Showing papers in "Jornal De Pediatria in 2011"

Effectiveness of school-based nutrition education interventions to prevent and reduce excessive weight gain in children and adolescents: a systematic review

Abstract: Objective: To evaluate the effectiveness of school-based nutrition education in reducing or preventing overweight and obesity in children and adolescents. Sources: Systematic search in 14 databases and five systematic reviews for randomized controlled trials conducted in schools to reduce or prevent overweight in children and adolescents. Body mass index and fruit and vegetable intake were used as primary and secondary measures of outcome, respectively. There was no restriction by date of publication or language, except for languages with structured logograms. We excluded studies on specific populations presenting eating disorders, dyslipidemia, diabetes, and physical or mental disabilities, as well as studies that used drugs or food supplements as components of the intervention. The assessment by title and abstract and the quality assessment were performed independently by two researchers. We used the Centre for Reviews and Dissemination’s guidance for undertaking reviews in health care and the software EPPI-Reviewer 3. Summary of the findings: From the initially retrieved 4,809 references, 24 articles met the inclusion criteria. The extracted data show that there is evidence of positive effects on anthropometry and of increase in fruit and vegetable consumption. Characteristics of the interventions that demonstrated effectiveness are: duration > 1 year, introduction into the regular activities of the school, parental involvement, introduction of nutrition education into the regular curriculum, and provision of fruits and vegetables by school food services. Conclusion: Interventions in schools to reduce overweight and obesity, as well as to increase fruits and vegetable consumption, have demonstrated effectiveness in the best-conducted studies.

Analysis of serum and supplemented vitamin C and oxidative stress in HIV-infected children and adolescents

Abstract: OBJECTIVES To assess adequacy of vitamin C intake in HIV-infected children and adolescents; to evaluate serum levels of vitamin C and indicators of oxidative stress; to compare with the uninfected group; to correlate serum vitamin C with oxidative stress and associate them according to the reference values METHODS Comparative cross-sectional study Two groups of 27 children and adolescents each, aged between 3 to 19 years Group 1 (G1) comprised individuals vertically infected with HIV seen at a regional outpatient clinic Group 2 (G2) comprised invited individuals without history of HIV infection The groups were matched for age, sex, and socioeconomic status The following variables were analyzed: body mass index for age; micronutrient intake and consumption; and serum vitamin C, C-reactive protein (CRP), and albumin RESULTS The mean age was 12 years old Most subjects were female (17, 63%), and there was prevalence of the economic class C (27, 50%) The most prevalent nutritional status was normal weight in 20 individuals (741%) in G1 and 21 (778%) in G2 The intake of vitamin C was significantly higher in G1 (p = 0006; t = 2987) according to the 24-hour dietary recall method There were significant differences in serum vitamin C concentration between the groups, with a lower level in G1 (p = 0000; t = -7309) In relation to oxidative stress, values of CRP in G1 were significantly higher (p = 0007; t = 2958) There was no association between deficiency of vitamin, CRP, and albumin CONCLUSION Our findings show that HIV-infected individuals have low levels of vitamin C; however, this deficiency is not related to eating habits, since the intake of this nutrient was higher in this group than in the control group HIV-infected individuals have specific characteristics that increase their oxidative stress, which is evidenced by increased CRP

Análise da vitamina C sérica e ingerida e estresse oxidativo em crianças e adolescentes infectados pelo vírus da imunodeficiência humana

Abstract: OBJECTIVES: To assess adequacy of vitamin C intake in HIV-infected children and adolescents; to evaluate serum levels of vitamin C and indicators of oxidative stress; to compare with the uninfected group; to correlate serum vitamin C with oxidative stress and associate them according to the reference values. METHODS: Comparative cross-sectional study. Two groups of 27 children and adolescents each, aged between 3 to 19 years. Group 1 (G1) comprised individuals vertically infected with HIV seen at a regional outpatient clinic. Group 2 (G2) comprised invited individuals without history of HIV infection. The groups were matched for age, sex, and socioeconomic status. The following variables were analyzed: body mass index for age; micronutrient intake and consumption; and serum vitamin C, C-reactive protein (CRP), and albumin. RESULTS: The mean age was 12 years old. Most subjects were female (17, 63%), and there was prevalence of the economic class C (27, 50%). The most prevalent nutritional status was normal weight in 20 individuals (74.1%) in G1 and 21 (77.8%) in G2. The intake of vitamin C was significantly higher in G1 (p = 0.006; t = 2.987) according to the 24-hour dietary recall method. There were significant differences in serum vitamin C concentration between the groups, with a lower level in G1 (p = 0.000; t = -7.309). In relation to oxidative stress, values of CRP in G1 were significantly higher (p = 0.007; t = 2.958). There was no association between deficiency of vitamin, CRP, and albumin. CONCLUSION: Our findings show that HIV-infected individuals have low levels of vitamin C; however, this deficiency is not related to eating habits, since the intake of this nutrient was higher in this group than in the control group. HIV-infected individuals have specific characteristics that increase their oxidative stress, which is evidenced by increased CRP.

