text:
Revista Brasileira de Ginecologia e Obstetrícia
Original Article, Obstetrics • Rev. Bras. Ginecol. Obstet. 42 (07) • July 2020 • https://doi.org/10.1055/s-0040-1712996 copy
Maternal and Sociodemographic Factors Influence the Consumption of Ultraprocessed and Minimally-Processed Foods in Pregnant Women
Fatores maternos e sociodemográficos influenciam o consumo de alimentos ultraprocessados e minimamente processados em gestantes
Monique Tavares Pereira
Graduate Program in Nutrition and Health, Department of Integrated Health Education, Universidade Federal do Espírito Santo, Vitória, ES, Brazilhttp://orcid.org/0000-0002-7107-8177
Monica Cattafesta
Graduate Program in Collective Health, Universidade Federal do Espírito Santo, Vitória, ES, Brazilhttp://orcid.org/0000-0002-8973-622X
Edson Theodoro dos Santos Neto
Graduate Program in Collective Health, Universidade Federal do Espírito Santo, Vitória, ES, Brazilhttp://orcid.org/0000-0002-7351-7719
Luciane Bresciani Salaroli
Graduate Program in Nutrition and Health, Department of Integrated Health Education, Universidade Federal do Espírito Santo, Vitória, ES, BrazilGraduate Program in Collective Health, Universidade Federal do Espírito Santo, Vitória, ES, Brazilhttp://orcid.org/0000-0002-1881-0306
To analyze the consumption of minimally-processed and ultraprocessed foods in relation with sociodemographic variables, maternal habits, educational activity received during prenatal care and clinical history.
A cross-sectional, analytical and descriptive study with 1,035 pregnant women who lives in the municipalities of the metropolitan region of Grande Vitória, Espírito Santo, Brazil (RMGV-ES), and who were hospitalized in establishments of the Unified Health System (SUS) due to childbirth (April-September 2010). The food frequency questionnaire, pregnant woman's card and information from the medical records of the health facility unit were analyzed. The Chi-square test and the binary logistic regression model were used to investigate the association between the independent variables and the consumption of ultraprocessed foods.
It was identified that pregnant women ≤ 19 years of agewere 2.9 timesmore likely to consume ultraprocessed foods (confidence interval [CI] 95% 1.683-5.168, p< 0.001), while those ≥ 35 years old were less likely to consume them (odds ratio [OR] 0.265, 95% CI 0.105-0.666, p= 0.005). Maternal smoking increased the odds of consumption of ultraprocessed foods by 2.2 times (95% CI 1.202-4.199, p= 0.011) and pregnant womenwho did not obtain information on healthy food during prenatal care presented 54.1% less chances of consuming minimally-processed foods (OR 0.459, 95% CI 0.307-0.687, p< 0.001).
Smoking during the gestational period and being a teenager are factors that influence the consumption of ultraprocessed foods of pregnant women. Race/ color, head of household, age group, receiving of information about feeding in the prenatal period and not having smoked in gestation determined the consumption of minimally-processed foods.
feeding behavior; dietary habits; ultraprocessed foods; pregnant; maternal nutrition
Analisar o consumo de alimentos minimamente processados e ultraprocessados e a sua associação com variáveis sociodemográficas, hábitos maternos, atividade educacional recebida durante o pré-natal e histórico clínico.
Estudo transversal, analítico e descritivo com 1.035 gestantes que moram nos municípios da Região Metropolitana da Grande Vitória, Espírito Santo, Brasil (RMGV-ES), e que foram internadas em estabelecimentos do Sistema Único de Saúde (SUS) devido ao parto (abril-setembro de 2010). Foramanalisados o questionário de frequência alimentar, o cartão da gestante e as informações dos prontuários da unidade de saúde.Oteste do Quiquadrado e o modelo de regressão logística binária foram utilizados para investigar a associação entre as variáveis independentes e o hábito alimentar.
Identificou-se que as gestantes com idade ≤ 19 anos tinham 2,9 vezes mais chances de consumirem alimentos ultraprocessados (intervalo de confiança [IC] 95% 1,683-5,168; p < 0,001), enquanto aquelas com ≥ 35 anos tinham menos chances de consumí-los (razão de chances [RC] 0,265; IC 95% 0,105-0,666; p = 0,005). O tabagismo materno aumentou as chances de consumo de alimentos ultraprocessados em 2,2 vezes (IC95% 1,202-4,199; p = 0,011) e as gestantes que não receberam orientações sobre alimentação saudável durante o pré-natal apresentaram 54,1%menos chances de consumiremalimentos minimamente processados (RC 0,459; IC95% 0,307-0,687; p < 0,001).
Fumar durante o período gestacional e ser adolescente são fatores que influenciam o consumo de alimentos ultraprocessados em gestantes. Raça/cor, chefe da família, faixa etária, recebimento de informações sobre alimentação no pré-natal e não fumar na gestação determinaram o consumo de minimamente processados.
comportamento alimentar; hábitos alimentares; alimentos ultraprocessados; gestante; nutrição materna
Major changes have occurred in the dietary patterns of the population in recent years, mainly in relation to the substitution of nutrient-rich in natura foods for industrialized foods with high energy density and low nutritional quality.11 Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica [Internet]. [Food guide for the Brazilian population]. 2nd ed. Brasília (DF): Ministério da Saúde; 2014 [cited 2018 Mar 20]. Available from: http://bvsms.saude.gov.br/ bvs/publicacoes/guia_alimentar_populacao_brasileira_2ed.pdf Factors such as the search for practicality and absence of time have led to various social changes and changes in health and food consumption of the population.22 Popkin BM, Adair LS, Ng SW. Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev. 2012;70 (01):3-21. Doi: 10.1111/j.1753-4887.2011.00456.x
https://doi.org/10.1111/j.1753-4887.2011... Given the scenario of modification of food patterns and changes in the forms of food and beverage processing, Monteiro et al. (2016)33 Monteiro CA, Cannon G, Levy RB, Moubarac JC, Jaime P, Martins AP, et al. NOVA. The star shines bright.World Nutr.. 2016;7(1-3): 28-38 proposed a new system for food classification. For this new classification, food items were grouped according to the extent and purpose of processing. Titled NOVA, consumption items are classified into four categories: in natura or minimally-processed foods; processed culinary ingredients; processed foods and ultraprocessed foods.33 Monteiro CA, Cannon G, Levy RB, Moubarac JC, Jaime P, Martins AP, et al. NOVA. The star shines bright.World Nutr.. 2016;7(1-3): 28-38 The presence of ultraprocessed foods in the food consumption of Brazilians has been gradually expanding, with the need for a deep investigation of their impact on the health of the population.33 Monteiro CA, Cannon G, Levy RB, Moubarac JC, Jaime P, Martins AP, et al. NOVA. The star shines bright.World Nutr.. 2016;7(1-3): 28-3844 Monteiro CA, Levy RB, Claro RM, Castro IRR, Cannon G. A new classification of foods based on the extent and purpose of their processing. Cad Saude Publica. 2010;26(11):2039-2049. Doi: 10.1590/S0102-311X2010001100005
https://doi.org/10.1590/S0102-311X201000... Although there is a trend of high intake of ultraprocessed foods at all stages of the life cycle,55 Martins AP, Levy RB, Claro RM, Moubarac JC, Monteiro CA. Increased contribution of ultra-processed food products in the Brazilian diet (1987-2009). Rev Saude Publica. 2013;47(04): 656-665. Doi: 10.1590/S0034-8910.2013047004968
https://doi.org/10.1590/S0034-8910.20130... 66 Devine CM, Bove CF, Olson CM. Continuity and change inwomen's weight orientations and lifestyle practices through pregnancy and the postpartum period: the influence of life course trajectories and transitional events. Soc Sci Med. 2000;50(04):567-582. Doi: 10.1016/s0277-9536(99)00314-7
https://doi.org/10.1016/s0277-9536(99)00... it is during gestation that women are more likely to change their pattern of food consumption due to concern about their maternal responsiveness.77 Padmanabhan U, Summerbell CD, Heslehurst N. A qualitative study exploring pregnant women's weight-related attitudes and beliefs in UK: the BLOOM study. BMC Pregnancy Childbirth. 2015;15:99. Doi: 10.1186/s12884-015-0522-3
https://doi.org/10.1186/s12884-015-0522-... Thus, we analyzed the consumption of minimally-processed and ultraprocessed foods in relation with sociodemographic factors, maternal habits, educational activities and clinical history of pregnant women during prenatal care.
