Reproducibility of eucapnic voluntary hyperpnoea for exercise-induced bronchoconstriction diagnosis in asthmatic children and adolescents.

BACKGROUND: Respiratory symptoms after exercise are frequently reported by asthmatic patients, and exercise-induced bronchoconstriction (EIB) is a frequent cause, which requires objective testing for diagnosis. Eucapnic voluntary hyperpnea (EVH) is recommended as a surrogate stimulus for this purpose. Its short-term reproducibility is not yet established in children and young adolescents with asthma. OBJECTIVE: To evaluate the short-term test-retest agreement and reproducibility of FEV1 changes after EVH in this population. METHODS: Asthmatic patients aged between 10 and 20 years underwent EVH for EIB diagnosis on two occasions 2-4 days apart at a specialized university clinic. FEV1 was measured at 5, 15, and 30 min after EVH with a target ventilation rate 21 times the baseline FEV1 . EIB was diagnosed as a decrease ≥10% in FEV1 from baseline. RESULTS: A total of 26 of 62 recruited individuals tested positive for EIB on both visits (positive group) and 17 on one visit only (divergent group), while 19 tested negative on both visits (negative group). The overall agreement was 72.5% (95%CI 61.6%, 83.6%), and Cohen's kappa coefficient was 0.452. Low bias (0.87%) and high intra-class correlation coefficient (0.854, 95%CI 0.758,0.912; p < .001) for FEV1 response between test days were found, but with wide limits of agreement (±20.72%). There were no differences in pre-challenge FEV1 or achieved ventilation rate between visits either between groups (p = .097 and p = .461) or within groups (p = .828 and p = .780). There were no safety issues. CONCLUSIONS: More than one EVH test should be performed in children and young adolescents with asthma to exclude EIB and minimize misdiagnosis and mistreatment.

Journalistic media and adolescents in the COVID-19 pandemic: a documental analysis.

OBJECTIVE: To analyze how the journalistic media has described the issues of quality of life (QoL), physical activity (PA) and mental health (MH) of adolescents during the COVID-19 pandemic. METHODS: This is a descriptive and qualitative study that used content analysis. Sixty-two journalistic publications were analyzed from a total of 8211 published by the most read newspapers in each Brazilian region between December 2019 and August 2021. RESULTS: The results were grouped and evaluated in three categories: QoL (n=11), PA (n =9) and MH (n=42). In the analyzed period, the adolescents had more time of exposure to screens, contributing to an inadequate diet, a decrease in PA and impairments in QoL. According to the media publications, the pandemic has also contributed to an increase in anxiety, depression, loneliness and fear resulting from the mental and emotional disorganization caused by the abrupt change in routine. Social vulnerability was presented as an aggravating factor in this context. The journalistic media did not pay the necessary attention to adolescents regarding the negative consequences of the pandemic on QoL, PA and MH. CONCLUSIONS: The analyzed reports showed that the pandemic caused a decrease in social interaction, feelings of uncertainty, fear and the appearance/exacerbation of symptoms of anxiety, stress and depression. Social vulnerability was presented as another obstacle to be faced in this problem.

Single breath counting technique to assess pulmonary function: a systematic review and meta-analysis.

Pulmonary function is usually assessed by measuring Vital Capacity (VC) using equipment such as a spirometer or ventilometer, but these are not always available to the population, as they are relatively expensive tests, difficult to transport and require trained professionals. However, the single breath counting technique (SBCT) appears as a possible alternative to respiratory function tests, to help in the pathophysiological understanding of lung diseases. The objective is to verify the applicability of the SBCT as a parameter for evaluating VC. This is a systematic review registered in the International Prospective Register of Systematic Reviews (CRD42023383706) and used for PubMed®, Scientific Electronic Library Online, LILACS, EMBASE, and Web of Science databases of articles published until January 2023. Methodological quality regarding the risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 and National Institutes of Health tools. Eleven of a total of 574 studies were included, of these, nine showed a correlation between VC and SBCT (weak in healthy, moderate in neuromuscular and strong in hospitalized patients). One study of hospitalized patients accurately identified a count value of 21 for a VC of 20 ml kg-1(Sensitivity = 94% and Specificity = 77%), and another estimated a count lower than 41 for a VC below 80% of predicted in patients with neuromuscular dystrophy (Sensitivity = 89% and Specificity = 62%), and another showed good intra and inter-examiner reproducibility in young, adult, and elderly populations. A meta-analysis of three studies showed a moderate correlation in subjects with neuromuscular diseases (r= 0.62, 95% CI = 0.52-0.71,p< 0.01). A high risk of bias was identified regarding the justification of the sample size and blinding of the evaluators. SBCT has been presented as an alternative to assess VC in the absence of specific equipment. There is a clear relationship between SBCT and VC, especially in neuromuscular and hospitalized individuals. New validation studies conducted with greater control of potential bias risks are necessary.

Comparison between impulse oscillometry parameters and spirometry for the diagnosis of exercise-induced bronchoconstriction in asthmatic children and adolescents.

