Development of a predictive model of body fat mass for newborns and infants.

OBJECTIVES: The aim of this study is to develop predictive body fat mass models, one for newborns and one for infants, using air displacement plethysmography as a reference method. METHODS: The study was carried out with 125 newborns (1-5 d of age) and 71 infants (≥3-6 mo). The stepwise method was used to estimate the final model from the predictors of sex, weight, length, triceps skinfold, waist circumference, mean arm circumference, and gestational age. The quality of the models was evaluated by the determination coefficient, variance inflation factor, and residual analysis. The paired t test and Bland-Altman plot were used to assess the agreement between observed and estimated values. RESULTS: The final model for newborns was - 0.76638 + 0.2512 * weight (kg) + 0.0620 * PCT (mm) + 0.0754 * gender (R² = 70%) and the final model for infants: -2.22748 + 0.4928 * weight (kg) + 0.0737 * TSF (mm) + 0.2647 * gender (R² = 84%). CONCLUSIONS: This work determined equations to estimate the BFM of term newborns and infants. The models can be used in clinical practice, especially in health units without access to technologies for measuring body composition, adding important information for nutritional monitoring.

Utilização de atendimentos no serviço de atenção básica em um município do Espírito Santo segundo perfil sociodemográfico e de condições de saúde / Use of primary care services in a city of Espírito Santo according to sociodemographic profile and health conditions

A Atenção Básicaé a principal porta de entrada do Sistema Único de Saúde. O acesso efetivo a esse serviço pode ser avaliado pela utilização de atendimentos, e não apenas pela disponibilidade. O conhecimento do perfil populacional permite identificar grupos vulneráveis ànão utilização, assim como conhecer as morbidades mais prevalentes para promover melhor organização da oferta e utilização do serviço. Este trabalho trata-se de um estudo transversal, cujas fontes de dados foram registros das fichas do e-SUS de 8.390 indivíduos, cadastrados numa Unidade de Saúde da Família (USF). Foi analisada a prevalência de utilização de atendimentos na USF, nos quais se incluíram consultas médicas e de enfermagem. Foram comparados os perfis sociodemográfico e de morbidade referida dos utilizadores e não utilizadores da USF em 2019. O percentual de utilização de consultas foi de 50,1% dos cadastrados, sendo a média de 2,3 consultas por habitante ao ano. A maioria dos utilizadores fez até cinco consultas ao ano, porém aproximadamente um terço das consultas se referiram aos hiperutilizadores. Ser do sexo feminino, ser pardo ou negro, ter baixa escolaridade, idade mais avançada e não possuir plano de saúde privado foram condições associadas à maior utilização de consulta.

Primary care is the main entry point into the Brazilian public health system. Effective access to this service can be assessed not only by the quality of the healthcare assistance but also by its availability. Knowledge of the population's profile makes it possible to identify groups that are vulnerable to non-use of the service as well as to the most prevalent morbidities, so theservice can be better offered and organized. This is a cross-sectional study whose data source was records of 8,390 e-SUS files registered in a Family Health Unit (USF, in Portuguese). The prevalence of use of services at the USF was analyzed, which included medical and nursing consultations. The sociodemographic and reported morbidity profiles of users and non-users of the USF in 2019 were compared. The percentage of consultations was 50.1% of registered ones, with an average of 2.3 consultations per inhabitant per year. Most users have up to five consultations per year, but approximately a third of those consultations are referred to as hyper-users. Being female, being mixed-race or black, having low-level education, being older, and not having a private health plan were associated with greater use of consultations.

Association of electrical bioimpedance vectors with the nutritional classification of vulnerable multiethnic children.

BACKGROUND & AIMS: Monitoring growth and body composition in childhood is vital for early detection of health and nutrition problems during child development. The bioelectrical impedance vector analysis (BIVA) revealed its effectiveness as an indicator of nutritional status. This study aimed to measure the bioimpedance vectors of a sample of multiethnic children and evaluate the utility of BIVA for the classification of the nutritional status in a group of children with greater vulnerability, including in the presence of obesity. METHODS: This is a cross-sectional study that analyzed the bioelectrical impedance of a sample of 321 children from public daycare centers, aged 1-4 years, using the RXc graph method (tetrapolar analysis at 50 kHz frequency). The 95%, 75%, and 50% tolerance ellipses were plotted by age group. The Z-scores of bioimpedance parameters (Xc/H-Z and R/H-Z) were calculated regarding age, which were used to build reference tolerance ellipses for a single group, regardless of age. Such ellipses were evaluated for their ability to recognize the pattern and classify the deviations, using individual vectors of obese children. RESULTS: The mean impedance vectors showed progressively higher reactances and lower resistances with age. In the group of obese children, the individual vectors located outside the 95% baseline tolerance ellipse were 12.5%, 18.75%, and 11.1% of the cases for the WHZ, WAZ, and BMIZ criteria, respectively, all above the expected 5%, but much below expectations. This may be a problem with the obesity criteria used, as WHZ, WAZ, and BMIZ do not differentiate fat from lean mass. CONCLUSION: Bioimpedance vector analysis reflects differences in the bioelectric patterns of children classified as obese. Provided the obesity criteria are constructed based on fat measurements, rather than lean mass, the use of tolerance ellipses in the BIVA chart is promising as a tool for monitoring nutritional status where measuring body composition is difficult, because constant tissue hydration cannot be assumed.

