Adolescent blood pressure classification curves and cardiometabolic risk factors: a comparison of the Brazilian and American references.

BACKGROUND: The American Academy of Pediatrics (AAP) adolescent blood pressure (BP) percentiles were updated in 2017, and have been used as reference in Brazil since then. However, specific BP percentiles for Brazilian adolescents were recently proposed based on data from the Study of Cardiovascular Risk in Adolescents (ERICA). OBJECTIVES: To compare the prevalence of arterial hypertension according to each reference, as well as to assess the cardiometabolic risk associated with the reclassification by Brazilian BP percentiles. METHODS: Data from 73 399 adolescents aged 12-17 years who participated in the ERICA study were analyzed. To assess cardiometabolic risk, 6185 adolescents who were reclassified upwards by the Brazilian reference were 1 : 1 matched with adolescents that were normotensive by both references and were of the same age, sex and height percentile. The parameters evaluated were: overweight/obesity, waist circumference, total cholesterol, triglycerides, LDL-c, HDL-c, fasting glucose, HbA1c and HOMA-ir. RESULTS: The classification according to Brazilian BP percentiles resulted in a higher prevalence of arterial hypertension (14%, 95% CI 13.2-14.8), when compared with the AAP percentiles (10.6%, 95% CI 10.0-11.2). The use of the Brazilian reference also resulted in higher prevalence of arterial hypertension in girls, teenagers ranging from 12 to 14 years, and those classified with adequate weight, overweight or obesity. In the case-control analysis, cardiometabolic risk factors were present more often in adolescents reclassified with arterial hypertension by the ERICA reference. DISCUSSION: The use of the BP percentiles proposed by ERICA is a sensitive method for tracking Brazilian adolescents with hypertension and higher cardiometabolic risk.

Does single-site robotic surgery makes sense for gallbladder surgery?

BACKGROUND: Cholecystectomy is one of the most performed surgeries. Several techniques were created, generating less pain, better aesthetic results and faster return to activities. Robotic surgery through a single portal combined the advantages of single-incision surgery with the principles of conventional laparoscopy, making it a safe and feasible procedure. However, due to the high costs, this technology is hardly available in practice, especially in the public health system. The objective is to evaluate the safety of robotic cholecystectomy using the da Vinci Single-Site © Surgical Platform (DVSSP) in a tertiary public hospital, and to assess alternatives that can reduce the costs, influencing the final real value of the procedure. METHODS: Prospective and descriptive study evaluating robotic cholecystectomies using the DVSSP technology performed at Hospital de Clínicas de Porto Alegre from May 2017 to November 2018. RESULTS: A total of 37 cholecystectomies were performed. The average time of surgery was 82.62 min, and no intraoperative complications were observed. There was a need for conversion to conventional laparoscopy in two surgeries (5.4%). The average cost of the robotic procedure was U$ 1146.23 and the amount passed on to the institution by the Brazilian Unified Health System was on average U$ 212.59 (p < 0.05). Postoperative outcomes were satisfactory, with an incisional hernia index of 8.1%. CONCLUSION: Although robotic surgery in this setting is a safe and feasible alternative, the high cost of the procedure prevents its dissemination on a large scale. New alternatives are needed to reduce the value and to allow greater accessibility.

Sleep quality and excessive daytime sleepiness in women with Premenstrual Syndrome.

OBJECTIVE: Examine the relationship between Premenstrual Syndrome (PMS) and sleep in different menstrual cycle phases. METHODS: Case-control survey conducted at the Primary Care Service and Clinical Research Center at Hospital de Clínicas de Porto Alegre with women aged between 18 and 45 years old. Women filled the Brazilian version of the Premenstrual Symptoms Screen Tool (PSST) for the screening of PMS; participants with positive screening completed the Daily Record of Severity of Problems (DRSP) to confirm PMS diagnosis. We applied the Pittsburg Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) Brazilian versions in the luteal phase (LP) and follicular phase (FP). RESULTS AND CONCLUSION: 69 women were characterized with PMS and 52 without PMS. The risk of poor sleep quality (SQ) was two times higher in women with PMS (p = .006; OR = 3.057; IC95% 1.44-6.45). An interaction between no PMS and LP was found in ESS (p = .014; generalized estimating equation - GEE - adjusted for multiple comparisons by the Bonferroni test and adjusted by age); besides that, women with PMS had greater scores in ESS (p = .022; GEE adjusted by age).