This is a cross-sectional, analytical and descriptive study, with data collected from April to September 2010. The data of the present study are part of a larger study titled "Evaluation of the Quality of Prenatal Care in the Metropolitan Region of Grande Vitória, Espírito Santo, Brazil (RMGV-ES): Access and Integration of Health Services."88 Santos Neto ET, Oliveira AE, Zandonade E, Gama SGN, Leal MdoC. [Prenatal patient cards and quality of prenatal care in public health services in Greater Metropolitan Vitória, Espírito Santo State, Brazil]. Cad Saude Publica. 2012;28(09):1650-1662. Doi: 10.1590/S0102-311X2012000900005
https://doi.org/10.1590/S0102-311X201200... The sample consisted of pregnant women living in the municipalities of the metropolitan region of Grande Vitória, ES (MRGV-ES), hospitalized in establishments of the Unified Health System (SUS, in the Portuguese acronym) due to childbirth. This research was conducted in eight health facilities of the MRGV-ES, with these being contracted or belonging to the SUS. To calculate the sample size, we used the sample size formula to estimate a proportion of women studied. Through the data provided by the Information System on Live Births (SINASC, in the Portuguese acronym), a total of 17,980 live births were established in the public network or through the SUS, which number approximately reflects the number of pregnant women residing in the MRGV-ES. The indicator "Percentage of Live Births With by Seven or More Prenatal Care Consultations" was also considered, as an approximation of the utilization of health services during pregnancy. Considering a desired precision of 4%, drawing effect equal to 1.5 and significance level of 5%, calculations resulted in the sample size of 850 women. The total was increased by ∼ 30% to consider possible losses or refusals. A pilot study was performed with 67 parturients (not included in the study) in one of the establishments where the main study was conducted, for verification of the graphical presentations of the questionnaires, as well as the test on the understanding of their items and the evaluation of the average time of completion of the forms. All questions were tested by the Kappa, weighted Kappa and McNemar tests. These analyses demonstrated their applicability in the population studied, including questions about food consumption. The data were collected by a team through a closed structured interview, a full copy of the pregnant woman's card, and the retrieval of information from the medical records of the health facility where the delivery was performed. The interviewers visited at least once a week all eight maternity hospitals included in the study, approached women at the time after the birth, when they verified the possibility of the interview and possession of the pregnant woman's card. Women who did not have a pregnant woman's card were excluded, as well as those who underwent prenatal (all or part) follow-up in the private subsystem; pregnant women hospitalized with complications who did not have babies; and those who had follow-up in the municipalities outside the MRGV-ES. The women who had cesarean delivery had their data collected 12 hours after delivery, so that the anesthetic effects of the surgical procedure would not interfere with the responses. The race/color variable was determined by autoclassification as white, black, or brown (brown/mulatto). In relation to age group, these were categorized as " ≤ 19 years," "between 20 and 34 years," or " ≥ 35 years," and the conjugal situation was categorized as "lives with partner" or "does not live with partner." The variable maternal occupation was classified as "paid work" for pregnant women who had some work with remuneration, and "without paid work," for those pregnant women who did not have paid work. In relation to the variable head of the family, these were categorized as "own," "companion," or "other." Socioeconomic classification was determined based on the criterion of Brazilian Economic Classification of the Brazilian Association of Research Companies.99 Associação Brasileira de Empresas de Pesquisa. [Economic Classification Criteria Brazil] [Internet]. 2003 [cited 2018 Jan 11]. Available from: http://www.abep.org/criterio-brasil
http://www.abep.org/criterio-brasil... The pregnant women were classified as class A/B, C1/C2, or D/E to improve the description of the outcomes. The use of tobacco and alcohol during pregnancy was analyzed through questions with direct answers ("yes" or "no"). It was questioned whether during the prenatal period there was information about the advantages of healthy food and its importance for the prevention of children's health problems. This variable was dichotomized in "yes" or "no." The data on prenatal medical care were analyzed considering the number of prenatal consultations reported by the pregnant woman. This variable was classified as having performed from "one to five" or "six or more" prenatal visits. Fifteen food items registered through the questionnaire applied were evaluated. This questionnaire was based on the Vigilance System for Risk Factors for Non-Communicable Chronic Diseases of the Brazilian Ministry of Health (Vigitel, in the Portuguese acronym), which annually evaluates the food habits in Brazilian capitals.1010 Ministério da Saúde. Secretaria de Vigilância em Saúde. Secretaria de Gestão Estratégica e Participativa [Internet]. [Vigitel Brazil 2009: surveillance of risk and protective factors for chronic diseases by telephone survey]. Brasília (DF): Ministério da Saúde; 2010 [cited 2020Mar 10]. Available from: http://189.28.128.100/dab/docs/publicacoes/geral/publicacao_vigitel_2009.pdf The frequency of reported intake was converted to daily frequency, so that all food items had the same unit. The daily frequency values were multiplied by the portion of each item consumed, thus revealing the number of servings consumed daily.1111 Cade J, Thompson R, Burley V, Warm D. Development, validation and utilisation of food-frequency questionnaires - a review. Public Health Nutr. 2002;5(04):567-587. Doi: 10.1079/PHN2001318
https://doi.org/10.1079/PHN2001318... After the calculation of the weight of the frequency of consumption of each item, the analyzed foods were inserted into groups established by the classification of foods based on the extent and purpose of their processing by NOVA.33 Monteiro CA, Cannon G, Levy RB, Moubarac JC, Jaime P, Martins AP, et al. NOVA. The star shines bright.World Nutr.. 2016;7(1-3): 28-38 The foods were grouped according to the criteria proposed by Monteiro et al. (2016)33 Monteiro CA, Cannon G, Levy RB, Moubarac JC, Jaime P, Martins AP, et al. NOVA. The star shines bright.World Nutr.. 2016;7(1-3): 28-38 in the NOVA classification, which considers the characteristics of the purpose and extent of the industrial processing they have undergone: in natura or minimaly-processed, processed culinary ingredients, processed foods and ultraprocessed foods. For this study, the foods that were classified as minimally-processed and ultraprocessed were used. The Chi-square test was used to analyze the differences in proportions. The significance level of α < 5% was adopted. The distribution of the consumption of minimally-processed and ultraprocessed foods was evaluated in quartiles. The binary logistic regression model was used to investigate the association between the independent variables and the consumption of minimally-processed foods and consumption of ultraprocessed foods. The variables included in the binary logistic regression analysis were selected according to the statistical significance in the Chi-square test (p < 0.2). The lowest quartile (Q1) and the highest quartile (Q4) were analyzed for the purpose of analyzing the extremes of consumption with the independent variables. All statistical analyzes were performed in the IBM SPSS Statistics for Windows, version 22.0 (IBM Corp., Armonk, NY, USA). This study was conducted according to the guidelines laid down in the Declaration of Helsinki, and all procedures involving human subjects were approved by Research Ethics Committee of the Health Sciences Center of Universidade Federal do Espírito Santo (grant number 3.060.797) and CAAE (grant number 99562818.0.0000.5060). Written informed consent was obtained from all subjects.
The sociodemographic variables, maternal habits, educational activity and clinical history were analyzed according to the quartiles of minimally-processed food consumption of 1,035 pregnant women (Table 1). The age group and the consumption of minimally-processed foods (p = 0.015) were associated, and it was observed that pregnant women aged ≤ 19 years had lower consumption of minimally-processed foods (32.8%, n = 76) than the other age groups. Women ≥ 35 years of age presented higher consumption of minimally-processed foods (32.5%, n = 26).
Sociodemographic variables, maternal habits, educational ctivity and clinical history according to the consumption of minimally-processed foods by pregnant women
There was an association between maternal occupation (p = 0.002) and consumption of minimally-processed foods, in which it was possible to observe that pregnant women without paid work had a lower consumption of minimally-processed (28.6%, n = 212). On the other hand, women with paid work had a higher consumption of minimally-processed foods (29.9%, n = 88).
A statistical difference was identified in pregnant women who received information on healthy eating during prenatal care (p < 0.001) in relation to the consumption of minimally-processed foods, since women who did not receive information about food presented lower consumption of minimally-processed foods (32.7%, n = 161).
It was observed that pregnant women who smoked during pregnancy had lower consumption of minimally-processed foods (p < 0.001).
Regarding the analysis of sociodemographic variables, maternal habits, educational activity, and clinical history according to consumption of ultraprocessed foods (Table 2), there was a statistically significant association between age group (p < 0.001) and the consumption of ultraprocessed foods, with higher consumption of ultraprocessed foods among pregnant women age ≤ 19 years, and lower consumption of ultraprocessed foods among women in the age group of ≥ 35 years.
Sociodemographic variables, maternal habits, educational activity and clinical history according to consumption of ultraprocessed foods by pregnant women
When evaluating the variables maternal occupation and head of the family, it was possible to identify an association with ultraprocessed food consumption, showing that women with paid work had lower ultraprocessed foods consumption, and women with unpaid work had higher consumption of ultraprocessed foods (p = 0.023). The pregnant women who were head of the family showed lower consumption of ultraprocessed foods (p = 0.004).
Women who smoked during pregnancy (37.7%, n = 49) had a statistically significant association with the highest quartile of ultraprocessed food consumption (p < 0.001).
Binary logistic regression analyses showed that pregnant women ≤ 19 years of age were 2.9 times more likely to consume ultraprocessed foods (odds ratio [OR] 2.950, confidence interval [CI] 95% 1.683–5.168, p < 0.001), while those ≥ 35 years of age had less chance to consume them (OR 0.265, 95% CI 0.105–0.666, p = 0.005). Smoking during pregnancy increased the chance of consumption of ultraprocessed foods by 2.2 times (OR 2.247, 95% CI 1.202–4.199, p = 0.011) (Table 3).
Binary logistic regression analysis between consumption of ultraprocessed foods and associated variables in pregnant women
As for the consumption of minimally-processed foods (Table 4), pregnant women aged ≤ 19 years were 45.3% less likely than pregnant women aged 20 to 34 to consume these foods (OR 0.547, 95% CI 0.324–0.923, p = 0.024). Brown-skinned women were 57.8% less likely to consume minimally-processed foods than white-skinned ones (OR 0.466, 95% CI 0.226–0.803, p = 0.008).
Binary logistic regression analysis between consumption of minimally-processed foods and associated variables in pregnant women
Pregnant women who had the family headed by their partners were 56.8% less likely to consume minimally-processed foods than pregnant women who were the head of the family (OR 0.432, 95% CI 0.217–0.859, p = 0.017). However, women who received information on healthy food during prenatal care presented 2.17 times more chances to consume minimally-processed foods (OR 2.177, 95% CI 1.455–3.257, p = 0.001).