Professional who attended childbirth and breastfeeding in the first hour of life.

OBJECTIVES: To investigate the association between the professionals who attended vaginal delivery and breastfeeding in the first hour of life. METHODS: This is a cross-sectional study with data from the Nascer no Brasil (Born in Brazil) survey, conducted in the 2011-2012 period. Data from 8,466 puerperae were analyzed using a logistic regression model with a hierarchical approach. RESULTS: The proportion of mothers who breastfed at birth was higher in deliveries attended by nurses (70%). A nurse-assisted delivery was 64% more likely to breastfeed in the first hour of life. Other factors associated with the outcome: residing in the North; age less than 35 years; multiparity; prenatal guidance on breastfeeding in the first hour of life; birth at Baby-Friendly Hospital; companion at birth; and female newborn. CONCLUSIONS: Obstetrician nurse/nurse-assisted delivery was a significant independent factor associated with breastfeeding in the first hour of life, suggesting the importance of strengthening the role of the obstetrician nurse.

The importance of bioelectrical impedance in the critical pediatric patient.

BACKGROUND & AIMS: Sepsis is still a significant cause of death in the Intensive Care Unit and its early diagnosis is vital. Changes in cell permeability have been observed early in sepsis. Lower values of bioelectrical impedance (BIA) such as reactance adjusted by height (Xc/H) and phase angle (PA) have already been studied as a prognostic biomarker for many diseases and may indicate cell injury. BIA is a low cost, practical, noninvasive method that can be measured at bedside. This study investigated the utility of PA and Xc/H raw values in the pediatric critical care unit as predictors of progression to septic shock, as a clinical monitoring tool and to support the diagnosis of septic shock. METHODS: We prospectively analyzed bioelectrical impedance in 145 children aged between one month and six years who were not in septic shock on admission to the intensive care unit Serial bioelectrical impedance analysis (BIA) measures were analyzed to determine the sensitivity and specificity of accurately identifying children who subsequently developed septic shock. Kaplan-Meier septic shock-free survival curves modeled by Xc/H and PA were done. RESULTS: The free-septic shock survival curve analysis showed that patients with the lowest median values of Xc/H and PA were associated with the highest percentage of occurrence of septic shock (p = 0.0001 for Xc/H and <0.0006 for PA) and longest length of stay in the intensive care unit (p < 0.0011 for Xc/H and p < 0.004 for PA). Values of Xc/H below 48.63 Ohm/m at admission showed statistically significant odds ratio (OR) of 3.72 for developing septic shock any time during the hospitalization period, with a 87% sensitivity, 35% specificity and an area under the curve (AUC) of 0.62. The PA at admission did not show significant results. During hospitalization, patients with Xc/H below 35.72 Ohm/m were 3.38 times more likely to develop septic shock in the next day, with a sensitivity of 66.7%, a specificity of 62.3% and AUC of 0.65. PA values below 3.27 had an OR of 9.58 for a septic shock the next day with a sensitivity of 95.8%, specificity of 29.4% and AUC of 0.62. The presence of a value of Xc/H below 33 Ohm/m showed a strong association with the occurrence of septic shock on the same day of the measurement, with an OR of 11.7, as well as a value of PA below 2.64, showed an OR of 14.2. CONCLUSIONS: The bioelectrical parameters Xc/H and phase angle have limitations in predicting septic shock as isolated biomarkers, but have a potential role as a monitoring tool in the pediatric intensive care unit. The comparative value with other biomarkers remains to be elucidated.

Professional who attended childbirth and breastfeeding in the first hour of life / Profesional que asistió al parto y amamantamiento en la primera hora de vida / Profissional que assistiu o parto e amamentação na primeira hora de vida

ABSTRACT Objectives: To investigate the association between the professionals who attended vaginal delivery and breastfeeding in the first hour of life. Methods: This is a cross-sectional study with data from the Nascer no Brasil (Born in Brazil) survey, conducted in the 2011-2012 period. Data from 8,466 puerperae were analyzed using a logistic regression model with a hierarchical approach. Results: The proportion of mothers who breastfed at birth was higher in deliveries attended by nurses (70%). A nurse-assisted delivery was 64% more likely to breastfeed in the first hour of life. Other factors associated with the outcome: residing in the North; age less than 35 years; multiparity; prenatal guidance on breastfeeding in the first hour of life; birth at Baby-Friendly Hospital; companion at birth; and female newborn. Conclusions: Obstetrician nurse/nurse-assisted delivery was a significant independent factor associated with breastfeeding in the first hour of life, suggesting the importance of strengthening the role of the obstetrician nurse.

