Maternal Schooling Research Articles

Evaluating Changes in Determinants of Stunting among Children Under 2 Years and Assessing Their Contribution to Socioeconomic Disparity in Child Nutritional Status across India.

Background:Despite concentrated global efforts to bring about reduction in malnutrition among children, it continues to remain a public health concern, especially in developing countries such as India. While substantial reduction in the levels of stunting has taken place over the years, high levels of variation exist in distribution of stunting across the country.Objective:The study aimed to identify the determinants of stunting in early childhood and their contribution to change in levels of stunting across India. It also compared the socioeconomic disparity in the levels of stunting and changes therein over the last decade.Methods:The study utilizes data from the National Family Health Survey (NFHS-3 and NFHS-4) on children aged under-2 years. Bivariate and multivariate logistic regression identified determinants of early childhood stunting followed by Oaxaca decomposition model to assess the contribution of each of the factors to reduction in levels of stunting over the years. Concentration index was used to study the socioeconomic disparity in early childhood stunting.Results:Nearly 19% decrease in early childhood stunting can be attributed to increase in institutional deliveries, 14% to increase in maternal schooling, and 10% to improvement in maternal body mass index. In spite of an overall decrease, very little change is seen in socioeconomic disparity of childhood stunting.Conclusions:The study identifies institutional deliveries, maternal schooling, and maternal health as major contributors of decrease in early childhood stunting. It identifies persisting socioeconomic disparity in childhood stunting over the last decade.

Consistent routines matter: Child routines mediated the association between interparental functioning and school readiness

School readiness is critical to children's academic and social-emotional success at school entry and over time. Using structural equation modeling, this study examined the mediating role of consistent child routines in the association between interparental functioning and school readiness among preschool-aged children in China. Participants included 349 preschoolers and both of their parents. Data were collected across two time points with 1.5 years apart. Consistency in child routines was found to mediate the association between maternal interparental functioning and child school readiness. Specifically, mother-perceived marital satisfaction was positively related to their contributions to coparenting, which further had a positive association with consistency in child routines, and this eventually predicted children's school readiness across multiple indicators. However, different patterns of findings emerged for paternal interparental functioning. Father-perceived marital satisfaction was directly linked to consistency in child routines without the mediation effect of paternal coparenting, which, in turn, predicted school readiness. Fathers’ contributions to coparenting also directly predicted children's social-emotional functioning. The findings have highlighted the importance of establishing and maintaining consistent routines for young children in order to promote school readiness across the preschool period.

Economic, social, and health determinants that influence exclusive breastfeeding in Colombia

Exclusive breastfeeding (EBF) is an important practice that offers many benefits, such as nutritional support, prevention of infectious and chronic diseases, and assistance in psychosocial and cognitive development. This study aims to identify the determinants associated with EBF abandonment in 1,527 children under six months of age, based on information collected by the Colombian National Survey of Nutritional Status and the Colombian National Demographic and Health Survey, 2010. This is an observational cross-sectional cohort study, in which a hierarchical Poisson regression model with robust variance was applied; considering in the first level the factors associated with the mother and child and, in the second level, the information of 32 departments and Bogotá. We noticed a high rate abandonment of EBF (57.6%) and its variation between departments. The factors associated with a longer time of EBF were higher maternal schooling level, having a partner, knowledge in breastfeeding, belonging to a lower level of income, living in the eastern region, having delivery assisted by qualified team, and low birth weight. According to the variance partition coefficient (VPC), 3.2% of the probability of abandonment of EBF may be related to factors within the departmental scope. The median odds ratio (MOR) indicates that the individual risk of abandoning EBF of a child would increase by 47% if the child moved from a department with a low prevalence of abandonment to a department with high prevalence. This study allows a better understanding of the abandonment of EBF from its determinants, providing evidence to implement more effective interventions for child nutrition.

