Showing papers in "Jornal De Pediatria in 2010"
TL;DR: Porem, ainda sao necessarios esforcos para que o Brasil atinja indices de AM compativeis com as recomendacoes da Organizacao Mundial da Saude.
Abstract: OBJETIVOS: Apresentar os indicadores de aleitamento materno (AM), obtidos na II Pesquisa de Prevalencia de Aleitamento Materno nas Capitais Brasileiras e Distrito Federal, bem como analisar sua evolucao no periodo de 1999 a 2008. METODOS: Pesquisa de corte transversal, envolvendo criancas menores de 1 ano de idade que participaram da segunda fase da campanha de multivacinacao de 2008. Foram utilizadas amostras por conglomerados, com sorteio em dois estagios. O questionario era composto por questoes fechadas, incluindo o consumo de leite materno, outros tipos de leite e outros alimentos no dia anterior a pesquisa. Foram analisadas as prevalencias de AM na primeira hora de vida; aleitamento materno exclusivo (AME) em menores de 6 meses; AM em criancas de 9 a 12 meses; e medianas do AME e AM. A variacao temporal do AM foi estabelecida por meio da comparacao das medianas do AME e AM em 1999 e 2008. RESULTADOS: Obtiveram-se dados de 34.366 criancas. Verificou-se que 67,7% (IC95% 66,7-68,8) mamaram na primeira hora de vida; a prevalencia do AME em criancas de 0 a 6 meses foi de 41% (IC95% 39,7-42,4), e do AM em criancas de 9 a 12 meses foi de 58,7% (IC95% 56,8-60,7). Houve aumento de 30,7 dias na duracao mediana do AME e de 45,7 dias na mediana do AM. CONCLUSAO: Houve melhora significativa da situacao do AM na ultima decada. Porem, ainda sao necessarios esforcos para que o Brasil atinja indices de AM compativeis com as recomendacoes da Organizacao Mundial da Saude.
130 citations
TL;DR: There was a significant improvement in the breastfeeding prevalence in the last decade, however, further efforts are required so that Brazil can reach BF rates compatible with the recommendations of the World Health Organization.
Abstract: OBJECTIVES: To present the breastfeeding (BF) indicators obtained in the Second Survey on Prevalence of Breastfeeding in the Brazilian Capitals and the Federal District and to analyze their evolution from 1999 to 2008 METHODS: A cross-sectional study was conducted in children younger than 1 year old who participated in the second phase of the multivaccination campaign in 2008 We used two-stage cluster sampling The questionnaire consisted of closed questions, including data on consumption of breast milk, other types of milk, and other foods on the day prior to the survey We analyzed the prevalence of BF in the first hour of life; exclusive BF in children younger than 6 months; BF in children aged 9 to 12 months; and medians of exclusive BF and BF The time variation of BF was established by comparing the medians of exclusive BF and BF in 1999 and 2008 RESULTS: We obtained data from 34,366 children We found that 677% (95%CI 667-688) of the children were breastfed in the first hour of life; the prevalence of exclusive BF in children aged 0 to 6 months was 41% (95%CI 397-424), while the prevalence of BF in children aged 9 to 12 months was 587% (95%CI 568-607) There was an increase of 307 days in the median duration of exclusive BF and 457 days in the median of BF CONCLUSION: There was a significant improvement in the breastfeeding prevalence in the last decade However, further efforts are required so that Brazil can reach BF rates compatible with the recommendations of the World Health Organization
119 citations
TL;DR: The present study showed a high frequency of inappropriate feeding practices and dietary intake in very young infants, which may lead to an increased risk of development of chronic diseases in the future.
Abstract: Objective: To assess feeding practices and dietary intake of healthy infants in three Brazilian municipalities Methods: By means of a prospective study, we analyzed the food record of 7 consecutive days of an intentional sample (quota and weighted sampling) of 179 healthy infants, aged between 4 and 12 months, from the municipalities of Curitiba, Sao Paulo, and Recife, who were not being exclusively breastfed Mothers received oral and written information provided by a nutritionist with the purpose of standardizing the feeding data The computer program NutWin was used to calculate the dietary intake Results: The median of the infants’ age was 68 months (40-126 months) We found that 503% of the infants were no longer being exclusively breastfed Of these, 120 and 67% among the infants younger and older than 6 months, respectively, were fed with infant formulae instead of breast milk Therefore, most infants received whole cow’s milk Infant formula dilution was correct in only 238 and 347% of the infants younger and older than 6 months old, respectively With regards to complementary feeding, we found that the median age was 4 months for its introduction and 55 months for the introduction of family diet There was high quantitative inappropriateness of micronutrient intake for infants between 6 and 12 months old who were not exclusively breastfed, mainly in terms of zinc (75%) and iron (45%)
97 citations
TL;DR: The near miss concept and indicators provided information that could be useful to evaluate the quality of care and set priorities for further assessments and health care improvement for newborn infants.