Prevalence of overweight and obesity among Brazilian adolescents over time: a systematic review and meta-analysis.

OBJECTIVE: To estimate the burden of excess weight in Brazilian adolescents. DESIGN: Systematic review with meta-analysis. SETTING: We searched the literature in four databases (MEDLINE/PubMed, EMBASE, SciELO and LILACS). Studies were included if they had cross-sectional or cohort design and enrolled Brazilian adolescents. Studies based on self-reported measures were excluded. Random effect models were used to calculate prevalence estimates and their 95 % CI. PARTICIPANTS: Brazilian adolescents (10 to 19 years old). RESULTS: One hundred and fifty-one studies were included. Trend analyses showed a significant increase in the prevalence of excess weight in the last decades: 8·2 % (95 % CI 7·7, 8·7) until year 2000, 18·9 (95 % CI 14·7, 23·2) from 2000 to 2009, and 25·1 % (95 % CI 23·4, 26·8) in 2010 and after. A similar temporal pattern was observed in the prevalence of overweight and obesity separately. In sensitivity analyses, lower prevalence of excess weight was found in older adolescents and those defined using International Obesity Task Force cut-off points. The Southeast and South regions had the highest prevalence of excess weight, overweight and obesity. No significant difference in prevalence by sex was found, except for studies before the year 2000. CONCLUSIONS: The prevalence of overweight and obesity in Brazilian adolescents is high and continues to rise. Public policies on an individual level and targeting modifications in the obesogenic environment are necessary.

Premenstrual Syndrome and Female Sexual Function.

PURPOSE: To examine the relationship between Premenstrual Syndrome (PMS) and female sexual function (FSF) with the luteal (LP) and follicular phases (FP). METHOD: We performed a cross-sectional survey using the Female Sexual Function Index (FSFI) questionnaire in the LP and FP. We used the Brazilian's version of the Premenstrual Symptoms Screen Tool (PSST) and the Daily Record of Severity of Problems (DRSP) for diagnosis of PMS. RESULTS: There was no difference in the FSF between groups in both cycle phases. We found an association between LP and worst scores on FSFI. CONCLUSION: PMS does not affect FSF.

The effect of probiotics, prebiotics or synbiotics on metabolic outcomes in individuals with diabetes: a systematic review and meta-analysis.

AIMS/HYPOTHESIS: The aim was to conduct a systematic review and meta-analysis of randomised controlled clinical trials assessing the effect of probiotic, prebiotic or synbiotic supplementation on gut microbiota and glucose control and lipid levels in individuals with diabetes. METHODS: MEDLINE, EMBASE and the Cochrane Library were searched. The eligibility criteria for the studies was involvement of participants with a diagnosis of type 1 or type 2 diabetes. Metabolic outcomes (glucose control, insulinaemia, and lipid profile) of any probiotic, prebiotic or synbiotic supplementation related to modification of gut microbiota (prebiotics, probiotics and synbiotics) were analysed. We provided a narrative synthesis and meta-analysis of the findings on metabolic outcomes from the studies. Metabolic outcomes were extracted post-intervention and expressed as mean differences (MDs) and 95% CIs between treatment and comparator groups. We pooled the results using a random-effects meta-analysis. The meta-analysis was conducted using Review Manager (RevMan) software. RESULTS: After the removal of duplicates and ineligible studies, 5219 studies were retained for review of titles and abstracts. The number of articles was reduced to 130 by review, for which the full-text articles were obtained and reassessed, 38 of which were included in the final meta-analysis. Overall, the use of prebiotics, probiotics or synbiotics reduced HbA1c levels, but did not reach the threshold for significance (-2.17 mmol/mol, 95% CI -4.37, 0.03; p = 0.05, [-0.20%, 95% CI -0.40 to 0.00; p = 0.05, I2 = 66%]) and had no effect on LDL-cholesterol levels (-0.05 mmol/l; 95% CI -0.14, 0.05, p = 0.35, I2 = 37%). However, their consumption decreased levels of fasting blood glucose (-0.58 mmol/l; 95% CI -0.86, -0.30; p < 0.01, I2 = 60%), total cholesterol (-0.14 mmol/l; 95% CI -0.26, -0.02, p = 0.02, I2 = 39%), triacylglycerols (-0.11 mmol/l; 95% CI -0.20, -0.02, p = 0.01, I2= 21%) and insulinaemia (-10.51 pmol/l; 95% CI -16.68,-4.33, p < 0.01, I2 = 74%), and increased HDL-cholesterol levels (0.04 mmol/l; 95% CI 0.01, 0.07, p < 0.01, I2= 24%). CONCLUSIONS/INTERPRETATION: In individuals with diabetes mellitus, supplementation with probiotics, prebiotics or synbiotics improved metabolic variables, although the magnitude of this effect is low. Our results suggest that consumption of probiotics, prebiotics or synbiotics may be a potential adjuvant treatment for improving metabolic outcomes. REGISTRATION: PROSPERO ID CRD42017080071. Graphical abstract.