INTRODUCTION: Impulse oscillometry (IOS) parameters are obtained more easily and effortlessly in comparison to forced expiratory volume in the first second (FEV1). OBJECTIVE: To compare IOS parameters to FEV1 in exercise-induced bronchoconstriction (EIB) diagnosis. METHODS: Seventy-four (60.8% male; 39.2 female) young asthmatics aged between 7 and 17 years (mean 12.6 ± 2.8 years) were evaluated. EIB was defined as a reduction in FEV1 ≥ 10% compared with basal after standardized challenge by treadmill running (TR). IOS parameters and FEV1 were obtained at baseline and 5,15, and 30 min after TR. The area under the receiver operator characteristic curve (AUC) was calculated from the reduction in FEV1 ≥ 10% to evaluate the best psychometric characteristics of IOS parameters. RESULTS: Twenty-four individuals (32.4%) were diagnosed with EIB. A moderate inverse correlation was found between the IOS and FEV1 variables immediately after the TR, with resistance at 5 Hz (R5Hz), resonant frequency (Fres), and reactance area (AX), (r = -0.64, r = -0.53 and r = -0.69, respectively, all with p < 0.05). An increase of 25 kPa/l/s in R5 Hz, of 19k Pa/l/s in AX and 21 Hz in Fres were found to best correlate with EIB diagnosis by FEV1 (sensitivity 67% and specificity 62%, sensitivity 84% and specificity 50%, and sensitivity 84% and specificity 60%, respectively). CONCLUSION: IOS parameters have a significant inverse correlation with FEV1. This study presents cut-off points for EIB diagnosis for R5Hz, AX, and Fres, however, the findings in IOS parameters should be used and interpreted carefully if the goal is to replace spirometry.

Accuracy of peak nasal flow to determine nasal obstruction in patients with allergic rhinitis.

Objective: The aim of this study was to investigate the ability of Peak Nasal Inspiratory Flow (PNIF) and Peak Nasal Expiratory Flow (PNEF) measures to predict symptoms of nasal obstruction. Methods: This is a cross-sectional study, carried out in 131 individuals (64 with symptomatic allergic rhinitis and 67 asymptomatic) aged between 16 and 50 years. Results: PNIF and PNEF were higher among non-rhinitis. In the curve analysis (receiver operating characteristic), a value of 115 was found for PNIF with a sensitivity of 98.4% and specificity of 87.5% (AUC = 0.99, p < 0.001) and 165 in PNEF with a sensitivity of 65.7% and specificity of 85.1% (AUC = 0.92, p < 0.001). Conclusions: PNIF and PNEF values were lower in patients with AR compared to asymptomatic cases. Our findings present reference values of PNIF and PNEF in the evaluation of nasal obstruction symptoms and reinforce the importance to complement more refined assessment of patients' symptoms. PNEF can be a valuable tool in screening patients and to complement PNIF measurement.

Impact of climate variability on exercise-induced bronchospasm in adolescents living in a semi-arid region.

OBJECTIVE: To examine the impact of climate variability on the occurrence of exercise-induced bronchospasm in the rainy and dry seasons of a Brazilian semi-arid region. METHODS: This sample comprised 82 adolescents aged 15 to 18 years, who were submitted to exercise-induced bronchospasm assessment on a treadmill and outdoors, during the rainy and the dry season. Anthropometric variables, sexual maturity and forced expiratory volume in the first second were analyzed. Air temperature and humidity, decline in forced expiratory volume in the first second (%) and frequency of bronchospasm were compared between seasons using the independent Student's t test, the Wilcoxon and McNemar tests, respectively. The level of significance was set at p<0.05. RESULTS: The mean age was 15.65±0.82 years. Air temperature, air humidity and decline in forced expiratory volume in the first second (%) differed between seasons, with higher air temperature and humidity in the rainy season (29.6ºC±0.1 and 70.8%±0.6 versus 28.5ºC±0.2 and 48.5%±0.6; p<0.05). The decline in forced expiratory volume in the first second (%) was greater in the dry season (9.43%±9.97 versus 12.94%±15.65; p<0.05). The frequency of bronchospasm did not differ between seasons. CONCLUSION: The dry season had a negative impact on forced expiratory volume in the first second in adolescents, with greater decrease detected during this period. Findings of this study suggested bronchospasm tends to be more severe under low humidity conditions.

Respiratory burden in obese and young asthmatics: a study of diaphragmatic kinetics. / Carga respiratória em obesos e jovens asmáticos: um estudo da cinética diafragmática.

OBJECTIVE: The aim of this study was to assess the diaphragm kinetics, respiratory function, and serum dosage of leptin and inflammatory cytokines (IL-6 and TNF-α) in three clinical groups: obese, asthmatic, and healthy. METHODS: This is a clinical exploratory study performed on 73 youths (12-24 years of age, 42.5% male) allocated into three groups: obesity (OG, n=33), body mass index (BMIz-score) ≥ +2, asthmatic (AG, n=26) controlled mild asthmatics, classified by GINA, and Healthy Control Group (CG, n=14). The participants were subjected to diaphragmatic ultrasound, spirometry, maximal respiratory pressure, serum leptin levels, and IL-6 and TNF-α whole blood cell culture levels. RESULTS: Diaphragm thickness was higher in OG in comparison to AG and CG (2.0±0.4 vs 1.7±0.5 and 1.6±0.2, both with p<0.05). Maximal voluntary ventilation (MVV) was significantly lower in OG and AG in relation to the CG (82.8±21.4 and 72.5±21.2 vs 102.8±27.3, both with p<0.05). OG has the highest leptin rate among the groups (with the other two groups had p<0.05). All groups had similar TNF-α and IL-6 levels. CONCLUSION: The muscular hypertrophy found in the diaphragm of the obese individuals can be justified by the increase in respiratory work imposed by the chronic condition of the disease. Such increase in thickness did not occur in controlled mild asthmatics. The IL-6 and TNF-α markers detected no evidence of muscle inflammation, even though leptin was expected to be altered in obese individuals. Both obese and asthmatic patients had lower pulmonary resistance than the healthy ones.

