Showing papers in "Jornal De Pediatria in 2016"
TL;DR: Abnormal, absent, or sporadic FMs indicate an increased risk for later neurological dysfunction, whereas normal FMs are highly predictive of normal development, especially if they co-occur with other smooth and fluent movements.
Abstract: Objectives: To describe fidgety movements (FMs), i.e., the spontaneous movement pattern that typically occurs at 3–5 months after term age, and discuss its clinical relevance. Sources: A comprehensive literature search was performed using the following databases: MEDLINE/PubMed, CINAHL, The Cochrane Library, Science Direct, PsycINFO, and EMBASE. The search strategy included the MeSH terms and search strings (‘fidgety movement*’) OR [(‘general movement*’) AND (‘three month*’) OR (‘3 month*’)], as well as studies published on the General Movements Trust website (www.general-movements-trust.info). Summary of the data: Virtually all infants develop normally if FMs are present and normal, even if their brain ultrasound findings and/or clinical histories indicate a disposition to later neurological deficits. Conversely, almost all infants who never develop FMs have a high risk for neurological deficits such as cerebral palsy, and for genetic disorders with a late onset. If FMs are normal but concurrent postural patterns are not age-adequate or the overall movement character is monotonous, cognitive and/or language skills at school age will be suboptimal. Abnormal FMs are unspecific and have a low predictive power, but occur exceedingly in infants later diagnosed with autism. Conclusions: Abnormal, absent, or sporadic FMs indicate an increased risk for later neurological dysfunction, whereas normal FMs are highly predictive of normal development, especially if they co-occur with other smooth and fluent movements. Early recognition of neurological signs facilitates early intervention. It is important to re-assure parents of infants with clinical risk factors that the neurological outcome will be adequate if FMs develop normally.
152 citations
TL;DR: Empirical data suggest a temporal association between the increased number of microcephaly notifications in Brazil and outbreak of Zika virus, primarily in the Brazil's Northeast.
Abstract: Objective: This study aimed to critically review the literature available regarding the Zika virus (ZikaV) outbreak in Brazil and its possible association with microcephaly cases. Sources: Experts from Instituto do Cerebro do Rio Grande do Sul performed a critical (nonsystematic) literature review regarding different aspects of the ZikaV outbreak in Brazil, such as transmission, epidemiology, diagnostic criteria, and its possible association with the increase of microcephaly reports. The PubMed search using the key word Zika virus in February 2016 yielded 151 articles. The manuscripts were reviewed, as well as all publications/guidelines from the Brazilian Ministry of Health, World Health Organization and Centers for Disease Control and Prevention (CDC-United States). Summary of ndings: Epidemiological data suggest a temporal association between the increased number of microcephaly notications in Brazil and outbreak of ZikaV, primarily in the Brazil’s Northeast. It has been previously documented that many different viruses might cause
106 citations
TL;DR: Recent evidence reinforces not only an environment rich in motor and global attention stimuli for the child, but, specifically, the continuous and early use of expressive language by parents with their children promote the achievement of better cognitive performance, especially in more vulnerable populations.
Abstract: 2 The child is a being undergoing constant development, both somatic development, with the differentiation of various organs, as well as neuropsychomotor development, with psycho-emotional differentiation. Development and environment are closely related; currently, several epigenetic phenomena are known to result from the modification of gene expression due to environmental influence. The environment in the very early phases of life influences the child’s health. Recent evidence reinforces not only an environment rich in motor and global attention stimuli for the child, but, specifically, the continuous and early use of expressive language by parents with their children promote the achievement of better cognitive performance, especially in more vulnerable populations.1,2 The effect of nutritional quality on growth has been conceptually known for many years, but the influence of the intestinal environment on the brain and the mechanisms involving the new concept of neuronutrition are recent. The intrauterine environment, type of maternal diet, type of delivery, gestational age at birth, and the presence of breastfeeding modulate the intestinal microbiome and are determinants of health or disease.3--5
81 citations
TL;DR: The studies included in this systematic review showed good performance of the nutritional screening tools in pediatrics, especially STRONGkids and STAMP, and the need to perform for more studies in this area.
Abstract: Objective: This systematic review aimed to verify the available scientific evidence on the clinical performance and diagnostic accuracy of nutritional screening tools in hospitalized pediatric patients. Data source: A search was performed in the Medline (National Library of Medicine United States), LILACS (Latin American and Caribbean Health Sciences), PubMed (US National Library of Medicine National Institutes of Health), in the SCIELO (Scientific Electronic Library Online), through CAPES portal (Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior), bases Scopus e Web of Science. The descriptors used in accordance with the Descriptors in Health Sciences (DeCS)/Medical Subject Headings (MeSH) list were “malnutrition”, “screening”, and “pediatrics”, as well as the equivalent words in Portuguese. Summary of the findings: The authors identified 270 articles published between 2004 and 2014. After applying the selection criteria, 35 were analyzed in full and eight articles were included in the systematic review. We evaluated the methodological quality of the studies using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS). Five nutritional screening tools in pediatrics were identified. Among these, the Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP) showed high sensitivity, almost perfect inter-rater agreement and between the screening and the reference standard; the Screening Tool Risk on Nutritional Status and Growth (STRONGkids) showed high sensitivity, lower percentage of specificity, substantial intra-rater agreement, and ease of use in clinical practice. Conclusions: The studies included in this systematic review showed good performance of the nutritional screening tools in pediatrics, especially STRONGkids and STAMP. The authors emphasize the need to perform for more studies in this area. Only one tool was translated and adapted to the Brazilian pediatric population, and it is essential to carry out studies of tool adaptation and validation for this population.
