Home management of INR in the public health system: feasibility of self-management of oral anticoagulation and long-term performance of individual POC devices in determining INR.

The home prothrombin time/international normalized ratio (PT/INR) self-management could be convenient for patients, enhancing treatment compliance and improving the quality of the oral anticoagulation. However, patient self-management (PSM) of oral anticoagulation may not be feasible for up to half of the patients due to cognitive or educational issues. In the present study, we aimed to evaluate the feasibility of a PSM program in a public health medical center that provides care for low-income patients. We also aimed to determine the accuracy of individual point-of-care devices (CoaguChek XS(®)) during long-term of home manipulation. Patients' time-in-therapeutic range (TTR) and perception of quality of life, were evaluated at scheduled study-visits to the center. Additionally, the accuracy of individual CoaguChek XS(®) was evaluated in comparison to the standard automated coagulometer at scheduled study-visits to the center. Twenty-five patients were included in the PSM program. The median TTR of patients was 75 % before inclusion, 72 % at 3 months, 75 % at 6 months and 100 % at 12 months after the beginning of self-management (P = 0.14).The median DASS scores were 64, 63, 61.5 and 71.5 before inclusion and at 3, 6 and 12 months, respectively (P = 0.09). One hundred paired INR values were obtained. Correlation between INR values delivered by individual CoaguChek XS(®) and the automated coagulometer was 94 % and the mean result bias was 0.07 INR units. The coefficient of correlation and the mean bias between methods was stable during 24 months of follow-up. The present study suggests that PSM is feasible for patients treated in the public health system and that the results delivered by CoaguChek XS(®) have long-term reliability.

Nutritional interventions in children and adolescents with cerebral palsy: systematic review.

OBJECTIVE: To systematically review the literature in search of the most suitable and effective nutritional interventions and indications for the nutritional treatment of children and adolescents with cerebral palsy (CP). DATA SOURCE: This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The articles were selected from seven databases (Cochrane, Literatura Latino-Americana e do Caribe em Ciências da Saúde - Lilacs, Embase, United States National Library of Medicine - PubMed, Scientific Electronic Library Online - SciELO, Scopus, and Web of Science). Studies from a pediatric group (0 to 18 years old) diagnosed with CP were included and the search strategy included the descriptors: "children" OR "childhood" AND "nutritional therapy" OR "nutritional intervention" OR "nutrition" OR "nutritional support" OR "diet" AND "cerebral palsy" OR "cerebral injury". Methodological quality was assessed using the checklist for cross-sectional analytical studies, the Newcastle-Ottawa scale or the Cochrane Collaboration tool for clinical trials. DATA SYNTHESIS: Fifteen studies (n=658) published from 1990 to 2020 met the inclusion criteria. All of them had a low risk of bias. The data showed that children and adolescents with CP have worse nutritional status than those normally developed. Those who received hypercaloric and hyperprotein nutritional supplementation benefited from its use. Studies indicate that enteral nutrition should be considered when nutritional needs are not met by the oral diet, especially in cases where oral motor functions are impaired. In addition, there was a direct relationship between the consistency of food, the level of motor function and nutritional status. CONCLUSIONS: Children and adolescents with CP have a greater risk of malnutrition. The use of nutritional supplementation may help with weight gain. In addition, enteral nutrition and modification of food texture have been used to improve the nutritional status of this group.

[Lifestyle of adolescent students from public and private schools in Recife: ERICA]. / Estilo de vida de adolescentes estudantes de escolas públicas e privadas em Recife: ERICA.

This study analyzes the behavior patterns related to the lifestyle of adolescents in Recife, Brazil. A cross-sectional study was conducted with data from the Cardiovascular Risk Study among Adolescents (ERICA) and 2400 students aged 12 to 17 were interviewed. The prevalence of physical activity, eating behavior, smoking and alcohol consumption were analyzed. The Chi-square test and 95% confidence interval (95%CI) were used to evaluate the statistical significance of the measurements. It was observed that 60% of the adolescents presented inadequate eating behaviors regarding the consumption of breakfast, daily water intake and meals eaten in front of the TV. About 40% (95%CI: 39.7-45) did not sit down to meals with their parents or guardians. The prevalence of physical inactivity was 52.4% (95%CI: 50-55). Female adolescents were more inactive (68.7%, 95%CI: 65-72) than males (36.4%, 95%CI: 33-40). Teenagers of economic classes D and E were the most inactive (60.7%, 95%CI: 46-73). Alcohol consumption was 18.7% (95%CI: 2.6-5.6) and smoking was prevalent in 3.8% (95%CI: 2-6) of the individuals. Inadequate eating behaviors and physical inactivity were the main areas responsible for an unhealthy lifestyle, followed by alcohol consumption and smoking.

