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Compared with full-term infants, preterm infants have fat-free mass deficit in the first months of life, which increases the risk of metabolic diseases in the future. In this cohort of children born under 32-week gestational age or less than 1500 g, we aimed to evaluate the associations of body composition at term equivalent age and in the first 3 months of life with fat-free mass and fat mass percentage at 4 to 7 years of life. Body composition assessments by air displacement plethysmography and anthropometry were performed at term, at 3 months of corrected age, and at 4 to 7 years of age. Multiple linear regression analysis was used to observe the associations between body composition at these ages. At term, fat mass percentage showed a negative association and fat-free mass a positive association with fat-free mass at 4 to 7 years. The fat-free mass at 3 months and the gain in fat-free mass between term and 3 months showed positive associations with fat-free mass at 4 to 7 years. Conclusion: Body composition at preschool age is associated with fat-free mass in the first 3 months of life, a sensitive period for the risk of metabolic diseases. What is Known: ⢠Preterm infants have a deficit in fat-free mass and high adiposity at term equivalent age compared to full-term infants. ⢠Fat-free mass reflects metabolic capacity throughout life and therefore is considered a protective factor against the risk of metabolic syndrome. What is New: â¢Fat-free mass gain in the first 3 months of corrected age is associated with fat-free mass at preschool and school ages. â¢The first 3 months of life is a sensitive period to the risk of metabolic diseases.
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Composición Corporal , Recien Nacido Prematuro , Humanos , Femenino , Masculino , Preescolar , Recien Nacido Prematuro/crecimiento & desarrollo , Recién Nacido , Lactante , Niño , Estudios de Cohortes , Adiposidad/fisiología , Pletismografía , AntropometríaRESUMEN
High-risk newborns are exposed to neonatal conditions such as prematurity, very low birth weight, and congenital malformations that can affect development and behavior. Coronavirus disease 2019 (COVID-19) restraint and control measures have been identified as important stressor events and cumulative risk factors for behavioral changes in these children. This study examined social isolation-related factors that contribute to internalizing and externalizing behavior problems in children already at risk for neurodevelopmental disorders. This cross-sectional, multicenter study included 113 children (18 months to 9 years) who were followed in reference services for neonatal follow-up in tertiary units of the public health system in the city of Rio de Janeiro, Brazil. Behavior was assessed using the child behavior checklist, and a structured questionnaire was used to assess sociodemographic aspects. In the bivariate analysis, prematurity was associated with externalizing problems and change in eating habits with internalizing problems. The logistic model indicated that both parents having completed high school and both sharing care of the child were protective factors for behavioral problems; however, reports of sleep problems and living with another child were risk factors. In conclusion, the study identified internalizing and externalizing behavior problems related to prematurity and aspects of family structure and routine in children at risk. The findings confirm the importance of family functioning for child health and family-centered interventions.
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BACKGROUND & AIMS: Greater energy expenditure is reported in newborns with bronchopulmonary dysplasia (BPD). This study assessed resting energy expenditure (REE) in newborns with BPD. METHODS: BPD was classified as mild and moderate/severe. REE was assessed using indirect calorimetry between the time points of the discontinuation of oxygen (O2) (T1) and at term-equivalent age (T2) in preterm newborns with BPD. RESULTS: The moderate group (10 newborns) presented with higher REE (kcal/kg/day) after discontinuation of mechanical ventilation and a decrease of 18% between the two time points; 72.7 and 59.6 kcal/kg/day at T1 and T2 respectively (p value 0.08). No differences were observed in REE in the mild BPD group between timepoints; 50.9-56.4 kcal/kg/day at T1 and T2 respectively (p value 0.73). CONCLUSION: Newborns with BPD presented different metabolic behaviors depending on the classification criteria: those classified as having moderate BPD showed a decrease in REE toward term-equivalent age.
