Candidemia in Brazilian neonatal intensive care units: risk factors, epidemiology, and antifungal resistance.

Candidemia is responsible for substantial morbidity and mortality in neonatal intensive care units and represents a challenge due to the complexity of hospitalized neonates, the deficiency in approved and precise diagnostic techniques, and the increasing number of species resistant to antifungal agents. Thus, the objective of this study was to detect candidemia among neonates evaluating the risk factors, epidemiology, and antifungal susceptibility. Blood samples were obtained from neonates with suspected septicemia, and the mycological diagnosis was based on yeast growth in culture. The fungal taxonomy was based on classic identification, automated system, and proteomic, when necessary molecular tools were used. The in vitro susceptibility tests were performed according to the broth microdilution method from Clinical and Laboratory Standards Institute. Statistical analysis was performed using the R software version R-4.2.2. The prevalence of neonatal candidemia was 10.97%. The major risk factors involved were previous use of parenteral nutrition, exposure to broad-spectrum antibiotics, prematurity, and prior use central venous catheter, but only this last was statistically associated with mortality risk. Species from Candida parapsilosis complex and C. albicans were the most frequent. All isolates were susceptible to amphotericin B, except C. haemulonii that also exhibited elevated MICs to fluconazole. C. parapsilosis complex and C. glabrata exhibit the highest MICs to echinocandins. Considering these data, we emphasize that an effective management strategy to reduce the impact of neonatal candidemia should involve the knowledge of risk factors, rapid and precise mycological diagnostic, and tests of antifungal susceptibility to help in the selection of an appropriate treatment.

Componentes da síndrome metabólica e fatores associados em adolescentes: estudo caso-controle / Components of metabolic syndrome and associated factors in adolescents: a case-control study

Introdução: A síndrome metabólica é representada por um conjunto de fatores de risco cardiovascular, usualmente relacionada à resistência insulínica. Objetivo: Determinar a frequência de componentes da síndrome metabólica em adolescentes e analisar os fatores associados. Métodos: Estudo caso-controle com 301 adolescentes de ambos os sexos com idades de 12 a 19 anos. A síndrome metabólica foi definida pelo critério pediátrico da International Diabetes Federation. A análise de regressão logística multivariada utilizou o modelo hierarquizado para entrada das variáveis. As razões de chance para a presença de pelo menos um componente da síndrome metabólica foram calculadas para cada variável de exposição. Resultados: A frequência da síndrome metabólica foi 4,7%, sendo maior em adolescentes com excesso de peso do que nos com peso adequado (10,2% vs 2,3%). Entre os componentes, observou-se: 21,3% obesidade abdominal, 12% baixo HDL colesterol, 10% hipertrigliceridemia, 8,3% pressão alta e 3,7% glicemia de jejum elevada. O modelo de regressão logística indicou que o índice de massa corporal (OR=6,6; IC:3,5-12,3), a história familiar positiva de doenças cardiovasculares (OR=1,7; IC:1,02-2,9) e o excesso de peso materno (OR=1,6; IC:1,01-2,8) foram os determinantes de maior poder explicativo para a presença de componentes da síndrome metabólica. Conclusão: Os adolescentes com excesso de peso apresentaram maior frequência de componentes da síndrome metabólica, estando o índice de massa corporal, a história familiar positiva de doenças cardiovasculares e o excesso de peso materno associados à presença de componentes da síndrome metabólica(AU)

Introduction: The metabolic syndrome comprises a number of cardiovascular risk factors, usually associated with insulin resistance. Aim: To determine the frequency of metabolic syndrome components in adolescents and to analyze associated factors. Methods: Case-control study of 301 adolescents of both sexes aged 12-19 years. Metabolic syndrome was defined by the pediatric criteria of the International Diabetes Federation. A multivariate logistic regression analysis used the hierarchical model for input variables. The odds ratios for the presence of at least one component of the metabolic syndrome were calculated for each exposure variable. Results: The prevalence of metabolic syndrome was 4.7%, being higher in overweight adolescents than in those with normal weight (10.2% vs 2.3%). The metabolic syndrome components found were: 21.3% abdominal obesity, 12% low HDL cholesterol, hypertriglyceridemia 10%, 8.3% high blood pressure, and 3.7% high fasting glucose. The logistic regression model indicated that body mass index (OR = 6.6; CI: 3.5-12.3), positive family history of cardiovascular disease (OR = 1.7; CI: 1,02-2.9) and excess maternal weight (OR = 1.6, CI: 1.01-2.8) were the determinants with the highest explanatory power for the presence of metabolic syndrome components. Conclusion: Overweight adolescents showed higher frequency of metabolic syndrome components, with body mass index, family history of cardiovascular disease, and excessive maternal weight associated with the presence of metabolic syndrome components(AU)

