Relationship of age at menarche and serum leptin with the metabolically unhealthy phenotype in adolescents / Relación de la edad de la menarquia y la leptina sérica con el fenotipo metabólicamente no saludable en adolescentes

OBJECTIVE: to analyze the relationship of age at menarche and leptin with the metabolically healthy (MH) and metabolically unhealthy (MUH) phenotypes in adolescent girls in different body mass index (BMI) categories. METHOD: an observational and cross-sectional study consisting of 139 female adolescents attended to at the Adolescent Reference Center in Macaé, Rio de Janeiro. Menarche was classified as early (EM) when the first menstruation occurred at or before 11 years of age; normal menarche (NM) was categorized at ages 12 to 14; menarche was considered late (LM) when it occurred at age 15 or older. The factors required to ascertain the subjects' phenotype, as well as their leptin levels, weight, and height, were measured and their BMIs were calculated. The girls were classified as MH or MUH based on the NCEP-ATP III criteria as adapted for children and adolescents. RESULTS: 82 % (n = 114) of the girls were classified as MH and 18 % (n = 25) as MUH. Mean age at menarche was 11.79 ± 1.39 years. There was a higher prevalence of MUH amongst the girls who had EM (p = 0.04). A higher inadequacy of serum leptin concentrations was found in girls who had EM (p = 0.05) and in those classified as MUH (p = 0.01). The adolescents who were severely obese exhibited inadequate leptin levels (p < 0.01) and had gone through EM (p = 0.02). A total of 8.1 % (n = 7) of the normal-weight girls were classified as MUH, and 29.4 % (n = 5) of those who were severely obese were classified as MH (p < 0.01). CONCLUSION: early menarche and high serum leptin concentrations are related with the MUH phenotype in adolescent girls in different BMI categories

OBJETIVO: analizar la relación de la edad de la menarquia y los niveles de leptina con los fenotipos metabólicamente saludables (MS) y metabólicamente no saludables (MNS) en adolescentes de diferentes categorías de índice de masa corporal (IMC). MÉTODO: estudio observacional y transversal compuesto por 139 adolescentes de sexo feminino, atendidas en el Centro de Referencia para Adolescentes de Macaé, Río de Janeiro. La menarquia se clasificó como precoz (MP) cuando se produjo la primera menstruación a o antes de los 11 años de edad; la menarquia normal (MN) se clasificó como aquella sucedida a la edad de 12 a 14 años; la menarquia se consideró tardía (MT) cuando ocurrió a los 15 años o más. Se midieron los factores necesarios para determinar el fenotipo de los sujetos, y se midieron sus niveles de leptina, peso y altura, y se calculó su IMC. Las adolescentes se clasificaron como MS y MNS según los criterios de NCEP-ATP III, adaptados para niños y adolescentes. RESULTADOS: el 82 % (n = 114) de las adolescentes se clasificaron como MH y el 18 % (n = 25) como MUH. La edad media de la menarquia fue de 11,79 ± 1,39 años. Hubo una mayor prevalencia de MUH entre las adolescentes que tenían MP (p = 0,04). Se encontró una mayor insuficiencia de las concentraciones séricas de leptina en las adolescentes que tenían MP (p = 0,05) y en aquellas clasificadas como MNS (p = 0,01). Las adolescentes que eran severamente obesas exhibieron niveles inadecuados de leptina (p < 0,01) y habían pasado por una MP (p = 0,02). El 8,1 % (n = 7) de las adolescentes de peso normal se clasificaron como MNS y el 29,4 % (n = 5) de las que eran severamente obesas se clasificaron como MS (p < 0,01). CONCLUSIÓN: la menarquia temprana y las altas concentraciones séricas de leptina están relacionadas con el fenotipo MNS en las adolescentes de diferentes categorías de IMC

Relationship of age at menarche and serum leptin with the metabolically unhealthy phenotype in adolescents.

