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Objective To evaluate the performance of the Systematic Review Support web-based system for the identification of duplicate records compared with similar software tools. Methods A methodological study was conducted assessing the automated process of de-duplication performed by the Systematic Review Support web-based system (version 1.0) versus the EndNote X9® and Rayyan® systems, adopting hand-checking as the benchmark reference for comparisons. A set of studies on three topics related to cystic fibrosis retrieved from the Pubmed, Embase and Web of Science electronic databases was used for testing purposes. The sensitivity, specificity, accuracy and area under the ROC curve of the software systems were compared to the benchmark values for performance evaluation. Results The database searches retrieved 1332 studies, of which 273 (20.5%) were true duplicates. The Systematic Review Support tool identified a larger proportion of true duplicates than the other systems tested. The sensitivity, specificity and accuracy of the Systematic Review Support tool exceeded 98%. Conclusion and implications for practice The Systematic Review Support system provided a high level of sensitivity, specificity and accuracy in identifying duplicate studies, optimizing time and effort by reviewers in the health field.

RESUMO Objetivo: Descrever as principais funcionalidades do sistema “Apoio à Revisão Sistemática” na identificação e exclusão de artigos duplicados e no auxílio na análise de elegibilidade durante a condução de estudo de revisão sistemática. Métodos: O sistema foi desenvolvido com base em um modelo de processo incremental, utilizando-se metodologia Ágil. É de código fechado e foi publicado em plataforma proprietária. O ambiente de produção onde o sistema foi implantado possui arquitetura que permite que a infraestrutura utilizada aumente ou diminua conforme a demanda. As funcionalidades foram apresentadas com inserção de imagens das interfaces da versão para computadores, simulando uma revisão sistemática. Resultados: Após a importação dos resumos recuperados nas bases de dados PubMed, Embase e Web of Science, o sistema permite a identificação e eliminação de duplicatas para posterior leitura e análise de título e resumo, etapa que pode ser realizada por mais de um revisor de maneira independente. Após a quebra do cegamento entre os revisores, as respostas sobre a elegibilidade dos estudos podem ser comparadas automaticamente para facilitar a resolução de divergências pelos pesquisadores. É possível filtrar os resultados e gerar um arquivo PDF com os estudos elegíveis. Conclusão: A versão 1.0 do sistema “Apoio à Revisão Sistemática” encontra-se disponível na web (sysrev.azurewebsites.net) para auxiliar pesquisadores nas etapas iniciais de um estudo de revisão sistemática.

RESUMO Objetivo: Avaliar o perfil nutricional da população atendida em centro de referência em fibrose cística. Métodos: Estudo transversal incluindo pacientes com fibrose cística de um centro pediátrico de referência de São Paulo, em 2014. Todos os sujeitos que concordaram em participar do estudo foram incluídos. Foi aplicado um questionário sobre hábitos alimentares (recordatório de 24 horas) e características socioeconômicas. Dados antropométricos (comparados com referencial da Organização Mundial da Saúde de 2006 e 2007) e função pulmonar foram coletados do prontuário. Os integrantes da pesquisa foram estratificados em faixas etárias para análise estatística. Resultados: Dos 101 pacientes incluídos no estudo, 59,4% eram masculinos, sendo a maioria caucasiana (86,4%), com mediana de idade de 10 anos. A maioria dos pacientes (n=77, 75%) foi classificada como eutrófica, mas valores menores de escore Z de índice de massa corpórea (IMC) foram observados em escolares e adolescentes. A proporção de pacientes com peso abaixo do esperado foi de 10% (n=2) na faixa etária pré-escolar e de 35% (n=6) em escolares. O consumo alimentar mostrou-se adequado, e somente dois suplementos (triglicérides de cadeia média e suplemento em pó completo) tiveram utilização ligada à adequação da ingesta de macronutrientes. Características socioeconômicas não apresentaram associação com o estado nutricional ou com o consumo nutricional. Valores de função pulmonar não apontaram diferença significante em adolescentes nem em indivíduos com pior estado nutricional no grupo estudado. Conclusões: A maioria dos pacientes apresentou estado nutricional e consumo alimentar adequados, indicando bom manejo das ações nutricionais. Novos estudos com foco em pré-escolares devem ser realizados para avaliar se é possível reduzir o risco nutricional de pacientes com fibrose cística em idades posteriores. ABSTRACT Objective: To evaluate the nutritional profile of the population assisted at a reference center for cystic fibrosis treatment. Methods: Cross-sectional study including patients with cystic fibrosis assisted at a pediatric reference center in São Paulo, Brazil, in 2014. All patients attending regular visits who agreed to participate in the study were included. A questionnaire on dietary habits (24-hour diet recall) and socioeconomic characteristics was applied. Anthropometric data (compared with the reference from the World Health Organization, 2006 and 2007) and pulmonary function data were collected from medical records. Patients were stratified into age groups for statistical analysis. Results: A total of 101 patients were included in the study (59.4% male, 86.4% Caucasian), with median age of 10 years old. Most patients (n=77; 75%) were classified as eutrophic, but lower values of body mass index (BMI) Z scores were observed in schoolchildren and adolescents. The proportion of underweight patients was 10% (n=2) among preschoolers and 35% (n=6) of the school age group. Dietary intake was adequate, and the use of only two supplements (medium chain triglycerides and complete powdered supplement) was associated with adequacy of macronutrient intake. The socioeconomic characteristics did not show any statistical association with the nutritional state or nutritional consumption. Lung function was not significantly different between neither adolescents nor individuals with worse nutritional status in this sample. Conclusions: Most of the patients presented adequate nutritional status and adequate consumption of calories and macronutrients, indicating appropriate nutritional management. New studies focusing on preschool children should be performed to assess if it is possible to reduce the nutritional risk of patients with cystic fibrosis at older ages.

