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Zarth K, Holand BL, Zoche E, Schaan CW, Lukrafka JL, Bosa VL. Nutritional risk and functionality of children and adolescents hospitalized with COVID-19. Eur J Pediatr 2024; 183:1223-1230. [PMID: 38087095 DOI: 10.1007/s00431-023-05274-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/29/2023] [Accepted: 10/08/2023] [Indexed: 01/10/2024]
Abstract
To evaluate the association between nutritional risk and functionality of children and adolescents hospitalized with COVID-19 at admission and discharge. METHODS Retrospective cross-sectional study with patients under 19 years old, positive for SARS-COV-2 by RT-PCR test, from February 2020 to May 2022. The STRONGKids screening (Screening Tool Risk On Nutritional Status and Growth) was used to assess nutritional risk on hospital admission and the Functional Status Scale (FSS-Brazil) to determine the functionality of patients on admission and discharge. Data was collected from hospital medical records. Poisson regressions with crude robust variance were used to test the association between nutritional risk and functional status at admission, with adjustments for the age, length of stay, and presence of complex chronic conditions. RESULTS Of the 217 patients, 55.7% (n = 121) were boys with a median age of 6 years (IQ 0-12), 58.5% (n = 127) had at least one complex chronic condition, 64% (n = 139) had medium/high nutritional risk, and 23.9% (n = 52) had some degree of dysfunctionality upon admission and 14.6% (n = 31) upon discharge. By associating STRONGKids and the FSS-Brasil of hospital admission, it was observed that children with low nutritional risk had a mean global FSS lower (6.4 ± 0.7) than children with medium/high nutritional risk (7. 7 ± 2.8; p < 0.001). Children with low nutritional risk on admission also had a lower mean (6.1 ± 0.59) on the FSS at hospital discharge than children with medium/high nutritional risk (7.1 ± 2.5; p < 0.001). After adjustments, it was identified that the addition of one STRONGKids point increases by 36% (PR 1.36; 95%CI 1.15-1.62) the probability of the patient presenting some degree of functional impairment on admission. Conclusion: The study found a positive association between nutritional risk and functional impairment in hospitalized children and adolescents with COVID-19 on admission, even after adjusting for age, length of stay, and complex chronic conditions. Furthermore, patients with medium/high nutritional risk at admission also had worse functionality, both on admission and at discharge. WHAT IS KNOWN • Children and adolescents infected with COVID-19 tend to exhibit milder symptoms and lower hospitalization rates compared to adults, although severe cases and complications can occur. • A paucity of targeted investigations exists regarding the correlation between nutritional risk and functionality in children and adolescents with COVID-19. WHAT IS NEW • Children and adolescents with COVID-19 who presented with medium to high nutritional risk upon hospital admission demonstrated functional impairments, both at admission and hospital discharge.
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Affiliation(s)
- Kahena Zarth
- Graduate Program in Food, Nutrition and Health, Federal University of Rio Grande do Sul, 2400 Ramiro Barcelos Street, Porto Alegre, State of Rio Grande do Sul, 90035-002, Brazil
| | - Bruna Luiza Holand
- Graduate Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Ester Zoche
- Nutrition Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Janice Luisa Lukrafka
- Department of Physical Therapy, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Vera Lúcia Bosa
- Graduate Program in Food, Nutrition and Health, Federal University of Rio Grande do Sul, 2400 Ramiro Barcelos Street, Porto Alegre, State of Rio Grande do Sul, 90035-002, Brazil.
- Nutrition Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
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Zarth K, Holand BL, Zoche E, Schaan CW, Lukrafka JL, Bosa VL. Correction to: Nutritional risk and functionality of children and adolescents hospitalized with COVID-19. Eur J Pediatr 2024; 183:1231. [PMID: 38193998 DOI: 10.1007/s00431-023-05396-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Affiliation(s)
- Kahena Zarth
- Graduate Program in Food, Nutrition and Health, Federal University of Rio Grande do Sul, 2400 Ramiro Barcelos Street, Porto Alegre, State of Rio Grande do Sul, 90035-002, Brazil
| | - Bruna Luiza Holand
- Graduate Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Ester Zoche
- Nutrition Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Janice Luisa Lukrafka
- Department of Physical Therapy, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Vera Lúcia Bosa
- Graduate Program in Food, Nutrition and Health, Federal University of Rio Grande do Sul, 2400 Ramiro Barcelos Street, Porto Alegre, State of Rio Grande do Sul, 90035-002, Brazil.
