Characteristics and clinical outcomes of adolescents infected by SARS-CoV-2: a systematic review / Características e desfechos clínicos de adolescentes infectados por SARS-CoV-2: uma revisão sistemática

ABSTRACT Objective: To verify the COVID-19 clinical characteristics, associated comorbidities, and outcomes in adolescents. Data source: This is a systematic review study based on articles published between 2020 and 2022 in the United States National Library of Medicine - PubMed (MedLine), Virtual Health Library - VHL (LILACS), Science Direct, Web of Science, and Scopus (Elsevier) databases. The study was registered in the International Prospective Register of Systematic Reviews, under No. CRD42022309108. Data synthesis: A total of 1188 studies were identified. After applying the selection criteria, 13 articles were included. Prevalence was 25%; mild cases were predominant; and fever, cough, headache, anosmia, nasal congestion, and ageusia were frequent. Fever and cough were proportionally higher in hospitalized cases: 81 and 68%, respectively. Dyspnea (odds ratio [OR] 6.3; confidence interval 95%[CI] 2.8-14.3), fever (OR 3.8; 95%CI 2.0-7.4), and cough (OR 3.4; 95%CI 2.0-6.0) were associated with severe cases. Up to 28% required intensive care and 38% required mechanical ventilation. Pre-existing comorbidities increased the risk of hospitalization and death. Severe cases were associated with the risk of death (relative risk [RR] 4.6; 95%CI 2.8-7.5). The black, mixed, and indigenous races/skin colors represented risk groups, as well as residents of poorer regions. Conclusions: The review provided a better understanding of the disease profile and may favor the development of public policies, in addition to contributing to the current literature in the field of adolescent health.

RESUMO Objetivo: Verificar as características clínicas, as comorbidades associadas e os desfechos da COVID-19 em adolescentes. Fontes de dados: Trata-se de uma revisão sistemática elaborada com base em artigos publicados entre 2020 e 2022 nas bases de dados United States National Library of Medicine (PubMed), Biblioteca Virtual em Saúde (BVS), Science Direct, Web of Science e Scopus. O estudo foi registrado no International Prospective Register of Systematic Reviews, n° CRD42022309108. Síntese dos dados: Foram identificados 1.188 estudos. Após a aplicação dos critérios de seleção, 13 artigos foram incluídos. A prevalência foi de 25%; os casos leves foram predominantes; e febre, tosse, cefaleia, anosmia, congestão nasal e ageusia foram frequentes. Febre e tosse foram proporcionalmente maiores em casos hospitalizados, com 81 e 68%, respectivamente. Dispneia (OR 6,3; IC95% 2,8-14,3), febre (OR 3,8; IC95% 2,0-7,4) e tosse (OR 3,4; IC95% 2,0-6,0) foram associados a casos graves. Até 28% necessitaram de cuidados intensivos e 38% de ventilação mecânica. A preexistência de comorbidade aumentou o risco de internação e óbito. Os casos graves estão associados ao risco de óbito (risco relativo — RR 4,6; IC95% 2,8-7,5). As raças/cores preta, parda e indígena e os moradores de regiões mais pobres foram grupo de risco. Conclusões: A revisão permitiu conhecer o perfil da doença e poderá favorecer a elaboração de políticas públicas, além de contribuir para a literatura atual no campo da saúde do adolescente.

Hidden hunger - a narrative review.

OBJECTIVE: Malnutrition is characterized by situations of undernutrition and obesity resulting from the lack of micronutrients with the greatest impact on children. The objective of this review was to highlight inadequate food consumption, food security, and nutritional inadequacy leading to hidden hunger and the prevention and treatment of the main micronutrient deficiencies in Brazil. DATA SOURCE: Literature review carried out through a bibliographic survey in PubMed (National Library of Medicine, United States), Lilacs (Latin American and Caribbean Literature in Health Sciences), and SciELO (Scientific Electronic Library Online) databases. The search used the terms Occult hunger, (hidden hunger), and Child, in articles published between 2013 and 2023 in Portuguese, English and Spanish. The search was performed on 06/25/2023. DATA SYNTHESIS: The lack of micronutrients can occur insidiously and without clinical manifestations, being called hidden hunger. The prevention of nutritional deficiencies is part of the recommended actions in childcare, with healthy eating. Studies were cited related to macro and micronutrient intake deficiencies, both national and international, and strategies to improve micronutrient intake, including routine supplementation of iron, and vitamins D and A. The diagnosis, prevention, and treatment of the main deficiencies in Brazil (iron, vitamin A, vitamin D, zinc), currently adopted, concluded the topic. CONCLUSION: Zero hunger and zero obesity must be part of the same policy, together with a nutritional education program.

Associação entre sedentarismo e nívelsocioeconômicoemadolescentes / Association between physical inactivity and socioeconomic status in adolescents

Introdução: O sedentarismo em adolescentes contribui para a ocorrência de diferentes doenças, sendo relevante investigar sobre fatores associados. Objetivo: Analisar a associação entre sedentarismo e nível socioeconômico em adolescentes de escolas públicas. Materiais e métodos: Estudo transversal, realizado com 347 adolescentes matriculados em escolas públicas do ensino médio do município de Divinópolis, Minas Gerais. A coleta de dados ocorreu no ano de 2017. O sedentarismo foi avaliado utilizando-se o International Physical Activity Questionnaire e o nível socioeconômico pelo critério da Associação Brasileira de Empresas de Pesquisa. Foi realizada estatística descritiva e analítica através de modelo de regressão logística multivariada. Resultados: Participaram da investigação 347 adolescentes. A média de idade do grupo foi de 16,4 ± 1,0 anos. Os indivíduos caracterizados como sedentários constituíram 38,9% da amostra, sendo que, destes, 66,7% eram do sexo feminino. Possuir maior nível socioeconômico diminui a probabilidade de ser sedentário (OR=0,235; p=0,021), assim como ser estudante das escolas públicas da região sudoeste aumenta essa chance(OR=2,680; p=0,04). Discussão: Os motivos pelos quais as condições socioeconômicas podem influenciar o sedentarismo são variados. A ausência de espaços públicos pode contribuir para a elevação do sedentarismo em adolescentes com menor nível socioeconômico. Conclusão: Esta investigação sinaliza a importância de investimentos públicos em políticas de estímulo à prática de atividade física para os adolescentes, em especial para os do sexo feminino e de menor nível socioeconômico.

