José Carlos Dalmas

The impact of different types of physical activity on total and regional bone mineral density in young Brazilian athletes.

Abstract Bone turnover is affected by exercise throughout the lifespan, especially during childhood and adolescence. The objective of this study was to investigate the impact of different sports on total and regional bone mineral density in male Brazilian adolescent athletes. Forty-six adolescents aged 10–18 years participated in the study: 12 swimmers, 10 tennis players, 10 soccer players, and 14 sedentary individuals. The athletes had engaged in physical activities for more than 10 h per week in the previous 6 months. Bone mineral density of the lumbar spine (L1–L4), left proximal femur region, and whole body was evaluated by dual-energy X-ray absorptiometry. Results showed higher mean values in the proximal femur region of tennis and soccer players (1.02 ± 0.18; 0.96 ± 0.16, respectively) than swimmers and controls (0.91 ± 0.14 and 0.87 ± 0.06, respectively) (P < 0.05). In relation to the impact of sporting activities based on bone age determination, we observed significant differences in bone mineral density at all evaluated sites at the end of puberty (16–18 years) compared with 10–12 years, with increases of 78% in the lumbar spine, 47% in the proximal femur, and 38% in the whole body.

Mineralização óssea em adolescentes do sexo masculino: anos críticos para a aquisição da massa óssea

OBJETIVO: Verificar o comportamento do conteudo mineral osseo e da densidade mineral ossea em adolescentes do sexo masculino em funcao da faixa etaria e do nivel maturacional dos caracteres sexuais secundarios. METODOS: 47 adolescentes saudaveis na faixa etaria de 10 a 19 anos foram avaliados quanto a ingestao de calcio, peso, estatura, indice de massa corporal, estagio puberal, densidade mineral ossea e conteudo mineral osseo na coluna e no femur proximal. A massa ossea foi mensurada atraves de densitometria ossea. A ingestao de calcio foi calculada atraves de registro dietetico de 3 dias. O indice de massa corporal foi calculado pelo Indice de Quetelet, e o estagio puberal foi definido segundo os criterios de Tanner. Foi utilizada estatistica descritiva, media e desvio padrao, analise de variância para comparacao entre os grupos etarios e teste de Tukey para localizar as diferencas significativas. RESULTADOS: A ingestao de calcio nao alcancou o valor minimo de 800 mg em varias faixas etarias estudadas. A densidade mineral ossea e o conteudo mineral osseo demonstraram incrementos com o avancar da idade, indicando diferencas significativas a partir dos 14 anos, bem como quando os adolescentes atingiam os estagios de maturacao sexual G4. Os parâmetros de mineralizacao revelaram aumento pronunciado quando os adolescentes atingiam G3, porem sem significado estatistico. CONCLUSAO: Os resultados apontam um aumento importante na mineralizacao ossea durante a adolescencia. A evidencia de aumento na mineralizacao dos adolescentes foi percebida em niveis maturacionais superiores a G3. Os anos criticos para a aquisicao da massa ossea neste estudo evidenciaram-se a partir dos 14-15 anos de idade.

Impacto da maturação esquelética em biomarcadores do metabolismo ósseo e na densidade mineral óssea em adolescentes brasileiros saudáveis