Prevalência e características de escolares vítimas de 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 1,075 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.

Developmental outcomes and quality of life in children born preterm at preschool- and school-age

Abstract: Objective: To review literature published in the last 5 years on the effects of premature birth on the development and quality of life of preschool- and school-age children. Sources: Systematic review of empirical studies published in the last 5 years and indexed on PubMed, MEDLINE, LILACS, SciELO and PsycINFO. Keywords were chosen that relate prematurity to developmental and quality of life outcomes. Summary of the findings: In the studies chosen, four global indicators of development were identified (neurological, neurodevelopment, executive functions and quality of life), in addition to seven specific indicators of development (cognition, motor function, behavior, language, academic performance, attention and memory). The most prevalent indicators were cognition and motor function. Premature children had worse performance in all developmental indicators than children born full term. Additionally, the younger the gestational age, the worse the performance in developmental indicator assessments. The studies identified both risk factors (lower birth weight, intraventricular hemorrhage and low maternal educational level) and protective factors (larger head circumference, breastfeeding and higher family income) for development of children born preterm. Conclusion: Children born extremely premature (≤ 30 weeks’ gestational age) are vulnerable to developmental and quality of life problems.

Toxocariasis: visceral larva migrans in children

Abstract: Objectives To present a detailed investigation of risk factors, symptoms, and laboratory and imaging tests that may be useful to establish the clinical laboratory diagnosis of visceral larva migrans (VLM) in children, demonstrating the importance of diagnosis and treatment to prevent complications in the eyes, liver, and other organs Sources Literature review using the MEDLINE and LILACS (1952-2009) databases, selecting the most recent and representative articles on the topic Summary of the findings VLM is an infectious disease with non-specific clinical presentation, whose transmission is related to contact with dogs, especially puppies, and which may progress to late systemic complications in vital organs such as the eyes and the central nervous system IgG (ELISA) anti-T canis can be used to establish the laboratory diagnosis Higher cutoff points suggest recent illness and lower cutoff points demonstrate mild infection or infection in remission Therapeutic response may be assessed by means of eosinophil blood cell count The present article provides the pediatrician with updated information regarding VLM, a disease of high prevalence worldwide and in Brazil Conclusions The diagnosis of VLM depends mainly on the presence of dogs in the child's household, associated with ELISA (IgG anti-T canis), using excretory-secretory antigens of Toxocara canis Prospective studies are warranted to assess the best drug therapy Prevention is the most important strategy because of the high prevalence of T canis in urban areas

Post-infectious bronchiolitis obliterans in children.

Abstract: OBJECTIVE To review publications about the main features of post-infectious bronchiolitis obliterans and its history, etiology, epidemiology, risk factors, pathogenesis, histological findings, clinical presentation, complementary tests, diagnostic criteria, differential diagnosis, treatment and prognosis. SOURCES Non-systematic review of MEDLINE and LILACS databases and selection of 66 most relevant studies. SUMMARY OF THE FINDINGS In the post-infectious bronchiolitis obliterans there is an insult to respiratory epithelial cells, and its clinical severity is associated with the degree of lesion and inflammation. Diagnosis is made according to clinical signs and symptoms, by exclusion of main differential diagnoses and with the aid of complementary tests. High resolution CT, particularly images obtained during inspiration and expiration, provide information for the evaluation of the small airways. Pulmonary function tests show fixed airway obstructions and marked decrease of FEF25-75%. Treatment has not been definitely established, and corticoids have been administered as pulse therapy or by inhalation of high doses of steroids. However, data about its efficacy are scarce in the literature. Long-term prognosis is variable, and there might be either clinical improvement or deterioration into respiratory insufficiency and death. CONCLUSION Post-infectious bronchiolitis obliterans is a disease with a high morbidity rate; it should be treated by a multidisciplinary team, and patients should be followed up for a long period of time.

Severity of viral coinfection in hospitalized infants with respiratory syncytial virus infection.

Abstract: Objective: To compare the severity of single respiratory syncytial virus (RSV) infections with that of coinfections. Methods: A historical cohort was studied, including hospitalized infants with acute RSV infection. Nasopharyngeal aspirate samples were collected from all patients to detect eight respiratory viruses using molecular biology techniques. The following outcomes were analyzed: duration of hospitalization and of oxygen therapy, intensive care unit admission and need of mechanical ventilation. Results were adjusted for confounding factors (prematurity, age and breastfeeding). Results: A hundred and seventy six infants with bronchiolitis and/or pneumonia were included in the study. Their median age was 4.5 months. A hundred and twenty one had single RSV infection and 55 had coinfections (24 RSV + adenovirus, 16 RSV + human metapneumovirus and 15 other less frequent viral associations). The four severity outcomes under study were similar in the group with single RSV infection and in the coinfection groups, independently of what virus was associated with RSV. Conclusion: Virus coinfections do not seem to affect the prognosis of hospitalized infants with acute RSV infection.