64 citations
TL;DR: A high prevalence of musculoskeletal pain in adolescents, as well as an increased amount of time using digital devices was observed, however, it was only possible to observe an association between the increased use of these devices and the presence of cervical and low back pain.
Abstract: Objective: This study investigated the presence of musculoskeletal symptoms in high school adolescents from public schools and its association with electronic device use. Methods: The sample consisted of 961 boys and girls aged 14 to 19 years who answered a questionnaire regarding the use of computers and electronic games, and questions about pain symptoms and physical activity. Furthermore, anthropometric assessments of all volunteers were performed. The chi-squared test and a multiple logistic regression model were used for the inferential analysis. Results: The presence of musculoskeletal pain symptoms was reported by 65.1% of the adolescents, being more prevalent in the thoracolumbar spine (46.9%), followed by pain in the upper limbs, representing 20% of complaints. The mean time of use for computers and electronic games was 1,720 and 583 minutes per week, respectively. The excessive use of electronic devices was demonstrated to be a risk factor for cervical and lumbar pain. Female gender was associated with the presence of pain in different body parts. Presence of a paid job was associated with cervical pain. Conclusion: A high prevalence of musculoskeletal pain in adolescents, as well as an increased amount of time using digital devices was observed. However, it was only possible to observe an association between the increased use of these devices and the presence of cervical and low back pain.
59 citations
TL;DR: Responsive feeding is very important in dietary habit formation and should be encouraged by health professionals in their advice to families.
Abstract: Objective To draw attention to the importance of interaction between caregiver and child during feeding and the influence of parenting style on dietary habit formation. Source of data A search was performed in the PubMed and Scopus databases for articles addressing responsive feeding; the articles considered most relevant by the authors were selected. Synthesis of data The way children are fed is decisive for the formation of their eating habits, especially the strategies that parents/caregivers use to stimulate feeding. In this context, responsive feeding has been emphasized, with the key principles: feed the infant directly and assist older children when they already eat on their own; feed them slowly and patiently, and encourage children to eat but do not force them; if the child refuses many types of foods, experiment with different food combinations, tastes, textures, and methods of encouragement; minimize distractions during meals; and make the meals an opportunity for learning and love, talking to the child during feeding and maintaining eye contact. It is the caregiver's responsibility to be sensitive to the child's signs and alleviate tensions during feeding, and make feeding time pleasurable; whereas it is the child's role to clearly express signs of hunger and satiety and be receptive to the caregiver. Conclusion Responsive feeding is very important in dietary habit formation and should be encouraged by health professionals in their advice to families.
56 citations
TL;DR: The data indicate that bullying is an important aspect that affects the learning-teaching process and the students' health.
Abstract: OBJECTIVES: To estimate the prevalence of bullying among Brazilian students from the aggressor's perspective and to analyze its association with individual and contextual variables. METHODS: This was a cross-sectional population-based study carried out with data from the National Survey on Student Health. A total of 109,104 students attending eight grade in public and private schools were included. Data were collected through a self-applied questionnaire. A model of association between bullying and variables in the following domains was tested: sociodemographics, risk behaviors, mental health, and family context. Univariate and multivariate analyses were also performed. RESULTS: The prevalence of aggressors in bullying situations was 20.8%. The following variables remained associated in the final multivariate model: male gender (OR: 1.87; 95% CI: 1.79-1.94), lower participation of 16-year-old students (OR: 0.66; 95% CI: 0.53-0.82), and students from private schools (OR: 1.33; 95% CI: 1.27-1.39). Most aggressors reported feeling lonely (OR: 1.22; 95% CI: 1.16-1.28), insomnia episodes (OR: 1.21; 95% CI: 1.14-1.29), and a high prevalence of physical violence in the family (OR: 1.97 95% CI: 1.87-2.08). Aggressors missed classes more frequently (OR: 1.45; 95% CI: 1.40-1.51), and they regularly consumed more tobacco (OR: 1.21; 95% CI: 1.12-1.31), alcohol (OR: 1.85; 95% CI: 1.77-1.92), and illegal drugs (OR: 1.91; 95% CI: 1.79-2.04); they also demonstrated increased sexual intercourse (OR: 1.49 95% CI: 1.43-1.55) and regular exercise (OR: 1.20; 95% CI: 1.16-1.25). CONCLUSIONS: The data indicate that bullying is an important aspect that affects the learning-teaching process and the students' health.
56 citations
TL;DR: The present survey confirms the high prevalence of prenatal, perinatal and postnatal factors in children with ASD and suggests the intervention of some of these factors, including acute fetal distress and difficult labor, as determinant variables for the genesis of ASD.