BackgroundGestational diabetes mellitus (GDM) is a common complication of pregnancy. It may predispose offspring to increased fat mass (FM) and the development of obesity, however few data from Latin America exist.ObjectiveTo investigate the influence of GDM on newborn FM in mother-newborn pairs recruited from a public maternity care center in São Paulo, Brazil.MethodsData were collected cross-sectionally in 2013-2014 from 72 mothers diagnosed with GDM, and 211 mothers with normal glucose tolerance (NGT). Newborn FM was evaluated by air-displacement plethysmography (PEA POD), and relevant demographic and obstetric data were collected from hospital records. Associations between maternal GDM status and newborn FM were investigated by multiple linear regression analysis, with adjustment for maternal age, pre-pregnancy BMI, gestational weight gain, type of delivery, sex of the child, and gestational age.ResultsFM was greater in GDM versus NGT newborns in a bivariable model (Median (IQR), GDM: 0.35 (0.3) kg vs. NGT: 0.27 (0.2) kg, p = 0.02), however GDM status was not a significant predictor of FM with adjustment for other variables. Rather, pre-pregnancy BMI (coefficient (β) 1.46; 95% confidence interval (CI) 0.66, 2.27), gestational weight gain (β 1.32; 95% CI 0.49, 2.15), and male sex (β -17.8; 95% CI -27.2, -8.29) predicted newborn FM. Analyzing GDM and NGT groups separately, pre-pregnancy BMI (β 6.75; 95% CI 2.36, 11.1) and gestational weight gain (β 5.64; 95% CI 1.16, 10.1) predicted FM in the GDM group, while male sex alone predicted FM in the NGT group (β -12.3; 95% CI -18.3, -6.34).ConclusionsCombined model results suggest that in our cohort, pre-pregnancy BMI and gestational weight gain are more important risk factors for increased neonatal FM than GDM. However, group-specific model results suggest that GDM status may contribute to variation in the relationship between maternal/offspring factors and FM. Our use of a binary GDM variable in the combined model may have precluded clearer results on this point. Prospective cohort studies including data on maternal pre-pregnancy BMI, GWG, and glycemic profile are needed to better understand associations among these variables and their relative influence on offspring FM.

Rural settlements are social arrangements expanding in the Amazon region, which generate disturbances in the natural environment, thus affecting the ecology of the species of Anopheles and thus the malaria transmission. Larval habitats are important sources for maintenance of mosquito vector populations, and holding back a natural watercourse is a usual process in the establishment of rural settlements, since the formation of micro-dams represents a water resource for the new settlers. Identifying characteristics of the larval habitats that may be associated with both the presence and abundance of Anopheles vectors species in an environment under ecological transition is background for planning vector control strategies in rural areas in the Amazon. Anopheles larvae collections were performed in two major types of habitats: natural and flow-limited water collections that were constructed by holding back the original watercourse. A total of 3123 Anopheles spp. larvae were captured in three field-sampling collections. The majority of the larvae identified were taken from flow-limited water collections belonged to species of the Nyssorhynchus subgenus (92%), whereas in the natural larval habitats a fewer number of individuals belonged to the Stethomyia (5%) and Anopheles (3%) subgenera. The total of Nyssorhynchus identified (1818), 501 specimens belonged to An. darlingi, 750 to An. triannulatus and 567 for others remaining species. In addition, 1152 could not be identified to subgenus/species level, because they were either in the first-instar or damaged. The primary vector in areas of the Amazon river basin, An. darlingi, was found exclusively in man-made habitats. Statistical analysis display An. triannulatus with specialist behavior for characteristics of man-made habitats. Modifications in the natural environment facilitate the rise of larval habitats for species with epidemiological importance for malaria in the region. This study showed that man-made habitats flow-limited water collections from dry lands could be a factor associated with the increase of An. darlingi and An. triannulatus populations, and other Nyssorhynchus species as well in endemic areas of the Amazon Region. Fil: Rufalco-Moutinho, Paulo. Universidade de Sao Paulo; Brasil Fil: Schweigmann, Nicolas Joaquin. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Ecología, Genética y Evolución. Grupo de Estudio de Mosquitos; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Ecología, Genética y Evolución de Buenos Aires. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Ecología, Genética y Evolución de Buenos Aires; Argentina Fil: Bergamaschi, Denise Pimentel. Universidade de Sao Paulo; Brasil Fil: Mureb Sallum, Maria Anice. Universidade de Sao Paulo; Brasil

On the ecological scale of an organism, a homogeneous geographical landscape can represent a mosaic of heterogeneous landscapes. The bionomy of Kerteszia mosquitoes can contribute to foundation landscape ecology by virtue of in the role of the configuration and composition of the habitat played in the distribution of mosquito species. Thus, this study aimed: to compare the abundance of Kerteszia in dense tropical rainforest, restinga and rural area, to assess the bioecological characteristics of the main bromeliads hosting Kerteszia, and to associate the bioecological arrangement of the bromeliads with Kerteszia distribution. Field collections were conducted in a monthly schedule from December of 2010 to November 2011. The vegetation of landscapes was characterized on the basis of a digital cartographic database, the manual of the Brazilian vegetation, environmental atlas information, satellite images and visits to the sites. Multivariate generalized linear models were employed using the R-project statistical program. The results were: Anopheles cruzii was the most frequent species in dense tropical rainforest (67.42%), with a positive association (deviance=25.8; P=0.002). Anopheles bellator was more abundant in the Restinga area (78.97%), with a positive association (deviance=10.4, P=0.018). There was a positive aggregation of Restinga with An. bellator (RR=2.42) but a lower level with An. cruzii (RR=0.31). Thus we can conclude that landscape characteristics influence the distribution of Kerteszia mosquitoes. An. bellator has a higher prevalence in Restinga areas, whereas An. cruzii was the most prevalent in the dense tropical rainforest.