Abstract: OBJECTIVES: To explore the use of the neonatal near miss concept as a tool to evaluate the quality of neonatal care as 3 million early neonatal deaths occur every year around the world and the majority of these deaths are avoidable and take place in developing countries METHODS: This is a secondary analysis of the 2005 WHO Global Survey on Maternal and Perinatal Health a cross-sectional study using data from 19 randomly selected Brazilian hospitals A pragmatic definition of neonatal near miss was developed and tested Near miss indicators were calculated RESULTS: Among the 15169 live born infants included in this analysis 424 presented at least one of the following conditions: very low birth weight less than 30 gestational weeks at birth or an Apgar score at the 5th minute of life less than 7 According to the operational definition these survivors from life-threatening conditions were considered neonatal near miss cases The early neonatal mortality rate was 82/1000 live births the neonatal near miss rate was 214 neonatal near miss cases/1000 live births Substantial variations in the mortality among neonates with life-threatening conditions at birth were observed suggesting intra-hospital quality of care issues CONCLUSION: The near miss concept and indicators provided information that could be useful to evaluate the quality of care and set priorities for further assessments and health care improvement for newborn infants
84 citations
TL;DR: Even with a carefully controlled newborn screening program, the probability of SS children dying was still found to be high and educational campaigns directed at health professionals and SCD patients' families should be boosted in order to decrease SCD mortality.
Abstract: Objective: To describe the deaths of children with sickle cell disease (SCD) in Minas Gerais, Brazil, and followed
80 citations
TL;DR: Verificou-se elevada inadequacao quantitativa na ingestao de micronutrientes para lactentes de 6 a 12 meses that nao recebiam AM, destacando-se as de zinco (75%) e ferro (45%).
Abstract: OBJETIVO: Avaliar as praticas e o consumo alimentar de lactentes saudaveis de tres metropoles do Brasil. METODOS: Por meio de estudo prospectivo, analisaram-se registros alimentares de 7 dias consecutivos de amostra intencional, por cotas e ponderada, das cidades de Curitiba, Sao Paulo e Recife, de 179 lactentes saudaveis, entre 4 e 12 meses, que nao se encontravam em aleitamento materno (AM) exclusivo. As maes receberam orientacao verbal e escrita, por nutricionista, visando a uniformizacao da anotacao do registro alimentar. Para o calculo de ingestao, utilizou-se o Programa de Apoio a Nutricao (NutWin). RESULTADOS: A mediana de idade dos lactentes foi de 6,8 meses (4,0-12,6 meses). Observou-se que 50,3% ja nao recebiam AM. Destes, 12,0 e 6,7% dos menores e maiores de 6 meses, respectivamente, utilizavam formulas infantis em substituicao ao leite materno. A maioria dos lactentes, portanto, recebia leite de vaca integral. A diluicao da formula infantil foi correta em apenas 23,8 e 34,7% das criancas menores e maiores de 6 meses, respectivamente. Em relacao a alimentacao complementar, observou-se que a mediana de idade foi de 4 meses para sua introducao e de 5,5 meses para a alimentacao da familia. Verificou-se elevada inadequacao quantitativa na ingestao de micronutrientes para lactentes de 6 a 12 meses que nao recebiam AM, destacando-se as de zinco (75%) e ferro (45%). CONCLUSAO: O presente estudo mostrou elevada frequencia de praticas e consumo alimentar inadequados em lactentes muito jovens. E possivel que essas praticas levem a aumento no risco de desenvolvimento futuro de doencas cronicas.
72 citations
TL;DR: Implementing programs designed to effect lifestyle changes to achieve physical fitness and healthy nutrition in these schools would meet the objectives of promoting healthy body weight and increased physical fitness among these schoolchildren.
Abstract: Objective: To analyze associations between health-related physical fitness and the anthropometric and demographic indicators of children from three elementary schools in Botucatu, SP, Brazil Methods: The sample for this cross-sectional study was composed of 988 students, recruited from the second to ninth grades (an age range of 7 to 15 years) The children underwent anthropometric assessment (weight, height, waist circumference and tricipital and subscapular skin folds) and were tested for health-related physical fitness (flexibility: sit and reach test; abdominal strength/resistance: 1-minute abdominal test; and aerobic resistance: 9-minute running/walking test) Data were analyzed using descriptive statistics plus Student’s t test, the chi-square test or Fisher’s exact test and logistic regression with a significance level of 5% Results: The physical fitness levels observed were significantly influenced by age (all levels), sex (abdominal strength/resistance), obesity (all levels), body adiposity (flexibility, abdominal strength/resistance) and abdominal adiposity (abdominal strength/resistance and aerobic resistance) Females were more prone to be unfit in abdominal strength/resistance Both obesity and excessive abdominal adiposity predisposed children to be unfit in abdominal strength/resistance and aerobic resistance Excess body adiposity increased the likelihood of poor trunk flexibility Conclusions: Unhealthy physical fitness levels were related to female sex, obesity and excessive abdominal adiposity Implementing programs designed to effect lifestyle changes to achieve physical fitness and healthy nutrition in these schools would meet the objectives of promoting healthy body weight and increased physical fitness among these schoolchildren
70 citations
60 citations
TL;DR: Mesmo em um programa de triagem neonatal com rigoroso controle do tratamento, a probabilidade of obito em criancas com genotipo SS ainda e elevada indicam dificuldades no reconhecimento da DF e das suas complicacoes.
