Neck circumference as a potential marker of metabolic syndrome among college students

OBJECTIVE:

to relate neck circumference with metabolic syndrome and its criteria among college students.

METHOD:

cross-sectional study conducted with 702 college students in Fortaleza, CE, Brazil from September 2010 to June 2011. Socio-demographic data, waist circumference and neck circumference were collected together with blood pressure, fasting blood sugar, triglyceride levels, and HDL-C.

RESULTS:

1.7% of the studied sample presented metabolic syndrome. Of these, 58.3% presented altered neck circumference (p<0.006). As neck circumference decreases, pressure levels improve (p<0.001). Additionally, college students with high fasting blood sugar (p=0.003) and high triglyceride levels (p<0.001) presented higher values of neck circumference.

CONCLUSION:

neck circumference is a potential predictive marker in the detection of metabolic syndrome and its components among college students.     

Prevalence and factors associated with sedentary behavior in adolescents

OBJECTIVE

To analyze the prevalence of sedentary behavior and associated factors in adolescents.

METHODS

A cross-sectional study with adolescents aged 10 to 17 years, of both sexes, belonging to a 1994-1999 birth cohort in the city of Cuiabá, MT, Central Western Brazil. Data were collected using a questionnaire containing sociodemographic, economic, lifestyle and anthropometric variables. Sedentary behavior was determined as using television and/or computer/video games for a time greater than or equal to 4 hours/day. Associations with sedentary behavior were evaluated using body mass index in childhood and adolescence and sociodemographic and behavioral variables using hierarchical logistic regression.

RESULTS

The overall prevalence of sedentary behavior was 58.1%. Of the 1,716 adolescents evaluated, 50.7% (n = 870) were male. In multivariate analysis, after adjustment for confounding factors, the variables that remained associated with sedentary behavior were: age (14 and over) (OR = 3.51, 95%CI 2.19;5.60); higher socioeconomic class (OR = 3.83, 95%CI 2.10;7.01), higher level of maternal education (OR = 1.81, 95%CI 1.09;3.01); living in the country (OR = 0.49, 95%CI 0.30;0.81); insufficient physical activity (OR = 1.25, 95%CI 1.02;1.53); experimentation with alcoholic beverages (OR = 1.34, 95%CI 1.08;1.66) and being overweight in adolescence (OR = 1.33, 95%CI 1.06;1.68).

CONCLUSIONS

The high proportion of adolescents in sedentary activities and the lack of association with being overweight in childhood, indicates the need for educational initiatives to reduce multiple risk behaviors. Encouraging physical activity in young people as a way of reducing sedentary behavior and, consequently, being overweight is fundamental.     

Music and 25% glucose pain relief for the premature infant: a randomized clinical trial

OBJECTIVE:

to analyze the total Premature Infant Pain Profile scores of premature infants undergoing arterial puncture during music and 25% glucose interventions, and to assess their association with neonatal and therapeutic variables.

METHOD:

a randomized clinical trial with 80 premature infants; 24 in the Experimental Group 1 (music), 33 in the Experimental Group 2 (music and 25% glucose), 23 in the Positive Control Group (25% glucose). All premature infants were videotaped and a lullaby was played for ten minutes before puncture in Experimental Groups 1 and 2; 25% glucose administered in Experimental Group 2 and the Positive Control Group two minutes before puncture.

RESULTS:

60.0% of premature infants had moderate or maximum pain; pain scores and intervention groups were not statistically significant. Statistically significant variables: Experimental Group 1: head and chest circumference, Apgar scores, corrected gestational age; Experimental Group 2: chest circumference, Apgar scores, oxygen therapy; Positive Control group: birth weight, head circumference.

CONCLUSION:

neonatal variables are associated with pain in premature infants. Brazilian Registry of Clinical Trials: UTN: U1111-1123-4821.     

Intimate partner violence and anxiety disorders in pregnancy: the importance of vocational training of the nursing staff in facing them

Objective:

to identify the relationship between posttraumatic stress disorder, trait and state anxiety, and intimate partner violence during pregnancy.

Method:

observational, cross-sectional study developed with 358 pregnant women. The Posttraumatic Stress Disorder Checklist - Civilian Version was used, as well as the State-Trait Anxiety Inventory and an adapted version of the instrument used in the World Health Organization Multi-country Study on Women''s Health and Domestic Violence.

