[Analysis of the influence of the timing of enrollment in daycares on child development]. / Análise da influência do momento do ingresso em creches no desenvolvimento infantil.

This study aimed to analyze the relationship between the age of enrollment into early childhood education (ECE) programs and child development. This is a cross-sectional study using data from the Birth Cohort of the Western Region of São Paulo, Brazil, with a 36-month follow-up of children born at the University Hospital of the University of São Paulo from 2012 to 2014, and their caregivers who participated in the 36-month follow-up conducted from 2015 to 2017. Child development was measured by the Engle Scale of the Regional Project on Child Development Indicators (PRIDI). ECE programs were evaluated in relation to their quality. The social characteristics of the children and their caregivers, as well as the characteristics of the economic and family context, were used as exposure variables. Our sample consisted of 472 children and their parents/caregivers. The enrollment into daycare from 13 and 29 months was the most frequent. When considered alone, a higher age of enrollment was associated with higher development score [ß = 0.21, 95%CI: 0.02; 0.40, p = 0.027]. After adjusting for confounding variables in the regression models, it was observed that being enrolled in a private institution, total time of breastfeeding, time spent by the main caregiver working outside home, and inhibitory control were determinants in explaining the infant development at 36 months in the sample. Older age of entry into ECE programs may have a positive effect on infant development at 36 months of age, but these findings must be carefully considered.

Este estudo objetivou analisar a relação entre a idade de ingresso nos programas de educação na primeira infância (EPI) e o desenvolvimento infantil. Trata-se de um estudo transversal com dados oriundos da Coorte de Nascimentos da Região Oeste de São Paulo, Brasil. Realizou-se o acompanhamento de crianças nascidas no Hospital Universitário da Universidade de São Paulo durante 36 meses, entre os anos de 2012 e 2014, e de seus cuidadores respondentes durante a onda de seguimentos dos 36 meses de idade (realizada entre os anos de 2015 e 2017). O desenvolvimento infantil foi mensurado pelo instrumento Engle Scale do Projeto Regional de Indicadores de Desenvolvimento Infantil (PRIDI). Os programas de EPI foram avaliados em relação a sua qualidade. Foram utilizadas como variáveis expositivas as características sociais das crianças e dos seus cuidadores, bem como as características do contexto econômico e familiar. A amostra foi composta por 472 crianças e cuidadores. Observou-se que o ingresso na creche entre 13 e 29 meses foi o mais frequente. Quando considerados isoladamente, observou-se que uma maior idade de ingresso esteve associada com maior escore de desenvolvimento [ß = 0,21, IC95%: 0,02; 0,40, p = 0,027]. Após a inclusão das variáveis de ajuste nos modelos de regressão, observou-se que estar inscrito em instituição do tipo privada, tempo total de aleitamento materno, horas trabalhadas fora de casa pelo cuidador principal e o controle inibitório foram determinantes para explicar o desenvolvimento infantil aos 36 meses na amostra. A idade de ingresso mais tardia nos programas de EPI pode ter efeito positivo sobre o desenvolvimento infantil aos 36 meses de idade, porém esses achados precisam ser ponderados.

Este estudio tuvo como objetivo analizar la relación entre la edad de ingreso a los programas de educación infantil (EPI) y el desarrollo infantil. Se trata de un estudio transversal con datos de la Cohorte de Nacimientos de la Región Oeste de São Paulo, Brasil, con seguimiento de 36 meses de niños nacidos en el Hospital Universitario de la Universidad de São Paulo entre 2012 y 2014 y sus cuidadores durante la ola de seguimientos de los 36 meses de edad (realizada entre los años de 2015 y 2017). El desarrollo infantil se midió utilizando el instrumento Engle Scale do Proyecto Regional de Indicadores de Desarollo Infantil (PRIDI). Los programas de EPI fueron evaluados por su calidad. Se utilizaron como variables expositivas las características sociales de los niños y sus cuidadores, así como las características del contexto económico y familiar. La muestra estuvo compuesta por 472 niños y cuidadores. Se observó que el ingreso a la guardería entre 13 y 29 meses fue el más frecuente. Cuando considerados aisladamente, se observó que una mayor edad de ingreso estuvo asociada con mayor puntuación de desarrollo [ß = 0,21, IC95%; 0,02; 0,40, p = 0,027]. Luego de incluir las variables de ajuste en los modelos de regresión, se observó que el estar matriculado en una institución privada, el tiempo total de lactancia, las horas trabajadas fuera del hogar por el cuidador principal y el control inhibitorio fueron determinantes para explicar el desarrollo infantil a los 36 meses de la muestra. La edad de ingreso más tardía en los programas de EPI puede tener un efecto positivo sobre el desarrollo infantil a los 36 meses de edad, pero estos hallazgos necesitan ser ponderados. cia al parto y nacimiento, con seguridad y cuidado, sin afectar los resultados.

