Journal of Human Growth and Development

Beyond ultra-processed foods: the new direction of the basic food basket in Brazil

Monica Cattafesta, Luciane Bresciani Salaroli — Thu, 11 Apr 2024 00:00:00 -0300

Decree 11.936/2024 initiates a significant transformation in the Brazilian basic food basket, focusing on encouraging healthier and more sustainable eating habits. By prioritizing whole foods and restricting ultra-processed foods, it aligns with nutritional policy guidelines and tax reform, demonstrating a commitment to public health and food sustainability. The document reconciles with the recommendations set forth by the Dietary Guidelines for the Brazilian Population, which emphasizes seasonality, family farming, local and regional traditions, biodiversity, and environmental respect essential elements for food and nutritional security that offer direct benefits to public health. Through this approach, it seeks to guide the population towards balanced eating practices, ensuring access to nutritionally adequate and sustainable food, especially for the most vulnerable segments of society.

Adherence to chest physiotherapy, airway clearance techniques and physical exercise by children and adolescents with cystic fibrosis

Thu, 11 Apr 2024 00:00:00 -0300

Introduction: chest physiotherapy, airway clearance techniques, and physical exercise are associated with better outcomes in cystic fibrosis, but adherence to these recommendations remains a challenge.

Objective: to assess adherence to chest physiotherapy, airway clearance techniques, and physical exercise by children and adolescents with cystic fibrosis and analyze the factors related to adherence.

Methods: retrospective study of children and adolescents with cystic fibrosis from a pediatric referral center in Brazil. Data were collected from electronic records of the multidisciplinary team responsible for caring for these patients at the referral center.

Results: the sample included all 83 patients registered at the referral center, with a mean age of 7.88 ± 4.88 years. Among them, 28.9% did not have weekly chest physiotherapy, 66.3% did not practice physical exercise regularly, and only 38.6% practiced airway clearance techniques from 6 to 7 times a week. Higher adherence to airway clearance techniques was associated with higher mean age (p<0.01) and correlated with FEV1 (r=-0.39; p=0.03), FEF25-75% (r =-0.36; p=0.02), FEV1/FVC (r =-0.43; p=0.01) and lower mean Shwachman-Kulczycki Score (r=-0.34; p<0.01). Higher physical exercise adherence was associated with a higher mean age (p<0.01). Individuals using public financing of physiotherapy services had a lower Shwachman-Kulczycki Score (p=0.02) than those using non-public services. The metropolitan region had a higher percentage of individuals using non-public services than other regions (p<0.01).

Conclusion: adherence to chest physiotherapy, airway clearance techniques and physical exercise was lower than recommendations. Airway clearance techniques and physical exercise adherence increased with age, and airway clearance techniques adherence was associated with the high severity of disease. These results suggest that patients only increase adherence when they get older and the disease worsens, highlighting the need for strategies to increase adherence early.

Self-perceived stress by women during the COVID-19 pandemic: an online survey with brazilian physiotherapists

Thu, 11 Apr 2024 00:00:00 -0300

Introduction: the COVID-19 pandemic highlighted the need to investigate the factors related to stress in female health professionals since women and men are exposed differently to pandemic consequences.

Objective: to analyze which psychosocial demands, sociodemographic, and clinical factors were associated with high levels of perceived stress among Brazilian female physiotherapists during the COVID-19 pandemic.

Methods: this is a cross-sectional study. The data were collected using the Perceived Stress Scale and an online questionnaire sent by e-mail. Unadjusted and adjusted odds ratios (ORs), with their respective 95% CI, were estimated by logistic regression.

Results: the sample was compounded by 339 physiotherapists. Participants who reported a lot/extreme concern with household workers (OR = 2.76; 95% CI: 1.40; 5.46), or relationship with a partner (OR = 4.06; 95% CI: 1.79; 9.21) or financial questions (OR = 2.24; 95% CI: 1.15; 4.35) were more likely to report high levels of perceived stress. In conclusion, the psychosocial demands associated with high levels of perceived stress are high or extreme concern with household chores, or with the relationship with a partner, or financial issues.

