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1.
Allergol Immunopathol (Madr) ; 52(1): 65-70, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38186195

RESUMO

BACKGROUND: Atopic dermatitis (AD) is a relapsing, chronic cutaneous inflammatory disease with onset, in general, in early childhood. Chronic skin inflammation is associated with overproduction of reactive oxygen species (ROS) such as superoxide and hydrogen peroxide. Oxidative stress, an imbalance between the production of free radicals and antioxidant defense, results in tissue inflammation due to the upregulation of genes that encode inflammatory cytokines. This condition plays an important role in the pathogenesis of AD. OBJECTIVE: To compare the antioxidant defense in children and adolescents with AD with that of healthy individuals and to verify the association of antioxidant defense with disease severity and nutritional status. METHODS: Cross-sectional study that evaluated 48 children and adolescents with AD and 25 controls for nutritional assessment (body mass index z score [BMIZ] and height for age z score [HAZ]) and levels of vitamins A, C, E, and D, zinc (Zn), copper (Cu), antioxidant enzymes (superoxide dismutase [SOD], catalase [CAT], glutathione peroxidase [GPx]), high-sensitivity C-reactive protein (CRP) and interleukin 33 (IL-33). RESULTS: There was no significant difference in the comparison between AD and control groups for serum levels of vitamins (A, D, C, and E), copper, and antioxidant enzymes. Serum zinc levels were higher in the AD group (ß = 24.20; 95% CI 13.95-34.91; P < 0.001) even after adjusting the BMIZ, HAZ, gender, IL-33, and CRP. Children and adolescents with moderate or severe AD compared to mild AD (SCORAD - 36.7±17.4 vs 11.8 ± 3.9; P < 0.001) had lower values of the vitamin E/total lipid ratio (3.68 [0.29;12.63] vs 5.92 [3.27;17.37]; P = 0.013). CONCLUSION: Children and adolescents with AD had higher concentrations OF elevated levels of zinc compared to controls, a fact not observed for other biomarkers of antioxidant defense. AD in moderate or severe forms presented lower concentrations of vitamin E, a potent antioxidant fat soluble.


Assuntos
Antioxidantes , Dermatite Atópica , Pré-Escolar , Criança , Adolescente , Humanos , Dermatite Atópica/epidemiologia , Interleucina-33 , Cobre , Estudos Transversais , Vitaminas , Vitamina E , Vitamina A , Inflamação , Gravidade do Paciente , Vitamina K , Zinco
2.
Allergol. immunopatol ; 52(1): 65-70, 01 jan. 2024. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-229176

RESUMO

Background: Atopic dermatitis (AD) is a relapsing, chronic cutaneous inflammatory disease with onset, in general, in early childhood. Chronic skin inflammation is associated with overproduction of reactive oxygen species (ROS) such as superoxide and hydrogen peroxide. Oxidative stress, an imbalance between the production of free radicals and antioxidant defense, results in tissue inflammation due to the upregulation of genes that encode inflammatory cytokines. This condition plays an important role in the pathogenesis of AD. Objective: To compare the antioxidant defense in children and adolescents with AD with that of healthy individuals and to verify the association of antioxidant defense with disease severity and nutritional status. Methods: Cross-sectional study that evaluated 48 children and adolescents with AD and 25 controls for nutritional assessment (body mass index z score [BMIZ] and height for age z score [HAZ]) and levels of vitamins A, C, E, and D, zinc (Zn), copper (Cu), antioxidant enzymes (superoxide dismutase [SOD], catalase [CAT], glutathione peroxidase [GPx]), high-sensitivity C-reactive protein (CRP) and interleukin 33 (IL-33). Results: There was no significant difference in the comparison between AD and control groups for serum levels of vitamins (A, D, C, and E), copper, and antioxidant enzymes. Serum zinc levels were higher in the AD group (β = 24.20; 95% CI 13.95–34.91; P < 0.001) even after adjusting the BMIZ, HAZ, gender, IL-33, and CRP. Children and adolescents with moderate or severe AD compared to mild AD (SCORAD – 36.7±17.4 vs 11.8 ± 3.9; P < 0.001) had lower values of the vitamin E/total lipid ratio (3.68 [0.29;12.63] vs 5.92 [3.27;17.37]; P = 0.013) (AU)


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Antioxidantes/sangue , Dermatite Atópica/sangue , Dermatite Atópica/imunologia , Estresse Oxidativo , Vitamina E/sangue , Vitamina K/sangue , Zinco/sangue , Índice de Gravidade de Doença , Estudos Transversais , Interleucina-33/imunologia , Vitamina A/sangue
4.
Allergol Immunopathol (Madr) ; 50(6): 10-16, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36335440

RESUMO

Our objective was to describe the serum vitamin D concentrations of children and adolescents with food allergy (FA) and to verify the association between the number of food allergens involved, length of sun exposure, and nutritional status. Through a cross-sectional study, 79 patients with FA, from ages 2 to 15 years, were assessed and followed up in a reference outpatient clinic, in Sao Paulo, Brazil. Clinical and biochemical data were collected for analysis of 25(OH)D, calcium, phosphorus, phosphatase, parathyroid hormone (PTH), and high-sensitivity C-reactive protein (hs-CRP). The cut-off point used for vitamin D deficiency was 25(OH)D ≤ 20 ng/mL. Vitamin D deficiency was detected in 45.6% of patients with a median age of 6.9 years (Interquartile range [IQR] 4.7; 10.2). The median serum 25(OH)D concentration was 21.1 ng/mL (IQR 17.8; 26.0). Multivariate linear regression was performed considering serum vitamin D level as a dependent variable. Allergy to multiple foods (inverse) and length of sun exposure (direct), but not nutritional status, were independently associated with serum 25(OH)D levels (P = 0.034 and P = 0.014, respectively). Patients with cow's milk allergy also showed lower vitamin D concentrations in comparison with other FA (19.1 ng/mL [IQR 16.6; 24.4] vs 22.2 ng/mL [IQR 18.1; 27.1] [P = 0.056]). Vitamin D deficiency affected about half of individuals with FA. Multiple food allergy was associated with lower vitamin D concentrations, reinforcing the importance of monitoring vitamin D status in patients with FA.


