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    "titulo" => "Comunicaciones orales : Salud infantil II"
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    "textoCompleto" => "<p class="elsevierStylePara"> Jueves 2 de Octubre &#47; Thursday 2&#44; October<br></br> 11&#58;30&#58;00 a&#47;to 13&#58;30&#58;00</p><p class="elsevierStylePara"> Moderador&#47;Chairperson&#58;<br></br> Charles Florey and Marisa Rebagliato</p><p class="elsevierStylePara"><span class="elsevierStyleBold">057</span><span class="elsevierStyleBold">TRENDS AND PATTERNS OF INFANT MORTALITY IN EUROPEAN COUNTRIES</span></p><p class="elsevierStylePara"> Jos&#233; Leopoldo Ferreira Antunes&#42;&#44; Eliseu Alves Waldman&#42;&#42;</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">&#42;School of Dentistry&#44; University of Sao Paulo&#44; Sao Paulo&#44; Brazil&#46; &#42;&#42;School of Public Health&#44; University of Sao Paulo&#44; Sao Paulo&#44; Brazil&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction&#58;</span> During the last decades&#44; Europe experienced intense geo-political transformations&#44; with warfare and the emergence of newly independent states in its central and eastern portion&#44; and the unification of richer western countries&#46; The present study aims to contribute to document the health status of European countries during this complex process&#44; by describing current levels and trends of infant mortality rate&#46; We also aimed at exploring different hypotheses of association between infant mortality and recent modifications of socio-economic conditions and the provision of health services&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Methods&#58;</span> The World Health Organisation Regional Office for Europe provided primary information for the country-area profile of infant mortality rates &#40;IMR&#41;&#44; and indices assessing socio-economic status and the provision of health services&#46; The estimation of trends and current levels for the IMR used the auto regression procedure of exact maximum-likelihood estimation for time-series analysis&#46; The appraisal of association between variables used OLS regression analysis&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results&#58;</span> Central and Eastern Europe &#40;CEE&#41; and Newly Independent States &#40;NIS&#41; presented a poorer profile of child survival than the European Union &#40;EU&#41;&#44; Nordic Countries &#40;NC&#41; and Switzerland &#40;SW&#41;&#44; with a threefold average for current levels of IMR&#46; Moreover&#44; CEE and NIS figures for this outcome decreased at a near 20&#37; lower rate during the last twenty years&#46; An improved profile of socio-economic status associated with lower figures of infant mortality in both sets of countries&#46; However&#44; the drop of rates in EU and NC was faster in poorer countries&#44; indicating that they benefited from the recent geo-political process&#44; the inverse occurring in CEE and NIS&#46; Health services contributed to reduce health inequalities&#44; by hastening the decrease of infant mortality&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusions&#58;</span> The main finding reported here is the contribution of health programmes to alleviate the unfavourable impact of economic standings on child survival&#46; The importance of fostering the provision of health services cannot be overemphasised&#59; it is a source of expectation for achieving the UNICEF&#39;s World Summit for Children Goal 1 of reducing by 33&#37; infant and under-5 mortality until 2010&#46; The present observation of higher levels concurrent with slower decreasing trends of IMR in CEE and NIS countries than in EU&#44; NC and SW relies on an excessive number of preventable infant deaths each year&#44; and points out as enlarging the gap between richer and poorer European regions&#46; This charge is unacceptable&#44; and overcoming it must remain a focus of international public health concern and policies&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">058</span><span class="elsevierStyleBold">THE PARADOX BETWEEN PETS AT HOME AND ASTHMA AND ALLERGY IN CHILDREN FROM VALENCIA &#40;SPAIN&#41;</span></p><p class="elsevierStylePara"> Maria de Mar Morales Suarez-Varela&#42;&#44; Maria Cristina Jimenez L&#243;pez&#42;&#42;&#44; Agustin Llopis Gonzalez&#42;&#42;&#44; Luis Garcia-Marcos &#193;lvarez&#42;&#42;&#42;</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">&#42;Unidad de Investigacion Clinica- Unitat de Salut Publica&#44; Hospital Dr Peset-Universitat de Valencia&#44; Valencia&#44; Espa&#241;a&#46; &#42;&#42;Unitat de Salut Publica&#44; Higiene i Sanitat Ambiental&#44; Universitat de Valencia&#44; Valencia&#44; Espa&#241;a&#46; &#42;&#42;&#42;Unidad Docente de Pediatria&#44; Universidad de Murcia&#44; Murcia&#44; Espa&#241;a&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction&#58;</span> Exposure to environmental factors at home&#44; such as cats&#44; dogs&#44; birds&#44; etc&#46; &#40;1&#41;&#44; and the characteristics of the house and child&#39;s bedroom&#44; have been proposed as factors closely related to the development of asthma symptoms in children &#40;2&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Objectives&#58;</span> A study is made of the pets in children&#39;s homes and their possible role in relation to asthma&#44; allergy and atopic dermatitis&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Material and Methods&#58;</span> The study was carried out among children 8 years old&#44; randomly selected from the second grade Primary Education setting in 65 schools in Valencia &#40;Spain&#41;&#46; The centers comprised both public and private schools&#46; A child was considered asthmatic&#44; allergic or with atopic dermatitis if their parents answered affirmatively to the ISAAC questionnaire &#40;International Study of Asthma and Allergies in Childhood&#41;&#40;3&#41;&#46; The odds ratios and 95&#37; confidence intervals were calculated&#46; Multivariate linear regression analyses were carried to study the possible relationship between asthma&#44; allergy and atopic dermatitis and the different study variables&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results&#58;</span> An OR&#61;0&#46;38 and OR&#61;0&#46;56 was observed for asthma and allergy in children who had cats in their first year of life&#44; versus OR&#61;0&#46;70 and OR&#61;0&#46;68 among those who had cats in the last year&#46; Children who had dogs in their first year of life had a risk of asthma and allergic rhinoconjunctivitis of OR&#61;0&#46;59 and OR&#61;0&#46;81&#44; respectively&#46; This risk was a little greater than in the case of those who had dogs in the last year&#58; OR&#61;0&#46;93 and OR&#61;0&#46;90&#44; respectively&#46; The multivariate analyses