Objective: To determine the impact of transferring a pediatric population to mechanical ventilator dependency units (MVDUs) or to home mechanical ventilation (HMV) on bed availability in the pediatric intensive care unit (ICU).Methods: This is a longitudinal, retrospective study of hospitalized children who required prolonged mechanical ventilation at the MVDU located at the Hospital Auxiliar de Suzano, a secondary public hospital in São Paulo, Brazil. We calculated the number of days patients spent at MVDU and on HMV, and analyzed their survival rates with KaplanMeier estimator.Results: Forty-one patients were admitted to the MVDU in 7.3 years. Median length of stay in this unit was 239 days (interquartile range = 102-479). Of these patients, 22 came from the ICU, where their transfer made available 8,643 bed-days (a mean of 14 new patients per month). HMV of eight patients made 4,022 bed-days available in the hospital in 4 years (a mean of 12 new patients per month in the ICU). Survival rates of patients at home were not significantly different from those observed in hospitalized patients. Conclusion:A hospital unit for mechanical ventilator-dependent patients and HMV can improve bed availability in ICUs. Survival rates of patients who receive HMV are not significantly different from those of patients who remain hospitalized. J Pediatr (Rio J). 2011;87(2):138-144:Height, malnutrition, overweight, adolescent, poverty. ResumoObjetivos: Testar se os indivíduos com escores z de estatura para idade entre -2 e -1 apresentam maior porcentagem de gordura corporal e, portanto, não devem ser classificados como tendo estado nutricional normal. Métodos: Foram estudados 96 indivíduos (52 meninos e 44 meninas, 57% púberes). A composição corporal foi analisada por absortometria radiológica de dupla energia.Resultados: O percentual de gordura abdominal em meninas pré-púberes com baixa estatura foi maior (27,4%; p = 0,01) quando comparado ao grupo com estatura normal (20,6%). Diferenças semelhantes na gordura abdominal (%) foram observadas para as meninas e meninos púberes com baixa estatura e estatura normal (37,6 e 29,8%, p = 0,01; 24,6 e 15,7%, p = 0,01, respectivamente). Os percentuais de gordura corporal total das meninas pré-púberes e dos meninos púberes com baixa estatura foram superiores (29,9 e 24,5%, p = 0,03; 26,3 e 18,1%, p= 0,01, respectivamente) aos dos grupo com estatura normal. Os grupos com estatura normal apresentaram menor circunferência da cintura. Conclusão:Adolescentes com baixa estatura leve apresentam alterações na composição corporal, indicando aumento do risco para doenças metabólicas.J Pediatr (Rio J). 2011;87(2):138-144: Estatura, desnutrição, sobrepeso, adolescentes, pobreza.

Purpose. To evaluate glucose and insulin profiles in adolescents with mild stunting and overweight in order to assess the possibility of increased predisposition to diabetes. Subjects and Methods. The study population consisted of 66 pubertal adolescents classified as mildly stunted (height-for-age z scores ≥−2 and <−1) or of normal stature, as well as overweight (body mass index ≥85th percentile) or normal weight. Beta-cell function and insulin resistance were evaluated according to the homeostasis model assessment (HOMA). Results. In the group with mild stunting, glucose, insulin, and HOMA-IR levels were significantly higher in overweight adolescents compared with those of normal weight, whereas HOMA-B levels were significantly lower. Adolescents with mild stunting showed significantly higher accumulations of body and abdominal fat than their normal stature counterparts. Conclusions. The presence of mild stunting was associated with higher levels of glucose and insulin, diminished function of beta cells, and increased insulin resistance. These results reinforce the need for intervention in adolescents with mild stunting.