Adesão ao seguimento ambulatorial e reinternação hospitalar após alta da segunda etapa do método canguru

Objectives: To assess compliance to outpatient follow-up after discharge from the second stage of the kangaroo method, and a rate of hospital readmission up to 30 days of corrected age. Methods: We ran a cross-sectional study with very low birth weight infants and/or children under 33 weeks of age born from January to December/2019 at the Januário Cicco Maternity School / Natal / RN. For data analysis we used the Shapiro-Wilk, Mann-Whitney and the Fishers Exact tests. Results: Of the 100 newborns included in the study, 13 did not return for outpatient follow-up. Among the 87 (100%) newborns in a row, 6 (6.9%) were readmitted for anemia requiring transfusion; 2 (33.3%) for urinary tract infection; 1 had regurgitation (16,5%); and 1 (16.5%) was undetermined. Newborns with follow-up had higher birth weight, fewer days in mechanical conditions and frequency of grade 3 and 4 peri-intraventricular hemorrhage compared with the no follow-up group. Conclusion: An important number of high-risk newborns did not return for outpatient follow-up, thus being an alert for the team that organized patient discharge. The low rate of readmission, in the first month of corrected age suggests a good condition of the patients at discharge. However, a longer period of observation should be used since the studies showed higher rates of readmission in those assessed up to 12 months of the corrected age.

Study on the Impact of Online Courses for Pregnant and Lying-In Women on Maternal and Infant Health during the Epidemic.

The sudden outbreak of the new crown pneumonia has brought online learning from a supporting role to the center of the teaching stage in an instant. On the basis of the feasibility analysis and demand analysis of the microcourse learning system, this paper uses Sina cloud server to build the WeChat public platform learning online course and designs and implements the microcourse learning system function based on the microcourse public platform. We completed the recording, editing, publishing, and testing of microclass courses and provided services for teachers and pregnant women's microclass learning in order to achieve better learning results. A total of 151 people regularly participate in maternity school courses, accounting for 30.4%. There are 190 people who have never attended the maternity school course, accounting for 38.2%. There are 156 people who occasionally participate in maternity school courses, accounting for 31.4%. The top five sources of health information during pregnancy are books, maternity schools, experience of elders, the Internet, and television. The results of one-way analysis of variance showed that pregnant women of different ages had statistically different scores in the dimensions of knowledge and ideas (P < 0.05). There are statistical differences in the scores of pregnant women with different economic incomes in this dimension (P < 0.05). The women with economic income ≥5000 yuan/month have the highest scores, and those with economic income ≥5000 yuan/month have the lowest scores. The scores of pregnant women who participated in the maternity school were significantly higher than those who did not participate in the maternity school (P < 0.05). There are statistical differences in the scores of maternal and child health basic skills among pregnant women of different age groups (P < 0.05). The women aged ≥35 years old have the highest scores, and those aged 20–24 years old have the lowest scores. The differences in the scores of pregnant women with different economic incomes in this dimension are statistically significant (P＜0.05). The women with economic income ≥5000 yuan/month have the highest score, and those with economic income<2000 yuan/month have the lowest score. Participation in maternity schools has an impact on the scores of this dimension. Pregnant women who regularly participate in maternity schools have the highest average scores, and those who do not participate in maternity schools have the lowest average scores.

Effectiveness of a longitudinal psychosocial intervention to strengthen mother–child interactions: The role of biological and contextual moderators

