Camila W. Schaan

Educational interventions in childhood obesity: a systematic review with meta-analysis of randomized clinical trials.

OBJECTIVEnTo assess the effectiveness of educational interventions including behavioral modification, nutrition and physical activity to prevent or treat childhood obesity through a systematic review and meta-analysis of randomized trials.nnnMETHODnA search of databases (PubMed, EMBASE and Cochrane CENTRAL) and references of published studies (from inception until May 2012) was conducted. Eligible studies were randomized trials enrolling children 6 to 12 years old and assessing the impact of educational interventions during 6 months or longer on waist circumference, body mass index (BMI), blood pressure and lipid profile to prevent or treat childhood obesity. Calculations were performed using a random effects method and pooled-effect estimates were obtained using the final values.nnnRESULTSnOf 22.852 articles retrieved, 26 trials (23.617 participants) were included. There were no differences in outcomes assessed in prevention studies. However, in treatment studies, educational interventions were associated with a significant reduction in waist circumference [-3.21 cm (95%CI -6.34, -0.07)], BMI [-0.86 kg/m(2) (95%CI -1.59, -0.14)] and diastolic blood pressure [-3.68 mmHg (95%CI -5.48, -1.88)].nnnCONCLUSIONSnEducational interventions are effective in treatment, but not prevention, of childhood obesity and its consequences.

Sleep duration and mortality in the elderly : a systematic review with meta-analysis

Objective The purpose of our study was to evaluate the association between short and long sleep duration and all-cause and cardiovascular mortality among elderly individuals. Design Systematic review and meta-analysis of population-based cohort studies. Setting Articles were retrieved from international and national electronic databases. Study selection Studies were identified in PubMed, EMBASE, LILACS (Latin American and Caribbean Health Sciences Literature), IBECS (Bibliographic Index on Health Sciences from Spain) and CAPES (PhD thesis repository) between 1980 and 2015. Studies which met all criteria were eligible: participants aged 60u2005years or over, assessment of sleep duration as 24u2005h, nighttime or daytime sleep, evaluation of all-cause or cause-specific mortality, population-based cohort studies conducted on representative samples. There was no language restriction and studies published as abstracts were excluded. Data extraction Data were analysed using the Comprehensive Meta-Analysis software (V.3.3.070), and summary estimates (relative risk (RR), 95% CI) were calculated using a random effects model. Heterogeneity and consistency were evaluated through Cochrans Q and the I2 statistics, respectively, and sensitivity analyses were conducted. Primary and secondary outcome measures All-cause and cardiovascular mortality. Results Overall, 27 cohort studies were selected, comprising >70u2005000 elderly individuals, and followed up from 3.4 to 35u2005years. In the pooled analysis, long and short sleep duration were associated with increased all-cause mortality (RR 1.33; 95% CI 1.24 to 1.43 and RR 1.07; 95% CI 1.03 to 1.11, respectively), compared with the reference category. For cardiovascular mortality, the pooled relative risks were 1.43 (95% CI 1.15 to 1.78) for long sleep, and 1.18 (95% CI 0.76 to 1.84) for short sleep. Daytime napping ≥30u2005min was associated with risk of all-cause mortality (RR 1.27; 95% CI 1.08 to 1.49), compared with no daytime sleep, but longer sleep duration (≥2.0u2005h) was not (RR 1.34; 95% CI 1.95 to 1.90). Conclusions Among elderly individuals, long and short sleep duration are associated with increased risk for all-cause mortality. Long sleep duration is associated with cardiovascular mortality.

Prevalence and correlates of screen time among Brazilian adolescents: findings from a country-wide survey.

The purpose of this study was to evaluate the distribution, prevalence, and correlates of excessive screen time (>2 h/day) among Brazilian adolescents. The Study of Cardiovascular Risks in Adolescents (ERICA) is a national, school-based, cross-sectional multicenter study. Information about time spent in front of screens was assessed by questionnaire. Poisson regression models were used to examine the associations between following correlates (region, sex, age, skin color, income, Internet access, and number of TVs at home) and excessive screen time. A total of 66u2009706 Brazilian adolescents (aged 12-17 years) were included. The overall mean time in front of screens was 3.25 h/day (95% confidence interval (95%CI): 3.20-3.31) and the prevalence of excessive screen time was 57.3% (95%CI: 55.9-58.6). Moreover, excessive screen time also differs across Brazilian regions, being higher in Southeast and South, respectively. In adjusted models stratified by region, the socioeconomic status was associated with excessive screen time in North, Northeast, and Midwest. In all regions, having a computer with Internet access was associated with higher prevalence of excessive screen time. In conclusion, prevalence of excessive screen time in Brazilian adolescents is high. It presents regional variations and facility for Internet access.