Objective: To build a life table and determine the factors related to the time of treatment of undernourished children at a nutrition rehabilitation centre (CREN), São Paulo, Brazil. Design: Nutritional status was assessed from weight-for-age, height-for-age and BMI-for-age Z-scores, while neuropsychomotor development was classified according to the milestones of childhood development. Life tables, Kaplan-Meier survival curves and Cox multiple regression models were employed in data analysis. Setting: CREN (Centre of Nutritional Recovery and Education), São Paulo, Brazil. Subjects: Undernourished children (n 228) from the southern slums of São Paulo who had received treatment at CREN under a day-hospital regime between the years 1994 and 2009. Results: The Kaplan-Meier curves of survival analysis showed statistically significant differences in the periods of treatment at CREN between children presenting different degrees of neuropsychomotor development (log-rank 5 6?621; P 5 0?037). Estimates based on the multivariate Cox model revealed that children aged $24 months at the time of admission exhibited a lower probability of nutritional rehabilitation (hazard ratio (HR) 5 0?49; P 5 0?046) at the end of the period compared with infants aged up 12 months. Children presenting slow development were better rehabilitated in comparison with those exhibiting adequate evolution (HR 5 4?48; P 5 0?023). No significant effects of sex, degree of undernutrition or birth weight on the probability of nutritional rehabilitation were found. Conclusions: Age and neuropsychomotor developmental status at the time of admission to CREN are critical factors in determining the duration of treatment.Undernutrition is characterised by a complex combination of factors including inadequate or insufficient ingestion of food, deficient intake of essential nutrients, unsatisfactory socio-economic conditions, unhealthy living environment, high frequency of infection and poor health care (1,2) . Evidently, the longer the exposure to such harmful factors the more damaging the consequences to the nutritional status of the individual. The height-for-age indicator reflects linear growth, and is related to long-term changes in nutritional status and overall health (3) . A deficit in this index is associated with cumulative growth retardation indicating chronic undernutrition. The problem of undernutrition is of global concern since, according to the latest FAO estimates, 925 million people ingest insufficient food to meet their minimum energy requirements, of whom 53 million live in Latin America and the Caribbean (4) . In developing countries, approximately 112 million children aged 5 years or less are affected by weight-for-age deficit and 32 % of children in this age group worldwide have been diagnosed with height-for-age deficit (2) . Indeed, height-for-age deficit is currently considered the most important nutritional problem faced by developing countries.In Brazil, 6 % of children aged less than 5 years suffer from height-for-age deficit,...

BackgroundExcess of weight is a serious public health concern in almost all countries, afflicting people of different ages and socioeconomic backgrounds. Studies have indicated the need for developing treatment strategies that intervene directly in the obesogenic environment. This study aims to evaluate the effectiveness of a multi-component and environmental school-based intervention, lasting 16 months, on the recovery of the nutritional status of low-income children and adolescents with overweight/ obesity.Methods/study designThe study was conducted by the Center for Recovery and Nutritional Education (CREN) in São Paulo, Brazil. Two schools located in poor neighborhoods were selected for the intervention, between March 2016 and June 2017. The participants were all students aged 8 to 12 years from the two participating schools. At the beginning of the intervention, anthropometric measurements were carried out to assess the nutritional status of the students. For convenience, students from one of the schools were considered as the control group, while those from the other school formed the experimental group. The intervention in the experimental group (n = 438) consists of the following weekly activities at school: psychological counseling in groups, theoretical/practical nutrition workshops, and supervised physical education classes. In addition, theoretical and practical educational activities are held regularly for parents, teachers, and cooks. Students with excess of weight (≥1 body mass index [BMI] –for-age Z score, n = 138) received clinical and nutritional care periodically at the outpatient care at CREN. Students enrolled in the control group (n = 353) participated in psychological counseling groups and theoretical/practical nutrition workshops for 6 months held in the school environment to provide motivation to entire classrooms. In the following 10 months, students with excess of weight from the control group (n = 125) were invited to attend the routine outpatient care at CREN.DiscussionThis study is the first to assess the effectiveness of a multi-component and environmental school-based intervention for the recovery of low-income, overweight/obese children and adolescents. If positive, the results demonstrate the feasibility for the recovery of excess of weight in populations of similar conditions and age.Trial registrationBrazilian Registry of Clinical Trials - ReBEC Primary Id Number RBR-9t2jr8. Registration Date: Nov. 30, 2016. Retrospectively registered. Protocol version: 3.

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