INTRODUCTION: Objective: to analyze the relationship of age at menarche and leptin with the metabolically healthy (MH) and metabolically unhealthy (MUH) phenotypes in adolescent girls in different body mass index (BMI) categories. Method: an observational and cross-sectional study consisting of 139 female adolescents attended to at the Adolescent Reference Center in Macaé, Rio de Janeiro. Menarche was classified as early (EM) when the first menstruation occurred at or before 11 years of age; normal menarche (NM) was categorized at ages 12 to 14; menarche was considered late (LM) when it occurred at age 15 or older. The factors required to ascertain the subjects' phenotype, as well as their leptin levels, weight, and height, were measured and their BMIs were calculated. The girls were classified as MH or MUH based on the NCEP-ATP III criteria as adapted for children and adolescents. Results: 82 % (n = 114) of the girls were classified as MH and 18 % (n = 25) as MUH. Mean age at menarche was 11.79 ± 1.39 years. There was a higher prevalence of MUH amongst the girls who had EM (p = 0.04). A higher inadequacy of serum leptin concentrations was found in girls who had EM (p = 0.05) and in those classified as MUH (p = 0.01). The adolescents who were severely obese exhibited inadequate leptin levels (p < 0.01) and had gone through EM (p = 0.02). A total of 8.1 % (n = 7) of the normal-weight girls were classified as MUH, and 29.4 % (n = 5) of those who were severely obese were classified as MH (p < 0.01). Conclusion: early menarche and high serum leptin concentrations are related with the MUH phenotype in adolescent girls in different BMI categories.

INTRODUCCIÓN: Objetivo: analizar la relación de la edad de la menarquia y los niveles de leptina con los fenotipos metabólicamente saludables (MS) y metabólicamente no saludables (MNS) en adolescentes de diferentes categorías de índice de masa corporal (IMC). Método: estudio observacional y transversal compuesto por 139 adolescentes de sexo feminino, atendidas en el Centro de Referencia para Adolescentes de Macaé, Río de Janeiro. La menarquia se clasificó como precoz (MP) cuando se produjo la primera menstruación a o antes de los 11 años de edad; la menarquia normal (MN) se clasificó como aquella sucedida a la edad de 12 a 14 años; la menarquia se consideró tardía (MT) cuando ocurrió a los 15 años o más. Se midieron los factores necesarios para determinar el fenotipo de los sujetos, y se midieron sus niveles de leptina, peso y altura, y se calculó su IMC. Las adolescentes se clasificaron como MS y MNS según los criterios de NCEP-ATP III, adaptados para niños y adolescentes. Resultados: el 82 % (n = 114) de las adolescentes se clasificaron como MH y el 18 % (n = 25) como MUH. La edad media de la menarquia fue de 11,79 ± 1,39 años. Hubo una mayor prevalencia de MUH entre las adolescentes que tenían MP (p = 0,04). Se encontró una mayor insuficiencia de las concentraciones séricas de leptina en las adolescentes que tenían MP (p = 0,05) y en aquellas clasificadas como MNS (p = 0,01). Las adolescentes que eran severamente obesas exhibieron niveles inadecuados de leptina (p < 0,01) y habían pasado por una MP (p = 0,02). El 8,1 % (n = 7) de las adolescentes de peso normal se clasificaron como MNS y el 29,4 % (n = 5) de las que eran severamente obesas se clasificaron como MS (p < 0,01). Conclusión: la menarquia temprana y las altas concentraciones séricas de leptina están relacionadas con el fenotipo MNS en las adolescentes de diferentes categorías de IMC.

Diagnosis of night blindness through standardized interview and electroretinography / Diagnóstico de la ceguera nocturna mediante entrevista normalizada y electrorretinografía

Objective: To compare the diagnosis of NB through the use of the standardized interview of the World Health Organization/Pan American Health Organization (WHO/PAHO) with electroretinography, and also to evaluate the association of these diagnoses with serum concentrations of retinol in class III obesity individuals. Methods: Adult patients of both genders, in the 20-60 age group, with BMI = 40 kg/m² were studied. NB was diagnosed through electroretinography and the standardized interview validated by the WHO/PAHO. Serum level of retinol was quantified by the HPLC-UV method, and VAD was diagnosed when levels were <1.05 µmol /L, and severity was also evaluated. Statistical analysis was carried out through the Statistical Package for the Social Sciences, version 21.0 (p < 0.05). Results: Mean BMI was 44.9 ? 11.8 kg/m², and a negative correlation was found in serum levels of retinol (p= 0.01). The prevalence of VAD, according to the serum concentrations of retinol, was 14%, and of this percentage 23.3% had NB according to the standardized interview, and 22.0% according to electroretinography. NB diagnosed by both methods showed an association with VAD according to the serum concentrations of retinol. Of these individuals with NB, according to the standardized interview, 6.9% showed severe VAD, 10.3% moderate VAD and 82.8% marginal VAD. Conclusion: The standardized interview for the diagnosis of NB can be a good strategy to evaluate the nutritional status of vitamin A, and it is a simple, non-invasive and low-cost method

