Orientador: Cristina Laguna Benetti Pinto / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-07T16:52:52Z (GMT). No. of bitstreams: 1 Camargo_LucianeBandeiraNunes_M.pdf: 544659 bytes, checksum: e0ad7abfe26ccd3b1dca4593778522d0 (MD5) Previous issue date: 2006 / Resumo: Introdução: Puberdade precoce central idiopática (PPCI) é uma disfunção que se caracteriza por sinais puberais em meninas menores de oito anos de idade, com aceleração da velocidade de crescimento e prejuízos para a altura final, devido à ativação precoce do eixo Hipotálamo-hipófise-ovariano (HHO). É tratada com análogo do GnRH (GnRHa), com o intuito de se obter menor perda de estatura na idade adulta e reduzir eventuais distúrbios psicológicos advindos do desenvolvimento puberal precoce. Entretanto, as respostas ao tratamento não são uniformes. Existem controvérsias a respeito de quais fatores poderiam influenciar na resposta ao tratamento, com maior ganho na altura. Objetivo: Detectar os fatores determinantes de maior ganho na estatura como resultado do tratamento com análogo do GnRH. Sujeito e métodos: Estudo de coorte retrospectivo avaliou 33 meninas, diagnóstico de PPCI, tratadas com GnRHa no Ambulatório de Ginecologia Endócrina do Departamento de Tocoginecologia/ CAISM/Unicamp. A coleta de dados foi realizada através de levantamento de prontuários médicos. Foram avaliadas as variáveis independentes: idade cronológica no início dos sintomas, idade cronológica no início do tratamento, tempo decorrido entre início de aparecimento dos caracteres puberais e início do tratamento, idade óssea, avanço de idade óssea, duração do tratamento com GnRHa, altura real e z score, altura predita e z-score no início do tratamento, dosagens hormonais de FSH e LH após teste de estímulo com GnRHa, que foram correlacionadas com a variável dependente ganho de altura predita no final do tratamento, calculada pela diferença entre altura predita no final e início do tratamento. Para análise estatística foi utilizada a correlação linear de Pearson, além da regressão linear múltipla. Resultados: A média de idade no início do tratamento era de 7,8±1,3 anos, com idade óssea média de 10,1±1,6 anos. O avanço de idade óssea era de 2,3±1,1 anos e foi controlado durante o tempo de tratamento. O ganho em altura predita com o tratamento foi de cerca de 3cm e correlacionou-se positivamente com a demora em instituir o tratamento e o avanço de idade óssea, e correlacionou-se negativamente com o z-score da altura no início do tratamento e com a altura predita no início do tratamento, sendo este o principal fator determinante do benefício do tratamento. Conclusão: Embora com diagnóstico tardio, as meninas com maior comprometimento ósseo e, portanto, da altura predita, beneficiaram-se mais com o tratamento, confirmando a indicação do uso do GnRHa / Abstract: Introduction: Idiopathic central precocious puberty (ICPP) is a dysfunction characterized by signs of pubertal development in girls younger than eight years of age, with accelerated growth rate, compromising final height, due to premature activation of the hypothalamic-pituitary-gonadal (HPG) axis. Treatment with GnRH analogue in ICPP is directed towards obtaining less compromise of adult height and decreasing eventual psychological problems that may arise from early pubertal development. However there is no uniformity in response to therapy. Controversy exists as to which factors may influence response to treatment, achieving a greater gain in height. Objective: To evaluate factors determining the greatest gain in height following treatment with GnRH analogue. Subject and Methods: A retrospective cohort study was conducted involving 33 girls diagnosed with idiopathic central precocious puberty and treated with GnRHa in the Gynecologic Endocrinology Outpatient Facility of the CAISM/UNICAMP Obstetrics and Gynecology Department. Data collection was performed, undertaking chart review. The following independent variables were assessed: chronological age at the beginning of therapy, chronological age at the onset of symptoms, time elapsed since the appearance of pubertal characteristics and the beginning of treatment, bone age, bone age advance, duration of GnRHa treatment, actual height and z-score, predicted height and z-score at the beginning of treatment, hormone measurements (FSH, LH levels and FSH/LH ratio following GnRHa stimulation), which were correlated with gain in height as the dependent variable at treatment discontinuation, calculated by the difference between the predicted height at the end and beginning of treatment. For statistical analysis, Pearson¿s linear correlation was used, in addition to multiple linear regression analysis. Results: The mean age at the beginning of treatment was 7,8±1,3 years, with a mean bone age of 10,1±1,6 years. Bone age advanced 2,3±1,1 years and was controlled during the treatment period. Gain in predicted height was about 3cm with treatment. It was positively correlated with the delay in starting treatment and bone age advancement and was negatively correlated with the z-score of height at the beginning of treatment and with the predicted height at the beginning of treatment, and this was the main factor determining benefit from treatment. Conclusion: Girls with the most significantly compromised bone and shortest predicted height were those who received the greatest benefit from treatment, confirming the indication to use GnRHa in these cases / Mestrado / Tocoginecologia / Mestre em Tocoginecologia

