Differential impact of endurance, strength, or combined training on quality of life and plasma serotonin in healthy older women.

Aging is associated with a progressive decline in physical and neurophysiological functions, and some studies suggest that cerebral serotonin is decreased in older adults. These factors contribute to reduced ability to perform daily activities, influencing quality of life (QoL). Regular physical activity has demonstrated important benefits in reversing ageing effects; however, little is known whether different training protocols might induce differential effects on QoL. The aim of this study was to verify the effects of different types of training on QoL and its relation with plasma serotonin in healthy older women. Forty-eight older women were randomly assigned in four groups: Strength Training (ST), Endurance Training (ET), Combined Training (CT), and Control Group (CG) which was instructed not to engage in any physical exercise during the study time. Participants underwent 12 weeks of training twice a week. Plasma serotonin and a scoring system questionnaire SF-36 for evaluation of QoL were assessed at baseline and after the completion of training protocols. When comparing pre- and post-training periods all trained groups showed improvement in QoL, but the CT improved more domains. Plasma serotonin was significantly lower in the ST and in the CT groups in comparison with controls after the 12-week training. Significant correlations of plasma serotonin with physical functioning, role-physical, general health, vitality, and mental health were observed. CT resulted in higher amelioration in QoL, in comparison with ET or ST only. All training protocols induced significant reductions in peripheral serotonin levels, which were negatively correlated with improvements in QoL.

Effects of Eccentric-Focused Versus Conventional Training on Lower Limb Muscular Strength in Older People: A Systematic Review With Meta-Analysis.

Eccentric-focused training promotes greater gains in muscle strength compared to other types of training in adults. However, for older people, these findings are still not well understood. A systematic review and meta-analysis were performed using manuscripts that performed eccentric-focused (ET) and conventional resistance training (CT) at least four weeks and evaluated maximum muscle strength through tests of maximum repetitions in weight machine exercises (knee extension and leg press exercises). Five studies were included (n=138). Increases in muscle strength were found in both resistance training groups, without difference between them through meta-analysis. However, a large effect size has been observed only in ET. The findings suggest that resistance training protocols are similar to improve maximal strength in older people, despite larger effect sizes for eccentric-focused training.

Burden of asthma among inner-city children from Southern Brazil.

OBJECTIVE: To assess the impact of asthma in a population of inner-city Brazilian children. METHODS: In a cross-sectional study, we selected children with asthma and healthy controls from public schools (8-16 years) from a capital city of Southern Brazil. Divided into three phases, questionnaires were administered, assessing lung function, body mass index and allergic sensitization. RESULTS: From 2500 children initially included in the study (48.4% males; mean age of 11.42 ± 2.32 years), asthma prevalence was detected in 28.6% (715/2500). The disease was not controlled in 42.7% (305/715) of the children, with 7.6% of hospitalization rate. School absenteeism (at least one day of missing school because of asthma) and sedentary behavior were high (57.1 and 67.2%, respectively), with 47.9% of subjects requiring oral steroids in the previous year, and physical well-being significantly lower than controls, directly interfering with quality of life, and therefore in the daily activities of these students. Moreover, 38% of the parents admitted to being non-adherent to treatment with their children and 31.1 and 53.6%, respectively, believed that rescue medication and exercise might be harmful. CONCLUSIONS: The burden of asthma in Brazilian children seems to be substantial. New international guidelines with a special focus in developing countries settings, with more pragmatic approaches, should be a priority for discussion and implementation actions.

RELATIONSHIP BETWEEN SCHOOLCHILDREN'S LEVELS OF PHYSICAL ACTIVITY, ANTHROPOMETRIC INDICES AND PULMONARY FUNCTION.

OBJECTIVE: To evaluate and to correlate levels of physical activity with the pulmonary function of children with and without a diagnosis of asthma. METHODS: This study was conducted in two phases with schoolchildren aged between eight and 16 years old in Porto Alegre/RS. In the first phase (cross sectional), the sample was classified as asthmatic if a physician had ever diagnosed them with asthma and if they reported symptoms and treatment for the disease in the past 12 months. In the second phase (control-case), the following were measured: anthropometry, physical activity levels, time spent in front of screens, and lung function (spirometry). Data are presented in mean and standard deviation or median and interquartile interval and by absolute and relative values. Chi-square, Student's t-test or Mann-Whitney test and Spearman correlation were applied, with p<0.05 being significant. RESULTS: 605 students participated in the study, 290 children with a clinical diagnosis of asthma and 315 classified as a control. 280 (47.3%) were male children, with an average age of 11.0±2.3 years old. The spirometric values showed differences in the classifications of airway obstruction levels between the asthma and control groups (p=0.005), as well as in the response to bronchodilator use for FEV1/FVC (p=0.023). In the correlation assessment, there was no correlation between physical activity with anthropometric values, nor with pulmonary function, pre-and post-bronchodilator. CONCLUSIONS: The study demonstrates that there is no relationship between either anthropometric values or physical activity levels with pulmonary function of asthmatic children.

