Low Maternal Educational Level Research Articles

A Developmental Surveillance Score for Quantitative Monitoring of Early Childhood Milestone Attainment: Algorithm Development and Validation.

Developmental surveillance, conducted routinely worldwide, is fundamental for timely identification of children at risk of developmental delays. It is typically executed by assessing age-appropriate milestone attainment and applying clinical judgment during health supervision visits. Unlike developmental screening and evaluation tools, surveillance typically lacks standardized quantitative measures, and consequently, its interpretation is often qualitative and subjective. Herein, we suggested a novel method for aggregating developmental surveillance assessments into a single score that coherently depicts and monitors child development. We described the procedure for calculating the score and demonstrated its ability to effectively capture known population-level associations. Additionally, we showed that the score can be used to describe longitudinal patterns of development that may facilitate tracking and classifying developmental trajectories of children. We described the Developmental Surveillance Score (DSS), a simple-to-use tool that quantifies the age-dependent severity level of a failure at attaining developmental milestones based on the recently introduced Israeli developmental surveillance program. We evaluated the DSS using a nationwide cohort of >1 million Israeli children from birth to 36 months of age, assessed between July 1, 2014, and September 1, 2021. We measured the score's ability to capture known associations between developmental delays and characteristics of the mother and child. Additionally, we computed series of the DSS in consecutive visits to describe a child's longitudinal development and applied cluster analysis to identify distinct patterns of these developmental trajectories. The analyzed cohort included 1,130,005 children. The evaluation of the DSS on subpopulations of the cohort, stratified by known risk factors of developmental delays, revealed expected relations between developmental delay and characteristics of the child and mother, including demographics and obstetrics-related variables. On average, the score was worse for preterm children compared to full-term children and for male children compared to female children, and it was correspondingly worse for lower levels of maternal education. The trajectories of scores in 6 consecutive visits were available for 294,000 children. The clustering of these trajectories revealed 3 main types of developmental patterns that are consistent with clinical experience: children who successfully attain milestones, children who initially tend to fail but improve over time, and children whose failures tend to increase over time. The suggested score is straightforward to compute in its basic form and can be easily implemented as a web-based tool in its more elaborate form. It highlights known and novel relations between developmental delay and characteristics of the mother and child, demonstrating its potential usefulness for surveillance and research. Additionally, it can monitor the developmental trajectory of a child and characterize it. Future work is needed to calibrate the score vis-a-vis other screening tools, validate it worldwide, and integrate it into the clinical workflow of developmental surveillance.

Systematic review and meta-analysis of maternal mortality ratio and related factors in the Islamic Republic of Iran.

Maternal mortality is an indication of the health status of women in the society. To investigate the maternal mortality ratio, causes of maternal mortality, and related risk factors among Iranian women. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist and the Peer Review of Electronic Search Strategies (PRESS) guideline, we systematically searched electronic databases, and the grey literature, for publications in Farsi and English from 1970 to January 2022 for studies that reported the number of maternal deaths and/or maternal mortality ratio and their related factors. Data analysis was conducted using Stata 16 and 2-sided P ≤ 0.05 was considered statistically significant, if not otherwise specified. A subgroup meta-analysis of studies conducted since 2000 estimated the maternal mortality ratio as 45.03 per 100 000 births during 2000-2004, 36.05 during 2005-2009, and 23.71 after 2010. The most frequent risk factors for maternal mortality were caesarean section, poor antenatal and delivery care, unskilled birth attendance, age, low maternal education level, lower human development index, and residence in rural or remote areas. There has been a significant decrease in maternal mortality in the Islamic Republic of Iran during the last few decades. Mothers in the country need to be monitored more carefully by trained healthcare workers during the pregnancy, delivery and postpartum periods so they can effectively handle postpartum complications, such as haemorrhage and infection, thereby further reducing maternal mortality.