- Nutrition Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
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Macedo ACPD, Schaan CW, Bock PM, Pinto MBD, Botton CE, Umpierre D, Schaan BD. Cardiorespiratory fitness in individuals with type 2 diabetes mellitus: a systematic review and meta-analysis. Arch Endocrinol Metab 2023; 67:e230040. [PMID: 37738467 PMCID: PMC10665050 DOI: 10.20945/2359-4292-2023-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 05/30/2023] [Indexed: 09/24/2023]
Abstract
Objective To conduct a systematic review and meta-analysis assessing the cardiorespiratory fitness (CRF) among individuals with and without type 2 diabetes. Materials and methods The current review was registered in PROSPERO under the number CRD42018082718. MEDLINE, EMBASE, and Cochrane Library databases were searched from inception through February 2022. Eligibility criteria consisted of observational or interventional studies that evaluated CRF through cardiopulmonary exercise testing or six-minute walk test in individuals with type 2 diabetes compared with individuals without type 2 diabetes. For data extraction, we used baseline CRF assessments of randomized clinical trials or follow-up CRF assessments in observational studies. We performed a meta-analysis using maximal oxygen consumption (VO2 max), and distance walked in the 6MWT as primary outcomes. They were extracted and expressed as mean differences (MDs) and 95% CIs between treatment and comparator groups. The meta-analysis was conducted using Review Manager (RevMan) software. Results Out of 8,347 studies retrieved, 77 were included. Compared with individuals without type 2 diabetes, individuals with diabetes achieved a lower VO2 max (-5.84 mL.kg-1.min-1, 95% CI -6.93, -4.76 mL.kg-1.min-1, p = <0.0001; I2 = 91%, p for heterogeneity < 0.0001), and a smaller distance walked in 6MWT (-93.30 meters, 95% CI -141.2, -45.4 meters, p > 0.0001; I2: 94%, p for heterogeneity < 0.0001). Conclusion Type 2 diabetes was associated with lower cardiorespiratory fitness, as observed by lower VO2 max on maximal tests, and smaller distance walked in 6MWT, however the quality of studies was low.
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Affiliation(s)
- Aline Chagastelles Pinto de Macedo
- Universidade Federal do Rio Grande do Sul, Programa de Pós-graduaçÃo em Ciências Médicas: Endocrinologia, Porto Alegre, RS, Brasil
- Laboratório de Atividade Física, Diabetes e Doença Cardiovascular (LADD), Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
| | - Camila Wohlgemuth Schaan
- Laboratório de Atividade Física, Diabetes e Doença Cardiovascular (LADD), Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
| | - Patricia Martins Bock
- Laboratório de Atividade Física, Diabetes e Doença Cardiovascular (LADD), Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil,
- Faculdades Integradas de Taquara, Taquara, RS, Brasil
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Mariana Brutto de Pinto
- Laboratório de Atividade Física, Diabetes e Doença Cardiovascular (LADD), Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
| | - Cintia Ehlers Botton
- Instituto de AvaliaçÃo de Tecnologia em Saúde (IATS) - CNPq/Brasil, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
- Universidade Federal do Ceará, Instituto de EducaçÃo Física e Esportes, Fortaleza, CE, Brasil
- Programa de Mestrado em Fisioterapia e Funcionalidade, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - Daniel Umpierre
- Laboratório de Atividade Física, Diabetes e Doença Cardiovascular (LADD), Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
- Instituto de AvaliaçÃo de Tecnologia em Saúde (IATS) - CNPq/Brasil, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
| | - Beatriz D Schaan
- Universidade Federal do Rio Grande do Sul, Programa de Pós-graduaçÃo em Ciências Médicas: Endocrinologia, Porto Alegre, RS, Brasil
- Laboratório de Atividade Física, Diabetes e Doença Cardiovascular (LADD), Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
- Instituto de AvaliaçÃo de Tecnologia em Saúde (IATS) - CNPq/Brasil, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
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de Oliveira JK, Schaan CW, Silva CK, Piva TC, Sousa ITE, Bruno F, Lukrafka JL. Reliability of ultrasound in the assessment of muscle thickness in critically ill children. An Pediatr (Barc) 2023:S2341-2879(23)00100-X. [PMID: 37198052 DOI: 10.1016/j.anpede.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/16/2023] [Indexed: 05/19/2023] Open
Abstract
INTRODUCTION Ultrasound has been used to quantify and qualify muscle morphology in critically ill children and can detect changes in muscle thickness. The aim of this study was to assess the reliability of ultrasound measurement of muscle thickness in critically ill children and to compare the assessments made by an expert with those made by inexperienced sonographers. MATERIAL AND METHODS Cross-sectional observational study conducted in the paediatric intensive care unit of a tertiary care university hospital in Brazil. The sample included patients aged 1 month to 12 years who received invasive mechanical ventilation for at least 24 h. Ultrasound images of the biceps brachii/brachialis and quadriceps femoris were obtained by one experienced sonographer and several inexperienced sonographers. We assessed intrarater and inter-rater reliability by means of the intraclass correlation coefficient (ICC) and Bland-Altman plot analysis. RESULTS Muscle thickness was measured in 10 children with a mean age of 15.5 months. The mean thickness of the assessed muscles as 1.14 cm for the biceps brachii/brachialis (standard deviation [SD], 0.27) and 1.85 cm for the quadriceps femoris (SD, 0.61). The intrarater and inter-rater reliability were good for all sonographers (ICC > 0.81). The differences were small, there was no significant bias in the Bland-Altman plots and all measurements were within the limits of agreement, except for 1 measurement of biceps and quadriceps. CONCLUSION Sonography can be used in critically ill children to accurately assess changes in muscle thickness, even by different evaluators. More studies are needed to establish a standardised approach to the use of ultrasound for monitoring muscle loss in order to incorporate it in clinical practice.
