ABSTRACT BACKGROUND: cardiorespiratory arrest (CRA) is a severe public health concern, and clinical simulation has proven to be a beneficial educational strategy for training on this topic. OBJECTIVE: To describe the implementation of a program for pediatric cardiac arrest care using rapid-cycle deliberate practice (RCDP), the quality of the technique employed, and participants' opinions on the methodology. DESIGN AND SETTING: This descriptive cross-sectional study of pre- and post-performance training in cardiopul monary resuscitation (CPR) techniques and reaction evaluation was conducted in a hospital in São Paulo. METHODS: Multidisciplinary groups performed pediatric resuscitation in a simulated scenario with RCDP mediated by a facilitator. The study sample included professionals working in patient care. During the simulation, the participants were evaluated for their compliance with the CRA care algorithm. Further, their execution of chest compressions was assessed pre- and post-intervention. RESULTS: In total, 302 professionals were trained in this study. The overall quality of CPR measured pre-intervention was inadequate, and only 26% had adequate technique proficiency, whereas it was 91% (P < 0.01) post-intervention. Of the participants, 95.7% responded to the final evaluation and provided positive comments on the method and their satisfaction with the novel simulation. Of these, 88% considered that repetition of the technique used was more effective than traditional simulation. CONCLUSIONS: The RCDP is effective for training multidisciplinary teams in pediatric CPR, with an emphasis on the quality of chest compressions. However, further studies are necessary to explore whether this trend translates to differential performances in practical settings. BACKGROUND (CRA concern topic OBJECTIVE rapidcycle rapid cycle RCDP, , (RCDP) employed methodology SETTING crosssectional cross sectional pre postperformance post performance (CPR Paulo METHODS facilitator algorithm Further postintervention. postintervention intervention. intervention post-intervention RESULTS total 30 preintervention inadequate 26 proficiency 91 P 0.01 001 0 01 957 95 7 95.7 these 88 CONCLUSIONS However settings (RCDP 3 2 9 0.0 00 95. 8 0.

RESUMO A incontinência urinária pós-prostatectomia tem importante impacto negativo na qualidade de vida do portador. O tratamento cirúrgico inclui slings masculinos e, entre os diversos modelos, os slings ajustáveis. O objetivo deste estudo foi avaliar a efetividade e a segurança do sling ajustável no tratamento da incontinência urinária pós-prostatectomia. Trata-se de revisão sistemática de literatura. Foram pesquisadas as seguintes bases de dados eletrônicas até janeiro de 2018: PubMed®, Embase, CENTRAL e LILACS. As palavras-chaves utilizadas nas estratégias de busca foram: “prostatectomy” [Mesh], “urinary incontinence” [Mesh] e “suburethral slings” [Mesh]. Foram incluídos ensaios clínicos randomizados e estudos observacionais controlados ou não com seguimento maior que 12 meses. Apenas um estudo randomizado com alto risco de viés foi localizado e concluiu a equivalência de efetividade de slings ajustáveis e não ajustáveis. Todos os outros estudos foram série de casos com pacientes de variados níveis de intensidade da incontinência e histórico de radioterapia pélvica e cirurgias prévias. A metanálise para 0 pad em 24 horas demonstrou efetividade de 53%. Para o desfecho 0 a 1 pad em 24 horas, a metanálise resultou em efetividade de 69%. Os fatores de risco para insucesso da cirurgia incluem radiação prévia, gravidade da incontinência urinária pós-prostatectomia e cirurgias anteriores. A metanálise da taxa de extrusão foi de 9,8%, e os efeitos adversos mais relatados foram dor e infecção local. Evidências de baixa qualidade indicam que os slings ajustáveis são efetivos para o tratamento da incontinência urinária pós-prostatectomia, com frequência de eventos adversos semelhantes à opção cirúrgica considerada padrão-ouro (o implante de esfíncter urinário artificial).

ABSTRACT Urinary incontinence after prostatectomy has a significant negative impact on the quality of life of the patient. The surgical treatment includes several models of male slings, such as adjustable slings. The objective of this study was to evaluate the effectiveness and safety of adjustable sling in the treatment of post-prostatectomy urinary incontinence. This is a systematic review of literature. The following electronic databases were searched until January 2018: PubMed®, Embase, CENTRAL and LILACS. The keywords used in the search strategies were: “prostatectomy” [Mesh], “urinary incontinence” [Mesh] and “suburethral slings” [Mesh]. Randomized clinical trials and observational studies, with or without Control Group, and follow-up of more than 12 months were included. Only one randomized study with high risk of bias was included and it concluded the effectiveness equivalence between adjustable and non-adjustable slings. All other studies were cases series with patients of varying levels of incontinence intensity and history of pelvic radiation therapy and previous surgeries. The meta-analysis for 0 pad in 24 hours demonstrated an effectiveness of 53%. For the 0 to 1 pad test in 24 hours, the meta-analysis resulted in an effectiveness of 69%. Risk factors for surgery failure include prior radiation, severity of post-prostatectomy urinary incontinence, and previous surgeries. The meta-analysis of the extrusion rate was 9.8% and the most commonly reported adverse effects were pain and local infection. Evidence of low quality indicates that adjustable slings are effective for treating post-prostatectomy urinary incontinence, with frequency of adverse events similar to the surgical option considered gold standard (the artificial urinary sphincter implant).