OBJETIVO: O objetivo deste estudo foi avaliar a cinética diafragmática, a função respiratória e a dosagem sérica de leptina e citocinas inflamatórias (IL-6 e TNF-α) em três grupos clínicos: obeso, asmático e saudável. MÉTODOS: Estudo clínico-exploratório realizado com 73 jovens (12-24 anos, sendo 42,5% do sexo masculino) alocados em três grupos: obesidade (GO, n = 33), índice de massa corporal (IMC z-score) ≥ + 2 e asmáticos leves controlados (GA, n = 26), classificados pela GINA, e grupo controle saudável (GC, n = 14). Os participantes foram submetidos à ultrassonografia diafragmática, espirometria, pressão respiratória máxima, níveis séricos de leptina e níveis de IL-6 e TNF-α em hemocultura total. RESULTADOS: A espessura do diafragma foi maior no GO em comparação ao GA e GC (2,0 ± 0,4 vs 1,7 ± 0,5 e 1,6 ± 0,2, respectivamente, com p < 0,05). A ventilação voluntária máxima (VVM) foi significativamente menor no GO e GA em relação ao GC (82,8 ± 21,4 e 72,5 ± 21,2 vs 102,8 ± 27,3, respectivamente, com p < 0,05). O GO tem a maior taxa de leptina entre todos os grupos (com os outros dois grupos, p < 0,05). Os três grupos tinham níveis semelhantes de TNF-α e IL-6. CONCLUSÃO: A hipertrofia muscular encontrada no diafragma de indivíduos obesos pode ser justificada pelo aumento do trabalho respiratório imposto pela condição crônica da doença. Esse aumento de espessura não ocorreu em asmáticos leves controlados. Os marcadores IL-6 e TNF-α não detectaram evidências de inflamação muscular, embora fosse esperado que a leptina estivesse alterada em indivíduos obesos. Pacientes obesos e asmáticos apresentaram menor resistência pulmonar do que os saudáveis.

PHYSICAL ACTIVITY LEVEL IN ASTHMATIC ADOLESCENTS: CROSS-SECTIONAL POPULATION-BASED STUDY.

OBJECTIVE: To assess the level of physical activity in asthmatics in comparison with non-asthmatics in a population study. METHODS: Cross-sectional study with 13 to 14-year-old adolescents who participated in the International Study of Asthma and Allergies in Childhood (ISAAC). The subjects were classified into three groups: individuals with active asthma, individuals diagnosed with asthma, and respiratory asymptomatic individuals. To evaluate the level of physical activity, the International Physical Activity Questionnaire (IPAQ-short version) was used. The analysis consisted of comparing individuals with active asthma, diagnosed as asthmatic and asymptomatic, with a significance level of 5%. RESULTS: The participants were 1,591 adolescents, of which 791 (49.7%) were male. There were 222 (14.0%) individuals with active asthma and 284 (17.8%) asthma diagnoses; 55% of the population were physically active. Adolescents diagnosed with asthma were more active than their non-asthmatic peers (64.4 versus 53.3%; p=0.001). CONCLUSIONS: Adolescents diagnosed with asthma were more physically active than their non-asthmatic peers.

Journalistic media and adolescents in the COVID-19 pandemic: a documental analysis / Mídia jornalística e os adolescentes na pandemia da COVID-19: uma análise documental

ABSTRACT Objective: To analyze how the journalistic media has described the issues of quality of life (QoL), physical activity (PA) and mental health (MH) of adolescents during the COVID-19 pandemic. Methods: This is a descriptive and qualitative study that used content analysis. Sixty-two journalistic publications were analyzed from a total of 8211 published by the most read newspapers in each Brazilian region between December 2019 and August 2021. Results: The results were grouped and evaluated in three categories: QoL (n=11), PA (n =9) and MH (n=42). In the analyzed period, the adolescents had more time of exposure to screens, contributing to an inadequate diet, a decrease in PA and impairments in QoL. According to the media publications, the pandemic has also contributed to an increase in anxiety, depression, loneliness and fear resulting from the mental and emotional disorganization caused by the abrupt change in routine. Social vulnerability was presented as an aggravating factor in this context. The journalistic media did not pay the necessary attention to adolescents regarding the negative consequences of the pandemic on QoL, PA and MH. Conclusions: The analyzed reports showed that the pandemic caused a decrease in social interaction, feelings of uncertainty, fear and the appearance/exacerbation of symptoms of anxiety, stress and depression. Social vulnerability was presented as another obstacle to be faced in this problem.

RESUMO Objetivo: Analisar como a mídia jornalística tem descrito as questões de qualidade de vida (QV), atividade física (AF) e saúde mental (SM) de adolescentes durante a pandemia da COVID-19. Métodos: Trata-se de um estudo descritivo e qualitativo que utilizou a análise de conteúdo. Foram analisadas 62 publicações jornalísticas do total de 8.211 veiculadas pelos jornais mais lidos de cada região brasileira entre dezembro de 2019 e agosto de 2021. Resultados: Os resultados foram agrupados e avaliados em três categorias: QV (n=11), AF (n=9) e SM (n=42). No período analisado as publicações jornalísticas sugerem que os adolescentes apresentaram maior tempo de exposição a telas, contribuindo para uma alimentação inadequada, diminuição da AF e prejuízos na QV. A pandemia também contribuiu com aumento da ansiedade, depressão, solidão e medo resultantes da desorganização mental e emocional causada pela mudança abrupta de rotina. A vulnerabilidade social apresentou-se como um fator agravante nesse contexto. As mídias jornalísticas não deram a atenção necessária aos adolescentes no que se refere às consequências negativas da pandemia na QV, AF e SM. Conclusões: As reportagens analisadas mostraram que a pandemia causou diminuição na interação social, sentimentos de incerteza, medo e o aparecimento/exacerbação de sintomas de ansiedade, estresse e depressão. A vulnerabilidade social apresentou-se como mais um obstáculo a ser enfrentado nesta problemática.

