Physical activity and nutrition education at the school environment aimed at preventing childhood obesity: evidence from systematic reviews

AbstractObjectiveTo organize the main findings and list the most frequent recommendations from systematic reviews of interventions developed at the school environment aimed at reducing overweight in children and adolescents.Data sourceSearches for systematic reviews available until December 31, 2014 were conducted in five electronic databases: Cochrane, PubMed, SciELO, SPORTDiscus, and Web of Science. Manual search for cross‐references were also performed.Summary of the findingsOf the initial 2,139 references, 33 systematic reviews adequately met the inclusion criteria and were included in the descriptive summary. In this set, interventions with periods of time greater than six months in duration (nine reviews), and parental involvement in the content and/or planned actions (six reviews) were identified as the most frequent and effective recommendations. Additionally, it was observed that boys respond more effectively to structural interventions, whereas girls respond to behavioral interventions. None of the included reviews was able to make inferences about the theoretical basis used in interventions as, apparently, those in charge of the interventions disregarded this component in their preparation.ConclusionsAlthough the summary identified evidence with important applications in terms of public health, there are still gaps to be filled in this field of knowledge, such as the effectiveness of different theoretical models, the identification of the best strategies in relation to gender and age of participants and, finally, the identification of moderating variables to maximize the benefits provided by the interventions.ResumoObjetivoOrganizar os principais achados e relacionar as recomendações mais frequentes das revisões sistemáticas de intervenções desenvolvidas no ambiente escolar com fins na redução do excesso de peso em crianças e adolescentes.Fonte dos dadosBuscas por revisões sistemáticas disponíveis até 31 de dezembro de 2014 foram feitas em cinco bases de dados eletrônicas: Cochrane, PubMed, SciELO, SPORTDiscus e Web of Science. Buscas manuais por referências cruzadas também foram desenvolvidas.Síntese dos dadosDas 2.139 referências iniciais, 33 revisões sistemáticas responderam adequadamente aos critérios de inclusão e compuseram a síntese descritiva. Nesse conjunto, identificaram‐se como recomendações mais frequentes e efetivas intervenções que têm períodos de tempo superior a seis meses de duração (nove revisões) e o envolvimento dos pais nos conteúdos e/ou ações previstas (seis revisões). Além disso, observou‐se que meninos respondem de forma mais efetivas às intervenções estruturais, enquanto as meninas às intervenções comportamentais. De modo consistente entre as revisões incluídas, nenhuma conseguiu fazer inferências sobre a base teórica usada nas intervenções, uma vez que, aparentemente, os responsáveis pelas intervenções desconsideraram esse componente em sua elaboração.ConclusõesEmbora a síntese tenha identificado evidências com aplicações importantes em termos de saúde coletiva, ainda existem lacunas a serem preenchidas nesse campo do conhecimento, tais como a efetividade de diferentes modelos teóricos, o reconhecimento das melhores estratégias em relação ao sexo e à idade dos participantes e, por fim, a identificação de variáveis moderadoras para potencializar os benefícios proporcionados pelas intervenções

Antenatal diagnosis of congenital hepatic hemangioma: a case report

Hepatic tumors in children account for only 1 to 5% of all pediatric tumors. Hepatic hemangioma is, however, the third most common tumor of the liver in childhood. We report a case of an antenatal diagnosis of a hepatic tumor detected on a first obstetric ultrasound, at 26th week of gestation. It revealed a complex, predominantly solid hepatic lesion with 3 × 3 cm and a marked, essentially peripheral, Doppler blood flow. Fetal echocardiography showed a normal heart besides a vena cava displacement by the hepatic mass. Fetal Hepatic hemangioma was suspected. Follow-up ultrasounds were unchanged. Pregnancy evolved well. At 36 weeks of gestation was spontaneously delivered a 3300 g boy whose examination revealed a visible thoracoabdominal circulation and a palpable liver. No skin lesions, namely hemangiomas or petechiae were identified. Postnatal magnetic resonance imaging confirmed the diagnosis of Hepatic hemangioma. Treatment was initiated with prednisolone followed by interferon. After 2 years, there is no active lesion

Systematic review of temporal trends of congenital syphilis in Brazil

The present study was aimed to retrieve and analyse the temporal trends of congenital syphilis (CS) in Brazil, as well as to list its main associated factors. Methods: In August 2019 a systematic review was developed in four electronic databases (Lilacs, Pubmed, Scielo and Web of Science) and in manual searches on reference lists. It was established that the synthesis of this review would be composed by ecological studies with CS temporal trends in the Brazilian territory, regardless of the population characteristics and data representativeness. More specifically, it was also established that the prevalence of CS of the first and last year of the time series would be presented in the descriptive synthesis. Results: Of the 2,157 initial studies, 14 adequately met the inclusion criteria and composed the synthesis. Twelve (85.7%) of these studies showed increases in time trends, with particular emphasis on the two nationwide studies, which showed positive trends between 2003–2008 (0.4) and 2010–2015 (3.7). Associations were found between CS and socioeconomic and ethnic factors, especially in the groups of women with low income, low education, brown / black skin colour and who had untreated partners. Conclusion: most of the available research showed an increase in the temporal trends of CS, highlighting that these data were observed at the national, state and municipal levels. Since mothers' socioeconomic and ethnic factors are associated with higher CS frequencies, efforts are needed to increase the coverage of the Unified Health System to vulnerable women