Introduction: A sedentary lifestyle in adolescents contributes to the occurrence of different diseases, making it relevant to investigate associated factors. Objective: To analyze the association between sedentary lifestyle and socioeconomic status in adolescents from public schools. Materials and methods: Cross-sectional study, carried out with 347 adolescents enrolled in public high schools in the city of Divinópolis, Minas Gerais. Data collection took place in 2017. Sedentary lifestyle was assessed using the International Physical Activity Questionnaire and socioeconomic status using the criteria of the Brazilian Association of Research Companies. Descriptive and analytical statistics were performed using a multivariate logistic regression model. Results: 347 adolescents participated in the investigation. The mean age of the group was 16.4 ± 1.0 years. Individuals characterized as sedentary constituted 38.9% of the sample, of which 66.7% were female. Having a higher socioeconomic level decreases the probability of being sedentary (OR = 0,235; p = 0.021), just as being a student in public schools in the southwest region increases this chance (OR = 2,680; p = 0.04). Discussion: The reasons why socioeconomic conditions can influence a sedentary lifestyle are varied. The absence of public spaces can contribute to the increase in sedentary lifestyles in adolescents with lower socioeconomic status. Conclusion: This investigation highlights the importance of public investments in policies to encourage the practice of physical activity for adolescents, especially for females and lower socioeconomic status.

Introducción: El sedentarismo en los adolescentes contribuye a la ocurrencia de diferentes enfermedades, por lo que es relevante investigar los factores asociados. Objetivo: Analizar la asociación entre sedentarismo y nivel socioeconómico en adolescentes de escuelas públicas. Materiales y métodos: Estudio transversal, realizado con 347 adolescentes matriculados en escuelas secundarias públicas de la ciudad de Divinópolis, Minas Gerais. La recolección de datos tuvo lugar en 2017. El estilo de vida sedentario se evaluó mediante el Cuestionario Internacional de Actividad Física y el nivel socioeconómico según los criterios de la Asociación Brasileña de Empresas de Investigación. La estadística descriptiva y analítica se realizó mediante un modelo de regresión logística multivariante. Resultados: 347 adolescentes participaron en la investigación. La edad media del grupo fue de 16,4 ± 1,0 años. Los individuos caracterizados como sedentarios constituyeron el 38,9% de la muestra, de los cuales el 66,7% eran mujeres. Tener un nivel socioeconómico más alto disminuye la probabilidad de ser sedentario (OR = 0,235; p = 0,021), al igual que ser alumno de escuelas públicas de la región suroeste aumenta esta posibilidad (OR = 2,680; p = 0,04). Discusión: Las razones por las que las condiciones socioeconómicas pueden influir en un estilo de vida sedentario son variadas. La ausencia de espacios públicos puede contribuir al aumento de estilos de vida sedentarios en adolescentes de menor nivel socioeconómico. Conclusión: Esta investigación destaca la importancia de la inversión pública en políticas para incentivar la práctica de actividad física en adolescentes, especialmente en mujeres y estrato socioeconómico más bajo.

Anemia and nutritional aspects in adolescent athletes: a cross-sectional study in a reference sport organization / Anemia e aspectos nutricionais em atletas adolescentes: estudo transversal em agremiação desportiva de referência nacional

ABSTRACT Objective: To assess the association between anemia and nutritional aspects in adolescent athletes from a large sport club. Methods: This is a cross-sectional study, involving 298 athletes aged between 10 and 17 years, submitted to measurement of skin folds, weight and height, and collection of capillary blood in duplicate to determine hemoglobin values. It was carried out in a random sample composed of athletes from eight sport modalities. Results: Regarding nutritional status, 10.1% of athletes were overweight based on body mass index and 70 (23.5%) athletes had a percentage of body fat classified as high or very high. The prevalence of anemia was 16.4%, being more prevalent in judo (37.1%), basketball (34%) and futsal (20.5%) athletes. Low hemoglobin levels were significantly associated with shorter stature (p=0.006). Conclusions: There was a significant association between anemia and short stature, suggesting that the athlete's height-weight development may be affected in suboptimal conditions of oxygen distribution.

RESUMO Objetivo: Avaliar a associação entre anemia e aspectos nutricionais em atletas adolescentes de um clube desportivo de grande porte. Métodos: Trata-se de estudo de corte transversal que envolveu 298 atletas com idades entre 10 e 17 anos, submetidos à aferição de dobras cutâneas, peso e altura, além de coleta de sangue capilar em duplicata para a determinação dos valores de hemoglobina. Foi realizado em amostra aleatória composta de atletas oriundos de oito modalidades esportivas. Resultados: Em relação ao estado nutricional, 10,1% dos atletas apresentaram excesso de peso com base no índice de massa corpórea e 70 (23,5%) atletas estavam com porcentagem de gordura corporal classificada como alta ou muito alta. A prevalência de anemia foi de 16,4%, mais prevalente nos atletas do judô (37,1%), basquete (34%) e futsal (20,5%). Níveis baixos de hemoglobina foram associados à menor estatura (p=0,006). Conclusões: Observou-se associação significativa entre anemia e baixa estatura, o que sugere que o desenvolvimento pôndero-estatural do atleta pode ser afetado em condições subótimas de distribuição de oxigênio.

Anemia and nutritional aspects in adolescent athletes: a cross-sectional study in a reference sport organization.