Abstract: OBJETIVO: Caracterizar os obitos das criancas com doenca falciforme (DF) triadas no estado de Minas Gerais e acompanhadas na Fundacao Hemominas. METODOS: Coorte de criancas diagnosticadas pelo Programa de Triagem Neonatal de Minas Gerais (marco/1998 - fevereiro/2005). Os obitos foram identificados pela busca ativa das criancas ausentes nas consultas agendadas nos hemocentros. Dados clinicos e epidemiologicos foram coletados dos documentos de obito, banco de dados da triagem neonatal, prontuarios medicos e em entrevistas com as familias. RESULTADOS: Foram triadas 1.833.030 criancas no periodo, sendo 1.396 com DF (1:1.300). Ocorreram 78 obitos: 63 em criancas com genotipo SS, 12 em criancas com genotipo SC e tres em criancas com genotipo S/β+ talassemia. Cinquenta e seis criancas (71,8%) morreram antes dos 2 anos de idade; 59 morreram em hospitais e 18 no domicilio ou trânsito. Causas de obito pelo atestado (n = 78): 38,5% infeccao; 16,6% sequestro esplenico agudo; 9% outras causas; 15,4% sem assistencia medica; e 20,5% indeterminada. Segundo as entrevistas (n = 52), o sequestro esplenico foi responsavel por quase 1/3 dos obitos, contrastando com a porcentagem de apenas 14% registrada nos atestados de obito. As probabilidades de sobrevida aos 5 anos (erro padrao da media) para criancas SS, SC e Sβ+ talassemia foram: 89,4 (1,4), 97,7 (0,7) e 94,7% (3,0), respectivamente (SS versus SC, p < 0,0001). CONCLUSOES: Mesmo em um programa de triagem neonatal com rigoroso controle do tratamento, a probabilidade de obito em criancas com genotipo SS ainda e elevada. Os obitos com causa indeterminada indicam dificuldades no reconhecimento da DF e das suas complicacoes. Esforcos educativos dirigidos a profissionais da saude e familiares devem ser incrementados para diminuir a mortalidade pela DF.
59 citations
TL;DR: The growth in body weight, height, and BMI of children and adolescents in the urban area of Brazil is increasingly similar to those reported in developed countries.
Abstract: Objective: To compare the growth of Brazilian children and adolescents with reference growth charts Methods: School-based cross-sectional study involving 41,654 students (23,328 boys and 18,326 girls) aged 7 to 17 years Physical growth variables (body weight, height) and body mass index (BMI) were measured Height, 50th percentile, and BMI, 85th percentile, were compared with the World Health Organization (WHO) reference values, and weight, 50th percentile, was compared with the Centers for Disease Control and Prevention (CDC) growth charts Results: Mean height and body weight of Brazilian schoolchildren were generally higher than the WHO and CDC reference values for both genders at most ages BMI values of Brazilian schoolchildren were significantly lower than the WHO obesity values at all ages Conclusion: The growth in body weight, height, and BMI of children and adolescents in the urban area of Brazil is increasingly similar to those reported in developed countries Further prospective studies should be conducted in Brazil comparing their results with the international growth charts to enable more accurate inferences
55 citations
TL;DR: Children and adolescents with MPAA subjected to a swim training program experienced a significant decrease in bronchial hyperresponsiveness, as determined by increased PC₂₀ values, when compared with asthmatic controls who did not undergo swim training.
Abstract: Objective: To investigate the medium-term benefits of a swimming program in schoolchildren and adolescents with moderate persistent atopic asthma (MPAA) Methods: A randomized, prospective study of children and adolescents (age 7-18 years) with MPAA was carried out at the Hospital de Clinicas of Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil After a 1-month run-in period, 61 patients (34 female) were randomized into two groups, a swimming group (n = 30) and a control group (n = 31), and followed for 3 months Both patient groups received inhaled fluticasone (dry powder, 250 mcg twice a day) and salbutamol as needed The swim training program consisted of two weekly classes over a 3-month period for a total of 24 sessions Both groups underwent spirometric assessment and methacholine challenge test – provocative concentration of methacholine causing a 20% fall in FEV1 (PC20) – before and after the study period Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were measured only in the swimming group Results: Significant increases in PC 20 (pre-training, 031±025; post-training, 063±078; p = 0008), MIP (pre-training, 6708±1713 cm H2O; post-training 7946±1866; p < 0001), and MEP (pre-training, 7169±2001 cm H2O; post-training, 7892±2145 cm H2O; p < 0001) were found in the swimming group Conclusion: Children and adolescents with MPAA subjected to a swim training program experienced a significant decrease in bronchial hyperresponsiveness, as determined by increased PC20 values, when compared with asthmatic controls who did not undergo swim training Participants in the swimming group also showed improvement in elastic recoil of the chest wall
TL;DR: It is possible that systematic neonatal screening in areas with high prevalence of infection may identify cases of congenital toxoplasmosis from an immunocompetent mother with chronic infection who had reactivation of ocular disease during pregnancy.
Abstract: Objective: To report a rare case of congenital toxoplasmosis from an immunocompetent mother with chronic infection who had reactivation of ocular disease during pregnancy. Description: The newborn was asymptomatic at birth and identified by neonatal screening (IgM anti- Toxoplasma gondii in dried blood) among other 190 infants with congenital toxoplasmosis during a 7-month period. His mother had had a non-treated episode of reactivation of toxoplasmic retinochoroiditis during pregnancy, with stable IgG titers and negative IgM results. Results of IgM and IgG in the newborn’s serum, as well as IgG immunoblotting were positive and active retinochoroidal lesions were detected in his peripheral retina. The neonate was treated with sulfadiazine, pyrimethamine and folinic acid. At 14 months of life, the child remained asymptomatic, with regression of retinochoroidal lesions and persistence of IgG. Comments: It is possible that systematic neonatal screening in areas with high prevalence of infection may identify these cases.