Conclusion: the factors associated with high levels of perceived stress in this sample of Brazilian physiotherapists were the following psychosocial demands: high or extreme concern with household chores, high or extreme with a relationship with a partner, or high or extreme with financial issues.

Temporal evolution of traffic accident mortality rates in the State of São Paulo, Brazil, in the period 2009-2019

Thu, 11 Apr 2024 00:00:00 -0300

Introduction: external causes are considered a public health problem in the world, associated with socioeconomic, political, and cultural diversities. Among them, traffic accidents stand out.

Objective: to assess the trend in traffic accident mortality for each sex in the state of São Paulo, Brazil.

Methods: ecological study of time series analyses. Secondary data referring to deaths from traffic accidents by place of residence in the state of São Paulo, Brazil, in the period 2009 - 2019 were used.

Results: the total mortality rate in 2019 for females is 39.80 and for males, 185.85, with a reduction of 4.96% per year for both sexes. The trends in mortality from traffic accidents for females proved to be stationary for motorcyclists, motorized tricycle, pickup truck, heavy transport vehicle, and bus occupants at the end of the study period. For males, the same pattern was observed, but only for truck, heavy transport vehicle, and bus occupants. In the rest of the vehicles, the mortality rate showed decreasing trends.

Conclusion: the highest number of deaths occurred among males (81.38%), aged between 20 and 49 years (58.70%), single (49.12%), on public roads (46.73%) and hospitals (45.64%). Females have more stationary trends than males.

Comparative analysis of the national curriculum guidelines for the dentistry courses in 2002 and 2021

Thu, 11 Apr 2024 00:00:00 -0300

Introduction: faced with the challenge of training dental surgeons who are fit for the job market, especially the Unified Health System, the National Curriculum Guidelines were established in 2002 with the aim of organizing the curricula of undergraduate dentistry courses, which were updated in 2021.

Objective: a comparative analysis of the 2002 and 2021 National Curriculum Guidelines for dentistry courses, verifying their proposals’ theoretical and practical similarities and differences.

Methods: this is a qualitative, descriptive, and exploratory study, using documentary analysis of these guidelines.

Results: from the documentary analysis, six analytical categories were identified: Profile of the graduate; General and specific competencies; Contents for the training of the dental surgeon; Supervised curricular internship and course completion work; Pedagogical project and curricular organization; and Assessment. The 2021 National Curriculum Guidelines is more detailed and complete than the 2002 and strengthens mechanisms for improving and adapting dentistry courses in Brazil.

Conclusion: progress has been made with the inclusion of aspects such as permanent training for teachers, humanization in relationships, interprofessional and entrepreneurship, with the aim of providing training that meets the health needs of the Brazilian population.

Mortality from cerebral stroke in the State of Pernambuco, Brazil: an ecological study

Thu, 11 Apr 2024 00:00:00 -0300

Introduction: cerebrovascular accident (CVA) is the second leading cause of death globally, characterized by cerebrovascular events due to dysfunctions in the cerebral blood supply. It can be ischemic or hemorrhagic and has high morbidity and mortality rates. In Brazil, it is the main cause of death, disabling many over 50 years of age and leading to around 40% of early retirements. Despite advances in initial treatment, mortality rates remain high, indicating flaws in prevention and treatment strategies. Therefore, the World Health Organization (WHO) emphasizes the need for immediate implementation of preventive and treatment measures for this condition.

Objective: to evaluate the trend in the mortality coefficient and proportional mortality from stroke in the population of Pernambuco, from 2000 to 2021.

Methods: This is an ecological time series study with data from the population of the state of Pernambuco, located in northeast region of Brazil, from 2000 to 2021. The eligibility criteria were deaths with a stroke occurring in the state of Pernambuco. Information on mortality, population estimates and number of deaths by sex and age group were extracted from the database of the Department of Informatics of the Unified Health System (DATASUS). For statistical analysis, it was calculated the mortality coefficient, proportional mortality, mean, standard deviation, skewness and kurtosis. The temporal trend of stroke was assessed by jointpoint regression.