OBJECTIVE: To assess the association between anemia and nutritional aspects in adolescent athletes from a large sport club. METHODS: This is a cross-sectional study, involving 298 athletes aged between 10 and 17 years, submitted to measurement of skin folds, weight and height, and collection of capillary blood in duplicate to determine hemoglobin values. It was carried out in a random sample composed of athletes from eight sport modalities. RESULTS: Regarding nutritional status, 10.1% of athletes were overweight based on body mass index and 70 (23.5%) athletes had a percentage of body fat classified as high or very high. The prevalence of anemia was 16.4%, being more prevalent in judo (37.1%), basketball (34%) and futsal (20.5%) athletes. Low hemoglobin levels were significantly associated with shorter stature (p=0.006). CONCLUSIONS: There was a significant association between anemia and short stature, suggesting that the athlete's height-weight development may be affected in suboptimal conditions of oxygen distribution.

Prevalence of childhood anaemia in Brazil: still a serious health problem: a systematic review and meta-analysis.

OBJECTIVE: To estimate the prevalence of anaemia in Brazilian children up to 83·9 months old. DESIGN: Systematic review and meta-analysis, using databases PubMed, Scopus, SciELO, Lilacs, Google Scholar, Periódicos Capes, Arca, Biblioteca Virtual em Saúde, Microsoft Academic Search and Cochrane Library using search terms: anaemia, prevalence, child and Brazil. PROSPERO Registration number: CRD42020208818. SETTING: Cross-sectional, cohort, case-control and intervention studies published between 2007 and 2020 were searched, excluding those who assessed children with an illness or chronic condition. The main outcome was anaemia prevalence. Random effects models based on the inverse variance method were used to estimate pooled prevalence measures. Sensitivity analyses removed studies with high contribution to overall heterogeneity. PARTICIPANTS: From 6790 first screened, 134 eligible studies were included, totalling 46 978 children aged zero to 83·9 months analysed, with adequate regions representativeness. RESULTS: Pooled prevalence of anaemia was 33 % (95 % CI 30, 35). Sensitivity analyses showed that withdrawal of studies that contributed to high heterogeneity did not influence national average prevalence. CONCLUSIONS: Childhood anaemia is still a serious public health problem in Brazil, exposing 33 % of Brazilian children to the anaemia repercussions. The main limitation of the study is the estimation of national prevalence based on local surveys, but a large number of studies were included, with representation in all regions of the country, giving strength to the results. In Brazil, more public policies are needed to promote supplementation, fortification and access to healthy eating to reduce the high level of anaemia among children.

Physical activity and adolescent sexual maturity: a systematic review. / Atividade física na adolescência e maturidade sexual: uma revisão sistemática.

The objective was to ve rify the association between sexual maturation and physical activity during adolescence. A systematic review of articles published between 2008 and 2018 was conducted using the following databases: PubMed/Medline, SciELO, Web of Science, Scopus, Lilacs, and BVS Adolec Brasil. The following descriptors and keywords were used in English and Portuguese: adolescent, sexual maturation, survey, questionnaire, and physical activity. The literature search retrieved 806 articles. Twelve articles were included after applying the selection criteria. Level of physical activity was highest in the initial stage of sexual maturation. Levels of physical activity appear to decrease with advancing sexual maturation status. There is no consensus about the association between sexual maturation and physical activity levels among adolescents within the literature reviewed by this study. Further research is needed to investigate whether this relationship exists and professionals involved in healthcare for adolescents should take effective steps to combat physical inactivity.

O objetivo é verificar a associação entre maturação sexual e atividade física na adolescência. Trata-se de um estudo de revisão sistemática elaborado a partir de artigos publicados entre 2008 a 2018 nas bases de dados Medline-PubMed, SciELO, Web of Science, Scopus, Lilacs e Adolec BVS. Utilizou-se os descritores e palavras-chave adolescente, maturação sexual, inquérito, questionário e atividade física, no idioma português e sua equivalência na língua inglesa e foram identificados 806 artigos. Após aplicação dos critérios de seleção foram incluídos 12 artigos. Maior nível da prática de atividade física foi observado em adolescentes em fase de maturação sexual inicial. A evolução do desenvolvimento maturacional sexual parece estar correlacionado à redução dos níveis de atividade física. Os achados não evidenciam um consenso sobre associação entre maturação sexual e nível de atividade física quanto à predisposição direta ou inversa da maturação sexual em relação ao nível de atividade física entre adolescentes. São necessárias mais pesquisas para compreender essa relação e possibilitar aos profissionais envolvidos com a saúde do adolescente agir efetivamente no combate à inatividade física.

Prevalence of metabolic syndrome in Brazilian children using three different sets of international criteria / Prevalencia del síndrome metabólico en niños brasileños utilizando tres diferentes criterios internacionales

BACKGROUND: the aim of the present study was to compare the prevalence of metabolic syndrome in Brazilian children aged 6-10 years using three different international criteria. METHODS: systolic and diastolic blood pressure (SBP and DBP), high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides, fasting glucose, and insulin levels were measured in 290 schoolchildren, and the presence of metabolic syndrome was analyzed according to the criteria established by Cook, Boney, and Ferreira. RESULTS: the prevalence of metabolic syndrome was 2.27 % (Boney and Ferreira criteria) and 7.58 % (Cook criteria) for girls, and 3.8 % (Boney and Ferreira criteria) and 5.06 % (Cook criteria) for boys. Agreement in pairs showed a concordance of 57.5 % (Kappa = 0.57) between Boney and Cook criteria, and 65.2 % (Kappa = 0.65) between Cook and Ferreira. The greatest concordance found was 77 % (Kappa = 0.77) between Boney and Ferreira criteria, demonstrating a substantial agreement. CONCLUSION: prevalences according to Boney and Ferreira criteria was lower than according to Cook criteria. Therefore, we suggest the use of Cook criteria in clinical practice for the diagnosis of metabolic syndrome, since this criterion provided a wider diagnostic range, thereby reducing the risk of underdiagnosis