RESUMO CONTEXTO E OBJETIVO: O Brasil tem a quinta maior população de obesos do mundo. Revistas femininas publicam um grande número de planos dietéticos. Assim, o objetivo deste estudo foi avaliar a qualidade desses planos. TIPO DE ESTUDO: Estudo descritivo transversal. MÉTODOS: Incluímos as revistas femininas brasileiras de maior circulação publicadas entre janeiro e junho de 2014 que tivessem uma chamada de dieta para perda de peso em sua capa. De cada plano dietético, foi extraída a quantidade de macro e micronutrientes. Comparamos esses valores com as diretrizes nutricionais da Organização Mundial de Saúde para mulheres adultas. Verificamos também a quantidade total de energia, se o plano recomendava consumo de água e prática de atividade física. RESULTADOS: Um total de 136 exemplares potencialmente elegíveis foi identificado; 41 foram excluídos e 95 exemplares de 6 revistas diferentes foram incluídos no estudo. A análise mostrou que 83,1 % dos planos apresentaram valores de carboidratos e de fibras menores do que os recomendados. Por outro lado, o teor de proteína e de ácidos graxos saturados foi maior do que o recomendado em 97,8% e 95,7% dos planos, respectivamente, e 75,7% dos planos tinham teor inadequado de cálcio e 70,5% de ferro. Apenas 30 planos especificaram a quantidade total de energia diária e em 53,3% desses, a informação foi discordante com nossas estimativas; 20% dos planos não recomendavam consumo diário de água, 35,7% não recomendavam a prática de atividade física. CONCLUSÃO: A qualidade dos planos dietéticos para perda de peso veiculados em revistas femininas brasileiras é baixa.

ABSTRACT CONTEXT AND OBJECTIVE: Brazil has the fifth largest population of obese individuals in the world. Women’s magazines publish a large number of diet plans, and therefore the objective of this study was to assess the quality of these plans. DESIGN: Cross-sectional descriptive study. METHODS: We included the Brazilian women’s magazines of highest circulation published between January and June 2014 that advertised diets for weight loss on their covers. We extracted the quantities of macro and micronutrients from each of these diet plans and compared these quantities with the World Health Organization nutritional guidelines for adult women. We also checked the total energy quantities of these plans, and any recommendations about water intake and physical activity. RESULTS: We identified 136 potentially eligible magazine issues; 41 were excluded and 95 issues of 6 different magazines were included in the study. We found that 83.1 % of the plans had carbohydrate and fiber levels below the recommendations. On the other hand, the protein and saturated fatty acid levels were above the recommendations in 97.8% and 95.7% of the plans, respectively; 75.7% of the diets had inadequate calcium levels and 70.5% had low iron levels. Only 30 plans specified the total daily quantity of dietary energy and in 53.3% of these, the information was inconsistent with our estimates; 20% of the plans had no recommendations on daily water intake and 37.5% did not give recommendations regarding physical activity practices. CONCLUSION: The diet plans for weight loss featured in Brazilian women’s magazines are of low quality.

ABSTRACT BACKGROUND: The timing of surgery for recently symptomatic carotid artery stenosis remains controversial. Early cerebral revascularization may prevent a disabling or fatal ischemic recurrence, but it may also increase the risk of hemorrhagic transformation, or of dislodging a thrombus. This review examined the randomized controlled evidence that addressed whether the increased risk of recurrent events outweighed the increased benefit of an earlier intervention. OBJECTIVES: To assess the risks and benefits of performing very early cerebral revascularization (within two days) compared with delayed treatment (after two days) for people with recently symptomatic carotid artery stenosis. METHODS: Search methods: We searched the Cochrane Stroke Group Trials Register in January 2016, the Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library 2016, issue 1), MEDLINE (1948 to 26 January 2016), EMBASE (1974 to 26 January 2016), LILACS (1982 to 26 January 2016), and trial registers (from inception to 26 January 2016). We also handsearched conference proceedings and journals, and searched reference lists. There were no language restrictions. We contacted colleagues and pharmaceutical companies to identify further studies and unpublished trials Selection criteria: All completed, truly randomized trials (RCT) that compared very early cerebral revascularization (within two days) with delayed treatment (after two days) for people with recently symptomatic carotid artery stenosis. Data collection and analysis: We independently selected trials for inclusion according to the above criteria, assessed risk of bias for each trial, and performed data extraction. We utilized an intention-to-treat analysis strategy. MAIN RESULTS: We identified one RCT that involved 40 participants, and addressed the timing of surgery for people with recently symptomatic carotid artery stenosis. It compared very early surgery with surgery performed after 14 days of the last symptomatic event. The overall quality of the evidence was very low, due to the small number of participants from only one trial, and missing outcome data. We found no statistically significant difference between the effects of very early or delayed surgery in reducing the combined risk of stroke and death within 30 days of surgery (risk ratio (RR) 3.32; confidence interval (CI) 0.38 to 29.23; very low-quality evidence), or the combined risk of perioperative death and stroke (RR 0.47; CI 0.14 to 1.58; very low-quality evidence). To date, no results are available to confirm the optimal timing for surgery. AUTHORS CONCLUSIONS: There is currently no high-quality evidence available to support either very early or delayed cerebral revascularization after a recent ischemic stroke. Hence, further randomized trials to identify which patients should undergo very urgent revascularization are needed. Future studies should stratify participants by age group, sex, grade of ischemia, and degree of stenosis. Currently, there is one ongoing RCT that is examining the timing of cerebral revascularization.

