Retinolemia em escolares eutróficos e com sobrepeso

Objectives: To determine the frequency of normal weight and overweight schoolchildren who have deficiency of vitamin A and to study the relationship between serum retinol concentrations and body mass index (BMI), body fat percentage and waist circumference of normal weight and overweight children. Methods: Cross-sectional, descriptive and analytical study carried out with schoolchildren aged 8 to 10 years old from public schools in Uberaba (MG). The sample consisted of eighty students matched for age and sex, being forty eutrophic schoolchildren and forty with overweight. Results: It was observed that 25% of students were overweight and 20% of normal weight children presented serum retinol disabled. There was no significant difference between the mean serum retinol concentrations in the eutrophic schoolchildren group and overweight group. No significant correlations were observed between serum concentrations and BMI, waist circumference and body fat percentage measured by bioelectrical impedance in both groups. Conclusion: The results show a high prevalence of deficient serum retinol, which are not related to body fat percentage and waist circumference measurement, in two groups of healthy schoolchildren, an eutrophic and another group, overweight

Characteristics of sleep habits among adolescents living in the city of Ribeirão Preto (SP)

Introduction: Adolescence is the period of transition between childhood and adult life, characterized by changes in physical, emotional, sexual and social development. Although during this phase most individuals are healthy, it is known that health status is related to behaviors and habits such as a healthy diet, the regular practice of physical activity and good sleep quality, which contribute to optimum physical and cognitive performanceObjective: To determine some sleep characteristics of adolescents living in the city of Ribeirão Preto (SP).Methods: this was a cross-sectional descriptive study conducted at 14 schools in the city of Ribeirão Preto (SP) including adolescents aged 10 to 19 years who answered a questionnaire about sleep habits. The chi-square test was used to determine differences between genders with the aid of the EPI-INFO 7 software, with the level of significance set at p<0.05.Results: A total of 535 adolescents (65% girls) were included in the study. Of these, 47.7% studied during the morning period and 10.3% had a job and studied in the evening period. Regarding sleep duration, 242 (45%) slept less than 9 hours per night during week days and 256 (48%) during the weekends (Saturday and Sunday), Of the total number of adolescents studied, 75.5% reported that they went to bed when they felt sleepy, 90% reported delay in falling asleep, 84.3% used some type of electronic equipment before going to sleep, and 44% reported that they woke up during the night. In the morning, 70.3% needed to be awakened, and 44.7% reported a delay in waking up. During the daytime, 70% felt somnolent and 34% reported that they slept during the day. Girls reported that they felt more daytime sleepiness (71.3%) and slept more during the day (62.1%) than boys (28.7% and 37.9%, respectively), with the difference being statistically significant (p < 0.05).Conclusions: Almost half the adolescents investigated sleep less than the minimum time considered ideal. Furthermore, the most of adolescents went to the bed when they felt sleepy, used electronic devices before to sleep, had difficulties to fall asleep, need to be awake in the morning and felt sleepy during the day. A substantial proportion of adolescents studied awoke at night and slept during the day. Compared to boys, girls felt sleepy and slept during the day significantly.

Estilo de vida sedentário entre adolescentes na cidade de Ribeirão Preto (SP)

Introduction: Physical inactivity has been pointed out as one of the major public health problems of the 21st century and the benefits of the regular practice of physical activity during adolescence are important for the biological process of growth and development. Objective: To analyze the prevalence of physical inactivity among adolescents enrolled in schools in the city of Ribeirão Preto (SP). Methods: From September 1 to November 30, 2013, a cross-sectional, observational and descriptive study was conducted  with adolescents enrolled in 14 state schools in the city of Ribeirão Preto (SP) using the International Physical Activity Questionnaire, short version. Results: A total of 535 adolescents participated, 35% of them boys and 65% girls; 65% were 10 to 14 years old and 35% were 15 to 19 years old; 52.3% studied in the evening period and 10.3% worked part time on a daily basis. Regarding the level of physical activity, 15.5% of the boys and 24.1% of the girls were classified as sedentary (p>0.05). 60.4% of the boys performed physical activity of vigorous intensity, while 56.3% of the girls showed preference for physical activity of low or moderate intensity (p=0.03). The girls aged 15 to 19 years spent more time sitting during the week, while the girls aged 10 to 14 years were less active during the weekend. 24.2% of the girls aged 10 to 14 years who studied during the morning period and 13.7% of the boys and 18% of the girls who studied during the evening period were classified as sedentary. Conclusion: High rates of sedentary lifestyle were observed among adolescents enrolled in state (or public?) schools in Ribeirão Preto (Brazil). Girls presented higher rates of sedentary lifestyle than boys. Boys performed physical activity of vigorous intensity more frequently than girls. The older girls had higher rates of physical inactivity (hours spent in the sitting position) during the week days compared to the younger ones, while the latter spent more time in physical inactivity during the weekend.  Introdução: Adolescência é o período de transição entre a infância e a vida adulta, caracterizado por modificações no desenvolvimento físico, emocional, sexual e social e pelos esforços em alcançar os objetivos relacionados às expectativas culturais da sociedade em que vive. Objetivo: Avaliar a prevalência de inatividade física entre adolescentes matriculados em escolas da cidade de Ribeirão Preto (SP). Métodos: Estudo transversal, observacional e descritivo realizado entre 01/09/2013 e 30/11/2013, com adolescentes matriculados em 14 escolas estaduais da cidade de Ribeirão Preto (SP), utilizando-se o International Physical Activity Questionnarie, versão curta. Resultados: Participaram 535 adolescentes sendo 35 % masculino e 65 % feminino; 65% tinham entre 10 e 14 anos e 35% entre 15 e 19 anos; 52,3% estudavam no período vespertino e 10,3% trabalhavam meio período ao dia. Quanto ao nível de atividade física encontrou-se 15,5% dos meninos e 24,1% das meninas classificados como sedentários (p>0,05). As moças com idades entre 10 e 14 anos referiram nível de atividade física menor que as da faixa etária dos 15 aos 19 anos (p= 0,507). 60,4% dos rapazes realizam atividade física de intensidade vigorosa enquanto 56,3% das moças mostraram preferência por atividades físicas de intensidade baixa ou moderada (p=0,03). As moças na faixa etária dos 15 aos 19 anos passam mais tempo sentadas durante a semana, enquanto que nos finais de semana são menos ativas aquelas com idades entre 10 e 14 anos. Classificou-se como sedentários 24,2% das moças com idades entre 10 e 14 anos que estudam no período da manhã e, no período vespertino, 13,7% dos rapazes e 18% das moças na faixa etária dos 15 aos 19 anos. Conclusões: A prevalência de sedentarismo foi de 21% sendo maior para o sexo feminino na faixa etária dos 10 aos 14 anos, que são menos ativas nos finais de semana e que estudam no período da manhã

