Showing papers in "Jornal De Pediatria in 2009"

Prevalence of physical inactivity and associated factors among high school students from state's public schools.

Abstract: Objective: To describe the prevalence of physical inactivity and associated factors among high school students from state’s public schools in the city of Sao Paulo, state of Sao Paulo, Brazil. Methods: Sixteen state’s public schools were randomly selected according to the geographic areas of the city (North, South, East, and West). The sample consisted of 3,845 high school students in 2006. Physical inactivity was measured using the International Physical Activity Questionnaire (short IPAQ) and was defined as practicing moderate and/or vigorous physical activity for a period of less than 300 minutes per week. The independent variables analyzed were: gender, age, socioeconomic level, geographic area of the city, awareness of the “Agita Sao Paulo” program, participation in physical education classes, smoking, alcohol intake and time spent per day watching television. Threelevel Poisson regression was used for assessing the variables, with a significance level of p < 0.05. Results: The general prevalence of physical inactivity among adolescents in Sao Paulo was 62.5% (95%CI 60.5-64.1). The factors associated with physical inactivity were gender, age, socioeconomic level, geographic area of the city, awareness of the “Agita Sao Paulo” program, non-participation in physical education classes, smoking, alcohol intake and time spent per day watching television. Conclusion: It was concluded that the prevalence of physical inactivity among adolescents in Sao Paulo was high in all the geographic areas evaluated, and that sociodemographic and behavioral factors contributed significantly to physical inactivity.

Prevalência de inatividade física e fatores associados em estudantes do ensino médio de escolas públicas estaduais

Abstract: OBJECTIVE: To describe the prevalence of physical inactivity and associated factors among high school students from state's public schools in the city of Sao Paulo, state of Sao Paulo, Brazil. METHODS: Sixteen state's public schools were randomly selected according to the geographic areas of the city (North, South, East, and West). The sample consisted of 3,845 high school students in 2006. Physical inactivity was measured using the International Physical Activity Questionnaire (short IPAQ) and was defined as practicing moderate and/or vigorous physical activity for a period of less than 300 minutes per week. The independent variables analyzed were: gender, age, socioeconomic level, geographic area of the city, awareness of the "Agita Sao Paulo" program, participation in physical education classes, smoking, alcohol intake and time spent per day watching television. Three-level Poisson regression was used for assessing the variables, with a significance level of p < 0.05. RESULTS: The general prevalence of physical inactivity among adolescents in Sao Paulo was 62.5% (95%CI 60.5-64.1). The factors associated with physical inactivity were gender, age, socioeconomic level, geographic area of the city, awareness of the "Agita Sao Paulo" program, non-participation in physical education classes, smoking, alcohol intake and time spent per day watching television. CONCLUSION: It was concluded that the prevalence of physical inactivity among adolescents in Sao Paulo was high in all the geographic areas evaluated, and that sociodemographic and behavioral factors contributed significantly to physical inactivity.

Cardiovascular risk factors, their associations and presence of metabolic syndrome in adolescents.

Abstract: Objective: To evaluate the occurrence of metabolic syndrome (MS) and independent associated risk factors in adolescents in the city of Vitoria, Brazil. Methods: We assessed 380 adolescents aged 10 to 14 years attending public schools. Body mass index and blood pressure at rest were measured. Fasting plasma concentrations of total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides and glucose were also obtained. Results: The prevalence of overweight was 9.6% for boys and 7.4% for girls, while obesity was found in 6.2 and 4.9%, respectively. Triglyceride concentrations were borderline or high in 6.8 and 3.4% of the boys and in 11.8 and 5.9% of the girls. HDL-cholesterol was below recommended levels in 8.5% of the boys and in 9.9% of the girls. Blood pressure at rest was borderline for 5.1% of the boys and 7.9% of the girls, while 3.4% of both boys and girls were hypertensive. Fasting glycemia was high in 0.6% of the boys and in 0.5% of the girls. In the group studied, 2.8% of the boys and 2.5% of the girls had two risk factors associated with MS. Prevalence of MS was 1.1% for boys and 1.5% for girls, and overall prevalence was 1.3%. Conclusions: MS and associated cardiovascular risk factors are serious clinical conditions in this age group. A significant number of adolescents showed borderline results, which may increase the prevalence of MS or independent risk factors in the short term. More investments should be made in primary prevention, considering that early diagnosis is an issue of fundamental importance.

Severe early childhood caries: an integral approach.

Abstract: Objective To provide information with the purpose of helping pediatricians to recognize the risk factors for the onset of severe early childhood caries, allowing for early intervention and thus avoiding this preventable disease and its consequences. Sources Information was collected from scientific articles published on the databases SciELO, MEDLINE and PUBMED in last 25 years, as well as technical books and guidelines of international committees. The keywords used were: early childhood caries, severe early childhood caries, dental caries, and children. Summary of the findings Severe early childhood caries affects infants and children. It is infectious, has a multifactor etiology and fast development, starting soon after dental eruption. Due to the presence of local sociocultural risk factors, it must be regarded as a symptom of alteration in the child's health and lack of adequate care. Its manifestations include pain, abscesses and chewing difficulty, affecting the child's feeding and sleep. Furthermore, it also affects the child's general health, speech, and self-esteem. Conclusions Preventive methods to avoid severe early childhood caries have been developed and they should be used as early as possible by means of prevention programs carried out in the community and with families. Professionals responsible for providing care to babies and children should be aware of cases at risk for caries and interfere in order to improve their patients' health.

