A randomized controlled trial testing the efficacy of a Nurse Home Visiting Program for Pregnant Adolescents.

To test the efficacy of a nurse home visiting program (HVP) on child development, maternal and environmental outcomes in the first years of life. We conducted a randomized controlled trial to test the efficacy of Primeiros Laços, a nurse HVP for adolescent mothers living in a poor urban area of São Paulo, Brazil. Eighty adolescent mothers were included and randomized to receive either Primeiros Laços (intervention group, n = 40) or healthcare as usual (control group, n = 40). Primeiros Laços is a home visiting intervention delivered by trained nurses that starts during the first 16 weeks of pregnancy and continues to the child's age of 24 months. Participants were assessed by blind interviewers at 8-16 weeks of pregnancy (baseline), 30 weeks of pregnancy, and 3, 6, 12, and 24 months of child's age. We assessed oscillatory power in the mid-range alpha frequency via electroencephalography when the children were aged 6 months. Child development was measured by the Bayley Scales of Infant Development Third Edition (BSID-III). Weight and length were measured by trained professionals and anthropometric indexes were calculated. The home environment and maternal interaction with the child was measured by the Home Observation and Measurement of the Environment. Generalized estimating equation models were used to examine intervention effects on the trajectories of outcomes. Standardized effect sizes (Cohen's d) were calculated using marginal means from endpoint assessments of all outcomes. The trial was registered at clinicaltrial.gov: NCT02807818. Our analyses showed significant positive effects of the intervention on child expressive language development (coefficient = 0.89, 95% CI [0.18, 1.61], p = 0.014), maternal emotional/verbal responsivity (coefficient = 0.97, 95% CI [0.37, 1.58], p = 0.002), and opportunities for variety in daily stimulation (coefficient = 0.37, 95% CI [0.09, 0.66], p = 0.009). Standardized effect sizes of the intervention were small to moderate. Primeiros Laços is a promising intervention to promote child development and to improve the home environment of low-income adolescent mothers. However, considering the limitations of our study, future studies should be conducted to assess Primeiros Laços potential to benefit this population.Clinical Trial Registration: The study was registered at clinicaltrial.gov (Registration date: 21/06/2016 and Registration number: NCT02807818).

Birth weight associated with dual energy X-ray absorptiometry-determined muscle-bone unit in young healthy women from the Nutritionists' Health Study.

Muscle and bone have been considered a functional unit that grows together early in life, deteriorates with aging, and can cause osteosarcopenia. Due to its importance in public health, detecting risk factors in early life is desirable. This study examined whether birth weight (BW) was associated with muscle-bone unit using dual energy X-ray absorptiometry (DXA) parameters in young women from the Nutritionists' Health Study (NutriHS), a cohort study of undergraduates and Nutrition graduates. This cross-sectional analysis included 170 young healthy women who answered early life events-questionnaire, and had anthropometric, muscle tests and DXA-determined body composition and bone densitometry (iDXA-Lunar®). A blood sample was obtained for a subsample of 148 participants. Appendicular skeletal muscle mass index (ASMI) was calculated. BW was categorized in quartiles (BWq) and variables of interest compared by ANOVA. Associations of BWq with calf circumference (CC), handgrip, muscle performance tests, ASMI, bone mineral density and content (BMD and BMC), and plasma glucose, lipids, insulin, and 25-hydroxyvitamin D were performed using multiple linear regression and directed acyclic graph-recommended adjustments. Mean values of age, body mass index, and BW were 23.0 years (20.0-28.0), 22.9 ± 2.9 kg/m2, and 3199 ± 424 g, respectively. Comparing variables across BWq, significant differences in CC, handgrip, ASMI, and total body BMC were detected. Regression models adjusted for confounders showed associations of BWq with CC (ß = 0.72, p = 0.005), handgrip (ß = 1.53, p = 0.001), ASMI (ß = 0.16, p = 0.022), total body BMC (ß = 64.8, p = 0.005), total femur BMC (ß = 0.70, p = 0.041), total body BMD (ß = 0.02, p = 0.043), and lumbar spine BMD (ß = 0.03, p = 0.028). We conclude that BW is associated with muscle-bone unit using DXA-parameters in Brazilian young healthy women from the NutriHS, suggesting a role for intrauterine environment for musculoskeletal health.

Efficacy of photographic educational materials for carbohydrate counting training of adolescents with diabetes mellitus.

BACKGROUND: Carbohydrate counting (CHC) is ack - nowledged by the American Diabetes Association (ADA) as an important tool. OBJECTIVE: To assess the efficacy of photographic educational materials to train adolescents with DM to perform CHC. SUBJECTS AND METHODS: 76 adolescents were randomly divided into two groups of CHC orientation: by means of photographic materials (Photo) or by a list of foods (List). One month afterwards, the participants were contacted via telephone to answer questions on CHC to reinforce the training (Quiz). Two days after taking the quiz, required the participants to visit an experimental kitchen to observe food portions in natura and to respond to a questionnaire on the weights in grams or carbohydrate equivalents of these portions. Statistical significance was established at p < 0.05. RESULTS: 54 adolescents completed the study (79.7% female), with 51.8% allocated to the Photo group and 48.1% to the List group. The mean age was 13.8 ± 2.0 years old, and the mean body mass index (BMI) was 21.0 ± 3.2 kg/m2. The participants had average of 7.9 ± 1.5 years of schooling, while their parents had 8.0 ± 3.8 years. The knowledge of CHC was similar in both groups before the intervention. After the intervention, the Photo group achieved a significantly higher hit difference on the CHC assessment test than the List group (Photo: 2.5 vs List: 1.0; p = 0.03). CONCLUSIONS: The photographic educational material was more effective in helping adolescents with DM understand and learn to perform carbohydrate counting.