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Affiliation(s)
- Jéssica Knisspell de Oliveira
- Programa de Posgrado en Pediatría, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre (RS), Brasil.
| | | | | | | | - Ian Teixeira E Sousa
- Programa de Posgrado en Salud Infantil y Adolescente, Universidade Federal do Rio Grande do Sul, Porto Alegre (RS), Brasil
| | - Francisco Bruno
- Hospital de Clínicas de Porto Alegre, Porto Alegre (RS), Brasil
| | - Janice Luisa Lukrafka
- Programa de Posgrado en Pediatría, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre (RS), Brasil
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de Oliveira JK, Schaan CW, Silva CK, Piva TC, Sousa ITE, Bruno F, Lukrafka JL. Fiabilidad de la ecografía en la evaluación del grosor muscular en niños críticamente enfermos. An Pediatr (Barc) 2023. [DOI: 10.1016/j.anpedi.2023.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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Schaan CW, Schaan BD, Cureau FV. Prevalence and correlates of meeting physical activity, screen time and sleep duration guidelines among Brazilian adolescents: findings from ERICA. Appl Physiol Nutr Metab 2022; 47:690-698. [PMID: 35395163 DOI: 10.1139/apnm-2021-0447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The prevalence of meeting movement guidelines is low in developed countries; however there is a lack of data among medium-income countries, including Brazil. We evaluated the prevalence and correlates of meeting physical activity, screen time, and sleep guidelines in Brazilian adolescents. Employing a cross-sectional design, Brazilian adolescents (aged 12-17) were surveyed about their physical activity levels, sleep, and screen time. The data was collected at schools through a self-administered questionnaire using a Personal Digital Assistant for entering the data. Poisson regression models were used to examine the associations between correlates (sex, age, socioeconomic status, region, skin colour and shift of school) and meeting movement guidelines. A total of 58,535 adolescents were included. Although only 8.7% of adolescents met all three movement guidelines, the prevalence of those who met physical activity, screen time and sleep duration guidelines was 46.4%, 42.5% and 40%, respectively. Moreover, male sex, age 14-15 years old, non-white skin colour, afternoon shift of school and living in the Northern and Northeastern regions were associated with a higher prevalence of meeting all movement guidelines. The prevalence of adolescents who met all three movement guidelines was low among Brazilian adolescents. Adolescents living in less developed regions show greater adherence to movement guidelines, suggesting a possible impact of the urbanization process on these behaviours. Novelty bullets: - The prevalence of Brazilian adolescents whom met all three movement behaviours guidelines was around 9%. - Among all adolescents, 40% met only one movement guideline.
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Affiliation(s)
- Camila Wohlgemuth Schaan
- Universidade Federal do Rio Grande do Sul, Graduate Program in Endocrinology, Porto Alegre, Brazil;
| | - Beatriz D Schaan
- HCPA, 37895, Endocrine Division, Porto Alegre, RS, Brazil.,UFRGS, 28124, Graduate Program in Endocrinology, Porto Alegre, RS, Brazil;
| | - Felipe Vogt Cureau
- Universidade Federal do Rio Grande do Sul, 28124, Faculty of Medicine, Graduate Program in Cardiology and Cardiovascular Sciences, Porto Alegre, RS, Brazil;
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Menger JDL, Mafaldo LR, Schiwe D, Schaan CW, Heinzmann-Filho JP. EFFECTS OF HAMMOCK POSITIONING ON CLINICAL PARAMETERS IN PRETERM INFANTS ADMITTED TO A NEONATAL INTENSIVE CARE UNIT: A SYSTEMATIC REVIEW. ACTA ACUST UNITED AC 2020; 39:e2019399. [PMID: 33263617 PMCID: PMC7703730 DOI: 10.1590/1984-0462/2021/39/2019399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 03/08/2020] [Indexed: 11/22/2022]
Abstract
Objective: To review the effects of the hammock positioning on clinical parameters of preterm newborn infants (PTNB) admitted to the Neonatal Intensive Care Unit (NICU). Data sources: This was a systematic review performed by searching the Pubmed, Lilacs, SciELO and PEDro databases. Intervention studies in English, Portuguese and Spanish that evaluated the effects of hammock positioning on clinical parameters of PTNB admitted to the NICU were selected. Three search strategies were used: 1) hammock positioning OR patient positioning AND intensive care units AND infant, newborn; 2) hammock positioning OR patient positioning AND intensive care units; 3) hammock positioning OR patient positioning AND intensive care units, neonatal. There was no restriction on the year of publication of the articles. Methodological quality was assessed by the PEDro scale. Data synthesis: Among 597 articles, only six were included and 139 neonates with gestational ages between 26 and 37 weeks and an average gestational weight <2240g were analyzed. Four studies included patients without any associated pathology and most of them placed the PTNB supine in hammock positioning. The duration of the intervention ranged from 15 to 180 minutes and most applied it at just one moment. There was an improvement in heart rate (HR), respiratory rate (RR) and pain (3/4 studies), as well as gains in peripheral oxygen saturation (SpO2) (2/4 studies). Only one study reported worsening of SpO2 with the intervention. The methodological quality of the studies was classified as low. Conclusions: Although this review suggests improvement with hammock positioning in HR, RR and pain in PTNB, the low methodological quality makes the results inconsistent.
