Search

Background It is important to understand the dynamics of SARS-CoV-2 transmission in close-contact settings such as households. We hypothesized that children would most often acquire SARS-CoV-2 from a symptomatic adult caregiver. Methods This prospective cohort study was conducted from April 2020 to July 2022 in a low-resource, urban settlement in Brazil. We recruited families who brought their children to a public clinic. We collected nasopharyngeal and oral swabs from household members and tracked symptoms and vaccination. Results In total, 1256 participants in 298 households were tested for SARS-CoV-2. A total of 4073 RT–PCR tests were run with 893 SARS-CoV-2 positive results (21.9%). SARS-CoV-2 cases were defined as isolated cases (N = 158) or well-defined transmission events (N = 175). The risk of household transmission was lower if the index case was a child (OR: 0.3 [95% CI: 0.16–0.55], P <.001) or was vaccinated (OR: 0.29 [95% CI: 0.1–0.85], P =.024), and higher if the index was symptomatic (OR: 2.53 [95% CI: 1.51–4.26], P <.001). The secondary attack rate for child index cases to child contacts was 0.29, whereas the secondary attack rate for adult index cases to child contacts was 0.47 (P =.08). Conclusions In this community, children were significantly less infectious to their household contacts than adolescents or adults. Most children were infected by a symptomatic adult, usually their mother. There was a double benefit of vaccination as it protected the vaccine from severe illness and prevented onward transmission to household contacts. Our findings may also be valid for similar populations throughout Latin America. [ABSTRACT FROM AUTHOR]

Infant feeding practices impact children's nutritional and health status, influencing growth and development. This study aimed to analyse the evolution of infant feeding practices from 9 to 24 months of age, considering infant and young child feeding (IYCF) indicators and food processing. The infant feeding practices in children from the Brazilian site of the MAL‐ED study were evaluated at 9 (n = 193), 15 (n = 182) and 24 months (n = 164) using 24‐h dietary recalls. IYCF indicators were evaluated, and the extent of food processing was evaluated, using the NOVA classification. Breastfeeding declined significantly over time, from 77.6% at 9 months to 45.1% at 24 months. Although dietary diversity did not significantly change during the study period (80.5% at 24 months), the minimum acceptable diet significantly increased from 67.9% to 76.1% at 24 months (p < 0.0005). All the studied children consumed sweetened beverages from 9 months. Unhealthy food consumption and zero vegetable or fruit consumption significantly increased over time (p < 0.0005). Unprocessed food consumption decreased from 9 to 24 months of age (p < 0.0005), while ultra‐processed food consumption increased (p < 0.0005) during the study period. Logistic regressions showed that, at 9 months, breastfed children presented a lower risk for ultra‐processed food consumption (odds ratio [OR] = 0.31; 95% confidence interval [CI] = 0.13–0.77); and children reaching the minimum acceptable diet presented more risk for ultra‐processed food consumption (OR = 2.31; 95% CI = 1.01–5.27). In conclusion, data showed a reduction in the quality of infant feeding practices over the first 2 years of life, with a decrease in breastfeeding and an increase in the consumption of unhealthy and ultra‐processed foods. Key messages: Data showed a reduction in the quality of infant feeding practices over the first 2 years of life.Breastfeeding decreased over the studied period. There was an increase in the consumption of ultra‐processed and unhealthy foods, which occurred concomitantly to the increase of no consumption of fruits/vegetables.Breastfeeding was an important protective factor against a greater consumption of ultra‐processed food.National nutrition policy should consider promoting breastfeeding and increasing fresh and minimally processed food consumption in children under 2 years. [ABSTRACT FROM AUTHOR]

Simple Summary: Lymphomas related to HIV are generally aggressive and have a poor prognosis, despite the use of effective combined antiretroviral therapy (cART) and effective chemotherapy treatment. This study aimed to evaluate, for the first time, survival and prognostic factors in children and adolescents living with HIV (CLWH) with lymphomas in Rio de Janeiro (RJ), Brazil. Our study population showed reduced overall, event-free, and disease-free survival probabilities. Performance status 4 (PS 4) and low CD4+ T-cell counts were considered poor prognostic factors. This study was designed to improve the quality of HIV-related lymphoma treatment in our population. Lymphomas related to HIV are generally aggressive and have a poor prognosis, despite the use of combined antiretroviral therapy (cART) and effective chemotherapy treatment. To determine survival and prognostic factors in children and adolescents living with HIV (CLWH) in Rio de Janeiro (RJ), Brazil, who developed lymphomas, we performed a retrospective and observational study of vertically infected CLWH aged from 0 to 20 incomplete years during1995 to 2018 at five reference centers for cancer and HIV/AIDS treatment. Of the 25 lymphomas, 19 were AIDS-defining malignancies (ADM) and 6 were non-AIDS-defining malignancies (NADM). The 5-year overall survival (OS) and 5-year event-free survival (EFS) probabilities were both 32.00% (95% CI = 13.72–50.23%), and the 5-year disease-free survival (DFS) probability was 53.30% (95% CI = 28.02–78.58%). In the multivariate Cox regression analysis, performance status 4 (PS 4) was considered a poor prognostic factor for OS (HR 4.85, 95% CI = 1.81–12.97, p = 0.002) and EFS (HR 4.95, 95% CI = 1.84–13.34, p = 0.002). For the DFS, higher CD4+ T-cell counts were considered a better prognostic factor (HR 0.86, 95% CI = 0.76–0.97, p = 0.017) in the multivariate Cox regression analysis. This study demonstrates, for the first time, survival and prognostic factors for CLWH who developed lymphomas in RJ, Brazil. [ABSTRACT FROM AUTHOR]

The study aimed to estimate sex differences in body mass index (BMI), motor competence (MC), health-related physical fitness (HRPF), perceived motor competence (PMC), and physical activity (PA) and to identify individual predictors associated with overweight in Brazilian children. A cross-sectional study was conducted, sampling 217 Brazilian children aged between 6-10 years old. PA was measured through pedometers. MC and PMC were estimated, respectively, by the Test of Gross Motor Development (2nd edition) battery and the Pictographic Scale of Perceived Competence Assessment in Motor Skills, while the HRPF was estimated through the curl up, push up, horizontal jump, sit and reach, and 6-minute walk/run tests. Height and weight were measured, and BMI was computed. Statistical analyses involved the use of the Mann Whitney U test and multiple logistic regression. Sex differences were observed for HRPF score, mean of weekend steps and total steps/week, favouring boys (p< 0.05). Multiple logistic regression analysis revealed that MC (OR= 0.97; 95%CI 0.92-- 0.98) and HRPF (OR= 0.78; 95%CI 0.66-- 0.93) were significantly associated with overweight, while any significant association were observed for PA and PMC. Results highlight that increases in MC and HRPF reduced the chances of children being overweight. [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]

Background The Zika virus (ZIKV) epidemic had devastating consequences in Brazil. We investigated whether a radiologic finding (ie, infratentorial abnormalities) was associated with sight-threatening defects in children born with congenital Zika syndrome (CZS). We also investigated whether ophthalmic abnormalities correlated with head circumference (HC) and gestational age of infection. Methods Cross-sectional evaluation based upon a previous cohort from March 2016 to December 2018, in Paraíba, Brazil. The study population was comprised of children born to mothers with laboratory-confirmed ZIKV infection during pregnancy (ZIKV reverse transcriptase polymerase chain reaction [RT-PCR]+) and children born with clinical and radiologic features of CZS. Results A total of 75 infants had complete data. All 75 had brain calcifications. Microcephaly was present in 53 (71%) of them. Infratentorial abnormalities were present in 17 infants (22.7%). Ophthalmic abnormalities were seen in 16 of the 17 children (94%) with infratentorial abnormalities, while 28% of children without infratentorial abnormalities had ophthalmic findings (odds ratio [OR]: 42.0; 95% confidence interval [CI]: 5.1-342.9). Similar associations were observed when macular chorioretinal atrophy and optic nerve abnormalities were analyzed individually (OR: 23.7; 95% CI: 6.0-93.3 and OR: 11.5; 95% CI: 3.3-40.0, respectively). Infratentorial abnormalities were more frequently associated with ophthalmic abnormalities (94%) than microcephaly (43.4%) (P <.001). Mean HC was statistically different between groups with and without ophthalmic abnormalities (P =.01). A statistically significant difference in gestational age between both groups was not noted (P =.12). Conclusions In children with CZS, the presence of infratentorial abnormalities is a significant predictor of ophthalmic abnormalities. All neonates whose mothers had ZIKV exposure during pregnancy should have an ophthalmologic examination. [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]

