Undernutrition is one of the most important public health problems, affecting more than 900 million individuals around the World. It is responsible for the highest mortality rate in children and has long-lasting physiologic effects, including an increased susceptibility to fat accumulation mostly in the central region of the body, lower fat oxidation, lower resting and postprandial energy expenditure, insulin resistance in adulthood, hypertension, dyslipidaemia and a reduced capacity for manual work, among other impairments. Marked changes in the function of the autonomic nervous system have been described in undernourished experimental animals. Some of these effects seem to be epigenetic, passing on to the next generation. Undernutrition in children has been linked to poor mental development and school achievement as well as behavioural abnormalities. However, there is still a debate in the literature regarding whether some of these effects are permanent or reversible. Stunted children who had experienced catch-up growth had verbal vocabulary and quantitative test scores that did not differ from children who were not stunted. Children treated before 6 years of age in day-hospitals and who recovered in weight and height have normal body compositions, bone mineral densities and insulin production and sensitivity.

It is estimated that over 51 million people in Brazil live in slums, areas where a high prevalence of malnutrition is also found. In general, the population of 'slum dwellers' is growing at a faster rate than urban populations. This condition is associated with poor sanitation, unhealthy food habits, low birthweight, and stunting. Stunting is of particular concern as longitudinal and cross-sectional studies of stunted adolescents have shown a high susceptibility to gain central fat, lower fat oxidation, and lower resting and postprandial energy expenditure. In addition, higher blood pressure, higher plasma uric acid and impaired flow-mediated vascular dilation were all associated with a higher level of hypertension in low birthweight and stunted children. In particular, stunted boys and girls also showed lower insulin production by pancreatic beta cells. All these factors are linked with a higher risk of chronic diseases later in life. Among stunted adults, alterations in plasma lipids, glucose and insulin have also been reported. However, adequate nutritional recovery with linear catch-up growth, after treatment in nutritional rehabilitation centers, can moderate the alterations in body composition, bone density and insulin production.

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Objective: To determine the impact of transferring a pediatric population to mechanical ventilator dependency units (MVDUs) or to home mechanical ventilation (HMV) on bed availability in the pediatric intensive care unit (ICU).Methods: This is a longitudinal, retrospective study of hospitalized children who required prolonged mechanical ventilation at the MVDU located at the Hospital Auxiliar de Suzano, a secondary public hospital in São Paulo, Brazil. We calculated the number of days patients spent at MVDU and on HMV, and analyzed their survival rates with KaplanMeier estimator.Results: Forty-one patients were admitted to the MVDU in 7.3 years. Median length of stay in this unit was 239 days (interquartile range = 102-479). Of these patients, 22 came from the ICU, where their transfer made available 8,643 bed-days (a mean of 14 new patients per month). HMV of eight patients made 4,022 bed-days available in the hospital in 4 years (a mean of 12 new patients per month in the ICU). Survival rates of patients at home were not significantly different from those observed in hospitalized patients. Conclusion:A hospital unit for mechanical ventilator-dependent patients and HMV can improve bed availability in ICUs. Survival rates of patients who receive HMV are not significantly different from those of patients who remain hospitalized. J Pediatr (Rio J). 2011;87(2):138-144:Height, malnutrition, overweight, adolescent, poverty. ResumoObjetivos: Testar se os indivíduos com escores z de estatura para idade entre -2 e -1 apresentam maior porcentagem de gordura corporal e, portanto, não devem ser classificados como tendo estado nutricional normal. Métodos: Foram estudados 96 indivíduos (52 meninos e 44 meninas, 57% púberes). A composição corporal foi analisada por absortometria radiológica de dupla energia.Resultados: O percentual de gordura abdominal em meninas pré-púberes com baixa estatura foi maior (27,4%; p = 0,01) quando comparado ao grupo com estatura normal (20,6%). Diferenças semelhantes na gordura abdominal (%) foram observadas para as meninas e meninos púberes com baixa estatura e estatura normal (37,6 e 29,8%, p = 0,01; 24,6 e 15,7%, p = 0,01, respectivamente). Os percentuais de gordura corporal total das meninas pré-púberes e dos meninos púberes com baixa estatura foram superiores (29,9 e 24,5%, p = 0,03; 26,3 e 18,1%, p= 0,01, respectivamente) aos dos grupo com estatura normal. Os grupos com estatura normal apresentaram menor circunferência da cintura. Conclusão:Adolescentes com baixa estatura leve apresentam alterações na composição corporal, indicando aumento do risco para doenças metabólicas.J Pediatr (Rio J). 2011;87(2):138-144: Estatura, desnutrição, sobrepeso, adolescentes, pobreza.

Brazil has the second largest e-commerce market in the world. One model used in this sector is "collective buying", a feature of which is impulse sales. Consumer behavior can be influenced by several factors, two of which are addressed in this article: the individual impulsivity of consumers and strategies of mix marketing. Impulsive buying is characterized by an unplanned purchase, i.e. the need to acquire the product arises just before the purchase. Consumers respond differently to mixed strategies depending on their degree of impulsivity. Thus, this article aims to analyze the efficacy of different marketing mix strategies for impulsive and non-impulsive consumer purchasing behavior. 137 participants were given a questionnaire containing the Buying Impulsiveness scale from Rook and Fisher (1995), and statements about the marketing strategies used by collective buying sites. Through a regression analysis, three strategies were found to relate more to impulsivity: search for products from well-known brands, search for deals with big discounts and confidence in receiving the product. For e-commerce and researchers, this study elucidates which strategies, from the consumer's perspective, effectively persuade purchasing behavior.DOI: 10.5585/remark.v13i3.2646

