Les hypersignaux de la substance blanche (HSB), visualisables par IRM, ont été identifiés comme des facteurs intermédiaires potentiels entre le risque vasculaire et la survenue de troubles cognitifs. Cependant, la relation entre les HSB et la cognition n'est pas encore clairement comprise. L'objectif de ce travail était d'identifier des facteurs susceptibles de moduler les effets des HSB sur la cognition afin de comprendre pourquoi, pour une charge identique en hypersignaux, certains sujets développent des troubles cognitifs quand d'autres ne manifestent aucun symptôme. Six cent soixante sujets sains issus de la population générale et âgés de 65 à 80 ans (Etude ESPRIT) ont été suivis sur une période de 10 ans après avoir passé une IRM cérébrale à l'inclusion. Dans cet échantillon, nous avons montré que l'association entre HSB et troubles cognitifs s'amenuisait avec l'âge, s'observait seulement chez les individus peu éduqués, et chez les sujets avec un profil spécifique de distribution spatiale des HSB, défini par un volume total élevé et une concentration des HSB dans le lobe temporal. Ces résultats suggèrent qu'il existe une population particulière (plus jeune, moins éduquée et avec une répartition des HSB spécifique) chez qui les effets des HSB sur la cognition semblent plus marqués et / ou sont plus facilement détectables. Dans les futures études utilisant les HSB comme marqueur du risque vasculaire dans la cognition, il pourrait être pertinent de cibler plus spécifiquement ce type de population. / Cerebral white matter hyperintensities (WMH), detected in vivo with MRI, are commonly used to assess cerebrovascular burden in cognitive impairment. However, the association between WMH and cognition is not consistent the across literature. In our longitudinal population-based study of 660 subjects aged 65 years and over with a brain MRI at baseline (ESPRIT Study), we aimed to identify factors that may modulate the effects of WMH on cognition. During the 10-year follow-up period, we observed that the association between WMH and cognitive impairment became weaker with advancing age, was only observed when the relationship was examined in low-educated individuals, and in patients with a specific spatial distribution of WMH, defined by a severe total WMH load with a high proportion of hyperintensities in the temporal lobe. These results suggest that there is a particular population (younger, less educated and with a specific distribution of WMH) in which the effects of WMH are more severe and/ or more easily detectable. In future studies using WMH as a marker of vascular burden in cognition, this particular population should be specifically considered.

Alterações morfométricas cerebrais em pacientes com esquizofrenia têm sido descritas em muitos estudos utilizando ressonância magnética estrutural, sendo as mais consistentes o aumento ventricular e a redução do volume de substância cinzenta em neocórtex pré-frontal e temporal, ínsula, tálamo e no hipocampo/giro parahipocampal. No entanto, a natureza e o curso dessas alterações ainda não foram esclarecidos. Embora a principal hipótese a respeito da etiopatogenia da esquizofrenia sugira a presença de alterações anatômicas de início precoce e estáveis ao longo da doença, estudos longitudinais de ressonância magnética estrutural a partir do primeiro episódio psicótico têm indicado que, apesar de observáveis já no início da doença, ou mesmo antes do surgimento da mesma, algumas alterações podem ser progressivas, principalmente nos primeiros anos. Neste trabalho, foi comparado, transversal e longitudinalmente, o volume de substância cinzenta entre pacientes com esquizofrenia e transtorno esquizofreniforme após o primeiro contato com serviços de saúde e controles não psicóticos. As imagens de ressonância magnética estrutural de 62 pacientes e 94 controles procedentes da mesma área de captação, recrutados a partir de um estudo epidemiológico na cidade de São Paulo, foram adquiridas em um aparelho de 1,5 Tesla. Após um intervalo médio de 16 meses, 39 pacientes e 52 controles foram reexaminados. As imagens foram analisadas pelo método de morfometria voxel-a-voxel com o uso do programa Statistical Parametric Mapping e a significância estatística foi estabelecida em p<0,05, corrigido para comparações múltiplas. A comparação inicial entre os grupos evidenciou áreas de redução de substância cinzenta nos pacientes em córtex pré-frontal direito e esquerdo, córtex temporal superior esquerdo, ínsula bilateral e hipocampo e giro parahipocampal direitos. A análise longitudinal evidenciou maior grau de preservação de substância cinzenta no grupo dos pacientes em córtex temporal superior esquerdo e em hipocampo/giro parahipocampal direitos. Não houve áreas de perda significativamente maior de substância cinzenta em pacientes comparados aos controles na análise longitudinal. Não foi encontrada diferença de volume de substância cinzenta entre pacientes com maior ou menor tempo de exposição aos antipsicóticos, tanto à análise