Assuntos
Hipersensibilidade a Leite , Deficiência de Vitamina D , Bovinos , Feminino , Animais , Alérgenos , Luz Solar , Estudos Transversais , Brasil/epidemiologia , Deficiência de Vitamina D/epidemiologia , Vitamina D , Vitaminas
5.
Arq. Asma, Alerg. Imunol ; 5(3): 255-266, jul.set.2021. ilus
Artigo em Português | LILACS | ID: biblio-1399345

RESUMO

A anafilaxia é uma reação alérgica mais grave e potencialmente fatal. Apresenta-se quase sempre com manifestações cutâneas, acompanhadas por acometimento dos sistemas respiratório, gastrointestinal, nervoso e cardiovascular. Indivíduos de todas as faixas etárias podem manifestar anafilaxia, e seu diagnóstico no primeiro ano de vida é difícil por ser o lactente incapaz de expressar de modo claro as sensações vividas durante o episódio agudo. Nessa faixa etária os alimentos são os agentes desencadeantes mais envolvidos, embora medicamentos e veneno de himenópteros também o sejam. Em pacientes submetidos a várias cirurgias e procedimentos médicos a alergia ao látex pode ocorrer. A adrenalina intramuscular é a primeira linha de tratamento da anafilaxia na fase inicial, mas continua sendo subutilizada. Além disso, medidas de suporte, tais como decúbito supino, reposição de fluidos, vias aéreas pérvias e oxigenação, devem ser instituídas. Após a alta, o paciente deve ser encaminhado à avaliação e seguimento por especialista visando à identificação do agente desencadeante, assim como educar responsáveis/cuidadores destes pacientes sobre a prevenção de novos episódios. É importante que esse paciente tenha consigo algum tipo de identificação que o aponte como tendo tido episódio de anafilaxia, sobretudo se tiver sido recorrente. A oferta de um plano escrito de como proceder diante de um novo episódio é fundamental.


Anaphylaxis is a serious and potentially fatal allergic reaction. Most frequently, it features cutaneous manifestations accompanied by involvement of the respiratory, gastrointestinal, nervous, and/or cardiovascular systems. Individuals of all age groups may present with anaphylaxis, and its diagnosis in the first year of life is difficult because the infant is unable to clearly express the sensations experienced during the acute episode. In this age group, foods are the most common triggering agents, together with medications and Hymenoptera venom. In patients undergoing multiple surgeries and medical procedures, latex allergy may occur. Intramuscular epinephrine is the first line of treatment for early anaphylaxis, but it remains underutilized. In addition, supportive measures such as supine decubitus, fluid replacement, patent airways, and oxygenation should be instituted. After discharge, the patient should be referred for evaluation and follow-up by a specialist, with the purpose of identifying the triggering agent as well as educating the caregivers of these patients about the prevention of new episodes. This patient should always carry some type of identification that indicates that he/she has had any episode of anaphylaxis, especially if it has been recurrent. Providing a written plan of how to proceed in the face of a new episode is essential.


Assuntos
Humanos , Recém-Nascido , Lactente , Venenos de Artrópodes , Manifestações Cutâneas , Epinefrina , Hipersensibilidade ao Látex , Hipersensibilidade Alimentar , Anafilaxia , Recidiva , Terapêutica , Preparações Farmacêuticas , PubMed , Diagnóstico , Diagnóstico Diferencial , Hipersensibilidade
6.
Allergol. immunopatol ; 48(3): 259-264, mayo-jun. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-192028

RESUMO

The clinical history is of importance in the investigation of allergic diseases but does have limitations. Many allergic conditions will be over-diagnosed if anamnesis alone is used for diagnostic criteria. Serum total immunoglobulin E (TIgE) quantification, as well as panels containing allergens prevalent in the studied population, may serve as screening tests and facilitate the diagnosis of allergic disease or its exclusion. We assessed the positivity of two versions of these tests, Phadiatop Europe® (PhEU) and Phadiatop Infant® (PhInf), as well as total IgE (TigE) values in patients with a medical diagnosis of allergic disease and non-allergic individuals. METHODS: A cross-sectional study performed in eleven Brazilian pediatric allergy centers with patients divided into groups according to the primary condition and a group of assessed control subjects. They were submitted to TIgE measurement and screening tests (PhEu and PhInf). RESULTS: TIgE mean serum levels were significantly higher among allergic patients, especially those with asthma/rhinitis or atopic dermatitis. The positivity of the screening tests, considering the total population, was 63.8% for PhEU and 72.6% for PhInf. These increased when we evaluated only the allergic subjects. The concordance index of the two tests was Kappa = 0.7 and higher among those of greater age. CONCLUSIONS: In the assessed population, there were significantly higher levels among those with positive screening tests and PhInf showed better performance in the identification of sensitized individuals, regardless of age. This is the first study to evaluate Phadiatop and Phadiatop Infant in the same population


