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Background: The exposure of pregnant women to multiple environmental pollutants may be more disadvantageous to birth outcomes when compared to single-compound contaminations. Objective: This study investigated the mixed exposures to mercury, manganese, or lead in 380 pregnant Surinamese women. The factors that might be associated with the heavy metal exposures and the relative risk of the potential factors to cause the mixed exposures were explored. The influencing factors of exposures to mixed contaminants assessed were living in Suriname's rural regions, several parts of which are contaminated with heavy metals emitted from artisanal and small-scale gold mining and agricultural activities; the consumption of potentially contaminated foods; advanced maternal age; as well as a relatively low formal educational level and monthly household income. Methods: Descriptive statistics were used to calculate frequency distributions and χ2-contingency analyses to calculate associations and relative risks (RR) with 95% confidence intervals (CI). Findings: Blood levels of two or three of the heavy metals above public health limits were observed in 36% of the women. These women were more often residing in the rural regions, primarily consumed potentially contaminated food items, were 35 years or older, were lower educated, and more often had a lower household income. However, only living in the rural regions (RR = 1.48; 95% CI 1.23-1.77) and a low household income (RR = 1.38; 95% CI 1.15-1.66) significantly increased the risk of exposure exceeding levels of concern to two or three of the heavy metals (by 48% and 38%, respectively). Conclusion: More comprehensive pharmacological, ecological, and epidemiological studies about exposures to mixed heavy metal contaminations in pregnant women are warranted.

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Ultra-processed foods (UPFs) are associated with unhealthy diets and chronic diseases. Hence, knowing the consumption pattern of UPFs in the general population is crucial to design policies to improve public health, such as the recently approved law for the Promotion of Healthy Eating in Argentina (Law N° 27.642). The aim of the study was to characterise the consumption of UPFs according to income level and to assess their association with the intake of healthy foods in the Argentinian population. Healthy foods were defined in this study as those non-UPF groups that have been shown to reduce the risk of non-communicable diseases and excluded certain natural or minimally processed foods such as red meat, poultry and eggs. We retrieved data from the 2018-2019 National Nutrition and Health Survey (ENNyS 2), a cross-sectional, nationally representative survey performed in Argentina, including 15 595 inhabitants. We classified the 1040 food items recorded by the degree of processing using the NOVA system. UPFs represented nearly 26% of daily energy. The intake of UPFs increased with income, with a difference of up to 5 percentage points between the lowest (24%) and the highest (29%) income levels (p < 0.001). Cookies, industrial pastries, cakes and sugar-sweetened beverages were the most consumed UPF items, accounting for 10% of daily energy intake. We found that UPF intake was associated with a decrease in consumption of healthy food groups, mainly fruits and vegetables, where a difference of -28.3 g/2000 kcal and -62.3 g/2000 kcal between tertile 1 and tertile 3 was estimated, respectively. Therefore, Argentina still maintains a UPF consumption pattern of a low- and middle-income country, where UPF intake increases with income, but these foods also compete with the intake of healthy foods.

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The generation of municipal solid waste (MSW) is an environmental problem worldwide. A high rate of MSW produces pollution and diseases and affects the economic development of countries. This study analyzes the effect that GDP, population density, urbanization, and tourists' flow have on the generation of MSW in 173 countries worldwide. We grouped countries according to their income levels to control for heterogeneity between regions. The results show that, during 2016, solid waste generation increased along with GDP increments, mainly in high-income countries. We show that the increase in MSW is also due to the rise in population and urbanization. Tourism also has a positive and significant impact on the generation of waste. Our results allow us to recommend some public policy actions.

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Early information on public health behaviors adopted to prevent the spread of coronavirus (COVID-19) may be useful in controlling the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) transmission. The objective of this study was to assess the role of income level (IL) and the perception of older adults, regarding COVID-19 susceptibility and severity, on adopting stay-at-home preventive behavior during the first week of the outbreak in Mexico. Participants in this cross-sectional study were urban community dwellers, aged ≥ 65 years from Mexico City. A total of 380 interviews were conducted over the phone. The mean respondent age was 72.9 years, and 76.1% were women. Over half (54.2%) of the participants perceived their susceptibility to COVID-19 as very low or low. Similarly, 33.4% perceived COVID-19 severity as being very low or low, and 57.6% had decided to stay at home: this behavior was associated with IL (ß = 1.05, p < 0.001), and its total effect was partially mediated (15.1%) by perceived severity. Educational attainment was also associated with staying at home (ß = 0.10, p = 0.018) and its total effect was partially mediated (15.0%) by perceived susceptibility. Interventions aimed at low income and less educated older adults should be developed to improve preventive behaviors in this vulnerable group during the COVID-19 pandemic.