inicial, quanto à análise longitudinal. Os resultados da análise transversal estão de acordo com a literatura sobre alterações cerebrais estruturais em primeiro episódio psicótico. Os achados da investigação longitudinal estão de acordo com alguns estudos de seguimento e apontam para a possibilidade de que essas alterações surgiriam antes do primeiro episódio psicótico. Além disso, tais resultados sugerem que, pelo menos durante o intervalo pesquisado, tais alterações não são progressivas. As diferenças volumétricas entre pacientes e controles não foram causadas pelo uso de antipsicóticos / Morphometric brain abnormalities have been extensively described in subjects with schizophrenia in many structural magnetic resonance imaging studies, the most consistent findings being ventricular enlargement and gray matter reductions in frontal and temporal neocortices, insula, thalamus and hippocampus/parahippocampal gyri. However, the nature and course of these abnormalities have not yet been clarified. Although the main hypothesis regarding the etiopathology of schizophrenia implies the presence of early and stable anatomical brains abnormalities, longitudinal magnetic resonance imaging studies have suggested that, despite being present at the first episode of psychosis, or even before its onset, some brain abnormalities may be progressive, especially at the first few years of the disorder. In the present study, gray matter volumes were compared, at baseline and longitudinally, between first-episode patients with schizophrenia or schizophreniform disorder and non-psychotic controls. Structural magnetic resonance images from 62 patients and 94 controls, recruited from the same catchment area for an epidemiological study in the city of São Paulo, were acquired using a 1.5 Tesla scanner. After a mean period of 16 months, 39 patients and 52 controls were rescanned. Images were analyzed by voxel-based morphometry with the Statistical Parametric Mapping software and statistical significance was set at p<0.05, corrected for multiple comparisons. The initial betweengroup comparison revealed gray matter reductions in patients, when compared to controls, in the right and left prefrontal cortices, left superior temporal cortex, bilateral insula and right hippocampus and parahipocampal gyrus. Longitudinally, patients exhibited significantly greater gray matter preservation in left superior temporal cortex and right hippocampus/ parahipocampal gyrus. There were no areas showing significantly greater gray matter loss in patients relative to controls in the longitudinal analysis. There were no gray matter differences between medicated and unmedicated patients, neither at baseline nor at follow-up. The findings of the baseline comparison are in accordance with previous studies that reported brain abnormalities in association with first episode psychosis. The longitudinal results are in accordance with some of the follow-up neuroimaging studies conducted to date and support the hypothesis that the described abnormalities could have been present before the onset of illness. Also, these findings suggest that, at least considering the follow-up interval of our study, such brain changes are not progressive. The volumetric differences between patients and controls observed in our study were not caused by antipsychotic medication effects

INTRODUÇÃO: Os processos oxidativos têm sido implicados no envelhecimento cerebral. O consumo de frutas e hortaliças, fontes de vitaminas antioxidantes, poderia estar relacionado à melhores performances em testes cognitivos e à prevenção do comprometimento cognitivo em idosos. OBJETIVO: Investigar as possíveis associações entre o consumo de frutas e hortaliças, e de vitaminas antioxidantes provenientes destes alimentos, e o funcionamento cognitivo de idosos de baixa renda do município de São Paulo. MÉTODOS: O presente estudo é parte da coorte prospectiva de base populacional São Paulo Ageing & Health Study (SPAH), com idosos com 65 anos ou mais, residentes de áreas pobres do Distrito do Butantã, zona oeste do município de São Paulo. Após identificação, foram conduzidas entrevistas nos domicílios dos participantes, seguindo um protocolo padronizado. O funcionamento cognitivo foi avaliado pelo Community Screening Instrument for Dementia (CSI-D) e o comprometimento cognitivo foi definido como escores cognitivos 1,5 desvios-padrão da média. O consumo de frutas e hortaliças foi estimado pela aplicação das respectivas seções de um Questionário de Freqüência Alimentar (QFA) desenvolvido para população da Região Metropolitana de São Paulo, a partir do qual também foram obtidas as ingestões individuais de carotenóides (alfa e beta-caroteno, licopeno, beta-criptoxantina, luteína/zeaxantina) e vitamina C. Avaliamos as associações entre o consumo de frutas e hortaliças e o funcionamento ou comprometimento cognitivo (sim/não) por modelos de regressão linear múltipla e regressão logística multivariada, respectivamente, em dois momentos diferentes no tempo: na inclusão