Helen Gonçalves

RESEARCH, TEACHING, or OTHER INTERESTS

Epidemiology, Social Sciences, Psychiatry and Mental health, Health (social science)

Scopus Publications

Does maternal anxiety predict child behavioral problems? An examination of internalizing and externalizing behaviors in children of participants in a Brazilian cohort study
Helen Gonçalves, Pedro San Martin Soares, Mariane da Silva Dias, Etiene Dias Alves, Ingrid Medeiros Lessa, Júlia Freire Danigno, Karisa Roxo Brina, Laura Moreira Goularte, Luisa Silveira da Silva, Mariana Marins Cleff,et al.
Elsevier BV



A cross-country comparison of temporal change in adolescent mental health problems in the UK and Brazil
J. M. Armitage, E. Viegas da Silva, F. Tseliou, L. Riglin, G. Hammerton, S. Collishaw, I. S. Santos, L. Tovo-Rodrigues, A. M. B. Menezes, C. F. Wehrmeister,et al.
Cambridge University Press (CUP)
Abstract Aims Epidemiological evidence shows a concerning rise in youth mental health difficulties over the past three decades. Most evidence, however, comes from countries in Europe or North America, with far less known about changes in other global regions. This study aimed to compare adolescent mental health across two population-based cohorts in the UK, and two population-based cohorts in Pelotas, Brazil. Methods Four population-based cohorts with identical mental health measures were compared. In Brazil, these included the 1993 Pelotas Birth Cohort and the 2004 Pelotas Birth Cohort. In the UK, cohorts included the Avon Longitudinal Study of Parents and Children, and the Millennium Cohort Study. Mental health was measured in all cohorts using identical, parent-rated scores from the Strengths and Difficulties Questionnaire (SDQ). This was assessed in both countries over approximately the same time periods, when adolescents were aged 11 (2004 vs 2015 in Brazil, and 2003 vs 2012 in the UK), with follow-up analyses focused on outcomes in later adolescence. Results Mental health problems were higher in the UK for adolescents born in the early 2000s compared to those born in the early 1990s. In Pelotas, the opposite was found, whereby problems were lower for adolescents born in the early 2000s compared to those born in the early 1990s. Despite these promising reductions in mental health problems in Pelotas over time, SDQ scores remained higher in Pelotas compared to the UK. Conclusions Our study represents the first to compare two population-based cohorts in the UK, and two population-based cohorts in Pelotas, Brazil, to understand how mental health problems have changed over time across the two settings. Our findings provide the most up-to-date insight into population-level rates of youth mental health problems in Pelotas, and shed novel insight into how these have changed over the last two decades in comparison to the UK. In doing so, our study provides a tentative first step towards understanding youth mental health over time at a more global scale, and presents a valuable opportunity to examine putative contributors to differences across time.


Time Trends and Socioeconomic Inequalities in Parental Physical Aggression and Adolescent Physical Fighting: Three Brazilian Birth Cohort Studies Over Twenty Years, 2000–2020
Vanessa Iribarrem Avena Miranda, Carolina V.N. Coll, Alicia Matijasevich, Ina S. Santos, Helen Gonçalves, Aluisio J.D. Barros, Luciana Tovo-Rodrigues, and Joseph Murray
Elsevier BV



Association of inflammatory markers and multimorbidity in young adults: cross-sectional findings from the Pelotas (Brazil) birth cohort, 1993
Isabel Oliveira de Oliveira, Tulio L. Correa, Gustavo Dias Ferreira, Bruno Pereira Nunes, Helen Gonçalves, Fernando César Wehrmeister, and Ana Maria Baptista Menezes
FapUNIFESP (SciELO)
Abstract: Early diagnosis can be a beneficial factor for minimizing health risks related to multimorbidity. This study aims to assess the association of multimorbidity with interleukin 6 (IL-6), C-reactive protein (CRP), and adiponectin in 22-year-old participants of the Pelotas (Brazil) birth cohort. A total of 3,578 subjects had serum measurements of IL-6, CRP, and adiponectin at the 22-year-old visit. For multimorbidity evaluation, a list of 15 morbidities was used and divided into subgroups (cardiometabolic, pulmonary, allergic diseases, and mental disorders). The occurrence of ≥ 2 morbidities was higher in females (55.1%) than in males (45.2%). A negative association between multimorbidity and adiponectin was found in females, whereas positive associations between the number of diseases and IL-6 and CRP were observed in males. For both sexes, cardiometabolic problem was the morbidity most associated with the markers. The analysis for isolated diseases identified dyslipidemia was the only cardiometabolic condition associated with physiological markers. Our findings suggest an inverse association between multimorbidity and adiponectin in females, as well as a direct cumulative association between the number of diseases and IL-6 and CRP in males at a young age.