yielded a statistically significant inverse relationship between the prevalence of diagnosed asthma and the presence of a cat in the house in the first year of life &#40;p&#60;0&#46;001&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusions&#58;</span> A statistically significant inverse relationship was observed between children who had pets or farm animals in their house and asthma&#44; allergic rhinoconjunctivitis and atopic dermatitis&#46; This may be due to tolerance to allergens from childhood&#46; If contact with domestic and farm animals took place only in the last year&#44; the opposite tendency was observed&#44; in favor of symptoms of asthma&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">References</span></p><p class="elsevierStylePara"> 1&#46; Leaderer BP&#44; Belanger K&#44; Triche E&#44; Holford T&#44; Gold DR&#44; Kim Y&#46; Dust mite&#44; cockroach&#44; cat&#44; and dog allergen concentrations in homes of asthmatic children in the Northeastern United States&#58; Impact of socioeconomic factors and population density&#46; Environmental Health Perspectives 2002 Apr&#46; 110&#40;4&#41;&#58;419-25&#46;</p><p class="elsevierStylePara"> 2&#46; Custovic A&#44; Murray CS&#44; Gore RB&#44; Woodcock A&#46; Controlling indoor allergens&#46; Ann Allergy Asthma Immunol 2002 May&#59; 88&#40;5&#41;&#58;432-41&#59; quiz 442-3&#46;</p><p class="elsevierStylePara"> 3&#46; Strachan DP&#44; Steering Comittee of the ISAAC&#46; Worldwide variations in prevalence of symptoms of allergic rhinoconjunctivitis in children&#58; The International Study of Asthma and Allergies in Childhood &#40;ISAAC&#41;&#46; Pediatr Allergy Immunol 1997&#59; 8&#58;161-76&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">059</span><span class="elsevierStyleBold">DETERMINANTS OF CHANGES IN BODY-MASS-INDEX IN CHILDREN BETWEEN THE AGES OF 4 AND 6 YEARS</span></p><p class="elsevierStylePara"> Kilian Rapp&#42;&#44; Karl-Heinz Schick&#42;&#42;&#44; Harald Bode&#42;&#42;&#42;&#44; Stephan K Weiland&#42;</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">&#42;Department of Epidemiology&#44; University of Ulm&#44; Germany&#46; &#42;&#42;Public Health Department Stuttgart&#44; Germany&#46; &#42;&#42;&#42;Department of Paediatrics&#44; University of Ulm&#44; Germany&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction&#58;</span> Childhood overweight is an increasing problem in developed countries&#46; Many cross-sectional studies examined associations between different factors and the prevalence of overweight&#44; but few studies have looked for determinants of changes in Body-Mass-Index &#40;BMI&#41;&#46; We investigated the influence of different determinants on changes in BMI in children between the ages of 4 and 6 years&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Methods&#58;</span> 2159 children participating in the compulsory school entrance health examination in 2002 in the city of Stuttgart&#44; Southern Germany&#44; were included &#40;response rate 70&#44;2&#37;&#41; and had their height and weight measured&#46; The height and weight of these children at the age of 4 years were abstracted from medical records&#44; the childrens screening books&#44; which were available for 1817 children&#46; Information on possible determinants of overweight was collected by parental questionnaire&#46; The relative age- and sex-specific BMI was calculated for both examination dates &#40;SDS<span class="elsevierStyleInf">LMS</span> method&#41; and multiple linear regression models were applied&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results&#58;</span> The prevalence of overweight &#40;&#62;&#61; 90&#46; percentile&#41; differed significantly between children of non-German mother tongue and German mother tongue &#40;crude OR 3&#44;52&#44; 95&#37; CI&#58; 2&#44;70 to 4&#44;60&#41; and there was evidence for effect modification between breast feeding duration and mother tongue&#46; Therefore all analysis were conducted stratified for mother tongue &#40;31&#37; non-German&#44; 69&#37; German&#41;&#46; In the multiple linear regression model the following variables had a significant influence &#40;p&#60;0&#44;05&#41; on changes in relative BMI&#46; For German children&#58; paternal BMI and duration of TV watching &#40;e&#46;g&#46; regression coefficient 0&#44;38 &#40;95&#37; CI&#58; 0&#44;16 to 0&#44;60&#41; for &#62;2 hours daily vs&#46; &#60;1 hour daily&#41; were positively&#44; duration of breast feeding was inversely associated with relative change in BMI&#46; For non-German children&#58; parental BMI and duration of TV watching were positively related to relative changes in BMI while duration of breast feeding &#40;e&#46;g&#46; regression coefficient -0&#44;27 &#40;95&#37; CI&#58; -0&#44;47 to &#168;C0&#44;08&#41; for 4-6 months vs&#46; &#60; 2 months&#41; was associated with a decrease in relative BMI to a greater extent than in German children&#46; Other potential determinants of overweight like maternal smoking during pregnancy&#44; low or high birth weight or educational status have no influence on changes in relative BMI between the ages of 4 and 6 years&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusions&#58;</span> Changes in age- and sex-specific BMI were associated with factors which are potentially amenable to prevention&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">060</span><span class="elsevierStyleBold">BREAST-FEEDING AND RISK OF HOSPITALIZATION FOR ALL CAUSES AND FEVER OF UNKNOWN ORIGIN</span></p><p class="elsevierStylePara"> Miguel Delgado-Rodr&#237;guez<span class="elsevierStyleSup">1</span>&#44; Rosa Pardo-Crespo<span class="elsevierStyleSup">2</span>&#44; Roc&#237;o P&#233;rez-Iglesias<span class="elsevierStyleSup">2</span>&#44; Silvia Palma<span class="elsevierStyleSup">1</span>&#44; Marcial Mariscal<span class="elsevierStyleSup">1</span>&#44; Javier Llorca<span class="elsevierStyleSup">3</span>&#44; Miguel Angel Martinez-Gonzalez<span class="elsevierStyleSup">4</span></p><p class="elsevierStylePara"><span class="elsevierStyleItalic"><span class="elsevierStyleSup">1</span>Medicina Preventiva&#44; Universidad de Ja&#233;n&#44; Ja&#233;n&#44; Espa&#241;a&#46; <span class="elsevierStyleSup">2</span>Pediatr&#237;a&#44; Universidad de Cantabria&#44; Santander&#46; <span class="elsevierStyleSup">3</span>Medicina Preventiva&#44; Universidad de Cantabria&#44; Santander&#46; <span class="elsevierStyleSup"> 4</span>Medicina Preventiva&#44; Universidad de Navarra&#44; Pamplona&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Background&#58;</span> Breast-feeding has shown to give a reduction in the risk of hospitalization due to respiratory tract infections and gastrointestinal conditions during the first two years of life&#46; No previous report on the association