BACKGROUND:Early recovery is an important factor for people undergoing facial plastic. However, the normal inflammatory processes that are a consequence of surgery commonly cause oedema (swelling) and ecchymosis (bruising), which are undesirable complications. Severe oedema and ecchymosis delay full recovery, and may make patients dissatisfied with procedures. Perioperative corticosteroids have been used in facial plastic surgery with the aim of preventing oedema and ecchymosis.OBJECTIVES:To determine the effects, including safety, of perioperative administration of corticosteroids for preventing complications following facial plastic surgery in adults.METHODS:Search strategy: In January 2014, we searched the following electronic databases: the Cochrane Wounds Group Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid Embase; EBSCO CINAHL; and Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS). There were no restrictions on the basis of date or language of publication. Selection criteria: We included RCTs that compared the administration of perioperative systemic corticosteroids with another intervention, no intervention or placebo in facial plastic surgery. ata collection and analysis: Two review authors independently screened the trials for inclusion in the review, appraised trial quality and extracted data.MAIN RESULTS: We included 10 trials, with a total of 422 participants, that addressed two of the outcomes of interest to this review: swelling (oedema) and bruising (ecchymosis). Nine studies on rhinoplasty used a variety of different types, and doses, of corticosteroids. Overall, the results of the included studies showed that there is some evidence that perioperative administration of corticosteroids decreases formation of oedema over the first two postoperative days. Meta-analysis was only possible for two studies, with a total of 60 participants, and showed that a single perioperative dose of 10 mg dexamethasone decreased oedema formation in the first two days after surgery (SMD = -1.16, 95% CI: -1.71 to -0.61, low quality evidence). The evidence for ecchymosis was less consistent across the studies, with some contradictory results, but overall there was some evidence that perioperatively administered corticosteroids decreased ecchymosis formation over the first two days after surgery (SMD = -1.06, 95% CI:-1.47 to -0.65, two studies, 60 participants, low quality evidence). The difference was not maintained after this initial period. One study, with 40 participants, showed that high doses of methylprednisolone (over 250 mg) decreased both ecchymosis and oedema between the first and seventh postoperative days. The only study that assessed facelift surgery identified no positive effect on oedema with preoperative administration of corticosteroids. Five trials did not report on harmful (adverse) effects; four trials reported that there were no adverse effects; and one trial reported adverse effects in two participants treated with corticosteroids as well as in four participants treated with placebo. None of the studies reported recovery time, patient satisfaction or quality of life. The studies included were all at an unclear risk of selection bias and at low risk of bias for other domains.AUTHORS' CONCLUSIONS:There is limited evidence for rhinoplasty that a single perioperative dose of corticosteroids decreases oedema and ecchymosis formation over the first two postoperative days, but the difference is not maintained after this period. There is also limited evidence that high doses of corticosteroids decrease both ecchymosis and oedema between the first and seventh postoperative days. The clinical significance of this decrease is unknown and there is little evidence available regarding the safety of this intervention. More studies are needed because at present the available evidence does not support the use of corticosteroids for prevention of complications following facial plastic surgery.

CONTEXTO E OBJETIVO: Alterações do desenvolvimento em crianças frequentemente têm sido tardiamente identificadas por profissionais de saúde que atuam na atenção básica. O objetivo deste estudo foi avaliar o impacto de um programa de educação permanente sobre desenvolvimento infantil nos conhecimentos e práticas desses profissionais.TIPO DE ESTUDO E LOCAL: Estudo de coorte única prospectivo (antes-e-depois), realizado no município de Belém, Pará, Brasil.MÉTODOS: 221 (82,2%) profissionais da rede básica de saúde que participaram do programa de educação permanente sobre desenvolvimento infantil foram avaliados antes e após a implantação do programa, através de testes sobre seus conhecimentos em desenvolvimento infantil com 19 questões para médicos e 14 para enfermeiros, e questionários sobre sua prática profissional.RESULTADOS: Um a três anos após o programa, a média de perguntas certas dos testes aumentou de 11,5 para 14,3 entre os médicos do Programa da Família Saudável (PFS); 13,0 para 14,3 entre os médicos de Unidades Municipais de Saúde (UMS); 8,3 para 10,0 entre os enfermeiros de PFS e 7,8 para 9,4 entre os enfermeiros de UMS. Nas entrevistas com mães atendidas por esses profissionais, verificou-se que, antes do programa, apenas 21,7% informaram que foram indagadas sobre o desenvolvimento dos seus filhos, 24,7% relataram que o profissional perguntou ou observou o desenvolvimento da sua criança e 11,1% receberam orientação sobre como estimulá-las; após o programa, esses percentuais aumentaram para 34,5%, 54,2% e 30,3%, respectivamente.CONCLUSÃO: Profissionais que participaram do programa apresentaram melhor desempenho quanto aos conhecimentos e práticas sobre desenvolvimento infantil.

