Association between handgrip strength and bone mass parameters in HIV-infected children and adolescents. A cross-sectional study

ABSTRACT BACKGROUND: Low bone mineral content (BMC) and bone mineral density (BMD) have been identified in human immunodeficiency virus (HIV)-infected children and adolescents. The direct adverse effects of HIV infection and combined antiretroviral therapy (ART) negatively contribute to bone metabolism. A direct relationship between muscle strength levels and BMD in HIV-infected adults and older adults has been described. However, it is unknown whether handgrip strength (HGS) is associated with bone mass in pediatric populations diagnosed with HIV. OBJECTIVE: To ascertain whether HGS levels are associated with BMC and BMD in HIV-infected children and adolescents. DESIGN AND SETTING: Cross-sectional study conducted in Florianãpolis, Brazil, in 2016. METHODS: The subjects were 65 children and adolescents (8-15 years) diagnosed with vertically-transmitted HIV. Subtotal and lumbar-spine BMC and BMD were obtained via dual-emission X-ray absorptiometry (DXA). HGS was measured using manual dynamometers. The covariates of sex, ART, CD4+ T lymphocytes and viral load were obtained through questionnaires and medical records. Sexual maturation was self-reported and physical activity was measured using accelerometers. Simple and multiple linear regression were used, with P < 0.05. RESULTS: HGS was directly associated with subtotal BMD (β = 0.002; R² = 0.670; P < 0.001), subtotal BMC (β = 0.090; R² = 0.734; P = 0.005) and lumbar-spine BMC (β = 1.004; R² = 0.656; P = 0.010) in the adjusted analyses. However, no significant association was found between HGS and lumbar-spine BMD (β = 0.001; R² = 0.464; P = 0.299). CONCLUSION: HGS was directly associated with BMD and BMC in HIV-infected children and adolescents.

Prevalence and determinants of the utilization of sexual and reproductive health services in the teen health kiosk of a public secondary school in the City of Dasmariñas

@#<p style="text-align: justify;"><strong>Objective:</strong> Despite the provision of local health policies promoting the utilization of sexual and reproductive health (SRH) services of adolescents, SRH services utilization remains very low and little information is known concerning the factors which may influence adolescents' use of these SRH services. This study aimed to determine the prevalence and determinants of school-based SRH services utilization among secondary school students.</p><p style="text-align: justify;"><strong>Materials and Methods:</strong> This is a cross-sectional study that used a self-administered questionnaire to gather data among students in one public secondary school in the City of Dasmariñas. A total of 24 sections from Grades 8 to 12 were randomly selected using stratified cluster sampling. Both descriptive and inferential statistics were used to analyze the data using Epi Info version 7.3.2.1.</p><p style="text-align: justify;"><strong>Results:</strong> Among 1,218 students who answered the questionnaire, 168 students (13.8%) utilized the SRH services in the Teen Health Kiosk (THK) during SY 2019-20. Students with favorable attitudes towards SRH issues (predisposing factor) were twice more likely to utilize the SRH services (Adjusted odds ratio, AOR 1.75, 95% CI 1.12-2.74) and those who have positive perceived accessibility on the SRH services (enabling factor) were 2.5 times more likely to utilize the SRH services (AOR 2.46, 95% CI 1.66 - 3.66).</p><p style="text-align: justify;"><strong>Conclusion:</strong> Attitudes towards SRH issues and perceived accessibility to SRH services were found to be determinants of SRH services utilization in the THK of the selected public secondary school in the City of Dasmariñas. Even with the marked increase in the utilization of SRH services in the THK from 0.2% in SY 2018-19 to 13.8% in SY 2019-20, intensified efforts are still needed in order to target students' attitudes on SRH and accessibility of THK and the SRH services it offers to its clients. It is recommended that the existing THK Club be strengthened as this will play a significant role in changing the attitudes of students towards SRH issues, thus increasing the utilization of SRH services. Additionally, formulating an SRH policy at the school level targeting THK's accessibility will be helpful in increasing the utilization of school-based SRH services. For one, a policy mandating THK service providers to deliver services beyond school hours may be discussed such that it can also cater students who are attending the school during weekends (i.e. ALS students, Open High students). Likewise, policy makers in the City Schools Division Office including their top management and personnel from the Health and Nutrition Unit as well as school administrators must endeavor to provide a more conducive THK where privacy and confidentiality can be maintained at all times and clients can freely discuss SRH issues with the THK service provider. An initiative to provide a separately detached room for the THK is encouraged in order to provide a more suitable counselling area and to ensure privacy and confidentiality of student clients and their shared information.</p>

