Navegando por Palavras-chave "adolescent"

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    Acidentes não fatais em adolescentes escolares de Belém, Pará
    (Sociedade de Pediatria de São Paulo, 2007-12-01) Carvalho, Maria Florinda P. P. de; Puccini, Rosana Fiorini [UNIFESP]; Silva, Edina Mariko Koga da [UNIFESP]; Universidade do Estado do Pará Disciplina de Pediatria; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE: Study the frequency of nonfatal accidents among adolescent students in the city of Belém, Pará, Brazil. METHODS: This cross-sectional study enrolled a probabilistic sample of 2,828 adolescent students, aged 17 and 18 years old, chosen in clusters obtained in multiple stages. Students were in their final year of high school, in public and private schools of the city of Belém, during the year 2000. Data was collected through a self-administered semi-structured questionnaire. Statistical analysis to compare the categorical variables between the two groups used the chi-square calculated by the Epitable of Epi-Info 6.01. RESULTS: The students' mean age was 17.7 years; 60% were female; 82% studied in public schools; 61% lived with both parents; and 23% with only one of their parents. The occurrence of at least one accident was reported by 1,987 (70%) adolescents. The most frequent types were: falls (35%), contact with sharp glass, knife, sword and dagger (30%), contact with heat and hot substances (22%), transport accidents (20%) and bite by dogs and other mammals (18%). Accidents were more frequent among males (78%) than females (65%), and among students of private schools (77%) than those of public schools (69%). One third of the accidents led the adolescents to healthcare services and, of these, 9% were hospitalized. CONCLUSIONS: A high accident rate was seen among adolescent students, confirming the vulnerability of this age group. Better social conditions, here represented by attendance of private schools, did not confer protection against accidents in this population.
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    Adolescentes modelos de passarela: como é o consumo alimentar deste grupo?
    (Sociedade de Pediatria de São Paulo, 2010-12-01) Rodrigues, Alexandra Magna [UNIFESP]; Cintra, Isa de Pádua [UNIFESP]; Santos, Luana Caroline dos; Martini, Ligia Araújo [UNIFESP]; Mello, Marco Tulio de [UNIFESP]; Fisberg, Mauro [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)
    OBJECTIVE: To evaluate the adequacy of energy, macro and micronutrients intake in adolescent runway models. METHODS: This cross-sectional study enrolled 33 models and 33 non-models, with ages ranging from 15 to 18 years, paired by age and body mass index (BMI). Food intake was evaluated by a three-day food record. The average energy values were estimated in kcal, the proportional values of macronutrients as to the total caloric value of the consumed diet were also calculated, as well as the mean/medium values of the following micronutrients: calcium, iron, zinc, phosphorus, magnesium, folate, vitamin D, vitamin C, vitamin A and vitamin E. RESULTS: Among the studied adolescents, 24% presented BMI below the minimum values for the age. Mean energy intake was lower among the models compared to non-models (1,480.93±582.95 versus 1,973.00±557.63 kcal) (p<0.05). The fat intake, higher than the recommended, was similar in both groups (30.3% in models and 36.4% of the non-model adolescents - p>0.05). The inadequate consumption of micronutrients such as calcium, iron, zinc, magnesium, phosphorus, liposoluble vitamins, folate and ascorbic acid was observed in both groups. CONCLUSIONS: The low energy intake (kcal) among models and the insufficient intake of minerals and vitamins are red flags for model agencies to be more committed to the health of these adolescents, ensuring that they get nutritional and medical follow-up.
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    Alterações oftalmológicas decorrentes do tratamento do lúpus eritematoso sistêmico juvenil
    (Sociedade Brasileira de Reumatologia, 2011-12-01) Fraga, Melissa Mariti [UNIFESP]; Len, Claudio Arnaldo [UNIFESP]; Finamor, Luciana Peixoto dos Santos [UNIFESP]; Matos, Kimble Teixeira Fonseca [UNIFESP]; Muccioli, Cristina [UNIFESP]; Hilário, Maria Odete Esteves [UNIFESP]; Terreri, Maria Teresa Ramos Ascensão [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE: To assess retrospectively the ocular changes in children and adolescents with juvenile systemic lupus erythematosus (JSLE) in a tertiary pediatric rheumatology service. METHODS: This study assessed 117 JSLE patients (85.5% female, 60.7% non-Caucasian), who met at least four criteria of the 1997 SLE classification of the American College of Rheumatology. Their mean age was 10.4 years, and their mean time of disease progression was 5.4 years. A protocol containing clinical and demographic data, ophthalmologic complaints and changes, age of onset, duration of medication use, and cumulative medication dose was applied. RESULTS: Of the 117 patients, 24 (20.5%) had ocular changes. Sixteen of them had abnormal fundoscopy associated with systemic hypertension and/or use of chloroquine; four had cataract; two had glaucoma; and two had cataract and glaucoma. The mean age of ocular change onset was 14.1 years. Patients with ocular changes received statistically higher and longer doses of glucocorticoid pulse therapy as compared with patients without ocular changes [1.5 (0.4 to 1.6) versus 1 (0.2 to 1.6) mg/kg, P = 0.003; 25.7 (2-99) versus 17.8 (1-114) months, P = 0.0001, respectively]. CONCLUSION: A high prevalence of ocular changes relating mainly to the treatment of JSLE was observed. This demonstrates the need for regular ophthalmologic examinations even in asymptomatic patients, aiming at the early diagnosis and intervention, and at decreasing the ocular morbidity related to that disease.