Antecedentes: El conteo de carbohidratos (CCH) es reconocido por la Asociación Americana de Diabetes (AAD) como una herramienta importante. Objetivo: Evaluar la eficacia de materiales educativos fotográficos en el entrenamiento de adolescentes con DM para realizar el CCH. Sujetos y Métodos: se distribuyó al azar a 76 adolescentes a dos grupos de orientación de CCH: mediante materiales fotográficos (Foto) o mediante listado de alimentos (Lista). Un mes después, se contactó a los participantes por teléfono para responder a preguntas sobre CCH para reforzar el entrenamiento (Encuesta). Dos días después de la encuesta, se pidió a los participantes que visitaran una cocina experimental para observar las porciones de los alimentos al natural y responder a un cuestionario sobre los pesos en gramos o equivalentes de carbohidratos de estas porciones. Se estableció la significación estadística en un valor de p < 0,05. Resultados: 54 adolescentes completaron el estudio (79,7 % mujeres), siendo el 51,8 % asignados al grupo Foto y el 48,1 % al grupo Lista. La edad promedio fue de 13,8 ± 2,0 años y el índice de masa corporal (IMC) promedio fue de 21,0 ± 3,2 kg/m2. Los participantes tenían un promedio de 7,9 ± 1,5 años de escolarización, y sus padres 8,0 ± 3,8 años. EL conocimiento en el CCH fue similar en ambos grupos antes de la intervención. Después de la misma, el grupo Foto consiguió una diferencia significativa en la tasa de aciertos en el test de evaluación del CCH con respecto al grupo Lista (Foto: 2,5 frente a Lista: 1.0; p = 0,03). Conclusiones: el material educativo fotográfico fue más eficaz a la hora de ayudar a los adolescentes con DM a comprender y aprender a realizar el conteo de hidratos de carbono.

Los contaminantes atmosféricos urbanos son factores de riesgo significativos para el asma y la neumonía en niños: influencia del lugar de medición de los contaminantes / Urban Air Pollutants are Significant Risk Factors for Asthma and Pneumonia in Children: The Influence of Location on the Measurement of Pollutants

Antecedentes: La contaminación atmosférica se asocia a una carga sustancial para la salud humana; sin embargo, los contaminantes de mayor importancia pueden variar según el lugar. Es necesaria una monitorización adecuada para determinar el efecto de dichos contaminantes sobre la salud respiratoria. Objetivos: Este estudio se diseñó para evaluar el papel de la exposición en el exterior, en el interior y personal a los contaminantes derivados de la combustión NO2 y O3 sobre la salud respiratoria de los niños en una zona urbana económicamente poco favorecida de São Paulo (Brasil). Métodos: Se determinaron de forma continua los niveles de NO2 y O3 en el aire del exterior, el interior, y también en la exposición personal, durante 30 días con el empleo de aparatos de medición pasiva. Se evaluó la salud respiratoria con una versión en brasileño del cuestionario ISAAC. Resultados: Se dispuso de datos completos de 64 niños de 6 a 10 años de edad. La morbilidad respiratoria fue alta, con 43 (67,2%) niños en los que había habido sibilancias en alguna ocasión, 27 (42,2%) con sibilancias en el mes anterior, 17 (26,6%) con asma en alguna ocasión y 21 (32,8%) con neumonía en alguna ocasión. Las correlaciones entre los niveles de NO2 y O3 determinados en las 3 localizaciones evaluadas fueron bajas. Los niveles de NO2 en el área de interior y la exposición personal a O3 mostraron una asociación independiente con el asma (p=0,02 en ambos casos), la neumonía (O3, p=0,02) y la presencia de sibilancias en alguna ocasión (p<0,01 en ambos casos). No se observaron asociaciones entre el NO2 y el O3 del exterior y la salud respiratoria(AU)

Conclusiones: La exposición a niveles más elevados de NO2 y O3 se asoció a un aumento del riesgo de asma y neumonía en los niños; sin embargo, el lugar en el que se determinan los contaminantes influye en los resultados. Las determinaciones realizadas en el interior y las determinaciones personales fueron las más exactas(AU)

Background: Air pollution is associated with a substantial burden on human health; however, the most important pollutants may vary with location. Proper monitoring is necessary to determine the effect of these pollutants on respiratory health. Objectives: This study was designed to evaluate the role of outdoor, indoor and personal exposure to combustion-related pollutants NO2 and O3 on respiratory health of children in a non-affluent urban area of São Paulo, Brazil. Methods: Levels of NO2 and O3 were continuously measured in outdoor and indoor air, as well as personal exposure, for 30 days using passive measurement monitors. Respiratory health was assessed with a Brazilian version of the ISAAC questionnaire. Results: Complete data were available from 64 children, aged 6-10 years. Respiratory morbidity was high, with 43 (67.2%) reporting having had wheezing at any time, 27 (42.2%) wheezing in the last month, 17 (26.6%) asthma at any time and 21 (32.8%) pneumonia at any time. Correlations between levels of NO2 and O3 measured in the three locations evaluated were poor. Levels of NO2 in indoor air and personal exposure to O3 were independently associated with asthma (both cases P=0.02), pneumonia (O3, P=0.02) and wheezing at any time (both cases P<0.01). No associations were seen between outdoor NO2 and O3 and respiratory health. Conclusions: Exposure to higher levels of NO2 and O3 was associated with increased risk for asthma and pneumonia in children. Nonetheless, the place where the pollutants are measured influences the results. The measurements taken in indoor and personal exposure were the most accurate(AU)