Spirometry And Volumetric Capnography In Lung Function Assessment Of Obese And Normal-weight Individuals Without Asthma

To analyze and compare lung function of obese and healthy, normal-weight children and adolescents, without asthma, through spirometry and volumetric capnography. Methods: Cross-sectional study including 77 subjects (38 obese) aged 5-17 years. All subjects underwent spirometry and volumetric capnography. The evaluations were repeated in obese subjects after the use of a bronchodilator. Results: At the spirometry assessment, obese individuals, when compared with the control group, showed lower values of forced expiratory volume in the first second by forced vital capacity (FEV1/FVC) and expiratory flows at 75% and between 25 and 75% of the FVC (p <0.05). Volumetric capnography showed that obese individuals had a higher volume of produced carbon dioxide and alveolar tidal volume (p <0.05). Additionally, the associations between dead space volume and tidal volume, as well as phase-3 slope normalized by tidal volume, were lower in healthy subjects (p <0.05). These data suggest that obesity does not alter ventilation homogeneity, but flow homogeneity. After subdividing the groups by age, a greater difference in lung function was observed in obese and healthy individuals aged >11 years (p <0.05). Conclusion: Even without the diagnosis of asthma by clinical criteria and without response to bronchodilator use, obese individuals showed lower FEV1/FVC values and forced expiratory flow, indicating the presence of an obstructive process. Volumetric capnography showed that obese individuals had higher alveolar tidal volume, with no alterations in ventilation homogeneity, suggesting flow alterations, without affecting lung volumes. © 2017 Sociedade Brasileira de Pediatria

Global surveillance of cancer survival 1995-2009: analysis of individual data for 25,676,887 patients from 279 population-based registries in 67 countries (CONCORD-2)

BACKGROUND: Worldwide data for cancer survival are scarce. We aimed to initiate worldwide surveillance of cancer survival by central analysis of population-based registry data, as a metric of the effectiveness of health systems, and to inform global policy on cancer control. METHODS: Individual tumour records were submitted by 279 population-based cancer registries in 67 countries for 25·7 million adults (age 15-99 years) and 75,000 children (age 0-14 years) diagnosed with cancer during 1995-2009 and followed up to Dec 31, 2009, or later. We looked at cancers of the stomach, colon, rectum, liver, lung, breast (women), cervix, ovary, and prostate in adults, and adult and childhood leukaemia. Standardised quality control procedures were applied; errors were corrected by the registry concerned. We estimated 5-year net survival, adjusted for background mortality in every country or region by age (single year), sex, and calendar year, and by race or ethnic origin in some countries. Estimates were age-standardised with the International Cancer Survival Standard weights. FINDINGS: 5-year survival from colon, rectal, and breast cancers has increased steadily in most developed countries. For patients diagnosed during 2005-09, survival for colon and rectal cancer reached 60% or more in 22 countries around the world; for breast cancer, 5-year survival rose to 85% or higher in 17 countries worldwide. Liver and lung cancer remain lethal in all nations: for both cancers, 5-year survival is below 20% everywhere in Europe, in the range 15-19% in North America, and as low as 7-9% in Mongolia and Thailand. Striking rises in 5-year survival from prostate cancer have occurred in many countries: survival rose by 10-20% between 1995-99 and 2005-09 in 22 countries in South America, Asia, and Europe, but survival still varies widely around the world, from less than 60% in Bulgaria and Thailand to 95% or more in Brazil, Puerto Rico, and the USA. For cervical cancer, national estimates of 5-year survival range from less than 50% to more than 70%; regional variations are much wider, and improvements between 1995-99 and 2005-09 have generally been slight. For women diagnosed with ovarian cancer in 2005-09, 5-year survival was 40% or higher only in Ecuador, the USA, and 17 countries in Asia and Europe. 5-year survival for stomach cancer in 2005-09 was high (54-58%) in Japan and South Korea, compared with less than 40% in other countries. By contrast, 5-year survival from adult leukaemia in Japan and South Korea (18-23%) is lower than in most other countries. 5-year survival from childhood acute lymphoblastic leukaemia is less than 60% in several countries, but as high as 90% in Canada and four European countries, which suggests major deficiencies in the management of a largely curable disease. INTERPRETATION: International comparison of survival trends reveals very wide differences that are likely to be attributable to differences in access to early diagnosis and optimum treatment. Continuous worldwide surveillance of cancer survival should become an indispensable source of information for cancer patients and researchers and a stimulus for politicians to improve health policy and health-care systems

