Denise Barbieri Marmo

Effects of swimming on spirometric parameters and bronchial hyperresponsiveness in children and adolescents with moderate persistent atopic asthma

OBJECTIVE To investigate the medium-term benefits of a swimming program in schoolchildren and adolescents with moderate persistent atopic asthma (MPAA). METHODS A randomized, prospective study of children and adolescents (age 7-18 years) with MPAA was carried out at the Hospital de Clínicas of Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil. After a 1-month run-in period, 61 patients (34 female) were randomized into two groups, a swimming group (n = 30) and a control group (n = 31), and followed for 3 months. Both patient groups received inhaled fluticasone (dry powder, 250 mcg twice a day) and salbutamol as needed. The swim training program consisted of two weekly classes over a 3-month period for a total of 24 sessions. Both groups underwent spirometric assessment and methacholine challenge test--provocative concentration of methacholine causing a 20% fall in FEV1 (PC₂₀)--before and after the study period. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were measured only in the swimming group. RESULTS Significant increases in PC₂₀ (pre-training, 0.31±0.25; post-training, 0.63±0.78; p = 0.008), MIP (pre-training, 67.08±17.13 cm H₂O; post-training 79.46±18.66; p < 0.001), and MEP (pre-training, 71.69±20.01 cm H₂O; post-training, 78.92±21.45 cm H₂O; p < 0.001) were found in the swimming group. CONCLUSION Children and adolescents with MPAA subjected to a swim training program experienced a significant decrease in bronchial hyperresponsiveness, as determined by increased PC₂₀ values, when compared with asthmatic controls who did not undergo swim training. Participants in the swimming group also showed improvement in elastic recoil of the chest wall.

Avaliação espirométrica e da hiper-responsividade brônquica de crianças e adolescentes com asma atópica persistente moderada submetidos a natação

OBJECTIVE: To investigate the medium-term benefits of a swimming program in schoolchildren and adolescents with moderate persistent atopic asthma (MPAA). METHODS: A randomized, prospective study of children and adolescents (age 7-18 years) with MPAA was carried out at the Hospital de Clinicas of Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil. After a 1-month run-in period, 61 patients (34 female) were randomized into two groups, a swimming group (n = 30) and a control group (n = 31), and followed for 3 months. Both patient groups received inhaled fluticasone (dry powder, 250 mcg twice a day) and salbutamol as needed. The swim training program consisted of two weekly classes over a 3-month period for a total of 24 sessions. Both groups underwent spirometric assessment and methacholine challenge test - provocative concentration of methacholine causing a 20% fall in FEV1 (PC20) - before and after the study period. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were measured only in the swimming group. RESULTS: Significant increases in PC20 (pre-training, 0.31±0.25; post-training, 0.63±0.78; p = 0.008), MIP (pre-training, 67.08±17.13 cm H2O; post-training 79.46±18.66; p < 0.001), and MEP (pre-training, 71.69±20.01 cm H2O; post-training, 78.92±21.45 cm H2O; p < 0.001) were found in the swimming group. CONCLUSION: Children and adolescents with MPAA subjected to a swim training program experienced a significant decrease in bronchial hyperresponsiveness, as determined by increased PC20 values, when compared with asthmatic controls who did not undergo swim training. Participants in the swimming group also showed improvement in elastic recoil of the chest wall.

