Nota: Estas diretrizes se prestam a informar e não a substituir o julgamento clínico do médico que, em última análise, deve determinar o tratamento apropriado para seus pacientes.

The scope of this study was to identify the characteristics of sexual abuse against children including the profiles of the victims and the perpetrators, and associated factors notified in a health service of reference with the database of the Brazilian Case Registry Database, in a city in the south of Brazil. Categorical variables are presented in prevalence with 95% confidence intervals. There were 489 notifications from 2008 to 2014 of confirmed or suspected child sexual abuse. The majority was related to female victims, but the repeated abuse was reported mainly with male victims. In most cases, the abuse took place at the victims' or perpetrators' homes and the main perpetrators of abuse were male and acquainted with the victims. Twelve victims have contracted sexually transmitted infections; pregnancies were six, five of them legally terminated. This study highlights that the child sexual abuse profiles were similar in almost all of Brazilian regions, showing that it is possible to have a coordinated national action to prevent this offence.

HIV-infected children and adolescents may be at risk for cardiovascular disease due to chronic inflammation and exacerbation of risk factors. The aim of this study was as follows: 1) compare cardiovascular risk factors, chronic inflammation, and carotid intima-media thickness (IMTc) between the HIV and control groups; 2) determine the association of HIV and antiretroviral (ART) regimens with cardiovascular risk factors, chronic inflammation, and IMTc; and 3) identify variables associated with elevated IMTc. Cross-sectional analysis of 130 children and adolescents, 8–15 years of age, divided into HIV-infected (n = 65) and healthy control (n = 65) participants. Body fat, blood pressure, glycemia, insulin, and glycated hemoglobin, total cholesterol and fractions (LDL-C and HDL-C), triglycerides, C-reactive protein (CRP), interleukin (IL)-6, tumor necrosis factor-alpha (TNF-α), and the IMTc were measured. The results showed HIV-infected children and adolescents had higher levels of glycemia (87.9 vs. 75.9 mg.dL−1, p< 0.001), LDL-c (94.7 vs. 79.5 mg.dL−1, p = 0.010), triglycerides (101.2 vs. 61.6 mg.dL−1, p< 0.001), CRP (1.6 vs. 1.0 mg.L−1, p = 0.007), IL-6 (1.42 vs. 0.01 pg.mL−1, p< 0.001), TNF-α (0.49 vs. 0.01 pg.mL−1, p< 0.001), mean IMTc (0.526 vs. 0.499 mm, p = 0.009), and lower HDL-c (53.7 vs. 69.4 mg.dL−1, p< 0.001) compared to controls. Systolic blood pressure (β = 0.006, p = 0.004) and TNF-α (β = −0.033, p = 0.029) accounted for 16% of IMTc variability in HIV-infected children and adolescents. In patients using protease inhibitors-based ART, male gender (β = −0.186, p = 0.008), trunk body fat (β = −0.011, p = 0.006), glucose (β = 0.005, p = 0.046), and IL-6 (β = 0.017, p = 0.039) accounted for 28% of IMTc variability. HIV-infected children and adolescents may be at risk for premature atherosclerosis due to chronic inflammation and dyslipidemia. Interventions with the potential to improve lipid profile, mitigate inflammation, and reduce cardiovascular risk are needed.

Background: Over the past three decades, the prevalence rate of overweight and obesity has increased in survivors with congenital heart disease, and little is known about the body composition and its association with clinical characteristics and lifestyle factors.Objectives: To evaluate excess total-body adiposity and central adiposity and, to describe associated factors.Methods: Cross-sectional study with children and adolescents who underwent procedure to treat congenital heart disease, from January to July 2017. Sociodemographic and clinical characteristics, and lifestyle factors (dietary intake, physical activity, and sedentary behavior) were assessed. Adiposity was assessed using air-displacement plethysmography and waist circumference. Factors associated with excess total-body adiposity and central adiposity were analyzed using logistic regression models. Results: Of 232 patients, 22.4% were identified with excess total-body adiposity and 24.6% with central adiposity. Significant factors positively associated with excess total-body adiposity were intake of added sugar and trans fatty acids, adjusted for confounding factors. Similarly, lifestyle factors were positively associated with central adiposity: intake of added sugar and trans fatty acids, sedentary behavior, and family history of obesity. Conclusions: Lifestyle factors were associated with excess total-body adiposity and central adiposity. Assessment of body composition and healthy-lifestyle counseling into outpatient care may be the key point to prevent obesity in children and adolescents with congenital heart disease.

Children and adolescents with HIV demonstrated lower aerobic fitness compared with the controls and the absence of HAART may increase peak VO impairment. Lower bouts of MVPA were also observed in HIV group despite the similar values of total MVPA of controls.

This study aimed to investigate if moderate to vigorous physical activity (MVPA) and aerobic fitness are associated with cardiovascular risk factors in HIV+ children and adolescents. Sixty-five children and adolescents (8 to 15 years) provided minutes of MVPA measured by accelerometers and peak oxygen uptake (peak VO) by breath-by-breath respiratory exchange. Cardiovascular risk factors were characterized by body fat, blood pressure, total cholesterol, HDL-c, LDL-c, triglycerides, glucose, insulin, C-reactive protein (CRP), interleukin (IL)-6, tumor necrosis factor-alpha (TNF-α) and carotid intima-media thickness. Results indicated that higher MVPA was associated with lower values of total (β =  -3.566) and trunk body fat (β = -3.495), total cholesterol (β = -0.112) and LDL-c (β = -0.830). Likewise, higher peak VO was associated with lower total (β = -0.629) and trunk body fat values (β = -0.592) and levels of CRP (β = -0.059). The physically active participants had lower total cholesterol (-24.4 mg.dL) and LDL-c (-20.1 mg.dL) compared to participants judged to be insufficiently active. Moreover, participants with satisfactory peak VO₂ showed lower total (-4.1%) and trunk (-4.3%) body fat, CRP (-2.3 mg.L), IL-6 (-2.4 pg.mL) and TNF-α (-1.0 pg.mL) compared to low peak VO peers. High levels of MVPA and aerobic fitness may prevent developing of cardiovascular risk factors in children and adolescents HIV+.

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