SUMMARY OBJECTIVE: The aim of this study was to describe homocysteine concentrations in overweight and obese children and adolescents and relate them to blood pressure levels, renal function, and insulin resistance. METHODS: This is a cross-sectional and observational study with 64 overweight children and adolescents (mean age: 11.6±3.5 years) in outpatient follow-up. The following parameters were evaluated: body mass index z-score, waist-to-height circumference ratio, pubertal stage, blood pressure, serum homocysteine, glycemia, insulin, lipid profile, renal function, high-sensitivity C-reactive protein, microalbuminuria, and creatinuria. Statistical analysis: analysis of variance and logistic regression (dependent variable: homocysteine) (p<0.05). RESULTS: The mean body mass index z-score was 2.9±1.1. The mean homocysteine concentrations were 8.6±2.2 μmol/L (10th and 90th percentiles: 6.6 and 11.2 μmol/L, respectively), with no difference when compared with children with severe obesity and obesity/overweight (p=0.431). High values of waist-to-height ratio (93.8%), systolic blood pressure (18.8%), diastolic blood pressure (12.5%), glycemia (4.7%), low-density lipoprotein cholesterol (31.1%), triglycerides (35.9%), non-high-density lipoprotein cholesterol (34.4%), and microalbuminuria (21.9%) were obtained. The mean glomerular filtration rate was 122.9±24.6 mL/min/1.73 m². Homocysteine concentrations were not associated with any of the studied variables (R²=0.095). CONCLUSION: Homocysteine concentrations in overweight children and adolescents (mean 8.6±2.2 μmol/L) were not associated with body mass index z-score, blood pressure, renal function, and insulin resistance.

ABSTRACT Objective To compare serum amyloid A concentrations between overweight and eutrophic children and adolescents and to relate it to lipid profiles, glucose tolerance, and carotid intima-media thickness. Methods One hundred children and adolescents (mean age: 10.8±3.16 years) were included and divided into two groups: overweight and non-overweight. The following were evaluated: Z-score body mass index, carotid intima-media thickness, lipid metabolism biomarkers (lipid profile and apolipoproteins A1 and B), inflammatory biomarkers (ultra-sensitive C-reactive protein and serum amyloid A), and glucose homeostasis model assessment of insulin resistance. Results The groups were homogeneous in age, sex, and pubertal stage. Higher levels of triglycerides, apolipoprotein B, homeostasis model assessment of insulin resistance, ultrasensitive C-reactive protein, serum amyloid A, and carotid intima-media thickness were observed in the overweight group. In the multivariate analysis, age (OR=1.73; 95%CI: 1.16-2.60, p=0.007), Z-score body mass index (OR=3.76; 95%CI: 1.64-8.59, p=0.002), apolipoprotein-B (OR=1.1; 95%CI: 1.01-1.2, p=0.030), and carotid intima-media thickness (OR=5.00; 95%CI: 1.38-18.04, p=0.014) were independently associated with serum amyloid A levels above the fourth quartile of the studied sample (>9.4mg/dL). Conclusion Overweight children and adolescents had higher serum amyloid A concentrations than eutrophic children. There was an independent association between higher concentrations of serum amyloid A and Z-score, body mass index, apolipoprotein B, and carotid intima-media thickness, indicating the importance of this inflammatory biomarker in identifying the early risk of atherosclerosis.

SUMMARY OBJECTIVE: This study aimed to compare neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio of overweight children and adolescents with the eutrophic ratios and to verify whether these ratios are associated with age, inflammation, Z-score of body mass index, and waist-to-height ratio. METHODS: This is a cross-sectional study involving 64 overweight and 106 eutrophic children and adolescents. Data on weight, height, and waist circumference (body mass index and waist-to-height ratio), blood count (neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio), and high-sensitivity C-reactive protein were collected. RESULTS: The mean age of participants was 8.4±3.2 years. The ratios did not differ between the overweight and non-overweight groups. The platelet-to-lymphocyte ratio has shown a direct and independent association with body mass index (p=0.031) and waist-to-height ratio (p=0.018), a fact not observed for neutrophil-to-lymphocyte ratio. The ultrasensitive C-reactive protein level was higher in the obesity group (p=0.003). Both ratios had a direct and independent association with age. CONCLUSION: The ratios did not differ between the overweight and non-overweight groups. There was a direct and independent association of platelet-to-lymphocyte ratio with overweight, not observed in neutrophil-to-lymphocyte ratio. The ratios have significantly increased according to the age of the participants.