of breast-feeding with fever of unknown origin &#40;FUO&#41; has been found&#46; This is the main objective of this report&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Methods&#58;</span> A case-reference study in Cantabria &#40;northern Spain&#41; was carried out&#46; Cases &#40;n &#61; 336&#41; were hospitalized children aged less than 24 months at University of Cantabria Hospital&#46; Newborns with congenital malformations were excluded&#46; Cases were selected using 40&#37; random sampling of all children up to 24 months old admitted to the hospital&#58; a 40&#37; random sample of days was generated with the EpiInfo 6&#46;0 &#40;CDC&#44; Atlanta&#44; USA&#41; software and all admissions in those days were included&#46; The reference was a 1&#58;1 matched &#40;by time from delivery to admission&#41; sample of children from mothers delivering at the same hospital&#46; Information on breast-feeding&#44; socioeconomic variables and employment were obtained&#46; Odds ratios &#40;ORs&#41;&#44; their 95&#37; confidence intervals &#40;CIs&#41;&#44; and mean length of breast-feeding were estimated after adjusment for confounding variables&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results&#58;</span> In the reference population&#44; shorter duration of breast-feeding was associated with smoking&#44; lower educational level&#44; and less privileged social strata&#46; The frequency of breast-feeding was higher in the reference than in the cases&#44; 82&#46;3&#37; vs 75&#46;6&#37; &#40;p&#61;0&#46;023&#41;&#46; Significant negative trends were noted in univariate analyses between the length of breast-feeding and both all admission causes and FUO&#44; although the statistical significance was lost after adjusting for confounding variables &#40;educational level&#44; social class&#44; smoking&#44; and use of incubator after delivery&#41;&#46; Breast-feeding was dichotomized according to different cut-off levels &#40;see figure 1&#41;&#46; The maximum protection &#40;minimum odds ratio&#41; for all causes was obtained for breast-feeding longer than two months and stronger for children up to six months of age than for older infants&#46; For FUO the lowest ORs were for durations of breast-feeding longer than 120 days&#44; although these figures were not statistically significant&#46; The adjusted mean length of breast-feeding was shorter in hospitalized children &#8804; 6 months old for both all admission causes &#40;40&#46;6 &#177; 5&#46;4 vs 99&#46;5 &#177; 5&#46;4&#44; p &#60; 0&#46;001&#41; and FUO &#40;40&#46;8 &#177; 12&#46;4 vs 91&#46;7 &#177; 12&#46;4&#44; p &#61; 0&#46;006&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusion&#58;</span> Breast-feeding time is shorter in hospitalized children for both all admission causes and FUO&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">061</span><span class="elsevierStyleBold">NEONATAL MORTALITY AND SOCIO-ECONOMIC STATUS&#58; A CASE-CONTROL STUDY</span></p><p class="elsevierStylePara"> Bradley N&#46; Manktelow&#44; Elizabeth S&#46; Draper</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">Dept&#46; Epidemiology and Public Health&#44; University of Leicester&#44; Leicester&#44; UK&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction&#58;</span> There is growing interest in the comparison of outcomes between health care providers&#46; To carry out fair comparisons it is important to allow for any underlying morbidity over which the provider has had no influence&#46; In neonatal care there is conflicting evidence whether maternal socio-economic deprivation is a predictor of neonatal mortality&#46; It is also unclear whether any possible association is solely because such babies tend to be born earlier and smaller&#46; This paper aims to investigate evidence for an independent association between maternal socio-economic deprivation and neonatal death&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Methods&#58;</span> The Leicestershire Perinatal Mortality Study is a case-control study of perinatal death occurring to women resident in Leicestershire&#44; UK&#46; From 1992 this study was extended to include all neonatal deaths&#46; In this paper data on all singleton control subjects and neonatal deaths from 1996 to 2000 were used&#46; Socio-economic status was defined in two ways&#46; First&#44; using social class derived from maternal interview&#58; the highest of either parent where they were cohabiting and the mother&#39;s alone if the parents were not cohabiting&#46; Second&#44; using the Department of the Environment Deprivation Score &#40;DoE&#41; calculated for each mother&#39;s area of residence at electoral Ward level&#46; Mortality ratios &#40;observed&#47;expected&#41; were calculated for each social class&#44; or quintile of DoE score&#44; both unadjusted and adjusted for gestation and weight at birth&#46; The DoE score was also investigated as a continuous variable in a logistic model&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results&#58;</span> 1470 births were identified of whom 1427 had complete data recorded&#58; 483 deaths within 28 days of birth and 944 controls&#46; Unadjusted mortality ratios for each social class ranged from 0&#46;86 to 1&#46;93 &#40;p-value for no difference between groups &#61; 0&#46;0003&#41; with a trend of higher neonatal mortality to mothers of lower social class&#46; After adjustment for gestation and weight at birth the mortality ratios ranged from 0&#46;97 to 1&#46;07 &#40;p &#61; 0&#46;85&#41;&#46; There was little evidence of a relationship between DoE score and neonatal mortality when entered in a logistic regression model &#40;p &#61; 0&#46;062&#41;&#46; The mortality ratios for the quintiles of DoE score ranged from 0&#46;86 to 1&#46;11&#44; with only very weak evidence of a trend towards higher mortality with higher deprivation&#44; and from 0&#46;91 to 1&#46;11 after adjustment for gestation and weight at birth&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusions&#58;</span> There is strong evidence that neonatal mortality is associated with social class derived from the mother&#39;s individual circumstances&#46; However&#44; there is no evidence that this is in addition to the effect of prematurity and low birth weight&#46; The association between neonatal mortality and the DoE Score&#44; a small-area derived deprivation score&#44; is much weaker&#46; When comparing neonatal mortality&#44; adjustment for gestation and weight at birth adequately adjusts for socio-economic differences&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">062</span><span class="elsevierStyleBold">BODY MASS INDEX AND DEPRESSIVE SYMPTOMS IN ADOLESCENTS</span></p><p class="elsevierStylePara"> Carlos Pereira&#44; Henrique Barros</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">Hygiene