Teleconsulta pelo terapeuta ocupacional: relato de experiência no acompanhamento de pessoas idosas em distanciamento social devido à pandemia COVID-19 / Teleconsultation by the occupational therapist: experience report in accompanying elderly people in social distancing due to the COVID-19 pandemic

Introdução: Pessoas idosas compõem a população com maior risco de desenvolver a forma grave da COVID-19 e tiveram sua saúde mental significativamente impactada no contexto pandêmico. A teleconsulta se mostra como uma ferramenta clínica segura que viabiliza os cuidados em saúde. Objetivo: Relatar desenvolvimento e repercussões do acompanhamento em teleconsulta pelo terapeuta ocupacional para pessoas idosas em distanciamento social devido à pandemia COVID-19. Método: Foram realizadas teleconsultas semanais a 12 idosos encaminhadas por serviços da região do Butantã no município de São Paulo. Tais encaminhamentos foram mediados por uma terapeuta ocupacional, preceptora do campo. Resultados: As teleconsultas enfatizaram a escuta atenta e qualificada. O processo de distanciamento social impôs a necessidade de readaptação da rotina. Os envolvidos consideram que o acompanhamento teleconsulta ampliou informações e cuidados em saúde e desempenho ocupacional. Discussão: Com o distanciamento social, readaptação da rotina ocupacional de todos foi necessária. As diferenças sociais evidenciaram o impacto que o contexto social e econômico tem sobre a participação. Conclusão: A teleconsulta pelo terapeuta ocupacional tem se mostrado ferramenta clínica relevante para o cuidado às pessoas idosas em distanciamento social

Introduction: Elderly people make up the population with the highest risk of developing the severe form of COVID-19 and have had their mental health significantly impacted in the pandemic context. Teleconsultation is shown to be a safe clinical tool that enables health care. Objective: Report the development and repercussions of follow-up in teleconsultation by the occupational therapist for elderly people in social distancing due to the COVID-19 pandemic. Method: Weekly teleconsultations were carried out with 12 elderly people referred by services in the Butantã region in the city of São Paulo. Such referrals were mediated by an occupational therapist, field preceptor. Results: The teleconsultations emphasized attentive and qualified listening. The process of social distancing imposed the need to readjust the routine. Those involved consider that the teleconsultation monitoring expanded information and care in health and occupational performance. Discussion: With social distancing, readaptation of everyone's occupational routine was necessary. Social differences highlighted the impact that the social and economic context has on participation. Conclusion: Teleconsultation by the occupational therapist has proven to be a relevant clinical tool for the care of elderly people in social distancing

Autoimmune hepatitis in 828 Brazilian children and adolescents: clinical and laboratory findings, histological profile, treatments, and outcomes / Hepatite autoimune em 828 crianças e adolescentes brasileiros: achados clínicos e laboratoriais, perfil histológico, tratamentos e resultados

Abstract Objective: This large study with a long-term follow-up aimed to evaluate the clinical presentation, laboratory findings, histological profile, treatments, and outcomes of children and adolescents with autoimmune hepatitis. Methods: The medical records of 828 children and adolescents with autoimmune hepatitis were reviewed. A questionnaire was used to collect anonymous data on clinical presentation, biochemical and histological findings, and treatments. Results: Of all patients, 89.6% had autoimmune hepatitis-1 and 10.4% had autoimmune hepatitis-2. The female sex was predominant in both groups. The median age at symptom onset was 111.5 (6; 210) and 53.5 (8; 165) months in the patients with autoimmune hepatitis 1 and autoimmune hepatitis-2, respectively. Acute clinical onset was observed in 56.1% and 58.8% and insidious symptoms in 43.9% and 41.2% of the patients with autoimmune hepatitis-1 and autoimmune hepatitis-2, respectively. The risk of hepatic failure was 1.6-fold higher for autoimmune hepatitis-2. Fulminant hepatic failure occurred in 3.6% and 10.6% of the patients with autoimmune hepatitis-1 and autoimmune hepatitis-2, respectively; the risk was 3.1-fold higher for autoimmune hepatitis-2. The gamma globulin and immunoglobulin G levels were significantly higher in autoimmune hepatitis-1, while the immunoglobulin A and C3 levels were lower in autoimmune hepatitis-2. Cirrhosis was observed in 22.4% of the patients; biochemical remission was achieved in 76.2%. The actuarial survival rate was 93.0%. A total of 4.6% underwent liver transplantation, and 6.9% died (autoimmune hepatitis-1: 7.5%; autoimmune hepatitis-2: 2.4%). Conclusions: In this large clinical series of Brazilian children and adolescents, autoimmune hepatitis-1 was more frequent, and patients with autoimmune hepatitis-2 exhibited higher disease remission rates with earlier response to treatment. Patients with autoimmune hepatitis-1 had a higher risk of death.

