre essas incidências; no GPT houve significativamente mais mães com sintomas clínicos de ansiedade-estado do que no GAT (p=0,006). Após a alta hospitalar dos bebês, houve uma redução estatisticamente significativa do número de mães do GPT com sintomas clínicos de ansiedade-estado (1a avaliação=35%; 2a avaliação=12%; p=0,006). Quanto aos conteúdos verbais maternos expressos pelos GPT e GAT, verificou-se que, no tópico sobre questões relacionadas ao bebê, 12% das mães do GPT verbalizaram sobre reações e sentimentos maternos, focalizadas predominantemente em emoções negativas, enquanto que apenas 1% do GAT apresentou esse tipo de verbalização. No tópico sobre amamentação, o GPT expressou mais preocupações e dúvidas em relação à amamentação (46%) do que as mães do GAT (4%), relativas principalmente ao leite materno secar, acabar ou ser insuficiente para satisfazer ao bebê. No tópico sobre maternidade, por sua vez, os dois grupos apresentaram conteúdos verbais semelhantes, predominando a identificação de diversos fatores que influenciam na maternidade (GPT=41%; GAT=47%). Os achados sugerem a necessidade de se avaliar indicadores de ansiedade e disforia/depressão em mães de bebês pré-termo de muito baixo peso, internados em UTIN, a fim de subsidiar decisões sobre o suporte psicológico oferecido às mães para regulação emocional, durante o período de internação hospitalar do bebê. / The aim of the present study was: a) to assess the indicators of anxiety, dysphoria and depression in a group of mothers of very low birthweight preterm neonates (GPT) and to compare these indicators with the ones of one group of mothers of fullterm neonates (GFT); b) to compare indicators of anxiety, dysphoria and depression of mothers of very low birthweight preterm neoantes that were assessed in two distinct moments, during the period of hospitalization and after their hospital discharge; c) to compare the verbal contents about the baby, the breastfeeding and the maternity that were expressed by the group of mothers of very low birthweight preterm neoantes and by the group of mothers of fullterm ones. The GPT was constituted by 50 mothers of neoantes that were born preterm and with very low birthweight (?1,500 grams), while the GFT was constituted by 25 mothers of neoantes that were born fullterm with birthweight equal or more than 2,500 grams. It was used the following instruments and materials: Structured Clinical Interview for DSM III-R Non-Patient (SCID/NP), State-Trait Anxiety Inventory (IDATE), Beck Depression Inventory (BDI), Interview Profile, Vital Events Scale and medical chart. First, it was administrated the SCID/NP to identify the mothers with psychiatric background, which were excluded from the final sample. After this, for the GPT, it was realized two sessions, during the hospitalization period of the baby (1st assessment): in the first one, it was administrated the Interview Profile and the Vital Events Scale, and in the second one, it was administrated the instruments IDATE and BDI. After the hospital discharge of the baby, it was realized one more session with the GPT for the re-administration of IDATE and of BDI (2nd assessment). For the GFT, the assessment instruments were administrated in only one session, in the first days of the baby?s life. In relation to the data analyses, the assessment instruments of anxiety, dysphoria/depression were corrected according to the tests? norms and it was realized the comparative analyses between groups (GFT X GPT) and within groups (GPT ? 1st assessment X GPT ? 2nd assessment). The maternal answers to the Profile Interview were submitted to the thematic content analyses and were quantified in terms of frequency and percentage. The results indicated incidence of 32% of the mothers of the GPT and 4% of the mothers of the GFT with scores that indicate clinical symptoms of anxiety-state type. The comparative analyses between groups showed statistically significant differences between these incidences; in the GPT there were significantly more mothers with clinical symptoms of anxiety-state than in the GFT (p=0,006). After the babies? hospital discharge, there was a statistically significant reduction in the number of mothers of the GPT with clinical symptoms of anxiety-state (1st assessment = 35%; 2nd assessment = 12%; p = 0,006). In relation to the maternal verbal contents that were expressed by GPT and GFT, it was verified that, in the topic about questions that are related to the baby, 12% of the mothers of the GPT verbalized about maternal feelings and reactions, focused, predominantly on negative emotions, while just 1% of the GFT presented this kind of verbalization. In the topic about breastfeeding, the GPT expressed more preoccupation and doubts related to breastfeeding (46%) than the mothers of the GFT (4%), these related principally to the fact of drying the maternal milk, finishing the milk or not being enough to satisfy the baby. In the topic about maternity, though, both groups presented similar verbal contents, predominating the identification of several factors that have influence in maternity (GPT = 41%; GFT = 47%). The findings suggest the necessity of assessing indicators of anxiety and dysphoria/depression in mothers of preterm and very low birthweight infants, that are admitted in the ICU, with the objective of subsiding decisions about the psychological support that is offered to the mothers to the emotional regulation, during the period of baby?s hospital admission.

