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Introducción. La calidad de la alimentación es un derecho vinculado con la supervivencia, el crecimiento saludable, la prevención de enfermedades crónicas y malnutrición en todas sus formas. El objetivo de este trabajo fue analizar las prácticas de lactancia y de alimentación de menores de 2 años de áreas urbanas de la Argentina en 2018-19, según el nivel de ingreso de los hogares. Población y métodos. Estudio secundario con datos de la 2da. Encuesta Nacional de Nutrición y Salud 2018-19. Se analizaron indicadores de lactancia y alimentación complementaria, según metodología de la Organización Mundial de la Salud (OMS) y Unicef. Se estratificó según nivel de ingresos del hogar. Resultados. El análisis incluyó 5763 menores de 24 meses. Aunque el 97 % fue alguna vez amamantado, solo el 47 % de los menores de 6 meses tuvo lactancia exclusiva el día previo y el 48 % mantenía la lactancia luego del año, con mayor prevalencia en los niños/as de menores ingresos. En el día previo, el 23 % de los niños/as de 6 a 23 meses no consumió ninguna verdura o fruta; el 60 % consumió alimentos no saludables y el 50 %, bebidas dulces. Las bebidas dulces y la ausencia de frutas y verduras fueron mayores en aquellos de hogares de menores ingresos. Conclusión. La calidad de la alimentación de los niños/as dista de las recomendaciones y está condicionada por los ingresos. En los sectores empobrecidos, es menor el inicio temprano de la lactancia, la diversidad alimentaria mínima y el consumo de frutas y verduras, y es mayor el consumo de bebidas dulces.

Introduction. Diet quality is a right related to survival, healthy growth, prevention of chronic diseases, and malnutrition in all its forms. The objective of this study was to analyze breastfeeding and feeding practices in children younger than 2 years from urban areas of Argentina in 2018­2019 according to their household income level. Population and methods. Secondary analysis of data of the Second National Survey on Nutrition and Health (ENNyS2) of 2018­2019. Breastfeeding and complementary feeding indicators proposed by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) were analized. Data were stratified by household income level. Results. The analysis included 5763 children younger than 24 months old. Although 97% was ever breastfed, only 47% of infants younger than 6 months were exclusively breastfed the previous day and 48% continued with breastfeeding after 1 year old, with a higher prevalence in low-income children. The previous day, 23% of children aged 6 to 23 months did not eat any fruit or vegetable, 60% consumed unhealthy foods, and 50% consumed sweet beverages. The consumption of sweet beverages and the absence of fruit and vegetables were higher in low-income households. Conclusion. The quality of children's diet is far from the recommendations and is conditioned by income. Early initiation of breastfeeding, minimum dietary diversity, fruit and vegetable consumption are lower and sweet beverage consumption is greater in impoverished sectors.

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Abstract Objectives: Age at menarche (MA) is a proxy for biological maturation and a parameter of socioeconomic changes. Worldwide, anticipation of menarche is associated with nutritional transition and excess weight. The objective of this study was to evaluate the MA in Amazonian students and its association with nutritional status, ethnicity, and socioeconomic level. Methods: Cross-sectional study with 1,017 students aged 6 to 17 living in the city of Manaus, Brazil. MA was analyzed by status quo and recall; its association with body mass index (BMI), race, socioeconomic status, and adult height was examined. Results: 559 (51.9%) participants had already experienced menarche. In 91.7%, menarche occurred between 10 and 14 years of age; the mean age at the onset of menarche was 11.9 years. Overweight (11.6 years) and obese (11.4 years) participants reached menarche earlier than those with normal weight (12 years) and lean (12.7 years) participants. The associations between MA and nutritional status showed that overweight and obesity are risk factors for the early occurrence of menarche. MA was not associated with socioeconomic status/parental education or race. However, excess weight was associated with earlier MA in all races and social classes. The adult height was slightly lower in girls with menarche before 12 years old (157.9 vs 159.4 cm). Conclusion: Regardless of socioeconomic level or ethnicity, excess weight was associated with earlier menarche in Amazonian students.