Results:

after adjusting to the multiple logistic regression model, intimate partner violence, occurred during pregnancy, was associated with the indication of posttraumatic stress disorder. The adjusted multiple linear regression models showed that the victims of violence, in the current pregnancy, had higher symptom scores of trait and state anxiety than non-victims.

Conclusion:

recognizing the intimate partner violence as a clinically relevant and identifiable risk factor for the occurrence of anxiety disorders during pregnancy can be a first step in the prevention thereof.     

Women experiencing the intergenerationality of conjugal violence

Objective:

to analyze the family relationship, in childhood and adolescence, of women who experience conjugal violence.

Method:

qualitative study. Interviews were held with 19 women, who were experiencing conjugal violence, and who were resident in a community in Salvador, Bahia, Brazil. The project was approved by the Research Ethics Committee (N. 42/2011).

Results:

the data was organized using the Discourse of the Collective Subject, identifying the summary central ideas: they witnessed violence between their parents; they suffered repercussions from the violence between their parents: they were angry about the mother''s submission to her partner; and they reproduced the conjugal violence. The discourse showed that the women witnessed, in childhood and adolescence, violence between their parents, and were injured both physically and psychologically. As a result of the mother''s submission, feelings of anger arose in the children. However, in the adult phase of their own lives, they noticed that their conjugal life resembled that of their parents, reproducing the violence.

Conclusion:

investment is necessary in strategies designed to break inter-generational violence, and the health professionals are important in this process, as it is a phenomenon with repercussions in health. Because they work in the Family Health Strategy, which focuses on the prevention of harm and illness, health promotion and interdepartmentality, the nurses are essential in the process of preventing and confronting this phenomenon.     

Risk factors for Type 2 Diabetes Mellitus in college students: association with sociodemographic variables

Objective

identify the modifiable risk factors for type 2 diabetes mellitus in college students and associate these factors with their sociodemographic variables.

Method

cross-sectional study, involving 702 college students from Fortaleza-CE, Brazil. Sociodemographic, anthropometric, physical exercise data and blood pressure and fasting plasma glucose levels were collected.

Results

the most prevalent risk factor was sedentariness, followed by overweight, central obesity, high fasting plasma glucose and arterial hypertension. A statistically significant association was found between overweight and sex (p=0.000), age (p=0.004) and marital status (p=0.012), as well as between central obesity and age (p=0.018) and marital status (p=0.007) and between high fasting plasma glucose and sex (p=0.033).

Conclusion

distinct risk factors were present in the study population, particularly sedentariness and overweight.     

Analysis of the changes and difficulties arising from kidney transplantation: a qualitative study

OBJECTIVE:

to identify the main gains and stressors perceived by the patient, one year subsequent to kidney transplantation.

METHOD:

a qualitative study, in which the data were obtained and analyzed through the Discourse of the Collective Subject and frequency counting, with the participation of 50 patients who had received kidney transplantation.

RESULTS:

the sample presented a mean age of 44±12.8 years old, and a predominance of males (62%). The principal positive changes provided by the transplant were: return to activities; freedom/independence; well-being and health; strengthening of the I; and closening of interpersonal relationships. The most-cited stressors were: fear; medication; excess of care/control; specific characteristics of the treatment; and failure to return to the social roles.

CONCLUSION:

kidney transplantation caused various positive changes in the patient''s routine, with the return to activities of daily living being the most important gain, in the participants'' opinion. In relation to the stressors, fear related to loss of the graft, and questions relating to the immunosuppressive medication were the main challenges to be faced following transplantation.     

Adolescent hypertension identified with correct cuff and its cardiovascular and gestational problems after 29 years

Objective

to identify, in 2011, rates of hypertension, cardiovascular and gestational problems in subjects presenting high blood pressure in 1982, when correct cuff size was used, according to the American Heart Association Arm Circumference/Cuff Width ratio of 0.40.

Methods

high blood pressure was defined in 2011 as systolic = 115 mmHg and diastolic = 80mmHg, resulting in 20 subjects between 39 and 43 years old. (Risk Group). They were compared to 20 subjects from the original sample with lower blood pressure values (Control group).

Results

the rates of hypertension, cardiovascular and gestational problems were significantly higher (Fisher: p=0.02) in the Risk Group, with one case of cardiovascular death. Our findings arouse speculations about whether, if a proper cuff had been used in clinical practice, the complications and death could have been avoided.

Conclusions

data suggest compliance with the use of cuff width corresponding to 40% of arm circumference, despite polemics concerning cuff availability and difficulties of using many sizes.     