The Impact of Maternal Age and Educational Level on Developmental Dysplasia of the Hip Diagnosis and Screening: A Descriptive Comparative Study.

Early and proper screening for developmental dysplasia of the hip (DDH) is very critical to prevent catastrophic complication on the developing hip joint. Many factors (either maternal or child-related) that hinder timely DDH screening have been previously investigated. A cross-sectional descriptive study design was adopted. 175 babies presented for DDH screening coming with their mothers were investigated. Maternal age, age group, and educational level were recorded. In addition, multiple child-related variables such as age of screening, gender, positive family history, preterm delivery, and mode of delivery were recorded as well. Analysis for association between delayed vs. early screening was made against the maternal and the child-related variables. A total number of 175 children with their mothers were investigated. The mean maternal age was 27.9 years, about one third of the mothers had a graduate level of education (36.3%), while 41.1% had high school education, and 22.3% had middle school education. On the other hand, 40.0% of the investigated babies were first born and two thirds of our sample babies were females (66.9%). Of the included babies, 100 (57.1%) were screened at the appropriate 4-month age, while 75 (42.9%) missed the 4-month screening. Chi-square analysis showed that delayed DDH screening was associated with a lower maternal educational level (P ≤ 0.001), younger maternal age (P ≤ 0.001), and first born baby (P ≤ 0.001). Positive family history was protective against delayed DDH screening (P = 0.032). The lower maternal educational level, younger maternal age group, and first born babies are risk factors for delayed DDH screening.

Double Burden of Malnutrition: A Population Level Comparative Cross-Sectional Study across Three Sub-Saharan African Countries-Malawi, Namibia and Zimbabwe.

The double burden of malnutrition in sub-Saharan African countries at different levels of economic development was not extensively explored. This study investigated prevalence, trends, and correlates of undernutrition and overnutrition among children under 5 years and women aged 15-49 years in Malawi, Namibia, and Zimbabwe with differing socio- economic status. Prevalence of underweight, overweight, and obesity were determined and compared across the countries using demographic and health surveys data. Multivariable logistic regression was used to ascertain any relationships between selected demographic and socio-economic variables and overnutrition and undernutrition. An increasing trend in overweight/obesity in children and women was observed across all countries. Zimbabwe had the highest prevalence of overweight/obesity among women (35.13%) and children (5.9%). A decreasing trend in undernutrition among children was observed across all countries, but the prevalence of stunting was still very high compared to the worldwide average level (22%). Malawi had the highest stunting rate (37.1%). Urban residence, maternal age, and household wealth status influenced maternal nutritional status. The likelihood of undernutrition in children was significantly higher with low wealth status, being a boy, and low level of maternal education. Economic development and urbanization can result in nutritional status shifts.

Longitudinal associations between socioeconomic status and psychosocial problems in preschool children

Socioeconomic status (SES) at different points in a child’s lifetime may have different effects on health outcomes. This study aimed to examine longitudinal associations between SES and psychosocial problems in preschool children (n = 2509, Mage = 24.2 ± 1.3 months). The psychosocial problems of children were assessed using the Brief Infant–Toddler Social and Emotional Assessment at age 2 years and age 3 years and categorized as having yes/no psychosocial problems. Four groups of pattern of presence/absence of psychosocial problems between age 2 and 3 years were classified: (1) ‘no problems’, (2) ‘problems at age two’, (3) ‘problems at age three’, and (4) ‘continuing problems’. Five indicators of SES (i.e., maternal education level, single-parent family, unemployment, financial problems, and neighborhood SES) were evaluated. Results showed around one-fifth (2Y = 20.0%, 3Y = 16.0%) of children had psychosocial problems. Multinomial logistic regression models revealed low and middle maternal education levels were associated with ‘problems at age two’; low maternal education level and financial problems were associated with ‘problems at age three’; low and middle maternal education level, single-parent family, and unemployment were associated with ‘continuing problems’. No associations were observed between neighborhood SES and any pattern. Results suggest children in a lower SES, indicated by maternal education, single-parent family, and financial stress, had higher odds of developing and continuously having psychosocial problems in early childhood. These findings call for optimally timing interventions to reduce the impact of disadvantaged SES in early childhood on psychosocial health.