Assessment of school readiness and the importance of executive functions for learning.

OBJECTIVE: Considering the importance of the beginning of the academic trajectory for children to reach their full development, this work aims to evaluate the school readiness of preschool-age children and identify which factors influence these results, in order to contribute to the proposition of strategies that allow improving the teaching-learning process and child development. METHODS: This is a cross-sectional, descriptive and analytical study with 443 preschool children belonging to the West Region Cohort (ROC Cohort), from the public school system of the city of São Paulo. School readiness was assessed by the International Development and Early Learning Assessment (IDELA) tool. Non-parametric techniques were used for the correlation analysis between IDELA scores and sociodemographic and socioeconomic conditions: Spearman's parametric correlation, Mann-Whitney and Kruskal-Wallis tests. RESULTS: The children's mean age was 69 months (standard deviation - SD=2.8; ranging from 55 to 72 months) and most of them came from families with low socioeconomic level. Most children showed adequate readiness in the overall score (65%) and in most domains, except for emergent literacy, in which most (56.9%) were classified as "emergent". The highest percentage of insufficiency was identified in executive functions (4.1%), which showed a correlation only with the caregiver's education. CONCLUSIONS: Children had adequate school readiness scores, except for emergent literacy, but the insufficiency in executive functions may compromise the future schooling of these children. Thus, pedagogical proposals should consider these aspects for learning and pediatricians need to reinforce the habit of reading and playing games to stimulate child development.

Differences in children and adolescents with SARS-CoV-2 infection: a cohort study in a Brazilian tertiary referral hospital.

OBJECTIVES: To compare demographic/clinical/laboratory/treatments and outcomes among children and adolescents with laboratory-confirmed coronavirus disease 2019 (COVID-19). METHODS: This was a cross-sectional study that included patients diagnosed with pediatric COVID-19 (aged <18 years) between April 11, 2020 and April 22, 2021. During this period, 102/5,951 (1.7%) of all admissions occurred in neonates, children, and adolescents. Furthermore, 3,962 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection samples were processed in patients aged <18 years, and laboratory-confirmed COVID-19 occurred in 155 (4%) inpatients and outpatients. Six/155 pediatric patients were excluded from the study. Therefore, the final group included 149 children and adolescents (n=97 inpatients and 52 outpatients) with positive SARS-CoV-2 results. RESULTS: The frequencies of sore throat, anosmia, dysgeusia, headache, myalgia, nausea, lymphopenia, pre-existing chronic conditions, immunosuppressive conditions, and autoimmune diseases were significantly reduced in children and adolescents (p<0.05). Likewise, the frequencies of enoxaparin use (p=0.037), current immunosuppressant use (p=0.008), vasoactive agents (p=0.045), arterial hypotension (p<0.001), and shock (p=0.024) were significantly lower in children than in adolescents. Logistic regression analysis showed that adolescents with laboratory-confirmed COVID-19 had increased odds ratios (ORs) for sore throat (OR 13.054; 95% confidence interval [CI] 2.750-61.977; p=0.001), nausea (OR 8.875; 95% CI 1.660-47.446; p=0.011), and lymphopenia (OR 3.575; 95% CI 1.355-9.430; p=0.010), but also had less hospitalizations (OR 0.355; 95% CI 0.138-0.916; p=0.032). The additional logistic regression analysis on patients with preexisting chronic conditions (n=108) showed that death as an outcome was significantly associated with pediatric severe acute respiratory syndrome (SARS) (OR 22.300; 95% CI 2.341-212.421; p=0.007) and multisystem inflammatory syndrome in children (MIS-C) (OR 11.261; 95% CI 1.189-106. 581; p=0.035). CONCLUSIONS: Half of the laboratory-confirmed COVID-19 cases occurred in adolescents. Individuals belonging to this age group had an acute systemic involvement of SARS-CoV-2 infection. Pediatric SARS and MIS-C were the most important factors associated with the mortality rate in pediatric chronic conditions with COVID-19.