Introducción: la deficiencia de vitamina A (DVA) es uno de los mayores problemas de salud pública a escala mundial, y la ceguera nocturna (CN) es el primer cambio funcional causado por la falta de esta vitamina. En este contexto, la electrorretinografía se destaca como el método de diagnóstico de referencia; sin embargo, es un método de coste elevado y su aplicabilidad en la práctica clínica presenta algunas dificultades. Objetivo: comparar el diagnóstico de CN mediante el uso de la entrevista estandarizada de la Organización Mundial de la Salud/Organización Panamericana de la Salud (OMS/OPS) con la electrorretinografía, y también evaluar la asociación de estos diagnósticos con las concentraciones séricas de retinol en las personas con obesidad de clase III. Métodos: se estudiaron pacientes adultos de ambos sexos, en el grupo de 20 a 60 años de edad y con IMC = 40 kg/m². La NB se diagnosticó mediante electrorretinografía y la entrevista estandarizada validada por la OMS/OPS. El nivel sérico de retinol se cuantificó mediante el método HPLC-UV, y el DVA se diagnosticó cuando los niveles eran < 1.05 µmol/l; también se evaluó la gravedad. El análisis estadístico se realizó a través del Paquete Estadístico para las Ciencias Sociales, versión 21.0 (p < 0,05). Resultados: el IMC promedio fue de 44,9 ± 11,8 kg/m² y se encontró una correlación negativa en los niveles séricos de retinol (p = 0,01). La prevalencia de DVA, según las concentraciones séricas de retinol, fue del 14 %; de este porcentaje, el 23,3 % tenían NB de acuerdo con la entrevista estandarizada y el 22,0 % según la electrorretinografía. La NB diagnosticada por ambos métodos mostró asociación con el DVA según las concentraciones séricas de retinol. De estos individuos con NB, según la entrevista estandarizada, el 6,9 % tenían VAD grave, el 10,3 % VAD moderado y el 82,8 % VAD marginal. Conclusión: la entrevista estandarizada para el diagnóstico de NB puede ser una buena estrategia para evaluar el estado nutricional de la vitamina A y es un método simple, no invasivo y de bajo coste

[Training of health professionals in breastfeeding and its association with knowledge, skills and practices]. / Capacitação de profissionais de saúde em aleitamento materno e sua associação com conhecimentos, habilidades e práticas.

A cross-sectional study was conducted in the 15 hospitals with over 1000 deliveries/year in Rio de Janeiro, Brazil, to verify the association between training of health professionals in breastfeeding and professional knowledge, skills and practices. Interviews were staged with 215 health professionals, 48.4% working in Baby-Friendly Hospitals, by means of a questionnaire adapted from the revalidation instrument of the initiative. The three dichotomized outcomes were subjected to bivariate and multivariate analysis. Adjusted prevalence ratios were obtained by the Poisson regression model: 48.1% of the professionals had adequate knowledge, 58.9% adequate skills and 74.9% reported adequate practice. Theoretical and practical training ≥ 18 hours considered adequate (by 65.6% of the professionals) showed a significant association with professional knowledge (aPR = 1.575), skills (aPR = 1.530) and practices (aPR = 1.312). Less working experience was associated with less knowledge (aPR = 0.723), but with better practices (aPR = 1.183). Nursing staff reported better practices than physicians (aPR = 0.808) and other categories (aPR = 0.658). The study concludes that training contributes to improved breastfeeding knowledge, skills and practices that are essential for maternal and child care.

Capacitação de profissionais de saúde em aleitamento materno e sua associação com conhecimentos, habilidades e práticas / Training of health professionals in breastfeeding and its association with knowledge, skills and practices

Resumo Para verificar a associação entre capacitação em aleitamento materno e conhecimentos, habilidades e práticas profissionais, foi conduzido estudo transversal nos 15 hospitais com mais de 1000 partos/ano do município do Rio de Janeiro. Foram entrevistados 215 profissionais, sendo 48,4% em Hospitais Amigos da Criança, por adaptação de questionário de reavaliação desta iniciativa. Os três desfechos, dicotomizados, foram utilizados em análises bivariadas e multivariadas, sendo obtidas razões de prevalência ajustadas por modelo de regressão de Poisson. Dos profissionais, 48,1% tinham conhecimentos; 58,9% habilidades e 74,9% práticas adequadas. A capacitação teórico-prática ≥ 18 horas, considerada adequada, presente em 65,6% dos profissionais, mostrou associação significativa com conhecimentos (RPa = 1,575), habilidades (RPa = 1,530) e práticas (RPa = 1,312). Profissionais com menor tempo de trabalho apresentaram menos conhecimentos (RPa = 0,723), mas relataram melhores práticas (RPa = 1,183). A enfermagem relatou melhores práticas em relação aos médicos (RPa = 0,808) e a outras categorias (RPa = 0,658). Conclui-se que a capacitação contribui para o aprimoramento de conhecimentos, habilidades e práticas em aleitamento materno, fundamentais à assistência materno-infantil.