A saúde na percepção do adolescente / Health in the adolescent's viewpoint

Na fase da adolescência, o indivíduo experimenta os melhores índices de saúde, os quais podem ser mantidos e/ou melhorados, dependendo da percepção e valorização dos mesmos, influenciando na sua qualidade de vida. O estudo avaliou a opinião de adolescentes (n=493) da Fundação Mirim do Município de Araçatuba - SP, quanto à saúde geral e bucal, bem como sua percepção sobre elas, por meio questionário semiestruturado, durante o ano letivo de 2006, já que os mesmos possuem acesso à atenção à saúde bucal e palestras sobre saúde. Dentre os entrevistados 34,5 por cento conceituaram a saúde como coisa ou algo que precisa(mos) cuidar; 26,6 por cento, como bem-estar; 18,1 por cento, como a própria existência; e 14,5 por cento, como ausência de doença. Em relação aos conceitos de saúde bucal, 68,4 por cento definiram como higiene; 16,2 por cento, como aparência; e 15,5 por cento, como ausência de doenças bucais. A percepção desses jovens quanto a sua saúde em geral foi para 46,5 por cento, ótima, e 44,1 por cento, boa, enquanto que a da sua saúde bucal foi para 53,6 por cento, boa, e 24 por cento, ótima. Pode-se concluir que os adolescentes têm uma ideia tanto sobre saúde geral como saúde bucal, porém a classificação é menor no que tange à saúde bucal, pois envolve aspectos afetivos, estéticos e sociais. Ademais, percebe-se a necessidade de programas educativo-preventivos direcionados a esse grupo.

During adolescence, the individual experiences the best health indexes, which can be maintained and/or improved, depending on their perception and valorization influencing their quality of life. The study assessed the opinion of adolescents (n=493) from the Mirim Foundation of the Araçatuba county in São Paulo State, Brazil, about their oral and general health, as well as their perception about them, through a semi-structured questionnaire, in the school year period of 2006, since they have access to information on oral health care and speeches about health in general. Among the interviees, 34.5 percent referred to health as something to be cared of; 26.6 percent defined it as well-being;ç 18.1 percent, as related to their very existence, and 14.5 percent, as an absence of disease. In relation to the concepts of oral health, 68.4 percent defined it as hygiene; 16.2 percent, as physical appearance and 15.5 percent, as to the absence of oral diseases. The perception of these youngsters about their health in general was excellent for 46.5 percent, and good for 44.1 percent. Concerning their oral health, for 53.6 percent it was good, and for 24 percent, excellent. One can conclude that the adolescents have an idea about general health, as well as oral health, but the oral health classification is lower, since it involves emotional, esthetic and social aspects. Moreover, the need of prevention-educative programs designed for this group is indubitable.