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La lactancia materna exclusiva (LME) ha sido considerada por varios organismos internacionales como la solución para combatir la desnutrición infantil, la cual es considerada como un problema de salud pública. Bajo este contexto, la presente investigación busca encontrar cuáles son los determinantes de la LME en el Ecuador, y mostrar cómo influye el nivel educativo de la madre sobre la duración de la lactancia materna exclusiva. Para cumplir dicho objetivo se emplea un modelo probabilístico obteniendo como resultado que el nivel de instrucción de la madre, la etnia, el quintil de ingresos, el género del recién del bebé y la edad de la madre juegan un papel importante sobre la duración de la lactancia materna en el Ecuador. En el caso del nivel de instrucción se encuentra que las mujeres con una educación superior tienen menos probabilidad de dar LME, por seis meses o más, que las madres sin un nivel de educación

Exclusive breastfeeding (EBF) has been considered by several international organizations as the solution to combat child malnutrition, which is considered a public health problem. In this context, the present research seeks to find the determinants of EBF in Ecuador, and to show how the mother's educational level influences the duration of exclusive breastfeeding. In order to fulfill this objective, a probabilistic model was used, obtaining as a result that the mother's level of education, ethnicity, income quintile, gender of the newborn and the mother's age play an important role in the duration of breastfeeding in Ecuador. In the case of educational level, it is found that women with higher education are less likely to breastfeed for six months or more than mothers with no education.

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La lactancia materna exclusiva (LME) ha sido considerada por varios organismos internacionales como la solución para combatir la desnutrición infantil, la cual es considerada como un problema de salud pública. Bajo este contexto, la presente investigación busca encontrar cuáles son los determinantes de la LME en el Ecuador, y mostrar cómo influye el nivel educativo de la madre sobre la duración de la lactancia materna exclusiva. Para cumplir dicho objetivo se emplea un modelo probabilístico obteniendo como resultado que el nivel de instrucción de la madre, la etnia, el quintil de ingresos, el género del recién del bebé y la edad de la madre juegan un papel importante sobre la duración de la lactancia materna en el Ecuador. En el caso del nivel de instrucción se encuentra que las mujeres con una educación superior tienen menos probabilidad de dar LME, por seis meses o más, que las madres sin un nivel de educación.

Exclusive breastfeeding (EBF) has been considered by several international organizations as the solution to combat child malnutrition, which is considered a public health problem. In this context, the present research seeks to find the determinants of EBF in Ecuador, and to show how the mother's educational level influences the duration of exclusive breastfeeding. In order to fulfill this objective, a probabilistic model was used, obtaining as a result that the mother's level of education, ethnicity, income quintile, gender of the newborn and the mother's age play an important role in the duration of breastfeeding in Ecuador. In the case of educational level, it is found that women with higher education are less likely to breastfeed for six months or more than mothers with no education.

O aleitamento materno exclusivo (AME) tem sido considerado por várias organizações internacionais como a solução para combater a desnutrição infantil, que é considerada um problema de saúde pública. Neste contexto, esta investigação tem como objetivo encontrar os determinantes do AME no Equador, e mostrar como o nível educacional da mãe influencia a duração do aleitamento materno exclusivo. Para cumprir este objetivo, é utilizado um modelo probabilístico, com o resultado de que o nível de educação da mãe, a etnia, o quintil de rendimentos, o sexo do recém-nascido e a idade da mãe desempenham um papel importante na duração do aleitamento materno no Equador. No caso do nível de educação, verifica-se que as mulheres com educação superior têm menos probabilidades de amamentar durante seis meses ou mais do que as mães sem educação.

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Background: Huntington's disease (HD) exerts significant impacts on individuals and families worldwide. Nevertheless, data on its economic burden in Brazil are scarce, revealing a critical gap in understanding the associated healthcare costs. Objective: This study was conducted at a tertiary neurology outpatient clinic in Brazil with the aim of assessing annual healthcare service utilization and associated costs for HD patients. Methods: We conducted a cross-sectional observational study involving 34 HD patients. A structured questionnaire was applied to collect data on direct medical costs (outpatient services, medications), non-medical direct costs (complementary therapies, mobility aids, home adaptations), and indirect costs (lost productivity, caregiver costs, government benefits) over one year. Results: Significant economic impacts were observed, with average annual direct medical costs of $4686.82 per HD patient. Non-medical direct and indirect costs increased the financial burden, highlighting extensive resource utilization beyond healthcare services. Thirty-three out of 34 HD patients were unemployed or retired, and 16 relied on government benefits, reflecting broader socioeconomic implications. Despite the dataset's limitations, it provides crucial insights into the economic impact of HD on patients and the Brazilian public health system. Conclusions: The findings underscore the urgent need for a more comprehensive evaluation of the costs to inform governmental policies related to HD. Future research is needed to expand the data pool and develop a nuanced understanding of the economic burdens of HD to help formulate effective healthcare strategies for patients.