Exercise-induced bronchospasm in children and adolescents with allergic rhinitis by treadmill and hyperventilation challenges.

BACKGROUND: Respiratory complaints after exercise are common in patients with rhinitis. Exercise-induced bronchospasm (EIB) may be one of the causes. OBJECTIVES: To evaluate EIB prevalence in a group of children and adolescents with allergic rhinitis, to compare the treadmill running (TR) and eucapnic voluntary hyperventilation (EVH) challenge methods as diagnostic tools and to assess the association between respiratory complaints on exercise and EIB. METHODS: Patients aged between 10 and 20 years were studied at the Pulmonology Department of the Hospital das Clínicas -UFPE- Recife, Brazil. The severity of symptoms of rhinitis and exercise-related respiratory complaints in the past year were evaluated. Challenges were performed in random sequence, no more than 72 h apart and followed international guidelines. Forced expiratory volume in the first second (FEV1) was determined before and 3, 5, 7, 10, 15 and 30 min after each challenge. A >10% reduction in FEV1 from baseline at two points after the challenge was considered sufficient to diagnose EIB. RESULTS: Of the thirty-five subjects evaluated, thirteen (37%) showed EIB, six by both methods, three only after TR and four only after EVH (Coens' Kappa = 0.489). There was no association between respiratory complaints after exercise and EIB (p = 0.74). CONCLUSION: A high prevalence of EIB was found in this population but only moderate agreement between the challenges used to diagnose EIB. Caution should be adopted when comparing these methods or interpreting their results interchangeably. There was no association between reported respiratory symptoms after exercise and EIB.

Lower prevalence and greater severity of asthma in hot and dry climate.

OBJECTIVE: To estimate asthma prevalence, severity, and associated factors in adolescents who live in a low relative humidity environment. METHODS: In this cross-sectional study, adolescents aged 13-14 years from the city of Petrolina located in the Brazilian semiarid region answered the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. The possible explanatory variables of the study were gender, family income, mother's education, smokers in the household, parental history of asthma, personal history of allergic rhinitis or atopic dermatitis, and physical activity level. Poisson regression analysis was used to assess the association between asthma and the explanatory variables. RESULTS: A total of 1591 adolescents participated in the study, of whom 49.7% were male. The prevalence of active asthma, severe asthma, and physician-diagnosed asthma were 14.0%, 10.4%, and 17.8%, respectively. Adolescents with asthma missed more school days than their peers (33 vs. 22 days/year; p<0.03). Associated factors that remained significant after adjustment were history of asthma in parents (PR=2.65, p<0.001) and personal diagnosis of allergic rhinitis (PR=1.96, p<0.001) and/or atopic dermatitis (PR=2.18, p<0.001). CONCLUSION: Asthma prevalence in this low-humidity environment was lower, but more severe than those reported in other Brazilian cities. The dry climate might hamper disease control and this may have contributed to the higher school absenteeism observed. The association of asthma with allergic rhinitis and atopic dermatitis as well as a history of asthma in parents suggests that atopy is an important risk factor for asthma in this population.

Exercise-induced bronchospasm in a hot and dry region: study of asthmatic, rhinitistic and asymptomatic adolescents.

BACKGROUND: Exercise-induced bronchospasm (EIB) is the bronchial narrowing that occurs after intense exercise in a significant number of asthmatics and in some non-asthmatics. This study aims to evaluate the occurrence of EIB in adolescents with asthma, rhinitis and respiratory asymptomatics in a hot and dry climate. RESEARCH DESIGN AND METHODS: This is a cross-sectional study based on an epidemiological study that evaluated the prevalence of asthma in schoolchildren in a semi-arid zone of Brazil. The EIB was defined as a reduction in forced expiratory volume in first second (FEV1) greater than 10%. RESULTS: A total of 114 individuals participated in the study (36.8% male), of whom 54 were asymptomatic, 30 asthmatic and 30 with rhinitis. Asthmatics presented a higher proportion of EIB in comparison to rhinitis and asymptomatics (46.7% vs. 13.3% and 7.4%, p = 0.001) and none of the individuals had severe EIB (ΔFEV1 ≥ 50%). CONCLUSIONS: A large proportion of the asthmatics selected from the community for the clinical study had EIB. Among participants with rhinitis, EIB was found in slightly more than 10%, while in the asymptomatics the frequency was slightly more than 5%. This study presents an important aspect in individuals living in hot and dry climates.

