ABSTRACT Objective: To evaluate the association between modifiable lifestyle behaviors and mental health indicators in Brazilian adolescents. Methods: This cross-sectional study used data from the 2019 National Survey of School Health including 152,860 students. The lifestyle behaviors and mental health indicators were obtained from a self-reported questionnaire. Logistic regression analyses were used to examine the association between lifestyle behaviors and mental health indicators. Results: Infrequent healthy eating (OR 1.22; 95%CI 1.14–1.31), being inactive (OR 1.82; 95%CI 1.65–2.01), smoking (OR 1.24; 95%CI 1.10–1.40), and irregular school attendance (OR 1.31; 95%CI 1.22–1.40) were associated with not having close friends. Additionally, not having close friends was also associated with unhealthy eating (OR 0.86; 95%CI 0.81–0.92) and alcohol consumption (OR 0.81; 95%CI 0.75–0.87). Infrequent healthy eating (OR 1.29; 95%CI 1.24–1.33), frequent unhealthy eating (OR 1.39; 95%CI 1.35–1.43), being inactive (OR 1.12; 95%CI 1.07–1.18), excessive screen time and sitting (OR 1.10; 95%CI 1.07–1.14 and OR 1.68; 95%CI 1.63–1.73, respectively), smoking (OR 1.26; 95%CI 1.19–1.34), alcohol (OR 1.33; 95%CI 1.28–1.37), drugs (OR 1.13; 95%CI 1.05–1.22), and irregular school attendance (OR 1.53; 95%CI 1.48–1.59) were associated with worse self-rated mental health. Conclusions: Various lifestyle behaviors are associated with different indicators of mental health. Objective adolescents Methods crosssectional cross sectional 201 152860 152 860 152,86 students selfreported self reported questionnaire Results 1.22 122 1 22 95CI CI 95 1.14–1.31, 114131 1.14–1.31 , 14 31 1.14–1.31) 1.82 182 82 1.65–2.01, 165201 1.65–2.01 65 2 01 1.65–2.01) 1.24 124 24 1.10–1.40, 110140 1.10–1.40 10 40 1.10–1.40) 1.31 131 1.22–1.40 122140 Additionally 0.86 086 0 86 0.81–0.92 081092 81 92 0.81 081 0.75–0.87. 075087 0.75–0.87 . 75 87 0.75–0.87) 1.29 129 29 1.24–1.33, 124133 1.24–1.33 33 1.24–1.33) 1.39 139 39 1.35–1.43, 135143 1.35–1.43 35 43 1.35–1.43) 1.12 112 12 1.07–1.18, 107118 1.07–1.18 07 18 1.07–1.18) 1.10 110 107114 1.07–1.1 1.68 168 68 163173 63 73 1.63–1.73 respectively, respectively respectively) 1.26 126 26 1.19–1.34, 119134 1.19–1.34 19 34 1.19–1.34) 1.33 133 1.28–1.37, 128137 1.28–1.37 28 37 1.28–1.37) 1.13 113 13 1.05–1.22, 105122 1.05–1.22 05 1.05–1.22) 1.53 153 53 1.48–1.59 148159 48 59 selfrated rated Conclusions 20 15286 15 152,8 1.2 9 11413 1.14–1.3 3 1.8 8 16520 1.65–2.0 6 11014 1.10–1.4 4 1.3 1.22–1.4 12214 0.8 08 0.81–0.9 08109 07508 0.75–0.8 7 12413 1.24–1.3 13514 1.35–1.4 1.1 11 10711 1.07–1. 1.6 16 16317 1.63–1.7 11913 1.19–1.3 12813 1.28–1.3 10512 1.05–1.2 1.5 5 1.48–1.5 14815 1528 152, 1. 1141 1.14–1. 1652 1.65–2. 1101 1.10–1. 1.22–1. 1221 0. 0.81–0. 0810 0750 0.75–0. 1241 1.24–1. 1351 1.35–1. 1071 1.07–1 1631 1.63–1. 1191 1.19–1. 1281 1.28–1. 1051 1.05–1. 1.48–1. 1481 114 1.14–1 165 1.65–2 1.10–1 1.22–1 0.81–0 075 0.75–0 1.24–1 135 1.35–1 107 1.07– 163 1.63–1 119 1.19–1 128 1.28–1 105 1.05–1 1.48–1 148 1.14– 1.65– 1.10– 1.22– 0.81– 0.75– 1.24– 1.35– 1.07 1.63– 1.19– 1.28– 1.05– 1.48– 1.14 1.65 0.75 1.35 1.0 1.63 1.19 1.28 1.05 1.48 0.7 1.4