Resumo Objetivo Analisar um instrumento para o monitoramento da atenção básica. Métodos Pesquisa quantitativa, descritiva e analítica, consistiu na aplicação do instrumento em 442 Unidades Básicas de Saúde - UBS do município de São Paulo, contando com a participação de gestores locais na sua elaboração; o instrumento foi composto por 47 quesitos que contemplaram indicadores de Estrutura, Processo e Resultado e foram organizados em seis blocos temáticos: I - recepção técnica acolhedora – RTA (acolhimento); II - trabalho da enfermagem; III - trabalho médico; IV - organização assistencial e integração da equipe; V - cobertura vacinal e de programas; VI- gestão e participação. Para análise estatística utilizou-se o programa SPSS 25.0. Resultados A média e a mediana de pontuação obtidas pelas 414 UBS avaliadas (total de 470 pontos possíveis) foram 356 e 380, respectivamente. Por meio de modelagem multivariada, nove quesitos de Estrutura e Processo se destacaram, quando analisados em relação aos quesitos de Resultado, apresentando associação estatística (p<0,05): RTA realizada em todos períodos da UBS; treinamento específico para atendimento na RTA; atuação clínica do enfermeiro; retaguarda médica sistematizada para RTA; equipe de saúde bucal completa; horário reservado para reunião da equipe; atendimento em grupo realizado sistematicamente; ações de promoção à saúde; acomodações físicas adequadas. Conclusão o instrumento apresentou capacidade para captar diferentes estágios da organização e de resultados das unidades participantes do estudo e, além de uma avaliação global, revelou questões críticas dos serviços relacionadas às mudanças pretendidas. Como ferramenta avaliativa para os serviços pode contribuir no monitoramento e no apoio à tomada de decisões tecno-gerenciais cotidianas.

Abstract Objective To analyze an instrument for monitoring primary care. Methods Qualitative, descriptive, and analytic research that consisted in the application of the instrument in 442 Basic Health Units - PCC from São Paulo city with the participation of local managers in its elaboration; the instrument is composed of 47 aspects that contemplated indicators of Structure, Process, and Result and we organized them in six thematic blocks: I - welcoming technical reception – WTR (reception); II - nursing work; III - medical work; IV - assistance organization and team integration; V - vaccination and program coverage; VI - management and participation. For the statistical analysis, we utilized the SPSS 25.0 program. Results The average and median scores obtained by the 414 evaluated Primary Care Centers (total of 470 possible points) were 356 and 380, respectively. Through the multivariate modeling, nine aspects of Structure and Processes stood out, when analyzed concerning the aspects of the Result, presenting statistical association (p<0.05): WTR carried out in every period of Primary Care Centers; specific training for the care in WTR; nurse clinical performance; systematized medical rearguard for WTR; complete oral health team; reserved time for team meeting; group appointment carried out systematically; health promotion actions; adequate physical accommodations. Conclusion The instrument presented the capacity to capture different stages of the organization and the results of the participant units of this study, and, besides a global evaluation, it revealed critical questions of the services related to the intended changes. As an evaluative tool for the services, it may contribute to the monitoring and the support to the everyday techno-management decision making.