Abstract: Objetivo: Identificar fatores de risco pre-natal, perinatal e pos-natal em criancas com transtorno do espectro do autismo (TEA) ao compara-las com irmaos sem transtornos de autismo. Metodo: Estudo e transversal e comparativo. Foi conduzido em tres meses (julho a setembro de 2014). Incluiu 101 criancas: 50 com TEA diagnosticadas de acordo com os criterios do DSM-5 e 51 irmaos nao afetados. A gravidade do TEA foi avaliada pela Escala de Avaliacao do Autismo na Infância (CARS). Resultados: Nosso estudo revelou uma prevalencia maior de fatores pre-natais, perinatais e pos-natais em criancas com TEA em comparacao com irmaos nao afetados. Tambem mostrou uma associacao significativa entre fatores perinatais e pos-natais e TEA (respectivamente p = 0,03 e p = 0,042). Nesse grupo, os fatores perinatais foram principalmente do tipo sofrimento fetal agudo (26% dos casos), longa duracao do parto e prematuridade (18% dos casos em cada fator), ao passo que fatores pos-natais foram representados principalmente por infeccoes respiratorias (24%). No que diz respeito a fatores dos pais, nenhuma correlacao foi encontrada entre a idade avancada dos pais no momento da concepcao e o TEA. Da mesma forma, nenhuma correlacao foi estabelecida entre a gravidade do TEA e fatores diferentes.Apos regressao logistica, os fatores de risco de autismo encontrados no modelo final foram: sexo masculino, infeccao pre-natal do trato urinario, sofrimento fetal agudo, parto dificil e infeccao respiratoria. Conclusoes: Esta pesquisa confirma a alta prevalencia de fatores pre-natais, perinatais e pos-natais em criancas com TEA e sugere a intervencao de alguns desses fatores (sofrimento fetal agudo, parto dificil) como variaveis determinantes para a genese do TEA.
48 citations
TL;DR: Although the summary identified evidence with important applications in terms of public health, there are still gaps to be filled in this field of knowledge, such as the effectiveness of different theoretical models, the identification of the best strategies in relation to gender and age of participants and, finally, the Identification of moderating variables to maximize the benefits provided by the interventions.
Abstract: OBJETIVO: Organizar os principais achados e relacionar as recomendacoes mais frequentes das revisoes sistematicas de intervencoes desenvolvidas no ambiente escolar com fins na reducao do excesso de peso em criancas e adolescentes. FONTE DOS DADOS: Buscas por revisoes sistematicas disponiveis ate 31 de dezembro de 2014 foram feitas em cinco bases de dados eletronicas: Cochrane, PubMed, SciELO, SPORTDiscus e Web of Science. Buscas manuais por referencias cruzadas tambem foram desenvolvidas. SINTESE DOS DADOS: Das 2.139 referencias iniciais, 33 revisoes sistematicas responderam adequadamente aos criterios de inclusao e compuseram a sintese descritiva. Nesse conjunto, identificaram-se como recomendacoes mais frequentes e efetivas intervencoes que tem periodos de tempo superior a seis meses de duracao (nove revisoes) e o envolvimento dos pais nos conteudos e/ou acoes previstas (seis revisoes). Alem disso, observou-se que meninos respondem de forma mais efetivas as intervencoes estruturais, enquanto as meninas as intervencoes comportamentais. De modo consistente entre as revisoes incluidas, nenhuma conseguiu fazer inferencias sobre a base teorica usada nas intervencoes, uma vez que, aparentemente, os responsaveis pelas intervencoes desconsideraram esse componente em sua elaboracao. CONCLUSOES: Embora a sintese tenha identificado evidencias com aplicacoes importantes em termos de saude coletiva, ainda existem lacunas a serem preenchidas nesse campo do conhecimento, tais como a efetividade de diferentes modelos teoricos, o reconhecimento das melhores estrategias em relacao ao sexo e a idade dos participantes e, por fim, a identificacao de variaveis moderadoras para potencializar os beneficios proporcionados pelas intervencoes.
47 citations
TL;DR: The prevalence of anemia is characterized as a moderate problem in the studied population and demonstrates the need for coordination of interdisciplinary actions for its reduction in CMEI nurseries.
Abstract: Objective: To identify the prevalence and factors associated with anemia in children attending Municipal Early Childhood Education Day Care Center (Centros Municipais de Educacao Infantil [CMEI]) nurseries in Colombo-PR. Methods: Analytical, cross-sectional study with a representative sample of 334 children obtained by stratified cluster sampling, with random selection of 26 nurseries. Data collection was conducted through interviews with parents, assessment of iron intake by direct food weighing, and hemoglobin measurement using the finger-stick test. Bivariate association tests were performed followed by multiple logistic regression adjustment. Results: The prevalence of anemia was 34.7%. Factors associated with anemia were: maternal age younger than 28 years old (p = 0.03), male children (p = 0.02), children younger than 24 months (p = 0.01), and children who did not consume iron food sources (meat + beans + dark green leafy vegetables) (p = 0.02). There was no association between anemia and iron food intake in CMEI. However, iron intake was well below the recommended levels according to the National Education Development Fund resolution, higher prevalence of anemia was observed in children whose intake of iron, heme iron, and nonheme iron was below the median. Conclusions: In terms of public health, the prevalence of anemia is characterized as a moderate problem in the studied population and demonstrates the need for coordination of interdisciplinary actions for its reduction in CMEI nurseries.
44 citations
TL;DR: Both environmental and biological factors were related to growth and development, however, biological variables showed a greater association with growth, whereas environmental variables were associated with development.