Assessment of school readiness and the importance of executive functions for learning / Avaliação da prontidão escolar e a importância das funções executivas para o aprendizado

ABSTRACT Objective: Considering the importance of the beginning of the academic trajectory for children to reach their full development, this work aims to evaluate the school readiness of preschool-age children and identify which factors influence these results, in order to contribute to the proposition of strategies that allow improving the teaching-learning process and child development. Methods: This is a cross-sectional, descriptive and analytical study with 443 preschool children belonging to the West Region Cohort (ROC Cohort), from the public school system of the city of São Paulo. School readiness was assessed by the International Development and Early Learning Assessment (IDELA) tool. Non-parametric techniques were used for the correlation analysis between IDELA scores and sociodemographic and socioeconomic conditions: Spearman's parametric correlation, Mann-Whitney and Kruskal-Wallis tests. Results: The children's mean age was 69 months (standard deviation — SD=2.8; ranging from 55 to 72 months) and most of them came from families with low socioeconomic level. Most children showed adequate readiness in the overall score (65%) and in most domains, except for emergent literacy, in which most (56.9%) were classified as "emergent". The highest percentage of insufficiency was identified in executive functions (4.1%), which showed a correlation only with the caregiver's education. Conclusions: Children had adequate school readiness scores, except for emergent literacy, but the insufficiency in executive functions may compromise the future schooling of these children. Thus, pedagogical proposals should consider these aspects for learning and pediatricians need to reinforce the habit of reading and playing games to stimulate child development.

RESUMO Objetivo: Considerando-se a importância do início da trajetória acadêmica para as crianças alcançarem o seu pleno potencial de desenvolvimento, este trabalho tem como objetivo avaliar a prontidão escolar de crianças em idade pré-escolar e identificar que fatores influenciam esses resultados, com a finalidade de propor estratégias que possam melhorar o processo de ensino-aprendizagem e o desenvolvimento da criança. Métodos: Trata-se de um estudo transversal, descritivo e analítico, com 443 pré-escolares pertencentes à Coorte da Região Oeste (Coorte ROC) da rede pública de ensino da cidade de São Paulo. A prontidão escolar foi avaliada pela ferramenta International Development and Early Learning Assessment (IDELA). Técnicas não paramétricas foram utilizadas para a análise de correlação entre escores de IDELA e as condições sociodemográficas e socioeconômicas: correlação paramétrica de Spearman, testes de Mann-Whitney e Kruskal-Wallis. Resultados: A média de idade das crianças foi de 69 meses (desvio padrão — DP=2,8; variando de 55 a 72 meses) e maioria era proveniente de famílias com baixo nível socioeconômico. A maioria das crianças apresentou prontidão adequada na pontuação geral (65%) e na maior parte dos domínios, com exceção da pré-escrita, na qual as crianças foram predominantemente (56,9%) classificadas como "emergentes". O maior percentual de insuficiência foi identificado nas funções executivas (4,1%), apresentando correlação apenas com a formação do cuidador. Conclusões: As crianças apresentaram escores adequados de prontidão escolar, exceto para a pré-escrita, mas a insuficiência nas funções executivas pode comprometer a escolaridade futura dessas crianças. Assim, as propostas pedagógicas devem considerar esses aspectos para a aprendizagem, e os pediatras precisam reforçar o hábito de ler e dos jogos e brincadeiras para estimular o desenvolvimento infantil.

Análise da influência do momento do ingresso em creches no desenvolvimento infantil / Analysis of the influence of the timing of enrollment in daycares on child development / Análisis de la influencia del momento de ingreso a las guarderías en el desarrollo infantil

Este estudo objetivou analisar a relação entre a idade de ingresso nos programas de educação na primeira infância (EPI) e o desenvolvimento infantil. Trata-se de um estudo transversal com dados oriundos da Coorte de Nascimentos da Região Oeste de São Paulo, Brasil. Realizou-se o acompanhamento de crianças nascidas no Hospital Universitário da Universidade de São Paulo durante 36 meses, entre os anos de 2012 e 2014, e de seus cuidadores respondentes durante a onda de seguimentos dos 36 meses de idade (realizada entre os anos de 2015 e 2017). O desenvolvimento infantil foi mensurado pelo instrumento Engle Scale do Projeto Regional de Indicadores de Desenvolvimento Infantil (PRIDI). Os programas de EPI foram avaliados em relação a sua qualidade. Foram utilizadas como variáveis expositivas as características sociais das crianças e dos seus cuidadores, bem como as características do contexto econômico e familiar. A amostra foi composta por 472 crianças e cuidadores. Observou-se que o ingresso na creche entre 13 e 29 meses foi o mais frequente. Quando considerados isoladamente, observou-se que uma maior idade de ingresso esteve associada com maior escore de desenvolvimento [β = 0,21, IC95%: 0,02; 0,40, p = 0,027]. Após a inclusão das variáveis de ajuste nos modelos de regressão, observou-se que estar inscrito em instituição do tipo privada, tempo total de aleitamento materno, horas trabalhadas fora de casa pelo cuidador principal e o controle inibitório foram determinantes para explicar o desenvolvimento infantil aos 36 meses na amostra. A idade de ingresso mais tardia nos programas de EPI pode ter efeito positivo sobre o desenvolvimento infantil aos 36 meses de idade, porém esses achados precisam ser ponderados.

