School and language performance in children born with low birth weight.

OBJECTIVES: To identify the impact of birth weight on the development of metalinguistic skills and performance in reading, writing, and arithmetic in students aged 6 to 10 years, enrolled from the 1st to the 4th grade of Elementary School in public schools of the metropolitan region of São Paulo. METHODS: The concurrent cohort included 315 students. Birth weight was the exposure variable, and the outcomes were performance in receptive and expressive language, oral metalinguistic skills, and performance in writing, arithmetic, and reading. The tools employed were the Test of Language Competence (TLC) and the School Performance Test (SPT). Students were grouped into quartiles by birth weight for data analysis (P1: < 2170 g, P2: from 2171 g to 2450 g, P3: from 2451 g to 3150 g, and P4: > 3150 g). RESULTS: The authors observed a tendency for the lower performance of the two groups with lower birth weights in listening comprehension and oral expression. The lower-weight group tended to perform poorly compared to the other groups vis-à-vis reading. In the global result of the SPT, worse performance was observed in the students in the first quartile compared to the others (p = 0.019). The multivariate analysis revealed no association between birth weight and results in the tests applied after adjusting for maternal schooling. CONCLUSIONS: Birth weight can interfere with oral and written language development. However, the determination of these processes occurs in the face of complex interaction that includes sociodemographic factors, especially family support and maternal schooling.

School and language performance in children born with low birth weight

Abstract Objectives To identify the impact of birth weight on the development of metalinguistic skills and performance in reading, writing, and arithmetic in students aged 6 to 10 years, enrolled from the 1st to the 4th grade of Elementary School in public schools of the metropolitan region of São Paulo. Methods The concurrent cohort included 315 students. Birth weight was the exposure variable, and the outcomes were performance in receptive and expressive language, oral metalinguistic skills, and performance in writing, arithmetic, and reading. The tools employed were the Test of Language Competence (TLC) and the School Performance Test (SPT). Students were grouped into quartiles by birth weight for data analysis (P1: < 2170 g, P2: from 2171 g to 2450 g, P3: from 2451 g to 3150 g, and P4: > 3150 g). Results The authors observed a tendency for the lower performance of the two groups with lower birth weights in listening comprehension and oral expression. The lower-weight group tended to perform poorly compared to the other groups vis-à-vis reading. In the global result of the SPT, worse performance was observed in the students in the first quartile compared to the others (p= 0.019). The multivariate analysis revealed no association between birth weight and results in the tests applied after adjusting for maternal schooling. Conclusions Birth weight can interfere with oral and written language development. However, the determination of these processes occurs in the face of complex interaction that includes sociodemographic factors, especially family support and maternal schooling.

Association of ACE gene insertion/deletion polymorphism with birth weight, blood pressure levels, and ACE activity in healthy children.

BACKGROUND: The human angiotensin-converting enzyme (ACE) gene contains a polymorphism consisting of either an insertion (I) or a deletion (D) of a 287 bp Alu repetitive sequence in intron 16. The potential role of ACE polymorphism in the risk of developing hypertension or other cardiovascular disorders has not been determined in relation to birth weight (BW). METHODS: The ACE genotype and plasma ACE activity were determined in 167 children. Among these children, 60 were identified with low BW (LBW), and 107 were of normal BW (NBW). RESULTS: ACE activity levels were significantly elevated in LBW children compared with the NBW group (P < 0.001). There was a significant association of the ACE activity with systolic blood pressure (SBP) levels in our population (P < 0.001). Among the ACE genotypes, no significant differences were found with respect to BW (P = 0.136). However, our results revealed that LBW children had a higher D allele frequency than NBW children (P = 0.036). When analyzed by quartiles of SBP or ACE activity, we found a greater frequency of both the LBW children and those carrying the DD genotype in the highest quartiles of these parameters, whereas the NBW children tended to be in the lowest quartile (P < 0.001). Similar results were observed with the heterozygote ID children after categorization by quartiles of both SBP (P < 0.001) and ACE activity (P = 0.004). CONCLUSIONS: The ACE I/D polymorphism, especially the DD genotype, can be interpreted as a major factor in association between LBW and high BP levels.