and Epidemiology&#44; university of Porto Medical School&#44; Porto&#44; Portugal&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction&#58;</span> Both obesity and depression are increasingly prevalent conditions&#44; commonly associated&#44; and relating with several other serious adult disease that begin expressing themselves relatively early in life&#46; The aim of this study was to estimate the association between depression and body mass index &#40;BMI&#41; in a community sample of adolescents&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Participants and methods&#58;</span> In a cross sectional survey we evaluated 5383 adolescents &#40;53&#46;1&#37; females&#41; aged 12 to 18 years&#44; randomly selected among student residents in Viseu&#44; Portugal&#46; Participants completed a self-administered questionnaire&#46; BMI &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41; was calculated from self-reported height and weight and participants grouped according to the sample distribution quartiles&#46; Depressive symptoms were assessed using the Portuguese validated version of Beck Depression Inventory for Adolescents using the 15 points score as the cut-off to consider depression&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results&#58;</span> The prevalence of depression in the total sample was 18&#46;7&#37;&#44; significantly higher in females &#40;31&#46;1 vs&#46; 15&#46;3&#44; p&#60;0&#46;01&#41; with symptoms mean scores increasing with age &#40;p for trend &#60;0&#44;001&#41;&#46; After adjusting for sex&#44; age&#44; chronic diseases and social-class&#44; there was an increasing risk of depression with increasing quartiles of BMI &#40;2nd quartile OR&#61;1&#46;3&#44; 95&#37; CI 1&#46;0-1&#46;6&#59; 3rd quartile OR &#61;1&#46;2&#44; 95&#37; CI 0&#46;9-1&#46;5&#59; and 4th quartile OR&#61;1&#44;4 95&#37; CI 1&#46;1-1&#46;8&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusion&#58;</span> We found a high prevalence of depression in adolescents that was significantly associated with increasing body mass index&#46; This finding suggest that as shown in the adult population obesity has a negative impact on psychosocial factors&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">063</span><span class="elsevierStyleBold">RISK FACTORS FOR LOW COGNITIVE FUNCTION AT AGE 5&#58; A FOLLOW-UP STUDY IN NORTH-EAST BRAZIL</span></p><p class="elsevierStylePara"> Darci N&#46; Santos<span class="elsevierStyleSup">1</span>&#44; Ana C&#46; Bastos<span class="elsevierStyleSup">2</span>&#44; Marcia M&#46; Pedromonico<span class="elsevierStyleSup">3</span>&#44; Naomar Almeida-Filho<span class="elsevierStyleSup">1</span>&#44; Laura C&#46; Rodrigues<span class="elsevierStyleSup">4</span>&#44; Mauricio L&#46; Barreto<span class="elsevierStyleSup">1</span>&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleItalic"><span class="elsevierStyleSup">1</span>Instituto de Saude Coletiva&#44; Universidade Federal da Bahia&#44; Salvador&#44; Brazil&#46; <span class="elsevierStyleSup">2</span>Departamento de Psicologia&#44; Universidade Federal da Bahia&#44; Salvador&#44; Brazil&#46; <span class="elsevierStyleSup">3</span>Escola de Medicina&#44; Universidade Federal de S&#227;o Paulo&#44; S&#227;o Paulo&#44; Brazil&#46; <span class="elsevierStyleSup">4</span>Epidemiology Unit&#44; London School of Hygiene and Tropical Medicine&#44; London&#44; UK&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction&#58;</span> It has been recognised that environments with low psychoeducational stimulation and poor levels of family organization together with poor hygiene&#44; unfavourable living conditions and malnutrition intensify the risk factors for child development increasing the probability of low cognitive performance&#46; This study aims to examine the associations between personal&#44; environmental&#44; and health-related factors during infancy and cognitive function in later childhood&#46; The first objective was to evaluate the effect of socioeconomic factors&#44; environmental characteristics&#44; quality of home stimulation&#44; and health &#40;including birth weight&#44; diarrhoea&#44; parasitic infections&#44; and anthropometric measures&#41; on cognitive function at 18-42 months&#59; the second&#44; to evaluate the effect of all these variables together with pre-school education on cognitive function at five years&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Methods&#58;</span> A cohort study was carried out in Salvador&#44; northeast Brazil &#40;population 2&#44;211&#44;539&#41;&#46; A health baseline survey &#40;1997-8&#41; collected data on diarrhoea&#44; stool samples&#44; nutritional status and environmental sanitation&#46; In 1999 two measurements were applied&#44; the Home Inventory&#44; and Bayley Scale for children below 42 months&#46; In 2001 346 children completed their pre-school assessment with the WPPSI-R Scale&#46; One way analysis of variance &#40;ANOVA&#41; was used for analysis of the WPPSI-R scores&#44; and a multivariate ANOVA model to identify factors independently associated with cognitive score at age 5 according to the conceptual framework&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results&#58;</span> The 346 children had a mean score on cognitive function of 96&#46;4 &#40;SD 11&#46;2&#41; below 42 months&#44; and 82&#46;6 points &#40;SD 13&#46;7&#41; at age 5&#46; Children living with families with income up to 1 minimum local wage had a lower mean score on the WPPSI-R test than those born to a family with a higher income&#46; Mean scores showed an improvement as family ownership capacity improved&#46; Lack of paternal income corresponded to lower mean WPPSI-R scores&#44; as did a home with significant overcrowding&#46; Children whose households lacked basic sanitary infrastructure&#44; in neighborhoods with poor sanitation&#44; had lower mean scores than those living in houses and areas of good sanitation&#46; Low birth-weight also gave lower mean scores&#46; The malnourished according to anthropometric measures had lower mean WPPSI-R scores as did children with over 7 days&#47;diarrehea&#47;year and positive helmintic infection&#46; Mean WPPSI-R scores were lower for children previously under low home psychosocial stimulation&#44; with low cognitive function during infancy&#44; as well as for children not attending day-care or kindergarten&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusion&#58;</span> Low socio-economic conditions&#44; low birth-weight&#44; stunting&#44; bad quality sanitation&#44; and low levels of home stimulation and cognitive function during infancy&#44; together with no kindergarten attendance&#44; has a strong adverse effect on cognitive function in later childhood&#46;</p>"