This study aimed to analyze the relationship between the age of enrollment into early childhood education (ECE) programs and child development. This is a cross-sectional study using data from the Birth Cohort of the Western Region of São Paulo, Brazil, with a 36-month follow-up of children born at the University Hospital of the University of São Paulo from 2012 to 2014, and their caregivers who participated in the 36-month follow-up conducted from 2015 to 2017. Child development was measured by the Engle Scale of the Regional Project on Child Development Indicators (PRIDI). ECE programs were evaluated in relation to their quality. The social characteristics of the children and their caregivers, as well as the characteristics of the economic and family context, were used as exposure variables. Our sample consisted of 472 children and their parents/caregivers. The enrollment into daycare from 13 and 29 months was the most frequent. When considered alone, a higher age of enrollment was associated with higher development score [β = 0.21, 95%CI: 0.02; 0.40, p = 0.027]. After adjusting for confounding variables in the regression models, it was observed that being enrolled in a private institution, total time of breastfeeding, time spent by the main caregiver working outside home, and inhibitory control were determinants in explaining the infant development at 36 months in the sample. Older age of entry into ECE programs may have a positive effect on infant development at 36 months of age, but these findings must be carefully considered.

Este estudio tuvo como objetivo analizar la relación entre la edad de ingreso a los programas de educación infantil (EPI) y el desarrollo infantil. Se trata de un estudio transversal con datos de la Cohorte de Nacimientos de la Región Oeste de São Paulo, Brasil, con seguimiento de 36 meses de niños nacidos en el Hospital Universitario de la Universidad de São Paulo entre 2012 y 2014 y sus cuidadores durante la ola de seguimientos de los 36 meses de edad (realizada entre los años de 2015 y 2017). El desarrollo infantil se midió utilizando el instrumento Engle Scale do Proyecto Regional de Indicadores de Desarollo Infantil (PRIDI). Los programas de EPI fueron evaluados por su calidad. Se utilizaron como variables expositivas las características sociales de los niños y sus cuidadores, así como las características del contexto económico y familiar. La muestra estuvo compuesta por 472 niños y cuidadores. Se observó que el ingreso a la guardería entre 13 y 29 meses fue el más frecuente. Cuando considerados aisladamente, se observó que una mayor edad de ingreso estuvo asociada con mayor puntuación de desarrollo [β = 0,21, IC95%; 0,02; 0,40, p = 0,027]. Luego de incluir las variables de ajuste en los modelos de regresión, se observó que el estar matriculado en una institución privada, el tiempo total de lactancia, las horas trabajadas fuera del hogar por el cuidador principal y el control inhibitorio fueron determinantes para explicar el desarrollo infantil a los 36 meses de la muestra. La edad de ingreso más tardía en los programas de EPI puede tener un efecto positivo sobre el desarrollo infantil a los 36 meses de edad, pero estos hallazgos necesitan ser ponderados. cia al parto y nacimiento, con seguridad y cuidado, sin afectar los resultados.

Análise da influência do momento do ingresso em creches no desenvolvimento infantil / Analysis of the influence of the timing of enrollment in daycares on child development / Análisis de la influencia del momento de ingreso a las guarderías en el desarrollo infantil

Este estudo objetivou analisar a relação entre a idade de ingresso nos programas de educação na primeira infância (EPI) e o desenvolvimento infantil. Trata-se de um estudo transversal com dados oriundos da Coorte de Nascimentos da Região Oeste de São Paulo, Brasil. Realizou-se o acompanhamento de crianças nascidas no Hospital Universitário da Universidade de São Paulo durante 36 meses, entre os anos de 2012 e 2014, e de seus cuidadores respondentes durante a onda de seguimentos dos 36 meses de idade (realizada entre os anos de 2015 e 2017). O desenvolvimento infantil foi mensurado pelo instrumento Engle Scale do Projeto Regional de Indicadores de Desenvolvimento Infantil (PRIDI). Os programas de EPI foram avaliados em relação a sua qualidade. Foram utilizadas como variáveis expositivas as características sociais das crianças e dos seus cuidadores, bem como as características do contexto econômico e familiar. A amostra foi composta por 472 crianças e cuidadores. Observou-se que o ingresso na creche entre 13 e 29 meses foi o mais frequente. Quando considerados isoladamente, observou-se que uma maior idade de ingresso esteve associada com maior escore de desenvolvimento [β = 0,21, IC95%: 0,02; 0,40, p = 0,027]. Após a inclusão das variáveis de ajuste nos modelos de regressão, observou-se que estar inscrito em instituição do tipo privada, tempo total de aleitamento materno, horas trabalhadas fora de casa pelo cuidador principal e o controle inibitório foram determinantes para explicar o desenvolvimento infantil aos 36 meses na amostra. A idade de ingresso mais tardia nos programas de EPI pode ter efeito positivo sobre o desenvolvimento infantil aos 36 meses de idade, porém esses achados precisam ser ponderados.