Investigating changes in IQ scores over a decade in Brazil: factors at play
Pedro San Martin Soares, Fernando César Wehrmeister, Ana Maria Menezes, Helen Gonçalves, Bernardo Horta, Janaina Motta, and Fernando Hartwig
Springer Science and Business Media LLC



Worldwide trends in diabetes prevalence and treatment from 1990 to 2022: a pooled analysis of 1108 population-representative studies with 141 million participants
Bin Zhou, Archie W Rayner, Edward W Gregg, Kate E Sheffer, Rodrigo M Carrillo-Larco, James E Bennett, Jonathan E Shaw, Christopher J Paciorek, Rosie K Singleton, Ana Barradas Pires,et al.
Elsevier BV



Gender Gap for Accelerometry-Based Physical Activity Across Different Age Groups in 5 Brazilian Cohort Studies
Luiza I.C. Ricardo, Andrea Wendt, Debora Tornquist, Helen Gonçalves, Fernando Wehrmeister, Bruna Gonçalves C. da Silva, Luciana Tovo-Rodrigues, Iná Santos, Aluisio Barros, Alicia Matijasevich,et al.
Human Kinetics
Objectives: This study aims to evaluate the gender inequalities in accelerometer-based physical activity (PA) across different age groups using data from 5 Pelotas (Brazil) cohorts. Methods: The data come from 4 birth cohort studies, covering all live births in the urban area of Pelotas for each respective year (1982, 1993, 2004, and 2015), and the Como vai? cohort study focusing on 60 years and above. Raw accelerometry data were collected on the nondominant wrist using GENEActive/ActiGraph devices and processed with the GGIR package. Overall PA was calculated at ages 1, 2, 4, 6, 11, 15, 18, 23, 30, and 60+ years, while moderate to vigorous PA was calculated from 6 years onward. Absolute (difference) and relative (ratio) gender inequalities were calculated and intersectionality between gender and wealth was also evaluated. Results: The sample sizes per cohort ranged from 965 to 3462 participants. The mean absolute gender gap was 19.3 minutes (95% confidence interval, 12.7–25.9), with the widest gap at 18 years (32.9 min; 95% confidence interval, 30.1–35.7) for moderate to vigorous PA. The highest relative inequality was found in older adults (ratio 2.0; 95% confidence interval, 1.92–2.08). Our intersectionality results showed that the poorest men being the most active group, accumulating around 60 minutes more moderate to vigorous PA per day compared with the wealthiest women at age 18. Conclusions: Men were more physically active than women in all ages evaluated. PA gender inequalities start at an early age and intensify in transition periods of life. Relative inequalities were marked among older adults.


Prevalence and Risk Factors of Gang Membership in a Brazilian Birth Cohort
Andreas Bauer, Rafaela Costa Martins, Gemma Hammerton, Hugo Gomes, Helen Gonçalves, Ana M. B. Menezes, Fernando C. Wehrmeister, and Joseph Murray
American Medical Association (AMA)
ImportanceThere is no longitudinal evidence on risk factors for gang membership in low- and middle-income countries, despite organized crime groups posing major challenges, including high homicide rates in Latin America. Furthermore, adverse childhood experiences (ACEs) have been largely overlooked in gang-related research worldwide.ObjectivesTo examine the associations of ACEs up to 15 years of age with past-year gang membership at 18 years of age and to compare crime and criminal justice involvement between gang members and non–gang members.Design, Setting, and ParticipantsThis cohort study assessed children from the 1993 Pelotas (Brazil) Birth Cohort—an ongoing population-based, prospective study. Assessments were undertaken perinatally (1993) and when the children were ages 11 (2004), 15 (2008), 18 (2011), and 22 (2015) years. All children born in 1993 were eligible (N = 5265), and 5249 (99.7%) were enrolled at birth. The study sample (N = 3794 [72.1%]) included those with complete data on ACEs. Data analyses were conducted from February to August 2024.ExposuresTwelve ACEs were assessed up to 15 years of age via child self-report and/or maternal report, including physical neglect, physical abuse, emotional abuse, sexual abuse, domestic violence, maternal mental illness, parental divorce, ever being separated from parents, parental death, poverty, discrimination, and neighborhood fear. These experiences were examined using a single adversity approach, cumulative risk, and latent classes.Main Outcomes and MeasuresThe main outcome was past-year gang membership at 18 years of age, assessed via self-report and analyzed using multivariate imputation.ResultsOf 3794 participants, 1964 (51.8%) were female and 1830 (48.2%) were male, and 703 (18.5%) were Black, 2922 (77.0%) were White, and 169 (4.5%) were coded as “other” race or ethnicity (no additional details are available to further disaggregate the other category). On the basis of the imputed data, 1.6% (SE, 0.2 percentage points) of participants reported gang membership at 18 years of age. Physical abuse (odds ratio [OR], 2.76; 95% CI, 1.27-5.98), emotional abuse (OR, 2.76; 95% CI, 1.51-5.02), domestic violence (OR, 3.39; 95% CI, 1.77-6.48), parental divorce (OR, 2.04; 95% CI, 1.17-3.54), and separation from parents (OR, 3.13; 95% CI, 1.54-6.37) were associated with an increased risk of gang membership. A dose-response association was observed, with 4 or more ACEs increasing the risk (OR, 8.86; 95% CI, 2.24-35.08). In latent class analysis, the class with child maltreatment and household challenges was associated with a higher risk of gang membership than the low-adversities class (OR, 7.10; 95% CI, 2.37-21.28). There was no robust evidence that children exposed to household challenges and social risks were at increased risk of gang membership (OR, 2.28; 95% CI, 0.46-11.25).Conclusions and RelevanceIn this prospective cohort study, ACEs, particularly child maltreatment and family conflict, were associated with gang involvement when examined individually, cumulatively, and as clusters in a high-crime environment in Brazil. These findings underscore the value of integrating the ACE framework into gang-related research and the potential to reduce gang-related crime by reducing ACEs.