TL;DR: Measures to prevent early discontinuation of exclusive breastfeeding must focus on women without breastfeeding experience and include prevention of nipple trauma, encourage breastfeeding on demand, and discourage the use of pacifiers.
Abstract: Objective: To investigate factors associated with discontinuation of exclusive breastfeeding in the first month of lactation, in the city of Feira de Santana, Brazil Methods: Cohort study with follow-up of 1,309 mother-child pairs selected from all maternities in the municipality Data were collected in hospital and in home visits during the first month of life Logistic regression analysis was used to examine the relationship between outcome and variables of interest Results: Lack of prior breastfeeding experience (PR 124; 95%CI 175-143), cracked nipples (PR 125; 95%CI 109-143), use of fixed breastfeeding schedules (PR 142; 95%CI 109-184) and pacifier use (PR 153; 95%CI 134-176) were identified as factors predicting discontinuation of ex clusive breastfeeding Conclusions: Measures to prevent early discontinuation of exclusive breastfeeding must focus on women without breastfeeding experience and include prevention of nipple trauma, encourage breastfeeding on demand, and discourage the use of pacifiers
TL;DR: In this article, a coorte com 1.309 duplas maes-bebes selecionadas in todas as maternidades do municipality of Feira de Santana, Brazil, was coletado no hospital and domicilio ao final do primeiro mes de lactacao.
Abstract: OBJETIVO: Averiguar os fatores associados a interrupcao do aleitamento materno exclusivo no primeiro mes de lactacao na cidade de Feira de Santana, BA. METODOS: Estudo de coorte com 1.309 duplas maes-bebes selecionadas em todas as maternidades do municipio. Os dados foram coletados no hospital e domicilio ao final do primeiro mes. A associacao entre desfecho e variaveis de interesse foi avaliada por meio de regressao logistica. RESULTADOS: Falta de experiencia previa com amamentacao (razao de prevalencia 1,24; IC95% 1,75-1,43), presenca de fissura mamilar (razao de prevalencia 1,25; IC95% 1,09-1,43), horarios pre-determinados para amamentar (razao de prevalencia 1,42; IC95% 1,09-1,84) e uso de chupeta (razao de prevalencia 1,53; IC95% 1,34-1,76) foram identificados como fatores preditivos da interrupcao do aleitamento exclusivo. CONCLUSOES: Medidas de prevencao da interrupcao do aleitamento exclusivo devem priorizar mulheres sem experiencia com amamentacao e contemplar prevencao de traumas mamilares, incentivo a pratica do aleitamento em livre demanda e desestimulo ao uso de chupeta.
TL;DR: In this paper, the authors investigate associacao da desnutricao em criancas residentes em assentamentos subnormais (favelas) of Maceio (AL) with o estado nutricional materno and as condicoes socioambientais.
Abstract: OBJETIVO: Investigar a associacao da desnutricao em criancas residentes em assentamentos subnormais (favelas) de Maceio (AL) com o estado nutricional materno e as condicoes socioambientais. METODOS: Estudo transversal, envolvendo amostra probabilistica de 2.075 maes (18 a 45 anos) e respectivos filhos (4 meses a 6 anos), moradoras nas favelas da cidade de Maceio (AL). Para escolha dos assentamentos, procedeu-se primeiramente a uma analise de clusters para eleger a regiao administrativa da cidade de Maceio com menor indice de desenvolvimento humano. Apos essa analise, a 7a Regiao Administrativa foi a designada para o estudo, com seus 23 assentamentos subnormais. Os dados socioeconomicos, demograficos, antropometricos e de saude materno-infantil foram coletados atraves de inquerito domiciliar. A estatistica analisou a razao de chances de uma crianca ser desnutrida, e a regressao univariada foi usada para verificar quais variaveis maternas estariam associadas a essa desnutricao. RESULTADOS: A desnutricao cronica (-2 desvios padrao/altura por idade) esteve presente em 8,6% das criancas e associou-se com idade e escolaridade materna, tipo de residencia, numero de comodos, revestimento de piso, origem da agua e baixo peso ao nascer (< 2.500 g) em criancas com idade < 24 meses. Encontrou-se tambem associacao entre desnutricao infantil e baixa estatura materna, que nao foi observada para indice de massa corporal. CONCLUSOES: A alta prevalencia de desnutricao infantil observada nesses assentamentos esteve relacionada as condicoes socioambientais e a baixa estatura das maes, que apresentaram deficit ou excesso de peso.
TL;DR: The criteria for classifying metabolic syndrome in children need to be standardized in order to identify those people at greatest risk of future complications, and the points on which they differ and the debate about them are presented.