da coorte (2003-2005) e no seguimento, 2 anos depois (2005-2007). RESULTADOS: Na análise transversal (n=1849), realizada na inclusão do SPAH, o consumo elevado de frutas e hortaliças combinadas (508g/dia) representou um aumento médio de 0,87 pontos (I95%C 0,43- 1,32) no escore de funcionamento cognitivo dos idosos, após o ajuste por potenciais variáveis de confusão. O consumo diário de beta-caroteno dos participantes do maior quartil de consumo (3,2mg/dia) resultou num aumento médio de 1 ponto no escore cognitivo. Idosos que atingiram as recomendações da Organização Mundial de Saúde (OMS) para a ingestão diária adequada de frutas e hortaliças combinadas (400g/dia) tiveram um risco 42% menor de apresentar declínio cognitivo. Nas análises de seguimento (n=1428; 17,8% de perdas), consideramos como exposição principal a média do consumo de frutas e hortaliças entre as duas aplicações do QFA e os desfechos foram o escore de funcionamento cognitivo ou o comprometimento cognitivo (sim/não), após 24 meses. As associações que encontramos mantiveram a mesma direção daquelas que observamos nas análises da inclusão, porém, esta tendência não foi significativa. CONCLUSÃO: Embora apenas 19,8% dos participantes tenham atingido as recomendações atuais da OMS para ingestão diária de frutas e hortaliças, nossos resultados apontaram na direção do papel protetor do consumo adequado destes alimentos, e de beta-caroteno, na preservação do funcionamento cognitivo de idosos. Políticas públicas de incentivo ao consumo de frutas e hortaliças no Brasil, com foco em idosos de baixa renda e escolaridade, devem ser instituídas, visando a preservação do funcionamento cognitivo nesta população. / BACKGROUND: Oxidative processes have been implicated in brain ageing. The intake of fruits and vegetables, sources of antioxidants vitamins, could be related to better performances in cognitive tests and to the prevention of cognitive impairment in elders. OBJECTIVE: To investigate the possible associations between fruits and vegetables intake, and antioxidants provided by these foods, and cognitive function in low income elderly of the city of São Paulo. METHODS: The present study is part of the population-based prospective cohort São Paulo Health & Angeing Study (SPAH), with elders of 65 years-old or more, residents of poor areas of the Butantã district, in the western side of São Paulo. After identification, interviews were conducted in the participants homes, following a standardized protocol. The cognitive function was assessed by the Comunnity Screening Instrument for Dementia (CSI-D) and cognitive impairment was defined as escores 1.5 standarddeviations of the mean. The fruits and vegetables intake was estimated by the administration of the respective sections of a Food Frequency Questionnaire (FFQ), developed to the Metropolitan Region of São Paulo population, from wich it was also obtained the individual intake of carotenoids (alfa and beta-carotene, lycopene, beta-criptoxantin, lutein/zeaxantin) and vitamin C. The associations between the fruits and vegetables intake, and antioxidant intake, and the congitive function or impairment (yes/no) were investigated using multiple linear regression and logistic regression, respectivelly, in two different moments in time: in the cohort baseline (2003- 2005) and in the follow-up, 2 year later (2005-2007). RESULTS: In the crosssectional analysis (n=1849), carried out in baseline of SPAH, the combined high intake of fruits and vegetables (508g/day) represented an average increase of 0.87 points (CI95% 0.43-1.32) in the score of cognitive function of the elderly, after adjustment for potential confounder. The daily intake of beta-carotene of the participants of the highest quartile of consumption (3.2mg/day) resulted in an average increase of 1 point in the cognitive score. The elders that accomplished the World Health Organization (WHO) recommendations for the adequate daily intake of fruits and vegetables (400g/dia) presented a risk 42% lower of cognitive impairment. In follow-up analysis (n=1428; 17.8% of losses), we considered the mean intake of fruits and vegetables, and antioxidants, between the two administrations of the FFQ as the main expositions and the outcomes were the score of cognitive function and the cognitive impairment (yes/no), after 24 months. The associations that we found have maintained the same directions of those we have observed in the baseline analysis, but this tendency was not significant. CONCLUSIONS: Although only 19.8% of the participants have reached the current WHO recommendations for the daily intake of fruits and vegetable, our findings pointed in the direction of the protector role of the adequate consumption of these foods, and of beta-carotene, in the preservation of cognitive function in the elderly. Public policies to increase the intake of fruits and vegetables in Brasil, focusing at low income and low schooling elders, should be instituted for the cognitive impairment prevention in this population.

