Julio Cesar Daneluzzi

Salivary cortisol for screening of Cushing's syndrome in children

Cushings syndrome (CS) is characterized by changes in diurnal cortisol variation and total or partial resistance to cortisol suppression by dexamethasone (DEX). Diagnosing CS is a challenge especially in childhood and requires differentiation from primary obesity. The aim was verify the efficacy of salivary cortisol in differentiating primary obesity from CS in children.

Prevalência de asma em escolares

OBJECTIVE: to assess the prevalence of asthma symptoms and of asthma in children due to the high frequency of pediatrics patients with symptoms suggestive of the disease and to the lack of data regarding prevalence of asthma in this population. METHODS: We carried out a cross-sectional study with 2,735 school-age children aged 6-7 years and 3,509 adolescents aged 13-14 years selected by random sampling. Data were collected between 1998 and 1999 using a translated version of the questionnaire of the International Study of Asthma and Allergies in Children, which has been previously tested and approved. Guardians were responsible for answering the questionnaire of younger children, whereas adolescents answered their own, in classroom. The data were computed and analyzed using EPI-info software. RESULTS: The response rates for questionnaires were 73.2% (6-7-years old) and 94% (13-14 years old). The prevalence of symptoms in children and adolescents were, respectively: wheezing ever 46.7% and 44.3% (P<0.05); wheezing in the last 12 months 22.7% and 21.2%; speech limited due to wheezing 4.7% and 4.0%; wheezing following exercise 6.3% and 18.2% (P<0.05); nighttime cough in the last 12 months 38.5% and 45.8% (P<0.05); asthma (bronchitis) ever 28.2% and 26.4% (P=0.11). CONCLUSIONS: The prevalence of asthma symptoms and of asthma of the two groups are among the highest results ever reported in Brazil; these results were compatible with those of high prevalence results reported worldwide using ISAAC questionnaires. The high prevalence of symptoms suggests a high prevalence of the disease, which makes asthma an important problem for public health in the region.

O Programa de Saúde da Família e a Puericultura

This paper suggests a proposal of Child Health Care, to children and adolescents, to be developed in the Family Health Care Programs.

Vitamin A deficiency in children aged 6 to 24 months in S~ao Paulo State, Brazil

Abstract Vitamin A deficiency (VAD), mainly the subclinical form, is endemic in several areas of the Brazilian Northeast. However, studies concerning its prevalence and etiology (risk factors) in urban areas of Sao Paulo State are lacking. The objective of the present study was to identify VAD and the risk factors among children attending a Child Care outpatient clinic in Ribeirao Preto city, Sao Paulo State, Brazil. A total of 103 children aged 6 to 24 months without any diarrhea or fever illness were selected from a pediatric outpatient clinic. A careful clinical history and physical examination provided information about breast-feeding, parental education, family income, family size, birth weight and anthropometric data. The children also underwent ophthalmologic examination to check for signs of xerophthalmia and were submitted to blood tests in order to determine hemoglobin and serum iron, zinc and retinol levels. Serum retinol levels £ 0.70 μmol/l are considered to be deficient by the World Health Organization. Retinol levels, determined by high performance liquid chromatography (HPLC), were £? 0.70 μ?mol/l in 22 children (21.4%). No child had xerophthalmia. The overall mean serum zinc level was 108.9 μg% (2SD ± 43.1 μg%) and the values for children with and without VAD were 105.1 μg% (2SD ± 44.1 μg%) and 110.0 μg% (2SD ± 43.2 μg%) respectively, with no child presenting serum zinc levels below the normal range. None of them showed a

Nível sérico de zinco e sua associação com deficiência de vitamina A em crianças pré-escolares

OBJECTIVES: To identify the prevalence of zinc deficiency in a population with high prevalence of vitamin A deficiency; to verify whether zinc deficiency is associated with vitamin A deficiency in the population studied; to verify risk factors for zinc deficiency (sex, age, diarrhea and fever). METHOD: Cross-sectional study of 182 healthy children aged > 24 months and 48 and 48 and < 60 months tended to have lower zinc serum levels than children of other ages. Zinc serum levels were not changed by previous diarrhea and/or fever.

Prevalence of asthma in school-age children

OBJECTIVE: To assess the prevalence of asthma symptoms and of asthma in children due to the high frequency of pediatrics patients with symptoms suggestive of the disease and to the lack of data regarding prevalence of asthma in this population. METHODS: We carried out a cross-sectional study with 2,735 school-age children aged 6-7 years and 3,509 adolescents aged 13-14 years selected by random sampling. Data were collected between 1998 and 1999 using a translated version of the questionnaire of the International Study of Asthma and Allergies in Children, which has been previously tested and approved. Guardians were responsible for answering the questionnaire of younger children, whereas adolescents answered their own, in classroom. The data were computed and analyzed using EPI-info software. RESULTS: The response rates for questionnaires were 73.2% (6-7-years old) and 94% (13-14 years old). The prevalence of symptoms in children and adolescents were, respectively: wheezing ever 46.7% and 44.3% (P<0.05); wheezing in the last 12 months 22.7% and 21.2%; speech limited due to wheezing 4.7% and 4.0%; wheezing following exercise 6.3% and 18.2% (P<0.05); nighttime cough in the last 12 months 38.5% and 45.8% (P<0.05); asthma (bronchitis) ever 28.2% and 26.4% (P=0.11). CONCLUSIONS: The prevalence of asthma symptoms and of asthma of the two groups are among the highest results ever reported in Brazil; these results were compatible with those of high prevalence results reported worldwide using ISAAC questionnaires. The high prevalence of symptoms suggests a high prevalence of the disease, which makes asthma an important problem for public health in the region.