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We investigated whether neighborhood greenspaces were associated with physical activity in adulthood over 3 cohort visits after considering perceived safety and neighborhood contextual factors. We also evaluated whether the association with greenspace varied by neighborhood socioeconomic status. Participants (N = 4,800) from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) residing in two Brazilian state capitals were evaluated in Visits 1 (2008-2010), 2 (2012-2014) and 3 (2017-2019). Greenspaces were categorized by quintiles of positive Normalized Difference Vegetation Index (NDVI) scores. Physical activity frequency was given by the number of visits at which participants reported moderate/vigorous physical activity (none, 1 or 2, and 3 visits). We used multinomial logistic regression. After adjustment for age, sex, education, research center, residence in slums, individuals in the 4th and 5th NDVI quintiles showed 73% higher odds of physical activity over 3 visits than those in the 1st quintile (4th quintile: 95%CI = 1.24-2.43; 5th quintile: 95%CI = 1.24-2.41). The strength of the association was attenuated after adjustment for perceived safety. After adjustment for contextual factors quantity of sidewalks and streetlights, the OR for the 4th and 5th NDVI quintiles decreased to 1.66 (95%CI = 1.18-2.33) and 1.62 (95%CI = 1.16-2.28), respectively. Finally, after including average household income per capita, the OR for physical activity in 3 visits for the 4th and 5th NDVI quintiles decreased to 1.48 (95%CI = 1.04-2.12) and 1.43 (95%CI = 1.00-2.04; p = 0.053), respectively. Greater greenspace contributed to sustained physical activity during the eight years of follow-up, indicating the potential contribution of public greenspaces to reducing health-related inequalities.

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INTRODUCTION: Worldwide, because of the demographic transition, the proportion of older adults has increased, which has been reflected in an increase in the prevalence of major neurocognitive disorder (MND). This phenomenon is especially important in low- and middle-income countries such as Colombia, given the high economic and social costs it entails. The objective was to analyse the association between socioeconomic variables with the presence of cognitive impairment in Colombian older adults. METHODS: The records of 23,694 adults over 60 years-of-age surveyed for SABE Colombia 2015, that took a stratified sample by conglomerates and were representative of the adult population over 60 years-of-age. This instrument assessed cognitive impairment using the abbreviated version of the Minimental (AMMSE) and collected information on multiple socioeconomic variables. RESULTS: 19.7% of the older adults included in the survey were reviewed with cognitive impairment by presenting a score <13 in the AMMSE. There was a higher prevalence of cognitive impairment in women (21.5%) than in men (17.5%). The socioeconomic variables were shown to impact the prevalence of deterioration, especially being currently working (OR = 2.74; 95%CI, 2.43-3.09) as a risk factor and having attended primary school as a protective factor (OR = 0.30; 95%CI, 0.28-0.32), differentially according to gender. CONCLUSIONS: An association between socioeconomic and sociodemographic factors with cognitive impairment in Colombian older adults was evidenced. Despite the above, a differential impact dependent on sex is suggested.

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OBJECTIVE: To determine the association between neighborhood disadvantage (ND) and functional brain development of in utero fetuses. STUDY DESIGN: We conducted an observational study using Social Vulnerability Index (SVI) scores to assess the impact of ND on a prospectively recruited sample of healthy pregnant women from Washington, DC. Using 79 functional magnetic resonance imaging scans from 68 healthy pregnancies at a mean gestational age of 33.12 weeks, we characterized the overall functional brain network structure using a graph metric approach. We used linear mixed effects models to assess the relationship between SVI and gestational age on 5 graph metrics, adjusting for multiple scans. RESULTS: Exposure to greater ND was associated with less well integrated functional brain networks, as observed by longer characteristic path lengths and diminished global efficiency (GE), as well as diminished small world propensity (SWP). Across gestational ages, however, the association between SVI and network integration diminished to a negligible relationship in the third trimester. Conversely, SWP was significant across pregnancy, but the relationship changed such that there was a negative association with SWP earlier in the second trimester that inverted around the transition to the third trimester to a positive association. CONCLUSIONS: These data directly connect ND and altered functional brain maturation in fetuses. Our results suggest that, even before birth, proximity to environmental stressors in the wider neighborhood environment are associated with altered brain development.