Impact of Covid-19 on the mental health, quality of life and level of physical activity in university students / Impacto da Covid-19 na saúde mental, qualidade de vida e nível de atividade física em universitários

Young people can have negative repercussions on their mental health, quality of life and on illnesses related to physical inactivity due to social isolation and fear of the disease (Covid-19). This study aimed to analyze the impact of the Covid-19 pandemic on the quality of life, level of physical activity and mental health of university students. College students (16-24 years old) completed an online interview, considering possible changes in mental health, quality of life and physical activity level, evaluating the moment before and during the pandemic. The recruitment strategy of the participants was the snowball type. 1,167 young people (69.2%-women) attended in the study, of which 8.8% had a confirmed diagnosis of Covid-19. There was a worsening in all scores of quality of life, stress and depression during the pandemic when compared to the period prior to the pandemic (p < 0.001). The pandemic also increased inactivity among young people (49.1% vs 28%, p < 0.001). Female students, from the health area, who had their own home and who did not have confirmed diagnosis of Covid-19 showed increased stress in the pandemic period. The Covid-19 pandemic worsened the indicators of mental health, quality of life and level of physical activity among university students. It is noteworthy that despite not being a risk group for the aggravation of the disease and consequent higher mortality, restrictions related to the pandemic limited or prevented the movement of people and this isolation can represent important changes in health in the medium and long term in this population

Jovens podem ter repercussões negativas em sua saúde mental, qualidade de vida e em doenças relacionadas com a inatividade física devido ao isolamento social e medo da doença (Covid-19). Este estudo teve como objetivo analisar o impacto da pandemia da Covid-19 na qualidade de vida, nível de atividade física e saúde mental de jovens universitários. Jovens universitários (16 a 24 anos) completaram uma entrevista online, considerando possíveis mudanças na saúde mental, qualidade de vida e nível de atividade física considerando o momento anterior e durante a pandemia. A estratégia de recrutamento dos participantes foi do tipo bola de neve. Participaram 1.167 jovens (69,2% mulheres), dos quais 8,8% tiveram diagnóstico de Covid-19 confirmado. Houve uma piora em todos os escores de qualidade de vida, estresse e depressão durante a pandemia quando comparados com o período anterior à pandemia (p < 0,001). A pandemia também aumentou a inatividade nos jovens (49% vs 28%, p < 0,001). Estudantes do sexo feminino, da área de saúde, que tinham casa própria e que não tiveram diagnóstico confirmado de Covid-19 apresentaram aumento do estresse no período pandêmico. A pandemia Covid-19 piorou os indicadores de saúde mental, qualidade de vida e nível de atividade física de jovens universitários. Chama atenção que apesar de não ser um grupo de risco para o agravamento da doença e consequente maior mortalidade, restrições relacionadas a pandemia limitaram ou evitaram a circulação de pessoas e esse isolamento pode representar importantes modificações na saúde a médio e longo prazo nesse público

Factors associated with neonatal death among adolescent mothers / Fatores associados ao óbito neonatal de mães adolescentes

Abstract Objectives: to analyze factors associated with neonatal death among adolescent mothers. Methods: randomized hospital-based cross-sectional study in a tertiary institution,, data from the Sistema de Informação sobre Nascidos Vivos (Sinasc), (Live Birth Information System), Sistema de Informação sobre Mortalidade (SIM) (Mortality Information System), and medical records. The study population was comprised of 1,341 adolescents aged 10-19 who had assisted childbirth at the institution between 2012 to 2016. The independent variables were sociodemographic characteristics, care, prenatal, childbirth, birth, and newborn's hospitalization, as well as the baby's characteristics. Logistic regression analysis was carried out to assess the association between neonatal death and explanatory variables. Results: the factors associated with death were from the countryside or other States (OR=2.68; CI95% =1.24-5.81), Apgar scores lower than 7 in the 1st (OR= 9.52; CI95% = 4.15-21.81) and the 5th (OR=4.17; CI95%=1.53-11.34) minutes of life; and birth weight less than 999g (OR=13.37; CI95% =3, 64-49.04) and between 1,500 to 2,499g (OR=3.43; CI95%=1.37-8.58). Conclusions: apgar and low birth weight were associated with the neonatal death among adolescent mothers, as well as the fact they come from the countryside and other States. These findings show, in addition to classic risks, potential difficulties for adolescents in having access to healthcare services in their hometown. To reduce the risks, there is a need for restructuring the maternal and child healthcare network and ensure a social protection network for these girls.

Resumo Objetivos: analisar fatores associados ao óbito neonatal de mães adolescentes. Métodos: estudo transversal de base hospitalar em instituição terciária, randomizado, com dados do Sistema de Informação sobre Nascidos Vivos (Sinasc), Sistema de Informação sobre Mortalidade (SIM) e de prontuários. A população do estudo compreendeu 1.341 adolescentes de 10 a 19 anos assistidos durante o parto na instituição entre 2012 a 2016. As variáveis independentes foram características sociodemográficas, assistenciais, relacionadas ao pré-natal, parto, nascimento e internamento do recém-nascido, além das características do bebê. Realizou-se análise de regressão logística para avaliar a associação entre óbito neonatal e variáveis explanatórias. Resultados: os fatores associados ao óbito foram municípios do interior e outros estados (OR=2,68; IC95%=1,24-5,81), índices de apgar menor que sete no 1º(OR=9,52; IC95%=4,15-21,81) e no 5º(OR=4,17; IC95%=1,53-11,34) minutos de vida e peso ao nascer menor que 999g (OR=13,37; IC95%= 3,64-49,04) e entre 1500 a 2499g (OR=3,43; IC95%= 1,37-8,58). Conclusões: o apgar e o baixo peso ao nascer se associaram ao óbito neonatal de mães adolescentes além da procedência de municípios do interior e outros estados. Estes achados mostram além de riscos clássicos, potenciais dificuldade das adolescentes em dispor de assistência nos seus lugares de residência. Para reduzir os riscos há necessidade de reorganizar a rede assistencial materno-infantil e garantir uma rede de proteção social a estas meninas.