RESUMEN Objetivos: investigar la asociación entre el profesional que asistió al parto vaginal y la lactancia en la primera hora de vida. Métodos: estudio transversal con datos de la investigación Nascer no Brasil (Nacer en Brasil), conducida en el periodo de 2011-2012. Se analizaron datos de 8.466 puérperas por medio de modelo de regresión logística con abordaje jerarquizado. Resultados: La proporción de madres que amamantaron al nacimiento fue mayor en los partos asistidos por el enfermero (70%). El parto asistido por enfermero presentó una probabilidad un 64% mayor de lactancia en la primera hora de vida. Otros factores asociados al desenlace: residir en el Norte; edad inferior a 35 años; multiparidad; orientación en el prenatal sobre lactancia materna en la primera hora de vida; nacimiento en el Hospital Amigo del Niño; acompañante en el parto; y el recién nacido de sexo femenino. Conclusiones: El parto asistido por el enfermero/enfermero obstetra fue un importante factor independiente asociado a la lactancia materna en la primera hora de vida, sugiriendo la importancia del fortalecimiento del papel del enfermero obstetra.

RESUMO Objetivos: investigar a associação entre o profissional que assistiu o parto vaginal e a amamentação na primeira hora de vida. Métodos: estudo transversal com dados da pesquisa Nascer no Brasil, conduzida em 2011/2012. Foram analisados dados de 8.466 puérperas por meio de modelo de regressão logística com abordagem hierarquizada. Resultados: A proporção de mães que amamentaram ao nascimento foi maior nos partos assistidos pelo enfermeiro (70%). O parto assistido por enfermeiro apresentou chance 64% maior de amamentação na primeira hora de vida. Outros fatores associados ao desfecho: residir no Norte; idade inferior a 35 anos; multiparidade; orientação no pré-natal sobre amamentação na primeira hora de vida; nascimento em Hospital Amigo da Criança; acompanhante no parto; e recém-nascido de sexo feminino. Conclusões: O parto assistido pelo enfermeiro/enfermeiro obstetra foi importante fator independente associado à amamentação na primeira hora de vida, sugerindo a importância do fortalecimento do papel do enfermeiro obstetra.

Professional who attended childbirth and breastfeeding in the first hour of life / Profesional que asistió al parto y amamantamiento en la primera hora de vida / Profissional que assistiu o parto e amamentação na primeira hora de vida

ABSTRACT Objectives: To investigate the association between the professionals who attended vaginal delivery and breastfeeding in the first hour of life. Methods: This is a cross-sectional study with data from the Nascer no Brasil (Born in Brazil) survey, conducted in the 2011-2012 period. Data from 8,466 puerperae were analyzed using a logistic regression model with a hierarchical approach. Results: The proportion of mothers who breastfed at birth was higher in deliveries attended by nurses (70%). A nurse-assisted delivery was 64% more likely to breastfeed in the first hour of life. Other factors associated with the outcome: residing in the North; age less than 35 years; multiparity; prenatal guidance on breastfeeding in the first hour of life; birth at Baby-Friendly Hospital; companion at birth; and female newborn. Conclusions: Obstetrician nurse/nurse-assisted delivery was a significant independent factor associated with breastfeeding in the first hour of life, suggesting the importance of strengthening the role of the obstetrician nurse.

RESUMEN Objetivos: investigar la asociación entre el profesional que asistió al parto vaginal y la lactancia en la primera hora de vida. Métodos: estudio transversal con datos de la investigación Nascer no Brasil (Nacer en Brasil), conducida en el periodo de 2011-2012. Se analizaron datos de 8.466 puérperas por medio de modelo de regresión logística con abordaje jerarquizado. Resultados: La proporción de madres que amamantaron al nacimiento fue mayor en los partos asistidos por el enfermero (70%). El parto asistido por enfermero presentó una probabilidad un 64% mayor de lactancia en la primera hora de vida. Otros factores asociados al desenlace: residir en el Norte; edad inferior a 35 años; multiparidad; orientación en el prenatal sobre lactancia materna en la primera hora de vida; nacimiento en el Hospital Amigo del Niño; acompañante en el parto; y el recién nacido de sexo femenino. Conclusiones: El parto asistido por el enfermero/enfermero obstetra fue un importante factor independiente asociado a la lactancia materna en la primera hora de vida, sugiriendo la importancia del fortalecimiento del papel del enfermero obstetra.