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    Ambiente familiar e consumo de álcool e tabaco entre adolescentes
    (Sociedade de Pediatria de São Paulo, 2009-12-01) Moreno, Rafael Souza [UNIFESP]; Ventura, Renato Nabas [UNIFESP]; Brêtas, José Roberto da Silva [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Grupo de Estudos Sobre Corporalidade e Promoção da Saúde
    OBJECTIVE: To analyze the influence of the family environment in relation to alcohol and tobacco use among adolescents. METHODS: This was a descriptive study consisting of in-depth analysis on the topic of family influence related to legal drug use. A semi-structured questionnaire containing 25 questions on alcohol and tobacco use was completed by 1,533 adolescents of both genders. Inclusion criteria were: adolescents aged ten to 20 years who were regularly attending morning classes in the sixth, seventh or eighth years of elementary education or in the first, second or third years of high school education at state schools in two regions of the municipality of Embu, São Paulo, Brazil. Subjects agreed to participate in preventive health promotion workshops of the Corporality and Health Promotion Project. Statistical analysis applied odds ratio, with a 95% confidence interval and chi-square test, being significant p<0.05. RESULTS: 66% of the adolescents who had not tried alcoholic drinks did not have any family members who were frequent drinkers (p<0.001) and 84% of those who smoked had family members who were smokers (p<0.001). CONCLUSIONS: The family environment induces and facilitates alcohol and tobacco use. It is extremely important to use this knowledge to design preventive health education projects.
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    Amenorréia e osteoporose em adolescentes atletas
    (Pontifícia Universidade Católica de Campinas, 2002-09-01) Mantoanelli, Graziela [UNIFESP]; Vitalle, Maria Sylvia de Souza [UNIFESP]; Amancio, Olga Maria Silverio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    The female participation in sports has been increasing over the years. Scientific studies have shown the benefits this practice brings to women's health, but, when it comes to competitive sports, problems may arise. The most common complication described by the literature is the Female Athlete Triad, which involves three processes: the eating disorder, the amenorrhea, and the osteoporosis. In the United States, the amenorrhea afflicts up to 66% of the competition athletes, and some of its possible causes of are: weight loss, excessive training, insufficient quantity of body fat, loss of specific stores of body fat, and inadequate diet. As a consequence of the amenorrhea, the sportswoman may develop precocious osteoporosis. It is not known for sure the percentage of athletes with osteopenia, but there are indications that the lack of estrogen, the inadequate diet, and the insufficient consumption of calcium are factors predisposing them to develop the disease.
