18 research outputs found
(Des)vinculações de Planos Municipais de Educação metropolitanos com outros instrumentos de gestão local da educação
Capacidade aeróbica em crianças e adolescentes com asma intermitente e persistente leve no perÃodo intercrises
Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study
Summary
Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally.
Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies
have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of
the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income
countries globally, and identified factors associated with mortality.
Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to
hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis,
exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a
minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical
status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary
intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause,
in-hospital mortality for all conditions combined and each condition individually, stratified by country income status.
We did a complete case analysis.
Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital
diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal
malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome
countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male.
Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3).
Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income
countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups).
Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome
countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries;
p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients
combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11],
p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20
[1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention
(ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety
checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed
(ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of
parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65
[0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality.
Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome,
middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will
be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger
than 5 years by 2030
Metodologia para o planejamento de aulas de hidroginástica
<p>O objetivo desse estudo foi analisar uma metodologia para o planejamento de aulas de hidroginástica. Dezessete mulheres realizaram individualmente uma aula de hidroginástica. Obteve-se o consumo de oxigênio (analisador de gases <em>TEEM 100</em>) e a frequência cardÃaca (frequencÃmetro<em> Polar<sup>®</sup>-Accurex Plus</em>) a cada 20 segundos, sendo a concentração de lactato sanguÃneo (lactÃmetro portátil Biosen 5030 <em>EKF-Diagnostic</em>) e o Ãndice de percepção de esforço (IPE) (Escala de Borg) verificados a cada 5 minutos e 50 segundos. A estatÃstica utilizada apresentou valores médios e a variância (<em>ANOVA OneWay</em> com<em> Post-hoc</em> de <em>Bonferroni</em>) para cada variável entre as fases e os seis blocos da aula (<em>p </em>< .05). Os resultados mostraram que as variáveis aumentaram progressivamente até o bloco 4 e partir do bloco 5 começaram a diminuir, confirmando a estrutura de pirâmide previamente elaborada. Os valores médios da fase principal da aula sugerem que a prática regular de aulas de hidroginástica nessas condições, provavelmente proporcionará a melhora do condicionamento fÃsico aeróbico em sujeitos com caracterÃsticas semelhantes aos do grupo avaliado, com IPE razoavelmente fácil. Conclui-se que a estrutura da aula sugerida poder ser eficiente na elaboração de aulas de hidroginástica.</p
Estudo das medidas antropométricas e das proporções orofaciais em crianças respiradoras nasais e orais de diferentes etiologias Study of anthropometric measurements and orofacial proportions of nasal- and mouth-breathing children from different etiologies
OBJETIVO: Verificar e comparar as medidas e proporções orofaciais de crianças respiradoras nasais, orais obstrutivas e orais viciosas, com dentição mista. MÉTODOS: Participaram do estudo 57 crianças, 32 meninas e 25 meninos, leucodermas, com idades entre sete anos e cinco meses e 11 anos e dez meses. Os participantes realizaram triagem fonoaudiológica e avaliação otorrinolaringológica para diagnóstico do modo respiratório e etiologia da respiração oral. As avaliações possibilitaram a classificação das crianças em três grupos: 15 respiradores nasais; 22 respiradores orais obstrutivos; e 20 respiradores orais viciosos. Foi realizada avaliação antropométrica orofacial, com paquÃmetro digital. As medidas e proporções orofaciais de cada grupo estudado foram descritas. Medidas antropométricas e proporções orofaciais dos grupos foram comparadas, num nÃvel de significância de 5%. RESULTADOS: Não foram verificadas diferenças nas medidas antropométricas e proporções orofaciais de respiradores nasais e respiradores orais obstrutivos e