Representações sociais de adolescentes primíparas sobre "ser mãe" / Primiparous adolecents' social representations of "being mothers" / Representaciones sociales de adolescentes primíparas cuanto al "ser madre"

Estudo exploratório descritivo, qualitativo, cujo objetivo foi analisar e comparar as representações sociais de adolescentes primíparas, acerca de "ser mãe", antes e após o nascimento dos bebês. Foram informantes, cinco adolescentes, que realizavam o pré-natal num Posto de Saúde, da periferia do Rio Grande RS, no período de agosto a novembro de 2006 .: Utilizou-se entrevista semi-estruturada na coleta de dados e análise de conteúdo no tratamento. Apreendeu-se no pré-natal, que todas demonstraram satisfação com a gravidez, orgulho com a barriga e o enxoval. Tinham a representação de mãe ancorada na imagem da mulher bondosa e abnegada, sendo a maternidade algo natural e irrefletidamente maravilhoso. Desconheciam os compromissos advindos da maternidade e limitavam seus sonhos e expectativas aquele momento de vida. Após o nascimento, referiram que a nova realidade foi impactante desencadeando inúmeras modificações em seus projetos de vida. Para tentarem assumir a condição de mãe, para a qual não tinham condições psicológicas nem sociais, cogitaram duas possibilidades, a de procurar um emprego e a de abandonar os estudos, ambas interferindo no processo de adolescer saudável e dificultando o vislumbramento de oportunidades. Acredita-se que, oportunizar o compartilhamento de tais representações com outras adolescentes possa diminuir a vulnerabilidade à gravidez precoce.

The present paper is a descriptive, qualitative study carried out to identify, analyze, and compare primipara adolescents' social representation of "being mothers", before and after the childbirth process. The subjects were five students who did their prenatal care in a health service institution on the outskirts of Rio Grande/RS, in the period between August and November of 2006. The data was collected by means of a semi-structured interview and content analysis in the treatment. It was noticed that all the girls seemed to be satisfied with their pregnancy and were proud of their appearance and to show the baby's trousseau. All of them correlated the social representations of "mothers" with the image of kind, abnegated women. In their opinion, maternity is natural and wonderful, something beautiful and great. They did not consider the commitment entailed by maternity and limited their dreams and expectations to that restricted moment of life. After the babies were born, reported that facing this new reality had a profound impact and unchained numerous changes in their personal expectations. In an attempt to assume the role of mothers, for which they were socially and psychologically unprepared, they came up with two alternatives: finding a job or quitting school, both interfering with the natural process of adolescence and impairing the outlook on opportunities. It is believed that giving the opportunity to the sharing of these representations with other adolescents can decrease the vulnerability to the premature pregnancy.

Estudio exploratorio descriptivo, cualitativo, realizado con el objetivo de analizar y comparar las representaciones sociales de adolescentes primíparas, acerca del "ser madre", antes y después del nacimiento de los bebes. Fueron informantes, cinco adolescentes, que realizaban el prenatal en una Unidad de Salud, de la periferia de Rio Grande RS, en el período de agosto a noviembre de 2006. Se realizó la colecta de datos, por medio de entrevista medio estructurada y el análisis del contenido para el tratamiento. Se aprendió que antes del parto, todas demostraron satisfacción con el embarazo, orgullo con la barriga y con el ajuar del bebe. Que tenían la representación social del "madre" anclada en el imagen de la mujer buena y abnegada. Para ellas la maternidad era algo "natural" y sin reflexión, maravillosa. Desconocían los compromisos relativos a la maternidad y limitaban sus sueños y expectativas a aquel momento de la vida. Después del nacimiento, refirieron que la nueva realidad fue impactante y desencadenó varias modificaciones en sus proyectos de vida. Intentando asumir la condición de madre, a la cual no tenían condiciones psicológicas ni sociales, mencionaron dos posibilidades, la de buscar un empleo y la de abandonar los estudios, ambas interfiriendo en el proceso del adolecer saludable y dificultando la visión de las oportunidades. Se acredita que, oportunizar el compartijamiento de tales representaciones con otras adolescentes, pueda disminuir la vulnerabilidad a la gravidez precoz.