RESUMO Objetivo: Avaliar a associação entre comportamentos modificáveis do estilo de vida e indicadores de saúde mental em adolescentes brasileiros. Métodos: Este estudo transversal utilizou dados da Pesquisa Nacional de Saúde do Escolar de 2019, incluindo 152.860 alunos. Comportamentos de estilo de vida e indicadores de saúde mental foram obtidos por meio de um questionário autoaplicável. Análises de regressão logística foram utilizadas para examinar a associação entre comportamentos de estilo de vida e indicadores de saúde mental. Resultados: Alimentação saudável infrequente (OR 1,22; IC95% 1,14–1,31), ser inativo (OR 1,82; IC95% 1,65–2,01), tabagismo (OR 1,24; IC95% 1,10–1,40) e frequência escolar inadequada (OR 1,31; IC95% 1,22–1,40) foram associados a não ter amigos próximos. Além disso, não ter amigos próximos também foi associado com alimentação não saudável (OR 0,86; IC95% 0,81–0,92) e consumo de álcool (OR 0,81; IC95% 0,75–0,87). Alimentação saudável infrequente (OR 1,29; IC95% 1,24–1,33), alimentação não saudável frequente (OR 1,39; IC95% 1,35–1,43), ser inativo (OR 1,12; IC95% 1,07–1,18), tempo excessivo em tela e sentado (OR 1,10; IC95% 1,07–1,14 e OR 1,68; IC95% 1,63–1,73, respectivamente), tabagismo (OR 1,26; IC95% 1,19–1,34), álcool (OR 1,33; IC95% 1,28–1,37), drogas (OR 1,13; IC95% 1,05–1,22) e frequência escolar irregular (OR 1,53; IC95% 1,48–1,59) foram associados a uma pior autopercepção de saúde mental. Conclusões: Vários comportamentos de estilo de vida foram associados a diferentes indicadores de saúde mental. Objetivo brasileiros Métodos 2019 152860 152 860 152.86 alunos autoaplicável Resultados 1,22 122 1 22 IC95 IC 1,14–1,31, 114131 1,14–1,31 , 14 31 1,14–1,31) 1,82 182 82 1,65–2,01, 165201 1,65–2,01 65 2 01 1,65–2,01) 1,24 124 24 1,10–1,40 110140 10 40 1,31 131 1,22–1,40 122140 disso 0,86 086 0 86 0,81–0,92 081092 81 92 0,81 081 0,75–0,87. 075087 0,75–0,87 . 75 87 0,75–0,87) 1,29 129 29 1,24–1,33, 124133 1,24–1,33 33 1,24–1,33) 1,39 139 39 1,35–1,43, 135143 1,35–1,43 35 43 1,35–1,43) 1,12 112 12 1,07–1,18, 107118 1,07–1,18 07 18 1,07–1,18) 1,10 110 107114 1,07–1,1 1,68 168 68 163173 63 73 1,63–1,73 respectivamente, respectivamente respectivamente) 1,26 126 26 1,19–1,34, 119134 1,19–1,34 19 34 1,19–1,34) 1,33 133 1,28–1,37, 128137 1,28–1,37 28 37 1,28–1,37) 1,13 113 13 1,05–1,22 105122 05 1,53 153 53 1,48–1,59 148159 48 59 Conclusões 201 15286 15 152.8 1,2 IC9 11413 1,14–1,3 3 1,8 8 16520 1,65–2,0 6 1,10–1,4 11014 4 1,3 1,22–1,4 12214 0,8 08 0,81–0,9 08109 9 07508 0,75–0,8 7 12413 1,24–1,3 13514 1,35–1,4 1,1 11 10711 1,07–1, 1,6 16 16317 1,63–1,7 11913 1,19–1,3 12813 1,28–1,3 1,05–1,2 10512 1,5 5 1,48–1,5 14815 20 1528 152. 1, 1141 1,14–1, 1652 1,65–2, 1,10–1, 1101 1,22–1, 1221 0, 0,81–0, 0810 0750 0,75–0, 1241 1,24–1, 1351 1,35–1, 1071 1,07–1 1631 1,63–1, 1191 1,19–1, 1281 1,28–1, 1,05–1, 1051 1,48–1, 1481 114 1,14–1 165 1,65–2 1,10–1 1,22–1 0,81–0 075 0,75–0 1,24–1 135 1,35–1 107 1,07– 163 1,63–1 119 1,19–1 128 1,28–1 1,05–1 105 1,48–1 148 1,14– 1,65– 1,10– 1,22– 0,81– 0,75– 1,24– 1,35– 1,07 1,63– 1,19– 1,28– 1,05– 1,48– 1,14 1,65 0,75 1,35 1,0 1,63 1,19 1,28 1,05 1,48 0,7 1,4

ABSTRACT Objective: To verify the level of knowledge of Brazilian pediatricians about anaphylaxis, identifying sociodemographic and educational characteristics of the professional which contribute to the adequate management of this clinical disorder. Methods: A survey was carried out on the management of anaphylaxis using a questionnaire prepared and distributed by email to pediatricians in different states in Brazil. The level of knowledge about anaphylaxis was classified as: satisfactory; unsatisfactory; more than satisfactory; ideal, according to evaluation criteria adopted for the statements of clinical cases that addressed the drug of choice, route of administration, positioning of the patient with anaphylaxis and recognition of the clinical case with differential diagnosis. Results: A total of 1,645 Brazilian pediatricians participated, of which 48.5% had satisfactory knowledge of the management of anaphylaxis. Approaches to choosing the preferred drug for anaphylaxis and the route of administration were the biggest obstacles to responses. The factors associated with satisfactory knowledge were shorter time since graduation, having a medical residency in pediatrics, having a qualification in allergy and immunology, having completed the Pediatric Advanced Life Support (PALS) in the last two years and having experience in anaphylaxis. Conclusions: The results regarding satisfactory knowledge of anaphylaxis are lower than those expected for the treatment of a potentially fatal condition. It is important to encourage the continuing education of pediatricians who work mainly in emergencies, wards, and intensive care units, in light of the use of the assumptions of andragogy and Ausubel’s theory, with active methodologies, to promote significant and permanent learning of management of anaphylaxis. Objective disorder Methods Brazil as unsatisfactory ideal choice diagnosis Results 1645 1 645 1,64 participated 485 48 5 48.5 responses graduation pediatrics immunology PALS (PALS Conclusions condition emergencies wards units Ausubels Ausubel s theory methodologies 164 64 1,6 4 48. 16 6 1,

