Age In Brazil Research Articles

Real-world effectiveness of original BNT162b2 mRNA COVID-19 against symptomatic Omicron infection among children 5–11 years of age in Brazil: A prospective test-negative design study

ObjectiveTo estimate original wild-type BNT162b2 effectiveness against symptomatic Omicron infection among children 5–11 years of age. MethodsThis prospective test-negative, case-control study was conducted in Toledo, southern Brazil, from June 2022 to July 2023. Patients were included if they were aged 5–11 years, sought care for acute respiratory symptoms in the public health system, and were tested for SARS-CoV-2 using reverse transcription polymerase chain reaction. In the primary analysis, we determined the effectiveness of two doses of original wild-type BNT162b2 against symptomatic COVID-19. The reference exposure group was the unvaccinated. ResultsA total of 757 children were enrolled; of these, 461 (25 cases; 436 controls) were included in the primary analysis. Mean age was 7.4 years, 49.7 % were female, 34.6 % were obese, and 14.1 % had chronic pulmonary disease. Omicron accounted for 100 % of all identified SARS-CoV-2 variants with BA.5, BQ.1, and XBB.1 accounting for 35.7 %, 21.4 % and 21.4 %, respectively. The adjusted estimate of two-dose vaccine effectiveness against symptomatic Omicron was 3.1 % (95 % CI, -133.7 % to 61.8 %) after a median time between the second dose and the beginning of COVID-19 symptoms of 192.5 days (interquartile range, 99 to 242 days). ConclusionIn this study with children 5–11 years of age, a two dose-schedule of original wild-type BNT162b2 was not associated with a significant protection against symptomatic Omicron infection after a median time between the second dose and the beginning of COVID-19 symptoms of 192 days, although the study may have been underpowered to detect a clinically important difference. Trial registration numberClinicalTrials.gov number, NCT05403307 (https://classic.clinicaltrials.gov/ct2/show/NCT05403307)

Major clinical and metabomic approaches to childhood obesity: a systematic review

Introduction: In the context of childhood obesity, of children under 5 years of age in Brazil, 7% are overweight and 3% meet the criteria for obesity. Globally, according to a report from the World Health Organization (WHO), it is estimated that the total number of overweight and obese children in the world could reach 75 million by the year 2025. Objective: It was to carry out a systematic review to present the main approaches to clinical and metabolomics of childhood obesity. Methods: The PRISMA Platform systematic review rules were followed. The research was carried out from February to April 2024 in the Scopus, PubMed, Science Direct, Scielo and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 110 articles were recruited for the initial evaluation. A total of 41 articles were evaluated and 19 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 28 studies with a high risk of bias and 28 studies that did not meet GRADE. Most studies showed homogeneity in their results, with X2=58.7%>50%. It was concluded that miRNAs are potential biomarkers for the development of pathologies, such as obesity. A heterogeneous group of these molecules was found to be associated with obesity in children. miR-15b-5p, miR-486-5p and hsa-miR-122-5p were considered good candidates for childhood obesity biomarkers. MiRNA-dependent mechanisms regulate up to 60% of all human genes. MiRNAs influence multiple pathways, including insulin signaling, immune-mediated inflammation, adipokine expression, adipogenesis, lipid metabolism, and regulation of food intake.

Epidemiological analysis of viral meningitis in children under 4 years of age in Brazil 2011–2021: Addressing prevalence, disparities, and public health challenges

Epidemiological analysis of viral meningitis in children under 4 years of age in Brazil 2011–2021: Addressing prevalence, disparities, and public health challenges

Percentiles of predicted 10-year cardiovascular disease risk by sex and age in Brazil and their association with estimated risk of long-term atherosclerotic events