Periodontal profile and presence of periodontal pathogens in young African-Americans from Salvador, BA, Brazil / Condição periodontal e presença de patógenos periodontais em uma população jovem de brasileiros afro-descendentes

This cross-sectional study evaluated the periodontal status and the presence of periodontopathogens in 132 young, black ethnic subjects who live in Salvador/Bahia-Brazil and have never smoked. Periodontal Probing Depth (PPD), Clinical Attachment Level (CAL), Plaque Index (PI) and Gingival Index (GI) were measured and analyzed by ANOVA and Wilcoxon tests (p<0.05) according to gender and age. The presence of A.actinomycetemcomitans, P.gingivalis, E.corrodens and F.nucleatum was determined by PCR and was analyzed by ANOVA, Wilcoxon, Student-t tests (p<0.05). Mean values of PPD and CAL were 2.18 and 1.0mm, respectively. Clinical parameters did not show differences between subjects of varying gender and age. The microbial prevalence was observed to be 95.45 percent for E.corrodens followed by F.nucleatum with 68.18 percent, A.actinomycetemcomitans with45.45 percent and P.gingivalis with 40.9 percent. An association between the presence of pathogens and gender and age was not observed (p<0.05). PPD, CAL and PI were not associated with P.gingivalis; however, GI appeared in higher frequencies among subjects without P.gingivalis. In this young, black ethnic, Brazilian population, a high percentage (96.96 percent) of subjects harbored at least one selected periodontal pathogen, but most subjects showed a healthy periodontal status. Further investigations are required to evaluate the actual influence of the presence of these bacterial species.

O objetivo do presente estudo foi avaliar a condição periodontal e presença de periodonto-patógenos em uma amostra de 132 jovens não fumantes, afro-descendentes, residentes em Salvador/Bahia-Brasil. Profundidade de Sondagem (PS), Nível Clínico de Inserção (NCI), Índice de Placa (IP) e Índice Gengival (IG) foram mensurados e analisados pelos testes ANOVA e Wilcoxon (p<0,05) em função do gênero e idade dos indivíduos. A. actinomycetemcomitans, P. gingivalis, E. corrodens e F. nucleatum foram identificados por PCR e analisados por ANOVA, Wilcoxon e t de Student (p<0,05). Foram observados valores médios de PS e NCI de 2,18 e 1,0mm respectivamente. Os parâmetros clínicos avaliados não sofreram influência dos fatores gênero e idade (p<0,05). E. corrodens foi a bactéria mais prevalente (95.45 por cento), seguido de F. nucleatum (68.18 por cento), A. actinomycetemcomitans (45.45 por cento) e P. gingivalis (40.9 por cento). Não foi observada associação entre os patógenos periodontais pesquisados com o gênero e idade dos indivíduos (p<0,05). PS, NCI e IP não estiveram associados a presença de P. gingivalis, todavia para o parâmetro IG este mostrou alta freqüência entre os indivíduos que não alocaram P. gingivalis. Nessa população jovem de brasileiros afro-descendentes um percentual (96,96 por cento) elevado de indivíduos apresentou pelo menos um patógeno periodontal, mas mostraram-se clinicamente saudáveis. Outras investigações são necessaries para avaliar a real influencia da presença dessas espécies bacterianas.

Relationship between oral health and its impact on quality of life among adolescents