RESUMO Objetivo: Verificar o nível de conhecimento dos pediatras brasileiros sobre anafilaxia, identificando características sociodemográficas e educacionais do profissional que contribuem para o adequado manejo desta desordem clínica. Métodos: Foi realizado um inquérito sobre o manejo da anafilaxia utilizando um questionário elaborado e distribuído por e-mail para os pediatras dos diversos estados do Brasil. O nível de conhecimento sobre anafilaxia foi classificado em: satisfatório, não satisfatório, mais que satisfatório e ideal, de acordo com critérios de avaliação adotados para as assertivas dos casos clínicos que abordavam a droga de escolha, via de administração, posicionamento do paciente com anafilaxia e reconhecimento do caso clínico com diagnóstico diferencial. Resultados: Participaram 1.645 pediatras brasileiros, dos quais 48,5% apresentaram conhecimento satisfatório no manejo da anafilaxia. Abordagens sobre a escolha da droga preferencial na anafilaxia e a via de administração foram os maiores entraves nas respostas. Os fatores associados ao conhecimento satisfatório foram: menor tempo desde a graduação, possuir residência médica em pediatria, possuir habilitação em alergia e imunologia, ter realizado o Pediatric Advanced Life Support (PALS) nos últimos dois anos e possuir experiência em anafilaxia. Conclusões: Os resultados quanto ao conhecimento satisfatório em anafilaxia são inferiores aos esperados para o tratamento de uma condição potencialmente fatal. É importante incentivar a educação permanente dos pediatras que atuam principalmente em emergências, enfermarias e unidades de tratamentos intensivos, à luz da utilização dos pressupostos da andragogia e da teoria de Ausubel, com metodologias ativas, a fim de promover uma aprendizagem significativa e permanente do manejo da anafilaxia. Objetivo clínica Métodos email mail Brasil ideal diferencial Resultados 1645 1 645 1.64 485 48 5 48,5 respostas graduação pediatria imunologia PALS (PALS Conclusões fatal emergências intensivos Ausubel ativas 164 64 1.6 4 48, 16 6 1.

RESUMO Objetivo: Esta revisão avalia o tratamento da urticária crônica (UC), sua eficácia e segurança em crianças, além das ferramentas de avaliação de resultados (PROMS) específicas para essa faixa etária. Fonte de dados: Dada a escassez de estudos em crianças, os autores realizaram uma revisão não sistemática de artigos publicados em inglês, espanhol e português na última década nos bancos de dados da United States National Library of Medicine (PubMed), Scientific Electronic Library Online (SciELO) e Embase. As palavras-chave utilizadas foram anti-histamínicos OU omalizumabe OU ciclosporina OU tratamento E urticária crônica E crianças OU adolescentes. Síntese dos dados: O tratamento padrão da UC envolve o uso de altas doses de anti-histamínicos em casos refratários à dose licenciada. Estudos mostraram eficácia desse aumento de dose em crianças, com taxas de controle variando entre 35 e 92%, embora haja poucos estudos sobre segurança. O omalizumabe é aprovado para crianças com mais de 12 anos de idade como segunda etapa de tratamento, com alguns dados indicando controle completo dos sintomas em mais de 80% dos casos infantis, sem eventos adversos, mesmo em menores de 12 anos. A ciclosporina, quando monitorada adequadamente, mostrou boa resposta na UC pediátrica, com poucos eventos adversos relatados. Além disso, PROMS validados para a idade, como UAS7, UCT, CU-Q2oL, podem ser úteis nas decisões clínicas. Conclusões: Embora mais estudos colaborativos sejam necessários para apoiar as recomendações das diretrizes em crianças, os dados existentes demonstram que esses medicamentos são seguros e eficazes para o tratamento da UC pediátrica, desde que haja ajuste adequado de doses. Objetivo UC, , (UC) (PROMS etária inglês PubMed, PubMed (PubMed) SciELO (SciELO Embase palavraschave palavras chave antihistamínicos anti histamínicos adolescentes licenciada 3 92 92% 1 80 infantis adequadamente pediátrica relatados disso UAS7 UAS UCT CUQ2oL, CUQ2oL CUQoL CU Q2oL, Q2oL Q oL CU-Q2oL clínicas Conclusões (UC (PubMed 9 8 CUQ QoL