Cross-sectional association between healthy and unhealthy food habits and leisure physical activity in adolescents.

Abstract: Objective: To analyze associations between two physical activity domains during leisure time and different food habits in adolescents. Methods: The sample comprised 1,630 adolescents (46% male and 54% female). Physical activity level, television (TV) viewing, and eating behaviors were assessed through an interview. According to the results of the assessment, adolescents were classified as physically active or engaged in high amounts of TV viewing and unhealthy/healthy diets. Results: Male adolescents were more active than females (21.7 and 9.4%, respectively; p = 0.001), while TV viewing was more frequent in females (44.0 and 29.2%; p = 0.001). Physical activity level was related to higher consumption of fruits (OR = 1.90; 95%CI 1.39-2.60) and vegetables (OR = 1.48; 95%CI 1.09-2.01), while higher consumption of fried foods (OR = 2.13; 95%CI 1.64-2.77) and snacks (OR = 1.91; 95%CI 1.49-2.45) was associated with TV viewing. Conclusion: This study presented epidemiological information indicating that active and inactive behaviors were differently and independently associated with healthy and unhealthy diets.

Impact of a brief intervention on the burnout levels of pediatric residents

Abstract: OBJECTIVES: To estimate burnout prevalence among pediatric residents and to evaluate the impact of a brief intervention aimed at controlling burnout. METHODS: A randomized controlled trial was conducted on 74 pediatric residents. The Maslach Burnout Inventory was administered to all subjects, and demographic information was gathered (age, gender, children, cohabitants, and residency year). The experimental group (n = 37) participated in self-care workshops over the course of 2 months, and the control group (n = 37) did not receive any intervention. After the intervention, the Maslach Burnout Inventory was administered again to all participants. All potential predictors of burnout were included in a logistic regression model. The efficacy of the intervention was evaluated by the chi-square test. P values < 0.05 were considered significant. RESULTS: The burnout prevalence among pediatric residents was 66%. After controlling for age, gender, children, and cohabitants, the prevalence of burnout was significantly higher among third-year residents (odds ratio = 11.8; 95% confidence interval 2.3-59.3; p = 0.003). There were no significant differences regarding burnout prevalence in the experimental group between the baseline and post-intervention periods (p = 0.8) or between the two groups after intervention (p = 0.8). The only difference observed was an improvement regarding "depersonalization" in the experimental group (p = 0.031). CONCLUSIONS: The burnout prevalence among pediatric residents was 66% and was higher among third-year residents. A brief intervention was not effective in reducing burnout prevalence, despite the achievement of an improvement in "depersonalization."

Probiotics and prebiotics in prevention and treatment of diseases in infants and children.

Abstract: Objective: To evaluate the impact of probiotics and prebiotics on the health of children Sources: MEDLINE and LILACS were searched for relevant English and French-language articles Summary of the findings: Human milk is rich in prebiotic oligosaccharides and may contain some probiotics No data suggest that addition of probiotics to infant formula may be harmful, but evidence of its efficacy is insufficient for its recommendation Since data suggest that addition of specific prebiotic oligosaccharides may reduce infections and atopy in healthy infants, their addition to infant formula seems reasonable Long-term health benefits of pro- and prebiotics on the developing immune system remain to be proven Selected probiotics reduce the duration of infectious diarrhea by 1 day, but evidence in prevention is lacking, except in antibiotic-associated diarrhea Some specific probiotics prevent necrotizing enterocolitis, and other microorganisms may be beneficial in Helicobacter pylori gastritis and in infantile colic Evidence is insufficient to recommend probiotics in prevention and treatment of atopic dermatitis The use of probiotics in constipation, irritable bowel syndrome, inflammatory bowel disease, and extra-intestinal infections requires more studies Conclusions: Duration of administration, microbial dosage, and species used need further validation for both pro- and prebiotics Unjustified health claims are a major threat for the pro- and prebiotic concept

Infant meningoencephalitis caused by yellow fever vaccine virus transmitted via breastmilk.