Results: Between 2000 and 2021, there were 39,410 deaths from stroke. Around 49.0% were male and 51.0% female. The female sex had an average of 913.45 in the number of deaths, being quantitatively higher than the average identified for the male sex of 877.04 deaths. The years with the highest number of deaths were 2006, 2007 and 2008, while 2018 had the lowest number. There was a progressive increase in the number of deaths from stroke from 2018 to 2021. There was a decline in the average annual percentage variation in the mortality rate for stroke in all groups studied, in addition to a drop in the average annual percentage of proportional mortality for stroke in the entire population. Throughout the period, there was a decline in the average annual percentage of proportional mortality from stroke in the entire population studied.

Conclusion: In the period from 2000 to 2021 there was a greater number of deaths due to stroke in women in contrast to men in the population of Pernambuco, Brazil. Furthermore, there was a downward trend in stroke rates in both the mortality rate and proportional mortality. In the period from 2018 to 2021 there was a progressive increase in the mortality rate and proportional mortality from stroke.

Mortality from Stroke in Pará, Brazilian Amazon: a Joinpoint Analysis

Thu, 11 Apr 2024 00:00:00 -0300

Introduction: Stroke is a significant cause of death worldwide. Temporal studies show a downward trend in mortality rates in recent decades, with variability between countries. The State of Pará, in northern Brazil, has a low human development index and high mortality from stroke; however, little research is reported.

Objective: This study aims to analyze the trend in stroke mortality in the adult population of Pará, between 2000 and 2021.

Method: This is an ecological, time series study based on official secondary population data. Joinpoint regression models were used to identify the trend of each coefficient segment of the mortality rate and years of potential life lost.

Results: There were 49,259 deaths in this period, with an absolute increase in fatalities during the time series and an increase in the age group. The mortality coefficient showed a stationary mortality trend of 0.4% between 2000 and 2021 (p=0.576); however, after 2008, the trend decreased -1.0% (p=0.003). In the stratified analysis, a decreasing mortality trend was detected: -2.3% between 30 and 39 years old (p<0.001), -2.8% between 40 and 49 years old (p<0.001), -2.1% between 50 and 59 years old (p<0.001) and -1.4% between 60 and 69 years old (p<0.001), between the year 2000 and 2021. In the other age groups, the trend decreased -2.5% between 20 and 29 years old after 2006 (p= 0.003), -1.8% between 70 and 79 years old after 2008 (p=0.001), and -5.1% among 80 years old and over after 2016 (p=0.010).

Conclusion: The mortality trend attributed to stroke among adults in Pará State remained stable from 2000 to 2021. Despite this stability, the absolute number of deaths remained consistently high, underscoring the critical need to mitigate risk factors and enhance the care and management of affected individuals.

Urinary markers of pain in children in neonatal intensive care units: a cross-section study

Thu, 11 Apr 2024 00:00:00 -0300

Introduction: Repetitive exposition to pain negatively affects newborns development. Procedural pain in newborn in Neonatal Intensive Care Unit (NICU) triggers a series of physiological, behavioral and hormonal disorders that may set off the impairment of the neurological development in preterm infants, who undergo long periods of hospitalization at a moment of physiological immaturity and fast brain development.

Objective: This study aimed not only to observe the pain score in newborns and infants when undergoing painful procedures in neonatal intensive care units but also to analyse urinary IL-8 and cortisol levels at such stressful moments.

Methods: Patients were submitted to venipuncture and to other methods of blood collection. Cortisol and IL-8 levels were measured by immunometric assay and chemiluminescence detection. For the collection of data regarding observation of neonatal pain, the Neonatal Infant Pain Scale was used with immediate results. To describe the qualitative variables, absolute and relative frequencies were used. For the quantitative variables with normal distribution, mean, standard deviation, minimum and maximum were used.

Results: A total of 81 patients were included: 47 were submitted to venipuncture and 36 to other methods of blood collection. Significance for cortisol can be seen (p=0.04); however, IL-8 levels, when associated with the pain scale, were not sensitive enough (p=0.11).

Conclusion: The results showed that cortisol is a better marker for pain than IL-8, and its accumulation in urine may help the detection and interpretation of pain. Conclusion: Based on this information, nurses can step in to reduce the discomfort brought by painful procedures, and thus highlight humanistic practices in nursing assistance.

