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Objective. The present study is aimed at assessing heart rate variability (HRV) and its correlation with visual acuity (VA) assessment of preterm newborns (PTNB) in neonatal intensive care units. Method. Cross-sectional study analyzing HRV during assessment of VA with the aid of a Polar RS800CX heart rate monitor (Polar Electro Oy, Finland). HRV was analyzed according to time and frequency domains and the chaos domain used the autocorrelation coefficient and entropy. The sample consisted of hospitalized PTNB, and static analysis included simple regression diagnosis. Results. A total of 14 PTNB were included in the sample. VA varied between 0.23 and 1.60 cpd, and only five PTNB obtained below-expected values for age. Statistical analysis demonstrated a negative correlation between VA and time domain (SDDN and SD2) and a positive correlation between frequency domain (heart rate and hertz), but in simple linear regression analysis, these variables did not influence VA. Conclusion. The results of the study demonstrate that visual acuity was inversely correlated with SDNN and SD2 and during stimulation, showing that the higher the visual performance, the lower the autonomic modulation response. [ABSTRACT FROM AUTHOR]

This study aimed to examine the association between breastfeeding and childhood obesity. A multinational cross‐sectional study of 4,740 children aged 9–11 years was conducted from 12 countries. Infant breastfeeding was recalled by parents or legal guardians. Height, weight, waist circumference, and body fat were obtained using standardized methods. The overall prevalence of obesity, central obesity, and high body fat were 12.3%, 9.9%, and 8.1%, respectively. After adjustment for maternal age at delivery, body mass index (BMI), highest maternal education, history of gestational diabetes, gestational age, and child's age, sex, birth weight, unhealthy diet pattern scores, moderate‐to‐vigorous physical activity, sleeping, and sedentary time, exclusive breastfeeding was associated with lower odds of obesity (odds ratio [OR] 0.76, 95% confidence interval, CI [0.57, 1.00]) and high body fat (OR 0.60, 95% CI [0.43, 0.84]) compared with exclusive formula feeding. The multivariable‐adjusted ORs based on different breastfeeding durations (none, 1–6, 6–12, and > 12 months) were 1.00, 0.74, 0.70, and 0.60 for obesity (Ptrend =.020) and 1.00, 0.64, 047, and 0.64 for high body fat (Ptrend =.012), respectively. These associations were no longer significant after adjustment for maternal BMI. Breastfeeding may be a protective factor for obesity and high body fat in 9‐ to 11‐year‐old children from 12 countries. [ABSTRACT FROM AUTHOR]

Highlights • Boys develop more pronounced isometric muscular strength starting at 10 years of age and it peaks at 14 and 15 years. • The Handheld dynamometer has excellent inter-rater reliability and an intra-rater agreement for all muscle groups tested. • The development of muscle strength for the Brazilian population is similar to that observed in the northern hemisphere. Abstract Objective Isometric muscle strength measured by Handheld dynamometer indicates physical ability. There is no normative data for the Brazilian population. This study aims (a) to describe the development of isometric muscle strength in healthy children and adolescents 5–15 years of age; (b) to evaluate Handheld dynamometer inter and intra-rater reliability. Methods Isometric muscle strength was obtained for shoulder abduction, elbow and knee flexion and extension, dorsiflexion and plantar flexion in 55 boys and 55 girls, aged between 5 and 15 years. Inter-rater reliability was determined based on the evaluation of 2 raters, with a 20-min interval between them. Intra-rater reliability was based on 2 evaluations from the same rater, one week apart. Interclass correlation coefficient (ICC 2,1; 3,1), Bland Altman plots and linear regression models with mixed effects were used to quantify inter and intra-rater reliability, agreement and associations with physical activity level and maturational factors. Results A linear development of isometric muscular strength was observed for ages between 5 and 10. After age 10, boys showed a larger isometric muscular strength, when compared to girls. Both inter and intra-rater measurements of the Handheld dynamometer are reliable (ICC > 0.63). Conclusions This study shows increase in isometric muscle strength starting at 10 years of age for boys, when compared to girls and inter and intra-rater reliability for the assessment of isometric strength, using the Handheld dynamometer for the muscle groups tested on the dominant and non-dominant side, for children between 5 and 15 years of age. [ABSTRACT FROM AUTHOR]