ObjectiveExpressing the cardiovascular disease (CVD) risk in relation to peers may complement the estimation of absolute CVD risk. We aimed to determine 10-year CVD risk percentiles by sex and age in the Brazilian population and evaluate their association with estimated long-term atherosclerotic CVD (ASCVD) risk. MethodsA cross-sectional analysis of baseline data from the ELSA-Brasil study was conducted in individuals aged 40–74 years without prior ASCVD. Ten-year CVD risk and long-term ASCVD risk were estimated by the WHO risk score and the Multinational Cardiovascular Risk Consortium tool, respectively. Ten-year risk percentiles were determined by ranking the calculated risks within each sex and age group. ResultsTen-year CVD risk versus percentile plots were constructed for each sex and age group using data from 13,364 participants (55% females; median age, 52 [IQR, 46–59] years). Long-term ASCVD risk was calculated in 12,973 (97.1%) participants. Compared to individuals at the <25th risk percentile, those at the ≥75th percentile had a greater risk of being in the highest quartile of long-term risk (ORs [95% CIs] 6.57 [5.18–8.30] in females and 11.59 [8.42–15.96] in males) in regression models adjusted for age, race, education, and 10-year CVD risk. In both sexes, the association between risk percentile and long-term risk weakened after age 50. A tool for calculating 10-year CVD risk and the corresponding percentile is available at https://bit.ly/3CzPUi6. ConclusionsWe established percentiles of predicted 10-year CVD risk by sex and age in the Brazilian population, which independently reflect the estimated long-term ASCVD risk in younger individuals.

Treatment of drug-resistant tuberculosis in children and young adolescents in Brazil

IntroductionDrug-resistant tuberculosis (DR-TB) is a global threat and a challenge for public health authorities worldwide. In children, the diagnosis is even more challenging and DR-TB is poorly described in the literature, as are its treatment outcomes. In this study, we aimed to describe the treatment of drug-resistant TB in children and young adolescents in Brazil. MethodsA descriptive epidemiological study of treatment for DR-TB in children under 15 years of age in Brazil between 2013 and 2020. The primary data source was the Information System for Special Tuberculosis Treatments (SITE-TB). Categorical variables were analyzed using relative frequencies (%) and continuous variables by measures of central tendency to characterize the profile of the cases, namely: sociodemographic, clinical characteristics, procedures, tests performed and treatment success. In order to verify the distribution of cases, a spatial analysis was carried out based on the municipality where the cases resided. ResultsBetween 2013 and 2020, 19,757 tuberculosis (TB) cases occurred in children aged <15 years in Brazil, and 46 cases of treatment for DR-TB were reported during the same period (annual average of 6 cases). Of these, 73.9% were aged 10–14, 65.2% were male, 4.3% were HIV+ and 43.3% were underweight (BMI<18.5) at the start of treatment. 17.4% had previous contact with TB, 69.6% had primary resistance, 47.8% multidrug resistance. The median duration of treatment was 15 months. DOT and standardized treatment regimen were performed in 52.2% of cases. Bacilloscopy was performed for 97.8% (57.8% positive); culture for 89.1% (75.6% positive), rapid molecular test for 73.9% with proven resistance to rifampicin in 55.8%. Susceptibility testing revealed resistance mainly to isoniazid (87.8%) and rifampicin (60.6%). 73.9% of cases were successfully treated and one death was reported. Cases were treated in 26 Brazilian municipalities, with the majority in Rio de Janeiro (15) and São Paulo (4). ConclusionDR-TB treatment was recorded in <1% of general TB cases in children and young adolescents, suggesting underreporting of drug-resistant cases in the country. Despite the low number of registered cases, the data reflect the situation of DR-TB in this population and describe important aspects of the problem, as the child needs comprehensive, individualized care, with support from different professionals. We recommend a strengthening of the country's referral services for the care of children with DR-TB so that surveillance and health care services can work together to identify and follow up cases.

Prevalence of vitamin B complex deficiencies in women in reproductive age, pregnant, or lactating woman in Brazil: a systematic review and meta-analysis protocol