Resumo Objetivo: Este estudo com acompanhamento de longo prazo visou a avaliar o quadro clínico, os achados laboratoriais, o perfil histológico, os tratamentos e os resultados de crianças e adolescentes com hepatite autoimune. Métodos: Foram analisados os prontuários médicos de 828 crianças e adolescentes com HAI. Foi usado um questionário para coletar os dados anônimos sobre o quadro clínico, os achados bioquímicos e histológicos e os tratamentos. Resultados: De todos os pacientes, 89,6% tinham hepatite autoimune-1 e 10,4% hepatite autoimune-2. O sexo feminino foi predominante nos dois grupos. A idade média no início dos sintomas foi 111,5 (6; 210) e 53,5 (8; 165) meses nos pacientes com hepatite autoimune-1 e hepatite autoimune-2, respectivamente. Foi observado início clínico agudo em 56,1% e 58,8% e sintomas insidiosos em 43,9% e 41,2% dos pacientes com hepatite autoimune-1 e hepatite autoimune-2, respectivamente. A probabilidade de insuficiência hepática foi 1,6 vezes maior para hepatite autoimune-2; 3,6% e 10,6% dos pacientes com hepatite autoimune-1 e hepatite autoimune-2, respectivamente, apresentaram insuficiência hepática fulminante; o risco foi 3,1 vezes maior para hepatite autoimune-2. Os níveis de gamaglobulina e imunoglobulina G foram significativamente maiores nos pacientes com hepatite autoimune-1, ao passo que os níveis de imunoglobulina A e C3 foram menores em pacientes com hepatite autoimune-2; 22,4% dos pacientes apresentaram cirrose e a remissão bioquímica foi atingida em 76,2%. A taxa de sobrevida atuarial foi de 93,0%. Um total de 4,6% pacientes foram submetidos a transplante de fígado e 6,9% morreram (hepatite autoimune-1: 7,5%; hepatite autoimune-2: 2,4%). Conclusões: Nesta grande série clínica de crianças e adolescentes brasileiros, a hepatite autoimune-1 foi mais frequente e os pacientes com hepatite autoimune-2 mostraram maiores taxas de remissão da doença com respostas mais rápidas aos tratamentos. Os pacientes com hepatite autoimune-1 apresentaram maior risco de óbito.

Autoimmune hepatitis in 828 Brazilian children and adolescents: clinical and laboratory findings, histological profile, treatments, and outcomes.

OBJECTIVE: This large study with a long-term follow-up aimed to evaluate the clinical presentation, laboratory findings, histological profile, treatments, and outcomes of children and adolescents with autoimmune hepatitis. METHODS: The medical records of 828 children and adolescents with autoimmune hepatitis were reviewed. A questionnaire was used to collect anonymous data on clinical presentation, biochemical and histological findings, and treatments. RESULTS: Of all patients, 89.6% had autoimmune hepatitis-1 and 10.4% had autoimmune hepatitis-2. The female sex was predominant in both groups. The median age at symptom onset was 111.5 (6; 210) and 53.5 (8; 165) months in the patients with autoimmune hepatitis 1 and autoimmune hepatitis-2, respectively. Acute clinical onset was observed in 56.1% and 58.8% and insidious symptoms in 43.9% and 41.2% of the patients with autoimmune hepatitis-1 and autoimmune hepatitis-2, respectively. The risk of hepatic failure was 1.6-fold higher for autoimmune hepatitis-2. Fulminant hepatic failure occurred in 3.6% and 10.6% of the patients with autoimmune hepatitis-1 and autoimmune hepatitis-2, respectively; the risk was 3.1-fold higher for autoimmune hepatitis-2. The gamma globulin and immunoglobulin G levels were significantly higher in autoimmune hepatitis-1, while the immunoglobulin A and C3 levels were lower in autoimmune hepatitis-2. Cirrhosis was observed in 22.4% of the patients; biochemical remission was achieved in 76.2%. The actuarial survival rate was 93.0%. A total of 4.6% underwent liver transplantation, and 6.9% died (autoimmune hepatitis-1: 7.5%; autoimmune hepatitis-2: 2.4%). CONCLUSIONS: In this large clinical series of Brazilian children and adolescents, autoimmune hepatitis-1 was more frequent, and patients with autoimmune hepatitis-2 exhibited higher disease remission rates with earlier response to treatment. Patients with autoimmune hepatitis-1 had a higher risk of death.