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Affiliation(s)
| | | | - Daniele Schiwe
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Schaan CW, Vieira VDS, Miller C, Peiter APD, Piccoli T, Cavion G, Lukrafka JL, Ferrari RS. HOSPITAL PHYSICAL THERAPY MANAGEMENT IN PEDIATRIC PATIENTS WITH COVID-19: CASE REPORTS. ACTA ACUST UNITED AC 2020; 39:e2020238. [PMID: 33206843 PMCID: PMC7669217 DOI: 10.1590/1984-0462/2021/39/2020238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 07/29/2020] [Indexed: 11/22/2022]
Abstract
Objective: To report the physiotherapeutic management of two pediatric cases with COVID-19 admitted in a reference state hospital to treat the disease in Porto Alegre, Southern Brazil. Cases description: Case 1, female, 10-month-old child, pre-existing chronic disease, hospitalized since birth, mechanical ventilation dependency via tracheotomy, progressed with hypoxemia, requiring oxygen therapy, and increased ventilator parameters, and a diagnosis of COVID-19 was confirmed. Airway clearance and pulmonary expansion maintenance therapies were performed. During hospitalization, the child acquired cephalic control, sitting without support, rolling, holding, and reaching objects. Recommendations were provided to a family member to maintain motor development milestones. Case 2, male, nine years old, previous psychiatric disease and obesity, showed worsening of the sensory state, requiring intensive care and invasive mechanical ventilation, with the diagnosis of SARS-Cov-2 infection. The physical therapy was performed to maintain airway clearance, pulmonary expansion, and early mobilization, showing ventilatory improvement during the intensive care hospitalization and successfully extubated after 17 days. The physical therapy evolved from passive to resistive exercises during the hospitalization, and the patient was able to walk without assistance at discharge, with the same previous functional status. Comments: The COVID-19 showed different manifestations in both cases. Physical therapy treatment was essential to maintain and to recover the functional status of the patients. Future studies are needed to improve the understanding of disease course and its functional consequences to offer an efficient treatment to pediatric patients with COVID-19.
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Affiliation(s)
| | | | - Cristina Miller
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Taciana Piccoli
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Gabriela Cavion
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
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Schunck EDR, Schaan CW, Pereira GA, Rosa NV, Normann TC, Ricachinevsky CP, Reppold CT, Ferrari RS, Lukrafka JL. Functional deficit in children with congenital heart disease undergoing surgical correction after intensive care unit discharge. Rev Bras Ter Intensiva 2020; 32:261-267. [PMID: 32667453 PMCID: PMC7405751 DOI: 10.5935/0103-507x.20200042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 01/09/2020] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate the functional status of pediatric patients undergoing congenital heart surgery after discharge from the intensive care unit, and to evaluate the correlations among clinical variables, functional status and surgical risk. Methods Cross-sectional study including patients aged 1 month to less than 18 years undergoing congenital heart surgery between October 2017 and May 2018. Functional outcome was assessed by the Functional Status Scale, surgical risk classification was determined using the Risk Adjustment for Congenital Heart Surgery-1 (RACHS-1), and clinical variables were collected from electronic medical records. Results The sample comprised 57 patients with a median age of 7 months (2 - 17); 54.4% were male, and 75.5% showed dysfunction, which was moderate in 45.6% of the cases. RACHS-1 category > 3 was observed in 47% of the sample, indicating higher surgical risk. There was a correlation between functional deficit and younger age, longer duration of invasive mechanical ventilation and longer intensive care unit stay. Moreover, greater functional deficit was observed among patients classified as RACHS-1 category > 3. Conclusion The prevalence of functional deficit was high among children and adolescents with congenital heart disease after cardiac surgery. Higher surgical risk, longer duration of invasive mechanical ventilation, longer intensive care unit stay and younger age were correlated with worse functional status.