Associated factors in high blood pressure among schoolchildren in a middle size city, southern Brazil.

Abstract: OBJECTIVE: To establish the prevalence of high blood pressure and associated factors among schoolchildren from Caxias do Sul, state of Rio Grande do Sul, Brazil. METHODS: This school-based cross-sectional study assessed boys and girls aged 7 to 12 years from private and public schools. Three measurements of the children's blood pressure were taken during one visit to the schools. Weight, height, and waist circumference were measured. We also assessed the children's aerobic capacity (9-minute running test) and socioeconomic status. Statistical analysis was carried out using the chi-square test and logistic regression in order to control for confounding factors. RESULTS: The sample included 1,413 children. Prevalence of schoolchildren with high blood pressure was 13.8% (systolic, diastolic, systolic/diastolic), and the proportion was higher (double) for obese and/or overweight children in comparison to normal-weight children. Children with increased waist circumference had 2.8 times greater chance of having high blood pressure levels than those with appropriate waist circumference (95% confidence interval 2.513-3.186 and p = 0.000). Individuals belonging to a high social class, defined according to the Brazilian National Economic Index, had 2.6 times greater chance of having high blood pressure. CONCLUSIONS: In the present study, schoolchildren aged 7 to 12 years from Caxias do Sul had high prevalence of high blood pressure levels; increased waist circumference, high socioeconomic status, and low physical capacity were associated with this condition. We suggest that measures be taken to promote the practice of physical activity and dietary control to improve blood pressure levels and thus reduce risk factors.

Cognitive and behavioral status of low birth weight preterm children raised in a developing country at preschool age

Abstract: Objective: To assess cognitive and behavioral development at preschool age of children born preterm and with low birth weight and raised in a developing country. Methods: Prospective cross-sectional study of 80 neonates born in a university hospital in southern Brazil. Neuropsychological assessment at age 4-5 years included the Wechsler Preschool and Primary Scale of Intelligence (WPPSI), Conners’ Parent Rating Scale-Revised, Denver test and neurological examination. Perinatal and early neuropsychomotor development information was collected from the database during follow-up. Results were related to birth weight, sex and gestational age. Results: WPPSI scores were: total intelligence quotient (IQ) 88.00±16.96, verbal IQ 89.72±16.72, and executive IQ 88.12±15.71 for the group with less than 1,500 grams; and total IQ 91.11±14.73, verbal IQ 93.36±12.65, and executive IQ 90.20±16.06 for the group between 1,500 and 2,500 grams. The best scores were obtained in tests that evaluated capacity of abstraction and symbolization, picture completion and common perception, in which only 5% and 6.3% of the children had abnormal results, respectively. The lowest scores were obtained in tests that evaluated visual-motor coordination and flexibility-speed of reasoning, in which 27.5% and 16.3% of the children had abnormal results, respectively. A total of 32.5% had abnormal results in the arithmetic tests. Behaviors related to attention deficit/ hyperactivity disorder (ADHD) were observed in 48% of the sample. Low score in the Bayley Mental Scale and abnormal result in the Denver test were significantly correlated to ADHD (p = 0.017 an dp=0 .004). Abnormal results in the Bayley Mental Scale (p < 0.001), Denver test (p < 0.001) and neurological examination (p = 0.002) were associated with lower IQ.

Incidence and main risk factors associated with extubation failure in newborns with birth weight < 1,250 grams

Abstract: Objectives: To determine the incidence of extubation failure in preterm newborns with birth weight < 1,250 g extubated to nasal continuous positive airway pressure and to identify the main risk factors associated with the need for reintubation in this population Methods: A retrospective review of eligible infants admitted and mechanically ventilated between July 2002 and June 2004 was performed Extubation failure was defined as the need for reintubation within 7 days after the first extubation attempt Results: Of the 52 patients included in the study, 13 died before the first extubation attempt Of the remaining 39 patients, only nine failed extubation (231%) Comparing the two groups (failure vs successful), there was a statistically significant difference regarding birth weight, gestational age and 5-minute Apgar score After logistic regression, only gestational age was significant Other secondary outcomes showed significant difference between the groups: intracranial hemorrhage grade III and/or IV, patent ductus arteriosus and death Conclusions: The incidence of extubation failure in our population was similar to the rate reported in the literature The main risk factor for extubation failure was prematurity (≤ 28 weeks) In this population of extreme preterm infants, implementation of strategies for early extubation, use of methylxanthines, prevention of patent ductus arteriosus, and use of different modes of assisted ventilation after extubation may improve the outcomes

Psychosocial adjustment and physical health in children of divorce.

Abstract: The authors are thankful to Patricia Silva, biologist and PhD student in Clinical Psychology in the Neuropsychophysiology Laboratory of the School of Psychology at Universidade do Minho, for the orthographic adaptation of the original article to Brazilian Portuguese.