RESUMO Objetivos: investigar a associação entre o profissional que assistiu o parto vaginal e a amamentação na primeira hora de vida. Métodos: estudo transversal com dados da pesquisa Nascer no Brasil, conduzida em 2011/2012. Foram analisados dados de 8.466 puérperas por meio de modelo de regressão logística com abordagem hierarquizada. Resultados: A proporção de mães que amamentaram ao nascimento foi maior nos partos assistidos pelo enfermeiro (70%). O parto assistido por enfermeiro apresentou chance 64% maior de amamentação na primeira hora de vida. Outros fatores associados ao desfecho: residir no Norte; idade inferior a 35 anos; multiparidade; orientação no pré-natal sobre amamentação na primeira hora de vida; nascimento em Hospital Amigo da Criança; acompanhante no parto; e recém-nascido de sexo feminino. Conclusões: O parto assistido pelo enfermeiro/enfermeiro obstetra foi importante fator independente associado à amamentação na primeira hora de vida, sugerindo a importância do fortalecimento do papel do enfermeiro obstetra.

External evaluation and self-monitoring of the Baby-friendly Hospital Initiative's maternity hospitals in Brazil.

Background: In Brazil, the Baby-Friendly Hospital Initiative (BFHI) proposes following the criteria, the "Ten Steps to Successful Breastfeeding", International Code of Marketing of Breast-milk Substitutes and Good birth and delivery practices. Brazilian Baby-Friendly Hospitals are reassessed triennially by external evaluators and annually by self-monitoring. This study aimed to verify if the self-monitoring system fulfills its role of enabling accredited hospitals to assess and improve their compliance with the BFHI criteria. In this sense, we will analyze the self-monitoring evaluation results and compare them with those of the external reassessment. Methods: This descriptive evaluation study of the compliance with the BFHI criteria by the Brazilian Baby-Friendly Hospitals by self-monitoring evaluators from 2010 to 2015 and by external evaluators in 2015. Results: Self-monitoring was performed in all years from 2010 to 2015 by 143 BFHI accredited hospitals. The trend of the levels of compliance with BFHI's criteria according to self-monitoring evaluations was stable over the assessed period. Most criteria presented compliance above 70%, except Step 4 (skin-to-skin contact and breastfeeding in the first hour of life), with mean compliance of 67%. Steps 1 (written policy), 7 (rooming-in) and 9 (give no artificial teats) showed mean compliance above 90%. Regarding the external evaluation carried out in 2015, the criteria with lowest compliance were Step 4 and Woman-Friendly care, both below 50%. Steps 9 and 10 (refer mothers to breastfeeding support groups) reached levels of compliance above 90%. For 2015, self-monitoring provided significant higher compliance levels than those from external evaluations in most criteria, except Step 3 (prenatal information on breastfeeding) and Step 10. There was a difference of more than 30% points between evaluations of Steps 1 (written policy), 2 (training), 5 (show mothers how to breastfeed), Woman-Friendly Care and father or mother stay with their newborn. Conclusions: The self-monitoring system fulfilled partially its role of allowing accredited hospitals to self-assess and improve rates of compliance with BFHI criteria. Future trainings of hospital managers need to address difficulties and identify solutions to improve implementation of Steps 4 and 6.

Dietary intake of pregnant adolescents cared for in primary health care units of a Brazilian urban municipality.

OBJECTIVE: to evaluate the adequacy of dietary intake and the anthropometric nutritional status of pregnant adolescents in the city of Niterói, Rio de Janeiro, Brazil. METERIALS AND METHODS: forty-two adolescents (13-19 years of age), with single-fetus gestation, assisted in the public prenatal health care units between 2008-2014, participated in the study. Body mass index (BMI) was used to assess the nutritional status. Dietary intake was assessed by 24h dietary recalls on two days during a week and one during weekend. Basal metabolic rate was measured by indirect calorimetry and used to determine the energy requirements. Mixed effects models were used to assess dietary intake over the gestational weeks (random effect) and BMI. RESULTS: mean age (SD) of the pregnant women was 16.5 (1.5) years and the majority received allowance from a cash transfer federal program. Overall, 30.3% were overweight/obese pre-pregnancy and 16.7%, during pregnancy. Energy and protein intake adequacies decreased with increasing BMI and gestational week. There was adequate dietary intake of energy, protein, vitamin A and zinc and insufficient intakes of iron and calcium. There was excessive intake of sodium. CONCLUSION: pregnant adolescents living in underprivileged socio-economic environments assisted for prenatal care in primary health care units have adequate intakes of energy, protein, vitamin A and zinc. Pre-pregnancy overweight and high sodium intake are causes of concern due to the future implications for their health. The official Brazilian recommended criterion for anthropometric assessment in pregnancy of adolescents proved to be inadequate.