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Affiliation(s)
| | - Camila Wohlgemuth Schaan
- Serviço de Fisioterapia, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | | | - Nathália Vieira Rosa
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil
| | | | - Claudia Pires Ricachinevsky
- Unidade de Terapia Intensiva Pediátrica, Hospital da Criança Santo Antônio, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brasil
| | | | - Renata Salatti Ferrari
- Serviço de Fisioterapia, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
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Schaan CW, Cureau FV, Salvo D, Kohl HW, Schaan BD. Unhealthy snack intake modifies the association between screen-based sedentary time and metabolic syndrome in Brazilian adolescents. Int J Behav Nutr Phys Act 2019; 16:115. [PMID: 31775773 PMCID: PMC6882160 DOI: 10.1186/s12966-019-0880-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 11/08/2019] [Indexed: 12/20/2022] Open
Abstract
Background Excessive screen time has been associated with metabolic syndrome (MetS) among adolescents; however, snack intake in front of screens may play a role in this association. Therefore, our objective was to investigate the association between screen-based sedentary time with MetS and whether this association is modified by unhealthy snack intake in front of screens. Methods This study was a nationwide, cross-sectional, school-based survey in Brazil including adolescents aged 12 to 17 years. The frequency of snack consumption in front of screen and screen-based sedentary time (TV view, computers and videogames use) were self-reported. Thereafter, screen time was categorized (≤2, 3–5 and ≥ 6 h/day); snack consumption in front of screens was dichotomized. Metabolic syndrome diagnosis was defined based on the International Diabetes Federation criteria. Associations between screen time and MetS were investigated using logistic regression in overall sample and after stratification by snack intake in front of screens. Results A total of 33,900 adolescents were included in the analysis. The final adjusted model, which included sociodemographic data, physical activity, and energy intake, showed that adolescents who spent ≥6 h/day in front of screens had an increased odds ratio for MetS (OR = 1.68, 95%CI: 1.03–2.74). However, after stratifying the sample according to reported snack intake, the association between higher screen-based sedentary time and MetS remained significant only for adolescents who reported consumption of snacks in front of screens. Conclusion Longer screen-based sedentary times were directly associated with MetS. However, this association seems to be modified by reported snack intake in front of screens.
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Affiliation(s)
- Camila Wohlgemuth Schaan
- Post-graduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre. Hospital de Clínicas de Porto Alegre, St. Ramiro Barcelos 2350/21, 90035-003, Porto Alegre, RS, Brazil.
| | - Felipe Vogt Cureau
- Post-graduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre. Hospital de Clínicas de Porto Alegre, St. Ramiro Barcelos 2350/21, 90035-003, Porto Alegre, RS, Brazil
| | - Deborah Salvo
- Washington University in St. Louis, Brown School, Prevention Research Center in St. Louis, Saint Louis, MO, USA
| | - Harold W Kohl
- University of Texas Health Science Center at Houston, School of Public Health, Michael and Susan Dell Center for Healthy Living and University of Texas at Austin, Department of Kinesiology and Health Education, Austin, TX, USA
| | - Beatriz D Schaan
- Post-graduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre. Hospital de Clínicas de Porto Alegre, St. Ramiro Barcelos 2350/21, 90035-003, Porto Alegre, RS, Brazil
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Bahia L, Schaan CW, Sparrenberger K, Abreu GDA, Barufaldi LA, Coutinho W, Schaan BD. Overview of meta-analysis on prevention and treatment of childhood obesity. J Pediatr (Rio J) 2019; 95:385-400. [PMID: 30121174 DOI: 10.1016/j.jped.2018.07.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 06/25/2018] [Accepted: 07/03/2018] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES This study aimed to assess the quality of systematic reviews on prevention and non-pharmacological treatment of overweight and obesity in children and adolescents. DATA SOURCE A search was done in electronic databases (Medline via PubMed, Web of Science, Scopus, LILACS, the Cochrane Library, and Clinical Trials), including only systematic reviews with meta-analysis. Reviews were selected by two researchers, and a third one solved the divergences. PRISMA statement and checklist were followed. SUMMARY OF DATA A total of 4574 records were retrieved, including 24 after selection. Six reviews were on obesity prevention, 17 on obesity treatment, and one on mixed interventions for prevention and treatment of obesity. The interventions were very heterogeneous and showed little or no effects on weight or body mass index. Mixed interventions that included dieting, exercise, actions to reduce sedentary behavior, and programs involving the school or families showed some short-term positive effects. Reviews that analyzed cardiovascular risk factors demonstrated significant improvements in the short-term. CONCLUSION The systematic reviews of interventions to prevent or reduce obesity in children and adolescents generally showed little or no effects on weight or body mass index, although cardiovascular profile can be improved. Mixed interventions demonstrated better effects, but the long-term impact of obesity treatments of children and adolescents remains unclear.
