ABSTRACT Objective: To analyze the association between low birth weight (LBW) and intrauterine growth restriction (IUGR) with handgrip strength (HGS) in adolescents. Methods: Birth cohort study from São Luís, Maranhão, Brazil, conducted between 1997 and 1998. The Jamar Plus+ dynamometer was used to measure HGS during the second follow-up. Birth weight was assessed from information from the participants’ hospital records. LBW was defined as a birth weight <2500 g, while IUGR was defined as a Kramer’s index <0.85. The associations of LBW and IUGR with HGS were estimated using linear regression models. The directed acyclic graph (DAG) was used to identify the variables for adjustment. Results: We evaluated 544 individuals who participated in the baseline and second follow-up, and 279 who participated in the first and second follow-ups. In crude and adjusted analyses, LBW was not associated with HGS. However, in the crude analysis, male adolescents with IUGR had lower HGS (β: -4.17; 95%CI -7.67; -0.66) compared with those without IUGR. In the adjusted analysis, the association was maintained, with male adolescents with IUGR showing a reduction of 4.36 kgf (β -4.36; 95%CI -7.88; -0.85) in HGS compared with those without IUGR. There was no association between IUGR and HGS in females. Conclusions: LBW was not associated with HGS. However, male adolescents with IUGR had lower HGS.
OBJECTIVE:To validate and culturally adapt a Brazilian version of the Checklist for Assessment of Gender Disadvantage (CAGED) for girls, boys, and gender-diverse adolescents, and determine the optimal cutoff point. METHODS:The original instrument, designed to assess perceptions of gender inequity among girls, was validated alongside a version for boys and gender-diverse people through seven stages: translation, synthesis, back translation, expert evaluation, pre-testing with 29 adolescents, re-evaluation, and clinical validation with 459 adolescents. To assess perceived gender discrimination, in addition to the original binary response options (yes/no), three alternative responses were tested to clarify whether "it never happened" or "it happened but does not bother me". The Content Validation Index (CVI) was calculated, with scores ≥0.80 indicating acceptable agreement. The scale's reliability was assessed using Cronbach's alpha, with a threshold of ≥0.70 indicating good internal consistency. The Self-Reporting Questionnaire (SRQ-20) was used as the gold standard to construct a receiver operating characteristic (ROC) curve and determine the optimal sensitivity, specificity, and cutoff point for the CAGED. RESULTS:The translation demonstrated excellent agreement, with all CVIs exceeding 0.80. The Cronbach's alpha in the pre-test was 0.97. Both response formats proved adequate, with CVIs of 0.83 for the binary and 0.79 for the three-response alternatives. The cutoff point with the highest sensitivity (72.08%) and specificity (82.61%) was 4. The area under the ROC curve was 0.823. CONCLUSIONS:The CAGED was successfully translated and culturally adapted for Brazilian adolescents, showing high internal consistency and clarity.
ABSTRACT Objective: To analyze the challenges in the diagnosis and care of Rett Syndrome based on the experiences of caregivers in Brazil. Methods: This study employed a convergent mixed-methods approach. Data were collected from 14 primary caregivers of children with genetically confirmed Rett Syndrome. Data collection included thematic analysis of semi-structured interviews and descriptive statistics from sociodemographic questionnaires. Results: The mean diagnostic delay was 3.6 years (standard deviation — SD=1.4 years; range, 2–6 years), with a median of 3.5 years. The distribution was assessed and deemed suitable for reporting the mean. Most cases (92.8%) were initially attributed to autism spectrum disorder. The main barriers were limited knowledge among professionals (78.6%), delays in genetic testing (92.8%), and difficulties accessing therapies. Caregivers (12 mothers, 2 fathers; mean age, 38.0 years [SD, 4.1]; 57.1% with a college degree) reported a significant physical and emotional burden, with 92.8% providing full-time care without institutional support. The qualitative analysis revealed four themes: the diagnostic journey, the battle for therapy, the impact on family life, and the burden of care. Conclusions: Diagnosis and care are hindered by knowledge gaps, systemic inefficiencies, and limited support. The findings highlight the need to improve education on rare diseases, streamline access to genetic testing and therapies, and implement support programs for caregivers.
