Evolution of adolescents' dietary patterns in Northeast Brazil from 2008 to 2018.

OBJECTIVE: To evaluate the evolution of the dietary patterns of adolescents in the northeast region of Brazil. METHODS: Secondary analysis of data from the Pesquisa de Orçamentos Familiares (POF - Household Budget Surveys), collected by the Brazilian Institute of Geography and Statistics (IBGE) in the years 2008-2009 and 2017-2018. A total of 3,095 adolescents were evaluated in 2008-2009 and 3,015 in 2017-2018. Food consumption was assessed using two dietary records in 2008-2009 and two 24-hour recalls in 2017-2018, applied on non-consecutive days. Based on these data, principal components factor analysis (PCFA) was performed, followed by orthogonal rotation of the varimax type, to derive dietary patterns, stratified by sex. The results were described as means or percentage frequencies, with their respective 95% confidence intervals. RESULTS: Three main dietary patterns were identified among adolescents from the northeast region of Brazil. Among boys, in 2008-2009, the patterns were called snacks, traditional Brazilian, and coffee; and in 2017-2018, traditional Brazilian, snacks, and mixed, in this order of representativeness of the group's eating habits. Among female adolescents, in 2008-2009, the patterns were snacks, traditional Brazilian, and coffee; and in 2017-2018, traditional Brazilian, snacks, and processed meats. CONCLUSION: The dietary patterns identified in 2008-2009 and 2017-2018 were similar in both genders; however, the snacks pattern, which explained most of the data variability in 2008-2009, was replaced by the traditional Brazilian.

Cardiometabolic risk assessment: A school-based study in Brazilian adolescent.

BACKGROUND AND AIMS: Recently, new indices combining routine and low-cost anthropometric and biochemical measurements have emerged. Among them, the visceral adiposity index (VAI) and lipid accumulation product (LAP) are being investigated for the prediction of altered blood pressure (BP) and insulin resistance (IR). Therefore, this study aimed to evaluate whether visceral adiposity index (VAI) and height-corrected lipid accumulation product (HLAP) are predictors of cardiometabolic risk in Brazilian adolescents. METHODS AND RESULTS: Data were obtained from the Cardiovascular Risk in Adolescents (ERICA) study, a cross-sectional, national, multicenter, school-based survey conducted between 2013 and 2014 in Brazil. The sample consisted of 37,815 adolescents aged 12-17 years of both genders attending the last 3 years of elementary or secondary school from public and private schools located in 273 municipalities with more than 100,000 inhabitants. A Poisson regression was performed to verify associations between VAI and HLAP indices and the presence of altered BP and IR according to sex. In addition, receiver operating characteristic curve (ROC) analysis was applied to compare the predictive ability and determine the cut-off points of the VAI and HLAP indices in identifying cardiometabolic risk obtained by altered BP and IR. The prevalences of altered BP and IR were 24.49 % (95 % confidence interval [CI]: 23.14-25.87) and 24.22 % (95 % CI: 22.70-25.80), respectively. CONCLUSIONS: The VAI and HLAP indices are good predictors of cardiometabolic risk in Brazilian adolescents. HLAP showed better performance in identifying insulin resistance in males.

Evolution of adolescents' dietary patterns in Northeast Brazil from 2008 to 2018

ABSTRACT OBJECTIVE To evaluate the evolution of the dietary patterns of adolescents in the northeast region of Brazil. METHODS Secondary analysis of data from the Pesquisa de Orçamentos Familiares (POF - Household Budget Surveys), collected by the Brazilian Institute of Geography and Statistics (IBGE) in the years 2008-2009 and 2017-2018. A total of 3,095 adolescents were evaluated in 2008-2009 and 3,015 in 2017-2018. Food consumption was assessed using two dietary records in 2008-2009 and two 24-hour recalls in 2017-2018, applied on non-consecutive days. Based on these data, principal components factor analysis (PCFA) was performed, followed by orthogonal rotation of the varimax type, to derive dietary patterns, stratified by sex. The results were described as means or percentage frequencies, with their respective 95% confidence intervals. RESULTS Three main dietary patterns were identified among adolescents from the northeast region of Brazil. Among boys, in 2008-2009, the patterns were called snacks, traditional Brazilian, and coffee; and in 2017-2018, traditional Brazilian, snacks, and mixed, in this order of representativeness of the group's eating habits. Among female adolescents, in 2008-2009, the patterns were snacks, traditional Brazilian, and coffee; and in 2017-2018, traditional Brazilian, snacks, and processed meats. CONCLUSION The dietary patterns identified in 2008-2009 and 2017-2018 were similar in both genders; however, the snacks pattern, which explained most of the data variability in 2008-2009, was replaced by the traditional Brazilian.