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The majority of people with dementia live in low or middle-income countries (LMICs) where resources that play a crucial role in brain health, such as quality education, are still not widely available. In Brazil, illiteracy remains a prevalent issue, especially in communities with lower socioeconomic status (SES). The PROAME study set out to explore basic education in illiterate adults as a means to improve cognitive reserve. Objective: This manuscript aims to explore the relationship between SES and learning, as well as cognitive outcomes, in an older illiterate population. Methods: This six-month clinical trial (NCT04473235) involved 108 participants, of which 77 concluded all assessments, enrolled in late-life basic education. SES assessments included Quality of Urban Living Index, Municipal Human Development Index and Household SES calculated for each participant. Cognitive assessments encompassed the Free and Cued Selective Reminding Test (FCSRT), a word list to assess reading, and the Beta III matrix. Results: The sample consisted primarily of women, with a mean age of 58.5. Participants improved their reading (p=0.01) and their FCSRT (p=0.003). Regarding episodic memory, women outperformed men (p=0.007) and younger participants improved more than their older counterparts (p=0.001). There was no association observed between SES and cognitive outcomes. Conclusion: Irrespective of SES, participants demonstrated positive outcomes after attending basic education. These findings highlight that late life education could be an important non-pharmacologic preventative measure, especially in LMICs.

A maioria das pessoas com demência vive em países de baixa/média renda, onde recursos essenciais para a saúde cerebral, como educação de qualidade, ainda não são amplamente acessíveis. No Brasil, o analfabetismo ainda é frequente, especialmente em comunidades de baixo nível socioeconômico. O estudo PROAME teve como objetivo explorar a educação básica tardia em pessoas analfabetas como ferramenta para o aumento da reserva cognitiva. Objetivo: Investigar a relação entre nível socioeconômico com aprendizado e com desempenho em testes cognitivos, em adultos analfabetos. Métodos: Este estudo clínico de seis meses (NCT04473235) contou com 108 participantes inscritos no projeto Educação para Jovens e Adultos (EJA), dos quais 77 completaram os testes. O nível socioeconômico de cada participante foi medido usando-se: o Índice de Qualidade de Vida Urbana, o Índice de Desenvolvimento Humano Municipal e o nível socioeconômico doméstico. Avaliações cognitivas incluíram: o Teste de Recordação Seletiva Livre e Guiada (TRSLG), uma lista de palavras para avaliar leitura e a matriz Beta III. Resultados: A amostra era predominantemente feminina, com idade média de 58,5. Os participantes melhoraram a leitura (p=0,01) e o TRSLG (p=0,003). Com relação à memoria episódica, as mulheres tiveram resultados superiores aos dos homens (p=0,007) e participantes mais jovens melhoraram mais que seus colegas mais velhos (p=0,001). Não foi observada nenhuma relação entre o nível socioeconômico e o desempenho cognitivo. Conclusão: Independentemente do nível socioeconômico, participantes obtiveram resultados positivos após frequentar a educação básica. Isso sugere que a educação tardia pode ser uma medida preventiva não farmacológica importante, especialmente em países de baixa/média renda.

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This article aims to assess the association between household demographic and socioeconomic characteristics and catastrophic health expenditure (CHE) in Argentina during 2017-2018. CHE was estimated as the proportion of household consumption capacity (using both income and total consumption in separate estimations) allocated for Out-of-Pocket (OOP) health expenditure. For assessing the determinants, we estimated a generalized ordered logit model using different intensities of CHE (10%, 15%, 20% and 25%) as the ordinal dependent variable, and socioeconomic, demographic and geographical variables as explanatory factors. We found that having members older than 65 years and with long-term difficulties increased the likelihood of incurring CHE. Additionally, having an economically inactive household head was identified as a factor that increases this probability. However, the research did not yield consistent results regarding the relationship between public and private health insurance and consumption capacity. Our results, along with the robustness checks, suggest that the magnitude of the coefficients for the household head characteristics could be exaggerated in studies that overlook the attributes of other household members. In addition, these results emphasize the significance of accounting for long-term difficulties and indicate that omitting this factor could overestimate the impact of members aged over 65.