Gestational Weight Gain and Overweight in Children Aged 3–6 Years

Objective

To determine whether gestational weight gain (GWG) was associated with increased odds of childhood overweight after accounting for pre-pregnancy BMI.

Methods

In a prospective cohort study based on a premarital and perinatal health care system in China, data of 100 612 mother-child pairs were obtained. The main exposure was GWG as both a continuous and categorical variable. The outcome measure was overweight, defined by age- and sex-specific cutoff values for body mass index (BMI) in children aged 3–6 years.

Results

A 1-kg increase in maternal GWG was associated with an increase of 0.009 (95% confidence interval [CI]: 0.007–0.010, P < 0.001) in children’s mean BMI; in the subgroup of pre-pregnancy overweight/obese mothers, the increase in children’s BMI was 0.028 (95% CI, 0.017–0.039, P < 0.001). Excessive GWG played an important role in childhood overweight when adequate GWG was used as the reference, with an odds ratio (OR) of 1.21 (95% CI, 1.12–1.29). The risk was highest (OR 2.22; 95% CI, 1.79–2.76) in the children of mothers who were overweight/obese before pregnancy and gained excessive weight during pregnancy.

Conclusions

Greater maternal GWG was associated with greater offspring BMI, and the risk of overweight was doubled in children whose mothers were overweight/obese before pregnancy and gained excessive weight during pregnancy. As a result, maintenance of appropriate weight gain during pregnancy and prophylaxis of maternal overweight/obesity before pregnancy should be a strategy for preventing childhood overweight/obesity.Key words: cohort study, gestational weight gain, childhood overweight, birth weight, maternal pre-pregnancy BMI     

Peer Reviewed: Effect of Socioeconomic Status on Weight Change Patterns in Adolescents

Introduction

Although socioeconomic differences in prevalence of obesity are well documented, whether patterns of weight gain during key periods of growth and development differ among youth from different socioeconomic backgrounds is unknown. This study examines socioeconomic disparities in overweight status and 5-year weight gain among adolescents.

Methods

Project EAT (Eating Among Teens)-II followed a socioeconomically and ethnically diverse sample of 2,516 adolescents from 1999 through 2004. Mixed-model regression analyses examined longitudinal trends in overweight status as a function of socioeconomic status (SES).

Results

Girls and boys in the low-SES category were more likely to be overweight than were those in the high-SES category. Boys in the high-SES category showed a significant decrease (P = .006) in overweight prevalence between 1999 and 2004, whereas boys in the low- and middle-SES categories showed no significant change. Girls in the low-SES category showed a significant 5-year increase (P = .004) in overweight prevalence compared with a stable prevalence of overweight among girls in the middle- and high-SES categories.

Conclusion

Our data show continued and, in some cases, increasing socioeconomic disparities in risk for overweight. Youth from low-SES backgrounds are at increased risk for overweight and are more likely to remain overweight (boys) or become overweight (girls). Designing obesity prevention and treatment interventions that reach and address the unique needs of youth and families from less-advantaged socioeconomic backgrounds is a public health priority.     

Trends in Measures of Childhood Obesity in Korea From 1998 to 2012

Background

During the last several decades, the number of children who are overweight or obese has reached alarming levels worldwide. The purpose of the present study was to examine trends in measures of childhood obesity among Korean children aged 2–19 from 1998 to 2012.

Methods

Height, weight, and waist circumference (WC) were measured, and body mass index (BMI) was calculated. Age-adjusted means of WC and BMI were compared between years. We used three international criteria (International Obesity Task Force [IOTF], World Health Organization [WHO], United States Centers for Disease Control and Prevention [CDC]) and a Korean national reference standard (Korea Centers for Disease Control and Prevention [KCDC]) to calculate age-standardized prevalence of childhood overweight and obesity.

Results

Despite differences in absolute prevalence of childhood overweight and obesity according to the four different criteria, the time trends of prevalence were generally similar across criteria. The prevalence of childhood overweight and obesity generally stabilized from 2001–2012 in both boys and girls. WC decreased from 2001–2012 in both boys and girls aged 2–19.

Conclusions

Further studies exploring the factors causing plateaued trends of childhood obesity measures are needed to implement effective policies for reducing the prevalence of childhood overweight and obesity.Key words: body mass index, waist circumference, obesity, child, trends, Korea     

Diagnostic accuracy of the defining characteristics of the excessive fluid volume diagnosis in hemodialysis patients

Objective:

to evaluate the accuracy of the defining characteristics of the excess fluid volume nursing diagnosis of NANDA International, in patients undergoing hemodialysis.