Abstract: Objective: To describe a case of infant meningoencephalitis that was probably caused by yellow fever vaccine

Desenvolvimento e qualidade de vida em crianças nascidas pré-termo em idades pré-escolar e escolar

Abstract: OBJETIVO: Revisar a literatura publicada nos ultimos 5 anos sobre o efeito do nascimento prematuro no desenvolvimento e qualidade de vida de criancas nas fases pre-escolar e escolar. FONTES DOS DADOS: Revisao sistematica de estudos empiricos dos ultimos 5 anos indexados nas bases de dados PubMed, MEDLINE, LILACS, SciELO e PsycINFO. Utilizaram-se palavras-chave que associaram a prematuridade aos desfechos de desenvolvimento e qualidade de vida. SINTESE DOS DADOS: Nos estudos, foram identificados quatro indicadores globais do desenvolvimento (neurologico, neurodesenvolvimento, funcoes executivas e qualidade de vida) e sete indicadores especificos do desenvolvimento (cognicao, motor, comportamento, linguagem, desempenho escolar, atencao e memoria). Os indicadores mais prevalentes foram cognicao e motor. Os prematuros apresentaram pior desempenho em todos os indicadores de desenvolvimento quando comparados as criancas nascidas a termo. Alem disso, quanto menor a idade gestacional, pior o desempenho nas avaliacoes dos indicadores de desenvolvimento. Verificou-se a presenca de fatores de risco (menor peso ao nascer, hemorragia intraventricular e baixo nivel educacional da mae) e fatores de protecao (maior perimetro cefalico, aleitamento materno e maior renda familiar) do desenvolvimento de criancas nascidas pre-termo. CONCLUSAO: Criancas nascidas com prematuridade extrema (< 30 semanas de idade gestacional) sao vulneraveis para apresentar problemas no desenvolvimento e na qualidade de vida.

Music therapy may increase breastfeeding rates among mothers of premature newborns: a randomized controlled trial

Abstract: Objective: To evaluate the impact of music therapy on breastfeeding rates among mothers of premature newborns. Method: In this open randomized controlled trial, mothers of premature neonates weighting ≤ 1,750 g were submitted to music therapy sessions three times a week for 60 minutes. The endpoints were breastfeeding rates at the moment of infant hospital discharge and at follow-up visits (7-15 days, 30 and 60 days after discharge). Results: A total of 94 mothers (48 in the music therapy group and 46 in the comparison group) were studied. Breastfeeding was significantly more frequent in the music therapy group at the first follow-up visit [relative risk (RR) = 1.26; 95% confidence interval (95%CI) = 1.01-1.57; p = 0.03; number needed to treat (NNT) = 5.6]. Moreover, this group showed higher breastfeeding rates at the moment of infant discharge (RR = 1.22; 95%CI = 0.99-1.51; p = 0.06; NNT = 6.3), and at days 30 and 60 after discharge (RR = 1.21; 95%CI = 0.73-5.6; p = 0.13 and RR = 1.28; 95%CI = 0.95-1.71; p = 0.09, respectively), but those results were not statistically significant. Conclusions: This study demonstrated that music therapy had a significant effect in increasing breastfeeding rates among mothers of premature newborns at the first follow-up visit, and also a positive influence (although not significant) that lasted up to 60 days after infant discharge. Music therapy may be useful for increasing breastfeeding rates among mothers of premature newborns.

Breastfeeding can prevent hospitalization for pneumonia among children under 1 year old.

Abstract: Objective: To evaluate the relationship between breastfeeding and hospitalization for pneumonia among children under 1 year old. Methods: Ecological study using secondary data of hospitalizations for pneumonia (outcome) and breastfeeding prevalence data (exposure) among children under 1 year old living in the Brazilian state capital cities and the Federal District in 2008. A negative binomial model of hospitalization was used to estimate the rate ratio (95% confidence interval), adjusted according to the Gini Index, and the prevalence rates of smokers in the general population and low birth weight individuals in the population investigated. Results: Breastfeeding prevalence among children between 9 and 12 months old and exclusive breastfeeding prevalence among children under 6 months old were associated with a lower rate ratio of hospitalization for pneumonia (RR = 0.62; 95%CI 0.51-0.74 and RR = 0.52; 95%CI 0.39-0.69, respectively). Conclusion: Increased prevalence rates of breastfeeding during the first year of life and exclusive breastfeeding during the first 6 months of life can reduce the number of hospitalizations for pneumonia.