IntroductionEarly parent–child relationships shape children’s future. Child development and parent–child interactions are multidetermined, and the combination of biological risks and social disadvantages can further compromise both outcomes. Interventions that promote responsive parenting may mitigate the risks for child development. We examined the effectiveness of a longitudinal psychosocial intervention to strengthen maternal interactive skills and the moderative role of biological and contextual variables. MethodsThe present study is part of a large study designed as a pragmatic quasi-experimental trial. The intervention was implemented in a public mother–child healthcare service, which is a reference for high-risk deliveries. The sample was a convenience subsample of the large project, comprised 67 mother–child dyads. The Intervention Group (IG) and Comparison Group (CG) included 33 and 34 dyads, respectively. The intervention consisted of two individual Newborn Behavioral Observation (NBO) sessions and six group sessions with the mothers. It was delivered at childbirth and 2, 4, 6, 9, and 12 months of child age. CG received usual care at the same age. IG and CG mothers were video recorded playing with their 12-month-old children; maternal interactive skills were assessed using the Parenting Interactions with Children: Checklist of Observations Linked to Outcomes (PICCOLO). PICCOLO captures mothers’ skills across four domains: affection, responsiveness, encouragement, and teaching. We performed a multiple linear regression to identify the moderative effect of the intervention on maternal interactive skills; the initial model included biological and contextual variables, the group, and the interaction between potential moderators and the group. ResultsIn general, most infants were boys, born preterm, and with low birth weight. On average, the mothers studied for 10 years, and most families were classified as having low or very low socioeconomic status. In general, IG mothers’ mean scores were higher than CG mothers’ in all PICCOLO domains, although without statistical significance. Lower maternal schooling moderated the effect of the intervention on mothers’ overall interaction and encouragement skills. Lower gestational age moderated the effect on PICCOLO total scores. Final regression models explained 22% and 14% of the variability of PICCOLO total and encouragement scores, respectively; no intervention’s effect was observed in other domains. ConclusionThe effects of our longitudinal psychosocial intervention on maternal interactive skills were moderated by infants’ gestational age and maternal years of schooling. These findings suggest that the intervention was more effective for vulnerable groups, specifically for mothers with less schooling and whose infants were born extremely preterm, confirming our hypothesis of the differential effect of the intervention.

Attention-deficit Disorder, Family Factors, and Oral Health Literacy

IntroductionRelationships amongst attention-deficit/hyperactivity disorder (ADHD), family factors, and oral health literacy (OHL) in adolescents are unclear. The objective of this research was to investigate whether family environment and signs of ADHD are associated with OHL at the onset of adolescence.MethodsA cross-sectional study was performed with 448 twelve-year-old adolescents enrolled in schools in Cajazeiras, Brazil. Adolescents responded to an instrument measuring OHL (Brazilian version of the Rapid Estimate of Adult Literacy in Dentistry [BREALD-30]) and a validated questionnaire addressing family cohesion and adaptability (Family Adaptability and Cohesion Scales [FACES III]). Parents and teachers answered subscales of the Swanson, Nolan, and Pelham Questionnaire (SNAP-IV) and a socioeconomic questionnaire. Adjusted Poisson regression analysis was employed for the data analysis (P < .05).ResultsGreater OHL was found in adolescents with higher family cohesion scores (rate ratio [RR], 1.02; 95% confidence interval [CI], 1.01–1.03), those whose mothers had more than 8 years of schooling (RR, 1.07; 95% CI, 1.03–1.12), and those whose families earned more than the Brazilian minimum salary (RR, 1.08; 95% CI, 1.03–1.12). Higher family adaptability scores (RR, 0.99; 95% CI, 0.98–0.99) and more signs of ADHD (teachers’ reports) (RR, 0.95; 95% CI, 0.91–0.99) were associated with lower OHL.ConclusionsOHL in adolescents was influenced by family adaptability and cohesion, signs of ADHD, maternal schooling, and family income.

Youth-friendly sexual and reproductive health services utilization and its determinants in Ethiopia: A systematic review and meta-analysis

