Fatores associados ao consumo alimentar de crianças de 6 a 12 meses acompanhadas na atenção básica de Porto Alegre em 2018

Introdução: A alimentação complementar é recomendada a partir dos 6 meses e é fundamental para a promoção da saúde, o desenvolvimento físico e intelectual e a redução do risco dos transtornos causados pelas deficiências nutricionais comuns na infância, além de prevenir doenças crônicas não transmissíveis ao longo da vida adulta. A análise do consumo alimentar e de seus determinantes é fundamental para o monitoramento e planejamento de ações e de políticas públicas para a promoção da alimentação saudável na infância. Objetivo: Investigar os fatores associados ao consumo alimentar de crianças de 6 a 12 meses acompanhadas na atenção básica de Porto Alegre/RS em 2018. Metodologia: Estudo transversal com dados secundários da Estratégia e-SUS Atenção Básica. Foram incluídas crianças com o questionário de marcadores de consumo alimentar preenchido em 2018. Os desfechos foram: 1) diversidade alimentar mínima (DAM), que incluía ter consumido pelo menos um alimento de seis grupos no dia anterior ao inquérito; 2) consumo de ultraprocessados (UP); e, 3) alimentação não saudável (NS), definida como não atingir DAM e apresentar UP. Para testar a associação entre as variáveis independentes e os desfechos utilizou-se o teste qui-quadrado de Pearson. As variáveis que indicaram um nível de significância de até 20% no teste foram incluídas na análise multivariada, realizada por meio de Regressão de Poisson com variância robusta, considerando nível de significância de 5% (p<0,05). Os dados foram processados e analisados no software SPSS versão 25.0. O projeto foi aprovado pelo Comitê de Ética em Pesquisa da Prefeitura Municipal de Porto Alegre (CAAE nº 33783420.00000.5338). Resultados: A amostra foi composta por 906 crianças provenientes de 50,8% (n=65) das unidades de saúde elegíveis do município. As prevalências dos padrões DAM, UP e NS foram 54,1%, 31,2% e 14,1%, respectivamente. Em relação as características da amostra, 50,8% das crianças eram do sexo feminino; entre as mães, 67% eram brancas, 62% apresentavam até 8 anos de escolaridade, e 70,3% situavam-se na faixa de 20 a 34 anos. A maioria das crianças nasceu de parto vaginal (63,3%), a termo (89,4%) e com peso adequado (85,9%). A idade da criança foi associada significativamente aos desfechos DAM e UP, sendo que quanto mais velha a criança, maior a prevalência de ambos. No padrão UP, maior prevalência também foi associada ao sexo masculino. O padrão NS não apresentou associação significativa com as variáveis testadas. Considerações finais: A alimentação complementar em Porto Alegre/RS está aquém do preconizado e conforme aumenta a idade das crianças, apesar de ocorrer um aumento na diversidade alimentar, também há incremento no consumo de alimentos não recomendados. Políticas de promoção da alimentação saudável infantil devem ser fortalecidas no município para melhorar este cenário.Introduction: Complementary feeding is recommended from 6 months onwards and is essential for promoting health, physical and intellectual development and reducing the risk of disorders caused by nutritional deficiencies common in childhood, in addition to preventing chronic non-communicable diseases throughout of adult life. The analysis of food consumption and its determinants is essential for monitoring and planning actions and public policies to promote healthy eating in childhood. Objective: To investigate the factors associated with the food consumption of children aged 6 to 12 months followed up in primary care in Porto Alegre/RS in 2018. Methods: Cross-sectional study with secondary data from the e-SUS Primary Care Strategy. Children with a food consumption questionnaire completed in 2018 were included. Outcomes were: 1) minimal dietary diversity (MDD), which included having consumed at least one food from six groups on the day before the survey; 2) consumption of ultra-processed products (UP); and, 3) unhealthy diet (NS), defined as not reaching BMD and having PU. To test the association between independent variables and outcomes, Pearson's chi-square test was used. Variables that indicated a significance level of up to 20% in the test were included in the multivariate analysis, performed using Poisson regression with robust variance, considering a significance level of 5% (p<0.05). Data were processed and analyzed using SPSS software version 25.0. The project was approved by the Research Ethics Committee of Porto Alegre (CAAE nº 33783420.00000.5338). Results: The sample consisted of 906 children from 50.8% (n=65) of eligible health units in the municipality. The prevalences of MDD, UP and NS patterns were 54.1%, 31.2% and 14.1%, respectively. Regarding the characteristics of the sample, 50.8% of the children were female; among mothers, 67% were white, 62% had up to 8 years of schooling, and 70.3% were between 20 and 34 years old. Most children were born vaginally (63.3%), at term (89.4%) and with adequate weight (85.9%). Child age was significantly associated with MDD and UP outcomes, and the older the child, the greater the prevalence of both. In the UP pattern, higher prevalence was also associated with males. The NS pattern showed no significant association with the variables tested. Conclusion: Complementary feeding in Porto Alegre/RS is below what is recommended and as children age, despite an increase in food diversity, there is also an increase in the consumption of non-recommended foods. Policies to promote healthy infant nutrition should be strengthened in the municipality to improve this scenario

Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≥60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P &lt; 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Outcome at Two Years of Very Preterm Infants Born after Rupture of Membranes before Viability

International audienc

Adaptation of Arterial Wall Viscosity to the Short‐Term Reduction of Heart Rate: Impact of Aging

Background Changes in arterial wall viscosity, which dissipates the energy stored within the arterial wall, may contribute to the beneficial effect of heart rate (HR) reduction on arterial stiffness and cardiovascular coupling. However, it has never been assessed in humans and could be altered by aging. We evaluated the effect of a selective HR‐lowering agent on carotid arterial wall viscosity and the impact of aging on this effect. Methods and Results This randomized, placebo‐controlled, double‐blind, crossover study performed in 19 healthy volunteers evaluated the effects of ivabradine (5 mg BID, 1‐week) on carotid arterial wall viscosity, mechanics, hemodynamics, and cardiovascular coupling. Arterial wall viscosity was evaluated by the area of the hysteresis loop of the pressure‐lumen cross‐sectional area relationship, representing the energy dissipated (WV), and by the relative viscosity (WV/WE), with WE representing the elastic energy stored. HR reduction by ivabradine increased WV and WE whereas WV/WE remained stable. In middle‐aged subjects (n=11), baseline arterial stiffness and cardiovascular coupling were less favorable, and WE was similar but WV and therefore WV/WE were lower than in youth (n=8). HR reduction increased WV/WE in middle‐aged but not in young subjects, owing to a larger increase in WV than WE. These results were supported by the age‐related linear increase in WV/WE after HR reduction (P=0.009), explained by a linear increase in WV. Conclusion HR reduction increases arterial wall energy dissipation proportionally to the increase in WE, suggesting an adaptive process to bradycardia. This mechanism is altered during aging resulting in a larger than expected energy dissipation, the impact of which should be assessed. Registration URL: https://www.clinicaltrials.gov; Unique identifier: 2015/077/HP. URL: https://www. eudract.ema.europa.eu; Unique identifier: 2015‐002060‐17

Screening for small for gestational age infants in early vs late third-trimester ultrasonography: a randomized trial