This study aimed to analyze the relationship between the age of enrollment into early childhood education (ECE) programs and child development. This is a cross-sectional study using data from the Birth Cohort of the Western Region of São Paulo, Brazil, with a 36-month follow-up of children born at the University Hospital of the University of São Paulo from 2012 to 2014, and their caregivers who participated in the 36-month follow-up conducted from 2015 to 2017. Child development was measured by the Engle Scale of the Regional Project on Child Development Indicators (PRIDI). ECE programs were evaluated in relation to their quality. The social characteristics of the children and their caregivers, as well as the characteristics of the economic and family context, were used as exposure variables. Our sample consisted of 472 children and their parents/caregivers. The enrollment into daycare from 13 and 29 months was the most frequent. When considered alone, a higher age of enrollment was associated with higher development score [β = 0.21, 95%CI: 0.02; 0.40, p = 0.027]. After adjusting for confounding variables in the regression models, it was observed that being enrolled in a private institution, total time of breastfeeding, time spent by the main caregiver working outside home, and inhibitory control were determinants in explaining the infant development at 36 months in the sample. Older age of entry into ECE programs may have a positive effect on infant development at 36 months of age, but these findings must be carefully considered.

Este estudio tuvo como objetivo analizar la relación entre la edad de ingreso a los programas de educación infantil (EPI) y el desarrollo infantil. Se trata de un estudio transversal con datos de la Cohorte de Nacimientos de la Región Oeste de São Paulo, Brasil, con seguimiento de 36 meses de niños nacidos en el Hospital Universitario de la Universidad de São Paulo entre 2012 y 2014 y sus cuidadores durante la ola de seguimientos de los 36 meses de edad (realizada entre los años de 2015 y 2017). El desarrollo infantil se midió utilizando el instrumento Engle Scale do Proyecto Regional de Indicadores de Desarollo Infantil (PRIDI). Los programas de EPI fueron evaluados por su calidad. Se utilizaron como variables expositivas las características sociales de los niños y sus cuidadores, así como las características del contexto económico y familiar. La muestra estuvo compuesta por 472 niños y cuidadores. Se observó que el ingreso a la guardería entre 13 y 29 meses fue el más frecuente. Cuando considerados aisladamente, se observó que una mayor edad de ingreso estuvo asociada con mayor puntuación de desarrollo [β = 0,21, IC95%; 0,02; 0,40, p = 0,027]. Luego de incluir las variables de ajuste en los modelos de regresión, se observó que el estar matriculado en una institución privada, el tiempo total de lactancia, las horas trabajadas fuera del hogar por el cuidador principal y el control inhibitorio fueron determinantes para explicar el desarrollo infantil a los 36 meses de la muestra. La edad de ingreso más tardía en los programas de EPI puede tener un efecto positivo sobre el desarrollo infantil a los 36 meses de edad, pero estos hallazgos necesitan ser ponderados. cia al parto y nacimiento, con seguridad y cuidado, sin afectar los resultados.

Association between maternal lifestyle and preschool nutrition.

INTRODUCTION:: Many of the health behaviors involved in the emergence of chronic non-communicable diseases (CNCD) are originated in childhood under parental influence. Mothers are the ones most involved in the education and health care of children. Lifestyle (LS) is a social determinant of health. Very few studies tried to understand the influence of maternal LS on child nutrition. OBJECTIVE:: To verify the association between maternal behavioral and non-behavioral LS and nutritional aspects in preschool children. METHOD:: From January 2010 to December 2010, we performed a cross-sectional study with 255 mothers of preschool children who were residents of five different sub-districts in southwestern São Paulo. A proportional stratified random sample was selected using two layers ("schools" and "children"). From the mother, sociodemographic and LS information were collected. From the child, data on anthropometry, sedentary behavior and food intake were collected. The association was calculated using chi-square test and logistic regression. RESULTS:: Children who ate minimally processed food were born from mothers with more socially aware non-behavioral LS, while children that ate more processed food were born from mothers with more consumerist non-behavioral LS. No association was found between nutritional characteristics of preschoolers and types of maternal behavioral LS. Children presenting "sedentary behavior" and the habit of eating "ultra-processed foods" had 113% and 84% higher chances, respectively, of being born to mothers that belonged to the "consumerist" cluster. CONCLUSION:: Mothers living a consumerist lifestyle can promote negative influences on child nutrition.