Práticas alimentares no primeiro ano de vida: representações sociais de mães adolescentes / Eating habits in the first year of life: social representations of young mothers / Los hábitos de alimentación en el primer año de vida: las representaciones sociales de las madres adolescentes

Trata-se de pesquisa qualitativa exploratória, que buscou analisar as representações sociais de mães adolescentes sobre as práticas alimentares do filho no primeiro ano de vida. Teve como sujeitos 10 mães adolescentes, cujos filhos encontravam-se na faixa etária de sete a doze meses de vida. Os dados foram coletados por meio de entrevista semi-estruturada, além da utilização de material visual. A análise seguiu a técnica de análise de conteúdo, apoiando-se no referencial da Teoria das Representações Sociais. Dessa análise, emergiram quatro temas: conflito do amamentar versus consagração do mingau; estabelecendo a alimentação complementar do filho; discurso cristalizado: "danoninho vale mais que um bifinho"; a (in)definição dos hábitos alimentares maternos: implicações para a alimentação infantil. As representações que conduzem as práticas maternas na escolha, preparo e oferta dos alimentos seguem uma lógica particular, onde as adolescentes reinterpretam os discursos técnicos nos termos da sua cultura.

This is qualitative research that investigates the social representations of adolescent mothers on child eating habits in the first year of life. Its subjects were 10 adolescent mothers, whose children were aged seven to twelve months. Data were collected through semi-structured interview, besides the use of visual material. The analysis followed the technique of content analysis, relying on the framework of Social Representations Theory. That analysis revealed four themes: the conflict of breastfeeding versus consecration of porridge; establishing complementary feeding of the child; crystallized speech: "yogurt is better than a little steak"; the (un)definition of maternal eating habits: implications for infant feeding. The representations that drive maternal practices in selecting, preparing and offering food follow a particular logic, where adolescents reinterpret technical speeches in terms of their culture.

Esta es una investigación cualitativa que investiga las representaciones sociales de madres adolescentes en las prácticas de alimentación infantil en el primer año de vida. El estudio incluyó a 10 madres adolescentes cuyos hijos tenían entre siete a doce meses. Los datos fueron obtenidos mediante entrevista semiestructurada, además de la utilización de material visual. El análisis se realizó por la técnica de análisis de contenido, basándose en el marco de la teoría de las representaciones sociales. Ese análisis revelo cuatro temas: el conflicto de la lactancia materna frente a la consagración de la papilla; el establecimiento de alimentación complementaria del niño; discurso cristalizado "el yogur es mejor que un filete"; la dieta materna sin definición: implicaciones para la alimentación infantil. Las representaciones que impulsan prácticas maternas en la selección, preparación y oferta de alimentos siguen una lógica particular, donde las adolescentes reinterpretan intervenciones técnicas en términos de su cultura.

Is breastfeeding protective for blood pressure in schoolchildren? A cohort study in northeast Brazil.

OBJECTIVE: This study assessed the influence of breastfeeding and nutritional status of full-term infants on blood pressure at school age. SUBJECTS AND METHODS: This was a cross-sectional study nested in a cohort of 375 infants recruited at birth between 1993 and 1994 in the state of Pernambuco, Brazil. A sample of 213 8-year-old children had their blood pressure measured. A multivariate linear regression analysis was used to identify the influence of low birth weight and breastfeeding duration on blood pressure, adjusting for socioeconomic conditions, maternal nutritional status, eating habits, growth rate (0-6 months), and the children's anthropometry at 8 years. RESULTS: Mean values of children's blood pressure were significantly higher with lower duration of breastfeeding. Higher per capita family income, maternal body mass index and height, child's weight and length at birth, and child anthropometric dimensions at 8 years of age were associated with higher levels of blood pressure. The multivariate linear regression analysis showed that children who were breastfed for less than 40 days had higher systolic blood pressures, explaining 2.2% of its variation. Anthropometry at 8 years of age explained the higher variance in systolic blood pressure (12.6%) with emphasis on waist circumference (9.5%), followed by per capita income (3.2%) and maternal height (2.1%). Birth weight and length had no influence on blood pressure levels in this age group. CONCLUSIONS: Children's waist circumference, duration of breastfeeding, socioeconomic conditions, and maternal nutritional status influenced blood pressure levels of schoolchildren born full term, rather than low birth weight.