ABSTRACT Objective: To investigate the effects of an eight-week physiotherapy program focusing on balance, coordination, and muscle strengthening on gait, mobility, posture, and motor proficiency in children with low vision. Methods: Twenty-two children aged 7-14 years with ophthalmologist-diagnosed low vision, based on World Health Organization criteria, were randomly assigned to treatment (n=10) or control (n=12) groups. The treatment group completed three 75-minute sessions per week for eight weeks, including balance, coordination, and muscle-strengthening exercises. Outcomes were assessed using the BOT-2 Short Form, New York Posture Assessment Test, Lovett muscle grading, and BTS G-Walk. Statistical analyses were performed using Statistical Package for the Social Sciences, version 25.0. Results: The treatment group showed significant pre- to post-intervention gains in total BOT-2 SF scores and in subscales related to fine motor integration, bilateral coordination, running speed, agility, and strength (p<0.05), with small to moderate effect sizes (Cohen’s d ≈ 0.30-0.90). The control group demonstrated smaller improvements, significant only in some subscales. Postural alignment increased significantly in both groups, with greater effect observed in the treatment group (Cohen’s d=0.74) (p<0.05). Gait analysis revealed increases in left step length and right pelvic propulsion only in the treatment group (p<0.05), whereas no significant changes were observed in the remaining spatiotemporal gait parameters. Manual muscle testing showed strength gains in both groups, with no statistically significant differences between them. Conclusions: An eight-week, thrice-weekly physiotherapy-based balance, coordination, and strengthening program improves motor proficiency, posture, gait, and muscle strength in children with low vision, supporting its use in pediatric rehabilitation.
OBJECTIVE:To evaluate the diagnostic value of the Outline of Unresponsiveness (FOUR) Score and Glasgow Coma Scale (GCS) to predict mortality in critically ill children with non-traumatic impaired consciousness. METHODS:In this single-center prospective observational study, children aged one month to 12 years admitted to the pediatric Intensive Care Unit (PICU) were included, and serial FOUR score and GCS at admission, 12th, and 24th hour were recorded. Children with PICU stay of <24 hours, with convulsion within the last hour, visual or motor impairment, or use of sedatives/ neuromuscular relaxants were excluded. Primary outcome: in-hospital mortality. Secondary outcome: requirement of intubation, and comparison of two scores for mortality. RESULTS:One hundred critically ill children were enrolled with a median (interquartile - IQR) age of 46.0 (10.0-84.0) months, and 53 children died during the hospital course. The GCS and FOUR scores were significantly higher among survivors (p<0.001). Both scores were independent predictors of mortality at admission and the 12th hour, but only the FOUR score was a statistically significant predictor of mortality at the 24th hour. The adjusted odds ratio (AOR) for mortality for FOUR24 was 0.505 (95% confidence interval - 95%CI 0.399-0.863) and for GCS24 score was 2.728 (95%CI 0.932-2.273). Sixty-three children needed intubation, with a median duration of 4.0 (1.0-7.0) days, and of these, 69.8% died. CONCLUSIONS:GCS and FOUR scores have comparable efficacy in predicting mortality during initial assessment. However, the FOUR score is better than GCS at the 24th hour and can hence be considered a prognostic tool.
ABSTRACT Objective: The aim of this study was to compare the nutritional status of individuals with cystic fibrosis (CF) diagnosed either through newborn screening (NBS) or based on clinical findings (early vs. late), at the time of diagnosis and 1 year later. Methods: This was an observational study including CF patients followed at a Referral Center from 2005 to 2023. Participants were classified into three subgroups according to the method and age at diagnosis: 1 (NBS); 2 (early signs and symptoms if the CF diagnosis was before 2 years of age); and 3 (late signs and symptoms if the CF diagnosis was after 2 years of age). Nutritional parameters were compared at diagnosis and 1 year after treatment. Results: A total of 63 individuals were included, 57.1% male, 81.0% non-white, and median (interquartile range) age at diagnosis of 6 (2–42) months. There were 21, 23, and 19 in subgroups 1, 2, and 3, respectively. At diagnosis, 26 (41.3%) individuals had short stature (SST) or very SST, corresponding to 57.1, 43.5, and 21.1% of children in subgroups 1, 2, and 3, respectively. After 1 year, these proportions decreased to 28.5 and 30.4% in subgroups 1 and 2, while remaining unchanged in subgroup 3. Pancreatic insufficiency was present in 85.7, 69.6, and 68.4% of participants in subgroups 1, 2, and 3, respectively. Conclusions: Short stature was frequent at diagnosis, even among children identified by NBS. After 1 year of follow-up, height improved in subgroups 1 and 2 but remained unchanged in subgroup 3. Early diagnosis and timely nutritional interventions are essential to prevent and correct growth deficits in individuals with CF.