General and abdominal adiposity and hypertension in eight world regions: a pooled analysis of 837 population-based studies with 7·5 million participants
Bin Zhou, James E Bennett, Aidan P Wickham, Rosie K Singleton, Anu Mishra, Rodrigo M Carrillo-Larco, Nayu Ikeda, Lakshya Jain, Ana Barradas-Pires, Rachel A Heap,et al.
Elsevier BV



Maternal mental health and offspring's IQ: Evidence from two Brazilian birth cohorts
Pedro San Martin Soares, Aluisio Jardim Dornellas de Barros, Iná dos Santos, Alicia Matijasevich, Fernando César Wehrmeister, Ana Maria Baptista Menezes, Helen Gonçalves, and Fernando Pires Hartwig
Elsevier BV



Association between breast feeding and food consumption according to the degree of processing in Brazil: a cohort study
Carolina Abreu de Carvalho, Poliana Cristina de Almeida Fonseca Viola, Elma Izze da Silva Magalhães, Soraia Pinheiro Machado, Alicia Matijasevich, Ana Maria Baptista Menezes, Luciana Tovo-Rodrigues, Ina S Santos, Helen Goncalves, Fernando C Wehrmeister,et al.
BMJ
BackgroundThe benefits of breast feeding may be associated with better formation of eating habits beyond childhood. This study was designed to verify the association between breast feeding and food consumption according to the degree of processing in four Brazilian birth cohorts.MethodsThe duration of exclusive, predominant and total breast feeding was evaluated. The analysis of the energy contribution of fresh or minimally processed foods (FMPF) and ultra-processed foods (UPF) in the diet was evaluated during childhood (13–36 months), adolescence (11–18 years) and adulthood (22, 23 and 30 years).ResultsThose who were predominantly breastfed for less than 4 months had a higher UPF consumption (β 3.14, 95% CI 0.82 to 5.47) and a lower FMPF consumption (β −3.47, 95% CI −5.91 to −1.02) at age 22 years in the 1993 cohort. Exclusive breast feeding (EBF) for less than 6 months was associated with increased UPF consumption (β 1.75, 95% CI 0.25 to 3.24) and reduced FMPF consumption (β −1.49, 95% CI −2.93 to −0.04) at age 11 years in the 2004 cohort. In this same cohort, total breast feeding for less than 12 months was associated with increased UPF consumption (β 1.12, 95% CI 0.24 to 2.19) and decreased FMPF consumption (β −1.13, 95% CI −2 .07 to −0.19). Children who did not receive EBF for 6 months showed an increase in the energy contribution of UPF (β 2.36, 95% CI 0.53 to 4.18) and a decrease in FMPF (β −2.33, 95% CI −4 .19 to −0.48) in the diet at 13–36 months in the 2010 cohort. In this cohort, children who were breastfed for less than 12 months in total had higher UPF consumption (β 2.16, 95% CI 0.81 to 3.51) and lower FMPF consumption (β −1.79, 95% CI −3.09 to −0.48).ConclusionExposure to breast feeding is associated with lower UPF consumption and higher FMPF consumption in childhood, adolescence and adulthood.