Violência doméstica contra crianças e adolescentes: um desafio

OBJECTIVE: To study children and adolescents victims of domestic violence treated at the Referenced Pediatric Emergency Unit of the Hospital de Clinicas of the Universidade Estadual de Campinas and its specialized outpatient clinic between January 2003 and December 2007, emphasizing sexual abuse. METHODS: The variables gender, age, origin, and classification were studied. For victims of sexual abuse, the following variables were also studied: type of abuse (rape), location (domestic/urban), duration (acute/chronic), perpetrator (known, incestuous), alterations at medical examination, notification to child protection agencies, and antiretroviral medication and serology (HIV, syphilis, hepatitis B and C). Patients were divided into two groups according to the type of abuse and type of perpertrator and they were associated with gender, age, and duration. For the comparison, chi-squared or Fishers exact test were performed (significance p < 0.05), as well as raw prevalence odds ratio. RESULTS: Of the total cases of abuse (551), neglect (33.9%) and sexual abuse (31.9%) predominated; the victims were female in 55.9% of the cases, and 50% were up to 5 years of age. Of the sexual abuse cases (95), 80% were female, and 58.9% were between 5 and 10 years of age. Rape was observed in 39% and indecent assault in 59.6%; 72.6% occurred in the domestic area, 81.1% by known perpetrator; 31.6% were incestuous, 47.4% were chronic, and 76.5% had no clinical alterations. 81.1% were referred to child protection agencies. Antiretroviral medication was prescribed to 49.1% of patients, and serological tests (HIV in 46 [48.4%], syphilis in 42 [44.2%], hepatitis B in 44 [46.3%] and hepatitis C in 45 [47.4%]%), all of which were negative, were more frequent in rape victims (p = 0.00). There was an association between rape and age (10 and 15 years, p = 0.01) and between incestuous perpetrator and chronic duration (p = 0.01). CONCLUSION: Although this study does not reflect reality, it can be used as a warning to pediatricians.

Tendência secular de crescimento em escolares de Paulínia, São Paulo-Brasil (1979/80 - 1993/94)

BACKGROUND: The purpose of this study was to evaluate the secular trends in height, weight and weight/height of schoolchildren from the city of Paulinia, Sao Paulo, Brazil between 1979/80 and 1993/94. METHODS: Anthropometric measurements (height, weight and weight/height) of 1,903 children (6.5-12.5y); 51.5% M: 48.5% F, from Paulinia public schools were compared with data from a previous study carried out in the same city 15 years earlier. Decade increments were calculated and data was smoothed by the technique of means and medians (3H3H3). RESULTS: Height and weight mean values were always greater than those of the previous study, with positive increments. Height increments ranged from 1.13 to 5.0 cm in boys and from 1.2 to 4.33cm in girls. Weight increments ranged from 0.53 to 4.13kg in males and from 0.87 to 3.0kg in females. In the two studies, weight/height means were very similar for both genders. CONCLUSIONS: Increments in height and weight during this period are an indicator of development on the economical and health levels. A positive secular trend was also observed in developed countries after the 2nd World War and in the Brazilian people.

Correlação entre o índice de massa corporal e a prega cutânea tricipital em crianças da cidade de Paulínia, São Paulo, SP

UNLABELLED Body mass index (BMI) has been considered a criterion to define and analyse obesity in adults and children. BACKGROUND the purpose of this study was to evaluate the correlation between BMI and triceps skinfold (TSF). METHODS there were studied 4,236 children (3.1-10.9y); 48.3%M:51.6%F, from four studies made in Paul nia, SP-Brazil. Height, weight and TSF (Holtain caliper) were measured. For each children BMI was calculated and transformed in SDS, according to North American data (Frisancho, 1993). Multiple linear regression analysis (stepwise) was used for the whole population and in three groups according to BMI: A) SDS < or = -1.0; B) -1.0 < SDS< 1.0) SDS(3) 1.0. Data were processed with SPSS software. RESULTS in group A, the TSF (7.8 +/- 2.3) variability was lower when compared with the groups B (10.1 +/- 4.0) and C (17.8 +/- 6.2). In multiple linear regression with the whole population, R = 0.478 for TSF. In groups B and C, R = 0.364 and 0.368 respectively for TSF, and in group A it was only 0.032. CONCLUSIONS these observations demonstrated a height correlation between BMI and TSF in children with obesity risk (group C). Therefore, we conclude that, in Brazil BMI can be used for childrens research of obesity in population studies, instead of TSF.

Domestic violence against children (First Part)

The authors interviewed 76.2% of the pediatricians from the Pediatric Department-School of Medical Sciences-Campinas University-UNICAMP, to analyse the difficulties of this professional group in the evaluation of the domestic violence against children. From the group of professionals, 86.7% had already attended a situation involving child abuse; the therapeutic aspects were referred in 44.4% as most important, and in 46%, the difficulties in the diagnostic aspects were referred. They conclude that, despite the experiences with the theme, a lot more could be done and studied.