Objective: to evaluate anthropometric and demographic indicators associated with high blood pressure in children aged 6 to 10 years in urban and rural areas of Minas Gerais. Method: this is a cross-sectional study with 335 children. Anthropometric, demographic and blood pressure data were collected. The statistics analyzes were performed using the chi-square, t-student, Mann-Whitney and logistic regression tests, and the odds ratio was the association measure. Results: the prevalence of high blood pressure was significantly higher among rural children. In the urban area, the chance of high blood pressure was higher in children who had a high body mass index (2.97 [1.13-7.67]) and in the rural area, in those who had increased waist circumference (35.4 [3.0-406.2]) and the age range of 9-10 years (4.29 [1.46-12.6]). Conclusion: elevated body mass index and waist circumference were important anthropometric indicators for high blood pressure, as well as age in children living in rural area. The evaluation of body mass index and waist circumference, in addition to nutritional assessments, represents an important action for the screening of high blood pressure in children from different territorial contexts. [ABSTRACT FROM AUTHOR]

Highlights • Children and adolescents with myelomeningocele showed higher heart rate at rest. • Children and adolescents with myelomeningocele did not show differences in HR and BP variability. • Children and adolescents with myelomeningocele showed lower baroreflex sensitivity. Abstract Background Cardiovascular autonomic dysfunction is associated with the development of cardiovascular diseases, but little is known about it in children and adolescents with myelomeningocele. Objective This study investigated the cardiovascular autonomic function in wheelchair-using children and adolescents with myelomeningocele. Methods Twenty-two participants were assigned to one of two groups: myelomeningocele group (n = 11) and Control group (n = 11). Heart rate variability and systolic blood pressure variability were collected in supine resting position using spectral analyses. Spontaneous baroreflex sensitivity was collected by time-domain through the sequence method. Results At rest, heart rate was higher in myelomeningocele group when compared to Control group (mean difference 22.1, 95% CI 4.82–39.40; p = 0.01). The heart rate and systolic blood pressure variability parameters did not show differences between groups. However, myelomeningocele showed lower gain mean in baroreflex sensitivity (mean difference −4.5, 95% CI −8.47 to −0.60; p = 0.02), when compared to Control. Conclusion Wheelchair-using children and adolescents with myelomeningocele presented differences in the autonomic cardiovascular function. This may be associated with hypomobility due to wheelchair dependence, and venous muscle pump insufficiency due to paraplegia. [ABSTRACT FROM AUTHOR]

We took advantage of a large population study in order to measure child behavior, as captured by the Child Behavior Checklist (CBCL) as a function of headache status in the children and their mothers. Of the target sample, consents and analyzable data were obtained from 1,856 families (85.4 %). Headache diagnoses were defined according to the second edition of the International Classification of Headache Disorders, and behavioral and emotional symptoms were assessed by the validated Brazilian version of the CBCL. We calculated the relative risk of abnormalities in the CBCL domains as a function of headache status in the children, after adjusting by a series of main effect models. Children with migraine were more likely to present abnormal scores in several of the CBCL scales, relative to children without migraine, and maternal migraine status contributed little to the model. However, when the mother had daily headaches, both children with and without migraine had similar CBCL scores. In multivariate analyses, migraine status in the children predicted CBCL scores ( p < 0.01). Headache status and headache frequency in the mother did not predict CBCL scores in children with migraine but predicted in children without migraine ( p < 0.01). The burden of migraine to the family is complex. Children with migraine are more likely to have behavioral and emotional symptoms than children without migraine. Children without migraine may be affected, in turn, by frequent headaches experienced by their mothers. [ABSTRACT FROM AUTHOR]

Objective To evaluate the potential drug interactions in patients with acute lymphoblastic leukaemia in the remission induction period of treatment. Design A prospective cohort study. Setting A tertiary referral centre. Subjects Twenty-two children undergoing treatment for acute lymphoblastic leukaemia. The median age was 4.5 years (minimum of 1 and maximum of 18 years) with male predominance (54.4%). Main outcome measure Presence of potential drug interactions in patients undergoing treatment for precursor cell lymphoblastic leukaemialymphoma. The potential drug interactions term refers to the ability of a drug to affect the pharmacologic intensity as well as the therapeutic effect of another and cause adverse reactions, as well as the possibility of clinical manifestations. Results All participants were exposed to at least one potential drug interaction. About 60% of interactions classified as more severe. Every new drug included in the treatment increased the chance of potential drug-drug interactions by 0.4 times. Conclusion These results demonstrated the patients under chemotherapeutic care for lymphoblastic leukaemia-lymphoma have high potential for drug interactions of greater severity. [ABSTRACT FROM AUTHOR]

Studies have shown associations of birth weight with increased concentrations of high sensitivity C-reactive protein. This study assessed the relationship between birth weight, anthropometric and metabolic parameters during childhood, and high sensitivity C-reactive protein. A total of 612 Brazilian school children aged 5–13 years were included in the study. High sensitivity C-reactive protein was measured by particle-enhanced immunonephelometry. Nutritional status was assessed by body mass index, waist circumference, and skinfolds. Total cholesterol and fractions, triglycerides, and glucose were measured by enzymatic methods. Insulin sensitivity was determined by the homeostasis model assessment method. Statistical analysis included chi-square test, General Linear Model, and General Linear Model for Gamma Distribution. Body mass index, waist circumference, and skinfolds were directly associated with birth weight (P<0.001, P=0.001, and P=0.015, resp.). Large for gestational age children showed higher high sensitivity C-reactive protein levels P<0.001 than small for gestational age. High birth weight is associated with higher levels of high sensitivity C-reactive protein, body mass index, waist circumference, and skinfolds. Large for gestational age altered high sensitivity C-reactive protein and promoted additional risk factor for atherosclerosis in these school children, independent of current nutritional status. [ABSTRACT FROM AUTHOR]

Background Tuberculosis is a major disease worldwide and most research focus on risk factors for adults, although there is a marked adolescent peak in incidence. The objective of this study was to identify risk factors for tuberculosis in children aged 7 to 19. Methods A case control study matched by age with 169 cases and 477 controls. The study population consisted of adolescents and older children from Recife, Brazil. Cases were individuals diagnosed with tuberculosis in the control programme and controls were selected in the neighborhood of cases. Conditional logistic regression was used to identify risk factors. Results Cigarette smoking increased by 50% the risk of tuberculosis but that this was not statistically significant (OR = 1.6). Other risk factors were sleeping in the same house as a case of tuberculosis (OR = 31.6), living in a house with no piped water (OR = 7.7) (probably as a proxy for bad living conditions), illiteracy (OR = 3.7) and male sex (OR = 1.8). The increase in risk with living in houses with no piped water was much more marked in males. The proportion of cases of tuberculosis attributed to contact with someone with TB was 38% and to illiteracy, lack of piped water and smoking, 20%. Conclusion Household contact with tuberculosis, social factors and male sex play the biggest role in determining risk of TB disease among children and adolescents in the study. We recommend further research on the relationship of cigarette smoking on tuberculosis in adolescents, and on whether the sex differentials are more marked in bad living conditions. Separate studies should be conducted in older children and in adolescents. [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]