Objective To investigate methodological aspects in body fat (BF) measurements in 7-to-10-year-old children. Study design Systematic review of the literature. Methods The studies were chosen from the PubMed and Scielo databases according to a protocol that defined: inclusion criteria; a search and quality-assessment strategy; and information extraction. Results 27 studies published from 2004 to 2014 were included. The literature describes skinfold measurements and dual energy X-ray absorptiometry (DEXA) as being the reference methods most widely used in the assessment of the ability of methods to identify BF. The most commonly-used statistical analyses were the Pearson correlation coefficient, and sensitivity and specificity performance analyses. The comparison between the tested methods and the references showed that body mass index (BMI) and waist circumference (WC) are strongly correlated to BF as calculated by bioelectrical impedance or skinfolds, and that there is a moderate positive correlation with percent body fat as calculated by DEXA, air-displacement plethysmography (ADP) or isotope dilution. There was a moderate positive correlation between weight-to-height ratio (WtHR) and BF, as estimated by ADP and skinfolds. Performance studies suggest that BMI and WC are very specific but less sensitive methods. Conclusions The results of this systematic review show favourable evidence for the use of anthropometric indicators – above all BMI and WC– in the measurement of BF, when more accurate techniques such as DEXA and ADP are not feasible. They also demonstrate features that make them advantageous for epidemiological studies in a child population, since they are easy and safe to obtain and well tolerated by the children.

To evaluate the nutritional profile of the population assisted at a reference center for cystic fibrosis treatment.Cross-sectional study including patients with cystic fibrosis assisted at a pediatric reference center in São Paulo, Brazil, in 2014. All patients attending regular visits who agreed to participate in the study were included. A questionnaire on dietary habits (24-hour diet recall) and socioeconomic characteristics was applied. Anthropometric data (compared with the reference from the World Health Organization, 2006 and 2007) and pulmonary function data were collected from medical records. Patients were stratified into age groups for statistical analysis.A total of 101 patients were included in the study (59.4% male, 86.4% Caucasian), with median age of 10 years old. Most patients (n=77; 75%) were classified as eutrophic, but lower values of body mass index (BMI) Z scores were observed in schoolchildren and adolescents. The proportion of underweight patients was 10% (n=2) among preschoolers and 35% (n=6) of the school age group. Dietary intake was adequate, and the use of only two supplements (medium chain triglycerides and complete powdered supplement) was associated with adequacy of macronutrient intake. The socioeconomic characteristics did not show any statistical association with the nutritional state or nutritional consumption. Lung function was not significantly different between neither adolescents nor individuals with worse nutritional status in this sample.Most of the patients presented adequate nutritional status and adequate consumption of calories and macronutrients, indicating appropriate nutritional management. New studies focusing on preschool children should be performed to assess if it is possible to reduce the nutritional risk of patients with cystic fibrosis at older ages.Avaliar o perfil nutricional da população atendida em centro de referência em fibrose cística.Estudo transversal incluindo pacientes com fibrose cística de um centro pediátrico de referência de São Paulo, em 2014. Todos os sujeitos que concordaram em participar do estudo foram incluídos. Foi aplicado um questionário sobre hábitos alimentares (recordatório de 24 horas) e características socioeconômicas. Dados antropométricos (comparados com referencial da Organização Mundial da Saúde de 2006 e 2007) e função pulmonar foram coletados do prontuário. Os integrantes da pesquisa foram estratificados em faixas etárias para análise estatística.Dos 101 pacientes incluídos no estudo, 59,4% eram masculinos, sendo a maioria caucasiana (86,4%), com mediana de idade de 10 anos. A maioria dos pacientes (n=77, 75%) foi classificada como eutrófica, mas valores menores de escore Z de índice de massa corpórea (IMC) foram observados em escolares e adolescentes. A proporção de pacientes com peso abaixo do esperado foi de 10% (n=2) na faixa etária pré-escolar e de 35% (n=6) em escolares. O consumo alimentar mostrou-se adequado, e somente dois suplementos (triglicérides de cadeia média e suplemento em pó completo) tiveram utilização ligada à adequação da ingesta de macronutrientes. Características socioeconômicas não apresentaram associação com o estado nutricional ou com o consumo nutricional. Valores de função pulmonar não apontaram diferença significante em adolescentes nem em indivíduos com pior estado nutricional no grupo estudado.A maioria dos pacientes apresentou estado nutricional e consumo alimentar adequados, indicando bom manejo das ações nutricionais. Novos estudos com foco em pré-escolares devem ser realizados para avaliar se é possível reduzir o risco nutricional de pacientes com fibrose cística em idades posteriores.

The study evaluated the nutritional status of 629 people living with HIV/AIDS attended at 12 specialized services of São Paulo's Municipal Health Department, Brazil. Data were obtained from medical records and through interviews during nutritional consultation. We used the classification criteria established by World Health Organization to assess malnourished individuals, a BMI < 18.5kg/m2. The prevalence of malnutrition in people with AIDS is 3.12 times that observed among people with HIV, and among people with co-infection it is 3.41 times that obtained among people without co-infection. This indicates how these conditions can harm the maintenance of the nutritional status, and shows that they demand a comprehensive understanding of the mechanisms involved in this phenomenon, as well as the development of strategies to improve the health care of individuals at nutritional risk.

Introduction The aim of this study was to identify the blood feeding sources of Nyssomyia intermedia (Ny. intermedia) and Nyssomyia neivai (Ny. neivai), which are Leishmania vectors and the predominant sandfly species in the Ribeira Valley, State of São Paulo, Brazil, an endemic area for cutaneous leishmaniasis. Methods Specimens were captured monthly between February 2001 and December 2003 on a smallholding and a small farm situated in the Serra district in the Iporanga municipality. The blood meals of 988 engorged females were tested using the avidin-biotin immunoenzymatic enzyme-linked immunosorbent assay (ELISA). Seven blood meal sources were investigated: human, dog, chicken, bovine, pig, horse and rat. Results The results showed that among the females that fed on one or more blood sources, the respective percentages for Ny. intermedia and Ny. neivai, respectively, were as follows: human (23% and 36.8%), pig (47.4% and 26.4%), chicken (25.7% and 36.8%) and dog (3.9% and 0%), and the differences in the blood sources between the two species were statistically significant (p = 0.043). Conclusions Both species had predominant reactivity for one or two blood sources, and few showed reactivity indicating three or four sources. Many different combinations were observed among the females that showed reactivity for more than one source, which indicated their opportunistic habits and eclecticism regarding anthropic environmental conditions.