Abstract: Objective To investigate child growth, cognitive/language development, and their environmental and biological determinants. Methods This was a cross-sectional, predictive correlation study with all 92 children aged 24–36 months who attended the municipal early childhood education network in a town in the Vale do Jequitinhonha region, in 2011. The socioeconomic profile was determined using the questionnaire of the Associacao Brasileira de Empresas de Pesquisa. The socio-demographicand maternal and child health profiles were created through a self-prepared questionnaire. The height-for-age indicator was selected to represent growth. Cognitive/language development was assessed through the Bayley Scale of Infant and Toddler Development. The quality of educational environments was assessed by Infant/Toddler Environment Scale; the home environment was assessed by the Home Observation for Measurement of the Environment. The neighborhood quality was determined by a self-prepared questionnaire. A multivariate linear regression analysis was performed. Results Families were predominantly from socioeconomic class D, with low parental education. The prevalence of stunted growth was 14.1%; cognitive and language development were below average at 28.6% and 28.3%, respectively. Educational institutions were classified as inadequate, and 69.6% of homes were classified as presenting a risk for development. Factors such as access to parks and pharmacies and perceived security received the worst score regarding neighborhood environment. Biological variables showed a greater association with growth and environmental variables with development. Conclusion The results showed a high prevalence of stunting and below-average results for cognitive/language development among the participating children. Both environmental and biological factors were related to growth and development. However, biological variables showed a greater association with growth, whereas environmental variables were associated with development.
TL;DR: Excessive crying in the early months is a prevalent symptom; the pediatrician's attention is necessary to understand and adequately manage the problem and offer support to exhausted parents.
Abstract: Objective Review the literature on excessive crying in young infants, also known as infantile colic, and its effects on family dynamics, its pathophysiology, and new treatment interventions. Data source The literature review was carried out in the Medline, PsycINFO, LILACS, SciELO, and Cochrane Library databases, using the terms “excessive crying,” and “infantile colic,” as well technical books and technical reports on child development, selecting the most relevant articles on the subject, with emphasis on recent literature published in the last five years. Summary of the findings Excessive crying is a common symptom in the first 3 months of life and leads to approximately 20% of pediatric consultations. Different prevalence rates of excessive crying have been reported, ranging from 14% to approximately 30% in infants up to 3 months of age. There is evidence linking excessive crying early in life with adaptive problems in the preschool period, as well as with early weaning, maternal anxiety and depression, attention deficit hyperactivity disorder, and other behavioral problems. Several pathophysiological mechanisms can explain these symptoms, such as circadian rhythm alterations, central nervous system immaturity, and alterations in the intestinal microbiota. Several treatment alternatives have been described, including behavioral measures, manipulation techniques, use of medication, and acupuncture, with controversial results and effectiveness. Conclusion Excessive crying in the early months is a prevalent symptom; the pediatrician's attention is necessary to understand and adequately manage the problem and offer support to exhausted parents. The prescription of drugs of questionable action and with potential side effects is not a recommended treatment, except in extreme situations. The effectiveness of dietary treatments and use of probiotics still require confirmation. There is incomplete evidence regarding alternative treatments such as manipulation techniques, acupuncture, and use of the herbal supplements and behavioral interventions.
TL;DR: Prophylactic supplementation of S. boulardii at a dose of 50mg/kg twice a day improved weight gain, improved feeding tolerance, and had no adverse effects in preterm infants >30 weeks old.
Abstract: Objective: The use of probiotics is increasingly popular in preterm neonates, as they may prevent necrotizing enterocolitis (NEC) sepsis and improve growth and feeding tolerance. There is only limited literature on Saccharomyces boulardii CNCM I-745 (S. boulardii) in preterm infants. Method: A prospective, randomized, case-controlled trial with the probiotic S. boulardii (50 mg/kg twice daily) was conducted in newborns with a gestational age of 30 to 37 weeks and a birth weight between 1,500 to 2,500 g. Results: 125 neonates were enrolled; 63 in the treatment and 62 in the control group. Weight gain (16.14 ± 1.96 vs. 10.73 ± 1.77 g/kg/day, p < 0.05) and formula intake at maximal enteral feeding (128.4 ± 6.7 vs. 112.3 ± 7.2 mL/kg/day, p < 0.05) were signicantly higher in the intervention group. Once enteral feeding was started, the time needed to reach full enteral feeding was signicantly shorter in the probiotic group (0.4 ± 0.1 vs. 1.7 ± 0.5 days, p < 0.05). There was no signicant difference in sepsis. NEC did not occur. No adverse effects related to S. boulardii were observed.
TL;DR: It was clear that ZIKV had managed to adapt to an old acquaintance of humans, Aedes aegypti mosquitoes, transmitters of urban yellow fever, four serotypes of dengue fever, chikungunya virus, and other arboviruses in Asia and Africa.
Abstract: This episode on Yap Islandwas followed by others, in the Pacific Ocean region of Poly-nesia and in some Southeast Asian countries, with outbreaksconfirmed by serology or polymerase chain reaction (PCR)for the ZIKV on Easter Island, and in the Solomon Islands,the Cook Islands, Indonesia, Malaysia, Thailand, and FrenchPolynesia.
TL;DR: The Brazilian Portuguese version of the Pediatric Daytime Sleepiness Scale shows satisfactory indicators of validity and can be applied in clinical practice and scientific research.
Abstract: Objective: The aim of this study was to translate and validate the Pediatric Daytime Sleepiness Scale (PDSS) into Brazilian Portuguese. Methods: The translation/validation process was carried out through translation, back translation, technical review, assessment of verbal comprehension/clarity of the scale by experts and a focus group, test---retest, and application of the tool. The reproducibility analysis was performed by applying the PDSS in test---retest; internal consistency was veried by applying the scale in 90 children and adolescents. Results: The mean score of the sum of PDSS questions was 15.6 (SD = 5.0) points. The PDSS showed appropriate indicators of content validation and clarity for the Brazilian Portuguese version. The internal consistency analysis showed a Cronbach’s alpha of 0.784. The PDSS showed adequate reproducibility. The PDSS scores showed a signicant and negative correlation with time spent in bed (r = 0.214; p = 0.023). Conclusion: The Brazilian Portuguese version of the PDSS shows satisfactory indicators of validity and can be applied in clinical practice and scientic research.