Introdução - Exposições adversas relacionadas ao estado nutricional na gestação têm sido associadas a desfechos desfavoráveis para a saúde materno-infantil. Nesse contexto, a deficiência de vitamina A (VA) é uma das carências nutricionais mais relevantes para a saúde dessa parcela da população, especialmente nos países em desenvolvimento. Objetivos - a) investigar preditores da concentração de retinol sérico no início do terceiro trimestre de gestação (Artigo 1), b) investigar a associação entre estado nutricional de VA durante a gestação e anemia materna no parto e peso ao nascer (Artigo 2) e c) investigar a prevalência e fatores associados com a cegueira noturna gestacional (XN) e anemia materna no parto (Artigo 3) em Cruzeiro do Sul, Acre, Amazônia Ocidental Brasileira. Métodos - Trata-se de estudo de coorte de nascimentos (MINA-Brasil: Saúde e Nutrição Materno-Infantil no Acre), a partir do recrutamento de gestantes do município. Entre fevereiro/2015 e maio/2016, gestantes inscritas no prénatal da área urbana foram rastreadas (n = 587) e dois inquéritos realizados: 1ª avaliação com 16-20 semanas de gravidez e a 2ª avaliação com 27-30 semanas de gestação. Informações sobre condições sociodemográficas, ambientais, histórico de saúde e estilo de vida, medidas antropométricas, coleta de sangue em jejum e exame de ultrassonografia foram obtidas pela equipe de pesquisa. Posteriormente, entre julho/2015 e junho/2016, foi realizado registro diário das internações para parto na única maternidade do município com coleta de informações sobre desfechos de interesse para o presente estudo. Modelos de regressão múltiplos de Poisson e lineares foram utilizados nas análises estatísticas, ao nível de significância P<0,05. Resultados - No Artigo 1 (n = 422), a presença de fumante no domicílio foi inversamente associado às concentrações de retinol sérico na gravidez (&#946;: -0,087; IC 95%: -0,166, -0,009); por outro lado, a sazonalidade (inverno amazônico - &#946;: 0,134; IC 95%: 0,063, 0,206), o consumo semanal de frutos amazônicos (ricos em carotenoides - &#946;: 0,087; IC 95%: 0,012, 0,162) e a concentração de retinol entre 16-20 semanas de gestação (&#946;: 0,045; IC 95%: 0,016, 0,074) foram positivamente associados à concentração de retinol sérico no início do terceiro trimestre gestacional. No Artigo 2 (n = 488), independente do momento avaliado na gestação, a deficiência de VA foi associada ao risco para anemia materna (RP: 1,39; IC 95%: 1,05, 1,84) e inversamente associada com as concentrações de hemoglobina materna no parto (&#946;: -3,34; IC 95%: -6,48, -0,20), após ajuste para covariáveis. No mesmo sentido, associação inversa também foi observada para o peso ao nascer (&#946;: -0,10; IC 95%: -0,20, -0,00), contudo, perdendo a significância estatística após ajuste para concentrações de ferritina plasmática. No Artigo 3 (n = 1.525), altas prevalências de cegueira noturna gestacional (11,54%) e anemia materna no parto (39,38%) foram encontradas nesta população. Os fatores associados à cegueira noturna foram o número de pessoas no domicílio (cinco ou mais- RP: 2,06; IC 95%: 1,24, 3,41), fumo na gestação (RP: 1,78; IC 95%: 1,15, 2,78) e ter realizado menos de seis consultas de pré-natal (RP: 1,61; IC 95%: 1,08, 2,40). Os fatores associados à anemia materna foram: ser adolescente (< 19 anos - RP: 1,18; IC 95%: 1,01, 1,38), malária na gestação (RP: 1,22; IC 95%: 1,01, 1,49), não ter usado suplementos na gestação (RP: 1,27; IC 95%: 1,01, 1,62) e o número de consultas de pré-natal (< 6 consultas - RP: 1,40; IC 95%: 1,15, 1,70) Conclusão - Em município da Amazônia Ocidental Brasileira, a carência de VA associou-se ao risco para anemia no parto e foi inversamente associada à hemoglobina materna e o peso ao nascer do bebê. Estratégias e ações para promoção da alimentação saudável e nutrição da mulher no pré-natal precisam ser reavaliadas visando redução dos efeitos adversos da carência de VA para o binômio mãe-filho. / Introduction - Adverse exposures related to antenatal nutrition care have been associated with poor maternal and child outcomes. In this sense, vitamin A (VA) deficiency is a relevant public health issue for this vulnerable population, especially in developing countries. Objectives - a) to investigate the predictors of serum retinol at the beginning of the third trimester of pregnancy (Article 1), b) to investigate associations between the VA status during pregnancy with the occurrence of maternal anemia and birth weight (Article 2), and c) to investigate the prevalence, as well as the associated factors with gestational night blindness and maternal anemia (Article 3) in Cruzeiro do Sul, Acre State, Western Brazilian Amazon. Methods - Prospective birth cohort study (MINA-Brazil: Maternal and Child Health and Nutrition in Acre State), starting with recruitment of pregnant women. Between February/2015 and