No disponible


Assuntos
Humanos , Lactente , Pré-Escolar , Criança , Adolescente , Testes Hematológicos/métodos , Hipersensibilidade/diagnóstico , Imunoglobulina E/sangue , Técnicas Imunológicas/métodos , Hipersensibilidade/imunologia , Brasil , Estudos Transversais , Alérgenos/imunologia , Dermatite Atópica/imunologia , Asma/imunologia , Rinite Alérgica/imunologia , Sensibilidade e Especificidade
7.
Arq. Asma, Alerg. Imunol ; 4(1): 103-120, jan.mar.2020. ilus
Artigo em Português | LILACS | ID: biblio-1381793

RESUMO

Introdução: A dermatite atópica (DA) é doença inflamatória da pele, recidivante e que acomete crianças e adultos e compromete a qualidade de vida destes doentes. Objetivos: Avaliar o impacto da DA moderada a grave na vida social e na qualidade de vida de pacientes adultos, assim como as suas expectativas quanto à evolução da doença e do seu tratamento. Métodos: Duzentos adultos (18 a 65 anos) com diagnóstico médico de DA moderada a grave responderam por via telefônica questionário com perguntas sobre a sua doença, interferência com o seu dia a dia, a atividade laboral, medicação em uso, assim como as suas expectativas com relação a novos tratamentos. Resultados: Na população avaliada houve predomínio de mulheres, média de idade de 37 anos, com nível elevado de escolaridade, e na sua maioria pertencentes às classes sociais A e B (68%). O tempo médio para obtenção do diagnóstico foi de 15 meses a partir dos primeiros sintomas. Lesões em dobras e pescoço, eritema, prurido e xerose foram os sinais/sintomas mais frequentes. As formas mais graves acompanharam-se por maior impacto no trabalho, autoestima e qualidade de vida. Setenta por cento procurou tratamento psicoterápico. Apesar de estarem em tratamento regular, um terço apresenta exacerbações da DA. Hidratantes e corticosteroides tópicos têm sido os mais utilizados. Em busca de cura, 90% abriria mão de objetos de desejo para iniciar tratamento de alto custo, desde que fosse eficaz. Conclusões: A DA compromete a qualidade de vida dos pacientes que buscam por soluções terapêuticas mais definitivas.


Introduction: Atopic dermatitis (AD) is a recurrent inflammatory skin disease that affects children and adults and compromises the quality of life of these patients. Objectives: To evaluate the impact of moderate-to-severe on social life and quality of life of adult patients with AD, as well as their expectations regarding new treatments. Methods: Two hundred adults aged 18 to 65 years with medical diagnosis of moderate-to-severe AD answered telephone-administered questions about their condition, impact on daily life and work, use of medication and expectations regarding new treatments. Results: In the study sample, most patients were female, their mean age was 37 years, and most of them had high level of education and belonged to upper social level (68%). The mean time to diagnosis was 15 months after the first symptoms. Lesions in folds and neck, erythema, pruritus and xerosis were the most common signs and symptoms. The most severe forms were related to greater impact on work, self-esteem and quality of life. Seventy percent sought psychotherapeutic treatment. Despite being under regular treatment, a third of patients had AD exacerbations. Moisturizers and topical corticosteroids were the most frequently used treatments. Ninety percent of respondents would forgo objects of desire to initiate a high-cost therapy as long as it was effective. Conclusions: AD compromises the quality of life of patients seeking more definitive therapeutic solutions.


Assuntos
Humanos , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Qualidade de Vida , Dermatite Atópica , Pacientes , Prurido , Autoimagem , Sinais e Sintomas , Terapêutica , Agentes Molhantes , Inquéritos e Questionários , Corticosteroides , Diagnóstico , Eritema
8.
Allergol Immunopathol (Madr) ; 48(3): 259-264, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31601506

RESUMO

The clinical history is of importance in the investigation of allergic diseases but does have limitations. Many allergic conditions will be over-diagnosed if anamnesis alone is used for diagnostic criteria. Serum total immunoglobulin E (TIgE) quantification, as well as panels containing allergens prevalent in the studied population, may serve as screening tests and facilitate the diagnosis of allergic disease or its exclusion. We assessed the positivity of two versions of these tests, Phadiatop Europe® (PhEU) and Phadiatop Infant® (PhInf), as well as total IgE (TigE) values in patients with a medical diagnosis of allergic disease and non-allergic individuals. METHODS: A cross-sectional study performed in eleven Brazilian pediatric allergy centers with patients divided into groups according to the primary condition and a group of assessed control subjects. They were submitted to TIgE measurement and screening tests (PhEu and PhInf). RESULTS: TIgE mean serum levels were significantly higher among allergic patients, especially those with asthma/rhinitis or atopic dermatitis. The positivity of the screening tests, considering the total population, was 63.8% for PhEU and 72.6% for PhInf. These increased when we evaluated only the allergic subjects. The concordance index of the two tests was Kappa=0.7 and higher among those of greater age. CONCLUSIONS: In the assessed population, there were significantly higher levels among those with positive screening tests and PhInf showed better performance in the identification of sensitized individuals, regardless of age. This is the first study to evaluate Phadiatop and Phadiatop Infant in the same population.