ABSTRACT Objective: This paper aims to review the efficacy and safety of current chronic urticaria (CU) treatment in children and the existing patient-reported outcome measures (PROMs) used in this age group. Data source: Since there are few studies of CU in children, the authors performed a non-systematic review of published articles in English, Spanish, and Portuguese in the PubMed database in the last decade. Keywords used were (antihistamines OR omalizumab OR cyclosporine OR treatment) AND (chronic urticaria) AND (children OR adolescents). Data synthesis: According to the current guideline’s algorithm, the treatment of CU involves using high doses of antihistamines when there is no response with the licensed dosage. The effectiveness of this increase in children has been demonstrated with control rates ranging from 35% to 92%, with few studies addressing safety profiles. Omalizumab is approved for children over 12 years of age as a second step in the algorithm. Although more studies with children are needed to assess its effectiveness and safety, some data show complete control of symptoms in more than 80% of pediatric cases with no adverse effects, including in children under 12 years. When monitored closely, cyclosporine showed a good response rate in pediatric CU with few adverse events. Also, PROMs validated for this age can be helpful in clinical decisions, such as Urticaria Activity Score summed over 7 days, Urticaria Control Test, and Chronic Urticaria Quality of Life Questionnaire. Conclusions: Collaborative studies are necessary to generate stronger evidence to support the guideline recommendations for children. The existing data indicate that these drugs are safe and effective for treatment when dose adjustments are made. Objective (CU patientreported patient reported (PROMs group source nonsystematic non systematic English Spanish decade adolescents. adolescents . adolescents) synthesis guidelines s algorithm dosage 35 92 92% profiles 1 80 effects closely events Also decisions days Test Questionnaire Conclusions made 3 9 8

Abstract Objective Evaluate biomarkers capable of safely guiding Yellow fever vaccine (YFV) vaccination among individuals suspicious of hen's egg allergy, and identify factors associated with a higher risk for adverse events after immunization (AEAI). Methods Patients underwent skin prick test (SPT) for standardized allergens: whole egg, egg white, egg yolk; YFV (1:10 dilution; Biomanguinhos-Fiocruz), and intradermal test (IDT; YFV 0.02 mL, 1:100 dilution) and positive and negative controls. Serum levels of specific IgE (sIgE) for a whole egg, egg white, egg yolk, egg albumin, ovomucoid, lysozyme, and conalbumin (ImmunoCap®; ThermoFisher®) were obtained. Patients sensitized to YFV were submitted to YFV desensitization, and those negatives received YFV (0.5mL) and remained under surveillance for at least one hour. Results 103 patients were enrolled, 95% under 12 years old. 71% (81/103) of patients had reactions: 80% immediate, 11% mixed, and 9% delayed. There was an association between positive skin test results with YFV and the severity of the reaction (OR:7.64; 95%CI:1.61-36.32; p =0,011). Only the presence of sIgE to ovomucoid was associated with clinical symptoms (p =0,025). Thirty patients underwent the YFV desensitization protocol. Conclusion There is a relationship between the positivity of the egg's components and the severity of the clinical reaction. Furthermore, the relationship between the positivity of the tests with the YFV and egg's components may show a tendency to look at ovomucoid and conalbumin, but it is not a certainty. Therefore, further studies are needed to confirm these associations, and for now, the authors still recommend using the vaccine for testing when necessary. (YFV hens hen s allergy AEAI. AEAI . (AEAI) SPT (SPT allergens white yolk 110 1 10 (1:1 dilution BiomanguinhosFiocruz, BiomanguinhosFiocruz Biomanguinhos Fiocruz , Biomanguinhos-Fiocruz) IDT (IDT 002 0 02 0.0 mL 1100 100 1:10 controls (sIgE albumin lysozyme ImmunoCap® ImmunoCap (ImmunoCap® ThermoFisher® ThermoFisher obtained 0.5mL 05mL 5mL (0.5mL hour enrolled 95 old 71 81/103 81103 81 (81/103 reactions 80 immediate 11 mixed 9 delayed OR7.64 OR764 OR 7.64 7 64 (OR:7.64 95%CI1.6136.32 95CI1613632 CI 95%CI 1.61 36.32 61 36 32 95%CI:1.61-36.32 =0,011. 0011 =0,011 011 =0,011) =0,025. 0025 =0,025 025 =0,025) protocol eggs Furthermore certainty Therefore associations now necessary (AEAI (1: Biomanguinhos-Fiocruz 00 0. 1:1 (ImmunoCap 81/10 8110 8 (81/10 OR7 OR7.6 OR76 764 7.6 6 (OR:7.6 CI1 6136 95%CI1.6136.3 95CI161363 95CI 161 1.6 3632 36.3 3 95%CI:1.61-36.3 001 =0,01 01 =0,02 (1 1: 81/1 811 (81/1 OR7. 76 7. (OR:7. 613 95%CI1.6136. 95CI16136 16 1. 363 36. 95%CI:1.61-36. =0,0 ( 81/ (81/ (OR:7 95%CI1.6136 95CI1613 95%CI:1.61-36 =0, (81 (OR: 95%CI1.613 95CI161 95%CI:1.61-3 =0 (8 (OR 95%CI1.61 95CI16 95%CI:1.61- = 95%CI1.6 95CI1 95%CI:1.61 95%CI1. 95%CI:1.6 95%CI1 95%CI:1. 95%CI:1 95%CI:

Abstract Objectives To assess the prevalence and pattern of behavioral problems in children and adolescents with atopic dermatitis (AD) and to study their associations with clinical data and severity. Methods This was a single-center, cross-sectional study of patients (6-17 years) with AD. Assessment of competencies and syndrome scale scores of behavioral problems was performed by applying the Child Behavior Checklist 6-18 (CBCL 6-18) and AD severity using the Eczema Area Severity Index (EASI) score. Results Of the 100 patients with AD, 56% were male, with a mean age of 11±3 years, and 43% had moderate/severe AD. Borderline or abnormal values were found in 75% of the patients for total social competence, 57% for internalization, 27% for externalization, and 18% for aggressive behavior. A higher prevalence of aggressive behavior (27.9% vs. 10.5%; p= 0.02) and sleep disorders (32.6% vs. 15.8%; p= 0.04) was observed in patients with moderate/severe AD than in those with mild AD. Children with current or previous use of immunosuppressants/immunobiological tests had a lower frequency of normal social competence (53% vs. 83%, p= 0.012). Regarding the critical questions, 8% responded affirmatively to suicidal ideation. Conclusion A high prevalence of behavioral problems was observed among children and adolescents with AD, with a predominance of internalizing profiles, mainly anxiety and depression. Children with moderate/severe AD have a higher prevalence of aggressive behaviors and sleep disorders. These findings highlight the importance of multidisciplinary teams, including mental health professionals, in caring for patients with AD. (AD singlecenter, singlecenter single center, center single-center crosssectional cross sectional 617 6 17 (6-1 years 618 18 6-1 CBCL EASI (EASI score 10 56 male 113 11 3 11± 43 moderatesevere moderate severe 75 57 internalization 27 externalization 27.9% 279 9 (27.9 vs 10.5% 105 5 p 0.02 002 0 02 32.6% 326 32 (32.6 15.8% 158 15 8 0.04 004 04 immunosuppressantsimmunobiological immunosuppressants immunobiological 53% 53 (53 83 83% 0.012. 0012 0.012 . 012 0.012) questions ideation profiles depression teams professionals 61 1 (6- 6- 4 7 2 27.9 (27. 10.5 0.0 00 32.6 (32. 15.8 (5 001 0.01 01 (6 27. (27 10. 0. 32. (32 15. ( (2 (3

ABSTRACT Purpose: The prevalence of ocular allergy varies according to the population and location of the study. Severe forms of ocular allergy are associated with compromised quality of life. In this study, we aimed to evaluate the application of the Brazilian-Portuguese version of the Quality of Life in Children with Keratoconjunctivitis questionnaire to children and adolescents with different subtypes of allergic conjunctivitis. Method: A total of 48 patients (aged 5-12 years) with allergic conjunctivitis were included in this study. They were enrolled and monitored at a specialized center. After the clinical appointment, the children responded to the questionnaire on two occasions at an interval of 30 days. Individual scores (ranging from 0 to 3) of the 16 items were added. Results: The Brazilian-Portuguese version of the Quality of Life in Children with Keratoconjunctivitis questionnaire demonstrated good translation, adaptation, and intellectual properties, with substantial internal consistency (Cronbach’s α coefficient = 0.702). There was no significant difference between the responses of the two interviews, revealing good reproducibility. The moderate/severe forms of allergic conjunctivitis had significantly higher quality of life scores (indicating a poorer quality of life) than the mild forms. Conclusions: The Brazilian-Portuguese version of the Quality of Life in Children with Keratoconjunctivitis proved to be quick, reliable, and reproducible for assessing the quality of life in children with allergic conjunctivitis. However, its ability to detect changes resulting from symptom aggravation or treatment needs to be further evaluated. Purpose study BrazilianPortuguese Brazilian Portuguese Method 4 aged 512 5 12 5-1 years center appointment 3 days ranging 1 added Results translation adaptation properties Cronbachs Cronbach s 0.702. 0702 0.702 . 702 0.702) interviews reproducibility moderatesevere moderate severe indicating Conclusions quick reliable However evaluated 51 5- 070 0.70 70 07 0.7 7 0.

Resumen La interacción entre el potencial genético y el medio ambiente, especialmente el aumento de la urbanización y la gestión inadecuada de residuos contribuye con la manifestación de enfermedades alérgicas. Los pacientes pediátricos son los más vulnerables, debido a la inmadurez de los sistemas respiratorio e inmunológico. La exposición prenatal y posnatal a contaminantes del aire, tanto en exteriores como interiores, acelera o agrava la morbilidad y mortalidad por enfermedades alérgicas. El "exposoma", que abarca todas las exposiciones ambientales a lo largo de la vida, influye en la salud. Las agresiones biológicas y químicas alteran la barrera epitelial, desencadenando respuestas inflamatorias y favoreciendo enfermedades alérgicas, como alergias alimentarias. El uso descontrolado de combustibles tóxicos, material particulado, detergentes y otros factores contribuyen con el deterioro continuo de la barrera epitelial intestinal, aumentando el riesgo de enfermedades alérgicas. Es importante tomar medidas urgentes para abordar estos problemas y proteger la salud del planeta.

Abstract The interaction between genetic potential and the environment, especially increased urbanization and inadequate waste management, contributes to the manifestation of allergic diseases. Pediatric patients are the most vulnerable, due to the immaturity of the respiratory and immune systems. Prenatal and postnatal exposure to air pollutants, both indoors and outdoors, accelerates or aggravates morbidity and mortality from allergic diseases. The “exposome,” which encompasses all environmental exposures throughout life, influences health. Biological and chemical attacks alter the epithelial barrier, triggering inflammatory responses and favoring allergic diseases, such as food allergies. The uncontrolled use of toxic fuels, particulate matter, detergents and other factors contribute to the continuous deterioration of the intestinal epithelial barrier, increasing the risk of allergic diseases. It is important to take urgent action to address these issues and protect the health of the planet.