Evaluation of whole blood profile as a tool in COVID-19 diagnosis and screening. A cross-sectional study

Thu, 11 Apr 2024 00:00:00 -0300

Backgroung: the COVID-19 epidemic began in December 2019, and the shortage of diagnostic resources has affected the reported data on the number of cases, resulting in variations in reported cases between countries. This situation underscores the necessity for a deeper understanding of SARS-CoV-2 pathophysiology, including blood profiles and potential predictors.

Methods: hematological variables were studied in 200 patients diagnosed with COVID-19, before the vaccination period started. We analyzed hemogram parameters: erythrocytes, hemoglobin, mean corpuscular hemoglobin (MCH), mean corpuscular volume (MCV) mean corpuscular hemoglobin concentration (MCHC), hematocrit, red cell distribution width (RDW), platelets, mean platelet volume (MPV), leukocytes, neutrophils, lymphocytes, neutrophils/lymphocytes ratio and Platelet-to-Lymphocyte Ratio (PLR), up to 9 days after positive result for COVID-19.

Results: the positive COVID-19 group presented a higher mean age, as well as a higher frequency of male individuals. Erythrocyte, hemoglobin, hematocrit and MCH values were significantly lower, while RDW and PLR showed higher values in the positive group. Leukocytes, neutrophil and the neutrophil/lymphocyte ratio presented higher values in the positive COVID-19 group.

Conclusion: data showed that the hemogram, a low-cost, minimally invasive exam, supports diagnosis and screening of COVID-19, allowing better evaluation of the disease course and assisting medical decisions facing lack of resources in a pandemic situation.

The influence of chemotherapy on nutritional status and oncological fatigue in cancer patients: Cross-sectional study

Thu, 11 Apr 2024 00:00:00 -0300

Introduction: chemotherapy can contribute to the impairment of nutritional status and increased fatigue.

Objective: the aim of this study is evaluate the influence of chemotherapy on nutritional status and oncological fatigue.

Methods: this is a study with patients undergoing chemotherapy. Data collection was performed in the first chemotherapy session, in the middle and in the last session.

Results: the final sample comprised 20 patients. There was an increase in the level of fatigue (p<0.05), and a difference between the percentage of weight loss (p<0.05). A direct relationship was found between fatigue and nutritional status (R= 0.484; p= 0.031).

Conclusion: fatigue increase during chemotherapy and nutritional status worsens throughout the sessions, with a direct relationship between fatigue and nutritional status.

Epidemiological evolution of COVID-19: a three-year perspective on coping with the pandemic in the States of Rio Grande do Sul and Paraná, Southern Region of Brazil

Thu, 11 Apr 2024 00:00:00 -0300

Introduction: The novel Coronavirus disease (COVID-19) is caused by SARS-CoV-2 and represents the agent responsible for a respiratory and metabolic disease with a high fatality rate, remaining a public health problem to this day. There has been an exacerbation of social inequalities experienced in Brazil and worldwide. Notably, the absence of a consolidated and universal healthcare system has contributed to the increased inequalities and survival opportunities for those affected by SARS-CoV-2 infection and manifestation of COVID-19. The southern region has become the second region with the highest number of cases in Brazil.

Objective: To avaluate the epidemiological outcomes of incidence, lethality, and mortality among the states of Rio Grande do Sul and Paraná in the southern region of Brazil.

Methods: An ecological time-series study was conducted using official secondary data on COVID-19 cases and deaths publicly disclosed by the health departments of the states of Rio Grande do Sul and Paraná. Time series were constructed applying the Prais-Winsten regression model. Statistical analyses were performed using STATA 14.0 software.

Results: It was observed that for the state of Rio Grande do Sul, the trends regarding incidence were increasing in 2020 and decreasing in 2021 (p<0.05). Regarding mortality, it increased in 2020 and decreased in 2021 and 2022 (p<0.05). When assessing lethality, a decreasing trend was observed for the entire period (p<0.05). In relation to Paraná, incidence increased in 2020 and over the entire period, while it decreased in 2021 and 2022 (p<0.05). Mortality was stationary in 2020 and decreased in 2021 and 2022 (p<0.05).