Early exposure to cannabis and bipolar disorder incidence: Findings from a 22-year birth cohort study in Brazil
Alan Cristian Rodrigues Jorge, Bruno Braga Montezano, Kyara Rodrigues de Aguiar, Lucas Tavares Noronha, Daniel Prates Baldez, Devon Watts, Ana Maria Baptista Menezes, Fernando C. Wehrmeister, Helen Gonçalves, Maurício Kunz,et al.
Wiley
AbstractBackground and ObjectivesBipolar disorder is a chronic condition affecting millions of people worldwide. Currently, there is some evidence to suggest that cannabis use during adolescence may be an environmental risk factor for its onset, however inconsistencies have been observed across the literature. Considering this, we aimed to assess whether early lifetime cannabis is associated with subsequent bipolar disorder in young adults between 18 and 22 years of age.MethodsUsing data from the 1993 Pelotas (Brazil) birth cohort (n = 5249), cannabis exposure was examined at age 18 by self‐report, and bipolar disorder diagnosis was measured at age 22 using the Mini International Neuropsychiatric Interview (MINI). In order to control the analysis, we considered socioeconomic status index, sex, skin color, physical abuse by parents and lifetime cocaine use.ResultsA total of 3781 individuals were evaluated in 2015 aged 22 years, of whom 87 were diagnosed with the bipolar disorder onset after the age of 18. Lifetime cannabis use predicted bipolar disorder onset at 22 years old (OR 1.82, 95% CI [1.10, 2.93]), and the effect remained after adjusting for socioeconomic status, sex, skin color, and physical abuse by parents (OR 2.00, 95% CI [1.20, 3.25]). However, this association was attenuated to statistically non‐significant after further adjustment for all available covariates, including lifetime cocaine use (OR 1.79, 95% CI [0.95, 3.19]). We also found similar results for early cocaine use, where the association with bipolar disorder onset did not maintain significance in the multivariate model (OR 1.35, 95% CI [0.62, 2.86]). Otherwise, when we considered cannabis or cocaine lifetime use as a unique feature, our findings showed that the adolescent exposure to cannabis or cocaine increased the odds by 1.95 times of developing bipolar disorder at 22 years age, even when controlling for all other study variables (OR 2.14, 95% CI [1.30, 3.47]). Finally, our models suggest that cocaine use may potentially exert a major influence on the effect of lifetime cannabis use on bipolar disorder onset, and that physical abuse by parents and sex may modify the effect of cannabis use for later bipolar disorder onset.ConclusionBased on our findings, early cannabis exposure predicted bipolar disorder onset in young adults, but this association was confounded by cocaine use. Contrary to schizophrenia, cannabis as a sole exposure was not associated with bipolar disorder onset after adjusting for control variables.


Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults
Nowell H Phelps, Rosie K Singleton, Bin Zhou, Rachel A Heap, Anu Mishra, James E Bennett, Christopher J Paciorek, Victor PF Lhoste, Rodrigo M Carrillo-Larco, Gretchen A Stevens,et al.
Elsevier BV



The politicizing clinic: insights on ‘the social’ for mental health policy and practice
Dominique P. Béhague, Helen Gonçalves, Suélen Henriques da Cruz, Larissa de Cruz, Bernardo L. Horta, and Natália P. Lima
Springer Science and Business Media LLC
Abstract Purpose In this paper, we explore how Brazilian socially sensitive therapy can respond to care-users’ desire to change the social and political forces shaping their lives. We use this case to demonstrate the limits of the “social determinants of health” agenda which, when operationalized, tends to leave questions of lasting structural change aside. Methods We report on mixed methods ethnographic and epidemiological results from the 1982 Pelotas (Brazil) birth cohort study, a prospective study of 5914 children. Ethnographic analysis explored the cyclical relationship between schooling, mental health care, conceptualizations of mental distress, social and political engagement, and experiences with diverse forms of discrimination. Epidemiological bivariate and multivariate analyses examined differences in socio-political participation and the reporting of discrimination at different time-points for participants who used therapy with those who did not. Effect modification analysis tested the hypothesis that the socially empowering effects of therapy were greater for marginalized and minoritized youth. Results Most young people living in situations of precarity experienced therapy, particularly when based in schools, to be a blame-inducing process. A more fulfilling and impactful therapeutic experience took shape when young people were able to shift the focus away from symptom reduction and behavioral management toward narrative life analyses, social debate, and political agency. Use of socially sensitive therapy was statistically associated with increased political participation and reporting of discrimination after controlling for confounders. The empowering effects of therapy were greater for those with less formal education and family income, but not for young people who identified as black, brown, or non-white. Conclusion The findings underscore the importance of considering agency, sociality, and politics when theorizing “the social” in clinical practice, and health and social policy.