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Comunicaciones orales : Salud infantil II
Child health II
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    "textoCompleto" => "<p class="elsevierStylePara"> Jueves 2 de Octubre &#47; Thursday 2&#44; October<br></br> 11&#58;30&#58;00 a&#47;to 13&#58;30&#58;00</p><p class="elsevierStylePara"> Moderador&#47;Chairperson&#58;<br></br> Charles Florey and Marisa Rebagliato</p><p class="elsevierStylePara"><span class="elsevierStyleBold">057</span><span class="elsevierStyleBold">TRENDS AND PATTERNS OF INFANT MORTALITY IN EUROPEAN COUNTRIES</span></p><p class="elsevierStylePara"> Jos&#233; Leopoldo Ferreira Antunes&#42;&#44; Eliseu Alves Waldman&#42;&#42;</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">&#42;School of Dentistry&#44; University of Sao Paulo&#44; Sao Paulo&#44; Brazil&#46; &#42;&#42;School of Public Health&#44; University of Sao Paulo&#44; Sao Paulo&#44; Brazil&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction&#58;</span> During the last decades&#44; Europe experienced intense geo-political transformations&#44; with warfare and the emergence of newly independent states in its central and eastern portion&#44; and the unification of richer western countries&#46; The present study aims to contribute to document the health status of European countries during this complex process&#44; by describing current levels and trends of infant mortality rate&#46; We also aimed at exploring different hypotheses of association between infant mortality and recent modifications of socio-economic conditions and the provision of health services&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Methods&#58;</span> The World Health Organisation Regional Office for Europe provided primary information for the country-area profile of infant mortality rates &#40;IMR&#41;&#44; and indices assessing socio-economic status and the provision of health services&#46; The estimation of trends and current levels for the IMR used the auto regression procedure of exact maximum-likelihood estimation for time-series analysis&#46; The appraisal of association between variables used OLS regression analysis&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results&#58;</span> Central and Eastern Europe &#40;CEE&#41; and Newly Independent States &#40;NIS&#41; presented a poorer profile of child survival than the European Union &#40;EU&#41;&#44; Nordic Countries &#40;NC&#41; and Switzerland &#40;SW&#41;&#44; with a threefold average for current levels of IMR&#46; Moreover&#44; CEE and NIS figures for this outcome decreased at a near 20&#37; lower rate during the last twenty years&#46; An improved profile of socio-economic status associated with lower figures of infant mortality in both sets of countries&#46; However&#44; the drop of rates in EU and NC was faster in poorer countries&#44; indicating that they benefited from the recent geo-political process&#44; the inverse occurring in CEE and NIS&#46; Health services contributed to reduce health inequalities&#44; by hastening the decrease of infant mortality&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusions&#58;</span> The main finding reported here is the contribution of health programmes to alleviate the unfavourable impact of economic standings on child survival&#46; The importance of fostering the provision of health services cannot be overemphasised&#59; it is a source of expectation for achieving the UNICEF&#39;s World Summit for Children Goal 1 of reducing by 33&#37; infant and under-5 mortality until 2010&#46; The present observation of higher levels concurrent with slower decreasing trends of IMR in CEE and NIS countries than in EU&#44; NC and SW relies on an excessive number of preventable infant deaths each year&#44; and points out as enlarging the gap between richer and poorer European regions&#46; This charge is unacceptable&#44; and overcoming it must remain a focus of international public health concern and policies&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">058</span><span class="elsevierStyleBold">THE PARADOX BETWEEN PETS AT HOME AND ASTHMA AND ALLERGY IN CHILDREN FROM VALENCIA &#40;SPAIN&#41;</span></p><p class="elsevierStylePara"> Maria de Mar Morales Suarez-Varela&#42;&#44; Maria Cristina Jimenez L&#243;pez&#42;&#42;&#44; Agustin Llopis Gonzalez&#42;&#42;&#44; Luis Garcia-Marcos &#193;lvarez&#42;&#42;&#42;</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">&#42;Unidad de Investigacion Clinica- Unitat de Salut Publica&#44; Hospital Dr Peset-Universitat de Valencia&#44; Valencia&#44; Espa&#241;a&#46; &#42;&#42;Unitat de Salut Publica&#44; Higiene i Sanitat Ambiental&#44; Universitat de Valencia&#44; Valencia&#44; Espa&#241;a&#46; &#42;&#42;&#42;Unidad Docente de Pediatria&#44; Universidad de Murcia&#44; Murcia&#44; Espa&#241;a&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction&#58;</span> Exposure to environmental factors at home&#44; such as cats&#44; dogs&#44; birds&#44; etc&#46; &#40;1&#41;&#44; and the characteristics of the house and child&#39;s bedroom&#44; have been proposed as factors closely related to the development of asthma symptoms in children &#40;2&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Objectives&#58;</span> A study is made of the pets in children&#39;s homes and their possible role in relation to asthma&#44; allergy and atopic dermatitis&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Material and Methods&#58;</span> The study was carried out among children 8 years old&#44; randomly selected from the second grade Primary Education setting in 65 schools in Valencia &#40;Spain&#41;&#46; The centers comprised both public and private schools&#46; A child was considered asthmatic&#44; allergic or with atopic dermatitis if their parents answered affirmatively to the ISAAC questionnaire &#40;International Study of Asthma and Allergies in Childhood&#41;&#40;3&#41;&#46; The odds ratios and 95&#37; confidence intervals were calculated&#46; Multivariate linear regression analyses were carried to study the possible relationship between asthma&#44; allergy and atopic dermatitis and the different study variables&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results&#58;</span> An OR&#61;0&#46;38 and OR&#61;0&#46;56 was observed for asthma and allergy in children who had cats in their first year of life&#44; versus OR&#61;0&#46;70 and OR&#61;0&#46;68 among those who had cats in the last year&#46; Children who had dogs in their first year of life had a risk of asthma and allergic rhinoconjunctivitis of OR&#61;0&#46;59 and OR&#61;0&#46;81&#44; respectively&#46; This risk was a little greater than in the case of those who had dogs in the last year&#58; OR&#61;0&#46;93 and OR&#61;0&#46;90&#44; respectively&#46; The multivariate analyses yielded a statistically