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Objective: To verify the association between reproductive autonomy and sociodemographic, sexual, and reproductive characteristics in Quilombola women (a term indicating the origin of politically organized concentrations of Afro-descendants who emancipated themselves from slavery). Methods: Cross-sectional and analytical study with 160 women from Quilombola communities in the southwest of Bahia, Brazil. Data were collected using the Reproductive Autonomy Scale and the questionnaire from the National Health Survey (adapted). Results: Out of the 160 participating women, 91.9% declared themselves as black, one out of every three were aged ≤ 23 years, 53.8% were married or had a partner, 38.8% had studied for ≤ 4 years, over half (58.1%) were unemployed, only 32.4% had a monthly income > R$ 430 (80 US dollars), 52.5% had their first menstruation at the age of 12, 70.7% had not accessed family planning services in the last 12 months, and over half used some method to avoid pregnancy (59.0%). The women had a high level of reproductive autonomy, especially in the "Decision-making" and "Freedom from coercion" subscales with a score of 2.53 and 3.40, respectively. A significant association (p<0.05) was found between the "Total reproductive autonomy" score and marital status, indicating that single or unpartnered women had higher autonomy compared to married or partnered women. Conclusion: The association of social determinants of health such as marital status, education, and age impacts women's reproductive choices, implying risks for sexual and reproductive health. The intergenerational reproductive autonomy of Quilombola women is associated with sociodemographic and reproductive factors.

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Purpose: The globally increasing older population raises concerns about age-related conditions, including cognitive impairment and depressive symptoms. In Latin America, nearly one-third of the population is affected by either of these conditions. However, data investigating the association between cognitive impairment and depressive symptoms, particularly in Brazil, are limited to small-scale studies that have not carefully examined the critical effects of variables such as education level and socioeconomic status on this relationship. We aimed at exploring this association in a representative population-based cohort. Methods: We used the Brazilian Longitudinal Study of Aging (ELSI-BRAZIL) database to examine the relationship between depressive symptoms and cognitive impairment in Brazilian older adults, adjusted for potential confounders. Direct acyclic graphs and multivariable linear regression were used to build our model. Depressive symptoms were measured using a short version of the Center for Epidemiologic Studies Scale (CES D-8), and combined memory recall test as a surrogate of cognitive impairment. Results: The study included 8280 participants. Only education level was identified as a confounder for the relationship between memory loss and depressive symptoms. After adjusting for age, sex, and education level, there was strong evidence for a negative association between depressive symptoms and memory performance. For every 5-unit increase in the CES D-8 score, there was a reduction in memory capacity, translating to a loss of approximately one word in the combined words recall test (mean - 0.18, 95% CI -0.22; -0.15, P < 0.001). In addition, we found strong evidence for an interaction between socioeconomic status and depressive symptoms. Subjects belonging to medium socioeconomic status (SES) showed more pronounced memory decline, when compared to those with lower SES (mean - 0.28, 95% CI -0.42 to -0.14, P < 0.001). Conclusions: In adults aged over 50, after adjusting for sex, age, and educational level, a 5-unit increase in CES D-8 score is associated with loss of one point in the combined memory recall test. This association seems to be confounded by educational level and significantly modified by socioeconomic status.

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To assess the temporal and spatial dynamics of chikungunya incidence and its association with social vulnerability indicators in Brazil, an ecological and population-based study was conducted herein, with confirmed cases of chikungunya and based on clinical and clinical-epidemiological criteria from 2017 to 2023. Data were obtained from the Notifiable Diseases Information System and social vulnerability indicators were extracted from the official platform of the United Nations Development Program and the Social Vulnerability Atlas. Temporal, spatial, and global spatial regression models were employed. The temporal trend showed that in 2017, the incidence increased by 1.9%, and this trend decreased from 2020 to 2021 (-0.93%). The spatial distribution showed heterogeneity and positive spatial autocorrelation (I: 0.71; p < 0.001) in chikungunya cases in Brazil. Also, the high-risk areas for the disease were concentrated in the northeast and north regions. The social vulnerability indicators associated with the outcome were those related to income, education, and housing conditions. Our analyses demonstrate that chikungunya continues to be a serious health concern in Brazil, but specially in the northeast and north regions. Lastly, mapping risk areas can provide evidence for the development of public health strategies and disease control in endemic regions.