Association between Eating Patterns and Excess Body Weight in Adolescents.

Background: Excess body weight is a risk factor for the development of diseases. Adolescence is a nutritionally vulnerable age group that suffers due to influences on food intake. We aimed to identify the main dietary patterns of adolescents to investigate their association with excess body weight. Methods: This was a cross-sectional study. Anthropometric measurements (weight and height) were collected to calculate the BMI. Nutritional statuses were classified according to World Health Organization classification. Food consumption data were obtained through a 24-hour recall and food patterns were identified through factor analyses of the main components. The patterns were categorized into quintiles and dichotomized into greater (fourth and fifth quintile) and lower (first to third quintile) adherences. Binomial regression was used to assess the association between food patterns and excess body weight. The study was conducted in a capital city in Northeast Brazil from adolescents aged between 10 and 19 years in 826 public schools. Results: Three main food patterns were identified in women and men: coffee with bread (white bread, coffee, fat, and eggs), common Brazilian (white rice, beans, meat, pasta, with negative factor load for regional foods), and mixed pattern (sweets, fruits, biscuits and cakes, vegetables, and dairy products). Adolescents with a greater adherence to the coffee and bread pattern [odds ratio (OR) = 0.68; 95% confidence interval (95% CI): 0.50-0.93] and the common Brazilian pattern (OR = 0.72; 95% CI: 0.53-0.99) had a lower chance of being excess body weight than those with lower adherence. Conclusions: Three main eating patterns were identified among adolescents, and greater adherence to the coffee with bread and common Brazilian patterns implied a lower chance of excess body weight.

Height-based equations as screening tools for elevated blood pressure in the SAYCARE study.

This study evaluated the accuracy of four height-based equations: blood pressure to height ratio (BPHR), modified BPHR (MBPHR), new modified BPHR (NMBPHR), and height-based equations (HBE) for screening elevated BP in children and adolescents in the SAYCARE study. We measured height and BP of 829 children and adolescents from seven South American cities. Receiving operating curves were used to assess formula performance to diagnose elevated BP in comparison to the 2017 clinical guideline. Sensitivity, specificity, and positive and negative predictive values (PPV, NPV) were calculated for the four screening formulas. The diagnostic agreement was evaluated with the kappa coefficient. The HBE equation showed the maximum sensitivity (100%) in children, both for boys and girls, and showed the best performance results, with a very high NPV (>99%) and high PPV (>60%) except for female children (53.8%). In adolescents, the highest sensitivity (100%) was achieved with the NMBPHR for both sexes. Kappa coefficients indicated that HBE had the highest agreement with the gold standard diagnostic method (between 0.70 and 0.75), except for female children (0.57). Simplified methods are friendlier than the percentile gold standard tables. The HBE equation showed better performance than the other formulas in this Latin American pediatric population.

Sampling and processing blood samples within the South American Youth/Child cARdiovascular and Environmental (SAYCARE) Study.

Obesity and overweight in children and adolescents is increasing rapidly worldwide; however, scarce data have been reported from South America countries. With the purpose of assessing hyperlipidemia, insulin resistance and chronic inflammation, the evaluation of blood biomarkers such as glucose, lipoproteins and chronic inflammation proteins is required. In the context of the SAYCARE study, in children and adolescents (3 to 18 years) from seven South American cities, our aim was to assess the impact of pre analytical conditions on different biomarkers evaluated in 474 fresh serum samples, in different country centers. We also evaluated the stability according to time and frozen storage within this study across the concordance of the results obtained from the 49 blood samples measured in three different centers. Significant correlations as well as concordance were observed in TG, Total-C, HDL-C and glucose between Buenos Aires and São Paulo. The samples evaluated in Teresina and São Paulo presented similar results, with exception of total cholesterol. We observed acceptable concordance between Buenos Aires vs São Paulo and Teresina vs São Paulo, suggesting that samples could be processed in each of these centers. This concordance is a consequence of the strict pre analytical conditions previously established in the SAYCARE study.