Orientadores: Elizete Aparecida Lomazi Da-Costa-Pinto, Antonio de Azevedo Barros Filho / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-17T03:05:14Z (GMT). No. of bitstreams: 1 Tamega_IzildadasEiras_D.pdf: 2217221 bytes, checksum: e9d4c3645d56bdb073deb9ab2debb4f7 (MD5) Previous issue date: 2010 / Resumo: Desvios nutricionais e disfagia são comumente relatados nas avaliações de crianças com encefalopatia crônica não progressiva. Apesar da importância do diagnóstico precoce, da estimulação neuro-psico-motora, da prevenção de co-morbidades e acompanhamento nutricional, são escassos os trabalhos longitudinais que avaliaram o crescimento em lactentes de risco para ECNP. O objetivo geral deste estudo foi acompanhar, prospectivamente, o crescimento de lactentes com antecedentes de fatores de risco para ECNP e exame neurológico alterado (N= 132). Os pacientes foram examinados aos 6, 12, 18 e 24 meses de idade, enquanto atendidos em ambulatório universitário. Foram registradas situação sócio-demográfica, condições de vida e saúde e realizado exame neurológico e fonoaudiológico no 6º e 24º meses. O grupo controle incluiu lactentes saudáveis (N= 125) acompanhados em unidade básica de saúde e de mesmas características sócio-econômicas. Os objetivos específicos foram mensurar indicadores antropométricos: peso, comprimento, perímetro cefálico e compará-los com os dados do grupo controle; analisar no grupo caso os valores de circunferência braquial, prega tricipital e os respectivos escores Z; descrever: aspectos sócio-demográficos, hábitos e condições alimentares, condições de nascimento, internações, morbidades, sintomas gastrintestinais, terapias auxiliares, uso de medicamentos e cuidados maternos; identificar a prevalência de distúrbios da deglutição, constipação intestinal e de erros alimentares e investigar a existência de associação entre distúrbios de deglutição e alterações neurológicas. Na análise estatística foram utilizados os testes Qui quadrado e exato de Fisher, o teste de Mann-Whitney e de Kruskal-Wallis. Para comparar as medidas longitudinais entre os 2 grupos foi utilizada a análise de variância para medidas repetidas, seguida do teste de comparação múltipla de Tukey e o teste de perfil por contraste. Os fatores de risco mais frequentes foram os do período perinatal, observados em 121 crianças (92%), prematuridade ocorreu em cerca da metade dos casos e esteve associada a outros fatores de risco. Apenas 7 crianças foram amamentadas após os 6 meses e em 50% dos pacientes observou-se erros alimentares e duração prolongada da alimentação. Sintomas de RGE ocorreram em 44 casos (33%), constipação em 17 (13%) e ambos em 65 casos (49%); metade das crianças seguiu irregularmente as terapias auxiliares e 78% utilizava medicamentos antirefluxo e anticonvulsivos. O grau de acometimento nos resultados dos exames neurológico e fonoaudiológico apresentou correlação positiva aos 6 e 24 m. Ao nascimento, os valores de peso, comprimento e perímetro cefálico dos pacientes encefalopatas foram significativamente inferiores aos valores das crianças saudáveis. A partir do 12º mês, a diferença estatística não se manteve, embora, no grupo caso, os dados absolutos permanecessem inferiores. Esse grupo apresentou incremento positivo ao longo do tempo, nos escores Z da circunferência braquial e prega tricipital, indicando acúmulo da massa gordurosa. A gravidade da disfagia correlacionou-se a maior comprometimento antropométrico. No grupo caso, a comparação do crescimento entre nascidos a termo e prematuros mostrou valores significativamente inferiores para os prematuros. Concluindo, os lactentes com agravo neurológico apresentaram comprometimento antropométrico significativo ao nascimento e aos 6 meses, sendo que o antecedente de prematuridade esteve associado a efeito negativo significativo no crescimento dessas crianças / Abstract: Nutritional disorders and dysphagia are frequently reported in children with non progressive chronic encephalopathy (NPCE). Despite the importance of early diagnosis, neuro-psycho-motor stimulation, prevention of co-morbidities and need of nutritional advising, longitudinal studies including infants at risk for NPCE are scarce. The objective of this study was to prospectively follow growth in infants with risk factors for NPCE and with abnormal neurological examination (N=132). Children were seen from 6 to 24 months age, in a tertiary outpatient clinic. Anthropometric data, neurological condition and speechaudiology test were recorded at 6th