Índice de massa corporal para predizer hiperglicemia e alterações lipídicas em adolescentes brasileiros

OBJECTIVE: To determine the best cut-offs of body mass index for identifying alterations of blood lipids and glucose in adolescents. METHODS: A probabilistic sample including 577 adolescent students aged 12-19 years in 2003 (210 males and 367 females) from state public schools in the city of Niterói, Southeastern Brazil, was studied. The Receiver Operating Characteristic curve was used to identify the best age-adjusted BMI cut-off for predicting high levels of serum total cholesterol (&gt;150mg/dL), LDL-C (&gt;100mg/dL), serum triglycerides (&gt;100mg/dL), plasma glucose (&gt;100mg/dL) and low levels of HDL-C (< 45mg/dL). Four references were used to calculate sensitivity and specificity of BMI cut-offs: one Brazilian, one international and two American. RESULTS: The most prevalent metabolic alterations (&gt;50%) were: high total cholesterol and low HDL-C. BMI predicted high levels of triglycerides in males, high LDL-C in females, and high total cholesterol and the occurrence of three or more metabolic alterations in both males and females (areas under the curve range: 0.59 to 0.67), with low sensitivity (57%-66%) and low specificity (58%-66%). The best BMI cut-offs for this sample (20.3 kg/m² to 21.0 kg/m²) were lower than those proposed in the references studied. CONCLUSIONS: Although BMI values lower than the International cut-offs were better predictor of some metabolic abnormalities in Brazilian adolescents, overall BMI is not a good predictor of these abnormalities in this population.OBJETIVO: Determinar los mejores puntos de corte del índice de masa corporal (IMC) para identificar alteraciones en el perfil lipémico y glicérico en adolescentes. MÉTODOS: Fueron evaluados 577 adolescentes de 12 a 19 años (210 niños y 367 niñas) en una muestra probabilística de estudiantes de escuelas estaduales de la ciudad de Niteroi, Sureste de Brasil, en 2003. Fue utilizada una curva Receiver Operating Characteristic para identificar el mejor punto de corte, ajustado a la edad, para predecir valores elevados de colesterol total sérico (=150mg/dL), LDL-C (=100mg/dL), triglicéridos (=100mg/dL), glicosis plasmática (&gt;100mg/dL) y bajos valores de HDL-C (OBJETIVO: Determinar os melhores pontos de corte do índice de massa corporal (IMC) para identificar alterações no perfil lipêmico e glicêmico em adolescentes. MÉTODOS: Foram avaliados 577 adolescentes de 12 a 19 anos (210 meninos e 367 meninas) em uma amostra probabilística de estudantes de escolas estaduais da cidade de Niterói (RJ), em 2003. Foi utilizada a curva Receiver Operating Characteristic para identificar o melhor ponto de corte, ajustado para idade, para predizer valores elevados de colesterol total sérico (&gt;150mg/dL), LDL-C (&gt;100mg/dL), triglicérides (&gt;100mg/dL), glicose plasmática (&gt;100mg/dL) e baixos valores de HDL-C