The aim of this study was to assess oral health status and its relationship with quality of life. A household population, cross-sectional study was carried out; participants were between 15 and 17 years of age (n = 247) and were examined by two calibrated dentists. Socio-economic status was classified according to ANEP-ABIPEME criteria. Clinical examinations to observe DMFT, CPI and Dean indices were performed as per WHO criteria. The Significant Caries Index (SiC) was used to evaluate polarization of the occurrence of caries among participants of the tercile with higher DMF-T. The OHIP instrument was used to measure quality of life. The Spearman and Mann-Whitney tests were used for assessing correlations (5 percent significance level). Examinations were carried out in 117 (47.37 percent) females and in 130 (52.63 percent) males. Of the examined participants, 45.75 percent were classified as belonging to socio-economic class C. Caries occurrence was observed in 218 subjects (88.26 percent); the mean DMFT was 5.40. The SiC index was 9.97. Almost half (47.77 percent) of the participants examined did not present sextants affected by periodontal disease. Of the participants examined, 80.16 percent presented absence of fluorosis. The mean OHIP was 3.95. The following correlations were observed: a positive and statistically significant correlation between the highest score in the OHIP and decayed teeth; a positive correlation with threshold significance between OHIP and DMFT; an inverse correlation between intact teeth and OHIP; and a positive and non statistically significant correlation between SiC and OHIP (correlation coefficient = 0.13, p = 0.245). Association between the mean OHIP and the terciles was not significant (p = 0.146); there were also no associations between periodontal condition and OHIP nor were there associations between the presence of fluorosis and mean OHIP.

O cotidiano de crianças infectadas pelo HIV no adolescer: compromissos e possibilidades do cuidado de si / The daily life of infected dy HIV in the process of becoming adolescent: compromise and possibilities to the care for themselves

Introdução: as crianças com aids por transmissão vertical transitam da infância para a adolescência, e pouco se sabe sobre como cuidam de si. Objetivo: compreender as possibilidades de cuidado de si no cotidiano do adolescer com aids. Métodos: foram depoentes: 11 adolescentes não institucionalizados, de 12 a 14 anos, que conheciam seu diagnóstico, atendidos em três HU/RJ. O projeto obteve aprovação de todos os CEP. Utilizou-se a entrevista fenomenológica e a análise hermenêutica heideggeriana. Resultados: desde que acharam o "negócio no sangue" têm que tomar remédio todos os dias, várias vezes e sempre, e não sabem se um dia poderão parar. Com a descoberta de que possuem o "vírus", compreenderam que têm de cuidar da saúde para continuar vivendo, irem sozinhos às consultas hospitalares, fazerem exames e controlarem seu tratamento. Por conta da adolescência, precisam trocar de doutores quesão legais. Precisam tomar o remédio do modo certo para terem saúde, imunidade, e evitarem doenças ou coisas mais graves. Estão cansados do tamanho ruim dos comprimidos e da interferência no dia a dia. Alguns tomam os comprimidos sozinhos, mas fazer o tratamento é difícil, então precisam de ajuda de alguém. Alguns nunca pararam o tratamento, outros o fi zeram por orientação médica ou por conta própria. Justifi cam: não aceitam o "problema". Sabem que a alimentação e os exercícios ajudam no tratamento. Conclusão: a transmissão vertical do HIV determinou uma necessidade especial na sua saúde: a dependência da tecnologia medicamentosa. Essa facticidade envolve a criança em uma rede de cuidados profissional e familiar. Durante a infância, necessitam integralmente dos cuidados prestados pelos familiares e, na transição da infância para a adolescência, passam a compreender a necessidade decuidar de si, a partir de suas responsabilidades "com-sigo" e da ajuda familiar. Assim, as crianças revelam-se no movimento de ser-cuidado-por para sercuidado-com.

Introduction: children with vertical transmission HIV/aids pass from childhood to adolescence and little is known about how they care about themselves. Objective: understand the possibilities of the care for oneself in the daily life of adolescents with aids. Methods: phenomenological interview was developed with 11 non-institutionalized 12-14 year-old-boys and girls with disclosed diagnosis from Brazilian teaching hospitals. The project was approved by the Ethics Review Committees. Heiddeger"s hermeneutic analyzes was applied. Results: since that "thing in the blood" was found they have to take medication everyday, many times and ever. When they discovered about the "virus" , they understood that they had to take care of their health to continue alive, to go alone to consultation, to take medical exams and have control about their treatment. Due to adolescence they have to change doctors. They have to take medication in the right way to be healthy, to have biological immunity, and avoid diseases and "worst things". They get tired. The pills" size/fl avor isbad and interfere in their daily live. Some take medication alone, but following the treatment is hard, so they need help. Some never stopped the treatment, however, others did that due to medical orientation or because they did not accept the "problem". They know that nutrition and physical activities help the treatment. Conclusion: aids determined a special need in their health: the medication technology dependency. The facticity involved them in a web care by professionals and relatives. During childhood, they needed family care integrally; and, in the transition from childhood to adolescence, they have to take care of themselves acquiring responsibilities with-themselves and being helped by relatives. Thus, children were revealed in the movement from beingcared- for to being-cared-with.