viciosos. CONCLUSÃO: Os resultados obtidos sugerem que o modo respiratório e as diferentes etiologias da respiração oral não determinam diferenças nas medidas e proporções orofaciais em crianças no perÃodo de dentição mista.PURPOSE: To verify and compare the orofacial measurements and proportions of children with nasal breathing, obstructive mouth breathing and habitual mouth breathing, with mixed dentition. METHODS: Fifty-seven children, 32 girls and 25 boys, caucasian, with ages varying from seven years and five months to 11 years and ten months, participated in this study. The participants carried out a Speech-Language Pathology screening and an otolaryngological evaluation, in order to diagnose the breathing mode and the mouth breathing etiology. Based on the evaluations, the children were classified into three groups: 15 nasal breathers; 22 obstructive mouth breathers; and 20 habitual mouth breathers. The orofacial anthropometric evaluation was carried out using a digital caliper. The measurements and orofacial proportions of each group were described and then statistically compared, with a significance level of 5%. RESULTS: No differences were observed between anthropometric measurements and orofacial proportions of nasal and mouth breathers (of both obstructive and habitual etiologies). CONCLUSION: The results obtained suggest that breathing mode and the different etiologies of mouth breathing do not determine differences in the orofacial measurements and proportions in children during the mixed dentition period
Exercise-induced bronchospasm in children and adolescents with a diagnosis of asthma
Introdução: A broncoconstrição temporária após o exercÃcio fÃsico tem elevada prevalência em crianças e adolescentes asmáticos. Objetivo: Determinar a freqüência e gravidade do broncoespasmo induzido pelo exercÃcio em crianças e adolescentes, com diagnóstico clÃnico de asma leve, moderada e grave. Método: Foi realizado um estudo descritivo, tipo transversal, não controlado. A amostra constituiu-se de 40 indivÃduos asmáticos, de ambos os sexos, com idade entre 7 e 18 anos, que não utilizavam regularmente medicação antiinflamat ória. Foi realizado teste padronizado de provocação brônquica com exercÃcio de corrida em esteira rolante. A espirometria foi padronizada em seis manobras expiratórias, realizadas antes e aos 1, 5, 10, 15, 20 e 30 minutos após o término do exercÃcio, sendo escolhida a de maior valor. O volume expiratório forçado no primeiro segundo (VEF1) foi utilizado para o diagnóstico e classificação da gravidade do broncoespasmo Os pacientes asmáticos apresentavam condições clÃnicas e espirométricas adequadas para os testes (VEF1 >70% do valor previsto). Foi utilizada como critério de positividade para o broncoespasmo induzido pelo exercÃcio queda >10% em relação ao VEF1 prévio ao exercÃcio. Resultados: Vinte e seis (65%) pacientes desenvolveram broncoespasmo após o exercÃcio. Dos pacientes com asma leve 44%, e dos com asma moderada e grave, 100% desenvolveram broncoespasmo. Houve associação significativa entre a freqüência do broncoespasmo induzido pelo exercÃcio e a gravidade da asma (p< 0,05), e diferença significativa entre a sua gravidade (confirmada por uma queda no VEF1) e a gravidade da asma (p < 0,05). Conclusão: A freqüência e gravidade do broncoespasmo induzido pelo exercÃcio estiveram relacionadas com a gravidade clÃnica da asma.Introduction: In asthmatic children and adolescents a high incidence of temporary bronchospasm is perceived after physical exertion. Objective: To investigate incidence and severity of exercise-induced bronchospasm in children and adolescents with a clinical diagnosis of mild, moderate or severe asthma. Method: A descriptive, cross-sectional, not controlled study was carried out. The sample encompassed follow-up of 40 asthmatic patients of both genders, between 7 and 18 years of age who were not regularly using anti-inflammatory medication. A standardized exercise provocation test that consisted of steady running on a treadmill with a 10% inclination was administered Pulmonary function was tested with forced spirometry using six expiratory maneuvers repeated at approximately 1, 5 ,10,15, 20 and 30 minutes after the exercise. The highest of six FEV1 readings was used for analysis. The FEV1 was employed to evaluate the presence and to classify the severity of positive exercise induced bronchospasm (EIB). The asthmatic patients presented adequate clinical and spirometric conditions for testing (FEV1 at least 70 % of the predicted value). A drop of ³ 10% in relation to FEV1 before exercise was adopted as a criterion for (EIB). Results: 26 (65 %) patients developed EIB. The proportion by category was: mild asthma 44%, moderate and severe asthma 100%. There was a significant association between proportion of EIB and severity of asthma (p<0.05), and a significant difference between severity of EIB (confirmed by a recorded decrease in the 1 second forced expiratory volume) and asthma severity (p<0.05). Conclusion: The proportion and severity of EIB were clearly related to the clinical severity of asthma