Resumen Objetivo Analizar un instrumento para el monitoreo de la atención básica. Métodos Estudio cuantitativo, descriptivo y analítico, que consistió en la aplicación de un instrumento en 442 Unidades Básicas de Salud (UBS) del municipio de São Paulo y contó con la participación de administradores locales para su elaboración. El instrumento estuvo compuesto por 47 ítems que contemplaron indicadores de Estructura, Proceso y Resultado, y fueron organizados en seis bloques temáticos: I – recepción técnica acogedora RTA (acogida); II – trabajo de enfermería; III – trabajo médico; IV – organización asistencial e integración del equipo; V – cobertura de vacunación y programas; VI – gestión y participación. Para el análisis estadístico se utilizó el programa SPSS 25.0. Resultados El promedio de puntuación obtenido por las 414 UBS evaluadas fue 356 y la mediana de 380 (total de 470 puntos posibles). Por medio de la modelación multivariada, se destacaron nueve ítems de Estructura y Proceso, al ser analizados con relación a los ítems de Resultado, y presentaron asociación estadística (p<0,05): RTA realizada en todos los períodos de la UBS, capacitación específica para atención en la RTA, actuación clínica del enfermero, retaguardia médica sistematizada para RTA, equipo de salud bucal completa, horario reservado para reunión del equipo, asistencia en grupo realizada sistemáticamente, acciones de promoción de la salud, instalaciones físicas adecuadas. Conclusión El instrumento presentó capacidad para captar diferentes niveles de la organización y de resultados de las unidades participantes en el estudio y, además de una evaluación global, reveló cuestiones críticas de los servicios relacionadas con los cambios pretendidos. Como herramienta evaluadora de los servicios, puede contribuir para monitorear y respaldar la toma de decisiones tecno-administrativas cotidianas.

SUMMARY OBJECTIVE: This study aimed to describe the prevalence of acanthosis nigricans and high blood pressure in children and adolescents from low-income families, and to verify the association of elevated blood pressure with nutritional status and the presence of acanthosis nigricans. METHODS: This is a cross-sectional and controlled study with 232 children and adolescents from an institution for low-income families. Pubertal stage, body mass index Z-score, waist-to-height circumference ratio (increased waist-to-height circumference ratio >0.5), the presence of acanthosis nigricans, and blood pressure were assessed. RESULTS: The prevalence of excess weight and the change in waist-to-height circumference ratio was 37.9%. Acanthosis nigricans and increased blood pressure occurred in 20.3 and 34.8%, respectively. The prevalence of acanthosis nigricans and hypertension was higher in individuals with excess weight (p<0.001; p<0.001) and with an increased waist-to-height circumference ratio (p=0.009; p<0.001). Logistic regression showed a significant and independent association of body mass index Z-score (OR 2.35; 95%CI 1.52–3.65; p<0.001) and the presence of acanthosis nigricans (OR 2.43; 95%CI 1.12–5.23; p=0.023) with elevated blood pressure. CONCLUSION: Acanthosis nigricans and elevated blood pressure occurred in one-fifth and one-third of the individuals in an institution for children from low-income families. Overweight and the presence of acanthosis nigricans increased the risk of high blood pressure more than twofold.

Abstract Objectives: To describe the ontogeny of the immune system and the adaptive mechanisms of the immune system in the neonatal period, with an emphasis on transplacental antibody transport and breastfeeding. Source of data: Non-systematic literature review in the PubMed database. Summary of the findings: The last two decades have witnessed a great advance in the knowledge of the immune system since conception. Several investigation tools have provided insight on phenomena that were previously inadequately understood. Still expanding, the functional and molecular investigation of various aspects of the immune system will make it possible to understand how intra-uterus maternal-fetal exchanges, the maternal microbiota interacting with the fetus and newborn, and the acquisition of immunological competence occur in healthy and disease scenarios. Conclusions: In-depth knowledge of the development of the immune system and of the adaptive mechanisms that allow a safer transition to the extrauterine environment are fundamental components of optimizing maternal and young infant vaccination, as well as the strategies associated with full postnatal development, and the early diagnosis and treatment of innate errors of immunity.