Un modelo Ecológico para la Salud mental Infanto Juvenil / Children and Adolescents Mental Health Ecological Model

Desarrollar un programa de salud mental Infanto-juvenil es complejo, por la multiplicidad de variables implicadas y la dificultad para integrarlas. Son muchos los sectores de la sociedad que juegan un rol determinante en el desarrollo infantil, lo que complejiza la generación de un diálogo integrador y efectivo entre ellos hacia un fin común, la salud mental. En el artículo se analiza la aplicación del modelo ecológico de Bronfenbrenner en la organización de salud mental de nuestro país. Planteamos que a través de él es posible ampliar la mirada y la comprensión de la complejidad del fenómeno de salud mental Infanto juvenil, facilitando el desarrollo de propuestas de intervención que incorporen la mayoría de las variables e intersectores intervinientes, como, salud, educación, Servicio nacional de menores (Sename), justicia, entre otros, y por supuesto la comunidad en general, como actores relevantes y determinantes sociales en el proceso salud­ cuidados­enfermedad.

Developing a mental health program for children and adolescents is very complex, due to the multiplicity of variables involved and the difficulty in integrating them. There are many sectors of our society that play a decisive role in child development, which complicate the generation of an inclusive and effective dialogue between them towards a common goal, mental health. The article analyzes the application of the ecological model of Urie Bronfenbrenner in the organization of public health and mental health in our country. We propose that through it, it is possible to broaden the view and understanding of the complexity of the mental health phenomenon for children and young people, facilitating the development proposals that incorporate most of the intervening variables and intervention target areas, such as health, education, Sename, justice, among others, and of course the community in general, as relevant actors and social determinants in the health- care-disease process.

Measuring Socioeconomic Status and Environmental Factors in the SAYCARE Study in South America: Reliability of the Methods.

OBJECTIVE: This paper aimed to test the reliability of two questionnaires in studies involving children and adolescents (aged 3-18 years) in seven South American cities. One assesses socioeconomic status (SES) and the other measures environmental factors. METHODS: The SES questionnaire was composed of 14 questions, which included the presence of several consumer goods, domestic services, family income, parental education level, and current parental occupation status. The environmental questionnaire was composed of 15 questions to measure the social and infrastructure characteristics of the area of residence. Parents or guardians completed the questionnaires on behalf of their children. Adolescents answered the questions themselves for environmental factors, while those related to SES factors were answered by their parents or guardians. We analyzed the reliability of the questionnaires through kappa coefficient determination. Multilevel linear regression models were applied to calculate the correlation between the total household scores, the household income, and parents' education level. RESULTS: The environmental questionnaire showed good reproducibility in both age groups (k = 0.132-0.612 in children and k = 0.392-0.746 in adolescents). The SES questionnaire showed strong reliability in both age groups for all indicators (k = 0.52-1.00 in children and k = 0.296-0.964 in adolescents). CONCLUSIONS: Our multiple indicator questionnaires focused on environmental factors and SES in pediatric health surveys provided useful and easily applicable additional indicators to measure these important determinants of cardiovascular health.

Is the Measurement of Blood Pressure by Automatic Monitor in the South American Pediatric Population Accurate? SAYCARE Study.

OBJECTIVE: This study aimed to test the validity of an automatic oscillometric device to measure the blood pressure (BP) in children (n = 191) and adolescents (n = 127) aged 3 to 18 years. METHODS: Systolic BP (SBP) and diastolic BP (DBP) levels were measured simultaneous by automatic device and mercury column with Y-connection. To verify the validity, Bland-Altman plots and limits of agreement of 95% (95% LOA), specificity and sensitivity of the device, and the grade of British Hypertension Society (BHS) criteria were used. RESULTS: The monitor measurements demonstrated lower measurement bias (mean difference [95% LOA]): 1.4 (-9.9 to 12.8) mmHg in children and 4.3 (-7.8 to 16.5) mmHg in adolescents for SBP. For DBP, it was 2.2 (-7.4 to 11.7) mmHg in children and 1.4 (-8.4 to 11.1) mmHg in adolescents. The sensitivity in children was 21.4 (95% CI = 16.3-26.6), and in adolescents, it was 20.0 (95% CI = 13.2-26.8); the specificity was 95.9 (95% CI = 93.4-98.4) in children and 100.0 (95% CI = 100.0-100.0) in adolescents. The monitor-tested ratings are Grade B for SBP in children and SBP and DBP in adolescents and Grade C for DBP in children. CONCLUSIONS: The automatic monitor presented high values of specificity and lower values of sensitivity to the diagnosis of HBP; however, it can be considered accurate (lower measurement bias) and valid for epidemiological and clinical practice in accordance with BHS criteria.