May/2016, pregnant women registered in antenatal clinics in the urban area of Cruzeiro do Sul were screened (n = 587) and two follow-up surveys were performed: the 1st one between 16 to 20 weeks of pregnancy and the 2nd one between 27 to 30 weeks of pregnancy. Socioeconomic, environmental, health history and lifestyle, anthropometric measures, blood samples, and ultrasounds data were gathered by the research team. Subsequently, between July/2015 and June/2016, daily visits to the municipal maternity hospital were performed in order to register all births and the outcomes of interest for this study. Multiple Poisson and linear regression models were used for statistical analysis, at P<0.05. Results - In the Article 1 (n = 422), having a smoker in the household was inversely associated with serum retinol in pregnancy (&#946;: -0.087; 95% CI: -0.166, - 0.009); on the other hand, the seasonality (Amazonian winter - &#946;: 0.134; 95% CI: 0.063, 0.206), the weekly consumption of Amazonian carotenoid-rich fruits (&#946;: 0.087; 95% CI: 0.012, 0.162), and serum retinol in the first assessment (&#946;: 0.045; 95% CI: 0.016, 0.074) were positively associated with serum retinol at the beginning of the third trimester of pregnancy. In the Article 2 (n = 488), regardless the period assessed, VA deficiency was associated with the risk for maternal anemia (PR: 1.39; 95% CI: 1.05, 1.84), as well as it was inversely associated with maternal serum hemoglobin (&#946;: -3.34; 95% CI: -6.48, - 0.20), after adjustment for covariates. Similarly, inverse association was observed for the birth weight (&#946;: -0.10; 95% CI: -0.20, -0.00), even though it was no longer associated after adjustment for plasma ferritin. In the Article 3 (n = 1,525), high prevalence rate of gestational night blindness (11.5%) and maternal anemia (39.4%) were observed. Associated factors with gestational night blindness were the number of people in the household (five or more- PR: 2.06; 95% CI: 1.24, 3.41), smoking during pregnancy (PR: 1.78; 95% CI: 1.15, 2.78), and the completeness of less than six antenatal care visits (PR: 1.61; 95% CI: 1.08, 2.40). Associated factors with maternal anemia were being teenage (< 19 years - PR: 1.18; 95% CI: 1.01, 1.38), gestational malaria (PR: 1.22; 95% CI: 1.01, 1.49), did not use any supplementation during pregnancy (PR: 1.27; 95% CI: 1.01, 1.62), and the number of antenatal care visits (< 6 visits - PR: 1.40; 95% CI: 1.15, 1.70). Conclusion - In a city in the Western Brazilian Amazon, the VA deficiency was associated with the risk for maternal anemia and was inversely associated with maternal serum hemoglobin and the birth weight. The current strategies and interventions targeting antenatal nutrition care must be reviewed in order to reduce the adverse effects for mother-child binomial caused by VA deficiency.

Objetivo: Analisar a influência dos cuidados maternos percebidos pelas mães sobre a frequência de aleitamento materno e aleitamento materno exclusivo, aos 3 e 6 meses de vida da criança em uma amostra expostas a diferentes ambientes intrauterinos. Métodos: Estudo observacional longitudinal, utilizando uma amostra de conveniência de mães e seus recém-nascidos, no qual os grupos foram classificados de acordo com as exposições maternas ocorridas no período gestacional, como diabetes mellitus, tabagismo ou desfecho do recém-nascido, como pequeno para idade gestacional, além de um grupo controle. Para algumas análises, os grupos em estudo foram subdivididos em grupo de condições intrauterinas adversas e grupo controle. A amostra foi selecionada em três hospitais de Porto Alegre, Rio Grande do Sul, Brasil, no período de 2011 a 2015. As mães e seus recém-nascidos foram avaliados ao nascimento, 7 e 15 dias, primeiro, terceiro e sexto mês de vida da criança. O aleitamento materno e o aleitamento materno exclusivo foram avaliados desde a entrevista do 15º dia até a entrevista do sexto mês de vida. Os questionários Parental Bonding Instrument (PBI), que avalia a percepção dos cuidados maternos e Edinburgh Postnatal Depression Scale (EPDS), que avalia a presença de sintomas depressivos após o parto, foram autoaplicados na entrevista do terceiro mês. Os testes utilizados foram ANOVA com post hoc de Tukey, teste Kruskal-Wallis com post hoc de Dunn, ANOVA de duas vias, ANCOVA e a Regressão de Poisson. As análises foram realizadas no programa Statistical Package for the Social Sciences versão 18.0. Resultados: A amostra foi composta de 212 duplas mãe/criança, 40 no grupo de mães com diabetes mellitus, 55 no grupo de tabagistas, 21 no grupo de nascidos pequenos para idade gestacional e 96 no grupo controle. A associação entre cuidado materno e amamentação entre os grupos em estudo mostrou que as mães que não praticavam mais o aleitamento materno no 3º mês de vida da criança apresentaram maiores escores na percepção de proteção e menores