BackgroundIn most developing countries, meeting young people’s sexual and reproductive health (SRH) needs remains a problem. Despite policy initiatives and strategic measures aimed at increasing youth utilization of sexual and reproductive health services in Ethiopia, its utilization remains very low. Therefore, this study aimed to assess Ethiopia’s youth-friendly sexual and reproductive health services’ utilisation and determinants. MethodsScopus, Medline, Google Scholar, and CINAHL databases were searched for articles published until March 2021. The pooled prevalence and effect size of youth-friendly sexual and reproductive health service use and associated factors were estimated using a weighted DerSimonian-laird random effect model. The I2 statistics were used to determine the degree of heterogeneity. The funnel plot and Egger's regression test were used to examine publication bias. Subgroup analyses were performed to reduce underlying heterogeneity. ResultsOne thousand one hundred and ninety-one articles were generated from various databases, and a final 26 articles were included in the review, including 16246 participants. Ethiopia’s pooled prevalence of youth-friendly sexual and reproductive health service utilization was 42.73 % (95% CI: 35.38–50.09). The findings of this study showed that grade level 11–12, grade level 9–10, close to home sexual and reproductive health services, male sex, and discussion of sexual and reproductive health service with family, friends, and groups, ever experience sexual activity were associated with utilization of youth-friendly sexual and reproductive health services. Maternal educational status secondary school and above, age 15–19 years, age 20–24 years, having ever experienced reproductive problems, living with a partner, living alone, knowing about sexual and reproductive health, having a convenient working hour for youth-friendly service, and participation in a school clubs were also associated with the utilization of youth-friendly sexual and reproductive health services. ConclusionWe found several determinant factors for adolescent and youth utilization of sexual and reproductive health services. The review highlights the importance of improving service usage through youth education and promotion and the scaling up and institutionalizing of youth-friendly services through extensive capacity building.

Perspective: Opportunities and Scope for Expanded Deworming Programs for Soil-Transmitted Helminths in India

The current deworming strategy for soil-transmitted helminthiases (STH) focuses on pre-school and school-aged children and women in the reproductive age to eliminate morbidity. However, mathematical modeling and meta-analysis show that STH could be eliminated if the entire population, including adults, were treated. The Government of India (GOI) has been deworming children through various maternal and child health programs and school health programs. One of the largest initiatives is the school-based biannual deworming program for children aged 1-19 years in the ‘National Deworming Day’ since 2015. Women of the reproductive age have the opportunity to get dewormed under the Anemia Free India program. Adult men and women have the opportunity to receive Albendazole in the lymphatic filariasis (LF) endemic districts. The gaps in deworming are women above the age of 49 and adult men above 19 years, living in non-LF endemic areas. Understanding gaps in deworming will help plan policy changes and program strategies for STH elimination in India, which has 21% of the global STH burden, as well as in other STH endemic countries.

Changes in asset-based wealth across the life course in birth cohorts from five low- and middle-income countries

BackgroundTemporally-harmonized asset-based measures of wealth can be used to study the association of life-course wealth exposures in the same scale with health outcomes in low- and middle-income countries (LMICs). The within-individual longitudinal stability of asset-based indices of wealth in LMICs is poorly understood. MethodsUsing data from five birth cohorts from three continents, we developed temporally-harmonized asset indices over the life course through polychoric principal component analysis of a common set of assets collected consistently over time (18 years in Brazil to 50 years in Guatemala). For each cohort, we compared the harmonized index to cross-sectional indices created using more comprehensive asset measures using rank correlations. We evaluated the rank correlation of the harmonized index in early life and adulthood with maternal schooling and own attained schooling, respectively. ResultsTemporally-harmonized asset indices developed from a consistently-collected set of assets (range: 10 in South Africa to 30 in Philippines) suggested that mean wealth improved over time for all birth cohorts. Cross-sectional indices created separately for each study wave were correlated with the harmonized index for all cohorts (Brazil: r = 0.78 to 0.96; Guatemala: r = 0.81 to 0.95; India: 0.75 to 0.93; Philippines: r = 0.92 to 0.99; South Africa: r = 0.84 to 0.96). Maternal schooling (r = 0.15 to 0.56) and attained schooling (r = 0.23 to 0.53) were positively correlated with the harmonized asset index in childhood and adulthood respectively. ConclusionsTemporally-harmonized asset indices displayed coherence with cross-sectional indices as well as construct validity with schooling.