ABSTRACT Objective: To investigate the association of constipation and stool consistency with diet quality screeners in school-aged children. Methods: A cross-sectional analysis was conducted using data from the second phase of the Botucatu Infant Cohort Study. During home visits, stool consistency was assessed using the Bristol Stool Form Scale, and the presence of constipation (yes/no) was defined according to the adapted Rome IV criteria. Dietary intake (yes/no) on weekdays and weekends of the seven foods used as dietary quality screeners by the Food and Nutrition Surveillance System (SISVAN) was assessed through telephone interviews. Two scores were calculated: the Healthy Eating Score (three fresh or minimally processed foods, range: 0–6) and the Unhealthy Eating Score (four ultra-processed foods, range: 0–8). Associations were tested using linear regression (scores vs. stool consistency) and Poisson regression (scores vs. constipation), with the significance level set at p<0.05. Results: Among 394 children (mean age: 7.9 years; SD=0.4), constipation prevalence was 10.2%. Most (68.5%) had daily bowel movements, with type 3 on the Bristol Scale being the most frequent (43.8%). Mean Healthy Eating Score was 3.7; Unhealthy Eating Score was 4.0, with no significant differences by constipation. The Unhealthy Eating Score was negatively associated with stool consistency (β=-0.10; 95%CI -0.18 to -0.02), but not with constipation. Conclusions: In school-aged children, poor dietary quality, indicated by the consumption of ultraprocessed foods and sugar-sweetened beverages, was associated with harder stools, but not with constipation. These findings reinforce the usefulness of SISVAN dietary assessment forms for identifying children at risk of constipation.
ABSTRACT Objective: This study aimed to examine the association between body weight dissatisfaction and self-reported experiences of discrimination among Brazilian adolescents, stratified by sex. Methods: Data were obtained from the "Brazilian Guide for the Assessment of Physical Fitness and Lifestyle Habits-Stage II", conducted in 2019 with a city-representative sample of school adolescents aged 14–17 years from São José, Santa Catarina, Brazil. Body weight dissatisfaction and experiences of discrimination were measured using standardized instruments and through self-report. Weighted prevalence estimates and sex-stratified logistic regression models were used to evaluate associations, adjusting for sociodemographic variables. Results: In the adjusted analysis, adolescents of both sexes who reported discrimination had higher odds of wanting to increase their body weight (odds ratio — OR 2.05; 95% confidence interval — 95%CI 1.41–2.98) and to decrease their body weight (OR 1.42; 95%CI 1.09–1.85). Stratified analyses revealed different patterns by sex: among male adolescents, discrimination was associated with higher odds of wanting to decrease body weight (OR 1.66; 95%CI 1.58–1.74), whereas among female adolescents, discrimination was associated with higher odds of wanting to increase body weight (OR 3.02; 95%CI 1.72–5.31). Conclusions: Dissatisfaction with body weight and experiences of discrimination are prevalent among Brazilian adolescents, with distinct patterns between boys and girls. Discrimination was associated with both the desire to gain and to lose weight, but in sex-specific directions, suggesting that social pressures shape body image differently for male and female adolescents.
