In order to investigate the relation between air pollution and child morbidity in São Paulo, a time‐series study was carried out. Daily records of hospital admissions for children under 13 years old were obtained at the Health State Secretary, covering 112 hospitals in the period from October 1992 to October 1993. Daily levels of PM10, ozone, SO2, CO and NO2 were obtained from the environmental state agency (CETESB), while both CETESB and the Institute of Astronomy and Geophysics (IAG) of the University of São Paulo provided daily measures of temperature and relative humidity. Daily counts of child respiratory admissions (RESP) were considered as the dependent variable of pollutants in regression models, controlled for months of the year, days of the week, weather factors, and the daily number of non respiratory admissions (NORESP). PM10 and ozone were the pollutants that exhibited the most robust association with RESP. The mean levels of PM10observed during the period of study (70 μg m−3) were associated with an increase of 12% in RESP. The association between air pollution and RESP was significant within a time lag between 1 to 7 days and was dose‐dependent. This result indicates that air pollution represents a significant pediatric health problem in São Paulo. Copyright © 1999 John Wiley & Sons, Ltd.

OBJECTIVE: To verify the prevalence of self-reported voice alteration among educators in crèches, and associated factors. METHODS:This was a cross-sectional observational study carried out in 2000, in eight crèches in the city of São Paulo at which actions within the Crèche Program were being developed. This program formed part of the health promotion activities of a speech therapy investigation laboratory. The data collection was done by means of a questionnaire that was filled out by 93 educators, with questions on sociodemographic characteristics, aspects of the organization and physical environment of the work, habitual voice utilization, history of illnesses, lifestyle and perceptions regarding voice alterations. Assessment of hearing perception was done on the participants' voices. The statistical analysis utilized proportions, central trend measurements, Chisquare test with Yates correction and multiple logistic regression analysis.

CONTEXT AND OBJECTIVE: When undergoing chemotherapy and/or radiotherapy, children with acute lymphocytic leukemia may present important nutritional disorders because of the gastrointestinal toxicity of most chemotherapy agents or the effects of radiation on the organism. These patients may also present changes in their serum concentrations of trace elements such as zinc and copper. The present study aimed to follow anthropometric parameters and serum levels of zinc and copper in a group of children under treatment for acute lymphocytic leukemia. DESIGN AND SETTING: Longitudinal study, at the Pediatric Section of Hospital das Clínicas, Ribeirão Preto, Brazil. METHODS: Forty-five children with acute lymphocytic leukemia were studied. Anthropometric parameters such as weight and height and the daily intakes and serum levels of copper and zinc were recorded at diagnosis and during the treatment. RESULTS: During the initial phase of the treatment, there was an increase in energy intake accompanied by weight gain. However, during the later phases of treatment there was a reduction in energy intake with accompanying weight loss. Decreased growth rate during treatment was more pronounced in children with high-risk acute lymphocytic leukemia, probably due to radiation therapy. Serum zinc levels remained basically unaltered during the treatment, whereas copper levels decreased dramatically with the beginning of treatment. CONCLUSIONS: The treatment given to children with acute lymphocytic leukemia has an important effect on their linear growth rate and nutritional status, and also on their serum copper levels.

Background: Brazil is undergoing nutritional transition and rates of obesity in preschool and school-aged children are increasing. Excess weight in the first years of life could predict excess weight in adulthood, making it essential to study risk factors in this population.Objective: Our goal was to investigate associations of parent feeding behaviors, as well as more distal familial influences including family SES and maternal and paternal weight, with BMI z-score in preschool and school-aged children in a Brazilian sample.Methods: Cross-sectional study. Data were collected in 14 Brazilian private schools. Parents of children aged 2–8 years (n = 1,071) completed a questionnaire assessing parent feeding behaviors, as well as sociodemographic and anthropometric information. Hierarchical linear regression models were fitted to investigate relationships between parent and child characteristics and child BMI z-score in preschool (2–5 years, n = 397) and school-aged (6–8 years, n = 618) children.Results: Final models indicated that higher maternal BMI and “restriction for weight control” were associated with higher child BMI z-score in both age groups (excessive weight, i.e., BMI ≥ +1 z-score, in preschoolers and school-aged children: 24.4 and 35.9%, respectively). In preschoolers only, “healthy eating guidance” and “pressure” were associated with lower child BMI z-score. For school-aged children, male sex, higher father BMI, and “restriction for health” were associated with higher child BMI z-score.Conclusions: Parent feeding behaviors and parent weight, as well as child sex, are associated with child BMI z-score, with evidence for differential relationships in preschool and school-aged children. Optimal obesity prevention and treatment strategies may differ by child age.