Assuntos
Fatores Etários , Hipersensibilidade/diagnóstico , Testes Cutâneos/métodos , Adolescente , Alérgenos/imunologia , Brasil/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Hipersensibilidade/epidemiologia , Imunoglobulina E/metabolismo , Lactente , Masculino , Prevalência
9.
Arq. Asma, Alerg. Imunol ; 3(2): 151-156, abr.jun.2019. ilus
Artigo em Português | LILACS | ID: biblio-1381188

RESUMO

Objetivos: Investigar o papel do patch test na avaliação da sensibilização por alimentos e no diagnóstico de alergia alimentar em pacientes com dermatite atópica (DA) e comparar duas distintas apresentações do teste. Métodos: Esse estudo prospectivo envolveu 20 crianças (mediana de idade de 8,4 anos) com dermatite atópica moderada ou grave que foram submetidas ao teste cutâneo de hipersensibilidade tardia (patch test ) com alimentos frescos e extratos comerciais, seguidos de teste de provocação oral (TPO) nos casos de resultado positivo, no intuito de avaliar a correlação clínica. Resultados: Entre os 20 pacientes avaliados, somente 4 (20%) apresentaram resultados positivos para o patch test, com maior positividade para os extratos comerciais (3/4), em comparação aos alimentos in natura. Não se observou concordância dos resultados obtidos entre as duas apresentações comparadas. Do total de 7 TPO realizados, 4 foram positivos (soja e milho para um paciente e amendoim para outros dois), com piora das lesões da DA (valor preditivo positivo de 57%). Apenas uma criança apresentou efeito adverso mais significativo. Conclusões: Embora tenha sido encontrada baixa sensibilização aos alérgenos alimentares na população estudada e discordância entre os resultados dos patch tests com alimentos frescos e extratos comerciais, o teste mostrou-se seguro. Para uma melhor análise estatística, recomenda-se estudo em população maior.


Objective: To evaluate the use of patch testing in determining food sensitization and allergy in patients with atopic dermatitis (AD) and compare two distinct assays. Method: Twenty children (median age, 8.4 years) with moderate-to-severe AD were prospectively evaluated by atopy patch test with commercial extracts and fresh food allergens. Positive results were further investigated by oral food challenge (OFC). Results: Only 4/20 patients (20%) had positive patch results, mostly to commercial extracts (3/4) compared to fresh food. There was no agreement between the results of the two presentations tested. Four of seven OFCs were positive (one patient to soy and corn, two others to peanut), with worsening AD eczema (positive predictive value of 57%). One child had a more significant side effect. Conclusion: In spite of poor sensitization rates in the study population and no observed correlation between the two presentations tested, atopy patch testing was safe. Studies with a broader population are needed for better conclusions.


Assuntos
Humanos , Pré-Escolar , Criança , Adolescente , Dermatite Atópica , Hipersensibilidade Alimentar , Papel , Testes do Emplastro , Alérgenos , Valor Preditivo dos Testes , Estudos Prospectivos , Diagnóstico , Eczema , Alimentos , Alimentos in natura , Métodos
11.
Arq. Asma, Alerg. Imunol ; 2(4): 399-404, out.dez.2018. ilus
Artigo em Português | LILACS | ID: biblio-1380985

RESUMO

Nas últimas décadas tem se observado aumento da prevalência das doenças alérgicas em todo o mundo. Embora a história clínica seja considerada de grande importância na suspeita de uma doença alérgica, resultados falso-positivos podem ser observados quando se utiliza apenas dados da anamnese. Com isso, indicadores mensuráveis utilizados para examinar quaisquer aspectos da doença tornam-se essenciais. A dosagem de imunoglobulina E total (TIgE), assim como painéis que contemplam alérgenos de maior prevalência na população estudada, podem funcionar como testes de triagem e facilitar o futuro diagnóstico de uma doença alérgica, ou na exclusão deste. Nesta revisão, são abordados os diferentes testes de triagem para doenças alérgicas (PhadiatopEuropa®, PhadiatopInfant ®, PhadiatopUSA®) na avaliação de crianças e adolescentes com história médica de alergia. Os testes de triagem não diagnosticam doenças alérgicas. Uma vez positivo, o encaminhamento ao especialista deve ser realizado.


In recent decades, the prevalence of allergic diseases has increased worldwide. Although medical history is considered of great importance in the suspicion of an allergic disease, false-positive results may be observed when anamnesis data are used alone. Thus, measurable indicators used to examine any aspects of a disease have become essential. Total immunoglobulin E (TIgE) measurement as well as panels containing allergens prevalent in the population under study may serve as screening tests and facilitate later diagnosis of an allergic disease. This review addresses the use of different screening tests for allergic diseases (PhadiatopEurope®, PhadiatopInfant®, and PhadiatopUSA®) in the evaluation of children and adolescents with medical history of allergy. Screening tests do not diagnose allergic diseases. If positive, the patient should be referred to a specialist.


Assuntos
Humanos , Imunoglobulina E , Alérgenos , Testes Laboratoriais , Hipersensibilidade , Pacientes , Diagnóstico , Anamnese
12.
Arq. Asma, Alerg. Imunol ; 2(2): 209-224, abr.jun.2018. ilus
Artigo em Português | LILACS | ID: biblio-1380826

RESUMO

Urticária é uma doença pruriginosa da pele na qual ocorrem urticas e/ou angioedema. A urticária é definida como crônica quando persiste por 6 semanas ou mais. A urticária crônica tem um grande impacto na vida diária do paciente. Atualmente, não há biomarcadores confiáveis para identificar e medir a atividade da doença na urticária crônica espontânea. Consequentemente, o uso de ferramentas conhecidas por patient-reported outcomes (PROs) é crucial ao avaliar e monitorar diferentes aspectos da urticária crônica, como atividade/gravidade da doença, controle da doença e qualidade de vida. Apresentamos uma visão geral de cinco PROs usados na avaliação da urticária crônica, e destacamos suas vantagens, limitações e uso na prática clínica e pesquisa.


