Cesarean section is associated with increased peripheral and central adiposity in young adulthood : cohort study

Background: Cesarean section (CS) has been associated with obesity, measured by body mass index (BMI), in some studies. It has been hypothesized that this association, if causal, might be explained by changes in gut microbiota. However, little is known about whether CS is also associated with increased adiposity as measured by indicators other than BMI. Objective: To assess the association between CS and indicators of peripheral and central adiposity in young adults. Methods: The study was conducted on 2,063 young adults aged 23 to 25 years from the 1978/79Ribeira˜o Preto birth cohort, Sa˜o Paulo, Brazil. CS was the independent variable. The anthropometric indicators of adiposity were: waist circumference (WC), waist-height ratio (WHtR), waist-hip ratio (WHR), tricipital skinfold (TSF), and subscapular skinfold (SSF). The association between CS and indicators of adiposity was investigated using a Poisson model, with robust adjustment of variance and calculation of incidence rate ratio (IRR) with 95% confidence interval (95%CI), and adjustment for birth variables. Results: Follow-up rate was 31.8%. The CS rate was 32%. Prevalences of increased WC, WHtR, WHR were 32.1%, 33.0% and 15.2%, respectively. After adjustment for birth variables, CS was associated with increased risk of adiposity when compared to vaginal delivery: 1.22 (95%CI 1.07; 1.39) for WC, 1.25 (95%CI 1.10;1.42) for WHtR, 1.45 (95%CI 1.18;1.79) for WHR, 1.36 (95%CI 1.04;1.78) for TSF, and 1.43 (95%CI 1.08;1.91) for SSF. Conclusion: Subjects born by CS had a higher risk for increased peripheral and central adiposity during young adult age compared to those born by vaginal delivery. The association of CS with adiposity was consistently observed for all indicators and was robust after adjustment for a variety of early life confounders

PROTEÇÃO SOCIAL EM METRÓPOLES: QUAIS SERVIÇOS SOCIOASSISTENCIAIS?

Esse relato faz parte de uma pesquisa em andamento, onde a inquietação principal diz respeito à gestão do SUAS – Sistema Único de Assistência Social em metrópoles, dada suas complexidades, acirramento de desigualdades e pobreza, somada ao conjunto de violências latentes. Tal inquietação circunscreve-se nas perguntas: o contexto das metrópoles favorece ou dificulta as mudanças necessárias na Política de Assistência Social? Com relação à gestão de metrópoles, que desafios estão postos? Como equacioná-los? Há uma equação possível? Neste artigo adotaremos a definição de metrópole prevista na Política Nacional de Assistência Social-PNAS/2004, que classifica os municípios com base no seu porte populacional. São tratadas como metrópoles as cidades cuja população agrega mais de 900 mil habitantes. Um dado interessante apontado na Política Nacional de Assistência Social - PNAS/04 diz respeito aos extremos, ou seja, 20% da população brasileira reside em metrópoles (apenas 17 cidades) e 20% em pequenos municípios. Cumpre salientar que a gestão de políticas públicas em metrópoles exige a implantação de estrutura administrativa e de serviços descentralizados com suficiente capilaridade para atingir os diversos territórios de que se compõem a grande cidade, que considere suas peculiaridades, dê conta de suas diferenças e complexidades, que leve em conta seu diferencial enquanto metrópole