Design and Objectives of the South American Youth/Child Cardiovascular and Environmental (SAYCARE) Study.

OBJECTIVE: The purpose of this paper is to introduce the overarching study design of the South American Youth/Child Cardiovascular and Environmental (SAYCARE) study, which is an observational multicenter feasibility study held in seven South American cities: Buenos Aires (Argentina), Lima (Peru), Medellin (Colombia), Montevideo (Uruguay), Santiago (Chile), and São Paulo and Teresina (Brazil). Children and adolescents (3-17 years of age) were studied. METHODS: The data management systems, quality assurance monitoring activities, standardized operating procedure manuals, and training and study management are addressed in this paper. Various quality controls to ensure the collection of valid and reliable data are also discussed. RESULTS AND CONCLUSIONS: Data were obtained from 237 preschoolers and schoolchildren and 258 adolescents during the validation phase measurements. The results of the SAYCARE study are expected to provide higher accuracy in the assessment of cardiovascular disease risk factors, including eating behaviors, body composition, physical activity, sedentary behaviors, lipid profiles and cardiovascular health biomarkers, oral health, social conditions, environmental factors and home environment, and their determinants in children and adolescents from ages 3 to 17 in seven South American cities.

Reliability and Validity of a Questionnaire for Physical Activity Assessment in South American Children and Adolescents: The SAYCARE Study.

OBJECTIVE: The objective of this article is to test the reliability and validity of the new and innovative physical activity (PA) questionnaire. METHODS: Subsamples from the South American Youth/Child Cardiovascular and Environment Study (SAYCARE) study were included to examine its reliability (children: n = 161; adolescents: n = 177) and validity (children: n = 82; adolescents: n = 60). The questionnaire consists of three dimensions of PA (leisure, active commuting, and school) performed during the last week. To assess its validity, the subjects wore accelerometers for at least 3 days and 8 h/d (at least one weekend day). The reliability was analyzed by correlation coefficients. In addition, Bland-Altman analysis and a multilevel regression were applied to estimate the measurement bias, limits of agreement, and influence of contextual variables. RESULTS: In children, the questionnaire showed consistent reliability (ρ = 0.56) and moderate validity (ρ = 0.46), and the contextual variable variance explained 43.0% with -22.9 min/d bias. In adolescents, the reliability was higher (ρ = 0.76) and the validity was almost excellent (ρ = 0.88), with 66.7% of the variance explained by city level with 16.0 min/d PA bias. CONCLUSIONS: The SAYCARE PA questionnaire shows acceptable (in children) to strong (in adolescents) reliability and strong validity in the measurement of PA in the pediatric population from low- to middle-income countries.

Clustering of multiple energy balance related behaviors is associated with body fat composition indicators in adolescents: Results from the HELENA and ELANA studies.

The objective of this study was to identify clustering patterns of four energy balance-related behaviors (EBRB): television (TV) watching, moderate and vigorous physical activity (MVPA), consumption of fruits and vegetables (F&V), and consumption of sugar-sweetened beverages (SSB), among European and Brazilian adolescents. EBRB associations with different body fat composition indicators were then evaluated. Participants included adolescents from eight European countries in the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescents) study (n = 2,057, 53.8% female; age: 12.5-17.5 years) and from the metropolitan region of Rio de Janeiro/Brazil in the ELANA study (the Adolescent Nutritional Assessment Longitudinal Study) (n = 968, 53.2% female; age: 13.5-19 years). EBRB data allowed for sex- and study-specific clusters. Associations were estimated by ANOVA and odds ratios. Five clustering patterns were identified. Four similar clusters were identified for each sex and study. Among boys, different cluster identified was characterized by high F&V consumption in the HELENA study and high TV watching and high MVPA time in the ELANA study. Among girls, the different clusters identified was characterized by high F&V consumption in both studies and, additionally, high SSB consumption in the ELANA study. Regression analysis showed that clusters characterized by high SSB consumption in European boys; high TV watching, and high TV watching plus high MVPA in Brazilian boys; and high MVPA, and high SSB and F&V consumption in Brazilian girls, were positively associated with different body fat composition indicators. Common clusters were observed in adolescents from Europe and Brazil, however, no cluster was identified as being completely healthy or unhealthy. Each cluster seems to impact on body composition indicators, depending on the group. Public health actions should aim to promote adequate practices of EBRB.