ANTECEDENTES: el objetivo del presente estudio fue comparar la prevalencia del síndrome metabólico en niños brasileños de 6 a 10 años de edad, usando tres diferentes criterios internacionales. MÉTODOS: se midieron la presión arterial sistólica y diastólica, el colesterol de alta y baja densidad, los triglicéridos, la glucemia en ayunas y la insulinemia en 290 escolares, y se analizó la presencia del síndrome metabólico de acuerdo con los criterios de Cook, Boney y Ferreira. RESULTADOS: la prevalencia del síndrome metabólico encontradas fueron del 2,27 % (criterios de Boney y Ferreira) y 7,58 % (criterios de Cook) para las niñas, y del 3,8 % (criterios de Boney y Ferreira) y 5,06 % (criterios de Cook) para los niños. La concordancia por pares fue del 57,5 % (Kappa = 0,57) entre los criterios de Boney y Cook, y del 65,2 % (Kappa = 0,65) entre los criterios de Cook y Ferreira. La mayor concordancia encontrada fue del 77 % (Kappa = 0,77) entre los criterios de Boney y Ferreira, demostrando una concordancia sustancial. CONCLUSIONES: la prevalencia de acuerdo con los criterios de Boney y Ferreira fue inferior a la encontrada con los criterios de Cook. Por lo tanto, sugerimos el uso de los criterios de Cook en la práctica clínica para el diagnóstico del síndrome metabólico, ya que utilizando este criterio se obtiene un rango diagnóstico más amplio, reduciéndose así el riesgo del infradiagnóstico

STATURE ESTIMATE OF CHILDREN WITH CEREBRAL PALSY THROUGH SEGMENTAL MEASURES: A SYSTEMATIC REVIEW.

OBJECTIVE: To review studies that evaluate the correspondence between the estimate height via segmental measures and the actual height of children with cerebral palsy. DATA SOURCES: Systematic literature review between 1995-2018, guided by the PRISMA criteria (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), in PubMed, BVS, MEDLINE and Lilacs databases. The descriptors, connected by the AND Boolean Operators, were: anthropometry, cerebral palsy, child and body height. The research comprised papers in Portuguese, English and Spanish, with Qualis-CAPES equal or superior to B3 that addressed the question: "Is there any correlation between estimate height by equations and direct height measures in children with cerebral palsy?" 152 studies were recovered and seven were selected. Their methodological quality was assessed by the scale of the Agency for Healthcare Research and Quality (AHRQ). DATA SYNTHESIS: Most studies showed no correspondence between estimated and real height. Studies that showed coincidence of the measures contain limitations that could jeopardize the results (sample losses, small samples and exclusion of patients with severe contractures, scoliosis and severe cerebral palsy). Japanese researchers developed an equation which harmoniously aligns the statures; the study comprised only Japanese patients, though. CONCLUSIONS: Given the importance of accuracy in height measures to evaluate infant health, it is crucial to carry out more researches in order to safely establish an association between both estimate and real statures. The development of anthropometric protocols, emerged from such researches, would benefit the follow-up of children with severe psychomotor disabilities.

Stature estimate of children with cerebral palsy through segmental measures: a systematic review / Estimativa de estatura em crianças com paralisia cerebral por meio de medidas segmentares: uma revisão sistemática

ABSTRACT Objective: To review studies that evaluate the correspondence between the estimate height via segmental measures and the actual height of children with cerebral palsy. Data sources: Systematic literature review between 1995-2018, guided by the PRISMA criteria (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), in PubMed, BVS, MEDLINE and Lilacs databases. The descriptors, connected by the AND Boolean Operators, were: anthropometry, cerebral palsy, child and body height. The research comprised papers in Portuguese, English and Spanish, with Qualis-CAPES equal or superior to B3 that addressed the question: "Is there any correlation between estimate height by equations and direct height measures in children with cerebral palsy?" 152 studies were recovered and seven were selected. Their methodological quality was assessed by the scale of the Agency for Healthcare Research and Quality (AHRQ). Data synthesis: Most studies showed no correspondence between estimated and real height. Studies that showed coincidence of the measures contain limitations that could jeopardize the results (sample losses, small samples and exclusion of patients with severe contractures, scoliosis and severe cerebral palsy). Japanese researchers developed an equation which harmoniously aligns the statures; the study comprised only Japanese patients, though. Conclusions: Given the importance of accuracy in height measures to evaluate infant health, it is crucial to carry out more researches in order to safely establish an association between both estimate and real statures. The development of anthropometric protocols, emerged from such researches, would benefit the follow-up of children with severe psychomotor disabilities.

RESUMO Objetivo: Revisar estudos que avaliam correspondência entre a altura estimada por medidas segmentares e a estatura real de crianças com paralisia cerebral. Fonte de dados: Revisão sistemática da literatura entre 1995 e 2018, guiada pela diretriz Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), nas bases de dados PubMed, Biblioteca Virtual em Saúde (BVS), Medical Literature Analysis and Retrieval System Online (MEDLINE) e Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS). Os descritores, combinados pelo operador booleano "and", foram: "anthropometry", "cerebral palsy", "child" e "body height". A pesquisa englobou artigos em português, inglês e espanhol, classificadas pelo Quali-CAPES igual ou superior a B3 e que respondiam à questão guia: "Existe correlação entre a altura estimada por equações em crianças com paralisia cerebral e as medidas diretas de altura?". Dos 152 artigos inicialmente recuperados, sete foram selecionados e sua qualidade metodológica foi avaliada pela escala da Agency for Healthcare Research and Quality (AHRQ). Síntese dos dados: A maioria dos trabalhos não encontrou correspondência entre altura real e estimada. Estudos que exibiram coincidência das medidas apresentaram limitações que poderiam comprometer os resultados (perda de amostra, amostra pequena e exclusão de indivíduos com contraturas severas, escoliose e paralisia cerebral grave). Pesquisadores japoneses desenvolveram equação que apresenta boa concordância entre as estaturas. Contudo, o estudo compreendeu apenas indivíduos japoneses. Conclusões: Dada a importância da precisão das medidas de estatura para avaliar a saúde infantil, tornam-se necessárias mais pesquisas visando estabelecer, de maneira mais segura, a associação entre a estatura estimada e a real. O desenvolvimento de protocolos antropométricos, resultantes dessas pesquisas, beneficiaria o acompanhamento de crianças com sequelas psicomotoras graves.