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Displasia Broncopulmonar , Calorimetría Indirecta , Metabolismo Energético , Humanos , Recién Nacido , Oxígeno , Respiración ArtificialRESUMEN
In this cross-sectional study, conducted in a cohort of infants with a gestational age of < 32 weeks, we aimed to evaluate and compare resting energy expenditure (REE) and body composition between infants who developed bronchopulmonary dysplasia (BPD) and those who did not. REE and body composition were assessed at term equivalent age using indirect calorimetry and air displacement plethysmography. Anthropometric measurements (weight, head circumference, and length) were obtained and transformed into Z-scores per the Fenton (2013) growth curve, at birth and at term equivalent age. Forty-two infants were included in this study, of which 26.2% developed BPD. Infants with BPD had significantly higher energy expenditure at term equivalent age, with no difference in body composition between the two groups. CONCLUSION: Despite expending more energy, infants with BPD maintained a similar body composition distribution to those without BPD, and this is likely due to the recommended nutritional approach. WHAT IS KNOWN: ⢠Greater resting energy expenditure impairs growth of preterm infants with bronchopulmonary dysplasia. WHAT IS NEW: ⢠Although preterm infants with bronchopulmonary dysplasia had a higher resting energy expenditure at the corrected term age, this did not affect their body composition and growth.
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Displasia Broncopulmonar , Composición Corporal , Estudios Transversales , Metabolismo Energético , Edad Gestacional , Humanos , Lactante , Recién Nacido , Recien Nacido PrematuroRESUMEN
The scope of this study was to identify empowering factors for the actions of the Family Health Strategy (FHS) in coping with violence among adolescents. The sample was random from 61 teams of the Family Health Strategy of three municipalities. Questionnaires tabulated by EpiINFO 7.0, with bivariate analyses were used. Chi-square, Fisher and the "classification tree" were then used to analyze the experiences in this theme and the following issues: bonding, time since training completed, qualification, knowledge of public policies among others. There is acknowledgement of adolescents' vulnerability to violence, however, only two teams have ongoing prevention experiences. The prevailing opinion is that such activities are not the responsibility of the FHS. The study identifies interdependent variables that increase the likelihood of preventing violence and the promoting of a culture of peace among adolescents.
Este estudo objetivou identificar fatores potencializadores das ações da Estratégia Saúde da Família (ESF) no enfrentamento das violências contra adolescentes. A amostra foi aleatória de 61 equipes da ESF de três municípios. Utilizou-se questionários tabulados pelo programa EpiINFO 7.0, com análises bivariadas: qui-quadrado, Fisher e "árvore de classificação", para análise das experiências nessa temática e das seguintes questões - vínculo, tempo de formado, capacitação, conhecimento de políticas públicas, entre outras. Há o reconhecimento da vulnerabilidade dos adolescentes às violências, porém apenas duas equipes possuem experiências de prevenção com continuidade. Predomina a opinião de que tais atividades não competem à ESF. O estudo identifica variáveis interdependentes que aumentam a probabilidade da prevenção das violências e a promoção de cultura de paz entre adolescentes.
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Salud de la Familia , Violencia , Adaptación Psicológica , Adolescente , Humanos , Encuestas y Cuestionarios , Violencia/prevención & controlRESUMEN
Resumo Este estudo objetivou identificar fatores potencializadores das ações da Estratégia Saúde da Família (ESF) no enfrentamento das violências contra adolescentes. A amostra foi aleatória de 61 equipes da ESF de três municípios. Utilizou-se questionários tabulados pelo programa EpiINFO 7.0, com análises bivariadas: qui-quadrado, Fisher e "árvore de classificação", para análise das experiências nessa temática e das seguintes questões - vínculo, tempo de formado, capacitação, conhecimento de políticas públicas, entre outras. Há o reconhecimento da vulnerabilidade dos adolescentes às violências, porém apenas duas equipes possuem experiências de prevenção com continuidade. Predomina a opinião de que tais atividades não competem à ESF. O estudo identifica variáveis interdependentes que aumentam a probabilidade da prevenção das violências e a promoção de cultura de paz entre adolescentes.
Abstract The scope of this study was to identify empowering factors for the actions of the Family Health Strategy (FHS) in coping with violence among adolescents. The sample was random from 61 teams of the Family Health Strategy of three municipalities. Questionnaires tabulated by EpiINFO 7.0, with bivariate analyses were used. Chi-square, Fisher and the "classification tree" were then used to analyze the experiences in this theme and the following issues: bonding, time since training completed, qualification, knowledge of public policies among others. There is acknowledgement of adolescents' vulnerability to violence, however, only two teams have ongoing prevention experiences. The prevailing opinion is that such activities are not the responsibility of the FHS. The study identifies interdependent variables that increase the likelihood of preventing violence and the promoting of a culture of peace among adolescents.