BackgroundVitamin B deficiencies are involved with several outcomes in fertility and pregnancy. In Brazil, the national prevalence rates of these micronutrient deficiencies in women of reproductive age were not known. This study aims to systematically identify, select, evaluate, analyze, and report the prevalence rates of vitamin B complex deficiencies in women of reproductive age in Brazil and identify variables that may modify the outcome rates.MethodsA systematic review will be conducted guided by the following question: “What is the prevalence of vitamin B deficiencies in women of reproductive age in Brazil?”. The studies will be identified and selected from a literature search using electronic databases, consultation with researchers/specialists, and reference lists of eligible studies and reviews on the topic. Major eligibility criteria include observational cross-sectional and cohort studies carried out in Brazil and performed in women 10–49 years old, or pregnant and lactating mothers, and investigated the deficiency of vitamin B complex by laboratory test. Two reviewers independently will perform the screening and selection of the studies, data extraction, and risk of bias assessment. For the data report, a narrative approach will be used to present the characteristics of the included studies and individual findings. A random meta-analysis model will be implemented to summarize the individual prevalence rates in a global value if the studies are sufficiently homogeneous.DiscussionThis study aims to identify the national and regional prevalence rates of vitamin B complex deficiencies in women of reproductive age; allow the policymakers discuss, plan, and implement public policies to screen; and prevent and/or treat these malnutrition conditions. This also aims to know the rates of nutritional deficiencies over the years, serving as an indirect indicator of the socioeconomic and dietary patterns of the population. Specifically for folate, this study allows to compare the prevalence rates of deficiency of this vitamin before and after the mandatory fortification of wheat and corn flours implemented since 2004 in Brazil, in this specific population. The evidence gathered may highlight the need for population-based studies to investigate the deficiency of these vitamins.Systematic review registrationPROSPERO CRD42020188474

Vaccination coverage of triple viral and poliomyelitis in Brazil, 2011-2021: temporal trend and spatial dependency.

To analyze the coverage of MMR and polio vaccines, the temporal trend and spatial dependence, in children up to one year of age in Brazil, between 2011 and 2021. Ecological study with secondary data on vaccination coverage rates, made available by the National Immunization Program Information System. Trend analysis was carried out using the joinpoint method, according to geographic regions, estimating the annual percentage change (APC) and its respective confidence interval (95%CI). Choropleth maps of distribution by health region were constructed and, subsequently, the spatial dependence was verified using Moran's statistics. Between 2011 and 2021, vaccination coverage declined in Brazil, both for MMR (APC: -6.4%; 95%CI -9.0; -3.8) and for poliomyelitis (APC: -4. 5%; 95%CI -5.5; -3.6). There was a decline in coverage of both vaccines in all geographic regions over the years of the study, except in the South and Midwest for the MMR vaccine. Since 2015, few health regions in the country have achieved adequate vaccination coverage (≥95.0% to <120.0%). The North and Northeast health regions showed low-low clusters in the univariate analysis for both immunobiological. It is urgent to consider studies like this one for the planning of more effective strategies for immunizing children, especially in areas with higher falls. In this way, barriers to access to immunization can be broken, given Brazil's heterogeneity, and access to reliable information that increases confidence in vaccine efficacy can be expanded.

Quality of care for children under two years of age in Brazil’s basic network in 2018: indicators and associated factors

To evaluate the quality of care for children under two years of age in the primary health care network with data from the external evaluation of the Program for the Improvement of Access and Quality of Primary Care in 2018. Users who had children under two years of age who were in the unit at the time of data collection were eligible for the study. The quality of care was evaluated using a synthetic indicator built with questions from the users' module. The exposure variables were: region, structure of basic health units, and staff process. A univariate analysis was performed and crude and adjusted prevalence ratios were estimated. The sample was composed of 15.745 users who had children under the age of two years. Only 36.8% (95%CI 36,0-37,6) of users were classified as having received good quality care for their children, with a downward trend in prevalence as the child's age increased. Better results were observed in the Northeast region, in units that presented all the inputs and vaccines and for teams that used protocols and materials, kept records, performed active search and healthy eating actions. The prevalence of good quality of care for children under two years of age was low. These data can be useful for managers' decision-making and for the implementation of actions aimed at professionals, that encourage a higher quality of care to children, mainly the child leaving a consultation with the next appointment scheduled and a first consultation being carried out until their seventh day of life.