Baby friendly hospital initiative: 25 years of experience in brazil / Iniciativa hospital amigo da criança: 25 anos de experiência no brasil

ABSTRACT Objective: To describe the experience of the 25-year-old trajectory of the Baby Friendly Hospital Initiative (BFHI) in Brazil. The first unit was implemented in 1992. Methods: Information and data were collected from publications on the World Health Organization (WHO), the United Nations International Children's Emergency Fund (UNICEF) and the Ministry of Health websites and in national and international journals, about the period 1990-2017. The descriptors used were: "iniciativa hospital amigo da criança", "hospital amigo da criança", "baby friendly initiative hospital", "aleitamento materno" and "breastfeeding". The number of hospitals in the 25 years, the course of the BFHI and its repercussions on breastfeeding in Brazil were evaluated. Results: The BFHI is an intervention strategy in hospital care at birth focused on the implementation of practices that promote exclusive breastfeeding from the first hours of life and with the support, among other measures of positive impact on breastfeeding, of the International Code of Marketing of Breastmilk Substitutes. Currently, the initiative has been revised, updated and expanded to integrate care for newborns in neonatal units and care for women since prenatal care. It can be concluded that, during these 25 years, the quantity of hospitals varied greatly, with numbers still below the capacity of hospital beds. BFHI shows higher rates of breastfeeding than non-accredited hospitals. However, the number of hospitals are still few when compared to other countries. Conclusions: The BFHI has contributed to breastfeeding in Brazil in recent decades. Greater support for public policies is needed to expand the number of accredited institutions in the country.

RESUMO Objetivo: Descrever a experiência de 25 anos da Iniciativa Hospital Amigo da Criança (IHAC) no Brasil, cuja primeira unidade foi implementada em 1992. Métodos: Informações e dados foram obtidos em publicações nos sites da Organização Mundial da Saúde (OMS), do Fundo Internacional de Emergência para a Infância das Nações Unidas (UNICEF) e do Ministério da Saúde e em periódicos nacionais e internacionais, abrangendo o período de 1990 a 2017. Utilizaram-se os descritores: "iniciativa hospital amigo da criança", "hospital amigo da criança", "baby friendly initiative hospital", "aleitamento materno" e "breastfeeding". Foram avaliados o número de hospitais nos 25 anos, a trajetória da IHAC e suas repercussões sobre o aleitamento materno no Brasil. Resultados: A IHAC é uma estratégia de intervenção na assistência hospitalar ao nascimento com foco na implementação de práticas que promovem o aleitamento materno exclusivo desde as primeiras horas de vida e com o apoio, entre outras medidas de impacto positivo na amamentação, do Código Internacional de Comercialização de Substitutos do Leite Materno. Atualmente, a iniciativa foi revisada, atualizada e expandida para integrar o cuidado aos recém-nascidos nas unidades neonatais e na atenção à mulher desde o pré-natal. Pôde-se concluir que, ao longo desses 25 anos, a quantidade de hospitais variou muito, com números ainda aquém da capacidade de leitos hospitalares. Hospitais credenciados como o Hospital Amigo da Criança mostram índices de amamentação superiores ao de hospitais não credenciados, entretanto o número de hospitais credenciados no Brasil ainda é pouco se comparado com outros países. Conclusões: A IHAC contribuiu para o aleitamento materno no Brasil nessas últimas décadas. Mais apoio pelas políticas públicas é necessário para ampliar o número de instituições credenciadas no país.

Measurement of physical activity and sedentary behavior in adolescents by accelerometer: a cross-sectional study / Atividade física e comportamento sedentário em adolescentes medidas por acelerômetro: um estudo transversal

The objective of this study was to analyze the level of physical activity and sedentary behavior (SB) in students from Minas Gerais, Brazil. It is a cross-sectional study with 153 participants of both sexes and had to be between 10 and 12 old. We carried out measurements of socioeconomic and anthropometric variables. Also, physical activity and sedentary behavior were measured using an accelerometer (MiniMitter, Actiheart®). The accelerometer was fixed on the chest and the participants should remain with it for three days (Thursday, Friday, and Saturday). We categorized the data as SB - < 1.6 METs (< 0.39 kcal.kg-1.15min-1); light physical activity - 1.6 to 2.9 METs (0.42 to 0.76 kcal.kg-1.15min-1). In the study, both sexes showed a low time of moderate and vigorous (~ 0.85 hours/day) activities. Higher times were recorded for light activity (~ 2.6 hours/day) and SB (~ 12.5 hours/day) in both sexes. Also, boys spent greater time on a vigorous physical activity and lower time of SB in the three evaluated days (~ 1.3 hours/day boys vs ~ 0.4 hours/day girls) (p = 0.001; np2= 0.42). However, the physical activity behavior was similar during weekdays and weekends (p = 0.14; np2= 0.078). We conclude that boys are more engaged than girls in physical activities in public schools of Minas Gerais, Brazil. However, SB is similar between them

O objetivo do estudo foi analisar o nível de atividade física e comportamento sedentário (CS) em escolares. Trata-se de um estudo transversal com 153 escolares de 10 a 12 anos de ambos os sexos, de escolas públi-cas de São João Nepomuceno do estado de Minas Gerais, Brasil. Foi realizada a mensuração de variáveis socioeconômicas e antropométricas e a utilização de acelerômetro para medir o nível atividade de física. O acelerômetro foi fixado no peito dos participantes por um período de 3 dias (quinta, sexta e sábado). A partir disso os dados do acelerômetro foram definidos em CS - < 1,6 METs (< 0,39 kcal.kg-1.15min-1); atividade física leve ­ 1,6 a 2,9 METs (0,42 a 0,76 kcal.kg-1.15min-1). No estudo, ambos os sexos apresentaram baixo tempo de atividades moderadas a vigorosas (~ 0,85 horas/dia). O principal achado indicou um elevado tempo em atividade leves (~ 2,6 horas/dia) e CS (~ 12,5 horas/dia) em ambos os sexos. De acordo com o sexo, os meninos apresentaram mais tempo envolvidos em atividades físicas moderada a vigorosas e baixo CS nos três dias avaliados (~ 1,3 horas/dia meninos e ~ 0,4 horas/dia meninas) (p = 0.001; np2= 0.42). Além disso, o comportamento da atividade física foi semelhante nos dias úteis e finais de semana (p = 0.14; np2= 0.078). Concluímos que para os três dias avaliados, meninos apresentam maior tempo de envolvimento em atividades moderada a vigorosa, porém ambos os sexos com alto CS

BABY FRIENDLY HOSPITAL INITIATIVE: 25 YEARS OF EXPERIENCE IN BRAZIL.