Prevalence of allergic rhinitis, atopic dermatitis, and wheezing at 15 and 22 years of age: the 1993 Pelotas (Brazil) Birth Cohort Study
G. A. Marques, André F. S. Amaral, Valéria Lima Passos, P. Weber, P. D. D. Oliveira, Ana Maria Baptista Menezes, Helen Gonçalves and F. Wehrmeister

ABSTRACT Objectives: To estimate the prevalence of allergic rhinitis (AR), atopic dermatitis (AD), and wheezing, and to describe their patterns of co-occurrence according to different characteristics in adolescence and early adulthood. Methods: Cross-sectional analyses from the 15-year and 22-year follow-ups of the 1993 Pelotas (Brazil) Birth Cohort. The outcomes were assessed based on self-reported data, and the patterns of co-occurrence were determined using cluster analysis. The sample was described using absolute and relative frequencies according to the independent variables. Venn diagrams were generated to visualize the co-occurrence of AR, AD, and wheezing. Results: Data on AR, AD, and wheezing were available for 4,286 participants at 15 years and 3,789 at 22 years. At 15 years, AR was reported by 20.9% of participants, AD by 25.2%, and wheezing by 33.4%. Meanwhile, at 22 years, AR was reported by 24.6%, AD by 14.2%, and wheezing by 30.7%. Notably, the overlap between AR and wheezing was greater than that of the other conditions (6.9% at 15 years and 8.3% at 22 years). Participants with lower maternal education and lower income were more likely to report having “no health condition”. At 15 years, White individuals most frequently reported “three conditions” (4.1%; p<0.001), whereas at 22 years, they primarily reported “two conditions” (15.6%; p<0.001). The co-occurrence of all three health conditions was found to be greater than expected, with an observed rate 2.1 times higher (95% CI 1.4 - 3.0) at 22 years. Conclusions: This study highlights the social gradient in the diagnosis and reporting of co-occurrence of AR, AD, and wheezing.


Perinatal Factors and Their Association with Early-Adulthood Suicidal Behavior in a Brazilian Birth Cohort
Heidi Eccles, Mila Kingsbury, Joseph Murray, Marie-Claude Geoffroy, Ana M. B. Menezes, Dawn-Li Blair, Gabriel Calegaro, Fernando C. Wehrmeister, Helen Gonçalves, and Ian Colman
Informa UK Limited
BACKGROUND The objectives of this study were to investigate the relationship between perinatal risk factors and suicidal ideation and attempts in young adults in Pelotas, Brazil. METHODS The data were collected from the 1993 Pelotas Birth Cohort study. Every pregnant woman who gave birth in one of the hospitals in Pelotas Brazil in 1993 was invited to participate in the study. The current study uses perinatal data collected in 1993, and follow-ups at ages 18 and 22. The primary outcome was lifetime suicide attempts with past month suicide ideation a secondary outcome. The association between perinatal predictors and suicidal ideation or lifetime suicide attempts was investigated using hierarchical logistic regression. FINDINGS There was an analytic sample size of 3493. The perinatal factors association with lifetime suicide attempts were sex (OR = 2.25 CI: 1.76-2.89), paternal education at birth (OR = 0.60, 95%CI: 0.36-0.99), maternal education (9-11 years OR = 2.81, 95%CI: 1.41-5.59, & 0-8 years OR = 2.21, 95%CI: 1.07-4.58), support from friends or neighbors at birth (OR = 0.36 95%CI: 0.17-0.77), and maternal smoking during pregnancy (OR = 1.41, 95%CI: 1.10-1.79). Patterns of associations were broadly similar with suicidal ideation. Interactions between sex and the perinatal factors paternal education, maternal education, smoking and support from friends were assessed and found to be not significant. CONCLUSION Several factors during the perinatal period are associated with risk of lifetime suicide attempts and ideation in young adults in Brazil. Early-life factors associated with suicide-related concerns in early adulthood were similar to those observed in studies from high-income settings.