Differences in children and adolescents with SARS-CoV-2 infection: a cohort study in a Brazilian tertiary referral hospital

OBJECTIVES: To compare demographic/clinical/laboratory/treatments and outcomes among children and adolescents with laboratory-confirmed coronavirus disease 2019 (COVID-19). METHODS: This was a cross-sectional study that included patients diagnosed with pediatric COVID-19 (aged <18 years) between April 11, 2020 and April 22, 2021. During this period, 102/5,951 (1.7%) of all admissions occurred in neonates, children, and adolescents. Furthermore, 3,962 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection samples were processed in patients aged <18 years, and laboratory-confirmed COVID-19 occurred in 155 (4%) inpatients and outpatients. Six/155 pediatric patients were excluded from the study. Therefore, the final group included 149 children and adolescents (n=97 inpatients and 52 outpatients) with positive SARS-CoV-2 results. RESULTS: The frequencies of sore throat, anosmia, dysgeusia, headache, myalgia, nausea, lymphopenia, pre-existing chronic conditions, immunosuppressive conditions, and autoimmune diseases were significantly reduced in children and adolescents (p<0.05). Likewise, the frequencies of enoxaparin use (p=0.037), current immunosuppressant use (p=0.008), vasoactive agents (p=0.045), arterial hypotension (p<0.001), and shock (p=0.024) were significantly lower in children than in adolescents. Logistic regression analysis showed that adolescents with laboratory-confirmed COVID-19 had increased odds ratios (ORs) for sore throat (OR 13.054; 95% confidence interval [CI] 2.750-61.977; p=0.001), nausea (OR 8.875; 95% CI 1.660-47.446; p=0.011), and lymphopenia (OR 3.575; 95% CI 1.355-9.430; p=0.010), but also had less hospitalizations (OR 0.355; 95% CI 0.138-0.916; p=0.032). The additional logistic regression analysis on patients with preexisting chronic conditions (n=108) showed that death as an outcome was significantly associated with pediatric severe acute respiratory syndrome (SARS) (OR 22.300; 95% CI 2.341-212.421; p=0.007) and multisystem inflammatory syndrome in children (MIS-C) (OR 11.261; 95% CI 1.189-106. 581; p=0.035). CONCLUSIONS: Half of the laboratory-confirmed COVID-19 cases occurred in adolescents. Individuals belonging to this age group had an acute systemic involvement of SARS-CoV-2 infection. Pediatric SARS and MIS-C were the most important factors associated with the mortality rate in pediatric chronic conditions with COVID-19.

Relation between birth weight, growth, and subclinical atherosclerosis in adulthood.

BACKGROUND AND OBJECTIVES: Adverse conditions in the prenatal environment and in the first years of life are independently associated with increased risk for cardiovascular disease. This paper aims to study the relation between birthweight, growth in the first year of life, and subclinical atherosclerosis in adults. METHODS: 88 adults aged between 20 and 31 were submitted to sociodemographic qualities, anthropometric data, blood pressure measurements, metabolic profile, and evaluation of subclinical atherosclerosis. RESULTS: Birthweight<2,500 grams (g) was negatively correlated with (a) increased waist-to-hip ratio (WHR), according to regression coefficient (RC) equal to -0.323, 95% CI [-0.571, -0.075] P<0.05; (b) diastolic blood pressure (RC=-4.744, 95% CI [-9.017, -0.470] P<0.05); (c) low HDL-cholesterol (RC=-0.272, 95% CI [-0.516, -0.029] P<0.05); (d) frequency of intima-media thickness (IMT) of left carotid>75th percentile (RC=-0.242, 95% CI [-0.476, -0.008] P<0.05). Birthweight>3,500 g was associated with (a) BMI>25.0 kg/m2, (RC=0.317, 95% CI [0.782, 0.557] P<0.05); (b) increased waist circumference (RC=0.284, 95% CI [0.054, 0.513] P<0.05); (c) elevated WHR (RC=0.280, 95% CI [0.054, 0.505] P<0.05); (d) minimum subcutaneous adipose tissue (SAT) (RC=4.354, 95% CI [0.821, 7.888] P<0.05); (e) maximum SAT (RC=7.095, 95% CI [0.608, 13.583] P<0.05); (f) right lobe of the liver side (RC=6.896, 95% CI [1.946, 11.847] P<0.001); (g) frequency's right lobe of the liver>75th percentile (RC=0.361, 95% CI [0.169, 0.552] P<0.001). Weight gain in the first year of life was inversely correlated with (a) mean IMT of left carotid (RC=-0.046, 95% CI [-0.086, -0.006] P<0.05; (b) frequency IMT of left carotid>75th percentile (RC=-0.253, 95% CI [-0.487, -0.018] P<0.05); (c) mean IMT (RC=-0.038, 95% CI [0.073, -0.002] P<0.05); (d) the frequency of the mean IMT>75th percentile (RC=-0.241, 95% CI [-0.442, -0.041] P<0.05). CONCLUSIONS: Adults birthweight<2,500 g and >3,500 g and with insufficient weight gain in the first year of life have showed different metabolic phenotypes, but all of them were related to subclinical atherosclerosis.