Conclusion: The COVID-19 pandemic is a serious public health problem in the states of Paraná and Rio Grande do Sul. Paraná presented a more severe epidemiological outcome compared to Rio Grande do Sul.

Space-temporal analysis of the incidence, mortality and case fatality of COVID-19 in the State of Rio Grande do Norte, in the period from 2020 to 2022, in the Northeast of Brazil

Thu, 11 Apr 2024 00:00:00 -0300

Introduction: the COVID-19 pandemic, caused by the SARS-CoV-2 coronavirus, has had a great impact on the state of Rio Grande do Norte, as well as around the world, constituting a relevant challenge for public health. Since its emergence, the disease has spread widely, causing a significant number of confirmed cases and deaths in the state.

Objective: to analyze the trend of incidence, mortality and case fatality of COVID-19 in the state of Rio Grande do Norte, located in the Northeast region of Brazil, between 2020 and 2022.

Methods: consists of an ecological analysis of time series of retrospective secondary data in population level. Incidence and mortality rates per 100,000 inhabitants were estimated, as well as case fatality and daily percentage variation, both expressed in percentages. The daily percentage variation was calculated using the generalized linear regression technique using the Prais-Winsten method, and served to classify the trend as increasing, decreasing or stationary, considering a significance level of 95%.

Results: data analysis showed the registration of 582,618 cases and 8,689 deaths from COVID-19 in the state of Rio Grande do Norte, during the period from March 2020 to December 2022. There was an initial increase in the incidence rate in 2020, followed by a significant reduction in 2021 and 2022. Mortality showed a decreasing trend in 2021 and a stationary trend in 2022, without notable variation in 2020. The case fatality rate decreased in 2020, but did not show significant trends in the following years.

Conclusion: the epidemiological analysis of COVID-19 in the state of Rio Grande do Norte revealed variations in incidence, mortality and case fatality over the study period. The daily percentage change over the total period of the incidence time series was stationary, while mortality and case fatality were decreasing.

Systemic arterial hypertension and metabolic profile: a systematic review

Thu, 11 Apr 2024 00:00:00 -0300

Introduction: Systemic arterial hypertension (SAH) is a significant cause of morbidity and mortality worldwide. Despite the difficulty in diagnosing SAH in the early stages, the rapid detection and management of SAH are essential in preventing the development of target organ injuries. Newer technologies such as metabolomics have been revealed as promising alternatives for SAH diagnoses.

Objectives: The purpose of this study is to evaluate, through a systematic review, the metabolomic profile of individuals with and without SAH.

Methods: This review followed the PRISMA guidelines on reporting items. It analyses articles selected from the EMBASE and MEDLINE databases that compares metabolites in a hypertensive group with a non-hypertensive group.

Results: The differences that reached statistical significance were a higher prevalence of lipids and lactic acid in the hypertensive group, as well as a reduction in methionine.

Conclusion: Future research should be conducted to establish a possible clinical implication to this metabolite alteration, by linking it to a potential target organ injury for SAH, such as atherosclerosis, renal failure, retinopathy our ventricular hypertrophy.

What do we know about the perpetrators of sexual homicide of adult victims? A systematic review and qualitative meta-synthesis

Thu, 11 Apr 2024 00:00:00 -0300

Introduction: sexual homicide is defined as lethal violence associated with sexual elements or motivations, predominantly perpetrated by men against women. Despite being a less frequent crime, there is a growing clinical and forensic interest in its specificities and the characteristics of the aggressor.

Objective: to review the scientific literature on men who commit sexual homicide against adult victims.

Methods: systematic review with MeSH ((“Sex Offenses”[Mesh]) AND “Homicide”[Mesh]) in the databases of MEDLINE, LILACS, MENDELEY and SciELO, between 1992 and 2023. The PICO strategy was used with the studied population (male sexual offenders), intervention (homicide of adult victims), context (sexual violence), and outcome (potential relationship between the issues). The stages of article selection and analysis involved two independent researchers. Original studies were included, excluding reviews, editorials, conference proceedings, books and chapters, theses, and dissertations. The selected articles were presented through qualitative meta-synthesis.