Women's employment and Children's education: Longitudinal evidence from Nepal

This study examines how maternal employment is related to children's school enrollment in rural Nepal. Using the Chitwan Valley Family Study we combine over 30 years (1974–2008) of yearly data on mother's employment and their children's education. Results reveal heterogeneity by gender, social status, and type of work. Children from historically disadvantaged social groups were more likely to be in school when their mothers started working. This was largely driven by mothers with jobs that allowed them to more easily combine work and family tasks (i.e., those self-employed in the home). In fact, maternal self-employment outside the home was associated with boys dropping out of school. Additionally, we find evidence that some of the observed relationship between maternal wage labor and children's school enrollment is due to household-level selection effects on mother's work.

EVALUATING THE PREVALENCE AND FACTORS ASSOCIATED WITH AN OPTIMAL NEURODEVELOPMENTAL OUTCOME IN CHILDREN WITH FONTAN CIRCULATION

<h3>BACKGROUND</h3> While youth with Fontan circulation are at increased risk for adverse neurodevelopmental outcomes, not all children encounter these limitations. We sought to evaluate the prevalence and factors associated with "optimal" neurodevelopmental outcomes in 4-6 year old children with Fontan circulation. <h3>METHODS AND RESULTS</h3> Patients who underwent the Fontan procedure born between September 1996 and December 31, 2015 and followed through the Western Canadian Complex Pediatric Therapies Follow-up Program (CPTFP) were included. All patients underwent a comprehensive neurocognitive assessment between 48-72 months of age. A composite outcome termed optimal neurodevelopmental outcome was defined as the absence of intellectual disability (full-scale intellectual quotient (FSIQ) < 80, visual motor index < 80, adaptive behavior assessment system, general adaptive composite < 80), chronic motor disability, permanent hearing loss, visual impairment, seizure disorder, or autism spectrum disorder. Multivariable regression models and decision algorithms (utilizing variables from the multivariable regression analysis, with cut-points determined to optimize a global accuracy index) were generated to evaluate demographic and clinical factors associated with optimal neurodevelopmental outcome. The Fontan procedure was completed on 225 children in the study period, with neurodevelopmental outcome data available for 205 (age at Fontan 3.4 +/- 0.9 years, age at assessment 4.6 +/- 0.5 years, 37% female). Optimal neurodevelopmental outcome was identified in 55% (112/205). In the multivariable regression analysis, factors independently associated with an increased odds ratio of optimal neurodevelopmental outcome were female sex [2.1 (95% confidence interval (CI) 1.1-4.1)], years of maternal schooling [1.2 (1.1-1.5)], age at Fontan (years) [0.97 (0.9-1.0)], need for concomitant atrioventricular valve (AVV) intervention [0.4 (0.2-1.0)], and time (hours) for lactate to be < 2mmol/L [0.9 (0.8-1.0)]. There was a wide range in the prevalence of optimal neurodevelopmental outcomes according to the presence or absence of clinical and demographic variables (Table). For example, if a patient was < 3.25 years at Fontan, did not have a concomitant AVV intervention, and the lactate was < 2mmol/L within eight hours post-operatively, 87% (27/31) had an optimal neurodevelopmental outcome. Conversely, the absence of each of these variables (>/=3.25 years, need for AVV intervention, and >/=8 hours to clear lactate) was associated with 7% (1/14) having optimal neurodevelopmental outcomes. <h3>CONCLUSION</h3> Optimal neurodevelopmental outcome was present in over half of 4-6 year old children with Fontan circulation in this single-center study, with important associated factors identified, including potentially modifiable factors such as younger age at Fontan and lack of concomitant AVV intervention. Multi-center evaluations are needed to further evaluate this previously undefined composite outcome.