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    Análise do polimorfismo do gene do receptor de melatonina mtnr1b em mulheres com síndrome dos ovários policisticos em uso de metformina e antinconcepcional
    (Universidade Federal de São Paulo (UNIFESP), 2014-02-12) Iwata, Margareth Chiharu [UNIFESP]; Soares Junior, Jose Maria [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    INTRODUCTION.The polycystic ovary syndrome (PCOS) is the most common endocrine disorder of reproductive age in women. The exact pathophysiological mechanism of the syndrome remains unclear, but it is believed that insulin and its receptor are involved. Hyperinsulinemia and its receptor defect. may contribute to the onset of ovarian and systemic hyperandrogenism as well as chronic anovulation. Melatonin is a hormone that can regulate insulin receptor sensitivity by tyrosine phosphorylation and also act on insulin secretion by pancreatic beta cells by MT2 receptor. Therefore, melatonin may be related to carbohydrate metabolism and thus, with PCOS pathogenesis. Studies have associated genetic alterations in MTNR1B gene encoding MT2 receptor with risk of developing type 2 diabetes. Another point in the PCOS would be the worsening of glucose tolerance with use of contraceptives, and patients with these polymorphisms could have worse outcome. Furthermore, if metformin was given, perhaps its action was not as effective. Therefore, we sought to evaluate the response of adolescents with PCOS using metformin and combined oral contraceptive, and analyze the influence of melatonin receptor gene polymorphisms in these patients. OBJECTIVE. identify four genetic polymorphisms of type 2 melatonin receptor correlating them with plasma glucose, plasma insulin and sex steroids; evaluate the use of insulin sensitizing drug (metformin) and therapy using etnilestradiol and cyproterone in adolescents with PCOS. METHODS. Prospective, randomized, double blind, placebo controlled clinical trial in adolescents with PCOS by Rotterdam criteria (2003), divided into group 1 - contraceptive (35 mcg ethinylestradiol + 2 mg of cyproterone acetate) and metformin 1500 mg / day; Group 2 - contraceptive and placebo. Time use: 6 months. Clinical parameters (BMI, waist-hip ratio, blood pressure, acanthosis nigricans, hirsutism, acne) and laboratory (AST, ALT, creatinine, FSH, LH, estradiol, total testosterone, androstenedione, SHBG, fasting and 2 hours after overload glucose and insulin, total cholesterol, HDL, LDL, triglycerides, melatonin) were evaluated. Polymorphisms rs10830963 C/G, rs12804291 C/T, rs3781638 A/C, 1387153 C/T by PCR and DNA sequencing. RESULTS. Polymorphisms were evaluated in 106 patients and the response to medication in 45 of them. Clinical improvement of hyperandrogenism was higher in the metformin and oral contraceptive group and not determined significant weight gain. Oral contraceptive plus placebo group showed significant increase in body mass index. Metformin and contraceptive determined marked reduction of LH, free testosterone and blood glucose and insulin parameters than in the placebo plus contraceptive after six months of treatment. There was no significant change in melatonin levels during the study. Adverse effects were greater in metformin plus contraceptive group. In the data before treatment, the polymorphism rs10830963 C/G determined higher values of fasting glucose; and rs3781638 polymorphism A/C determined lower insulin levels after glucose overload. During treatment, the polymorphism rs1387153 C/T determined elevated blood glucose levels, while rs12804291C/T and rs3781638 A/C determined increase and decrease, respectively, of total testosterone. CONCLUSIONS. The use of metformin may be safe in adolescents and the association of metformin may provide additional benefit in these patients, particularly in relation to body weight, carbohydrate metabolism and hyperandrogenism. MTNR1B gene polymorphisms are associated with metabolism of glucose and insulin and may influence the response to treatment with metformin and combined oral contraceptive.
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    Anorexia nervosa: estudo de caso com uma abordagem de sucesso
    (Universidade Federal Fluminense, Departamento de Psicologia, 2008-12-01) Cañete, Márcia Cecília Vianna [UNIFESP]; Vitalle, Maria Sylvia de Souza [UNIFESP]; Silva, Flávia Calanca da [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Anorexia nervosa (AN) is a severe disease of multifactorial etiology, that involves genetic predisposition, sociocultural factors, biological and psychological vulnerabilities. This article aims to analyze the kind of psychotherapeutic treatment used, in heterogenous group, without focusing on the anorexic behaviour through the description of a case of AN. We have also approached the implications of the disease in the social and family aspects, in the education and sexuality of the patient. The kind of psychotherapeutic treatment used, in heterogenous group, without focusing in the anorexic behaviour, proved effective in the adherence to treatment as well as in the evolution of the case.