Results: of the 70 selected articles, 66 articles (94.2%) adopted quantitative methods, 2 (2.9%) qualitative design, and 2 (2.9%) case reports. We found 41 articles (58.6%) conducted in North America and 22 articles (31.4%) in Europe, totaling 63 articles (90.0%). Another five articles (7.1%) were from Asia, one (1.4%) from Africa, and one (1.4%) from Oceania. In 52 articles (74.3%), there was an emphasis on aspects related to psychiatric, behavioral, or psychological disorders of the perpetrator, sexual sadism, or forms of sexual violence or lethal outcomes employed.

Conclusion: sexual homicidal men possess characteristics that set them apart from other homicidal offenders or those who commit sexual violence, directing their crimes towards a heterogeneous group of adult victims. Studies have focused on the psychiatric and behavioral disorders of the perpetrator, as well as the relationship with traumatic experiences in childhood.

Birth Body Mass Index (Bmi) of Late Preterm and Early-Term Newborns

Thu, 11 Apr 2024 00:00:00 -0300

Introduction: the nutritional status and the growth achieved by the newborn until birth have been used as a marker/indicator of early risks of morbidity and mortality. Even though BMI is a good marker of adiposity and is commonly used in older children and adults, there are still gaps in knowledge and there are few studies on the behavior of BMI according to gestational age.

Objective: to analyze the Body Mass Index (BMI) at the birth of late preterm newborns (34th to 36th week of gestational age) and early-term newborns (37th to 38th week of gestational age) and according to gestational age.

Methods: this is a descriptive, analytical, and quantitative study with 2,486 newborns, developed from the project’s database “Biometric characteristics at birth, of young adult women’s babies, in a municipality with a high human development index.” After collection, data consistency was verified. The analysis evaluated measures of central tendency and dispersion of values, in addition to correlations and regressions of their evolution according to gestational age.

Results: BMI scores Z distribution wasn’t different between male and female late preterm newborns as in early-term newborns. The same was observed concerning gestational ages. In terms of absolute BMI values, it was observed that late preterm newborns had a lower BMI (12.6 kg/m2) than early-term newborns (13.6 kg/m2). However, considering their gestational age, late preterm newborns were proportionally bigger than early-term newborns. A proportionally higher rate of BMI growth was observed in late preterm newborns, with a tendency to slow down in early-term newborns. As for weight gain, from the 37th week of gestational age, it tends to decrease compared to the reference values.

Conclusion: Regarding the BMI reference values, early-term and late-preterm newborns are equivalent. Late-preterm newborns have the same BMI Z-scores as reference values as early-term newborns.

Body mass index assessment of preschool children during the COVID-19 pandemic

Thu, 11 Apr 2024 00:00:00 -0300

Introduction: the COVID-19 pandemic has brought socioeconomic, behavioral and clinical losses that can compromise the nutritional status of children, and studies on the subject are essential.

Objective: to assess the Body Mass Index of preschool children during the COVID-19 pandemic.

Methods: the data in this study comes from a cohort of children created to prospectively investigate determinants of growth and development in the period from birth to 1,000 days of life in a municipality in the interior of Paraíba, Brazil. For this study, data were collected from children at 4 years of age examining repercussions of the COVID-19 pandemic on maternal and child life. Data on the children (biological characteristics, health conditions, food consumption, screen time, behaviors during the COVID-19 pandemic, satisfaction with school and home life) and their mothers (overweight/obesity, sociodemographic characteristics, childcare, attitudes and practices related to the COVID-19 pandemic) were included, and the Body Mass Index-for-age average (Z-score) was compared using hierarchical multiple linear regression.

Results: not breastfeeding in the first hour of life (p = 0.046) and regular consumption of filled cookies, sweets or candies (p = 0.042) were the characteristics of the children that represented the highest means of the outcome. Children whose mothers were diagnosed as overweight/obese (p = 0.034), who had not completed high school (p = 0.042), who had difficulty caring for the child and guiding them in health aspects (p = 0.010), as well as those whose mothers needed psychological care (p = 0.047) and mental health medication (p = 0.036) during the COVID-19 pandemic, also had higher mean scores.

Conclusion: maternal mental health (psychological care and use of medication) during the COVID-19 pandemic had an impact on the child’s nutritional status.