significant inverse relationship between the prevalence of diagnosed asthma and the presence of a cat in the house in the first year of life &#40;p&#60;0&#46;001&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusions&#58;</span> A statistically significant inverse relationship was observed between children who had pets or farm animals in their house and asthma&#44; allergic rhinoconjunctivitis and atopic dermatitis&#46; This may be due to tolerance to allergens from childhood&#46; If contact with domestic and farm animals took place only in the last year&#44; the opposite tendency was observed&#44; in favor of symptoms of asthma&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">References</span></p><p class="elsevierStylePara"> 1&#46; Leaderer BP&#44; Belanger K&#44; Triche E&#44; Holford T&#44; Gold DR&#44; Kim Y&#46; Dust mite&#44; cockroach&#44; cat&#44; and dog allergen concentrations in homes of asthmatic children in the Northeastern United States&#58; Impact of socioeconomic factors and population density&#46; Environmental Health Perspectives 2002 Apr&#46; 110&#40;4&#41;&#58;419-25&#46;</p><p class="elsevierStylePara"> 2&#46; Custovic A&#44; Murray CS&#44; Gore RB&#44; Woodcock A&#46; Controlling indoor allergens&#46; Ann Allergy Asthma Immunol 2002 May&#59; 88&#40;5&#41;&#58;432-41&#59; quiz 442-3&#46;</p><p class="elsevierStylePara"> 3&#46; Strachan DP&#44; Steering Comittee of the ISAAC&#46; Worldwide variations in prevalence of symptoms of allergic rhinoconjunctivitis in children&#58; The International Study of Asthma and Allergies in Childhood &#40;ISAAC&#41;&#46; Pediatr Allergy Immunol 1997&#59; 8&#58;161-76&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">059</span><span class="elsevierStyleBold">DETERMINANTS OF CHANGES IN BODY-MASS-INDEX IN CHILDREN BETWEEN THE AGES OF 4 AND 6 YEARS</span></p><p class="elsevierStylePara"> Kilian Rapp&#42;&#44; Karl-Heinz Schick&#42;&#42;&#44; Harald Bode&#42;&#42;&#42;&#44; Stephan K Weiland&#42;</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">&#42;Department of Epidemiology&#44; University of Ulm&#44; Germany&#46; &#42;&#42;Public Health Department Stuttgart&#44; Germany&#46; &#42;&#42;&#42;Department of Paediatrics&#44; University of Ulm&#44; Germany&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction&#58;</span> Childhood overweight is an increasing problem in developed countries&#46; Many cross-sectional studies examined associations between different factors and the prevalence of overweight&#44; but few studies have looked for determinants of changes in Body-Mass-Index &#40;BMI&#41;&#46; We investigated the influence of different determinants on changes in BMI in children between the ages of 4 and 6 years&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Methods&#58;</span> 2159 children participating in the compulsory school entrance health examination in 2002 in the city of Stuttgart&#44; Southern Germany&#44; were included &#40;response rate 70&#44;2&#37;&#41; and had their height and weight measured&#46; The height and weight of these children at the age of 4 years were abstracted from medical records&#44; the childrens screening books&#44; which were available for 1817 children&#46; Information on possible determinants of overweight was collected by parental questionnaire&#46; The relative age- and sex-specific BMI was calculated for both examination dates &#40;SDS<span class="elsevierStyleInf">LMS</span> method&#41; and multiple linear regression models were applied&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results&#58;</span> The prevalence of overweight &#40;&#62;&#61; 90&#46; percentile&#41; differed significantly between children of non-German mother tongue and German mother tongue &#40;crude OR 3&#44;52&#44; 95&#37; CI&#58; 2&#44;70 to 4&#44;60&#41; and there was evidence for effect modification between breast feeding duration and mother tongue&#46; Therefore all analysis were conducted stratified for mother tongue &#40;31&#37; non-German&#44; 69&#37; German&#41;&#46; In the multiple linear regression model the following variables had a significant influence &#40;p&#60;0&#44;05&#41; on changes in relative BMI&#46; For German children&#58; paternal BMI and duration of TV watching &#40;e&#46;g&#46; regression coefficient 0&#44;38 &#40;95&#37; CI&#58; 0&#44;16 to 0&#44;60&#41; for &#62;2 hours daily vs&#46; &#60;1 hour daily&#41; were positively&#44; duration of breast feeding was inversely associated with relative change in BMI&#46; For non-German children&#58; parental BMI and duration of TV watching were positively related to relative changes in BMI while duration of breast feeding &#40;e&#46;g&#46; regression coefficient -0&#44;27 &#40;95&#37; CI&#58; -0&#44;47 to &#168;C0&#44;08&#41; for 4-6 months vs&#46; &#60; 2 months&#41; was associated with a decrease in relative BMI to a greater extent than in German children&#46; Other potential determinants of overweight like maternal smoking during pregnancy&#44; low or high birth weight or educational status have no influence on changes in relative BMI between the ages of 4 and 6 years&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusions&#58;</span> Changes in age- and sex-specific BMI were associated with factors which are potentially amenable to prevention&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">060</span><span class="elsevierStyleBold">BREAST-FEEDING AND RISK OF HOSPITALIZATION FOR ALL CAUSES AND FEVER OF UNKNOWN ORIGIN</span></p><p class="elsevierStylePara"> Miguel Delgado-Rodr&#237;guez<span class="elsevierStyleSup">1</span>&#44; Rosa Pardo-Crespo<span class="elsevierStyleSup">2</span>&#44; Roc&#237;o P&#233;rez-Iglesias<span class="elsevierStyleSup">2</span>&#44; Silvia Palma<span class="elsevierStyleSup">1</span>&#44; Marcial Mariscal<span class="elsevierStyleSup">1</span>&#44; Javier Llorca<span class="elsevierStyleSup">3</span>&#44; Miguel Angel Martinez-Gonzalez<span class="elsevierStyleSup">4</span></p><p class="elsevierStylePara"><span class="elsevierStyleItalic"><span class="elsevierStyleSup">1</span>Medicina Preventiva&#44; Universidad de Ja&#233;n&#44; Ja&#233;n&#44; Espa&#241;a&#46; <span class="elsevierStyleSup">2</span>Pediatr&#237;a&#44; Universidad de Cantabria&#44; Santander&#46; <span class="elsevierStyleSup">3</span>Medicina Preventiva&#44; Universidad de Cantabria&#44; Santander&#46; <span class="elsevierStyleSup"> 4</span>Medicina Preventiva&#44; Universidad de Navarra&#44; Pamplona&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Background&#58;</span> Breast-feeding has shown to give a reduction in the risk of hospitalization due to respiratory tract infections and gastrointestinal conditions during the first two years of life&#46; No previous report on the association of breast-feeding with fever