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    Aprepitant in Adolescent Patients for Prevention of Chemotherapy-Induced Nausea and Vomiting: A Randomized, Double-Blind, Placebo-Controlled Study of Efficacy and Tolerability
    (Wiley-Blackwell, 2009-02-01) Gore, Lia; Chawla, Sant; Petrilli, Antonio [UNIFESP]; Hemenway, Molly; Schissel, Debra; Chua, Vickey; Carides, Alexandra D.; Taylor, Arlene; DeVandry, Suzanne; Valentine, Jack; Evans, Judith K.; Oxenius, Bettina; Adolescent Aprepitant Canc Study G; Univ Colorado Denver; Childrens Hosp; Sarcoma Oncol Ctr; Universidade Federal de São Paulo (UNIFESP); Merck Res Labs
    Background. the neurokinin-1 receptor antagonist aprepitant, plus a 5HT3 antagonist and corticosteroid is well-tolerated and effective in preventing chemotherapy-induced nausea and vomiting in adults but has not been formally assessed in adolescents. Procedure. Patients age 11-19 years old receiving emetogenic chemotherapy were randomized 2:1 to aprepitant triple therapy (aprepitant [A] 125 mg p.o., dexamethasone [D] 8 mg p.o., and ondansetron [O]0.15 mg/kg i.v. t.i.d. day 1; A 80 mg, D 4 mg, and 0 0.15 mg/kgt.i.d. day 2; A 80 mg and D4 mg day 3; and D 4 mg day 4) or a control regimen (D 16 mg and 0 0.15 mg/kg t.i.d. day 1; D 8 mg and 0 0.15 mg/1
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    Asthma in children and adolescents in Brazil: contribution of the International Study of Asthma and Allergies in Childhood (ISAAC)
    (Sociedade de Pediatria de São Paulo, 2014-03-01) Solé, Dirceu [UNIFESP]; Camelo-Nunes, Ines Cristina; Wandalsen, Gustavo Falbo [UNIFESP]; Mallozi, Marcia Carvalho [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objective:To assess asthma among Brazilian pediatric population applying the International Study of Asthma and Allergies in Childhood (ISAAC), an internationally standardized and validated protocol.Data sources:ISAAC was conceived to maximize the value of epidemiologic studies on asthma and allergic diseases, establishing a standardized method (self-applicable written questionnaire and/or video questionnaire) capable to facilitate the international collaboration. Designed to be carried out in three successive and dependent phases, the ISAAC gathered a casuistic hitherto unimaginable in the world and in Brazil. This review included data gathered from ISAAC official Brazilian centers and others who used this method.Data synthesis:At the end of the first phase, it has been documented that the prevalence of asthma among Brazilian schoolchildren was the eighth among all centers participating all over the world. Few centers participated in the second phase and investigated possible etiological factors, especially those suggested by the first phase, and brought forth many conjectures. The third phase, repeated seven years later, assessed the evolutionary trend of asthma and allergic diseases prevalence in centers that participated simultaneously in phases I and III and in other centers not involved in phase I.Conclusions:In Brazil, the ISAAC study showed that asthma is a disease of high prevalence and impact in children and adolescents and should be seen as a Public Health problem. Important regional variations, not well understood yet, and several risk factors were found, which makes us wonder: is there only one or many asthmas in Brazil?
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    Atraso na erupção dental em adolescente com hipotireoidismo
    (Sociedade de Pediatria de São Paulo, 2012-12-01) Vitalle, Maria Sylvia de Souza [UNIFESP]; Weiler, Rosa Maria E. [UNIFESP]; Niskier, Sheila Rejane [UNIFESP]; Braga, Josefina Aparecida Pellegrini [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE: To report the case of an adolescent with undiagnosed hypothyroidism who sought dental clinic care due to delayed tooth eruption. Multiprofessionalwork enabled the diagnosis. CASE DESCRIPTION: This is a 16 years and 4 month-old patient whose initial complaint was delayed tooth eruption. Dental evaluation drew attention to the significant delay in tooth eruption as it could be related to organic diseases. This has prompted the intervention of medical professionals who diagnosed hypothyroidism in the follow-up. COMMENTS: Teenagers typically value acceptance by their peers and may have aesthetic concerns that lead them to seek health services for seemingly trivial complaints. A high degree of surveillance in these cases can detect more serious underlying organic problems. We highlight the importance of the multidisciplinary team in this approach.
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    Avaliação de influências sociais e econômicas sobre a pressão arterial de adolescentes de escolas públicas e privadas: um estudo epidemiológico
    (Sociedade Brasileira de Nefrologia, 2011-06-01) Almeida, Fernando Antonio De; Konigsfeld, Henrique Pinheiro; Machado, Lígia Maria De Oliveira; Canadas, Andréa Farias; Issa, Evelyn Yuri Okumura; Giordano, Roberto Hernandes; Cadaval, Ricardo Augusto De Miranda [UNIFESP]; Cornell University Medical College; Pontifícia Universidade Católica de São Paulo Faculdade de Ciências Médicas e da Saúde; Universidade Federal de São Paulo (UNIFESP)
    INTRODUCTION: The high prevalence of hypertension in high school students in Sorocaba, São Paulo, Brazil, has already been described. In this study, within a new sample of high school students from public and private schools, we evaluated if socioeconomic and lifestyle influence on blood pressure values. METHODS: This is an epidemiological study, which is part of the activities of a community-based work conducted by medical students. They give speeches to high school students aiming at stimulating a healthy lifestyle and primary prevention of hypertension. In a random sample of 410 students in junior high school (209 from public schools and 201 from private schools), we determined the weight, height, and blood pressure, furthermore, a questionnaire identifying epidemiological and socioeconomic status was applied. RESULTS: No statistical differences were found among students from public and private schools regarding the distribution of gender, body mass index (BMI), systolic and diastolic blood pressure, prevalence of hypertension (16.3%), percentage of smokers (5.9%), regular physical activity, and family history of hypertension. In public schools, there is a higher percentage of African descendents students and a higher percentage of students who also work due to low family income. Men from public and private schools have higher prevalence of hypertension, and their mean blood pressure is higher than in women. BMI has a positive correlation with systolic and diastolic blood pressure. CONCLUSIONS: Hypertension and other cardiovascular risk factors have an early beginning and require educational interventions for primary prevention. Socioeconomic factors do not affect blood pressure in adolescence.