The intergenerational effects on birth weight and its relations to maternal conditions, São Paulo, Brazil.

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

The effects of a people-centred model on longitudinality of care and utilization pattern of healthcare services--Brazilian evidence.

Brazil is experiencing a time of change in pattern of care: from 'traditional' to Family Health Strategy (FHS), a model guided by the principles of people, family and community-centred medicine. The heterogeneity in care currently offered affects the primary care impact. This study aims to evaluate the longitudinality of care and correlate this primary care principle to the utilization pattern of care among patients hospitalized due to preventable conditions, comparing the two care models currently offered in Brazil. It is a cross-sectional, analytical and descriptive study with a quantitative approach. The sample consisted of 501 patients from 0 to 14 years old. Data was collected in 2011 and the Primary Care Assessment Tool (PCATool-Brazil) child version was used. Bivariate and multivariate analyses were performed including patient-related variables (age, maternal education, income and type of diagnosis) and care model. From the hospitalizations occurred during the period, 65.2% were Ambulatory Care Sensitive Conditions. Patients evaluated 'longitudinality' as regular. Both the care continuity dimension and the utilization pattern of care services showed a link with the care model offered. Findings suggest that the FHS care model, based on the assumptions of people-centred medicine, was associated with better ratings of care continuity, which was reflected in a more appropriate utilization pattern of care services.

Association between maternal lifestyle and preschool nutrition / Associação do estilo de vida materno com a nutrição de pré-escolares

Summary Introduction: Many of the health behaviors involved in the emergence of chronic non-communicable diseases (CNCD) are originated in childhood under parental influence. Mothers are the ones most involved in the education and health care of children. Lifestyle (LS) is a social determinant of health. Very few studies tried to understand the influence of maternal LS on child nutrition. Objective: To verify the association between maternal behavioral and non-behavioral LS and nutritional aspects in preschool children. Method: From January 2010 to December 2010, we performed a cross-sectional study with 255 mothers of preschool children who were residents of five different sub-districts in southwestern São Paulo. A proportional stratified random sample was selected using two layers (“schools” and “children”). From the mother, sociodemographic and LS information were collected. From the child, data on anthropometry, sedentary behavior and food intake were collected. The association was calculated using chi-square test and logistic regression. Results: Children who ate minimally processed food were born from mothers with more socially aware non-behavioral LS, while children that ate more processed food were born from mothers with more consumerist non-behavioral LS. No association was found between nutritional characteristics of preschoolers and types of maternal behavioral LS. Children presenting “sedentary behavior” and the habit of eating “ultra-processed foods” had 113% and 84% higher chances, respectively, of being born to mothers that belonged to the “consumerist” cluster. Conclusion: Mothers living a consumerist lifestyle can promote negative influences on child nutrition.

