Abstract: Introduction: supporting the constitutional rights of people with disabilities includes meeting new curricular guidelines and requires higher education that considers diversity in different contexts. Thus, the undergraduate curricula of health professionals must meet the multifaceted needs of people with disabilities in a way that transcends the biomedical model and permeates the promotion of an inclusive culture. Attitudes and values about disability often influence people’s behavior, making it imperative to introduce this topic. Aim: the present study aim to describe an approach in the curricula and teachers’ conceptions about children and adolescents with disabilities in medical courses. Method: this exploratory, cross-sectional study with a qualitative approach included the documental analysis of official documents of the courses and official pages of the universities, published until the first semester of 2021 and interviews of teachers participating in the course. The content analysis technique was used for the interview material. Results: the documental analysis pointed in the general topics a direction towards a humanistic formation, while respecting the differences; however, when the topic is the disability, the focus was centered on biological issues. During the interviews, the following topics were identified: 1) The importance of the Unified Health System as a space for medical training; 2) The contribution of the National Curriculum Guidelines in guiding the activities of teachers and highlighting relevant points; 3) Development of teaching activities aimed at children and adolescents with disabilities, based on the teachers’ experiences; 4) Conception about the person with disabilities and teacher training; 5) Teacher training for the development of teaching activities about children and adolescents with disabilities and knowledge about public policies in the area. Conclusions: a weakness was identified in the approach to the subject, with specific insertions on the subject, usually from the perspective of the disease and from the opportunities that arise. Among the teachers, the predominance of the biomedical perspective was identified, as well as the lack of training on the subject and its fragile insertion in academic practice. However, the importance of the topic was recognized and its potential to integrate the curricular matrix in a cross-sectional way.

Resumo: Introdução: Amparar os direitos constitucionais das pessoas com deficiência inclui atender aos novos direcionamentos curriculares e exige um ensino superior que considere a diversidade em diversos contextos. Assim, os currículos de graduação de profissionais de saúde devem atender às necessidades multifacetadas das pessoas com deficiência de modo que transcendam o modelo biomédico e perpassem pela promoção da cultura inclusiva. As atitudes e os valores sobre a deficiência frequentemente influenciam o comportamento das pessoas, tornando imperativa a introdução desta temática. Objetivo: Este estudo teve como objetivo descrever a abordagem nos currículos e as concepções de professores sobre crianças e adolescentes com deficiência em cursos de Medicina. Método: Trata-se de um estudo exploratório, transversal e de abordagem qualitativa que incluiu a análise documental de documentos oficiais dos cursos e páginas oficiais das universidades publicados até o primeiro semestre de 2021, e entrevistas de professores participantes do curso. A análise de conteúdo foi a técnica utilizada para o material das entrevistas. Resultado: A análise documental apontou nos tópicos gerais um direcionamento para uma formação humanística, com respeito às diferenças. Entretanto, quando a temática é a deficiência, o enfoque foi centrado nas questões biológicas. Nas entrevistas, identificaram-se os seguintes eixos temáticos: 1. a importância do Sistema Único de Saúde como espaço de formação médica; 2. a contribuição das Diretrizes Curriculares Nacionais na orientação das atividades dos docentes e destaque a pontos relevantes; 3. desenvolvimento de atividades de ensino voltadas à criança e ao adolescente com deficiência, com base nas experiências dos docentes; 4. concepção sobre a pessoa com deficiência e formação docente; 5. formação docente para o desenvolvimento de atividades de ensino sobre a criança e o adolescente com deficiência e conhecimento sobre as políticas públicas da área. Conclusão: Foi identificada uma fragilidade na abordagem da temática, com inserções pontuais sobre o tema, geralmente na perspectiva da doença e a partir de oportunidades surgidas. Entre os docentes, identificaram-se a predominância do olhar biomédico, a ausência de formação para a temática e a frágil inserção desta na prática acadêmica. Entretanto, houve reconhecimento da importância do tema e seu potencial em integrar a matriz curricular de forma transversal.