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    Avaliação do impacto de intervenção nutricional na composição corporal de adolescentes com lúpus eritematoso sistêmico juvenil
    (Universidade Federal de São Paulo (UNIFESP), 2015-11-12) Abad, Thais Tobaruela Ortiz [UNIFESP]; Terreri, Maria Teresa de Sande e Lemos Ramos Ascensao Terreri [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objective: to evaluate the impact of a dietary intervention in body composition changes and food intake of adolescents with juvenile Systemic Lupus erythematosus; to evaluate the association between body composition changes and physical activity, disease activity and medication use. Methods: thirty-one female adolescents with juvenile Systemic Lupus erythematosus, aged between 10 and 19 years old and minimum time of diagnosis of 6 months. In moment 1 (pre-intervention) body composition exam was performed and questionnaires of physical activity and food intake (24-hour recall) were applied. Patients were randomized into two groups: nutritional intervention and control group (no intervention). After a nine-month intervention, the exam and the questionnaires were repeated. Results: In the intervention group, we observed significant reduction in calorie (p=0.017), carbohydrate (p=0.030), total fat (p=0.020), saturated fat (p=0.013) and trans fat (p=0.012) intake. After nine months, control group presented increase in BMI (p=0.016), fat percentage (p=0.023), fat mass (p=0.024), trunk fat (p=0.005) and fat mass index (p=0.047) and appendicular fat index (p=0.016). No significant changes were observed in the intervention group. There was an average increase of 3.66kg of fat mass (p=0.013) and 0.36kg/m2 of appendicular fat index (0.007) in the control group. Conclusion: a nine-month dietary intervention aiming at healthy food behavior in teenagers with juvenile Systemic Lupus erythematosus is effective in promoting better food habits and seems to protect excess weight and fat mass gain.
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    Avaliação dos hábitos de atividades físicas de adolescentes com epilepsia do município de Toledo-PR
    (Liga Brasileira de Epilepsia (LBE), 2008-12-01) Cervelini, Renato; Scorza, Fulvio Alexandre [UNIFESP]; Cavalheiro, Esper Abrão [UNIFESP]; Arida, Ricardo Mario [UNIFESP]; Universidade do Paraná; Universidade Federal de São Paulo (UNIFESP)
    INTRODUCTION: Although the beneficial effect of physical activity in general population and those with different types of diseases, people with epilepsy are often discouraged and excluded from physical activity participation. This usually occurs due the fear that physical activity might induce or worse epileptic seizures. Stigma and prejudice are factors which contribute to these attitudes. In spite of several studies in literature have analyzed the relationship between epilepsy and physical activity, there are no evident data evaluating the teenager population profile in relation to their physical activity habits. OBJECTIVE: Therefore, we sought to study the degree of participation in physical activities among teenagers with epilepsy of Toledo City-PR using a questionnaire. METHODS: Teenagers outpatients with epilepsy were checked by Consortium (CISCOPAR) in Toledo City-PR and invited to participate as study subject during a workaday visit at professional physician. RESULTS: All the teenagers reported opportunities of leisure time. Eighty percent of the teenagers participated physical activities, but not all of them regularly. Sixty-nine percent of the individuals (n = 20) in our study presented seizures during physical exercise and fifty-two percent (n = 14) were afraid that exercise might cause seizures. CONCLUSION: In spite of the small number of individuals analyzed in this study, our results show that epilepsy has a negative influence on physical activity habits in adolescents.