SUMMARY OBJECTIVE: To evaluate whether there is an association between the body mass index z-score and waist-to-height ratio of children and adolescents. METHODS: This was a cross-sectional study conducted in a school in Santo André, SP, between June and August 2019. Body mass index was measured for all participants, adopting the z-score cutoff of +2 recommended by the World Health Organization. The waist-to-height ratio was determined in children over two years of age and considered abnormal when ≥0.5. The qualitative variables are presented as absolute numbers and percentages. To compare qualitative data, we used the χ2 test or Fisher's exact test. Pearson's test was applied to assess the correlation between BMI and waist-to-height ratio. The level of significance adopted was 5%. RESULTS: The body mass index was calculated for 518 children and the waist-to-height ratio for 473 children. Regarding body mass index, 60.6% of the participants had normal weight, 3.1% were underweight, and 36.3% were overweight. overweight (24.7%) and obesity (22.7%) were more prevalent in adolescents. The waist-to-height ratio was abnormal in 50.5% of the sample. There was an increasing association between body mass index and waist-to-height ratio with age, according to the Pearson correlation coefficients for the age groups <5 years (r=0.459; p<0.001), 5 to 10 years (r=0.687; p<0.001) and >10 years (r=0.805; p<0.001). CONCLUSION: There was a significant correlation between body mass index and waist-to-height ratio. This association was higher in adolescents. The waist-to-height ratio is easy to apply and may be useful as a predictor of cardiometabolic risk.

RESUMO Objetivo: Identificar os efeitos da suplementação de vitamina D durante a gestação no recém-nascido e lactente. Fontes de dados: Revisão integrativa da literatura baseada em ensaios clínicos publicados em revistas indexadas nas bases de dados PubMed e Web of Science. Foi realizada uma busca em cada base de dados, que partiu da associação (and) dos descritores de saúde vitamin D e pregnancy. Na busca pelas informações, foram estabelecidos critérios de seleção e não houve limitação de idioma nem de ano de publicação. Síntese de dados: A seleção final resultou em 44 ensaios clínicos - a maioria randomizada e duplo-cego -, que foram realizados em ambulatórios, hospitais de referência e universidades sobretudo da Europa. As amostras estudadas foram predominantemente de recém-nascidos. Nesses 44 ensaios, foram testadas 23 formas de suplementação de vitamina D na gestação, com diferentes doses, regimes e tempos de uso, e estudaram-se 14 desfechos diferentes nos recém-nascidos e lactentes. Dos 44 estudos, 35 demonstraram efeitos benéficos da suplementação de vitamina D durante a gestação nos recém-nascidos e lactentes de forma estatisticamente significante, quando comparados aos do grupo controle. Conclusões: A suplementação de vitamina D na gestação, por no mínimo três meses antes do parto, potencialmente influencia de forma positiva o metabolismo do cálcio, o crescimento físico e o desenvolvimento do sistema imunológico dos recém-nascidos e lactentes, entretanto não há conhecimento suficiente para a definição da dose ideal nem para garantir a inexistência de possíveis efeitos adversos em longo prazo.

ABSTRACT Objective: To identify the effects of vitamin D supplementation during pregnancy on newborns and infants. Data sources: The present study is an integrative review of literature based on clinical trials published in journals indexed in the PubMed and Web of Science databases. Two searches were carried out, starting with the association (and) of the health term “vitamin D” with “pregnancy”. In the search for information, selection criteria were established, and there was no language limitation and year of publication. Data synthesis: The final selection resulted in 44 clinical trials, most of which were randomized and double blind, which were carried out in outpatient clinics, referral hospitals and universities, mainly in Europe. The samples studied were predominantly of newborns. In these 44 trials, 23 types of different doses of vitamin D during pregnancy, with different doses, regimens and times of use, and 14 different outcomes were studied in newborns (NB) and infants. Of the 44 studies performed, 35 showed statistically significant beneficial effects of vitamin D supplementation during pregnancy on newborns and infants compared to control groups. Conclusions: Vitamin D supplementation during pregnancy for at least three months before delivery has the potential of positively influencing calcium metabolism, physical growth and immune system development in newborns and infants. However, there is insufficient knowledge to define the optimal dose and to guarantee the absence of possible long-term adverse effects.

RESUMO Objetivo Avaliar o conhecimento de pediatras emergencistas sobre transfusão de concentrados de hemácias e reações transfusionais. Métodos Aplicação de formulário para pediatras emergencistas de um hospital pediátrico. Resultados Menos de 20% dos participantes demonstraram conhecimento adequado sobre prescrição de concentrados de hemácias e reconhecimento de reações transfusionais. Não houve diferença estatística significativa quando avaliados o tempo de formação profissional e o fato de ter recebido aula de hemoterapia na graduação ou na residência médica. Conclusão Os pediatras têm conhecimento insuficiente sobre prescrição de concentrados de hemácias e reconhecimento de reações transfusionais.