Abstract Objective: To describe the participation of the environment in the childhood obesity epidemic, since childhood obesity currently represents a great challenge, with high prevalence worldwide, including in Brazil. Data source: Survey of articles published in the last 10 years in PubMed, evaluating the interface between the environment and childhood obesity. Data synthesis: Recent studies show that the environment is very important in the etiopathogenesis of obesity and its comorbidities. Therefore, factors such as air pollution, exposure to chemical substances that interfere with the metabolism, excessive consumption of ultra-processed foods, changes in the intestinal microbiota, and sedentary lifestyle are associated with increased obesity, insulin resistance, type 2 diabetes, and changes in lipid metabolism. These factors have a greater impact on some stages of life, such as the first thousand days, as they affect the expression of genes that control the adipogenesis, energy expenditure, and the mechanisms for hunger/satiety control. Conclusions: Environmental aspects must be taken into account in the prevention and treatment of childhood obesity, both from the individual and the population point of view, with adequate and comprehensive public health policies.

SUMMARY OBJECTIVE: The aim of this study was to describe the motor development (MD) and growth of infants born with low birth weight (LBW) versus adequate birth weight (ABW) by using the Alberta Infant Motor Scale (AIMS). METHODS: The cross-sectional study including LBW infants (aged 6–12 months) followed at an outpatient clinic from a University Hospital in Brazil and a group of infants of the same age with ABW. The variables were recorded as maternal, birth, and infant conditions. The infants were assessed for MD using the AIMS. RESULTS: In total, 98 infants (38 LBW versus 60 ABW) were evaluated and no statistically significant differences were found in demographic characteristics and in the AIMS results. The AIMS results of the total sample were suspicious or abnormal MD in 44 (45%) of total infants. Higher frequency of suspected or abnormal motor behavior was found in the age group between 9 and 12 (54.6%) months. CONCLUSIONS: A frequency of 45% of suspected or abnormal behavior was observed in the evaluated infants, with a higher frequency of occurrence in those aged 9–12 months (54.6%).

OBJECTIVES: To compare the effects of low-dose conjugated estrogen (CE), raloxifene, and the combination thereof on the endometrium of postmenopausal women. METHODS: Postmenopausal women between 45 and 60 years of age, with Gail score≥1.67 and no endometrial disorders, were randomly assigned to receive low-dose CE (0.3 mg), raloxifene (60 mg), or combined therapy for 1 year. Transvaginal ultrasound was performed at baseline and every 3 months; the Kupperman Index was assessed at baseline and every 6 months. Endometrial biopsies were performed if endometrial thickness (ET) was ≥5 mm or if vaginal bleeding occurred. The primary outcome was the occurrence of ET≥5 mm over the one-year period. RESULTS: Seventy-three women were randomly assigned and analyzed on an intent-to-treat basis. Eight, three, and four women in the CE, raloxifene, and combination groups, respectively, exhibited ET≥5 mm. No genital bleeding was reported in the combination group. Endometrial biopsy revealed atrophy or polyps in all groups, with one patient in the CE group exhibiting a proliferative endometrium without atypia. At 6 months, there was a progressive increase in mean ET in the CE group, but not in the other two groups, with statistically significant differences at 6, 9, and 12 months. Mean scores for vasomotor symptoms and Kupperman Index favored the CE and combination groups over raloxifene. CONCLUSION: Combined raloxifene and low-dose CE decreased the severity of menopausal symptoms to a similar extent as CE alone and had similar effects as raloxifene alone on the endometrium.

ABSTRACT The present research evaluated the seroprevalence of anti-zika virus (anti-ZIKV) antibodies by virus neutralization test (VNT) in 529 bovines from Andradina city, São Paulo state, Brazil. The reading was performed in an inverted optical microscope, considering reagents when the antibodies were capable to neutralize the ZIKV. Of the 529 samples, 53 (10.01%) were reagents. The animals were healthy at the time of collection. The samples were collected in February 2018, a favorable period for the multiplication of the vector and the highest risk of disease transmission. None of the animals showed anti-bovine viral diarrhea virus (anti-BVDV) antibodies, ruling out a possible cross-reaction, reinforcing the possible contact of the bovine with the ZIKV. In the herd, 88 pregnant females were evaluated; of these, 12 cows were reactive, with no history of reproductive problems or fetal malformations. This is the first research on the seroprevalence of ZIKV in cattle in Brazil, and studies should continue to evaluate cattle as a possible host of this arbovirus and its possible consequences for unique health and agribusiness.