of unknown origin &#40;FUO&#41; has been found&#46; This is the main objective of this report&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Methods&#58;</span> A case-reference study in Cantabria &#40;northern Spain&#41; was carried out&#46; Cases &#40;n &#61; 336&#41; were hospitalized children aged less than 24 months at University of Cantabria Hospital&#46; Newborns with congenital malformations were excluded&#46; Cases were selected using 40&#37; random sampling of all children up to 24 months old admitted to the hospital&#58; a 40&#37; random sample of days was generated with the EpiInfo 6&#46;0 &#40;CDC&#44; Atlanta&#44; USA&#41; software and all admissions in those days were included&#46; The reference was a 1&#58;1 matched &#40;by time from delivery to admission&#41; sample of children from mothers delivering at the same hospital&#46; Information on breast-feeding&#44; socioeconomic variables and employment were obtained&#46; Odds ratios &#40;ORs&#41;&#44; their 95&#37; confidence intervals &#40;CIs&#41;&#44; and mean length of breast-feeding were estimated after adjusment for confounding variables&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results&#58;</span> In the reference population&#44; shorter duration of breast-feeding was associated with smoking&#44; lower educational level&#44; and less privileged social strata&#46; The frequency of breast-feeding was higher in the reference than in the cases&#44; 82&#46;3&#37; vs 75&#46;6&#37; &#40;p&#61;0&#46;023&#41;&#46; Significant negative trends were noted in univariate analyses between the length of breast-feeding and both all admission causes and FUO&#44; although the statistical significance was lost after adjusting for confounding variables &#40;educational level&#44; social class&#44; smoking&#44; and use of incubator after delivery&#41;&#46; Breast-feeding was dichotomized according to different cut-off levels &#40;see figure 1&#41;&#46; The maximum protection &#40;minimum odds ratio&#41; for all causes was obtained for breast-feeding longer than two months and stronger for children up to six months of age than for older infants&#46; For FUO the lowest ORs were for durations of breast-feeding longer than 120 days&#44; although these figures were not statistically significant&#46; The adjusted mean length of breast-feeding was shorter in hospitalized children &#8804; 6 months old for both all admission causes &#40;40&#46;6 &#177; 5&#46;4 vs 99&#46;5 &#177; 5&#46;4&#44; p &#60; 0&#46;001&#41; and FUO &#40;40&#46;8 &#177; 12&#46;4 vs 91&#46;7 &#177; 12&#46;4&#44; p &#61; 0&#46;006&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusion&#58;</span> Breast-feeding time is shorter in hospitalized children for both all admission causes and FUO&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">061</span><span class="elsevierStyleBold">NEONATAL MORTALITY AND SOCIO-ECONOMIC STATUS&#58; A CASE-CONTROL STUDY</span></p><p class="elsevierStylePara"> Bradley N&#46; Manktelow&#44; Elizabeth S&#46; Draper</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">Dept&#46; Epidemiology and Public Health&#44; University of Leicester&#44; Leicester&#44; UK&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction&#58;</span> There is growing interest in the comparison of outcomes between health care providers&#46; To carry out fair comparisons it is important to allow for any underlying morbidity over which the provider has had no influence&#46; In neonatal care there is conflicting evidence whether maternal socio-economic deprivation is a predictor of neonatal mortality&#46; It is also unclear whether any possible association is solely because such babies tend to be born earlier and smaller&#46; This paper aims to investigate evidence for an independent association between maternal socio-economic deprivation and neonatal death&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Methods&#58;</span> The Leicestershire Perinatal Mortality Study is a case-control study of perinatal death occurring to women resident in Leicestershire&#44; UK&#46; From 1992 this study was extended to include all neonatal deaths&#46; In this paper data on all singleton control subjects and neonatal deaths from 1996 to 2000 were used&#46; Socio-economic status was defined in two ways&#46; First&#44; using social class derived from maternal interview&#58; the highest of either parent where they were cohabiting and the mother&#39;s alone if the parents were not cohabiting&#46; Second&#44; using the Department of the Environment Deprivation Score &#40;DoE&#41; calculated for each mother&#39;s area of residence at electoral Ward level&#46; Mortality ratios &#40;observed&#47;expected&#41; were calculated for each social class&#44; or quintile of DoE score&#44; both unadjusted and adjusted for gestation and weight at birth&#46; The DoE score was also investigated as a continuous variable in a logistic model&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results&#58;</span> 1470 births were identified of whom 1427 had complete data recorded&#58; 483 deaths within 28 days of birth and 944 controls&#46; Unadjusted mortality ratios for each social class ranged from 0&#46;86 to 1&#46;93 &#40;p-value for no difference between groups &#61; 0&#46;0003&#41; with a trend of higher neonatal mortality to mothers of lower social class&#46; After adjustment for gestation and weight at birth the mortality ratios ranged from 0&#46;97 to 1&#46;07 &#40;p &#61; 0&#46;85&#41;&#46; There was little evidence of a relationship between DoE score and neonatal mortality when entered in a logistic regression model &#40;p &#61; 0&#46;062&#41;&#46; The mortality ratios for the quintiles of DoE score ranged from 0&#46;86 to 1&#46;11&#44; with only very weak evidence of a trend towards higher mortality with higher deprivation&#44; and from 0&#46;91 to 1&#46;11 after adjustment for gestation and weight at birth&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusions&#58;</span> There is strong evidence that neonatal mortality is associated with social class derived from the mother&#39;s individual circumstances&#46; However&#44; there is no evidence that this is in addition to the effect of prematurity and low birth weight&#46; The association between neonatal mortality and the DoE Score&#44; a small-area derived deprivation score&#44; is much weaker&#46; When comparing neonatal mortality&#44; adjustment for gestation and weight at birth adequately adjusts for socio-economic differences&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">062</span><span class="elsevierStyleBold">BODY MASS INDEX AND DEPRESSIVE SYMPTOMS IN ADOLESCENTS</span></p><p class="elsevierStylePara"> Carlos Pereira&#44; Henrique Barros</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">Hygiene and