Formação de profissionais de Educação Física que atuam nos núcleos de apoio à saúde da família do Estado de São Paulo

O objetivo do presente estudo foi descrever aspectos relacionados à formação superior de profissionais de Educação Física (PEF) atuantes nos Núcleos de Apoio à Saúde da Família do estado de São Paulo (NASF). Para tanto, se conduziu um inquérito transversal descritivo, por meio de entrevista estruturada via telefone, no qual foram coletados dados sobre a formação de 91 PEF vinculados aos NASF. Como resultados, observou-se que apenas 22% dos PEF tiveram contato com o tema “Saúde Pública/Saúde Coletiva” no curso de graduação (n = 20) e menos de 5% fizeram residência multiprofissional em saúde (n = 5). A maioria dos profissionais (61,5%, n = 56) discordou que teve formação adequada para atuar no SUS, e este percentual de discordância não teve grandes alterações segundo a faixa etária, tempo de conclusão de curso de graduação e se fez ou não curso de pós-graduação. Os dados apresentados mostram que os PEF atuantes nos NASF do estado de São Paulo relataram que tiveram uma formação distanciada daquela que se pretende para a atuação neste contexto. Reflexões e discussões sobre possíveis melhoras na formação do curso de graduação e de pós-graduação dos PEF para atuarem nos NASF devem ser fomentadas por gestores e professores que atuam nesta área

PRODUCCIÓN CIENTÍFICA EN ACTIVIDAD FÍSICA Y SALUD EN CHILE: UNA REVISIÓN SISTEMÁTICA

Describir la producción científica sobre epidemiología de la actividad física en Chile. Revisión sistemática en cuatro bases de datos electrónicas y búsquedas manuales. Los criterios de Inclusión fueron: estudios realizados en Chile y la aplicación de métodos epidemiológicos en el estudio de la actividad física. Se buscaron referencias disponibles hasta 16/12/2014. Se encontraron 98 artículos desde el año 1990, con una tendencia incremental en el tiempo. Los estudios sobre temáticas de niveles y tendencias de actividad física fueron los mayormente identificados (33,6%), siendo el diseño más frecuente el transversal (64,2%). El grupo etario más estudiado fueron menores de 20 años (44,9%), incluyendo fundamentalmente a la Región Metropolitana de Santiago (45,9%). La etnia indígena fue considerada en el 5,1 % de los estudios. Se evidencia un interés creciente en la investigación sobre actividad física en Chile, sugiriéndose aumentar en adultos mayores, grupos étnicos y con equidad geográfica

Comportamento Sedentário

Desde o início dos anos 2000 se observou um crescente número de trabalhos científicos voltados à compreensão do comportamento sedentário. Adotando uma linha cautelosa, visto que o conjunto de evidências existentes ainda deixa mais dúvidas do que certezas, e realista, uma vez que muitas destas atividades fazem parte do cotidiano das pessoas e não podem ser extintas a qualquer custo, o presente ensaio oferece um panorama das pesquisas voltadas ao comportamento sedentário, desde a delimitação do termo, perpassando pelos seus impactos na saúde e questões fisiológicas correlatas, até a proposição de sugestões às futuras pesquisas

The effect of school-based physical activity interventions on body mass index: a meta-analysis of randomized trials

This study reviewed the effectiveness of school-based physical activity interventions aimed at reducing overweight, obesity and hypertension in children. We searched 14 databases and analyzed studies published between April 2009 and September 2012. Only randomized controlled trials performed at the school level that included elements of physical activity but did not include nutritional co-interventions were analyzed. Studies were assessed by two recommended tools (EPHPP and GRADE), and the standardized mean differences with 95% confidence intervals were collected for a random-effect meta-analysis. A total of 12 papers were included in the meta-analysis, and these were divided according to three outcomes: body mass index (11 trials, n  =  4,273, −0.02, 95% CI: −0.13 to 0.17, p  =  0.8); body weight (5 trials, n  =  1,330, −0.07, 95% CI: −0.18 to 0.04, p  =  0.2); and blood pressure (6 trials, n  =  1,549), including systolic (0.11, 95% CI: −0.10 to 0.31, p  =  0.3) and diastolic pressure (−0.00, 95% CI: −0.10 to 0.10, p  =  0.9). This meta-analysis of data from 11 randomized, school-based physical activity interventions suggests that, regardless of the potential benefits of physical activity in the school environment, the interventions did not have a statistically significant effect. However, it is difficult to generalize from these results because the duration, intensity and type of physical activity used in the interventions varied greatly.Cotas do Programa de Pos-Graduacao do Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq)Fundacao de Amparo a Pesquisa de Sao Paulo (FAPESP)Universidade de São Paulo Hospital das Clinicas Faculdade de MedicinaFederal University of São PauloFederal University of São Paulo Pediatrics Department, NutrologyUNIFESP, Pediatrics Department, Nutrology09/12438-5SciEL