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Affiliation(s)
- Luciana Bahia
- Universidade do Estado do Rio de Janeiro (UERJ), Departamento de Medicina Interna, Rio de Janeiro, RJ, Brazil; Instituto de Avaliação de Tecnologia em Saúde (IATS), Porto Alegre, RS, Brazil
| | - Camila Wohlgemuth Schaan
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Ciências Médicas: Endocrinologia, Porto Alegre, RS, Brazil
| | - Karen Sparrenberger
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Ciências Médicas: Endocrinologia, Porto Alegre, RS, Brazil.
| | - Gabriela de Azevedo Abreu
- Universidade Federal do Rio de Janeiro (UFRJ), Instituto de Estudos em Saúde Coletiva, Rio de Janeiro, RJ, Brazil
| | - Laura Augusta Barufaldi
- Ministério da Saúde, Secretaria de Vigilância em Saúde, Departamento de Vigilância de Doenças e Agravos Não Transmissíveis e Promoção da Saúde, Brasília, DF, Brazil
| | - Walmir Coutinho
- Pontifícia Universidade Católica do Rio de Janeiro (PUC-Rio), Instituto Estadual de Diabetes e Endocrinologia (IEDE), Rio de Janeiro, RJ, Brazil
| | - Beatriz D Schaan
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Ciências Médicas: Endocrinologia, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Departamento de Medicina Interna, Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
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Bahia L, Schaan CW, Sparrenberger K, Abreu GDA, Barufaldi LA, Coutinho W, Schaan BD. Overview of meta‐analysis on prevention and treatment of childhood obesity. Jornal de Pediatria (Versão em Português) 2019. [DOI: 10.1016/j.jpedp.2018.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Piva TC, Ferrari RS, Schaan CW. Early mobilization protocols for critically ill pediatric patients: systematic review. Rev Bras Ter Intensiva 2019; 31:248-257. [PMID: 31215603 PMCID: PMC6649221 DOI: 10.5935/0103-507x.20190038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 11/01/2018] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To describe the existing early mobilization protocols in pediatric intensive care units. METHODS A systematic literature review was performed using the databases MEDLINE®, Embase, SciELO, LILACS and PeDRO, without restrictions of date and language. Observational and randomized and nonrandomized clinical trials that described an early mobilization program in patients aged between 29 days and 18 years admitted to the pediatric intensive care unit were included. The methodological quality of the studies was evaluated using the Newcastle-Ottawa Scale, Methodological Index for Non-Randomized Studies and the Cochrane Collaboration. RESULTS A total of 8,663 studies were identified, of which 6 were included in this review. Three studies described the implementation of an early mobilization program, including activities such as progressive passive mobilization, positioning, and discussion of mobilization goals with the team, in addition to contraindications and interruption criteria. Cycle ergometer and virtual reality games were also used as resources for mobilization. Four studies considered the importance of the participation of the multidisciplinary team in the implementation of early mobilization protocols. CONCLUSION In general, early mobilization protocols are based on individualized interventions, depending on the child's development. In addition, the use of a cycle ergometer may be feasible and safe in this population. The implementation of institutional and multidisciplinary protocols may contribute to the use of early mobilization in pediatric intensive care units; however, studies demonstrating the efficacy of such intervention are needed.
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Affiliation(s)
- Taila Cristina Piva
- Programa de Residência Integrada Multiprofissional em Saúde da Criança, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | - Renata Salatti Ferrari
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | - Camila Wohlgemuth Schaan
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
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Schaan CW, Feltez G, Schaan BD, Pellanda LC. FUNCTIONAL CAPACITY IN CHILDREN AND ADOLESCENTS WITH CONGENITAL HEART DISEASE. Rev paul pediatr 2019; 37:65-72. [PMID: 30624535 PMCID: PMC6362379 DOI: 10.1590/1984-0462/;2019;37;1;00016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 12/06/2017] [Indexed: 11/22/2022]
Abstract
Objective: To evaluate the physical activity level and functional capacity of children and adolescents with congenital heart disease and to describe correlations between functionality, surgical and echocardiographic findings, metabolic and inflammatory profile and differences between acyanotic and cyanotic heart defects. Methods: A cross-sectional study including children and adolescents with congenital heart disease between six and 18 years old that were evaluated with the 6-minute walk test (6MWT) to assess functional capacity. The short version form of the International Physical Activity Questionnaire (IPAQ) was performed to evaluate physical activity levels. Also, echocardiography and blood collection, to evaluate the metabolic (blood glucose, lipids, insulin) and inflammatory markers (C-reactive protein), were assessed. Results: Twenty-five individuals were evaluated. Of them, 14 had acyanotic heart defects and 11 cyanotic heart defects. Mean age was 12.0±3.7 years, and 20 (80%) were male. IPAQ showed that six (24%) individuals were very active, eight (32%) were active, nine (36%) had irregular physical activity, and two (8%) were sedentary. The mean distance walked in the 6MWT, considering all studied individuals, was 464.7±100.4 m, which was 181.4±42.0 m less than the predicted (p=0.005). There was a positive correlation between Z score 6MWT and the number of surgical procedures (r=-0.455; p=0.022). Conclusions: Children and adolescents with congenital heart disease have low functional capacity, but they are not completely sedentary.