OBJECTIVE: To describe the experience of the 25-year-old trajectory of the Baby Friendly Hospital Initiative (BFHI) in Brazil. The first unit was implemented in 1992. METHODS: Information and data were collected from publications on the World Health Organization (WHO), the United Nations International Children's Emergency Fund (UNICEF) and the Ministry of Health websites and in national and international journals, about the period 1990-2017. The descriptors used were: "iniciativa hospital amigo da criança", "hospital amigo da criança", "baby friendly initiative hospital", "aleitamento materno" and "breastfeeding". The number of hospitals in the 25 years, the course of the BFHI and its repercussions on breastfeeding in Brazil were evaluated. RESULTS: The BFHI is an intervention strategy in hospital care at birth focused on the implementation of practices that promote exclusive breastfeeding from the first hours of life and with the support, among other measures of positive impact on breastfeeding, of the International Code of Marketing of Breastmilk Substitutes. Currently, the initiative has been revised, updated and expanded to integrate care for newborns in neonatal units and care for women since prenatal care. It can be concluded that, during these 25 years, the quantity of hospitals varied greatly, with numbers still below the capacity of hospital beds. BFHI shows higher rates of breastfeeding than non-accredited hospitals. However, the number of hospitals are still few when compared to other countries. CONCLUSIONS: The BFHI has contributed to breastfeeding in Brazil in recent decades. Greater support for public policies is needed to expand the number of accredited institutions in the country.

Accuracy of photogrammetry for detecting adolescent idiopathic scoliosis progression.

BACKGROUND: The gold standard method of monitoring the evolution of scoliosis has been serial standing, posteroanterior, full-length spine radiographs with curvature measurements using the Cobb method. However, over the course of follow-up, patients can receive high radiation doses. Various studies have shown that repeated exposure to radiation in children and adolescents can be harmful to their health. PURPOSE: To determine the accuracy of photogrammetry in evaluating the progression of adolescent idiopathic scoliosis in comparison with radiography. STUDY DESIGN: Diagnostic study. PATIENT SAMPLE: Ninety adolescents subjected to radiographic follow-up of idiopathic scoliosis. OUTCOME MEASURES: The angle of scoliotic curvature was measured using the Cobb radiographic method and photogrammetry. An increase of 5° or more between two radiographic exams was considered a progression of the curvature and was defined as the standard for calculations of sensitivity, specificity, predictive value, and accuracy of the photogrammetric method for measuring scoliosis progression. METHODS: Patients were subjected to radiographic and photogrammetric exams concomitantly and were reevaluated after an average of 8.6 months. The exams were analyzed separately and independently by two examiners for progression of scoliosis. RESULTS: The measurements of the curves at the beginning of the study were 39.5±16.7° and 39.5±14.3° for radiographic and photogrammetric exams, respectively (p=1.0). At the end of the study, the measurements of the curves were 40.2±16.2° and 41.3±15.1° for the radiographic and photogrammetric exams, respectively (p=.310). The photogrammetric method had an accuracy of 89% (Confidence interval [CI] 95%=82.5-95.5) for the detection of scoliosis progression, with a sensitivity of 94.4% (CI 95%=89.6-99.2), a specificity of 86.7% (CI 95%=79.7-93.7), a positive predictive value of 75.5% (CI 95%=66.6-84.4), a negative predictive value of 97.2% (CI 95%=93.8-100), and a Kappa index of 0.75 (CI 95%=66.1-83.9). The interclass correlation coefficient between the two methods was 0.74 (CI 95%=0.65-0.81; p=0). CONCLUSIONS: The photogrammetric method showed good performance for detecting the progression of adolescent idiopathic scoliosis in comparison with the radiographic exam method.

Criteria validity of the Netherlands physical activity questionnaire for children / Validade critério do Netherland Physical Activity Questionnaire para crianças

Abstract Physical activity measurement with accuracy and precision is extremely important in establishing the dose-response relationship between levels of physical activity and the different outcome possibilities. Subjective methods of measurement, such as proxy-reports have been used as a possibility to check physical activity in children. The aim of this study was to test the Netherlands Physical Activity Questionnaire (NPAQ), valid for Brazilian schoolchildren using physical aerobic fitness as a criterion. The study included 290 children aged 6-10 years from public schools of Itaúna/MG. NPAQ was applied to parents or guardians and children were tested using the Luc Léger test. NPAQ had mean score of 25 for children (25 for boys and 24 for girls) and VO2max was 50.8 ml/kg/min for children (52.6 and 50.2 ml/kg/min for boys and girls, respectively). The Spearmam correlation test showed significant correlation (rsho = 0.146; p = 0.013) between NPAQ and VO2max, but the correlation is weak (Kappa -0.14). The results showed that NPAQ presented poor construct validity for physical activity measurement in a Brazilian schoolchildren sample, based on aerobic physical fitness criteria.

Resumo A mensuração da atividade física com acurácia e precisão é de extrema importância no estabelecimento da relação de dose-resposta entre os níveis de atividade física e as diversas possibilidades de desfecho, sendo um desafio de extrema complexidade. A utilização de métodos subjetivos de mensuração, como os instrumentos proxy-reports, é uma possibilidade de verificação de atividade física em crianças. O objetivo deste estudo foi testar a validade do Netherland Physical Activity Questionnaire (NPAQ) em escolares brasileiros tendo como medida critério a aptidão física aeróbica. Participaram deste estudo 290 crianças de seis a 10 anos de idade, matriculados em escolas públicas do município de Itaúna/MG. Foi aplicado aos responsáveis o NPAQ e as crianças realizaram o teste de Luc Léger. O NPAQ apresentou um escore mediano de 25 para as crianças (25 meninos e 24 meninas) e o VO2máx foi de 50,8 ml/kg/min para as crianças (52,6 e 50,2 ml/kg/min para meninos e meninas, respectivamente). O NPAQ e o VO2máx apresentaram no teste de correlação simples de Spearmam rsho = 0,146 (p = 0,013) correlação significativa, porém fraca (Kappa -0.14). Os resultados permitem concluir que o NPAQ apresentou fraca validade de constructo para mensuração de atividade física em uma amostra de escolares brasileiros, tendo como medida critério a aptidão física aeróbica.