Qualidade de vida em pacientes pediátricos com dermatite atópica

Abstract: OBJETIVO: Avaliar o impacto da dermatite atopica (DA) sobre a qualidade de vida de pacientes pediatricos e de seus familiares, estabelecendo correlacoes com escores de severidade da doenca. METODOS: Estudo observacional com correlacao entre indicador clinico de gravidade e dois questionarios sobre qualidade de vida: o Indice de Qualidade de Vida da Dermatite Atopica em Criancas (IDQOL) e o Impacto da Dermatite Atopica na Familia (DFI). O estudo incluiu tambem um escore de gravidade do eczema (Indice de Gravidade do Eczema por Area). Foram investigadas 42 criancas com DA e 44 criancas com outras dermatoses em relacao ao impacto do eczema na qualidade de vida. Na analise de correlacao, utilizou-se o teste de correlacao de Pearson, e a comparacao entre os dois grupos foi realizada atraves do teste de Mann-Whitney. RESULTADOS: A analise dos dados demonstrou significativa diferenca entre a pontuacao dos dois grupos. A media de pontuacao no grupo com DA foi de 9,2 (variando de 1 a 19) para o IDQOL e de 8,5 (variando de 0 a 17) para o DFI. Os dominios mais comprometidos no IDQOL foram os relativos ao prurido, alteracoes de humor e problemas com o tratamento. Quanto ao DFI, os dominios de maior impacto foram os relacionados a despesas com o tratamento e a perturbacao do sono de membros da familia. CONCLUSOES: A DA interfere negativamente na qualidade de vida dos pacientes pediatricos e dos seus familiares. Dados obtidos nos estudos de qualidade de vida em DA devem nortear a pratica clinica de modo a individualizar as estrategias de tratamento e levar a adocao de medidas que possam minimizar o impacto da doenca sobre pacientes e familiares.

Trends and patterns of exclusive breastfeeding for under-6-month-old children.

Abstract: OBJECTIVES: To study the trends and patterns of exclusive breastfeeding (EBF) for under-6-month-old infants in the city of Bauru Brazil. METHODS: Data from three methodologically equivalent cross-sectional surveys integrating the project for monitoring breastfeeding indicators in Sao Paulo state were compared. Infants aged zero to 6 months who attended one of the two phases of the Multivaccination Campaign in 1999 2003 and 2006 respectively 496 674 and 509 infants were studied. Descriptive statistics were presented to compare the prevalence of EBF according to age (in months) and for the set of children under 6 months. The differences in prevalence were expressed in percentage and submitted to statistical tests (Pearsons chi-square and tendency) adopting p < 0.05 as the critical level. Factors associated with EBF interruption in 2006 were also studied by uni- and multivariate analysis. RESULTS: Increase in EBF prevalence was found in under-6-month-old infants: in the 1999-2003 period increase of 9.1%; in the 2003-2006 period increase of 6.6% thus reaching the annual increase rate of 2.3% in the first period and 2.2% in the second period. Significant inverse association was observed between EBF and the use of pacifiers (hazard ratio = 2.03; 95% confidence interval 1.44-2.84). CONCLUSION: EBF prevalence in under-6-month-old infants in the city of Bauru Brazil increased almost threefold in the studied period changing from 8.5% in 1999 to 24.2% in 2006 which represents an increase of 184.7%. The use of pacifiers was the only factor associated with greater chances of EBF interruption.

Avaliação do efeito da educação nutricional na prevalência de sobrepeso/obesidade e no consumo alimentar de escolares do ensino fundamental

Abstract: OBJETIVO: Avaliar o efeito de um programa de educacao nutricional na prevalencia de sobrepeso/obesidade e no consumo alimentar de alunos da 2a serie do ensino fundamental. METODOS: Amostra composta por 135 escolares de uma escola privada e uma publica de Florianopolis (SC), divididos entre os grupos com intervencao (n = 55) e sem intervencao (n = 80). Realizaram-se duas avaliacoes antropometricas e de consumo alimentar, antes e apos a aplicacao de um programa de educacao nutricional. O programa foi composto por oito encontros quinzenais e abordou temas referentes a alimentacao saudavel, confeccao de lanches adequados e atividade fisica. O diagnostico nutricional foi obtido pelo indice de massa corporal para idade, de acordo com o Centers for Disease Control and Prevention, e os alimentos consumidos na escola foram classificados em permitidos ou proibidos pela Lei das Cantinas de Santa Catarina. Os dados foram analisados no Statistical Package for the Social Sciences, considerando como significativo p 0,05). Observou-se diminuicao significante no consumo de suco artificial (p = 0,013), alimento proibido pela Lei, nas turmas com intervencao. Nas turmas sem intervencao, observou-se aumento significante no consumo de alimentos proibidos, como salgadinho industrializado (p = 0,021) e refrigerante (p = 0,031). Alem disso, o cereal matinal, alimento apropriado para o lanche escolar, teve consumo reduzido (p = 0,039). CONCLUSAO: Foram observadas melhorias em relacao a qualidade dos alimentos consumidos pelos escolares apos a aplicacao do programa de educacao nutricional, apesar de sua curta duracao.

Pacifier habit: history and multidisciplinary view

Abstract: Objectives To review the history of pacifiers and to compile a multidisciplinary literature review, searching for pros and cons with the purpose of providing health professionals with arguments when parents request guidance. Sources History and art books, as well as non-medical literature and museums were used in the historical survey. Multidisciplinary data were collected from MEDLINE, LILACS, SciELO, and The Cochrane Library. Search criteria were: the keyword "pacifiers" present in articles published in the last 5 years that included abstract and were written in Portuguese, English, or Spanish. Summary of the findings There is evidence that their precursors have been used since the Neolithic Period to calm down children. Small balls made of fabric containing food were portrayed in paintings. Other balls made of non-perishable material persisted throughout time. Pacifiers have been used to stimulate sucking or to coordinate this reflex, promoting an earlier beginning of the oral feeding of newborns. Some authors suggest that pacifiers reduce the incidence of the sudden death syndrome, but the topic is controversial. Pacifiers prevent the establishment of breastfeeding and lead to weaning. Their use may cause suffocation, poisoning, or allergies and increases the risk of caries, infections, and intestinal parasitic diseases. Harmful effects are related to frequency, duration, and intensity of the habit. It should be discontinued by the age of 3 or 4 in order not to affect speech and dentition. Conclusions There are more harmful effects than benefits. It is advisable that health professionals inform parents of the pros and cons of pacifiers so that they can make a conscious decision regarding its use.