Blood pressure levels in childhood: probing the relative importance of birth weight and current size.

Several studies have reported data supporting the idea that an impaired intrauterine environment that deprives the fetus of optimal nutrient delivery results in the predisposition of the fetus to experience cardiovascular and metabolic dysfunction in later life. However, contradictory data still exist. Our purpose was to investigate the effects of both birth weight and weight gain on the risk for high blood pressure levels in 6- to 10-year-old children. This cross-sectional study included 739 children divided into quartiles of birth weight. The mean values of both systolic and diastolic pressure were significantly different between quartiles of birth weight, with increasing blood pressure values as the birth weight decreased (P<0.001). Covariance analysis adjusting for gender, prematurity, and body mass index (BMI) showed that both systolic and diastolic pressure remained greater in the lowest than in the highest birth weight quartile. Separating those with low and normal birth weight demonstrated that the risk of childhood hypertension was significantly higher among children with low birth weight and current obesity (odds ratio [OR]: 5.0, confidence interval [CI]: 3.3 to 16.1; P=0.023). The inverse association between birth weight and blood pressure levels appears to be programmed during fetal life, while weight gain during childhood adds to this risk.

Development of a tool for early referral of children and adolescents with signs and symptoms suggestive of chronic arthropathy to pediatric rheumatology centers.

OBJECTIVE: To develop an easy, time-efficient tool to identify children and adolescents with signs and symptoms suggestive of chronic arthropathies, and to evaluate its interobserver reproducibility and reliability. METHODS: The instrument used standardized techniques as required for the development of health-related instruments, targeting parents of apparently healthy children and adolescents ages 1-16 years. A multidisciplinary team was involved in the design of the instrument. RESULTS: Each health professional generated 10-15 questions addressing musculoskeletal complaints that they considered to be the most relevant. A total of 60 questions were listed. During the reduction step, each health professional scored questions from 1 to 4 according to the question's relevance. The tool comprised 12 questions and was administered to the parents of 3 groups: patients with juvenile idiopathic arthritis (JIA; n = 48), children with diffuse musculoskeletal pain (n = 39), and a healthy control group (n = 42). The JIA group achieved the highest scores, followed by the diffuse musculoskeletal pain group and the control group. Nine (18.7%) of 48 patients with JIA and 2 (5.1%) of 39 children with musculoskeletal pain had a score of 5. The interobserver reproducibility was confirmed. All 12 questions were included in the final version of the instrument. We determined that children and adolescents with a score > or =5 should be referred for a rheumatologic evaluation (cluster analysis and logistic regression). CONCLUSION: Our questionnaire seems to be a useful tool for the early detection of musculoskeletal problems in children that may need a referral for a rheumatologic evaluation.

Immunogenicity of a combined DTPa-HB vaccine co-administered with Haemophilus influenzae type B conjugate vaccine (PRP-T) for primary and booster vaccinations

OBJECTIVE: To evaluate the immunogenicity of a combined DTPa-HB vaccine co-administered with Haemophilus influenzae type b conjugate vaccine (PRP-T) in Brazilian infants. MATERIAL AND METHODS: A prospective and open clinical study, in which 110 infants were immunized with a three-dose primary vaccination regime at two, four and six months of age and with a single booster vaccination. Blood samples were drawn immediately before the first dose, one month after the third dose, at the time of the booster dose and one month after the booster to assess seropositivity and antibody geometric mean titers (GMTs) of antibodies for diphtheria, tetanus, hepatitis B, Haemophilus influenzae type b and for the three pertussis antigens: Pertussis Toxin (PT), Filamentous Hemagglutinin (FHA) and Pertactin (PRN). RESULTS: Among the original 110 infants, 93 completed the study. Seropositivity was 100 percent for all seven involved antibodies, after the primary vaccination course. At the time of the booster dose, all antibodies (except diphtheria 33.7 percent and anti-PT 59 percent) were seropositive for more than 94 percent of subjects. After the booster, seropositivity increased to 100 percent for all antibodies. The GMT of these antibodies followed a similar pattern, with a strong increase after the primary course, followed by a second increase after the booster dose. At this time, GMT was2- to 7-fold higher than after the primary course, for all vaccine components. CONCLUSIONS: Concomitant administration of DTPa-HB and Hib vaccines elicited strong seroprotection for all the antigenic components. No interference with antibody response was evident. The vaccines provided high immunogenicity, following both the primary vaccinations and the booster dose.