Para-infectious brain injury in COVID-19 persists at follow-up despite attenuated cytokine and autoantibody responses

To understand neurological complications of COVID-19 better both acutely and for recovery, we measured markers of brain injury, inflammatory mediators, and autoantibodies in 203 hospitalised participants; 111 with acute sera (1–11 days post-admission) and 92 convalescent sera (56 with COVID-19-associated neurological diagnoses). Here we show that compared to 60 uninfected controls, tTau, GFAP, NfL, and UCH-L1 are increased with COVID-19 infection at acute timepoints and NfL and GFAP are significantly higher in participants with neurological complications. Inflammatory mediators (IL-6, IL-12p40, HGF, M-CSF, CCL2, and IL-1RA) are associated with both altered consciousness and markers of brain injury. Autoantibodies are more common in COVID-19 than controls and some (including against MYL7, UCH-L1, and GRIN3B) are more frequent with altered consciousness. Additionally, convalescent participants with neurological complications show elevated GFAP and NfL, unrelated to attenuated systemic inflammatory mediators and to autoantibody responses. Overall, neurological complications of COVID-19 are associated with evidence of neuroglial injury in both acute and late disease and these correlate with dysregulated innate and adaptive immune responses acutely

Repositioning of the global epicentre of non-optimal cholesterol

High blood cholesterol is typically considered a feature of wealthy western countries1,2. However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world3 and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health4,5. However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol—which is a marker of cardiovascular risk—changed from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million–4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.</p

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

A century of trends in adult human height

Being taller is associated with enhanced longevity, and higher education and earnings. We reanalysed 1472 population-based studies, with measurement of height on more than 18.6 million participants to estimate mean height for people born between 1896 and 1996 in 200 countries. The largest gain in adult height over the past century has occurred in South Korean women and Iranian men, who became 20.2 cm (95% credible interval 17.5-22.7) and 16.5 cm (13.3-19.7) taller, respectively. In contrast, there was little change in adult height in some sub-Saharan African countries and in South Asia over the century of analysis. The tallest people over these 100 years are men born in the Netherlands in the last quarter of 20th century, whose average heights surpassed 182.5 cm, and the shortest were women born in Guatemala in 1896 (140.3 cm; 135.8-144.8). The height differential between the tallest and shortest populations was 19-20 cm a century ago, and has remained the same for women and increased for men a century later despite substantial changes in the ranking of countries

Repositioning of the global epicentre of non-optimal cholesterol

High blood cholesterol is typically considered a feature of wealthy western countries1,2. However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world3 and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health4,5. However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol�which is a marker of cardiovascular risk�changed from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95 credible interval 3.7 million�4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world. © 2020, The Author(s), under exclusive licence to Springer Nature Limited

Reasons For Non-adherence To Obesity Treatment In Children And Adolescents [razões Do Abandono Do Tratamento De Obesidade Por Crianças E Adolescentes]