Assessment of functional capacity and pulmonary in pediatrics patients renal transplantation

INTRODUCTIONnPediatric patients undergoing kidney transplantation can present changes in pulmonary function and functional capacity for exercise.nnnOBJECTIVEnTo evaluate the functional capacity and pulmonary function in children and adolescents undergoing kidney transplantation.nnnMETHODnChildren and adolescents aged six to 18 years of age were evaluated in Outpatient Clinic of Nephrology, Hospital da Criança Santo Antônio, Santa Casa de Porto Alegre, RS, Brazil in period the june of 2010 the march of 2011. Pulmonary capacity was assessed by spirometry and maximal respiratory pressures and functional capacity through 6-minute walk test (6MWT).nnnRESULTSnThe sample comprised 25 patients, 14 (56%) males with a mean age of 13.5 ± 3.3 years. From, 19 (76%) underwent dialysis before transplantation. Mean forced vital capacity (FVC) was 97.91 + 24.32% and forced expiratory volume in one second (FEV1) 100.53 + 17.66% from predicted value. In the 6MWT, the patients walked 229.14 meters less than predicted (p < 0.001). The maximum inspiratory pressure (MIP) was significantly lower than predicted, and the difference in cmH₂O -24.63 (p = 0.03), as the maximum expiratory pressure (MEP), with a difference of 49.27 cmH₂O (p < 0.001). By correlating, functional capacity, spirometry and maximal respiratory pressures, find an association between FVC and 6MWT (r = 0.52, p = 0.01) and FVC and MIP (r = 0.54, p = 0.01).nnnCONCLUSIONnReduced functional capacity and maximum respiratory pressures were diagnosed in a small cohort of pediatric patients after kidney transplantation. Better the functional capacity and PiMáx better the FVC.

Functional Capacity in Congenital Heart Disease: A Systematic Review and Meta-Analysis

Background Children and adolescents with congenital heart disease often have alterations in their exercise capacity that can be evaluated by various functional testing. Objective To evaluate the functional capacity of children and adolescents with congenital heart disease (CHD) with systematic review and meta-analyses. Methods The review included observational studies, data from the first evaluation of randomized clinical trials or observational follow-up periods after clinical trials which evaluated functional capacity by cardiopulmonary exercise test, stress testing, six-minute walk test or step test, in children and adolescents with CHD, aged between six and 18 years, and comparisons with healthy controls in the same age group. The quantitative assessment was performed by meta-analysis, by comparing the maximal oxygen consumption (VO2max) of children and adolescents with CHD and respective control groups. Results Twenty-five of 2.683 studies identified in the search met the inclusion criteria. The VO2max measurement showed that patients with CHD have a decrease of 9.31 ml/Kg/min (95% CI. -12.48 to -6.13; I2, 94.3%, P for heterogeneity < 0.001) compared with the control group. The meta-analysis of the data of maximum heart rate (HR) reached during cardiopulmonary test and stress testing, retrieved from 18 studies, showed a HR value of -15.14 bpm (95% CI. -20.97 to -9.31; I2, 94.3%, P for heterogeneity < 0.001) compared with the control group. Conclusion Children and adolescents with CHD have lower VO2max and HR compared to controls.

Prevalence of excessive screen time and TV viewing among Brazilian adolescents: a systematic review and meta-analysis

PURPOSEnTo evaluate the prevalence of excessive screen-based behaviors among Brazilian adolescents through a systematic review with meta-analysis.nnnDATA SOURCEnSystematic review and meta-analysis were recorded in the International Prospective Register of Ongoing Systematic Reviews (PROSPERO-CRD 2017 CRD42017074432). This review included observational studies (cohort or cross-sectional) that evaluated the prevalence of excessive screen time (i.e. combinations involving different screen-based behaviors) or TV viewing (≥2h/day or >2h/day in front of screen) through indirect or direct methods in adolescents aged between 10 and 19 years. The research strategy included the following databases: MEDLINE, LILACS, SciELO and ADOLEC. The search strategy included terms for screen time, Brazil, and prevalence. Random effect models were used to estimate the prevalence of excessive screen time in different categories.nnnDATA SUMMARYnTwenty-eight out of 775 studies identified in the search met the inclusion criteria. The prevalence of excessive screen time and TV viewing was 70.9% (95% CI: 65.5-76.1) and 58.8% (95% CI: 49.4-68.0), respectively. There was no difference between sexes in both analyses. The majority of studies included showed a low risk of bias.nnnCONCLUSIONSnThe prevalence of excessive screen time and TV viewing was high among Brazilian adolescents. Intervention are needed to reduce the excessive screen time among adolescents.