We investigated if children with excess weight who submitted to two types of intervention at school for 16 months showed improvements in thyroid and glycemic function and food intake. Children (8–11 years) with a body mass index-for-age (BMI/A) of ≥1 Z score were divided into two groups: Treatment 1 (n = 73) involved motivation to adopt healthier lifestyle; Treatment 2 (n = 103) involved performing weekly nutritional education, motivational, and physical activities at school. A semi-quantitative food frequency questionnaire was used. The delta BMI/A were similar after 16 months; Treatment 1 showed higher decrease in thyroid-stimulating hormone (TSH; median (range)): −0.45 (−3.19 to 2.17) and 0.06 (−4.57 to 1.63) mIU/L, p = 0.001), FreeT3 (−0.46 (−2.92 to 1.54) and −0.15 (−2.46 to 1.38) pmol/L, p = 0.038), and FreeT4 −1.41 (−6.18 to 3.47) and −0.90 (−4.89 to 2.96) pmol/L, p = 0.018), followed by decrease in energy intake (7304 (6806 to 7840) and 8267 (7739 to 8832) kJ, Ptreatment = 0.439, Ptime <0.001, interaction group–time p < 0.001), macronutrients and sugar. A positive correlation between FreeT3 and BMI/A, and a negative correlation with FreeT4 and insulin were found at baseline (r 0.212, p < 0.01; r −0.155, p < 0.01, respectively) and follow-up (r 0.222, p < 0.01; r −0.221, p < 0.01). The decrease in overall diet and particularly sugar intake was accompanied by a greater reduction in TSH and FreeT3 in Treatment 1, demonstrating the impact of dietary intake on thyroid function.

Protein -energy malnutrition promotes adaptive hormonal changes that result in stunting. A previous study showed that stunted children had increased insulin sensitivity and diminished pancreatic b-cell function. The objectives of the present study were to analyse the glucose, insulin, homeostasis model assessment of insulin sensitivity (HOMA-S) and homeostasis model assessment of pancreatic b-cell function (HOMA-B) levels after nutritional recovery. The recovered group (n 62) consisted of malnourished children after treatment at a nutrition rehabilitation centre. At the beginning of treatment their age was 2·41 (SD 1·28) and 2·31 (SD 1·08) years, weight-for-age Z score 22·09 (SD 0·94) and 2 2·05 (SD 0·55) and height-for-age Z score 21·85 (SD 1·11) and 2 1·56 (SD 0·90), for boys and girls respectively. The control group consisted of well-nourished children without treatment (n 26). After treatment, boys of the recovered group gained 1·29 (SD 1·06) Z scores of height-for-age and 1·14 (SD 0·99) Z scores of weight-for-age, and girls, 1·12 (SD 0·91) and 1·21 (SD 0·74) Z scores respectively. No differences were found between control and recovered groups in insulin levels for boys (P¼0·704) and girls (P¼0·408), HOMA-B for boys (P¼0·451) and girls (P¼0·330), and HOMA-S (P¼ 0·765) for boys and girls (P¼ 0·456) respectively. The present study shows that the changes observed previously in glucose metabolism and insulin were reverted in children who received adequate treatment at nutritional rehabilitation centres and showed linear catch-up. Stunting: Nutritional recovery: Insulin sensitivity: Homeostasis model assessmentMalnutrition is still a public health problem of high prevalence in many parts of the world 1 , leading to stunting when it occurs chronically during childhood 2 . In developing countries, stunting is associated with intra-uterine and maternal malnutrition, inadequate quality or quantity of complementary foods during infancy, impaired absorption of nutrients caused by intestinal infections and parasites or a combination of these factors 3 .The long-term consequences of childhood malnutrition have been associated with metabolic changes that may contribute to the onset of non-communicable diseases 4 . Even though studies on the consequences of postnatal malnutrition are scarce, a study done by González-Barranco et al. 5 concluded that regardless of birth weight, malnutrition has adverse effects on insulin metabolism and glucose tolerance in young men.A series of studies in Brazil identified alterations in body composition associated with stunting among adolescents. Stunted girls living in slums were found to be more susceptible to weight-for-height gain when compared with a control group when consuming fat-rich diets, increasing the risk of developing obesity 6 . Martins et al. 7 in a prospective study of 11 -15-year-old adolescents observed that stunted girls gained less lean mass and had a significantly higher increase of fat mass at follow up. A recent study with the same adolescents found a lower concentr...

O objetivo desse artigo é investigar a relação entre o sistema de transferência da educação e a eficiência nos serviços de educação básica dos municípios paraibanos, usando com backgraud o flypaper effect. Para isso, foram utilizados modelos de dados em painel de uma amostra de 208 dos 223 municípios no período de 2009 a 2011. Foram coletados juntos ao Tribunal de Contas do Estado da Paraíba - TCE/PB, dados referentes às receitas originárias de transferências intergovernamentais, receitas próprias, e o índice de eficiência. Os resultados apontam que os municípios que têm, relativamente, receitas próprias maiores são municípios mais eficientes e os municípios que recebem mais recursos do que envia para o FUNDEB são menos eficientes. Esses resultados estão em consonância com a literatura sobre o federalismo, na qual prevê a aplicações de recursos de forma ineficiente devido ao efeito flypaper nas transferências não condicionais e sem contrapartida.