Objective: To analyze the reasons for non-adherence to follow-up at a specialized outpatient clinic for obese children and adolescents. Methods: Descriptive study of 41 patients, including information from medical records and phone recorded questionnaires which included two open questions and eight closed ones: reason for abandonment, financial and structural difficulties (distance and transport costs), relationship with professionals, obesity evolution, treatment continuity, knowledge of difficulties and obesity complications. Results: Among the interviewees, 29.3% reported that adherence to the program spent too much time and it was difficult to adjust consultations to patients' and parents' schedules. Other reasons were: children's refusal to follow treatment (29.3%), dissatisfaction with the result (17.0%), treatment in another health service (12.2%), difficulty in schedule return (7.3%) and delay in attendance (4.9%). All denied any relationship problems with professionals. Among the respondents, 85.4% said they are still overweight. They reported hurdles to appropriate nutrition and physical activity (financial difficulty, lack of parents' time, physical limitation and insecure neighborhood). Among the 33 respondents that reported difficulties with obesity, 78.8% had emotional disorders such as bullying, anxiety and irritability; 24.2% presented fatigue, 15.1% had difficulty in dressing up and 15.1% referred pain. The knowledge of the following complications prevailed: cardicac (97.6%), aesthetic (90.2%), psychological (90.2%), presence of obesity in adulthood (90.2%), diabetes (85.4%) and cancer (31.4%). Conclusions: According to the results, it is possible to create weight control public programs that are easier to access, encouraging appropriate nutrition and physical activities in order to achieve obesity prevention.313338343Wang, Y., Monteiro, C.A., Popkin, B.M., Trends of obesity and underweight in older children and adolescents in the United States, Brazil, China, and Russia (2002) Am J Clin Nutr, 75, pp. 971-977(2009) WHO forum and technical meeting on population-based prevention strategies for childhood obesity, , World Health Organization. Geneva: WHO;(2010) Pesquisa de orçamentos familiares 2008-2009: Antropometria e estado nutricional de crianças, adolescentes e adultos no Brasil, , Brasil. Ministério do Planejamento, Orçamento e Gestão Instituto Brasileiro de Geografia e Estatística. Diretoria de pesquisas. Coordenação de trabalho e rendimento. Rio de Janeiro: IBGE;Daniels, S.R., The consequences of childhood overweight and obesity (2006) Future Child, 16, pp. 47-67Warder Wal, J.S., Mitchell, E.R., Psychological complications of pediatric obesity (2011) Pediatr Clin North Am, 58, pp. 1393-1401Porter, J.S., Bean, M.K., Gerke, C.K., Stern, M., Psychosocial factors and perspectives on weight gain and barriers to weight loss among adolescents enrolled in obesity treatment (2010) J Clin Psychol Med Settings, 17, pp. 98-102Daniels, S.R., Complications of obesity in children and adolescents (2009) Int J Obes (Lond), 33 (SUPPL. 1), pp. S60-S65Ferreira, J.S., Aydos, R.D., Prevalence of hypertension among obese children and adolescents (2010) Cienc Saude Coletiva, 15, pp. 97-104VI Diretrizes Brasileiras de Hipertensão (2010) Rev Bras Hipertens, 17, pp. 1-64. , Sociedade Brasileira de CardiologiaMitka, M., Programs to reduce childhood obesity seem to work, say Cochrane reviewers (2012) JAMA, 307, pp. 444-445Lenders, C.M., Gorman, K., Lim-Miller, A., Puklin, S., Pratt, J., Practical approaches to the treatment of severe pediatric obesity (2011) Pediatr Clin North Am, 58, pp. 1425-1438Waters, E., de Silva-Sanigorski, A., Hall, B.J., Brown, T., Campbell, K.J., Gao, Y., Interventions for preventing obesity in children (2011) Cochrane Database Syst Rev, pp. CD001871Zambon, M.P., Antônio, M.A., Mendes, R.T., Barros Filho, A.A., Obese children and adolescents: Two years of interdisciplinary follow-up (2008) Rev Paul Pediatr, 26, pp. 130-135(2012) Obesidade na infância e adolescência: Manual de Orientação, , http://www.sbp.com.br/PDFs/Man%20Nutrologia_Obsidade.pdf, Sociedade Brasileira de Pediatria [homepage on the Internet]. Departamento de Nutrologia. Rio de Janeiro: SBP[cited 2013 Jun 4]. Available fromBarlow, S.E., Expert Committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: Summary report (2007) Pediatrics, 120, pp. S164-S192. , Expert CommitteeBarlow, S.E., Ohlemeyer, C.L., Parent reasons for nonreturn to a pediatric weight management program (2006) Clin Pediatr (Phila), 45, pp. 355-360Moroshko, I., Brennan, L., O'Brien, P., Predictors of dropout in weight loss interventions: A systematic review of the literature (2011) Obes Rev, 12, pp. 912-934Kitscha, C.E., Brunet, K., Farmer, A., Mager, D.R., Reasons for non-return to a pediatric weight management program (2009) Can J Diet Pract Res, 70, pp. 89-94Lara, M.D., Baker, M.T., Larson, C.J., Mathiason, M.A., Lambert, P.J., Kothari, S.N., Travel distance, age, and sex as factors in follow-up visit compliance in the post-gastric by pass population (2004) Surg Obes Relat Dis, 1, pp. 17-21Sivagnanam, P., Rhodes, M., The importance of follow-up and distance from centre in weight loss after laparoscopic adjustable gastric banding (2010) Surg Endosc, 24, pp. 2432-2438Stewart, L., Chapple, J., Hughes, A.R., Poustie, V., Reilly, J.J., Parents' journey through treatment for their child's obesity: A qualitative study (2008) Arch Dis Child, 93, pp. 35-39Minniti, A., Bissoli, L., Di Francesco, V., Fantin, F., Mandragona, R., Olivieri, M., Individual versus group therapy for obesity: Comparison of dropout rate and treatment outcome (2007) Eat Weight Disord, 12, pp. 161-167Venturini, L.P., (2000) Obesidade e família-Uma caracterização de famílias de crianças obesas e a percepção dos familiares e das crianças de sua imagem corporal, , [tese de mestrado] Ribeirão Preto (SP): USP;Keeton, V.F., Kennedy, C., Update on physical activity including special needs populations (2009) Curr Opin Pediatr, 21, pp. 262-268Palma, A., Atividade física, processo saúde-doença e condições sócio-econômicas: Uma revisão da literatura (2000) Rev Paul Educ Fis, 14, pp. 97-106Skelton, J.A., Beech, B.M., Attrition in paediatric weight management: A review of the literature and new directions (2011) Obes Rev, 12, pp. e273-e281Muller, R.C., Obesidade na adolescência (2001) Pediatr Mod, 37, pp. 45-48Lee, Y.S., Consequences of childhood obesity (2009) Ann Acad Med Singapore, 38, pp. 75-77Skelton, J.A., Beech, B.M., Attrition in paediatric weight management: A review of the literature and new directions (2011) Obes Rev, 12, pp. e273-e281Skelton, J.A., DeMattia, L.G., Flores, G., A pediatric weight management program for high-risk populations: A preliminary analysis (2008) Obesity (Silver Spring), 16, pp. 1698-170