OBJETIVO: Avaliar a validade concorrente e a equivalência operacional do questionário "Lista de Atividades Físicas" em crianças.MÉTODOS: O estudo complementa o processo de adaptação transcultural do Physical Activity Checklist Interview. Participaram 118 escolares de sete a dez anos matriculados do segundo ao quinto ano do ensino fundamental de São Paulo, SP, em 2009. Foram quantificados o tempo de engajamento em atividades físicas moderadas a vigorosas e em atividades sedentárias, assim como custos metabólicos total e ponderado. Adotou-se o acelerômetro como medida de atividade física. Foram quantificados a atividade física total (counts/min) e o tempo em atividade física moderada a vigorosa. A validade foi avaliada pelo coeficiente de correlação de Pearson e a equivalência operacional por meio dos dados referentes à duração e avaliação da entrevista.RESULTADOS: Os valores do coeficiente de correlação entre os resultados provenientes do questionário e do acelerômetro variaram de 0,34 a 0,40. O questionário "Lista de Atividades Físicas" superestimou o tempo em atividade física moderada a vigorosa quando comparado ao acelerômetro. A duração média da entrevista foi de 24 minutos (mínima = 13 min; máxima = 41 min; desvio-padrão = 5 min). O item da entrevista com pior resultado foi a habilidade do escolar em estimar tempo (ruim ou regular em 24,8% das entrevistas).CONCLUSÕES: Em relação à versão original, o questionário "Lista de Atividades Físicas" apresenta valores similares de indicadores de validade concorrente e de equivalência operacional, confirmando a adequação do processo de adaptação transcultural. OBJETIVO: Objetivo: evaluar la validez concomitante y la equivalencia operativa del cuestionario "Lista de Actividades Físicas" en niñosMÉTODOS: El estudio complementa el proceso de adaptación transcultural del Physical Activiy Checklist Interview. Participaron 118 escolares de siete a diez años matriculados del 2º al 5º año de educación básica de Sao Paulo, SP (Brasil), en 2009. Se cuantificó el tiempo de compromiso en actividades físicas moderadas a vigorosas y en actividades sedentarias, así como los costos metabólicos total y ponderado. Se adoptó el acelerómetro como medida de actividad física. Se cuantificaron la actividad física total (counts/min) y el tiempo en actividad física moderada a vigorosa. La validez fue evaluada por el coeficiente de correlación de Pearson y la equivalencia operativa por medio de datos relacionados con la duración y evaluación de la entrevista.RESULTADOS: Los valores del coeficiente de correlación entre los resultados provenientes del cuestionario y del acelerómetro variaron entre 0,34 y 0,40. El cuestionario "Lista de Actividades Físicas" sobreestimó el tiempo en la actividad física moderada a vigorosa al compararse con el acelerómetro. La duración promedio de la entrevista fue de 24 minutos (mínimo = 13 min; máximo = 41 min; desvío estándar = 5 min). El ítem de la entrevista con peor resultado fue la habilidad del escolar para estimar tiempo (malo o regular en 24,8% de las entrevistas).CONCLUSIONES: Con respecto a la versión original, el cuestionario "Lista de Actividades Físicas" presenta valores similares de indicadores de validez concomitante y de equivalencia operativa, confirmando la adecuación del proceso de adaptación transcultural. OBJECTIVE: To assess the validity and operational equivalence of the "Physical Activity Checklist" in children.METHODS: This study complements the cross-cultural adaptation of the Physical Activity Checklist Interview, conducted with 118 school children aged between seven and ten years old, enrolled from the second to the fifth grades of primary education in the city of Sao Paulo, SP, Southeastern Brazil, in 2009. The questionnaire enables the quantification of time spent in moderate and vigorous physical activities and sedentary activities and the total and weighted metabolic costs. The accelerometer was adopted as a criterion measure of physical activity. The variables total physical activity (counts/min) and time spent in moderate to vigorous physical activity were quantified. The concurrent validity was assessed by Pearson's correlation coefficient while the operational equivalence was assessed by data concerning the duration and evaluation of the interview.RESULTS: The values for the correlation coefficient between the results from the questionnaire and the accelerometer ranged from 0.34 to 0.40. It was found that LAF overestimates time spent doing moderate and vigorous physical activity when compared to the accelerometer. The average duration of the interviews was 24 minutes (minimum = 13 min, maximum = 41 min, sd = 5 min). The interview item showing the poorest result was the children's ability to estimate time (poor or fair in 24.8% of interviews).CONCLUSIONS: In relation to the original version, the questionnaire "Physical Activity Checklist" presents similar indices of concurrent validity and operational equivalence, confirming the appropriateness of the cross-cultural adaptation.

OBJETIVO:Descrever características antropométricas e da gestação de mulheres com HIV/AIDS, usuárias do Sistema Único de Saúde (SUS) e o peso de seus recém-nascidos. MÉTODOS: Participaram do estudo gestantes atendidas nos serviços de assistência à DST/AIDS da Secretaria Municipal de Saúde do município de São Paulo. A avaliação antropométrica foi realizada por nutricionistas treinadas e as demais informações foram obtidas em prontuários. Para a comparação entre os dados do estudo e os da população geral, foram utilizados dados secundários da mãe e da gestação oriundos das Declarações de Nascidos Vivos, disponíveis no Sistema de Informações sobre Nascidos Vivos. As variáveis contínuas foram resumidas por meio da média e desvio padrão ou pelos percentis 25, 50 e 75, valores mínimo e máximo. As demais variáveis são apresentadas em porcentagens. As médias foram comparadas por meio dos testes t Student ou Kruskall-Wallis, a depender do cumprimento das pressuposições, com decisão baseada no valor de p. RESULTADOS: Observaram-se presença de inadequação nutricional materna se considerada a prega cutânea do tríceps (60,9%), baixo peso (18,5%) e sobrepeso ou obesidade (40%), segundo o índice de massa corporal (IMC) gestacional; ausência de associação entre diagnóstico (HIV ou AIS) e peso, estatura, massa magra e gorda. Para filhos de mães com HIV/AIDS, observou-se peso médio ao nascer menor ao da população sem esta condição. CONCLUSÕES: Os resultados do presente estudo indicam a necessidade de desenvolvimento de curvas adaptadas que permitam a avaliação nutricional mais acurada deste grupo populacional. PURPOSE: To describe the anthropometric and pregnancy characteristics of women with HIV/AIDS, assisted by the Brazilian National Health System and the birth weight of their newborns. METHODS: The participants were women assisted at public STD/AIDS clinics of the Municipal Health system of São Paulo. The anthropometric characteristics were evaluated by trained nutritionists and other information was obtained from the medical records. For comparison of the survey data to those of the general population, secondary maternal and pregnancy data were obtained from live birth certificates through the Live Birth Information System. Continuous variables were summarized as mean and standard deviation or as the 25th, 50th and 75th percentiles and minimum and maximum values. The other variables are presented as percentages. Means were compared by the Student's t-test or Kruskal-Wallis test depending on the fulfillment of assumptions, with the decision based on the p value. RESULTS: We found the presence of inadequate maternal nutrition according to triceps skinfold (60.9%). The BMI/gestational age showed the presence of underweight (18.5%) and overweight or obesity (40%). There was no association between disease status (HIV or AIDS) and weight, height, and lean or fat mass. Mean newborn birth weight was lower than the value for the general population without infection or disease. The results of this study indicate the need to develop adapted curves to allow a more accurate nutritional assessment of this population group.