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Introduction: According to the literature, education and income are determinants factors of diet quality and consequently of micronutrient intake. However, this association is still little known among adults who live in middle-income countries. Objective: To estimate energy and micronutrients intake by men and women living in a capital city in southern Brazil, according to education and income levels, and to identify prevalence of inadequate micronutrient intake according also to education and income levels. Method: This is a second wave cross-sectional analysis of a population-based longitudinal study, the EpiFloripa Adultos, including 1,222 individuals of 22-63 years. Data on food consumption were obtained through applying two 24-hour dietary recalls, and the prevalence of inadequate micronutrient intake, following the recommendations of the Institute of Medicine and from the National Research Council. Results: A tendency of increased intake with an increase in income (calcium, vitamins C, E) and education levels (calcium, vitamins A, C, D) was observed for most of the micronutrients analyzed (p<0.05 in all cases); still, a prevalence of inadequacy according to Estimated Average Requirement (EAR) between 85.5-100% in intake of vitamins A, D and E were found for the whole sample. Iron inadequate intake was associated with education level and among women less than 50 years of age (p=0.018). Conclusion: The results showed an influence of the education and income levels on micronutrient intake, point to the need of daily food consumption, of minimally processed and in natura foods (as fruits, vegetables, whole grains, milk and its derivatives) as a means to reduce the encountered inadequacies.

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Background: Pneumococcal conjugate vaccines (PCVs) have prevented deaths due to pneumonia among children. The effect may differ between higher- and lower-income populations due to various factors, such as differences in the distribution of pneumococcal serotypes, healthcare access, and PCV uptake. This study aims to evaluate an association between increasing PCV coverage and population-level declines in death due to pneumonia and its variation by socioeconomic status of subnational regions. Methods: We analyzed municipality-level mortality data from 2005 and 2015 for children aged 2-23 months in Brazil, Colombia, and Peru. We fit Poisson regression models to estimate the relationship between changes in PCV uptake and deaths due to all-cause pneumonia among subnational regions with different income levels. We controlled for changes unrelated to PCV by using data on non-respiratory deaths over time. Results: Uptake of the third dose of PCV varied across subnational regions and was higher in high-income regions. Higher uptake of PCV was associated with larger declines in pneumonia mortality. This association did not differ by income level of the region in Brazil and Colombia. In Peru, low-income regions observed larger declines in pneumonia deaths, but there was large uncertainty in the difference between the low- and high-income regions. We estimated that, with 90% coverage, there would be 4-38% declines in all-cause pneumonia mortality across income levels and countries. Conclusions: Regions with higher PCV coverage experienced larger declines in pneumonia deaths, regardless of the income level. Having more reliable data on mortality records and vaccine uptake would improve the reliability of vaccine impact estimates.

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Actualmente, Chile presenta niveles por sobre el promedio regional y mundial de sobrepeso y obesidad. Esta condición se distribuye desigualmente entre la población, concentrándose en mujeres (quienes lideran el ranking latinoamericano de obesidad), acrecentándose entre aquellas de bajos ingresos. Este dato corrobora que el problema nutricional excede con creces el ámbito biológico y que si se busca tener resultados positivos en la disminución del sobrepeso y obesidad, urge observar sus condicionantes socioculturales. Desde 2005 las políticas públicas han implementado medidas basadas principalmente en ofrecer recomendaciones e información nutricional a la población. A través de un estudio cualitativo- etnográfico nos interrogamos respecto al modo en que las mujeres perciben el discurso salubrista y las recomendaciones nutricionales. Confirmamos que los mensajes sobre la adecuada alimentación son recibidos y comprendidos. Sin embargo, se interiorizan como una imposición altamente restrictiva, que no se condice con sus estilos de vida, que exige implementar cambios para los que no se sienten capaces ni suficientemente respaldadas por su entorno cercano. Se concluye que es necesario reorientar los esfuerzos, desplazando el foco desde la difusión de información y la responsabilización individual, hacia la construcción de estrategias que pongan como eje central a las personas dentro de sus contextos particulares.

Currently, Chile has levels above the regional and the global average for overweight and obesity. This condition is distributed unequally among the population, concentrating among women (who lead the Latin American obesity ranking) and increasing among those with low incomes. This data verifies that the nutritional problem exceeds the biological scope, thus it is crucial to observe its sociocultural conditions. Since 2005, public policies have been implemented based mainly on offering recommendations and nutritional information to the population. Through a qualitative-ethnographic study, we inquired about the woman's perception of the health discourse and the nutritional recommendations. We confirm that messages about proper eating are received and understood. However, they are internalized as highly restrictive, incompatible with their lifestyles, and require changes that participants felt they were incapable of or sufficiently supported by their immediate environment. We concluded that it is necessary to redirect efforts, shifting the focus from the dissemination of information and individual responsibility, to the construction of strategies that place people at the center of their particular contexts.