ABSTRACT Objective To assess the level of knowledge of emergency pediatricians on red blood cell transfusions and their reactions. Methods Written survey with emergency pediatricians from a pediatric hospital. Results Less than 20% of pediatricians showed appropriate knowledge on prescribing red blood cells and recognition of transfusion reactions. There was no significant statistical regarding time since graduation and blood transfusion classes in undergraduate studies or during medical residency. Conclusion Pediatricians have insufficient knowledge about red blood cell transfusions and recognition of transfusion reactions.

Resumo Objetivo: Descrever a frequência de albuminúria em crianças e adolescentes com sobrepeso e obesidade e relacioná-la com a gravidade da obesidade, estadiamento puberal, morbidades associadas e com a taxa de filtração glomerular. Método: Estudo transversal incluindo 64 crianças e adolescentes com sobrepeso e obesidade entre 5 e 19 anos de idade. Dados coletados: peso, estatura, circunferência abdominal e pressão arterial sistêmica. Exames laboratoriais: perfil lipídico; glicemia e insulina, utilizados para cálculo do Homeostasis Model Assessment (HOMA-IR); proteína C reativa; transaminase glutâmico-pirúvica e albuminúria em amostra isolada de urina (ponto de corte < 30 mg/g). A creatinina foi utilizada para o cálculo da taxa de filtração glomerular estimada (eTFG, mL/min/1,73m2). Resultados: A média de idade foi 11,6±3,4 anos, 32 (50%) e 29 (45,3%) eram do gênero masculino e pré-púberes. Quarenta e seis (71,9%) apresentavam obesidade grave. A frequência e a mediana (min/max) dos valores observados para albuminúria (> 30 mg/g) foram 14 (21,9%) e 9,4 mg/g (0,70; -300,7 mg/g). A média da eTFG foi 122,9±24,7 mL/min/1,73 m2. Não houve correlação significante entre o índice de massa corporal, estadiamento puberal, insulina e HOMA-IR com os valores de albuminúria e nem com a eTFG. Crianças com albuminúria tiveram tendência a valores mais elevados de pressão arterial diastólica (75,0±12,2 vs 68,1±12,4, p = 0,071). Conclusão: A albuminúria, apesar de frequente em crianças e adolescentes com obesidade, não se associou com outras morbidades e nem com a taxa de filtração glomerular nesses pacientes.

Abstract Objective: To describe the frequency of albuminuria in overweight and obese children and adolescents and to relate it to the severity of obesity, pubertal staging, associated morbidities and the glomerular filtration rate. Method: Cross-sectional study including 64 overweight and obese children and adolescents between 5 and 19 years of age. Data collected: weight, height, waist circumference and systemic arterial pressure. Laboratory tests: lipid profile; glycemia and insulin, used to calculate the Homeostasis Model Assessment (HOMA-IR); C-reactive protein; glutamic-pyruvic transaminase and albuminuria in an isolated urine sample (cutoff <30 mg/g). Creatinine was used to calculate the estimated glomerular filtration rate (eGFR, mL/min/1.73 m2). Results: The mean age was 11.6 ± 3.4 years, 32 (50%) and 29 (45.3%) were male and prepubertal. Forty-six (71.9%) had severe obesity. The frequency and median (min/max) of the observed values for albuminuria (> 30 mg/g) were 14 (21.9%) and 9.4 mg/g (0.70, -300.7 mg/g). The mean eGFR was 122.9 ± 24.7 mL/min/1.73 m2. There was no significant correlation between body mass index, pubertal staging, insulin and HOMA-IR with albuminuria values and neither with eGFR. Children with albuminuria tended to have higher values of diastolic blood pressure (75.0 ± 12.2 vs. 68.1 ± 12.4, p = 0.071). Conclusion: Albuminuria, although frequent in children and adolescents with obesity, was not associated with other morbidities and the glomerular filtration rate in these patients.