Hepatobiliary disease in children and adolescents with cystic fibrosis / Doença hepatobiliar em crianças e adolescentes com fibrose cística

Abstract Objectives: The aims of the study were to determine the frequency of hepatobiliary disease in patients with cystic fibrosis and to describe the sociodemographic, clinical, and laboratory profile of these patients. Methods: This was a retrospective, descriptive, and analytical study of 55 patients diagnosed with cystic fibrosis, aged between 3 months and 21 years, followed-up from January 2008 to June 2016 in a referral center. Medical records were consulted and sociodemographic, clinical and laboratory data, including hepatobiliary alterations, imaging studies, genetic studies, liver biopsies, and upper digestive endoscopies were registered. Results: Hepatobiliary disease was diagnosed in 16.4% of the patients and occurred as an initial manifestation of cystic fibrosis in 55.6% of these cases. The diagnosis of hepatopathy occurred before or concomitantly with the diagnosis of cystic fibrosis in 88.9% of the children. All patients with hepatobiliary disease were considered non-white, with a predominance of females (77.8%) and median (IQR) of 54 (27-91) months. Compared with the group without hepatobiliary disease, children with liver disease had a higher frequency of severe mutations identified in the CFTR gene (77.8% vs. 39.6%, p = 0.033) and severe pancreatic insufficiency (88.9% vs. 31.6%, p = 0.007). Conclusion: The frequency of hepatobiliary disease was high, with a very early diagnosis of the disease and its complications in the studied series. A statistical association was observed between the occurrence of hepatobiliary disease and the presence of pancreatic insufficiency and severe mutations in the CFTR gene. It is emphasized that cystic fibrosis is an important differential diagnosis of liver diseases in childhood.

Resumo Objetivos: Os objetivos do estudo foram determinar a frequência da doença hepatobiliar em pacientes com fibrose cística e descrever o perfil sociodemográfico, clínico e laboratorial destes. Métodos: Estudo retrospectivo, descritivo e analítico de 55 pacientes com diagnóstico de fibrose cística, entre três meses e 21 anos, acompanhados de janeiro de 2008 a junho de 2016 em um centro de referência. Foi realizada consulta aos prontuários médicos, registrando-se os dados sociodemográficos, clínicos e laboratoriais, incluindo-se alterações hepatobiliares, exames de imagem, estudos genéticos, biópsias hepáticas e endoscopias digestivas altas. Resultados: A doença hepatobiliar foi diagnosticada em 16,4% dos pacientes e ocorreu como manifestação inicial da fibrose cística em 55,6% destes casos. O diagnóstico da hepatopatia ocorreu antes ou concomitante ao diagnóstico da fibrose cística em 88,9% das crianças. Todos os pacientes com doença hepatobiliar foram considerados não brancos, havendo predominância do sexo feminino (77,8%) e mediana (I.I.Q) de idade de 54 (27-91) meses. Em comparação com o grupo sem doença hepatobiliar, as crianças com hepatopatia tiveram maior frequência de mutações graves no gene CFTR identificadas (77,8% vs 39,6%; p = 0,033) e de insuficiência pancreática grave (88,9% vs 31,6%; p = 0,007). Conclusão: A frequência de doença hepatobiliar foi elevada, observando-se um diagnóstico muito precoce da mesma e de suas complicações na casuística estudada. Houve associação estatística entre a ocorrência de doença hepatobiliar e a presença de insuficiência pancreática e de mutações graves do gene CFTR. Enfatiza-se que a fibrose cística represente um importante diagnóstico diferencial de hepatopatias na infância.

Hepatobiliary disease in children and adolescents with cystic fibrosis.