Musculoskeletal pain in obese adolescents

Abstract: Objective: To determine the prevalence of pain, musculoskeletal syndromes, orthopedic disorders and using computers and playing videogames among obese adolescents. Methods: This was a cross‑sectional study that investigated 100 consecutive obese adolescents and 100 healthy‑ weight controls using a confidential, self-report questionnaire covering demographic data, sports participation, painful musculoskeletal system symptoms and using computers and playing videogames. The questionnaire’s testretest reliability was tested. Physical examination covered six musculoskeletal syndromes and seven orthopedic disorders. Results: The kappa index for test-retest was 0.724. Pain and musculoskeletal syndromes were equally prevalent in both groups (44 vs. 56%, p = 0.09; 12 vs. 16%, p = 0.541; respectively). Notwithstanding, orthopedic disorders (98 vs. 76%, p = 0.0001), tight quadriceps (89 vs. 44%, p = 0.0001) and genu valgum (87 vs. 24%, p = 0.0001) were significantly more prevalent in obese adolescents than in controls. Median time spent using a computer the day before, on Saturdays and on Sundays were all lower among the obese subjects (30 vs. 60 minutes, p = 0.0001; 1 vs. 60 minutes, p = 0.001; and 0 vs. 30 minutes, p = 0.02; respectively). Obese adolescents were less likely to play handheld videogames (2 vs. 11%, p = 0.003) and there was no difference in the two groups’ use of full-sized videogames (p > 0.05). Comparing obese adolescents with pain to those free from pain revealed that pain was more frequent among females (59 vs. 39%, p = 0.048) and was associated with greater median time spent playing on Sundays [0 (0‑720) vs. 0 (0‑240) minutes, p = 0.028]. Conclusions: Obesity can cause osteoarticular system damage at the start of adolescence, particularly to the lower limbs. Programs developed specifically for obese female adolescents with musculoskeletal pain are needed.

Toxocaríase: larva migrans visceral em crianças e adolescentes

Abstract: OBJECTIVES: To present a detailed investigation of risk factors, symptoms, and laboratory and imaging tests that may be useful to establish the clinical laboratory diagnosis of visceral larva migrans (VLM) in children, demonstrating the importance of diagnosis and treatment to prevent complications in the eyes, liver, and other organs. SOURCES: Literature review using the MEDLINE and LILACS (1952-2009) databases, selecting the most recent and representative articles on the topic. SUMMARY OF THE FINDINGS: VLM is an infectious disease with non-specific clinical presentation, whose transmission is related to contact with dogs, especially puppies, and which may progress to late systemic complications in vital organs such as the eyes and the central nervous system. IgG (ELISA) anti-T. canis can be used to establish the laboratory diagnosis. Higher cutoff points suggest recent illness and lower cutoff points demonstrate mild infection or infection in remission. Therapeutic response may be assessed by means of eosinophil blood cell count. The present article provides the pediatrician with updated information regarding VLM, a disease of high prevalence worldwide and in Brazil. CONCLUSIONS: The diagnosis of VLM depends mainly on the presence of dogs in the child's household, associated with ELISA (IgG anti-T. canis), using excretory-secretory antigens of Toxocara canis. Prospective studies are warranted to assess the best drug therapy. Prevention is the most important strategy because of the high prevalence of T. canis in urban areas.

Association of air pollution and hematologic parameters in children and adolescents

Abstract: Objective: To assess the relationship between air pollution and hematologic parameters in a population-based sample of children and adolescents. Methods: This cross-sectional study was conducted in 2009-2010 among school students randomly selected from different areas of Isfahan city, the second largest and most air-polluted city in Iran. The association of air pollutant levels with hemoglobin, platelets, red and white blood cells (RBC and WBC, respectively) was determined by multiple linear and logistic regression analyses, after adjustment for age, gender, anthropometric measures, meteorological factors, and dietary and physical activity habits. Results: The study participants consisted of 134 students (48.5% boys) with a mean age of 13.10±2.21 years. While the mean Pollutant Standards Index (PSI) was at moderate level, the mean particulate matter ≤ 10 µm (PM10) was more than twice the normal level. Multiple linear regression analysis showed that PSI and most air pollutants, notably PM10, had significant negative relationship with hemoglobin and RBC count, and positive significant relationship with WBC and platelet counts. The odds ratio of elevated WBC increased as the quartiles of PM10, ozone and PSI increased, however these associations reached significant level only in the highest quartile of PM10 and PSI. The corresponding figures for hemoglobin and RBC were in opposite direction. Conclusions: The association of air pollutants with hematologic parameters and a possible pro-inflammatory state is highlighted. The presence of these associations with PM10 in a moderate mean PSI level underscores the necessity to re-examine environmental health policies for the pediatric age group.

Reference curves for the Brazilian Alberta Infant Motor Scale: percentiles for clinical description and follow-up over time