The latent category of resilience and its relationship with the mental health and coping styles of medical students

BackgroundMedical students suffer more pressure due to various reasons and their mental health problems get more attention. Resilience is a positive psychological perspective to explore the medical students’ mental health and coping style problems. This study focuses on the medical students in school and uses the method of latent category analysis (LCA) to analyze the classification characteristics of their resilience. Therefore, the study aims to help psychological educators in medical colleges to develop positive mental health education strategies for medical students.ObjectiveTo explore the potential categories of resilience of medical students and the relationship between these categories and mental health and coping style.MethodsA total of 1,457 medical students from four medical colleges in Anhui Province were selected as the research subjects by a convenience sampling method. A general information questionnaire, the Connor-Davidson Resilience Scale (CD-RISC), Kessler 10 and the Simplified Coping Style Questionnaire (SCSQ) were used to investigate; SPSS 25.0 and Mplus 7 software were used for basic analysis and latent category exploration.Expected resultsThe medical students were divided into three potential categories of mental resilience: the low resilience group, moderate resilience self-improvement group and high resilience tough group. The optimism dimension level of the three categories was low. There were statistically significant differences in the distribution of resilience among medical students, such as gender, source of students, and paternal and maternal education level. There were significant differences in the mental health, positive coping style and negative coping style scores among the three categories. Female medical students with low parental education levels have a lower level of resilience. Logistic regression analysis showed that a lower maternal education level was a risk factor for resilience level, and a high positive coping style score and gender were protective factors for resilience level.DiscussionThere are group differences in the resilience of medical students, which suggests that school health workers should formulate targeted intervention programs for different types of students to improve their resilience and mental health, and further more, this study reminds mental health workers in colleges and universities to pay more attention to the mental health status of female medical students whose parents are less educated.

"Zero Dose" Children in the Democratic Republic of the Congo: How Many and Who Are They?

(1) Background: The Democratic Republic of the Congo (DRC) is one of the countries with the highest number of never vaccinated or "zero-dose" (ZD) children in the world. This study was conducted to examine the proportion of ZD children and associated factors in the DRC. (2) Methods: Child and household data from a provincial-level vaccination coverage survey conducted between November 2021-February 2021 and 2022 were used. ZD was defined as a child aged 12 to 23 months who had not received any dose of pentavalent (diphtheria-tetanus-pertussis-Haemophilus influenzae type b (Hib)-Hepatitis B) vaccine (by card or recall). The proportion of ZD children was calculated and associated factors were explored using logistic regression, taking into account the complex sampling approach. (3) Results: The study included 51,054 children. The proportion of ZD children was 19.1% (95%CI: 19.0-19.2%); ZD ranged from 62.4% in Tshopo to 2.4% in Haut Lomami. After adjustment, being ZD was associated with low level of maternal education and having a young mother/guardian (aged ≤ 19 years); religious affiliation (willful failure to disclose religious affiliation as the highest associated factor compared to being Catholic, followed by Muslims, revival/independent church, Kimbanguist, Protestant); proxies for wealth such as not having a telephone or a radio; having to pay for a vaccination card or for another immunization-related service; not being able to name any vaccine-preventable disease. A child's lack of civil registration was also associated with being ZD. (4) Conclusions: In 2021, one in five children aged 12-23 months in DRC had never been vaccinated. The factors associated with being a ZD child suggest inequalities in vaccination that must be further explored to better target appropriate interventions.

Determinants of Equity in Coverage of Measles-Containing Vaccines in Wales, UK, during the Elimination Era.