ABSTRACT Objective: The aim of this study was to compare the sputum inflammatory profile of children and adolescents with cystic fibrosis (CF) to that of healthy saliva controls and to assess the association between these markers and key clinical variables. Methods: This is an observational study comparing a group of CF patients with a healthy control group, including sputum samples from patients aged 6–18 years, followed up at a CF referral center. All procedures were performed on the same day, including spirometry, cardiopulmonary exercise testing, and sputum collection and processing. Demographic and clinical data were collected from patient records. Results: A total of 12 CF patients were included with a mean age of 13.0±2.8 years, a mean forced expiratory volume in one second of 86.4±20.8%, and a peak oxygen consumption (VO2peak) of 35.4±4.6 mL kg −1 min−1. A predominance of neutrophils was found in the sputum. The median (interquartile range) of interleukin-8 (IL-8) was 386.8 (310.5) pg/g of protein, and thiobarbituric acid-reactive substances (TBARS) had a median of 2.2 (0.9) μM/g of protein. When comparing CF patients and healthy individuals, the CF group showed higher IL-8 concentrations (p<0.001) and increased TBARS levels (p=0.01). A correlation was found between IL-6 concentration and the number of days on antibiotics (rho=0.71; p=0.009), and an inverse moderate correlation was found between IL-8 and forced expiratory flow between 25 and 75% (FEF25–75%) (rho=-0.62; p=0.033). Conclusions: Individuals with CF exhibited increased sputum inflammation compared with healthy controls, which correlated with lung function and morbidity but not with aerobic fitness.
ABSTRACT Objective: The aim of this study was to investigate the association between pneumoniarelated mortality and morbidity and urban, environmental, and socioeconomic conditions in the administrative districts of São Paulo, Brazil. Methods: We conducted an ecological study using aggregated data from 2010 to 2020 across 96 administrative districts in ã Paulo. Mortality and hospitalization data for individuals up to 19 years old were analyzed in relation to the Geographic Index of the Socioeconomic Context for Health and Social Studies (GeoSES), housing standards, and urban conditions. Spatial analysis involved estimating relative risk using SaTScan, and Ordinary Least Squares (OLS) and Geographically Weighted Regression (GWR) were applied to assess spatial associations. Results: Between 2010 and 2020, 1486 deaths and 1,56,112 hospitalizations due to pneumonia were recorded among individuals up to 19 years old. Mortality was higher among males (54.7%) and displayed spatial clustering. Mortality rates were negatively associated with the proportion of high-standard residences and the GeoSES index and positively associated with the presence of rapid-transit roadways. The GWR model outperformed the OLS model (adjusted R2=0.44 vs. 0.40) for mortality. Hospitalization rates were more uniformly distributed and showed a weaker association with socioeconomic indicators (adjusted R2=0.17 for OLS). Conclusions: Pneumonia mortality among children and adolescents in São Paulo is spatially associated with socioeconomic and urban conditions. These findings underscore the need for geographically targeted public health interventions that address urban planning and social inequalities in disease prevention strategies.
OBJECTIVE:The aim of this study was to identify factors associated with increased caregiver burden of children with medical complexity and to guide management strategies. METHODS:This cross-sectional study was conducted in a specialized service for patients with complex chronic conditions. Caregiver burden was assessed using the Zarit Burden Interview, which measures subjective burden, encompassing emotional, social, and personal impacts associated with caregiving, and is categorized as mild, moderate, or severe according to the total score. Bivariate analyses used chi-square tests, followed by multivariable Poisson regression with robust variance estimation, with results expressed as prevalence ratios (PRs) and 95% confidence intervals; p<0.05 was considered significant. RESULTS:A total of 173 caregivers were interviewed, predominantly mothers (88.4%), with a mean age of 38.8 years, from low-income households. Among the patients, 28.7% had cerebral palsy, 59.4% used assistive devices, and 57.2% required help with daily life activities. A severe burden score was reported by 31.2%. Polypharmacy was associated with a higher prevalence of moderateto-severe caregiver burden (PR=1.48; p=0.015), whereas daily care support (PR=0.79; p=0.039) and adequate sleep (PR=0.78; p=0.027) were associated with a lower prevalence of the outcome. CONCLUSIONS:Care-related needs, particularly polypharmacy, daily care support, and sleep quality, were associated with caregiver burden level. These findings highlight potentially modifiable factors and support the integration of a family-centered approach in the clinical follow-up of children and adolescents with medical complexity.