LEITE, F. Influência da restrição de crescimento intra-uterino na idade da menarca: estudo da coorte de nascidos vivos de Ribeirão Preto de 1978/9. 2008. 85 p. Dissertação (Mestrado) apresentada à Faculdade de Medicina de Ribeirão Preto/USP. A idade da menarca é um marco da puberdade e, quando antecipada, parece estar associada a um maior risco de desenvolvimento de câncer de mama, síndrome metabólica e obesidade. É possível que alterações no ambiente intrauterino, como a restrição de crescimento do feto, levem a interferências no sistema hipotálamo-hipófise-gonadal resultando em alterações na idade da menarca. Em vista da controvérsia dos fatores que influenciam na idade da menarca, este estudo testou a hipótese da associação entre restrição de crescimento intra-uterino (baixo peso ao nascer, pequeno para idade gestacional, restrição intra-uterina de Kramer) e antecipação da idade da menarca. Em uma sub-amostra foi testada a possível interação entre a restrição de crescimento intra-uterino e o índice de massa corpórea. Para esse estudo foram utilizadas informações coletadas nos seguimentos de 1987/9 e 2004/5 de 1056 meninas nascidas em Ribeirão Preto, provenientes do estudo de coorte dos nascidos vivos em Ribeirão Preto de 1978/9. Menarca antecipada foi definida como primeiro sangramento vaginal ocorrido antes dos 12 anos de idade. Análise univariada foi seguida de análise bivariada e multivariada por meio de modelo generalizado empregando distribuição de Poisson para estimativa de riscos relativos e erro padrão por meio de método robusto. Os fatores de confusão controlados foram idade, escolaridade e situação conjugal da mãe, número de irmãos, comprimento ao nascer, prematuridade e índice de massa corpórea (apenas para a subamostra). Em média, a menarca ocorreu aos 12,3 anos (DP=1,5). A ocorrência de menarca antecipada foi de 27,7% (n= 293) para a coorte inteira e de 29,1% (n= 172) na sub-amostra. Foi encontrada associação negativa entre restrição de crescimento intra-uterino, seja representado por baixo peso ao nascer (Risco Relativo, RR= 0,47; Intervalo de Confiança de 95%, IC95%: 0,26-0,84), pequeno para idade gestacional (RR = 0,57;IC95%:0,37-0,89) ou restrição de Kramer (RR= 0,65; IC95%:0,47-0,92), com a antecipação da idade da menarca. Os resultados foram semelhantes na análise da sub-amostra, porém sem significância estatística. Quando o índice de massa corpórea foi considerado na análise da sub-amostra, não houve modificação dos resultados. Desta forma, este estudo demonstrou associação negativa entre restrição de crescimento intra-uterino e antecipação da idade da menarca, ou seja, a restrição de crescimento foi fator de proteção da menarca antecipada. / LEITE, F. Influence of intrauterine growth restriction on the age of menarche: the cohort study of live births of Ribeirao Preto in 1978/9. 2008. 85 p. Dissertation (Master) submitted to the Faculty of Medicine of Ribeirao Preto/USP. This study tested the hypothesis of association between intrauterine growth restriction and early age of menarche. For this study, follow-up data (n = 1056) from the population based livebirth cohort study of Ribeirao Preto of 19789 were analyzed. Early menarche was defined as having the first menstrual event before 12 years-old and intrauterine growth restriction was defined by three measurements: low birthweight (< 2500grs), small for gestational age (< 10% Williams growth curve) and fetal growth ratio (< 0.85 mean weight for gestational age). Relative risks were estimated by generalized estimation equations (Poisson distribution) with robust method for estimation of standard errors. Analyzes were adjusted for maternal age, education and marital status, number of siblings, birth length and preterm. Body mass index was tested as intervenient or interaction factor in a subsample of the cohort examined at 9 yrs-old. The mean age of menarche was 12.3 years (Standard Deviation = 1.5). Early menarche was observed for 27.7% for the entire cohort and 29.1% for the sub-sample. Negative association was observed between intrauterine growth restriction and early menarche. The adjusted relative risks and respective confidence intervals (95% CI) for low birth weight, small for gestational age and fetal growth ratio were respectively: 0.47 (95% CI: 0.26-0.84), 0.57 (95% CI: 0,37-0,89), and 0.65 (95%CI: 0,47-0, 92). No evidence that body mass index was an intermediate or interaction factor was observed. Thus, this study showed a negative association between intrauterine growth restriction and anticipation of age of menarche.