Resumo O objetivo deste artigo é avaliar a condição nutricional de crianças com baixo peso ao nascer (BPN) e possíveis associações com variáveis independentes maternas, sexo e antecedentes neonatais Estudo transversal com 544 escolares com BPN (5 a 10 anos de idade) da região metropolitana de São Paulo. Variáveis: dados neonatais das declarações de nascidos vivos (peso ao nascer e idade gestacional), informações sobre a gestação e a condição nutricional atual das mães. A avaliação da condição nutricional dos escolares foi realizada por meio da obtenção dos dados de peso e estatura utilizados cálculo do escore z da estatura/idade (ZEI) e índice de massa corporal (ZIMC). Observou-se baixa estatura; sobrepeso e obesidade em 6,2%, 8,6% e 12,3% das crianças avaliadas, respectivamente. A presença de baixa estatura nos escolares associou-se com estatura materna < 150 cm (OR = 6,94; IC95% 2,34–20,6). O sobrepeso/obesidade nas crianças com BPN associou-se de forma independente com o sobrepeso/obesidade da mãe (OR = 2,40; IC95% 1,44–4,01) e o sexo masculino (OR = 1,77; IC95% 1,06–2,95). Um quinto dos escolares com BPN apresentaram excesso de peso, que se associou à condição nutricional materna atual e ao gênero masculino; a baixa estatura associou-se à estatura materna.

Abstract The scope of this study is to assess the nutritional status of low birth weight (LBW) children and the possible associations with independent maternal variables, gender and neonatal history. It involved a cross-sectional study with 544 LBW schoolchildren (five to ten years of age) in the metropolitan area of São Paulo. Variables: the neonatal data of liveborn infant declarations and the current weight and height of the mothers were collected. The weight and stature used to calculate the height/age z (HAZ) score and the body mass index (BMI) of children were evaluated. Among the LBW children 6.2% were of short stature, 12.3% overweight and 8.6% obese. There was an association between short stature in LBW schoolchildren and short maternal stature < 150 cm (OR = 6.94; 95 % CI 2.34–20.6). Excess weight/obesity in LBW children was independently associated with overweight/obesity of the mother (OR = 2.40; 95% CI 1.44–4.01), and the male gender (OR = 1.77; 95% CI 1.06–2.95). A fifth of schoolchildren with low birth weight were overweight, which was associated with current maternal nutritional status and the male gender and stunting was associated with maternal stature.

Resumo O objetivo deste artigo é avaliar a condição nutricional de crianças com baixo peso ao nascer (BPN) e possíveis associações com variáveis independentes maternas, sexo e antecedentes neonatais Estudo transversal com 544 escolares com BPN (5 a 10 anos de idade) da região metropolitana de São Paulo. Variáveis: dados neonatais das declarações de nascidos vivos (peso ao nascer e idade gestacional), informações sobre a gestação e a condição nutricional atual das mães. A avaliação da condição nutricional dos escolares foi realizada por meio da obtenção dos dados de peso e estatura utilizados cálculo do escore z da estatura/idade (ZEI) e índice de massa corporal (ZIMC). Observou-se baixa estatura; sobrepeso e obesidade em 6,2%, 8,6% e 12,3% das crianças avaliadas, respectivamente. A presença de baixa estatura nos escolares associou-se com estatura materna < 150 cm (OR = 6,94; IC95% 2,34–20,6). O sobrepeso/obesidade nas crianças com BPN associou-se de forma independente com o sobrepeso/obesidade da mãe (OR = 2,40; IC95% 1,44–4,01) e o sexo masculino (OR = 1,77; IC95% 1,06–2,95). Um quinto dos escolares com BPN apresentaram excesso de peso, que se associou à condição nutricional materna atual e ao gênero masculino; a baixa estatura associou-se à estatura materna.

Abstract The scope of this study is to assess the nutritional status of low birth weight (LBW) children and the possible associations with independent maternal variables, gender and neonatal history. It involved a cross-sectional study with 544 LBW schoolchildren (five to ten years of age) in the metropolitan area of São Paulo. Variables: the neonatal data of liveborn infant declarations and the current weight and height of the mothers were collected. The weight and stature used to calculate the height/age z (HAZ) score and the body mass index (BMI) of children were evaluated. Among the LBW children 6.2% were of short stature, 12.3% overweight and 8.6% obese. There was an association between short stature in LBW schoolchildren and short maternal stature < 150 cm (OR = 6.94; 95 % CI 2.34–20.6). Excess weight/obesity in LBW children was independently associated with overweight/obesity of the mother (OR = 2.40; 95% CI 1.44–4.01), and the male gender (OR = 1.77; 95% CI 1.06–2.95). A fifth of schoolchildren with low birth weight were overweight, which was associated with current maternal nutritional status and the male gender and stunting was associated with maternal stature.