OBJECTIVES: The aims of the study were to determine the frequency of hepatobiliary disease in patients with cystic fibrosis and to describe the sociodemographic, clinical, and laboratory profile of these patients. METHODS: This was a retrospective, descriptive, and analytical study of 55 patients diagnosed with cystic fibrosis, aged between 3 months and 21 years, followed-up from January 2008 to June 2016 in a referral center. Medical records were consulted and sociodemographic, clinical and laboratory data, including hepatobiliary alterations, imaging studies, genetic studies, liver biopsies, and upper digestive endoscopies were registered. RESULTS: Hepatobiliary disease was diagnosed in 16.4% of the patients and occurred as an initial manifestation of cystic fibrosis in 55.6% of these cases. The diagnosis of hepatopathy occurred before or concomitantly with the diagnosis of cystic fibrosis in 88.9% of the children. All patients with hepatobiliary disease were considered non-white, with a predominance of females (77.8%) and median (IQR) of 54 (27-91) months. Compared with the group without hepatobiliary disease, children with liver disease had a higher frequency of severe mutations identified in the CFTR gene (77.8% vs. 39.6%, p=0.033) and severe pancreatic insufficiency (88.9% vs. 31.6%, p=0.007). CONCLUSION: The frequency of hepatobiliary disease was high, with a very early diagnosis of the disease and its complications in the studied series. A statistical association was observed between the occurrence of hepatobiliary disease and the presence of pancreatic insufficiency and severe mutations in the CFTR gene. It is emphasized that cystic fibrosis is an important differential diagnosis of liver diseases in childhood.

Iron deficiency anemia in adolescents; a literature review.

INTRODUCTION: Anemia is one of the most important nutritional deficiencies affecting various social and socioeconomic strata. It is more common in developing countries, with children and adolescents being at a significantly higher risk for the condition. OBJECTIVE: To perform a literature review on iron deficiency anemia in adolescence as a public health issue and on the risk factors that may contribute towards nutritional deficiencies, stunted growth and development in this age group, emphasizing the physiopathology and causes of anemia, the different diagnostic approaches, and its clinical characteristics, prevention and treatment. METHODOLOGY: The LILACS-BIREME, SCIELO and PUBMED databases were consulted for the study. Scientific papers published in Spanish, Portuguese or English between 2000 and 2013 on the subject of iron deficiency anemia in adolescents were selected for inclusion. A total of 102 studies published between January 1st, 2000 and June 30th, 2013 were identified and evaluated. Forty-two articles meeting the inclusion criterion (adolescents with anemia) were selected for this review. Finally, an analysis was conducted and the papers were evaluated in accordance with the study objectives. RESULTS AND DISCUSSION: The studies reviewed revealed a prevalence of iron deficiency anemia of around 20% in adolescents and described the harmful effects of anemia in this age group. CONCLUSION: Preventive action is required with respect to iron deficiency anemia. Healthcare professionals should be aware of the need for early diagnosis, prophylaxis and treatment.

Introducción: La anemia es una de las deficiencias nutricionales más importantes que afecta a varios estratos sociales y socioeconómicos. Es más frecuente en países en vías de desarrollo, estando los niños y los adolescentes en un riesgo significativamente mayor para padecer esta afección. Objetivo: Realizar una revisión bibliográfica sobre la anemia ferropénica en la adolescencia como un problema de salud pública y sobre los factores de riesgo que podrían contribuir en las deficiencias nutricionales, la detención del crecimiento y el desarrollo en este grupo de edad y poniendo el énfasis sobre la fisiopatología y las causas de la anemia, los diferentes abordajes diagnósticos y sus características clínicas, la prevención y el tratamiento. Metodología: Para este estudio, se consultaron las bases de datos LILACS-BIREME, SCIELO y PUBMED. Se seleccionaron los trabajos científicos publicados en español, portugués o inglés entre 2000 y 2013 sobre la anemia ferropénica. Se identificaron y evaluaron un total de 102 estudios publicados entre el 1º de enero de 2000 y el 30 de junio de 2013. Cuarenta y dos artículos que reunían los criterios de inclusión (adolescentes con anemia) se seleccionaron para esta revisión. Finalmente, se realizó un análisis y se evaluaron los artículos de acuerdo con los objetivos del estudio. Resultados y discusión: Los estudios revisados mostraron una prevalencia de anemia ferropénica cercana al 20 % en los adolescentes y describían los efectos deletéreos de la anemia en este grupo. Conclusión: Se requiere una acción preventiva con respecto a la anemia ferropénica. Los profesionales sanitarios deberían ser conscientes de la necesidad de un diagnóstico, profilaxis y tratamiento precoces.EL.