The present study allowed identifying the factors associated with the consumption of ultraprocessed and minimally-processed foods. The data show that the consumption of ultraprocessed products diverged between the age groups, demonstrating a lower consumption of ultraprocessed foods among older women. This finding was similar to that in the study by Alves-Santos et al.1212 Alves-Santos NH, Eshriqui I, Franco-Sena AB, Cocate PG, Freitas- Vilela AA, Benaim C, et al. Dietary intake variations from preconception to gestational period according to the degree of industrial processing: A Brazilian cohort. Appetite. 2016; 105:164-171. Doi: 10.1016/j.appet.2016.05.027
https://doi.org/10.1016/j.appet.2016.05.... in which older women showed a lower intake of ultraprocessed foods than the younger ones, indicating the age factor as strongly associated with the consumption of minimally-processed foods. It is still consistent with the findings by McGowan and McAuliffe,1313 McGowan CA, McAuliffe FM. Maternal dietary patterns and associated nutrient intakes during each trimester ofpregnancy. PublicHealth Nutr. 2013;16(01):97-107. Doi: 10.1017/S1368980012000997
https://doi.org/10.1017/S136898001200099... in which older women tend to adhere to a "healthy conscience" pattern, consisting mainly of higher intakes of whole-grain breads, fruits, vegetables, low-fat milk, and white meat, among others. This relationship can also be observed in Brazilian households, considering the 2008 to 2009 family budgets survey, conducted with individuals who were 10 years of age or older, which showed the consumption of ultraprocessed products tends to decrease as age increases.1414 Instituto Brasileiro de Geografia e Estatística [Internet]. [Family budget survey 2008-2009: analysis of personal food consumption in Brazil]. Rio de Janeiro: IBGE; 2011 [cited 2018 Jun 13]. Available from: https://biblioteca.ibge.gov.br/visualizacao/livros/liv50063.pdf
However, younger pregnant women presented high consumption of ultraprocessed foods, in agreement with the results already presented in the adolescent population of the city of Rio de Janeiro, in which pregnant women presented a high frequency of consumption of soft drinks, pizza, potato chips, and salty snacks, indicating food habit that is harmful to health.1515 Barros DC, Pereira RA, Gama SGN, Leal MdoC. [Food consumption by pregnant adolescents in Rio de Janeiro, Brazil]. Cad Saude Publica. 2004;20(Suppl 1):S121-S129. Doi: 10.1590/S0102- 311X2004000700013
https://doi.org/10.1590/S0102-... The association between high consumption of ultraprocessed products and age groups can also be found in non-pregnant women, in which adolescents consumed and spent more to purchase ultraprocessed foods, compromising the quality of their diet.1616 Chen YC, Huang YC, Lo YC, Wu HJ, Wahlqvist ML, Lee MS. Secular trend towards ultra-processed food consumption and expenditure compromises dietary quality among Taiwanese adolescents. Food Nutr Res. 2018;62:1565. Doi: 10.29219/fnr. v62.1565
https://doi.org/10.29219/fnr...
The present study showed that maternal habits may interfere with food consumption. Women who reported having smoked during pregnancy were associated with higher consumption of ultraprocessed foods. Knowing that maternal smoking has a negative impact on the health of the mother and is related to a series of risk behaviors because it is associated with a greater chance of maternal and fetal intercurrences,1717 Roelands J, Jamison MG, Lyerly AD, James AH. Consequences of smoking during pregnancy on maternal health. J Womens Health (Larchmt). 2009;18(06):867-872. Doi: 10.1089/jwh. 2008.1024
https://doi.org/10.1089/jwh... 1818 Freire K, Padilha PdeC, Saunders C. [Factors associated to alcohol and smoking use in pregnancy]. Rev Bras Ginecol Obstet. 2009;31 (07):335-341. Doi: 10.1590/S0100-72032009000700003
https://doi.org/10.1590/S0100-7203200900... it is important to offer pregnant women information about the effects of substances, which, in turn, will contribute to benefit obstetric outcomes.1818 Freire K, Padilha PdeC, Saunders C. [Factors associated to alcohol and smoking use in pregnancy]. Rev Bras Ginecol Obstet. 2009;31 (07):335-341. Doi: 10.1590/S0100-72032009000700003
https://doi.org/10.1590/S0100-7203200900... The impacts of maternal smoking on pregnancy outcomes are well documented and include predisposition to gestational diabetes,1919 Leng J, Shao P, Zhang C, Tian H, Zhang F, Zhang S, et al. Prevalence of gestational diabetes mellitus and its risk factors in Chinese pregnant women: a prospective population-based study in Tianjin, China. PLoS One. 2015;10(03):e0121029. Doi: 10.1371/journal. pone.0121029
https://doi.org/10.1371/journal... higher mortality and morbidity,2020 Lanting CI, Buitendijk SE, Crone MR, Segaar D, Bennebroek Gravenhorst J, van Wouwe JP. Clustering of socioeconomic, behavioural, and neonatal risk factors for infant health in pregnant smokers. PLoS One. 2009;4(12):e8363. Doi: 10.1371/ journal.pone.0008363
https://doi.org/10.1371/... and increased risk of preterm birth, and the consequences of cigarette smoking during pregnancy may accompany the baby throughout life.2121 Kyrklund-Blomberg NB, Granath F, Cnattingius S. Maternal smoking and causes of very preterm birth. Acta Obstet Gynecol Scand. 2005;84(06):572-577. Doi: 10.1111/j.0001-6349.2005.00848.x
https://doi.org/10.1111/j.0001-6349.2005... In addition, fetuses exposed to cigarette smoke during pregnancy tend to have a higher body mass index (BMI) in adulthood.2222 Beyerlein A, Rückinger S, Toschke AM, Schaffrath Rosario A, von Kries R. Is low birth weight in the causal pathway of the association between maternal smoking in pregnancy and higher BMI in the offspring? Eur J Epidemiol. 2011;26(05):413-420. Doi: 10.1007/s10654-011-9560-y
https://doi.org/10.1007/s10654-011-9560-...
Other adverse outcomes associated with maternal smoking include congenital malformations,2323 Hackshaw A, Rodeck C, Boniface S.Maternal smoking in pregnancy and birth defects: a systematic reviewbased on 173 687malformed cases and 11.7million controls. HumReprod Update. 2011;17(05): 589-604. Doi: 10.1093/humupd/dmr022
https://doi.org/10.1093/humupd/dmr022... 2424 Haug K, Irgens LM, Skjaerven R, Markestad T, Baste V, Schreuder P. Maternal smoking and birthweight: effect modification of period, maternal age and paternal smoking. Acta Obstet Gynecol Scand. 2000;79(06):485-489. Doi: 10.1034/j.1600-0412.2000.079006 485.x
https://doi.org/10.1034/j.1600-0412.2000... low birth weight2121 Kyrklund-Blomberg NB, Granath F, Cnattingius S. Maternal smoking and causes of very preterm birth. Acta Obstet Gynecol Scand. 2005;84(06):572-577. Doi: 10.1111/j.0001-6349.2005.00848.x
https://doi.org/10.1111/j.0001-6349.2005... 2222 Beyerlein A, Rückinger S, Toschke AM, Schaffrath Rosario A, von Kries R. Is low birth weight in the causal pathway of the association between maternal smoking in pregnancy and higher BMI in the offspring? Eur J Epidemiol. 2011;26(05):413-420. Doi: 10.1007/s10654-011-9560-y
https://doi.org/10.1007/s10654-011-9560-... and restriction of intrauterine growth,2020 Lanting CI, Buitendijk SE, Crone MR, Segaar D, Bennebroek Gravenhorst J, van Wouwe JP. Clustering of socioeconomic, behavioural, and neonatal risk factors for infant health in pregnant smokers. PLoS One. 2009;4(12):e8363. Doi: 10.1371/ journal.pone.0008363
https://doi.org/10.1371/... 2525 Suzuki K, Sato M, Zheng W, Shinohara R, Yokomichi H, Yamagata Z. Effect of maternal smoking cessation before and during early pregnancy on fetal and childhood growth. J Epidemiol. 2014;24 (01):60-66. Doi: 10.2188/jea.JE20130083
https://doi.org/10.2188/jea.JE20130083... suggesting that any newborn with significant exposure to smoking during gestation is likely to be adversely affected to some degree due to the chemical and toxic additives of tobacco.2626 Rogers JM. Tobacco and pregnancy. Reprod Toxicol. 2009;28(02): 152-160. Doi: 10.1016/j.reprotox.2009.03.012
https://doi.org/10.1016/j.reprotox.2009.... The present study has shown that pregnant women who presented a maternal habit of not smoking during the gestational period had a better habit of food consumption. In light of that, women who quit smoking before or during pregnancy can substantially reduce risks for themselves and their children.2727 Vardavas CI, Chatzi L, Patelarou E, Plana E, Sarri K, Kafatos A, et al. Smoking and smoking cessation during early pregnancy and its effect on adverse pregnancy outcomes and fetal growth. Eur J Pediatr. 2010;169(06):741-748. Doi: 10.1007/s00431-009-1107-9
Sociodemographic factors were associated with the consumption of minimally-processed foods, specifically race/skin color and being head of household. In a study of American women who were in the third trimester of pregnancy, it was shown that Black women tended to have higher caloric intake, consuming foods rich in fats, carbohydrates, and sugar and poor in important nutrients, such as folate and fiber.2828 Gennaro S, Biesecker B, Fantasia HC, NguyenM, Garry D. Nutrition profiles of African [corrected] American women in the third trimester. MCN Am J Matern Child Nurs. 2011;36(02):120-126. Doi: 10.1097/NMC.0b013e3182057a13
https://doi.org/10.1097/NMC.0b013e318205...
The head of household association and the consumption of healthier foods may demonstrate social inequalities, since female-headed households are largely associated with situations of economic vulnerability, in which women often end up in domestic activities and care of the offspring, which, in turn, results in greater difficulties to guarantee the subsistence of their own family, already with part-time affected generates dependency in low-paid jobs.2929 Pinto RMF, Micheletti FABO, Bernardes LM, Fernandes JMPA, Monteiro GV, Silva MLN, et al. [Female condition of female heads of households in situations of social vulnerability]. Serv Soc Soc. 2011;(105):167-179. Doi: 10.1590/S0101-66282011000100010
https://doi.org/10.1590/S0101-6628201100...