OBJECTIVE: To evaluate the behavior of biomarkers of bone formation and resorption in healthy male Brazilian adolescents according to their biological maturation. METHODS: Eighty-seven volunteers were divided into age groups according to bone age (BA): 10-12 years (n = 25), 13-15 years (n = 36), and 16-18 years (n = 26). Weight (kg), height (m), body mass index (kg/m2), calcium intake from 3 days assessed by 24-h food recall (mg/day), pubertal event evaluation by Tanner criteria, and serum biomarker levels (osteocalcin [OC] [ng/mL], bone alkaline phosphatase [BAP] [U/L], and serum carboxyterminal telopeptide [S-CTx] [ng/mL]) were recorded and correlated to bone mineral density (BMD) (g/cm2) measured by dual energy X-ray absorptiometry of the lumbar spine, proximal femur, and whole body. RESULTS: Biomarkers showed similar behaviors, presenting higher median values in the 13-15 year group (BAP = 154.71 U/L, OC = 43.0 ng/mL, S-CTx = 2.09 ng/mL; p < 0.01) and when adolescents were in the pubertal stage G4. Median biomarker values decreased with advancing BA and sexual maturation. Biomarker values showed parallelism with peak height velocity, and, interestingly, bone formation biomarkers indicated significant negative correlation with BMD in the different evaluated locations, i.e., higher BMD values correlated with lower bone biomarker values. CONCLUSIONS: This is the first study of healthy Brazilian adolescents with rigid and careful inclusion and exclusion criteria to assess the correlation of bone markers and BMD with biological maturation indicators. Our results can help understand bone turnover and monitor bone metabolism.OBJECTIVE To evaluate the behavior of biomarkers of bone formation and resorption in healthy male Brazilian adolescents according to their biological maturation. METHODS Eighty-seven volunteers were divided into age groups according to bone age (BA): 10-12 years (n = 25), 13-15 years (n = 36), and 16-18 years (n = 26). Weight (kg), height (m), body mass index (kg/m(2)), calcium intake from 3 days assessed by 24-h food recall (mg/day), pubertal event evaluation by Tanner criteria, and serum biomarker levels (osteocalcin [OC] [ng/mL], bone alkaline phosphatase [BAP] [U/L], and serum carboxyterminal telopeptide [S-CTx] [ng/mL]) were recorded and correlated to bone mineral density (BMD) (g/cm(2)) measured by dual energy X-ray absorptiometry of the lumbar spine, proximal femur, and whole body. RESULTS Biomarkers showed similar behaviors, presenting higher median values in the 13-15 year group (BAP = 154.71 U/L, OC = 43.0 ng/mL, S-CTx = 2.09 ng/mL; p < 0.01) and when adolescents were in the pubertal stage G4. Median biomarker values decreased with advancing BA and sexual maturation. Biomarker values showed parallelism with peak height velocity, and, interestingly, bone formation biomarkers indicated significant negative correlation with BMD in the different evaluated locations, i.e., higher BMD values correlated with lower bone biomarker values. CONCLUSIONS This is the first study of healthy Brazilian adolescents with rigid and careful inclusion and exclusion criteria to assess the correlation of bone markers and BMD with biological maturation indicators. Our results can help understand bone turnover and monitor bone metabolism.

Análise preditiva da densidade mineral óssea em adolescentes brasileiros eutróficos do sexo masculino

Osteoporosis is considered one of the most serious public health diseases and studies show that it is a pediatric disease that manifests during senility. It is usually diagnosed in clinical practice by dual-energy x-ray absorptiometry (DXA). This exam has a high cost and it is difficult to apply to a pediatric population because specific equipment and special software are required. This study presents predictive equations to evaluate the bone mineral density (BMD) among male adolescents. To better predict the equations, some parameters were used as the bone age (by left hand and wrist x-ray), pubertal stages, weight, height and the lumbar spine and femur BMD from 61 healthy adolescents, ages 10 through 19 years. The prediction models were carried through analysis of multiple regressions stepwise. The results have indicated a prediction model for BMD with a coefficient of 0.87 and 0.80, respectively for the spine and the femoral regions. In conclusion, the results have confirmed that BMD depends on the skeletal age and the physical growth during adolescence. The proposed equations are easy to use, has a low operational cost, and the clarification rate is 75% and 65% for lumbar spine and femoral BMD, respectively.

Bone mineralization among male adolescents: critical years for bone mass gain

OBJECTIVE To verify the behavior of the mineral bone content and density in male adolescents according to age and secondary sexual characters. METHODS 47 healthy adolescents between 10 and 19 years of age were assessed according to weight, height, body mass index, puberty stage, calcium intake, bone mineral density and content in the lumbar spine and in the proximal femur. The bone mass was measured through bone densitometries. The intake of calcium was calculated through a 3-day diet. The BMI (body mass index) was calculated with the Quetelet Index and the puberty stage was defined according to Tanners criteria. The analysis used descriptive statistics such as average and standard deviation, and variance estimates to compare the different age groups. Moreover, the Tukey test was used to determine the significant differences. RESULTS It was evident that the calcium intake in the different ages assessed has not reached the minimum value of 800 mg. The bone mineral density and content showed an increase after the age of 14, as well as when the teenagers reached the sexual maturation stage G4. The mineralization parameters showed a high level when the teenagers were in the G3 stage, however, without statistical significance. CONCLUSION The results indicate an important level of bone mineralization during adolescence. Maturation levels superior to G3 have shown more mineralization. This study proves that the critical years for bone mass gain start after the age of 14-15 years or older.

Bone metabolism biomarkers, body weight, and bone age in healthy Brazilian male adolescents.