Urticaria is an itching skin disease characterized by the presence of wheals and/or angioedema. Urticaria is defined as chronic when it persists for 6 weeks or more. Chronic urticaria has great impact on the daily lives of patients. Currently, there are no reliable biomarkers to identify and measure disease activity in chronic spontaneous urticaria. Consequently, the use of tools known as patient-reported outcomes (PROs) is crucial when evaluating and monitoring different aspects of chronic urticaria such as disease activity/severity, disease control, and quality of life. We present an overview of the five PROs used in the evaluation of chronic urticaria, highlighting their advantages, limitations, and use in clinical practice and research.


Assuntos
Humanos , Qualidade de Vida , Medidas de Resultados Relatados pelo Paciente , Urticária Crônica , Angioedema , Pacientes , Prurido , Pesquisa
14.
Rev Paul Pediatr ; 35(1): 39-45, 2017.
Artigo em Português, Inglês | MEDLINE | ID: mdl-28977315

RESUMO

OBJECTIVE: To analyze the relationship between habits and attitudes of mothers and the types of milk offered to their children in their first two years of life. METHODS: Retrospective study including 773 interviews of mothers from 11 Brazilian cities with children under 2 years of age. Interviews were conducted in 11 cities of Brazil. The following factors were analyzed: breastfeeding method planned during pregnancy and the method actually applied after birth; type(s) of milk(s) used on the day of the interview and earlier; age at which the child was introduced to whole milk; and source of advice used to choose a certain type of milk. RESULTS: Breast milk was offered to 81.7% of infants during their first six months of life, to 52.2% of infants during their second semester (p<0.001) and to 32.9% of infants during their second year of life (p<0.001). In contrast, cow's milk consumption increased from 31.1 to 83.8% (p<0.001) and 98.7% (p=0.05), respectively, for these three age groups. Infant (15.0%) and follow-on (also known as toddler's) (2.3%) formulas were used by a much smaller number of infants than whole cow's milk. Most mothers were not prescribed whole cow's milk. Pediatricians were the health care professionals who most often recommended infant formulas. CONCLUSIONS: Rates of breastfeeding in Brazil remain below recommended levels. Brazilian mothers often decide to feed their infants with whole cow's milk on their own initiative. The use of infant formulas after weaning is still too low.


OBJETIVO: Analisar a relação entre hábitos e atitudes de mães com os tipos de leite oferecidos para seus filhos nos dois primeiros anos de vida. MÉTODOS: Estudo retrospectivo incluindo 773 entrevistas de mães de 11 cidades brasileiras com filhos com até 2 anos de idade. Foram analisadas as seguintes informações: tipo de aleitamento que planejava enquanto estava na gestação e o efetivamente realizado após o nascimento; tipo(s) de leite(s) utilizado(s) no dia da entrevista e anteriormente; idade de introdução do leite de vaca integral; e origem das recomendações para usar determinado tipo de leite. RESULTADOS: O leite materno era oferecido para 81,7% dos lactentes no primeiro semestre de vida, 52,2% no segundo semestre (p<0,001) e 32,9% no segundo ano de vida (p<0,001). Por sua vez, o consumo de leite de vaca integral aumentou de 31,1 para 83,8% (p<0,001) e 98,7% (p=0,05), respectivamente, nestas três faixas etárias. Fórmula de partida (15,0%) e de seguimento (2,3%) eram utilizadas por um número de lactentes muito menor em relação aos que recebiam leite de vaca integral. A maioria das mães não recebeu prescrição de leite de vaca integral. Os pediatras foram os profissionais da área da saúde que mais frequentemente recomendaram fórmula infantil. CONCLUSÃO: As taxas de aleitamento natural no Brasil continuam abaixo das recomendações. As mães brasileiras, com frequência, decidem oferecer leite de vaca integral por iniciativa própria. É muito baixa a utilização de fórmula infantil quando o aleitamento natural é interrompido.


Assuntos
Aleitamento Materno/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Fórmulas Infantis/estatística & dados numéricos , Mães/psicologia , Adulto , Brasil , Comportamento Alimentar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , População Urbana , Adulto Jovem
15.
Rev. paul. pediatr ; 35(1): 39-45, jan.-mar. 2017. tab
Artigo em Português | LILACS | ID: biblio-845727

RESUMO

RESUMO Objetivo: Analisar a relação entre hábitos e atitudes de mães com os tipos de leite oferecidos para seus filhos nos dois primeiros anos de vida. Métodos: Estudo retrospectivo incluindo 773 entrevistas de mães de 11 cidades brasileiras com filhos com até 2 anos de idade. Foram analisadas as seguintes informações: tipo de aleitamento que planejava enquanto estava na gestação e o efetivamente realizado após o nascimento; tipo(s) de leite(s) utilizado(s) no dia da entrevista e anteriormente; idade de introdução do leite de vaca integral; e origem das recomendações para usar determinado tipo de leite. Resultados: O leite materno era oferecido para 81,7% dos lactentes no primeiro semestre de vida, 52,2% no segundo semestre (p<0,001) e 32,9% no segundo ano de vida (p<0,001). Por sua vez, o consumo de leite de vaca integral aumentou de 31,1 para 83,8% (p<0,001) e 98,7% (p=0,05), respectivamente, nestas três faixas etárias. Fórmula de partida (15,0%) e de seguimento (2,3%) eram utilizadas por um número de lactentes muito menor em relação aos que recebiam leite de vaca integral. A maioria das mães não recebeu prescrição de leite de vaca integral. Os pediatras foram os profissionais da área da saúde que mais frequentemente recomendaram fórmula infantil. Conclusão: As taxas de aleitamento natural no Brasil continuam abaixo das recomendações. As mães brasileiras, com frequência, decidem oferecer leite de vaca integral por iniciativa própria. É muito baixa a utilização de fórmula infantil quando o aleitamento natural é interrompido.