PEDIATRIC ASTHMA: IMPACT OF THE DISEASE IN CHILDREN RECEIVING OUTPATIENT TREATMENT IN SOUTHERN BRAZIL.

OBJECTIVE: To evaluate the impact of pediatric asthma on patients of a specialized outpatient clinic in Southern Brazil. METHODS: The study included children aged 8 to 17 years old with asthma diagnosis (mild, moderate and severe) under treatment at the asthma clinic of Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Brazil. Measurements of spirometry, quality of life, disease control and atopy tests were applied. RESULTS: A total of 66 children were included in the study and divided into groups, according to the severity of the disease: mild, moderate or severe asthma. The results showed similarities in both the treatment and the impact of asthma between groups, except for adherence to treatment: the group with mild asthma showed least adherence to treatment, and the group with severe asthma, greater adherence (p=0.011). As to school absenteeism, the group with severe asthma showed higher frequency (p=0.012), with over 10 days per year (p=0.043). Spirometry showed lower volume/capacity for the group with moderate asthma, followed by the groups with severe and mild asthma. All groups had a high prevalence of allergic asthma, with mites as the main allergens. For quality of life (QOL), and health-related quality of life (HRQOL) levels, there were no differences between groups. In addition, the values were close to the acceptable levels for the total score and for each one of the six domains. The same occurred for the HRQOL-asthma module. CONCLUSIONS: QOL and HRQOL present acceptable levels regardless of the severity of the disease.

Comparison between the health-related quality of life of children/adolescents with asthma and that of their caregivers: a systematic review and meta-analysis.

OBJECTIVE: To evaluate the health-related quality of life (HRQoL) of children/adolescents with asthma and that of their caregivers, comparing the two. METHODS: This was a systematic review and meta-analysis based on the criteria of Preferred Reporting Items for Systematic Reviews and Meta-Analyses, with a strategy of searching five health-related databases (MEDLINE/PubMed, EMBASE, ScienceDirect, SciELO, and LILACS). We included studies that evaluated the HRQoL of children/adolescents with asthma and that of their caregivers with the Pediatric Asthma Quality of Life Questionnaire and the Pediatric Asthma Caregiver's Quality of Life Questionnaire, respectively, using the total scores and the scores on the domains activity limitation, symptoms (children/adolescents only), and emotional function. RESULTS: We identified 291 articles, and we evaluated 133 of those. A total of 33 articles, collectively including 4,101 subjects, were included in the meta-analysis. An analysis stratified by study design showed no differences between the HRQoL of the caregivers and that of the children/adolescents in the activity limitation domain and in the total score. However, the mean emotional function domain scores were significantly higher (better) among children/adolescents with asthma than among their caregivers in longitudinal studies-Δ = 0.82 (0.21-1.44)-and randomized clinical trials-Δ = 0.52 (0.29-0.79)-although not in cross-sectional studies-Δ = -0.20 (-0.03 to 0.43). CONCLUSIONS: The total HRQoL scores proved to be similar between children/adolescents with asthma and their caregivers. However, the two groups differed in their perception of their emotional function, the caregivers scoring significantly lower than the children/adolescents in that domain.

Prevalence and impact of asthma in schoolchildren in the city of Caxias do Sul-RS.

OBJECTIVE: To analyze the prevalence and impact of asthma in schoolchildren from the city of Caxias do Sul, RS, Brazil. METHODS: Cross-sectional observational and case-control study with children and adolescents between 7 and 15 years old, from public schools in Caxias do Sul, RS. The study is composed of two phases: Phase I analyzed the prevalence of asthma in the delimited population, investigating 1915 schoolchildren; Phase II quality of life questionnaires, asthma control and classification (for the asthmatic group), physical activity, school performance, pulmonary function tests and anthropometric measures were applied to 266 asthmatics and 288 controls. RESULTS: The estimated prevalence of asthma was 16.1%. In the comparison between asthmatics and nonasthmatics premature birth (p<0.001) and diagnosis of another chronic disease at birth (p<0.001) were found. Regarding pulmonary function, significant differences were found in the values between groups in FEV1, FEV1/FVC and forced expiratory flow in the 25 and 75% (FEF25-75%), being that asthmatics presented lower values. Among asthmatics, 133 (50.8%) did not have the disease controlled. In the anthropometric variables, significant differences were observed, with higher values in controls, in the the waist-to-height ratio (p=0.009) and in the perception of health (p<0.001). Quality of life is lower in asthmatics in the physical well-being domain (p=0.001) and in the total score (p=0.016). The total school performance score did not present a statistically significant difference between the groups. CONCLUSION: The prevalence of asthma is similar to that of other industrialized urban centers and may negatively affect some areas of the development of schoolchildren.

Effect of physical activity on asthma control in schoolchildren.