LEITE, F. Influência da restrição de crescimento intra-uterino na idade da menarca: estudo da coorte de nascidos vivos de Ribeirão Preto de 1978/9. 2008. 85 p. Dissertação (Mestrado) apresentada à Faculdade de Medicina de Ribeirão Preto/USP. A idade da menarca é um marco da puberdade e, quando antecipada, parece estar associada a um maior risco de desenvolvimento de câncer de mama, síndrome metabólica e obesidade. É possível que alterações no ambiente intrauterino, como a restrição de crescimento do feto, levem a interferências no sistema hipotálamo-hipófise-gonadal resultando em alterações na idade da menarca. Em vista da controvérsia dos fatores que influenciam na idade da menarca, este estudo testou a hipótese da associação entre restrição de crescimento intra-uterino (baixo peso ao nascer, pequeno para idade gestacional, restrição intra-uterina de Kramer) e antecipação da idade da menarca. Em uma sub-amostra foi testada a possível interação entre a restrição de crescimento intra-uterino e o índice de massa corpórea. Para esse estudo foram utilizadas informações coletadas nos seguimentos de 1987/9 e 2004/5 de 1056 meninas nascidas em Ribeirão Preto, provenientes do estudo de coorte dos nascidos vivos em Ribeirão Preto de 1978/9. Menarca antecipada foi definida como primeiro sangramento vaginal ocorrido antes dos 12 anos de idade. Análise univariada foi seguida de análise bivariada e multivariada por meio de modelo generalizado empregando distribuição de Poisson para estimativa de riscos relativos e erro padrão por meio de método robusto. Os fatores de confusão controlados foram idade, escolaridade e situação conjugal da mãe, número de irmãos, comprimento ao nascer, prematuridade e índice de massa corpórea (apenas para a subamostra). Em média, a menarca ocorreu aos 12,3 anos (DP=1,5). A ocorrência de menarca antecipada foi de 27,7% (n= 293) para a coorte inteira e de 29,1% (n= 172) na sub-amostra. Foi encontrada associação negativa entre restrição de crescimento intra-uterino, seja representado por baixo peso ao nascer (Risco Relativo, RR= 0,47; Intervalo de Confiança de 95%, IC95%: 0,26-0,84), pequeno para idade gestacional (RR = 0,57;IC95%:0,37-0,89) ou restrição de Kramer (RR= 0,65; IC95%:0,47-0,92), com a antecipação da idade da menarca. Os resultados foram semelhantes na análise da sub-amostra, porém sem significância estatística. Quando o índice de massa corpórea foi considerado na análise da sub-amostra, não houve modificação dos resultados. Desta forma, este estudo demonstrou associação negativa entre restrição de crescimento intra-uterino e antecipação da idade da menarca, ou seja, a restrição de crescimento foi fator de proteção da menarca antecipada. / LEITE, F. Influence of intrauterine growth restriction on the age of menarche: the cohort study of live births of Ribeirao Preto in 1978/9. 2008. 85 p. Dissertation (Master) submitted to the Faculty of Medicine of Ribeirao Preto/USP. This study tested the hypothesis of association between intrauterine growth restriction and early age of menarche. For this study, follow-up data (n = 1056) from the population based livebirth cohort study of Ribeirao Preto of 19789 were analyzed. Early menarche was defined as having the first menstrual event before 12 years-old and intrauterine growth restriction was defined by three measurements: low birthweight (< 2500grs), small for gestational age (< 10% Williams growth curve) and fetal growth ratio (< 0.85 mean weight for gestational age). Relative risks were estimated by generalized estimation equations (Poisson distribution) with robust method for estimation of standard errors. Analyzes were adjusted for maternal age, education and marital status, number of siblings, birth length and preterm. Body mass index was tested as intervenient or interaction factor in a subsample of the cohort examined at 9 yrs-old. The mean age of menarche was 12.3 years (Standard Deviation = 1.5). Early menarche was