The sexuality of HIV-positive adolescents: rights and challenges for healthcare

Sexualidade e saúde reprodutiva configuram questões relevantes para o cuidado integral à saúde de pessoas vivendo com HIV. Políticas públicas e serviços de saúde, entretanto, têm dedicado insuficiente atenção ao assunto. O objetivo deste trabalho é compreender como adolescentes e jovens soropositivos lidam com suas experiências sexuais e projetos de namoro, desejo de constituir família e de ter filhos. O estudo qualitativo entrevistou em profundidade 21 adolescentes vivendo com HIV (por transmissão vertical, sexual ou sanguínea) e 13 cuidadores de crianças e jovens, vivendo em São Paulo e em Santos, Brasil. As narrativas descrevem como aprenderam a lidar com a sexualidade e a ansiedade da revelação do diagnóstico nesse contexto. Destacam-se nas narrativas o despreparo, a desinformação sobre prevenção e a falta de apoio para lidar com a situação, assim como o estigma e a discriminação que atravessa grande parte das dificuldades relatadas. O artigo discute criticamente alguns dos desafios postos para uma adequada atenção à questão no Brasil, especialmente a consideração de jovens soropositivos como sujeitos de direitos sexuais, sugerindo diretrizes para a incorporação desta temática a um cuidado integral e humanizado de crianças e jovens vivendo com HIV.Sexuality and reproductive healthcare represent relevant issues for comprehensive care of HIV-positive adolescents. However, public policies and health services give this issue insufficient attention. The scope of this article is to assess how HIV-positive young people and teenagers cope with their sexuality, dating and the urge to have children and start a family. In a qualitative study, in-depth interviews were staged with 21 HIV-positive (contracted by vertical, sexual or intravenous transmission) teenagers and 13 caregivers of children and youths living in Sao Paulo and Santos. The interviews revealed the different ways teenagers cope with their sexuality and with the anxiety of HIV disclosure in this context. Lack of information about HIV prevention, lack of support and skills to cope with their sexuality were revealed in the reports. Furthermore, stigma and discrimination were the most frequently reported difficulties. The main challenges to be faced in Brazil in regard to this issue are discussed, especially the need to consider HIV-positive youth as entitled to sexual rights. Recommendations are also made for incorporating the issue into a humanized and comprehensive care approach for HIV-positive children and young people

PROTEÇÃO SOCIAL EM METRÓPOLES: QUAIS SERVIÇOS SOCIOASSISTENCIAIS?

Esse relato faz parte de uma pesquisa em andamento, onde a inquietação principal diz respeito à gestão do SUAS – Sistema Único de Assistência Social em metrópoles, dada suas complexidades, acirramento de desigualdades e pobreza, somada ao conjunto de violências latentes. Tal inquietação circunscreve-se nas perguntas: o contexto das metrópoles favorece ou dificulta as mudanças necessárias na Política de Assistência Social? Com relação à gestão de metrópoles, que desafios estão postos? Como equacioná-los? Há uma equação possível? Neste artigo adotaremos a definição de metrópole prevista na Política Nacional de Assistência Social-PNAS/2004, que classifica os municípios com base no seu porte populacional. São tratadas como metrópoles as cidades cuja população agrega mais de 900 mil habitantes. Um dado interessante apontado na Política Nacional de Assistência Social - PNAS/04 diz respeito aos extremos, ou seja, 20% da população brasileira reside em metrópoles (apenas 17 cidades) e 20% em pequenos municípios. Cumpre salientar que a gestão de políticas públicas em metrópoles exige a implantação de estrutura administrativa e de serviços descentralizados com suficiente capilaridade para atingir os diversos territórios de que se compõem a grande cidade, que considere suas peculiaridades, dê conta de suas diferenças e complexidades, que leve em conta seu diferencial enquanto metrópole

INTERVENÇÕES CIRÚRGICAS EM CRIANÇAS COM DISTÚRBIOS ENDÓCRINOS EM SITUAÇÕES DE URGÊNCIA NEUROLÓGICA.