Perinatal risk factors for the onset of bipolar disorder in young adulthood: A 22-year birth cohort
Vanessa Gnielka, Bruno Braga Montezano, Daniel Prates Baldez, Augusto Ossamu Shintani, Francisco Diego Rabelo-da-Ponte, Ana Maria Baptista Menezes, Fernando C. Wehrmeister, Helen Gonçalves, Maurício Kunz, Márcia Kauer-Sant'Anna,et al.
EDITORA SCIENTIFIC
Objective: Bipolar disorder (BD) is a major cause of disability-adjusted life years in young adults. Pregnancy complications have previously been associated with BD. The current study aimed to examine the association between perinatal factors and BD. Methods: We included 3,794 subjects from the 1993 Pelotas population-based birth cohort study. We assessed 27 variables at birth and modeled BD onset at 18 and 22 years. Bivariate analysis was performed by means of binomial logistic regression models. The variables with p-values less than 0.05 were included in a multiple regression with confounders. Results: Maternal smoking was associated with a 1.42-fold increased risk of BD at 18 or 22 years old (95%CI 1.091-1.841), and maternal passive exposure to tobacco with a 1.43-fold increased risk (95%CI 1.086-1.875). No association was found between other perinatal factors and BD after controlling for confounders. Conclusion: The results of the present cohort study corroborate previous reports in the literature indicating a negative effects of maternal smoking during pregnancy. These findings can be further tested and support the development of strategies to prevent the onset development of BD.


Prevalence, co-occurrence, and associated factors of intimate partner violence among Brazilian university students
Inaê Dutra Valério, Ana Luiza Gonçalves Soares, Claudia Leite de Moraes, and Helen Gonçalves
FapUNIFESP (SciELO)
Abstract Intimate Partner Violence (IPV) among youth is a public health problem worldwide because of its high prevalence and lifelong serious consequences in health and quality of life. This cross-sectional census aimed to describe the IPV victimization among all freshman students in a Brazilian university (n=1,509), which was selected from a larger population of 2,706 freshmen. We created a 10-item questionnaire inspired by established instruments to measure the prevalence of IPV. Multivariate logistic regression assessed the association between demographic, socioeconomic, and behavioral factors with various types of IPV. We visualized co-occurrence using a Venn diagram and employed multinomial logistic regression to examine the relationship between covariates and the cooccurrence of IPV types. The chance of IPV was higher in males, those who were currently in a relationship, and those with a higher risk of alcohol abuse. These same characteristics were also associated with an increased likelihood of experiencing the co-occurrence of two or more types of IPV. Prevention strategies should consider those groups and monitoring of those who abuse alcohol, which can be a predictor behavior or a mechanism to deal with the stress arising from IPV.


Relation between child maltreatment and human capital: results from a population-based birth cohort
Roberta Hirschmann, Cauane Blumenberg, Pedro San Martin Soares, Ana Maria Baptista Menezes, Fernando César Wehrmeister, and Helen Gonçalves
FapUNIFESP (SciELO)
Abstract: This study aimed to investigate the association between child maltreatment and human capital, measured by intelligence quotient (IQ) at age 18 years and schooling at age 22 years in 3,736 members from a population-based birth cohort in Southern Brazil. A multiple linear regression was used to assess the association between child maltreatment and human capital measurements. Physical and emotional abuse and physical neglect occurring up to 15 years of age were considered child maltreatment. Physical neglect was associated with lower IQ scores in women (β = -4.40; 95%CI: -6.82; -1.99) and men (β = -2.58; 95%CI: -5.17; -0.01) and lower schooling for all sexes: women (β = -1.19; 95%CI: -1.64; -0.74) and men (β = -0.82; 95%CI: -1.34; -0.30). Moreover, men who had experienced one type of child maltreatment and women who had experienced two or more types had lower years of schooling at 22 years (β = -0.41; 95%CI: -0.73; -0.89 and β = -0.57; 95%CI: -0.91; -0.22, respectively) than those who suffered no kind of maltreatment. Efforts to improve future educational and cognitive outcomes must include early prevention and intervention strategies for child maltreatment.


Women’s health and well-being in five birth cohorts from low- and middle-income countries: Domains and their associations with early-life conditions
Fernando Pires Hartwig, Anushka Ataullahjan, Linda Adair, Helen Gonçalves, Bernardo Horta, Nanette Lee, Reynaldo Martorell, Ana Maria B Menezes, Janaina Vieira dos Santos Motta, Shane Norris,et al.
International Society of Global Health
Background Women’s health and well-being (WHW) have been receiving growing attention, but limited progress has been made on how to measure its different domains in low- and middle-income countries (LMICs). We used data from five long-term birth cohorts in Brazil, Guatemala, the Philippines and South Africa to explore different domains of adult WHW, and how these domains relate to early life exposures. Methods Based upon an a priori conceptualisation of eight postulated WHW outcomes available in the data, we grouped them as follows: human capital (intelligence quotient, schooling, height, and teenage childbearing), metabolic health (body mass index and metabolic syndrome score), and psychological (happiness and Self-Reported Questionnaire (SRQ) scores). Correlation analyses confirmed the variables theoretically belonging to the same dimension of WHW were statistically related. We then applied principal component analysis to each group of variables separately and used the first principal component as a summary quantitative measure of the corresponding WHW dimension. Finally, we assessed the association of each domain with a range of early-life factors: wealth, maternal education, maternal height, water, and sanitation, birthweight, length at two years and development quotient in mid-childhood. Results The three domains were largely uncorrelated. Early determinants were positively associated with human capital, while birth order was negatively associated. Fewer associations were found for the metabolic or psychological components. Birthweight and weight at age two years were inversely associated with metabolic health. Maternal education was associated with better psychological health. Conclusions Our findings indicate that WHW is multidimensional, with most women in the cohorts being compromised in one or more domains while few women scored highly in all three domains. Our analyses are limited by lack of data on adolescent exposures and on other relevant WHW dimensions such as safety, agency, empowerment, and violence. Further research is needed in LMICs for identifying and measuring the multiple domains of WHW.