OBJECTIVE: To investigate the effect of levels of physical activity on asthma control in children. METHODS: A cross-sectional study, including public school students aged 8 to 12 years, of both sexes, with asthma, from a capital and a medium-sized cities in Southern Brazil. At home, the students answered the questionnaire on levels of physical activity and disease control. RESULTS: A total of 482 schoolchildren with asthma participated in the study, with mean age of 10.9±2.2 years, and 253 (52%) were girls. Regarding disease control, 50% had controlled asthma, and 67% were considered sedentary. Schoolchildren with controlled asthma were more active than those with uncontrolled asthma (p=0.032). Active schoolchildren were more likely to have asthma controlled (OR=1.5; 95%CI: 1.04-2.25). CONCLUSION: The results demonstrated an association between physical activity levels and asthma control. More active schoolchildren were more likely to have asthma controlled.

Asthma control in the quality of life levels of asthmatic patients' caregivers: a systematic review with meta-analysis and meta-regression.

OBJECTIVE: To perform a systematic review with meta-analysis and meta-regression to correlate the total scores of asthma control with the increase in the total scores of health-related quality of life levels of parents of asthmatic children. SOURCES: The search was carried out in the following databases: PubMed (MEDLINE); Embase and ScienceDirect (Elsevier); SciELO and LILACs (Bireme) in June 2017. The included studies assessed asthma control through the Asthma Control Questionnaire (ACQ), Asthma Control Test (C-ACT/ACT), and Global Initiative for Asthma (GINA) questionnaires, whereas the Pediatric Asthma Caregiver's Quality of Life Questionnaire (PACQLQ) was applied to assess the HRQoL of parents and family members. SUMMARY OF THE FINDINGS: 294 articles were evaluated in the selected databases, of which (n=38) were excluded for duplicity; (n=239) after the reading of the titles and abstracts and (n=5) after reading the studies in full, totaling 12 studies eligible for the meta-analysis. Of the 12 eligible articles, 11 (92%) were published in the last five years, and evaluated children and adolescents aged 1-20 years, totaling 2804 samples. In the evaluation of the correlation between the disease control scores by ACQ and C-ACT/ACT, the results were satisfactory for both ACQ analyses [R2: -0.88; p<0.001], and for C-ACT/ACT [R2: 0.82; p<0.001]. CONCLUSIONS: The results show that asthma control levels can influence the total HRQoL scores of parents or relatives of children and adolescents with asthma.

COMPARISON OF TWO INHALATIONAL TECHNIQUES FOR BRONCHODILATOR ADMINISTRATION IN CHILDREN AND ADOLESCENTS WITH ACUTE ASTHMA CRISIS: A META-ANALYSIS. / COMPARAÇÃO DE DUAS TÉCNICAS INALATÓRIAS PARA ADMINISTRAR BRONCODILATADOR EM CRIANÇAS E ADOLESCENTES COM CRISE AGUDA DE ASMA: METANÁLISE.

OBJECTIVE: To compare the efficacy of pediatric asthma treatment by nebulizer and metered-dose inhaler with the use of a spacer (MDI-spacer) in rescue techniques for asthmatic patients assisted at pediatric emergency units. DATA SOURCES: A systematic review was conducted to identify the most relevant randomized controlled trials comparing the administration of a bronchodilator (ß-2 agonist) by two inhalation techniques (nebulization and MDI-spacer) to treat asthma in children at pediatric emergency units. The following databases were searched: PubMed, Scientific Electronic Library Online (SciELO), and ScienceDirect. Two researchers independently applied the eligibility criteria, and only randomized controlled trials that compared both inhalation techniques (nebulization and MDI-spacer) for asthma treatment at pediatric emergency units were included. DATA SYNTHESIS: 212 articles were pre-selected, of which only nine met the eligibility criteria and were included in meta-analysis. Results show no differences between inhalation techniques for any of the four outcomes analyzed: heart rate (difference - Df: 1.99 [95% confidence interval - 95%CI -2.01-6.00]); respiratory rate (Df: 0.11 [95%CI -1.35-1.56]); O2 saturation (Df: -0.01 [95%CI -0.50-0.48]); and asthma score (Df: 0.06 [95%CI -0,26-0.38]). CONCLUSIONS: The findings demonstrate no differences in cardiorespiratory frequency, O2 saturation, and asthma scores upon administration of ß-2 agonist by both inhalation techniques (nebulization and MDI-spacer) to asthmatic patients assisted at pediatric emergency units.

