Relation between birth weight, growth, and subclinical atherosclerosis in adulthood.

BACKGROUND AND OBJECTIVES: Adverse conditions in the prenatal environment and in the first years of life are independently associated with increased risk for cardiovascular disease. This paper aims to study the relation between birthweight, growth in the first year of life, and subclinical atherosclerosis in adults. METHODS: 88 adults aged between 20 and 31 were submitted to sociodemographic qualities, anthropometric data, blood pressure measurements, metabolic profile, and evaluation of subclinical atherosclerosis. RESULTS: Birthweight<2,500 grams (g) was negatively correlated with (a) increased waist-to-hip ratio (WHR), according to regression coefficient (RC) equal to -0.323, 95% CI [-0.571, -0.075] P<0.05; (b) diastolic blood pressure (RC=-4.744, 95% CI [-9.017, -0.470] P<0.05); (c) low HDL-cholesterol (RC=-0.272, 95% CI [-0.516, -0.029] P<0.05); (d) frequency of intima-media thickness (IMT) of left carotid>75th percentile (RC=-0.242, 95% CI [-0.476, -0.008] P<0.05). Birthweight>3,500 g was associated with (a) BMI>25.0 kg/m2, (RC=0.317, 95% CI [0.782, 0.557] P<0.05); (b) increased waist circumference (RC=0.284, 95% CI [0.054, 0.513] P<0.05); (c) elevated WHR (RC=0.280, 95% CI [0.054, 0.505] P<0.05); (d) minimum subcutaneous adipose tissue (SAT) (RC=4.354, 95% CI [0.821, 7.888] P<0.05); (e) maximum SAT (RC=7.095, 95% CI [0.608, 13.583] P<0.05); (f) right lobe of the liver side (RC=6.896, 95% CI [1.946, 11.847] P<0.001); (g) frequency's right lobe of the liver>75th percentile (RC=0.361, 95% CI [0.169, 0.552] P<0.001). Weight gain in the first year of life was inversely correlated with (a) mean IMT of left carotid (RC=-0.046, 95% CI [-0.086, -0.006] P<0.05; (b) frequency IMT of left carotid>75th percentile (RC=-0.253, 95% CI [-0.487, -0.018] P<0.05); (c) mean IMT (RC=-0.038, 95% CI [0.073, -0.002] P<0.05); (d) the frequency of the mean IMT>75th percentile (RC=-0.241, 95% CI [-0.442, -0.041] P<0.05). CONCLUSIONS: Adults birthweight<2,500 g and >3,500 g and with insufficient weight gain in the first year of life have showed different metabolic phenotypes, but all of them were related to subclinical atherosclerosis.

The intergenerational effects on birth weight and its relations to maternal conditions, São Paulo, Brazil.

BACKGROUND AND OBJECTIVES: Parents' birth weight acts as a predictor for the descendant birth weight, with the correlation more strongly transmitted through maternal line. The present research aims to study the correlation between the child's low or increased birth weight, the mother's birth weight, and maternal conditions. METHODS: 773 mother-infant binomials were identified with information on both the baby's and the mother's birth weight recorded. Group studies were constituted, dividing the sample according to birth weight (<2,500 grams (g) and ≥3,500 grams (g)). The length at birth was also studied in children ≤47.5 cm (lower quartile). Chi(2) test or Fisher's exact test, Spearman's Rho, and odds ratio were performed in order to investigate the relation between the children's weight and length at birth and the mothers' and children's variables. RESULTS: The girls were heavier at birth than their mothers, with an average increase at birth weight between the generations of 79 g. The child's birth weight <2,500 g did not show any correlation with maternal birth weight <2,500 g (Fisher 0.264; Spearman's Rho 0.048; OR 2.1 and OR lower 0.7) or with maternal stature below the lower quartile (<157 cm) (Chi (2) sig 0.323; with Spearman's Rho 0.036; OR 1.5 and OR lower 0.7). The child's low birth weight (<2,500 g) was lightly correlated with drug use by the mother during pregnancy (Fisher 0.083; Spearman's Rho 0.080; OR 4.9 and OR lower 1.0). The child's birth weight <2,500 g showed increased correlation with gestational age lower than 38 weeks and 3 days (Chi (2) sig 0.002; Spearman's Rho 0.113; OR 3.2 and OR lower 1.5). The child's weight at birth ≥3,500 g showed strong correlation with maternal weight at birth ≥3,500 g (Chi (2) sig 0; Spearman's Rho +0.142; OR 0.5 and OR upper 0.7). It was also revealed that the higher the maternal prepregnancy BMI, the stronger the correlation with child's birth weight ≥3,500 g ((maternal prepregnancy BMI > 25.0 with Chi (2) sig 0.013; Spearman's Rho 0.09; OR 1.54 and OR upper 2.17) and (maternal prepregnancy BMI > 30.0 with Chi (2) sig 0 Spearman's Rho 0.137; OR 2.58 and OR upper 4.26)). The child's length at birth in the lower quartile (≤47.5 cm) showed strong correlation with drug use by the mother during pregnancy (Chi (2) sig 0.004; Spearman's Rho 0.105; OR 4.3 and OR lower 1.5). CONCLUSIONS: The mother's increased weight at birth and the prenatal overweight or obesity were correlated with increased weight and length at birth of the newborn, coupled with the tendency of increasing birth weight between generations of mothers and daughters. Also, descendants with smaller length at birth are the children of women with the lowest statures.

