Preven����o da s��ndrome metab��lica em crianças obesas: uma proposta de interven����o

OBJETIVO: Analisar o efeito de 12 semanas de interven����o envolvendo pr��tica de atividade f��sica, orienta����es alimentar e psicol��gica sobre fatores de risco para o desenvolvimento da s��ndrome metab��lica em crianças e adolescentes obesos. M��TODOS: Estudo longitudinal com 23 crianças e adolescentes obesos, com idade entre seis e 16 anos (12,0��3,2 anos). Foram mensurados: gordura corporal total e de tronco, glicemia, colesterol total e triglic��rides, press��o arterial sist��lica e diast��lica. Os jovens foram submetidos a tr��s sess��es semanais de 60 minutos de exerc��cio f��sico (atividades esportivas recreativas, gin��stica, circuitos e caminhadas), durante 12 semanas. O teste do qui-quadrado foi usado para comparar dados categ��ricos daqueles que apresentaram valores acima das recomenda����es para cada fator de risco. O teste t para dados pareados foi aplicado para comparar os dois momentos do estudo. RESULTADOS: em indiv��duos com altera����es metab��licas no in��cio do estudo, observou-se, ap��s a interven����o, a diminui����o de 11,6% na glicemia (105 para 93mg/dL; p=0,046) e de 24,9% no triglic��rides (217 para 163mg/dL; p=0,013); por��m, n��o houve diferen��as na press��o arterial e no colesterol total. CONCLUS��ES: O programa de exerc��cio f��sico aplicado nas crianças e adolescentes foi eficiente para melhorar os valores de glicemia e triglic��rides.

Desempenho de diferentes equa����es antropom��tricas na predi����o de gordura corporal excessiva em crianças e adolescentes

OBJETIVO: O objetivo do presente estudo foi analisar a efici��ncia de diferentes equa����es antropom��tricas para a identifica����o de excesso de gordura corporal entre crianças e adolescentes. M��TODOS: A amostra foi composta por 1.498 indiv��duos (678 meninos e 820 meninas), com idade entre 7 e 17 anos (M=13,7, DP=2,0), da cidade de Presidente Prudente (SP). A massa corporal e a estatura foram mensuradas para o c��lculo do ��ndice de Massa Corporal. Tamb��m foi realizada a mensura����o da circunfer��ncia de cintura e das dobras cut��neas subescapular, tricipital, abdominal e da panturrilha. O percentual de gordura corporal foi calculado por meio de quatro equa����es: Slaughter et al., Slaughter II et al., Dezenberg et al., e Deurenberg et al.. Para indicar a efici��ncia das diferentes equa����es antropom��tricas na indica����o da obesidade, foi utilizada a an��lise da curva Receiver Operating Characteristic Curve. RESULTADOS: No grupo masculino, foram observados valores de sensibilidade elevados (82,4% a 100,0%) e valores oscilando de baixo a alto, para a especificidade (20,9% a 94,9%). Para o sexo feminino, os valores de sensibilidade variaram entre moderado e alto (72,2% a 99,4%); e os de especificidade apresentaram, tamb��m, grande oscila����o entre baixo e alto (21,6% a 98,2%). CONCLS��O: A equa����o proposta por Deurenberg et al., apresentou o melhor desempenho no diagn��stico tanto da presen��a como da aus��ncia de obesidade na amostra investigada.

Crescimento e estado nutricional de crianças e adolescentes de Presidente Prudente, S��o Paulo, Brasil

OBJETIVOS: avaliar peso, altura, ��ndice de massa corporal (IMC) e preval��ncia de sobrepeso e obesidade de crianças e adolescentes de Presidente Prudente, S��o Paulo, Brasil. M��TODOS: foram avaliados 1327 jovens (692 masculino e 635 feminino) com idade de 7 a 19 anos. Os dados foram coletados com o mesmo equipamento e seguindo procedimento padr��o descrito na literatura. O teste t de Student para vari��veis independentes foi utilizado para as compara����es entre sexo (p<0,05), e foram calculados os percentis para cada idade. Utilizou-se o programa SPSS, vers��o-10.0. A plotagem das curvas foi realizada no programa Minitab, vers��o-14.0. Os percentis 85 e 95 serviram para classifica����o de sobrepeso e de obesidade e foram analisados em rela����o aos dois estudos mais aceitos internacionalmente. RESULTADOS o peso e a altura est��o acima dos valores encontrados em outras regi��es brasileiras e semelhantes a dos pa��ses desenvolvidos. O IMC revelou alta preval��ncia de sobrepeso e obesidade, principalmente no sexo masculino, entre 7 e 10 anos. Esta preval��ncia foi menor no grupo feminino, especialmente entre as adolescentes. CONCLUS��ES: a amostra apresenta padr��o de crescimento acima de outras regi��es brasileiras e compar��veis a pa��ses desenvolvidos, entretanto o IMC indica alta preval��ncia de sobrepeso e obesidade.