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Humanos , Adolescente , Violencia/prevención & control , Salud de la Familia , Adaptación Psicológica , Encuestas y CuestionariosRESUMEN
This cohort study evaluated the nutritional supply in 78 very preterm newborns, with 20.5% developing bronchopulmonary dysplasia (BPD). This work aimed to evaluate the nutritional intake and the calorie/protein ratio received in the first 4 weeks of life. Anthropometric measures at birth and term age, the weight at each of the first 4 weeks of life, and the feeding practices were registered. The mean gestational age and birth weight were lower in those who developed BPD. At term age, head circumference and length Z-scores were significantly lower in newborns with BPD, who started enteral feeding and reached full diet later, staying longer in parenteral nutrition. The protein rate received by all newborns was similar, whether developing BPD or not, but those who developed BPD received significantly lower fluid volume and calorie rates after the second week. The daily calorie/protein ratio (30 kcal/1-g protein) was reached by 88.7% of the newborns who did not develop BPD in the third week, with those who developed BPD receiving less than this ratio until the second week, persisting in 56.3% of them on the fourth week.Conclusion: A calorie/protein ratio below that recommended for growth was found in preterm newborns who developed BPD, and providing nutrition for these newborns remains a challenge. What is Known: ⢠The importance of preterm newborn nutrition is well known. ⢠Early nutritional support may avoid severe BPD. What is New: ⢠Newborns who developed BPD received a calorie/protein ratio below that recommended for preterm newborns' growth during the first 2 weeks of life, lasting until the fourth week in most of these newborns.
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Displasia Broncopulmonar , Displasia Broncopulmonar/prevención & control , Estudios de Cohortes , Ingestión de Alimentos , Edad Gestacional , Humanos , Lactante , Recién Nacido , Recien Nacido PrematuroRESUMEN
BACKGROUND: Studies have investigated risk factors for infections by specific species of carbapenem-resistant Gram-negative bacilli (CR-GNB), but few considered the group of GNB species and most of them were performed in the setting of bacteremia or hospital infection. This study was implemented to identify risk factors for sepsis by CR- and carbapenem-susceptible (CS) GNB in intensive care unit (ICU) patients to improve management strategies for CR-GNB sepsis. METHODS: We developed a case-case-control study from a prospective cohort of patients with systemic inflammatory response syndrome (SIRS), sepsis-2 or sepsis-3 criteria in which blood and other sample cultures were collected and antimicrobial therapy was instituted, in an adult clinical-surgical ICU, at tertiary public hospital in Rio de Janeiro, from August 2015 through March 2017. RESULTS: Among the total of 629 ICU admissions followed by 7797 patient-days, after applying inclusion and exclusion criteria we identified 184 patients who developed recurrent or single hospital-acquired sepsis. More than 90% of all evaluable cases of sepsis and 87% of control group fulfilled the modified sepsis-3 definition. Non-fermenting bacilli and ventilator-associated pneumonia predominated as etiology and source of CR-GNB sepsis. While Enterobacteriaceae and intra-abdominal surgical site plus urinary-tract infections prevailed in CS-GNB than CR-GNB sepsis. Carbapenemase production was estimated in 76% of CR-GNB isolates. Multivariate logistic regression analysis revealed previous infection (mostly hospital-acquired bacterial infection or sepsis) (OR = 4.28; 95% CI 1.77-10.35), mechanical ventilation (OR = 4.21; 95% CI 1.17-15.18), carbapenem use (OR = 3.42; 95% CI 1.37-8.52) and length of hospital stay (OR = 1.03; 95% CI 1.01-1.05) as independent risk factors for sepsis by CR-GNB. While ICU readmission (OR = 6.92; 95% CI 1.72-27.78) and nosocomial diarrhea (OR = 5.32; 95% CI 1.07-26.45) were factors associated with CS-GNB sepsis. CONCLUSIONS: The investigation of recurrent and not only bacteremic episodes of sepsis was the differential of this study. The results are in agreement with the basic information in the literature. This may help improve management strategies and future studies on sepsis by CR-GNB.