Introduction: Ambulatory Care Sensitive Conditions (ACSC) are conditions for which hospitalisation is thought to be avoidable with the use of effective preventive care and early disease management. The objective of this study was to estimate the rate of avoidable hospitalisations in children younger than 24 months of age participating in a Brazilian national representative survey and to identify the risk factors for such hospitalisations. Methods: We analysed data from a cross-sectional study of 1901 children from the 2006 Brazilian National Demographic Health Survey of Women and Children (NDHS). The children's socioeconomic, biological and maternal characteristics, nutritional status, and access to healthcare were tested; variables with p < 0.20 were selected to fit a Poisson regression. Results: The prevalence of avoidable hospitalisation was 11.8 % (95 % Confidence Interval [CI], 9.0,15.2); the prevalence was higher in the Southeast (40.1 %) and Northwest (21.7 %) macro-regions. The multivariate model identified five risk factors for avoidable hospitalisation: male gender (Prevalence Ratio [PR] = 1.48, p = 0.004), low socioeconomic level (PR= 1.51, p = 0.005), children from mothers younger than 20 years of age (PR= 1.41, p = 0.031), not breastfed within the first hour of life (PR = 1.29, p = 0.034), and neonatal hospitalisation (PR = 1.66, p = 0.043). Conclusions: To decrease the costs associated with avoidable hospitalisations, health managers and professionals should focus their efforts on providing effective primary healthcare to families of low socioeconomic levels, particularly prenatal and paediatric care, as well as encouraging breastfeeding and supporting young mothers. Strategies to improve children's health by controlling such hospitalisations in Brazil should consider all residence areas and geopolitical macro-regions. [ABSTRACT FROM AUTHOR]

Our objective was to estimate the prevalence and test the association between psychological well-being and overweight in children. We conducted a cross-sectional study using anthropometrical measures and interviews with 1048 6-10-year-old school children from a Brazilian town. Overweight was assessed by the body mass index and included obesity. Psychological data of children and their parents were collected using a face scale. Poisson regression models were used to test the associations and to obtain unadjusted and adjusted prevalence ratios (PR). The prevalence of overweight was of 15.3% (95% CI: 13.2-17.6) and of only obesity was 3.8% (2.8-5.2). After controlling for age, sex, school type and parental overweight, the prevalence of overweight was 52% and 44% higher in children who reported a psychological dissatisfaction in themselves and in their mothers when compared with those with positive self perception (PR = 1.52 95% CI = 1.02-2.28; P = 0.038) and (PR = 1.44 95% CI = 1.00-2.09; P = 0.049), respectively. The study suggests that actions aiming weight control of children should take into account psychological aspects of children and their families. [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]

Background: Treadmill gait training as a therapeutic resource in the rehabilitation of children with cerebral palsy has recently been the focus of many studies; however, little is still known regarding its effect on static and functional balance in children. Objective: The aim of the present study was to compare the effects of treadmill training and over ground gait training in children with cerebral palsy. Method: A randomized controlled trial with blinded evaluator was conducted with children with cerebral palsy between three and 12 years of age categorized in Levels I to III of the Gross Motor Function Classification System. Assessments were performed before and after the intervention and involved the Berg balance scale as well as the determination of oscillations from the center of pressure in the anteroposterior and mediolateral directions with eyes open and closed. The experimental group was submitted to treadmill training and the control group performed gait training over the ground. The intervention consisted of two 30-minute sessions per week for seven weeks. Results: Both groups exhibited better functional balance after the protocol. The experimental group had higher Berg balance scale scores and exhibited lesser mediolateral oscillation with eyes open in comparison to the control group. Conclusions: Treadmill training had a greater effect on functional balance and mediolateral oscillation in comparison to over ground gait training in children with cerebral palsy. Trial registration: RBR-5v3kg9 (Brazilian Registry of Clinical Trials). [ABSTRACT FROM AUTHOR]

Objective: To identify predisposing factors for peripheral intravenous puncture failure in children. Methods: Cross-sectional cohort study conducted with 335 children in a pediatric ward of a university hospital after approval of the ethics committee. The Wald Chi-squared, Prevalence Ratio (PR) and backward procedure (p<0.05) tests were applied. Results: Success of peripheral intravenous puncture was obtained in 300 (89.5%) children and failure in 35 (10.4%). The failure rates were significantly influenced by: presence of clinical history of difficult venous access, malnourishment, previous use of peripherally inserted central venous catheter, previous use of central venous catheter, and history of phlebitis or infiltration. In the multivariate model, being malnourished and having previously been submitted to central venous catheterization were the predisposing factors for the failure. Conclusion: The failure rate of 10.4% is similar to that identified in analogous studies and was influenced by characteristics of the children and intravenous therapy. In association with this, malnutrition and previous use of a central venous catheter were the most important variables influencing increase in peripheral intravenous puncture failure. [ABSTRACT FROM AUTHOR]

Objective To evaluate the effectiveness of two screening methods (imitanciometry screening and questionnaire) to identify children at risk for conductive hearing loss, comparing this data with complete audiologic evaluation. Methods Of 507 children aged between three and six, 111 completed all procedures. The observational methods used were: imitanciometry screening, a questionnaire to identify risk factors for hearing loss and complete audiologic evaluation. Results obtained in the first two instruments were compared with results from complete audiologic evaluation (gold standard). From these comparisons, sensitivity and specificity, accuracy, positive and negative predictive values, and odds ratio were determined for the two screening methods and for the combination of both methods. Results The two methods applied in series (questionnaire and after imitanciometry screening) showed a greater odds ratio and better correlation between sensitivity and proportion of false-positives (ROC curve). Conclusion Combining the two tests in series improved screening accuracy. This combination was the best tool for identifying children at risk for conductive hearing loss. [ABSTRACT FROM AUTHOR]

Objective: To investigate the respiratory and postural adaptations associated with mouth and nasal breathing and to evaluate the associations of such adaptations in mouth breathers' self-perceived quality of life. Method: Cross-sectional study with mouth breathers (initial n=116 and final n=48) and nasal breathers (initial n=131 and final n=24) from elementary school, aged between 7 and 14 years. Chest expansion, using cirtometry, the breathing pattern and the use of accessory muscles, by means of clinical evaluations and photogrammetry, and flexibility tests were evaluated in both groups. Subsequently, the mouth breathers were asked to complete the quality of life questionnaire. Statistical tests: Chi-square, odds ratio, Mann-Whitney, and binomial tests were first applied followed by logistic regressions. Results: Thoracic breathing (p=0.04), using of accessory muscles (p=0.03) and reductions in flexibility (p=0.001) increased the chances of an individual being a mouth breather when compared to nasal breathers. Subsequently, using of accessory muscles decreased the chances of snoring among mouth breathers (p=0.03); the presence of shoulder asymmetry reduced the chances of experiencing quiet sleep (p=0.05) and increased the chances of coughing or being tired when playing or running (p=0.008). Finally, forward head position reduced the chances of waking up at night (p=0.04) and experiencing shortness of breath (p=0.05). Conclusions: Respiratory and postural adaptations increased the chances of individuals persisting with mouth breathing. Additionally, these adaptations could be associated with mouth breathers' self-perceived quality of life. [ABSTRACT FROM AUTHOR]