Resumo O estudo objetivou investigar a relação do índice de massa corpórea (IMC), do perímetro da cintura (PC) e da razão cintura/estatura (RCE) com a soma de dobras cutâneas em crianças de 7-10 anos de uma escola pública de São Paulo (SP). Foram tomadas as medidas estatura, peso, PC e dobras tricipital, bicipital, subescapular e suprailíaca, e calculados a soma de dobras cutâneas, o IMC e a RCE. Para a comparação de métodos utilizou-se a estratégia de Bland e Altman com valores transformados em z. Pela análise dos limites de concordância e seus respectivos intervalos de confiança, encontrou-se evidência de boa concordância, principalmente entre IMC e PC com a soma de dobras cutâneas, observando-se estreitos limites de concordância e diferenças menores que 1 desvio-padrão (dp). A RCE apresentou limites de concordância de amplitude moderada, de -1,02 a +0,64 dp (meninos) e -0,74 a +1,12 dp (meninas), e seu desempenho não foi melhor que o do PC isolado, cujos limites de concordância inferior e superior foram de -0,91 a +0,58 dp (meninos) e de -0,56 a +0,89 dp (meninas). Os resultados apoiam o uso de indicadores antropométricos para classificação do estado nutricional, especialmente IMC e PC, considerando que ambos são semelhantes ao classificar crianças segundo a gordura corporal e apresentam vantagens como facilidade de obtenção e baixo custo. Abstract This study aimed to investigate the relationship between anthropometric indicators - body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) - and the sum of skinfold thicknesses in 7-10-year-old children attending a public school in São Paulo (SP). Height, weight, WC and triceps, biceps, subscapular and suprailiac skinfolds were measured, and the sum of skinfold thicknesses, BMI and WHtR were calculated. A Bland-Altman analysis was used in order to compare methods, with values transformed into z-scores. The analysis of limits of agreement and confidence intervals showed evidence of good agreement, above all between BMI and WC, and the sum of skinfold thicknesses, complying with strict agreement limits and differences smaller than 1 standard deviation (SD). WHtR showed moderate limits of agreement, from -1.02 to + 0.64 SD (boys) and -0.74 to + 1.12 SD (girls); its performance was not better than that of WC alone, the lower and upper limits of agreement for which were -0.91 to + 0.58 SD (boys) and -0.56 to + 0.89 SD (girls). The results support the use of anthropometric indicators to classify nutritional status, above all BMI and WC, in that both are similar when classifying children according to body fatness, and confer the advantages of being easy to obtain and affordable.

El objetivo de este estudio fue evaluar el efecto de las acciones de educacion alimentaria y nutricional en el consumo de alimentos en el entorno escolar. Se trata de un estudio de intervencion comunitaria con escolares de 8 a 14 anos, de dos escuelas publicas de Cuiaba, Mato Grosso, Brasil, en 2010. El grupo de intervencion fue sometido a las acciones de educacion alimentaria y el grupo control no recibio ninguna accion educativa. Las variables resultantes, como por ejemplo “efecto positivo en el consumo de alimentos”, se definieron segun criterios basados en variables relacionadas al consumo de alimentos, a los alimentos preferidos y su frecuencia de consumo. Se observo efecto positivo de la intervencion en la preferencia por las frutas y ensaladas de frutas ofrecidas en la merienda escolar (p=0,048) y en el consumo de caramelos, chupetines y chicles comprados en la tienda escolar (p=0,043). Las acciones educativas alimentares y nutricionales parecen influir en la eleccion de alimentos saludables, especialmente cuando se realizan de forma continua y cotidiana en esta etapa de la vida en la cual se establecen los habitos alimentarios