International audienceBACKGROUND: Recent studies have demonstrated that a routine third-trimester ultrasound scan may improve the detection of small for gestational age infants when compared with clinically indicated ultrasound scans but with no reported reduction in severe perinatal morbidity. Establishing the optimal gestational age for the third-trimester examination necessitates evaluation of the ability to detect small for gestational age infants and to predict maternal and perinatal outcomes. Intrauterine growth restriction most often corresponds with small for gestational age infants associated with pathologic growth patterns. OBJECTIVE: This study aimed to assess the performance of routine early ultrasound scans vs late ultrasound scans during the third trimester of pregnancy to identify small for gestational age infants and fetuses with intrauterine growth restriction. STUDY DESIGN: This was an open-label, randomized, parallel trial conducted in Upper Normandy, France, from 2012 to 2015. The study eligibility criteria were heathy, nulliparous women older than 18 years with gestational age determined using the crown-rump length at the first trimester routine scan and with no fetal malformation or suspected small for gestational age fetus at the routine second trimester scan. Pregnant women were randomly assigned to a third-trimester scan group at 31 weeks gestational age ±6 days (early ultrasound scan) or at 35 weeks gestational age ±6 days (late ultrasound scan). The primary outcome of this trial was the ability of a third trimester scan to predict small for gestational age infants (customized birth weight <10th percentile) and intrauterine growth restriction (customized birth weight <third percentile) using birth weight as the gold standard. The purpose of these adjustments was to optimize the detection of fetal weight associated with pathologic growth patterns. It was calculated that a sample size of 3720 women would be required to obtain 80% power at a 2-sided level of 0.05 with a 15% difference in sensitivity between the 2 intervention group to detect small for gestational age fetuses in favor of the late ultrasound scan group and considering that small for gestational age infants would represent 10% of all live births. Secondary outcomes were maternal and perinatal morbidities with interventions reported. The analysis was based on the intention-to-treat principle. RESULTS: Results from 1853 women assigned to the early ultrasound scan group and 1848 women assigned to the late ultrasound scan group were analyzed. The sensitivity was found to be higher in the late ultrasound scan group than in the early ultrasound scan group, both for identifying small for gestational age infants (27%; 22%–32% vs 17%; 13%–22%; P=.004) and intrauterine growth restriction (44%; 35%–54% vs 18%; 11%–27%; P<.001). There was little difference in the specificity between the late ultrasound scan and early ultrasound scan groups in identifying cases of small for gestational age (97%; 96%–98% and 98%; 97%–99%, respectively; P=.04) and intrauterine growth restriction (96%; 95%–97% and 97%; 96%;–97%, respectively; P=.24). Overall, the maternal and neonatal outcomes were comparable between the early ultrasound scan and late ultrasound scan groups with the exception of additional (at least 1) ultrasound scans performed (25% in the early ultrasound scan group vs 19% in the late ultrasound scan group; P<.001). Rates of perinatal death (0.4% vs 0.8%; P=.12) and adverse perinatal outcomes (1.8% vs 2.7%; P=.08) were comparable between the early ultrasound scan and late ultrasound scan assigned groups, and the overall sensitivity to detect small for gestational age infants and intrauterine growth restriction, including in the last ultrasound scan performed before delivery, were also similar (30%; 25%–36% vs 26%; 21%–31%; P=.23; and 50%; 40%–60% vs 38%; 28%–48%; P=.07). CONCLUSION: A late ultrasound scan performed in the third trimester increases the probability of detecting small for gestational age infants and intrauterine growth restriction with fewer additional scans reported than for the early ultrasound scan group. The overall perinatal outcome risk was comparable between the 2 groups. However, the overall sensitivity for detecting small for gestational age fetuses and intrauterine growth restriction, including in the last ultrasound scan performed before delivery, remains comparable between the late ultrasound scan and early ultrasound scan groups

In vivo probe‐based confocal laser endomicroscopy in chronic interstitial lung diseases: Specific descriptors and correlation with chest CT

International audienceProbe-based confocal laser endomicroscopy (pCLE) enables in vivo microimaging of the distal lung, during bronchoscopy. This study aims at identifying pCLE descriptors of chronic interstitial lung diseases (ILD), their correlations with chest HRCT and assessing inter-observer agreement

In vivo probe‐based confocal laser endomicroscopy in chronic interstitial lung diseases: Specific descriptors and correlation with chest CT

International audienceProbe-based confocal laser endomicroscopy (pCLE) enables in vivo microimaging of the distal lung, during bronchoscopy. This study aims at identifying pCLE descriptors of chronic interstitial lung diseases (ILD), their correlations with chest HRCT and assessing inter-observer agreement