Leptinemia de jejum em crianças e adolescentes eutr��ficos

OBJETIVO: Determinar, em um grupo de crianças e adolescentes eutr��ficos, os valores de leptinemia de jejum e sua correla����o com idade e ��ndice de Massa Corporal (IMC). M��TODOS: Estudo de corte transversal realizado em duas escolas p��blicas de Ribeir��o Preto, Brasil. Foram obtidos medidas antropom��tricas e amostra de sangue venoso em jejum para dosagem da leptinemia de 448 crianças e adolescentes eutr��ficos, maturadores m��dios, de ambos os sexos, com idades entre 7 e 17,9 anos. Utilizando-se o teste de Mann-Whitney foram realizadas compara����es entre as concentra����es obtidas para meninos e meninas em cada faixa et��ria. Posteriormente, utilizandose o teste de Kruskal-Wallis, foram comparados os valores em cada faixa et��ria e, por meio do teste de correla����o de Spearman, foi avaliada a correla����o entre a leptinemia de jejum e a idade e entre leptinemia de jejum e o escore z do IMC. RESULTADOS: O valores de leptinemia de jejum diferiram entre meninos e meninas em todas as faixas et��rias sendo sempre mais elevados para as meninas. Entre os meninos, os valores de leptinemia n��o apresentam varia����o estatisticamente significativa; entre as meninas, observou-se variabilidade, com aumento progressivo de acordo com a faixa et��ria. O estudo de correla����o, mostrou que a leptinemia apresenta correla����o positiva com o escore z do ��ndice de massa corporal em ambos os sexos. em rela����o �� idade, observou-se correla����o apenas entre as meninas. CONCLUS��O: Os dados apontam para a necessidade do estabelecimento de curvas de refer��ncia para a leptinemia de jejum que levem em conta o sexo, a idade e o IMC.

Efeitos da inclina����o da esteira na marcha de crianças com s��ndrome de down

Background: Down syndrome (DS) is a genetic alteration characterized by being a nonprogressive congenital encephalopathy. Children with DS have hypotonia and developmental delays that interfere in the movement`s acquisition for these children. Objective: Analyze the effects of treadmill inclination on angle and spatiotemporal gait characteristics of these individuals. Methodology: We studied 23 subjects of both sexes, with ages ranged between 05 and 11 years, they presented ability to walk on level 5 classified according to the Functional Ambulation Category (FAC). Initially held a subjective evaluation of balance through a questionnaire (Berg Balance Scale-BBS) then the kinematic gait analysis was realized on a treadmill first, without inclination and then, with inclination of 10%, using the motion system analysis Qualisys System. Data analysis was done using BioStat 5.0 attributing significance level of 5%. Normality of data was verified using D'Agostino test and later was applied paired t-test to compare data in two experimental conditions. Results: There was a statistically significant difference in the spatiotemporal variables: reduction in the cadence (from 108.92 �� 39.07 to 99.11 �� 27.51, p <0.04), increase in cycle time (from 1.24 �� 0.27 to 1.36 �� 0.34, p = 0.03 ) and increase in time to take stock (from 0.77 �� 0.15 to 0.82 �� 0.18, p <0.001). Angular variables that showed statistically significant increasing were: the hip in the initial contact (12.23 �� 4.63 to 18.49 �� 5.17, p <0.0001) and max. flexion in balance (12.96��4:32 to 19.50 �� 4.51, p <0.0001 ), knee in the initial contact (15.59 to �� 6.71 to 21.63 �� 6.48, p <0.0001), the ankle in the initial contact (-2.79 �� 9.8 to 2.25 �� 8.79, p <0.0001), max dorsiflexion in stance (4.41 �� 10.07 to 7.13 �� 11.58, p <0.0009), maximum plantar flexion in the pre-assessment of the ankle joint (increase of -6.33 �� 8.77 to -2.69 �� 8.62, p <0.0004).Conclusions: The inclination acts in a positive way for angular and spatiotemporal features gait of children with Down syndrome, demonstrating possible benefit of using this surface in the gait rehabilitation of children with Down Syndrome

Equa����es preditivas para as press��es respirat��rias m��ximas de crianças brasileiras