Toxoplasmose congênita em filho de mãe cronicamente infectada com reativação de retinocoroidite na gestação

Abstract: OBJETIVO: Apresentar um caso raro de toxoplasmose congenita de uma mae imunocompetente com infeccao cronica que teve reativacao da doenca ocular durante a gestacao. DESCRICAO: O recem-nascido estava assintomatico no nascimento e foi identificado atraves de triagem neonatal (IgM anti-Toxoplasma gondii em sangue seco) entre outros 190 bebes com toxoplasmose congenita durante um periodo de 7 meses. Sua mae tinha tido um episodio nao tratado de reativacao de retinocoroidite toxoplasmica durante a gestacao, com titulos de IgG estaveis e resultados negativos para IgM. Os resultados de IgM e IgG no soro do recem-nascido e o teste de immunoblotting para IgG foram positivos, e detectou-se lesoes retinocoroideanas ativas na periferia da retina. O recem-nascido foi tratado com sulfadiazina, pirimetamina e acido folinico. Aos 14 meses de vida, a crianca permanecia assintomatica, com regressao das lesoes retinocoroideanas e persistencia de IgG. COMENTARIOS: E possivel que a triagem neonatal sistematica em areas com alta prevalencia de infeccao possa identificar esses casos.

Riscos isolados e agregados de anemia em crianças frequentadoras de berçários de creches

Abstract: OBJETIVO: Identificar e quantificar os fatores de risco isolados e agregados de anemia, proporcionando visao ampliada quanto a probabilidade da sua ocorrencia. METODOS: Estudo transversal com 482 criancas, entre 4 e 29 meses de idade, frequentadoras de bercarios de creches publicas e filantropicas do municipio de Sao Paulo (SP), que participaram de dois inqueritos (2004 e 2007). Foram realizadas entrevistas com as maes, coleta de sangue por puncao digital e antropometria. Considerou-se anemia, hemoglobina inferior a 11 g/dL. Foi ajustado modelo de regressao logistica nao-condicional para fatores de risco de anemia, considerando-se estatisticamente significantes associacoes com p < 0,05. Para definicao das probabilidades pos-teste, foram utilizados os calculos das chances pos-teste e razoes de verossimilhanca. Os pacotes estatisticos utilizados foram o Epi-InfoTM 2000 e o Stata 10.0. RESULTADOS: A prevalencia de anemia foi de 43,6% (IC95% - 39,1 a 48,1%). O modelo logistico final incluiu cinco variaveis: idade materna inferior a 28 anos (OR = 1,50; p = 0,041), renda per capita inferior a meio salario minimo (OR = 1,56; p = 0,029), aleitamento materno exclusivo inferior a 2 meses (OR = 1,71; p = 0,009), perda de escore z peso/idade do nascimento ao inquerito (OR = 1,47; p = 0,050) e idade inferior a 17 meses (OR = 2,44; p < 0,001). As probabilidades pos-teste nas associacoes de fatores de risco de anemia isolados e agregados apresentaram-se entre 54,5 e 100%. CONCLUSOES: A probabilidade de anemia aumentou quanto mais agregados estiveram os cinco fatores de risco identificados. Esse calculo disponibiliza instrumento simples e rapido de suspeicao de anemia em criancas em triagem clinica ou populacional.

Uso de chupeta: história e visão multidisciplinar

Abstract: OBJECTIVES: To review the history of pacifiers and to compile a multidisciplinary literature review, searching for pros and cons with the purpose of providing health professionals with arguments when parents request guidance. SOURCES: History and art books, as well as non-medical literature and museums were used in the historical survey. Multidisciplinary data were collected from MEDLINE, LILACS, SciELO, and The Cochrane Library. Search criteria were: the keyword "pacifiers" present in articles published in the last 5 years that included abstract and were written in Portuguese, English, or Spanish. SUMMARY OF THE FINDINGS: There is evidence that their precursors have been used since the Neolithic Period to calm down children. Small balls made of fabric containing food were portrayed in paintings. Other balls made of non-perishable material persisted throughout time. Pacifiers have been used to stimulate sucking or to coordinate this reflex, promoting an earlier beginning of the oral feeding of newborns. Some authors suggest that pacifiers reduce the incidence of the sudden death syndrome, but the topic is controversial. Pacifiers prevent the establishment of breastfeeding and lead to weaning. Their use may cause suffocation, poisoning, or allergies and increases the risk of caries, infections, and intestinal parasitic diseases. Harmful effects are related to frequency, duration, and intensity of the habit. It should be discontinued by the age of 3 or 4 in order not to affect speech and dentition. CONCLUSIONS: There are more harmful effects than benefits. It is advisable that health professionals inform parents of the pros and cons of pacifiers so that they can make a conscious decision regarding its use.

Overweight and physical inactivity in children living in favelas in the metropolitan region of Recife, Brazil.