ABSTRACT Objective: To analyze the relationship between habits and attitudes of mothers and the types of milk offered to their children in their first two years of life. Methods: Retrospective study including 773 interviews of mothers from 11 Brazilian cities with children under 2 years of age. Interviews were conducted in 11 cities of Brazil. The following factors were analyzed: breastfeeding method planned during pregnancy and the method actually applied after birth; type(s) of milk(s) used on the day of the interview and earlier; age at which the child was introduced to whole milk; and source of advice used to choose a certain type of milk. Results: Breast milk was offered to 81.7% of infants during their first six months of life, to 52.2% of infants during their second semester (p<0.001) and to 32.9% of infants during their second year of life (p<0.001). In contrast, cow’s milk consumption increased from 31.1 to 83.8% (p<0.001) and 98.7% (p=0.05), respectively, for these three age groups. Infant (15.0%) and follow-on (also known as toddler’s) (2.3%) formulas were used by a much smaller number of infants than whole cow’s milk. Most mothers were not prescribed whole cow’s milk. Pediatricians were the health care professionals who most often recommended infant formulas. Conclusions: Rates of breastfeeding in Brazil remain below recommended levels. Brazilian mothers often decide to feed their infants with whole cow’s milk on their own initiative. The use of infant formulas after weaning is still too low.


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Adulto , Adulto Jovem , Aleitamento Materno/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Fórmulas Infantis/estatística & dados numéricos , Mães/psicologia , População Urbana , Brasil , Estudos Retrospectivos , Comportamento Alimentar
16.
Rev. paul. pediatr ; 34(2): 184-188, Apr.-June 2016. tab, graf
Artigo em Inglês | LILACS | ID: lil-784339

RESUMO

Objective: To describe the frequency and etiology of rhinitis, oral breathing, types of malocclusion and orofacial disorders in patients treated for dental malocclusion. Methods: Patients with poor dental occlusion (n=89, 8-15 years) undergoing orthodontic treatment at the Postgraduate Orthodontics Center (São Paulo, Brazil) participated in the study. Rhinitis and oral breathing were diagnosed by anamnesis, clinical assessment and allergic etiology of rhinitis through immediate hypersensitivity skin prick test with airborne allergens. The association between types of breathing (oral or nasal), rhinitis and types of dental malocclusion, bruxism and cephalometric alterations (increased Y axis of facial growth) compared to standard cephalometric tracing (Escola de Odontologia da Universidade de São Paulo) were assessed. Results: The frequency of rhinitis in patients with dental malocclusion was 76.4% (68), and, of these, 81.7% were allergic (49/60 positive skin prick test), whereas the frequency of oral breathing was 62.9%. There was a significant association between an increased Y axis of facial growth and oral breathing (p<0.001), as well as between oral breathing and rhinitis (p=0.009). There was no association between rhinitis and bruxism. Conclusions: The frequency of rhinitis in children with dental malocclusion is higher than that in the general population, which is approximately 30%. Patients with oral breathing have a tendency to a dolichofacial growth pattern (increased Y axis of facial growth). In patients with rhinitis, regardless of the presence of oral breathing, the dolichofacial growth tendency was not observed.


Objetivo: Descrever a frequência e etiologia da rinite, da respiração oral, os tipos de má oclusão e as alterações orofaciais em pacientes tratados por má oclusão dentária. Métodos: Pacientes com má oclusão dentária (n=89, oito a 15 anos) em tratamento ortodôntico em centro de pós-graduação em ortodontia (São Paulo, Brasil) participaram do estudo. Rinite e respiração oral foram diagnosticadas por anamnese e exame clínico e a etiologia alérgica dessa por teste cutâneo de hipersensibilidade imediata (TCHI) com aeroalérgenos. Avaliou-se a relação entre tipos de respiração (oral ou nasal), rinite e tipos de má oclusão dentária, bruxismo e alterações cefalométricas (aumento do eixo Y de crescimento facial) em comparação com o traçado cefalométrico padrão (Escola de Odontologia da Universidade de São Paulo). Resultados: A frequência de rinite nos pacientes com má oclusão dentária foi de 76,4% (68), desses 81,7% eram alérgicos (49/60 TCHI positivo) e a frequência de respiração oral foi de 62,9%. Houve associação significativa entre ter o eixo Y de crescimento facial aumentado e respiração oral (p<0,001), o mesmo entre respiração oral e rinite (p=0,009). Não houve associação entre rinite e bruxismo. Conclusões: A frequência de rinite em crianças com má oclusão dentária é superior à da população geral, que gira ao redor de 30%. Os pacientes com respiração oral têm tendência de crescimento dólico facial (eixo Y de crescimento aumentado). Nos pacientes com rinite, independentemente da presença da respiração oral, a tendência dólico facial não foi observada.