In the context of the WHO's measles and rubella elimination targets and European Immunization Agenda 2030, this large cross-sectional study aimed to identify inequalities in measles vaccination coverage in Wales, UK. The vaccination status of individuals aged 2 to 25 years of age, alive and resident in Wales as of 31 August 2021, was ascertained through linkage of the National Community Child Health Database and primary care data. A series of predictor variables were derived from five national datasets and all analysis was carried out in the Secure Anonymised Information Linkage Databank at Swansea University. In these 648,895 individuals, coverage of the first dose of measles-containing vaccine (due at 12-13 months of age) was 97.1%, and coverage of the second dose (due at 3 years and 4 months) in 4 to 25-year-olds was 93.8%. In multivariable analysis, excluding 0.7% with known refusal, the strongest association with being unvaccinated was birth order (families with six or more children) and being born outside of the UK. Living in a deprived area, being eligible for free school meals, a lower level of maternal education, and having a recorded language other than English or Welsh were also associated with lower coverage. Some of these factors may also be associated with refusal. This knowledge can be used to target future interventions and prioritise areas for catch up in a time of limited resource.

Association between attention-deficit/hyperactivity symptoms and sleep in preschoolers

IntroductionSleep problems are frequent in children with attention-deficit/hyperactivity disorder (ADHD). Some authors have tried to characterize paediatric sleep habits in Portugal, but none has focused on preschool-age children nor attempted to establish their association with ADHD. We aimed to assess the prevalence of ADHD symptoms in preschool-age children and to study their association with sleep habits. Material and methodsWe conducted a cross-sectional study. We distributed questionnaires to a random sample of caregivers of children enrolled in early childhood education centres in Porto. We collected data on sociodemographic characteristics, television watching and outdoor activities. We assessed ADHD symptoms and sleep habits with the Portuguese versions of the Conners’ Parents Rating Scale, Revised and the Children’s Sleep Habits Questionnaire (CSHQ-PT), respectively. ResultsThe study included 381 preschoolers (50.90% male). We found high scores for ADHD symptoms in 13.10%, with a higher prevalence in girls (14.40% vs. 11.85%; P = 0.276). In the CSHQ-PT, 45.70% of participants had a mean total score greater than 48, which is the cut-off point applied in the screening of sleep disturbances in the Portuguese population. There was a significant association between high scores for ADHD symptoms and a lower maternal education level (P < 0.001), a shorter sleep duration (P = 0.049), and higher scores on parasomnias (P = 0.019) and sleep disordered breathing (P = 0.002) in CSHQ-PT subscales. ConclusionsADHD and sleep disorders are common in preschoolers, in Porto, and this study suggests some clinical correlations between them. Since these interactions are complex and far from being elucidated, further studies are paramount to provide guidance for prevention and managing strategies in younger children at risk for ADHD.

Trajectories of brain volumes in young children are associated with maternal education.

Brain growth in early childhood is reflected in the evolution of proportional cerebrospinal fluid volumes (pCSF), grey matter (pGM), and white matter (pWM). We study brain development as reflected in the relative fractions of these three tissues for a cohort of 388 children that were longitudinally followed between the ages of 18 and 96 months. We introduce statistical methodology (Riemannian Principal Analysis through Conditional Expectation, RPACE) that addresses major challenges that are of general interest for the analysis of longitudinal neuroimaging data, including the sparsity of the longitudinal observations over time and the compositional structure of the relative brain volumes. Applying the RPACE methodology, we find that longitudinal growth as reflected by tissue composition differs significantly for children of mothers with higher and lower maternal education levels.