and 24th months of life. Control group with the same socio-economic characteristics included healthy infants (N=125) followed in a primary care health center. Specific objectives were to record anthropometric indicators: weight, length, head circumference and respective Z scores and to compare them to the control group; to analyze case group values of arm circumference, triceps skin fold and respective Z scores; to describe socio-demographic aspects, habits and nutritional conditions, birth conditions, hospital admissions, co-morbidities, gastrointestinal symptoms and use of medications. Statistical analysis used chi-square, Fisher's exact, Mann-Whitney and Kruskal-Wallis tests. Analysis of variance for repeated measurements, followed by Tukey's multiple comparison test and the contrast profile test were used to compare longitudinal measurements between both groups. Most common risk factors were those occurred in perinatal period, observed in 121 children (92%), prematurity was seen in about half of cases and was associated with other risk factors. Only 7 children were breastfed after 6 months and feeding misinterpretation were seen in 50% of patients. Gastroesophageal reflux symptoms were referred in 44 infants (33%), constipation in 17 (13%) and both in 65 (49%). Adherence to therapies with speech-therapist or physiotherapist was irregular. Neurological severity was associated with dysphagia. Dysphagia severity was also associated with greater anthropometric impairment at 6th and 24th months. At birth, NPCE patient's weight, length and head circumference were significantly lower, but the statistical difference did not remain at 12th month, although with lower absolute values in the case group. The case group showed a positive increment in arm circumference and triceps skinfold Z scores throughout time, indicating accumulation of fat mass. The severity of dysphagia correlated with more severe anthropometric impairment. preterm newborns in case group showed significantly lower growth values when compared to term infants In conclusion, infants with NPCE presented significant anthropometric impairment at birth and at 6 months, and preterm infants were significantly smaller than term patients / Doutorado / Saude da Criança e do Adolescente / Doutor em Saude da Criança e do Adolescente

published_or_final_version / Dentistry / Master / Master of Dental Surgery

The problem of this study is that of comparing certain physical fitness and anthropometric measures for early adolescent Mexican-American and Anglo-American males. The purposes of the study are to determine if Mexican-American and Anglo-American males differ in physical fitness or anthropometric measures; to determine if the relationships between age and physical fitness, age and arthropometric measures, and anthropometric measures and physical fitness items are significantly different for Mexican-American and Anglo-American males; to compare the rate of maturation for pre-adolescent Mexican-American and Anglo-American males in physical fitness items and anthropometric measures.

The objectives of this study were to determine the nature of data recorded on the Road to Health Card (RtHC) and its utilisation by nurses at primary health care setting, comparing it with norms and standards on the RtHC guideline, and to provide guidelines for optimal utilisation of the RtHC by health workers. A quantitative nonexperimental descriptive method was used. Two methods were used to collect data; document analysis of the RtHC and structure observation of nurses. A structured exit interview of caregivers was conducted to validate observations from nurses. A sample size of 18 nurses from all categories from six clinics was observed, and 36 RtHC of children under five years of age were analysed. Results indicated that data recorded on the RtHC was mostly inaccurate, incomplete and not interpreted. The study identified a need to train health workers on optimal utilisation of the RtHC facilitating health improvement of children under five years of age. / Health Studies / M.A. (Health Studies)

The objectives of this study were to determine the nature of data recorded on the Road to Health Card (RtHC) and its utilisation by nurses at primary health care setting, comparing it with norms and standards on the RtHC guideline, and to provide guidelines for optimal utilisation of the RtHC by health workers. A quantitative nonexperimental descriptive method was used. Two methods were used to collect data; document analysis of the RtHC and structure observation of nurses. A structured exit interview of caregivers was conducted to validate observations from nurses. A sample size of 18 nurses from all categories from six clinics was observed, and 36 RtHC of children under five years of age were analysed. Results indicated that data recorded on the RtHC was mostly inaccurate, incomplete and not interpreted. The study identified a need to train health workers on optimal utilisation of the RtHC facilitating health improvement of children under five years of age. / Health Studies / M.A. (Health Studies)