Abstract: OBJECTIVE: To present the components of the metabolic syndrome in children and adolescents and to discuss how they are assessed in the pediatric population in addition to presenting the major metabolic syndrome classifications for the age group. SOURCES: A review of literature published from 1986 to 2008 and found on MEDLINE databases. SUMMARY OF THE FINDINGS: The prevalence of childhood obesity has been increasing globally over recent decades and as a result its complications, such as diabetes mellitus, arterial hypertension and dyslipidemia, have also increased. The concept of metabolic syndrome, already common with adults, is now beginning to be applied to children through classifications using the criteria for adults modified for the younger age group. Notwithstanding, these classifications differ in terms of the cutoff points used and whether they employ body mass index or waist circumference to define obesity. The review presents these classifications, highlighting the points on which they differ and the debate about them. CONCLUSIONS: If childhood obesity goes untreated, it will have severe consequences in the future. A number of models for classifying metabolic syndrome in children have been published, but there is considerable diversions between them. The criteria for classifying metabolic syndrome in children therefore need to be standardized in order to identify those people at greatest risk of future complications.
TL;DR: The concept of near miss neonatal has been used as uma ferramenta for avaliacao da qualidade do atendimento neonatal, e 3 milhoes of obitos neonatais precoces ocorrem a cada ano em todo o world.
Abstract: OBJETIVOS: Explorar o uso do conceito de near miss neonatal como uma ferramenta para a avaliacao da qualidade do atendimento neonatal, ja que 3 milhoes de obitos neonatais precoces ocorrem a cada ano em todo o mundo A maioria desses obitos e evitavel e ocorre em paises em desenvolvimento METODOS: Esta e uma analise secundaria do 2005 WHO Global Survey on Maternal and Perinatal Health, um estudo transversal Nossa analise incluiu dados de 19 hospitais brasileiros selecionados aleatoriamente Uma definicao pragmatica de near miss neonatal foi desenvolvida e testada Os indicadores de near miss foram calculados RESULTADOS: Entre os 15169 nascidos vivos incluidos nesta analise, 424 apresentaram pelo menos uma das seguintes condicoes: muito baixo peso ao nascer, menos de 30 semanas de gestacao ao nascer ou escore de Apgar aos 5 minutos de vida menor que 7 De acordo com a definicao operacional, esses sobreviventes de condicoes com risco de vida foram considerados casos de near miss A taxa de mortalidade neonatal precoce foi de 8,2/1000 nascidos vivos, e a taxa de near miss neonatal foi de 21,4 casos/1000 nascidos vivos Variacoes substanciais na mortalidade entre recem-nascidos com condicoes com risco de vida ao nascer foram observadas, o que sugere a existencia de questoes relacionadas a qualidade do atendimento intra-hospitalar CONCLUSAO: O conceito de near miss e os indicadores forneceram informacoes que poderiam ser uteis para avaliar a qualidade do atendimento e para estabelecer prioridades para outras avaliacoes e para a melhoria da atencao a saude dos recem-nascidos
TL;DR: Prevalence of dyslipidemia and, therefore, risk for cardiovascular diseases were high during the use of highly active antiretroviral therapy.
Abstract: OBJECTIVE: To describe lipid profile body shape changes and cardiovascular risk factors in children and adolescents infected with HIV/AIDS receiving highly active antiretroviral therapy METHODS: We investigated 43 children and adolescents being treated with this therapy at the outpatient clinic of pediatric infectious diseases of Instituto Fernandes Figueira/Fundacao Oswaldo Cruz Rio de Janeiro Brazil Values of total cholesterol high-density lipoprotein low-density lipoprotein and triglycerides were determined We also performed glucose tolerance test and analyzed body fat distribution nutritional status dietary intake and family history of cardiovascular risk The statistical analysis was performed using Students t test Significance level of p-value was lower than 005 RESULTS: We found lipid abnormality in 883% and body shape change in 139% of the cases Nutritional status was adequate (813%) in most of the study population Cholesterol intake in children older than 9 years was above the recommended value CONCLUSION: Prevalence of dyslipidemia and therefore risk for cardiovascular diseases were high during the use of highly active antiretroviral therapy
TL;DR: In this article, a cross-sectional study involving 41,654 students (23,328 boys and 18,326 girls) aged 7 to 17 years was conducted to compare the growth of Brazilian children and adolescents with reference growth charts.
Abstract: OBJECTIVE: To compare the growth of Brazilian children and adolescents with reference growth charts. METHODS: School-based cross-sectional study involving 41,654 students (23,328 boys and 18,326 girls) aged 7 to 17 years. Physical growth variables (body weight, height) and body mass index (BMI) were measured. Height, 50th percentile, and BMI, 85th percentile, were compared with the World Health Organization (WHO) reference values, and weight, 50th percentile, was compared with the Centers for Disease Control and Prevention (CDC) growth charts. RESULTS: Mean height and body weight of Brazilian schoolchildren were generally higher than the WHO and CDC reference values for both genders at most ages. BMI values of Brazilian schoolchildren were significantly lower than the WHO obesity values at all ages. CONCLUSION: The growth in body weight, height, and BMI of children and adolescents in the urban area of Brazil is increasingly similar to those reported in developed countries. Further prospective studies should be conducted in Brazil comparing their results with the international growth charts to enable more accurate inferences.
TL;DR: In this paper, the authors evaluate the impact of a metodo canguru on aleitamento materno exclusivo on 6 primeiros meses of vida of bebes de baixo peso.