Abstract: Objective: To assess the prevalence of overweight and obesity and its association with physical activity levels in children living in favelas in the city of Recife, state of Pernambuco, Brazil. Methods: A cross-sectional study was performed with 973 children ranging from 7 to 10 years old, all from two favelas in Recife, Fragoso and Caranguejo (total population of 9,315); of the 973 children assessed, 733 were included in the study. Overweight was defined as body mass index (BMI) equal to or above the 85th percentile, and obesity as BMI equal to or above the 95th percentile, using Centers for Disease Control and Prevention growth charts. Physical activity level was assessed by the Physical Activity Questionnaire for Older Children (PAQ-C). Children with scores ≥ 3 were considered active, while those with scores < 3 were considered inactive. Results: Of the 733 children studied, overweight and obesity were observed in 92 (12.6%). There was no statistical association between physical inactivity and sex, income, maternal schooling, number of siblings and hours of television. However, more children with physical inactivity were observed among overweight or obese children, 66/92 (71.6%) vs. 363/641 (56.7%) (p = 0.008). Conclusions: The prevalence of overweight and obesity is high, and is associated with physical inactivity in children living in favelas in the city of Recife, Brazil.

Quality of life in pediatric patients with atopic dermatitis

Abstract: OBJECTIVE To measure the impact of atopic dermatitis (AD) on the quality of life of pediatric patients and their families, establishing correlations with scores of disease severity METHODS This was an observational study of the correlations between clinical indicators of severity and two questionnaires on quality of life: IDQOL and DFI The study also included scoring of eczema severity EASI Forty-two children with AD, fulfilling established diagnostic criteria, and 44 children with other dermatologic diseases were investigated for the effect of eczema on quality of life Pearson's correlation was used for the correlation analysis and the comparison between the groups was carried out using the Mann-Whitney test RESULTS Data analysis demonstrated significant differences between the scores for the two groups The mean score in the eczema group was 92 (range 1-19) for IDQOL and 85 (range 0-17) for DFI The highest scoring questions for IDQOL referred to itching and scratching, mood changes and problems caused by treatment For the FDI, the highest impact domains were treatment-related expenditure and sleep disturbance affecting family members CONCLUSIONS AD has a negative impact on the quality of life of pediatric patients and their families Data obtained in studies of quality of life in AD should be used to guide clinical practice in order to identify individual treatment strategies and should lead to the adoption of measures to reduce the impact of the disease on patients and their families

Evaluating the effect of nutritional education on the prevalence of overweight/obesity and on foods eaten at primary schools.

Abstract: Objective To assess the effects of a nutritional education program on the prevalence of overweight/obesity and on the foods eaten by schoolchildren in the 2nd grade of primary education Methods The sample was made up of 135 schoolchildren, recruited from one private and one public school in Florianopolis, Brazil, and allocated to either an intervention group (n = 55) or a no-intervention group (n = 80) The children underwent two anthropometric assessments and two dietary intake assessments, before and after attending a nutritional education program The program consisted of eight fortnightly meetings and covered subjects related to healthy diets, how to make healthy snacks, and physical activity Nutritional status was classified according to body mass index for age, using the Centers for Disease Control and Prevention growth charts as reference, and the foods the children ate at school were classified according to the Santa Catarina School Canteens Act Data were analyzed using the Statistical Package for the Social Sciences, and values of p Results The percentage of overweight/obese schoolchildren increased from 218 to 236% in the intervention group and from 337 to 350% in the no-intervention group (p > 005) The intervention group significantly (p = 0013) reduced its intake of artificial juice, which is prohibited by the Act In the no-intervention group, there was a significant increase in intake of prohibited foods, such as mass-produced snacks (p = 0021) and soda (p = 0031) Furthermore, the intake of breakfast cereal, which is appropriate for eating at school, decreased (p = 0039) Conclusion Despite its short duration, after attending the nutritional education program, there were improvements in the quality of the food the schoolchildren were eating

Assessment of domestic violence against children and adolescents with enuresis.

Abstract: OBJECTIVE: To describe the frequency of domestic violence against Brazilian children and adolescents due to episodes of enuresis, as well as associated risk factors METHODS: A cross-sectional study was carried out with 149 patients aged between 6 and 18 years who received the diagnosis of primary monosymptomatic nocturnal enuresis A semi-structured interview was done with the patients and their guardians to collect information about the characteristics of domestic violence and abusers In addition, a playful activity was performed by the patients Abuse was characterized as verbal aggression, physical aggression without physical contact, and physical aggression with physical contact RESULTS: Eighty-nine percent (n = 132) of the patients suffered abuse due to episodes of urine leakage All cases were characterized by verbal punishment associated or not with other types of aggression Physical punishment without physical contact occurred in 508% of the cases, while physical punishment with physical contact accounted for 485% of the cases The main abuser was the mother (879%) One patient suffered an intentional severe genital injury, and reconstructive surgery was necessary There was a significant correlation (p = 0043, r = -0768) between the abuser's educational level and punishment severity CONCLUSIONS: Punishment rates due to episodes of urine leakage are alarming Children and adolescents with enuresis who live with low-educated people can be considered a population at risk of suffering domestic violence Language: en

Eating attitudes and body image in ethnic Japanese and Caucasian adolescent girls in the city of São Paulo, Brazil