How much or how often? Examining the screening properties of the DSM cross-cutting symptom measure in a youth population-based sample
João Pedro Gonçalves Pacheco, Christian Kieling, Pedro H. Manfro, Ana M. B. Menezes, Helen Gonçalves, Isabel O. Oliveira, Fernando C. Wehrmeister, Luis Augusto Rohde, and Maurício Scopel Hoffmann
Cambridge University Press (CUP)
AbstractBackgroundThe DSM Level 1 Cross-Cutting Symptom Measure (DSM-XC) allows for assessing multiple psychopathological domains. However, its capability to screen for mental disorders in a population-based sample and the impact of adverbial framings (intensity and frequency) on its performance are unknown.MethodsThe study was based on cross-sectional data from the 1993 Pelotas birth cohort in Brazil. Participants with completed DSM-XC and structured diagnostic interviews (n = 3578, aged 22, 53.6% females) were included. Sensitivity, specificity, positive (LR+), and negative (LR−) likelihood ratios for each of the 13 DSM-XC domains were estimated for detecting five internalizing disorders (bipolar, generalized anxiety, major depressive, post-traumatic stress, and social anxiety disorders) and three externalizing disorders (antisocial personality, attention-deficit/hyperactivity, and alcohol use disorders). Sensitivities and specificities &gt;0.75, LR+ &gt; 2 and LR− &lt; 0.5 were considered meaningful. Values were calculated for the DSM-XC's original scoring and for adverbial framings.ResultsSeveral DSM-XC domains demonstrated meaningful screening properties. The anxiety domain exhibited acceptable sensitivity and LR− values for all internalizing disorders. The suicidal ideation, psychosis, memory, repetitive thoughts and behaviors, and dissociation domains displayed acceptable specificity for all disorders. Domains also yielded small but meaningful LR+ values for internalizing disorders. However, LR+ and LR− values were not generally meaningful for externalizing disorders. Frequency-framed questions improved screening properties.ConclusionsThe DSM-XC domains showed transdiagnostic screening properties, providing small but meaningful changes in the likelihood of internalizing disorders in the community, which can be improved by asking frequency of symptoms compared to intensity. The DSM-XC is currently lacking meaningful domains for externalizing disorders.


Why are pregnant women physically inactive? A qualitative study on the beliefs and perceptions about physical activity during pregnancy
Helen Gonçalves, Ana Luiza Gonçalves Soares, Marlos Rodrigues Domingues, Andréa Damaso Bertoldi, Maiara Gonçalves dos Santos, Mariângela Freitas da Silveira, and Carolina de Vargas Nunes Coll
FapUNIFESP (SciELO)
This study aimed to describe the beliefs and perceptions of pregnant women and healthcare providers about physical activity during pregnancy. Using a qualitative approach, 30 pregnant women and the 14 healthcare providers caring for them were interviewed in the second trimester of pregnancy. We included women who maintained, decreased, or stopped physical activity since becoming pregnant. They were divided into low (≤ 8 years) and high schooling (&gt; 8 years). Semi-structured, in-depth interviews were conducted and guided by three key questions: (1) When does physical activity during pregnancy start to be considered a wrong behavior?; (2) What are the main barriers (biological or others) to physical activity?; and (3) Do the actions of healthcare providers and people close to pregnant women reinforce barriers? Interviews were audio recorded, transcribed, and analyzed based on recurring themes. All women changed their physical activity behavior (decreased or stopped) when they discovered their pregnancy. Fear of miscarriage, contractions, bleeding, and of causing malformations in the baby were the most reported reasons for decreasing or stopping physical activity. Participants also lacked access to consistent information and healthcare providers’ support on the benefits of physical activity. Despite the current international recommendations to regular physical activity during pregnancy, uncertainty regarding its benefits remains. Interventions to promote physical activity during this period should include the training of healthcare providers so they can advise and discard ideas contrary to mother-child health benefits.