TL;DR: Recommendations are direct viral invasion and chronic immune response due to the reactivation of the latent state of the virus, or even various DNA mutations, which should be considered when physicians encounter similar clinical pictures of the viral infection.
Abstract: Objective: Clarify the frequency and the pathophysiological mechanisms of the rare manifestations of Epstein–Barr virus infection. Sources: Original research studies published in English between 1985 and 2015 were selected through a computer-assisted literature search (PubMed and Scopus). Computer searches used combinations of key words relating to "EBV infections" and "atypical manifestation. Summary of the findings: "Epstein–Barr virus is a herpes virus responsible for a lifelong latent infection in almost every adult. The primary infection concerns mostly children and presents with the clinical syndrome of infectious mononucleosis. However, Epstein–Barr virus infection may exhibit numerous rare, atypical and threatening manifestations. It may cause secondary infections and various complications of the respiratory, cardiovascular, genitourinary, gastrointestinal, and nervous systems. Epstein–Barr virus also plays a significant role in pathogenesis of autoimmune diseases, allergies, and neoplasms, with Burkitt lymphoma as the main representative of the latter. The mechanisms of these manifestations are still unresolved. Therefore, the main suggestions are direct viral invasion and chronic immune response due to the reactivation of the latent state of the virus, or even various DNA mutations. Conclusions: Physicians should be cautious about uncommon presentations of the viral infection and consider EBV as a causative agent when they encounter similar clinical pictures.
TL;DR: The most effective treatment that addresses the cause of sialorrhea in children with cerebral palsy is training of sensory awareness and oral motor skills, performed by a speech therapist.
Abstract: Objective To review the literature on sialorrhea in children with cerebral palsy. Source of data Non-systematic review using the keywords “sialorrhea” and “child” carried out in the PubMed®, LILACS®, and SciELO® databases during July 2015. A total of 458 articles were obtained, of which 158 were analyzed as they were associated with sialorrhea in children; 70 had content related to sialorrhea in cerebral palsy or the assessment and treatment of sialorrhea in other neurological disorders, which were also assessed. Data synthesis The prevalence of sialorrhea is between 10% and 58% in cerebral palsy and has clinical and social consequences. It is caused by oral motor dysfunction, dysphagia, and intraoral sensitivity disorder. The severity and impact of sialorrhea are assessed through objective or subjective methods. Several types of therapeutic management are described: training of sensory awareness and oral motor skills, drug therapy, botulinum toxin injection, and surgical treatment. Conclusions The most effective treatment that addresses the cause of sialorrhea in children with cerebral palsy is training of sensory awareness and oral motor skills, performed by a speech therapist. Botulinum toxin injection and the use of anticholinergics have a transient effect and are adjuvant to speech therapy; they should be considered in cases of moderate to severe sialorrhea or respiratory complications. Atropine sulfate is inexpensive and appears to have good clinical response combined with good safety profile. The use of trihexyphenidyl for the treatment of sialorrhea can be considered in dyskinetic forms of cerebral palsy or in selected cases.
TL;DR: Results showed significant differences in circulating levels of the evaluated markers when lean, overweight and obese individuals were compared, suggesting that these biomarkers may change from lean to overweight and from overweight to obesity.
Abstract: Objective Childhood obesity has been associated with metabolic syndrome and cardiovascular diseases. This study aimed to compare plasma levels of traditional metabolic markers, adipokines and soluble tumor necrosis factor receptor type 1 (sTNFR1) in overweight, obese and lean children. We also assessed the relationships of these molecules with classical metabolic risk factors. Methods This study included 104 children and adolescents, which were grouped as: lean ( n = 24), overweight ( n = 30), and obese subjects ( n = 50). They were subjected to anthropometrical, clinical and laboratorial measurements. All measurements were compared between groups. Correlation analyses were also performed to evaluate the association between clinical data, traditional metabolic markers, adipokines and sTNFR1. Results Fasting glucose, insulin, homeostatic model assessment of insulin resistance (HOMA-IR), LDL-cholesterol and triglycerides were comparable in lean, overweight and obese subjects. Plasma levels of sTNFR1 were similar in lean and overweight subjects, but significantly increased in obese group. Leptin, adiponectin and resistin levels did not differ when overweight were compared to obese subjects. However, all adipokines differed significantly when lean subjects were compared to overweight and obese individuals. Plasma levels of adiponectin were negatively correlated with body mass index (BMI), whereas leptin, resistin and sTNFR1 concentrations positively correlated with BMI. Conclusion Our results showed significant differences in circulating levels of the evaluated markers when lean, overweight and obese individuals were compared, suggesting that these biomarkers may change from lean to overweight and from overweight to obesity.
TL;DR: Infant mortality rates have decreased in developing countries, but these reductions have been largely due to decreases in deaths from pneumonia and diarrheal disease after the neonatal period, while earlier deaths relating to prematurity, birth asphyxia, and infection have experienced a lower decrease.