GRAVIDEZ NA ADOLESCÊNCIA: SIGNIFICADOS PARA A FAMÍLIA DE HOJE

This article presents the results of the study carried through with the objective to develop a theoretical model, whose central subjectis: the love and its components, and as sub subjects: the sensitivity, the perception, the interaction and the communication, among others, with the purpose to contribute for the strength of auto-esteem of a group of adolescents, with the support of its familiar groups and the health service team. It was carried through the implantation of workshops with the adolescents and the accompaniment of its familiar and agents of health. Forthe development of the work the information related to the demographic aspects had been collected and identified the risk and security factors of the group of adolescents, applied the self-esteem scale of Janda1 before and after application of the theoretical model. During the development of the theoretical model the participants had been interviewed. The results demonstrate the risks and security factors that live the adolescents in general, and had presented an addition to the values on self-esteem scale comparative with the initial measurement, the interviews revealed five categories related with the process of pregnancy lived by the adolescents: in search of identity; the familiar and social expectations interrupted; love and lovelessness in the interpersonal relations, influence of the feminine figure in the decisions, and the loving challenge as rescue of auto-esteem and expression of the feelings. The development of the workshops allowed the strengthening of the health agents with the pregnant adolescents through the sensitization and the reflection about the theme discussed, the concepts of the theoretical model of the loving challenge.El embarazo en la adolescente tiende a ser desaprobado en los contextos familiar y social, considerándose una conducta que se aleja de las expectativas familiares y sociales, lo que genera en la adolescente diferentes tipos de sentimientos. El presente artículo aborda la problemática de la familia frente a la adolescente embarazada, la cual se ha determinado a partir de la aplicación de un Modelo fundamentado en el amor 1. Estudio realizado con adolescentes grávidas de condición soioeconómica media baja de la ciudad de Cali. El estudio se realizó desde el enfoque cualitativoy de investigación acción y las adolescentes participantes estuvieron presentes desde del cuarto mes de gestación con edades entre 14 y 19 años, recolectando información relacionada con aspectos sociodemográficos; factores de riesgo y protectores; y entrevista en profundidad. Se aplicó el modelo a través de la implementación de talleres en los que tomaron parte además de las adolescentes los agentes de salud del área de influencia.Los hallazgos confirman los factores de riesgo y protectores que viven las adolescentes en general y las entrevistas en profundidad revelaron cinco categorías relacionadas con el proceso de embarazo vivido por las adolescentes y su familia: búsqueda de identidad, expectativas familiares y sociale interrumpidas, amor y desamor en las relaciones interpersonales, influencia de la figura femenina en las decisiones, y el desafío amoroso como rescate de autoestima y expresión de sentimientos. En este artículo nos referiremos a tres de ellas por considerarlas que son las que nos revelan con mayor detalle el significado de la gravidez en las adolescentes para la familia de hoy .Este artigo apresenta os resultados do estudo realizado com o objetivo de desenvolver um modelo teórico, cujo tema central é: o amor e seus componentes, e como sub temas: a sensibilidade, a percepção, a interação e a comunicação, entre outros, com a finalidade de contribuir para o fortalecimento da auto-estima de um grupo de adolescentes, com o apoio de seus grupos familiares e da equipe de saúde. Foi realizado através da implantação de oficinas com as adolescentes e do acompanhamento de seus familiares e de agentes de saúde. Para o desenvolvimentodo trabalho foram coletadas as informações relacionadas aos aspectos demográficos e se identificaram os fatores de risco e segurança do grupo de adolescentes, aplicou-se a escala de auto-estima de Janda 1 antes e após a aplicação do modelo. Durante o desenvolvimento do modelo foram realizadas entrevistas diretas com as participantes. Os achados demonstram os fatores de riscos e segurança que vivenciam as adolescentes em geral, e apresentaram um acréscimo aos valores da escala de auto-estima comparado com a medição inicial. As entrevistas diretas revelaram cinco categorias relacionadas com o processo de gravidez vivenciado pelas adolescentes: busca da identidade, EXPECTATIVAS FAMILIARES E SOCIAIS INTERROMPIDA, amor e desamor nas relações interpessoais, INFLUÊNCIA DA FIGURA FEMININA NAS DECISÕES, e o desafio amoroso como resgate da auto-estima e expressão dos sentimentos. O desenvolvimento das oficinas permitiu a interação dos agentes de saúde com as adolescentes grávidas através da sensibilização e a reflexão das temáticas abordadas, dos conceitos do modelo do desafio amoroso