Abstract Objective: Through a literature review, make recommendations regarding immunizations in people living with Inborn Error of Metabolism (IEM) in Brazil, assess the possible impact on metabolic decompensations after immunization, and if this specific population may have an impaired immune response to vaccines. Source of data: The MeSH Terms vaccination OR vaccine OR immunization associated with the term inborn error of metabolism AND recommendation were used in combination with search databases. Only articles published after 1990, in the languages English, Spanish, French or Portuguese, human-related were included. Synthesis of data: A total of 44 articles were included to make the following recommendations. Individuals with IEMs need to be up to date with their immunizations. Regarding which vaccines should be offered, children and adults should follow the routine immunization schedules locally available, including the COVID-19 vaccines. The only exception is the rotavirus vaccine for hereditary fructose intolerance. The benefit of immunization outweighs the very low risk of metabolic decompensation. Since not all patients will have an adequate immune response, measuring antibody conversion and titers is recommended Conclusions: All patients should receive age-appropriate immunizations in their respective schedules without delays. The only situation when vaccination may be contraindicated is with oral rotavirus vaccine in hereditary fructose intolerance. Monitoring the levels of antibodies should be done to detect any immune dysfunction or the necessity for boosters. A personalized immunization schedule is ideal for patients with IEMs. The reference organizations could improve their recommendations to address all IEMs, not only some of them. Objective review IEM (IEM Brazil data databases 1990 English Spanish Portuguese humanrelated human related 4 offered available COVID19 COVID 19 COVID-1 intolerance decompensation Conclusions ageappropriate age appropriate delays boosters them 199 COVID1 1 COVID-

Abstract Objectives: Since the beginning of its use for the prevention of tuberculosis (TB) in 1921, other uses of BCG (Bacillus Calmette-Guérin) have been proposed, particularly in the treatment of malignant solid tumors, multiple sclerosis, and other autoimmune diseases. Its beneficial impact on other infections, by nontuberculous mycobacteria, and by viruses, has been more often studied in recent years, especially after the introduction of the concept of trained immunity. The present study’s objective was to review the possible indications of BCG and the immunological rationale for these indications. Data source: Non-systematic review carried out in the PubMed, SciELO and Google Scholar databases, using the following search terms: “BCG” and “history”, “efficacy”, “use”, “cancer”, “trained immunity”, “other infections”, “autoimmune diseases”. Data synthesis: There is epidemiological evidence that BCG can reduce overall child morbidity/mortality beyond what would be expected from TB control. BCG is able to promote cross-immunity with nontuberculous mycobacteria and other bacteria. BCG promotes in vitro changes that increase innate immune response to other infections, mainly viral ones, through mechanisms known as trained immunity. Effects on cancer, except bladder cancer, and on autoimmune and allergic diseases are debatable. Conclusions: Despite evidence obtained from in vitro studies, and some epidemiological and clinical evidence, more robust evidence of in vivo efficacy is still needed to justify the use of BCG in clinical practice, in addition to what is recommended by the National Immunization Program for TB prevention and bladder cancer treatment. Objectives (TB 1921 Bacillus CalmetteGuérin Calmette Guérin Calmette-Guérin proposed tumors sclerosis infections viruses years immunity studys study s source Nonsystematic Non systematic PubMed databases terms “BCG history, history , “history” efficacy, “efficacy” use, “use” “cancer” immunity, immunity” infections” . diseases” synthesis morbiditymortality morbidity mortality control crossimmunity cross bacteria ones debatable Conclusions studies practice 192 “history “efficacy “use “cancer 19 1

RESUMEN Introducción. La salud ambiental infantil es la rama de la pediatría que estudia la influencia del medioambiente en la salud y la enfermedad de los niños. Las exposiciones ambientales globales representan una seria amenaza para la salud, lo que justifica una mayor investigación y acción. Objetivo. Evaluar la salud ambiental de una muestra de niños que viven en áreas urbanas y rurales de la ciudad de Uruguaiana, Brasil. Población y métodos. Se incluyeron padres/tutores (n = 714) de niños atendidos en el Policlínico Infantil de la Ciudad de Uruguaiana de enero a octubre de 2021, que respondieron la anamnesis ambiental en pediatría (Sociedad Brasileña de Pediatría). Los datos obtenidos se analizaron según la residencia en zona urbana o rural, o el ingreso familiar. Resultados. Al comparar los habitantes de la zona urbana (n = 660) con los de la zona rural (n = 54), verificamos que entre los de la zona rural fue significativamente mayor la actividad con productos químicos (15 % vs. 32,7 %; p = 0,004), vivir cerca de plantación (7,5 % vs. 74,5 %; p <0,001) o con fuente de contaminación (4,8 % vs. 32,7 %; p <0,001), tener perro (62 % vs. 87,3 %; p <0,001), usar plaguicidas (0,6 % vs. 32,7 %; p <0,001) y exposición a contaminación química (2,6 % vs. 18,2 %; p <0,001). En el área urbana predominó la exposición al tránsito de vehículos cerca de la vivienda (85 % vs. 48,1 %; p <0,001), renta media inferior a 3 salarios mínimos (90 %) y baja escolaridad. Conclusión. Realizar la anamnesis ambiental es fundamental para la detección de amenazas ambientales presentes en los lugares donde los niños y adolescentes viven, aprenden, juegan y estudian.