Mis ideas en tres minutos: futuros maestros que escriben y reflexionan

This article reports the results of the systematization of the experience named My ideas in three minutes, an activity implemented in the Maternal School course of the Bachelor's Degree in Early Childhood Education at Universidad Autonoma de Bucaramanga, Colombia. The One minute paper technique was used to encourage students to reflect on their future role as teachers, by composing texts containing the analysis of their experiences and practices. Those documents were collected and analyzed, using Nvivo program, based on the following categories: identity as teachers and conceptual appropriation. However, during the process, some categories emerged, such as, appreciations about the educational system and others related to writing. The conclusions point out the potential of this technique for a reflexive exercise to be carried out in an agile way; besides, it promotes in the students the habit of constantly questioning themselves, making it possible for them to be more self-critical.

Social and obstetric factors associated with the way of delivery: reality of a maternity school in the interior of the northeast

The study aims to identify the social and obstetric factors associated with the mode of delivery of postpartum women attending a public maternity hospital located in the interior of the state of Sergipe, in the northeast region. This is a cross-sectional study that included 1,149 postpartum women in the immediate period, carried out between November 2016 and December 2019, who underwent functional kinesiological assessment for physical therapy care. Descriptive analysis and binary logistic regression were performed using the mode of delivery as the dependent variable. The results showed that the prevalence of cesarean deliveries was of 49.24% (n=565). Most puerperal women were young, married, primiparous and with elementary education. Vaginal delivery was associated with postpartum women with married marital status (OR, 10.463; 95%CI, 2.367-46.254), multipregnancy (OR, 9.54; 95% CI, 7.19-12.65), multiparous (OR, 8.79; 95%CI, 6.66-11.62), with no pain (OR, 2.08; 95%CI, 1.63-2.65), no comorbidities (OR,1.69, 95%CI, 1.23-2.28), number of prenatal consultations from one to seven (OR, 1.534; 95%CI, 1.18-1.98), and without difficulty to breastfeed (OR, 1.373, 95%CI, 1.04-1.80). The cesarean delivery route was associated with abortion in primiparae (OR, 1.69; 95%CI, 1.192-2.415) and education at the elementary level. (OR, 2.99; 95%CI, 1.403-6.411). It is concluded that social factors (education level and marital status), obstetric factors (parity, number of pregnancies, comorbidities, obstetric care) and immediate puerperal complaints (pain and difficulty in breastfeeding) were associated with the modes of delivery.

Maternal involvement in education mediates longitudinal associations between maternal depressive symptoms and child adjustment.

Children of mothers with high depressive symptoms are at heightened risks for maladjustment in grade school. Yet, the process through which maternal depressive symptoms pose risks for child adjustment is not well understood. This study examined the mediating role of maternal involvement in education in the longitudinal associations between maternal depressive symptoms and children's school adjustment. Three waves of data spanning from first to fifth grades were used (N = 1,364). Depressive symptoms, maternal involvement in education, and children's internalizing and externalizing problems were reported by mothers. Teachers reported children's academic performance. Results showed that maternal depressive symptoms were negatively associated with their subsequent involvement in education. Low maternal involvement in education mediated longitudinal relations of maternal depressive symptoms to poor academic performance and internalizing problems, but not externalizing problems, in children. Results further demonstrated that the role of maternal involvement in education was independent of parental sensitivity. Findings highlighted the unique role of low maternal involvement in education in understanding the risks that maternal depressive symptoms pose on children's adjustment in grade school. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Training Preceptors of Obstetrics-Gynecology Residents through the One-minute Preceptor Model.

To analyze the effect of the One-minute Preceptor model for preceptors who work at the emergency department of a maternity teaching hospital. A quantitative intervention study conducted with Obstetrics and Gynecology residency preceptors at a maternity teaching hospital in northeastern Brazil. Three stages were performed: 1) a preintervention survey with the residents; 2) planning and execution of a pedagogical training course for the preceptors, which involved a lecture and a dramatization about the One-Minute Preceptor model; and 3) thirty days after the intervention, the residents answered another survey about the model and its repercussions and advantages. The preintervention assessment with the residents showed that 91.7% agreed that there were discrepancies regarding the teaching model among the preceptors. After the training, all preceptors agreed that the model engages the student in the decision-making process, and that they would apply it to their routine. The postintervention results showed that 95.8% agreed that the model is more inviting than traditional teaching approaches. There was a perception of improvement in learning among 70.9% of the residents. In addition, the present study found a significant change in feedback before and after implementing the model, from 20.8% to 66.7%. The training course of preceptors in the One-Minute Preceptor model proved to be efficient in providing formative feedback to residents in the emergency department of a maternity school. Further studies are needed to assess the consolidation of the methodology in the long term.

