Factores relacionados con la presencia de desnutrición hospitalaria en pacientes menores de cinco años en una unidad de tercer nivel / Factors related to the presence of hospital malnutrition in patients under five years old in a third level unit

Objetivo: identificar los factores relacionados con la presencia de desnutrición hospitalaria (DH) en pacientes menores de cinco años hospitalizados en una unidad de tercer nivel de atención. Material y métodos: estudio de cohorte. Se incluyeron pacientes menores de cinco años de edad hospitalizados. Del expediente se identificaron la edad, el sexo, los antecedentes patológicos, el motivo de ingreso y el estado nutricional mediante el cálculo de los índices peso/edad (P/E), talla/edad (T/E) y peso/talla (P/T). El proceso de toma de somatometría completa se realizó al ingreso y se repitió en los días 2, 4 y 7 de seguimiento. La DH se definió como disminución de más de 0,25 desviaciones estándar en el índice de P/T después de siete días de hospitalización. Resultados: se identificaron 83 pacientes. El motivo de ingreso fue patología no quirúrgica en un 77% (n = 64). El 70% (n = 58) presentaba alguna enfermedad subyacente. Al momento del ingreso, el 66% (n = 55) tenía desnutrición. Se observó una disminución progresiva del score Z de P/T conforme avanzó el tiempo de hospitalización (p < 0,001). Se identificó una incidencia del 67,5% de DH. Se demostró que la presencia de desnutrición al ingreso de la hospitalización aumentaba el riesgo de DH (OR 2,9, IC 95% 1,05 a 8,10, p = 0,03) y en los pacientes con desnutrición desde el ingreso una edad menor a dos años disminuía el riesgo de DH (OR 0,093, IC 95% 0,009 a 0,959, p = 0,046), mientras que alguna enfermedad subyacente aumentaba el riesgo (OR 6,34, IC 95% 1,009 a 39,89, p = 0,049). Conclusiones: la presencia de desnutrición y antecedentes patológicos previo al ingreso fueron factores de riesgo para presentar DH

Objective: to identify the factors related to the presence of hospital malnutrition (HM) in patients under five years of age hospitalized in a third level care unit. Material and methods: cohort study. Patients under five years of age hospitalized were included. The record identified age, sex, pathological history, reason for admission and nutritional status by calculating weight/age (W/A), height/age (H/A) and weight/height (W/H). The entire somatometry intake process was performed upon admission, and was repeated on days 2, 4 and 7 of follow-up. The HM was defined as a decrease of more than 0.25 standard deviations in the W/H after seven days of hospitalization. Results: eighty-three patients were identified. The reason for admission was non-surgical pathology in 77% (n = 64). Seventy per cent (n = 58) had underlying disease. At the time of admission, 66% (n = 55) presented malnutrition. A progressive decrease in the Z score of W/H was observed as hospitalization progressed (p < 0.001). An incidence of 67.5% of HM was identified. It was shown that the presence of malnutrition at admission of hospitalization increased the risk of HM (OR 2.9, 95% CI 1.05 to 8.10, p = 0.03). In patients with malnutrition from admission, an age younger than two years decreased the risk of HM (OR 0.093, 95% CI 0.009 to 0.959, p = 0.046), while the underlying disease increased the risk (OR 6.34, 95% CI 1.009 to 39.89, p = 0.049). Conclusions: the presence of malnutrition and underlying disease prior to admission were risk factors to present HM

[Factors related to the presence of hospital malnutrition in patients under five years old in a third level unit]. / Factores relacionados con la presencia de desnutrición hospitalaria en pacientes menores de cinco años en una unidad de tercer nivel.

INTRODUCTION: Objective: to identify the factors related to the presence of hospital malnutrition (HM) in patients under five years of age hospitalized in a third level care unit. Material and methods: cohort study. Patients under five years of age hospitalized were included. The record identified age, sex, pathological history, reason for admission and nutritional status by calculating weight/age (W/A), height/age (H/A) and weight/height (W/H). The entire somatometry intake process was performed upon admission, and was repeated on days 2, 4 and 7 of follow-up. The HM was defined as a decrease of more than 0.25 standard deviations in the W/H after seven days of hospitalization. Results: eighty-three patients were identified. The reason for admission was non-surgical pathology in 77% (n = 64). Seventy per cent (n = 58) had underlying disease. At the time of admission, 66% (n = 55) presented malnutrition. A progressive decrease in the Z score of W/H was observed as hospitalization progressed (p < 0.001). An incidence of 67.5% of HM was identified. It was shown that the presence of malnutrition at admission of hospitalization increased the risk of HM (OR 2.9, 95% CI 1.05 to 8.10, p = 0.03). In patients with malnutrition from admission, an age younger than two years decreased the risk of HM (OR 0.093, 95% CI 0.009 to 0.959, p = 0.046), while the underlying disease increased the risk (OR 6.34, 95% CI 1.009 to 39.89, p = 0.049). Conclusions: the presence of malnutrition and underlying disease prior to admission were risk factors to present HM.