Nutritional Status and Adverse Outcomes in Older Depressed Inpatients:A Prospective Study

OBJECTIVES: Significant weight loss and/or loss of appetite is a criterion of a depressive episode. While malnutrition is associated with many adverse health outcomes, the impact of malnutrition in late-life depression has hardly been examined. The present study aims to (1) evaluate the prevalence of malnutrition in depressed older inpatients, and (2) whether and which indices of malnutrition predict adverse health outcomes in late-life depression. DESIGN: A prospective study at 6 months follow-up. SETTING: A University-based psychiatric hospital. PARTICIPANTS: 105 older adults (psychiatric inpatients suffering from unipolar MDD). MEASUREMENTS: Participants were evaluated according the Mini Nutritional Assessment (MNA) and anthropometric measures to assess their nutritional status. Multiple regression analyses were used to evaluate the association between the MNA score as well as anthropometric measures with either falls or rehospitalization for any reason. RESULTS: Based on the MNA score, 78 (74.3%) patients were at risk of malnutrition and 13 (12.4%) actually presented malnutrition. Malnutrition was associated with a higher age, frailty, lower body mass index, and smaller calf circumference. During follow-up, 21 (20%) patients fell, 27 (25.7%) were rehospitalized, and 3 died (2.9%). The MNA score was associated with adverse health outcomes, but a low calf circumference predicted falling (OR 4.93 [95% CI: 1.42-17.2], p=.012) and a higher calf circumference rehospitalization (OR 1.17 [95% CI: 1.01-1.35], p=.032). CONCLUSION: Malnutrition is prevalent in older depressed inpatients. In contrast to subjective proxies for malnutrition, which are common in depression, only objective measures of malnutrition predict adverse health outcomes such as falls and rehospitalization

The Solar Twin Planet Search: V. Close-in, low-mass planet candidates and evidence of planet accretion in the solar twin HIP 68468

Context. More than two thousand exoplanets have been discovered to date. Of these, only a small fraction have been detected around solar twins, which are key stars because we can obtain accurate elemental abundances especially for them, which is crucial for studying the planet-star chemical connection with the highest precision. Aims. We aim to use solar twins to characterise the relationship between planet architecture and stellar chemical composition. Methods. We obtained high-precision (1 m s-1) radial velocities with the HARPS spectrograph on the ESO 3.6 m telescope at La Silla Observatory and determined precise stellar elemental abundances (~0.01 dex) using spectra obtained with the MIKE spectrograph on the Magellan 6.5 m telescope. Results. Our data indicate the presence of a planet with a minimum mass of 26 ± 4 Earth masses around the solar twin HIP 68468. The planet is more massive than Neptune (17 Earth masses), but unlike the distant Neptune in our solar system (30 AU), HIP 68468c is close-in, with a semi-major axis of 0.66 AU, similar to that of Venus. The data also suggest the presence of a super-Earth with a minimum mass of 2.9 ± 0.8 Earth masses at 0.03 AU; if the planet is confirmed, it will be the fifth least massive radial velocity planet candidate discovery to date and the first super-Earth around a solar twin. Both isochrones (5.9 ± 0.4 Gyr) and the abundance ratio [Y/Mg] (6.4 ± 0.8 Gyr) indicate an age of about 6 billion years. The star is enhanced in refractory elements when compared to the Sun, and the refractory enrichment is even stronger after corrections for Galactic chemical evolution. We determined a nonlocal thermodynamic equilibrium Li abundance of 1.52 ± 0.03 dex, which is four times higher than what would be expected for the age of HIP 68468. The older age is also supported by the low log (R'HK) (–5.05) and low jitter (<1 m s-1). Engulfment of a rocky planet of 6 Earth masses can explain the enhancement in both lithium and the refractory elements. Conclusions. The super-Neptune planet candidate is too massive for in situ formation, and therefore its current location is most likely the result of planet migration that could also have driven other planets towards its host star, enhancing thus the abundance of lithium and refractory elements in HIP 68468. The intriguing evidence of planet accretion warrants further observations to verify the existence of the planets that are indicated by our data and to better constrain the nature of the planetary system around this unique starJ.M. acknowledges support from FAPESP (2012/24392-2) and CNPq (Bolsa de Produtividade). M.B. is supported by the National Science Foundation (NSF) Graduate Research Fellowships Program (grant no. DGE1144082). J.B. and M.B. acknowledge support for this work from the NSF (grant no. AST-1313119). J.B. is also supported by the Alfred P. Sloan Foundation and the David and Lucile Packard Foundation. M.A. acknowledges support from the Australian Research Council (grants FL110100012 and DP120100991)

Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease

Background: Experimental and clinical data suggest that reducing inflammation without affecting lipid levels may reduce the risk of cardiovascular disease. Yet, the inflammatory hypothesis of atherothrombosis has remained unproved. Methods: We conducted a randomized, double-blind trial of canakinumab, a therapeutic monoclonal antibody targeting interleukin-1β, involving 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter. The trial compared three doses of canakinumab (50 mg, 150 mg, and 300 mg, administered subcutaneously every 3 months) with placebo. The primary efficacy end point was nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. RESULTS: At 48 months, the median reduction from baseline in the high-sensitivity C-reactive protein level was 26 percentage points greater in the group that received the 50-mg dose of canakinumab, 37 percentage points greater in the 150-mg group, and 41 percentage points greater in the 300-mg group than in the placebo group. Canakinumab did not reduce lipid levels from baseline. At a median follow-up of 3.7 years, the incidence rate for the primary end point was 4.50 events per 100 person-years in the placebo group, 4.11 events per 100 person-years in the 50-mg group, 3.86 events per 100 person-years in the 150-mg group, and 3.90 events per 100 person-years in the 300-mg group. The hazard ratios as compared with placebo were as follows: in the 50-mg group, 0.93 (95% confidence interval [CI], 0.80 to 1.07; P = 0.30); in the 150-mg group, 0.85 (95% CI, 0.74 to 0.98; P = 0.021); and in the 300-mg group, 0.86 (95% CI, 0.75 to 0.99; P = 0.031). The 150-mg dose, but not the other doses, met the prespecified multiplicity-adjusted threshold for statistical significance for the primary end point and the secondary end point that additionally included hospitalization for unstable angina that led to urgent revascularization (hazard ratio vs. placebo, 0.83; 95% CI, 0.73 to 0.95; P = 0.005). Canakinumab was associated with a higher incidence of fatal infection than was placebo. There was no significant difference in all-cause mortality (hazard ratio for all canakinumab doses vs. placebo, 0.94; 95% CI, 0.83 to 1.06; P = 0.31). Conclusions: Antiinflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab at a dose of 150 mg every 3 months led to a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering. (Funded by Novartis; CANTOS ClinicalTrials.gov number, NCT01327846.

Global prevalence and genotype distribution of hepatitis C virus infection in 2015 : A modelling study

Publisher Copyright: © 2017 Elsevier LtdBackground The 69th World Health Assembly approved the Global Health Sector Strategy to eliminate hepatitis C virus (HCV) infection by 2030, which can become a reality with the recent launch of direct acting antiviral therapies. Reliable disease burden estimates are required for national strategies. This analysis estimates the global prevalence of viraemic HCV at the end of 2015, an update of—and expansion on—the 2014 analysis, which reported 80 million (95% CI 64–103) viraemic infections in 2013. Methods We developed country-level disease burden models following a systematic review of HCV prevalence (number of studies, n=6754) and genotype (n=11 342) studies published after 2013. A Delphi process was used to gain country expert consensus and validate inputs. Published estimates alone were used for countries where expert panel meetings could not be scheduled. Global prevalence was estimated using regional averages for countries without data. Findings Models were built for 100 countries, 59 of which were approved by country experts, with the remaining 41 estimated using published data alone. The remaining countries had insufficient data to create a model. The global prevalence of viraemic HCV is estimated to be 1·0% (95% uncertainty interval 0·8–1·1) in 2015, corresponding to 71·1 million (62·5–79·4) viraemic infections. Genotypes 1 and 3 were the most common cause of infections (44% and 25%, respectively). Interpretation The global estimate of viraemic infections is lower than previous estimates, largely due to more recent (lower) prevalence estimates in Africa. Additionally, increased mortality due to liver-related causes and an ageing population may have contributed to a reduction in infections. Funding John C Martin Foundation.publishersversionPeer reviewe

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