ANÁLISE DOS REGISTROS DE CARDIOPATIAS CONGÊNITAS EM CRIANÇAS MENORES DE UM ANO NO BRASIL

OBJECTIVE: To describe the records of congenital heart diseases in children under one year of age in Brazil, from 1998 to 2018. METHOD: Descriptive, quantitative research that used DATASUS records for diagnoses and deaths due to malformations of the device as a data source. Cardiocirculatory flow in children under one year of age. The data were analyzed until 12/31/2018 and statistically analyzed by the software R. RESULTS: On the basis of SINASC, 26,841 diagnoses of congenital heart diseases were observed, with greater frequency in 2018 (11%), among males (57.3%), white color / race (57.02%) and in the southeast region (66.76%). At the base of the SIM, 60,931 deaths from congenital heart diseases were recorded, with a greater number in 2014 (5.45%), among males (54.01%), aged 28 to 364 days (47.17%), color / white race (51.37%) and southeast region (41.32%). There was significant statistics for the ratio of confirmed cases and deaths at the age of 0 to 6 days with (p = 0.01) and (p = 0.00) and from 28 to 364 days (p = 0.01) and (p = 0.02), respectively. CONCLUSION: The number of malformations found is alarming compared to the number of births. Consolidating such information prepares professionals to face the studied pathology.

IMPACT OF SARS-COV-2 VIRUS INFECTION IN CHILDREN UNDER 5 YEARS OLD IN A CITY IN BRAZIL´S NORTHEAST

Introduction: There are few reports about the impact of SARS-CoV-2 virus infection on children under 5 years of age in Brazil´s northeastern is no well-known. Objectives: To evaluate the clinical, demographic, laboratory characteristics and outcomes of children under five years of age with COVID-19, observed from April 2020 to April 2021 in the city of Cajazeiras, Paraíba. Material and Method: An observational, analytical, retrospective cohort study was conducted, using data collected from municipal epidemiological surveillance (E-SUS VE, SIVEP-flu), hospital records and home visits, of COVID-19 cases in children under 5 years of age, laboratory confirmed, in the first year of the pandemic, in the municipality of Cajazeiras, Paraíba. The database was created using SPSS software, and Pearson's chi-square or Fisher's exact tests were used for inferential statistical techniques, with a margin of error of 5.0% and intervals with a reliability of 95.0%. Results: Bivariate analysis showed a statistically significant association between age groups and clinical characteristics such as fever; coryza; headache; taste disorders; hypoactivity and elevated C-reactive protein. As well as, between the outcomes and the presence of history of: neuropathy; lung disease; bronchopneumonia; diabetes and neonatal O2 use. The most frequent diagnoses were: pneumonia; pleural effusion; ITRI; NRTI and Streptococcus Septicemia. In 18.9% of cases, clinical manifestations were observed after the acute phase of Covid-19. Conclusion: The reduced number of hospitalizations (2.2%) and the absence of deaths may suggest possible underdiagnosis and underreporting of deaths. Active surveillance and differentiated care are recommended for children with chronic diseases, who have vulnerability factors for the aggravation of COVID-19.&#x0D; Keywords: Child; SARS-CoV-2; Covid-19; Coronavirus; Infection.

P015 Nutrition Literacy Level Differentiates by Age, Gender, and Income in a Sample of Brazilian Adults

<h3>Background</h3> Nutrition literacy (NL) is the capacity to obtain, process, and understand nutrition information and skills needed to make appropriate nutrition decisions. NL is associated with sociodemographic characteristics and predicted adherence to healthy or unhealthy diet patterns among adults with chronic diseases and pregnant women in the US. However, little is known about the association of NL with sociodemographic characteristics in developing countries. <h3>Objective</h3> To assess the NL level and its association with sociodemographic characteristics in bank employees. <h3>Study Design, Setting, Participants</h3> Non-probablistic, quantitative and cross-sectional study carried out in 2020 in the Federal District (DF), Brazil with 1,174 workers aged ≥ 18 years old recruited from a financial institution . <h3>Measurable Outcome/Analysis</h3> NL was measured by the Nutrition Literacy Assessment Instrument for Brazilians (NLit-Br). We used the online version, validated with confirmed substantial reliability (ICC > 0.75). Sociodemographic questions (age, biological sex, Monthly Household Income (MHI) and education level) preceded NLit-Br. Descriptive analyses were used for NL and sociodemographic characteristics. Student's t-test and Analysis of Variance (ANOVA) were used to measure associations between NL with sociodemographic characteristics. <h3>Results</h3> Most participants were male (61%), with a graduate degree (74%) and with a MHI higher 7 minimum wages (MW), U$ 1515,31 (85%). The diagnosis of moderate NL level predominated among the population studied (62.3%). Participants who were females aged less than 40 years old and with MHI above U$ 1515,31 had statistically significant higher NL than participants who were male, aged over 49 years old and with an MHI below U$ 1082,36 (<i>P =</i> 0.00). <h3>Conclusions</h3> In this study, participants men, middle and older age (≥50 years old), and with a MHI below U$1298,84 (< 6 MW), had statistically significant lower NL scores. This is one of the first studies to report NL inequality for biological sex and age in Brazil. Future studies should further explore the NL inequality observed for Brazilian males, middle to older adults, and lower household income impacts on their dietary and health outcomes. <h3>Funding</h3> None