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Antibacterianos/uso terapéutico , Carbapenémicos/uso terapéutico , Bacterias Gramnegativas/efectos de los fármacos , Infecciones por Bacterias Gramnegativas/sangre , Unidades de Cuidados Intensivos/estadística & datos numéricos , Sepsis/microbiología , Adulto , Anciano , Anciano de 80 o más Años , Brasil , Estudios de Casos y Controles , Enfermedad Crítica , Infección Hospitalaria/tratamiento farmacológico , Infección Hospitalaria/microbiología , Femenino , Bacterias Gramnegativas/patogenicidad , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Recurrencia , Factores de Riesgo , Sepsis/tratamiento farmacológico , Centros de Atención Terciaria/estadística & datos numéricos , Adulto JovenRESUMEN
Objective To compare growth and body composition of preterm infants (gestational age <32 weeks) with and without bronchopulmonary dysplasia (BPD). Methods A prospective cohort involving three neonatal units in the public health system of the Brazilian city of Rio de Janeiro. Inclusion: newborns with gestational age <32 weeks. EXPOSURE: BPD. Anthropometric measurements were performed at birth and at 1 month of infant corrected age. Body composition was measured using an air displacement plethysmography (ADP) (PEA POD®) at 1 month of infant corrected age. Results Ninety-five newborns were eligible, of which 67 were included, 32.8% of them with BPD. Newborns with BPD presented lower gestational age at birth, greater need for resuscitation in the delivery room, received parenteral nutrition (PN) for a longer period of time, achieved lower weights during hospital stay and required more time to reach a full enteral diet. No statistically significant differences were observed in relation to anthropometric measurements and body composition at 1 month of infant corrected age between the groups with and without BPD. Conclusion This study, unlike previous ones, has shown that children who developed BPD were able to regain growth, as measured by anthropometric measures, with no change in body composition at 1 month of infant corrected age.
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Composición Corporal , Displasia Broncopulmonar/fisiopatología , Desarrollo Infantil , Crecimiento , Femenino , Humanos , Recién Nacido , Recien Nacido Prematuro , Masculino , Estudios ProspectivosAsunto(s)
Composición Corporal , Retardo del Crecimiento Fetal/patología , Recien Nacido Prematuro/crecimiento & desarrollo , Tejido Adiposo/crecimiento & desarrollo , Tejido Adiposo/patología , Adiposidad , Peso al Nacer , Brasil , Desarrollo Infantil , Estudios de Cohortes , Femenino , Humanos , Lactante , Recien Nacido Extremadamente Prematuro/crecimiento & desarrollo , Recién Nacido , Recién Nacido Pequeño para la Edad Gestacional/crecimiento & desarrollo , Masculino , Delgadez/patologíaRESUMEN
The response of healthcare services to new information systems depends upon, among other factors, their local organization. This study aimed at comparing the chemotherapy and radiotherapy production registers for the cities Rio de Janeiro and Belo Horizonte, Brazil, in the Ambulatory Information System of the Unified Brazilian Health System (in Portuguese, SUS) between November/1998 and February/2003. Both cities showed a pattern of increase for the chemotherapy production series, while the radiotherapy series showed such increase only for Rio de Janeiro. Comparing Box-Jenkins models for each series, Rio de Janeiro showed a delay of three months in recording production, due to public services. In Belo Horizonte, the delay was shorter than in Rio de Janeiro and there was no difference between public and non-public services. The observed differences between the cities seem to be associated with the fact that Belo Horizonte already had a mechanism to control and evaluate production before the introduction of the system in 1998.
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Sistemas de Información en Atención Ambulatoria/normas , Neoplasias/tratamiento farmacológico , Neoplasias/radioterapia , Sistemas de Información en Atención Ambulatoria/estadística & datos numéricos , Brasil , Femenino , Humanos , MasculinoRESUMEN
A resposta dos servicos à implantacão de um sistema de informacão depende de uma série de fatores, entre os quais, destaca-se a organizacão local. Este trabalho comparou o padrão de registro dos dados de producão de quimioterapia e radioterapia dos municípios do Rio de Janeiro e Belo Horizonte, Brasil, no Sistema de Informacão Ambulatorial do SUS, no período de novembro de 1998 a fevereiro de 2003. Ambos os municípios mostraram uma tendência de alta na série de producão de quimioterapia, e apenas o Rio de Janeiro, na série de radioterapia. Comparando os modelos de Box-Jenkins de cada série, verificou-se que o Rio de Janeiro apresenta um atraso de três meses no registro de producão, devido às unidades públicas. Em Belo Horizonte, o atraso é menor e não foi observada diferenca no registro da producão entre as unidades públicas e contratadas. A diferenca observada entre os municípios parece estar associada ao fato de Belo Horizonte dispor de um sistema de controle e avaliacão da producão anterior a 1998, ano da implantacão do sistema.