Purpose: to identify changes in the food intake patterns among overweight children and teenagers, treated at a reference medical centre. Method: the method used is that of a cohort study, between April 2010 and April 2011. A total of 109 children and teenagers, either obese or overweight, took part in the study. The population was divided into two subgroups depending on the permanence period (more than 6 months, and less than 6 months off the treatment). The chi-square test and logistic regression were carried out. Results: the group which had been longer off the treatment tended to consume more soft drinks, pasta and fried foods, and less fruit and vegetables. The group with less time showed an improvement, with a reduction of consumption of soft drinks and other goodies. There was confirmation of an increased risk for consumption of soft drinks, pasta and goodies in general, as also detachment from the treatment in adolescence. Conclusions: The group with a longer period of monitoring has had a positive change in food intake frequency. The main contribution made by this study is that of showing that multiprofissional treatment, including some nursing care, is efficient in progressively changing the food intake of children and adolescents who are overweight. [ABSTRACT FROM AUTHOR]

Introduction: The prevalence of undernutrition, which is closely associated with socioeconomic and sanitation conditions, is often higher among indigenous than non-indigenous children in many countries. In Brazil, in spite of overall reductions in the prevalence of undernutrition in recent decades, the nutritional situation of indigenous children remains worrying. The First National Survey of Indigenous People's Health and Nutrition in Brazil, conducted in 2008-2009, was the first study to evaluate a nationwide representative sample of indigenous peoples. This paper presents findings from this study on the nutritional status of indigenous children < 5 years of age in Brazil. Methods: A multi-stage sampling was employed to obtain a representative sample of the indigenous population residing in villages in four Brazilian regions (North, Northeast, Central-West, and Southeast/South). Initially, a stratified probabilistic sampling was carried out for indigenous villages located in these regions. Households in sampled villages were selected by census or systematic sampling depending on the village population. The survey evaluated the health and nutritional status of children < 5 years, in addition to interviewing mothers or caretakers. Results: Height and weight measurements were taken of 6,050 and 6,075 children, respectively. Prevalence rates of stunting, underweight, and wasting were 25.7%, 5.9%, and 1.3%, respectively. Even after controlling for confounding, the prevalence rates of underweight and stunting were higher among children in the North region, in low socioeconomic status households, in households with poorer sanitary conditions, with anemic mothers, with low birthweight, and who were hospitalized during the prior 6 months. A protective effect of breastfeeding for underweight was observed for children under 12 months. Conclusions: The elevated rate of stunting observed in indigenous children approximates that of non-indigenous Brazilians four decades ago, before major health reforms greatly reduced its occurrence nationwide. Prevalence rates of undernutrition were associated with socioeconomic variables including income, household goods, schooling, and access to sanitation services, among other variables. Providing important baseline data for future comparison, these findings further suggest the relevance of social, economic, and environmental factors at different scales (local, regional, and national) for the nutritional status of indigenous peoples. [ABSTRACT FROM AUTHOR]

ABSTRACT: Introduction : The diagnosis of acute rheumatic fever (RF) is based on clinical findings. However, during the chronic phase of the disease, the clinical approach is not sufficient for the follow-up of the patients and the Doppler echocardiography is a tool for the diagnosis of cardiac involvement. Prognostic variables that influence long-term outcomes are not well known.Methods : 462 patients with RF according to Jones criteria were studied, and followed-up from the initial attack to 13.6 ± 4.6 years. All patients underwent clinical assessment and Doppler echocardiography for the detection of heart valve involvement in the acute and chronic phases. Multivariate logistic regression analysis was used to identify the factors influencing long-term heart valve disease.Results : Carditis occurred in 55.8% and subclinical valvulit is in 35.3% patients. In the chronicphase, 33% of the patients had significant valvular heart disease. No normal Doppler echocardiography exam was observed on patients who had severe valvulitis, although heart auscultation had become normal in 13% of these. In the multivariate analysis, only the severity of carditis and the mitral and/or aortic valvulitis were associated with significant valvular heart disease. Chorea or arthritis were protective factors for significant valvular heart disease, odds ratio 0.41 (95% C.I. 0.22 - 0.77) and 0.43 (95% C.I.0.23 - 0.82), respectively.Conclusions : Our study suggests that the use of Doppler echocardiography during RF helps to identifyprognostic factors regarding the development of significant valvular heart disease.Initial severe carditis is an important factor in the long-term prognosis of chronic RHD,whereas arthritis and chore during the initial episode of RF appears to be protective.Strict secondary prophylaxis should be mandatory in high risk patients [ABSTRACT FROM AUTHOR]

Background. In a Latin American trial, a monovalent G1P[8] rotavirus vaccine showed high efficacy against severe rotavirus diarrhea. Protection was lower against serotypically unrelated G2P[4] strains, which circulated infrequently. This case-control study was undertaken to assess the effectiveness of this monovalent G1P[8] rotavirus vaccine against G2P[4] strains in Brazil. Methods. Case patients were children with severe G2P[4] rotavirus diarrhea who presented at a hospital in Recife, Brazil, from March 2006 through September 2008. Vaccination rates among case patients were compared with rates among 2 groups of control participants—children with rotavirus-negative diarrhea and children admitted for acute respiratory tract infection (ARI)—to calculate vaccine effectiveness, after controlling for the birth month and year. Results. We enrolled 70 G2P[4] rotavirus-positive case patients with severe diarrhea, 484 rotavirus-negative control participants with diarrhea, and 416 control participants with ARI, aged ⩾6 months. Among children aged 6-11 months, the effectiveness of the vaccine against G2P[4] diarrhea was 77% (95% confidence interval [CI], 42%-91%) and 77% (95% CI, 43%-90%) among the rotavirus-negative control participants with diarrhea and control participants with ARI, respectively. Vaccine effectiveness in children aged ⩾ 12 months decreased to -24% (95% CI, -190% to 47%) and 15% (95% CI, -101 to 64) among the rotavirus-negative control groups with diarrhea and ARI, respectively. Conclusions. This monovalent G1P[8] rotavirus vaccine was effective against severe G2P[4] rotavirus diarrhea among children aged 6-11 months. Effectiveness declined among children aged ⩾12 months, which suggests waning immunity. [ABSTRACT FROM AUTHOR]

Methylphenidate hydrochloride is used to treat children, adolescents, and adults with attention deficit/hyperactivity disorder (ADHD). Multiphasic release formulation has been used to control drug levels, mainly during children's school period. This study aimed to evaluate the bioequivalence between two methylphenidate hydrochloride extended-release tablets to meet regulatory requirements for registration in Brazil. Two independent studies (under fasting and fed conditions) designed as open-label, randomized, single-dose, two-period, two-way crossover trials were conducted in healthy subjects of both genders. Subjects were enrolled and randomly received a single dose of the test formulation methylphenidate hydrochloride 54 mg extended-release tablet (Consiv®, Adium S.A., São Paulo, Brazil) or the reference formulation (Concerta®, Janssen-Cilag Farmacêutica Ltd., São Paulo, Brazil), in each period, with a 7-day washout interval. Serial blood samples were collected up to 24 h post dose and methylphenidate plasma concentrations were obtained using a validated LC-MS/MS method. A total of 96 healthy subjects were enrolled in the fasting study, of which 80 completed the study. For the fed study, 52 healthy subjects were enrolled, and 46 subjects completed it. In both studies, 90% confidence intervals for Cmax, AUC0–t, AUC0–inf, and partial AUCs were within the acceptable limits of 80.00 to 125.00%. Thus, according to regulatory requirements, the test formulation (Consiv®) was considered to be bioequivalent to the reference formulation (Concerta®) in both conditions (fasting and fed) and, therefore, it can be considered interchangeable in clinical practice. Both formulations were safe and well tolerated in single-dose administration. [ABSTRACT FROM AUTHOR]