Epidemiology&#44; university of Porto Medical School&#44; Porto&#44; Portugal&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction&#58;</span> Both obesity and depression are increasingly prevalent conditions&#44; commonly associated&#44; and relating with several other serious adult disease that begin expressing themselves relatively early in life&#46; The aim of this study was to estimate the association between depression and body mass index &#40;BMI&#41; in a community sample of adolescents&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Participants and methods&#58;</span> In a cross sectional survey we evaluated 5383 adolescents &#40;53&#46;1&#37; females&#41; aged 12 to 18 years&#44; randomly selected among student residents in Viseu&#44; Portugal&#46; Participants completed a self-administered questionnaire&#46; BMI &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41; was calculated from self-reported height and weight and participants grouped according to the sample distribution quartiles&#46; Depressive symptoms were assessed using the Portuguese validated version of Beck Depression Inventory for Adolescents using the 15 points score as the cut-off to consider depression&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results&#58;</span> The prevalence of depression in the total sample was 18&#46;7&#37;&#44; significantly higher in females &#40;31&#46;1 vs&#46; 15&#46;3&#44; p&#60;0&#46;01&#41; with symptoms mean scores increasing with age &#40;p for trend &#60;0&#44;001&#41;&#46; After adjusting for sex&#44; age&#44; chronic diseases and social-class&#44; there was an increasing risk of depression with increasing quartiles of BMI &#40;2nd quartile OR&#61;1&#46;3&#44; 95&#37; CI 1&#46;0-1&#46;6&#59; 3rd quartile OR &#61;1&#46;2&#44; 95&#37; CI 0&#46;9-1&#46;5&#59; and 4th quartile OR&#61;1&#44;4 95&#37; CI 1&#46;1-1&#46;8&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusion&#58;</span> We found a high prevalence of depression in adolescents that was significantly associated with increasing body mass index&#46; This finding suggest that as shown in the adult population obesity has a negative impact on psychosocial factors&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">063</span><span class="elsevierStyleBold">RISK FACTORS FOR LOW COGNITIVE FUNCTION AT AGE 5&#58; A FOLLOW-UP STUDY IN NORTH-EAST BRAZIL</span></p><p class="elsevierStylePara"> Darci N&#46; Santos<span class="elsevierStyleSup">1</span>&#44; Ana C&#46; Bastos<span class="elsevierStyleSup">2</span>&#44; Marcia M&#46; Pedromonico<span class="elsevierStyleSup">3</span>&#44; Naomar Almeida-Filho<span class="elsevierStyleSup">1</span>&#44; Laura C&#46; Rodrigues<span class="elsevierStyleSup">4</span>&#44; Mauricio L&#46; Barreto<span class="elsevierStyleSup">1</span>&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleItalic"><span class="elsevierStyleSup">1</span>Instituto de Saude Coletiva&#44; Universidade Federal da Bahia&#44; Salvador&#44; Brazil&#46; <span class="elsevierStyleSup">2</span>Departamento de Psicologia&#44; Universidade Federal da Bahia&#44; Salvador&#44; Brazil&#46; <span class="elsevierStyleSup">3</span>Escola de Medicina&#44; Universidade Federal de S&#227;o Paulo&#44; S&#227;o Paulo&#44; Brazil&#46; <span class="elsevierStyleSup">4</span>Epidemiology Unit&#44; London School of Hygiene and Tropical Medicine&#44; London&#44; UK&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction&#58;</span> It has been recognised that environments with low psychoeducational stimulation and poor levels of family organization together with poor hygiene&#44; unfavourable living conditions and malnutrition intensify the risk factors for child development increasing the probability of low cognitive performance&#46; This study aims to examine the associations between personal&#44; environmental&#44; and health-related factors during infancy and cognitive function in later childhood&#46; The first objective was to evaluate the effect of socioeconomic factors&#44; environmental characteristics&#44; quality of home stimulation&#44; and health &#40;including birth weight&#44; diarrhoea&#44; parasitic infections&#44; and anthropometric measures&#41; on cognitive function at 18-42 months&#59; the second&#44; to evaluate the effect of all these variables together with pre-school education on cognitive function at five years&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Methods&#58;</span> A cohort study was carried out in Salvador&#44; northeast Brazil &#40;population 2&#44;211&#44;539&#41;&#46; A health baseline survey &#40;1997-8&#41; collected data on diarrhoea&#44; stool samples&#44; nutritional status and environmental sanitation&#46; In 1999 two measurements were applied&#44; the Home Inventory&#44; and Bayley Scale for children below 42 months&#46; In 2001 346 children completed their pre-school assessment with the WPPSI-R Scale&#46; One way analysis of variance &#40;ANOVA&#41; was used for analysis of the WPPSI-R scores&#44; and a multivariate ANOVA model to identify factors independently associated with cognitive score at age 5 according to the conceptual framework&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results&#58;</span> The 346 children had a mean score on cognitive function of 96&#46;4 &#40;SD 11&#46;2&#41; below 42 months&#44; and 82&#46;6 points &#40;SD 13&#46;7&#41; at age 5&#46; Children living with families with income up to 1 minimum local wage had a lower mean score on the WPPSI-R test than those born to a family with a higher income&#46; Mean scores showed an improvement as family ownership capacity improved&#46; Lack of paternal income corresponded to lower mean WPPSI-R scores&#44; as did a home with significant overcrowding&#46; Children whose households lacked basic sanitary infrastructure&#44; in neighborhoods with poor sanitation&#44; had lower mean scores than those living in houses and areas of good sanitation&#46; Low birth-weight also gave lower mean scores&#46; The malnourished according to anthropometric measures had lower mean WPPSI-R scores as did children with over 7 days&#47;diarrehea&#47;year and positive helmintic infection&#46; Mean WPPSI-R scores were lower for children previously under low home psychosocial stimulation&#44; with low cognitive function during infancy&#44; as well as for children not attending day-care or kindergarten&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusion&#58;</span> Low socio-economic conditions&#44; low birth-weight&#44; stunting&#44; bad quality sanitation&#44; and low levels of home stimulation and cognitive function during infancy&#44; together with no kindergarten attendance&#44; has a strong adverse effect on cognitive function in later childhood&#46;</p>"
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