Prevalência de anemia e determinantes da concentração de hemoglobina em gestantes / Prevalence of anemia and determinants of hemoglobin concentration in pregnant women

Resumo Introdução A anemia é caracterizada pela reduzida concentração de hemoglobina e, durante a gestação, está associada à maior morbimortalidade fetal e materna. Objetivo Avaliar a prevalência de anemia e os fatores determinantes da concentração de hemoglobina em gestantes. Método Estudo transversal com uma amostra de 328 gestantes atendidas nas unidades de saúde urbanas de Vitória da Conquista, na Bahia. Foram realizadas a aplicação de questionário, a avaliação antropométrica e a coleta de sangue por punção capilar para dosagem de hemoglobina em β-hemoglobinômetro portátil. Foram consideradas anêmicas as gestantes com hemoglobina < 11 g/dL. Os determinantes da concentração de hemoglobina sérica foram identificados por meio da regressão linear múltipla. Resultados A prevalência de anemia foi de 18,9%, e a média de hemoglobina, de 11,9 g/dL (desvio-padrão: 1,2). Foram observadas menores médias de concentração de hemoglobina entre as gestantes que iniciaram o pré-natal no segundo trimestre (β: -0,28; IC95%: -0,54 a -0,02) e que não usavam suplemento de ferro (β: -0,51; IC95%: -0,79 a -0,23), enquanto a maior média foi verificada entre as mulheres primigestas (β: 0,34; IC95%: 0,06 a 0,62). Conclusão A anemia nas gestantes avaliadas é um leve problema de saúde pública, e as concentrações de hemoglobina foram associadas aos fatores obstétricos e à assistência pré-natal.

Abstract Background Anemia is characterized by reduced hemoglobin concentration and, during pregnancy is associated with increased fetal and maternal morbidity and mortality. Objective To evaluate the prevalence of anemia and the determinants factors of hemoglobin concentration in pregnant women. Methods Cross-sectional study with a sample of 328 pregnant women patients of the urban Health Units of Vitória da Conquista, Bahia. We applied a questionnaire, anthropometric evaluation, and collected blood by capillary puncture for dosage of haemoglobin using a portable β-hemoglobinometer. Were considered anemic those pregnant women with hemoglobin <11 g/dL. The determinants of serum hemoglobin concentration were identified through multiple linear regression. Results We observed anemia in 18.9% of the participants, and the mean hemoglobin concentration was 11.9 g/dL (standard deviation: 1.2). We observed lower mean of hemoglobin concentration among pregnant women who started prenatal care in the second trimester (β: -0.28; 95% CI: -0.54 to -0.02) and who did not used iron supplementation (β: -0.51, 95% CI: -0.79 to -0.23), while a higher mean was observed among primigavidae women (β: 0.34, 95% CI: 0.06 to 0.62). Conclusion Anemia in the population evaluated is a mild public health problem, and hemoglobin concentrations were associated to obstetric factors and prenatal care.

HIERARCHICAL ANALYSIS OF THE FACTORS ASSOCIATED WITH ANEMIA IN INFANTS. / ANÁLISE HIERARQUIZADA DOS FATORES ASSOCIADOS À ANEMIA EM LACTENTES.

OBJECTIVE: To evaluate the prevalence of anemia and the associated factors in infants assisted in health units of Vitória da Conquista, Bahia, Northeast Brazil. METHODS: Cross-sectional study with a representative sample of 366 children aged 6 to 23 months. A questionnaire was applied to the caregiver, and the children's anthropometric measurements and hemoglobin levels were collected. The associations were identified by Poisson regression with robust variances based on a hierarchical analysis model. RESULTS: The prevalence of anemia was 26.8%, and the associated factors were: family income equal to or lower than one minimum wage (PR: 1.50; 95%CI 1.03-2.18), number of household members higher than five (PR: 1.50; 95%CI 1.07-2.11), use of unfiltered water (PR: 1.68; 95%CI 1.11-2.56), number of offspring higher than three (PR: 1.64; 95%CI 1.01-2.68), consumption of meat and/or viscera less than once/week (PR: 1.78; 95%CI 1.24-2.58) and age 6-11 months (PR: 1.75; 95%CI 1.20-2.55). CONCLUSIONS: Anemia in the infants assessed is a moderate public health problem, which is associated with socioeconomic, demographic, and dietary factors; thus, measures are necessary for its prevention.

OBJETIVO: Avaliar a prevalência e os fatores associados à anemia em lactentes assistidos por Unidades de Saúde de Vitória da Conquista, Bahia. MÉTODOS: Estudo transversal com uma amostra representativa de 366 crianças de 6 a 23 meses. Realizou-se aplicação de questionário ao cuidador, avaliação antropométrica e dosagem de hemoglobina das crianças. As associações foram identificadas por meio da regressão de Poisson com variâncias robustas com seleção hierárquica das variáveis independentes. RESULTADOS: A prevalência de anemia foi de 26,8%, e os fatores associados foram: renda familiar igual ou inferior a um salário mínimo (RP: 1,50; IC95% 1,03-2,18), número de moradores no domicílio superior a cinco (RP: 1,50; IC95% 1,07-2,11), utilização de água não filtrada (RP: 1,68; IC95% 1,11 -2,56), número de filhos maior que três (RP: 1,64; IC95% 1,01-2,68), consumo de carne e/ou vísceras menor que uma vez por semana (RP: 1,78; IC95% 1,24-2,58) e idade de 6 a 11 meses (RP: 1,75; IC95% 1,20-2,55). CONCLUSÕES: A anemia nos lactentes avaliados é um moderado problema de saúde pública, a qual está associada a fatores socioeconômicos, demográficos e dietéticos. Dessa forma, medidas são necessárias para sua prevenção.