RESUMO Objetivo: Verificar a adequação na prescrição de concentrado de plaquetas por pediatras em diferentes setores da pediatria de um hospital geral. Métodos: Estudo transversal avaliando 218/227 fichas de requisição de concentrado de plaquetas de crianças e adolescentes (zero a 13 anos), de janeiro de 2007 a abril de 2015 pelos pediatras do pronto-socorro, enfermaria e unidade de terapia intensiva. Excluíram-se as requisições em portadores de doenças hematológicas e aquelas sem o número de plaquetas. Resultados: Crianças com menos de 12 meses receberam 98 prescrições de concentrado de plaquetas (45,2%). A maioria das transfusões foi profiláticas (165; 79%). Em relação ao local da transfusão, 39 (18%) foram no pronto-socorro, 27 (12,4%) na enfermaria e 151 (69,6%) na unidade de terapia intensiva. O gatilho, o volume prescrito e o subtipo de concentrado de plaquetas foram adequados em 59 (28,2%), 116 (53,5%) e 209 (96,3%) das transfusões, respectivamente. Prescrições para pacientes com hemorragia apresentaram adequação em 42 (95,5%) transfusões, enquanto para crianças sem hemorragia houve adequação em 17 (10,3%) vezes. A inadequação mais comum em relação ao volume foi a prescrição acima da recomendação (95; 43,8%). Foram prescritos oito concentrados de plaquetas sem indicação de solicitação de subtipos. Conclusão: Os resultados obtidos nesse estudo mostraram que a prescrição de transfusão de concentrado de plaquetas foi mais adequada em crianças com hemorragia ativa em comparação com a transfusão profilática. Houve tendência à prescrição de volumes elevados e de subtipos de plaquetas, o que não se justifica segundo os protocolos atuais. O ensino da medicina transfusional deve ser mais valorizado na graduação e na residência médica.

ABSTRACT Objective: To verify the adequacy of platelet concentrate prescription by pediatricians in different pediatric sectors of a general hospital. Methods: A cross-sectional study evaluating 218/227 platelet concentrate records in children and adolescents (zero to 13 years old), from January 2007 to April 2015, by the pediatricians of the emergency room, sick bay and intensive care unit. The requisitions were excluded in patients with hematological diseases and those without the number of platelets. Results: Children under 12 months received 98 platelet concentrates (45.2%). Most of the transfusions were prophylactic (165; 79%). Regarding the transfusion site, 39 (18%) were in the emergency room, 27 (12.4%) in the sick bay and 151 (69.6%) in the intensive care unit. The trigger, prescribed volume and platelet concentrate subtype were adequate in 59 (28.2%), 116 (53.5%) and 209 (96.3%) of the transfusions, respectively. Patients with hemorrhage presented adequacy in 42 (95.5%), while children without bleeding presented in 17 (10.3%). The most common inadequacy related to volume was the prescription above recommendation (95; 43.8%). Eight platelet concentrates were prescribed with subtype requests without indication. Conclusion: The results obtained in this study showed that transfusion of platelet concentrate occurred more adequately in children with active bleeding compared to prophylactic transfusion. There was a tendency to prescribe high volumes and platelet subtypes not justified according to current protocols. The teaching of transfusion medicine should be more valued at undergraduate and medical residency.