RESUMO OBJETIVO Descrever a prevalência de dislipidemias em crianças e adolescentes com doenças reumáticas autoimunes (Drai), em particular artrite idiopática juvenil (AIJ), lúpus eritematoso sistêmico juvenil (Lesj) e dermatomiosite juvenil (DMJ). MÉTODOS Estudo transversal retrospectivo realizado no ambulatório de reumatologia pediátrica. Foram avaliados 186 crianças e adolescentes com idades entre 5 e 19 anos. Foram coletados dos prontuários dados demográficos, clínicos, atividade de doença e perfil lipídico (triglicérides (TG), colesterol total (CT) e frações LDL-c (low density lipoprotein); HDL-c (high density lipoprotein) e VLDL-c (very low density lipoprotein). Foi também calculada a fração não HDL do colesterol (CT-NHDL -c). Para classificação do perfil lipídico, foram adotados os pontos de corte propostos pela American Academy of Pediatrics. RESULTADOS A dislipidemia foi observada em 128 pacientes (68,8%), sendo a mais comum a diminuição do HDL-c em 74 (39,8%). No grupo AIJ houve uma associação entre o subtipo sistêmico com alteração de LDL-c e NHDL-c, mostrando um perfil mais aterogênico neste subtipo (p=0,027 e 0,017, respectivamente). Em relação aos pacientes com Lesj, podemos observar que a dose cumulativa de CTC teve associação com o aumento do LDL-c (p=0,013) e com a diminuição do HDL-c (p=0,022). CONCLUSÃO A dislipidemia é frequente em crianças e adolescentes com Drai, em especial, AIJ, Lesj e DMJ, e a principal alteração no perfil lipídico desses pacientes foi a diminuição do HDL-c.

SUMMARY AIM To describe the prevalence of dyslipidemia in children and adolescents with autoimmune rheumatic diseases (ARDs), particularly juvenile idiopathic arthritis (JIA), juvenile systemic lupus erythematosus (jSLE), and juvenile dermatomyositis (JDM). METHODS Retrospective cross-sectional study conducted in the pediatric rheumatology outpatient clinic. We evaluated 186 children and adolescents between the ages of 5 and 19 years. The medical records were reviewed for the following data: demographic and clinical features, disease activity, and lipid profile (triglycerides (TG), total cholesterol (TC), low density lipoprotein (LDL-C), high density lipoprotein (HDL-C) and very low density lipoprotein (VLDL-C)). In addition, non-HDL cholesterol was calculated as TC minus HDL-C. The cut-off points proposed by the American Academy of Pediatrics were used to classify the lipid profile. RESULTS Dyslipidemia was observed in 128 patients (68.8%), the most common being decreased HDL-C (74 patients, 39.8%). In the JIA group there was an association between the systemic subtype and altered LDL-C and NHDL-C, which demonstrated a more atherogenic profile in this subtype (p=0.027 and p=0.017, respectively). Among patients with jSLE, the cumulative corticosteroid dose was associated with an increase in LDL-C (p=0.013) and with a decrease in HDL-C (p=0.022). CONCLUSION Dyslipidemia is common in children and adolescents with ARDs, especially JIA, jSLE, and JDM, and the main alteration in the lipid profile of these patients was decreased HDL-C.