I ntroduction: The assessment of respiratory muscle strength is important in the diagnosis and monitoring of the respiratory muscles weakness of respiratory and neuromuscular diseases. However, there are still no studies that provide predictive equations and reference values for maximal respiratory pressures for children in our population. Aim: The purpose of this study was to propose predictive equations for maximal respiratory pressures in healthy school children. Method: This is an observational cross-sectional study. 144 healthy children were assessed. They were students from public and private schools in the city of Natal /RN (63 boys and 81 girls), subdivided in age groups of 7-8 and 9-11 years. The students presented the BMI, for age and sex, between 5 and 85 percentile. Maximal respiratory pressures were measured with the digital manometer MVD300 (Globalmed ��). The maximal inspiratory pressure (MIP) and maximal expiratory pressures (MEP) were measured from residual volume and total lung capacity, respectively. The data were analyzed using the SPSS Statistics 15.0 software (Statistical Package for Social Science) by assigning the significance level of 5%. Descriptive analysis was expressed as mean and standard deviation. T'Student test was used for unpaired comparison of averages of the variables. The comparison of measurements obtained with the predicted values in previous studies was performed using the paired t'Student test. The Pearson correlation test was used to verify the correlation of MRP's with the independent variables (age, sex, weight and height). For the equations analysis the stepwise linear regression was used. Results: By analyzing the data, we observed that in the age range studied MIP was significantly higher in boys. The MEP did not differ between boys and girls aged 7 to 8 years, the reverse occurred in the age between 9 and 11 years. The boys had a significant increase in respiratory muscle strength with advancing age. Regardless sex and age, MEP was always higher than the MIP. The reference values found in this study are similar to a sample of Spanish and Canadian children. The two models proposed in previous studies with children from other countries were not able to consistently predict the values observed in this studied population. The variables sex, age and weight correlated with MIP, whereas the MEP was also correlated with height. However, in the regression models proposed in this study, only gender and age were kept exerting influence on the variability of maximal inspiratory and expiratory pressures. Conclusion: This study provides reference values, lower limits of normality and proposes two models that allow predicting, through the independent variables, sex and age, the value of maximal static respiratory pressures in healthy children aged between 7 and 11 years old

Fun����o pulmonar de crianças com leucemia aguda

Introduction: The leukemias are the most common malignancy in children and adolescents. With the improvement in outcomes, there is a need to consider the morbidity to generate the protocols used in children under treatment. Aim: To evaluate pulmonary function in children with acute leukemia. Method: This study is an observational cross sectional. We evaluated 34 children distributed in groups A and B. Group A comprised 17 children with acute leukemia in the maintenance phase of chemotherapy treatment and group B with 17 healthy students from the public in the city of Natal / RN, matched for gender, age and height. The thoracic mobility was evaluated by thoracic expansion in the axillary and xiphoid levels. Spirometry was measured using a spirometer Microloop Viasys �� following the rules of the ATS and ERS. Maximal respiratory pressures were measured with digital manometer MVD300 (Globalmed ��). The maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were measured from residual volume and total lung capacity, respectively. The data were analyzed using the SPSS 17.0 software assigning the significance level of 5%. Descriptive analysis was expressed as mean and standard deviation. T'student test was used to compare unpaired values found in group A with group B values, as well as with the reference values used. To compare the respiratory coefficients in the axillary level with the xiphoid in each group, we used paired testing t student. Results: Group A was significantly decreased thoracic mobility and MIP compared to group B, and MIP compared to baseline. There was no significant difference between spirometric data from both groups and the values of group A with the reference values Mallozi (1995). There was no significant difference between the MIP and MEP values and lower limits of reference proposed by Borja (2011). Conclusion: Children with acute leukemia, myeloid or lymphoid, during maintenance phase of chemotherapy treatment have reduced thoracic mobility and MIP. However, to date, completion of clinical treatment, the spirometric variables and the strength of the expiratory muscles appear to remain preserved in children between five and ten years

Influ��ncia da adi����o de carga na marcha em esteira de crianças com paralisia cerebral hemipar��tica esp��stica