Iron deficiency anemia in adolescents; a literature review / Anemia por deficiencia de hierro en adolescentes; una revisión de la literatura

Introduction: Anemia is one of the most important nutritional deficiencies affecting various social and socioeconomic strata. It is more common in developing countries, with children and adolescents being at a significantly higher risk for the condition. Objective: To perform a literature review on iron deficiency anemia in adolescence as a public health issue and on the risk factors that may contribute towards nutritional deficiencies, stunted growth and development in this age group, emphasizing the physiopathology and causes of anemia, the different diagnostic approaches, and its clinical characteristics, prevention and treatment. Methodology: The LILACS-BIREME, SCIELO and PUBMED databases were consulted for the study. Scientific papers published in Spanish, Portuguese or English between 2000 and 2013 on the subject of iron deficiency anemia in adolescents were selected for inclusion. A total of 102 studies published between January 1st, 2000 and June 30th, 2013 were identified and evaluated. Forty-two articles meeting the inclusion criterion (adolescents with anemia) were selected for this review. Finally, an analysis was conducted and the papers were evaluated in accordance with the study objectives. Results and Discussion: The studies reviewed revealed a prevalence of iron deficiency anemia of around 20% in adolescents and described the harmful effects of anemia in this age group. Conclusion: Preventive action is required with respect to iron deficiency anemia. Healthcare professionals should be aware of the need for early diagnosis, prophylaxis and treatment (AU)

Introducción: La anemia es una de las deficiencias nutricionales más importantes que afecta a varios estratos sociales y socioeconómicos. Es más frecuente en países en vías de desarrollo, estando los niños y los adolescentes en un riesgo significativamente mayor para padecer esta afección. Objetivo: Realizar una revisión bibliográfica sobre la anemia ferropénica en la adolescencia como un problema de salud pública y sobre los factores de riesgo que podrían contribuir en las deficiencias nutricionales, la detención del crecimiento y el desarrollo en este grupo de edad y poniendo el énfasis sobre la fisiopatología y las causas de la anemia, los diferentes abordajes diagnósticos y sus características clínicas, la prevención y el tratamiento. Metodología: Para este estudio, se consultaron las bases de datos LILACS-BIREME, SCIELO y PUBMED. Se seleccionaron los trabajos científicos publicados en español, portugués o inglés entre 2000 y 2013 sobre la anemia ferropénica. Se identificaron y evaluaron un total de 102 estudios publicados entre el 1º de enero de 2000 y el 30 de junio de 2013. Cuarenta y dos artículos que reunían los criterios de inclusión (adolescentes con anemia) se seleccionaron para esta revisión. Finalmente, se realizó un análisis y se evaluaron los artículos de acuerdo con los objetivos del estudio. Resultados y discusión: Los estudios revisados mostraron una prevalencia de anemia ferropénica cercana al 20 % en los adolescentes y describían los efectos deletéreos de la anemia en este grupo. Conclusión: Se requiere una acción preventiva con respecto a la anemia ferropénica. Los profesionales sanitarios deberían ser conscientes de la necesidad de un diagnóstico, profilaxis y tratamiento precoces (AU)

The prevalence of overweight and obesity in adolescents in Bahia, Brazil.

AIM: A cross-sectional study was conducted with 1,477 middle school students enrolled in the public school network in Salvador, Bahia, Brazil to assess the prevalence of overweight and obesity. METHODS: The sample was determined using a two-stage cluster sampling technique for selecting schools and classes. A posteriori error was estimated. The students were classified as overweight or obese according to the World Health Organization's 2007 classifications. They were also classified according to age, stage of sexual maturity, socioeconomic class and the presence of abdominal obesity. RESULTS: Overall, 9.3% of the students were overweight and 6.4% were obese; therefore, 15.7% of the students were considered to have excess weight (obesity + overweight), at a 95% confidence interval. Abdominal obesity was found in 12.9% of all students and in 13% of those of normal weight. An association was found between excess weight and age < 14 years (p = 0.030) and abdominal obesity (p = 0.001). CONCLUSIONS: Intervention programs should be implemented to prevent and treat obesity in childhood and adolescence. In addition, professionals working with individuals in this age group should be sensitized to this problem. The need to standardize the anthropometric indicators used in the different studies is also emphasized.