Este estudo analisa os comportamentos relacionados ao estilo de vida de adolescentes em Recife, Brasil. Estudo transversal com dados do Estudo de Riscos Cardiovasculares em Adolescentes (ERICA). 2.400 estudantes de 12 a 17 anos foram entrevistados. Foram analisadas as prevalências de atividade física, comportamento alimentar, tabagismo e consumo de álcool. O teste Qui-quadrado e Intervalo de confiança 95% (IC95%) foram usados para avaliar a significância estatística das medidas. Observou-se 60% dos adolescentes com comportamentos alimentares inadequados quanto ao consumo de café da manhã, água/dia e refeições em frente à TV. Cerca de 40% (IC95%: 39,7-45) não realizavam refeições com os pais ou responsáveis. A prevalência de inatividade física foi de 52,4% (IC95%: 50-55). Adolescentes do sexo feminino foram mais inativas (68,7%; IC95%: 65-72) em relação aos meninos (36,4%; IC95%: 33-40). Adolescentes das classes econômicas D e E foram os mais inativos (60,7%; IC95%: 46-73). O consumo de bebida alcoólica foi de 18,7% (IC95%: 2,6-5,6) e o tabagismo foi de 3,8% (IC95%: 2-6) dos indivíduos. Comportamentos alimentares inadequados e a inatividade física foram os principais domínios responsáveis por um estilo de vida não saudável, seguidos pelo consumo de álcool e tabagismo.

Nutritional interventions in children and adolescents with cerebral palsy: systematic review / Intervenções nutricionais em crianças e adolescentes com paralisia cerebral: revisão sistemática

ABSTRACT Objective: To systematically review the literature in search of the most suitable and effective nutritional interventions and indications for the nutritional treatment of children and adolescents with cerebral palsy (CP). Data source: This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The articles were selected from seven databases (Cochrane, Literatura Latino-Americana e do Caribe em Ciências da Saúde — Lilacs, Embase, United States National Library of Medicine — PubMed, Scientific Electronic Library Online — SciELO, Scopus, and Web of Science). Studies from a pediatric group (0 to 18 years old) diagnosed with CP were included and the search strategy included the descriptors: "children" OR "childhood" AND "nutritional therapy" OR "nutritional intervention" OR "nutrition" OR "nutritional support" OR "diet" AND "cerebral palsy" OR "cerebral injury". Methodological quality was assessed using the checklist for cross-sectional analytical studies, the Newcastle-Ottawa scale or the Cochrane Collaboration tool for clinical trials. Data synthesis: Fifteen studies (n=658) published from 1990 to 2020 met the inclusion criteria. All of them had a low risk of bias. The data showed that children and adolescents with CP have worse nutritional status than those normally developed. Those who received hypercaloric and hyperprotein nutritional supplementation benefited from its use. Studies indicate that enteral nutrition should be considered when nutritional needs are not met by the oral diet, especially in cases where oral motor functions are impaired. In addition, there was a direct relationship between the consistency of food, the level of motor function and nutritional status. Conclusions: Children and adolescents with CP have a greater risk of malnutrition. The use of nutritional supplementation may help with weight gain. In addition, enteral nutrition and modification of food texture have been used to improve the nutritional status of this group.