escores na percepção de cuidados maternos do que aquelas crianças que estavam em aleitamento materno exclusivo (p=0,038; p=0,017, respectivamente). O grupo controle apresentou maior escore na percepção de cuidados e menor escore na percepção de proteção materna em relação ao grupo de ambientes intrauterinos adversos (p=0,005, p=0,049, respectivamente). Em relação aos resultados da análise de regressão de Poisson entre amamentação, grupos, PBI e EPDS os dados mostram que, a cada um ponto a mais no protocolo de EPDS, o risco de não amamentar até 3 meses aumenta em 10,4% e até os 6 meses aumenta em 4,7% (p<0,001 e 0,004, respectivamente). Em relação ao aleitamento materno exclusivo, a cada um ponto a mais no protocolo de EPDS, o risco de não amamentar até 6 meses aumenta em 5,4% (p=0,002). As puérperas que perceberam restrição de carinho de suas mães aos 6 meses, apresentaram risco de 2,42% em relação à categoria de cuidado ótimo para não amamentar. Aquelas mães que perceberam suas mães como negligentes, apresentaram tendência de maior risco de 2,53% em relação à categoria de cuidado ótimo para não amamentar aos 6 meses de vida da criança. Conclusão: Os achados deste estudo sugerem que o estilo parental de baixo cuidado e de superproteção percebidos durante a infancia, interfere na frequencia do aleitamento materno e leva a sintomas depressivos após o parto. Demonstram, ainda, que os sintomas depressivos maternos após o parto influencia na frequencia da amamentação. / Objective: To analyze the influence of maternal care perceived by mothers on the frequency of breastfeeding and exclusive breastfeeding at 3 and 6 months of the child's life in a sample exposed to different intrauterine environments. Methods: A longitudinal observational study used a convenience sample of mothers and their newborns. They were classified according to maternal exposure occurring during pregnancy, such as diabetes mellitus, smoking or outcome newborn, the small for gestational age, and a control group. For some analyzes, the study groups were divided into two groups: the group of adverse intrauterine conditions and control group. The recruitment of participants was in three hospitals in Porto Alegre, Rio Grande do Sul, Brazil, from 2011 to 2015. The mothers and their newborns were evaluated at the newborns birth, 7 and 15 days, first, third and sixth month of child’s life. Breastfeeding and exclusive breastfeeding was evaluated from the 15th day to the sixth month of life, through questionnaires. The Parental Bonding Instrument questionnaires (PBI), which evaluates the perception of maternal care and Edinburgh Postnatal Depression Scale (EPDS), to assess the presence of depressive symptoms after delivery, were self-administered in the third month interview. The statistical tests used were ANOVA one-way with post hoc Tukey, Kruskal-Wallis test with post hoc Dunn, The two-way ANOVA, ANCOVA test and Poisson regression. Analyzes were performed using the Statistical Package for the Social Sciences version 18.0. Results: The sample was composed of 212 mothers with their child, 40 pairs in the diabetes mellitus group, 55 in the smokers group, 21 in small for gestational age group and 96 in the control group. The association between maternal care and breastfeeding among study groups showed that mothers who no longer practiced breastfeeding in the 3rd month of the child's life had higher scores in the perception of protection and lower scores in the perception of maternal care than those children who were in exclusive breastfeeding (p = 0.038, p = 0.017, respectively). The control group had higher scores of perceived care and lower perception of maternal protection in relation to the adverse intrauterine environment group (p=0.005, p=0.049, respectively). Regarding the results of the Poisson regression analysis between breastfeeding groups, PBI, and EPDS data show that each additional point on the EPDS protocol, the risk of not breastfeeding up to 3 months increased by 10.4% and up 6 months increases by 4.7% (p <0.001 and 0.004, respectively). Compared with exclusive breastfeeding, each additional point on the EPDS protocol, the risk of not breastfeeding up to 6 months increased by 5.4% (p = 0.002). The mothers realized that restriction affection from their mothers at 6 months had a risk of 2.42% compared to the great care category to not breastfeed. Those mothers who perceived their mothers as negligent tended to increase the risk of 2.53% compared to the great care category for not breastfeeding at 6 months of child's life. Conclusion: The findings of this study suggest that low care and overprotection parenting style perceived during childhood, interfere with the frequency of breastfeeding and leads to depressive symptoms after delivery. They also demonstrated those maternal depressive symptoms after birth influences breastfeeding frequency.