Receiving information about healthy food during prenatal care was highlighted among women who had the highest consumption of minimally-processed foods, as recommended in the pregnant woman's booklet, which states that to have a healthy pregnancy the pregnant woman should seek to have a diet rich in natural foods and poor in processed foods, in favor of maternal well-being, growth, and adequate training of the fetus.3030 Ministério da Saúde [Internet]. [Pregnantwoman's notebook]. 3rd ed. Brasília (DF): Ministério da Saúde; 2016 [cited 2018 Sep 27]. Available from: https://www.mds.gov.br/webarquivos/arquivo/ crianca_feliz/Treinamento_Multiplicadores_Coordenadores/ Caderneta-Gest-Internet(1).pdf
Participants who did not receive information about healthy eating during the prenatal period had less chance of having healthier eating habits. Considering that such educational activities depend on health professionals, the challenge seems to be to understand the reasons why these behaviors are not being fully available to the target population.3131 Tomasi E, Fernandes PA, Fischer T, Siqueira FC, Silveira DS, Thumé E, et al. [Quality of prenatal services in primary healthcare in Brazil: indicators and social inequalities]. Cad Saude Publica. 2017;33(03):e00195815. Doi: 10.1590/0102-311X00195815
https://doi.org/10.1590/0102-311X0019581... The educator role played by the health professional during prenatal consultations is essential, since pregnant women should be instructed to adopt improvements or maintenance of healthy eating practices, making changes and/or creating new habits and, thus promoting a pregnancy free of future intercurrences.3232 Rios CTF, Vieira NFC. [Educational action in prenatal care: a reflection on nursing consultation as an opportunity for health education]. CienSaudeColet. 2007;12(02):477-486. Doi: 10.1590/S1413- 81232007000200024
https://doi.org/10.1590/S1413- 812320070... With these data, prenatal monitoring is identified as an important source of information that may contribute to excellent results in food consumption during pregnancy.
In the study done by Barros et al.1515 Barros DC, Pereira RA, Gama SGN, Leal MdoC. [Food consumption by pregnant adolescents in Rio de Janeiro, Brazil]. Cad Saude Publica. 2004;20(Suppl 1):S121-S129. Doi: 10.1590/S0102- 311X2004000700013
https://doi.org/10.1590/S0102-... it was verified that the adolescent pregnant women who received information about healthy eating during the prenatal period had better results in nutrient consumption. Verbeke and De Bourdeaudhuij3333 Verbeke W, De Bourdeaudhuij I. Dietary behaviour of pregnant versus non-pregnant women. Appetite. 2007;48(01):78-86. Doi: 10.1016/j.appet.2006.07.078
https://doi.org/10.1016/j.appet.2006.07.... analyzed the eating behavior and nutritional choices of 148 pregnant women and 130 non-pregnant women and observed that pregnant women who followed nutritional recommendations made better eating choices than non-pregnant women. This corroborates the importance of prenatal follow-up, recognized as a relevant stage in the collection and perception of information, effectively contributing to improvements in the results of food consumption and gestation.1515 Barros DC, Pereira RA, Gama SGN, Leal MdoC. [Food consumption by pregnant adolescents in Rio de Janeiro, Brazil]. Cad Saude Publica. 2004;20(Suppl 1):S121-S129. Doi: 10.1590/S0102- 311X2004000700013
https://doi.org/10.1590/S0102-...
The limitations of the present study are related to the possibility of occurrence of recall bias, because the data was obtained through an interview, but this limitation may have been minimized by investigating the pregnant woman's medical chart and/or card. Still, the method used to collect data on eating habits may have involved underestimation; however, it made it possible to assess the consumption of the main food items evaluated in national surveys. Nevertheless, despite the limitations pointed out, the data presented here reflect the reality of the public and/or contracted establishments that performed the deliveries by the SUS of the MRGV-ES, and the design adopted enables assuming that the conclusions can be used in similar contexts.
It is also highlighted that it is the first study to investigate the association between maternal variables and educational activity received during prenatal care with ultraprocessed and minimally-processed consumption and, differently from other studies that analyzed isolated foods, in this study we used a classification that groups the foods according to purpose and extent of processing.33 Monteiro CA, Cannon G, Levy RB, Moubarac JC, Jaime P, Martins AP, et al. NOVA. The star shines bright.World Nutr.. 2016;7(1-3): 28-38
Although this classification was recent and in the present study the fourth quartile was used to define the high consumption of a certain group, it allowed to classify in a satisfactory way those foods that belonged to the group that presented high amounts of sugars, saturated fat, trans fat, and low amount of fiber, characteristics that the literature shows belong to the ultraprocessed foods, which intensifies the risks for various diseases.11 Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica [Internet]. [Food guide for the Brazilian population]. 2nd ed. Brasília (DF): Ministério da Saúde; 2014 [cited 2018 Mar 20]. Available from: http://bvsms.saude.gov.br/ bvs/publicacoes/guia_alimentar_populacao_brasileira_2ed.pdf33 Monteiro CA, Cannon G, Levy RB, Moubarac JC, Jaime P, Martins AP, et al. NOVA. The star shines bright.World Nutr.. 2016;7(1-3): 28-383434 Moubarac JC, Martins AP, Claro RM, Levy RB, Cannon G, Monteiro CA; Evidence fromCanada. Consumption of ultra-processed foods and likely impact on human health. Public Health Nutr. 2013;16 (12):2240-2248. Doi: 10.1017/ S1368980012005009
https://doi.org/10.1017/... 3535 Yang Q, Zhang Z, Gregg EW, FlandersWD, Merritt R, Hu FB. Added sugar intake and cardiovascular diseases mortality among US adults. JAMA Intern Med. 2014;174(04):516-524. Doi: 10.1001/ jamainternmed.2013.13563
https://doi.org/10.1001/... 3636 Louzada MLC, Martins APB, Canella DS, Baraldi LG, Levy RB, Claro RM, et al. Impact of ultra-processed foods on micronutrient content in the Brazilian diet. Rev Saude Publica. 2015;49:45. Doi: 10.1590/S0034-8910.2015049006211
https://doi.org/10.1590/S0034-8910.20150...
The results of the present study suggest that being a pregnant adolescent and having smoked during pregnancy influence the increase in the consumption of ultraprocessed foods, which, consequently, can have an impact on the quality of the food choices of pregnant women.
The data also indicate that being an older pregnant woman, not being of brown skin color, being the head of the household, not having smoked cigarettes during pregnancy and having received information about healthy eating during prenatal care contribute to the better consumption of minimally-processed or in natura foods, thus offering better eating habits. It is necessary to evaluate the food consumption through these food groups, as it allows to identify the vulnerability of the population to food excesses, and thus to adapt and propose intervention measures that guarantee maternal and baby health. The present results point out that there is a need for the implementation of intervention measures in health service establishments with the objective of providing educational information and promoting healthy eating for mothers.
The authors would like to acknowledge all the Research Group in Epidemiology, Health and Nutrition (GEMNUT, in the Portuguese acronym). We gratefully acknowledge data fromthe "Evaluation of theQuality of Prenatal Care in the Metropolitan Area of Grande Vitória, Espírito Santo (RMGV-ES): Access and Integration of Health Services" project. The authors would like to thank the Foundation for Research Support of Espírito Santo/State Department of Health of Espírito Santo (FAPES, in the Portuguese acronym) and the Coordination for the Improvement of Higher Education Personnel (CAPES, in the Portuguese acronym). None of these funding agencies had any role in the design and conduct of the study.
Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica [Internet]. [Food guide for the Brazilian population]. 2nd ed. Brasília (DF): Ministério da Saúde; 2014 [cited 2018 Mar 20]. Available from: http://bvsms.saude.gov.br/ bvs/publicacoes/guia_alimentar_populacao_brasileira_2ed.pdf
Popkin BM, Adair LS, Ng SW. Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev. 2012;70 (01):3-21. Doi: 10.1111/j.1753-4887.2011.00456.x
» https://doi.org/10.1111/j.1753-4887.2011.00456.x
Monteiro CA, Cannon G, Levy RB, Moubarac JC, Jaime P, Martins AP, et al. NOVA. The star shines bright.World Nutr.. 2016;7(1-3): 28-38
Monteiro CA, Levy RB, Claro RM, Castro IRR, Cannon G. A new classification of foods based on the extent and purpose of their processing. Cad Saude Publica. 2010;26(11):2039-2049. Doi: 10.1590/S0102-311X2010001100005
» https://doi.org/10.1590/S0102-311X2010001100005
Martins AP, Levy RB, Claro RM, Moubarac JC, Monteiro CA. Increased contribution of ultra-processed food products in the Brazilian diet (1987-2009). Rev Saude Publica. 2013;47(04): 656-665. Doi: 10.1590/S0034-8910.2013047004968
» https://doi.org/10.1590/S0034-8910.2013047004968
Devine CM, Bove CF, Olson CM. Continuity and change inwomen's weight orientations and lifestyle practices through pregnancy and the postpartum period: the influence of life course trajectories and transitional events. Soc Sci Med. 2000;50(04):567-582. Doi: 10.1016/s0277-9536(99)00314-7