OBJECTIVE: To investigate the biological behavior of classical and atypical osteoblastomas in comparison to osteosarcomas. METHODS: Based on histological parameters, 30 osteoblastomas were subclassified as classical osteoblastomas (23/30) or atypical osteoblastoma (high cellularity, prominent blue osteoid, and epithelioid osteoblasts-7/30). Comparative immunohistochemical and clinical analysis was performed in 17 cases of patients with high-grade osteosarcoma. Formalin-fixed, paraffin-embedded archival tissue was immunostained for p53 and proliferation cell nuclear antigen. Tumors with positive p53 stain underwent molecular analyses for fragments of exon 10. RESULTS: The mean proliferating cell nuclear antigen indexes for classical osteoblastoma, atypical osteoblastoma, and osteosarcoma were 33%, 61%, and 79%, respectively. The atypical subgroup showed similar results to those of the osteosarcoma group (P < 0.001). p53 protein was detected in 4 (13%) osteoblastomas (3 of these were atypical osteoblastoma), and 4 osteosarcomas (23%) also showed p53 positivity. DNA mutation performed in p53-positive cases was confirmed in exon 10 in 2 atypical osteoblastomas (2/3), 1 classical osteoblastoma (1/1), and 1 osteosarcoma (1/4). Disease recurrence was correlated with p53 expression (P = 0.009), atypical subtype (P = 0.031), spiculated blue bone on histology (P = 0.018), and proliferating cell nuclear antigen labeling index ≥ 40 (P = 0.015). CONCLUSION: These results validate atypical osteoblastoma as an entity, with p53 and proliferation cell nuclear antigen immunoexpression closer to that of osteosarcoma than of classical osteoblastoma. Proliferating cell nuclear antigen labeling index and p53 may be useful predictors of recurrence.

ObjectiveTo determine the prevalence and severity of occlusal problems in populations at the ages of deciduous and permanent dentition and to carry out a meta-analysis to estimate the weighted odds ratio for occlusal problems comparing both groups. Methods Data of a probabilistic sample (n=985) of schoolchildren aged 5 and 12 from an epidemiological study in the municipality of São Paulo, Brazil, were analyzed using univariate logistic regression (MLR). Results of cross-sectional study data published in the last 70 years were examined in the meta-analysis. ResultsThe prevalence of occlusal problems increased from 49.0% (95% CI =47.4%-50.6%) in the deciduous dentition to 71.3% (95% CI =70.3%-72.3%) in the permanent dentition (p<0.001). Dentition was the only variable significantly associated to the severity of malocclusion (OR=1.87; 95% CI =1.43-2.45; p<0.001). The variables sex, type of school and ethnic group were not significant. The meta-analysis showed that a weighted OR of 1.95 (1.91; 1.98) when compared the second dentition period with deciduous and mixed dentition. ConclusionsIn planning oral health services, some activities are indicated to reduce the proportion of moderate/severe malocclusion to levels that are socially more acceptable and economically sustainable. (IC 95% =47,6) na dentição decídua para 71,3% (IC 95% =70,3) na dentição permanente (p<0,001). O tipo de dentição foi a única variável estatisticamente associada à presença de má oclusão moderada/severa (OR=1,87; IC 95% =1,45; p<0,001 Resumo Objetivo Analisar a prevalência e severidade de problemas oclusais em populações em idades relacionadas à dentição decídua e permanente, e efetuar uma meta-análise para estimar odds ratio ponderada para problemas oclusais comparando os dois grupos. Métodos

Objective: To investigate whether domestic violence during pregnancy is associated with unfavorable infant health outcomes, measured by low birth weight or prematurity. Methods:This was a prospective cohort study enrolling pregnant women whose prenatal care was provided by 10 basic health units in the city of Campinas, SP, Brazil, between 2004 and. A structured questionnaire was employed that had previously been validated for use in Brazil. Each mother attended a minimum of two and a maximum of three interviews during the prenatal and postnatal periods. Data were analyzed using descriptive statistics. Student's t test was used to compare means for birth weight and gestational age between mothers who had suffered domestic violence during the current pregnancy and those who had not. Logistic regression analysis was employed to identify factors associated with low birth weight or prematurity.Results: During the prenatal and postnatal periods, 89.1% (n = 1,229) of the pregnant women were followed up, 10.9% being lost to follow-up, basically due to changes of address. Mean birth weight was 3,233 g; mean gestational age was 38.56 weeks. A total of 13.8% of the infants had low birth weight or were premature. Conditions associated with risk of low birth weight or prematurity were: mothers who had previously given birth prematurely (p < 0.005), who smoked (p < 0.001), who delivered by caesarian (p < 0.001) and whose partners had a low educational level (p < 0.008). Conclusions:In this study, no statistically significant association was observed between domestic violence perpetrated by partners and low birth weight or prematurity.J Pediatr (Rio J). 2008;84(1):60-67: Cohort studies, low birth weight newborn infants, premature newborn infants, domestic violence and pregnancy.

Ice treatment is safe, and application times of 10 or 15 minutes are as beneficial as an application time of 20 minutes to relieve perineal pain.