Carga respiratória em obesos e jovens asmáticos: um estudo da cinética diafragmática / Respiratory burden in obese and young asthmatics: a study of diaphragmatic kinetics

RESUMO Objetivo O objetivo deste estudo foi avaliar a cinética diafragmática, a função respiratória e a dosagem sérica de leptina e citocinas inflamatórias (IL-6 e TNF-α) em três grupos clínicos: obeso, asmático e saudável. Métodos Estudo clínico-exploratório realizado com 73 jovens (12-24 anos, sendo 42,5% do sexo masculino) alocados em três grupos: obesidade (GO, n = 33), índice de massa corporal (IMC z-score) ≥ + 2 e asmáticos leves controlados (GA, n = 26), classificados pela GINA, e grupo controle saudável (GC, n = 14). Os participantes foram submetidos à ultrassonografia diafragmática, espirometria, pressão respiratória máxima, níveis séricos de leptina e níveis de IL-6 e TNF-α em hemocultura total. Resultados A espessura do diafragma foi maior no GO em comparação ao GA e GC (2,0 ± 0,4 vs 1,7 ± 0,5 e 1,6 ± 0,2, respectivamente, com p < 0,05). A ventilação voluntária máxima (VVM) foi significativamente menor no GO e GA em relação ao GC (82,8 ± 21,4 e 72,5 ± 21,2 vs 102,8 ± 27,3, respectivamente, com p < 0,05). O GO tem a maior taxa de leptina entre todos os grupos (com os outros dois grupos, p < 0,05). Os três grupos tinham níveis semelhantes de TNF-α e IL-6. Conclusão A hipertrofia muscular encontrada no diafragma de indivíduos obesos pode ser justificada pelo aumento do trabalho respiratório imposto pela condição crônica da doença. Esse aumento de espessura não ocorreu em asmáticos leves controlados. Os marcadores IL-6 e TNF-α não detectaram evidências de inflamação muscular, embora fosse esperado que a leptina estivesse alterada em indivíduos obesos. Pacientes obesos e asmáticos apresentaram menor resistência pulmonar do que os saudáveis.

ABSTRACT Objective The aim of this study was to assess the diaphragm kinetics, respiratory function, and serum dosage of leptin and inflammatory cytokines (IL-6 and TNF-α) in three clinical groups: obese, asthmatic, and healthy. Methods This is a clinical exploratory study performed on 73 youths (12-24 years of age, 42.5% male) allocated into three groups: obesity (OG, n=33), body mass index (BMIz-score) ≥ +2, asthmatic (AG, n=26) controlled mild asthmatics, classified by GINA, and Healthy Control Group (CG, n=14). The participants were subjected to diaphragmatic ultrasound, spirometry, maximal respiratory pressure, serum leptin levels, and IL-6 and TNF-α whole blood cell culture levels. Results Diaphragm thickness was higher in OG in comparison to AG and CG (2.0±0.4 vs 1.7±0.5 and 1.6±0.2, both with p<0.05). Maximal voluntary ventilation (MVV) was significantly lower in OG and AG in relation to the CG (82.8±21.4 and 72.5±21.2 vs 102.8±27.3, both with p<0.05). OG has the highest leptin rate among the groups (with the other two groups had p<0.05). All groups had similar TNF-α and IL-6 levels. Conclusion The muscular hypertrophy found in the diaphragm of the obese individuals can be justified by the increase in respiratory work imposed by the chronic condition of the disease. Such increase in thickness did not occur in controlled mild asthmatics. The IL-6 and TNF-α markers detected no evidence of muscle inflammation, even though leptin was expected to be altered in obese individuals. Both obese and asthmatic patients had lower pulmonary resistance than the healthy ones.

Maximum phonation time in the pulmonary function assessment / Tempo máximo de fonação para avaliação da função pulmonar

ABSTRACT Purpose: to evaluate the reliability of the maximum phonation time (MPT) and Vital Capacity intra and inter-examiner, by means of the single-breath counting test (CT) and the sustained /a/ phoneme, and the slow vital capacity (SVC). Methods: a reliability study carried out in three groups of healthy individuals, each group with 30 volunteers, allocated according to age. SVC was measured using a spirometer, while the MPT was assessed by the phoneme /a/ and CT. The data were analyzed using SPSS version 20.0. Initially, descriptive statistics were used and for data reliability, the intraclass correlation coefficient (ICC). Results: the Intraclass Correlation Coefficients (ICC) were considered excellent, with significant results above 0.92 for SVC and greater than 0.79 for CT and phoneme /a/. Regarding the inter-examiner evaluation, the ICCs were also significant for both SVC with values greater than 0.96, and for CT and the phoneme /a/ with values greater than 0.85. The error inherent in the technique was assessed using the standard error of the measurement for intra and inter-examiner analyses with values ranging from 1.79 to 3.29 for phoneme /a/, 3.20 to 6.58 for CT and 65, 05 to 206.73 for SVCml. Conclusion: phonation techniques with the phoneme /a/ and CT, as well as SVC, have an excellent reliability, due to intra and inter-examiner agreement measures.