Abstract: h 4 c Maternal, infant, and neonatal mortality rate are benchmarks for maternal/infant care and the health of a society in general. Global efforts to reduce these mortality rates have been led by the World Health Organization (WHO) and the United Nations; the rates have decreased substantially worldwide, but the ambitious reductions set forth by the Millennium Development Goals have not been achieved. Maternal mortality has decreased by approximately 45% from the Millennium Development Goals baseline rate in 1990.1 One in four babies worldwide are delivered without the presence of a skilled birth attendant. Every day, hundreds of preventable maternal deaths occur due to pregnancy or childbirth-related complications. Infant mortality rates have decreased in developing countries, but these reductions have been largely due to decreases in deaths from pneumonia and diarrheal disease after the neonatal period, while earlier deaths relating to prematurity, birth asphyxia, and infection have experienced a lower decrease.2 As a consequence, neonatal deaths now account for 44% of the childhood mortality, the highest rate ever.2 Approximately 2.8 million babies worldwide die each year during the first month after birth; most of these deaths occur in developing countries.2 Scaling up interventions proven to be very effective could substantially reduce the regrettable loss of young lives.
TL;DR: Intervention opportunities are related to modifications in political, environmental, and individual settings, and school and physical activities in the educational environment are intertwined with nutrition intervention in continuous education.
Abstract: Objectives: To evaluate environmental obesogenic-related factors, such as physical activity in neighborhoods and schools, nutritional behavior, and intervention programs. Sources: Critical analysis of literature with personal point of view from infant obesity experts and political advisors for public intervention. Data synthesis: Although obesity is a public health problem affecting several age groups, it is among children and adolescents that it plays a more important role, due to treatment complexity, high likelihood of persistence into adulthood, and association with other non- transmissible diseases while still in early age. Environment is a main component of the genesis and outcomes in the near future or long term. Modification of intake with high-density food, meal skipping, and high intake of saturated fat, sugar, and salt, associated to high levels of sedentarism are main causes of obesity. Conclusion: Intervention opportunities are related to modifications in political, environmental, and individual settings. School and physical activities in the educational environment are intertwined with nutrition intervention in continuous education. A critical review of some different scenarios in Latin American countries is presented.
TL;DR: Very low birth weight preterm newborns are more likely to have feeding problems in early postnatal stages and during childhood when compared with full-term infants.
Abstract: OBJECTIVE: To analyze the scientific literature on dietary changes in preterm children during the first years of life. DATA SOURCE: The PubMed database was used for article selection. The texts were analyzed according to their objectives, research design, and research group characteristics. The following were selected to comprise the criteria: (1) publications in the period from 1996 to 2014; (2) participation of infants and children from birth to 10 years of age; (3) development of oral motor skills necessary for feeding; (4) development of the feeding process; and (5) feeding difficulties during childhood. SUMMARY OF THE FINDINGS: There were 282 studies identified, of which 17 were used in the review, and five more articles were identified through the reference list of selected articles, totaling 22 references. CONCLUSION: Very low birth weight preterm newborns are more likely to have feeding problems in early postnatal stages and during childhood when compared with full-term infants. Monitoring the feeding of these infants after hospital discharge is strictly recommended in an early intervention program aiming at better development of feeding skills.
TL;DR: Sleep deficit appears to be a reality among adolescents; the results suggest a higher prevalence in students from private schools, and sleep deprivation is associated with older age in adolescents and possible presence of sleep disorders, such as sleep hyperhidrosis.
Abstract: Objective: Sleep deprivation in adolescents has lately become a health issue that tends to increase with higher stress prevalence, extenuating routines, and new technological devices that impair adolescents’ bedtime. Therefore, this study aimed to assess the excessive sleepiness frequency and the factors that might be associated to it in this population. Methods: The cross-sectional study analyzed 531 adolescents aged 10---18 years old from two private schools and one public school. Five questionnaires were applied: the Cleveland Adolescent Sleepiness Questionnaire; the Sleep Disturbance Scale for Children; the Brazilian Economic Classication Criteria; the General Health and Sexual Maturation Questionnaire; and the Physical Activity Questionnaire. The statistical analyses were based on comparisons between schools and sleepiness and non-sleepiness groups, using linear correlation and logistic regression. Results: Sleep deprivation was present in 39% of the adolescents; sleep decit was higher in private school adolescents (p < 0.001), and there was a positive correlation between age and sleep decit (p < 0.001; r = 0.337). Logistic regression showed that older age (p = 0.002; PR: 1.21 [CI: 1.07---1.36]) and higher score level for sleep hyperhidrosis in the sleep disturbance scale (p = 0.02; PR: 1.16 [CI: 1.02---1.32]) were risk factors for worse degree of sleepiness. Conclusions: Sleep decit appears to be a reality among adolescents; the results suggest a higher prevalence in students from private schools. Sleep deprivation is associated with older age in adolescents and possible presence of sleep disorders, such as sleep hyperhidrosis.
TL;DR: Training of hospital health professionals has been effective in improving knowledge, skills, and practices and five interventions employed the theoretical and practical training of the Baby-Friendly Hospital Initiative.
Abstract: Objective To identify the impact of training in breastfeeding on knowledge, skills, and professional and hospital practices. Data source The systematic review search was carried out through the MEDLINE, Scopus, and LILACS databases. Reviews, studies with qualitative methodology, those without control group, those conducted in primary care, with specific populations, studies that had a belief and/or professional attitude as outcome, or those with focus on the post-discharge period were excluded. There was no limitation of period or language. The quality of the studies was assessed by the adapted criteria of Downs and Black. Summary of data The literature search identified 276 articles, of which 37 were selected for reading, 26 were excluded, and six were included through reference search. In total, 17 intervention articles were included, three of them with good internal validity. The studies were performed between 1992 and 2010 in countries from five continents; four of them were conducted in Brazil. The training target populations were nursing practitioners, doctors, midwives, and home visitors. Many kinds of training courses were applied. Five interventions employed the theoretical and practical training of the Baby-Friendly Hospital Initiative. All kinds of training courses showed at least one positive result on knowledge, skills, and/or professional/hospital practices, most of them with statistical significance. Conclusions Training of hospital health professionals has been effective in improving knowledge, skills, and practices.