Nos últimos anos o padrão de consumo alimentar no Brasil sofreu diversas modificações por conta dos processos de transição nutricional, marcado intensamente pelo alto consumo de alimentos com elevado teor calórico, ricos em gorduras, açúcares simples, sódio e ao baixo consumo de frutas, hortaliças e alimentos in natura. Este trabalho de caráter longitudinal teve por principal objetivo avaliar a mudança do estado nutricional dos alunos da rede pública de educação básica de ensino de Guariba (estado de São Paulo), no triênio 2013-2016, estimando as variáveis associadas às mudanças do estado nutricional, e analisar a ingestão de energia, macronutrientes, vitaminas, minerais, fibra alimentar e sua relação com o estado nutricional. Para a avaliação nutricional dos alunos foram analisados os indicadores antropométricos (escore Z do Índice de Massa Corporal). As informações referentes ao consumo de alimentos, qualitativa e quantitativa, foram obtidas por meio da adoção de 2 (dois) Recordatórios 24h (nas duas fases - F1 e F2), e as prevalências de inadequação de consumo de micronutrientes foram calculadas utilizando as recomendações nutricionais indicadas para cada estrato etário. Merece destaque a prevalência de excesso de peso dos alunos (49,58%) principalmente no que tange a proporção de obesos (15,60%), e as mudanças significativas no aumento o IMC com o transcorrer do tempo. Quanto ao consumo de macronutrientes, carboidratos, proteínas e gorduras saturadas apresentam-se acima dos valores preconizados de recomendações dietéticas. Quanto aos micronutrientes, os achados assemelham-se aos dados nacionais quanto à inadequação de cálcio, magnésio, sódio e potássio. Foi possível captar associação entre a inatividade física, medido pelo \"tempo de tela\", com o aumento do IMC na segunda fase da pesquisa. O número de alunos inativos tende a um quadro favorável ao incremento das taxas de sobrepeso e obesidade na população estudada, uma vez que um elevado percentual dos alunos classificados como obesos são sedentários (96,43%, na Fase 2). Políticas de saúde públicas municipais direcionadas a orientação dos adolescentes matriculados nas escolas de educação básica de ensino urgem em ser implantadas, com o intuito de que esta população não apresente altos índices de doenças crônicas relacionadas à baixa qualidade da dieta, sedentarismo e excesso de peso na idade adulta. / In recent years the pattern of food consumption in Brazil has suffered several modifications on porpoise of nutritional transition, marked by the intensively high consumption of high-calorie, high in fats, simple sugars, sodium and low consumption of fruits, vegetables and unprocessed foods. This work of longitudinal character has main objective to evaluate the change of nutritional status of students in the public education of basic education Guariba (State of São Paulo), in the 2013-2016 three years, estimating the variables associated to changes of state nutritional, and analyze the energy intake, macronutrients, vitamins, minerals, dietary fiber and your relationship with nutritional status. For the nutritional evaluation of the students analyzed the anthropometric indicators (Z score of body mass index). Information relating to the consumption of food, qualitative and quantitative, were obtained through the adoption of 2 (two) 24 hour recall (in two phases-F1 and F2), and the prevalence of inadequacy of consumption of micronutrients were calculated using the recommendations indicated for each age stratum nutritional. The prevalence of overweight students (49.58%) especially regarding the proportion of obese (15.60%), and significant changes in increasing the body mass index (BMI) with the elapse of time. As for the consumption of macronutrients carbohydrates, proteins and fats are saturated above the recommended values of dietary recommendations. As for micronutrients, the findings are similar to national data regarding the inadequacy of calcium, magnesium, sodium and potassium. It was possible to capture association between physical inactivity, measured by \"screen time\", with the increase in BMI in the second phase of the research. The number of inactive students tends to favor the increasing rates of overweight and obesity in the population studied, since a high percentage of students classified as obese are sedentary (96.43%, in Stage 2). Municipal public health policies directed to guidance of adolescents enrolled in schools teaching basic education urge to be deployed, with the intention that this population with high rates of chronic diseases related to poor quality of diet, physical inactivity and overweight in adulthood.

Background: Persistent infection with high risk HPV is a necessary but insufficient cause of cervical cancer. Behavioural, viral and host factors modulate the risk of HPV persistence. In this thesis, I explore the role of the vaginal microbiota, a host factor and the presence of multiple HPV infections, a viral factor in HPV persistence. Considering the limited data on the epidemiology of HPV related diseases in low and middle-countries (LMIC), and the limited success of cervical cancer screening strategies in many LMIC, I provide data on the distribution of HPV related diseases in Nigeria and evaluate the acceptability of innovative strategies to increase cervical cancer screening uptake. Methods/Results: To achieve my aims, I implemented a longitudinal cohort study of 1,020 women in Nigeria. I begin my results chapters with two methodological papers. Attrition is an important consideration for every longitudinal cohort, particularly in LMIC, therefore, I present my findings on attrition, determinants of attrition and practical strategies to ensure low attrition in studies conducted in LMIC. Considering that sexual behaviour is an important potential confounder in all HPV studies, and the reliability of self-reported history is often questioned, I present findings on the test-retest reliability of self-reported sexual behaviour history collected in my study. Having found that attrition levels were low and that self-reported sexual behaviour history was generally reliable within my cohort, I present my findings on the association between the vaginal microbiota and persistent hrHPV; and the role of multiple HPV infections in viral persistence. I found that the vaginal microbiota was associated with persistent hrHPV in HIV negative women, but not in HIV positive women; and that multiple HPV infections did not increase the risk of viral persistence when compared to single HPV infections. Next, I present my findings on the prevalence and incidence of anogenital warts in Nigeria, with additional reports on the prevalence of cervical cancer and other HPV associated cancers using data from two population based cancer registries. Finally, I present my findings on the acceptability of innovative strategies to improve cervical cancer screening uptake in Nigeria. I found that Nigerian women had a favorable attitude to the use of HPV DNA based screening as part of routine antenatal care, however attitudes towards the use of self-sampling techniques for HPV based cervical cancer screening varied by religious affiliations. Conclusion: In my thesis, I was able to systematically investigate the epidemiology of HPV infections in a LMIC. I considered the distribution of HPV related diseases, host and viral determinants of HPV persistence and investigated control strategies to reduce the burden of cervical cancer in a LMIC. My results provide useful data for surveillance, monitoring and evaluation of control programs on HPV and cervical cancer in Nigeria and may be useful to cervical cancer control programs in other LMIC.