CONTEXT AND OBJECTIVE: Children's developmental disorders are often identified late by healthcare professionals working in primary care. The aim of this study was to assess the impact of a continuing education program on child development, on the knowledge and practices of these professionals.DESIGN AND SETTING: Prospective single-cohort study (before-and-after study), conducted in the city of Belém, Pará , Brazil.METHODS: Two hundred and twenty-one professionals working in primary healthcare (82.2%) participated in a continuing education program on child development and were assessed before and after implementation of the program through tests on their knowledge of child development, consisting of 19 questions for physicians and 14 for nurses, and questionnaires on their professional practices.RESULTS: One to three years after the program, the mean number of correct answers in the tests had increased from 11.5 to 14.3 among physicians in the Healthy Family Program (Programa Família Saudável, PFS); 13.0 to 14.3 among physicians in Municipal Health Units (Unidades Municipais de Saúde, UMS); 8.3 to 10.0 among PFS nurses; and 7.8 to 9.4 among UMS nurses. In interviews with mothers attended by these professionals before the program, only 21.7% reported that they were asked about their children's development, 24.7% reported that the professional asked about or observed their children's development and 11.1% received advice on how to stimulate them. After the program, these percentages increased to 34.5%, 54.2% and 30.3%, respectively.CONCLUSIONS: Professionals who participated in the program showed improved performance regarding child development knowledge and practices.

OBJETIVO: Avançar no entendimento sobre o perfil do usuário e as tendências de busca por informações de saúde na internet. MÉTODOS: As análises foram feitas a partir de 1.828 indivíduos que responderam a um questionário eletrônico disponibilizado em um portal de saúde de grande acesso. Paralelamente, por meio do método de "survey de elites", 20 especialistas foram entrevistados para avaliar estratégias de controle de qualidade das informações de saúde veiculadas na rede. RESULTADOS: Verificou-se o predomínio de usuários do gênero feminino que buscam informações para própria saúde(= 90%), que consideram a internet uma de suas principais fontes de informação em saúde (86%) e passam de 5 a 35 horas na web por semana (62%). Atribui-se alta confiança às informações vindas de especialistas (76%) e baixa confiança na televisão, rádio ou blogs (14%). CONCLUSãO: Conclui-se que a internet tem-se mostrado uma fonte de informação em saúde de grande relevância para população e que a certificação de sites é uma estratégia a ser considerada, na perspectiva de melhoria da qualidade das informações e promoção da saúde pública.

OBJECTIVE: To progress in the understanding of the user profile and of search trends for health information on the internet. METHODS: Analyses were performed based on 1,828 individuals who completed an electronic questionnaire available on a very popular health website. At the same time, through the "elite survey" method, 20 specialists were interviewed, aiming at assessing quality control strategies regarding health information disseminated online. RESULTS: A predominance of female users who research information for themselves (= 90%), who consider the internet one of their main sources of health information (86%), and who spend from 5 to 35 hours online every week (62%) was verified. High reliability is assigned to information from specialists (76%), and low reliability to television, radio, or blogs (14%). CONCLUSION: It can be concluded that the internet is proving to be a major source of health information for the population, and that website certification is a strategy to be contemplated to improve the quality of information and to promote public health.

INTRODUÇÃO: No Distrito Federal, Brasil, houve importante redução das taxas de mortalidade e de letalidade por AIDS logo após a introdução da terapia antirretroviral altamente ativa, mas nos últimos anos o declínio dessas taxas não foi significativo. Não adesão ao tratamento e diagnóstico tardio parecem ser os principais fatores que elevam o risco de óbito por AIDS. Fatores comportamentais, socioeconômicos e biológicos também podem estar associados ao maior risco de óbito por AIDS. O objetivo deste estudo foi identificar quais desses fatores apresentaram associação com os óbitos por AIDS no Distrito Federal. MÉTODOS: Estudo do tipo caso-controle, utilizando os dados registrados no Sistema de Informação de Agravos de Notificação, em que foram considerados casos os óbitos por AIDS ocorridos em 2007, residentes no Distrito Federal e maiores de 12 anos de idade e, controles os doentes de AIDS que não foram a óbito até 31 de dezembro de 2007, também residentes no Distrito Federal e com mais de 12 anos de idade. Prepararam-se, para cada grupo, tabelas de frequência e proporção para as variáveis. Foi verificada a associação estatística de cada fator isoladamente com a ocorrência dos óbitos e também por meio de um modelo de análise multivariável por regressão logística. RESULTADOS: Os fatores que apresentaram associação com maior risco de óbito foram: usar drogas injetáveis, ter idade maior ou igual a 50 anos e residir em local cujos moradores possuem baixa renda per capita. CONCLUSÕES: Identificaram-se fatores associados ao óbito por AIDS que poderão nortear o planejamento em saúde.

INTRODUCTION: In the jurisdiction of Brasília, Brazil, significant reductions in mortality rates and lethality resulting from acquired immunodeficiency syndrome (AIDS) were observed shortly after the introduction of highly active antiretroviral therapy. In recent years, however, the decline of these rates has not been as significant. Non-adherence to treatment and delayed diagnosis appear to be the main factors that increase the risk of death from AIDS. Behavioral, socioeconomic, and biological factors could also be associated with increased risk of death due to AIDS. This study aimed to identify which of these factors were associated with deaths from AIDS in Brasília. METHODS: A case-control study was undertaken using the data recorded in the Information System of Notifiable Diseases. Cases consisted of AIDS deaths occurring in 2007, residing in Brasília, and over 12 years of age. Controls consisted of AIDS patients who did not die until December 31 2007, also residing in Brasília, and over 12 years of age. For each group, frequency and proportion tables for the variables were prepared. The statistical association of each factor in isolation with the occurrence of the deaths was verified through a model of multivariate analysis using logistic regression. RESULTS: The factors that were associated with an increased risk of death were intravenous drug use, age 50 years or more, and residing in a region whose residents have low per capita income. CONCLUSIONS: We identified factors associated with death due to AIDS that can guide health planning.