Resumo Objetivo: Determinar a prevalência de rinite alérgica e fatores associados em adolescentes e em seus pais/responsáveis. Métodos: Estudo transversal, com aplicação de questionário escrito padronizado e validado. Adolescentes (13–14 anos; n=1.058) e seus pais/responsáveis (média de idade=42,1 anos; n=896) residentes na cidade de Uruguaiana, Sul do Brasil, responderam aos questionários padrão da Global Asthma Network. Resultados: A prevalência de rinite alérgica em adolescentes foi de 28,0%, a de rinoconjuntivite alérgica foi de 21,3% e a de formas graves de rinite alérgica, de 7,8%. Nos adultos, a prevalência de rinite alérgica foi de 31,7%. Alguns fatores associados à rinite alérgica em adolescentes incluem fazer pouco exercício físico (odds ratio — OR 2,16; intervalo de confiança — IC95% 1,15–4,05), ter apenas um irmão mais velho (OR 1,94; IC95% 1,01–3,72) e consumir carne diariamente (OR 7,43; IC95% 1,53–36,11). Por outro lado, consumir açúcar (OR 0,34; IC5% 0,12–0,93) ou azeite de oliva (OR 0,33 IC95% 0,13–0,81) uma ou duas vezes por semana e comer vegetais diariamente (OR 0,39; IC95% 0,15–0,99) foram considerados fatores associados negativamente. Em adultos, a exposição a fungos no domicílio (OR 5,25; IC95% 1,01–27,22) e o consumo de carne uma ou duas vezes por semana (OR 46,45; IC95 2,12–1020,71) foram fatores associados ao diagnóstico médico de rinite alérgica, enquanto a baixa escolaridade (OR 0,25; IC95% 0,07–0,92) se mostrou como fator associado negativamente. Conclusões: A prevalência de rinite alérgica em adolescentes é alta, assim como seu diagnóstico médico em adultos residentes em Uruguaiana. Fatores ambientais, especialmente hábitos alimentares, foram associados aos achados em ambos os grupos. Objetivo paisresponsáveis pais responsáveis Métodos transversal validado 13–14 1314 13 14 (13–1 anos n=1.058 n1058 n 1 058 média idade421 idade 42 idade=42, n=896 n896 896 Uruguaiana Brasil Network Resultados 280 28 0 28,0% 213 21 3 21,3 78 7 8 7,8% 317 31 31,7% odds 2,16 216 2 16 IC 1,15–4,05, 115405 1,15–4,05 , 15 4 05 1,15–4,05) 1,94 194 94 1,01–3,72 101372 01 72 7,43 743 43 1,53–36,11. 1533611 1,53–36,11 . 53 36 11 1,53–36,11) lado 0,34 034 34 IC5 0,12–0,93 012093 12 93 033 33 0,3 0,13–0,81 013081 81 0,39 039 39 0,15–0,99 015099 99 negativamente 5,25 525 5 25 1,01–27,22 1012722 27 22 46,45 4645 46 45 IC9 2,12–1020,71 212102071 1020 71 0,25 025 0,07–0,92 007092 07 92 Conclusões alta ambientais alimentares grupos 13–1 131 (13– n=1.05 n105 idade42 idade=42 n=89 n89 89 28,0 21, 7,8 31,7 2,1 11540 1,15–4,0 1,9 19 9 1,01–3,7 10137 7,4 74 153361 1,53–36,1 03 0,12–0,9 01209 0, 0,13–0,8 01308 0,15–0,9 01509 5,2 52 1,01–27,2 101272 46,4 464 2,12–1020,7 21210207 102 0,2 02 0,07–0,9 00709 13– (13 n=1.0 n10 idade4 idade=4 n=8 n8 28, 7, 31, 2, 1154 1,15–4, 1, 1,01–3, 1013 15336 1,53–36, 0,12–0, 0120 0,13–0, 0130 0,15–0, 0150 5, 1,01–27, 10127 46, 2,12–1020, 2121020 10 0,07–0, 0070 (1 n=1. n1 idade= n= 115 1,15–4 1,01–3 101 1533 1,53–36 0,12–0 012 0,13–0 013 0,15–0 015 1,01–27 1012 2,12–1020 212102 0,07–0 007 ( n=1 1,15– 1,01– 153 1,53–3 0,12– 0,13– 0,15– 1,01–2 2,12–102 21210 0,07– 00 1,15 1,01 1,53– 0,12 0,13 0,15 2,12–10 2121 0,07 1,1 1,0 1,53 0,1 2,12–1 212 0,0 1,5 2,12– 2,12