No association between low birth weight and cardiovascular risk factors in early adulthood: evidence from São Paulo, Brazil.

BACKGROUND: A growing literature suggests that low birth weight increases the risk of poor health outcomes in adulthood. We tested this hypothesis among young adults living in São Paulo State, Brazil. METHODS AND FINDINGS: To identify the effects of low birth weight on young adulthood outcomes, a medical assessment of 297 individuals born between 1977 and 1989 was conducted at a primary care unit in São Paulo State, Brazil. We analyzed body mass index (BMI), waist-hip ratio, blood pressure, fasting glucose and total cholesterol levels using linear and logistic regressions. Low birth was negatively associated with BMI (ß = -2.0, 95% CI: -3.69, -0.27, p = 0.02), fasting glucose levels (ß = -1.9, 95% CI: -3.9, -0.07, p = 0.05), waist-hip ratio (ß = -0.03, 95% CI: -0.07, -0.01, p = 0.10), systolic blood pressure (ß = -3.32, 95% CI: -7.60, 0.96, p = 0.12), and total cholesterol levels (ß = -3.19, 95% CI: -16.43, 10.05, p = 0.636). Low birth weight was also associated with lower odds of young adults being overweight and obese, but neither association was statistically significant. Weight gain in the first 12 months of life was associated with higher adult BMI (ß = 0.79, 95% CI: -0.0455, 1.623, p = 0.064) and blood pressure (ß = 2.79, 95% CI: 0.22, 5.35, p = 0.034). No associations were found between low birth weight and early life (catch-up) growth. CONCLUSIONS: Low birth weight was not associated with poor health outcomes among young adults in Brazil. These results appear inconsistent with the original Barker hypothesis, but will need to be corroborated in larger samples with longer follow-ups to allow a more general evaluation of the validity of the hypothesis in low and middle income countries.

Aspectos diagnósticos da otite média com derrame na faixa etária pediátrica: [revisão] / Diagnostic aspects of otitis media with effusion in children: [review]

OBJETIVOS: apresentar e discutir aspectos diagnósticos da otite média com derrame (OMD) na prática clínica da atenção primária à saúde. MÉTODOS: foram pesquisadas as bases de dados Medline, Lilacs e SciELO (1994-2004). Identificados 523 artigos, dos quais 30 foram considerados para o presente trabalho. RESULTADOS: os estudos revelaram disparidade entre as definições, inconsistência no quadro clínico e falta de padronização dos critérios diagnósticos. Isto contribuiu para a inadequação diagnóstica da OMD. As evidências que levaram ao diagnóstico de efusão foram: a) pelo menos duas anormalidades do tímpano relacionadas à coloração, opacificação e mobilidade; e/ou b) membrana timpânica (MT) tipicamente retraída, côncava, e com alteração da coloração; e/ou c) mobilidade reduzida ou ausente na otoscopia pneumática (OP). A OP mostrou ser mais acurada que a otoscopia simples (OS), sendo considerada como método de escolha para o diagnóstico clínico da OMD. Quando houver dúvida na otoscopia pneumática, pode-se indicar a timpanometria, que aumenta a acurácia deste diagnóstico. CONCLUSÕES: na prática clínica, o diagnóstico da OMD deve ser realizado, primariamente pela otoscopia pneumática, em toda criança com suspeita de OMD. Em caso de dúvida deve-se indicar a timpanometria.

OBJECTIVES: to present and discuss diagnostic aspects of middle ear infection with effusion at a primary health care clinic. METHODS: research was carried out using the Medline, Lilacs and SciELO databases (1994-2004). Five hundred and twenty-three articles were found, of which 30 were considered for this review. RESULTS: the study revealed considerable disparity with regard to definitions, inconsistency in terms of clinical profile and a lack of standardization of diagnostic criteria. This has contributed to inadequate diagnosis of otitis media with effusion (OME). Evidence leading to a diagnosis of effusion were: a) at least two eardrum abnormalities relating to discoloration, darkening and mobility; and/or b) tympanic membrane (MT) typically retracted, concave, and with altered coloration; and/or c) reduced mobility or absence of mobility on pneumatic otoscopy (PO). The PO was shown to be more accurate than simple otoscopy (SO), which is considered the method of choice for diagnosis of OME. When the pneumatic otoscopy is inconclusive, tympanometry may recommended, as this increases the accuracy of the diagnosis. CONCLUSIONS: in clinical practice, diagnosis of OME should be carried out principally by way of pneumatic otoscopy, to which all children suspected of having OME should be submitted. Where there is doubt, tympanometry is recommended.