Abstract Eighty-seven male volunteers were grouped according to bone age (BA): 10–12 years (n=25), 13–15 years (n=36), and 16–18 years (n=26), and the following were recorded for each: weight (kg), height (m), BMI (kg/m2), calcium intake from three 24-h food recalls (mg/day), puberty evaluation by Tanner stages, bone biomarker (BB) evaluation, serum osteocalcin (OC), bone alkaline phosphatase (BAP), carboxyterminal telopeptide (S-CTx), and bone mineral density (BMD) evaluations by dual-energy X-ray absorptiometry (g·cm2) in the lumbar spine, proximal femur, and the whole body. BBs showed similar behaviors, and very high median values were observed for individuals aged 13–15 years (BAP=155.50 IU/L, OC=41.63 ng/mL, S-CTx=2.09 ng/mL). Lower median BB values were observed with advancing BA between 16 and 18 years (BAP=79.80 IU/L, OC=27.80 ng/mL, S-CTx=1.65 ng/mL). Stepwise multiple regression analysis showed body weight associated with BA as independent variables with greater determination power for S-CTx (r2=0.40) and OC (r2=0.21). For BAP, stepwise analysis showed body weight and whole-body BMD (r2=0.34). All predictive models showed significance (p<0.01). A high turnover for both bone formation and resorption biomarkers, particularly from 13 to 15 years of BA, were observed along with very low values in the 16–18 age range. Weight and BA were significant in determining predictive equations of OC and of S-CTx, whereas for BAP, weight and BMD of full body were selected.

Respostas agudas pós-exercício dos níveis de lactato sanguíneo e creatinofosfoquinase de atletas adolescentes

The growing interest of children and adolescents in competitive sports demands a higher concern with suitable training prescription to this specific population. The knowledge of the impact of the competitive physical training intensity over the young populations health is still scarce in the literature. Thus, the aim of this study was to examine acute responses in blood lactate (Lac) and creatine phosphokinase (CPK) concentration after a physical training session with young athletes trained in different sports modalities. Forty-three male adolescents (aged 9-17 years) were divided in three groups: swimmers, tennis players, and indoor soccer players. There were no changes in rules or procedures before or after the practice session. Diet and activity (no exercise) were standardized during the twenty-four hours before the evaluation. Venous blood samples (5 mL) were collected from the antecubital vein immediately before and after the training session. The bone age was obtained through the Greulich & Pyle method and was analyzed for skeleton maturity grading. Statistical analysis included Kruskal-Wallis variance analysis and Mann-Whitney U test (alpha was set at 0.05). Both Lac and CPK were higher post-session than pre-session in all sports studied. Age appeared to influence Lac and CPK concentration. The age group between nine and eleven years old had lower values compared to the older group, both pre- and post-session. The increases in CPK and Lac with exercise are similar to the findings previously reported in the literature. Moreover, CPK and Lac are higher with older chronological age. Thus, it is possible to demonstrate that Lac and CPK have a positive correlation to bone maturation and chronological age.

Quality assessment of the wound dressing procedure in patients at a university hospital

Estudio observacional y seccional analizo la calidad del procedimiento curativo, realizado en pacientes internadosen una unidad medico-quirurgica de un Hospital Universitario, de acuerdo con el grado de dependencia asistencial ylas fases de realizacion de la actividad. Con la utilizacion de un instrumento tipo check list fueran observados 168curativos, entre octubre y diciembre 2005. La cualidad de los procedimientos fue analizada basada en el Indice dePositividad (IP) y fueron considerados satisfactorios aquellos que alcanzaron valoresThis observational and sectional study analyzed the quality of the wound dressing procedure performed on hospitalized patients at a medical surgical unit of a University Hospital, based on their classification according to the degree of care dependency and activity performance phases. Using a check list, 168 wound dressings were observed between October and December 2005. Procedure quality was analyzed based on the Positivity Index (IP) and values >70% were considered satisfactory. For the preparation, the IP was 68%, 63%, 73% and 75% for patients with degrees I, II, III and IV, respectively; for execution, 70%, 69%, 71% and 75% and, for unit organization, it was >70% for all degrees. However, the items: validity time frame checking, respect for aseptic principles and maintenance of logical sequence of procedures were compromised. Rigorous execution of procedures allows for risk decrease and assures beneficial results for patients, conferring quality to nursing actions.

