Relationship between OSA pathophysiological phenotypes and treatment response to mandibular advancement devices: a pilot study.

STUDY OBJECTIVES: To assess whether critical pathophysiological phenotypes predict treatment response in patients with obstructive sleep apnea (OSA) using a mandibular advancement device (MAD). METHODS: Thirty-one OSA patients were treated with a MAD. Individuals were categorized and graded into four pathophysiological phenotypes based on polysomnographic features (anatomical, ventilatory control, arousal threshold and muscle responsiveness). Morphoanthropometric data were additionally assessed. Patients were classified as responders or nonresponders. Associations between polysomnographic phenotypes and treatment response were documented, as was morphoanthropometric data and their impact on therapeutic success. RESULTS: There was a male predominance (64.5%), with a median age of 49 years (25p:40; 75p:55), BMI=27.4 kg/m2 (26; 28.8) and apnea-hypopnea index (AHI) of 18.2 (25p:11.7; 75p: 27.6). The majority of patients treated with a MAD (58%) were good responders (68.0% mild and moderate versus 16.7% severe). Treatment response was associated with shorter intermolar and interpremolar distances in the lower arch (p = 0.0092 and 0.0129). Rapid eye movement sleep AHI (REMAHI) and MAD-related treatment response were inversely correlated (p = 0.0013). Favorable anatomical (p = 0.0339) and low muscle response (p = 0.0447) phenotypes were correlated with outcomes. CONCLUSIONS: According to our results, a favorable response occurred in a better 'anatomical phenotype' and in the worse 'muscular responsiveness phenotype' according to polysomnographic data. Furthermore, other favorable predictors, such as a REMAHI <16 and a smaller distance between lower molars and premolars, were found. These findings indicate that clinical and polysomnographic aspects can discriminate phenotypes that may guide decisions on MAD treatment for OSA.

Hospitalizations of children and adolescents with complex chronic conditions in Brazil: a temporal analysis from 2009 to 2020.

Access to advanced and sophisticated health technologies made it possible to increase the survival of children with complex chronic conditions. Thus, the profile of pediatric patients admitted to hospitals has changed in recent decades. In Brazil, there are few epidemiological studies on this subject. This study aims to evaluate the main characteristics and temporal trend of hospital admissions of children and adolescents with complex chronic conditions in Brazil, 2009-2020. This is a cross-sectional study with data on hospitalizations of children and adolescents with complex chronic conditions, extracted from the Hospital Information System of the Unified Health System, 2009-2020, in the 26 Brazilian states and the Federal District. The analysis included descriptive statistics and a generalized linear model. From 2009 to 2020, there were 1,337,120 hospitalizations of children and adolescents with complex chronic conditions, and of these, 735,820 (55.0%) were male. The percentage of hospital deaths during the analyzed period was 4.0%. The most recurrent diagnostic category was malignancy (41.0%), with an annual incidence increase of 2.61 (95% CI: 1.16-4.05). Between 2009 and 2019, the increase in hospitalizations for complex chronic conditions was 27.4% for boys and 25.2% for girls, and the reductions in the number of hospitalizations for other causes were 15.4% and 11.9% for boys and girls, respectively.  Conclusions: Hospitalizations for complex chronic conditions in pediatrics are increasing in Brazil. This increase is a new challenge for the Brazilian public health system. What is Known: • The profile of pediatric patients admitted to hospitals has changed in recent decades, with a reduction in the total number of hospitalizations, but with an increase in the complexity and costs of these hospitalizations. • The world's scientific production on CCC is concentrated in the United States health care system. Epidemiological studies on the topic in universal health care systems are scarce. What is New: • This is the first study that evaluated the temporal trend of hospitalizations of children and adolescents with CCC in Brazil. • Hospitalizations for CCC in pediatrics are increasing in Brazil, with emphasis on the condition of malignancy, higher incidence in males and in children under one year of age. Furthermore, our study found a decrease in hospitalizations for other pediatric causes.

Association of Weight Perception, Body Satisfaction, and Weight Loss Intention With Patterns of Health Risk Behaviors in Adolescents With Overweight and Obesity.