Immunogenicity of a combined DTPa-HB vaccine co-administered with Haemophilus influenzae type B conjugate vaccine (PRP-T) for primary and booster vaccinations.

OBJECTIVE: To evaluate the immunogenicity of a combined DTPa-HB vaccine co-administered with Haemophilus influenzae type b conjugate vaccine (PRP-T) in Brazilian infants. MATERIAL AND METHODS: A prospective and open clinical study, in which 110 infants were immunized with a three-dose primary vaccination regime at two, four and six months of age and with a single booster vaccination. Blood samples were drawn immediately before the first dose, one month after the third dose, at the time of the booster dose and one month after the booster to assess seropositivity and antibody geometric mean titers (GMTs) of antibodies for diphtheria, tetanus, hepatitis B, Haemophilus influenzae type b and for the three pertussis antigens: Pertussis Toxin (PT), Filamentous Hemagglutinin (FHA) and Pertactin (PRN). RESULTS: Among the original 110 infants, 93 completed the study. Seropositivity was 100% for all seven involved antibodies, after the primary vaccination course. At the time of the booster dose, all antibodies (except diphtheria 33.7% and anti-PT 59%) were seropositive for more than 94% of subjects. After the booster, seropositivity increased to 100% for all antibodies. The GMT of these antibodies followed a similar pattern, with a strong increase after the primary course, followed by a second increase after the booster dose. At this time, GMT was 2- to 7-fold higher than after the primary course, for all vaccine components. CONCLUSIONS: Concomitant administration of DTPa-HB and Hib vaccines elicited strong seroprotection for all the antigenic components. No interference with antibody response was evident. The vaccines provided high immunogenicity, following both the primary vaccinations and the booster dose.

Conhecimento de mäes e auxiliares de desenvolvimento infantil referente ao desenvolvimento da linguagem de crianças de zero a vinte e quatro meses / Knowledge of mothers and nursey school assistants concerning the language development of children from zero to twenty four months of age

O objetivo desta pesquisa foi verificar o conhecimento de mäes e auxiliares de desenvolvimento infantil referente ao desenvolvimento da linguagem de crianças de zero a vinte e quatro meses de idade e sua relaçäo com o nível de escolaridade dessas cuidadoras. Foram utilizados os seguinte métodos: estudo transversal analítico, realizado com uma amostra näo probabilística de 200 mäes e 50 auxiliares de desenvolvimento infantil, que constou de aplicaçäo de questionário constituído por treze questões sobre o desenvolvimento de linguagem nessa faixa etária. Os principais resultados foram: nos grupos de mäes, a frequência de acertos aumentou conforme o nível de escolaridade em apenas quatro questões. Os resultados obtidos no grupo de auxiliares de desenvolvimento infantil ficaram aquém do esperado, quando comparados aos das mäes com mesma escolaridade. Concluiu-se que os grupos de mäes e auxiliares de desenvolvimento infantil foram capazes de observr a emergência de marcos significativos do desenvolvimento da linguagem em crianças de zero a vinte e quatro meses e apresentaram diferenças pouco relevantes entre si.

[Recurrent pain in children and adolescents]. / Dores recorrentes na infância e adolescência.

OBJECTIVE: To perform a bibliographic review of recurrent pain in children and adolescents, focusing on differential diagnosis and management of such patients. SOURCES: Search of Medline and Lilacs databases, covering the last four and ten years, respectively. Classical studies and texts related to the matter were also included. SUMMARY OF THE FINDINGS: Studies carried out in different parts of the world demonstrate that the most frequent kinds of recurrent pain in children and adolescents are abdominal pain, headache, and limb pain. The occurrence of organic etiology is low, observed in 5% to 10% of the cases. Among the well defined organic etiology, no predominance is observed. The main advances regarding the pathophysiology of recurrent pain in its main localizations were analyzed. Guidelines for the diagnostic and therapeutic approach of the most common infantile diseases related to recurrent pain are presented. CONCLUSIONS: Recurrent pain in children and adolescents is very common and determines significant demand on healthcare services. Defined etiology is only presented by 5% to 10% of patients. Anamnesis, physical examination and follow-up are extremely important instruments for dealing with such patients.