Resumo O objetivo do estudo foi verificar a presença e a associação entre diagnósticos prováveis de transtornos mentais em gestantes da atenção básica e condições dos recém-nascidos. Estudo longitudinal com gestantes (18 a 39 anos), no segundo e terceiro trimestres da gravidez, assistidas na atenção básica da região Metropolitana de São Paulo (fevereiro a agosto/2014). Foram aplicados: questionário sociodemográfico, instrumento para Avaliação de Transtornos Mentais na Atenção Primária e entrevista sobre informações e percepção do comportamento do recém-nascido. Das 300 gestantes entrevistadas, 76 apresentaram diagnóstico provável de transtorno mental, sendo que 46 apresentavam sintomas de depressão/distimia e 58, ansiedade/pânico. Observou-se baixo peso ao nascer e prematuridade em 14 e 19 dos recém-nascidos, respectivamente, e não foi verificada associação com diagnósticos prováveis de transtorno mental; a presença destes associou-se com a percepção materna de alterações no comportamento do recém-nascido. Gestantes em acompanhamento de pré-natal de baixo risco apresentam frequência relevante de transtornos mentais, logo, a identificação dessas alterações na gestação pode colaborar para melhor compreensão da dinâmica do binômio mãe-filho e na qualidade na assistência à família.

Abstract This study aimed to determine the presence and association of possible mental disorders diagnoses in primary care pregnant women and newborns’ conditions. This is a longitudinal study with pregnant women (18-39 years), in the second and third trimesters of pregnancy, attended at primary care facilities in the metropolitan region of São Paulo (February to August/2014). The following tools were used: sociodemographic questionnaire; Mental Disorders in Primary Care Assessment tool; and an interview with information and mother´s perception of the behavior of newborns. Of the 300 pregnant women interviewed, 76 had possible diagnosis of mental disorders, 46 women had depression/dysthymia and 58 anxiety/panic symptoms. Low birth weight and prematurity was observed in 14 and 19 newborns, respectively, and there was no association with the probable diagnosis of mental disorders; the possible presence of mental disorders was associated with the mother’s perception of newborns behavior. Pregnant women attended at low risk prenatal care showed relevant frequency of mental disorders; thus, the identification of these changes during pregnancy can also contribute to a better understanding of the mother-and-child dynamics and in the quality of family care.

Resumo O objetivo do estudo foi verificar a presença e a associação entre diagnósticos prováveis de transtornos mentais em gestantes da atenção básica e condições dos recém-nascidos. Estudo longitudinal com gestantes (18 a 39 anos), no segundo e terceiro trimestres da gravidez, assistidas na atenção básica da região Metropolitana de São Paulo (fevereiro a agosto/2014). Foram aplicados: questionário sociodemográfico, instrumento para Avaliação de Transtornos Mentais na Atenção Primária e entrevista sobre informações e percepção do comportamento do recém-nascido. Das 300 gestantes entrevistadas, 76 apresentaram diagnóstico provável de transtorno mental, sendo que 46 apresentavam sintomas de depressão/distimia e 58, ansiedade/pânico. Observou-se baixo peso ao nascer e prematuridade em 14 e 19 dos recém-nascidos, respectivamente, e não foi verificada associação com diagnósticos prováveis de transtorno mental; a presença destes associou-se com a percepção materna de alterações no comportamento do recém-nascido. Gestantes em acompanhamento de pré-natal de baixo risco apresentam frequência relevante de transtornos mentais, logo, a identificação dessas alterações na gestação pode colaborar para melhor compreensão da dinâmica do binômio mãe-filho e na qualidade na assistência à família.

Abstract This study aimed to determine the presence and association of possible mental disorders diagnoses in primary care pregnant women and newborns’ conditions. This is a longitudinal study with pregnant women (18-39 years), in the second and third trimesters of pregnancy, attended at primary care facilities in the metropolitan region of São Paulo (February to August/2014). The following tools were used: sociodemographic questionnaire; Mental Disorders in Primary Care Assessment tool; and an interview with information and mother´s perception of the behavior of newborns. Of the 300 pregnant women interviewed, 76 had possible diagnosis of mental disorders, 46 women had depression/dysthymia and 58 anxiety/panic symptoms. Low birth weight and prematurity was observed in 14 and 19 newborns, respectively, and there was no association with the probable diagnosis of mental disorders; the possible presence of mental disorders was associated with the mother’s perception of newborns behavior. Pregnant women attended at low risk prenatal care showed relevant frequency of mental disorders; thus, the identification of these changes during pregnancy can also contribute to a better understanding of the mother-and-child dynamics and in the quality of family care.