Abstract: OBJETIVOS: Comparar os dados de infantes brasileiros com a normativa canadense e estabelecer as curvas de referencia e percentis do desenvolvimento motor da Escala Motora Infantil de Alberta segundo sexo. METODOS: Participaram da pesquisa, 795 criancas com idade entre 0 e 18 meses provenientes de diferentes cidades de uma regiao do Brasil. Os participantes foram avaliados com a Escala Motora Infantil de Alberta, em uma sala silenciosa, por um experiente pesquisador. Foi realizada analise dos percentis (P5, P10, P25, P50, P75, P90) por faixa etaria da escala e sexo. RESULTADOS: Nao foram encontradas diferencas significativas (p > 0,05) entre meninos e meninas na maioria das diferentes faixas etarias. Apenas aos 14 meses, foi encontrada superioridade das meninas no escore total de desempenho motor (p = 0,015) e no percentil de desenvolvimento (0,021). Verificou-se, para ambos os sexos e para criancas tipicas e atipicas, uma tendencia de desenvolvimento motor alinear nas curvas desenvolvimentistas. Observou-se variacao reduzida das aquisicoes motoras nos limites etarios, nos dois primeiros meses de vida e a partir dos 15 meses. CONCLUSOES: A Escala Motora Infantil de Alberta, embora seja um instrumento amplamente utilizado em clinica e pesquisa, possui restricoes considerando a diferenciacao comportamental ate os 2 meses e depois dos 15 meses. Essa reduzida sensibilidade da escala nas extremidades etarias pode estar relacionada com o numero e dificuldade dos itens motores avaliados nessas idades. Sugere-se a utilizacao de outros instrumentos de triagem para criancas acima dos 15 meses de idade.

A efetividade de intervenções de educação nutricional nas escolas para prevenção e redução do ganho excessivo de peso em crianças e adolescentes: uma revisão sistemática

Abstract: OBJECTIVE: To evaluate the effectiveness of school-based nutrition education in reducing or preventing overweight and obesity in children and adolescents. SOURCES: Systematic search in 14 databases and five systematic reviews for randomized controlled trials conducted in schools to reduce or prevent overweight in children and adolescents. Body mass index and fruit and vegetable intake were used as primary and secondary measures of outcome, respectively. There was no restriction by date of publication or language, except for languages with structured logograms. We excluded studies on specific populations presenting eating disorders, dyslipidemia, diabetes, and physical or mental disabilities, as well as studies that used drugs or food supplements as components of the intervention. The assessment by title and abstract and the quality assessment were performed independently by two researchers. We used the Centre for Reviews and Dissemination's guidance for undertaking reviews in health care and the software EPPI-Reviewer 3. SUMMARY OF THE FINDINGS: From the initially retrieved 4,809 references, 24 articles met the inclusion criteria. The extracted data show that there is evidence of positive effects on anthropometry and of increase in fruit and vegetable consumption. Characteristics of the interventions that demonstrated effectiveness are: duration > 1 year, introduction into the regular activities of the school, parental involvement, introduction of nutrition education into the regular curriculum, and provision of fruits and vegetables by school food services. CONCLUSION: Interventions in schools to reduce overweight and obesity, as well as to increase fruits and vegetable consumption, have demonstrated effectiveness in the best-conducted studies.

Gravidade das coinfecções virais em lactentes hospitalizados com infecção por vírus sincicial respiratório

Abstract: OBJETIVO: Comparar a gravidade de infeccoes causadas por um unico virus (VSR) com a gravidade de coinfeccoes METODOS: Este estudo avaliou uma coorte historica de lactentes com infeccao aguda por VSR Secrecao de nasofaringe foi coletada de todos os pacientes rotineiramente para pesquisa viral usando tecnicas de biologia molecular Os seguintes desfechos foram analisados: tempo total de internacao, duracao da oxigenioterapia, admissao em unidade de terapia intensiva e uso de ventilacao mecânica Os resultados foram ajustados para os fatores confundidores (prematuridade, idade e aleitamento materno) RESULTADOS: Foram incluidos no estudo 176 lactentes com idade media de 4,5 meses e diagnosticos de bronquiolite e/ou pneumonia Cento e vinte e um tinham infeccao unica por VSR, e 55 tinham coinfeccoes (24 VSR + adenovirus, 16 VSR + metapneumovirus humano e 15 outras associacoes menos frequentes) Os quatro desfechos de gravidade avaliados foram semelhantes entre o grupo com infeccao unica por VSR e os grupos com coinfeccoes, independente do tipo de virus associado com o VSR CONCLUSAO: As coinfeccoes virais nao parecem alterar o prognostico de lactentes hospitalizados com infeccao aguda por VSR

Prevalence and determinants of overweight in preschool children

Abstract: Objective: To examine the prevalence of overweight and its association with socioeconomic and environmental factors, ownership of household goods, maternal nutritional status, and healthcare in preschoolers. Methods: Cross-sectional study with 954 preschoolers from the state of Pernambuco, Brazil, 2006. Multiple logistic regression with hierarchical modeling was conducted. Odds ratios for overweight (crude and adjusted for confounders) were calculated for each independent variable. Results: The prevalence of overweight was 8.1% for the state as a whole and 9% for the Recife Metropolitan Region. In urban and rural areas, the prevalence was 9.7 and 6.8%, respectively. A high prevalence of overweight was found among children whose families lived in better socioeconomic conditions (per capita family income, high educational achievement and access to household goods, better housing and sanitation, and healthcare). The logistic regression final model indicated that maternal educational achievement, ownership of household goods, and maternal body mass index were the determinants that best explained child overweight. Conclusion: Overweight was more prevalent than malnutrition among preschoolers. The prevalence was highest among children living in more privileged socioeconomic conditions.