OBJETIVO: Comparar a eficácia no tratamento da asma pediátrica por nebulizador e inalador dosimetrado com uso de espaçador (MDI-espaçador), no emprego das técnicas de resgate de pacientes asmáticos atendidos em emergências pediátricas. FONTES DE DADOS: Realizou-se uma revisão sistemática para identificar os principais estudos randomizados controlados que comparam a administração de broncodilatador (ß-2 agonista) por meio das técnicas inalatórias nebulização e MDI-espaçador no tratamento da asma em unidades de emergência pediátrica. Foram pesquisadas as bases de dados PubMed, Scientific Electronic Library Online (SciELO) e ScienceDirect. Dois pesquisadores, de forma independente, aplicaram os critérios de elegibilidade, sendo incluídos na pesquisa apenas estudos randomizados controlados com o objetivo de comparar as técnicas inalatórias nebulização e MDI-espaçador no tratamento da asma em unidades de emergência pediátrica. SÍNTESE DOS DADOS: Foram pré-selecionados 212 artigos, dos quais apenas nove seguiram os critérios de elegibilidade e foram incluídos na metanálise. Os resultados apontam não existir diferenças nas técnicas inalatórias em nenhum dos quatro desfechos analisados: frequência cardíaca (diferença -Df: 1,99 [intervalo de confiança de 95% - IC95% -2,01-6,00]); frequência respiratória (Df: 0,11 [IC95% -1,35-1,56]); saturação de O2 (Df: -0,01 [IC95% -0,50-0,48]); e escore clínico de asma (Df: 0,06 [IC95% -0,26-0,38]). CONCLUSÕES: Os achados demonstram não haver diferenças na frequência cardiorrespiratória, na saturação de O2 nem nos escores de asma, na administração de ß-2 agonista entre as técnicas inalatórias (nebulizador e MDI-espaçador) em pacientes asmáticos atendidos em emergências pediátricas.

Mite Fauna Assessment in Houses of Two distinct Socioeconomic Groups From Southern Brazil.

House dust mites (HDM) are the main source of aeroallergens worldwide, yet epidemiological differences between socioeconomic factors in association with this medical condition have not been studied in the south region of Brazil. To assess the prevalence of HDM in two socioeconomically distinct populations of patients with allergic asthma or rhinitis, the differences between samples from houses of high-income families and low-income families were analyzed. Mite samples were collected between July and December 2015, in Porto Alegre, Brazil. The HDM were Dermatophagoides pteronyssinus and Dermatophagoides farinae (Hughes; Acari: Pyroglyphidae). Also, other non-pyroglyphid house mites were identified in dust samples: Tyrophagus putrescentiae (Schrank; Acari: Acaridae), Chortoglyphus arcuatus, and Cheyletus malaccensis. Identification of species was performed through morphological keys with a stereomicroscope and a phase optical microscope. A total of 104 homes was evaluated (low-income group: n = 53; high-income group, n = 51). We found a total of 721 mites, representing 11 species, in 93 (89%) houses. In the remaining houses, no mites were found. We observed no significant differences of species composition between the groups studied. However, the number of mites was significantly higher in the low-income group (P < 0.001). D. pteronyssinus was the predominant species detected, with 286 mites (39.6%). D. farinae was not detected in any sample. Our results show that living-rooms from low-income families present higher numbers of HDM.

Levels of knowledge about asthma of parents of asthmatic children.

OBJECTIVE: To evaluate the levels of knowledge about asthma of parents of school children. METHODS: A cross-sectional study was carried out with parents of children with medical diagnosis of asthma (mild, moderate and severe), followed up at an outpatient referral center for childhood asthma in the Southern region of Brazil (Asthma Group). Parents of children with asthma in remission and healthy children were also selected (Control Group). The Newcastle Asthma Knowledge Questionnaire (NAKQ) questionnaire was applied in both groups. RESULTS: A total of 154 parents of children participated in the study; in that, 62 (40.26%) in the Asthma Group, and 92 (59.74%) in the Control Group, with a mean age of 35.60±10.03 years. Of these, 132 (85.7%) were female, and 72 (46.8%) parents studied up to high school. The average score of level of knowledge was 18.06±4.11 points. Only 30.5% parents had acceptable levels of knowledge about asthma, which were more prevalent in the Asthma Group than in the Control Group (41.9% versus 22.8%, p=0.01). The mean score in Newcastle Asthma Knowledge Questionnaire (NAKQ) was higher in the Asthma Group (19.32±3.92 versus 17.21±4.03, p=0.001), respectively. The parents with mild and moderate asthmatic children scored more than those of severe asthma (19.5 and 19.9 versus 18.2 points, p=0.02). CONCLUSION: Most parents had an unsatisfactory level of knowledge about asthma, which reinforces the need for changes in public asthma management programs.

EVALUATION OF QUALITY OF LIFE OF PARENTS AND CAREGIVERS OF ASTHMATIC CHILDREN. / AVALIAÇÃO DA QUALIDADE DE VIDA DE PAIS E CUIDADORES DE CRIANÇAS ASMÁTICAS.

OBJECTIVE: To evaluate and compare the levels of quality of life of parents/caregivers of children with and without diagnosis of asthma. METHODS: Parents of children with asthma (asthma group) undergoing outpatient care and parents of children without asthma or asthma in remission (control group) were selected from public schools. They answered a questionnaire about quality of life (The World Health Organization Quality of Life- WHOQOL-BREF), previously validated for the study population. Domains (physical, psychological, social relations, environment and total score) were compared between groups, as well as the levels of correlation of self-perceived quality of life and satisfaction with health. RESULTS: 101 parents/caregivers were included in the sample, that is, 50 (49.5%) parents of asthmatic children and 51 (50.5%) in the control group. Most parents included in the sample were females (n=89; 88.1%), with mean age of 33.5±10.4 years. When assessing quality of life, the overall score of domains was considered satisfactory, both in general evaluation (68.6±13.4) and in each group (asthma: 62.8±10.7; control: 74.3±13.4; p-value<0.001). Comparison of asthma and control groups showed significant differences in total score and in scores of all domains (p<0.001). CONCLUSIONS: Parents/caregiversof children with asthma have a lower quality of life compared to parents/caregivers of healthy children.