ABSTRACT Objective: The aim of this study was to analyze the outcomes — joint range of motion, functional aspects, anatomical aspects, and complications — of percutaneous musculotendinous lengthening in children with cerebral palsy. Data source: In total, six databases were searched (Medline/PubMed, Cochrane Library, Physiotherapy Evidence Database/PEDro, LILACS, Biblioteca Virtual em Saúde/BVS, and SciELO) for publications from 2004 to 2024 on percutaneous musculotendinous lengthening in children with cerebral palsy (0–18 years), with ≥1 year of follow-up, in English or Portuguese. The quality of nonrandomized studies was assessed using the Newcastle-Ottawa Scale, and that of randomized trials using the Cochrane risk-of-bias tool. Data synthesis: Of 151 studies identified, 14 met the inclusion criteria, including three randomized trials. Methodological limitations were frequent, including short follow-up periods, demographic heterogeneity, nonuniform evaluation methods, and the lack of confounder control. Only three studies used three-dimensional gait analysis. Notably, seven studies on hamstring percutaneous musculotendinous lengthening showed functional and range-of-motion improvements. Comparisons with open techniques showed no consistent kinematic differences. Evidently, three studies on adductor percutaneous musculotendinous lengthening found increased hip abduction, with no additional benefit from subsequent open procedures. Notably, the literature regarding Achilles issues is limited to three studies; of these, a single long-term clinical trial identified a 43% recurrence rate without calcaneus deformity, whereas the remaining two were restricted to anatomical and compartment pressure-related issues. Significantly, one study confirmed lower costs and blood loss in comparison with open procedures. The use of post-op immobilization and complications — overcorrection, recurrence, nerve and muscle injury, and increased pelvic tilt — were reported. Conclusions: Percutaneous musculotendinous lengthening may offer benefits, but stronger evidence from high-quality, long-term studies is needed to confirm its effectiveness.
ABSTRACT Objective: Urinary tract infections (UTIs) are among the most common bacterial infections in childhood and a frequent cause of morbidity and antibiotic use. The aim of this study was to identify urinary pathogens in children and adolescents, assess antimicrobial resistance patterns, and analyze their correlation with clinical factors. Methods: This observational and retrospective study was conducted in a pediatric hospital from January 1 to December 31, 2022, including patients with positive urine cultures. Results: A total of 894 cases were analyzed, mostly children aged 1 to 5 years (58.6%) and female (67.9%). Escherichia coli was the main pathogen (63.1%), followed by Proteus mirabilis (11.1%) and Pseudomonas aeruginosa (6.4%). E. coli showed high resistance to ampicillin (38.9%) and trimethoprim/sulfamethoxazole (14.5%), maintaining high susceptibility to second- and third-generation cephalosporins and aminoglycosides. Extended-spectrum beta-lactamase was detected in 2.8% of samples. Previous history of UTI was the only factor significantly associated with antimicrobial resistance. Conclusions: The findings underscore the importance of continuous epidemiological surveillance to guide empirical treatment and rational antibiotic use in children.
OBJECTIVE:The aim of this study was to develop and validate the content of a nutritional risk screening tool for critically ill children and adolescents in pediatric intensive care units (PICUs). METHODS:Care-convergent study for the development and content validation of an instrument for assessing nutritional risk in children admitted to the PICU. The initial development was based on a literature review and the clinical experience of the authors. Content validation was conducted using the Delphi technique in two successive rounds with intentionally selected experts, each with a minimum of 5 years of experience in pediatric intensive nutritional therapy (NT). Consensus analysis was performed using the content validity index (CVI), with minimum values of 0.70 for individual items and 0.90 for the overall instrument. RESULTS:Validation occurred in two rounds. In the first round, 18 experts suggested adjustments, and the revised version was reassessed by 12 experts in the second round. The final tool achieved an overall CVI of 0.958. The validated version included age subgroups, presence of chronic diseases, length of prior hospitalization, subjective impression of malnutrition risk, type of NT at admission, and C-reactive protein (CRP) levels. CONCLUSIONS:The nutritional risk screening tool for critically ill pediatric patients, named NutriRisKids-ICU, was developed, and its content was validated by expert consensus. The tool combines theoretical evidence and clinical expertise, showing potential for application in PICUs. However, further studies are needed to assess its applicability, sensitivity, and specificity.