Abstract: OBJETIVO: Avaliar o impacto do metodo canguru sobre o aleitamento materno exclusivo nos 6 primeiros meses de vida em recem-nascidos de baixo peso. METODOS: Estudo prospectivo realizado com 43 bebes (23 do grupo canguru e 20 do grupo-controle) com peso < 2.000 g e permanencia na unidade neonatal por pelo menos 7 dias. Os grupos foram comparados quanto a frequencia da amamentacao exclusiva ate o sexto mes de vida, utilizando-se o teste do qui-quadrado, adotando-se nivel de significância de 0,05. RESULTADOS: A amamentacao exclusiva foi superior no grupo canguru a alta (82,6 versus 0%; p = 0,00), as 40 semanas de idade gestacional (73,9 versus 31,6%; p = 0,01), aos 3 meses (43,5 versus 5,0%; p = 0,005) e aos 6 meses (22,7 versus 5,9%; p = 0,20) de vida. CONCLUSAO: O metodo canguru foi facilitador da amamentacao exclusiva para bebes de baixo peso ate o sexto mes de vida.
TL;DR: The high prevalence of malnutrition observed in children living in substandard settlements of Maceió, Brazil was related to social and environmental conditions and short maternal height, who had weight deficit or weight excess.
Abstract: Objective: To investigate the association of malnutrition in children living in substandard settlements (favelas) of Maceio, Brazil, with maternal nutritional status and environmental conditions. Methods: Cross-sectional study involving a probability sample of 2,075 mothers (18 to 45 years) and their children (4 months to 6 years), living in the favelas of the city of Maceio. First, we conducted a cluster analysis with the purpose of choosing the settlements and the administrative region of the city of Maceio with the lowest human development index). After this analysis, the 7th Administrative Region was designated for the study, including its 23 substandard settlements. Socioeconomic, demographic, anthropometric, and maternal and child health data were collected by means of household survey. The statistical analysis included the odds ratio of a child to be malnourished, and the univariate regression was used to check which maternal variables were associated with this malnutrition. Results: Chronic malnutrition (-2 standard deviations/height for age) was found in 8.6% of children and was associated with mother’s age and educational level, type of residence, number of rooms, flooring, water supply, and low birth weight (< 2,500 g) in children aged ≤ 24 months. We also found an association between child malnutrition and maternal height. Such association was not observed regarding body mass index. Conclusions: The high prevalence of malnutrition observed in these settlements was related to social and environmental conditions and short maternal height, who had weight deficit or weight excess.
TL;DR: The history of infant nutrition has always been determined and conditioned by the social value attributed to breastfeeding, and exclusive breastfeeding is recommended up to 6 months, to be supplemented with other foods from this age on and continued until at least 2 years of age.
Abstract: Objective To retrace the history of infant nutrition with the objective of better understanding breastfeeding Sources of data Bibliographic searches were run on MEDLINE, LILACS, SciELO, and the Internet Encyclopedias, scientific textbooks and books for the general public, in addition to literature, art and history, were also used Texts on child care from several different periods were consulted, in addition to the history of medicine and recent scientific articles on infant nutrition Summary of the findings During the preindustrial period, customs varied little and the likelihood of survival was linked to breastfeeding or its substitution by a wetnurse's milk Where this was not possible, infants were given animal milk, pre-chewed foods or paps that were poor in nutrients and contaminated, which caused high mortality rates There was nothing that could successfully substitute breastfeeding and the survival of the species was dependent on breastfeeding Once the industrial revolution had started, women who had been accustomed to breastfeeding went to work in factories, stimulating the search for alternative infant nutrition Consumption of animal milk and formulae (diluted, flour-based, powdered milk) and premature introduction of complementary foods compromised children's health The feminist movement and the contraceptive pill caused a fall in birth rates Manufacturers in search of profits developed modified formulae and invested in advertising Society reacted with breastfeeding support movements Conclusions Nowadays, the advantages of breastmilk are recognized and exclusive breastfeeding is recommended up to 6 months, to be supplemented with other foods from this age on and continued until at least 2 years of age Infant nutrition, whether natural or artificial, has always been determined and conditioned by the social value attributed to breastfeeding
TL;DR: This study has identified the behavioral characteristics of bullying victims which may prove useful for local policies designed to protect the targets of bullying.
Abstract: OBJECTIVE: To describe the prevalence of bullying victims, the characteristics of those victims and their associated symptoms in the domains of emotion, behavior, hyperactivity and peer relationships. METHOD: This was a cross-sectional study nested in a cohort that assesses disorders of reading, writing and arithmetic in 1075 students enrolled in the first to eighth grades of two public schools in a lower-middle-class neighborhood of the city of Pelotas, RS, Brazil. The KIDSCAPE questionnaire was used to evaluate the prevalence of bullying and the Strengths and Difficulties Questionnaire was used to assess victims' behavioral characteristics. RESULTS: The prevalence of bullying was 17.6%. The most prevalent type of intimidation was verbal, followed by physical, emotional, racial and sexual. After adjustment for confounding factors, bullying was still associated with male sex (PR 1.49 95%CI 1.14; 1.96), hyperactivity (PR 1.89 95%CI 1.25; 2.87) and peer relationship problems (PR 1.85 95%CI 1.24; 2.76). Among the victims of bullying, 47.1% had also initiated bullying. CONCLUSION: This study has identified the behavioral characteristics of bullying victims which may prove useful for local policies designed to protect the targets of bullying. Language: en
TL;DR: During the preoperative period, children who participate in playful activities in the recreation room have their anxiety reduced in comparison with those that only stay in the preoperatively holding area for at least 15 minutes.