Spatiotemporal analysis of hospital admissions for primary care-sensitive conditions in women and children in the first 1000 days of life.

ObjectiveTo analyze the spatiotemporal distribution of hospital admission rates for primary care-sensitive conditions (PCSC) in women and children in the first 1000 days of life in Brazil.MethodsEcological study, with spatiotemporal analyses, using secondary data from Brazilian municipalities. PCSC in women, related to prenatal care and childbirth, and in children under two years old, from 2008 to 2019 were used to characterize trends and formations of spatiotemporal clusters/outliers. Crude PCSC rates were calculated and adjusted by the local empirical Bayesian method, presented in choropleth maps. We also used Anselin Local Moran I type analyses to identify spatial clusters, and space-time cube with clustering by emerging hotspot, followed by time series clustering, for analysis of spatiotemporal trends (alpha = 5%).ResultsA total of 1,850,776 PCSC were registered in pregnant women, puerperae, and children under two years of age in Brazil, representing 1.7% of the total number of hospital admissions in the period. PCSC rates showed different behaviors when the groups of women and children were evaluated, with a predominant growing trend of 109% in admissions in the first group and a reduction of 34.4% in the second. The North, Northeast, and Midwest regions had larger high-risk clusters and more significant increasing trends in PCSC in the two subpopulations studied.ConclusionsHealth actions and services in primary care may be reducing hospital admissions for children, but they are not being effective in reducing hospital admissions for women for causes related to prenatal care and childbirth, especially in the North, Northeast, and Midwest of Brazil. Investments in the qualification of care over the thousand days are urgent in the country.

Prevalence of vitamin A deficiency in women of childbearing age in Brazil: a systematic review and meta-analysis.

Vitamin A is an essential micronutrient, especially during pregnancy. We aimed to assess the prevalence of vitamin A deficiency in Brazilian women of childbearing age. We conducted a systematic review with meta-analysis of studies that assessed vitamin A deficiency in women of childbearing age following the registered protocol (CRD42020171856). Independent peer researchers selected the studies retrieved from MEDLINE, Embase, Scopus and other sources. Data from the eligible studies were extracted in pairs and assessed for methodological quality. The prevalence of vitamin A deficiency (< 0·70 µmol/l or <0·20 µg/dl) and 95 % CI was combined by meta-analysis, and heterogeneity was estimated by I2. Out of 3610 screened records, thirty-two studies were included, which assessed 12 577 women from 1965 to 2017, mostly in maternity hospitals. Main limitations of the studies were in sample frame (30/32) and sampling method (29/32). Deficiency occurred in 13 % (95 % CI 9·4, 17·2 %; I² = 97 %) of all women and was higher in pregnant women (16·1 %; 95 % CI 5·6, 30·6 %; I² = 98 %) than non-pregnant women (12·3 %; 95 % CI 8·4, 16·8 %; I² = 96 %). The prevalence increased according to the decade, from 9·5 % (95 % CI 1·9–21·6 %; I² = 98 %) up to 1990, 10·8 % (95 % CI 7·9, 14·2 %; I² = 86 %) in the 2000s and 17·8 % (95 % CI 8·7, 29·0 %; I² = 98 %) in the 2010s. Over 10 % of Brazilian women in childbearing age were deficient in vitamin A. Higher prevalence was observed in pregnant women, and deficiency seemed to be increasing over the decades. Low representativeness of the studies, mainly based on convenience sampling that included pregnant, postpartum, lactating and non-pregnant women, as well as high heterogeneity, limits the findings.