CONTEXTO E OBJETIVO: A hipertensão arterial (HA) é um problema de saúde pública por sua elevada prevalência e complicações em longo prazo. No Brasil as doenças cardiovasculares foram responsáveis, em 2005, por 28% do total de óbitos em geral. Esforços vêm sendo implementados na atenção básica para o seu adequado controle. O Programa de Saúde da Família tem o objetivo de promover qualidade de vida assim como intervir nos fatores que a coloquem em risco. O objetivo deste estudo foi verificar a taxa de controle da HA em pacientes acompanhados nas Unidades de Saúde da Família (USF) comparados com pacientes acompanhados nas Unidades Básicas de Saúde (UBS). TIPO DE ESTUDO E LOCAL: Estudo transversal analítico, no município de Petrópolis, Rio de Janeiro, entre janeiro e dezembro de 2005. MÉTODOS: Foram incluídos 500 pacientes com diagnóstico de HA, sendo 250 em acompanhamento em duas USF e 250 em duas UBS. O diagnóstico de HA foi baseado no IV Consenso Brasileiro de Hipertensão e os pacientes precisavam estar em acompanhamento nas Unidades por no mínimo 12 meses. Foram considerados controlados os pacientes que apresentaram níveis pressóricos inferiores a 140/90 mmHg na última consulta. RESULTADOS: A taxa de controle da pressão arterial foi de 29,2% (n = 73) nas USF e de 39,23% (n = 98) nas UBS (odds ratio = 0,64; intervalo de confiança = 0,44-0,93), P = 0,024). CONCLUSÃO: Foi observado melhor controle da pressão arterial nos pacientes acompanhados nas UBS quando comparados aos pacientes acompanhados nas USF.

CONTEXT AND OBJECTIVE: Hypertension is a public health problem due to its high prevalence and long-term cardiovascular complications. In Brazil in 2005, cardiovascular diseases were responsible for 28% of all deaths. Efforts are being made within primary care to achieve adequate hypertension control. The Family Health Program (FHP) has the aims of promoting quality of life and intervening in factors that put this at risk. The objective of this study was to evaluate the rate of blood pressure control among patients followed up at FHP units compared with those at primary healthcare units (PHUs). DESIGN AND SETTING: Analytical cross-sectional study in the municipality of Petrópolis, Rio de Janeiro, from January to December 2005. METHODS: Five hundred patients with a diagnosis of hypertension were included: 250 were being followed up at two FHP units and 250 at two PHUs. The diagnosis of hypertension was based on the Fourth Brazilian Hypertension Consensus, and the patients needed to have been under follow-up at the units for at least 12 months. Patients' blood pressure was considered to be under control if it was less than 140/90 mmHg at the last consultation. RESULTS: Blood pressure was under control in 29.2% (n = 73) at FHP units and 39.23% (n = 98) at PHUs (odds ratio = 0.64; confidence interval = 0.44-0.93; P = 0.024). CONCLUSION: Blood pressure control was better among patients followed up at PHUs than among those followed up at FHP units.

OBJECTIVE:To compare the frequency of risk factors in children attending basic health units (UBS) in two periods (1988-1989 and 2005-2006) and to analyze the association of these factors with malnutrition, hospitalization and death. METHODS: A retrospective study using a quantitative approach with a random cohort sample (n = 414) of children under one year of age, enrolled in two UBS of Embu (SP) in 2005-2006. Independent variables: high risk and presence of risk factors. Outcomes: unfavorable weight gain, malnutrition, hospitalization and death. Statistics: Chi-square and Odds Ratio. RESULTS: In 2005-2006, we found: a higher frequency of neonatal complications and adolescent mothers; lower rates of malnutrition or death of a sibling <5 years; unfavorable weight gain (1.6%); nutritional deficit (2.9%); BMI > 2z (17.9%); hospitalizations (21.8%); no deaths. Low birth weight was associated with hospitalization (OR = 4.04, 95% : 1,35-12, 04). CONCLUSIONS: Low birth weight remains an important risk factor and the proportion of overweight / obesity indicates a need for redirection of child health activities.

OBJETIVO: comparar las frecuencias de los factores de riesgo en niños matriculados en unidades básicas de salud (UBS) en dos períodos (1988-1989 y 2005-2006) y analizar la asociación de esos factores con desnutrición, internamiento y óbito. MÉTODOS: Estudio de abordaje cuantitativo, tipo cohorte retrospectivo con muestra probabilística (n=414) de niños menores de un año matriculados en dos UBSs de Embu (SP), en 2005-2006. Las variables independientes: alto riesgo y presencia de factores de riesgo. Desenlace: evolución ponderal desfavorable, déficit nutricional, internamiento, óbito. Estadística: Chi-Cuadrado y Odds Ratio. RESULTADOS: en 2005-2006, se verificó: mayor frecuencia de variaciones neonatales y madres adolescentes; menor frecuencia de desnutrición u óbito de hermano < 5 años; evolución ponderal desfavorable (1,6%); déficit nutricional (2,9%); IMC > 2z (17,9%); internamientos (21,8%); ningún óbito. Bajo peso al nacer se asoció al internamiento (OR=4,04;IC95%:1,35-12,04). CONCLUSIONES: Bajo peso al nacer permanece, como un importante factor de riesgo y la proporción de sobrepeso/obesidad indica la necesidad de redireccionamiento de las acciones de salud del niño.