Programa innovador para evaluar uso y preferencia de hábitat / Innovative program for habitat use and preference evaluation

La preferencia de hábitat por parte de una especie es una temática de gran importancia en biología, ecología, evolución, y manejo y conservación de la biodiversidad, ya que nos permite determinar los recursos y condiciones que requiere una especie para su supervivencia, reproducción y perduración en el tiempo. Este tema es prioritario, dado los rápidos cambios climáticos que, según las predicciones, afectarán de forma directa o indirecta los recursos, condiciones y por ende el hábitat de las especies; modificando la abundancia, distribución espacial y probabilidad de extinción local. Actualmente es un tema difícil de abordar, debido a que la literatura existente es difusa, incluye contradicciones teóricas y los métodos matemáticos para inferir preferencia son repetitivos y no han sido priorizados. Considerando estas dificultades, se ha creado el programa HaviStat que permite realizar la mayoría de los procedimientos matemáticos, estadísticos y gráficos requeridos para inferir uso, selección, preferencia de hábitat o recursos (18 índices y 2 intervalos de confianza) y amplitud de nicho (4 índices y 2 intervalos de confianza) para cualquier especie. El programa fue creado en lenguaje Visual Basic sobre la plataforma de Microsoft Office Excel®, y es el resultado de una exhaustiva revisión bibliográfica, donde se han seleccionado y compilado los índices más relevantes. La literatura complementaria ayudará a los investigadores a plantear el diseño experimental y entender la importancia de los resultados; además brindará las herramientas para entender cómo funcionan y cuándo deben ser aplicados los índices.

The species habitat preference is an important topic in biology, ecology, evolution, and management andconservation of biodiversity, since it allows us to determine the resources and conditions required by species forsurvival, reproduction and persistence through time. This topic is high priority due to the rapid climatic changesthat, according to model predictions, will directly or indirectly affect the resources, conditions and therefore itshabitat, modifying its abundance, spatial distribution, and local probability of extinction. At the moment this topic is difficult to approach, because the existing literature is disperse, there are theoretical contradictions, andmathematical methods to infer preference are repetitive, and have not been ranked. Considering these difficulties, HaviStat© has been created. This program can perform the majority of mathematical, statistical, and graphical procedures required to infer habitat use, selection, preference or resources (18 indices and 2 confidence intervals), and niche amplitude for any species (4 indices and 2 confidence intervals). The program was made on Visual Basic® language on the Microsoft Office Excel® platform. It is the result of an exhaustive literature review, where the most relevant index were selected and compiled. Complementary literature will help researchers to setup experimental designs, and to know the importance of the results; also, it will bring basic tools to understandhow the index work and when they must be applied.

Técnica de Klisic vs. la gran intervención de Leveuf-Bertrand-Derqui en el tratamiento de la luzación congénita inveterada de cadera en niños en edad de caminar en el IAHULA: estudio de cohorte hospitalaria / Technique of Klisic vs. the great intervention of Leveuf-Bertrand-Derqui in the treatment of the inveterate congenital luzatation of hip in children in age of walking in the IAHULA: study of hospital cohort