» https://doi.org/10.1016/s0277-9536(99)00314-7
Padmanabhan U, Summerbell CD, Heslehurst N. A qualitative study exploring pregnant women's weight-related attitudes and beliefs in UK: the BLOOM study. BMC Pregnancy Childbirth. 2015;15:99. Doi: 10.1186/s12884-015-0522-3
» https://doi.org/10.1186/s12884-015-0522-3
Santos Neto ET, Oliveira AE, Zandonade E, Gama SGN, Leal MdoC. [Prenatal patient cards and quality of prenatal care in public health services in Greater Metropolitan Vitória, Espírito Santo State, Brazil]. Cad Saude Publica. 2012;28(09):1650-1662. Doi: 10.1590/S0102-311X2012000900005
Associação Brasileira de Empresas de Pesquisa. [Economic Classification Criteria Brazil] [Internet]. 2003 [cited 2018 Jan 11]. Available from: http://www.abep.org/criterio-brasil
» http://www.abep.org/criterio-brasil
Ministério da Saúde. Secretaria de Vigilância em Saúde. Secretaria de Gestão Estratégica e Participativa [Internet]. [Vigitel Brazil 2009: surveillance of risk and protective factors for chronic diseases by telephone survey]. Brasília (DF): Ministério da Saúde; 2010 [cited 2020Mar 10]. Available from: http://189.28.128.100/dab/docs/publicacoes/geral/publicacao_vigitel_2009.pdf
Cade J, Thompson R, Burley V, Warm D. Development, validation and utilisation of food-frequency questionnaires - a review. Public Health Nutr. 2002;5(04):567-587. Doi: 10.1079/PHN2001318
» https://doi.org/10.1079/PHN2001318
Alves-Santos NH, Eshriqui I, Franco-Sena AB, Cocate PG, Freitas- Vilela AA, Benaim C, et al. Dietary intake variations from preconception to gestational period according to the degree of industrial processing: A Brazilian cohort. Appetite. 2016; 105:164-171. Doi: 10.1016/j.appet.2016.05.027
» https://doi.org/10.1016/j.appet.2016.05.027
McGowan CA, McAuliffe FM. Maternal dietary patterns and associated nutrient intakes during each trimester ofpregnancy. PublicHealth Nutr. 2013;16(01):97-107. Doi: 10.1017/S1368980012000997
» https://doi.org/10.1017/S1368980012000997
Instituto Brasileiro de Geografia e Estatística [Internet]. [Family budget survey 2008-2009: analysis of personal food consumption in Brazil]. Rio de Janeiro: IBGE; 2011 [cited 2018 Jun 13]. Available from: https://biblioteca.ibge.gov.br/visualizacao/livros/liv50063.pdf
Barros DC, Pereira RA, Gama SGN, Leal MdoC. [Food consumption by pregnant adolescents in Rio de Janeiro, Brazil]. Cad Saude Publica. 2004;20(Suppl 1):S121-S129. Doi: 10.1590/S0102- 311X2004000700013
» https://doi.org/10.1590/S0102-
Chen YC, Huang YC, Lo YC, Wu HJ, Wahlqvist ML, Lee MS. Secular trend towards ultra-processed food consumption and expenditure compromises dietary quality among Taiwanese adolescents. Food Nutr Res. 2018;62:1565. Doi: 10.29219/fnr. v62.1565
» https://doi.org/10.29219/fnr
Roelands J, Jamison MG, Lyerly AD, James AH. Consequences of smoking during pregnancy on maternal health. J Womens Health (Larchmt). 2009;18(06):867-872. Doi: 10.1089/jwh. 2008.1024
» https://doi.org/10.1089/jwh
Freire K, Padilha PdeC, Saunders C. [Factors associated to alcohol and smoking use in pregnancy]. Rev Bras Ginecol Obstet. 2009;31 (07):335-341. Doi: 10.1590/S0100-72032009000700003
Leng J, Shao P, Zhang C, Tian H, Zhang F, Zhang S, et al. Prevalence of gestational diabetes mellitus and its risk factors in Chinese pregnant women: a prospective population-based study in Tianjin, China. PLoS One. 2015;10(03):e0121029. Doi: 10.1371/journal. pone.0121029
» https://doi.org/10.1371/journal
Lanting CI, Buitendijk SE, Crone MR, Segaar D, Bennebroek Gravenhorst J, van Wouwe JP. Clustering of socioeconomic, behavioural, and neonatal risk factors for infant health in pregnant smokers. PLoS One. 2009;4(12):e8363. Doi: 10.1371/ journal.pone.0008363
» https://doi.org/10.1371/
Kyrklund-Blomberg NB, Granath F, Cnattingius S. Maternal smoking and causes of very preterm birth. Acta Obstet Gynecol Scand. 2005;84(06):572-577. Doi: 10.1111/j.0001-6349.2005.00848.x
Beyerlein A, Rückinger S, Toschke AM, Schaffrath Rosario A, von Kries R. Is low birth weight in the causal pathway of the association between maternal smoking in pregnancy and higher BMI in the offspring? Eur J Epidemiol. 2011;26(05):413-420. Doi: 10.1007/s10654-011-9560-y
Hackshaw A, Rodeck C, Boniface S.Maternal smoking in pregnancy and birth defects: a systematic reviewbased on 173 687malformed cases and 11.7million controls. HumReprod Update. 2011;17(05): 589-604. Doi: 10.1093/humupd/dmr022
» https://doi.org/10.1093/humupd/dmr022
Haug K, Irgens LM, Skjaerven R, Markestad T, Baste V, Schreuder P. Maternal smoking and birthweight: effect modification of period, maternal age and paternal smoking. Acta Obstet Gynecol Scand. 2000;79(06):485-489. Doi: 10.1034/j.1600-0412.2000.079006 485.x
» https://doi.org/10.1034/j.1600-0412.2000.079006
Suzuki K, Sato M, Zheng W, Shinohara R, Yokomichi H, Yamagata Z. Effect of maternal smoking cessation before and during early pregnancy on fetal and childhood growth. J Epidemiol. 2014;24 (01):60-66. Doi: 10.2188/jea.JE20130083
» https://doi.org/10.2188/jea.JE20130083
Rogers JM. Tobacco and pregnancy. Reprod Toxicol. 2009;28(02): 152-160. Doi: 10.1016/j.reprotox.2009.03.012
» https://doi.org/10.1016/j.reprotox.2009.03.012
Vardavas CI, Chatzi L, Patelarou E, Plana E, Sarri K, Kafatos A, et al. Smoking and smoking cessation during early pregnancy and its effect on adverse pregnancy outcomes and fetal growth. Eur J Pediatr. 2010;169(06):741-748. Doi: 10.1007/s00431-009-1107-9
Gennaro S, Biesecker B, Fantasia HC, NguyenM, Garry D. Nutrition profiles of African [corrected] American women in the third trimester. MCN Am J Matern Child Nurs. 2011;36(02):120-126. Doi: 10.1097/NMC.0b013e3182057a13
» https://doi.org/10.1097/NMC.0b013e3182057a13
Pinto RMF, Micheletti FABO, Bernardes LM, Fernandes JMPA, Monteiro GV, Silva MLN, et al. [Female condition of female heads of households in situations of social vulnerability]. Serv Soc Soc. 2011;(105):167-179. Doi: 10.1590/S0101-66282011000100010
Ministério da Saúde [Internet]. [Pregnantwoman's notebook]. 3rd ed. Brasília (DF): Ministério da Saúde; 2016 [cited 2018 Sep 27]. Available from: https://www.mds.gov.br/webarquivos/arquivo/ crianca_feliz/Treinamento_Multiplicadores_Coordenadores/ Caderneta-Gest-Internet(1).pdf
Tomasi E, Fernandes PA, Fischer T, Siqueira FC, Silveira DS, Thumé E, et al. [Quality of prenatal services in primary healthcare in Brazil: indicators and social inequalities]. Cad Saude Publica. 2017;33(03):e00195815. Doi: 10.1590/0102-311X00195815
Rios CTF, Vieira NFC. [Educational action in prenatal care: a reflection on nursing consultation as an opportunity for health education]. CienSaudeColet. 2007;12(02):477-486. Doi: 10.1590/S1413- 81232007000200024
» https://doi.org/10.1590/S1413- 81232007000200024
Verbeke W, De Bourdeaudhuij I. Dietary behaviour of pregnant versus non-pregnant women. Appetite. 2007;48(01):78-86. Doi: 10.1016/j.appet.2006.07.078
Moubarac JC, Martins AP, Claro RM, Levy RB, Cannon G, Monteiro CA; Evidence fromCanada. Consumption of ultra-processed foods and likely impact on human health. Public Health Nutr. 2013;16 (12):2240-2248. Doi: 10.1017/ S1368980012005009
Yang Q, Zhang Z, Gregg EW, FlandersWD, Merritt R, Hu FB. Added sugar intake and cardiovascular diseases mortality among US adults. JAMA Intern Med. 2014;174(04):516-524. Doi: 10.1001/ jamainternmed.2013.13563
Louzada MLC, Martins APB, Canella DS, Baraldi LG, Levy RB, Claro RM, et al. Impact of ultra-processed foods on micronutrient content in the Brazilian diet. Rev Saude Publica. 2015;49:45. Doi: 10.1590/S0034-8910.2015049006211
This is an open-access article distributed under the terms of the Creative Commons Attribution License
Graduate Program in Nutrition and Health, Department of Integrated Health Education, Universidade Federal do Espírito Santo, Vitória, ES, Brazil
Graduate Program in Collective Health, Universidade Federal do Espírito Santo, Vitória, ES, Brazil
Address for correspondence Luciane Bresciani Salaroli, PhD, Universidade Federal do Espírito Santo, Av. Marechal Campos, 1468, Vitória, ES, 29040-090, Brazil (e-mail: lucianebresciani@gmail.com).
PereiraM. T. contributed to conceptualization, data curation, formal analysis, investigation,methodology, resources, visualization, writing-original draft andwriting-review&editing. CattafestaM. contributedto conceptualization,data curation, formal analysis, investigation, methodology, resources, supervision, validation, visualization, writing-original draft andwriting-review&editing. SantosNeto E. T. contributed to conceptualization, data curation, formal analysis, funding acquisition, investigation, methodology, project administration, resources, supervision, validation, visualization, writing- original draft and writing-review & editing. Salaroli L. B. contributed to conceptualization, data curation, formal analysis, investigation, methodology, project administration, resources, supervision, validation, visualization, writingoriginal draft and writing-review & editing.
The authors have no conflict of interests to declare.
Table 1 Sociodemographic variables, maternal habits, educational ctivity and clinical history according to the consumption of minimally-processed foods by pregnant women
Minimally-processed food consumption* * The distribution of the consumption of foods was evaluated in quartiles.
P† † The differences between quartiles were tested by the Chi-square test.