OBJETIVO: comparar as frequências dos fatores de risco em crianças matriculadas em unidades básicas de saúde (UBS) em dois períodos (1988-1989 e 2005-2006) e analisar a associação desses fatores com desnutrição, internação e óbito. MÉTODOS:Estudo de abordagem quantitativa, tipo coorte retrospectiva com amostra probabilística (n=414) de crianças menores de um ano matriculadas em duas UBSs do Embu (SP), em 2005-2006. Variáveis independentes: alto risco e presença de fatores de risco. Desfechos: evolução ponderal desfavorável, déficit nutricional, internação, óbito. Estatística: Qui-Quadrado e Odds Ratio. RESULTADOS: em 2005-2006, verificou-se: maior frequência de intercorrências neonatais e mães adolescentes; menor freqüência de desnutrição ou óbito de irmão < 5 anos; evolução ponderal desfavorável (1,6%); deficit nutricional (2,9%); IMC > 2z (17,9%); internações (21,8%); nenhum óbito. Baixo peso ao nascer associou-se à internação (OR=4,04;IC95%:1,35-12,04). CONCLUSÕES: Baixo peso ao nascer permanece, como importante fator de risco e a proporção de sobrepeso/obesidade indica necessidade de redirecionamento das ações de saúde da criança.

OBJETIVO: comparar as frequências dos fatores de risco em crianças matriculadas em unidades básicas de saúde (UBS) em dois períodos (1988-1989 e 2005-2006) e analisar a associação desses fatores com desnutrição, internação e óbito. MÉTODOS:Estudo de abordagem quantitativa, tipo coorte retrospectiva com amostra probabilística (n=414) de crianças menores de um ano matriculadas em duas UBSs do Embu (SP), em 2005-2006. Variáveis independentes: alto risco e presença de fatores de risco. Desfechos: evolução ponderal desfavorável, déficit nutricional, internação, óbito. Estatística: Qui-Quadrado e Odds Ratio. RESULTADOS: em 2005-2006, verificou-se: maior frequência de intercorrências neonatais e mães adolescentes; menor freqüência de desnutrição ou óbito de irmão < 5 anos; evolução ponderal desfavorável (1,6%); deficit nutricional (2,9%); IMC > 2z (17,9%); internações (21,8%); nenhum óbito. Baixo peso ao nascer associou-se à internação (OR=4,04;IC95%:1,35-12,04). CONCLUSÕES: Baixo peso ao nascer permanece, como importante fator de risco e a proporção de sobrepeso/obesidade indica necessidade de redirecionamento das ações de saúde da criança.

OBJECTIVE:To compare the frequency of risk factors in children attending basic health units (UBS) in two periods (1988-1989 and 2005-2006) and to analyze the association of these factors with malnutrition, hospitalization and death. METHODS: A retrospective study using a quantitative approach with a random cohort sample (n = 414) of children under one year of age, enrolled in two UBS of Embu (SP) in 2005-2006. Independent variables: high risk and presence of risk factors. Outcomes: unfavorable weight gain, malnutrition, hospitalization and death. Statistics: Chi-square and Odds Ratio. RESULTS: In 2005-2006, we found: a higher frequency of neonatal complications and adolescent mothers; lower rates of malnutrition or death of a sibling <5 years; unfavorable weight gain (1.6%); nutritional deficit (2.9%); BMI > 2z (17.9%); hospitalizations (21.8%); no deaths. Low birth weight was associated with hospitalization (OR = 4.04, 95% : 1,35-12, 04). CONCLUSIONS: Low birth weight remains an important risk factor and the proportion of overweight / obesity indicates a need for redirection of child health activities.

OBJETIVO: comparar las frecuencias de los factores de riesgo en niños matriculados en unidades básicas de salud (UBS) en dos períodos (1988-1989 y 2005-2006) y analizar la asociación de esos factores con desnutrición, internamiento y óbito. MÉTODOS: Estudio de abordaje cuantitativo, tipo cohorte retrospectivo con muestra probabilística (n=414) de niños menores de un año matriculados en dos UBSs de Embu (SP), en 2005-2006. Las variables independientes: alto riesgo y presencia de factores de riesgo. Desenlace: evolución ponderal desfavorable, déficit nutricional, internamiento, óbito. Estadística: Chi-Cuadrado y Odds Ratio. RESULTADOS: en 2005-2006, se verificó: mayor frecuencia de variaciones neonatales y madres adolescentes; menor frecuencia de desnutrición u óbito de hermano < 5 años; evolución ponderal desfavorable (1,6%); déficit nutricional (2,9%); IMC > 2z (17,9%); internamientos (21,8%); ningún óbito. Bajo peso al nacer se asoció al internamiento (OR=4,04;IC95%:1,35-12,04). CONCLUSIONES: Bajo peso al nacer permanece, como un importante factor de riesgo y la proporción de sobrepeso/obesidad indica la necesidad de redireccionamiento de las acciones de salud del niño.