Dietary intake of pregnant adolescents cared for in primary health care units of a brazilian urban municipality / Consumo dietético de adolescentes embarazadas atendidas en unidades de atención primaria de salud de un municipio urbano brasileño

Objective: to evaluate the adequacy of dietary intake and the anthropometric nutritional status of pregnant adolescents in the city of Niterói, Rio de Janeiro, Brazil. Materials and methods: forty-two adolescents (13-19 years of age), with single-fetus gestation, assisted in the public prenatal health care units between 2008-2014, participated in the study. Body mass index (BMI) was used to assess the nutritional status. Dietary intake was assessed by 24h dietary recalls on two days during a week and one during weekend. Basal metabolic rate was measured by indirect calorimetry and used to determine the energy requirements. Mixed effects models were used to assess dietary intake over the gestational weeks (random effect) and BMI. Results: mean age (SD) of the pregnant women was 16.5 (1.5) years and the majority received allowance from a cash transfer federal program. Overall, 30.3% were overweight/obese pre-pregnancy and 16.7%, during pregnancy. Energy and protein intake adequacies decreased with increasing BMI and gestational week. There was adequate dietary intake of energy, protein, vitamin A and zinc and insufficient intakes of iron and calcium. There was excessive intake of sodium. Conclusions: pregnant adolescents living in underprivileged socio-economic environments assisted for prenatal care in primary health care units have adequate intakes of energy, protein, vitamin A and zinc. Pre-pregnancy overweight and high sodium intake are causes of concern due to the future implications for their health. The official Brazilian recommended criterion for anthropometric assessment in pregnancy of adolescents proved to be inadequate

Objetivo: evaluar la adecuación de la ingesta dietética y el estado nutricional antropométrico de adolescentes embarazadas en Niterói, Río de Janeiro, Brasil. Materiales y métodos: participaron en el estudio 42 adolescentes de 13-19 años, con gestación de feto único, asistidas en las unidades públicas de atención prenatal entre 2008 y 2014. El índice de masa corporal (IMC) se utilizó para evaluar el estado nutricional. La ingesta dietética fue evaluada por recuerdos diarios de 24h dos días durante una semana y uno durante el fin de semana. La tasa metabólica basal se midió mediante calorimetría indirecta y se utilizó para determinar los requerimientos energéticos. Se emplearon modelos de efectos mixtos para evaluar la ingesta alimentaria durante las semanas de gestación (SG, efecto aleatorio) y el IMC. Resultados: la mayoría de las mujeres embarazadas recibían subsidios de un programa federal de Transferencia de efectivo. En general, el 30,3% tenía sobrepeso/obesidad antes del embarazo y el 16,7%, durante el embarazo. La cantidad de energía y la ingesta de proteínas disminuyeron con el aumento del IMC y la SG. Había una ingesta dietética adecuada de energía, proteínas, vitamina A y una ingesta insuficiente de hierro y calcio. Conclusiones: las adolescentes embarazadas tienen un consumo adecuado de energía, proteínas y vitamina A. El sobrepeso previo y el alto consumo de sodio son causas de preocupación debido a las implicaciones futuras para su salud. El criterio oficial brasileño recomendado para la evaluación antropométrica en el embarazo de los adolescentes demostró ser inadecuado

Use of a monitoring tool for growth and development in Brazilian children – systematic review / Uso de instrumento de acompanhamento do crescimento e desenvolvimento da criança no Brasil – revisão sistemática de literatura

To assess the use of a health monitoring tool in Brazilian children, with emphasis on the variables related to growth and development, which are crucial aspects of child health care. Data source: A systematic review of the literature was carried out in studies performed in Brazil, using the Cochrane Brazil, Lilacs, SciELO and Medline databases. The descriptors and keywords used were “growth and development”, “child development”, “child health record”, “child health handbook”, “health record and child” and “child handbook”, as well as the equivalent terms in Portuguese. Studies were screened by title and summary and those considered eligible were read in full. Data synthesis: Sixty-eight articles were identified and eight articles were included in the review, as they carried out a quantitative analysis of the filling out of information. Five studies assessed the completion of the Child's Health Record and three of the Child's Health Handbook. All articles concluded that the information was not properly recorded. Growth monitoring charts were rarely filled out, reaching 96.3% in the case of weight for age. The use of the BMI chart was not reported, despite the growing rates of childhood obesity. Only two studies reported the completion of development milestones and, in these, the milestones were recorded in approximately 20% of the verified tools. Conclusions: The results of the assessed articles disclosed underutilization of the tool and reflect low awareness by health professionals regarding the recording of information in the child's health monitoring document.

Avaliar o uso de instrumento de acompanhamento de saúde da criança, com ênfase nas variáveis do acompanhamento do crescimento e do desenvolvimento, eixo central do cuidado à saúde infantil. Fontes dos dados: Feita revisão sistemática da literatura de estudos no Brasil nas bases de dados Cochrane Brasil, Lilacs, SciELO e Medline. Os descritores e as palavras-chave usadas foram “crescimento e desenvolvimento”, “desenvolvimento infantil”, “cartão da criança”, “caderneta de saúde da criança”, “cartão e criança” e “caderneta da criança”. Os estudos foram rastreados por título e resumo e foi feita a leitura completa daqueles considerados elegíveis. Síntese dos dados: Foram identificados 68 artigos e oito foram incluídos no estudo por fazer a análise quantitativa do preenchimento. Cinco estudos avaliaram o preenchimento do Cartão da Criança e três da Caderneta de Saúde da Criança. Todos os artigos concluíram que as informações não foram adequadamente registradas. Os gráficos de acompanhamento do crescimento raramente foram preenchidos e chegaram a 96,3% no caso de peso para a idade. O uso do gráfico do IMC não foi relatado, a despeito do quadro crescente da obesidade infantil. Apenas dois estudos referiram preenchimento dos marcos do desenvolvimento e, nesses, houve registro dos marcos em aproximadamente 20% dos instrumentos verificados. Conclusões: Os resultados dos artigos revistos evidenciam subutilização do instrumento e refletem baixa sensibilização dos profissionais de saúde para o registro no documento de acompanhamento de saúde da criança.