Assessing the Inequality of Early Child Development in China - A Population-Based Study.

BackgroundAs a country with the second largest child population in the world, China has little population-level evidence on who has been left behind in early childhood development (ECD). Knowledge of inequalities in ECD will inform the Chinese government in policies on promoting ECD and guide global-level monitoring on ECD progress.MethodsUsing data from the first wave of ECD surveys conducted in China at the least-developed region, most-developed region, and a megacity (Shanghai) in 2017 and 2018, we measured population-level ECD with early Human Capability Index for a total of 63,559 children aged 36-59 months old. A child was classified as developmentally on track if his/her overall development score was above the 20th percentile of the pooled populations. We measured inequalities in ECD with the absolute inequality in five domains: gender/sex, family income, maternal schooling, residential Hukou, and migrant- or left-behind status. Besides observed inequalities, we used a multilevel logistic regression model to generate adjusted inequalities.FindingsChildren developmentally on track ranges from 71% (95% CI 70 to 72%) in the least-developed region, 82% (95% CI 81 to 83%) in the most-developed region, and 86% (95% CI 85 to 87%) in Shanghai. Significant unadjusted inequalities in ECD were observed in all five dimensions. After controlling for other socioeconomic factors, significant differences remained in three dimensions: those living in the poorest families, or with lower maternal schooling, or boys were less likely to be developmentally on track than their counterparts (lower by 10[95% CI 8 to 11]-15[95% CI 13 to 17], 7[95% CI 5 to 10]-10[95% CI 7 to 12], and 5[95% CI 4 to 6]-6[95% CI 5 to 8] percentage points respectively).InterpretationEfforts of reducing ECD inequalities in China shall focus primarily on reducing poverty and improving maternal education.FundingNational Natural Science Foundation of China (81773443), Shanghai Committee of Science and Technology (2018SHZDZX05), Shanghai Municipal Health Commission (GWV-10.1-XK07; GDEK201708), Shanghai Education Committee, Chinese Social Science Foundation (BFA140046), Macao Tong Chai Charity Association, Beijing Sany Charitable Foundation, China Medical Board (#20-388), UNICEF, Faculty Grant of Brigham & Women's Hospital, Economic and Social Research Council [grant reference number ES/T003936/1’] as a UKRI Collective Fund Award “UKRI GCRF Harnessing the Power of Global Data to Support Young Children's Learning and Development Collaborative."

Sociodemographic and Clinical Factors Associated with Postpartum Hemorrhage in a Maternity Ward

Objective: Checking the sociodemographic and clinical factors associated with the prevalence of postpartum hemorrhage (PPH) in a maternity school. Materials and methods: A quantitative cross-sectional study in a maternity hospital in Salvador, Bahia, Brazil. In data collection, we used a standardized form that contained sociodemographic and clinical data from the medical records of 83 women for the period of 2018. Stata version 14 software was used in the analyses. Bivariate analysis was conducted using Pearson’s or Fisher’s exact tests. Poisson regression was performed with robust variation in multivariate analysis. Prevalence ratios (PR) and respective 95 % confidence intervals were estimated. The significance level of the tests was 5 %. Results: The prevalence of PPH was 38.6 % and 25.6 % for atony as the cause. In the bivariate analysis, there was an association between PPH and non-breastfeeding in the first hour of life (p = 0.039). In the multivariate analysis, it was identified that multiparous women had an increase in the prevalence of PPH by almost twice (PR = 1.97). Not breastfeeding in the first hour of life increased this prevalence more than four times (PR = 4.16). Conclusions: Monitoring multiparous women during birth care and encouraging breastfeeding in the first hour of life may decrease the prevalence of PPH.