OBJETIVO: Avaliar a confiabilidade do questionário Lista de Atividades Físicas em crianças. MÉTODOS: O estudo é parte da adaptação transcultural do questionário, realizado com 83 escolares de sete a dez anos, matriculados do segundo ao quinto ano do ensino fundamental da cidade de São Paulo, SP, em 2008. O questionário foi respondido pela criança por meio de entrevista individual, apresenta lista com 21 atividades físicas moderadas a vigorosas realizadas no dia anterior, é dividido em períodos (antes, durante e após a escola) e possui seção de avaliação da entrevista. O questionário permite quantificar: tempo em atividades físicas e sedentárias; e custos metabólicos total e ponderado. A confiabilidade foi avaliada comparando-se duas entrevistas realizadas com intervalo médio de três horas. Para a seção C (avaliação da entrevista), compararam-se dados da primeira entrevista e de um avaliador externo. Utilizaram-se a proposta de Bland & Altman e os coeficientes de correlação intraclasse e de correlação de concordância de Lin na avaliação da confiabilidade. RESULTADOS: Os limites inferiores dos coeficientes de correlação intraclasse para os desfechos analisados variaram de 0,84 a 0,96. A precisão e concordância variaram, respectivamente, de 0,83 a 0,97 e de 0,99 a 1. A reta estimada a partir de pares de valores obtidos nas duas aplicações para atividade física indica elevada precisão dos dados. O item da entrevista com pior resultado foi a habilidade em estimar tempo (regular em 27,7% das entrevistas). Os itens da seção C apresentaram coeficientes de correlação intraclasse entre 0,60 e 0,70, exceto o nível de cooperação (0,46). CONCLUSÕES: A Lista de Atividades Físicas apresenta alta confiabilidade para aferir atividade física e sedentária do dia anterior em crianças. OBJECTIVE: To assess the reliability of the Lista de Atividades Físicas (Brazilian version of the Physical Activity Checklist Interview) in children. METHODS: The study is part of a cross-cultural adaptation of the Physical Activity Checklist Interview, conducted with 83 school children aged between seven and ten years, enrolled between the 2nd and 5th grades of primary education in the city of São Paulo, Southeastern Brazil, in 2008. The questionnaire was responded by children through individual interviews. It is comprised of a list of 21 moderate to vigorous physical activities performed on the previous day, it is divided into periods (before, during and after school) and it has a section for interview assessment. This questionnaire enables the quantification of time spent in physical and sedentary activities and the total and weighed metabolic costs. Reliability was assessed by comparing two interviews conducted with a mean interval of three hours. For the interview assessment, data from the first interview and those from an external evaluator were compared. Bland-Altman's proposal, the intraclass correlation coefficient and Lin's concordance correlation coefficient were used to assess reliability. RESULTS: The intraclass correlation coefficient lower limits for the outcomes analyzed varied from 0.84 to 0.96. Precision and agreement varied between 0.83 and 0.97 and between 0.99 and 1, respectively. The line estimated from the pairs of values obtained in both interviews indicates high data precision. The interview item showing the poorest result was the ability to estimate time (fair in 27.7% of interviews). Interview assessment items showed intraclass correlation coefficients between 0.60 and 0.70, except for level of cooperation (0.46). CONCLUSIONS: The Brazilian version of the Physical Activity Checklist Interview shows high reliability to assess physical and sedentary activity on the previous day in children. OBJETIVO: Evaluar la confiabilidad del cuestionario Lista de Actividades Físicas en niños. MÉTODOS: El estudio es parte de la adaptación transcultural del cuestionario, realizado con 83 escolares de siete a diez años, matriculados del 2º al 5º año de enseñanza fundamental de la ciudad de Sao Paulo, Sureste Brasil, en 2008. El cuestionario fue respondido por el niño por medio de entrevista individual, presenta lista con 21 actividades físicas moderadas a vigorosas realizadas en el día anterior, es dividido en períodos (antes, durante y posterior a la escuela) y posee sección de evaluación de la entrevista. El cuestionario permite cuantificar: tiempo en actividades físicas y sedentarias; y costos metabólicos total y ponderado. La confiabilidad fue evaluada comparándose dos entrevistas realizadas con intervalo promedio de tres horas. Para la Sección C (evaluación de la entrevista), se compararon datos de la primera entrevista y de un evaluador externo. Se utilizaron propuesta de Bland y Altman y los coeficientes de correlación intraclase y de correlación de concordancia de Lin en la evaluación de la confiabilidad. RESULTADOS: Los límites inferiores de los coeficientes de correlación intraclase para los resultados analizados variaron de 0,84 a 0,96. La precisión y depuración variaron, respectivamente, de 0,83 a 0,97 y de 0,99 a 1. La recta estimada a partir de pares de valores obtenidos en las dos aplicaciones para actividad física indica elevada precisión de los datos. El ítem de la entrevista con peor resultado fue la habilidad en estimar tiempo (regular en 27,6% de las entrevistas). Los itens de la Sección C presentaron coeficientes de correlación intraclase entre 0,60 y 0,70, excepto el nivel de cooperación (0,46). CONCLUSIONES: La Lista de Actividades Físicas presenta alta confiabilidad para contrastar actividad física y sedentaria del día anterior en niños.

Zoonotic Visceral leishmaniasis (ZVL) is a neglected tropical disease that in the Americas is caused by the infection of Leishmania infantum and the domestic dog (Canis familiaris) is the main parasite reservoir in urban areas. The parasite is mainly transmitted by populations of the sibling species Lutzomyia longipalpis that has been spreading in countries including Brazil, Argentina, Paraguay and more recently Uruguay. Although bionomic parameters such as population survival and the duration of the gonotrophic cycle are critical in evaluating vector capacity, field studies have rarely been applied to sand fly populations. The present study sought to evaluate basic bionomic parameters related to the vectorial capacity of the (S)-9-methylgermacrene-B population of the Lu. longipalpis complex in a visceral leishmaniasis area of Sao Paulo state. The daily survival rate, the duration of the gonotrophic cycle and the dispersal pattern were evaluated through the mark- release-recapture method. A total of 1,547 males and 401 females were marked and released in five experiments carried out between February 2013 and February 2014. The higher recapture rates occurred within 100 meters of the release point and the estimated daily survival rates varied between 0.69 and 0.89 for females and between 0.69 and 0.79 for males. The minimum duration of the gonotrophic cycle observed was five days. The absolute population size, calculated ranged from 900 to 4,857 females and from 2,882 to 9,543 males. Our results demonstrate a high survival rate of this vector population and low dispersal that could be associated with the presence of all necessary conditions for its establishment and maintenance in the peridomiciles of this area. Our findings contribute to the basic data necessary for the understanding of ZVL dynamics and the evaluation of the implementation of prevention and control measures., Author summary American Visceral leishmaniasis (VL) is an anthropozoonosis resulting from infection by Leishmania infantum mainly transmitted by the bite of females of the sand fly Lutzomyia longipalpis which feed mainly on domestic dogs. It is a serious tropical disease that in some countries has spread in association with several factors such as human migration, precarious urbanization and vector adaptation to urban areas. In Brazil, although control measures such as the elimination of infected dogs, the application of residual insecticide and environmental management have been applied by the health authorities, however, they have not resulted in any significant reduction in VL incidence. The knowledge of bionomic parameters of vector populations is critical for the understanding of the transmission dynamic of VL and to evaluate prevention and control measures. Therefore, in the present study we applied the mark-release-recapture (MRR) method to evaluate under field conditions some basic bionomic parameters of a population of the Lutzomyia longipalpis complex. Our findings demonstrate a high survival rate of this vector and a low population dispersal. These results suggest that measures applied to dog populations to prevent sand fly bites could contribute to the reduction of the surviving vector population and indirectly to the reduction of the host biting rate. Additionally, the low dispersal suggests that environmental management could contribute to the reduction of vector density. Our data serve as the first estimates of vector survival rates of populations of the sibling species Lu. longipalpis under natural conditions and could be applied in the evaluation of prevention and control measures.