OBJECTIVE:The aim of this study was to describe electrocardiographic changes in healthy pediatric patients receiving low-dose ondansetron and to determine whether these changes are associated with the occurrence of cardiac dysrhythmias. DATA SOURCE:The search was conducted in PubMed, EMBASE, LILACS, SciELO, and the Cochrane databases, selecting articles published until September 2024. The primary outcome was the mean change in the corrected QT interval (QTc) interval. The mean variation of the Tp-e interval and the incidence of significant QTc prolongation were assessed as secondary outcomes. DATA SYNTHESIS:Four studies were included in this review, including 231 healthy pediatric patients who received ondansetron (IV or oral). Most were male, aged 0.6-18 years. The mean IV ondansetron dose ranged from 0.1 to 0.2 mg/kg, while the mean oral dose was 0.18 mg/kg, with a maximum dose of 8 mg. The mean change in the QTc interval was 4.7 ms (95% confidence interval [CI] 1.48.1), and in the Tp-e interval was 7.7 ms (95%CI 2.0-13.5). The risk of a significant QTc prolongation was 2.5% (95%CI -0.009-0.059). No dysrhythmia was observed in the studies. CONCLUSIONS:There was a statistically significant increase in QTc and Tp-e intervals following ondansetron administration in healthy pediatric patients. However, it is highly unlikely that these changes result in cardiac dysrhythmia, suggesting no relationship between low-dose ondansetron use and an increased risk of dysrhythmia in healthy pediatric patients.
Objective: The aim of this study was to evaluate the role of the triglyceride-glucose (TyG) index in identifying changes in lipid profile and atherogenic risk in adolescents, according to the presence or absence of excess weight. Methods: This cross-sectional study included 823 students aged 10-18 years, classified as having or not having excess weight based on body mass index. Lipid profile was assessed and classified according to the guidelines of the Brazilian Society of Cardiology. Atherogenic risk was evaluated using the Castelli I and II indices, the Atherogenic Index of Plasma, and the atherogenic coefficient. The TyG index was assessed in tertiles. The association between TyG and lipid and atherogenic outcomes was analyzed using logistic and linear regression, stratified by excess weight status. Results: Elevated TyG was associated with altered total cholesterol (TC), high-density lipoproteincholesterol (HDL-c), low-density lipoprotein-cholesterol (LDL-c), and non-HDL-c in adolescents without excess weight (p<0.001), whereas in those with excess weight, this association was found only in TC and non-HDL-c. All atherogenic indices were positively associated with elevated TyG (p<0.001). Conclusions: Adolescents without excess weight showed clearer associations between TyG and lipid profile; however, atherogenic risk was directly associated with elevated TyG, regardless of the presence or absence of excess weight.
Objective: The aim of this study was to analyze the prevalence, associated factors, and the relationship between the existence of school violence prevention policies and physical aggression victimization among Brazilian adolescents. Methods: Cross-sectional study based on data from the 2015 National School Health Survey (PeNSE). The sample included 15,954 adolescents aged 11-19 years, enrolled in public and private schools across all regions of Brazil. Victimization was measured through self-reported experiences of physical aggression in the past 12 months. Sociodemographic, behavioral, relational, and school-related variables were analyzed. The association between these variables and victimization was estimated using Poisson regression with robust variance. Results: The prevalence of physical aggression victimization was 17.1%. Factors associated with higher prevalence included male sex, Black or other non-White ethnicities, reports of bullying, alcohol and cigarette use, high screen time, and being physically active. In contrast, older age and having a larger number of friends were protective factors. The presence of integrated actions with primary health care was associated with a lower likelihood of victimization (PR 0.82; 95%CI 0.74-0.90; p<0.001), whereas formal school policies showed no significant association. Conclusions: Physical aggression victimization among adolescents isa relevant and multifactorial problem. Intersectoral actions between health and education have the potential to reduce school violence, whereas isolated policies are ineffective without community engagement and a contextualized approach.