[Eating habits in the first year of life: social representations of young mothers]. / Práticas alimentares no primeiro ano de vida: representações sociais de mães adolescentes.

This is qualitative research that investigates the social representations of adolescent mothers on child eating habits in the first year of life. Its subjects were 10 adolescent mothers, whose children were aged seven to twelve months. Data were collected through semi-structured interview, besides the use of visual material. The analysis followed the technique of content analysis, relying on the framework of Social Representations Theory. That analysis revealed four themes: the conflict of breastfeeding versus consecration of porridge; establishing complementary feeding of the child; crystallized speech: "yogurt is better than a little steak"; the (un)definition of maternal eating habits: implications for infant feeding. The representations that drive maternal practices in selecting, preparing and offering food follow a particular logic, where adolescents reinterpret technical speeches in terms of their culture.

Padrão de atividade física em diferentes domínios e sua associação com a pressão arterial em adolescentes / Pattern of physical activity in different domains and its association with blood pressure in adolescents

Introdução: A atividade física compreende uma gama de dimensões que incluem as atividades voluntárias, as ocupacionais, de lazer, domésticas e de deslocamento. O objetivo do estudo foi analisar o padrão de atividade física em diferentes domínios e a associação com a pressão arterial em adolescentes. Métodos: Participaram 734 adolescentes (15,9±1,6 anos) de ambos os sexos. A atividade física foi determinada através de quatro domínios: prática de esporte no lazer, locomoção à escola, educação física escolar e comportamento sedentário. A pressão alta foi definida a partir de valores acima do percentil 90, ajustada para a estatura, idade e sexo. Resultados: A prevalência de inatividade física variou conforme os domínios: 30,1% são inativos fisicamente na locomoção à escola, 23,2% não praticam esporte no lazer, 29,4% têm comportamento sedentário e 15,0% são ausentes na educação física escolar. A prevalência de pressão alta em ambos os sexos foi de 14,3%. Foram observadas médias superiores, nos valores sistólico e diastólico, no sexo masculino e naqueles que não praticam esporte no lazer. Após o ajustamento, a faixa etária (p=0,30) e a educação física escolar (p=0,16) não estiveram associadas à pressão arterial. Conclusão: A pressão arterial elevada esteve presente e mais prevalente no sexo masculino. Constataram-se prevalências de inatividade física em ambos os sexos e nos diferentes domínios, com maior frequência na locomoção à escola e no comportamento sedentário. O sedentarismo na prática de esporte no lazer, na locomoção à escola e o comportamento sedentário se apresentaram associados à pressão arterial elevada em adolescentes

Introduction: Physical activity comprises a range of dimensions that include volunteer, occupational, leisure, home, and travel activities. The aim of the study was to analyze the pattern of physical activity in different domains and the association with blood pressure in adolescents. Methods: Participants were 734 adolescents (15.9 ± 1.6 years) of both sexes. Physical activity was measured using four domains: sports practice at leisure, transportation to school, physical education and sedentary behavior. High blood pressure was defined as values above the 90th percentile, adjusted for height, age and sex. Results:The prevalence of physical inactivity shifted across domains: 30.1% are physically inactive in getting to school, 23.2% do not practice sports at leisure, 29.4% have sedentary behavior and 15.0% are absent from physical education classes. The prevalence of high blood pressure in both sexes was 14.3%. Higher means in systolic and diastolic values were observed in males and in those who do not practice sports at leisure. After adjustment, age (p = 0.30) and physical education (p = 0.16) were not associated with blood pressure. Conclusion: High blood pressure was present and more prevalent in males. Prevalences of physical inactivity were found in both sexes and different domains, most often in transportation to school and sedentary behavior. Physical inactivity in the practice of sports at leisure, in getting to school, and sedentary behavior were associated with high blood pressure in adolescents

Prevalência e fatores associados ao excesso de peso em adolescentes da rede pública de ensino de João Pessoa, Paraíba / Prevalence and associated factors of overweight in adolescents from public schools in João Pessoa, Paraíba