Comparison of two microscopic interpretations of vaginal microbiota with molecular profiling

ObjectiveTo compare the diagnosis of bacterial vaginosis (BV) by Nugent scoring criteria (Nugent-BV) and the diagnosis of BV and/or aerobic vaginitis (AV) using Donders criteria (Donders-BV/AV) for identifying Molecular-BV detected by bacterial 16s rRNA profiling. MethodsWe enrolled 512 women of reproductive age in Brazil with data available on Nugent and Donders microscopic analysis and 16S rRNA sequencing. We constructed receiver operating characteristic (ROC) curves of Nugent-BV and Donders-BV/AV and calculated their area under the curves (AUCs) and 95% confidence interval (CI) for matching Molecular-BV. ResultsA total of 155 (28.7%) participants were positive for Nugent-BV. Donders-BV and -AV were detected in 90 (17.6%) and 75 (14.6%) participants, respectively, while 28 (5.5%) had concurrent Donders-BV and -AV. Molecular-BV was identified in 139 (27.1%) participants. Analysis of ROC curves showed that diagnosis of Nugent-BV more accurately aligned with presence of Molecular-BV (AUC: 0.88, 95% CI: 0.84–0.91) when compared to Donders-AV/BV (AUC: 0.84; CI: 0.80–0.87) (P = 0.005). ConclusionThe use of Nugent-BV is more representative of Molecular-BV than Donders-AV/BV.

Body in the Brazilian New Age ethos

This exploratory paper aims to discuss the body in the Brazilian New Age. In the first part, we deal with the New Age in Brazil and how its materiality contributes to this ethos. Ultimately, we present the body in the Brazilian New Age, briefly dealing with health and sexuality. The last part was elaborated in dialogs with more general definitions of the theme by international authors (Heelas, Hanegraaff), interspersed with the ideas of authors who have researched the theme specifically in Brazil.

Effect of early life antibiotic use on serologic responses to oral rotavirus vaccine in the MAL-ED birth cohort study

BackgroundOral rotavirus vaccine efficacy is lower in low- and middle-income countries (LMICs) than in high-income countries. The degree to which antibiotic use impacts rotavirus vaccine immunogenicity in LMICs is unknown. Using data from a multisite prospective birth cohort study of malnutrition and enteric disease, MAL-ED, we examined the effect of early life antibiotic use on the immune response to rotavirus vaccine. MethodsWe assessed whether antibiotic use from birth up to 7 days following rotavirus vaccine series completion was associated with rotavirus seropositivity at 7 months of age in Brazil, Peru, and South Africa using a modified Poisson regression. We then used parametric g-computation to estimate the impact of hypothetical interventions that treated all children and alternatively prevented inappropriate antibiotic treatments on seropositivity. ResultsOf 537 children, 178 (33%) received at least one antibiotic course during the exposure window. Probability of seropositivity was 40% higher among children who had at least one course of antibiotics compared with those with no antibiotic exposure (PR: 1.40, 95% CI: 1.04, 1.89). There was no significant difference by the number of antibiotic courses received or total duration of antibiotics. Treating all children with antibiotics would be associated with a 19% (95% CI: 18%, 21%) absolute increase in seropositivity at 7 months. In contrast, removing inappropriate antibiotics would result in a 4% absolute reduction (95% CI: −5%, −2%) in seropositivity. ConclusionsEarly life antibiotic use was associated with increased seropositivity. However, a hypothetical intervention to remove inappropriate antibiotics would have little effect on overall seropositivity. Further investigation into the underlying mechanisms of antibiotic use on the infant gut microbiome and immune response are needed.

Impact of the COVID-19 pandemic on the vaccination of children 12 months of age and under: an ecological study.

This study aimed to evaluate the impact of the COVID-19 pandemic on the vaccination numbers for immunization geared toward individuals under 12 months of age in Brazil. This study analyzed the numbers of the nationwide vaccination coverage of ten vaccines present in the calendar from the National Immunization Program (NIP) over the past eight years (2013-2020). This is an ecological study, and all data were taken from the NIP. In comparison to the previous years, 2020 recorded the lowest figures of vaccination coverage (VC) of the average of the group of studied vaccines - 79.07% - while in 2019, this same index was 84.44%, resulting in a drop of 11.10% between these two periods. Moreover, during the year of the pandemic, of the ten analyzed vaccines, nine recorded their lowest historical VC figures, all of which were at least 14 percentage points below the goals set by the Brazilian Ministry of Health (MS, in Portuguese). Although there had already been a tendency toward a decline in VC, for various reasons, the present study illustrates that the numbers recorded in 2020 were significantly lower, a phenomenon also reported in other countries. Therefore, although it is impossible to affirm that the COVID-19 pandemic and its distancing measures are the causes for the drop in the immunization numbers, it can be inferred that there is indeed an association.