An individual’s life history is a sequence of events which eventually determine its contribution to the next generation, or fitness. These events are affected by environmental factors, genetic make-up and decisions made by an individual and its breeding partner. Recognition of these determinants helps to understand both short-term ecological changes and long-term evolutionary dynamics in a population. In this thesis long-term individual-based data on common gull (Larus canus) is used to study age-dependent reproductive success, survival, pair retention and breeding time. Collected pedigree data enabled to study genetic variation of traits and the selection on them. The reproductive success of common gulls increased steadily until very old age. This increase cannot be explained by selection effects, since individuals with lower breeding success were shown not to have lower survival. Consequently, this gain must be ascribed primarily to an age-related improvements of individual competence and/or increased reproductive effort. Annual survival of adult birds was age- and year-dependent. The latter was partly explained by winter severity. The size of the white spots on five outermost primaries predicted the bird’s future survival and divorce probabilities and hence, pair endurance capability. Gulls with larger spots enjoyed higher survival and lower divorce rates compared to birds with smaller spots. This suggests that the wing tip pattern might function as a condition dependent signal, revealing individual variation in quality. One of the advantages of persistent pair bond was the ability to start breeding early in the season. The timing of breeding of firm pairs advanced with time not only due to mates’ increasing age, but also owing to their experience together. Although both sexes had phenotypic effects on laying date, it was heritable only in females. On the phenotypic and genotypic level, early laying was under positive fecundity and survival selection in females.

The primary aim of the study was to develop knowledge about how unaccompanied asylum-seeking children manage their life circumstances and challenges after being granted a residence permit and maturing into adulthood in Sweden. A second aim was to develop knowledge about the life circumstances of these children in their respective countries of origin, the motives behind their flight to Sweden, the means by which they came to Sweden.  The thesis is a ten-year follow-up study. The first set of data is clinical in nature: 100 unaccompanied children were interviewed shortly after their arrival. Ten years later a register study was made of these now young adults. The research group was now reduced to the 68 young adults who remained in Sweden after receiving their permanent resident permits. Twenty of them were chosen for a qualitative interview by means of strategic sampling. The unaccompanied asylum-seeking children who, ten years after becoming permanent residents, remained in Sweden have become established in a favourable life situation as young adults. The process of becoming established in Sweden from the stressing conditions in the country of origin is marked by both risks and possibilities that occur in periodical sequences in the life course of the unaccompanied asylum-seeking children.  The children/youths may have come alone, but they did not remain alone. A majority were taken in hand by relatives in Sweden who were links to the family’s transnational network. The other children who had no family with which to reunite sought to establish transnational links on their own. A transnational perspective can shed light on how these young adults have created cross-national networks and this appears to have been of decisive importance for their socialisation and favourable establishment in Sweden.

The aim of this thesis was to identify risk factors for the onset of adult asthma. Other objectives were to study determinants of smoking habits and the association between sensitization and outcome of asthma. In 1990, a questionnaire was distributed to 12,732 individuals from three age groups (16, 30-39 and 60-69 years) in two counties of Sweden. In a second phase, 2538 subjects who had reported respiratory symptoms and 600 controls were invited to clinical investigations, 81% participated. At the follow-up in 2003 subjects of the remaining cohort (11,282) were re-invited. Analyses are based on the 67% (n=7563) who responded to both questionnaires 1990 and 2003. In 2003, 17.2% of the young adults, 11.4% of the middle-aged and 10.3% of the elderly reported having, or having had, asthma. A total of 791 subjects reported onset of asthma during the 13-year study period. Lifestyle factors such as smoking, obesity, hard physical training and a low consumption of fruit and fish were constant risk factors for onset of asthma after adjusting for socioeconomic group. A smoker’s risk of asthma onset was increased by 37%. The impact of risk factors differed between the age-groups. BMI had a significantly higher impact in the middle-aged and elderly. In subjects participating in the clinical investigations in 1990, sensitization to pets, were determinants of both persistent asthma and onset of asthma in 2003. The risk for persistent asthma was threefold. The risk for onset of asthma was more than doubled. Smoking at baseline in 1990 was the strongest determinant of being a smoker in 2003. Allergic sensitization and clinically verified asthma were not associated with smoking habits in 2003. No differences in changing smoking habits could be identified between smokers with or without asthma. In conclusion, modifiable lifestyle factors are important risk factors for adult onset asthma. The co-occurrence and interplay between asthma and cigarette smoking is still puzzling.