Assessment of the body posture of mouth-breathing children and adolescents.

Abstract: Objective: To investigate associations between mouth breathing (MBr), nose breathing (NBr) and body posture classification and clinical variables in children and adolescents, by comparing patients with mouth breathing syndrome with a control group of similar age. Methods: This was an observational, analytical, controlled, cross-sectional study conducted at a university hospital. Children aged 5 years or more were recruited to one of two groups: healthy controls (NBr) or an MBr group. The MBr group comprised patients with a diagnosis of mouth breathing syndrome confirmed by clinical examination by a physician plus nasal endoscopy. The control group comprised healthy volunteers of the same age, with NBr confirmed by medical examination. All participants underwent postural assessment. Data were analyzed using the Mann-Whitney nonparametric test, the chi-square test and Fisher’s exact test, to a significance level of 0.05%. Results: A total of 306 MBr and 124 NBr were enrolled. Mouth breathers were more likely to be male (p = 0.0002), have more frequent and more severe nasal obstruction and larger tonsils (p = 0.0001) than NBr. Mouth breathers also exhibited higher incidence rates of allergic rhinitis (p = 0.0001), of thoracic respiratory pattern (p = 0.0001), high-arched palate (p = 0.0001) and unfavorable postural classifications (p = 0.0001) with relation to the control group. Postural classification scores were directly proportional to nasal obstruction (p = 0.0001) and male sex (p = 0.0008). Conclusions: Postural problems were significantly more common among children in the group with mouth breathing syndrome, highlighting the need for early interdisciplinary treatment of this syndrome.

Prevalência e determinantes do excesso de peso em pré-escolares

Abstract: OBJETIVO: Identificar a prevalencia do excesso de peso e sua associacao com as condicoes socioeconomicas, ambientais, bens de consumo, estado nutricional materno e assistencia a saude em pre-escolares. METODOS: Estudo transversal com 954 pre-escolares do estado de Pernambuco, no ano de 2006. Foi realizada regressao logistica multipla, utilizando-se o modelo hierarquizado. Razoes de chances de excesso de peso (bruta e ajustada para confundimento) foram calculadas para cada variavel de exposicao. RESULTADOS: A prevalencia de excesso de peso foi de 8,1% para o estado e 9% para a regiao metropolitana de Recife (PE). No interior urbano e rural, foram encontradas prevalencias de 9,7 e 6,8%, respectivamente. Maiores prevalencias de excesso de peso foram observadas entre criancas pertencentes a familias com melhores condicoes socioeconomicas: maior renda familiar per capita e nivel de escolaridade, acesso a bens de consumo, melhores condicoes de moradia e saneamento basico e de assistencia a saude. O modelo final de regressao logistica multipla indicou que a escolaridade materna, os bens de consumo e o indice de massa corporal da mae foram os fatores que melhor explicaram o excesso de peso das criancas. CONCLUSOES: As prevalencias do excesso de peso superam as de desnutricao entre pre-escolares no estado, e esse excesso acomete principalmente as criancas de familias com condicoes socioeconomicas mais favorecidas.

Carga de trabalho de profissionais da saúde e eventos adversos durante ventilação mecânica em unidades de terapia intensiva neonatal

Abstract: Objective:To investigate a possible association between the intensity of staff workload and intermediate adverse events, such as accidental extubation, obstruction of the endotracheal tube, and accidental disconnection of the ventilator circuit, during neonatal mechanical ventilation in high-risk neonatal units. Method:This prospective cohort study analyzed data of 543 newborns from public neonatal intensive care units (NICUs) in the city of Sao Luis, state of Maranhao, Northeastern Brazil, for 6 months, during which 136 newborns were submitted to mechanical ventilation in 1,108 shifts and were observed a total of 4,554 times. Results: Adverse events occurred 117 times during this period. The associations between workload and adverse events were analyzed by means of generalized estimating equations. The adjustment variables were: birth weight, gender, maternity unit, Clinical Risk Index for Babies score, and care demand, the latter measured by the Northern Neonatal Network Scale. The larger the number of newborns classified by care demand (NCCD) per nurse and nursing technician, the more likely the occurrence of intermediate adverse events linked to mechanical ventilation. A number of NCCD > 22 per nurse (relative risk [RR] = 2.86) and > 4.8 per auxiliary nurse (RR = 3.41) was associated with a higher prevalence of intermediate adverse events. Conclusions: The workload of NICU professionals seems to interfere with the intermediate results of neonatal care and thus should be taken into consideration when evaluating NICU outcomes

Incidence of periventricular/intraventricular hemorrhage in very low birth weight infants: a 15-year cohort study

Abstract: Objective: To assess the incidence of periventricular/intraventricular hemorrhage (PIVH) in very low birth rate neonates

Non-authoritative parents and impact on drug use: the perception of adolescent children.