Age, y (n 1,035) 0.015
≤ 19 76 32.8 54 23.3 61 26.3 41 17.7 232 22.4
20–34 177 24.5 200 27.7 165 22.8 181 25.0 723 69.9
≥ 35 15 18.8 18 22.5 21 26.3 26 32.5 80 7.7
Race/color (n = 977) 0.096
White 21 15.7 33 24.6 41 30.6 39 29.1 134 13.7
Brown 188 27.5 180 26.3 156 22.8 160 23.4 684 70.0
Black 41 25.8 43 27.0 36 22.6 39 24.5 159 16.3
Marital status (n = 1,030) 0.294
Living with a partner 214 25.8 208 25.0 203 24.4 206 24.8 831 22.5
Not living with a partner 54 27.1 61 30.7 42 21.1 42 21.1 199 70.2
Maternal occupation (n = 1,034) 0.002
No paid work 212 28.6 197 26.6 171 23.1 160 21.6 740 71.6
Paid work 55 18.7 75 25.5 76 25.9 88 29.9 294 28.4
Householder (n 1028) 0.073
House owner 21 18.9 32 28.8 20 18.0 38 34.2 111 10.8
Partner's house 179 26.5 168 24.9 168 24.9 160 23.7 675 65.7
Others 65 26.9 70 28.9 57 23.6 50 20.7 242 23.5
Socioeconomic classification (n = 913) 0.994
D/E 73 25.5 74 25.8 69 24.1 70 24.5 286 31.3
C1/C2 152 26.2 157 27.0 139 23.9 133 22.9 581 63.6
A/B 11 23.9 14 30.4 10 21.7 11 23.9 46 5.0
Information on prenatal diet (n = 1,012) < 0.001
No 161 32.7% 128 26.0% 98 19.9% 106 21.5% 493 48.7
Yes 94 18.1% 137 26.4% 147 28.3% 141 27.2% 519 51.3
Alcohol use during pregnancy (n = 1,034) 0.215
No 238 25,5 239 25.6 229 24.5 228 24.4 934 90.3
Yes 30 30.0 32 32.0 18 18.0 20 20.0 100 9.7
Smoking during pregnancy (n = 1,026) < 0.001
No 211 23.5 241 26.9 212 23.7 232 25.9 896 87.3
Yes 53 40.8 29 22.3 33 25.4 15 11.5 130 12.7
Prenatal consultations (n = 948) 0.134
≤ 5 83 34.2 67 27.5 61 27.1 59 25.0 270 28.5
> 6 160 65.8 177 72.5 164 72.9 177 75.0 678 71.5
Parity‡ ‡ Number of parturitions. (n 997) 0.991
1 106 26.9 102 25.9 94 23.9 92 23.4 394 39.5
2 76 25.6 76 25.6 71 23.9 74 24.9 297 29.8
3 or more 74 24.2 80 26.1 75 24.5 77 25.2 306 30.7
Abbreviations: Q1, first quartile; Q2, second quartile; Q3, third quartile; Q4, fourth quartile.
The distribution of the consumption of foods was evaluated in quartiles.
The differences between quartiles were tested by the Chi-square test.
Number of parturitions.
Table 2 Sociodemographic variables, maternal habits, educational activity and clinical history according to consumption of ultraprocessed foods by pregnant women
Ultraprocessed food consumption∗
Age, y (n = 1,035) < 0.001
≤ 19 36 15,5 55 23.7 59 25.4 82 35.3 232 22.4
≥ 35 32 40.0 27 33.8 15 18.8 6 7.5 80 7.7
Householder (n = 1,028) 0.004
Own 36 32.4 22 19.8 24 21.6 29 26.1 111 10.8
Companion 187 27.7 183 27.1 146 21.6 159 23.6 675 65.7
A/B 9 19.6 11 23.9 15 32.6 11 23.9 46 5.0
Information on prenatal diet (n = 1,012) 0.534
Yes 128 24.7 132 25.4 125 24.1 134 25.8 519 51.3
1 93 23.6 104 26.4 94 23.9 103 26.1 394 39.5
Table 3 Binary logistic regression analysis between consumption of ultraprocessed foods and associated variables in pregnant women
Ultraprocessed food consumption
Gross values
Adjusted values
Pa a Statistical significance ≤ 0.2% in the Chi-square test were included in the analysis.
OR* * ORs were adjusted to the other variables using binary logistic regression with 95%CIs.
LL 95%
UL 95%
Age, y
≤ 19 < 0.001 2.731 1.754 4.251 < 0.001 2.95 1.683 5.168
≥ 35 0.001 0.225 0.092 0.551 0.005 0.265 0.105 0.666
Maternal occupation
No paid work 1 1
Paid work 0.002 0.544 0.367 0.804 0.225 0.762 0.491 1.182
Own 1 1
Companion 0.842 1.056 0.62 1.798 0.98 0.992 0.543 1.814
Others 0.03 1.998 1.069 3.735 0.243 1.543 0.745 3.194
Alcohol use during pregnancy
Yes 0.067 1.756 0.9613 3.2074 0.298 1.480 0.708 3.092
Yes < 0.001 3.1721 1.809 5.5622 0.011 2.247 1.202 4.199
3 or more 0.042 0.649 0.427 0.985 0.562 1.170 0.689 1.987
Abbreviations: CI, confidence interval; LL, lower limit; OR, odds ratio; UL, upper limit.
Statistical significance ≤ 0.2% in the Chi-square test were included in the analysis.
ORs were adjusted to the other variables using binary logistic regression with 95%CIs.
Table 4 Binary logistic regression analysis between consumption of minimally-processed foods and associated variables in pregnant women
Minimally-processed food consumption
P a a Statistical significance ≤ 0.2% in the Chi-square test were included in the analysis.
≤ 19 0.004 0.528 0.342 0.813 0.024 0.547 0.324 0.923
Race/color
White 1 1
Brown 0.007 0.458 0.259 0.811 0.008 0.426 0.226 0.803
Black 0.057 0.512 0.257 1.019 0.053 0.469 0.217 1.011
Living with a partner 1 1
Not living with a partner 0.349 0.808 0.517 1.263 0.273 0.749 0.447 1.256
Paid work < 0.001 2.12 1.429 3.145 0.281 1.295 0.809 2.072
Companion 0.016 0.494 0.278 0.877 0.017 0.432 0.217 0.859
Others 0.01 0.425 0.222 0.813 0.125 0.544 0.25 1.184
Information on prenatal feeding
Yes < 0.001 2.278 1.593 3.259 < 0.001 2.177 1.455 3.257
Yes < 0.001 0.2574 0.1409 0.4703 < 0.001 0.269 0.132 0.545
Prenatal consultations
<5 1 1
>6 0.0287 1.5562 1.047 2.3132 0.1684 1.3771 0.8734 2.1713
Federação Brasileira das Sociedades de Ginecologia e Obstetrícia Av. Brigadeiro Luís Antônio, 3421, sala 903 - Jardim Paulista, 01401-001 São Paulo SP - Brasil, Tel. (55 11) 5573-4919 - Rio de Janeiro - RJ - Brazil
E-mail: editorial.office@febrasgo.org.br


text:
'Keep Pushing': Momentum Grows Behind Effort to Ban Stock Trading
Jerri-Lynn here: I'm inherently suspicious of legislative proposals being heavily touted by the core of the current Democratic leadership, particularly Chuck Schumer – even though pushback from Nancy Pelosi's almost certainly a welcome sign. Nonetheless, there's no doubt that current rules are too lax. As with so much financial regulation, the devil's in the details. And as happened in the Dodd-Frank fiasco, I fear any reform current Congresscritters can agree will be overly complex and riddled with loopholes, so when all's said and done, one wonders, what was the point?
Yet recall, we once knew how to enact toothsome reforms. Look at New Deal legislation, particularly the securities regulatory framework. So, I'll just say here, the situation deserves careful scrutiny.
By Jake Johnson. Originally published at Common Dreams
The momentum behind a widely popular effort to ban stock trading by members of Congress is growing, with Senate Majority Leader Chuck Schumer reportedly instructing fellow Democrats to unite behind a specific legislative proposal.
"After weeks of silence, Senate Democratic leaders have asked lawmakers to propose improvements on rules governing congressional stock trading," Insider reports. "In a call Friday, Democratic leadership staff told legislative directors for Democratic senators about their aspirations for bringing a congressional stock-trading ban bill to the floor of the U.S. Senate."
The development comes weeks after Sen. Jon Ossoff (D-Ga.) ignored pushback from prominent Democratic leaders—including House Speaker Nancy Pelosi (D-Calif.)—and unveiled legislation that would bar members of Congress, their spouses, and their children from buying and selling stock while in office.
"It's working. Keep pushing," Ossoff tweeted Sunday, highlighting the Senate Democratic leadership's openness to the proposed ban.
Thus far, just eight Senate Democrats have officially signed on as co-sponsors of Ossoff's bill (S.3494), which he introduced alongside Sen. Mark Kelly (D-Ariz.) last month.
"It's time for Congress to act and ban members from trading stocks while they're in office," Sean Eldridge, founder and president of Stand Up America, said Sunday.
Despite broad support from the public and growing backing from rank-and-file lawmakers, some Democratic leaders remain opposed to a prohibition on stock trading. House Majority Leader Steny Hoyer (D-Md.) said last week that he's "not sure that it's necessary" to enact such a ban given existing rules against insider trading—rules that critics say are far too lax and seldom enforced.
Schumer, for his part, said last month that he doesn't "own any stocks" and that banning individual trading by sitting lawmakers would be "the right thing to do."
It's unclear where Sen. Joe Manchin (D-W.Va.), a key swing vote who owns a stake in his son's West Virginia coal business, stands on the proposal.
"I don't own any stocks, and I think that's the right thing to do."
Majority Leader Chuck Schumer comments on the recent push to bar members of Congress from trading individual stocks. pic.twitter.com/pZ3V7EE4pm
— Forbes (@Forbes) January 11, 2022
A recent analysis of financial documents by Capitol Trades and reporting from MarketWatch found that congressional lawmakers or members of their families traded an estimated $355 million worth of stock in 2021, a year in which the coronavirus pandemic killed hundreds of thousands of people across the U.S. and pushed many into financial ruin.
While insider trading has long been commonplace on Capitol Hill, suspiciously timed transactions during the pandemic—particularly soon after Covid-19 was detected in the U.S.—brought fresh attention to lawmakers' use of secret information to buy and sell stock.