Coordena����o de Aperfei��oamento de Pessoal de N��vel Superior

Fisioterapia respirat��ria em crianças com pneumonia: revis��o sistem��tica

Introduction: Pneumonia is an inflammatory lung disease and it is the greatest cause of deaths in children younger than five years of age worldwide. Chest physiotherapy is widely used in the treatment of pneumonia because it can help to eliminate inflammatory exudates and tracheobronchial secretions, remove airway obstructions, reduce airway resistance, enhance gas exchange and reduce the work of breathing. Thus, chest physiotherapy may contribute to patient recovery as an adjuvant treatment even though its indication remains controversial. Objectives: To assess the effectiveness of chest physiotherapy in relation to time until clinical resolution in children (from birth up to 18 years old) of either gender with any type of pneumonia. Methods: We searched CENTRAL 2013, Issue 4; MEDLINE (1946 to May week 4, 2013); EMBASE (1974 to May 2013); CINAHL (1981 to May 2013); LILACS (1982 to May 2013); Web of Science (1950 to May 2013); and PEDro (1950 to May 2013). We consulted the ClinicalTrials.gov and the WHO ICTRP registers to identify planned, ongoing and unpublished trials. We consulted the reference lists of relevant articles found by the electronic searches for additional studies. We included randomised controlled trials (RCTs) that compared chest physiotherapy of any type with no chest physiotherapy in children with pneumonia. Two review authors independently selected the studies to be included in the review, assessed trial quality and extracted data. Results: Three RCTs involving 255 inpatient children are included in the review. They addressed conventional chest physiotherapy, positive expiratory pressure and continuous positive airway pressure. The following outcomes were measured: duration of hospital stay, time to clinical resolution (observing the following parameters: fever, chest indrawing, nasal flaring, tachypnoea and peripheral oxygen saturation levels), change in adventitious sounds, change in chest X-ray and duration of cough in days. Two of the included studies found a significant improvement in respiratory rate and oxygen saturation whereas the other included study failed to show that standardised respiratory physiotherapy and positive expiratory pressure decrease the time to clinical resolution and the duration of hospital stay. No adverse effects related to the interventions were xvi described. Due to the different characteristics of the trials, such as the duration of treatment, levels of severity, types of pneumonia and the techniques used in children with pneumonia, as well as differences in their statistical presentation, we were not able to pool data. Two included studies had an overall low risk of bias whereas one included study had an overall unclear risk of bias. Conclusion: Our review does not provide conclusive evidence to justify the use of chest physiotherapy in children with pneumonia due to a lack of data. The number of included studies is small and they differed in their statistical presentation

Teias de caridade e o lugar social dos expostos da Freguesia de N�� Sr�� da Apresenta����o: capitania do Rio Grande do Norte, s��culo XVIII

The abandonment of newborn children is a reality nowadays. This reality enables us to discuss this issue in other temporalities, in all kinds of societies. Thus, this work aims to demonstrate how the population that lived at Freguesia de Nossa Senhora da Apresenta����o, a civil parish at a Rio Grande do Norte captaincy, socially placed the abandoned newborn during in the eighteenth century. These newborn were called exposed ones at the time and were inserted in a regional Exposed Circle. The research also discussed how the local Council assembly sheltered these newborn. For research development the following manuscript documents were used: baptism, wedding and demise documents at Freguesia de Nossa Senhora da Apresenta����o as well as the first Book of Records if the matrix church at this civil parish. The research also considered the terms of the Council assembly. Some printed documents were used such as Philippine Ordainments, the First Constitutions of the Archbishop in 1707 including the Lunario contents as well as texts from Andr�� Jo��o Antonil and Henry Koster. In the analysis reference work related to Social History was used. Thus, it is possible confirm that there was construction of socially accepted places for these exposed on behalf of the colonist at the region

Indicativos de problemas de comportamento e de habilidades sociais em crianças: um estudo longitudinal

O estudo teve como objetivo avaliar o desenvolvimento de crianças indicadas por suas professoras na Educa����o Infantil (EI) como apresentando problemas de comportamento (Grupo IPC) ou comportamentos socialmente habilidosos (Grupo ICSH), em dois momentos: quando tinham cinco anos e quando tinham 10 anos. Participaram 48 professoras de 62 crianças de ambos os sexos. Os instrumentos utilizados foram Question��rio de Respostas Socialmente Habilidosas para Professores e Escala Comportamental Infantil B. Os resultados indicaram diminui����o dos problemas de comportamento e aumento dos comportamentos socialmente adequados no grupo IPC; os grupos eram bastante diferentes na primeira avalia����o, quando na EI, mas as mudan��as se atenuaram no ensino fundamental. em ambas as avalia����es, as crianças do Grupo ICSH foram avaliadas como mais habilidosas.