OBJETIVO: Avaliar e comparar os níveis de qualidade de vida (QV) de pais de crianças com e sem diagnóstico médico de asma. MÉTODOS: Foi realizado um estudo com pais e cuidadores de crianças com e sem asma no período de 2015 a 2016. Foram selecionados pais de crianças com asma (grupo asma) em acompanhamento ambulatorial e pais de crianças sem asma ou com asma em remissão (grupo controle) em escolas proximais ao estudo, sendo aplicado um questionário respiratório para classificação da amostra. Para avaliação dos níveis de QV, foi aplicado o instrumento desenvolvido pela Organização Mundial da Saúde (OMS)- The World Health Organization Quality of Life (WHOQOL-BREF), previamente validado para a população em estudo, sendo comparados os domínios físico, psicológico, das relações sociais e do meio ambiente e o escore total, além ter sido realizada correlação entre os níveis de autopercepção da QV e da satisfação com a saúde. RESULTADOS: Participaram do estudo 101 cuidadores de crianças com e sem asma- 50 (49,5%) formaram o grupo asma, e 51 (50,5%), o grupo controle. Amaioria dos genitores é do sexo feminino (n=89; 88,1%), com idade média de 33,5±10,4anos. Naavaliação da QV, o valor do escore total dos domínios foi considerado satisfatório, tanto na avaliação geral (68,6±13,4) quanto por grupos (asma: 62,8±10,7; controle: 74,3±13,4), demonstrando diferenças significativas entre estes em todos domínios estipulados pelo instrumento (p<0,001), bem como no escore total (p<0,001). CONCLUSÕES: Cuidadores de crianças com asma possuem QV significativamente inferior à dos responsáveis por crianças saudáveis.

Impact of omalizumab in children from a middle-income country with severe therapy-resistant asthma: A real-life study.

BACKGROUND: Severe asthma in children is a global health problem. Severe therapy-resistant asthma (STRA) in children is a major clinical challenge due to persistent symptoms despite high doses of corticosteroids and results in high public health costs. Omalizumab (anti-IgE monoclonal antibody) has been described as an effective add-on therapy in these patients. The characteristics of children with STRA from low- and middle-income countries have scarcely been reported, and no real-life study has been published on the effects of omalizumab in this group of patients. The aim of our study is to report the first clinical real-life experiences with omalizumab in Brazilian children with STRA. METHODS: Children (6-18 years old) from a referral center who were diagnosed with STRA were included in this retrospective study based on our clinical databases. The included children had undergone at least 6 months of omalizumab treatment and fulfilled the following initial criteria: 1) >6 years old; 2) a positive skin-prick test for at least one aeroallergen; and 3) a serum total IgE level between 30 and 1500 IU/mL. Clinical and lung function variables were analyzed before and after treatment. RESULTS: Fourteen children (mean age: 11.9 years; percentage female: 72%) were included in this study. Omalizumab treatment significantly increased control of the disease according to a standardized questionnaire administered at every visit (P < 0.0001), ceased hospitalizations in 70% (P = 0.02) of patients, and allowed 8/9 (89%) patients to be weaned off oral steroids (P = 0.004). CONCLUSIONS: In this retrospective report, the use of omalizumab in Brazilian children with STRA significantly improved disease control, decreased hospitalizations, and allowed suspension of continuous oral corticosteroids.

The impact of asthma in Brazil: a longitudinal analysis of data from a Brazilian national database system.