RESUMO Objetivo: Comparar os resultados da concentração de homocisteína usando os métodos de quimioluminescência e HPLC em amostras de crianças escolares. Determinar os valores de referência desse grupo etário e avaliar o valor prognóstico real da homocisteína em crianças saudáveis. Métodos: Um estudo prospectivo observacional foi executado para determinar os níveis de homocisteína usando dois ensaios diversos, o HPLC e a quimioluminescência, em 185 amostras de crianças em idade escolar moradoras da cidade de Santo André, que não apresentassem doenças crônicas ou inflamatórias, na ausência de desenvolvimento puberal. Resultados: Os resultados foram apresentados em percentis e os valores de referência foram determinados para esse grupo etário (7-9 anos). As concentrações de homocisteína variaram de 2,0 a 9,9 µmol/l (r = 0,821 e p < 0,001). Conclusões: Verificamos que o método da quimioluminescência é comparável ao método HPLC quando as técnicas são usadas para detectar a homocisteína em crianças em idade escolar. Houve importante correlação entre os dois métodos, o que permite a investigação desse aminoácido como um fator de risco para doenças cardíacas.

ABSTRACT Objective: To compare the results for homocysteine concentration using chemiluminescence and HPLC methods in samples from school-age children. In addition, to determine the reference values for patients of this age group and assess the real prognostic value of homocysteine in healthy children. Methods: A prospective observational study was undertaken to determine plasma levels of homocysteine using two different assays, HPLC and chemiluminescence, in 185 samples from school-age children living in Santo Andre, with no chronic or inflammatory diseases, and absence of pubertal development. Results: The results were presented in percentiles and reference values were determined within this age group (7-9 years old). Homocysteine concentration ranged from 2.0 to 9.9 µmol/l (r = 0.821 and p < 0.001). Conclusions: It was verified that chemiluminescence is comparable to HPLC when both techniques are used to detect homocysteine in school-age children. There is an important correlation between both methods, which allows investigation of this amino acid as a risk factor for heart diseases.

OBJETIVOS: Determinar a ingestão dietética de vitamina A e os níveis séricos de carotenóides e retinol em crianças e adolescentes com déficit estatural sem causa hormonal, atendidos no Ambulatório de Endocrinopediatria do Núcleo de Nutrição (NUNADI) da Secretaria de Estado da Saúde de São Paulo. MÉTODOS: Foram avaliados de maneira prospectiva 47 pacientes pré-púberes, entre 4 e 14 anos, com relação a: antropometria, idade óssea, inquérito alimentar, bioimpedanciometria e nível sérico de retinol e carotenóides. RESULTADOS: A média do escore Z da estatura foi de -2,4; 20% dos pacientes eram desnutridos, 25,5% tinham inadequação da massa gorda e maior atraso da idade óssea. Os níveis séricos de retinol e carotenóides foram inadequados em 21% dos pacientes, sendo que foi maior o percentual de inadequação dos carotenóides nos pacientes que apresentavam déficit estatural mais acentuado. Não houve relação dos níveis séricos de retinol e carotenóides com a velocidade de crescimento. Em 82,9% dos inquéritos alimentares realizados, houve ingestão de vitamina A inferior a 50% do estabelecido na Pirâmide de Alimentos. CONCLUSÃO: Baseados nestes resultados, concluímos que há uma elevada prevalência de desnutrição, comprometimento da idade óssea, inadequação no nível sérico de carotenóides e ingestão de vitamina A em crianças com comprometimento estatural.

OBJECTIVES: To determine the vitamin A intake and the blood levels of carotenoids and retinol in stunted children and adolescents without hormonal disease, assisted in the Clinic of Pediatric Endocrinology of the Center for Nutrition and Child Development - Department of Health, State of São Paulo, Brazil. METHODS: We evaluated, in a prospective and randomized trial, 47 prepubertal patients between 4 and 14 years old. All patients were submitted to anthropometric evaluation, bone age, bioelectric impedance and serum retinol and carotenoid levels. RESULTS: The average of the stature z score was -2.4; 20% of the patients were undernourished, 25.5% they had inadequacy of the fat mass as well as larger delay of the bone age. The more stunted the patients the lower were the carotenoid levels. There was no relationship between the levels of retinol and carotenoids and the growth velocity. In 82.9% of the recall record of food intake, the vitamin A intake was lower than 50% of the established one in the Food Guide Pyramid. CONCLUSION: There is a high prevalence of malnutrition, bone age delay and inadequacy of the levels of carotenoids and vitamin A intake in stunted children and adolescents.