ObjectiveTo estimate factors associated with double burden of nutritional outcomes in the mother–child dyad at the household level (child stunting and/or maternal overweight).DesignCross-sectional study using the Brazilian Demographic and Health Survey. Nutritional outcomes were: mother with normal weight and child with normal height; overweight mother and child with normal height; mother with normal weight and short-stature child; and overweight mother and child with short stature (double burden). The child was classified as short when height-for-age Z-score was <−2 and the mother as overweight when BMI was ≥25·00 kg/m2. Socio-economic status, environment, social vulnerability, maternal characteristics and the child’s food intake were the exposure factors. The hierarchical approach for multinomial logistic regression modelling was used to assess the associations.SettingNational Demographic and Health Survey of Children and Women conducted in Brazil, 2006–2007.SubjectsMother–child dyads (n 3676).ResultsAfter adjustments, lower maternal educational level (OR=3·53; 95 % CI 1·33, 9·33) and inadequate household (non-masonry house; OR=2·54; 95 % CI 1·39, 4·66) were associated with the double burden of malnutrition. Mother’s short stature (OR=3·41; 95 % CI 1·76, 6·61), child’s vegetable intake on less than or equal to 4 d/week (OR=2·21; 95 % CI 1·03, 4·75) and inadequate household (non-masonry house; OR=2·29; 95 % CI 1·36, 3·87) were associated with child’s short stature. The lack of breast-feeding (OR=2·00; 95 % CI 1·07, 3·72) was associated with maternal overweight.ConclusionsThe present findings contribute to establishing strategies promoting health and healthy diets, by considering the growth deficit and overweight/obesity concomitantly. [ABSTRACT FROM AUTHOR]

• The CMTPedS-Br is culturally appropriate for the Brazilian population. • The CMTPedS-Br showed adequate reliability and face validity. • The CMTPedS-Br will allow Brazil to be part of multicentered studies on such a rare but debilitating condition. The Charcot-Marie-Tooth disease Pediatric Scale (CMTPedS) has been used to measure aspects of disability in children with all types of Charcot-Marie-Tooth disease (CMT). To translate and cross-culturally adapt the CMTPedS into Brazilian–Portuguese and determine its reliability and validity. The translation and cross-cultural adaptation followed international guidelines recommendations. Twenty individuals with CMT were assessed. Two examiners assessed the participants for inter-rater reliability. Face validity was assessed by eight physical therapists that judged the relevance of each test item. The Bland-Altman analysis (bias) and standard error of measurement (SEM) complemented the analysis. Furthermore, intraclass correlation coefficients (ICC), weighted kappa (k), and internal consistency (Cronbach's alpha) was determined. The CMTPedS was successfully translated and cross-culturally adapted. Twenty children/youth were enrolled in the study. Of these, the majority (55%) were girls with a mean age of 13.9 (range: from 6 to 18) years. Regarding face validity, the CMTPedS-Br showed relevant items for assessing children and youth with CMT. The ICC for the total score showed excellent reliability (ICC 2.1 = 0.93, 95% CI = 0.84, 0.97). The most reliable items were grip, dorsiflexion and plantar flexion strength while the least reliable items were pinprick, vibration, and gait. The internal consistency was excellent (α = 0.96, 95% CI = 0.91, 0.99) and the agreement showed small variability (bias = 0.15, 95% CI= -4.28, 4.60). The CMTPedS-Br showed adequate reliability and face validity to measure disability in individuals with CMT. This tool will allow Brazil to be part of multicentered studies on such a rare but debilitating condition. [ABSTRACT FROM AUTHOR]

Among a cohort of children in a poor urban setting in Brazil, the relative risk for the occurrence of a new episode of diarrhea in the two weeks following antibiotic use vs all other weeks was 1.44 (95% confidence interval (CI) = 1.33, 2.45). Among children ever [corrected] exposed to antibiotics, the odds ratio was 1.34 (95% CI = 0.84, 2.16) after stratifying by individual child and controlling for previous diarrhea. Further research is needed to confirm whether antibiotics are a risk factor for diarrhea in such settings. [ABSTRACT FROM AUTHOR]

This study aims to investigate the effect of maternal pre‐pregnancy body mass index (BMI) and gestational weight gain (GWG) on offspring body composition. In this prospective cohort study, offspring body composition at 6 years of age was obtained through air displacement plethysmography. Linear regression was used to obtain crude and adjusted coefficients. Information regarding offspring body composition and maternal pre‐pregnancy BMI was available for 3156 children and on offspring body composition and GWG for 3129 children. There was a direct association of maternal pre‐pregnancy BMI and GWG with offspring's fat mass (FM), fat‐free mass (FFM), fat mass index (FMI), fat‐free mass index (FFMI) and body fat percent (BF%) in crude and adjusted analyses. After adjustment for co‐variables, for each kg m−2 of maternal pre‐pregnancy BMI increase, there was a mean increment of 0.13 kg in the offspring FFM, 0.06 kg m−2 in FFMI, 0.11 kg in FM, 0.07 kg m−2 in FMI and 0.18% in BF%. For each kilogram of maternal GWG increase, there was a mean increment of 0.08 kg in offspring's FM, 0.05 kg m−2 in FMI, 0.04 kg in FFM, 0.01 kg m−2 in FFMI and 0.18 % in BF%. Mothers with a higher pre‐pregnancy BMI or GWG tend to have children with greater adiposity at age 6 years. Fetal overnutrition is more likely among mothers with greater BMI during pregnancy; as a consequence, it can accelerate the childhood obesity epidemic. [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]

Background: The main modifiable risk factors for obesity are related to lifestyle and significantly influenced by the family, environment and culture. We aimed to estimate the prevalence of overweight/obesity and associated lifestyle factors in children from Bento Gonçalves, a southern Brazil city with strong Italian immigration influence. Italian traditional foods were locally adapted since the immigrants' arrival in the XIX century, to include more fat and fewer vegetables, and physical activity levels have decreased. Methods: Cross-sectional study of a population-based cluster sample with students aged 9-18 years. We assessed time spent in sedentary behaviors, hours of physical activity, food frequency and family history. All children underwent physical examination with anthropometric and blood pressure measurements. Overweight and obesity were classified according to WHO percentile curves. Results: A total of 590 students were evaluated. Mean age was 12.45 ± 1.49 years. The prevalence of overweight and obesity was 16.3% and 8.3%, respectively. Boys were more frequently overweight and obese than girls (16.3% and 12.2% versus 16.2% and 5.5%, respectively). Vegetables and fruits were consumed less than 4 times per week in 49% and 36.8%, while soft drinks, fast food and sweets were consumed more than 4 times a week by 71%, 70.3% and 42.7%, respectively. The habit of omitting breakfast was associated with overweight (p = 0.007). The average screen time was 5.38 ± 2.88 hours/day. Overweight/obesity was present in 12.2% (n = 5), 24.8% (n = 122) and 36.8% (n = 14) children with low birth weight, normal birth weight and high birth weight respectively (p = 0.04). The prevalence of high blood pressure was higher in obese (30.6%) and overweight (21.2%) children, comparing to eutrophic children (6.8%; p < 0.001). Excess weight was more frequent among fathers (62.8%) than in mothers (46.3%), but excess weight in mothers was positively associated with excess weight in children (p 0.048). Conclusion: The city showed high prevalence of overweight and obesity. These findings reinforce the importance of implementing prevention strategies aimed at children and their families, considering that health habits are shared and transmitted along generations. [ABSTRACT FROM AUTHOR]