Classification Performance of the Ages and Stages Questionnaire: Influence of Maternal Education Level

(1) Background: The Ages and Stages Questionnaire-Third Edition (ASQ-3) is a parental screening questionnaire increasingly being used to evaluate the development of preterm children. We aimed to assess the classification performance of the ASQ-3 in preterm infant follow-up. (2) Methods: In this cross-sectional study, we included 185 children from the SEVE longitudinal cohort born <33 weeks of gestational age between November 2011 and January 2018, who had both an ASQ-3 score at 24 months of corrected age (CA) and a revised Brunet-Lézine (RBL) scale score at 30 months of CA. The ASQ-3 overall score and sub-scores were compared to the RBL developmental quotient (DQ) scores domain by domain. The diagnostic performance of the ASQ-3 was evaluated with the RBL as the reference method by calculating sensitivity, specificity, and positive and negative likelihood ratios. A multivariate analysis assessed the association between low maternal education level and incorrect evaluation with the ASQ-3. (3) Results: The ASQ-3 overall score had a specificity of 91%, a sensitivity of 34%, a positive likelihood ratio of 3.82, and a negative likelihood ratio of 0.72. Low maternal education level was a major risk factor for incorrectly evaluating children with the ASQ-3 (odds ratio 4.16, 95% confidence interval 1.47-12.03; p < 0.01). (4) Conclusions: Regarding the low sensitivity and the impact of a low maternal education level on the classification performance of the ASQ-3, this parental questionnaire should not be used alone to follow the development of preterm children.

Prevalence of Attention Deficit Hyperactivity Disorder and Sluggish Cognitive Tempo Symptoms in Children Presenting with Foreign Body Ingestion: A Case-Control Study

Foreign body ingestion (FBI) is one of the common causes of emergency admissions in infancy and childhood. Although the large majority of children who present with the FBI have no psychiatric diagnosis, present studies demonstrate that attention deficit hyperactivity disorder (ADHD) and related psychiatric problems might be a risk factor for FBI. This study aimed to compare the demographic variables and attention deficit hyperactivity disorder levels and sluggish cognitive tempo symptoms (ADHD-SCT) in children who ingested foreign bodies with healthy children. Also, we aimed to address the relationship between ADHD-SCT symptoms and the age of FBI. The FBI group comprised 44 children (age 2-8, median age: 5, 68.2% boys) admitted to the emergency, pediatric surgery, and pediatric gastroenterology department after FBI, and the healthy control group comprised 30 children (age 3-8, median age: 6, 56.7% boys). We administered the sociodemographic information form, SNAP-IV ADHD rating scale, and Barkley’s child SCT ratings scale to both groups of parents. Our results demonstrated that maternal education level was significantly lower in the FBI group, although other demographic characteristics of the samples were similar (p=0.023). In addition, ADHD-hyperactivity/impulsivity scores were significantly higher in the FBI group (p=0.01). Still, there were no significant differences in ADHD-inattention, SCT-daydreaming, and SCT-sluggishness scores (for all, p&gt;0.05). We found positive-moderate relationships between SCT-daydreaming and sluggishness symptoms and FBI age (r=0.314, r=0.348, respectively). This means that higher SCT scores are related to an older FBI age. In conclusion, for the first time, we evaluated the ADHD and SCT symptoms in young children against FBI and found that ADHD-hyperactivity, but not ADHD-inattention symptoms, were significantly higher in the FBI group, and SCT symptoms increase the risk of FBI at an older age. In addition, we found that a lower maternal education level could be an additional risk factor for FBI. Despite the high hyperactivity in the FBI group, the low rate of child psychiatry evaluation should be considered when evaluating a child.

Risk Factors of Language Delay at Two Years of Corrected Age among Very-Low-Birth-Weight Preterm Infants: A Population-Based Study.