Former Sen. David Perdue (R-Ga.), Ossoff's Republican opponent in the 2021 U.S. Senate runoff in Georgia, was a prolific stock trader, and he was accused of using insider information to buy shares of companies that stood to benefit from the pandemic.
"Recent revelations about stock trades at the outset of the Covid-19 pandemic and economic downturn, increasingly prevalent violations of the STOCK Act's reporting requirements, and investigations and even convictions of members of Congress pertaining to insider trading have all served to galvanize public interest and media scrutiny around real and perceived corruption in Congress," a coalition of 14 advocacy groups wrote in a letter endorsing Ossoff's legislation last month.
"The public needs to know that Congress recognizes the issue of insider trading as a problem that undermines its own legitimacy and erodes the trust of voters," the coalition added. "The good news is that Congress is able to respond to this concern in a meaningful way by advancing S. 3494 and sending it to President Biden's desk for his signature."
Previous Previous post: Michael Hudson: America's Real Adversaries Are Its European and Other Allies
Next Next post: The Super Wealthy versus the Merely Rich

redpajama_set_name: RedPajamaCommonCrawl


text:
E-Library: Research & Learn
A–Z Resources
Skip Sidebar Navigation
Countries & Geography
Current Events & Topics
Encyclopedias & Almanacs
Homework Tutoring
ABCmouse
For children 2-6+ years. Build a strong foundation in reading, language arts, math, science, social studies, art, and music. 3500+ books, games, puzzles, and activities.
View available apps for ABCmouse
Only available at Pima County Public Library
Britannica Library Edition Read Encyclopedias
Find all the answers with Encyclopedia Britannica, including detailed information at the children's, young adult, and adult reading level, as well as extras including images, further reference lists, and primary sources.
Jack & Jill Magazine Read Magazines
Poetry, humor, games, stories, and crafts that help you learn about health, nutrition, and safety. Ideal for first, second, and third-graders. Available in EBSCO MasterFILE Complete.
Kids InfoBits Learning Library
Fun and interactive, Kids InfoBits from Gale helps kids K–5 find information on current events, the arts, science, people, history, and more, with translation into 12 languages available. Statewide access.
Science Buddies – Hands-On Science Experiments
Looking for inspiration for a science fair project? With over 1150 ideas, students, parents, and teachers will all find something cool to experiment with.
Online Resource FAQs
Do I need special software or devices to use the digital media services?
How do I get help with digital media & E-Library resources, including eBooks, audiobooks, movies, music, and language learning?
Looks like you have more than one option for eBooks. What's the difference between the services?
Can I check in my eBook or audiobook early?
What happened to the Librarian Files?


text:
- Any -Annual ReportCommission MemberHearingsBasic pagePress ReleaseResearchStaffTestimonies & SpeechesTrade Bulletin
U.S.- CHINA | ECONOMIC and SECURITY REVIEW COMMISSION
U.S.-China Economic AND Security Review Commission
Security and Foreign Affairs
Trade Bulletins
Chinese Companies Listed on Major U.S. Stock Exchanges
PRC in International Organizations
China-Ukraine Timeline
China's Internet of Things
The Internet of Things (IoT)—the interconnection of physical and virtual things via information and communication technologies—is being applied to virtually every sector from smart thermostats in households to swarms of autonomous drones in the battlefield. This report, contracted by the USCC and authored by SOS International, outlines China's state-led approach to IoT development, assesses the implications for the U.S. economy, national security, and the privacy of U.S. data, and makes recommendations for U.S. policymakers. China's concerted, state-led approach, including ongoing efforts to influence international IoT standards, has put China in a position to credibly compete against the United States and other leaders in the emerging IoT industry. China's research into IoT security vulnerabilities and its growing civil-military cooperation raise concerns about gaining unauthorized access to IoT devices and sensitive data. In addition, China's authorized access to the IoT data of U.S. consumers will only grow as Chinese IoT companies leverage their advantages in production and cost to gain market share in the United States based on the terms of use and sweeping Chinese government data access powers.
Internet of things,
Cyber,
China's Internet of Things2.57 MB
09/20/2022 • Research
LOGINK: Risks from China's Promotion of a Global Logistics…
This staff issue brief reviews how widespread adoption of a Chinese platform for sharing…
China's Evolving Data Governance Regime
Chinese regulators are implementing and enforcing more data-related laws and regulations, which… Read More
Request for Proposals on China's National Public…
The Commission invites proposals for a report on China's National Public Information Platform for… Read More
U.S.-China Economic and
Security Review Commission
444 North Capitol Street NW
Suite 602, Hall of the States
contact@uscc.gov


Click here to log in if you have your username and password.
Northwest ISD continues providing guardians with electronic report cards and progress reports (NISD eGrades).
Report cards and progress reports will be emailed to guardians using the district's Home Access Center (HAC). After logging into the HAC, click the My Alerts link (if you have more than one child in the district, select a child to view the link). Placea checkmark next to the progress report and report card alerts options to receive these alerts.
For parents who wish to continue to receive printed report cards and progress reports, please contact your student's campus.
NOTE: Official report card grades are available online the Thursday following the end of the reporting period.
Ex: If the reporting period ends Friday, October 5, official report card grades are available onlineThursday, October 11.
Northwest ISD provides online parent access to student grades and attendance through the eSchool Plus Home Access Center (HAC).
Additionally, you can receive email updates and access all of your children's information with a single logon.
Q: I do not have a login to view my child's grades. Who do I contact?
Please contact your child's campus to receive the letter with your username and password to gain access to the Home Access Center.
Q: What do I do if my username and password do not work?
Please contact your child's campus.
Q: Why do I see some of my children but not all of them?
There are a few different causes.Please contact your child's campus.
Please contact your child's campus to update all contact information.
Q: Why am I not receiving grade, attendance or reporting emails?
Emails with grades are sent every morning Monday - Friday. Attendance emails are sent every afternoon if your child has had attendance information entered for them. Progress report emails are sent the Monday following the end of the progress reporting period, and report card emails are emailed the Thursday following the end of the reporting period.
If you do not receive these emails, please log into the Home Access Center. Select the My Alerts link and confirm the checkboxes are selected for the emails you would like to receive for each child.
If you still do not receive emails, login to the HAC to confirm the above/below fields next to the Classwork Email Alerts option are blank. If the fields are blank, please contact your child's campus to confirm the email address on file.
Q: I see an "X", "DG", "A", or "M" in place of a grade for an assignment. What does that mean?
An "X" means that your child is not responsible for the assignment. When averages are calculated, the "X" is ignored.
A "DG" means that the grade for this assignment was dropped. If the student receives a higher grade on a summative assessment, the lowest formative grade (other than homework) preparing for the summative assessment is dropped. When averages are calculated, the "DG" is ignored.
An "A" means your child was absent on the day the assignment was assigned. When averages are calculated, the "A" is ignored.
An "M" means that the assignment is missing. When averages are calculated, the "M" is calculated as a zero.
Q: Why do some classes have many assignments listed in the grade book and others do not?
No two courses are alike. The volume of assignments/tests and the speed at which they are corrected will vary from course to course and teacher to teacher.
Q: What should I do if an assignment is listed as missing?
Discuss the missing assignment with your child. Once an assignment is turned in, it could be several days before a teacher corrects the work and records the mark in the grade book. If an assignment that your child has turned in is listed as missing, and several days have passed since it was turned in, have your child ask the teacher about the status of the assignment. If these steps do not resolve your concern, contact the teacher directly.
Q: What should I do if my child disputes an assignment/test score as listed in grade book?
Discuss the concern with your child. Have your child work with the teacher to clear up the mark in question. Ask to see the graded assignment. If these steps do not resolve your concern, contact the teacher directly.
Q: Why would I not be able to view grades for one/some of my child's classes?
Parents should be able to view grades for every class in which their child is enrolled. When a teacher is working in their grade book, the grade may not show. If you are unable to view grades for a particular class for more than a few days, contact the teacher directly.
Q: What should I do if I believe my child's attendance in Home Access Center is not accurate?
Discuss the concern with your child. Tell your child to clear up the absence with their teacher. If these steps do not resolve your concern, contact the attendance clerk at your campus.
Q: What does it mean if I receive an e-mail attendance notification from Home Access Center?
An e-mail alert is sent to you when your child has attendance information entered for them. There are many reasons for this including a tardy to class. Please check the Home Access Center later to see if the child was absent or tardy. If by the end of the day, the attendance mark is still a concern, talk to your child about the attendance situation.
Q: What if I receive an e-mail attendance notification, but when I go to Home Access Center attendance, my child has not been marked absent or tardy?
The e-mail alert is sent when a student is marked absent or tardy to class. If the teacher changed the student's attendance, you might see that they were actually present in class. Remember that the data in Home Access Center is more current than the e-mail alert.
Q: What is the best way to contact a teacher?
You may contact a teacher directly via e-mail or by contacting the campus. All teacher e-mail addresses may be found on the Northwest Independent School District web site, http://www.nisdtx.org/ (select your child's campus from the drop-down list located toward the upper right-hand side of the screen, then select the Staff Directory). Teacher email addresses can also be found on the HAC home page (Daily Summary) in the Today's Schedule section. Simply click on the teacher's name to open an email message.
Q: What is a reasonable amount of time to expect a response after e-mailing a teacher?
Under normal circumstances, a response should be received within 48 hours.
Q: When can I expect to see the average for each six weeks?
The average should be displayed the day that the report cards are distributed; however, progress can be monitored throughout the six weeks.
Q: If my child has been assigned to an alternative placement, will I be able to view his/her grades online?
Yes, as soon as the AEP teacher has returned completed work to the home campus usually by the end of the six weeks. If you need updates, please contact the Northwest ISD Special Programs Center at 817-215-0900.
Q: I opened grade or attendance reports in my email (Outlook, Hotmail, etc) and the columns are not straight. What should I do?
Open the .txt file of the report in Notepad or Wordpad, and it should be easy to read. You may also login to the Home Access center to review grades online.
Q: How secure is the online reporting?
Very specific information is required for access.
Q: Who other than school personnel can access my child's grade?