Severity of obesity is associated with worse cardiometabolic risk profile in adolescents: Findings from a Brazilian national study (ERICA).

OBJECTIVE: The prevalence of obesity and severe obesity among adolescents has increased dramatically in developing countries. However, the distribution of cardiometabolic risk factors through the severity of obesity continuum is relatively unknown among youth. The aim of this study was to evaluate the association of weight categories with cardiometabolic risk factors among Brazilian adolescents. METHODS: ERICA (The Study of Cardiovascular Risk in Adolescents) was a multicenter, school-based, cross-sectional study composed of Brazilian adolescents (12-17 y of age). Severity of obesity was classified according to the International Obesity Task Force reference values for body mass index (BMI) and several cardiometabolic risk factors were measured after clinical and biochemical exams and categorized using standard definitions of abnormal values. RESULTS: Among the 37 892 adolescents enrolled, 8708 had excess weight, being classified with overweight (17.2%), obesity (5.6%), and severe obesity (1.3%). Increasing severity of obesity was associated with a worse cardiometabolic profile in the overall sample. Multivariable models that controlled for age, sex, skin color, socioeconomic status, physical activity, and total energy intake, showed that individuals in higher categories of severity of obesity tended to have higher prevalence ratios of most cardiometabolic risk factors compared with the other weight groups, except for high fasting blood glucose among boys. CONCLUSIONS: Progressive degrees of excess weight are positively associated with cardiometabolic risk factors in youth from a middle-income country, indicating the importance in classifying the severity of weight excess among adolescents and considering this to plan prevention programs against early development of obesity-related diseases.

Higher adiponectin concentrations are associated with reduced metabolic syndrome risk independently of weight status in Brazilian adolescents.

OBJECTIVE: To evaluate the association between adiponectin concentrations and metabolic syndrome (MetS) risk and to investigate if this association is independent of weight status in adolescents. METHODS: Adiponectin concentrations and MetS risk were assessed in 4546 Brazilian adolescents (12-17 years old) enrolled in The Study of Cardiovascular Risks in Adolescents ("ERICA"), a cross-sectional multicenter study in Brazil. For analyses, adiponectin was categorized in sex and age-specific quartiles and MetS risk was expressed as a continuous score, calculated as the average of the standardized values (z-score) of the five MetS components. Multiple linear regression models were used to investigate the association between the quartiles of adiponectin and MetS risk. RESULTS: Adiponectin was inversely associated with waist circumference and log-transformed triglycerides, and positively associated with HDL-c. We also observed an inverse association between adiponectin concentrations and MetS risk. After adjustment for sociodemographic variables, physical activity, skipping breakfast and body mass index (BMI), higher quartiles of adiponectin remained inversely associated with waist circumference and MetS risk. A direct association between adiponectin and HDL-c was also observed. In further analysis, the sample was stratified by weight status and an inverse association between quartiles of adiponectin and MetS risk was observed in both normal weight and overweight/obese adolescents. CONCLUSION: Higher adiponectin concentrations were independently and inverse associated with MetS risk in Brazilian adolescents, even after adjusting for BMI. These results were similar in normal weight and overweight/obese adolescents, suggesting that adiponectin may play a role in early development of MetS.