Obesity is a public health issue and childhood is a critical window in which to establish healthy eating patterns and modify risk factors for overweight. This study aims to verify the association of weight perception, body satisfaction, and weight loss intention with patterns of health risk behaviors in adolescents with overweight and obesity. We analyzed health risk behavior from a school-based national survey conducted in 2015 in Brazil (n = 2,703 students with overweight or obesity, aged 13-17 years). We performed latent class analysis of alcohol consumption, tobacco use, physical activity, screen time, and eating habits for adolescents with overweight and identified four distinct health behavior patterns. The association of these patterns with weight perception, body satisfaction, and weight loss intention was analyzed through multinomial logistic regression. Adolescents who perceived themselves as "fat" or "very fat" were more likely to have a sedentary lifestyle and low consumption of fruit and vegetables. Body satisfaction was a protective factor against sedentary lifestyle. Students who reported weight loss intention were less likely to be in high-health-risk behavior groups (low consumption of fruit and vegetables; sedentary lifestyle; tobacco and alcohol use). Self-perception as overweight had detrimental associations, while body satisfaction was a protective factor for a healthy lifestyle. Weight loss intention still requires rigorous analysis due to inconsistencies in the literature. The complexity of the relationship between body image and obesity needs to be highlighted. Multicomponent strategies are required to control the global obesity pandemic.

How are children with medical complexity being identified in epidemiological studies? A systematic review.

BACKGROUND: There are different definitions to identify/classify children with medical complexity (CMC). We aimed to investigate and describe the definitions used to classify CMC in epidemiological studies. METHODS: PubMed, SciELO, LILACS, and EMBASE were searched from 2015 to 2020 (last updated September 15th, 2020) for original studies that presented the definition used to classify/identify CMC in the scientific research method. We applied the Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology. From the included studies, the following were identified: first author, year of publication, design, population, study period, the definition of CMC used, limitations, and strengths. RESULTS: Nine hundred and sixty-seven records were identified in the searched databases, and 42 met the inclusion criteria. Of the 42 studies included, the four most frequent definitions used in the articles included in this review were classification of CMC into nine diagnostic categories based on the International Classification of Diseases, Ninth Revision (ICD-9) (35.7%, 15 articles); update of the previous classification for ICD-10 codes with the inclusion of other conditions in the definition (21.4%, nine articles); definition based on a medical complexity algorithm for classification (16.7%, seven articles); and a risk rating system (7.1%, three articles). CONCLUSIONS: CMC definitions using diagnostic codes were more frequent. However, several limitations were found in its uses. Our research highlighted the need to improve health information systems to accurately characterize the CMC population and promote the provision of comprehensive care.

Factors associated with not adopting healthy behavior among hypertensive individuals: a population-based study in Brazil.

Adoption of a healthy lifestyle is strongly recommended for the control of hypertension, but professional advice alone does not ensure uptake of healthy behavior. Therefore, this study aimed to investigate the factors-associated with non-adoption of healthy behaviors among individuals with a medical diagnosis of hypertension. It was a cross-sectional study using data from the National Health Survey (PNS) carried out in Brazil in 2013, based on interviews with adults (≥18 years) (n = 60,202). The outcome variable was the non-adoption-two or fewer-of healthy behaviors (regular physical activity, recommended consumption of fruit and vegetables, no excessive alcohol consumption, no smoking, and very low/low salt intake [self-perceived]). A logistic regression model was used to verify the factors-associated with non-adoption of healthy behaviors. Approximately 64% of the study sample did not adopt healthy behaviors, i.e., they adopted two or fewer healthy habits. The most frequently mentioned healthy behaviors were not drinking excessively (91.5%), followed by not smoking (86%). Short time since disease diagnosis (OR = 1.20, 95% CI: 1.01-1.43), not using antihypertensive medication (OR = 1.38, 95% CI: 1.13-1.68), not making regular doctor visits (OR = 1.43, 95% CI: 1.23-1.65), and good self-rated health (OR = 1.16, 95% CI: 1.01-1.36) increased the chance of individuals not adopting healthy behaviors compared with their respective reference categories, independently of gender, age, schooling, and economic status. Counseling strategies should consider patient particularities, and health professionals need to be aware of issues that can interfere with the adoption of healthy behaviors of hypertensive patients.