Assuntos
Humanos , Criança , Adolescente , Cefalometria , Má Oclusão/complicações , Respiração Bucal/complicações , Rinite/epidemiologia , Rinite/etiologia , Bruxismo
17.
Rev Paul Pediatr ; 34(2): 184-8, 2016 Jun.
Artigo em Português | MEDLINE | ID: mdl-26631324

RESUMO

OBJECTIVE: To describe the frequency and etiology of rhinitis, oral breathing, types of malocclusion and orofacial disorders in patients treated for dental malocclusion. METHODS: Patients with poor dental occlusion (n=89, 8-15 years) undergoing orthodontic treatment at the Postgraduate Orthodontics Center (Sao Paulo, Brazil) participated in the study. Rhinitis and oral breathing were diagnosed by anamnesis, clinical assessment and allergic etiology of rhinitis through immediate hypersensitivity skin prick test (SPT) with airborne allergens. The association between types of breathing (oral or nasal), rhinitis and types of dental malocclusion, bruxism and cephalometric alterations (increased Y axis of facial growth) compared to standard cephalometric tracing (Escola de Odontologia da Universidade de São Paulo) were assessed. RESULTS: The frequency of rhinitis in patients with dental malocclusion was 76.4% (68), and, of these, 81.7% were allergic (49/60 positive skin prick test), whereas the frequency of oral breathing was 62.9%. There was a significant association between an increased Y axis of facial growth and oral breathing (p<0.001), as well as between oral breathing and rhinitis (p=0.009). There was no association between rhinitis and bruxism. CONCLUSIONS: The frequency of rhinitis in children with dental malocclusion is higher than that in the general population, which is approximately 30%. Patients with oral breathing have a tendency to a dolichofacial growth pattern (increased Y axis of facial growth). In patients with rhinitis, regardless of the presence of oral breathing, the dolichofacial growth tendency was not observed.


Assuntos
Má Oclusão/complicações , Respiração Bucal/epidemiologia , Respiração Bucal/etiologia , Rinite/epidemiologia , Rinite/etiologia , Adolescente , Criança , Ossos Faciais/anormalidades , Humanos
18.
Trials ; 16: 346, 2015 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-26268930

RESUMO

BACKGROUND: Individuals with chronic lung disease are more susceptible to present reduction in exercise tolerance and muscles strength not only due to pulmonary limitations but also due systemic repercussions of the pulmonary disease. The aim of this study is to assess the physical capacity, peripheral muscle function, physical activity in daily life, and the inflammatory markers in children and adolescents with asthma after pulmonary rehabilitation program. METHOD: This is a study protocol of randomized controlled trial in asthmatic patients between 6 to 18 years old. The assessments will be conducted in three different days and will be performed at the beginning and at the end of the protocol. First visit: quality of life questionnaire, asthma control questionnaire, pre- and post-bronchodilator spirometry (400 µcg salbutamol), inflammatory assessment (blood collection), and cardiopulmonary exercise test on a cycle ergometer to determine aerobic capacity. Second visit: assessment of strength and endurance of the quadriceps femoris and biceps brachii muscles with concomitant electromyography to assess peripheral muscle strength. Third visit: incremental shuttle walk test (ISWT) and accelerometer to evaluate functional capacity and physical activity in daily life during 7 days. Then, the volunteers will be randomized to receive pulmonary rehabilitation program (intervention group) or chest physiotherapy + stretching exercises (control group). Both groups will have a supervised session, twice a week, each session will have 60 minutes duration, with minimum interval of 24 hours, for a period of 8 weeks. Intervention group: aerobic training (35 minutes) intensity between 60 to 80 % of the maximum workload of cardiopulmonary exercise testing or of ISWT; strength muscle training will be applied to the quadriceps femoris, biceps brachii and deltoid muscles (intensity: 40 to 70 % of maximal repetition, 3 x 8 repetition); finally the oral high-frequency oscillation device (Flutter®) will be used for 5 minutes. The control group: oral high-frequency oscillation device (Flutter®) for 10 minutes followed by the stretching of upper and lower limbs for 40 minutes. It is expected to observe the improvement in aerobic capacity, physical activity in daily life, muscle strength and quality of life of patients in the intervention group, and reduction in inflammatory markers. CLINICAL TRIAL NUMBER: NCT02383069. Data of registration: 03/03/2015.


Assuntos
Asma/reabilitação , Tolerância ao Exercício , Mediadores da Inflamação/sangue , Pulmão/fisiopatologia , Força Muscular , Músculo Quadríceps/fisiopatologia , Atividades Cotidianas , Adolescente , Fatores Etários , Asma/sangue , Asma/diagnóstico , Asma/fisiopatologia , Biomarcadores/sangue , Brasil , Criança , Protocolos Clínicos , Eletromiografia , Teste de Esforço , Feminino , Humanos , Masculino , Qualidade de Vida , Recuperação de Função Fisiológica , Projetos de Pesquisa , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento , Caminhada
19.
Rev Paul Pediatr ; 32(1): 114-25, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24676199

RESUMO

OBJECTIVE: To assess asthma among Brazilian pediatric population applying the International Study of Asthma and Allergies in Childhood (ISAAC), an internationally standardized and validated protocol. DATA SOURCES: ISAAC was conceived to maximize the value of epidemiologic studies on asthma and allergic diseases, establishing a standardized method (self-applicable written questionnaire and/or video questionnaire) capable to facilitate the international collaboration. Designed to be carried out in three successive and dependent phases, the ISAAC gathered a casuistic hitherto unimaginable in the world and in Brazil. This review included data gathered from ISAAC official Brazilian centers and others who used this method. DATA SYNTHESIS: At the end of the first phase, it has been documented that the prevalence of asthma among Brazilian schoolchildren was the eighth among all centers participating all over the world. Few centers participated in the second phase and investigated possible etiological factors, especially those suggested by the first phase, and brought forth many conjectures. The third phase, repeated seven years later, assessed the evolutionary trend of asthma and allergic diseases prevalence in centers that participated simultaneously in phases I and III and in other centers not involved in phase I. CONCLUSIONS: In Brazil, the ISAAC study showed that asthma is a disease of high prevalence and impact in children and adolescents and should be seen as a Public Health problem. Important regional variations, not well understood yet, and several risk factors were found, which makes us wonder: is there only one or many asthmas in Brazil?