Dores recorrentes na infância e adolescência / Recurrent pain in children and adolescents

Objetivo: realizar revisão bibliográfica sobre dores recorrentes na infância e na adolescência, com enfoque no diagnóstico diferencial e manejo desses pacientes.Fontes de dados: levantamento bibliográfico no Medline eLilacs, abrangendo os últimos quatro e dez anos, respectivamente, além de estudos e textos clássicos que tratam sobre o tema. Síntese dos dados: estudos realizados em diferentes partes do mundo demonstram que as dores recorrentes mais freqüentes na infância e adolescência são dor abdominal, cefaléia e dor em membros. A ocorrência de causa orgânica é baixa, observada em 5 por cento a 10 por cento dos casos. Dentre as causas orgânicas bem definidas de dor abdominal recorrente, cefaléia e dor em membros, não se observa nenhuma etiologia predominante. Foram analisados os principais avanços quanto à fisiopatologia das dores recorrentes, nas suas diferentes localizações, apresentando-se uma orientação para abordagem diagnóstica e terapêutica das afecções mais freqüentes em pediatria Conclusões: as dores recorrentes na infância e adolescência são muito freqüentes e determinam significativa demanda aos serviços de saúde. A anamnese, o exame físico e o seguimento do paciente constituem a base para abordagem dessas crianças e adolescentes

Desigualdades sociais e uso de serviços de saúde: evidências de análise estratificada / Social inequalities and health services use: evidences from a stratified household survey

Objetivo: Identificar os grupos populacionais näo alcançados pelo programa local de saúde materno-infantil, buscando caracterizar os possíveis pontos de exclusäo, com vistas ao estudo de intervençöes capazes de ampliar o acesso e a utilizaçäo das principais açöes de saúde oferecidas pelo programa. Métodos: Estudou-se uma amostra de 465 menores de um ano residentes no Município de Embu, SP (Brasil). A análise estatística, orientada pela hipótese que esperava maior disponibilidade de planos de saúde entre as famílias que näo usavam o programa local de saúde infantil, consistiu em análises de associaçäo estratificadas que buscaram detectar heterogeneidade entre os quatro estratos de famílias e no interior deles, definidos segundo diferentes padröes de condiçöes de vida. Resultados: Apesar de apenas 85,4 por cento das crianças estudadas serem matriculadas nas unidades básicas de saúde, 91,2 por cento eram assistidas pelas principais açöes de saúde. No estrato 3, onde reside a populaçäo periférica, estäo concentradas as crianças näo alcançadas pelo programa. O estudo de diferenças dentro dos estratos revelou que também no estrato 3 encontra-se a possibilidade de que algumas famílias estejam usando convênios ou planos de saúde como alternativa ao programa local de saúde. Os resultados apontam ainda que a populaçäo com piores condiçöes de vida (favelas) dispöe do sistema público do município como única alternativa para cuidar de sua saúde. Conclusöes: É na populaçäo residente na periferia do município que se concentram as crianças näo assistidas pelo programa local de saúde infantil e existe maior heterogeneidade entre as famílias quanto à disponibilidade de outros recursos para os cuidados de saúde de suas crianças