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BACKGROUND: The Confusion, Hubbub, and Order Scale (CHAOS in English Version) was originally developed in the USA by Matheny et al (Bringing order out of chaos: psychometric characteristics of the confusion, hubbub, and order scale. Journal of Applied Developmental Psychology 16(3):429-444, 1995) to measure chaos in the family environment, characterized by confusion, lack of routine, and organization. OBJECTIVE: To present evidence of content validity, internal structure validity, and validity based on relationships with external measures of an adapted version of the CHAOS into Brasilian Portuguese with adolescents sample in São Paulo - Brasil. METHOD: Study 1 involved the translation/back-translation and adaptation of the scale into Brazilian Portuguese [here named "Escala de Confusão, Alvoroço e Ordem no Sistema familiar" (CAOS)], assessed by 5 judges. In Study 2, we conducted an exploratory factor analyses (EFA) to determine the scale's factor structure (N = 180 adults). In Study 3, we carried out confirmatory factor analyses (CFA) to confirm the internal validity of the scale, along with complete structural equation modeling to explore convergent validity in another sample (N = 239 adolescents). RESULTS: The CAOS scale displayed content validity, and the EFA and CFA showed a unifactorial structure (with some scale adjustments) with an acceptable fit. The family chaos latent factor was associated with externalizing symptoms and perceived stress in adolescents. CONCLUSION: Overall, the Brazilian version of the scale presented evidence of construct, internal, and concurrent validity that indicate its usefulness in Brazil.

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This study examines the relationship between ethnic endogamy and socioeconomic status (SES) within the socioeconomically divergent Jewish and Native-Chilean Mapuche communities of Santiago, Chile. By leveraging the Hispanic naming convention to analyze dual ethnic surnames, we trace endogamy patterns across comprehensive datasets that go back to 1884 up to the present. Our quantile regression analysis reveals that individuals from the lower SES brackets of the Jewish community and the higher brackets of the Mapuche community are more likely to have mixed ethnic backgrounds. This finding shows a nuanced interplay between socioeconomic standing and marital choices, suggesting that these factors significantly influence the persistence and transformation of SES within minority groups. The study introduces the Ecological Model of Ethnic Disaffiliation, providing a theoretical framework that explains how socioeconomic outliers within ethnic groups could lead to a narrowing of their socioeconomic range over generations.

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The genomic characteristics of Peruvian patients with gastric adenocarcinoma from diverse socioeconomic backgrounds were examined in consideration of the possibility that patients from different socioeconomic backgrounds may be exposed to different risk factors. We conducted a prospective pilot study in two Peruvian cities (Lima and Ica). This study enrolled 15 patients from low socioeconomic status (LSES) and 15 patients from medium/high socioeconomic status (MHSES). The genomic profiling of gastric adenocarcinoma samples was done through the FoundationOne CDx platform. We compared the genomic characteristics and the need for targeted therapy and immunotherapy between LSES and MHSES. The genes with higher rates of alterations were TP53 (73.3% vs. 50.0%, P = 0.2635); CDH1 (26.7% vs. 28.6%, P = 1); CDKN2A (20.0% vs. 28.6%, P = 1); KRAS (33.3% vs. 7.1%, P = 0.1686); ARID1A (20.0% vs. 14.3%, P = 1); MLL2 (13.3% vs. 21.4%, P = 1) and SOX9 (33.3% vs. 0.0%, P = 0.0421) in LSES versus HMSES, respectively. There was no significant difference in tumor mutational burden (P = 0.377) or microsatellite status (P = 1). The LSES group had a higher need for targeted therapy or immunotherapy according to gene involvement and alterations. A significant genomic difference exists among patients with gastric adenocarcinoma of different socioeconomic status, which may result in a different need for targeted therapy and immunotherapy.