Repeatability and Diagnostic Value of Nasal Potential Difference in a Genetically Admixed Population.

BACKGROUND: The genetic diversity of the Brazilian population results from three ethnic groups admixture: Europeans, Africans and Amerindians, thus increasing the difficulty of performing cystic fibrosis (CF) diagnosis. The nasal potential difference (NPD) evaluates the cystic fibrosis transmembrane conductance regulator (CFTR) and epithelial sodium channel (ENaC) activity. Despite being a useful CF diagnostic test and a biomarker of CFTR-modulator drugs, it is also highly operator dependent. Therefore, it may be difficult to get accurate results and to interpret them. Wilschanski and Sermet scores were proposed to address these issues. This study aimed to evaluate repeatability and diagnostic value of NPD parameters and Wilschanski and Sermet scores in a CF center in Rio de Janeiro. METHODS: NPD was performed in 78 subjects. Maximal PD, amiloride response, total chloride response, and Wilschanski and Sermet scores were explored as means (confidence interval, CI). One-way ANOVA was used to compare mean differences and Scheffe test was used to pair-wise comparisons. Repeatability was evaluated by scatter and Bland-Altman plots. The Ethics Committee of the CF Center has approved the study protocol. Parents and adult participants signed an informed consent form. RESULTS: Forty-eight healthy-volunteers, 19 non-CF and 11 CF patients were enrolled in this study. Significant differences were found when comparing CF patients' NPD parameters to the other two groups (P = 0.000). Moreover, no significant differences were found when parameters from non-CF patients were compared with those from healthy volunteers (P > 0.05). The means of NPD parameters and diagnostic scores of each group were in concordance with disease/non-disease conditions. The repeatability data - Wilschanski and Sermet and NPD - allow NPD to be performed in this Brazilian CF Center. CONCLUSIONS: The present study gathered consistent data for Bland-Altman plots. The results of Wilschanski and Sermet diagnostic scores suggest that they were concordant with CF/non-CF conditions. More NPD tests should be performed in the Rio de Janeiro CF dynamic cohort to contribute to international NPD validation studies and to provide NPD as a biomarker in Brazil.

[Use of a monitoring tool for growth and development in Brazilian children - systematic literature review]. / Uso de instrumento de acompanhamento do crescimento e desenvolvimento da criança no Brasil - Revisão sistemática de literatura.

OBJECTIVE: To assess the use of a health monitoring tool in Brazilian children, with emphasis on the variables related to growth and development, which are crucial aspects of child health care. DATA SOURCE: A systematic review of the literature was carried out in studies performed in Brazil, using the Cochrane Brazil, Lilacs, SciELO and Medline databases. The descriptors and keywords used were "growth and development", "child development", "child health record", "child health handbook", "health record and child" and "child handbook", as well as the equivalent terms in Portuguese. Studies were screened by title and summary and those considered eligible were read in full. DATA SYNTHESIS: Sixty-eight articles were identified and eight articles were included in the review, as they carried out a quantitative analysis of the filling out of information. Five studies assessed the completion of the Child's Health Record and three of the Child's Health Handbook. All articles concluded that the information was not properly recorded. Growth monitoring charts were rarely filled out, reaching 96.3% in the case of weight for age. The use of the BMI chart was not reported, despite the growing rates of childhood obesity. Only two studies reported the completion of development milestones and, in these, the milestones were recorded in approximately 20% of the verified tools. CONCLUSIONS: The results of the assessed articles disclosed underutilization of the tool and reflect low awareness by health professionals regarding the recording of information in the child's health monitoring document.

Association between quality of the diet and cardiometabolic risk factors in postmenopausal women.

BACKGROUND: Climateric is a phase of women's life marked by the transition from the reproductive to the non-reproductive period. In addition to overall weight gain, the menopause is also associated with the increase of abdominal fat. We used The Healthy Eating Index as a summary measure to evaluate the major components and the quality of women's diet after the onset of the menopause. This study aims at examining the association between the quality of the diet and cardiometabolic risk factors in postmenopausal women. METHODS: Cross-sectional study including 215 postmenopausal women attending a public outpatient clinic. The 24-hour dietary recall method was used to assess the food intake and to establish the Healthy Eating Index. Diets were then classified as appropriate diet (>80 points), diet "requiring improvement" (80-51 points), and poor diet (<51 points). Cardiometabolic risk factors included abdominal obesity, dyslipidemia, diabetes mellitus, and hypertension. The Fisher's exact test was utilized for the Statistical analysis. RESULTS: The analysis of the food intake showed that the average daily intake of lipids (36.7%) and sodium (2829.9 mg) were above the recommended. Only 8.8% of the women performed moderate or intense physical exercises on a regular basis. The diet was considered poor in 16.3%, "requiring improvement" in 82.8%, and appropriate for only 0.9% of the women. The study detected increased waist circumference in 92.1% of the participants. The mean concentration of triglycerides was of 183.3 mg/dl, and 130.7 mg/dl for cholesterol (Low Density Lipoprotein). CONCLUSION: Women consume a low quality diet, possibly due to the low intake of vegetables and fruits and excessive consumption of sodium. These inappropriate eating habits are associated with and, have a negative impact on the cardiometabolic risk factors such as abdominal obesity.