Deficiency and Insufficiency of Vitamin D in Women of Childbearing Age: A Systematic Review and Meta-analysis.

To estimate the prevalence of inadequate vitamin D level and its associated factors for women of childbearing age in Brazil. A systematic review was conducted (last updated May 2020). Meta-analyses were performed using the inverse-variance for fixed models with summary proportion calculation by Freeman-Tukey double arcsine. Reporting and methodological quality were assessed using the Joanna Briggs Institute tool for prevalence studies. Our review identified 31 studies, comprising 4,006 participants. All the studies had at least one weakness, mainly due to the use of convenience sampling and small sample size. The overall prevalence of vitamin D deficiency, insufficiency, and both deficiency and insufficiency were 35% (confidence interval, 95%CI: 34-37%), 42% (95%CI: 41-44%), and 72% (95%CI: 71-74%), respectively. Although the magnitude of the prevalence of inadequate levels of vitamin D is uncertain, the evidence suggests that presence of vitamin D deficiency or insufficiency in women of reproductive age can cause moderate to severe problems.

Relação entre Desnutrição Infantil e o Risco de Doença Respiratória em crianças de até 4 anos no Brasil: um Estudo Epidemiológico

Malnutrition has a relationship with infectious diseases, suggesting that it can lead to damage in some aspects of the immune response, and this disorder may increase the susceptibility to infections, having been shown to be mainly related to respiratory infections. The objective was to carry out an analysis of the number of hospitalizations for malnutrition and respiratory disease in children up to 4 years of age in Brazil, in order to carry out a survey of data between 2017 and 2019 on the occurrence of these conditions by region of the federation. This is a search of articles published on SciELO, Academic Google, Virtual Health Library and data provided by DATASUS platforms. It was shown that the total number of hospitalizations for respiratory tract infections was greater than the number of hospitalizations for malnutrition in all regions of the federation and that the highest number of cases of malnutrition was found in the Northeast region. It is concluded that there is still a large occurrence of child malnutrition in Brazilian regions and that there is also a large number of hospitalizations for respiratory infections in the pediatric age group targeted by the study.

Deficiency of vitamins C and E in women of childbearing age in Brazil: a systematic review and meta-analysis.

Despite the several options available for supplements containing vitamins C and E, evidence regarding the prevalence of deficiency or insufficiency of these vitamins is weak. To estimate the prevalence of deficiency or insufficiency of vitamins C and E and associated factors among women of childbearing age, in Brazil. Systematic review and meta-analysis conducted at a Brazilian public university. A search from index inception until May 2020 was conducted. Meta-analyses were performed using inverse variance for fixed models, with summary proportions calculation using Freeman-Tukey double arcsine (base case). Reporting and methodological quality were assessed using the Joanna Briggs Institute tool for prevalence studies. Our review identified 12 studies, comprising 1,316 participants, especially breastfeeding women. There was at least one quality weakness in all studies, mainly regarding sampling method (i.e. convenience sampling) and small sample size. The prevalence of vitamin C deficiency ranged from 0% to 40%. Only vitamin E deficiency was synthetized in meta-analyses, with mean prevalences of 6% regardless of the alpha-tocopherol cutoff in plasma, and 5% and 16% for cutoffs of < 1.6-12.0 mmol/l and < 16.2 mmol/l, respectively. The cumulative meta-analysis suggested that a trend to lower prevalence of vitamin E deficiency occurred in recent studies. Although the studies identified in this systematic review had poor methodological and reporting quality, mild-moderate vitamin C and E deficiencies were identified, especially in breastfeeding women. Thus, designing and implementing policies does not seem to be a priority, because the need has not been properly dimensioned among women of childbearing age in Brazil. CRD42020221605.