Language delays are often underestimated in very-low-birth-weight (VLBW) preterm infants. We aimed to identify the risk factors of language delay at two years of corrected age in this vulnerable population. VLBW infants, who were assessed at two years of corrected age using the Bayley Scale of Infant Development, third edition, were included using a population-based cohort database. Language delay was defined as mild to moderate if the composite score was between 70 and 85 and severe if the score was < 70. Multivariable logistic regression analysis was used to identify the perinatal risk factors associated with language delay. The study comprised 3797 VLBW preterm infants; 678 (18%) had a mild to moderate delay and 235 (6%) had a severe delay. After adjusting for confounding factors, low maternal education level, low maternal socioeconomic status, extremely low birth weight, male sex, and severe intraventricular hemorrhage (IVH) and/or cystic periventricular leukomalacia (PVL) were found to be significantly associated with both mild to moderate and severe delays. Resuscitation at delivery, necrotizing enterocolitis, and patent ductus arteriosus requiring ligation showed significant associations with severe delay. The strongest factors predicting both mild to moderate and severe language delays were the male sex and severe IVH and/or cystic PVL; thus, early targeted intervention is warranted in these populations.

Epidemiology of neonatal mortality: a spatial and multilevel analysis of the 2019 mini-Ethiopian demographic and health survey data

BackgroundSub-Saharan African countries are a high-burden region of neonatal mortality and showed slow progress in its reduction. In developing countries, as long as the current trend of mortality persists, achieving a sustainable development target for neonatal mortality would be challenging. The aim of this study was to detect significant geographic areas and identify community and individual-level predictors of neonatal mortality in Ethiopia to draw attention to a policy.Methods A weighted total sample of 24,136 mothers from the 2019 mini-Ethiopian demographic and health survey data were included in the analysis. Global Moran’s I statistics was run to check the clustering of neonatal mortality and then kriging interpolation was done to predict the magnitude of neonatal mortality in Ethiopia. In addition, SaTScan analysis was also executed to identify hot spot clusters of neonatal mortality. Finally, a multilevel mixed-effect logistic regression model was used to identify community and individual-level predictors of early neonatal and neonatal mortality.ResultsThe lifetime early neonatal and neonatal mortality among mothers in Ethiopia was 5.08 (95% CI: 4.13–6.03) and 6.54 (5.55, 7.52) per 1000 births respectively. Neonatal mortality was spatially clustered in the country and the SaTScan analysis identified significant hotspot areas of neonatal mortality in the Amhara and Afar regions and some areas of the Somali and Oromia regions. Its predicted magnitude was > 8 per 1000 births in wide areas of the Amhara and Benishangul regions. A multilevel mixed-effect logistics regression analysis identified that a lower level of maternal education, being a twin neonate, and being a male neonate were predictors of both early neonatal and neonatal mortality. Whereas, the younger age of mothers predicted neonatal mortality.ConclusionsNeonatal mortality in Ethiopia is geographically clustered and sociodemographic and obstetric factors played a significant role. Policy direction should focus on evidence-based practices like midwives-led community and facility-based continuum of care from preconception to postnatal periods to possibly reduce neonatal mortality.

The association between early introduction of tiny tastings of solid foods and duration of breastfeeding

BackgroundConflicting advice and non-evidence-based recommendations have a negative effect on breastfeeding. Since 2011, the National Food Agency in Sweden has informed parents that they can introduce tiny tastings (1 mL of solid food, i.e. other sources of nutrition than breastmilk/formula) to infants from four months of age. It is unknown how national recommendations, which differ from the Word Health Organisation’s recommendation, affect breastfeeding. We hypothesised that introduction of tiny tastings of solid foods would shorten the duration of continued breastfeeding.MethodsThis retrospective study utilises data from the longitudinal ‘Swedish Pregnancy Planning Study’, in which mothers were recruited at antenatal clinics on a national level. The participants completed three questionnaires up to one year after birth (n = 1,251). Linear regression models were used to analyse the association between the introduction of solid foods and the duration of breastfeeding.ResultsAs hypothesised, introduction of tiny tastings shortened the duration of continued breastfeeding. Half of all infants (48%) were fed with tiny tastings already in the fourth month. The correlation analysis showed that the earlier the infants started with tiny tastings, the earlier they ate larger amounts of solid food. In a multivariate linear regression analysis, five factors were identified as having a negative effect on the duration of breastfeeding: low infant age upon introduction of tiny tastings, low maternal age, low level of maternal education, high maternal BMI and twin birth.ConclusionsEarly introduction of tiny tastings of solid foods shortened the duration of breastfeeding. It is difficult to influence most conditions that affect breastfeeding, for example, the mother’s educational level, BMI, age and if she has given birth to twins. In contrast, national guidelines can always be updated. Recommendations from the Swedish authorities should adhere to the WHO’s recommendation, which states exclusive breastfeeding for six months and continued breastfeeding for at least two years or longer.

