RESUMO
OBJECTIVE: The objective of this study was to define the minimum academic content required for pediatricians to recognize the risk of kernicterus. METHODS: A questionnaire was developed on the basis of American Academy of Pediatrics guidelines seeking to develop a consensus for pediatricians in training on the theoretical content about neonatal hyperbilirubinemia. To validate the instrument, we used the Delphi consensus method. The 14 invited experts interviewed, eminent Brazilian researchers of neonatal hyperbilirubinemia, analyzed the questions posed in accordance with the literature and validated the instrument FINDINGS: An assessment instrument, the Student Questionnaire (SQ), was developed on the basis of indicators of risk of neonatal hyperbilirubinemia obtained from the literature. A panel of academic experts, composed of the leading researchers of neonatal hyperbilirubinemia in Brazil according to research rankings of the Brazilian government's Lattes Platform, was assembled for consensus validation of the assessment instrument. Validation of the SQ was achieved after two rounds of the Delphi technique. Finally, the SQ itself was validated with the medical education content required for recognition of kernicterus risk. CONCLUSION: The consensus among experts stressed the need to identify the primary epidemiologic risk factors for significant hyperbilirubinemia associated with neonatal jaundice and to characterize risk of bilirubin encephalopathy according to the literature. The minimum capacity required of physicians in training is that they have the insight to consult the reference material specific to each clinical situation in which hyperbilirubinemia may be involved. The present study emphasized the need for knowledge of the four variables related to management of neonatal jaundice: gestational age, birth weight, infant age, and total serum bilirubin. This validated questionnaire can be a useful tool to prepare pediatricians to recognize the possibility of bilirubin encephalopathy in neonates and prescribe intervention as necessary.
RESUMO
OBJECTIVE: To evaluate the relationship between asthma and overweight in adolescents. METHODS: Cross-sectional study including 13-14-year-old adolescents in Rio de Janeiro, Brazil. Asthma was defined according to the International Study of Asthma and Allergies in Childhood (ISAAC). Body Mass Index (BMI) was calculated; overweight was defined as BMI > or = 85th percentile. The distribution of asthma and associated symptoms were compared according weight category using the chi(2) test for linear trend. The association between asthma and overweight, controlling for confounding variables, was studied using odds ratios (OR), confidence intervals (95% CI) and logistic regression, stratified by sex. RESULTS: 2,858 (50.1% female) adolescents were studied; 458 (16.1%) were overweight and 13.3% asthmatic. Average BMI was higher among asthmatics (p = 0.01). When stratified, this difference remained only among girls (p = 0.03). Asthma prevalence increased with higher BMI (p = 0.02). Asthma was associated to overweight (OR = 1.51; 95% CI: 1.07-2.13), irrespective of sedentary lifestyle, smoking mother and presence of dog in the domicile, but only among the girls. CONCLUSIONS: In Rio de Janeiro adolescents, we found a positive association between asthma and overweight, exclusively among girls. This suggests that health policies related to asthma and overweight/obesity in this age group need to take sex into consideration.