Abstract: Objective: To verify the influence of playful activities during the preoperative period on the anxiety of children participating in the therapeutic recreation project conducted at the outpatient surgical center of Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Brazil. Methods: The modified Yale Preoperative Anxiety Scale (mYPAS) was administered to 50 children between 5 and 12 years of age undergoing medical procedures at the outpatient surgical center. The children were divided in two groups: recreation group (individuals who participated in playful interventions in the recreation room) and control group (individuals who did not participate in playful interventions). Anxiety was measured using the mYPAS at two different moments: soon after the individuals arrived at the outpatient surgical center (minute 0) and 15 minutes after the first measurement. Results: The results showed that soon after arriving at the outpatient surgical center, the patients did not have significant differences regarding anxiety, showing high values. However, after 15 minutes waiting or undergoing intervention, the children in the recreation group had reduced anxiety levels and those in the control group remained anxious. Conclusions: During the preoperative period, children who participate in playful activities in the recreation room have their anxiety reduced in comparison with those that only stay in the preoperative holding area for at least 15 minutes.
TL;DR: Lack of knowledge of the toxic action of agents stored in households is not a risk factor for childhood poisoning and the elimination of other factors, such as distraction and storage below 150 cm, would lead to the prevention of 13 and 19% of poisonings in childhood, respectively.
Abstract: OBJECTIVE: To investigate whether the lack of knowledge of toxic agents in households is a risk factor for individual unintentional childhood poisoning. METHODS: The case group (n = 25) was composed of caregivers of children under 60 months of age who underwent accidental oral poisoning and were treated at two reference hospitals in Porto Alegre, southern Brazil, and recorded in the Toxicology Information Center database. The control group (n = 25) was composed of caregivers of children matched for sex, age, and presence in their homes of the same toxic agents found in the case group, who sought emergency medical care at the same hospitals, but for other reasons. A structured questionnaire was administered to verify the following questions: sociodemographic data, clinical history, behavioral antecedents of caregivers, storage of toxic agents, history of previous poisoning accidents. RESULTS: The children's mean age was 31.8 months (±0.97) and mean height was 93 cm (±11). Families, in both groups, were aware of the toxic action of agents available in their homes; however, caregivers in the control group were twice as likely to have such knowledge compared to the case group. Distraction was 15 times more likely to occur among caregivers of children who underwent poisoning compared to the control group. Storage of toxic agents below 150 cm was approximately 17 times more likely to occur in the group of children who underwent poisoning compared to children in the control group. CONCLUSIONS: Lack of knowledge of the toxic action of agents stored in households is not a risk factor for childhood poisoning. The attributable risks described in this study indicated that the elimination of other factors, such as distraction and storage below 150 cm, would lead to the prevention of 13 and 19% of poisonings in childhood, respectively. Language: en
TL;DR: The high prevalence of intestinal parasitosis matched the elevated rates of environmental contamination in this indigenous community.
Abstract: OBJECTIVE: To evaluate the prevalence of intestinal parasitoses in Native Brazilian children from 2 to 9 years old METHODS: A search for ova and parasites was conducted in the stools of children between 2 to 9 years old living in six indigenous villages located in the Middle and Lower Xingu River, to wit: Pavuru, Moygu, Tuiarare, Diauarum, Capivara, and Ngojwere The study utilized the Paratest kit® (Diagnostek, Brazil) to preserve collected stools Fecal samples were shipped to the Laboratory of the Pediatric Gastroenterology Division of the UNIFESP/EPM, in Sao Paulo, for analysis The search for ova and parasites was performed utilizing the Hoffman method, and later through optical microscopic evaluation Fecal samples were collected one year apart from each other RESULTS: There were no significant statistical differences between the mean ages of the children from the six indigenous villages studied The search for ova and parasites found positive results for the stools of 975% (198/202) and 961% (98/102) of children in the first and second collections, respectively There was no statistical association with the children's age The search performed one year later found no differences in the proportion of parasites identified in the first collection for protozoa (933% in 2007 versus 933% in 2008, McNemar = 001, p = 01) or for helminths (371% in 2007 versus 382% in 2008, McNemar = 003, p = 085) There were significant differences in prevalence of Entamoeba coli between 2007 (438%) and 2008 (618%) (McNemar Chi 61; p = 00135) There were no significant differences for other parasites when comparing the results of the two studies CONCLUSION: The high prevalence of intestinal parasitosis matched the elevated rates of environmental contamination in this indigenous community
TL;DR: In this article, the authors examined the association between wheezing in children and adolescents and living downwind of the dispersion plume of atmospheric pollutants emitted by the Guamare Petrochemical Complex, in the state of Rio Grande do Norte, Brazil.