observed for 27.7% for the entire cohort and 29.1% for the sub-sample. Negative association was observed between intrauterine growth restriction and early menarche. The adjusted relative risks and respective confidence intervals (95% CI) for low birth weight, small for gestational age and fetal growth ratio were respectively: 0.47 (95% CI: 0.26-0.84), 0.57 (95% CI: 0,37-0,89), and 0.65 (95%CI: 0,47-0, 92). No evidence that body mass index was an intermediate or interaction factor was observed. Thus, this study showed a negative association between intrauterine growth restriction and anticipation of age of menarche.

Objetivos: Diversos trabalhos documentaram a associação entre o fumo ativo na gestação e a redução no peso,comprimento e perímetro cefálico dos recémnascidos. Porém, existem controvérsias quanto aos efeitos do fumo passivo. Esse estudo buscou colaborar na elucidação sobre os efeitos da exposição da gestante ao fumo nas medidas antropométricas do recém-nascido. Métodos: Estudo transversal, que incluiu 200 parturientes, identificando a intensidade da exposição das mesmas ao fumo através da mensuração da cotinina urinária e do auto-relato sobre seu hábito tabágico e de seus familiares,o que possibilitou categorizá-las em não fumantes, fumantes passivas e fumantes ativas e posterior comparação com as medidas antropométricas dos recémnascidos. Resultados: Encontramos uma diferença estatisticamente significativa no peso,quando comparamos as fumantes passivas às não fumantes, -152g (IC95%: -285 a -18;P=0,026) e a diferença encontrada nas fumantes ativas foi de - 159g (IC95%: -301 a -16; P=0,029), em relação às não fumantes. Na medida do comprimento, observou-se uma diferença significativa entre as fumantes passivas, -0,8cm (IC95%: -1,4 a -0,2;P=0,012) em relação às não fumantes, e entre as fumantes ativas a diferença foi de -1,0cm (IC95%: -1,6 a -0,3;P=0,003), quando comparado às não fumantes. Quanto à medida do perímetro cefálico, não foram observadas diferenças significativas quando os grupos, das fumantes passivas e fumantes ativas, foram comparados ao grupo das não fumantes. Conclusões: Os resultados sugerem que o fumo passivo durante a gestação pode apresentar efeitos semelhantes aos do fumo ativo nas medidas antropométricas dos recém-nascidos. / Objectives: Several studies have documented the association between active smoking during pregnancy to weight, height and head circumference reduction on newborns. However, there are controversies about the passive smoking. The present study sough the elucidation of the effects of tobacco exposition of pregnant women on anthropometric measurements of newborns. Methods: Cross-sectional study, including 200 in labor women, identifying the intensity of their exposition to tobacco through the measurement of urine cotinine and the self reported information about the smoking habit of their relatives and themselves, what allowed us to classify them as non-smokers, passive smokers and active smokers and later the comparison with the anthropometric measurements of newborns. Results: We found a statistically significant difference in weight when comparing passive smokers to non-smokers, -152g (CI 95%: -285 to –18; P=0.026) and the difference found on active smokers was - 159g (CI 95%: -301 to 16; P=0.029) when compared to non-smokers. On the height measurements, a significant difference was found within the group of passive smokers, -0,8 cm (CI 95%: -1,4 to -0.2; P=0.012) comparing to the non-smokers group, within the smokers group the difference was -1,0 cm (CI 95%: -1,6 to -0.3; P=0.003) when compared to nonsmokers. About the measurements of head circumference, no was found a significant difference when the passive smokers and active smokers group was compared to non-smokers group. Conclusions: The results suggest that the passive smoking during pregnancy may present similar effects as the active smoking on the anthropometric measurements of newborns.