A pediatria comunitária e o ensino médico em creches / Community Pediatrics and Medical Education in Day-Care Centers

Os autores apresentam o Estágio Creche da Pediatria Comunitária, da Disciplina de Pediatria Preventiva e Social, do Departamento de Pediatria da Faculdade de Medicina da Universidade de São Paulo, destinado aos médicos Residentes de Primeiro Ano de Pediatria. São discutidos os objetivos e a metodologia de ensino do estágio.

O ensino da estratégia "atenção integrada às doenças prevalentes da infância" (AIDPI) em pediatria / Teaching the Strategy \"Integrated Management of Childhood Illness\"

A mortalidade em crianças menores que 5 anos de idadeé um problema importante nos países em desenvolvimento. Com o intuito de alterar estas elevadas taxas de mortalidade, em 1996, a Organização Mundial de Saúde (OMS) e o Fundo para Crianças das Nações Unidas(UNICEF) desenvolveram a estratégia "Atenção Integrada às Doenças Prevalentes da Infância" (AIDPI), que tem como objetivo diminuir a mortalidade por meio de ações preventivas e curativas que focam um atendimento integrado da criança, aproveitando o momento da consulta por uma queixa, para a prevenção e promoção da saúde, envolvendo a família e a comunidade. Deve-se reforçar a inclusão do ensino da estratégia AIDPI para os alunos de Medicina em geral e para os de Pediatria em particular, especialmente durante o seu treinamento em atenção primária. Considera-se o ensino desta estratégia fundamental no sentido de preparar os alunos a lidar com as doenças mais prevalentes, melhorando a qualidade e resolutividade da atenção básica.

A interdisciplinaridade e a aplicaçäo da estrategia de atencao integrada as doencas prevalentes na infancia: instrumentos para a consolidacao do sistema unico de saude / The interdisciplinarity and the integrated management of childhood illness: tools for the consolidation of the national health system

Diante do desafio de adequar a assistencia a saude aos perfis de morbi-mortalidade infantis nos paises em desenvolvimento, a Organizacao Mundial da Saude e o Fundo das Nacoes Unidas para a Infancia elaboraram a proposta de Atencao Integrada as Doencas Prevalentes na Infancia. Tomando-se a interdisciplinaridade como um alicerce para o desenvolvimento dessa estrategia, em consonancia com os principios de universalidade, equidade e integralidade, estabelecidos pelo Sistema Unico de Saude, as autoras vem desenvolvendo...

Residencia basica de pediatria do Departamento de Pediatria da Faculdade de Medicina da USP: um projeto de ensino realizado em creches no municipio de Sao Paulo, vinculado a uma unidade basica de saude / Medical residence of pediatrics at the Medical College, Sao Paulo University, Pediatrics Department: a teaching project realized in day care centers in Sao Paulo, linked a basic health unit

Os autores relatam um modelo de ensino desenvolvido para o curso de residencia basica do Departamento de Pediatria da Faculdade de Medicina da Universidade de Sao Paulo. Durante o estagio realizado no Centro de Saude Escola "Prof. Samuel B. Pessoa" da USP, os residentes participam de atividades docente-assistenciais em 4 creches localizadas na area de abrangencia desta unidade basica de saude. Estas atividades tem contribuido para formar profissionais mais preparados para programar acoes de saude, de cunho educativo e preventivo, nao so individuais, mas tambem coletivas

Pesquisa em assistência primária: instrumento de ensino-aprendizagem na residência básica de pediatria / Primary care research: a usefull teaching tool for medical residence of pediatrics

O objetivo é descrever uma proposta de ensino para médicos residentes em Pediatria, em estágio numa unidade básica de saúde, centrada na realizaçäo de uma pesquisa vinculada as suas atividades assitenciais no local. A avaliaçäo preliminar do projeto, que já esta em desenvolvimento há dois anos e meio no Centro de Saúde Escola "Prof. Samuel B. Pessoa", mostra um saldo bastante favorável que ultrapassa os limites da iniciaçäo dos residentes na metodologia científica. Entre outras coisas o modelo proposto se mostrou interessante por propiciar um maior engajamento do residente com a sua prática ao nível primário...

O ensino de pediatria preventiva e social ao nível da graduaçäo na Faculdade de Medicina da Universidade de Säo Paulo / The education of preventive and social pediatrics at undergraduate level in the Faculdade de Medicina da Universidade de Säo Paulo

Os autores, após consideraçöes iniciais a proposito da posiçäo peculiar dos Departamentos de Pediatria no contexto da educaçäo médica, apresentam o desempenho do Departamento de Pediatria da Faculdade de Medicina de Säo Paulo no ensino da pediatria preventiva e social. Säo comentados a carga horária, os locais de aprendizados, os conteúdos acadêmicos, os recursos humanos, o espaço disponivel, o numero de alunos, o tempo de estágio e a avaliaçäo referentes as Diciplinas de Pediatria Preventiva e Social I, II, e III. Comenta-se também a responsabilidade dessas Diciplinas a luz do desempenho terminal do aluno após l.155 horas de aprendizado sob a responsabilidade do Departamento de Pediatria.