A ADOLESCENTE GRÁVIDA: UM DESAFIO PARA A FAMÍLIA AO CONFRONTAR-SE COM SUA AUTO-ESTIMA

Investigación llevada a cabo con el propósito de aplicar un modelo teórico, que tiene como concepto central: el amor y sus componentes y como subconceptos: la sensibilidad, la percepción, la interacción y la comunicación, entre otros con el fin de contribuir al fortalecimiento de la autoestima de un grupo de adolescentes, con el apoyo de sus grupos familiares y del equipo de salud. Este modelo se llevó a cabo a través de la implementación de talleres con adolescentes, con acompañamiento de sus familiares y con agentes de salud. Se partió de la recolección de información relacionada con aspectos demográficos y se identificaron los factores de riesgo y protectores del grupo de adolescentes, igualmente se aplicó la escala de autoestima de Janda (1). Se realizaron entrevistas a las participantes. Los hallazgos confirman los factores de riesgo y protectores que viven las adolescentes y mostraron un incremento en los valores de la escala de autoestima comparado con la medición inicial. Las entrevistas revelaron cinco categorías relacionadas con el proceso de embarazo vivido por las adolescentes: búsqueda de identidad, expectativas familiares y sociales interrumpidas, amor y desamor en las relaciones interpersonales, influencia de la figura femenina en las decisiones, y el desafío amoroso como rescate de autoestima y expresión de sentimientos. El desarrollo de los talleres permitió fortalecer en los agentes de salud y adolescentes gravidas, a través de la sensibilización y reflexión de las temáticas abordadas, los conceptos del modelo del desafío amoroso.Results of the study which aimed to develop a theoretical model, whose central theme is: love and its components, and as sub-themes: the sensitivity, the perception, the interaction and the communication, among others, in order to contribute for selfesteem strengthening of a group of adolescents, with the support of their family members and health team.Workshops were carried out with the adolescents and their family members as well as health agents were followed up. Information related to the demographic aspects was collected and adolescents’ risk and safety factors were identified; Janda’s (1) self-esteem scale was applied. The participants were also interviewed. The results demonstrate the risks and safety factors that adolescents experience, and an increase in the values of the self-esteem scale was verified if compared to the initial measurement. The interviews disclosed five categories related to the pregnancy process lived by the adolescents: search for identity; interrupted family and social expectations; love and unconcern in the interpersonal relations, influence of the feminine figure in the decisions, and the love challenge as rescue of self-esteem and feeling expression. The workshops allowed the strengthening of health agents with the pregnant adolescents through sensitization and reflection on the discussed themes, the concepts of the theoretical model of love challenge.Resultados do estudo realizado com o objetivo de desenvolver um modelo teórico, cujo tema central é: o amor e seus componentes, e como subtemas, a sensibilidade, a percepção, a interação e a comunicação, entre outros, com a finalidade de contribuir para o fortalecimento da auto-estima de um grupo de adolescentes, com o apoio de seus grupos familiares e da equipe de saúde. Foi realizado através de oficinas com as adolescentes e do acompanhamento de seus familiares e de agentes de saúde. Foram coletadas as informações relacionadas aos aspectos demográficos e se identificaram os fatores de risco e segurança do grupo de adolescentes; aplicouse a escala de auto-estima de Janda (1). Foram realizadas também entrevistas diretas com as participantes. Os achados demonstram os fatores de risco e segurança que vivenciam as adolescentes, e apresentaram um acréscimo aos valores da escala de auto-estima, comparado com a medição inicial.As entrevistas revelaram cinco categorias relacionadas com o processo de gravidez vivenciado pelas adolescentes: busca da identidade, expectativas familiares e sociais interrompidas, amor e desamor nas relações interpessoais, influência da figura feminina nas decisões, e o desafio amoroso como resgate da auto-estima e expressão dos sentimentos. O desenvolvimento das oficinas permitiu o fortalecimento dos agentes de saúde com as adolescentes grávidas através da sensibilização e a reflexão das temáticas abordadas, dos conceitos do modelo do desafio amoroso

Defining the causes of sporadic Parkinson's disease in the global Parkinson's genetics program (GP2)

The Global Parkinson’s Genetics Program (GP2) will genotype over 150,000 participants from around the world, and integrate genetic and clinical data for use in large-scale analyses to dramatically expand our understanding of the genetic architecture of PD. This report details the workflow for cohort integration into the complex arm of GP2, and together with our outline of the monogenic hub in a companion paper, provides a generalizable blueprint for establishing large scale collaborative research consortia

Multi-ancestry genome-wide association meta-analysis of Parkinson?s disease

Although over 90 independent risk variants have been identified for Parkinson’s disease using genome-wide association studies, most studies have been performed in just one population at a time. Here we performed a large-scale multi-ancestry meta-analysis of Parkinson’s disease with 49,049 cases, 18,785 proxy cases and 2,458,063 controls including individuals of European, East Asian, Latin American and African ancestry. In a meta-analysis, we identified 78 independent genome-wide significant loci, including 12 potentially novel loci (MTF2, PIK3CA, ADD1, SYBU, IRS2, USP8, PIGL, FASN, MYLK2, USP25, EP300 and PPP6R2) and fine-mapped 6 putative causal variants at 6 known PD loci. By combining our results with publicly available eQTL data, we identified 25 putative risk genes in these novel loci whose expression is associated with PD risk. This work lays the groundwork for future efforts aimed at identifying PD loci in non-European populations

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