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    Avaliação nutricional de crianças com doença renal crônica
    (Sociedade de Pediatria de São Paulo, 2009-06-01) Brecheret, Ana Paula [UNIFESP]; Fagundes, Ulysses [UNIFESP]; Lazaretti-Castro, Marise [UNIFESP]; Andrade, Maria Cristina de [UNIFESP]; Carvalhaes, João Tomás de Abreu [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE:Malnutrition is a frequent complication among children with renal diseases. Short stature is the main clinical sign. The aim of this study is to analyze the nutritional status of children with renal disease using anthropometry. METHODS: This cross sectional study enrolled 21 (43%) boys and 28 (57%) girls with age ranging from 5.3 to 19.5 years. They were divided in three groups based on their creatinine clearance (mL/min/1.73m²): Group 1, >37 (n=19); Group 2, between 15 and 37 (n=9) and Group 3, <15 (n=21). Weight and height were obtained in order to calculate the following indexes: Weight/age (W/A), height/age (H/A) and body mass index (BMI); then, Z scores were obtained. Malnutrition was defined as Z scores below -2. ANOVA test was used to compare groups. RESULTS: There were no differences among the groups for anthropometric data. 19 patients (38.8%) presented short-stature and 22 (44.8%) low-weight. Z scores were similar among groups relative to W/A, H/A and BMI values. W/A Z score values were: Group 1: -1.9±1.8; Group 2: -2.6±3.1 and Group 3: -2.5±1.4 (p=0.47). H/A Z scores values were: Group 1: -1.5±1.2; Group 2: -2.3±1.8 and Group 3: -2.1±1.1 (p=0.18). The calculated BMI Z scores were: Group 1: -1.2±1.4; Group 2: -1.7±3.9 and Group 3: -1.6±1.3 (p=0.82). 19 children presented short stature and 22 presented low weight. There were no differences between the studied groups. CONCLUSIONS: The sample presented high prevalence of malnutrition. Even considering the disease stage, there were no nutritional differences between the studied groups.
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    A baixa estatura leve está associada a índices mais elevados de gordura corporal: estudo de uma população de baixa renda
    (Sociedade Brasileira de Pediatria, 2011-04-01) Clemente, Ana Paula Grotti [UNIFESP]; Santos, Carla Danusa da Luz [UNIFESP]; Martins, Vinícius José Baccin [UNIFESP]; Benedito-Silva, Ana Amélia [UNIFESP]; Albuquerque, Maria Paula; Sawaya, Ana Lydia [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP); Centro de Recuperação e Educação Nutricional
    OBJECTIVE: To determine the impact of transferring a pediatric population to mechanical ventilator dependency units (MVDUs) or to home mechanical ventilation (HMV) on bed availability in the pediatric intensive care unit (ICU). METHODS: This is a longitudinal, retrospective study of hospitalized children who required prolonged mechanical ventilation at the MVDU located at the Hospital Auxiliar de Suzano, a secondary public hospital in São Paulo, Brazil. We calculated the number of days patients spent at MVDU and on HMV, and analyzed their survival rates with Kaplan-Meier estimator. RESULTS: Forty-one patients were admitted to the MVDU in 7.3 years. Median length of stay in this unit was 239 days (interquartile range = 102-479). Of these patients, 22 came from the ICU, where their transfer made available 8,643 bed-days (a mean of 14 new patients per month). HMV of eight patients made 4,022 bed-days available in the hospital in 4 years (a mean of 12 new patients per month in the ICU). Survival rates of patients at home were not significantly different from those observed in hospitalized patients. CONCLUSION: A hospital unit for mechanical ventilator-dependent patients and HMV can improve bed availability in ICUs. Survival rates of patients who receive HMV are not significantly different from those of patients who remain hospitalized.
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    A baixa estatura leve está associada ao aumento da pressão arterial em adolescentes com sobrepeso
    (Sociedade Brasileira de Cardiologia - SBC, 2012-01-01) Clemente, Ana Paula Grotti [UNIFESP]; Santos, Carla Danusa [UNIFESP]; Benedito-Silva, Ana Amélia [UNIFESP]; Martins, Vinícius José Baccin [UNIFESP]; Marchesano, Anna Carolina [UNIFESP]; Fernandes, Mariana Belluca [UNIFESP]; Albuquerque, Maria Paula; Sawaya, Ana Lydia [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP); Centro de Recuperação e Educação Nutricional
    BACKGROUND: Studies have shown that pre/postnatal undernutrition leads to higher risk of non communicable diseases such as diabetes, hypertension and obesity in adulthood. OBJECTIVE: To determine whether overweight adolescents with mild stunting [height-for-age Z scores (HAZ) in the range <-1 to >-2] have higher blood pressure than overweight individuals with normal stature (HAZ >-1). MEHTODS: Participants were classified as mildly stunted or of normal stature, and further stratified according to body mass index-for-age percentiles as overweight, normal or underweight. Systolic (SBP) and diastolic (DPB) blood pressures were determined according to guidelines, and abdominal fat was analyzed by dual energy X-ray absorptiometry. RESULTS: Mild stunted overweight individuals showed higher DBP values (p=0.001) than their underweight counterparts (69.75 ± 12.03 and 54.46±11.24 mmHg, respectively), but similar to those of normal BMI. No differences were found in DBP values of normal, overweight and underweight individuals among the normal stature groups. An increase in SBP (p=0.01) among mild stunted individuals was found when those with overweight were compared to their underweight and normal BMI counterparts (114.70 ± 15.46, 97.38 ± 10.87 and 104.72 ± 12.24 mmHg, respectively). Although no differences were observed in the means of SBP between mild stunting and normal stature groups, a significant intercept was found (p=0.01), revealing higher SBP among stunted individuals. There was a correlation between SBP and abdominal fat (r=0.42, ρ=0.02) in the stunted group. CONCLUSION: Stunted individuals with overweight showed higher SBP than those of normal stature and overweight. These findings confirm that mild stunting increase the risk of future hypertension and alterations are evident at early age.