Vitamin A deficiency among Brazilian school-aged children in a healthy child service

Background/Objectives:Vitamin A deficiency (VAD) is a world public health problem contributing to the increase in childhood morbidity and mortality in developing countries and severe deficiency of vitamin A may lead to xerophthalmia and blindness. The objective of this study was to determine the prevalence of VAD among Brazilian school-aged children attended at a primary health unit and to verify if some considered risk factor was associated with VAD in this group.Subjects/Methods:A descriptive prospective transverse study was conducted on 103 randomly selected children. A total of 54 boys and 49 girls aged 5.5–11 years had the relative dose–response (RDR) test performed on. Possible ocular alterations related to vitamin A and the status of anemia, serum zinc, some acute-phase proteins, and anthropometric situation were determinate by an analytic design.Results:No child presented xerophthalmia. Serum retinol values lower than 1.05 and 0.7 μmol l−1, respectively were found in 26.2 and 5.8% of the children. The prevalence of hypovitaminosis detected by RDR test was 20.4%. The following variables and their relationship with VAD were evaluated: sex (P=0.33; 95% confidence interval 0.61–4.34), weight and height (P⩾0.5), hemoglobin (P=0.15), C-reactive protein (P=0.56; 95% confidence interval 0.75–18.26), α-1-acid-glycoprotein (P=0.56; 95% confidence interval 0.15–15.42) and serum zinc (P=0.31). None of these variables was related to VAD.Conclusions:In this population, the prevalence of VAD detected could be considered a public health problem. School-aged children can be considered at risk for VAD mainly of a subclinical level, even without some associated risk factors.

Detection of vitamin A deficiency in Brazilian preschool children using the serum 30-day dose–response test

Background: Vitamin A deficiency (VAD) is endemic in Brazil and health professionals have difficulty in recognizing its subclinical form. In addition, serum retinol concentrations do not always represent vitamin A status in the organism.Objective: To identify VAD in preschool children by the serum 30-day dose–response test (+S30DR) and to examine its potential as a tool for the assessment of vitamin A status in the community.Design: A prospective transverse study in which blood samples were obtained from 188 preschool children for the determination of serum retinol concentrations and the children were submitted to ocular inspection and anthropometric measurements. Information about the presence of diarrhea and/or fever during the 15 days preceding the study was also obtained. The children received an oral dose of 200,000 IU vitamin A immediately after the first blood collection. A second blood sample was obtained 30–45 days after supplementation in order to determine the +S30DR.Results: In all, 74.5% (140/188; 95% confidence interval: 68.3–80.7%) of the children presented +S30DR values indicative of low hepatic reserves. The mean serum retinol concentration was significantly lower before supplementation (0.92 and 1.65 μmol/l, respectively; P<0.0001). No child presented xerophthalmia; 3.7% (7/188) of the children were malnourished. The presence of fever and/or diarrhea during the 15 days preceding the first blood collection did not affect the +S30DR value.Conclusions: The prevalence of VAD in the study group was elevated. +S30DR proved to be a good indicator of subclinical VAD in children from an underdeveloped country.Sponsorship: The study was supported by School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.

Zinc serum levels and their association with vitamin A deficiency in preschool children

OBJECTIVES To identify the prevalence of zinc deficiency in a population with high prevalence of vitamin A deficiency; to verify whether zinc deficiency is associated with vitamin A deficiency in the population studied; to verify risk factors for zinc deficiency (sex, age, diarrhea and fever). METHOD Cross-sectional study of 182 healthy children aged > or = 24 months and < 72 months. Peripheral blood samples were obtained from fasting children to determine zinc serum levels. Information about presence of diarrhea and/or fever during the 15 days preceding the study was also obtained. Vitamin A deficiency was identified by a serum 30-day dose-response test (+S30DR). RESULTS Of the children studied, 0.5% (1/182) presented zinc serum levels < 65 microg/dL; however, 74.7% (136/182) of them had vitamin A deficiency. Zinc serum levels were not correlated with retinol serum levels. Zinc serum levels were not changed by previous diarrhea and/or fever. There was no difference in zinc levels between boys and girls. Children aged between > or = 48 and < 60 months tended to have lower zinc serum levels than children of other ages. CONCLUSION Zinc deficiency prevalence was low and did not represent a risk factor for vitamin A deficiency. Children aged between > or = 48 and < 60 months tended to have lower zinc serum levels than children of other ages. Zinc serum levels were not changed by previous diarrhea and/or fever.

Tendência secular do aleitamento materno em uma unidade de atenção primária à saúde materno-infantil em Ribeirão Preto, São Paulo

OBJECTIVES: to determine the secular trend of breastfeeding and the average breastfeeding period among children in the Child and Mother Program of a primary health care clinic. METHODS: a retrospective survey of the medical files of children under one year old, enrolled in the Child Care Program of the Vila Lobato Community and Social Center in 1970, 1980, 1990 and 2000 followed up for at least one year. RESULTS: seven hundred and twenty eight children, 118 from 1970, 193 from 1980, 201 from 1990 and 216 from 2000 respectively. Breastfeeding, low in 1970, increased in the following years not only among the same age group in each one of the years as well as during the six first months of the year during the three years of the study. Reduction in breastfeeding frequencies during the first six months of age was higher in the first two months of age in 1970, in the first four months in 2000 and of five months in 1980 and 1990. CONCLUSIONS: Child Care Programs as in the Vila Lobato Community are an important tool to consolidade and promote breastfeeding practices.