Introdução: A importante dimensão que a obesidade vem adquirindo na sociedade contemporânea, incluindo tanto os países desenvolvidos quanto os emergentes, vem se apresentando como um sério problema de saúde para a população. O estudo teve como objetivos determinar a prevalência de excesso de peso e analisar os fatores associados em adolescentes. Métodos: Trata-se de estudo transversal com 734 adolescentes de ambos os sexos com idades entre 11 e 19 anos (15,9±1,6 anos), alocados por técnica de amostragem probabilística por conglomerado em 10 escolas públicas estaduais de João Pessoa, Paraíba, no período 2009-2010. O excesso de peso foi estimado através do cálculo do IMC/idade de acordo com os critérios da Organização Mundial de Saúde. A análise de regressão logística múltipla utilizou o modelo hierarquizado para entrada das variáveis. As razões de chance para o excesso de peso foram calculadas para cada variável de exposição. Resultados:O excesso de peso foi observado em 20,8% dos adolescentes, de forma similar entre os sexos. O déficit ponderal esteve presente em 1,6% dos adolescentes. O modelo final de regressão logística indicou que o excesso de peso materno, o antecedente familiar de doenças crônicas não transmissíveis, a inatividade física e o baixo consumo de frutas/verduras foram osdeterminantes de maior poder explicativo para o excesso de peso em adolescentes. Conclusão: A prevalência de excesso de peso entre adolescentes da rede pública estadual de João Pessoa é elevada, se apresenta generalizada segundo sexo e está associada a fatores biológicos e ao estilo de vida.

Introduction: The significant dimension that obesity has acquired in contemporary society, including both developed and emerging countries, has been presented as a serious health problem for the population. This study aimed to determine the prevalence of overweight and assess the associated factors in adolescents. Methods: This is a cross-sectional study of 734 adolescents of both sexes aged between 11 and 19 years (15.9 ± 1.6 years), allocated by a probabilistic cluster sampling technique in 10 public schools of João Pessoa, Paraíba, in the 2009-2010 period. Overweight was estimated by calculating the BMI/age according to the criteria of the World Health Organization. The multiple logistic regression analysis used the hierarchical model for entering variables. Odds ratios for overweight were calculated for each independent variable. Results: Overweight was observed in 20.8% of the adolescents, and was similar between the sexes. Underweight was present in 1.6% of the adolescents. The fi nal model of logistic regression showed that maternal overweight, family history of non transmissible chronic diseases, physical inactivity, and low fruit/vegetables were the strongest determinants of overweight in adolescents. Conclusion: The prevalence of overweight among adolescents in public schools of João Pessoa is high, similarly distributed between the sexes and associated with biological factors and lifestyle.

Bases biológicas e evidências epidemiológicas da contribuição do crescimento fetal e pós-natal na composição corporal: uma revisão / The biological bases of and epidemiological evidence for the contribution of fetal and postnatal growth to body composition: a review

Apresentar as bases biológicas e evidências epidemiológicas do crescimento fetal e pós-natal relacionadas ao tamanho e composição corporal. MÉTODOS: a busca de artigos publicados nos últimos 15 anos foi realizada nas bases de dados Lilacs, SciELO, Medline através dos descritores: crescimento, restrição do crescimento fetal, baixo peso ao nascer, aceleração compensatória do crescimento, composição corporal, índice de massa corporal e hormônios. Os estudos foram selecionados de acordo com a pertinência às evidências a serem analisadas. RESULTADOS: os artigos apontam para a influência da restrição do crescimento intraútero na supressão da termogênese e regulação hormonal, que por sua vez interferem no ganho de peso após o nascimento, e explicam como ambos os processos, restrição do crescimento fetal e rápido ganho de peso pós-natal, influenciam as medidas corporais em fases posteriores da vida, com consequências que poderão afetar gerações. CONCLUSÕES: o crescimento fetal influencia o padrão de crescimento pós-natal devido a diversos fatores relacionados à regulação hormonal, porém existe ainda uma lacuna sobre a contribuição da somação entre crescimento fetal e pós-natal no tamanho e composição corporal em fases posteriores da vida...

To present the biological bases of and epidemiological evidence for fetal and postnatal growth in relation to size and body composition. METHODS: a search of papers published in the last 15 years was carried out in the Lilacs, SciELO, and Medline databases using the key words: growth, fetal growth restriction, low birth weight, catchup growth, body composition, body mass index and hormones. The studies were selected according to relevance to the evidence to be analyzed. RESULTS: the articles show the influence of intrauterine growth restriction on the suppression of thermogenesis and hormonal regulation, which in turn interfere with weight gain after birth, and explain how both processes, fetal growth restriction and rapid postnatal weight gain influence body measurements in later life, with consequences that might affect generations. CONCLUSIONS: fetal growth influences the pattern of postnatal growth due to several factors related to hormone regulation, but there is still a gap on the contribution of the combination of fetal growth and postnatal size to body composition in later life...