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    Body mass index percentiles in adolescents of the city of São Paulo, Brazil, and their comparison with international parameters
    (Sociedade Brasileira de Endocrinologia e Metabologia, 2010-03-01) Passos, Maria Aparecida Zanetti [UNIFESP]; Cintra, Isa de Pádua [UNIFESP]; Branco, Lúcia Maria; Machado, Helymar da Costa; Fisberg, Mauro [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Centro Paula Souza Escola Técnica Estadual (ETEC) Getúlio Vargas; Universidade Estadual de Campinas (UNICAMP)
    OBJECTIVE: To describe the percentile distribution of body mass index (BMI) in school adolescents, by gender and age, comparing them with international parameters. SUBJECTS AND METHODS: The study included 8,020 adolescents aged 10-15 years from 43 schools in the city of São Paulo, southeastern Brazil. BMI values of the study sample were distributed in percentiles and compared to international parameters (CDC, Must and cols. and Cole and cols.). RESULTS: Both male and female adolescents aged 10 to 14 years showed BMI cut-offs over the international parameters, especially in the P50-P85 percentile range. At the age of 15, the observed values were very similar to reference data; however, BMI values in the 95th percentile were much higher than international parameters. CONCLUSIONS: The study results show how important it is to use adequate BMI values for Brazilian adolescents aged 10-15 since international parameters may not reflect the actual nutritional status of this group.
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    Capacidade física e reprodutibilidade do teste de caminhada de seis minutos em crianças e adolescentes após o transplante hepático
    (Universidade Federal de São Paulo (UNIFESP), 2011-05-25) Silva, Rosangela Maria da [UNIFESP]; Carvalho, Werther Brunow de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introdução: O transplante hepático pediátrico é um dos mais bem sucedidos transplantes de órgãos sólidos. Independente do tipo de transplante de órgãos, a fase pós-operatória representa um período de importante redução na capacidade de exercício do receptor. Unnitban et al., 2006, reportaram baixo nível de condicionamento cardiopulmonar, em crianças após o transplante hepático, quando comparadas a crianças saudáveis. O teste de esforço cardiopulmonar é o padrão-ouro para avaliação do condicionamento cardiopulmonar. No entanto, não é um procedimento disponível para avaliação diária, sobretudo na população pediátrica, pois requer equipamentos e habilidade técnica específica. Em contraste, o teste da caminhada de seis minutos (TC6’) é um teste prático, seguro, barato, de fácil execução, que reflete melhor as atividades de vida diária. Objetivo: Avaliar a reprodutibilidade e a capacidade física do TC6’, em crianças e adolescentes após o transplante hepático, comparando-as com valores de referência obtidos em crianças brasileiras saudáveis e, secundariamente, analisar a relação entre a distância caminhada em seis minutos (DC6’) com variáveis antropométricas e clínicas. Método: Estudo transversal prospectivo, realizado de Janeiro de 2009 a Dezembro de 2010. Amostra de conveniência de 23 crianças e adolescentes no pós- transplante hepático, entre seis a dezessete anos de idade, ambos os sexos, acompanhadas no ambulatório de transplante hepático, da Universidade Federal de São Paulo, UNIFESP/EPM, São Paulo (Brasil). Medidas antropométricas e de função pulmonar foram obtidas utilizando protocolos padrão. O TC6’ foi conduzido, de acordo com os critérios da ATS 2002, em um corredor de 20 metros. Dois testes foram realizados em intervalos de trinta minutos. Os critérios de interrupção ocorreram na presença de sintomas clínicos. As variáveis fisiológicas foram mensuradas no repouso e ao final do teste. A reprodutibilidade do TC6’ foi avaliada em todas as crianças do estudo. A relação entre a distância caminhada e o trabalho (produto da distância caminhada pelo peso corpóreo) foi avaliada com medidas antropométricas, clínicas e de função pulmonar.Resultados: 23 participantes (56,5%) foram do sexo feminino e média de idade (148,87 ± 34,58 meses). A reprodutibilidade do TC6’ (ICC= 0,63) foi boa na população do estudo. Comparada aos valores de referência de Aquino et al., 2010, a média da distância caminhada das crianças e adolescentes no póstransplante foi significantemente reduzida (p<0,001). A DC6’ apresentou moderada correlação com o volume corrente (r=0,5, p<0,015). O trabalho da distância caminhada mostrou significante correlação com a idade (r=0,6 p<0,004), peso (r=0,9 p<0,001), altura (r=0,8 p<0,001), IMC (r=0,6 p<0,002), CVF (r=0,7 p<0,001), pico de fluxo (r=0,6 p<0,002) e VM (r=0,4 p<0,038). Na análise de regressão múltipla as variáveis idade, CVF e VM influenciaram em 78,6% a variância do trabalho da distância caminhada (ω). Conclusão: O TC6’ é reprodutível em crianças e adolescentes após o transplante hepático. Estes pacientes apresentaram menor capacidade física, comparativamente aos valores de referência de crianças saudáveis. O trabalho da distância caminhada (ω) parece ser um parâmetro adicional na determinação da capacidade física destes pacientes, comparado à distância caminhada isoladamente.