O objetivo foi determinar a prevalência de sobrepeso e obesidade em escolares e a associação com baixo peso ao nascer e antecedentes familiares para doença cardiovascular. Estudo transversal que utilizou amostra probabilística de 929 escolares com idades de 6 a 10 anos. Variáveis: Índice de Massa Corpórea (IMC), peso ao nascer e antecedentes familiares para doença cardiovascular. Análise estatística: teste qui-quadrado (Pearson) e odds ratio como medidas de associação. 14,4% e 13,3% dos escolares (54,6% do sexo feminino) apresentaram sobrepeso e obesidade, respectivamente. Baixo peso ao nascer foi referido em 9,4% das crianças e a presença de antecedentes familiares para doença cardiovascular em 35,2%. Sobrepeso ou obesidade (IMC maior ou igual a P85) associaram-se à presença de antecedentes familiares para doença cardiovascular (OR=1,66; IC95% 1,23-2,23) e ao sexo masculino (OR=1,37; IC 95% 1,02-1,83); não houve associação com o peso ao nascer. Os resultados indicam a necessidade de ações preventivas direcionadas às crianças com antecedentes familiares para doença cardiovascular.

The aim was to determine the prevalence of overweight and obesity in schoolchildren and the association with birth weight and family antecedents of cardiovascular disease. This cross-sectional study used a probabilistic sample of 929 schoolchildren aged 6 to 10 years. The variables were: body mass index (BMI), birth weight and family antecedents of cardiovascular disease. The statistical analysis consisted of the chi-square test (Pearson) and odds ratio, as association measurements. Of the schoolchildren (54.6% of which were female), 14.4% and 13.3% were overweight and obese, respectively. Low birth weight was reported among 9.4% and family antecedents of cardiovascular disease among 35.2%. Overweight or obesity (BMI e" P85) was associated with the presence of family antecedents of cardiovascular disease (OR = 1.66; 95% CI 1.23-2.23) and male sex (OR = 1.37; 95%CI 1.02-1.83); there was no association with birth weight. The results indicate the need for preventive actions for children with family antecedents of cardiovascular disease.

O objetivo foi determinar a prevalência de sobrepeso e obesidade em escolares e a associação com baixo peso ao nascer e antecedentes familiares para doença cardiovascular. Estudo transversal que utilizou amostra probabilística de 929 escolares com idades de 6 a 10 anos. Variáveis: Índice de Massa Corpórea (IMC), peso ao nascer e antecedentes familiares para doença cardiovascular. Análise estatística: teste qui-quadrado (Pearson) e odds ratio como medidas de associação. 14,4% e 13,3% dos escolares (54,6% do sexo feminino) apresentaram sobrepeso e obesidade, respectivamente. Baixo peso ao nascer foi referido em 9,4% das crianças e a presença de antecedentes familiares para doença cardiovascular em 35,2%. Sobrepeso ou obesidade (IMC maior ou igual a P85) associaram-se à presença de antecedentes familiares para doença cardiovascular (OR=1,66; IC95% 1,23-2,23) e ao sexo masculino (OR=1,37; IC 95% 1,02-1,83); não houve associação com o peso ao nascer. Os resultados indicam a necessidade de ações preventivas direcionadas às crianças com antecedentes familiares para doença cardiovascular.

The aim was to determine the prevalence of overweight and obesity in schoolchildren and the association with birth weight and family antecedents of cardiovascular disease. This cross-sectional study used a probabilistic sample of 929 schoolchildren aged 6 to 10 years. The variables were: body mass index (BMI), birth weight and family antecedents of cardiovascular disease. The statistical analysis consisted of the chi-square test (Pearson) and odds ratio, as association measurements. Of the schoolchildren (54.6% of which were female), 14.4% and 13.3% were overweight and obese, respectively. Low birth weight was reported among 9.4% and family antecedents of cardiovascular disease among 35.2%. Overweight or obesity (BMI e" P85) was associated with the presence of family antecedents of cardiovascular disease (OR = 1.66; 95% CI 1.23-2.23) and male sex (OR = 1.37; 95%CI 1.02-1.83); there was no association with birth weight. The results indicate the need for preventive actions for children with family antecedents of cardiovascular disease.

CONTEXTO E OBJETIVO: Doppler transcraniano (DTC) detecta risco de acidente vascular cerebral (AVC) em crianças com anemia falciforme (AF). O objetivo foi avaliar os resultados ao DTC nos diferentes genótipos da doença falciforme (DF) e correlacionar a velocidade média-máxima (VMMáx) às características hematológicas. TIPO DE ESTUDO E LOCAL: Estudo transversal analítico realizado no setor de Hematopediatria da Universidade Federal de São Paulo. MÉTODOS: 85 pacientes com DF, 2-18 anos, ambos os sexos, foram avaliados e divididos em: grupo I (62 com AF ou Sß0 talassemia); e grupo II (23 com hemoglobinopatia SC ou Sß+ talassemia). DTC foi realizado e revisado por um único investigador usando um aparelho de ultrassonografia Doppler com transdutor de 2MHz, conforme critérios do protocolo STOP (Stroke Prevention Trial in Sickle Cell Anemia). As variáveis hematológicas avaliadas foram: hematócrito, hemoglobina, reticulócitos, leucócitos, plaquetas, hemoglobina fetal. Análise univariada e coeficiente de Pearson calculados para parâmetros hematológicos e VMMáx, P < 0,05. RESULTADOS: As média das VMMáx foram de 137 ± 28 cm/s e 103 ± 19 cm/s nos grupos I e II, respectivamente. Houve correlação negativa da VMMáx com hematócrito e hemoglobina no grupo I. Houve um (1,6%) resultado anormal e 5 (8,1%) condicionais no grupo I; no grupo II, todos estavam normais. Artérias cerebrais médias foram as únicas acometidas. CONCLUSÃO: Houve baixa prevalência de resultados anormais ao DTC em pacientes com DF. A VMMáx foi significativamente diferente entre os genótipos da DF e apresentou correlação com variáveis hematológicas.