• This study shows a high incidence of new episode of low back pain over a one-year period. • Female sex and clinical mental health problem were predictors of low back pain. • Sitting tablet use, daily tablet use time, hours of cell phone use per day, and lying down while using cell phone were predictors of low back pain Low back pain (LBP) is a common complaint among children and adolescents and can negatively impact their physical and mental health. Although previous studies investigating the incidence of low back pain (LBP) in children and adolescents have been performed in high income countries, it is unclear whether countries such as Brazil would show similar incidence rates. To determine the incidence and to identify predictors of new episodes of LBP in high school students. This is a 1-year longitudinal study of high school students from public schools in the city of Bauru, Sao Paulo. Collected clinical data were: demographic and socioeconomic factors, information on the use of electronic devices, mental health status (the Strengths and Difficulties Questionnaires), level of habitual physical activity (Baecke Physical Activity Questionnaire), and incidence of LBP (measured with question about LBP in the past 12 months and the Nordic Musculoskeletal Questionnaire). Descriptive analysis and bivariate and multivariate logistic regressions were performed. The cumulative incidence of new LBP episodes for the total cohort of 757 high school students was 18.9% (95% CI: 16.2, 21.8). The cumulative incidence was 14.8% (95% CI: 11.7, 18.5) for male students and 24.1% (95% CI: 19.8, 29.9) for female students. Being a female student (OR = 1.78; 95% CI: 1.23, 2.59), sitting posture while using tablet (OR = 4.34; 95% CI: 1.19, 16.60), daily time spent on tablet (OR = 3.21; 95% CI: 1.41, 7.30), daily time spent on mobile phone (OR =1.49; 95% CI: 1.11, 2.00), lying posture while using mobile phone (OR = 1.49; 95% CI: 1.05, 2.12), and mental health status (OR = 2.81; 95% CI: 1.76, 4.48) were identified as predictor variables. Our findings showed that one in five high school students reported having a LBP episode over the last year. The predictors found to be associated with low back pain include those related to sex, time and posture while using electronic devices, and mental health status. [ABSTRACT FROM AUTHOR]

The TP53 R337H mutation is associated with increased incidence of pediatric adrenocortical tumor (ACT). The different environmental conditions where R337H carriers live have not been systematically analyzed. Here, the R337H frequencies, ACT incidences, and R337H penetrance for ACT were calculated using the 2006 cohort with 4165 R337H carriers living in Paraná state (PR) subregions. The effectiveness of a second surveillance for R337H probands selected from 42,438 tested newborns in PR (2016 cohort) was tested to detect early stage I tumor among educated families without periodical exams. Estimation of R337H frequencies and ACT incidence in Santa Catarina state (SC) used data from 50,115 tested newborns without surveillance, ACT cases from a SC hospital, and a public cancer registry. R337H carrier frequencies in the population were 0.245% (SC) and 0.306% (PR), and 87% and 95% in ACTs, respectively. The ACT incidence was calculated as ~6.4/million children younger than 10 years per year in PR (95% CI: 5.28; 7.65) and 4.15/million in SC (CI 95%: 2.95; 5.67). The ACT penetrance in PR for probands followed from birth to 12 years was 3.9%. R337H carriers living in an agricultural subregion (C1) had a lower risk of developing pediatric ACT than those living in industrial and large urban subregion (relative risk = 2.4). One small ACT (21g) without recurrence (1/112) was detected by the parents in the 2016 cohort. ACT incidence follows R337H frequency in each population, but remarkably environmental factors modify these rates. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the median duration of total and exclusive breastfeeding in quilombola children and identify which factors interfere in the duration of total breastfeeding. Methods: This is a cross-sectional study conducted with 207 children younger than 24 months of 27 quilombola communities on a state of northeastern Brazil. The median duration of total and exclusive breastfeeding were calculated in days with Kaplan-Meier estimator and the associated factors obtained through Cox regression. Results: The median duration of total and exclusive breastfeeding was 270 and 60 days, respectively. Maternal age ≥ 30 years [Hazard Ratio (HR): 0.66; 95% Confidence Interval (95% CI): 0.45 - 0.97] was shown to be protective for the continuity of breastfeeding, while the community not certificated (HR: 1.40; 95%CI: 1.03 - 1.89) and juice consumption before six months of life (HR: 1.75; 95% CI: 1.25 - 2.55) were risk factors. Conclusion: The duration of exclusive and total breastfeeding, although high, was below the recommended. The highest maternal age and juice consumption before the age of six months were the only associated factors, evidencing that breastfeeding is susceptible to environmental and physiological conditions. [ABSTRACT FROM AUTHOR]

Background: To determine the effects of an educational playful intervention on nasal hygiene behaviors among preschool (3-4 years old) children. Methods: A quasi-experimental before-after study was conducted with 39 children attending public daycare center in Sao Paulo, Brazil. A group-based intervention consisted of two educational sessions to promote healthy behaviors for nasal hygiene. It was adopted playful strategies such as a story told by puppets, card games and simulation of nasal hygiene in front of the mirror. The outcome was evaluated by observing six healthy behaviors for nasal hygiene one week before and after the intervention. Differences in the outcome before and after the intervention were tested using Wilcoxon signed rank test and McNemar's test. Results: The median of healthy nasal hygiene behaviors went from 3.0 to 4.0 after the intervention, with a significant statistical difference (P=0.0004) and a difference of behaviors. After the intervention, forcing the air out of one opened nostril increased from 5.1%to 30.8% (P=0.001, CI 95%: 0-0.440), forcing the air out of the other nostril increased from 5.1% to 28.2% (P=0.003/CI 95%: 0-0.50), throwing the piece of toilet paper in the garbage increased from 53.8% to 87.21% (P=0.04, CI 95%: 0.035-0.65), and sanitizing the hands with soap and water increased from 15.4% to 43.6% (P=0.039-0.76). Conclusion: the educational playful intervention improved the autonomy of preschoolers to adopt healthy nasal hygiene behaviors. [ABSTRACT FROM AUTHOR]

ObjectiveWe examined associations between the frequency of fruit and vegetable (F&V) consumption and nutritional deficiencies among Brazilian schoolchildren.DesignA cross-sectional, population-based study was performed. A short FFQ was used to assess consumption of fruits and vegetables (F&V) over the past month. The prevalence ratios (PR) and 95 % confidence intervals for stunting, obesity, anaemia, vitamin A and folate deficiencies, vitamin E and vitamin D insufficiencies were estimated for low F&V consumption frequency (vegetables ≤3 times/month and fruits ≤3 times/week) and compared with children with usual F&V consumption frequency (vegetables ≥1 time/week and fruits ≥4 times/week).SettingAcrelândia, Western Brazilian Amazon.SubjectsA total of 702 children aged 4–10 years.ResultsOnly 5 % of children consumed F&V ≥5 times/d. Prevalence of deficiency was 31 %, 15 %, 9 % and 2 % for vitamins D, A, E and folate, respectively. Overall, 6·3 % of children were anaemic, 3·3 % were stunted, 2·7 % were obese and 33 % had multiple nutritional deficiencies. Low frequency of F&V consumption was associated with lower plasma concentrations of carotenoids and vitamin E. Nutritional deficiencies were higher among non-consumers of F&V when compared with usual consumers: anaemia (PR=1·9; 95 % CI 1·0, 3·7), vitamin E insufficiency (PR=2·5; 95 % CI 1·5, 4·2), vitamin D insufficiency (PR=1·5; 95 % CI 1·1, 1·9) and stunting (PR=2·6; 95 % CI 1·1, 6·1).ConclusionsIn our study, the occurrence of nutritional deficiencies in children with low F&V consumption was twice as high as in children with usual F&V consumption, reinforcing the importance of effective actions to promote the consumption of F&V. [ABSTRACT FROM PUBLISHER]

Low- to middle-income countries may experience the occurrence of a dual burden of under and overnutrition. To better understand the overall progression of body mass index ( BMI) during childhood, we estimated average BMI-for-age z-score ( BAZ) growth curves in a population-based longitudinal study of 255 children living in the Brazilian Amazon. Children were aged 0.1-5.5 years at recruitment (2003). We collected data on socio-economic and maternal characteristics, children's birthweight and infant feeding practices. Child anthropometric measurements were taken in 2003, 2007 and 2009. BAZ differences among categories of exposure variables were calculated at 6 and 12 months, and 2, 7 and 10 years. At baseline, the mean (standard deviation) age was 2.6 (1.4) years; 12.9% were overweight and 3.9% thin. After adjustment, mean BAZ estimates were mostly negative. Boys were close to the median value for BAZ until 12 months, whereas girls were below the median ( P = 0.05). Children from households above the wealth median were 0.36 z- and 0.49 z-less underweight than poorer children at 7 and 10 years, respectively ( P < 0.01). Maternal BMI was positively associated with children's BAZ since 12 months old; BAZ in children from overweight mothers was higher by 0.69 compared with their counterparts at 10 years ( P < 0.01). Birthweight was positively related to BAZ up until 2 years ( P = 0.01). Socio-economic background and maternal nutritional status are important predictors of BAZ throughout childhood. Although excessive weight gain is a public health concern, it is critical to restrict inequities, while promoting healthier growth in developing countries. [ABSTRACT FROM AUTHOR]