Globally, the prevalence of Type 2 diabetes is rising. The most affected populations are those that have undergone recent and rapid transition towards a Western lifestyle, characterised by energy-dense diets and physical inactivity.¶ Two major hypotheses have attempted to explain the variation in diabetes prevalence, both between and within populations, beyond the contributions made by adult lifestyle. The thrifty genotype hypothesis proposes that some populations are genetically well adapted to surviving in a subsistence environment, and are predisposed to develop diabetes when the dietary environment changes to one that is fat and carbohydrate rich. The programming hypothesis focuses on the developmental environment, particularly on prenatal and early postnatal conditions: nutritional deprivation in utero and early postnatal life, measured by low birthweight and disrupted child growth, is proposed to alter metabolism permanently so that risk of diabetes is increased with subsequent exposure to an energy-dense diet. Both hypotheses emphasise discord between adaptation (genetic or developmental) and current environment, and both now put forward insulin resistance as a likely mechanism for predisposition.¶ Diabetes contributes significantly to morbidity and mortality among Australia’s Indigenous population. Indigenous babies are more likely to be low birthweight, and typical patterns of child growth include periods of faltering and rapid catch-up. Although there have been numerous studies in other populations, the programming hypothesis has not previously been tested in an Australian Indigenous community. The framework of the programming hypothesis is thus expanded to consider exposure of whole populations to adverse prenatal and postnatal environments, and the influence this may have on diabetes prevalence.¶ The present study took place in Cherbourg, a large Aboriginal community in southeast Queensland with a high prevalence of diabetes. Study participants were adults with diagnosed diabetes and a random sample of adults who had never been diagnosed with diabetes. Data were collected on five current risk factors for diabetes (general and central obesity, blood pressure, age and family history), in addition to fasting blood glucose levels. A lifestyle survey was also conducted. Participants’ medical records detailing weight growth from birth to five years were analysed with regard to adult diabetes risk to determine whether childhood weight and rate of weight gain were associated with subsequent diabetes. Adult lifestyle factors were xiialso explored to determine whether variation in nutrition and physical activity was related to level of diabetes risk.¶ Approximately 20% of adults in Cherbourg have diagnosed diabetes. Prevalence may be as high as 38.5% in females and 42% in males if those who are high-risk (abnormal fasting glucose and three additional factors) are included. Among those over 40 years, total prevalence is estimated to be 51% for females and 59% for males.¶ Patterns of early childhood growth may contribute to risk of diabetes among adults. In particular, relatively rapid weight growth to five years is associated with both general and central obesity among adult women. This lends some qualified support to the programming hypothesis as catch-up growth has previously been incorporated into the model; however, although the most consistent association was found among those who gained weight more rapidly, it was also found that risk is increased among children who are heavier at any age.¶ No consistent associations were found between intrauterine growth retardation (as determined by lower than median birthweight and higher than median weight growth velocity to one and three months) and diabetes risk among women or men. A larger study sample with greater statistical power may have yielded less ambiguous results.¶ Among adults, levels of physical activity may be more important than nutritional intake in moderating diabetes risk, although features of diet, such as high intake of simple carbohydrates, may contribute to risk in the community overall, especially in the context of physical inactivity. A genetic component is not ruled out. Two additional areas which require further investigation include stress and high rates of infection, both of which are highly relevant to the study community, and may contribute to the insulin resistance syndrome.¶ Some accepted thresholds indicating increased diabetes risk may not be appropriate in this population. Given the relationship between waist circumference and other diabetes risk factors and the propensity for central fat deposition among women even with low body mass index (BMI), it is recommended that the threshold where BMI is considered a risk be lowered by 5kg/m2 for women, while no such recommendation is made for men.¶ There are a number of social barriers to better community health, including attitudes to exercise and obesity, patterns of alcohol and tobacco use and consumption of fresh foods. Some of these barriers are exacerbated by gender roles and expectations.¶