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BACKGROUND: Identifying individuals with depressive symptomatology (DS) promptly and effectively is of paramount importance for providing timely treatment. Machine learning models have shown promise in this area; however, studies often fall short in demonstrating the practical benefits of using these models and fail to provide tangible real-world applications. OBJECTIVE: This study aims to establish a novel methodology for identifying individuals likely to exhibit DS, identify the most influential features in a more explainable way via probabilistic measures, and propose tools that can be used in real-world applications. METHODS: The study used 3 data sets: PROACTIVE, the Brazilian National Health Survey (Pesquisa Nacional de Saúde [PNS]) 2013, and PNS 2019, comprising sociodemographic and health-related features. A Bayesian network was used for feature selection. Selected features were then used to train machine learning models to predict DS, operationalized as a score of ≥10 on the 9-item Patient Health Questionnaire. The study also analyzed the impact of varying sensitivity rates on the reduction of screening interviews compared to a random approach. RESULTS: The methodology allows the users to make an informed trade-off among sensitivity, specificity, and a reduction in the number of interviews. At the thresholds of 0.444, 0.412, and 0.472, determined by maximizing the Youden index, the models achieved sensitivities of 0.717, 0.741, and 0.718, and specificities of 0.644, 0.737, and 0.766 for PROACTIVE, PNS 2013, and PNS 2019, respectively. The area under the receiver operating characteristic curve was 0.736, 0.801, and 0.809 for these 3 data sets, respectively. For the PROACTIVE data set, the most influential features identified were postural balance, shortness of breath, and how old people feel they are. In the PNS 2013 data set, the features were the ability to do usual activities, chest pain, sleep problems, and chronic back problems. The PNS 2019 data set shared 3 of the most influential features with the PNS 2013 data set. However, the difference was the replacement of chronic back problems with verbal abuse. It is important to note that the features contained in the PNS data sets differ from those found in the PROACTIVE data set. An empirical analysis demonstrated that using the proposed model led to a potential reduction in screening interviews of up to 52% while maintaining a sensitivity of 0.80. CONCLUSIONS: This study developed a novel methodology for identifying individuals with DS, demonstrating the utility of using Bayesian networks to identify the most significant features. Moreover, this approach has the potential to substantially reduce the number of screening interviews while maintaining high sensitivity, thereby facilitating improved early identification and intervention strategies for individuals experiencing DS.

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Background: Intestinal infectious diseases are a global concern in terms of morbidity, and they are closely linked to socioeconomic variables such as quality of life, weather and access to healthcare services. Despite progress in spatial analysis tools and geographic information systems in epidemiology, studies in Ecuador that evaluate temporal trends, specific geographic groups, and their correlation with socioeconomic variables are lacking. The absence of such information makes it challenging to formulate public health policies. This study sought to identify the spatial and temporal patterns of these diseases in Ecuador, along with their correlation with socioeconomic variables. Methods: In Ecuador, the study was carried out in a continental territory, focusing on data related to intestinal infectious diseases collected from the National Institute of Statistics and Census (Instituto Nacional de Estadística y Censos) during the period from 2014 to 2019. This study involved spatial and temporal analyses using tools such as the global Moran's index and Local Indicators of Spatial Association to identify spatial clustering patterns and autocorrelation. Additionally, correlations between morbidity rates and socioeconomic variables were examined. Results: During the investigated period, Ecuador registered 209,668 cases of these diseases. Notable variations in case numbers were identified, with a 9.2% increase in 2019 compared to the previous year. The most impacted group was children under 5 years old, and the highest rates were centered in the southern and southwestern regions of the country, with Limón Indanza and Chunchi being the cantons with the highest rates, notably showing a significant increase in Limón Indanza. Additionally, there were significant correlations between morbidity rates and socioeconomic variables, school dropout rates, low birth weight, and access to water services. Conclusion: This study emphasizes the importance of considering socioeconomic variables when addressing these diseases in Ecuador. Understanding these correlations and geospatial trends can guide the development of health policies and specific intervention programs to reduce the incidence in identified high-risk areas. More specific research is needed to understand the underlying causes of variability in morbidity and develop effective prevention strategies.

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Abstract Objective: To analyze the prevalence evolution of Guthrie, hearing, and eye screening testing among newborns in Brazil, between 2013 and 2019, according to demographic and socioeconomic characteristics. Methods: This is a cross-sectional study with data from 5231 infants from the Pesquisa Nacional de Saude (PNS), in 2013, and 6637 infants, in 2019, for the Guthrie test, hearing, and red reflex tests. The authors analyzed the outcomes according to the region of residence, self-reported color/race, having health insurance, and per capita household income. By using bivariate and multivariate Poisson regression models, the prevalence ratios and their respective 95 % Confidence Intervals (CI95%) were calculated for each year. Results: In 2013, Guthrie test, hearing, and red reflex tests were performed in 96.5 % (95%CI 95,8;97,0), 65.8 % (95%CI 63,9;67,7), and 60.4 % (95%CI 58,5;62,3) of infants, respectively. In 2019, the prevalence was 97.8 % (95%CI 97,3;98,2) in the Guthrie test, 81.6 % (95%CI 80,3;82,9) in the hearing test, and 78.6 % (95%CI 77,1;79,9) in the red reflex test. The testing frequency was higher among residents of the Southeast and South regions of Brazil, among infants whose mother or guardian was white, had health insurance, and was in the higher income strata; and the most evident differences were in the eye and hearing testing. Conclusions: The coverage inequalities according to the region of residence, income, and having health insurance highlight the need to use strategies that enable exams to be carried out, with more information about their importance, encompassing actions from primary care, prenatal care to the puerperium, aiming at universal access and equity.