Contraceptive practices of Brazilian adolescents: social vulnerability in question / Práticas contraceptivas de adolescentes brasileiras: vulnerabilidade social em questão

This article seeks to analyze contraceptive practices of Brazilian adolescents and to discuss associated vulnerability situations. A cross-sectional study was conducted, using the database of the National Survey on Demography and Health of Women and Children _ PNDS 2006. Factors associated with the current use of contraceptive methods were investigated. The analysis included 986 sexually-active adolescents. Bivariate analysis between the outcome and each of the socioeconomic, demographic and reproductive characteristics of women was performed. The associations between variables were evaluated using multivariate logistic regression. Four factors related to outcome were identified in the multivariate analysis: having completed junior high school (aOR=2.29; CI 95% 1.07_4.85); being married or cohabiting with a partner (aOR=2.85; CI 95% 1.45_5.59); having used contraceptives during the first sexual intercourse (aOR=2.77; CI 95% 1.36_5.63); and having access to transportation to get to health center services (aOR=3.33; CI 95% 1.42_7.80). Adolescents with higher social vulnerability are at a disadvantage regarding adoption of contraceptive methods. This points to the need to establish intersectoral articulations of public policies, which could ensure their reproductive rights.

O objetivo deste estudo é analisar práticas contraceptivas de adolescentes brasileiras e discutir situações associadas de vulnerabilidade. Estudo transversal, utilizando banco de dados da Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher (PNDS) 2006. Foram investigados fatores associados ao uso atual de métodos anticoncepcionais. A análise incluiu 986 adolescentes sexualmente ativas. Foi realizada análise bivariada entre desfecho e cada variável independente. Associações entre variáveis foram avaliadas pela regressão logística multivariada. O nível de significância foi de 0,05. Na análise multivariada identificamos quatro fatores associados ao desfecho: ter no mínimo o ensino fundamental completo (p = 0,03; ORajustado = 2,17; IC 95% 1,034,55); união estável (p < 0,01; ORajustado = 2,84; IC 95% 1,455,54); uso de método anticoncepcional na primeira relação sexual (p < 0,01; ORajustado = 2,72; IC 95% 1,375,42); e acesso a transporte para chegar ao serviço de saúde (p < 0,01; ORajustado = 2,90; IC 95% 1,326,36). Adolescentes com maior vulnerabilidade social utilizam menos métodos anticoncepcionais. Isto aponta para a necessidade de estabelecer articulações intersetoriais com políticas públicas que garantam os direitos reprodutivos de adolescentes.

Contraceptive practices of Brazilian adolescents: social vulnerability in question.

This article seeks to analyze contraceptive practices of Brazilian adolescents and to discuss associated vulnerability situations. A cross-sectional study was conducted, using the database of the National Survey on Demography and Health of Women and Children _ PNDS 2006. Factors associated with the current use of contraceptive methods were investigated. The analysis included 986 sexually-active adolescents. Bivariate analysis between the outcome and each of the socioeconomic, demographic and reproductive characteristics of women was performed. The associations between variables were evaluated using multivariate logistic regression. Four factors related to outcome were identified in the multivariate analysis: having completed junior high school (aOR=2.29; CI 95% 1.07_4.85); being married or cohabiting with a partner (aOR=2.85; CI 95% 1.45_5.59); having used contraceptives during the first sexual intercourse (aOR=2.77; CI 95% 1.36_5.63); and having access to transportation to get to health center services (aOR=3.33; CI 95% 1.42_7.80). Adolescents with higher social vulnerability are at a disadvantage regarding adoption of contraceptive methods. This points to the need to establish intersectoral articulations of public policies, which could ensure their reproductive rights.

Bioelectrical impedance parameters in critically ill children: importance of reactance and resistance.