RESUMO Objetivo: Revisar sistematicamente a literatura em busca das intervenções e indicações nutricionais mais adequadas e eficazes para o tratamento nutricional de crianças e adolescentes com paralisia cerebral (PC). Fontes de dados: Esta revisão foi conduzida de acordo com as diretrizes Preferred Reporting Items for Systematic Reviews and Meta-Analyses — PRISMA. Os artigos foram selecionados em sete bases de dados (Cochrane, Literatura Latino-Americana e do Caribe em Ciências da Saúde — Lilacs, Embase, United States National Library of Medicine — PubMed, Scientific Electronic Library Online — SciELO, Scopus, and Web of Science). Foram incluídos estudos de um grupo pediátrico (zero a 18 anos) com diagnóstico de PC e a estratégia de busca incluiu os descritores: "children" OR "childhood" AND "nutritional therapy" OR "nutritional intervention" OR "nutrition" OR "nutritional support" OR "diet" AND "cerebral palsy" OR "cerebral injury". A qualidade metodológica foi avaliada utilizando a lista de verificação para estudos transversais analíticos, escala Newcastle-Ottawa ou ferramenta da Cochrane Collaboration, para ensaios clínicos. Síntese dos dados: Quinze estudos (n=658) publicados de 1990 a 2020 preencheram os critérios de inclusão. Todos tiveram baixo risco de viés. Os dados mostraram que crianças e adolescentes com PC apresentam pior estado nutricional do que os normalmente desenvolvidos. Aqueles que receberam suplementação nutricional hipercalórica e hiperproteica beneficiaram-se de seu uso. Estudos demonstram que a nutrição enteral deve ser considerada quando as necessidades nutricionais não são supridas pela dieta oral, principalmente nos casos em que as funções oromotoras estão prejudicadas. Além disso, houve relação direta entre a consistência dos alimentos, o nível de função motora e o estado nutricional. Conclusões: Crianças e adolescentes com PC têm maior risco de desnutrição. O uso de suplementação nutricional pode auxiliar no ganho de peso desses pacientes. Além disso, a nutrição enteral e a modificação da textura dos alimentos têm sido artifícios utilizados para a melhora do estado nutricional neste grupo.

Nutritional interventions in children and adolescents with cerebral palsy: systematic review / Intervenções nutricionais em crianças e adolescentes com paralisia cerebral: revisão sistemática

ABSTRACT Objective: To systematically review the literature in search of the most suitable and effective nutritional interventions and indications for the nutritional treatment of children and adolescents with cerebral palsy (CP). Data source: This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The articles were selected from seven databases (Cochrane, Literatura Latino-Americana e do Caribe em Ciências da Saúde — Lilacs, Embase, United States National Library of Medicine — PubMed, Scientific Electronic Library Online — SciELO, Scopus, and Web of Science). Studies from a pediatric group (0 to 18 years old) diagnosed with CP were included and the search strategy included the descriptors: "children" OR "childhood" AND "nutritional therapy" OR "nutritional intervention" OR "nutrition" OR "nutritional support" OR "diet" AND "cerebral palsy" OR "cerebral injury". Methodological quality was assessed using the checklist for cross-sectional analytical studies, the Newcastle-Ottawa scale or the Cochrane Collaboration tool for clinical trials. Data synthesis: Fifteen studies (n=658) published from 1990 to 2020 met the inclusion criteria. All of them had a low risk of bias. The data showed that children and adolescents with CP have worse nutritional status than those normally developed. Those who received hypercaloric and hyperprotein nutritional supplementation benefited from its use. Studies indicate that enteral nutrition should be considered when nutritional needs are not met by the oral diet, especially in cases where oral motor functions are impaired. In addition, there was a direct relationship between the consistency of food, the level of motor function and nutritional status. Conclusions: Children and adolescents with CP have a greater risk of malnutrition. The use of nutritional supplementation may help with weight gain. In addition, enteral nutrition and modification of food texture have been used to improve the nutritional status of this group.