Congenital syphilis: associated factors in a follow-up outpatient clinic.

This study aimed to describe the characteristics of mothers and children assisted in a follow-up clinic for congenital syphilis and identify the factors associated with the confirmation of the diagnosis. This is a prospective study conducted from 2016 to 2019 in Montes Claros, Northern Minas Gerais, Brazil. Specific forms addressing maternal sociodemographic, behavioral, and lifestyle habit characteristics, as well as characteristics related to access to healthcare, were used. Hierarchical Poisson regression analysis was performed to define the factors associated with diagnostic confirmation, including the calculation of the prevalence ratios (PR) and respective 95% confidence intervals (95%CI). A total of 200 binomials (mother-child) who attended at least one appointment as part of the follow-up after discharge from the maternity hospital were eligible for the study. Themothers were mostly young (79.0%), with a low educational level (43.0%), and black (89.5%). Nearly half of the mothers reported not having a steady sexual partner (42.5%). About a quarter attended less than six prenatal appointments (27.5%). Nearly half did not treat the disease adequately during pregnancy (24.5%). The diagnosis of congenital syphilis was confirmed for 116 children. The following factors were associated with the diagnostic confirmation after multiple analyses: low maternal educational level (PR 1.30; 95%CI 1.05-1.60), maternal risky sexual behavior (PR 1.34; 95%CI 1.07-1.66), inadequate treatment of the mother (PR 3.16; 95%CI 2.42-4.47), and lack of treatment of the partner (PR 1.44; 95%CI 1,18-1.81). Syphilis remains a major challenge. The results highlight the social inequities associated with congenital syphilis and the lack of proper management of pregnant women and their partners.

Effects of fine ambient particulate matters on de novo hypertensive disorders of pregnancy and blood pressure before 20 weeks

The effects of fine particulate matter (PM) on de novo hypertensive disorders of pregnancy (HDP) were inconsistent during the first and second trimesters. This study aimed to assess the trimester-specific effects of PM2.5 and PM1 prior to diagnosis of de novo HDP. The exposure of fine PM was predicted by satellite remote sensing data according to maternal residential addresses. De novo HDP was defined as gestational hypertension and preeclampsia during the current pregnancy. A logistic regression model was performed to assess the association of PM2.5 and PM1 with HDP during the first and early second trimesters (0–13 weeks and 14–20 weeks). The generalized estimating equation model was conducted to assess the effect of PM2.5 and PM1 on blood pressure. The present study included 22,821 pregnant women (mean age, 29.1 years) from 2013 to 2017. PM2.5 and PM1 were significantly associated with an increased risk of de novo HDP during the first trimester (OR = 1.070, 95% CI: 1.013–1.130; OR = 1.264, 95% CI: 1.058–1.511 for per 10 μg/m3) and early second trimester (OR = 1.045, 95% CI: 1.003–1.088; OR = 1.170, 95% CI: 1.002–1.366 for per 10 μg/m3). Significant trends of increased de novo HDP risk was also observed with the increment of PM (all P for trend <0.05). The stratified analyses demonstrated that the associations between exposure to fine PM and the risk of HDP were more pronounced among the pregnant women with maternal age above 35 and low maternal education level (all OR >1.047). Each 10 μg/m3 increase of PM1 and PM2.5 before diagnosis of de novo HDP elevated 0.204 (95% CI: 0.098–0.310) and 0.058 (95%CI: 0.033–0.083) mmHg of systolic blood pressure. Exposure to PM2.5 and PM1 during the first and early second trimester were positively associated with the risk of de novo HDP. The fine PM before diagnosis of de novo HDP elevated the systolic blood pressure.