OBJECTIVE:: To present official longitudinal data on the impact of asthma in Brazil between 2008 and 2013. METHODS:: This was a descriptive study of data collected between 2008 and 2013 from an official Brazilian national database, including data on asthma-related number of hospitalizations, mortality, and hospitalization costs. A geographical subanalysis was also performed. RESULTS:: In 2013, 2,047 people died from asthma in Brazil (5 deaths/day), with more than 120,000 asthma-related hospitalizations. During the whole study period, the absolute number of asthma-related deaths and of hospitalizations decreased by 10% and 36%, respectively. However, the in-hospital mortality rate increased by approximately 25% in that period. The geographic subanalysis showed that the northern/northeastern and southeastern regions had the highest asthma-related hospitalization and in-hospital mortality rates, respectively. An analysis of the states representative of the regions of Brazil revealed discrepancies between the numbers of asthma-related hospitalizations and asthma-related in-hospital mortality rates. During the study period, the cost of asthma-related hospitalizations to the public health care system was US$ 170 million. CONCLUSIONS:: Although the numbers of asthma-related deaths and hospital admissions in Brazil have been decreasing since 2009, the absolute numbers are still high, resulting in elevated direct and indirect costs for the society. This shows the relevance of the burden of asthma in middle-income countries. OBJETIVO:: Apresentar dados longitudinais oficiais sobre o impacto da asma no Brasil entre 2008 e 2013. MÉTODOS:: Estudo descritivo de dados extraídos de um banco de dados do governo brasileiro entre 2008 e 2013, no qual foram analisados as hospitalizações e óbitos por asma, bem como o custo das hospitalizações. Foi também realizada uma subanálise geográfica. RESULTADOS:: Em 2013, 2.047 pessoas morreram de asma no Brasil (5 óbitos/dia), com mais de 120.000 hospitalizações por asma. Durante o período de estudo, o número absoluto de óbitos e hospitalizações por asma diminuiu 10% e 36%, respectivamente. No entanto, a taxa de mortalidade hospitalar aumentou aproximadamente 25%. A subanálise geográfica mostrou que as regiões Norte/Nordeste e Sudeste apresentaram as maiores taxas de hospitalização e mortalidade hospitalar por asma, respectivamente. A análise dos estados representativos de cada região mostrou discrepâncias entre as hospitalizações por asma e as taxas de mortalidade hospitalar por asma. Durante o período de estudo, as hospitalizações por asma custaram US$ 170 milhões ao sistema público de saúde. CONCLUSÕES:: Embora os óbitos e hospitalizações por asma no Brasil estejam diminuindo desde 2009, os números absolutos ainda são altos, com elevados custos diretos e indiretos para a sociedade, o que mostra a relevância do impacto da asma em países de renda média.

Asthma and Obesity in Children Are Independently Associated with Airway Dysanapsis.

BACKGROUND: An increase in the prevalence of overweight and asthma has been observed. Both conditions affect negatively lung function in adults and children. The aim of this study was to analyze the effect of overweight and asthma on lung function in children. METHODS: We designed a case-control study of healthy and asthmatic subjects nested within an epidemiological asthma prevalence study in children between 8 and 16 years of age. The effect of asthma and overweight on lung function was assessed by impulse oscillometry and spirometry obtained at baseline and 10-15 min after salbutamol. RESULTS: 188 children were recruited, 114 (61%) were asthmatics and 72 (38%) were overweight or obese. Children with asthma and overweight had a higher FVC (+1.16 z scores, p < 0.001) and higher FEV1 (+0.79 z scores, p = 0.004) and lower FEV1/FVC (-0.54 z scores, p = 0.008) when compared to healthy controls. Compared to normal weight asthmatics, the overweight had higher FVC (+0.78 z scores, p = 0.005) and lower FEV1/FVC (-0.50 z scores, p = 0.007). In the multivariate analysis, overweight was associated with an increase of 0.71 and 0.44 z scores in FVC and FEV1, respectively, and a reduction in FEV1/FVC by 0.40 z scores (p < 0.01 for all). Overweight had no effect on maximal flows and airway resistance at baseline, and this was not modified by inhalation of a bronchodilator. Asthma was also associated with higher post-BD FVC (0.45 z scores, p = 0.012) and FEV1 (0.35 z scores, p = 0.034) but not with FEV1/FVC and FEF25-75%. Two-way analysis of variance did not detect any interaction between asthma and overweight on lung function variables before or after bronchodilator. CONCLUSION: Our results suggest that asthma and overweight are independently associated with airway dysanaptic growth in children which can be further scrutinized using impulse oscillometry. Overweight contributed more to the reduction in FEV1/FVC than asthma in children without increasing airway resistance. Spirometry specificity and sensitivity for obstructive diseases may be reduced in populations with high prevalence of overweight. Adding impedance oscillometry to spirometry improves our understanding of the ventilatory abnormalities in overweight children.

Relationship between schoolchildrens levels of physical activity, anthropometric indices and pulmonary function / Relação entre níveis de atividade física, índices antropométricos e função pulmonar de escolares

ABSTRACT Objective: To evaluate and to correlate levels of physical activity with the pulmonary function of children with and without a diagnosis of asthma. Methods: This study was conducted in two phases with schoolchildren aged between eight and 16 years old in Porto Alegre/RS. In the first phase (cross sectional), the sample was classified as asthmatic if a physician had ever diagnosed them with asthma and if they reported symptoms and treatment for the disease in the past 12 months. In the second phase (control-case), the following were measured: anthropometry, physical activity levels, time spent in front of screens, and lung function (spirometry). Data are presented in mean and standard deviation or median and interquartile interval and by absolute and relative values. Chi-square, Student's t-test or Mann-Whitney test and Spearman correlation were applied, with p<0.05 being significant. Results: 605 students participated in the study, 290 children with a clinical diagnosis of asthma and 315 classified as a control. 280 (47.3%) were male children, with an average age of 11.0±2.3 years old. The spirometric values showed differences in the classifications of airway obstruction levels between the asthma and control groups (p=0.005), as well as in the response to bronchodilator use for FEV1/FVC (p=0.023). In the correlation assessment, there was no correlation between physical activity with anthropometric values, nor with pulmonary function, pre-and post-bronchodilator. Conclusions: The study demonstrates that there is no relationship between either anthropometric values or physical activity levels with pulmonary function of asthmatic children.