Home fortification with multiple micronutrient powder (MNP) is effective in the prevention of anemia in young children. However, the impact on their vitamin A status remains controversial. This study aimed to evaluate the effect of MNP on vitamin A status in young Brazilian children. A multicenter pragmatic, controlled trial was carried out in primary health centers in four Brazilian cities. In the beginning of the study, the control group (CG) consisted of children 11-14 months old ( n = 395) attending in routine pediatric health care. In parallel, the intervention group (IG) was composed of children 6-8 months old ( n = 399), in the same health centers, who followed the intervention with MNP for 2-3 months. The analysis of the effect of MNP on vitamin A status was performed by comparing the IG with the CG after a 4- to 6-month follow-up when IG children had reached the age of the controls. The prevalence of vitamin A deficiency (VAD; serum retinol <0.70 μmol/L) in the CG was 16.2%, while in the IG was 7.5%-a 55% reduction in the VAD [prevalence ratio (95% confidence interval) = 0.45 (0.28; 0.72)]. This reduction was also significant when stratifying the study centers by coverage of the Brazilian Vitamin A Supplementation Program. The adjusted mean of vitamin A serum concentrations improved in the IG compared with CG children, with a shift to the right in the vitamin A distribution. Home fortification with MNP was effective in reducing VAD among young Brazilian children. [ABSTRACT FROM AUTHOR]

Objective. Complete deficiency of Complement C4 component is a strong genetic risk factor for SLE. C4 is encoded by two different genes, C4A and C4B, which show considerable gene copy number (GCN) variation. This study investigates the association of total C4, C4A and C4B GCN with JSLE. Methods. Ninety JSLE patients, 170 adult-onset SLE (aSLE) patients and 200 healthy individuals were evaluated for C4A and C4B GCN by quantitative real-time PCR. Results. JSLE patients had lower GCN for C4A (mean = 1.7; 95% CI: 1.5, 1.9) and C4B (mean = 1.5; 95% CI: 1.3, 1.6) compared with healthy individuals (mean C4A = 2.3; 95% CI: 2.2, 2.5, P< 0.001; C4B = 2.0; 95% CI: 1.8, 2.1; P<0.001) or with aSLE patients (mean C4A = 1.9; 95% CI: 1.8, 2.1, P = 0.006; mean C4B = 1.8; 95% CI: 1.7, 1.9, P< 0.001). Low total C4 GCN (<4 copies) was more frequent in JSLE than in healthy individuals (59% vs 28%; P< 0.001). The same was observed for low C4A (≤1 copy) (52% vs 18%; P < 0.001) and for low C4B (60% vs 31 %; P < 0.001). JSLE had a stronger association with low total C4 (OR = 3.68, 95% CI: 2.19, 6.20), C4A (OR = 4.98, 95% CI: 2.88, 8.62) and C4B (OR = 3.26; 95% CI: 1.95, 5.47) than aSLE (C4 OR = 2.03; 95% CI: 1.32, 3.13; C4A OR = 2.36; 95% CI: 1.46, 3.81; C4B OR = 1.13; 95% CI: 0.73, 1.74). In addition, pericarditis in JSLE patients was associated with low C4 (OR=4.13; 95% CI: 1.02, 16.68; P = 0.047) and low C4A (OR = 5.54; 95% CI: 1.37, 22.32; P = 0.016). Conclusion. Low total C4, C4A and C4B GCN were associated with a stronger risk for developing JSLE than aSLE. Additionally, low total C4 and C4A GCN are risk factors for pericarditis in JSLE. [ABSTRACT FROM AUTHOR]

The participation of children and adolescents in sports is becoming increasingly common, and this increased involvement raises concerns about the occurrence of sports injuries. Objectives: To characterize the sports injuries and verify the associated factors with injuries in children and adolescents. Method: Retrospective, epidemiological study. One thousand three hundred and eleven children and adolescents up to 18 years of age enrolled in a sports initiation school in the city of Presidente Prudente, State of São Paulo, Brazil. A reported condition inquiry in interview form was used to obtain personal data and information on training and sports injuries in the last 12 months. Injury was considered any physical complaint resulting from training and/or competition that limited the participation of the individual for at least one day, regardless of the need for medical care. Results: The injury rate per 1000 hours of exposure was 1.20 among the children and 1.30 among the adolescents. Age, anthropometric data, and training characteristics only differed with regard to the presence or absence of injuries among the adolescents. The most commonly reported characteristics involving injuries in both the children and adolescents were the lower limbs, training, non-contact mechanism, mild injury, asymptomatic return to activities, and absence of recurrence. Conclusions: The injury rate per 1000 hours of exposure was similar among children and adolescents. Nevertheless, some peculiarities among adolescents were observed with greater values for weight, height, duration of training, and weekly hours of practice. [ABSTRACT FROM AUTHOR]