Method:

this was a study of diagnostic accuracy, with a cross-sectional design, performed in two stages. The first, involving 100 patients from a dialysis clinic and a university hospital in northeastern Brazil, investigated the presence and absence of the defining characteristics of excess fluid volume. In the second step, these characteristics were evaluated by diagnostic nurses, who judged the presence or absence of the diagnosis. To analyze the measures of accuracy, sensitivity, specificity, and positive and negative predictive values were calculated. Approval was given by the Research Ethics Committee under authorization No. 148.428.

Results:

the most sensitive indicator was edema and most specific were pulmonary congestion, adventitious breath sounds and restlessness.

Conclusion:

the more accurate defining characteristics, considered valid for the diagnostic inference of excess fluid volume in patients undergoing hemodialysis were edema, pulmonary congestion, adventitious breath sounds and restlessness. Thus, in the presence of these, the nurse may safely assume the presence of the diagnosis studied.     

Peer Reviewed: Effect of a Multifaceted,Church-Based Wellness Program on Metabolic Syndrome in 41 Overweight or Obese Congregants

Introduction

A rise in obesity, poor-quality diets, and low physical activity has led to a dramatic increase in the number of Americans with metabolic syndrome and diabetes. Our objective was to determine the effect of a short-term, multifaceted wellness program carried out in a church setting on weight, metabolic syndrome, and self-reported wellness.

Methods

Forty-one overweight or obese adults in a church congregation provided fasting blood samples and answered a wellness questionnaire before and after completing an 8-week diet and exercise program. We also measured weight, body fat, body mass index, and waist and hip circumference.

Results

The intervention decreased weight, body fat, and central adiposity; improved indexes of metabolic syndrome; and increased self-reported wellness.

Conclusion

A multifaceted wellness intervention that emphasizes diet and exercise can rapidly influence weight, insulin resistance, metabolic syndrome, and self-reported wellness.     

High risk for obstructive sleep apnea in patients with acute myocardial infarction

Objectives:

to stratify the risk for obstructive sleep apnea in patients with acute myocardial infarction, treated at a public, tertiary, teaching hospital of the state of São Paulo, Brazil, and to identify related sociodemographic and clinical factors.

Method:

cross-sectional analytical study with 113 patients (mean age 59.57 years, 70.8% male). A specific questionnaire was used for the sociodemographic and clinical characterization and the Berlin Questionnaire for the stratification of the risk of obstructive sleep apnea syndrome.

Results:

the prevalence of high risk was 60.2% and the outcome of clinical worsening during hospitalization was more frequent among these patients. The factors related to high risk were body mass index over 30 kg/m2, arterial hypertension and waist circumference indicative of cardiovascular risk, while older age (60 years and over) constituted a protective factor.

Conclusion:

considering the high prevalence of obstructive sleep apnea and its relation to clinical worsening, it is suggested that nurses should monitor, in their clinical practice, people at high risk for this syndrome, guiding control measures of modifiable factors and aiming to prevent the associated complications, including worsening of cardiovascular diseases.     

Common mental disorders and intimate partner violence in pregnancy

OBJECTIVE

To investigate the association between common mental disorders and intimate partner violence during pregnancy.

METHODS

A cross sectional study was carried out with 1,120 pregnant women aged 18-49 years old, who were registered in the Family Health Program in the city of Recife, Northeastern Brazil, between 2005 and 2006. Common mental disorders were assessed using the Self-Reporting Questionnaire (SRQ-20). Intimate partner violence was defined as psychologically, physically and sexually abusive acts committed against women by their partners. Crude and adjusted odds ratios were estimated for the association studied utilizing logistic regression analysis.

RESULTS

The most common form of partner violence was psychological. The prevalence of common mental disorders was 71.0% among women who reported all form of violence in pregnancy and 33.8% among those who did not report intimate partner violence. Common mental disorders were associated with psychological violence (OR 2.49, 95%CI 1.8;3.5), even without physical or sexual violence. When psychological violence was combined with physical or sexual violence, the risk of common mental disorders was even higher (OR 3.45; 95%CI 2.3;5.2).

CONCLUSIONS

Being assaulted by someone with whom you are emotionally involved can trigger feelings of helplessness, low self-esteem and depression. The pregnancy probably increased women`s vulnerability to common mental disorders