BACKGROUND & AIMS: Currently, there are no clinical or laboratory parameters that can be used efficiently to predict the prognosis of critically ill patients, but in some situations, raw bioelectrical impedance parameters have been shown to be useful. The purpose of this study was to investigate the behavior of reactance and resistance in the severity of the critically ill pediatric patient. METHODS: We prospectively analyzed bioelectrical impedance in a sample of 332 critically ill pediatric patients submitted to mechanical ventilation. The values taken on admission and discharge were correlated with major outcomes to the critically ill patient. RESULTS: We found an association of low values of Xc/H (<27.7 Ohm/m) and of R/H (<563.6 Ohm/m) on admission with multiple organs dysfunction greater or equal to 4. Both R/H and Xc/H increased significantly between admission and discharge among survivors, while among nonsurvivors there was a trend of decrease between admission and the last measurement before death. CONCLUSIONS: Bioelectrical impedance is a useful tool for monitoring of critically ill pediatric patients. A possible role of R/H and Xc/H, especially the latter, as a predictive biomarker of evolution for septic shock and organ dysfunction still remains to be elucidated.

Alimentação saudável, escolaridade e excesso de peso entre mulheres de baixa renda / Healthy eating, schooling and being overweight among low-income women

OBJETIVO: Analisar os fatores associados à prevalência do excesso de peso e obesidade em uma população de mulheres adultas de baixa renda, moradoras de uma região metropolitana; e sua associação com variáveis socioeconômicas, demográficas, reprodutivas e comportamentais, destacando a alimentação saudável. MÉTODOS: Foi realizado um estudo transversal de base populacional com uma amostra probabilística de 758 mulheres de 20 anos ou mais moradoras de Campos Elíseos - Duque de Caxias. Utilizou-se análise bivariada e regressão multivariada hierarquizada para identificar fatores associados ao excesso de peso e obesidade. RESULTADOS: Encontrou-se uma prevalência de obesidade de 23% e prevalências de 56,0%, quando somados o excesso de peso e a obesidade. Encontrou-se associação inversa entre anos de estudo, excesso de peso e obesidade. A maioria das mulheres referiu alimentação saudável (73,6%), que aumentou positivamente com a renda, escolaridade e idade. Não consumir semanalmente verduras esteve associado ao excesso de peso e não realizar alimentação saudável esteve associado à obesidade. CONCLUSÕES: Os resultados demonstraram que mesmo em uma população com renda baixa, um maior nível de escolaridade tem impacto na prevenção deste agravo e nas escolhas alimentares.

The scope of this study was to analyze the factors associated with the prevalence of being overweight and obesity in a population of low-income adult women living in a metropolitan region and its association with socioeconomic, demographic, reproductive and lifestyle variables, highlighting the importance of healthy eating. A population-based, cross-sectional study was conducted with a random sample of 758 women aged 20 or older living in Campos Elíseos - Duque de Caxias - State of Rio de Janeiro. Bivariate and multivariate hierarchical regression was used to identify factors associated with overweight and obesity. A prevalence of 23% of obesity was found, and a prevalence of 56% of being overweight and obesity combined. An inverse association was found between years of study, being overweight and obesity. Most of the women reported having a healthy diet (73.6%) that increased positively with income, education and age. Failure to consume vegetables weekly was associated with being overweight and not having a healthy diet was associated with obesity. The results of this study demonstrate that even in low-income populations, a higher level of education has an impact on prevention of this problem and in food choices.

[Healthy eating, schooling and being overweight among low-income women]. / Alimentação saudável, escolaridade e excesso de peso entre mulheres de baixa renda.

The scope of this study was to analyze the factors associated with the prevalence of being overweight and obesity in a population of low-income adult women living in a metropolitan region and its association with socioeconomic, demographic, reproductive and lifestyle variables, highlighting the importance of healthy eating. A population-based, cross-sectional study was conducted with a random sample of 758 women aged 20 or older living in Campos Elíseos - Duque de Caxias - State of Rio de Janeiro. Bivariate and multivariate hierarchical regression was used to identify factors associated with overweight and obesity. A prevalence of 23% of obesity was found, and a prevalence of 56% of being overweight and obesity combined. An inverse association was found between years of study, being overweight and obesity. Most of the women reported having a healthy diet (73.6%) that increased positively with income, education and age. Failure to consume vegetables weekly was associated with being overweight and not having a healthy diet was associated with obesity. The results of this study demonstrate that even in low-income populations, a higher level of education has an impact on prevention of this problem and in food choices.

Distribution of bioelectrical impedance vector values in multi-ethnic infants and pre-school children.

BACKGROUND & AIMS: Ethnicity may influence bioimpedance values. The goal of this study was to measure total body impedance vector in infants and pre-school children in Brazil and compare them with those reported in other countries. METHODS: We analyzed bioelectrical impedance from a sample of 255 healthy Brazilian children, aged 1-36 months, using the RXc graph method (tetrapolar analysis at 50 kHz frequency). The 95%, 75% and 50% tolerance ellipses were plotted by age group. RESULTS: The mean impedance vector showed migration across age groups, with progressive higher reactances and lower resistances as age increased. The mean bioimpedance vectors from the present sample of Brazilian children were different from those of European children of the same age ranges. CONCLUSIONS: Our results confirm the importance of defining reference values of total body impedance vector for each country in view of the considerable ethnic diversity among different geographical areas.