Prevalence of metabolic syndrome and its associated factors in overweight and obese adolescents.

Background Metabolic syndrome (MetS) is not only a problem of adulthood but is already present in children and adolescents. The aim of this study was to estimate the prevalence of MetS in adolescents and to identify the associated factors. Methods This was a cross-sectional study with 354 overweight and obese school-aged adolescents (10-19 years). Sociodemographic, anthropometric, clinical, biochemical and lifestyle variables were collected. MetS was identified according to the criteria proposed by the International Diabetes Federation (IDF). Multivariate logistic regression models were used to examine the associations between risk variables and MetS. Results The prevalence of MetS was 9.6%. Among adolescents with MetS, all of them had low high-density lipoprotein cholesterol (HDL-c), while 76.5% had hyperglycemia and 38.2% had hypertriglyceridemia. Only 12.1% did not present any component of MetS, while 40% had at least two components. Multivariate analysis showed that being a girl was a protective factor (odds ratio [OR] = 0.29, confidence interval [CI] = 0.13-0.65) for the presence of MetS, while obesity (OR = 3.63, CI = 1.62-8.17) and being insufficiently active (OR = 4.60, CI = 1.01-20.96) were the risk factors for MetS. Conclusions Obese and insufficiently active male adolescents are more likely to have MetS. Early identification of MetS components, especially among obese adolescents, is an important tool for the prevention of cardiovascular complications in adult life.

Gender and schooling inequalities in risk and protective factors for chronic diseases among Brazilian adults.

Background: There is consistent evidence showing that low socioeconomic level, both at the individual and contextual levels, is an important predictor of morbidity and mortality due to noncommunicable diseases. Objective: To identify gender and schooling inequalities in the distribution of risk and protective factors for chronic diseases among Brazilian adults. Methods: This study included data from 97 468 individuals interviewed in 2012 and 2013 from the Surveillance System of Risk and Protective Factors for Chronic Diseases (VIGITEL). Age-adjusted prevalence ratios at different schooling levels were calculated using Poisson regression. Results: Tobacco use, alcohol abuse and the consumption of meat with visible fat were more frequent among men, while the medical diagnosis of diseases such as diabetes, high blood pressure and dyslipidaemia was more frequent among women. In both genders, the highest level of education was associated with a lower prevalence of tobacco use, excessive consumption of soft drinks and excessive TV time, as well as increased alcohol abuse. Conclusion: The results of this study represent a challenge for public health policies in Brazil, since sociodemographic inequalities reflect differences in the prevalence of risk factors and, consequently, in the prevalence of chronic noncommunicable diseases.

Variation in dietary intake and physical activity pattern as predictors of change in body mass index (BMI) Z-score among Brazilian adolescents.

OBJECTIVE: To assess whether changes in dietary intake and physical activity pattern are associated with the annual body mass index (BMI) z-score change among adolescents. METHODS: The study was conducted in public schools in the city of Piracicaba, Sao Paulo, Brazil, with a probabilistic sample of 431 adolescents participating in wave I (2004) (hereafter, baseline) and 299 in wave II (2005) (hereafter, follow-up). BMI, usual food intake, physical activity, screen time, sexual maturation and demographic variables were assessed twice. The association between annual change in food intake, physical activity, screen time, and annual BMI z-score changes were assessed by multiple regression. RESULTS: The study showed a positive variation in BMI z-score over one-year. Among variables related to physical activity pattern only playing videogame and using computer increased over the year. The intake of fruits and vegetables and sugar-sweetened beverages increased over one year, while the others variables showed a reduction. An increased consumption of fatty foods (ß = 0.04, p = 0.04) and sweetened natural fruit juices (ß = 0.05, p = 0.03) was positively associated with the rise in BMI z-score. CONCLUSIONS: Unhealthy dietary habits can predict the BMI z-score gain more than the physical activity pattern. The intake of fatty foods and sweetened fruit juices is associated with the BMI z-score over one year.