INTRODUCCIÓN: Objetivo: identificar los factores relacionados con la presencia de desnutrición hospitalaria (DH) en pacientes menores de cinco años hospitalizados en una unidad de tercer nivel de atención. Material y métodos: estudio de cohorte. Se incluyeron pacientes menores de cinco años de edad hospitalizados. Del expediente se identificaron la edad, el sexo, los antecedentes patológicos, el motivo de ingreso y el estado nutricional mediante el cálculo de los índices peso/edad (P/E), talla/edad (T/E) y peso/talla (P/T). El proceso de toma de somatometría completa se realizó al ingreso y se repitió en los días 2, 4 y 7 de seguimiento. La DH se definió como disminución de más de 0,25 desviaciones estándar en el índice de P/T después de siete días de hospitalización. Resultados: se identificaron 83 pacientes. El motivo de ingreso fue patología no quirúrgica en un 77% (n = 64). El 70% (n = 58) presentaba alguna enfermedad subyacente. Al momento del ingreso, el 66% (n = 55) tenía desnutrición. Se observó una disminución progresiva del score Z de P/T conforme avanzó el tiempo de hospitalización (p < 0,001). Se identificó una incidencia del 67,5% de DH. Se demostró que la presencia de desnutrición al ingreso de la hospitalización aumentaba el riesgo de DH (OR 2,9, IC 95% 1,05 a 8,10, p = 0,03) y en los pacientes con desnutrición desde el ingreso una edad menor a dos años disminuía el riesgo de DH (OR 0,093, IC 95% 0,009 a 0,959, p = 0,046), mientras que alguna enfermedad subyacente aumentaba el riesgo (OR 6,34, IC 95% 1,009 a 39,89, p = 0,049). Conclusiones: la presencia de desnutrición y antecedentes patológicos previo al ingreso fueron factores de riesgo para presentar DH.

Comparative Effectiveness of Two Walking Interventions on Participation, Step Counts, and Health.

PURPOSE: To (1) compare the effects of two worksite-based walking interventions on employee participation rates; (2) compare average daily step counts between conditions, and; (3) examine the effects of increases in average daily step counts on biometric and psychologic outcomes. DESIGN: We conducted a cluster-randomized trial in which six employer groups were randomly selected and randomly assigned to condition. SETTING: Four manufacturing worksites and two office-based worksite served as the setting. SUBJECTS: A total of 474 employees from six employer groups were included. INTERVENTION: A standard walking program was compared to an enhanced program that included incentives, feedback, competitive challenges, and monthly wellness workshops. MEASURES: Walking was measured by self-reported daily step counts. Survey measures and biometric screenings were administered at baseline and 3, 6, and 9 months after baseline. ANALYSIS: Analysis used linear mixed models with repeated measures. RESULTS: During 9 months, participants in the enhanced condition averaged 726 more steps per day compared with those in the standard condition (p < .001). A 1000-step increase in average daily steps was associated with significant weight loss for both men (-3.8 lbs.) and women (-2.1 lbs.), and reductions in body mass index (-0.41 men, -0.31 women). Higher step counts were also associated with improvements in mood, having more energy, and higher ratings of overall health. CONCLUSIONS: An enhanced walking program significantly increases participation rates and daily step counts, which were associated with weight loss and reductions in body mass index.

Obtenção de informações sobre violência sexual infantojuvenil entre universitários do Triângulo Mineiro / The acquisition of information on juvenile sexual violence by undergraduate students in the Triangulo Mineiro / Obtención de información sobre la violencia sexual infantojuvenil entre estudiantes universitarios de Triangulo Mineiro

Objetiva-se caracterizar jovens ingressantes em uma universidade pública do Triângulo Mineiro, Brasil, descrever como obtêm informações sobre violência sexual infantojuvenil, e discutir formas de acesso à temática durante a formação acadêmica. Trata-se de estudo exploratório, transversal, quantitativo-descritivo. Os dados foram coletados por questionário estruturado autoaplicável nas salas de aula da universidade em 2011. Participaram 946 estudantes (70,2% do total dos ingressantes), média de idade de 19,5 anos; 59,8% do sexo feminino, 93,7% solteiros, 79,0% cor da pele branca, maioria frequentou ensino médio em instituições privadas. Abuso sexual e pedofilia foram os temas mais conhecidos pelos universitários. Televisão e internet foram veículos de comunicação em que mais obtiveram informações sobre a temática. Apenas 40 estudantes haviam participado de cursos ou eventos que tratassem deste assunto. Identificaram diversas formas para abordagem da violência sexual infantojuvenil na formação acadêmica, como: estudos de caso, exibição e discussão de filmes, além das aulas expositivas. Canais de comunicação precisam ser estreitados entre as universidades e os jovens, no sentido de aprimorar as abordagens à violência sexual infantojuvenil. Esses resultados podem direcionar ações de maior diálogo entre academia, sociedade civil e poder público, que promovam abordagens mais efetivas no enfrentamento da violência sexual infantojuvenil.