Abstract: OBJECTIVE: Despite investigations into the rapid increase in eating disorders across diverse ethnic groups, conclusions concerning ethnicity and eating disorders are contradictory. The objective of the present study was to investigate eating attitudes in ethnic Japanese and Caucasian adolescents in Brazil. The influence of body mass index (BMI), menarche and social-affective relationships on the development of eating disorders was also assessed. METHODS: Questionnaires evaluating the incidence of eating disorders and the influence of social-affective relationships were applied to 544 Japanese-Brazilian and Caucasian adolescent girls: 10 to 11-year-old Japanese-Brazilian (n = 122) and Caucasian (n = 176) pre-menarcheal adolescents, and 16 to 17-year-old Japanese-Brazilian (n = 71) and Caucasian (n = 175) post-menarcheal adolescents. RESULTS: Caucasian girls obtained higher scores on the Eating Attitudes Test (EAT-26), showed greater body image dissatisfaction, dieted more often and had more diet models introduced by their mothers and peers than the Japanese-Brazilian girls. CONCLUSION: The Caucasian adolescents overall appeared to be more sensitive to aesthetic and social pressures regarding body image than the Japanese adolescents. The high incidence of EAT-26 scores above 20 in the Caucasian pre-menarcheal group indicates that individual body image concerns are developing at an earlier age. Multiple logistic regression revealed several associations between mother-teen interactions and the development of abnormal eating attitudes.

Impact of obesity on metabolic syndrome components and adipokines in prepubertal children.

Abstract: Objective: To verify the impact of obesity on metabolic syndrome components and adipokine levels in prepubertal children. Methods: This cross-sectional study compared 30 obese, 31 overweight and 33 eutrophic children attending a university hospital-based outpatient pediatric clinic. Parameters assessed included glucose, serum lipids, insulin, homeostasis model assessment-insulin resistance (HOMA-IR), glucose/insulin relation, adiponectin, and leptin. We compared the frequency of acanthosis nigricans and changes in waist, blood pressure, glucose, serum lipids, and insulin. The correlation between body mass index (BMI) z score and adipokines was evaluated. Results: Among obese children, there was a difference in the mean values of HDL cholesterol and adiponectin, whereas among the eutrophic children, there was a difference in the mean values of insulin, HOMA-IR, glucose/insulin relation, and leptin (p < 0.001). A difference was also observed regarding the frequency of acanthosis nigricans and alteration in waist and HDL cholesterol (p < 0.005) in the obese group. The BMI z score showed a positive correlation with leptin (p < 0.001) and a negative correlation with adiponectin (p = 0.001). In multiple linear regression, this correlation was maintained only for leptin; HDL-cholesterol correlated with adiponectin (p = 0.007) and HOMA-IR correlated with both variables (p < 0.05). Conclusion: These findings provide evidence of the influence of obesity on metabolic syndrome components and on adipokine levels in prepubertal children, indicating that these components may contribute to the beginning of cardiovascular diseases.

Nonnutritive sucking habits among preschool-aged children

Abstract: Objective: To verify the prevalence and factors associated with nonnutritive sucking habits in preschool-aged children attending daycare centers and preschools in Natal, Brazil Methods: A cross-sectional study was conducted with 1,190 children of both sexes, aged 3 to 5 years, enrolled in daycare centers and preschools in Natal, Brazil Exclusion criteria were: children with cleft lip and palate, temporomandibular joint disorders, or submitted to orthodontic and/or orthopedic treatment; as well as institutions specialized in children with disabilities Parents or guardians answered a structured questionnaire providing information on the institution, children’s sex and age, parents’ educational level, and habit-related questions Data analysis was performed using the chi-square test and logistic regression Results: A prevalence of 402% of nonnutritive sucking habits was obtained; of these, 277% were pacifier-sucking and 125% were finger-sucking habits Girls showed a higher percentage of sucking habits, especially finger sucking (p = 002); younger children showed a higher prevalence of pacifier-sucking habits (p = 00006) A higher frequency of pacifier- and finger-sucking habits was associated, respectively, with parents’ higher education (p < 005) and elementary education (p < 005) Logistic regression revealed that younger individuals (p = 0033) and secondary education level of parents (p = 0035) are independent factors for habit persistence Conclusion: A high prevalence of nonnutritive sucking habits was verified, highlighting younger age groups and secondary education level of parents as important associated factors

Incidência e principais fatores associados à falha de extubação em recém-nascidos com peso de nascimento < 1.250 gramas

Abstract: OBJETIVOS: Determinar a incidencia de falha de extubacao em recem-nascidos prematuros com peso de nascimento < 1.250 g extubados para pressao positiva continua nas vias aereas nasais e identificar os principais fatores de risco que possam estar associados a necessidade de reintubacao nessa populacao. METODOS: Analise retrospectiva dos prontuarios de pacientes internados e ventilados mecanicamente durante o periodo de julho de 2002 a junho de 2004. Falha na extubacao foi definida como necessidade de reintubacao nos primeiros 7 dias apos a primeira tentativa de extubacao. RESULTADOS: Entre 52 pacientes estudados, 13 faleceram antes da primeira tentativa de extubacao. Do restante, apenas nove falharam na extubacao (23,1%). Comparando esses recem-nascidos com aqueles extubados com sucesso, houve diferenca estatisticamente significativa em relacao a peso de nascimento, idade gestacional e escore de Apgar no 5o minuto. Apos a regressao logistica, apenas a idade gestacional se manteve significativa. Alguns resultados secundarios tambem foram significativamente diferentes: incidencia de hemorragia intracraniana graus III e/ou IV, persistencia do canal arterial e obito. CONCLUSOES: Nosso estudo demonstrou uma incidencia de falha na extubacao semelhante a da literatura. O principal fator de risco para falha nessa populacao foi a prematuridade (≤ 28 semanas). Nesses prematuros extremos, a implementacao de estrategias para extubacao precoce, o uso de metilxantinas, a prevencao da abertura do canal arterial e o uso de outros metodos de assistencia ventilatoria pos-extubacao podem contribuir para a melhora desses resultados.