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    Características da violência física e sexual contra crianças e adolescentes atendidos no IML de Maceió
    (Universidade Federal de São Paulo (UNIFESP), 2009) Guimarães, João Alfredo Tenório Lins [UNIFESP]; Villela, Wilza Vieira [UNIFESP]
    Contexto: A violência contra crianças e adolescentes é um fenômeno histórico-cultural com desdobramentos que tem se revelado problemas crescentes para a saúde pública. Objetivo: Descrever as principais características epidemiológicas da violência física e sexual contra crianças e adolescentes na população atendida no IML/Maceió. Método: Foram incluídos 303 casos consecutivos de crianças e adolescentes vítimas de violência física e sexual, submetidos a exame de corpo de delito no IML/Maceió no período de setembro/2008 a março/2009. Para estas, foram coletados dados referentes ao tipo de violência, sexo, idade, estado civil, procedência, ocupação, escolaridade e classificação econômica da vítima; escolaridade da mãe; identificação do agressor e do denunciante, local da prática e reincidência da violência. Os dados foram tabulados e analisados por meio do programa SPSS® (Microsoft corporation). Resultados: Os resultados demonstraram predomínio de vítimas do sexo feminino, de cor parda, classificação econômica D, baixa escolaridade da vítima e sua mãe. Os agressores foram, na maioria, pessoas conhecidas fora da família. Predominaram casos de violência sexual entre as crianças e, física entre os adolescentes. A casa da vítima e via pública foram os locais mais comuns para a prática da violência contra crianças e adolescentes respectivamente. Conclusão: A análise dos dados mostrou que a violência contra crianças e adolescentes que chegam ao IML está concentrada nas camadas sociais mais baixas e tem nas meninas e jovens do sexo feminino as principais vítimas. Estudos adicionais devem ser realizados no sentido de identificar se a violência contra crianças e adolescentes nos demais segmentos sociais de fato não existe ou apenas não demanda exames de corpo de delito, o que contribui para sua invisibilidade. Adicionalmente, o estudo mostra que devem ser elaboradas políticas específicas de prevenção da violência no sentido de proteger meninas e adolescentes – sobretudo nos segmentos mais vulneráveis.
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    Characteristics of physical and sexual violence against children and adolescents attended at Medical-Legal Institute of Maceio
    (Universidade Federal de São Paulo (UNIFESP), 2009-09-30) Guimarães, João Alfredo Tenório Lins [UNIFESP]; Villela, Wilza Vieira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Context: violence against children and adolescents has historical and cultural origins and consequences which have revealed themselves as public health problems. Purpose: to describe major epidemiological features of physical and sexual violence against children and adolescents undergone to examination in the Medico-Legal Institute of Maceio (MLI/Maceio). Methods: 303 consecutive cases of children and adolescents victims of physical or sexual violence were assessed from September, 2008 to March, 2009. Each victim was interviewed and data were collected concerning violence type, sex, age, marital status, origin, occupation, schooling and economical class, mother’s schooling, aggressor and reporter identification, violence place and reincidence. Data were tabled and analyzed through SPSS© (Microsoft corporation). Results: results showed female predominancy, low schooling and economical status. Aggressors were mostly known people outside the family. Sexual abuse was common among children while physical aggression predominated among adolescents. Victim’s home and public way were the most frequent violence places concerning children and adolescents respectively. Conclusion: data analysis showed that violence against children and adolescents in our survey is concentrated in low economical classes and female children are the most prevalent victims. Further studies must be developed in order to identify whether violence against other social classes and males in fact doesn’t exist or simply doesn’t demand Medical-Legal examination, which contributes to its invisibility. Besides, this study suggests that specific policies on violence prevention must be developed in order to protect female children and adolescents mainly in vulnerable groups.