Cerebral palsy (CP) is the most common disability in children caused by central nervous system lesion. The aim of the present study was to verify the intensive neuromotor therapy effects in children with CP, in a reference Brazilian centre. In this study, three years of medical records from a Brazilian reference Centre of Intensive Neuromotor Therapy (INMT) which use the INMT protocol were analysed. The motor evaluation for each child was done by the Gross Motor Function Classification System (GMFCS) and GMFM-88 by an experienced professional, before and after each INMT module. A total of 53 children between the ages of 1 and 15 years (age at treatment initiation, initial evaluation), with a mean age of 5.94±3.38 years, participated in the study. Participants performed between 1 and 10 INMT modules. There was no strong correlation between age and overall performance on the GMFM scale, but it was observed a strong negative correlation between the percentage of GMFM gains and the number of modules (r=-0.709; R² = 0.50; p = 0.022, CI95%[0.014 - 0.026]), suggesting that patients tend to present higher percentage gains in the first modules. Through an intra-module comparison, it was observed statistical difference in the total score in each of the modules. [ABSTRACT FROM AUTHOR]

Objective To estimate the risk of microcephaly in babies born to women infected by the Zika virus during pregnancy in Brazil in an epidemic between 2015 and 2016. Methods We obtained data on the number of notified and confirmed microcephaly cases in each Brazilian state between November 2015 and October 2016 from the health ministry. For Pernambuco State, one of the hardest hit, weekly data were available from August 2015 to October 2016 for different definitions of microcephaly. The absolute risk of microcephaly was calculated using the average number of live births reported in each state in the corresponding time period between 2012 and 2014 and assuming two infection rates: 10% and 50%. The relative risk was estimated using the reported background frequency of microcephaly in Brazil of 1.98 per 10 000 live births. Findings The estimated absolute risk of a notified microcephaly case varied from 0.03 to 17.1% according to geographical area, the definition of microcephaly used and the infection rate. Assuming a 50% infection rate, there was an 18-127 fold higher probability of microcephaly in children born to mothers with infection during pregnancy compared with children born to mothers without infection during pregnancy in Pernambuco State. For a 10% infection rate, the probability was 88-635 folds higher. Conclusion A large variation in the estimated risk of microcephaly was found in Brazil. Research is needed into possible effect modifiers, reliable measures of Zika virus infection and clear endpoints for congenital malformations. [ABSTRACT FROM AUTHOR]

Background. There is little information regarding the ability of observational scales to properly assess children’s behavior during procedural sedation. Aim. To evaluate the characteristics of the Houpt scales, the Ohio State University Behavioral Rating Scale (OSUBRS) and the Venham Behavior Rating Scale when applied to preschool children undergoing conscious dental sedation. Design. This study included 27 children, 4–6 years old with early childhood caries that participated in a clinical trial (NCT02284204) that investigated two sedative regimes using oral midazolam/ketamine. Dental appointments were video-recorded; five calibrated observers assessed 1,209 minutes of video recording to score the children’s behavior, following the instructions of the investigated scales. Data were analyzed by descriptive analysis and Spearman correlation tests (P<0.05). Results. The Houpt overall behavior and the Venham scale were highly correlated (rho = −0.87; P<0.001). OSUBRS scores were better correlated with Houpt overall behavior and Venham ratings, when compared to Houpt scores in the categories for movement and crying. Conclusions. The Houpt overall behavior and the Venham scores are global scales that properly measure children’s behavior during dental sedation. Continuous assessment with OSUBRS through videos has a chance to give more precise data, while the Houpt categories can easily demonstrate children’s behavior during procedures. [ABSTRACT FROM AUTHOR]

Background Since 1988, Brazil's Unified Health System has sought to provide universal and equal access to immunisations. Inequalities in immunisation may be examined by contrasting vaccination coverage among children in the highest versus the lowest socioeconomic strata. The authors examined coverage with routine infant immunisations from a survey of Brazilian children according to socioeconomic stratum of residence census tract. Methods The authors conducted a household cluster survey in census tracts systematically selected from five socioeconomic strata, according to average household income and head of household education, in 26 Brazilian capitals and the federal district. The authors calculated coverage with recommended vaccinations among children until 18 months of age, according to socioeconomic quintile of residence census tract, and examined factors associated with incomplete vaccination. Results Among 17 295 children with immunisation cards, 14 538 (82.6%) had received all recommended vaccinations by 18 months of age. Among children residing in census tracts in the highest socioeconomic stratum, 77.2% were completely immunised by 18 months of age versus 81.2%e86.2% of children residing in the four census tract quintiles with lower socioeconomic indicators (p<0.01). Census tracts in the highest socioeconomic quintile had significantly lower coverage for bacille Calmette-Guérin, oral polio and hepatitis B vaccines than those with lower socioeconomic indicators. In multivariable analysis, higher birth order and residing in the highest socioeconomic quintile were associated with incomplete vaccination. After adjusting for interaction between socioeconomic strata of residence census tract and household wealth index, only birth order remained significant. Conclusions Evidence from Brazilian capitals shows success in achieving high immunisation coverage among poorer children. Strategies are needed to reach children in wealthier areas. [ABSTRACT FROM AUTHOR]

Objective: to analyze the use of contraceptive methods and the intention to become pregnant among women attending the Brazilian Unified Health System. Method: a cross-sectional study conducted with 688 women aged 18-49 years old, attending the Family Health Strategy Facilities in the eastern part of the city of São Paulo, Brazil, who were awaiting medical or nursing consultation. Data were obtained through interviews with a structured instrument, allocated in tablets. The analysis was conducted with "strong desire to avoid pregnancy" as the dependent variable. Chisquare and multiple logistic regression were used, calculated in Stata 14.2. Results: 56.5% used some contraceptive method, covariates of the strong desire to avoid pregnancy were marital status (OR=0.49; CI95%=0.33-0.74), parity -- two and more children (OR=15.9; IC95%=4.29-59.1); and pregnancy planning -- planned (OR=0.69; IC95%=0.73-0.94) and ambivalent (OR=2.94; IC95%=1.30-3.83). There was no statistical difference between the strong desire to avoid pregnancy and the type of contraceptive used. Conclusion: women with a strong desire to avoid pregnancy used basically the same types of contraceptive methods as women in general, which shows that they have not been supported to achieve their reproductive preferences. [ABSTRACT FROM AUTHOR]

Objective: to assessed the prevalence of diabetes mellitus (DM) and drug abuse in mothers of children with orofacial clefts (OFC). Methods: 325 women who had children (0-3y) with clefts were interviewed. Data regarding type of diabetes, use of legal/illegal drugs during pregnancy, waist girth and fasting blood sugar at the first prenatal consult were collected. Results: twenty seven percent of the women had DM, out of these, 89% had gestational DM, 5,5% type 1 DM and 5,5% type 2 DM. The prevalence of DM in mothers of children with OFC was 27%, it is significantly higher than the average Brazilian population which is 7.6% (p<0.01) (OR=4.5, 95%CI = 3.5-5.8). Regarding drug abuse during pregnancy, 32% of the mothers used drugs and a significant positive correlation was observed between drug abuse and the occurrence of clefts and other craniofacial anomalies (p=0.028) (OR=2.87; 95%CI=1.1-7.4). Conclusions: DM and drug abuse during pregnancy increases the risk for OFC and related anomalies and early diagnosis of DM and prevention of drug abuse, especially in pregnant women, should be emphasized. [ABSTRACT FROM AUTHOR]