Overview of meta-analyses on prevention and treatment of childhood obesity

OBJECTIVESnThis study aimed to assess the quality of systematic reviews on prevention and non-pharmacological treatment of overweight and obesity in children and adolescents.nnnDATA SOURCEnA search was done in electronic databases (Medline via PubMed, Web of Science, Scopus, LILACS, the Cochrane Library, and Clinical Trials), including only systematic reviews with meta-analysis. Reviews were selected by two researchers, and a third one solved the divergences. PRISMA statement and checklist were followed.nnnSUMMARY OF DATAnA total of 4574 records were retrieved, including 24 after selection. Six reviews were on obesity prevention, 17 on obesity treatment, and one on mixed interventions for prevention and treatment of obesity. The interventions were very heterogeneous and showed little or no effects on weight or body mass index. Mixed interventions that included dieting, exercise, actions to reduce sedentary behavior, and programs involving the school or families showed some short-term positive effects. Reviews that analyzed cardiovascular risk factors demonstrated significant improvements in the short-term.nnnCONCLUSIONnThe systematic reviews of interventions to prevent or reduce obesity in children and adolescents generally showed little or no effects on weight or body mass index, although cardiovascular profile can be improved. Mixed interventions demonstrated better effects, but the long-term impact of obesity treatments of children and adolescents remains unclear.

Functional evaluation of pediatric patients after discharge from the intensive care unit using the Functional Status Scale

Objective To evaluate the functional status of pediatric patients after discharge from the pediatric intensive care unit using the Functional Status Scale and to compare the time of invasive mechanical ventilation, length of stay in the pediatric intensive care unit, and Pediatric Index of Mortality 2 results among individuals with different degrees of functional impairment. Methods A cross-sectional study was conducted on patients who were discharged from a pediatric intensive care unit. The functional evaluation by the Functional Status Scale was performed on the first day after discharge from the unit, and the Pediatric Index of Mortality 2 was used to predict the mortality rate at the time of admission to the pediatric intensive care unit. Results The sample consisted of 50 individuals, 60% of which were male, with a median age of 19 [6 - 61] months. The overall score of the Functional Status Scale was 11.5 [7 - 15], and the highest scores were observed in the motor function 3 [1 - 4] and feeding 4 [1 - 4] domains. Compared to patients who were not readmitted to the pediatric intensive care unit, patients who were readmitted presented a worse overall score (p = 0.01), worse scores in the motor function (p = 0.01), feeding (p = 0.02), and respiratory (p = 0.036) domains, and a higher mortality rate according to the Pediatric Index of Mortality 2 (p = 0.025). Conclusion Evaluation of the functional status using the Functional Status Scale indicated moderate impairment in patients after discharge from the pediatric intensive care unit, mainly in the motor function and feeding domains; patients who were readmitted to the pediatric intensive care unit demonstrated worse overall functional, motor function, feeding and respiratory scores. Individuals with greater functional impairment had longer times of invasive mechanical ventilation and hospitalization in the pediatric intensive care unit.

Ventilação mecânica não invasiva na bronquiolite viral aguda: estudo de coorte retrospectivo

Objetivo: Avaliar a utilizacao da ventilacao mecânica nao invasiva (VMNI) sobre parâmetros clinicos nas primeiras 24 horas em pacientes internados em uma emergencia pediatrica com diagnostico de bronquiolite viral aguda (BVA). Materiais e Metodos: Estudo de coorte retrospectivo atraves de coleta de dados de prontuarios de criancas internadas com diagnostico de BVA que fizeram uso de VMNI em uma emergencia pediatrica durante dois invernos consecutivos. Dados coletados: demograficos (sexo, idade), caracteristicas clinicas (frequencia cardiaca, frequencia respiratoria, saturacao periferica de oxigenio), tempo de uso da VMNI, internacao em UTI pediatrica e tempo de internacao. Foram utilizados testes de Friedman e Wilcoxon para comparacao de variaveis clinicas entre cada periodo de tempo, teste de Mann-Withney e ANOVA para comparacoes entre o grupo que utilizou e nao utilizou VMNI. Resultados: Amostra composta por 14 pacientes, o tipo de virus mais prevalente foi o virus sincicial respiratorio, o modo ventilatorio nao invasivo predominantemente utilizado foi o CPAP. Nao houve diferenca significativa dos sinais vitais em relacao ao momento da instalacao da VMNI, seis, 12 e 24 horas. Na utilizacao de oxigenio suplementar houve diferenca significativa entre o momento da instalacao da VMNI e apos 24 horas. Quando comparadas as caracteristicas clinicas dos pacientes que falharam na VMNI e necessitaram de suporte ventilatorio invasivo, a frequencia cardiaca diferiu significativamente tanto no momento da instalacao da VMNI como apos 6 horas. Conclusao: Houve reducao significativa da necessidade de oxigenio suplementar apos 24 horas da instalacao da VMNI. Nao foram observadas diferencas significativas nas demais caracteristicas clinicas dos pacientes.