Abstract: Objective: To evaluate the association between drug use and parenting styles perceived by Brazilian adolescent children. Methods: This cross-sectional study enrolled adolescents aged 14 to 19 years that used the Servico Nacional de Orientacoes e Informacoes sobre a Prevencao do Uso Indevido de Drogas (VIVAVOZ). A total of 232 adolescents participated in the study. Phone interviews were conducted using the Parental Responsiveness and Demandingness Scale, which classifies maternal and paternal styles perceived by adolescent children as authoritative, neglectful, indulgent or authoritarian. Sociodemographic variables were collected and an instrument was used to assess monthly drug use and abuse. Results: Maternal and paternal parenting styles perceived as neglectful, indulgent or authoritarian (nonauthoritative) were significantly associated with drug use (odds ratio [OR] = 2.8; 95% confidence interval [95%CI], 1.3-5.7 for mothers and OR = 2.8; 95%CI, 1.3-6.3 for fathers). Non-authoritative styles also had a significant association with tobacco use in the previous month in the analysis of maternal (OR = 2.7; 95%CI, 1.2-6.5) and paternal (OR = 3.9; 95%CI, 1.4-10.7) styles, and use of cocaine/crack in the previous month (OR = 3.9; 95%CI, 1.1-13.8) and abuse of any drug (OR = 2.2; 95%CI, 1.0-5.1) only for the paternal style. Logistic regression revealed that maternal style (OR = 3.3; 95%CI, 1.1-9.8), adolescent sex (OR = 3.2; 95%CI, 1.5-7.2) and age (OR = 2.8; 95%CI, 1.2-6.2) were associated with drug use. Conclusions: Adolescents that perceived their mothers as non-authoritative had greater chances of using drugs. There was a strong association between non-authoritative paternal styles and adolescent drug abuse.

Effects of glucocorticoids on growth and bone mineralization

Abstract: Objective: To review the various mechanisms of glucocorticoid action and the ability of these agents to induce osteoporosis and growth deficits Sources: A review of the scientific literature was conducted on the basis of a MEDLINE search using the keywords and descriptors "glucocorticoids," "bone mineralization," "growth," and "side effects" and limited to articles published in the last decade The references cited by these articles were used to identify relevant older publications, with an emphasis on landmark studies essential to an understanding of the topic Summary of the findings: Emphasis was placed on the actions of glucocorticoids on the hormones and cytokines that modulate linear growth The end effects of glucocorticoids on the skeletal system are the result of systemic effects on bone metabolism and of direct actions on bone cells, which alter bone cell counts and predispose to bone loss The mechanisms underlying catch-up growth and bone mass recovery after discontinuation of glucocorticoid treatment are discussed, followed by a review of diagnostic methods available for assessment of bone metabolism and mineralization and of measures for prevention and management of glucocorticoid-induced bone changes Conclusion: Patient monitoring on a case-by-case basis plays an essential role in detection and, potentially, reversal of the damage associated with chronic glucocorticoid therapy

Mothers' perception of obesity in schoolchildren: a survey and the impact of an educational intervention

Abstract: OBJETIVOS: Investigar o conhecimento das maes a respeito do problema de peso dos filhos e avaliar o impacto de uma intervencao educativa na conscientizacao das maes sobre a obesidade dos filhos. METODOS: Doze escolas primarias foram escolhidas aleatoriamente na cidade de Teera, Ira. As criancas obesas foram selecionadas, e 300 maes participaram do estudo. Um questionario foi preenchido pelas maes, que a seguir foram divididas aleatoriamente em dois grupos. Um grupo recebeu instrucao sobre obesidade, enquanto o outro grupo nao recebeu nenhuma intervencao. Depois de 2 meses, o mesmo questionario foi preenchido pelos dois grupos. Foi realizada regressao logistica multipla. RESULTADOS: O conhecimento preexistente da mae sobre obesidade, sua escolaridade e ocupacao, assim como a renda familiar, tiveram efeitos significativos na exatidao das maes em identificar a obesidade nos filhos. A intervencao educativa melhorou significativamente a capacidade das maes em identificar a obesidade dos filhos, quando comparadas as que nao receberam intervencao (OR = 15,23; IC95% 5,95-38,96). CONCLUSOES: No Ira, a maioria das maes nao possui conhecimento geral sobre qual deve ser o peso saudavel para uma crianca, portanto foi incapaz de reconhecer que seus filhos estavam obesos. Intervencoes educacionais poderiam reduzir a proporcao de tal engano e posteriormente modificar o cuidado parental.