Quality of life of asthmatic adolescents: assessment of asthma severity, comorbidity, and life style

Abstract: OBJECTIVE: To assess the quality of life (QoL) of asthmatic adolescents and its association with asthma severity, chronic diseases, and life style METHOD: Cross-sectional study involving 210 female and male asthmatic adolescents between 12 and 21 years old The Paediatric Asthma Quality of Life Questionnaire, a self-administered instrument, was used Explanatory variables were: allergic diseases, use of medication, passive smoking, occupational status, asthma severity, and life style The analyses considered the dichotomous outcome (good/poor QoL) based on the mean scores Generalized linear models (log-binomial) were used to calculate the crude and adjusted prevalence ratios (PR) RESULTS: Forty-six per cent of the girls and 57% of the boys had poor QoL There was no correlation between chronic diseases and poor QoL Low educational level, use of medication, passive smoking, and occupational factors had a statistically significant association (p < 005) with poor QoL The adjusted analysis showed that severe asthma (PR = 153; 95%CI 112-211), use of medication (PR = 158; 95%CI 109-228), having asthma diagnosis established less than 5 years ago (PR = 130; 95%CI 097-186), passive smoking (PR = 138; 95%CI 135-200), and being employed (PR = 130; 95%CI 096-174) were associated with poor QoL CONCLUSION: A multidisciplinary team needs to face the challenge of providing good QoL with the purpose of making these patients better adapted to society and to their own needs

Acute splenic sequestration in children with sickle cell anemia

Abstract: Since this topic is related to medical emergency, it is very important for all of us who work in general pediatrics. Other strengths of the study are the facts that it presents national data and, more importantly, what occurs in the context of the Brazilian public health services. I believe it is crucial to consider such aspect that has an overwhelming influence on good medical practice.I also would like to emphasize the fact that, at emergency rooms, the diagnosis of acute splenic sequestration (ASS) is not always established based on the classic definition presented in the article – “sudden increase in the splenic volume, associated with a drop of at least 2 g/dL in hemoglobin concentration and reticulocytosis.” Some of the factors contributing to that are: 1) relatives not always take to the emergency department the child’s clinical and baseline hematologic data reports provided by hematology referral centers; 2) lack of computerized medical record available to all medical care units, what could solve the previously mentioned problem; and 3) the fact that sometimes it is not possible to perform reticulocyte count at many emergency department laboratories. With regard to the item 3 specifically, the results shown in Table 1 of the above mentioned article suggest that this was also a difficulty in the cases reported by Rezende et al.: hemoglobin concentration was measured in 80% (138/173) of the ASS cases, whereas reticulocyte count was performed only in 14% (24/173) of them.In face of these limitations, the diagnosis of ASS is established based on clinical parameters such as significant splenomegaly, pallor and hemodynamic instability, in addition to very low hemoglobin levels. The following consequences arise from that:- Severe cases of ASS will not be underdiagnosed and will receive appropriate treatment at the emergency department. At discharge, patients will be sent to the referral center, in order to define the follow-up management.- These extreme criteria are not sufficient to diagnose mild cases of ASS. Within the age group with the highest risk for ASS, splenomegaly, anemia and reticulocytosis are typical findings of underlying disease, even if there are no complications. If the child’s clinical and baseline hematologic data are not available for the emergency department pediatrician, a mild case of ASS might be misdiagnosed as possible exacerbation of typical findings, triggered by infection, an event which these patients are more prone to. Even though it may not compromise the emergency care, in such situation, underdiagnosis certainly results in inappropriate follow-up of the patient, who will not receive the best care – attentive follow-up, periodic transfusion program or indication of splenectomy. - There might be a diagnostic confusion between ASS and red cell aplasia if reticulocyte count is not performed at the emergency department before blood transfusion. This might cause under or overestimation of the actual frequency of ASS.I would like to know if some data were analyzed in this population and not presented in the study:- Were caregiver’s educational level and family’s town of residence (and access to the health care facility) associated with the case-fatality of ASS?- Did pneumococcal vaccine protect patients against ASS?- Was parvovirus B19 serology performed in any of these reported cases?- And finally, a question not related to the main topic of the study: is the Neonatal Screening Program of Minas Gerais able to offer any kind of counseling to the relatives of children diagnosed with sickle cell trait regarding occasional reproductive risks for the person in adulthood?I congratulate the authors for the published data, and it will certainly contribute to encourage debate and increase knowledge about this topic.