Premorbid intelligence quotient and school failure as risk markers for bipolar disorder and major depressive disorder
Francisco Diego Rabelo-da-Ponte, Lauro Estivalete Marchionatti, Devon Watts, Thiago Henrique Roza, Silvia Amoretti, Fernando C. Barros, Fernando C. Wehrmeister, Helen Gonçalves, Ana Maria B Menezes, Maurício Kunz,et al.
Elsevier BV



Leisure-Time Physical Activity in a Southern Brazilian City (2004–2021): Applying an Equity Lens to Time-Trend Analyses
Andrea Wendt, Alan G. Knuth, Bruno P. Nunes, Mario Renato de Azevedo Jr, Helen Gonçalves, Pedro C. Hallal, and Inácio Crochemore-Silva
Human Kinetics
Background: This study aimed to verify leisure-time physical activity trends over 15 years and monitor inequalities according to gender, self-reported skin color, and socioeconomic position in a Southern Brazilian city. A secondary aim is to evaluate intersectionalities in physical activity. Methods: Trend analysis using 3 population-based surveys carried out in 2004, 2010, and 2021. Main outcome assessed was the prevalence of physical activity according to recommendations (150 min/wk). Inequalities dimensions measured were sex, self-reported skin color, and wealth. Intersectionalities were evaluated using Jeopardy index combining all inequality dimensions. Trend analysis was performed using least-squares weighted regression. Results: We included data from 3090, 2656, and 5696 adults in 2004, 2010, and 2021, respectively. Prevalence of physical activity remains stable around 25% in the 3 years. In the 3 periods evaluated, men presented a prevalence in average 10 percentage points higher than women (SII2004 = −11.1 [95% confidence interval, CI, −14.4 to −7.8], SII2021 = −10.7 [95% CI, −13.7 to −7.7]). Skin color inequalities did not present a clear pattern. Richest individuals, in general presented a prevalence of leisure-time physical activity level 20pp higher than poorest ones (SII2004 = 20.5 [95% CI, 13.7 to 27.4]; SII2021 = 16.7 [95% CI, 11.3 to 22.0]). Inequalities were widely marked, comparing the most privileged group (represented by men, the wealthiest, and White) and the most socially vulnerable group (represented by women, the poorest, and Black/Brown). The Slope Index of Inequality for intersectionalities was −24.5 (95% CI, −31.1 to −17.9) in 2004 and −18.8 in 2021 (95% CI, −24.2 to −13.4). Conclusions: Our analysis shows that women, Black/Brown, and poor present lower leisure-time physical activity level. This group is often neglected regarding other health and social outcomes.


Effect of preterm birth on growth and blood pressure in adulthood in the Pelotas 1993 cohort
Winok Lapidaire, Alvaro Proaño, Cauane Blumenberg, Christian Loret de Mola, Carlos A Delgado, Darwin del Castillo, Fernando C Wehrmeister, Helen Gonçalves, Robert H Gilman, Richard A Oberhelman,et al.
Oxford University Press (OUP)
Abstract Background Preterm birth has been associated with increased risk of hypertension and cardiovascular disease later in adulthood, attributed to cardiovascular and metabolic alterations in early life. However, there is paucity of evidence from low- and middle-income countries (LMICs). Methods We investigated the differences between preterm (&amp;lt;37 weeks gestational age) and term-born individuals in birth length and weight as well as adult (18 and 20 years) height, weight and blood pressure in the Brazilian 1993 Pelotas birth cohort using linear regressions. Analyses were adjusted for the maternal weight at the beginning of pregnancy and maternal education and family income at childbirth. Additional models were adjusted for body mass index (BMI) and birthweight. Separate analyses were run for males and females. The complete sample was analysed with an interaction term for sex. Results Of the 3585 babies included at birth, 3010 were followed up in adulthood at 22 years. Preterm participants had lower length and weight at birth. This difference remained for male participants in adulthood, but female participants were no shorter than their term counterparts by 18 years of age. At 22 years, females born preterm had lower blood pressures (systolic blood pressure −1.00 mmHg, 95%CI −2.7, 0.7 mmHg; diastolic blood pressure −1.1 mmHg, 95%CI −2.4, 0.3 mmHg) than females born at term. These differences were not found in male participants. Conclusions In this Brazilian cohort we found contrasting results regarding the association of preterm birth with blood pressure in young adulthood, which may be unique to an LMIC.

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