Relationship between aerobic capacity with Birth Weight and breastfeeding patterns in children: A cross-sectional study / Relação da capacidade aeróbica com o peso ao nascer e padrões de aleitamento materno em crianças: um corte transversal de escolares

ABSTRACT Objective To analyze if aerobic capacity is related to Birth Weight and breastfeeding patterns in boys and girls, products of a term pregnancy and normal weight. Methods A representative sample of 230 Brazilian children (6-10 years old), born at term (after 37-weeks' gestation) with normal weight (between 2.5 and 4.0kg). These children performed a Yo-Yo Test to estimate their aerobic capacity and mothers reported their children's Birth Weight and breastfeeding patterns. The Pearson correlation coefficient was used to measure the association between aerobic capacity with Birth Weight and breastfeeding patterns. Results We did not observe any significant associations between aerobic capacity with Birth Weight and breastfeeding time in either sexes (p>0.05). Conclusion These results indicate that aerobic capacity is not related with Birth Weight or breastfeeding time in children born with normal weight and gestational age, suggesting that this complex physiological parameter does not appear to be determined by intrauterine factors that dictate the Birth Weight and breastfeeding patterns in the beginning of life.

RESUMO Objetivo Analisar a relação do desempenho aeróbico com o peso ao nascer e padrões de aleitamento materno na infância de crianças nascidas a termo com peso gestacional adequado. Métodos Duzentas e trinta crianças (6-10 anos), nascidas a termo (pós-37 semanas de gestação) e com peso normal (entre 2,5 e 4kg) participaram do estudo. O desempenho aeróbico foi estimado pelo Yo-Yo Test. O peso ao nascer e os padrões de aleitamento materno foram relatados pelas mães das crianças mediante questionário. A correlação de Pearson foi utilizada para avaliar a relação do desempenho aeróbico com o peso ao nascer e a duração do aleitamento materno. Resultados Não observou-se relação do desempenho aeróbico com o peso ao nascer ou com a duração do aleitamento materno em nenhum dos sexos (p>0,05). Conclusão Os resultados apontam que o desempenho aeróbico não está relacionado ao peso ao nascer e nem à duração do aleitamento materno em crianças nascidas a termo e com peso normal, sugerindo que este parâmetro fisiológico parece não ser associado à fatores intrauterinos que determinam o peso no nascimento e nem ao padrão alimentar no início da vida.

Análise hierarquizada dos fatores associados à anemia em lactentes / Hierarchical analysis of the factors associated with anemia in infants

RESUMO Objetivo: Avaliar a prevalência e os fatores associados à anemia em lactentes assistidos por Unidades de Saúde de Vitória da Conquista, Bahia. Métodos: Estudo transversal com uma amostra representativa de 366 crianças de 6 a 23 meses. Realizou-se aplicação de questionário ao cuidador, avaliação antropométrica e dosagem de hemoglobina das crianças. As associações foram identificadas por meio da regressão de Poisson com variâncias robustas com seleção hierárquica das variáveis independentes. Resultados: A prevalência de anemia foi de 26,8%, e os fatores associados foram: renda familiar igual ou inferior a um salário mínimo (RP: 1,50; IC95% 1,03-2,18), número de moradores no domicílio superior a cinco (RP: 1,50; IC95% 1,07-2,11), utilização de água não filtrada (RP: 1,68; IC95% 1,11 -2,56), número de filhos maior que três (RP: 1,64; IC95% 1,01-2,68), consumo de carne e/ou vísceras menor que uma vez por semana (RP: 1,78; IC95% 1,24-2,58) e idade de 6 a 11 meses (RP: 1,75; IC95% 1,20-2,55). Conclusões: A anemia nos lactentes avaliados é um moderado problema de saúde pública, a qual está associada a fatores socioeconômicos, demográficos e dietéticos. Dessa forma, medidas são necessárias para sua prevenção.

ABSTRACT Objective: To evaluate the prevalence of anemia and the associated factors in infants assisted in health units of Vitória da Conquista, Bahia, Northeast Brazil. Methods: Cross-sectional study with a representative sample of 366 children aged 6 to 23 months. A questionnaire was applied to the caregiver, and the children's anthropometric measurements and hemoglobin levels were collected. The associations were identified by Poisson regression with robust variances based on a hierarchical analysis model. Results: The prevalence of anemia was 26.8%, and the associated factors were: family income equal to or lower than one minimum wage (PR: 1.50; 95%CI 1.03-2.18), number of household members higher than five (PR: 1.50; 95%CI 1.07-2.11), use of unfiltered water (PR: 1.68; 95%CI 1.11-2.56), number of offspring higher than three (PR: 1.64; 95%CI 1.01-2.68), consumption of meat and/or viscera less than once/week (PR: 1.78; 95%CI 1.24-2.58) and age 6-11 months (PR: 1.75; 95%CI 1.20-2.55). Conclusions: Anemia in the infants assessed is a moderate public health problem, which is associated with socioeconomic, demographic, and dietary factors; thus, measures are necessary for its prevention.

Religiosity as a possible protective factor against "binge drinking" among 12-year-old students: a population-based study. / Religiosidade como possível fator de proteção do "binge drinking" por escolares de 12 anos de idade: um estudo de base populacional.

Associated with positive impacts on health, religiosity has presented itself as a possible protection factor against alcohol consumption by teenagers. This study evaluated the prevalence of binge drinking and its association with religiosity among 12-year-old students, from Diamantina, State of Minas Gerais. Statistical analyses involved chi-square Pearson (p < 0,05) and Poisson regression with robust variance. The sample included a census of 588 students. Participation in religious activities was associated with no binge drinking (PR = 0,823; 95% CI: 0,717 - 0,945); and consumption of alcoholic beverages by the best friend was associated with binge drinking (PR = 1.554; 95% CI: 1,411-1,711). It was concluded that religiosity was associated with no consumption of alcoholic beverages in binge drinking sessions.