Variation in dietary intake and physical activity pattern as predictors of change in body mass index (BMI) Z-score among Brazilian adolescents* / Variacao da ingestao dietetica e do padrao de atividade fisica como preditores da mudanca do escore-z do Indice de Massa Coporal (IMC) entre adolescentes brasileiros

Objective: To assess whether changes in dietary intake and physical activity pattern are associated with the annual body mass index (BMI) z-score change among adolescents. Methods: The study was conducted in public schools in the city of Piracicaba, Sao Paulo, Brazil, with a probabilistic sample of 431 adolescents participating in wave I (2004) (hereafter, baseline) and 299 in wave II (2005) (hereafter, follow-up). BMI, usual food intake, physical activity, screen time, sexual maturation and demographic variables were assessed twice. The association between annual change in food intake, physical activity, screen time, and annual BMI z-score changes were assessed by multiple regression. Results: The study showed a positive variation in BMI z-score over one-year. Among variables related to physical activity pattern only playing videogame and using computer increased over the year. The intake of fruits and vegetables and sugar-sweetened beverages increased over one year, while the others variables showed a reduction. An increased consumption of fatty foods (β = 0.04, p = 0.04) and sweetened natural fruit juices (β = 0.05, p = 0.03) was positively associated with the rise in BMI z-score. Conclusions: Unhealthy dietary habits can predict the BMI z-score gain more than the physical activity pattern. The intake of fatty foods and sweetened fruit juices is associated with the BMI z-score over one year. .

Objetivo: Avaliar se as mudanças no padrão alimentar e no padrão de atividade física estão associadas com mudança anual do escore-z do índice de massa corporal (IMC) entre os adolescentes. Métodos: O estudo foi realizado em escolas públicas de Piracicaba, São Paulo, Brasil, com uma amostra probabilística de 431 adolescentes participantes na onda I (2004) (doravante linha de base) e 299 na onda II (2005) (doravante seguimento). Nos dois momentos foram avaliados o IMC, a ingestão habitual de alimentos, atividade física, atividades sedentárias, maturação sexual e variáveis demográficas. A associação entre variação anual do consumo de alimentos, atividade física, atividades sedentárias e mudanças anuais do escore-z do IMC foi avaliada a partir de regressão múltipla. Resultados: O estudo mostrou uma variação positiva no escore-z do IMC ao longo de um ano. Entre as variáveis relacionadas ao padrão de atividade física apenas jogar videogame e usar o computador apresentou aumento ao longo do ano. A ingestão de frutas e legumes e de bebidas artificiais adoçadas aumentou ao longo de um ano e as demais variáveis apresentaram uma redução. Observou-se que o aumento do consumo de alimentos ricos em gordura (β = 0,04, p = 0,04) e de suco natural adoçado (β = 0,05, p = 0,03) associou-se positivamente ao aumento do escore-z do IMC. Conclusão: Hábitos alimentares não saudáveis predizem mais o aumento do escore-z do IMC do que o padrão de atividade física. A ingestão de alimentos ricos em gordura e de suco naturais adoçado associou-se positivamente ao escore-z do IMC ao longo de 1 ano. .

Hábitos alimentares de adolescentes residentes em áreas rurais da cidade de Piedade, São Paulo / Dietary habits of adolescents living in rural areas of the city of Piedade, state of São Paulo

The objective of this study was to describe the dietary habits of adolescents from the city of Piedade, SP, concerning the intake of fruit, vegetables, sweets and sugars, sugar-sweetened beverages and soft drinks. It was carried out with 100 adolescents of both genders, ranging from the age of 10 to 14 years old, from the public education system of Piedade, São Paulo. During the interview, information about food intake (measured through a Food Frequency Questionnaire) and the nutritional status of the adolescents (assessed through the body mass index) were obtained. The recommendations of the Dietary Guidelines for Americans were adopted to verify if the intakes of sweets, fruits and vegetables were adequate. Information about the intake of soft drinks and sugar-sweetened beverages were evaluated based on literature. Data were analyzed using Mann-Whitney and Kruskal Wallis tests. Statistically signifi cant differences between girls and boys were not observed regarding the intake of fruit, sweets/ sugar, and soft drinks. Boys presented a higher intake of vegetables (p<0.05). Only sugar-sweetened beverage intake showed a signifi cant difference (p=0.05) compared to the nutritional status of the participants. Overweight adolescents reported a higher intake of fruits and vegetables, although the difference was not statistically signifi cant. An inadequate intake of vegetables, sweets/sugars and soft drinks among adolescents was evidenced. The average fruit intake was adequate only among girls. The most worrying result is the high intake of sweets / sugars and soft drinks, no matter the nutritional status.