Assuntos
Asma/epidemiologia , Adolescente , Brasil , Criança , Humanos , Internacionalidade , Prevalência , Inquéritos e Questionários
20.
Rev. paul. pediatr ; 32(1): 114-125, Jan-Mar/2014. tab
Artigo em Inglês | LILACS | ID: lil-704761

RESUMO

Objective: To assess asthma among Brazilian pediatric population applying the International Study of Asthma and Allergies in Childhood (ISAAC), an internationally standardized and validated protocol. Data sources: ISAAC was conceived to maximize the value of epidemiologic studies on asthma and allergic diseases, establishing a standardized method (self-applicable written questionnaire and/or video questionnaire) capable to facilitate the international collaboration. Designed to be carried out in three successive and dependent phases, the ISAAC gathered a casuistic hitherto unimaginable in the world and in Brazil. This review included data gathered from ISAAC official Brazilian centers and others who used this method. Data synthesis: At the end of the first phase, it has been documented that the prevalence of asthma among Brazilian schoolchildren was the eighth among all centers participating all over the world. Few centers participated in the second phase and investigated possible etiological factors, especially those suggested by the first phase, and brought forth many conjectures. The third phase, repeated seven years later, assessed the evolutionary trend of asthma and allergic diseases prevalence in centers that participated simultaneously in phases I and III and in other centers not involved in phase I. Conclusions: In Brazil, the ISAAC study showed that asthma is a disease of high prevalence and impact in children and adolescents and should be seen as a Public Health problem. Important regional variations, not well understood yet, and several risk factors were found, which makes us wonder: is there only one or many asthmas in Brazil? .


Objetivo: Evaluar el asma en la población pediátrica brasileña por el protocolo del International Study of Asthma and Allergies in Childhood (ISAAC), internacionalmente estandarizado y validado. Fuentes de datos : El ISAAC, idealizado para maximizar el valor de estudios epidemiológicos en asma y enfermedades alérgicas, estableció un método estandarizado (cuestionario escrito autoaplicable y/o video-cuestionario) capaz de facilitar la colaboración internacional. Concebido para realizarse en tres etapas sucesivas y dependientes, el ISAAC reunió una casuística hasta entonces inimaginable en el mundo y en Brasil. En esta visión, se reunieron los datos de centros brasileños oficiales del ISAAC y de otros que emplean su método. Síntesis de los datos: Finalizada la primera etapa, la prevalencia de asma entre escolares brasileños fue documentada como la octava en magnitud entre todos los centros participantes del estudio. Los pocos centros involucrados en la segunda etapa investigaron posibles factores etiológicos, especialmente aquellos sugeridos por los resultados de la primera etapa, y generaron muchas especulaciones. La tercera etapa, repetida tras siete años, evaluó la tendencia evolutiva de la prevalencia de asma y de las enfermedades alérgicas en los centros participantes simultáneamente en las etapas I y III y determinó la prevalencia en otros no involucrados en la etapa I. Conclusiones: En Brasil, el ISAAC demostró, de modo definitivo, que el asma es una enfermedad de alta prevalencia e impacto en niños y adolescentes, debiendo ser encarada como problema de Salud Pública. Se encontraron importantes variaciones regionales, todavía no bien aclaradas, así como diversos factores de riesgo, lo que nos hace cuestionar: ¿hay en Brasil una o muchas asmas? .


Objetivo: Avaliar a asma na população pediátrica brasileira pelo protocolo do International Study of Asthma and Allergies in Childhood (ISAAC), internacionalmente padronizado e validado. Fontes de dados: O ISAAC, idealizado para maximizar o valor de estudos epidemiológicos em asma e doenças alérgicas, estabeleceu um método padronizado (questionário escrito autoaplicável e/ou vídeo-questionário) capaz de facilitar a colaboração internacional. Concebido para ser realizado em três fases sucessivas e dependentes, o ISAAC reuniu uma casuística até então inimaginável no mundo e no Brasil. Nesta revisão, reuniram-se os dados de centros brasileiros oficiais do ISAAC e de outros que empregaram o seu método. Síntese dos dados: Finalizada a primeira fase, a prevalência de asma entre escolares brasileiros foi documentada como a oitava em magnitude entre todos os centros participantes do estudo. Os poucos centros envolvidos na segunda fase investigaram possíveis fatores etiológicos, especialmente aqueles sugeridos pelos resultados da primeira fase, e geraram muitas especulações. A terceira fase, repetida após sete anos, avaliou a tendência evolutiva da prevalência de asma e das doenças alérgicas nos centros participantes simultaneamente das fases I e III e determinou a prevalência em outros não envolvidos na fase I. Conclusões: No Brasil, o ISAAC demonstrou, de forma definitiva, que a asma é uma doença de alta prevalência e impacto em crianças e adolescentes, devendo ser encarada como problema de Saúde Pública. Encontraram-se importantes variações regionais, ainda não bem esclarecidas, assim como diversos fatores de risco, o que traz a questão: há no Brasil uma ou muitas asmas? .


Assuntos
Adolescente , Criança , Humanos , Asma/epidemiologia , Brasil , Internacionalidade , Prevalência , Inquéritos e Questionários
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