Resumo Introdução: muitos dos comportamentos de saúde envolvidos no aparecimento das doenças crônicas não comunicáveis são originados na infância sob influência dos pais. A mãe é a pessoa mais envolvida na educação e nos cuidados de saúde da criança. O estilo de vida (EdV) é um determinante social da saúde. Poucos estudos compreenderam a influência do EdV materno na nutrição infantil. Objetivo: verificar a associação do EdV materno comportamental e não comportamental com aspectos nutricionais do pré-escolar. Método: entre janeiro e dezembro de 2010, realizou-se um estudo transversal com 255 pares de mães-pré-escolares moradoras de cinco subdistritos da região sudoeste, do município de São Paulo. Selecionou-se uma amostra probabilística aleatória estratificada proporcional, com dois estratos (“escola” e “criança”). Da mãe, foram coletadas informações sociodemográficas e de EdV. Da criança, foram coletadas informações antropométricas, de comportamento sedentário e consumo alimentar. As associações foram calculadas por meio do teste do qui-quadrado e por regressão logística. Resultados: as crianças com alimentação “minimamente processada” eram filhas de mães com EdV não comportamental mais “socioconsciente”, enquanto as crianças com alimentação “ultraprocessada” eram filhas de mães com EdV não comportamental mais do tipo “consumista”. Nenhuma associação foi encontrada entre as características nutricionais do pré-escolar e os tipos de EdV materno comportamental. As crianças com “comportamento sedentário presente” e alimentação “ultraprocessada” tiveram chances 113 e 84% maiores, respectivamente, de serem filhas de mães pertencentes ao cluster “consumista”. Conclusão: mães com EdV do tipo “consumista” podem proporcionar influências negativas na nutrição infantil.

Análise econômica da quimiorradioterapia concomitante em pacientes portadores de carcinoma espinocelular de cabeça e pescoço / Economic analysis of chemo radiotherapy in head and neck cancer

INTRODUÇÃO: O presente trabalho teve como objetivo elaborar análise custoefetividade do esquema de quimiorradioterapia com cisplatina (estratégia 2) comparado ao tratamento radioterápico (estratégia 1) para pacientes portadores de CECCP localmente avançado não elegíveis para tratamento cirúrgico. MÉTODOS: levantamos dados prospectivos de 33 pacientes na estratégia 2 e dados retrospectivos de 29 pacientes tratados no HC-FMUSP e Hospital A.C. Camargo, (estratégia 1). Consideramos a tabela de reembolso do Sistema Único de Saúde (perspectiva SUS) e custos do HC-FMUSP com honorários profissionais, medicamentos, demais insumos e depreciação de equipamentos (perspectiva Institucional). A medida de efetividade foi 1 ano de vida ganho, livre de progressão da doença (SLPD). Calculamos a Razão Incremental Custo Efetividade (RICE). RESULTADOS: 31% dos pacientes da estratégia 1 e 58% na estratégia 2) tiveram 1 ano de SLPD. Na perspectiva SUS o custo total por paciente na estratégia 1 foi de R$ 2.798,52 e R$ 4.938,11 na estratégia 2. Na perspectiva institucional os custos foram R$ 26.798,52 e R$ 5.040,79, respectivamente. A RICE na perspectiva SUS foi de R$ 7.924,00 reais por ano de vida ganho e R$ 8.912,71 na perspectiva institucional. CONCLUSÃO: nas duas perspectivas a estratégia 2 se mostrou custo-efetiva, sendo o custo incremental considerado aceitável, segundo diretrizes do Banco Mundial.

INTRODUCTION: The present study aims to conduct a cost-effectiveness analysis comparing chemoradiotherapy with cisplatine and radiotherapy alone, to treat inoperative advanced head and neck cancer. METHODS: we collected data from 29 patients in a prospective study on chemoradiotherapy with cisplatin, conducted at Hospital das Clínicas HC-FMUSP,(strategy 2). For strategy 1, we collected retrospective data of 33 patients treated with radiotherapy at HC-FMUSP and Hospital A.C. Camargo. We considered only direct costs (personnel, drugs, material and equipment depreciation). We considered, the National Health Service (SUS) reimbursement parameters as the National Security System perspective, and HC-FMUSP costs as the institutional perspectives. We measured effectiveness as one year of diseasefree life gained. We collected costs and effectiveness data and calculated the cost-effectiveness incremental ratio ICER, which expresses additional costs per life year gained, in strategy 2, compared to strategy 1 RESULTS: 31.0% of the patients treated in strategy 1 lived more than 12 months, without disease progression, compared to 58.0% of the patients in strategy 2. According to SUS perspective, the total cost per patient in strategy 1) is R$ 2.798,52 and R$ 4.938,11 in strategy 2. Considering the institutional perspective, total costs are R$ 2.634,36, and R$ 5.040,79 respectively. In SUS perspective, the ICER ratio of strategy 2 compared to 1 is R$ 7.924,00 per lifes year gained. In the institutional perspective, ICER is R$ 8.912,71. We conducted a one way sensitivity analysis to verify our calculations. CONCLUSION: Chemoradioterapy with cisplatin proved more cost-effective than radiotherapy. Using the World Bank guidelines, wich considers the countries GDP per capita an acceptable cost per additional year of life (R$ 12.491,00 in 2006), the incremental cost of both is acceptable.