CONTEXT AND OBJECTIVE: Transcranial Doppler (TCD) detects stroke risk among children with sickle cell anemia (SCA). Our aim was to evaluate TCD findings in patients with different sickle cell disease (SCD) genotypes and correlate the time-averaged maximum mean (TAMM) velocity with hematological characteristics. DESIGN AND SETTING: Cross-sectional analytical study in the Pediatric Hematology sector, Universidade Federal de São Paulo. METHODS: 85 SCD patients of both sexes, aged 2-18 years, were evaluated, divided into: group I (62 patients with SCA/Sß0 thalassemia); and group II (23 patients with SC hemoglobinopathy/Sß+ thalassemia). TCD was performed and reviewed by a single investigator using Doppler ultrasonography with a 2 MHz transducer, in accordance with the Stroke Prevention Trial in Sickle Cell Anemia (STOP) protocol. The hematological parameters evaluated were: hematocrit, hemoglobin, reticulocytes, leukocytes, platelets and fetal hemoglobin. Univariate analysis was performed and Pearson's coefficient was calculated for hematological parameters and TAMM velocities (P < 0.05). RESULTS: TAMM velocities were 137 ± 28 and 103 ± 19 cm/s in groups I and II, respectively, and correlated negatively with hematocrit and hemoglobin in group I. There was one abnormal result (1.6%) and five conditional results (8.1%) in group I. All results were normal in group II. Middle cerebral arteries were the only vessels affected. CONCLUSION: There was a low prevalence of abnormal Doppler results in patients with sickle-cell disease. Time-average maximum mean velocity was significantly different between the genotypes and correlated with hematological characteristics.

CONTEXTO E OBJETIVO: A infecção por Helicobacter pylori é adquirida principalmente na infância e é associada a morbidade significativa em adultos. O objetivo foi avaliar a soroprevalência de infecção por H. pylori bem como fatores de risco em crianças de baixo nível socioeconômico atendidas em um hospital público em São Paulo, Brasil. TIPO DE ESTUDO E LOCAL: Estudo transversal, realizado entre pacientes atendidos em ambulatório. MÉTODOS: Foram avaliadas 326 crianças (150 meninos e 176 meninas, idade: média 6,82 ± 4,07 anos) em estudo transversal. Foram excluídas aquelas com doenças crônicas, tratamento prévio de H. pylori e cujo responsável não consentiu participar do estudo. Os responsáveis responderam questionário demográfico e foi coletada uma amostra de sangue. O teste sorológico empregado foi o CobasCore II, exame de segunda geração, sendo considerados positivos títulos > 5 U/ml. RESULTADOS: Infecção por H. pylori foi diagnosticada em 116 (35,6%). A idade dos pacientes infectados foi maior que a dos demais (7,77 ± 4,08 anos versus 5,59 ± 3,86 anos; p < 0,0001). A prevalência aumenta de 20,8% entre dois e quatro anos de idade para 58,3% entre maiores de 12 anos. Não houve relação significativa entre soropositividade e sexo, raça, aleitamento materno, número de pessoas ou de cômodos na casa, compartilhamento de camas, domicílio em favela, escolaridade materna, renda familiar ou estado nutricional. Na análise multivariada, a única variável significativamente associada a soropositividade foi idade. CONCLUSÃO: A infecção possui prevalência intermediária na população estudada, e a idade foi associada a maior prevalência.

CONTEXT AND OBJECTIVE: Helicobacter pylori infection is mainly acquired during childhood, and is associated with significant morbidity in adults. The aim here was to evaluate the seroprevalence and risk factors of H. pylori infection among children of low socioeconomic level attended at a public hospital in São Paulo, Brazil. DESIGN AND SETTING: Cross-sectional study, among patients attended at an outpatient clinic. METHODS: 326 children were evaluated (150 boys and 176 girls; mean age 6.82 ± 4.07 years) in a cross-sectional study. Patients with chronic diseases or previous H. pylori treatment, and those whose participation was not permitted by the adult responsible for the child, were excluded. The adults answered a demographic questionnaire and blood samples were collected. The serological test used was Cobas Core II, a second-generation test. Titers > 5 U/ml were considered positive. RESULTS: H. pylori infection was diagnosed in 116 children (35.6%). Infected children were older than uninfected children (7.77 ± 4.08 years versus 5.59 ± 3.86 years; p < 0.0001). The seroprevalence increased from 20.8% among children aged two to four years, to 58.3% among those older than 12 years. There were no significant relationships between seropositivity and gender, color, breastfeeding, number of people in the home, number of rooms, bed sharing, living in a shantytown, maternal educational level, family income or nutritional status. In multivariate analysis, the only variable significantly associated with H. pylori seropositivity was age. CONCLUSION: Infection had intermediate prevalence in the study population, and age was associated with higher prevalence.