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Introducción: El estado nutricional de las adolescentes embarazadas influye en la salud de la madre y del hijo. Objetivo: Determinar el estado nutricional y características sociodemográficas en adolescentes embarazadas del Programa Alimentario Nutricional Integral. Hospital Regional de Encarnación 2016. Metodología: Estudio observacional descriptivo de corte trasversal con componente analítico. Se utilizaron fichas completas de pacientes embarazadas desde la décima semana de gestación, en el período de enero a diciembre de 2016, considerando los datos de edad, peso, talla, edad gestacional, nivel educativo, ingreso familiar y el diagnóstico nutricional realizado por las tablas de Rosso - Mardones. Resultados: De las 172 fichas utilizadas, el rango etario fue de 12 a 19 años con una mediana de 17 (16,0 ­ 18,0) años, pertenecían a la clasificación de adolescencia temprana el 6% (n= 11) y adolescencia tardía el 94% (n= 161). El nivel educativo predominante fue educación media 39% (n=67) y tercer ciclo de escolar básica 36% (n=62). El ingreso familiar menor a un salario mínimo fue del 63% (n=108), hasta un salario mínimo 37% (n=63). La mediana del peso fue de 58,0 (51,15 ­ 66,0) kg. Una talla promedio de 1.58 ±0.06 m. La mediana de la edad gestacional de ingreso fue de 18 (12 ­ 27) semanas. El estado nutricional de las adolescentes embarazadas evaluadas por Rosso - Mardones presentó 46% bajo peso, 32% adecuado, 13% sobrepeso y 9% obesidad. Conclusiones: De las embarazadas evaluadas al ingreso del Programa Alimentario Nutricional Integral el mayor porcentaje correspondía a bajo peso. No se encontró asociación entre nivel educativo y el estado nutricional, así como tampoco se encontró asociación entre nivel de ingreso y el estado nutricional

Introduction: The nutritional status of adolescents pregnant women influences the health of the mother and the child. Objective: To determine the nutritional status and sociodemographic characteristics of pregnant adolescents women admitted to the PANI program during the year 2016 in the HRE. Methodology: A cross-sectional, observational, cross-sectional study with analytical component and complete records of pregnant patients were used from the tenth week of gestation in the period of January to December 2016, considering data on age, weight, height, gestational age, educational level, and the nutritional diagnosis made by the charts of Rosso - Mardones. Results: Of the 172 medical records used in the 12 to 19 year age range with a median of 17 (16.0 - 18.0) years, 6% (n = 11) and 94% (n=161) belonged to late adolescence and to the early adolescence correspondingly. The predominant educational level was middle education 39% (n = 67) and the third cycle of basic education (36%) (n = 62). Family income less than a minimum wage was of the 63% (and=108), up to a minimum wage of 37% (n = 63). The median weight was 58.0 (51.15 - 66.0) kg. An average size of 1.58 ± 0.06 m. The median gestational age of admission was 18 (12 - 27) weeks. The nutritional status of pregnant adolescents evaluated by Rosso - Mardones charts presented 46% low weight, 32% adequate, 13% overweight, 9% obesity. Conclusions: Of the pregnant women evaluated at the entrance of the Integral Nutritional Feeding Program the highest percentage of correspondence at low weight. The association between educational level and nutritional status was not found, nor was the association between income level and nutritional status found

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PURPOSE: To explore the association between food insecurity and dietary intake among Mexican-American women after controlling for sociocultural and economic factors including participation in federal food assistance programs. DESIGN: Cross-sectional. SETTING: Three cities in Texas. SUBJECTS: Seven hundred seven Mexican-American women (26-44 years). MEASURES: Demographics, anthropometrics, acculturation, and food security status were obtained using validated measures. Dietary intake was assessed by a 24-hour dietary food record. ANALYSIS: Logistic regression was used to examine the association between individual and household characteristics on food security status. One-way analysis of covariance tested the association between food security status and dietary intake after adjusting for socio-demographic variables, acculturation, body mass index, participation in federal food assistance programs, and energy intake. RESULTS: About 77% of food-insecure women participated in at least one federal food assistance program. Each additional child in the household increased the odds of being food insecure by 25%. A higher proportion of obese women was found in the food-insecure group. No significant differences in dietary intake were found by food security status. CONCLUSION: Food insecurity did not negatively influence dietary intake independently of women's participation in federal food assistance programs. Food security did not ensure consumption of nutritionally adequate foods. Educational and food assistance programs need to be optimized to facilitate enrollment and improve the nutritional status of this ethnic group, food secure or not.

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