Objetivo: Un estudio transversal se llevó a cabo con 1477 estudiantes de primaria matriculados en las escuelas públicas de Salvador, Bahía, Brasil, para evaluar la prevalencia del sobrepeso y la obesidad. Métodos: La muestra se determinó por la técnica de muestreo por conglomerados en dos etapas para la selección de escuelas y clases. Más tarde, posteriori error se calculó. Los estudiantes fueron clasificados como sobrepeso u obesos de acuerdo con la clasificación de la Organización Mundial de la Salud, 2007. Ellos también fueron clasificados de acuerdo a la edad, la etapa de maduración sexual, y la presencia de obesidad abdominal. Resultados: En general, el 9,3% de los estudiantes tenían sobrepeso y el 6,4% eran obesos, por lo tanto, el 15,7% de los alumnos se considera que tienen exceso de peso (sobrepeso + obesidad), con un intervalo de confianza del 95%. De la población total estudiada el 12,9% presentaron obesidad abdominal, esta condición se observa en el 13% de su peso normal. Se encontró asociación entre el sobrepeso y la edad < 14 AÑOs (p = 0,030) y obesidad abdominal (p = 0,001). Conclusiones: Los programas de intervención deben ser implementados para prevenir y tratar la obesidad en la infancia y la adolescencia. Además, los profesionales que trabajan con las personas en este grupo de edad deben ser sensibles a este problema. La necesidad de estandarizar los indicadores antropométricos utilizados en los diferentes estudios se enfatiza también.

The prevalence of overweight and obesity in adolescents in Bahia, Brazil / La prevalencia de sobrepeso y obesidad en adolescentes de Bahía, Brasil

Aim: A cross-sectional study was conducted with 1,477 middle school students enrolled in the public school network in Salvador, Bahia, Brazil to assess the prevalence of overweight and obesity. Methods: The sample was determined using a two-stage cluster sampling technique for selecting schools and classes. A posteriori error was estimated. The students were classified as overweight or obese according to the World Health Organization's 2007 classifications. They were also classified according to age, stage of sexual maturity, socioeconomic class and the presence of abdominal obesity. Results: Overall, 9.3% of the students were overweight and 6.4% were obese; therefore, 15.7% of the students were considered to have excess weight (obesity + overweight), at a 95% confidence interval. Abdominal obesity was found in 12.9% of all students and in 13% of those of normal weight. An association was found between excess weight and age < 14 years (p = 0.030) and abdominal obesity (p = 0.001). Conclusions: Intervention programs should be implemented to prevent and treat obesity in childhood and adolescence. In addition, professionals working with individuals in this age group should be sensitized to this problem. The need to standardize the anthropometric indicators used in the different studies is also emphasized (AU)

Objetivo: Un estudio transversal se llevó a cabo con 1477 estudiantes de primaria matriculados en las escuelas públicas de Salvador, Bahía, Brasil, para evaluar la prevalencia del sobrepeso y la obesidad. Métodos: La muestra se determinó por la técnica de muestreo por conglomerados en dos etapas para la selección de escuelas y clases. Más tarde, posteriori error se calculó. Los estudiantes fueron clasificados como sobrepeso u obesos de acuerdo con la clasificación de la Organización Mundial de la Salud, 2007. Ellos también fueron clasificados de acuerdo a la edad, la etapa de maduración sexual, y la presencia de obesidad abdominal. Resultados: En general, el 9,3% de los estudiantes tenían sobrepeso y el 6,4% eran obesos, por lo tanto, el 15,7% de los alumnos se considera que tienen exceso de peso (sobrepeso + obesidad), con un intervalo de confianza del 95%. De la población total estudiada el 12,9% presentaron obesidad abdominal, esta condición se observa en el 13% de su peso normal. Se encontró asociación entre el sobrepeso y la edad < 14 años (p = 0,030) y obesidad abdominal (p = 0,001). Conclusiones: Los programas de intervención deben ser implementados para prevenir y tratar la obesidad en la infancia y la adolescencia. Además, los profesionales que trabajan con las personas en este grupo de edad deben ser sensibles a este problema. La necesidad de estandarizar los indicadores antropométricos utilizados en los diferentes estudios se enfatiza también (AU)