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Schaan CW, Cureau FV, Bloch KV, de Carvalho KMB, Ekelund U, Schaan BD. Prevalence and correlates of screen time among Brazilian adolescents: findings from a country-wide survey. Appl Physiol Nutr Metab 2018; 43:684-690. [DOI: 10.1139/apnm-2017-0630] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The purpose of this study was to evaluate the distribution, prevalence, and correlates of excessive screen time (>2 h/day) among Brazilian adolescents. The Study of Cardiovascular Risks in Adolescents (ERICA) is a national, school-based, cross-sectional multicenter study. Information about time spent in front of screens was assessed by questionnaire. Poisson regression models were used to examine the associations between following correlates (region, sex, age, skin color, income, Internet access, and number of TVs at home) and excessive screen time. A total of 66 706 Brazilian adolescents (aged 12–17 years) were included. The overall mean time in front of screens was 3.25 h/day (95% confidence interval (95%CI): 3.20–3.31) and the prevalence of excessive screen time was 57.3% (95%CI: 55.9–58.6). Moreover, excessive screen time also differs across Brazilian regions, being higher in Southeast and South, respectively. In adjusted models stratified by region, the socioeconomic status was associated with excessive screen time in North, Northeast, and Midwest. In all regions, having a computer with Internet access was associated with higher prevalence of excessive screen time. In conclusion, prevalence of excessive screen time in Brazilian adolescents is high. It presents regional variations and facility for Internet access.
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Affiliation(s)
- Camila Wohlgemuth Schaan
- Post-graduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul – Hospital de Clínicas de Porto Alegre. 2350, Ramiro Barcelos Street, building 21. Porto Alegre 90035-003, RS, Brazil
| | - Felipe Vogt Cureau
- Post-graduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-003, Brazil
| | - Katia Vergetti Bloch
- Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-598, Brazil
| | | | - Ulf Ekelund
- Department of Sports Medicine, Norwegian School of Sports Science, Ullevål Stadion, 0806, Oslo, Norway
| | - Beatriz D. Schaan
- Post-graduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-003, Brazil and Endocrine Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-903, Brazil
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Pereira GA, Schaan CW, Ferrari RS. Functional evaluation of pediatric patients after discharge from the intensive care unit using the Functional Status Scale. Rev Bras Ter Intensiva 2017; 29:460-465. [PMID: 29236844 PMCID: PMC5764558 DOI: 10.5935/0103-507x.20170066] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 06/22/2017] [Indexed: 11/26/2022] Open
Abstract
Objective To evaluate the functional status of pediatric patients after discharge from
the pediatric intensive care unit using the Functional Status Scale and to
compare the time of invasive mechanical ventilation, length of stay in the
pediatric intensive care unit, and Pediatric Index of Mortality 2 results
among individuals with different degrees of functional impairment. Methods A cross-sectional study was conducted on patients who were discharged from a
pediatric intensive care unit. The functional evaluation by the Functional
Status Scale was performed on the first day after discharge from the unit,
and the Pediatric Index of Mortality 2 was used to predict the mortality
rate at the time of admission to the pediatric intensive care unit. Results The sample consisted of 50 individuals, 60% of which were male, with a median
age of 19 [6 - 61] months. The overall score of the Functional Status Scale
was 11.5 [7 - 15], and the highest scores were observed in the "motor
function" 3 [1 - 4] and "feeding" 4 [1 - 4] domains. Compared to patients
who were not readmitted to the pediatric intensive care unit, patients who
were readmitted presented a worse overall score (p = 0.01), worse scores in
the "motor function" (p = 0.01), "feeding" (p = 0.02), and "respiratory" (p
= 0.036) domains, and a higher mortality rate according to the Pediatric
Index of Mortality 2 (p = 0.025). Conclusion Evaluation of the functional status using the Functional Status Scale
indicated moderate impairment in patients after discharge from the pediatric
intensive care unit, mainly in the "motor function" and "feeding" domains;
patients who were readmitted to the pediatric intensive care unit
demonstrated worse overall functional, motor function, feeding and
respiratory scores. Individuals with greater functional impairment had
longer times of invasive mechanical ventilation and hospitalization in the
pediatric intensive care unit.