RESUMO Objetivo: avaliar a concordância do tempo máximo de fonação (TMF) com a Capacidade Vital, intra e interexaminador, por meio da técnica de contagem numérica em uma única respiração (TC) e do fonema /a/ sustentado e da capacidade vital lenta (CVL). Métodos: trata-se de um estudo de concordância realizado em três grupos de indivíduos saudáveis, cada grupo com 30 voluntários, alocados de acordo a idade. A CVL foi mensurada por meio do espirômetro, enquanto o TMF foi avaliado pela emissão do fonema/a/ e da TC. Os dados foram analisados pelo programa SPSS versão 20.0. Inicialmente utilizou-se estatística descritiva e para concordância dos dados foi utilizado o coeficiente de correlação intraclasse (CCI). Resultados: os Coeficientes de Correlação Intraclasse (CCI) intraexaminadores foram considerados excelentes, com resultados significantes acima de 0,92 para a CVL e maiores que 0.79 para a TC e fonema/a/. Em relação à avaliação interexaminadores, os CCIs também foram significantes tanto para a CVL com valores maiores que 0,96 quanto para a TC e o fonema/a/ com valores maiores que 0,85. O erro inerente a técnica foi avaliada por meio do erro padrão da medida para as analises intra e interexaminadores com valores que variaram de 1,79 a 3,29 para fonema/a/, 3,20 a 6,58 para TC e 65,05 a 206,73 para CVLml. Conclusão: as técnicas de fonação com o fonema /a/ e TC, assim como a CVL, demonstraram uma excelente concordância intra e interexaminadores.

Impact of climate variability on exercise-induced bronchospasm in adolescents living in a semi-arid region / Influência de alterações climáticas sobre a ocorrência do broncoespasmo induzido por exercício em adolescentes de uma região semiárida

ABSTRACT Objective: To examine the impact of climate variability on the occurrence of exercise-induced bronchospasm in the rainy and dry seasons of a Brazilian semi-arid region. Methods: This sample comprised 82 adolescents aged 15 to 18 years, who were submitted to exercise-induced bronchospasm assessment on a treadmill and outdoors, during the rainy and the dry season. Anthropometric variables, sexual maturity and forced expiratory volume in the first second were analyzed. Air temperature and humidity, decline in forced expiratory volume in the first second (%) and frequency of bronchospasm were compared between seasons using the independent Student's t test, the Wilcoxon and McNemar tests, respectively. The level of significance was set at p<0.05. Results: The mean age was 15.65±0.82 years. Air temperature, air humidity and decline in forced expiratory volume in the first second (%) differed between seasons, with higher air temperature and humidity in the rainy season (29.6ºC±0.1 and 70.8%±0.6 versus 28.5ºC±0.2 and 48.5%±0.6; p<0.05). The decline in forced expiratory volume in the first second (%) was greater in the dry season (9.43%±9.97 versus 12.94%±15.65; p<0.05). The frequency of bronchospasm did not differ between seasons. Conclusion: The dry season had a negative impact on forced expiratory volume in the first second in adolescents, with greater decrease detected during this period. Findings of this study suggested bronchospasm tends to be more severe under low humidity conditions.

RESUMO Objetivo: Verificar a influência das alterações climáticas sobre o broncoespasmo induzido por exercício, nos períodos chuvoso e seco de uma região do semiárido brasileiro. Métodos: Foram submetidos à avaliação do broncoespasmo em esteira ergométrica, em ambiente externo, nos períodos chuvoso e seco, 82 adolescentes, com idades de 15 a 18 anos. Foram avaliadas as variáveis antropométricas, a maturação sexual e o volume expiratório forçado no primeiro segundo. Para comparação da temperatura e umidade, queda do volume expiratório forçado no primeiro segundo (%) e frequência do broncoespasmo entre os períodos, foram utilizados o teste t de Student independente, o teste de Wilcoxon e o teste de McNemar, respectivamente. O nível de significância adotado foi p<0,05. Resultados: A média de idade foi 15,65±0,82 anos. A temperatura, a umidade e a queda do volume expiratório forçado no primeiro segundo (%) diferiram entre os períodos, com valores de temperatura e umidade maiores no período chuvoso (29,6ºC±0,1 e 70,8%±0,6 versus 28,5ºC±0,2 e 48,4%±0,6; p<0,05). A queda do volume expiratório forçado no primeiro segundo (%) foi maior no período seco (9,43%±9,97 versus 12,94%±15,65; p<0,05), e não foi encontrada diferença da frequência do broncoespasmo entre os períodos. Conclusão: O período seco influenciou negativamente no volume expiratório forçado no primeiro segundo de adolescentes, observando maior percentual de queda dessa variável nesse período. De acordo com os achados, propõe-se uma maior gravidade do broncoespasmo induzido por exercício em condições de baixa umidade.

Quality of life and physical activity in intensive care professionals from middle São Francisco.

OBJECTIVE: The objective was to assess the level of physical activity (LPA) and the quality of life QL of the professionals who work in ICU. METHOD: This was a cross-sectional study carried out in Adult ICUs. LPA was assessed by the International Questionnarie of Physical Activity--short form (IQPA-SF) and the QL by the Medical Outcomes Study 36 (SF-36) questionnaire. RESULTS: It was classified active 50.89% out of a total of 59 professionals. Nursing technicians were considered the most active with 60.6%. The QL of the professionals who were considered active were better when compared to inactives, with statistical differences to the category of physical aspects limitation, social aspects and mental health. The working hours were higher than recommend, the physicians were higher than the physical therapist, nurses and technicians nurses (p = 0.046). CONCLUSION: Physically active professionals who work in ICU had higher quality of life probably why have lower hours of work and consequently more free time to engage in physical activity.