TL;DR: The T-cell receptor excision circles (TRECs) quantification technique is reliable and can be applied on a large scale after the training of technical teams throughout Brazil.
Abstract: Objective To apply, in Brazil, the T-cell receptor excision circles (TRECs) quantification technique using real-time polymerase chain reaction in newborn screening for severe combined immunodeficiency and assess the feasibility of implementing it on a large scale in Brazil. Methods 8715 newborn blood samples were collected on filter paper and, after DNA elution, TRECs were quantified by real-time polymerase chain reaction. The cutoff value to determine whether a sample was abnormal was determined by ROC curve analysis, using SSPS. Results The concentration of TRECs in 8,682 samples ranged from 2 to 2,181 TRECs/µL of blood, with mean and median of 324 and 259 TRECs/µL, respectively. Forty-nine (0.56%) samples were below the cutoff (30 TRECs/µL) and were reanalyzed. Four (0.05%) samples had abnormal results (between 16 and 29 TRECs/µL). Samples from patients previously identified as having severe combined immunodeficiency or DiGeorge syndrome were used to validate the assay and all of them showed TRECs below the cutoff. Preterm infants had lower levels of TRECs than full-term neonates. The ROC curve showed a cutoff of 26 TRECs/µL, with 100% sensitivity for detecting severe combined immunodeficiency. Using this value, retest and referral rates were 0.43% (37 samples) and 0.03% (3 samples), respectively. Conclusion The technique is reliable and can be applied on a large scale after the training of technical teams throughout Brazil.
TL;DR: Calcium intake was significantly lower in the segment with lower education of the head of the family and lower per capita family income, in individuals from other cities or states, and in individuals who consumed fruit less than four times a week.
Abstract: Objective: To analyze calcium intake in adolescents according to sociodemographic variables, health-related behaviors, morbidities, and body mass index. Methods: This was a cross-sectional population-based study, with a two-stage cluster sampling that used data from a survey conducted in Campinas, Sao Paulo, Brazil, between 2008 and 2009. Food intake was assessed using a 24-hour dietary recall. The study included 913 adolescents aged 10 to 19 years. Results: Average nutrient intake was signicantly lower in the segment with lower education of the head of the family and lower per capita family income, in individuals from other cities or states, those who consumed fruit less than four times a week, those who did not drink milk daily, those who were smokers, and those who reported the occurrence of headaches and dizziness. Higher mean calcium intake was found in individuals that slept less than seven hours a day. The prevalence of calcium intake below the recommendation was 88.6% (95% CI: 85.4 to 91.2). Conclusion: The results alert to an insufcient calcium intake and suggest that certain subgroups of adolescents need specic strategies to increase the intake of this nutrient.
TL;DR: The IgG-WB showed greater sensitivity than the detection of IgM anti-T.
Abstract: Objetivo: Avaliar o metodo Western Blotting para deteccao de IgG anti-Toxoplasma gondii (T. gondii) (IgG-WB) no soro de criancas com suspeita de toxoplasmose congenita. Metodos: Acompanhamos 47 maes com toxoplasmose adquirida na gravidez e seus filhos, entre junho de 2011 e junho de 2014. O IgG-WB foi feito internamente e o teste foi considerado positivo quando a crianca apresentava anticorpos que reconheciam pelo menos uma banda nas manchas de IgG diferente das bandas da mae ou com maior intensidade do que a banda materna correspondente, durante os primeiros 3 meses de vida. Resultados: Atenderam aos criterios para diagnostico de toxoplasmose congenita 15 criancas (15,1%) e 32 (32,3%) tiveram o diagnostico excluido. Os sintomas foram observados em 12 criancas (80%) e os mais frequentes foram calcificacao cerebral em nove (60%), coriorretinite em oito (53,3%) e hidrocefalia em quatro (26,6%). Os anticorpos IgM anti-T. gondii detectados por quimiluminescencia (QL) foram encontrados em seis criancas (40%) e a reacao em cadeia da polimerase (RCP) para deteccao do DNA de T. gondii foi positiva em cinco de sete reacoes (71,4%). A sensibilidade do IgG-WB foi de 60% [intervalo de confianca (IC) de 95%, 32,3 a 83,7%] e a especificidade foi de 43,7% (IC de 95%, 26,7 a 62,3%). A sensibilidade do IgG-WB aumentou para 76 e 89,1% quando relacionada a pesquisa de IgM anti-T. gondii ou a RCP, respectivamente. Conclusoes: O IgG-WB mostrou maior sensibilidade do que a deteccao de IgM anti-T. gondii; portanto, pode ser usado para o diagnostico de toxoplasmose congenita em associacao com outros marcadores de infeccao congenita.
TL;DR: The integrated analysis of these studies suggests that coparenting is a key mechanism within the family system for the prediction of child mental health after marital dissolution, and thus, it is recommended that pediatricians, psychologists, and other health professionals considerCoparenting as a psychosocial variable for children's mental health assessment and diagnosis.