Abstract A cross-sectional study was conducted in the 15 hospitals with over 1000 deliveries/year in Rio de Janeiro, Brazil, to verify the association between training of health professionals in breastfeeding and professional knowledge, skills and practices. Interviews were staged with 215 health professionals, 48.4% working in Baby-Friendly Hospitals, by means of a questionnaire adapted from the revalidation instrument of the initiative. The three dichotomized outcomes were subjected to bivariate and multivariate analysis. Adjusted prevalence ratios were obtained by the Poisson regression model: 48.1% of the professionals had adequate knowledge, 58.9% adequate skills and 74.9% reported adequate practice. Theoretical and practical training ≥ 18 hours considered adequate (by 65.6% of the professionals) showed a significant association with professional knowledge (aPR = 1.575), skills (aPR = 1.530) and practices (aPR = 1.312). Less working experience was associated with less knowledge (aPR = 0.723), but with better practices (aPR = 1.183). Nursing staff reported better practices than physicians (aPR = 0.808) and other categories (aPR = 0.658). The study concludes that training contributes to improved breastfeeding knowledge, skills and practices that are essential for maternal and child care.

Impact of health professional training in breastfeeding on their knowledge, skills, and hospital practices: a systematic review / Repercussão da capacitação de profissionais de saúde em aleitamento materno sobre seus conhecimentos, habilidades e práticas hospitalares: uma revisão sistemática

Abstract Objective To identify the impact of training in breastfeeding on knowledge, skills, and professional and hospital practices. Data source The systematic review search was carried out through the MEDLINE, Scopus, and LILACS databases. Reviews, studies with qualitative methodology, those without control group, those conducted in primary care, with specific populations, studies that had a belief and/or professional attitude as outcome, or those with focus on the post-discharge period were excluded. There was no limitation of period or language. The quality of the studies was assessed by the adapted criteria of Downs and Black. Summary of data The literature search identified 276 articles, of which 37 were selected for reading, 26 were excluded, and six were included through reference search. In total, 17 intervention articles were included, three of them with good internal validity. The studies were performed between 1992 and 2010 in countries from five continents; four of them were conducted in Brazil. The training target populations were nursing practitioners, doctors, midwives, and home visitors. Many kinds of training courses were applied. Five interventions employed the theoretical and practical training of the Baby-Friendly Hospital Initiative. All kinds of training courses showed at least one positive result on knowledge, skills, and/or professional/hospital practices, most of them with statistical significance. Conclusions Training of hospital health professionals has been effective in improving knowledge, skills, and practices.

Resumo Objetivo Identificar a repercussão da capacitação em aleitamento materno sobre conhecimentos, habilidades e práticas profissionais e hospitalares. Fontes dos dados A busca da revisão sistemática foi efetuada nas bases MedLine, Scopus e Lilacs. Foram excluídos artigos de revisão, de metodologia qualitativa, estudos sem grupo controle, conduzidos na atenção primária, com clientelas específicas, cujos desfechos eram crença e/ou atitude profissional e trabalhos com foco no período pós-alta hospitalar. Não houve limitação quanto ao ano ou idioma, foi feita avaliação da qualidade dos artigos por critério adaptado de Downs & Black. Síntese dos dados Na busca de literatura foram encontrados 276 artigos e selecionados 37 para leitura integral. Foram excluídos 26 artigos e incluídos seis mediante busca das referências. Foram incluídos 17 artigos de intervenção e três apresentaram boa validade interna. Os estudos foram conduzidos entre 1992 e 2010, quatro no Brasil, em países de cinco continentes. O principal público-alvo das capacitações foram profissionais de enfermagem, médicos, parteiras e visitadores domiciliares. Os cursos de capacitação foram diversos, cinco intervenções empregaram o treinamento teórico-prático da Iniciativa Hospital Amigo da Criança. Todas as formas de capacitação apresentaram algum resultado positivo sobre os conhecimentos, as habilidades e/ou práticas profissionais e hospitalares, a maioria com significância estatística. Conclusões As capacitações de profissionais de saúde que atuam em hospitais têm sido efetivas em aprimorar conhecimentos, habilidades e práticas.