Body segments and biological maturation to estimate the propulsive force of the arm in young swimmers / Segmentos corporais e maturação biológica para estimar a força propulsiva da braçada em jovens nadadores

Abstract This study aimed to estimate the propulsive force of the arm (PFA) in young freestyle swimmers and propose an equation to estimate propulsive force, considering anthropometric variables and maturity offset. Seventy-six competitive swimmers [boys: n= 53; age= 13.58 ± 1.79; girls: n= 23; age= 12.98 ± 1.79] participated in this study. Height, lean mass, sitting height, leg length, arm span, triceps skinfold, arm muscle area (AMA), and maturity offset were assessed. The propulsive force of the arm was measured by the tethered swim test. A multiple linear regression (concurrent model) was used to develop the equation using the variables AMA, arm span, and maturity offset. The Bland-Altman method was used to compare the values found between PFA and propulsive force-estimated (PFE). There was a significant correlation between the variables PFA and AMA (R²=0.12; p<0.01), arm span (R²=0.21; p<0.01), and maturity offset (R²=0.20; p<0.01) for boys, whilst in girls theses values were: AMA (R²=0.07;p=0.20), arm span (R²=0.50;p<0.01), and maturity offset (R²=0.44;p<0.01). Two linear equations were established to predict the PFA in boys and girls Bland-Altman analysis showed an agreement between PFA and PFE. In conclusion, the equation is a valuable tool to monitor training and help improve swimmer performance.

Resumo Este estudo teve como objetivo estimar a força propulsora da braçada(FPB) em jovens nadadores do estilo livre e propor uma equação para estimar a força propulsora, considerando variáveis antropométricas e a maturação. Setenta e seis nadadores competitivos [meninos: n = 53; idade = 13,58 ± 1,79; meninas: n = 23; idade = 12,98 ± 1,79] participaram deste estudo. Foram avaliados: altura, massa magra, estatura sentada, comprimento da perna, envergadura, dobra cutânea do tríceps, área muscular do braço (AMB) e maturação. A força propulsiva da braçada foi medida pelo teste de nado atado. Uma regressão linear múltipla (modelo concorrente) foi usada para desenvolver a equação usando as variáveis AMB, envergadura e maturação. O método de Bland - Altman foi utilizado para comparar os valores encontrados entre FPB e força propulsiva estimada (FPE). Houve correlação significativa entre as variáveis FPB e AMB (R² = 0,12; p <0,01), envergadura (R² = 0,21; p <0,01) e maturação (R² = 0,20; p <0,01) para meninos, enquanto os valores das meninas foram: AMB (R² = 0,07; p = 0,20), envergadura (R² = 0,50; p <0,01) e maturação (R² = 0,44; p <0,01). Duas equações lineares foram estabelecidas para predizer a FPB em meninos e meninas. A análise de Bland-Altman mostrou concordância entre FPB e FPE. Em conclusão, a equação é uma ferramenta valiosa para monitorar o treinamento e ajudar a melhorar o desempenho do nadador.

Accuracy of single-breath counting test to determine slow vital capacity in hospitalized patients / Acurácia do teste de contagem em uma única respiração para determinar a capacidade vital lenta em pacientes hospitalizados

ABSTRACT Purpose: to identify the accuracy of the single-breath counting test to determine slow vital capacity in hospitalized patients and to evaluate the repeatability of the same examiner. Methods: a diagnostic study and the choice of techniques were randomly assigned. The area under the curve (receiver operating characteristic) was calculated from the slow vital capacity (20ml/kg) to evaluate the best psychometric characteristics of single-breath counting Test for this cutoff point. Repeatability observed by the same examiner was assessed using the Intraclass Correlation Coefficient. Results: 516 patients hospitalized for various diseases were analyzed. In the curve analysis (receiver operating characteristic/slow vital capacity=20ml/Kg), the value of 21 in single-breath counting test with a sensitivity of 94.44% and specificity of 76.62% (area under the curve =0.93, p<0.005) was found. The intraclass correlation coefficient value for the single-breath counting test was 0.976 with p>0.005. Conclusion: the single-breath counting test was a valid and repetitive technique, and may be an important screening option for assessment of lung function in the absence of specific equipment. This technique opens perspectives to replace slow vital capacity measurement in hospitals, which lack spirometric equipment, or in patients who may have a contagious disease, which has a risk of contamination and spread of disease from one patient to another.

RESUMO Objetivo: identificar a acurácia do teste de contagem em uma única respiração para determinar a capacidade vital lenta em pacientes hospitalizados e avaliar sua repetibilidade entre o mesmo examinador. Métodos: estudo de diagnóstico em que a escolha das técnicas foi aleatoriamente atribuída. A área sob a curva (característica de operação do receptor) foi calculada a partir da capacidade vital lenta (20ml/kg) para avaliar as melhores características psicométricas do teste de contagem em uma única respiração para este ponto de corte. A repetibilidade observada pelo mesmo examinador foi avaliada usando o coeficiente de correlação intraclasse. Resultados: foram analisados (característica de operação do receptor/capacidade vital lenta=20ml/Kg), foi encontrado o valor de 21 em teste de contagem em uma única respiração com uma sensibilidade de 94,44% e especificidade de 76,62% (área abaixo da curva=0,93, p<0,005). O valor do coeficiente de correlação intraclasse para o teste de contagem foi 0,976 com p>0,005. Conclusão: o teste de contagem em uma única respiração foi uma técnica válida, repetitiva e pode ser uma importante opção de rastreamento para avaliação da função pulmonar na ausência de equipamentos específicos. Essa técnica abre perspectivas no que se refere à substituição da medição da capacidade vital lenta em hospitais que não possuem equipamento espirométrico ou em pacientes que apresentam uma doença contagiosa com risco de contaminação e propagação de doença de um paciente para outro.