Children less than five years of age are at a risk of growth failure worldwide. The South African National Food Consumption Survey (NFCS) of 1999 showed that 25.5% of children aged 1 - 3 years were stunted. Poor growth of young children in developing countries (South Africa included) has been associated with multiple micronutrient deficiencies because of the use of starchy plant-based complementary foods with little variety, especially among resource poor households. Dietary diversification through the use of crop and livestock production has been recommended as a strategy to improve the micronutrient intake and food security of households in resource poor settings. This study was a cross sectional secondary analysis of the South African NFCS of 1999 data, designed to investigate the impact of crop and livestock production on nutrient intake, dietary diversity, intake of selected food groups, hunger perceptions and anthropometric status of children aged 1 - 3 years in South Africa. Children from households producing crops only (n=211), crops and livestock (n=110), livestock only (n=93) and non-producers were compared at the national, in rural areas and among households with a total income of less than R12 000.00 per household per year. In rural areas and among households with a total income of less than R12 000.00 per household per year, children in the crops and livestock group had higher nutrient intakes for energy, vitamin 86, calcium and folate than the other groups (p<0.05), while the crops only group had higher nutrient intakes for vitamin A and vitamin C. The majority of children in all the four study groups had less than 67% of the RDAs for vitamin A, vitamin C, folate, calcium, iron and zinc. In addition , children in all the groups had a median dietary diversity score of four out of 13 food groups. In rural areas and among low income households, higher percentages (over 60%) of children in the crops only group consumed vegetables while the non-producers group was the lowest (47.7%). The non-producers group had the highest percentages of children consuming meat and meat products and the crops and livestock and livestock only groups had the lowest percentages. In both rural areas and among households withlow income, the majority of the households in all the study groups were experiencing hunger. In rural areas, one in five households were food secure. Crop and livestock production improved the nutrient intake and the intake of vegetables of children in rural and poor households. However, nutrient intakes were not adequate to meet the recommended nutrient levels. The high levels of food insecurity require support of these households to increase crop and livestock production and, integration of nutrition education to increase the consumption of the produced products. / Thesis (M.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2006.

Department of Nutrition / MSCPNT

Lo Wing-sze. / One booklet (14 p. : col. ill. ; 21 cm.) mounted on leaf 156. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (leaves 100-113). / Abstracts in English and Chinese; questionnaires also in Chinese. / Acknowledgements --- p.ii / Abstract --- p.iii / Abstract (Chinese Version) --- p.v / Publications / Table of Contents --- p.viii / List of Figures --- p.xiii / List of Tables --- p.xv / List of Abbreviations --- p.xviii / Chapter Chapter One: --- Introduction / Chapter 1.1 --- Childhood obesity trends and measurement in Hong Kong and Elsewhere in the recent decade --- p.1 / Chapter 1.2 --- Health consequences of childhood obesity --- p.3 / Chapter 1.3 --- Determinants of childhood obesity --- p.4 / Physical inactivity --- p.4 / High-fat diet --- p.5 / Chapter 1.4 --- Parental eating attitudes on family food environments --- p.6 / Home food purchasing and availability --- p.6 / Family meal frequency and location --- p.7 / Child feeding practices- the food and eating rules --- p.8 / Chapter 1.5 --- The relationship of socioeconomic status and obesity --- p.8 / The economic status of households in Hong Kong --- p.10 / Chapter 1.6 --- Targeting children aged three and four years --- p.12 / Chapter 1.7 --- Conceptual framework and study objectives --- p.13 / Chapter Chapter Two: --- Survey Design / Chapter 2.1 --- Sample design and subject recruitment --- p.15 / Chapter 2.2 --- Survey methods --- p.17 / Anthropometric measurement --- p.17 / Lifestyle questionnaire --- p.18 / Three-day 24-hour dietary intake recall --- p.20 / Chapter 2.3 --- Data management and analysis methods --- p.23 / Anthropometric measurements --- p.23 / Lifestyle questionnaire --- p.24 / Three-day 24-hour dietary intake recall --- p.24 / Socioeconomic status (SES) of the subjects (Households) --- p.25 / Chapter 2.4 --- Ethics --- p.25 / Chapter Chapter Three: --- Results / Chapter 3.1 --- Responses to various components of the survey --- p.26 / Chapter 3.2 --- Socioeconomic status and related characteristics