The aim of this study is to characterize undergraduate freshman students at a public university in the Triângulo Mineiro, a region in the Brazilian state of Minas Gerais; to describe how they obtain information regarding juvenile sexual violence; and to discuss ways to integrate the theme into their formal education. This is an exploratory, cross-sectional, quantitative-descriptive study, using data collected by means of a structured and self-administered questionnaire in classrooms at the university in 2011. A total of 946 students (70.2% of all freshmen) participated in the study, with a mean age of 19.5 years, 59.8% of which were female, 93.7% were single, 79.0% white, and most of them completed high school at private educational institutions. Sexual abuse and pedophilia were the most well-known themes among the study participants, and television and the Internet were the communication media through which most obtained information on these themes. Only 40 undergraduates had attended courses or events that addressed the issue of juvenile sexual violence, and they identified several ways to approach juvenile sexual violence in university education, such as case studies, watching and discussing films, and lectures. Channels of communication must be enhanced between universities and young students in order to improve the treatment of juvenile sexual violence. The results of this study can guide actions towards a better dialogue among educational institutions, society and government so as to promote more effective approaches to combat juvenile sexual violence.

Este estudio tiene el objetivo de caracterizar a los jóvenes estudiantes del primer año de una universidad pública en Triângulo Mineiro, Minas Gerais, Brasil; de describir cómo obtienen informaciones sobre violencia sexual infantojuvenil, y de discutir maneras de acceso al tema durante su formación académica. Se trata de estudio exploratorio, transversal, cuantitativo-descriptivo. Los datos fueron recogidos mediante un cuestionario estructurado, auto-aplicable en las aulas de clase, en 2011. Participaron 946 estudiantes (70,2% del total de estudiantes del primer año), edad promedio 19,5 años, 59,8% del sexo femenino, 93,7% solteros, 79,0% color de la piel blanca, la mayoría frecuentó la enseñanza secundaria en escuelas privadas. Abuso sexual y pedofilia fueron los temas más conocidos por los universitarios. Televisión e Internet fueron los medios de comunicación de donde más obtuvieron informaciones sobre el tema. Sólo 40 estudiantes habían participado de cursos o eventos que abordasen este asunto. Se identificaron varias maneras de abordaje de la violencia sexual infantojuvenil en la formación académica, como: estudios de caso, exhibición y discusión de películas, además de las clases expositivas. Canales de comunicación necesitan ser estrechadas entre las universidades y los jóvenes, con el fin de mejorar los abordajes a la violencia sexual infantojuvenil. Estos resultados pueden orientar acciones de mayor diálogo entre universidades, sociedad civil y poder público, para promover enfoques más eficaces en el enfrentamiento de la violencia sexual infantojuvenil.

Hereditary hemochromatosis in a Brazilian university hospital in São Paulo State (1990-2000).

Hereditary hemochromatosis (HH) is the most common genetic disease among individuals of European descent. Two mutations (845G-->A, C282Y and 187C-->G, H63D) in the hemochromatosis gene (HFE gene) are associated with HH. About 85-90% of patients of northern European descent with HH are C282Y homozygous. The prevalence of HH in the Brazilian population, which has a very high level of racial admixture, is unknown. The aims of the present study were to identify individuals with diagnostic criteria for HH among patients with a body iron overload attended at the university hospital of the Faculty of Medicine of Ribeirao Preto from 1990 to 2000, and to evaluate the prevalence of HFE mutations. We screened first-degree relatives for HFE mutations. Four of 72 patients (three men and one woman, mean age 47 years) fulfilled the criteria for HH. HFE mutations were studied in three patients [two C282Y homozygotes (patients 1 and 2) and one H63D heterozygote]. Patient 1 had four children (all C282Y heterozygotes with no iron overload) and seven brothers and sisters: two sisters (66 and 76 years old) were C282Y homozygotes and both had an iron overload (a liver biopsy in one showed severe iron deposits), one sister (79 years old) was a compound heterozygote with no iron overload, one brother (78 years old) was a C282Y heterozygote with no iron overload, two individuals were H63D heterozygotes (one brother, 49 years old, obese, with a body iron overload and abnormal liver enzymes - a biopsy showed non-alcoholic steatohepatitis, and one 70-year-old sister with no iron overload). Patient 2 had two children (22 and 24 years old who were C282Y heterozygotes with no iron overload) but no brothers or sisters. These results showed that HH was uncommon among individuals attended at our hospital, although HFE mutations were found in all patients. Familial screening is valuable for the early diagnosis of individuals at risk since it allows treatment to be initiated before the onset of the clinical manifestations of organ damage associated with HH.