Prevalence of excessive screen time and TV viewing among Brazilian adolescents: a systematic review and meta-analysis / Prevalência de tempo excessivo de tela e tempo de TV em adolescentes brasileiros: revisão sistemática e metanálise

Abstract Purpose: To evaluate the prevalence of excessive screen-based behaviors among Brazilian adolescents through a systematic review with meta-analysis. Data source: Systematic review and meta-analysis were recorded in the International Prospective Register of Ongoing Systematic Reviews (PROSPERO-CRD 2017 CRD42017074432). This review included observational studies (cohort or cross-sectional) that evaluated the prevalence of excessive screen time (i.e. combinations involving different screen-based behaviors) or TV viewing (≥2 h/day or >2 h/day in front of screen) through indirect or direct methods in adolescents aged between 10 and 19 years. The research strategy included the following databases: MEDLINE, LILACS, SciELO and ADOLEC. The search strategy included terms for "screen time", "Brazil", and "prevalence". Random effect models were used to estimate the prevalence of excessive screen time in different categories. Data summary: Twenty-eight out of 775 studies identified in the search met the inclusion criteria. The prevalence of excessive screen time and TV viewing was 70.9% (95% CI: 65.5-76.1) and 58.8% (95% CI: 49.4-68.0), respectively. There was no difference between sexes in both analyses. The majority of studies included showed a low risk of bias. Conclusions: The prevalence of excessive screen time and TV viewing was high among Brazilian adolescents. Intervention are needed to reduce the excessive screen time among adolescents.

Resumo Objetivo: Avaliar a prevalência de tempo excessivo de tela e de TV em adolescentes brasileiros através de revisão sistemática com metanálise. Fontes de dados: A revisão sistemática e a metanálise foram registradas no Registro Prospectivo Internacional da Base de Dados de Análises Sistemáticas (Prospero-CRD 2017 CRD 42017074432). Esta análise incluiu estudos observacionais (coorte ou transversais) que avaliaram a prevalência de tempo excessivo de tela (ou seja, combinações que envolvem diferentes comportamentos baseados em tempo de tela) ou tempo em frente à TV (≥ 2 horas/dia ou > 2 horas/dia em frente à tela) por avaliação direta ou indireta em adolescentes com idades entre 10 a 19 anos. A estratégia de pesquisa incluiu as seguintes bases de dados: MEDLINE, LILACS, SciELO e ADOLEC. A estratégia de busca incluiu termos como "tempo de tela", "Brasil" e "prevalência". Os modelos de efeito aleatório foram utilizados para estimar a prevalência de tempo excessivo de tela em diferentes categorias. Resumo de dados: Dos 775 estudos identificados na busca 28 atenderam aos critérios de inclusão. A prevalência de tempo excessivo de tela e tempo de TV foi 70,9% (IC de 95%: 65,5 a 76,1) e 58,8% (IC de 95%: 49,4 a 68,0), respectivamente. Não houve diferença entre os sexos nas duas análises. A maior parte dos estudos incluídos mostrou baixo risco de viés. Conclusões: A prevalência de tempo excessivo de tela e tempo de TV foi alta entre os adolescentes brasileiros. São necessárias intervenções para reduzir o tempo excessivo de tela entre os adolescentes.

Prevalence of excessive screen time and TV viewing among Brazilian adolescents: a systematic review and meta-analysis.

PURPOSE: To evaluate the prevalence of excessive screen-based behaviors among Brazilian adolescents through a systematic review with meta-analysis. DATA SOURCE: Systematic review and meta-analysis were recorded in the International Prospective Register of Ongoing Systematic Reviews (PROSPERO-CRD 2017 CRD42017074432). This review included observational studies (cohort or cross-sectional) that evaluated the prevalence of excessive screen time (i.e. combinations involving different screen-based behaviors) or TV viewing (≥2h/day or >2h/day in front of screen) through indirect or direct methods in adolescents aged between 10 and 19 years. The research strategy included the following databases: MEDLINE, LILACS, SciELO and ADOLEC. The search strategy included terms for "screen time", "Brazil", and "prevalence". Random effect models were used to estimate the prevalence of excessive screen time in different categories. DATA SUMMARY: Twenty-eight out of 775 studies identified in the search met the inclusion criteria. The prevalence of excessive screen time and TV viewing was 70.9% (95% CI: 65.5-76.1) and 58.8% (95% CI: 49.4-68.0), respectively. There was no difference between sexes in both analyses. The majority of studies included showed a low risk of bias. CONCLUSIONS: The prevalence of excessive screen time and TV viewing was high among Brazilian adolescents. Intervention are needed to reduce the excessive screen time among adolescents.