This article investigates the conceptual, item, and semantic equivalence between the Dysfunctional Voiding Scoring System (DVSS) originally developed in English and a Portuguese-language version for use in Brazil. The instrument is used to evaluate lower urinary tract dysfunction in children. The first stage evaluated the conceptual and item equivalence, followed by two independent translations of the original instrument into Portuguese. In the second stage, 63 individuals were interviewed and items were modified according to difficulties in interpretation. In the third stage, the Portuguese instrument was back-translated into English, and the semantic equivalence was evaluated, based on referential and general (connotative) meaning. In the fourth stage, the pre-test version of the instrument was applied to 20 individuals from the target population. The Portuguese version of the instrument is presented with conceptual, item, and semantic equivalence. Nevertheless, unlike the original instrument, DVSS information collection was more adequate for the Brazilian population when performed through interviews as compared to self-applied questionnaires.

The network of HIV counseling and testing centers in São Paulo, Brazil is a major source of data used to build epidemiological profiles of the client population. We examined HIV-1 incidence from November 2000 to April 2001, comparing epidemiological and socio-behavioral data of recently-infected individuals with those with long-standing infection. A less sensitive ELISA was employed to identify recent infection. The overall incidence of HIV-1 infection was 0.53/100/year (95% CI: 0.31-0.85/100/year): 0.77/100/year for males (95% CI: 0.42-1.27/100/year) and 0.22/100/ year (95% CI: 0.05-0.59/100/year) for females. Overall HIV-1 prevalence was 3.2% (95% CI: 2.8-3.7%), being 4.0% among males (95% CI: 3.3-4.7%) and 2.1% among females (95% CI: 1.6-2.8%). Recent infections accounted for 15% of the total (95% CI: 10.2-20.8%). Recent infection correlated with being younger and male (p = 0.019). Therefore, recent infection was more common among younger males and older females. Secretaria Municipal de Saúde de São Paulo Universidade de São Paulo Faculdade de Saúde Pública Departamento de Epidemiologia Santa Casa de São Paulo Faculdade de Ciências Médicas Departamento de Medicina Social Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Laboratório de Retrovirologia UNIFESP, EPM, Laboratório de Retrovirologia SciELO

The network of HIV counseling and testing centers in Sao Paulo, Brazil is a major source of data used to build epidemiological profiles of the client population. In this study, HIV-1 incidence from November of 2000 to April of 2001 was estimated, comparing recently infected individuals to those with long-standing infection in terms of epidemiological and socio-behavioral aspects. To identify recent infection, less sensitive ELISA was employed. The overall incidence of HIV-1 infection among the clients was 0.53/100/year (95% CI: 0.31-0.85/100/year): 0.77/100/year for males (95% CI: 0.42-1.27/100/year) and 0.22/100/year (95% CI: 0.05-0.59/100/year) for females. Overall HIV-1 prevalence was 3.2% (95% CI: 2.8-3.7%), being 4.0% among males (95% CI: 3.3-4.7%) and 2.1% among females (95% CI: 1.6-2.8%). Recent infections accounted for 15% of the total (95% CI: 10.2-20.8%). Recent infection correlated with being younger and male (p = 0.019). Therefore, recent infection was more common among younger males and older females.

This study aimed to investigate the relationship between anthropometric indicators - body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) - and the sum of skinfold thicknesses in 7-10-year-old children attending a public school in São Paulo (SP). Height, weight, WC and triceps, biceps, subscapular and suprailiac skinfolds were measured, and the sum of skinfold thicknesses, BMI and WHtR were calculated. A Bland-Altman analysis was used in order to compare methods, with values transformed into z-scores. The analysis of limits of agreement and confidence intervals showed evidence of good agreement, above all between BMI and WC, and the sum of skinfold thicknesses, complying with strict agreement limits and differences smaller than 1 standard deviation (SD). WHtR showed moderate limits of agreement, from -1.02 to + 0.64 SD (boys) and -0.74 to + 1.12 SD (girls); its performance was not better than that of WC alone, the lower and upper limits of agreement for which were -0.91 to + 0.58 SD (boys) and -0.56 to + 0.89 SD (girls). The results support the use of anthropometric indicators to classify nutritional status, above all BMI and WC, in that both are similar when classifying children according to body fatness, and confer the advantages of being easy to obtain and affordable.

O objetivo do estudo é apresentar aspectos metodológicos relativos à concordância entre avaliadores, na seleção inicial de artigos em estudo de revisão sistemática com ou sem metanálise. Foram utilizados como exemplo dados da fase inicial do estudo "Suplementação de vitamina A em lactantes: revisão sistemática". Estes constituem o resultado da leitura, realizada por dois avaliadores, de resumos de artigos selecionados, criteriosamente, em bases bibliográficas eletrônicas. Para cada resumo, foram respondidas as questões: "O estudo envolve mulheres no pós-parto?"; "Trata-se de um estudo com suplementação de vitamina A?"; "O estudo é ensaio clínico?"; seguidas da decisão (inclusão/exclusão) do trabalho. Os dados foram inseridos em planilha Excel, com dupla digitação e uso de procedimento de validação. Utilizou-se o índice de concordância kappa para os aspectos: população, intervenção, tipo de estudo e decisão. Foram identificados 2.553 trabalhos. Os índices de concordância kappa foram, quanto à adequação da população de estudo: k=0,46; do tipo de intervenção: k=0,59; do tipo de estudo: k=0,59 e, sobre a decisão pela inclusão/exclusão: k=0,44. Com base nas concordâncias razoável (tipo de estudo e intervenção) e pobre (população de estudo) observadas entre avaliadores, enfatiza-se a necessidade da leitura inicial dos trabalhos por pelo menos dois avaliadores. As reuniões para consenso realizadas nos casos discordantes foram úteis para resolver diferenças de interpretação entre os avaliadores, possibilitando nova leitura e maior reflexão, e colaboraram, portanto, para diminuir as chances de exclusão de um artigo que, na verdade, deveria ser incluído, com conseqüente maior controle sobre possível vício de seleção. The objective of this study is to present the methodological aspects of inter-rater agreement in the initial selection of studies for a systematic review with or without meta-analysis. As an example, we used data from the initial phase of the study called "Vitamin A supplementation for breastfeeding mothers: systematic review". The data are the result of a reading carried out by two raters of article abstracts selected judiciously among electronic bibliography databases. For each study we posed the questions: "Does the study involve post-partum females?"; "Is it a vitamin A supplementation study?"; "Is it a clinical trial?", followed by a decision (inclusion/exclusion) concerning the study. The data were keyed twice into an Excel spreadsheet and a validation procedure was followed. The kappa agreement rate was applied to the following aspects: population, intervention, study type, and decision. We identified 2,553 studies. The kappa agreement rates were: k=0.46 for suitability of the population studied; k= 0.59 for intervention type; k=0.59 for study type; and k=0.44 for the inclusion/exclusion decision. Given the fair (intervention and study type) and slight (population studied) agreement between raters, we emphasize the need for the studies to be read initially by at least two raters. The consensus meetings carried out in the presence of disagreement were useful to solve differences of interpretation between raters, provided new understanding and deeper reflection, contributed to reduce the chance of non-inclusion of necessary studies, and thus enhanced control over a possible selection bias.