Sedentary behavior in Brazilian children and adolescents: a systematic review

OBJETIVO Descrever as características metodológicas dos estudos selecionados e verificar variáveis associadas ao comportamento sedentário em crianças e adolescentes brasileiros. MÉTODOS Para esta revisão sistemática, foram realizadas buscas nas bases de dados eletrônicas PubMed, Web of Knowledge, Lilacs, SciELO e Google Acadêmico. Foi feita busca complementar nas listas de referências dos artigos analisados e em periódicos não indexados. Foram incluídos estudos observacionais com crianças e adolescentes de três a 19 anos de idade desenvolvidos no Brasil, que apresentaram análises de associações por meio de métodos de regressão, publicados até 30 de setembro de 2014. RESULTADOS Das 264 referências recuperadas nas buscas, 49 atenderam aos critérios de inclusão e compuseram a síntese descritiva. Neste conjunto, identificou-se grande número de pesquisas transversais (n = 43; 88,0%) e alta variabilidade metodológica sobre os tipos de comportamento sedentário avaliados, instrumentos de avaliação utilizados e pontos de corte adotados. As variáveis mais frequentemente associadas ao comportamento sedentário foram “níveis elevados de peso corporal” (em 15 de 27 estudos; 55,0%) e “menor nível de atividade física” (em oito de 16 estudos; 50,0%). CONCLUSÕES Os achados da presente revisão levantam as seguintes demandas à agenda brasileira de pesquisa em comportamento sedentário voltada às crianças e adolescentes: realização de estudos longitudinais, validação de instrumentos de medida, estabelecimento de pontos de corte, mensuração do comportamento sedentário para além do tempo de tela e utilização de medidas objetivas como recurso paralelo ao questionário. Nos artigos disponíveis, as associações entre comportamento sedentário com “níveis elevados de peso corporal” e “baixos níveis de atividade física” foram observadas em distintas regiões do território brasileiro.OBJECTIVE To describe the methodological characteristics of the studies selected and assess variables associated with sedentary behavior in Brazilian children and adolescents. METHODS For this systematic review, we searched four electronic databases: PubMed, Web of Knowledge, LILACS, SciELO. Also, electronic searches were applied in Google Scholar. A supplementary search was conducted in the references lists of the included articles and in non-indexed journals. We included observational studies with children and adolescents aged from three to 19 years developed in Brazil, presenting analyses of associations based on regression methods and published until September 30, 2014. RESULTS Of the 255 potential references retrieved by the searches, 49 met the inclusion criteria and composed the descriptive synthesis. In this set, we identified a great number of cross-sectional studies (n = 43; 88.0%) and high methodological variability on the types of sedentary behavior assessed, measurement tools and cut-off points used. The variables most often associated with sedentary behavior were “high levels of body weight” (in 15 out of 27 studies; 55.0%) and “lower level of physical activity” (in eight out of 16 studies; 50.0%). CONCLUSIONS The findings of this review raise the following demands to the Brazilian agenda of sedentary behavior research geared to children and adolescents: development of longitudinal studies, validation of measuring tools, establishment of risk cut-offs, measurement of sedentary behavior beyond screen time and use of objective measures in addition to questionnaires. In the articles available, the associations between sedentary behavior with “high levels of body weight” and “low levels of physical activity” were observed in different regions of Brazil

The effect of school-based physical activity interventions on body mass index: a meta-analysis of randomized trials

This study reviewed the effectiveness of school-based physical activity interventions aimed at reducing overweight, obesity and hypertension in children. We searched 14 databases and analyzed studies published between April 2009 and September 2012. Only randomized controlled trials performed at the school level that included elements of physical activity but did not include nutritional co-interventions were analyzed. Studies were assessed by two recommended tools (EPHPP and GRADE), and the standardized mean differences with 95% confidence intervals were collected for a random-effect meta-analysis. A total of 12 papers were included in the meta-analysis, and these were divided according to three outcomes: body mass index (11 trials, n  =  4,273, −0.02, 95% CI: −0.13 to 0.17, p  =  0.8); body weight (5 trials, n  =  1,330, −0.07, 95% CI: −0.18 to 0.04, p  =  0.2); and blood pressure (6 trials, n  =  1,549), including systolic (0.11, 95% CI: −0.10 to 0.31, p  =  0.3) and diastolic pressure (−0.00, 95% CI: −0.10 to 0.10, p  =  0.9). This meta-analysis of data from 11 randomized, school-based physical activity interventions suggests that, regardless of the potential benefits of physical activity in the school environment, the interventions did not have a statistically significant effect. However, it is difficult to generalize from these results because the duration, intensity and type of physical activity used in the interventions varied greatly