RESUMO Objetivo: Revisar sistematicamente a literatura em busca das intervenções e indicações nutricionais mais adequadas e eficazes para o tratamento nutricional de crianças e adolescentes com paralisia cerebral (PC). Fontes de dados: Esta revisão foi conduzida de acordo com as diretrizes Preferred Reporting Items for Systematic Reviews and Meta-Analyses — PRISMA. Os artigos foram selecionados em sete bases de dados (Cochrane, Literatura Latino-Americana e do Caribe em Ciências da Saúde — Lilacs, Embase, United States National Library of Medicine — PubMed, Scientific Electronic Library Online — SciELO, Scopus, and Web of Science). Foram incluídos estudos de um grupo pediátrico (zero a 18 anos) com diagnóstico de PC e a estratégia de busca incluiu os descritores: "children" OR "childhood" AND "nutritional therapy" OR "nutritional intervention" OR "nutrition" OR "nutritional support" OR "diet" AND "cerebral palsy" OR "cerebral injury". A qualidade metodológica foi avaliada utilizando a lista de verificação para estudos transversais analíticos, escala Newcastle-Ottawa ou ferramenta da Cochrane Collaboration, para ensaios clínicos. Síntese dos dados: Quinze estudos (n=658) publicados de 1990 a 2020 preencheram os critérios de inclusão. Todos tiveram baixo risco de viés. Os dados mostraram que crianças e adolescentes com PC apresentam pior estado nutricional do que os normalmente desenvolvidos. Aqueles que receberam suplementação nutricional hipercalórica e hiperproteica beneficiaram-se de seu uso. Estudos demonstram que a nutrição enteral deve ser considerada quando as necessidades nutricionais não são supridas pela dieta oral, principalmente nos casos em que as funções oromotoras estão prejudicadas. Além disso, houve relação direta entre a consistência dos alimentos, o nível de função motora e o estado nutricional. Conclusões: Crianças e adolescentes com PC têm maior risco de desnutrição. O uso de suplementação nutricional pode auxiliar no ganho de peso desses pacientes. Além disso, a nutrição enteral e a modificação da textura dos alimentos têm sido artifícios utilizados para a melhora do estado nutricional neste grupo.

Estilo de vida de adolescentes estudantes de escolas públicas e privadas em Recife: ERICA / Lifestyle of adolescent students from public and private schools in Recife: ERICA

Resumo Este estudo analisa os comportamentos relacionados ao estilo de vida de adolescentes em Recife, Brasil. Estudo transversal com dados do Estudo de Riscos Cardiovasculares em Adolescentes (ERICA). 2.400 estudantes de 12 a 17 anos foram entrevistados. Foram analisadas as prevalências de atividade física, comportamento alimentar, tabagismo e consumo de álcool. O teste Qui-quadrado e Intervalo de confiança 95% (IC95%) foram usados para avaliar a significância estatística das medidas. Observou-se 60% dos adolescentes com comportamentos alimentares inadequados quanto ao consumo de café da manhã, água/dia e refeições em frente à TV. Cerca de 40% (IC95%: 39,7-45) não realizavam refeições com os pais ou responsáveis. A prevalência de inatividade física foi de 52,4% (IC95%: 50-55). Adolescentes do sexo feminino foram mais inativas (68,7%; IC95%: 65-72) em relação aos meninos (36,4%; IC95%: 33-40). Adolescentes das classes econômicas D e E foram os mais inativos (60,7%; IC95%: 46-73). O consumo de bebida alcoólica foi de 18,7% (IC95%: 2,6-5,6) e o tabagismo foi de 3,8% (IC95%: 2-6) dos indivíduos. Comportamentos alimentares inadequados e a inatividade física foram os principais domínios responsáveis por um estilo de vida não saudável, seguidos pelo consumo de álcool e tabagismo.

Abstract This study analyzes the behavior patterns related to the lifestyle of adolescents in Recife, Brazil. A cross-sectional study was conducted with data from the Cardiovascular Risk Study among Adolescents (ERICA) and 2400 students aged 12 to 17 were interviewed. The prevalence of physical activity, eating behavior, smoking and alcohol consumption were analyzed. The Chi-square test and 95% confidence interval (95%CI) were used to evaluate the statistical significance of the measurements. It was observed that 60% of the adolescents presented inadequate eating behaviors regarding the consumption of breakfast, daily water intake and meals eaten in front of the TV. About 40% (95%CI: 39.7-45) did not sit down to meals with their parents or guardians. The prevalence of physical inactivity was 52.4% (95%CI: 50-55). Female adolescents were more inactive (68.7%, 95%CI: 65-72) than males (36.4%, 95%CI: 33-40). Teenagers of economic classes D and E were the most inactive (60.7%, 95%CI: 46-73). Alcohol consumption was 18.7% (95%CI: 2.6-5.6) and smoking was prevalent in 3.8% (95%CI: 2-6) of the individuals. Inadequate eating behaviors and physical inactivity were the main areas responsible for an unhealthy lifestyle, followed by alcohol consumption and smoking.