A deficiência de vitamina A constitui um problema de saúde pública no Nordeste brasileiro. O objetivo deste estudo foi determinar a prevalência da deficiência de vitamina A e os fatores associados em pré-escolares de Teresina, Piauí, Brasil. Os níveis de retinol sérico foram determinados por HPLC, e foram investigadas as características sócio-econômicas e demográficas de 631 crianças com idade de 36 a 83 meses. Investigou-se a associação entre os níveis de retinol e as variáveis de interesse por análise de regressão linear uni e multivariada. O nível médio de retinol foi de 1,21mmol/L (IC95%: 1,17-1,25µmol/L), independente do sexo (p = 0,259). A hipovitaminose A (retinol < 0,69µmol/L) foi observada em 15,4% das crianças (IC95%: 12,7-18,4), com tendência à diminuição com o avanço da idade; 29% das crianças (IC95%: 25,2-32,4) tinham valores aceitáveis de retinol, mas não adequados (0,70 a 1,04µmol/L). Encontrou-se associação positiva entre níveis de retinol e idade, renda per capita, suplementação prévia com vitamina A e escolaridade materna. A prevalência de hipovitaminose A representa um problema moderado de saúde pública, ressaltando a importância das estratégias de combate a essa carência na região. Vitamin A deficiency is a public health problem in the Northeast of Brazil. This study aimed to determine the prevalence of vitamin A deficiency and associated factors among preschool children in Teresina, Piauí, Brazil. We studied the serum retinol levels and socioeconomic and demographic characteristics of 631 children from 36 to 83 months of age. The statistical association between each of the above characteristics and serum retinol levels was investigated by univariate and multivariate linear regression analysis. Mean serum retinol was 1.21mmol/L (95%CI: 1.17-1.25µmol/L) and was independent of gender (p = 0.259). Prevalence of vitamin A deficiency (retinol < 0.69µmol/L) was 15.4% (95%CI: 12.7-18.4), with a tendency to decrease with age. Acceptable but not adequate retinol levels (0.70 to 1.04µmol/L) were observed in 29% of children (95%CI: 25.2-32.4). There were positive associations between retinol levels and age, income, vitamin A supplementation, and maternal schooling. Vitamin A deficiency appeared as a moderately serious public health problem, emphasizing the importance of strategies to combat this problem in the region.

OBJETIVO: Descrever a atividade de hematofagia de Aedes aegypti e Aedes albopictus em área submetida ao controle e à vigilância entomológica. MÉTODOS: O estudo foi realizado de abril de 1993 a setembro de 1994, na cidade de Cosmópolis, Estado de São Paulo. Utilizou-se isca humana para coleta dos exemplares. Calculou-se o número médio mensal de fêmeas capturadas por domicílio segundo as áreas central e periférica do município e os locais intra e peridomiciliar. Apresenta-se o índice pluviométrico mensal sem ajuste de modelo. RESULTADOS: Observou-se a presença de fêmeas das espécies em 83% (Ae. albopictus) e 61% (Ae. aegypti) do período estudado. Os meses de janeiro, fevereiro e março apresentaram maior atividade de fêmeas para as duas espécies, com maior presença de Ae. albopictus do que de Ae. aegypti. Os exemplares foram capturados na área central e periférica da cidade, nos períodos matutino, das 9:00 às 12:00 e crepuscular vespertino, das 16:00 às 19:00. Com utilização de modelo de regressão de Poisson, observou-se que fêmeas de Ae. albopictus foram mais capturadas no peridomicílio, independente se área central ou periférica. CONCLUSÕES: Foi detectada diferença no perfil de atividade da hematofagia somente para o Ae. albopictus, sendo de relevância o peridomicílio. OBJECTIVE: To describe the hematophagous activity of Ae. aegypti and Ae. albopictus in an area under control and surveillance. METHODS: The study was conducted during 18 months, from April, 1993 to October, 1994, in Cosmópolis, São Paulo state, Brazil. Human baits were used to collect mosquitoes. The number of females captured is presented monthly by area of the city and local in the household. The rainfall was measured and indices are presented without model adjustment. RESULTS: The presence of females of both species was observed in 83% (Ae albopictus) and 61% (Ae. aegypti) of the period studied. The months of January, February and March presented the highest rates of activity for females of both species, with Ae. albopictus being more frequently captured than Ae. aegypti. Both species were captured in central and peripheral areas of the city, during the day from 9 to 12 am and from 4 to 7 pm. By a Poisson regression, it was observed that Ae. albopictus females were more frequently captured in the peri-housed area, in an independent way considering the area of the city. CONCLUSIONS: It has been identified difference on the hematophagous activity only for Ae. albopictus, being of importance the outside area of the house.