RESUMO Objetivo: Avaliar e correlacionar os níveis de atividade física com a função pulmonar de crianças com e sem diagnóstico de asma. Métodos: Estudo realizado em duas fases, em escolares de oito a 16 anos de Porto Alegre (RS). Na fase I (transversal), classificaram-se como asmáticos os escolares com diagnóstico positivo de um médico alguma vez na vida, com crises e tratamento para a doença nos últimos 12 meses. Na fase II (caso controle), foram avaliados: antropometria, níveis de atividade física e tempo gasto em frente às telas e função pulmonar (espirometria). Os dados são apresentados por média e desvio padrão ou mediana e intervalo interquartil e por valores absolutos e relativos, sendo aplicados os testes χ2, t de Student ou de Mann-Whitney e correlação de Spearman, com valor de significância p<0,05. Resultados: Participaram do estudo 605 escolares, 290 crianças com diagnóstico clínico de asma e 315 classificadas como controle. Do total, 280 (47,3%) crianças eram do sexo masculino, com média de idade de 11,0±2,3 anos. Os valores espirométricos demonstraram diferenças nas classificações dos níveis de obstrução das vias aéreas entre grupos asma e controle (p=0,005), além da resposta ao uso de broncodilatador, para o volume expiratório forçado no primeiro segundo (VEF1)/capacidade vital forçada (CVF) (p=0,023). Não houve correlação entre a prática de atividades físicas e valores antropométricos, tampouco entre a função pulmonar e o pré e pós-uso de broncodilatador. Conclusões: O estudo demonstrou não existir relação entre valores antropométricos e níveis de atividade física com a função pulmonar de crianças asmáticas em idade escolar.

Colorectal cancer prevalence linked to human papillomavirus: a systematic review with meta-analysis. / Prevalência de câncer colorretal associado ao papilomavírus humano: uma revisão sistemática com metanálise.

INTRODUCTION:: Colorectal cancer is one of the most prevalent types of tumors worldwide. Deaths caused by these malignant tumors remain high and have stayed practically at the same level for the last few decades. Among the established risk factors for the development of cancer are infections due to pathogens or viruses. Among the viruses, the human papillomavirus (HPV) is the most prevalent, with over 180 strains, 40 of which are directly related to anogenital infections. OBJECTIVE:: Systematically assess the main studies which link HPV to colorectal cancer with meta-analysis. METHODS:: The search strategy adopted was the logic based on specific descriptors (English language), in combination with the Boolean operators (AND/OR). The search was conducted in the following databases: PubMed, ScienceDirect, and Scientific Electronic Library Online (SciELO), between April and May 2015. RESULTS:: 1,549 samples were assessed, with 956 (61.7%) being males. Six hundred thirty out of 1,358 cases of colorectal cancer due to HPV were diagnosed (51.9%). From these, 408 of 767 (51.9%) were male and 404 of 598 (67.5%) were linked to HPV 16 and 18, with tumor prevalence in the area of the cervix (253 of 411; 61.3%). From the total of 598 samples for the prevalence estimate of HPV 16 and 18, the number of cases with similar numbers was 204 (31.7%) and 200 (35.8%), respectively. Relatively significant numbers were found in the area of the cervix, 253 (61.3%), and the area of the rectum, 158 (38.7%). CONCLUSION:: After conducting the present study, the link between HPV and colorectal cancer was made evident, without a distinction between the sexes, with similar values between HPV 16 and HPV 18.

Validation of the Brazilian version of the childhood asthma control test (c-ACT).

BACKGROUND: Children's perception of their symptoms has proved reliable and relevant to disease management and should be considered when assessing their asthma control. The aim of the study is to validate the Brazilian Portuguese version of the Childhood Asthma Control Test (c-ACT) in children aged 4-11 years. METHODS: This is a cross-sectional study in children diagnosed with asthma undergoing treatment in a pediatric pulmonology outpatient clinic in Porto Alegre, Brazil. The translation and linguistic adaptation of the instrument were performed in accordance with international recommendations for questionnaire validation. RESULTS: A total of 105 participants were included, aged 4-11 years. VALIDITY: all correlations between the total score and items on the questionnaire were significant and obtained values of r ≥ 0.3, and c-ACT means showed statistically significant differences between the GINA categories (P < 0.01). The controlled asthma group showed significantly higher c-ACT scores than those of uncontrolled asthma group (controlled 22.0 ± 2.9 vs. uncontrolled 16.3 ± 5.3 P < 0.01); and partially controlled asthma group showed significantly higher c-ACT scores than those of uncontrolled asthma group (partially controlled 20.0 ± 4.0 vs. uncontrolled 16.3 ± 5.3 P = 0.03). Correlations between the c-ACT total score and spirometry and nitric oxide were poor (r = 0.020; P = 0.866 and r = 0.035; P = 0.753, respectively). Reliability: the α-C coefficient for the c-ACT total score was 0.677 (95%CI 0.573-0763). Sensitivity to change had an effect size of 0.8 and an intraclass correlation coefficient of 0.598. No floor or ceiling effects were observed. CONCLUSION: The Brazilian version of the Childhood Asthma Control Test proved to be valid and reliable in children aged 4-11 years.