Objectives. To investigate the association between the maternal alcohol consumption during pregnancy and early age leukemia (EAL) in offspring. Methods. Datasets were analyzed from a case-control study carried out in Brazil during 1999–2007. Data were obtained by maternal interviews using a standardized questionnaire. The present study included 675 children (193 acute lymphoid leukemia (ALL), 59 acute myeloid leukemia (AML), and 423 controls). Unconditional logistic regression was performed, and adjusted odds ratios (adj. OR) on the association between alcohol consumption and EAL were ascertained. Results. Alcohol consumption was reported by 43% of ALL and 39% of AML case mothers and 35.5% of controls’. Beer consumption before and during pregnancy was associated with ALL in crude analysis (OR = 1.54, 95% CI, 1.08–2.19), although in adjusted analysis no statistical significance was found. For weekly intake of ≤1 glass (adj. OR = 1.30, 95% CI, 0.71–2.36) and ≥1 glass/week (adj. OR = 1.47, 95% CI, 0.88–2.46) a potential dose-response was observed (P trend < 0.03). Conclusion. This study failed to support the hypothesis of an increased risk of EAL associated with maternal alcohol intake during pregnancy, neither with the interaction with tobacco nor with alcohol consumption. [ABSTRACT FROM AUTHOR]

Background and Objectives. Parents’ birth weight acts as a predictor for the descendant birth weight, with the correlation more strongly transmitted through maternal line. The present research aims to study the correlation between the child’s low or increased birth weight, the mother’s birth weight, and maternal conditions. Methods. 773 mother-infant binomials were identified with information on both the baby’s and the mother’s birth weight recorded. Group studies were constituted, dividing the sample according to birth weight (<2,500 grams (g) and ≥3,500 grams (g)). The length at birth was also studied in children ≤47.5 cm (lower quartile). Chi2 test or Fisher’s exact test, Spearman’s Rho, and odds ratio were performed in order to investigate the relation between the children’s weight and length at birth and the mothers’ and children’s variables. Results. The girls were heavier at birth than their mothers, with an average increase at birth weight between the generations of 79 g. The child’s birth weight <2,500 g did not show any correlation with maternal birth weight <2,500 g (Fisher 0.264; Spearman’s Rho 0.048; OR 2.1 and OR lower 0.7) or with maternal stature below the lower quartile (<157 cm) (Chi2 sig 0.323; with Spearman’s Rho 0.036; OR 1.5 and OR lower 0.7). The child’s low birth weight (<2,500 g) was lightly correlated with drug use by the mother during pregnancy (Fisher 0.083; Spearman’s Rho 0.080; OR 4.9 and OR lower 1.0). The child’s birth weight <2,500 g showed increased correlation with gestational age lower than 38 weeks and 3 days (Chi2 sig 0.002; Spearman’s Rho 0.113; OR 3.2 and OR lower 1.5). The child’s weight at birth ≥3,500 g showed strong correlation with maternal weight at birth ≥3,500 g (Chi2 sig 0; Spearman’s Rho +0.142; OR 0.5 and OR upper 0.7). It was also revealed that the higher the maternal prepregnancy BMI, the stronger the correlation with child’s birth weight ≥3,500 g ((maternal prepregnancy BMI>25.0 with Chi2 sig 0.013; Spearman’s Rho 0.09; OR 1.54 and OR upper 2.17) and (maternal prepregnancy BMI>30.0 with Chi2 sig 0 Spearman’s Rho 0.137; OR 2.58 and OR upper 4.26)). The child’s length at birth in the lower quartile (≤47.5 cm) showed strong correlation with drug use by the mother during pregnancy (Chi2 sig 0.004; Spearman’s Rho 0.105; OR 4.3 and OR lower 1.5). Conclusions. The mother’s increased weight at birth and the prenatal overweight or obesity were correlated with increased weight and length at birth of the newborn, coupled with the tendency of increasing birth weight between generations of mothers and daughters. Also, descendants with smaller length at birth are the children of women with the lowest statures. [ABSTRACT FROM AUTHOR]

Background: The Manual Ability Classification System (MACS) has been widely used to describe the manual ability of children with cerebral palsy (CP); however its reliability has not been verified in Brazil. Objective: To establish the inter- and intra-rater reliability of the Portuguese-Brazil version of the MACS by comparing the classifications given by therapists and parents of children with CP. Method: Data were obtained from 90 children with CP between the ages of 4 and 18 years, who were treated at the neurology and rehabilitation clinics of a Brazilian hospital. Therapists (an occupational therapist and a student) classified manual ability (MACS) through direct observation and information provided by parents. Therapists and parents used the Portuguese-Brazil version of the MACS. Intra- and inter-rater reliability was obtained using unweighted Kappa coefficient (k) and intra-class correlation coefficient (ICC). The Chi-square test was used to identify the predominance of disagreements in the classification of parents and therapists. Results: An almost perfect agreement resulted among therapists [K=0.90 (95% CI 0.83-0.97); ICC=0.97 (95%CI 0.96‑0.98)], as well as with intra-rater (therapists), with Kappa ranging between 0.83 and 0.95 and ICC between 0.96 and 0.99 for the evaluator with more and less experience in rehabilitation, respectively. The agreement between therapists and parents was fair [K=0.36 (95% CI 0.22-0.50); ICC=0.79 (95% CI 0.70-0.86)]. Conclusions: The Portuguese version of the MACS is a reliable instrument to be used jointly by parents and therapists. [ABSTRACT FROM AUTHOR]

Objective: to analyze the relationship between perception of social support and emotional and physical symptoms associated with psychiatric conditions among women. Method: a cross-sectional, quantitative study was carried out with a randomized random sample of 141 women attended at a Family Health Unit of the city of Ribeirão Preto/ SP. A sociodemographic questionnaire, the Social Support Questionnaire and the Self-Report Questionnaire were used. Results: there was no association between sociodemographic characteristics and mental disorder, but between aspects such as low income and schooling. The exercise of professions culturally considered as of low prestige gave rise to some reflections related to gender inequality. There was a significant difference in the satisfaction scores between the women who reported or not the symptoms of tiredness and sadness and the number of supporters among those who reported or not the symptom of fatigue. Spouses and children were the most mentioned supporters, and having mental disorder was significantly associated with having no friends in the support network. Conclusion: issues related to gender equity and satisfaction with social support are important aspects of care. For the promotion of mental health, efforts must be made to make women feel more connected and supported by the supporters available in their social environment. [ABSTRACT FROM AUTHOR]

Objective: to evaluate self-esteem, the consumption of alcohol, tobacco and other substances in outsourced workers of a public university. Method: a descriptive-analytical, crosssectional, quantitative study developed with 316 outsourced workers from a municipality in the Southeast of Brazil. Data was collected through a characterization tool, the Rosenberg Self-Esteem Scale and the Alcohol, Smoking and Substance Involvement Screening Test. For data analysis, we used descriptive statistics, Pearson's chi-square test, Fisher's exact test, odds ratio and logistic regression. Results: the majority of workers had high self-esteem and some used alcohol, tobacco, marijuana and inhalants. A significant association between gender, age group and work shift with self-esteem; between the risk of developing problems related to alcohol consumption with sex, age group, marital status, religious belief and number of children; between the practice of physical activity and the risk of developing problems related to the consumption of tobacco products was found. Conclusion: this study contributes to the increase of knowledge due to the small number of researches involving this subject and to contribute to the nurses to have subsidies to work with this population using strategies to combat the triggers of psychic disorders. [ABSTRACT FROM AUTHOR]