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Resumen Introducción: diversos estudios describen los diferentes beneficios de la práctica de actividad física en niños y adolescentes; su déficit en estos grupos etarios, provoca un aumento concomitante de alteraciones cardiovasculares y metabólicas. Objetivo: analizar los patrones de actividad física, la maduración biológica y el contenido mineral óseo en escolares colombianos entre 8 y 16 años de edad en función del estrato socioeconómico al que pertenecen. Materiales y métodos: estudio de enfoque cuantitativo, descriptivo, transversal con alcance correlacional el cual incluyó una muestra representativa para escolares colombianos entre 8-16 años de edad a los cuales se les valoró el nivel de actividad física a través del PAQ-C, igualmente, se evaluaron diferentes medidas antropométricas y de manera indirecta se determinó la velocidad pico de crecimiento (VPC) y la densidad mineral ósea (DMO). Resultados: se evaluaron un total de 2147 escolares de los cuales el 56,7 % pertenecían a instituciones educativas del sistema público, se encontraron asociaciones estadísticamente significativas entre el sexo y el estrato socioeconómico con el nivel de actividad física (p<0,005) y las demás variables de estudio. Conclusión: se puede concluir que la actividad física, la maduración biológica y la salud ósea guardan estrecha relación con la condición socioeconómica en escolares colombianos lo que permite establecer diagnósticos tempranos y toma de decisiones frente a programas y estrategias educativas y de salud pública.

Abstract Introduction: Several studies describe the different benefits of physical activity in children and adolescents. Indeed, when a deficit of physical activity is evident in these age groups, there is a concomitant increase in metabolic and metabolic disorders. Objective: to analyze the patterns of physical activity, biological maturation and bone mineral content in Colombian schoolchildren between 8 and 16 years of age according to the socioeconomic status to which they belong. Materials and methods: A quantitative, descriptive, cross-sectional study with a correlational scope, which included a representative sample of Colombian schoolchildren between 8 and 16 years of age, who were assessed for their level of physical activity through the PAQ-C, also, different anthropometric measurements are evaluated and indirectly the peak growth velocity (PSV) and bone mineral density (BMD) are prolonged. Results: a total of 2147 schoolchildren were evaluated, of which 56.7% belonged to educational institutions of the public system, statistically significant associations were found between sex and socioeconomic status with the level of physical activity and the other study variables. Conclusion: It can be concluded that physical activity, biological maturation and bone health are closely related to socioeconomic status in Colombian schoolchildren, which allows early diagnoses and decision-making regarding educational and public health programs and strategies.

Resumo Introdução: Vários estudos descrevem os diferentes benefícios da prática de atividade física em crianças e adolescentes. De fato, quando um déficit de atividade física é evidenciado nessas faixas etárias, ocorre um aumento concomitante de distúrbios cardiovasculares e metabólicos. Objetivo: analisar os padrões de atividade física, maturação biológica e conteúdo mineral ósseo em escolares colombianos entre 8 e 16 anos de idade de acordo com o status socioeconômico ao qual pertencem. Materiais e métodos: Um estudo quantitativo, descritivo, transversal com escopo correlacional, que incluiu uma amostra representativa de escolares colombianos entre 8 e 16 anos de idade, que foram avaliados quanto ao seu nível de atividade física por meio do PAQ-C, além disso, diferentes medidas antropométricas são avaliadas e, indiretamente, a velocidade máxima de crescimento (PSV) e a densidade mineral óssea (DMO) são prolongadas. Resultados: Um total de 2147 escolares foram avaliados, dos quais 56,7% pertenciam a instituições educacionais do sistema público, foram encontradas associações estatisticamente significativas entre sexo e status socioeconômico com o nível de atividade física e as outras variáveis do estudo. Conclusão: Pode-se concluir que a atividade física, a maturação biológica e a saúde óssea estão intimamente relacionadas ao status socioeconômico em escolares colombianos, o que permite diagnósticos precoces e tomada de decisões em relação a programas e estratégias educacionais e de saúde pública.

Assuntos