of the households --- p.28 / Chapter 3.3 --- Characteristics of the preschooler and their carers --- p.34 / Preschooler s weight status --- p.34 / Preschooler s growth --- p.35 / Other characteristicsof the preschoolers --- p.37 / Chapter 3.4 --- Home food purchasing and its determinants --- p.40 / Chapter 3.5 --- Family meal frequency and location --- p.43 / Chapter 3.6 --- Preschoolers' meal preparation activities --- p.48 / Chapter 3.7 --- Food and eating rules and mealtime activities --- p.50 / Chapter 3.8 --- Child's sedentary activities patterns and parental perceptions --- p.53 / Chapter 3.9 --- "Parental perceptions of preschooler's height and weight, and eating habits" --- p.57 / Chapter 3.10 --- Nutrient intakes of the preschoolers --- p.59 / Chapter 3.11 --- Food consumption patterns of the preschoolers --- p.63 / Chapter 3.12 --- Meal and snack patterns of the preschoolers --- p.67 / Chapter 3.13 --- Main contribution of food sub-groups to energy and various nutrient intakes for preschoolers --- p.69 / Chapter 3.14 --- Intakes of energy and various nutrients from foods eaten at home and outside home --- p.72 / Chapter 3.15 --- "Associations of parental feeding practices, preschoolers' nutrient intakes and physical activity patterns with childhood overweight and obesity" --- p.75 / Parental feeding practices and attitudes toward healthy eating by preschoolers'weight status --- p.75 / Activity patterns of the preschoolers by weight status --- p.76 / Energy and various nutrient intakes of the preschoolers by weight status --- p.77 / Chapter Chapter Four: --- Discussion / Chapter 4.1 --- Childhood obesity rate by SES group --- p.80 / Chapter 4.2 --- Characteristics of the preschoolers and the households --- p.81 / Chapter 4.3 --- High SES families dined together less frequently than their low SES counterparts --- p.84 / Chapter 4.4 --- Preferences of family members as an influential factor in purchasing fruits and vegetables --- p.86 / Chapter 4.5 --- Encouraging healthy food shopping practices with the preschoolers --- p.87 / Chapter 4.6 --- Food and eating rules imposed by parents may influence preschooler's eating habits and nutrient intakes --- p.88 / Chapter 4.7 --- Preschooler's sedentary activities patterns --- p.89 / Chapter 4.8 --- Incorrect parental perceptions of preschooler's weight --- p.91 / Chapter 4.9 --- Nutrient intakes of the preschoolers overall --- p.91 / Chapter 4.10 --- Comparing the nutrient intakes of the preschoolers with another study carried out in 2000 --- p.93 / Chapter 4.11 --- Parental/preschooler association on fruit and vegetable consumption --- p.94 / Chapter 4.12 --- Main contributors of food sub-groups to energy and various nutrient intakes for the preschoolers by SES group --- p.95 / Chapter 4.13 --- "Differences in family food environments, feeding practices, eating habits and nutrient intakes of preschoolers by maternal education level and mother's employment status" --- p.95 / Chapter 4.14 --- Strengths and limitations of the study --- p.96 / Chapter Chapter Five: --- Conclusions and Recommendations --- p.99 / References --- p.100 / Appendices / Chapter A1 --- Invitation letter to principals (English version) --- p.114 / Chapter A2 --- Invitation letter to principals (Chinese version) --- p.117 / Chapter B --- Summary of the background information of the participating schools --- p.120 / Chapter C1 --- Consent form and letter to parent(s) or guardian(s) (English version) --- p.121 / Chapter C2 --- Consent form and letter to parent(s) or guardian(s) (Chinese version) --- p.123 / Chapter D --- Paper fans with food and physical activity pyramid pictures --- p.125 / Chapter E --- Health report --- p.126 / Chapter F1 --- Lifestyle questionnaire (English version) --- p.127 / Chapter F2 --- Lifestyle questionnaire (Chinese version) --- p.136 / Chapter G1 --- 24-hour dietary recall forms (English version) --- p.144 / Chapter G2 --- 24-hour dietary recall forms (Chinese version) --- p.150 / Chapter H --- Food photo booklet --- p.156 / Chapter I1 --- Table: Households receiving social benefits by paternal occupations (p<0.001) --- p.157 / Chapter I2 --- Table: Summaries some of the characteristics of the surveyed preschoolers by gender and altogether --- p.158 / Chapter I3a --- Table: Preschooler's parents' age --- p.159 / Chapter I3b --- Table: Parents age by SES --- p.159 / Chapter I4 --- Table: Factors considered by interviewee when buying food items --- p.160 / Chapter I5 --- Table: Cost as a factor of buying queried food items by SES income group --- p.161 / Chapter I6 --- Table: Frequencies of eating out or having takeaway meals in/from different types of caterers by SES group --- p.162 / Chapter I7 --- Type of utensils used to feed the preschoolers by SES group --- p.162 / Chapter I8 --- Preschoolers' activities during dinner by SES group --- p.163 / Chapter I9 --- "Proportion of interviewees with adequate fruit, vegetable, and both fruit and vegetable intakes per day by SES group" --- p.163