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Affiliation(s)
- Gabriela Alves Pereira
- Universidade Federal de Ciências da Saúde de Porto Alegre - Porto Alegre (RS), Brasil.,Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | - Camila Wohlgemuth Schaan
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | - Renata Salatti Ferrari
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
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Schaan CW, Macedo ACPD, Sbruzzi G, Umpierre D, Schaan BD, Pellanda LC. Functional Capacity in Congenital Heart Disease: A Systematic Review and Meta-Analysis. Arq Bras Cardiol 2017; 109:357-367. [PMID: 28876372 PMCID: PMC5644216 DOI: 10.5935/abc.20170125] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 03/09/2017] [Indexed: 11/20/2022] Open
Abstract
Background Children and adolescents with congenital heart disease often have alterations
in their exercise capacity that can be evaluated by various functional
testing. Objective To evaluate the functional capacity of children and adolescents with
congenital heart disease (CHD) with systematic review and meta-analyses. Methods The review included observational studies, data from the first evaluation of
randomized clinical trials or observational follow-up periods after clinical
trials which evaluated functional capacity by cardiopulmonary exercise test,
stress testing, six-minute walk test or step test, in children and
adolescents with CHD, aged between six and 18 years, and comparisons with
healthy controls in the same age group. The quantitative assessment was
performed by meta-analysis, by comparing the maximal oxygen consumption
(VO2max) of children and adolescents with CHD and respective
control groups. Results Twenty-five of 2.683 studies identified in the search met the inclusion
criteria. The VO2max measurement showed that patients with CHD
have a decrease of 9.31 ml/Kg/min (95% CI. -12.48 to -6.13; I2,
94.3%, P for heterogeneity < 0.001) compared with the control group. The
meta-analysis of the data of maximum heart rate (HR) reached during
cardiopulmonary test and stress testing, retrieved from 18 studies, showed a
HR value of -15.14 bpm (95% CI. -20.97 to -9.31; I2, 94.3%, P for
heterogeneity < 0.001) compared with the control group. Conclusion Children and adolescents with CHD have lower VO2max and HR
compared to controls.
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Affiliation(s)
| | | | | | - Daniel Umpierre
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Lucia Campos Pellanda
- Instituto de Cardiologia, Fundação Universitária de Cardiologia, Porto Alegre, RS, Brazil
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Abstract
OBJECTIVE The purpose of our study was to evaluate the association between short and long sleep duration and all-cause and cardiovascular mortality among elderly individuals. DESIGN Systematic review and meta-analysis of population-based cohort studies. SETTING Articles were retrieved from international and national electronic databases. STUDY SELECTION Studies were identified in PubMed, EMBASE, LILACS (Latin American and Caribbean Health Sciences Literature), IBECS (Bibliographic Index on Health Sciences from Spain) and CAPES (PhD thesis repository) between 1980 and 2015. Studies which met all criteria were eligible: participants aged 60 years or over, assessment of sleep duration as 24 h, nighttime or daytime sleep, evaluation of all-cause or cause-specific mortality, population-based cohort studies conducted on representative samples. There was no language restriction and studies published as abstracts were excluded. DATA EXTRACTION Data were analysed using the Comprehensive Meta-Analysis software (V.3.3.070), and summary estimates (relative risk (RR), 95% CI) were calculated using a random effects model. Heterogeneity and consistency were evaluated through Cochran's Q and the I(2) statistics, respectively, and sensitivity analyses were conducted. PRIMARY AND SECONDARY OUTCOME MEASURES All-cause and cardiovascular mortality. RESULTS Overall, 27 cohort studies were selected, comprising >70,000 elderly individuals, and followed up from 3.4 to 35 years. In the pooled analysis, long and short sleep duration were associated with increased all-cause mortality (RR 1.33; 95% CI 1.24 to 1.43 and RR 1.07; 95% CI 1.03 to 1.11, respectively), compared with the reference category. For cardiovascular mortality, the pooled relative risks were 1.43 (95% CI 1.15 to 1.78) for long sleep, and 1.18 (95% CI 0.76 to 1.84) for short sleep. Daytime napping ≥ 30 min was associated with risk of all-cause mortality (RR 1.27; 95% CI 1.08 to 1.49), compared with no daytime sleep, but longer sleep duration (≥ 2.0 h) was not (RR 1.34; 95% CI 1.95 to 1.90). CONCLUSIONS Among elderly individuals, long and short sleep duration are associated with increased risk for all-cause mortality. Long sleep duration is associated with cardiovascular mortality.
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Affiliation(s)
- Andressa Alves da Silva
- Postgraduate Studies Program in Epidemiology, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Renato Gorga Bandeira de Mello
- Postgraduate Studies Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Camila Wohlgemuth Schaan
- Postgraduate Studies Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Flávio D Fuchs
- Division of Cardiology, National Institute for Health Technology Assessment (IATS/CNPq), Hospital de Clinicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Susan Redline
- Department of Medicine, Sleep Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sandra C Fuchs
- Postgraduate Studies Program in Epidemiology, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
- Postgraduate Studies Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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Ferrari RS, Schaan CW, Cerutti K, Mendes J, Garcia CD, Monteiro MB, Lukrafka JL. Assessment of functional capacity and pulmonary in pediatrics patients renal transplantation. J Bras Nefrol 2013; 35:35-41. [DOI: 10.5935/01012800.20130006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 11/20/2012] [Indexed: 11/20/2022] Open
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