El objetivo del trabajo fue describir los hábitos alimenticios en relación al consumo de frutas, verduras, dulces y azúcares, bebidas con adición de azúcar y refrescos de adolescentes de la ciudad de Piedade, Estado de São Paulo, Brasil.El estudio fue realizado con 100 adolescentes de ambos sexos, con edad de 10 a 14 años, del sistema escolar público. Durante la entrevista secolectó información sobre la ingesta de alimentos, por medio de un cuestionario de frecuencia de consumo. Y también, el estado nutricional de los adolescentes por el índice de masa corporal. Para evaluar la adecuación de la ingesta de dulces, frutas y verduras se usaron las recomendaciones propuestas por la Guía Alimentaría de los Estados Unidos. Los datos de consumo a de gaseosas y bebidas con adición de azúcar fueran evaluados con base en literatura. Fueron utilizadas las pruebas de Mann-Whitney y Kruskal Wallis para el análisis estadístico. No se observaron diferencias estadísticamente signifi cativas para la ingestión de frutas, dulces/azúcares y gaseosa entre niños y niñas. Para las verduras, la ingesta es superior en los niños (p <0,05). Sólo la ingesta de bebidas con adición de azúcar fue diferente estadísticamente (p=0,05) en relación al estado nutricional de los participantes. Los adolescentes con sobrepeso informaron mayor consumo de frutas y verduras, aunque la diferencia no fue estadísticamente signifi cativa. Se evidenció una inadecuada ingestión de verduras, dulces/ azúcares y gaseosas entre los adolescentes. La ingesta media de frutas fue adecuada sólo entre las niñas. El resultado más crítico es el elevado consumo de dulces/azúcares y gaseosas, para cualquier estado nutricional.

Visou-se descrever os hábitos alimentares em relação ao consumo de frutas, verduras e legumes, doces e açúcares, bebidas adicionadas de açúcares e refrigerantes dos adolescentes do município de Piedade, SP. Participaram do estudo 100 adolescentes de ambos os sexos, com idade entre 10 e 14 anos, matriculados na rede pública de ensino do município de Piedade û SP. Durante a entrevista foram obtidas informações relativas ao consumo alimentar, avaliado por um Questionário de Freqüência de Consumo Alimentar, e ao estado nutricional dos adolescentes a partir do índice de massa corporal. Utilizaram-se as recomendações propostas pelo Dietary Guidelines for Americans para se avaliar a adequação do consumo de doces, frutas e vegetais. Os dados de consumo de refrigerantes e bebidas com adição de açúcar foram avaliados tendo como base literatura especializada. Foram utilizados os testes de Mann-Whitney e Kruskal Wallis para as análises estatísticas. Não foram observadas diferenças estatisticamente signifi cantes para o consumo de frutas, doces/açúcares e refrigerantes entre meninas e meninos. Em relação aos vegetais, constatou-se maior ingestão entre os meninos (p<0,05). Somente o consumo de bebidas com adição de açúcar apresentou diferença significante (p=0,05) em relação ao estado nutricional dos participantes. Os adolescentes com excesso de peso relataram maior consumo de frutas e vegetais, embora a diferença não tenha sido estatisticamente significante. Evidenciou-se inadequação do consumo de vegetais, doces/ açúcares e refrigerantes entre os adolescentes. A ingestão média de frutas se revelou adequada somente entre as meninas. O resultado mais preocupante diz respeito ao elevado consumo de doces/açúcares e refrigerantes, sem distinção do estado nutricional.