Abstract: Objective Research has shown that coparenting is a vital family mechanism in predicting mental health in children and adolescents. Considering the increasing prevalence of marital dissolution in Western societies, the objective of this systematic review was to summarize the key results of empirical studies that tested the association between mental health of children and coparenting after marital dissolution. Data source The studies were obtained from three databases (PsycInfo, PubMed, and Web of Knowledge), published between January 2000 and October 2014. The titles, abstracts, and key words of the generated citations were independently reviewed by two investigators to consensually select the articles that met the inclusion criteria. Articles that used psychometrically valid tools to measure at least one mental health indicator and at least one dimension of coparenting in samples with divorced parents were included in the review. Data synthesis Of the 933 screened articles, 11 met the inclusion criteria. Significant positive associations were found between coparental conflict and behavioral problems and symptoms of anxiety, depression, and somatization. Significant positive associations were also found between other specific dimensions of coparenting (coparental support, cooperation, and agreement), overall mental health, self-esteem, and academic performance. Conclusions The integrated analysis of these studies suggests that coparenting is a key mechanism within the family system for the prediction of child mental health after marital dissolution, and thus, it is recommended that pediatricians, psychologists, and other health professionals consider coparenting as a psychosocial variable for children's mental health assessment and diagnosis.
TL;DR: Brazil's neonatal mortality rate has improved in recent times, but maternal mortality rates have stagnated, failing to meet the Millennium Development Goals.
Abstract: Objective Maternal and neonatal mortality are important public health issues in low-income countries. This study evaluated spatial and temporal maternal and neonatal mortality trends in Brazil between 1997 and 2012. Methods This study employed spatial analysis techniques using death records from the mortality information system. Maternal mortality rates per 100,000 and neonatal mortality rates (early and late) per 1000 live births were calculated by state, region, and period (1997–2000, 2001–2004, 2005–2008, and 2009–2012). Multivariate negative binomial models were used to explain the risk of death. Results The mean Brazilian maternal mortality rate was 55.63/100,000 for the entire 1997–2012 period. The rate fell 10% from 1997–2000 (58.92/100,000) to 2001–2004 (52.77/100,000), but later increased 11% during 2009–2012 (58.69/100,000). Early and late neonatal mortality rates fell 33% (to 7.36/1000) and 21% (to 2.29/1000), respectively, during the 1997–2012 period. Every Brazilian region witnessed a drop in neonatal mortality rates. However, maternal mortality increased in the Northeast, North, and Southeast regions. Conclusion Brazil's neonatal mortality rate has improved in recent times, but maternal mortality rates have stagnated, failing to meet the Millennium Development Goals. Public policies and intersectoral efforts may contribute to improvements in these health indicators.
TL;DR: Overall, the feeding of infants and preschool children in Brazil is characterized by low consumption of meat, fruits, and vegetables; high consumption of cow's milk and inadequate preparation of bottles; as well as early and high intake of fried foods, candies/sweets, soft drinks, and salt.
Abstract: Objective To assess the feeding profile of Brazilian infants and preschool children aged 6 months to 6 years, based on the qualitative and quantitative analysis of food and nutrient intake. Data source This review analyzed studies carried out in Brazil that had food survey data on infants and preschool children. The search was limited to publications from the last 10 years included in the LILACS and MEDLINE electronic databases. Data summary The initial search identified 1480 articles, of which 1411 were excluded after the analysis of abstracts, as they were repeated or did not meet the inclusion criteria. Of the 69 articles assessed in full, 31 articles contained data on food survey and were selected. Only three studies concurrently assessed children from different Brazilian geographical regions. Of the assessed articles, eight had qualitative data, with descriptive analysis of food consumption frequency, and 23 had predominantly quantitative data, with information on energy and nutrient consumption. Conclusions The articles assessed in this review showed very heterogeneous results, making it difficult to compare findings. Overall, the feeding of infants and preschool children is characterized by low consumption of meat, fruits, and vegetables; high consumption of cow's milk and inadequate preparation of bottles; as well as early and high intake of fried foods, candies/sweets, soft drinks, and salt. These results provide aid for the development of strategies that aim to achieve better quality feeding of Brazilian infants and preschoolers.
TL;DR: Oxidative stress parameters in children's erythrocytes were determined using simple laboratory methods with small volumes of blood; these biomarkers can be useful to evaluate disease progression and outcomes in patients.
Abstract: Objective To determine eight parameters of oxidative stress markers in erythrocytes from children with sickle cell disease and compare with the same parameters in erythrocytes from healthy children, since oxidative stress plays an important role in the pathophysiology of sickle cell disease and because this disease is a serious public health problem in many countries. Methods Blood samples were obtained from 45 children with sickle cell disease (21 males and 24 females with a mean age of 9 years; range: 3–13 years) and 280 blood samples were obtained from children without hemoglobinopathies (137 males and 143 females with a mean age of 10 years; range: 8–11 years), as a control group. All blood samples were analyzed for methemoglobin, reduced glutathione, thiobarbituric acid reactive substances, percentage of hemolysis, reactive oxygen species, and activity of the enzymes glucose 6-phosphate dehydrogenase, superoxide dismutase, and catalase. Data were analyzed using Student's t-test and were expressed as the mean ± standard deviation. A p-value of <0.05 was considered significant. Results Significant differences were observed between children with sickle cell disease and the control group for the parameters methemoglobin, thiobarbituric acid reactive substances, hemolysis, glucose 6-phosphate dehydrogenase activity, and reactive oxygen species, with higher levels in the patients than in the controls. Conclusions Oxidative stress parameters in children's erythrocytes were determined using simple laboratory methods with small volumes of blood; these biomarkers can be useful to evaluate disease progression and outcomes in patients.