El tratamiento quirúrgico de la luxación congénita inveterada de cadera en los niños en edad de caminar se realiza con el objetivo de incrementar la longevidad de la articulación. Sin embargo, resulta un desafío para el cirujano ortopedista infantil seleccionar la técnica quirúrgica que pueda garantizar este objetivo. El objetivo de esta investigación fue, determinar la efectividad absoluta de la técnica de Klisic y la de la gran intervención de Leveuf-Bertrand-Derqui (LBD) desde el punto de vista clínico y radiológico; de igual manera determinar la efectividad relativa entre ambas técnicas. Se realizó un estudio de coorte hospitalaria (IAHULA, 1985-2002) en el cual se evaluaron 30 caderas en 30 pacientes, 12 tratados con la técnica de Klisic y 18 con la de LBD. El promedio de seguimiento para el primero de ellos fue de 8.1 años y para el segundo 14 años. La evaluación clínica se hizo de acuerdo a la escala de Harris y la evaluación radiológica según Severin y Kalamchi- MacEwen. La edad promedio fue de 64 meses (30-139). Klisic, 10 satisfactorios y 2 no satisfactorios. LDB, 15 satisfactorios y 3 no satisfactorios con una p=1.00 y una efectividad relativa igual a 1. Klisic, 9 satisfactorios y 3 no satisfactorios. LBD, 4 satisfactorios y 14 no satisfactorios con una p=0.008 y una efectividad relativa de 10.5. La técnica de Klisic impresiona ser la que ofrece mejores resultados, que se traducen enmayor longevidad de las caderas intervenidas.

Prostatectomía retropúbica transcervical: abordaje ideal para las prostatectomias abiertas / Transcervical retropubic prostatectomy: ideal approach for open prostatectomy

Una vez es hecho el diagnóstico de prostatismo mediante la utilización de los métodos convencionales; secundario este a un adenoma prostático obstructivo suceptible de remoción quirúrgica, queda entonces la decisión de la vía de abordaje a utilizar en la cirugía. La mayor parte de las veces en nuestro medio (90% de los casos) estos adenomas tras ser evaluados primordialmente en cuanto al tamaño y características de los mismos son abordados transuretralmente. El 10% restante de los casos se aborda mediante cirugía prostática abierta; clásicamente mediante una prostatectomía suprapúbica transversical. En este trabajo exponemos una alternativa quirúrgica abierta con la cual pretendemos demostrar una evolución postoperatoria más corta, más benigna y más aceptable para el paciente que con otras técnicas abiertas convencionales para la cirugía de próstata por hiperplasia benigna. Así mismo, se comparan los resultados obtenidos tras los primeros veintiún casos realizados con esta técnica en nuestro servicio con los resultados obtenidos con otros tipos de prostatectomías abiertas realizadas; principalmente suprapúbica transvesical, durante el año previo a la introducción de la misma. Se hace también una comparación de los resultados obtenidos en las prostectomías transcervicales con los obtenidos en las resecciones transuretrales de próstata efectuadas en igual período de tiempo, en cuanto a la estancia hospitalaria postoperatoria y otros aspectos

Cistolitotripsia electrohidráulica: un nuevo enfoque en el manejo de las litiasis vesicales / Electrohidraulic cystolithotripsy: a new approach in the management of vesical calculi

La extracción o remoción de cálculos de cualquier punto del árbol urinario sin lesionar este y de la manera mas sencilla posible, ha representado desde la antigüedad un reto urológico. Desde la época de Ambrose Paré, quien en más de una ocasión al tratar una de las llamadas "carnosites" se encontró con una litiasis vesical en el camino de sus instrumentos se inicio el manejo de las litiasis vesicales. Siglos más tarde se perfeccionó el tratamiento transuretral de las mismas mediante el uso de múltiples y complicados instrumentos urológicos, los cuales fueron abandonados por ser poco prácticos y por las serias lesiones que ocasionaban en la vejiga, uretra y próstata. Si bien algunos de ellos han llegado hasta nuestros días con muy pocas modificaciones, han caido en el desuso. En los años cincuenta en Rusia se desarrolla un nuevo principio en el manejo de las litiasis vesicales; la onda expansiva hidraúlica, capaz de romper cálculos urinarios. Sin embargo no es hasta los años setenta cuando se logra perfeccionar tal técnica y se informan las primeras experiencias exitosas. En l984 se introduce el uso del cistolitotriptor electrohidraúlico en Panamá. Se hace una evaluación de los primeros casos realizados durante el primer año de su utilización y se hace un análisis de la experimentación en cuanto al tamaño de las litiasis el tipo de anestesia utilizada, el tiempo empleado y las complicaciones presentadas. Se compara con otros tipos de tratamiento y alternativas. Se concluye recomendando esta técnica por su sencillez, costo relativamente bajo y ausencia de complicaciones