No one can access your child's grades unless you have given your password and student ID login to them.


Without this, your case is nothing: getting direct examinations right.
Who should attend: Civil and criminal litigators who wish to develop, hone, or renew the skill fundamental to the conduct of a trial—direct examination.
In the world of trial techniques, cross-examination gets a lot of attention while direct examination is usually taken for granted. We often assume direct examination is straightforward. After all, it's just your witness telling his or her story, no? Experienced counsel know that it is not quite so simple. As it is probably true that more cases are won or lost on direct examination than cross-examination. In this vein, this full-day program aims to improve your skills in direct examination through a review of the principles and practices that underlie effective preparation and execution of direct examination.
Lisa Martz is a civil litigation lawyer with more than 20 years' experience. Formerly a partner in the Vancouver office of McCarthy Tétrault LLP, she joined the litigation boutique firm of Gudmundseth Mickelson LLP in 2015.
Lisa's diverse commercial/civil litigation and administrative law practice includes extensive experience in disputes involving real estate, as well as commercial contracts of all kinds. She has acted for many of the city's major real estate developers on a wide range of issues, and has also served as counsel and litigation advisor for the Urban Development Institute.
Lisa also has high-profile experience in public law, having served as commission counsel on a number of public inquiries, and as counsel for the Attorney General of BC in a range of civil litigation matters.
Lisa prides herself on being a 'problem solver': a litigator who helps her clients make strategic decisions to avoid litigation where possible, but who is also ready to present her client's case effectively in court where that is what solving the problem is going to take.
Marilyn Sandford is counsel with the firm Ritchie Sandford McGowan, and has practiced as a civil and criminal litigator since 1990. She was part of the defence team in the R. v. Pickton case, represented Ivan Henry in his civil and criminal cases related to his wrongful convictions, and acted for John Nuttall in defending terrorism charges related to the BC Legislature bombing plot.


In this Decision, the Commission approves in part Mitchell Seaforth Cable T.V. Ltd.'s request to exclude certain distribution serving areas in Dublin, Ontario from Bell Canada's broadband expansion plan.
In Telecom Decision 2007-110, the Commission approved Mitchell Seaforth Cable T.V. Ltd.'s (Mitchell Seaforth) application to review and vary Telecom Decision 2007-50. As a result, the Commission excluded Dublin, Ontario from the list of uncontested communities in the Attachment to Telecom Decision 2007-50, pending further review of Mitchell Seaforth's request. In order to have a full record on which to base its final decision regarding Dublin, the Commission directed Mitchell Seaforth to file with the Commission and serve on all parties to the Telecom Public Notice 2006-15 proceeding the information identified in paragraph 9(a) of Telecom Public Notice 2006-15. The Commission also directed the company to file answers to Commission interrogatories issued concurrent with Telecom Decision 2007-110.
Bell Canada, on behalf of itself and Bell Aliant Regional Communications, Limited Partnership (Bell Aliant) (collectively, Bell Canada et al.), filed comments regarding Mitchell Seaforth's submission. The public record of this proceeding is available on the Commission's website at www.crtc.gc.ca under "Public Proceedings."
The Commission considers that the issue to be addressed in its determinations is whether the broadband service provided by Mitchell Seaforth is comparable to the one proposed by Bell Canada et al. for Dublin, based on the criteria established in Telecom Decision 2008-1.
In Telecom Public Notice 2006-15, the Commission initiated a proceeding to consider the incumbent local exchange carriers' (ILECs) proposals to use deferral account funds to expand broadband service to rural and remote communities within their serving territories. As part of this process, alternative broadband service providers (ABSPs) had the opportunity to file submissions to exclude any community identified in the ILECs' proposals that was already served or likely to be served in the near future.
In Telecom Decision 2007-50, the Commission approved the use of deferral account funds by Bell Aliant, Bell Canada, MTS Allstream Inc., and TELUS Communications Company to expand broadband services to certain rural and remote communities in Rate Bands E, F, and G in British Columbia, Manitoba, Ontario, and Quebec where no ABSP had indicated, on the record of the Telecom Public Notice 2006-15 proceeding, that it currently provided or had firm plans to provide broadband services in the near future. As part of that Decision, the Commission approved the expansion of broadband services to the community of Dublin.
In Telecom Decision 2008-1, the Commission approved the use of deferral account funds for additional communities. The Commission also outlined the criteria it uses to assess ABSPs' claims that a community is already served or that firm plans are in place to serve it in the near future. As well, the Commission stated that an ABSP's broadband service rates, terms, conditions, upload and download speeds, and reliability must be comparable to those of the ILEC in order to exclude a community from the ILEC's proposed broadband expansion plan.
Mitchell Seaforth noted that the Dublin area includes Bell Canada et al.'s distribution serving areas (DSAs) 180-1, 180-2, 360-1, and 380-2 and submitted that those DSAs are already well served. Mitchell Seaforth confirmed that it serves DSA 360-1 using cable technology and DSAs 180-1 and 380-2 using wireless technology. It also confirmed that it currently serves part of DSA 180-2, including the hamlet of Brodhagen, using wireless service, and that it plans to expand its wireless service into the rest of DSA 180-2 in 2008. Bell Canada et al. agreed that DSA 360-1 should be excluded from Bell Canada's broadband expansion plan. However, they disagreed that DSAs 180-1, 180-2 and 380-2 should be excluded from their proposed broadband expansion plan.
Mitchell Seaforth submitted that it provides cable modem broadband service at a monthly cost of $39.95, with a one-time service charge of $9.95, for download and upload speeds of 3 Mbps and 385 Kbps respectively. Regarding its wireless broadband service, Mitchell Seaforth submitted that it charges $44.95 per month, with a one-time service charge of $600, for download and upload speeds of 2 Mbps and 256 Kbps respectively.
In Telecom Decision 2008-1, the Commission concluded that some variation in rates between the ILEC's and the ABSP's services is acceptable. However, the Commission determined that a rate would not be considered comparable where a significant installation cost applies that, alone or in combination with the monthly rate, would make the service unreasonably expensive for a large proportion of the general public in the identified community. The Commission considers that Mitchell Seaforth's wireless broadband service in DSAs 180-1, 180-2, and 380-2 is not comparable to Bell Canada et al.'s broadband service with respect to the rates charged, because the service charge of $600 is sufficiently large so as to be unaffordable for a large proportion of residents of these DSAs.
Accordingly, the Commission determines that Mitchell Seaforth's broadband service in DSAs 180-1, 180-2, and 380-2 is not comparable to that of Bell Canada et al. The Commission therefore denies Mitchell Seaforth's request to exclude these DSAs from Bell Canada's broadband expansion plan and approves the use of deferral account funds by Bell Canada et al. for expansion of broadband service in these DSAs.
The Commission considers that Mitchell Seaforth's cable modem broadband service provided in DSA 360-1 is comparable to Bell Canada et al.'s broadband service, when assessed against the service requirements identified in Telecom Decision 2008-1. Accordingly, the Commission approves Mitchell Seaforth's request to exclude DSA 360-1 from Bell Canada's broadband expansion plan.


Joy Tour & Travel offers a wide range of travel services for different needs and groups. Our staff has traveled extensively to bring you first-hand knowledge of the world. We are ready to recommend and arrange the perfect travel plans for your and your travel companions.
Are you interested in both adventure and the element of surprise? If so, JOY's mystery trips are very popular and very fun! We align with you on the budget and time away – Then just grab your bag and Let's Go!
Have a need for support in arranging business travel? JOY is here to plan and coordinate details for your upcoming business trips both domestically or internationally.
Have the travel bug and need help making upcoming travel enjoyable and easy? JOY has a wide range of travel options that are likely on your bucket list. Choose from a range of favorite JOY Tour & Travel experiences or let us help you plan your own. We'll do all the work on travel planning and trip details so you can focus on enjoying your trip of a lifetime!
Do you have a mission group in need of assistance for travel planning? JOY is ready to help you plan and coordinate the purposeful travel experience you are seeking.


text:
Pedro Aparicio puede referirse a:

 Pedro Kohji Aparicio, futbolista nacido en Perú.
 Pedro Aparicio Sánchez, alcalde de Málaga desde 1979 a 1995 perteneciente al PSOE.
 Juan Pedro Aparicio, escritor nacido en León.
 Pedro "Papeles" Aparicio, personaje ficticio protagonista de El oro de Moscú y la daga de Rasputín.

redpajama_set_name: RedPajamaWikipedia


Singletons living alone, combined with people flocking from country to city are just some of the reasons Germany has a dwindling amount of empty housing, according to a new survey.
Despite 2012 being the sixth consecutive year in which there fewer free houses, "we can't say that there is an accommodation shortage in Germany," Reiner Braun, chairman of Empirica the thinktank that carried out the study, told Die Welt newspaper.
Worst hit were the country's 20 biggest cities, with more singles living in their own apartment and Germans from other areas moving to live there being cited as some of the reasons for this. The figure of available accommodation dropped to 3.2 percent in 2012, down 0.2 percent from a year earlier.
In the former West Germany, just 2.7 percent of houses were free. Munich's housing market had, the study found, the fewest empty offerings as just 0.6 percent of its housing stood uninhabited. In Hamburg this was 0.7 percent and in Ingolstadt, Bavaria, 0.8 percent.
Of the 114 towns and cities examined, the former East Germany had the most free space with 6.5 percent of accommodation up for grabs standing empty. This was particularly high in Salzgitter at 11.7 percent, in Chemnitz at 10.4 percent, and in Schwerin 9.9 percent.
Yet in other eastern German cities like Magdeburg, Emden and Frankfurt/Oder, the amount of houses with no one living in them up for grabs was shrinking faster than anywhere else in the country.
And although building on what empty spaces are left would provide respite, it would only be a short-lived solution, said Braun. Without a proper re-think, rents would continue to rise, he added.
The figures are the first of their kind to be published in years, giving a previously-unseen overview of the country's housing situation. Empirica, alongside construction company CBRE, did not include uninhabitable buildings.