Abstract Objective: To determine the prevalence of allergic rhinitis and associated factors in adolescents and in their parents/guardians. Methods: A cross-sectional study, applying a standardized and validated written questionnaire. Adolescents (13–14 years old; n=1,058) and their parents/guardians (mean age=42.1 years old; n=896) living in the city of Uruguaiana, southern Brazil, responded to the Global Asthma Network standard questionnaires. Results: The prevalence of allergic rhinitis in adolescents was 28.0%, allergic rhinoconjunctivitis, 21.3%, and severe forms of allergic rhinitis, 7.8%. In the adults, the prevalence of allergic rhinitis was 31.7%. Some associated factors with allergic rhinitis in adolescents include low physical exercise (OR 2.16; 95%CI 1.15–4.05), having only one older sibling (OR 1.94; 95CI 1.01–3.72) and daily meat consumption (OR 7.43; 95% CI 1.53–36.11). In contrast, consuming sugar (OR 0.34; 95%CI 0.12–0.93) or olive oil (OR 0.33; 95%CI 0.13–0 .81) once or twice a week, and eating vegetables daily (OR 0.39; 95%CI 0.15–0.99) were considered factors negatively associated. In adults, exposure to fungi at home (OR 5.25; 95%CI 1.01–27.22) and consumption of meat once or twice a week (OR 46.45; 95CI 2.12–1020.71) were factors associated with the medical diagnosis of allergic rhinitis, while low education (OR 0.25; 95%CI 0.07–0.92) was found to be a factor negatively associated. Conclusions: The prevalence of allergic rhinitis in adolescents is high, as well as its medical diagnosis in adults living in Uruguaiana. Environmental factors, especially food habits, were associated with findings in both groups. Objective parentsguardians parents guardians Methods crosssectional cross sectional study questionnaire 13–14 1314 13 14 (13–1 old n=1,058 n1058 n 1 058 mean age421 age 42 age=42. n=896 n896 896 Uruguaiana Brazil questionnaires Results 280 28 0 28.0% rhinoconjunctivitis 213 21 3 21.3% 78 7 8 7.8% 317 31 31.7% OR 2.16 216 2 16 95 1.15–4.05, 115405 1.15–4.05 , 15 4 05 1.15–4.05) 1.94 194 94 1.01–3.72 101372 01 72 7.43 743 43 1.53–36.11. 1533611 1.53–36.11 . 53 36 11 1.53–36.11) contrast 0.34 034 34 0.12–0.93 012093 12 93 0.33 033 33 0130 0.13– .81 81 0.39 039 39 0.15–0.99 015099 99 5.25 525 5 25 1.01–27.22 1012722 27 22 46.45 4645 46 45 2.12–1020.71 212102071 1020 71 0.25 025 0.07–0.92 007092 07 92 Conclusions high habits groups 13–1 131 (13– n=1,05 n105 age42 age=42 n=89 n89 89 28.0 21.3 7.8 31.7 2.1 9 11540 1.15–4.0 1.9 19 1.01–3.7 10137 7.4 74 153361 1.53–36.1 0.3 03 0.12–0.9 01209 013 0.13 .8 0.15–0.9 01509 5.2 52 1.01–27.2 101272 46.4 464 2.12–1020.7 21210207 102 0.2 02 0.07–0.9 00709 13– (13 n=1,0 n10 age4 age=4 n=8 n8 28. 21. 7. 31. 2. 1154 1.15–4. 1. 1.01–3. 1013 15336 1.53–36. 0. 0.12–0. 0120 0.1 0.15–0. 0150 5. 1.01–27. 10127 46. 2.12–1020. 2121020 10 0.07–0. 0070 (1 n=1, n1 age= n= 115 1.15–4 1.01–3 101 1533 1.53–36 0.12–0 012 0.15–0 015 1.01–27 1012 2.12–1020 212102 0.07–0 007 ( n=1 1.15– 1.01– 153 1.53–3 0.12– 0.15– 1.01–2 2.12–102 21210 0.07– 00 1.15 1.01 1.53– 0.12 0.15 2.12–10 2121 0.07 1.1 1.0 1.53 2.12–1 212 0.0 1.5 2.12– 2.12

Abstract Objective: To develop, validate, and test the reproducibility of a new test capable of assessing functional performance in children and adolescents (PAY test: Performance Activity in Youth). Methods: participants without and with asthma were included in the development and validation phases, respectively. The PAY test includes five activities: transition from sitting to standing, walking 10 m, step climbing, shoulder extension and flexion, and star jumps. Participants underwent the Pediatric Glittre test (TGlittre-P test time), modified shuttle test (MST), and cardiopulmonary exercise test (CPET). Outcomes: PAY test and TGlittre-P test times, oxygen uptake (VO2peak), and distance walked in the MST. Results: 8 healthy volunteers, aged 12 (7 -15) years old were included in the development phase and 34 participants with asthma, aged 11 (7-14) years old, in the validation phase. The PAY test elicited greater physiological responses (VO2peak 33.5 ± 6.9 mL/kg) than the TGlittre-P (VO2peak: 27.4 ± 9.0 mL/kg), but lower than the MST (VO2peak: 48.9 ± 14.2 mL/kg) and CPET (VO2peak: 42.0 ± 8.8 mL/kg), p < .05. Moderate correlation between the PAY test time and the TGlittre-P time (r = 0.70, p < .001) and distance walked in the MST (r = -0.72, p < .001). The PAY test time was longer in participants with asthma than in healthy participants (3.1 [3.0 – 3.3] min vs. 2.3 [2.1 – 2.4 min]), p < .001.; and the test was reproducible (ICC 0.78, CI 95% 0.55-0.90, p < .001). Conclusions: The PAY test is a valid and reproducible tool for assessing functional performance in children and adolescents with asthma.