Objective: to describe the process of cross-cultural adaptation and clinical validation of the Neonatal Skin Condition Score. Methods: this methodological cross-cultural adaptation study included five steps: initial translation, synthesis of the initial translation, back translation, review by an Committee of Specialists and testing of the pre-final version, and an observational cross-sectional study with analysis of the psychometric properties using the Adjusted Kappa, Intraclass Correlation Coefficient, and Bland- Altman Method statistical tests. A total of 38 professionals were randomly recruited to review the clarity of the adapted instrument, and 47 newborns hospitalized in the Neonatology Unit of the Clinical Hospital of Porto Alegre were selected by convenience for the clinical validation of the instrument. Results: the adapted scale showed approximately 85% clarity. The statistical tests showed moderate to strong intra and interobserver item to item reliability and from strong to very strong in the total score, with a variation of less than 2 points among the scores assigned by the nurses to the patients. Conclusions: the scale was adapted and validated to Brazilian Portuguese. The psychometric properties of the Brazilian version of the Neonatal Skin Condition Score instrument were similar to the validation results of the original scale. [ABSTRACT FROM AUTHOR]

This study aimed to generate equations for the indirect determination of lactate minimum (LM) intensity from short-distance maximal performances in 10- to 17-year-old swimmers. Seventy-one male (n = 41) and female (n = 30) competitive swimmers were divided into subgroups: one to generate predictive equations for LM (~70% of the sample), and the second to cross-validate the proposed equations (~30% of the sample). All participants swam maximally short-distance using front crawl stroke, and mean speed of the 100 (S100), 200 (S200), and 400 m (S400) performances were calculated in m·s-1. The LM protocol was measured after an 8 min of passive recovery from the S200, consisting of five progressive 200 m performances (~80%, 84%, 88%, 92%, and 96% of S200). Multiple linear regressions generated predictive equations for LM from single performances (S100, S200, and S400), also considering as independent variables age, pubic hair index, body mass, height, and body fat. The relationships between variables were examined using standard error of estimate (SEE). Nevertheless, age, biological maturation and anthropometric variables did not contribute to explain LM. Further, for both genders, S200 was the best predictor for LM, contributing to 95% of LM variation in males and 81% in females. The generated equations were: "LM = 0.24 + 0.67 × S200" (adjusted R2 = 0.95; SEE = 0.03 m·s-1) for boys and "LM = 0.13 + 0.79 × S200" (adjusted R2 = 0.81; SEE = 0.03 m·s-1) for girls. The predicted LM did not differ from the measured LM during cross-validation analysis. A single performance was found to be a valid LM predictor in 10- to 17-year-old swimmers regardless of gender, age and biological maturation. Thus, this is a practical, non-invasive, and economical alternative to estimate the aerobic capacity in young swimmers. [ABSTRACT FROM AUTHOR]

Background: An association between pesticide exposure and cancer has been suggested. Infant leukemia is a rare neoplasm and its association with maternal pesticide exposure has been poorly explored. Objectives: We investigated the association between pesticide exposure during pregnancy and leukemia in children < 2 years of age. Methods: A hospital-based case-control study was carried out in 13 Brazilian states during 1999-2007. Mothers of 252 cases and those of 423 controls were interviewed. Information on pesticide exposures 3 months before pregnancy, throughout pregnancy, and during breastfeeding was obtained. Unconditional logistic regression was used to estimate adjusted odds ratios (aORs) for associations between pesticide exposures and leukemia. Results: Associations with ever use of pesticides during pregnancy were observed for acute lymphoid leukemia (ALL) (aOR = 2.10; 95% CI: 1.14, 3.86) and acute myeloid leukemia (AML) (aOR = 5.01; 95% CI: 1.97, 12.7) in children 0-11 months of age, and with ALL (aOR = 1.88; 95% CI: 1.05, 5.23) at 12-23 months of age. According to reported maternal exposure to permethrin, higher risk estimates were verified for children 0-11 months of age (aOR = 2.47; 95% CI: 1.17, 5.25 for ALL; and aOR = 7.28; 95% CI: 2.60, 20.38 for AML). Maternal pesticide exposure related to agricultural activities showed an aOR of 5.25 (95% CI: 1.83, 15.08) for ALL, and an aOR of 7.56 (95% CI: 1.83, 31.23) for AML. Conclusions: These results support the hypothesis that pesticide exposure during pregnancy may be involved in the etiology of acute leukemia in children < 2 years of age. [ABSTRACT FROM AUTHOR]