Abstract: Objective: To examine the association between wheezing in children and adolescents and living downwind of the dispersion plume of atmospheric pollutants emitted by the Guamare Petrochemical Complex, in the state of Rio Grande do Norte, Brazil Methods: Cross-sectional study of wheezing in children and adolescents (aged 0 to 14 years) living in the vicinity of the Guamare petrochemical complex in 2006 The standardized International Study of Asthma and Allergies in Childhood questionnaire was used, with additional questions concerning tobacco use, income, living conditions, and educational achievement Daily concentrations of PM 10 , PM 25 , black carbon, SO 2 , NO 2 , O 3 , benzene, toluene, and xylenes were measured at a fixed monitoring station According to their position relative to wind direction, communities present in the area affected by plant emissions were categorized into one of two groups, exposed communities and reference communities Results: Two hundred and nine children and adolescents took part in the study Mean daily concentrations of the monitored pollutants were consistently below established acceptable upper limits The prevalence of wheezing in the 12 months prior to study was 273% After adjustment, statistically significant associations were found between wheezing and living in exposed communities (adjusted odds ratio [ORadj] 201; 95% confidence interval [95%CI] 101-401), male gender (ORadj 250; 95%CI 121-518), and age 0 to 6 years (ORadj 500; 95%CI 241-1039) Conclusion: Even with low levels of atmospheric pollutants, respiratory symptoms in children and adolescents were associated with living downwind of a petrochemical plant Male preschoolers were the most vulnerable group
TL;DR: The high frequency of children who were not taken to the child health care service for follow- up is associated with low maternal educational level and family structure, as well as the perception that follow-up visits are not necessary when the child does not have a disease.
Abstract: OBJETIVO: Avaliar os fatores sociodemograficos associados a frequencia da utilizacao do servico de puericultura por familias de baixo nivel socioeconomico. METODOS: Analise transversal de 393 criancas, com idades entre 12 e 16 meses, que participaram de um ensaio de campo randomizado no primeiro ano de vida em um programa de intervencao nutricional. O estudo iniciou nos setores de atendimento do Sistema Unico de Saude da maternidade da cidade de Sao Leopoldo (RS). As criancas foram avaliadas quanto ao acompanhamento na puericultura e calendario de vacinacao. Para analise dos dados utilizou-se teste qui-quadrado de Pearson e razao de prevalencia (RP) com respectivo intervalo de confianca de 95% (IC95%). RESULTADOS: A frequencia de criancas que nao foram levadas regularmente foi de 53,2%. A analise multivariada sugere que os fatores associados a ausencia de utilizacao regular do servico foram: escolaridade materna < 8 anos (RP 1,32; IC95% 1,02-1,71), estrutura familiar nao nuclear (RP 1,32; IC95% 1,10-1,59) e nao ser filho unico (RP 1,38; IC95% 1,10-1,72). Os motivos relatados para o nao acompanhamento da crianca na puericultura foram: 66,2% consideraram desnecessario, 21,7% referiram insatisfacao com o servico, 6,05% impossibilidade devido ao emprego e 6,05% outros motivos. CONCLUSAO: A elevada frequencia de criancas que nao sao levadas para acompanhamento no servico de puericultura esta associada a baixa escolaridade materna e a estrutura familiar, alem da percepcao de que e desnecessario na ausencia de doenca da crianca.
TL;DR: Implementing programs designed to effect lifestyle changes to achieve physical fitness and healthy nutrition in these schools would meet the objectives of promoting healthy body weight and increased physical fitness among these schoolchildren.
Abstract: OBJETIVO: Analisar a associacao da aptidao fisica relacionada a saude com os indicadores demograficos e antropometricos de criancas de tres escolas do municipio de Botucatu (SP). METODOS: A amostra deste estudo transversal foi de 988 escolares do ensino fundamental, do 2o ao 9o ano (faixa etaria de 7 a 15 anos). As avaliacoes realizadas foram antropometricas (peso, estatura, circunferencia abdominal e dobras cutâneas tricipital e subescapular) e de aptidao fisica relacionada a saude (flexibilidade: teste de sentar e alcancar; forca/resistencia abdominal: teste abdominal em 1 minuto; e resistencia aerobia: teste de correr/andar por 9 minutos). Para a analise dos dados, utilizou-se estatistica descritiva, teste t de Student, qui-quadrado ou exato de Fisher e regressao logistica com nivel de significância de 5%. RESULTADOS: As aptidoes fisicas estudadas foram significativamente influenciadas por idade (todas), sexo (forca/resistencia abdominal), obesidade (todas), adiposidade corporea (flexibilidade, forca/resistencia abdominal) e adiposidade abdominal (forca/resistencia abdominal e resistencia aerobia). O sexo feminino mostrou-se mais propenso a inaptidao de forca/resistencia abdominal, enquanto que a obesidade e a hiperadiposidade abdominal predispoem os escolares a inaptidao de forca/resistencia abdominal e resistencia aerobia. O excesso de adiposidade corporea aumentou as chances de ocorrencia da flexibilidade do tronco fraca. CONCLUSOES: As inaptidoes fisicas foram relacionadas ao sexo feminino, a obesidade e a hiperadiposidade abdominal. Programas de mudanca do estilo de vida nas escolas, voltados a aptidao fisica e a adequacao alimentar, preencheriam os objetivos de promocao da eutrofia e da maior aptidao fisica desses escolares.
TL;DR: It is crucial to strengthen the health systems and improve the quality of care women and children receive, in particular during childbirth, to make progress in these goals.
Abstract: Reducing infant mortality and improving maternal health are the two of the eight Millennium Development Goals (MDG) set by the international community to promote development worldwide. It is crucial to strengthen the health systems and improve the quality of care women and children receive, in particular during childbirth, to make progress in these goals. Valid and reliable tools are needed to routinely assess quality of care and provide improvements accordingly.