Perfil dos consumidores de alimentos de rua / Profile of consumers of street foods / Perfil de los consumidores de alimentos de la calle

O consumidor de alimentos de rua é aquele que adquire o alimento comercializado pelo vendedor ambulante de mercadorias em vias públicas. O objetivo deste artigo é caracterizar o perfil dos consumidores de comida de rua de Santo Antônio de Jesus, Bahia. Realizou-se estudoexploratório e descritivo, com 200 sujeitos entrevistados mediante aplicação de questionário semiestruturado em três praças públicas, no período de junho de 2010 a março de 2011. Os resultados indicam que a maioria dos participantes eram mulheres (58%), na faixa etária de 16 a25 anos (55%), escolaridade prevalente segundo grau completo (39%) e renda de até dois salários mínimos (50%). Apenas 5% utilizam a falta de dinheiro como critério para a compra dos alimentos e 92,5% creem que os produtos constituem risco à saúde, tendo 60% evitado a ingestão de algum tipo de alimento desse tipo. Sintomas de doenças transmitidas por alimentos foram revelados por 44% dos entrevistados e o refrigerante e o acarajé os alimentos mais consumidos. Dos entrevistados, 96% ingerem os produtos nos pontos de venda e 50,5% apresentam um consumode ao menos uma vez por semana. Constatou-se baixa ingestão de produtos naturais e regionais. Os resultados podem subsidiar a elaboração de políticas públicas na área de alimentação e nutrição, devido à importância socioeconômica, cultural, sanitária e nutricional dos produtoscomercializados por vendedores ambulantes. Concluiu-se que, para a melhoria da qualidade dos alimentos de rua, é necessária a educação sanitária dos consumidores.

The consumer of street foods is someone who purchases food commercialized by street vendors in public places. The aim of this article is to characterize the profile of consumers of street foods in Santo Antonio de Jesus, Bahia, Brazil. An exploratory and descriptive study was conducted based on the interviews of 200 subjects, through the application of semi-structured questionnaire in three public places in the period of June 2010 to March 2011. Among the respondents, the majority were female (58%) and were aged between16 to 25 years (55%), completed high school (39%) and 50% had income less than two minimum wages. No more than 5% of the respondents used lack of money as answer to the purchase of street foods. Most of the respondents (92.5%) believe that the products are a health hazard and 60% have avoided the ingestion of this kind of food. Symptoms of diseases transmitted by food were revealed by 44% of the people interviewed, and soft drinks (soda) and acarajé were the most consumed foods in this study. The largest part (96%) consumes street food at the place where they were bought it and 50.5% of respondents consume the food on the streets at least once a week. The consumption of regional and natural foods were barely mentioned. The results may support the development of public policies in the area of food and nutrition, due to socio-economic, cultural, health and nutritional of the products sold by street vendors. It can be concluded that in order to improve the quality of street foods, health education is needed for consumers.

El consumidor de alimentos de la calle es aquel que adquiere el alimento vendido en vías públicas. El objetivo de este estudio es caracterizar el perfil de los consumidores de alimentos en la calle, en Santo Antonio de Jesús, Bahia, Brasil. Estudio exploratorio y descriptivo, con 200 personas entrevistadas a través de un cuestionario semiestructurado, en tres plazas públicas, en el período de junio de 2010 a marzo de 2011. Los resultados indican que la mayoría de los encuestados eran mujeres (58%), con edades entre 16 y 25 años (55%), con enseñanza secundaria completa (39%), y el (50%) con renta de hasta dos sueldos base. Apenas un 5% utilizan como criterio la falta de dinero para consumiralimentos en la calle y, el 92,5% cree que los productos constituyen un riesgo a la salud, siendo que el 60% evitan la ingestión de ese tipo de alimento. El 44% de los entrevista refirió síntomas de enfermedades transmitidas por alimentos y, la gaseosa y el acarajé, fueron losalimentos más consumidos. De los entrevistados, 96% ingieren los productos en la calle y el 50,5% los consumen, por lo menos, una vez por semana. Se constató una baja ingestión de productos naturales y regionales. Los resultados pueden servir de subsidio para el desarrollode políticas públicas en el área de la alimentación y la nutrición, debido a la importancia socioeconómica, cultural, de salud y nutricional de los productos vendidos en la calle. Se concluye que para mejorar la calidad de estos alimentos, es necesario una educación sanitaria de los consumidores.