Relación entre los síntomas de déficit de atención/hiperactividad y el sueño en preescolares

IntroductionSleep problems are frequent in children with attention-deficit/hyperactivity disorder (ADHD). Some authors have tried to characterize paediatric sleep habits in Portugal, but none has focused on preschool-age children nor attempted to establish their association with ADHD. We aimed to assess the prevalence of ADHD symptoms in preschool-age children and to study their association with sleep habits. Material and methodsWe conducted a cross-sectional study. We distributed questionnaires to a random sample of caregivers of children enrolled in early childhood education centres in Porto. We collected data on sociodemographic characteristics, television watching and outdoor activities. We assessed ADHD symptoms and sleep habits with the Portuguese versions of the Conners’ Parents Rating Scale, Revised and the Children's Sleep Habits Questionnaire (CSHQ-PT), respectively. ResultsThe study included 381 preschoolers (50.90% male). We found high scores for ADHD symptoms in 13.10%, with a higher prevalence in girls (14.40% vs. 11.85%; P=.276). In the CSHQ-PT, 45.70% of participants had a mean total score greater than 48, which is the cut-off point applied in the screening of sleep disturbances in the Portuguese population. There was a significant association between high scores for ADHD symptoms and a lower maternal education level (P<.001), a shorter sleep duration (P=.049), and higher scores on parasomnias (P=.019) and sleep disordered breathing (P=.002) in CSHQ-PT subscales. ConclusionsADHD and sleep disorders are common in preschoolers, in Porto, and this study suggests some clinical correlations between them. Since these interactions are complex and far from being elucidated, further studies are paramount to provide guidance for prevention and managing strategies in younger children at risk for ADHD.

Seasonality and predictors of childhood stunting and wasting in drought-prone areas in Ethiopia: a cohort study

Background and objectivesOver centuries, Ethiopia has experienced severe famines and periods of serious drought, and malnutrition remains a major public health problem. The aims of this study were to estimate...

Do preventive child examinations in general practice reduce the risk of overweight and obesity?

Abstract Background The prevalence of children with overweight and obesity is increasing. General practitioners in Denmark follow children throughout early childhood via the preventive child health examinations. These examinations are offered to all children from birth to the age of five. Thus, the general practitioners have a unique opportunity for early tracing and identification of overweight and obesity, but the impact of the examinations are not examined. Therefore, the aim of this study was to examine the association between attending preventive child health examinations and the risk of overweight and obesity at the age of six both for the total pediatric population and within groups of vulnerable children such as children of parents with low educational level or low household income. Methods A population-based birth cohort study was conducted including all Danish children born from 2000-2012 using the Danish nationwide registers. Data included information on child participation in preventive health examinations at general practice, height and weight at the age of six, and parental information on socioeconomic factors. Results The analyses included 801,444 children. Attending preventive child health examinations were not associated with a lower risk of overweight at the age of six. A lower risk of obesity was seen in children attending the examinations, both in the general population (RR 0.71, 95% CI 0.66-0.76) and within vulnerable groups (low level of maternal education: RR 0.80, 95% CI 0.72-0.89), low household income (RR 0.79, 95% CI 0.72-0.87). The risk of obesity was greater in the vulnerable groups than in the not-vulnerable groups. Conclusions Attending preventive child health examinations were associated with a lower risk of obesity at the age of six, but not overweight. This was seen for both the general pediatric population and within vulnerable groups. The lowest risk of obesity was seen in the not-vulnerable groups. Key messages • The results indicated that attending preventive child health examinations in general practice reduced the risk of obesity at the age of six, but not the risk of overweight. • The lowest risk of obesity was seen in the not-vulnerable groups attending the preventive child health examinations in general practice.