Assessing morbidity in the paediatric community

Introduçäo: Informaçöes sobre morbidade säo de fácil acesso através de registros médicos. Porém seu escopo é limitado à populaçäo ou grupo que demanda o serviço. Informaçöes de prevalência de doenças requerem inquéritos domiciliares, os quais nem sempre säo possíveis. Estas duas fontes de informaçäo representam duas alternativas para avaliaçäo da ocorrência de doenças na comunidade, chamadas morbidade de demanda e morbidade referida. O objetivo do estudo foi pesquisar uma possível relaçäo entre elas, a fim de validar a primeira na ausência da segunda fonte. Métodos: Uma comunidade de 13.365 famílias de dois bairros do Município do Embu, Grande Säo Paulo, Brasil, foi estudada durante o período de 15/11/94 a 15/01/95. Foram coletados dados referentes à morbidade de crianças menores de 5 anos por meio de inquérito domiciliar e de registros de consultas médicas de duas unidades básicas de saúde (UBS). A prevalência de doenças foi calculada a partir dos dados de morbidade referida e comparada com a estimativa de prevalência extraída dos dados de demanda. Resultados: O estudo trabalhou com dois grupos etários separadamente: crianças menores de um ano e de 1 a 4 anos completos. Os grupos de doenças mais importantes foram doenças respiratórias, diarréia, problemas de pele e outras doenças infecciosas ou parasitárias. As UBS apresentaram melhor cobertura para os menores de um ano. A ocorrência de doenças näo mostrou diferença dentro ou fora das unidades, as quais cobrem apenas diarréia e outras doenças infecciosas ou parasitárias para menores de um ano, e diarréia no grupo etário mais velho. Foi encontrada equivalência entre as duas fontes de morbidade no grupo etário de menores de um ano, referindo-se aos grupos de doença que apresentam maior cobertura. Um odds de procura de serviço por grupo de doenças igual ou superior a 4:10 parece assegurar a equivalência de prevalência. Conclusäo: Provida uma boa cobertura dos serviços de saúde, os dados de morbidade de demanda podem ser usados como indicadores da morbidade da comunidade

Fatores de risco para morbidade e desnutriçäo em crianças acompanhadas em programa de atençäo à saúde da criança / Morbidity and malnutrition risk factors in children followed up by a child health care program

Objetivo: O objetivo do estudo foi identificar fatores de risco associados à desnutriçäo e morbidade na populaçäo de crianças acompanhadas no Programa de Atençäo à Saúde da Criança no município do Embu, Säo Paulo (Brasil), visando o melhor direcionamento das açäes de saúde. Métodos: A casuística foi constituída por uma coorte de 1094 crianças, que correspondia a 25,0 por cento (amostra sistemática probabilística) do total de crianças menores de 12 meses inscritas em 6 unidades básicas de saúde do município, no período de julho de 1988 a julho de 1989. Os fatores de risco foram analisados segundo a presença ou ausência de internaçäo e evoluçäo ponderal - favorável ou desfavorável - até os dois anos de idade. para a análise estatística utilizou-se a análise multivariada, pela técnica de regressäo logística...

Avaliaçäo do Programa de Recuperaçäo de Desnutridos do Município do Embu, na Regiäo Metropolitana de Säo Paulo / Evaluation of the Malnourished Children's Recuperation Program in the town of Embu, located in the Metropolitan Area of Säo Paulo

Este estudo teve como objetivo avaliar a evoluçäo antropométrica de crianças acompanhadas no Programa de Recuperaçäo de Desnutridos no Município do Embu, bem como analisar algumas variáveis que interferiram nesta evoluçäo. O estudo incluiu 233 crianças menores de cinco anos, inscritas no Programa no período de janeiro de 1984 a dezembro de 1985, sendo 201 (86,3 por cento) desnutridas de grau II e 32 (13,7 por cento) de grau III (segundo a classificaçäo de Gomez). Os incrementos percentuais do Peso para a Idade (P/I) e Estatura para a Idade (E/I)-variáveis dependentes, na primeira e última consultas do Programa-foram analisados utilizando-se a regressäo linear múltipla. As crianças de menor idade e piores condiçöes nutricionais apresentaram maiores incrementos de P/I e E/I. O baixo peso ao nascer, o maior número de consultas agendadas e o maior tempo de permanência do Programa, associaram-se com menores incrementos de P/I. A presença de patologias crônicas comprometeu os incrementos de E/I. Concluímos que há grande importância no desenvolvimento desses programas, tendo em vista o maior risco de morbi-mortalidade da criança desnutrida.