Diminishing benefits of urban living for children and adolescents’ growth and development

AbstractOptimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1–6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5–19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was &lt;1.1 kg m–2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified.</jats:p

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI 2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining https://researchonline.ljmu.ac.uk/images/research_banner_face_lab_290.jpgunderweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity

Risco e vulnerabilidade nas práticas dos profissionais de saúde Riesgo y vulnerabilidad en las prácticas laborales de los profesionales del área de la salud Risk and vulnerability in the practice of professional healthcare

O objetivo deste estudo foi analisar a produção científica da área da saúde e enfermagem acerca dos fatores de risco e da vulnerabilidade nas práticas dos profissionais de saúde, por meio de uma revisão integrativa. Os artigos foram pesquisados nas bases de dados LILACS e SCIELO, entre 2005 e 2010, a partir dos descritores vulnerabilidade, risco, riscos ocupacionais e pessoal de saúde, constituindo uma amostra de 21 publicações. Na atenção primária à saúde, os riscos e as vulnerabilidades relacionam-se à deficiência de recursos para o trabalho, à violência física e ao desgaste emocional. No contexto hospitalar, destacaram-se os acidentes com material biológico relacionados ao uso inadequado e não adesão a medidas de proteção, a sobrecarga de trabalho e a autoconfiança. Ressalta-se a importância da elaboração de políticas públicas em saúde do trabalhador, visando à melhoria das condições de trabalho e maior satisfação profissional.<br>Este estudio tuvo como objetivo analizar los riesgos y vulnerabilidades presentes en las prácticas de los profesionales de la salud, a través de una revisión integradora de la producción científica en salud y enfermería. Los artículos fueron consultados en la bases LILACS y SciELO, de 2005 a 2010, según los descriptores: vulnerabilidad, riesgo, riesgos laborales y personal de salud, que abarca una muestra de 21 publicaciones. En la atención primaria, los riesgos y las vulnerabilidades están relacionados con la deficiencia de recursos para el trabajo, la violencia física y el estrés emocional. En el ámbito hospitalario se pueden destacar: los accidentes con material biológico relacionado con el uso indebido y el incumplimiento de las medidas de protección, sobrecarga de trabajo y confianza en uno mismo. Hacemos hincapié en la importancia de desarrollar políticas públicas dirigidas a mejorar las condiciones laborales del trabajador y una mayor satisfacción y concienciación profesional.<br>The purpose of this study is to analyze the risks and vulnerability found in professional healthcare and the safe practices adopted, based on academic research in the field of healthcare and nursing, by means of an integrative review. The articles were found in the LILACS and SCIELO databases, from the years 2005-2010, in a search for the descriptors vulnerability, risk, and occupational and personal health risks, establishing a sample of 21 articles. In basic healthcare, risks and vulnerabilities are related to the lack of resources needed for work, physical violence and emotional strain. In a hospital context, the problems are related to accidents with biological materials caused by improper use and failure to adopt protective measures, as well as excessive work and self-confidence. The importance of implementing public policies in worker health to improve working conditions and provide greater satisfaction and professional awareness is emphasized

Terminal ileum of patients who underwent colonoscopy: endoscopic, histologic and clinical aspects Íleo terminal de pacientes submetidos a colonoscopia: aspectos endoscópicos, histológicos e clínicos

CONTEXT: For the diagnosis of the diseases which affect the terminal ileum, the colonoscopy allows macroscopic evaluation and the performing of biopsies. Studies with criteria for the endoscopic and histological characterization of this segment are scarce and there are still some doubts about the need of biopsies in patients with normal ileoscopy. OBJECTIVE: Study the terminal ileum of patients who underwent colonoscopy considering: endoscopic and histological correlation; agreement between results of the initial histological evaluation and slides review, and the chance of subjects with normal ileoscopy with abdominal pain and/or chronic diarrhea to show histological alterations. METHODS: In a prospective study, 111 patients who presented smooth mucosa without enanthema in the endoscopic exam of the terminal ileum were selected. Biopsies of the ileal mucosa of such patients were performed, being the slides routinely examined and reviewed afterwards. RESULTS: The correlation between patients with normal ileoscopy and ileum with preserved histological architecture was of 99.1%. The agreement between initial histological evaluation and slides review calculated by the Kappa test was 0.21. In patients with abdominal pain and/or chronic diarrhea, the chance of showing histological alterations was 2.5 times higher than the others. CONCLUSIONS: The correlation between endoscopic and histological findings was high. The agreement between the initial histologic evaluation and slides review was not satisfactory. The chance of subjects with normal ileoscopy with abdominal pain and/or chronic diarrhea, showing histological alterations was higher in relation to the asymptomatic ones or with other symptoms, although the clinical importance of this datum was not evaluated.<br>CONTEXTO: Para o diagnóstico de doenças que afetam o íleo terminal, a colonoscopia permite avaliação macroscópica e realização de biopsias. Estudos com critérios para caracterização endoscópica e histológica desse segmento são escassos e ainda persistem dúvidas quanto à necessidade de biopsias em pacientes com ileoscopia normal. OBJETIVO: Estudar o íleo terminal de pacientes submetidos a colonoscopia, considerando correlação endoscópica e histológica; concordância entre resultados da avaliação histológica inicial e revisão de lâminas e chance de indivíduos com ileoscopia normal, com dor abdominal e ou diarreia crônica apresentarem alterações histológicas. MÉTODOS: Estudo prospectivo, no qual foram selecionados 111 pacientes, que apresentaram ao exame endoscópico do íleo terminal mucosa lisa e sem enantema. Foram realizadas biopsias da mucosa ileal nesses indivíduos, sendo as lâminas examinadas rotineiramente e revisadas posteriormente. RESULTADOS: A correlação entre pacientes com ileoscopia normal e íleo com arquitetura histológica preservada foi de 99,1%. A concordância entre avaliação histológica inicial e revisão de lâminas calculada pelo teste de Kappa, foi 0,21. Nos pacientes com ileoscopia normal, com dor abdominal e ou diarreia crônica, a chance de apresentarem alterações histológicas foi 2,5 vezes maior em relação aos demais. CONCLUSÃO: A correlação entre achados endoscópicos e histológicos foi elevada. A concordância entre avaliação histológica inicial e revisão de lâminas não foi satisfatória. A chance de indivíduos com ileoscopia normal, com dor abdominal e ou diarreia crônica, apresentarem alterações histológicas foi maior, porém a importância clínica desse dado não foi avaliada

Aspectos endoscópicos no diagnóstico de doenças que acometem o íleo terminal

O íleo compreende cerca de 3/5 distais do intestino delgado, sendo responsável pela digestão e absorção de alimentos. O diagnóstico de doenças que afetam esse segmento pode ser feito por meio de avaliação clínica e exames complementares. A colonoscopia, além da possibilidade de análise macroscópica, permite realização de biópsias para avaliação histológica. Apenas três publicações sobre a descrição das características endoscópicas do íleo terminal foram encontradas na literatura. Ainda assim, não foram encontradas descrições ou classificação em publicações que mencionavam o aspecto endoscópico do íleo terminal, sendo reportados apenas como íleo normal. Isso reforça a idéia do desconhecimento ou não aceitação dessas pela comunidade científica. Os aspectos endoscópicos desse segmento, quando afetado por diversas doenças variam de íleo endoscopicamente normal a casos que o exame macroscópico demonstra características especificas dessas doenças. Nesse estudo, existem dúvidas quanto à necessidade de biópsias desse segmento em pacientes com ileoscopia normal. Além disso, foram encontrados poucos estudos com critérios para caracterização macro e microscópica do íleo