Study of Cardiovascular Risks in Adolescents (ERICA): factors associated with work in adolescence.

This study aimed to verify the association between work and sociodemographic factors, health behaviors, and cardiovascular risk in Brazilian adolescents. Data from the Study of Cardiovascular Risks in Adolescents (ERICA) were analyzed, with a sample of 37,815 adolescents aged 12-17 years and morning shift students. Considering complex sampling, crude and adjusted Prevalence Ratios (PR) were calculated with interval estimates for variables by Poisson multiple regression model with robust variance estimate. The sociodemographic factors associated with work among Brazilian adolescents were male gender (PR 1.34), aged 15-17 years, with maternal schooling up to elementary school (PR 1.26), public school students (PR 1.63), and from the rural area (PR 1.90). Regarding lifestyle habits and social behavior, the association was significant in physically active (PR 1.19) and alcohol-consuming students (PR 1.35). In conclusion, work among Brazilian adolescent morning shift students is still strongly linked to social issues. Work was associated with alcohol consumption, and there was no association with metabolic markers.

Low-grade intraventricular haemorrhage is not as harmless as first thought when born extremely preterm.

Intraventricular haemorrhage (IVH) is a known serious complication of preterm birth, especially in extreme preterm infants. IVH pathophysiology is thought to be multifactorial with changes in the germinal matrix, cerebral autoregulation coupled with underlying problems of coagulation and possible genetic issues.1 In this study, the authors looked at IVH and the neurodevelopmental outcomes at 8 years of corrected age. They strengthen the understanding that higher grades of IVH have worse neurodevelopmental outcomes. However, they show data to suggest that lower grades of IVH have an increased risk of cerebral palsy compared with no IVH. This study was designed well, with a large sample size of over 500 infants, and the controls were matched for an expected date of delivery, the child's sex, maternal health insurance status and country of birth. The study was performed in a large centre with good rates of follow-up to 8 years of corrected age in both groups. Even taking into account the good aspects, a few areas were not clear. The term born controls were used to generate IQ and academic performance. However, they were not matched with regard to maternal age and maternal school achievement, which are independent risk factors for poor neurodevelopmental outcomes.2 Also, the controls were difficult to follow during this study, with no results stating the rates of cerebral palsy in the controls compared with extreme preterm infants. The authors also rightly mention the significance of periventricular leukomalacia (PVL) and white matter damage as concerns for neurodevelopmental outcomes.3 However, this confounder was not accounted for in the analysis. In addition, there is no discussion about the impact of bilateral vs unilateral IVH on the outcome. Finally, there was a change in the assessment of cerebral palsy during the study process, but the authors discuss this change. This study has highlighted a few points to consider for future practice. We as clinicians already understand the relationship between grade 3 and grade 4 IVH with worse outcomes, and we counsel parents well on this association.4 This study empathises the worse motor outcomes for grade 3 and grade 4 IVH with 43% and 92%, respectively, for extremely preterm infants having any motor dysfunction. Most clinicians are often reassured when counselling for the lower grades of IVH; however, this and other studies5-7 conclude that grade 1 and grade 2 IVH are independent risk factors for poor neurodevelopmental outcomes with increased risk of cerebral palsy. The main message of this study was to remind clinicians of the higher risk of cerebral palsy at the lower grades of IVH, informing neonatologists that the risk is more than doubled from no IVH to grade 1. This study highlights that lower grades of IVH are not as benign as first thought. At 8 years of life, they have a greater risk of cerebral palsy, more than double the rate, compared with no IVH.8 From these observations, clinicians should be cautious and tentative about sounding optimistic regarding the prognosis of lower grade IVH and should communicate this with families sensitively. None.