Problemas de comportamento de crianças/adolescentes e dificuldades de pais/cuidadores: um estudo de caracteriza����o

Fam��lias que estimulam comportamentos socialmente habilidosos parecem favorecer o desenvolvimento social de seus filhos. Assim, intervir no relacionamento dos pais parece ser uma sa��da para minimizar indicativos de problemas de comportamento. Para uma efetiva interven����o �� recomendado especificar as demandas das pessoas que procuram por atendimento, seja atrav��s da caracteriza����o do repert��rio de pais e cuidadores, seja da caracteriza����o das dificuldades e/ou habilidades das crianças e/ou adolescentes. O objetivo da pesquisa foi o de caracterizar, atrav��s de uma Entrevista Cl��nica Semiestruturada, queixas e dificuldades de 59 pais/cuidadores que buscaram atendimento psicol��gico em um Centro de Psicologia Aplicada. Os resultados principais s��o: a) queixas de problemas externalizantes, tais como agressividade, desobedi��ncia e birras; b) dificuldades dos pais/cuidadores quanto ��s habilidades envolvidas no estabelecer limites (bater e n��o ter consist��ncia) e na comunica����o. Discute-se a interdepend��ncia entre os comportamentos dos adultos e crianças/adolescentes e repercuss��es para futuras interven����es.

Assist��ncia odontol��gica diferenciada para crianças de 0 a 3 anos: avalia����o de impacto no Servi��o P��blico Municipal em Natal-RN

In Brazil, 0-5 years old children just have an oral health care system since 1990 s. Innumerable experiences of implantation of the attendance to the babies in the cities had appeared throughout the years, but it hasn��t been evaluated the comparative effect between children displayed and not displayed to the program. In this regard, the main of this research was describe the Early Childhood Oral Health Care in public health service in Natal, Rio Grande do Norte, Brazil and evaluate the impact of this specific oral health care for babies by comparison of indicators between exposed and non-exposed children. It was created an experimental group, formed by children covered by program which was paired, based on sex, age and socioeconomic status, with a control group, formed by uncovered children. After filling ethical application, the parents of children were questioned about some risk factors to dental caries and, in sequence, it was accomplish an oral examination in the child. It was verified the Visible Plaque Index (VPI), Gingival Bleeding Index (GBI), dmf-s and verification of caries activity. The sample was 40 children in each group. The results showed, for VPI, a difference of 7 percentile points for the experimental group, however this difference had no statistical significance, obtained by Student s t test (p=0.314). In relation to GBI, the control group showed a low mean (0.8%) comparing with experimental group (2.77%) and this difference was statistically significant (p=0.003). The results for dmf-s and evaluation of caries activity showed no statistical difference between groups. Among the probable reasons for absence of impact of intervention, could be included: (a) the practice model was the same in two groups, or the difference was very weak and (b) the oral health care has intrinsic limitations for to impact on oral health in low income populations

Preval��ncia e fatores de risco �� persist��ncia de h��bitos bucais de suc����o n��o nutritiva em crianças de 3 a 5 anos de idade

Coordena����o de Aperfei��oamento de Pessoal de N��vel Superior

Influ��ncia de fatores de risco na preval��ncia de h��bitos bucais delet��rios em crianças de 0 a 5 anos na cidade do Natal-RN

Literature has demonstrated to the narrow relation between deleterious habits and the occurrence of malocclusion in minors of 5 years. The existence of these habits, however, already considered as risk factors, having also, its determinative ones, which present cultural dimensions and economic social, many of them related to the parents of the child, having in account that such habits if develop in phases in which the child establish a narrow relation of dependence. This study it had an objective to investigate the prevalence of deleterious buccal habits in children and its relation with the economic social and characteristics of the parents. It was developed an epidemiologist study of transversal character with interview, through daily pay-tested form, with 218 parents in the day of the National Campaign of Vaccination. In the cast of the variable that had composed the study, they had been used, as changeable dependents, the use of the baby's bottle, bottle and the digital suction, being considered as outcomes of the research. Amongst the independent variable, the economic social factors (type of occupation, number of children, civil state, sort, schooling and age) and staffs of the parents (self perception in oral health) had entered as the variable to be analyzed in the problems of the infantile odontology. The collected data had been submitted to the analysis descriptive and inferential statistics, being used the test qui-square and the analysis of the possibility reasons. As main results, it was found that breast feeding before the six months if presents as one of the main factors of risk for the use of baby's bottle (p< 0.001, OR= 2.8, I.C= 1.589 4.906), bottle (p< 0.001, OR= 3.7, I.C.= 2.076 6.624) and digital suction (p< 0.014, OR= 3.5, I.C.= 1.225 10.181). From the data found, one concludes that breast-feeding is considered a primordial factor for not the installation of deleterious oral habits and that the economic social and cultural factors can reflect in central way in the performance of this act