Inadequação do consumo alimentar de crianças e adolescentes com artrite idiopática juvenil e lúpus eritematoso sistêmico

Abstract: OBJETIVOS: Avaliar o consumo alimentar de criancas e adolescentes com artrite idiopatica juvenil (AIJ) e lupus eritematoso sistemico (LES) por recordatorio de 24 horas e relaciona-lo com caracteristicas clinicas e antropometricas e com os medicamentos empregados. METODOS: Em estudo transversal, avaliamos os recordatorios de 24 horas de pacientes ambulatoriais. O estado nutricional foi classificado pelo CDC, 2000. Para o calculo da ingestao, utilizamos o software NutWin UNIFESP-EPM. Para a analise quantitativa e qualitativa, adotamos as Recommended Dietary Allowances e a pirâmide alimentar brasileira. RESULTADOS: A mediana de idade foi 12 na AIJ e 16,5 anos no LES. Na AIJ, 37,5% dos pacientes estavam em atividade de doenca, e, no LES, 68,2% tinham Systemic Lupus Erythematosus Disease Activity Index > 4. Foi encontrada desnutricao em 8,3 e 4,5% dos pacientes com AIJ e com LES, respectivamente, e obesidade, em 16,7 e 18,2%. Na AIJ, o consumo excessivo de energia, proteina e lipidios foi de 12,5, 75 e 31,3%, respectivamente. No LES, o consumo excessivo de energia, proteina e lipidios foi de 13,6, 86,4 e 36,4%, respectivamente. Consumo deficiente de ferro, zinco e vitamina A foi observado em 29,2 e 50, 87,5 e 86,4 e 87,5 e 95,2% dos pacientes com AIJ e LES, respectivamente. Nao houve relacao significante entre consumo, atividade da doenca e estado nutricional. CONCLUSAO: Pacientes com doencas reumaticas apresentam inadequacao do consumo alimentar. Ressaltamos a ingestao excessiva de lipidios e proteinas e a ingestao insuficiente de micronutrientes.

Physical activity in adolescents

Abstract: publish an article entitled “Prevalence of physical inactivity and associated factors among high school students from state’s public schools.” This topic is very important because physical activity has important health benefits in youth. Physical inactivity is associated with a clustering of cardiovascular disease (CVD) risk factors in youth, i.e., the levels of many CVD risk factors tend to increase simultaneously.

Diarrhea mortality: what can the world learn from Brazil?

Abstract: 11. Greenough A, Milner AD, Dimitriou G. Synchronized mechanical ventilation for respiratory support in newborn infants . Cochrane Database Syst Rev. 2004;(3):CD000456. Correspondence: Professor Anne Greenough Regional Neonatal Intensive Care Centre 4th Floor Golden Jubilee Wing King’s College Hospital, Denmark Hill London, SE5 9RS, United Kingdom Tel.: +44 (20) 3299.3037 Fax: +44 (20) 3299.8284 E-mail: anne.greenough@kcl.ac.uk

Traqueostomia na criança

Abstract: OBJETIVO: Apresentar revisao atualizada sobre a traqueostomia na idade pediatrica, com enfase nas indicacoes, tecnica cirurgica, complicacoes e manejo da traqueostomia a nivel hospitalar e domiciliar. FONTES DOS DADOS: Foram selecionados pelo site de busca medica (MEDLINE e PubMed) artigos originais e de revisao sobre traqueostomia na crianca, utilizando as seguintes palavras-chave: tracheostomy, tracheotomy, children, newborn. SiNTESE DOS DADOS: A indicacao de traqueostomia vem mudando progressivamente. No momento, ela e mais indicada na crianca em ventilacao mecânica prolongada. A faixa etaria mais comum do procedimento tambem mudou, sendo atualmente mais comumente realizada em criancas menores de 1 ano de idade. Exceto em situacoes de emergencia, a traqueostomia deve ser realizada em unidade cirurgica, com a crianca entubada. E preconizada a incisao transversa da pele e abertura longitudinal da traqueia, sem resseccao da mesma. Embora as complicacoes da traqueostomia na crianca nao sejam incomuns, elas, na maioria das vezes, nao necessitam de tratamentos sofisticados ou mesmo de intervencao cirurgica. Embora a mortalidade possa ocorrer em ate 40% das criancas traqueostomizadas, ela e diretamente relacionada a traqueostomia em apenas 0 a 6% das criancas. CONCLUSOES: A decisao de realizar traqueostomia na crianca continua complexa e dependente de varios fatores. O procedimento e seguro e com menores complicacoes quando realizado em hospital terciario de referencia e por equipe treinada e experiente.

Dietary supplement use by adolescents

Abstract: Objective: To review the use, benefits and adverse effects of the main dietary supplements consumed by adolescents. Sources: The literature review was performed using MEDLINE and LILACS databases (1997-2008). We analyzed 377 articles, and 52 of them were selected as references. Summary of the findings: Consumption of dietary supplements is widely spread among adolescents. This habit has often been detected in pediatric and adolescent medicine clinics. Most of the time, the use of supplements is motivated by the search of the “ideal body.” Other reasons for this practice are: attempt to compensate for an inadequate diet, increase immunity, prevent diseases, improve athletic performance and overcome their own athletic limits. The dietary supplements most frequently used and for which there is little evidence of beneficial effects in healthy adolescents are: proteins, amino acids, beta-hydroxy-beta-methylbutyrate, microelements, carnitine, creatine, vitamins, caffeine, and bicarbonate. This dietary supplementation may be beneficial for competitive athletes who do not have a balanced diet after a specific dietary deficiency has been detected. Conclusion: The unrestrained consumption of dietary supplements should be avoided, since, besides the lack of evidence that such practice will lead to improvement of performance, it exposes adolescents to several adverse effects. Balanced nutrition, with intake of essential energy and nutrients is usually enough to achieve good athletic performance. The use of dietary supplements must be allowed only for selected cases in which specific nutritional deficiencies are identified.