Secular Trends Of Growth Of Schoolchildren From Paulínia, São Paulo-brazil (1979/80 - 1993/94) [tendência Secular De Crescimento Em Escolares De Paulínia, São Paulo-brasil (1979/80 - 1993/94).]

BACKGROUND: The purpose of this study was to evaluate the secular trends in height, weight and weight/height of schoolchildren from the city of Paulínia, São Paulo, Brazil between 1979/80 and 1993/94. METHODS: Anthropometric measurements (height, weight and weight/height) of 1,903 children (6.5-12.5 y); 51.5% M: 48.5% F, from Paulínia public schools were compared with data from a previous study carried out in the same city 15 years earlier. Decade increments were calculated and data was smoothed by the technique of means and medians (3H3H3). RESULTS: Height and weight mean values were always greater than those of the previous study, with positive increments. Height increments ranged from 1.13 to 5.0 cm in boys and from 1.2 to 4.33 cm in girls. Weight increments ranged from 0.53 to 4.13 kg in males and from 0.87 to 3.0 kg in females. In the two studies, weight/height means were very similar for both genders. CONCLUSIONS: Increments in height and weight during this period are an indicator of development on the economical and health levels. A positive secular trend was also observed in developed countries after the 2nd World War and in the Brazilian people.50438639

Nutritional Status Of Children And Teenagers With Chronic Renal Failure [avaliação Do Estado Nutricional De Crianças E Adolescentes Com Insuficiência Renal Crônica.]

BACKGROUND: the purpose of this study is to evaluate the nutritional status of children and teenagers with chronic renal (CRF) failure using anthropometric measurements. MATERIAL AND METHODS: 41 children and adolescents with (CRF) (creatinine "clearance" < 50 ml/min/1,73m(2)) followed at the Pediatric Nephrology Unit (HC-UNICAMP), between January 1995 and November 1996, were evaluated by the assessment of anthropometric measurements, mid upper arm circunference (MUAC) and triceps skinfold (TSF). With these measurements, mid arm fat area (MUAFA) and arm muscle area (AMA) were calculated and its z-scores. These measurements were performed twice at least, ranging from 0.21 to 1.3 years (0.88 +/- 0.04). RESULTS: all the z-scores (MUAC, TSF, MUAFA and AMA) were very low, and only the AMA z-score was statistically significant (p= 0,03 Wilcoxon test). The patients were divided in to groups, according to their treatment, and the MAC z-score for the renal transplantation group was statistically significant (p= 0,02 Wilcoxon test). CONCLUSIONS: these data demonstrate a compromised nutritional status from both muscle and fat stores, with an improvement in muscle stores.47213714