AVALIAÇÃO DA QUALIDADE DO PROCEDIMENTO CURATIVO EM PACIENTES INTERNADOS EM UM HOSPITAL UNIVERSITÁRIO

Estudio observacional y seccional analizo la calidad del procedimiento curativo, realizado en pacientes internadosen una unidad medico-quirurgica de un Hospital Universitario, de acuerdo con el grado de dependencia asistencial ylas fases de realizacion de la actividad. Con la utilizacion de un instrumento tipo check list fueran observados 168curativos, entre octubre y diciembre 2005. La cualidad de los procedimientos fue analizada basada en el Indice dePositividad (IP) y fueron considerados satisfactorios aquellos que alcanzaron valoresThis observational and sectional study analyzed the quality of the wound dressing procedure performed on hospitalized patients at a medical surgical unit of a University Hospital, based on their classification according to the degree of care dependency and activity performance phases. Using a check list, 168 wound dressings were observed between October and December 2005. Procedure quality was analyzed based on the Positivity Index (IP) and values >70% were considered satisfactory. For the preparation, the IP was 68%, 63%, 73% and 75% for patients with degrees I, II, III and IV, respectively; for execution, 70%, 69%, 71% and 75% and, for unit organization, it was >70% for all degrees. However, the items: validity time frame checking, respect for aseptic principles and maintenance of logical sequence of procedures were compromised. Rigorous execution of procedures allows for risk decrease and assures beneficial results for patients, conferring quality to nursing actions.

Prevalence of Metabolic Syndrome among nursing personnel and its association with occupational stress, anxiety and depression.

; ;OBJETIVO: ; ; identificar la prevalencia del Sindrome Metabolico entre trabajadores de enfermeria y su asociacion con el estres ocupacional, ansiedad y depresion. ; ; ; ;METODO: ; ; estudio descriptivo, correlacional, con 226 trabajadores de enfermeria de un hospital universitario. La recoleccion de datos fue realizada por medio de la aplicacion de la Job Stress Scale, de la Escala Hospitalaria de Ansiedad y Depresion y del cuestionario sociodemografico, con variables del Sindrome Metabolico. Fueron utilizados analisis univariados y pruebas Chi-cuadrado y de Pearson para evaluar la correlacion entre las variables, con nivel de significacion de 5%. ; ; ; ;RESULTADOS: ; ; los trabajadores que presentaron Sindrome Metabolico fueron 86 (38,1%); de los trabajadores que tomaron parte en el estudio 183 eran (81,1%) del sexo femenino y 43 (19,9%) del sexo masculino, con edades entre 23 y 66 anos. En relacion a la ansiedad y depresion, 154 (68,1%) presentaron ansiedad, siendo que 48 (31,2%) tambien presentaron el Sindrome Metabolico; 185 (81,8%) presentaron depresion, de los cuales 62 (33,5%) tambien tenian el Sindrome Metabolico; y, se verifico que 61 (27,0%) trabajadores presentaron estres y de estos 14 (22,9%) presentaron el Sindrome Metabolico. ; ; ; ;CONCLUSION: ; ; se constato correlacion entre las variables ansiedad y Sindrome Metabolico y estres y Sindrome Metabolico, sin correlacion entre las variables depresion y Sindrome Metabolico. ; ;OBJECTIVE: to identify the prevalence of Metabolic Syndrome among nursing personnel, and its association with occupational stress, anxiety and depression. METHOD: a descriptive correlational study undertaken with 226 nursing personnel from a teaching hospital. Data collection was undertaken through application of the Job Stress Scale, the Hospital Anxiety and Depression Scale and a sociodemographic questionnaire, with variables of Metabolic Syndrome. Univariate analyses and Chi-squared and Pearson tests were used for correlation between the variables, with a level of significance of 5%. RESULTS: 86 (38.1%) workers presented Metabolic Syndrome, of whom 183 (81.1%) were female, and 43 (19.9%) male, aged between 23 and 66 years old. In relation to anxiety and depression, 154 (68.1%) presented anxiety, with 48 (31.2%) also presenting Metabolic Syndrome; 185 (81.8%) presented depression, of whom 62 (33.5%) also had Metabolic Syndrome. It was ascertained that 61 (27.0%) workers presented stress and that of these, 14 (22.9%) presented Metabolic Syndrome. CONCLUSION: a correlation was observed between the variables of anxiety and Metabolic Syndrome and stress and Metabolic Syndrome, there being no correlation between the variables of depression and Metabolic Syndrome.