Sala de emergência em pediatria: casuística de um hospital universitário

AbStRAct Objective : Describe the clinical course of pediatric patients treated at a pediatric emergency room in a university hospital. Methods : This retrospective descriptive study was conducted between January 1 st and December 31 st , 2004. Data retrieved were: demographical and clinical characacteristics, diagnostic hy-potheses, need of tracheal intubation, deaths, transfers and need of hospitalization of children between zero and 14 years old. Patients were divided in four groups: no deaths; deaths 24 hours; transfers to other hospitals after initial care. Results : 203 children were treated: 59.1% boys; mean age of 3.4 years; 65% previously healthy. The most common diag-nosis was respiratory failure (31.1%). Of the 22 deaths, 3.5% took place during the first 24 hours and 7.4% after this; 172 children (84.7%) were discharged after a mean hospital length of stay of 19.2 days. Nine children (4.4%) were transferred to other hospitals. Among the 203 children, 50 children (24.6%) were intubated after admission and 86 children (42.4%) had to be admitted to a pediatric intensive care unit.

Domestic violence against children and adolescents: a challenge

OBJECTIVE To study children and adolescents victims of domestic violence treated at the Referenced Pediatric Emergency Unit of the Hospital de Clínicas of the Universidade Estadual de Campinas and its specialized outpatient clinic between January 2003 and December 2007, emphasizing sexual abuse. METHODS The variables gender, age, origin, and classification were studied. For victims of sexual abuse, the following variables were also studied: type of abuse (rape), location (domestic/urban), duration (acute/chronic), perpetrator (known, incestuous), alterations at medical examination, notification to child protection agencies, and antiretroviral medication and serology (HIV, syphilis, hepatitis B and C). Patients were divided into two groups according to the type of abuse and type of perpertrator and they were associated with gender, age, and duration. For the comparison, chi-squared or Fishers exact test were performed (significance p < 0.05), as well as raw prevalence odds ratio. RESULTS Of the total cases of abuse (551), neglect (33.9%) and sexual abuse (31.9%) predominated; the victims were female in 55.9% of the cases, and 50% were up to 5 years of age. Of the sexual abuse cases (95), 80% were female, and 58.9% were between 5 and 10 years of age. Rape was observed in 39% and indecent assault in 59.6%; 72.6% occurred in the domestic area, 81.1% by known perpetrator; 31.6% were incestuous, 47.4% were chronic, and 76.5% had no clinical alterations. 81.1% were referred to child protection agencies. Antiretroviral medication was prescribed to 49.1% of patients, and serological tests (HIV in 46 [48.4%], syphilis in 42 [44.2%], hepatitis B in 44 [46.3%] and hepatitis C in 45 [47.4%]%), all of which were negative, were more frequent in rape victims (p = 0.00). There was an association between rape and age (10 and 15 years, p = 0.01) and between incestuous perpetrator and chronic duration (p = 0.01). CONCLUSION Although this study does not reflect reality, it can be used as a warning to pediatricians.

P01-215 - Child sexual abuse: a literature review of psychosocial and psychodynamic aspects

Objectives To review the literature on child sexual abuse with emphasis on psychosocial/psychodynamic aspects.Methods Systematic literature review from the articles indexed in Medline, PSYinfo, Pepsic, Lilacs and Scielo in the last ten years. Terms researched were: child sexual abuse, psychosocial, psychodynamic and psychoanalysis.Results Child sexual abuse can have devastating consequences for the psychological functioning of children, possibly interfering with their proper process of development. It can contribute to violent behavior, acts of delinquency and mental disorders in adolescence and adulthood, as well as the development of comorbid post-traumatic stress and self-aggressive behaviors, risk behaviors and teenage pregnancy. Gravity of psychic consequences increase in relation to the frequency of abuse. Aspects of power, seduction and coercion are involved. Inequalities of age and gender are highlighted. Often practiced without the use of physical force, it may be difficult to be proven. A frequent abuser of familiarity with the child creates conditions that foster abuse. The revelation of the abuse may not occur, perpetuating the suffering and helplessness of the child. Sexually abused children may develop identification with the abuser and even become sexual offenders in adulthood. There are difficulties in the conceptual definition of abuse, the establishment of protocols for investigative and therapeutic management of cases and in predicting the immediate consequences along with the medium and long-term consequences.Conclusions Studies on the therapeutic practices used for the treatment of abused children and their families can help to construct therapeutic models, minimizing suffering in this terrible situation of violence.