Avaliação dos níveis de alfabetismo em saúde, conhecimento em asma e qualidade de vida de pais associados ao controle da doença em crianças e adolescentes com diagnóstico de asma de centros especializados / Evaluation of levels of literacy in health, knowledge in asthma and quality of life of parents associated with disease control in children and adolescents diagnosed with asthma from specialized centers

Objetivo: avaliar o nível de conhecimento em asma, alfabetismo em saúde e qualidade de vida de cuidadores de crianças e adolescentes com diagnóstico da doença, bem como, a associação com o controle da asma, adesão ao tratamento e qualidade de vida. Métodos: estudo transversal, realizado com cuidadores e pacientes de dois centros especializados de referência no Sul do Brasil, entre março de 2018 e novembro de 2018. Participaram pais e cuidadores de crianças e adolescentes com diagnóstico de asma, com idade a partir de 18 anos. Foram aplicados os questionários: sociodemográfico, Short Assessment of Health Literacy for Portuguese-Speaking Adults, Questionário de Conhecimento em Asma Pediátrica e Paediatric Asthma Caregiver's Quality of Life Questionnaire. Para fins estatísticos, foram utilizados o teste t, qui-quadrado e Regressão Logística Binária. Resultados: foram incluídos 125 cuidadores, sendo 89 (71,2%) mães, com idade média de 35,7±9,2 anos, 65 (52%) com ensino médio completo e 100 (80%) pertencentes à classe econômica C. Do total, 74 (59,2%) apresentaram níveis inadequados de alfabetismo em saúde e 117 (94,4%) inadequados níveis de conhecimento em asma. A asma não estava controlada em 91 (72,8%) dos pacientes, estando associado a menor qualidade de vida deles e de seus cuidadores (p<0,001). A Regressão Logística verificou se o alfabetismo em saúde, o conhecimento em asma e a qualidade de vida dos cuidadores estavam associados ao controle da asma dos pacientes, sendo esse modelo significativo [X2(4) = 22,083; p<0,001, R2Nagelkerke = 0,484]. As variáveis categóricas utilizadas como referência foram as que apresentaram maior frequência (asma não controlada e conhecimentos inadequados). O alfabetismo em saúde (OR = 3,650; IC95% = 1,335 - 9,984) e qualidade de vida (OR = 3,095; IC95% = 1,850 ­ 5,178) também foram significativos. Conclusão: a população analisada apresentou níveis de alfabetismo em saúde e conhecimento em asma insatisfatórios. Ainda, os níveis de controle da doença foram baixos podendo estar associados aos níveis de qualidade de vida.

Aims: to evaluate the level of knowledge in asthma, health literacy and quality of life of caregivers of children and adolescents diagnosed with the disease, as well as the association with asthma control, treatment adherence and quality of life. Methods: this cross-sectional study was conducted with caregivers and patients from two specialized referral centers in southern Brazil, between March 2018 and November 2018. Parents and caregivers of children and adolescents diagnosed with asthma, aged 18 years and older, participated in the study. The following questionnaires were applied: sociodemographic, Short Assessment of Health Literacy for Portuguese-Speaking Adults and Paediatric Asthma Caregiver's Quality of Life Questionnaire. For statistical purposes, the t-test, chi-square and Binary Logistic Regression were used. Results: a total of 125 caregivers were included, 89 (71.2%) mothers, with a mean age of 35.7±9.2 years, 65 (52%) with completed high school and 100 (80%) belonging to economy class C. Of the total, 74 (59.2%) inadequate levels of literacy in health and 117 (94.4%) inadequate levels of knowledge in asthma. Asthma was not controlled in 91 (72.8%) of the patients, being associated with a lower quality of life of them and their caregivers (p<0.001). Logistic Regression verified whether health literacy, asthma knowledge and caregivers' quality of life were associated with asthma control of patients, and this model was significant [X2(4) = 22.083; p<0.001, R2Nagelkerke = 0.484]. The categorical variables used as reference were the ones with the highest frequency (uncontrolled asthma and inadequate knowledge). Health literacy (OR = 3,650; CI95% = 1.335 - 9.984) and quality of life (OR = 3.095; CI95% = 1.850 - 5.178) were also significant. Conclusion: the analyzed population presented levels of literacy in health and knowledge in asthma unsatisfactory. Furthermore, the levels of disease control were low and may be associated with quality of life levels.