This review article addresses the origin, spread and clinical signs of ovarian cysts in children, a complex gynecological condition that significantly impacts diagnosis and treatment. The incidence of these cysts varies according to age group, being less common in children before puberty and more frequent in newborns and adolescents, due to changes in gonadotropic activity. The objective is to expand knowledge about the causes and symptoms of ovarian cysts in pediatric patients, highlighting the importance of precise approaches to diagnosis and treatment. The methodology used was an integrative literature review, carried out through research in databases of articles related to the subject. Only texts that met the objectives of the study were evaluated, excluding theses, dissertations and duplicate content. The results indicate that the majority of cysts in babies and children are linked to problems in follicular development. Some cysts are hormonal and can cause the early onset of puberty, while others, such as Sertoli-Leydig cell tumors, can lead to virilization. Symptoms can be diverse, from symptomless masses in the abdomen to acute symptoms that look like appendicitis, which makes clinical diagnosis more complicated. In summary, ovarian cysts in children are difficult to diagnose due to the different forms of manifestation. This can cause some trauma to the child neurologically and may require correct intervention in emergency situations.Neste artigo de revisão são abordados a origem, propagação e sinais clínicos dos cistos ovarianos em crianças, uma condição ginecológica complexa que impacta significativamente no diagnóstico e tratamento. A incidência destes cistos varia de acordo com a faixa etária, sendo menos comum em crianças antes da puberdade e mais frequente em recém-nascidos e adolescentes, devido às mudanças na atividade gonadotrópica. O objetivo é ampliar o conhecimento sobre as causas e sintomas dos cistos ovarianos em pacientes pediátricos, ressaltando a importância de abordagens precisas no diagnóstico e tratamento. A metodologia utilizada foi uma revisão integrativa da literatura, realizada através de pesquisa em bases de dados de artigos relacionados ao assunto. Foram avaliados apenas os textos que atendiam aos objetivos do estudo, excluindo teses, dissertações e conteúdos duplicados. Os resultados apontam que a maioria dos cistos em bebês e crianças está ligada a problemas no desenvolvimento folicular. Alguns cistos são hormonais e podem causar o início precoce da puberdade, enquanto outros, como os tumores de células de Sertoli-Leydig, podem levar à virilização. Os sintomas podem ser diversos, desde massas no abdômen sem sintomas até sintomas agudos que se parecem com apendicite, o que torna o diagnóstico clínico mais complicado. Em resumo, os cistos ovarianos nas crianças são difíceis de diagnosticar devido às diferentes formas de manifestação. Aonde pode trazer alguns traumas na crianda de forma neurológica e pondendo levar em situações de urgências para uma intervenção correta

Uma capitania dos novos tempos: economia, sociedade e política na São Paulo restaurada (1765-1822)

O artigo reflete sobre a trajetória da Capitania de São Paulo, a partir de 1750, apontando sua transformação, de fronteira e "boca do sertão", para território estratégico da conquista e defesa das partes meridionais e área economicamente integrada aos circuitos mercantis atlânticos.In this article, we reflect upon the history of the Captaincy of São Paulo as from 1750, drawing attention to its transformation from frontier land and "door to the backcountry" into a territory of strategic value for the purposes of conquest and defense of the southern regions, and economically integrated into the Atlantic trade routes

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

Vulnerability, Human Rights, and Comprehensive Health Care Needs of Young People Living With HIV/AIDS

We sought to identify and understand the health care needs of young people living with HIV/AIDS, particularly in terms of their psychosocial well-being. We conducted a qualitative analysis of HIV-positive young people and their caregivers, focusing on the implications of an HIV diagnosis for health care needs. Stigma was a recurrent issue that arose in the interviews conducted with the respondents, and it was evident that youths had been denied many rights related to health. We concluded that young people living with HIV need comprehensive care based on a human rights approach. In this regard, we offer some practical recommendations for health programs

Distribution of birth variables according to the presence of indicators of increased adiposity in young adults.

*<p>Increased WC: ≥90 cm for men and ≥80 cm for women);</p>†<p>Increased WHtR: >0.5;</p>‡<p>Increased WHR: ≥0.90 for men and ≥0.85 for women;</p>§<p>Increased TSF and SSF: >90th percentile of the study population.</p><p>Ribeirão Preto, 2002/04.</p