Tradução e adaptação cultural para o português do instrumento "The Bowel Disease Questionnaire", utilizado para a avaliação de doenças gastrointestinais funcionais / Portuguese-language cultural adaptation and translation of The Bowel Disease Questionnaire used to assess functional bowel disorders

RACIONAL: As doenças gastrointestinais funcionais são reconhecidas como um problema de saúde pública e sua prevalência é pouco estudada no nosso meio. Em 1989, pesquisadores da Mayo Clinic elaboraram e validaram um questionário para a avaliação das doenças gastrointestinais funcionais denominado "The Bowel Disease Questionnaire". Apesar de ter sido utilizado em diferentes populações, sua aplicação em um contexto sociocultural diferente daquele para o qual foi desenvolvido, necessita de prévia adaptação para garantir a qualidade das informações a serem captadas. OBJETIVO: Realizar a tradução e a adaptação cultural do "The Bowel Disease Questionnaire" para o português com a finalidade de aplicação a uma população de adolescentes do Rio de Janeiro. MÉTODOS: Foram avaliadas as equivalências conceitual e de itens através de revisão bibliográfica e de reuniões com especialistas. A avaliação da igualdade semântica constou de julgamento acerca das equivalências de significado referencial e geral entre a retradução e o original e entre esta e a edição em português, respectivamente. A equivalência de mensuração foi avaliada através da confiabilidade e da consistência interna. RESULTADOS: Os conceitos abarcados pelo questionário original foram considerados pertinentes no nosso meio. O significado geral e referencial das palavras/termos se manteve na maioria das questões. A confiabilidade variou de razoável a quase perfeita, enquanto os grupos de questões referentes às doenças gastrointestinais funcionais mostraram consistência interna variando de 0,66 a 0,74. CONCLUSÃO: A versão em português do "The Bowel Disease Questionnaire" parece ser semântica e de conceito equivalente ao original e avaliar adequadamente as doenças gastrointestinais funcionais. O instrumento resultante da adaptação pode ser útil para avaliar as doenças gastrointestinais funcionais em populações de adolescentes no contexto brasileiro.

BACKGROUND: Functional bowel disorders are considered a public health problem, but there are a few prevalence studies in Brazil. In 1999, researchers from the Mayo Clinic developed The Bowel Disease Questionnaire with the purpose to evaluate functional bowel disorders. Although this has been used in different studies and population, it is often necessary to perform a cultural adaptation of a questionnaire developed for use in another culture, in order to improve the quality of the information obtained. OBJECTIVE: To translate and adapt the Bowel Disease Questionnaire to Portuguese for its use in adolescents. METHODS: Assessment of conceptual and item equivalence involved evaluation of the pertinence of the concepts in the Brazilian context; translation was evaluated through semantic equivalence between the original instrument and the Portuguese version; measurement equivalence between the original and the Portuguese version was assessed by the intra-observer reliability and internal consistency. RESULTS: The Bowel Disease Questionnaire's concepts were considered pertinent in the Brazilian context; the semantic equivalence between the original and the Portuguese version were high; reliability ranged from moderate to almost perfect; internal consistency of the scales ranged from 0,66 to 0,74. CONCLUSION: The Portuguese version of the Bowel Disease Questionnaire seems to be semantically and culturally equivalent to the original version and might be useful for measuring functional bowel disorders among Brazilian adolescents.