Jornal de pediatria最新文献

{"title":"Bioelectrical impedance phase angle and nutritional status in children with intestinal failure on prolonged parenteral nutrition","authors":"","doi":"10.1016/j.jped.2023.12.006","DOIUrl":"10.1016/j.jped.2023.12.006","url":null,"abstract":"<div><h3>Objective</h3><p>To compare the phase angle (PhA) through bioelectrical impedance (BIA) of children with intestinal failure (IF) using prolonged parenteral nutrition (PN) followed by an Intestinal Rehabilitation Program, with a control group.</p></div><div><h3>Methods</h3><p>Children under 10 years of age with IF using prolonged PN for &gt;60 days (study group) were included. The control group consisted of healthy children without chronic pathologies, matched by sex and age. Anthropometric parameters evaluated were: weight, height, weight/age z-score (W/A), height/age z-score (H/A), BMI, BMI/A z-score, arm circumference, triceps skinfold, subscapular skinfold, mid-arm muscle circumference. BIA parameters were resistance (R), reactance (Xc), and phase angle (PhA).</p></div><div><h3>Results</h3><p>Twenty-eight children were included in the study group, median (IQR) age was 11 (8–27) months, 53.6 % were male. In the control group, 28 children were included, median (IQR) age was 12.5 (8–24.7) months, 50 % were male. Children from the study group had W/A z-scores and H/A z-scores significantly lower than controls. There was no significant difference between PhA in the study group and controls, [median (IQR) 4.3° (3.8;4.6) vs 4.0° (3.8;5.4) respectively, <em>p</em> = 0.980]. Prematurity was significantly higher in the study group than in the controls, but there was no significant correlation between gestational age at birth and PhA of the children from the study group.</p></div><div><h3>Conclusion</h3><p>Children with IF using prolonged PN showed lower W/A and H/A compared to the control group, but without significant difference between the PhA of children with IF compared to controls.</p></div>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0021755724000391/pdfft?md5=79a54a9966a5ab45454589feca8df9c2&pid=1-s2.0-S0021755724000391-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140770218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-fidelity simulation versus case-based discussion for training undergraduate medical students in pediatric emergencies: a quasi-experimental study","authors":"Nathalia Veiga Moliterno ,&nbsp;Vitor Barreto Paravidino ,&nbsp;Jaqueline Rodrigues Robaina ,&nbsp;Fernanda Lima-Setta ,&nbsp;Antônio José Ledo Alves da Cunha ,&nbsp;Arnaldo Prata-Barbosa ,&nbsp;Maria Clara de Magalhães-Barbosa","doi":"10.1016/j.jped.2024.03.007","DOIUrl":"10.1016/j.jped.2024.03.007","url":null,"abstract":"<div><h3>Objective</h3><p>To evaluate the effect of high-fidelity simulation of pediatric emergencies compared to case-based discussion on the development of self-confidence, theoretical knowledge, clinical reasoning, communication, attitude, and leadership in undergraduate medical students.</p></div><div><h3>Methods</h3><p>33 medical students were allocated to two teaching methods: high-fidelity simulation (HFS, <em>n</em> = 18) or case-based discussion (CBD, <em>n</em> = 15). Self-confidence and knowledge tests were applied before and after the interventions and the effect of HFS on both outcomes was estimated with mixed-effect models. An Objective Structured Clinical Examination activity was conducted after the interventions, while two independent raters used specific simulation checklists to assess clinical reasoning, communication, attitude, and leadership. The effect of HFS on these outcomes was estimated with linear and logistic regressions. The effect size was estimated with the Hedge's g.</p></div><div><h3>Results</h3><p>Both groups had an increase in self-confidence (HFS 59.1 × 93.6, <em>p</em> &lt; 0.001; CDB 50.5 × 88.2, <em>p</em> &lt; 0.001) and knowledge scores over time (HFS 45.1 × 63.2, <em>p</em> = 0.001; CDB 43.5 × 56.7, p-value &lt; 0.01), but no difference was observed between groups (group*time effect in the mixed effect models adjusted for the student ranking) for both tests (<em>p</em> = 0.6565 and <em>p</em> = 0.3331, respectively). The simulation checklist scores of the HFS group were higher than those of the CBD group, with large effect sizes in all domains (Hedges g 1.15 to 2.20).</p></div><div><h3>Conclusion</h3><p>HFS performed better than CBD in developing clinical reasoning, communication, attitude, and leadership in undergraduate medical students in pediatric emergency care, but no significant difference was observed in self-confidence and theoretical knowledge.</p></div>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S002175572400038X/pdfft?md5=55bfcb590e1dd5d6c5c69dced3307c21&pid=1-s2.0-S002175572400038X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140765701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Direct costs for outpatient excess body weight treatment in Brazilian children and adolescents attending a public children's hospital","authors":"Aline Denise Hanauer ,&nbsp;Zaíne Glaci Durte Corrêa ,&nbsp;Gleci Blazius ,&nbsp;Rodolfo Coelho Prates ,&nbsp;Marco Fabio Mastroeni","doi":"10.1016/j.jped.2024.03.005","DOIUrl":"10.1016/j.jped.2024.03.005","url":null,"abstract":"<div><h3>Objective</h3><p>To estimate the direct costs of treating excess body weight in children and adolescents attending a public children's hospital.</p></div><div><h3>Methods</h3><p>This study analyzed the costs of the disease within the Brazilian Unified Health System (SUS) for 2,221 patients with excess body weight using a microcosting approach. The costs included operational expenses, consultations, and laboratory and imaging tests obtained from medical records for the period from 2009 to 2019. Healthcare expenses were obtained from the Table of Procedures, Medications, Orthoses/Prostheses, and Special Materials of SUS and from the hospital's finance department.</p></div><div><h3>Results</h3><p>Medical consultations accounted for 50.6% (R$703,503.00) of the total cost (R$1,388,449.40) of treatment over the period investigated. The cost of treating excess body weight was 11.8 times higher for children aged 5–18 years compared to children aged 2–5 years over the same period. Additionally, the cost of treating obesity was approximately 4.0 and 6.3 times higher than the cost of treating overweight children aged 2–5 and 5–18 years, respectively.</p></div><div><h3>Conclusion</h3><p>The average annual cost of treating excess body weight was R$138,845.00. Weight status and age influenced the cost of treating this disease, with higher costs being observed for individuals with obesity and children over 5 years of age. Additionally, the important deficit in reimbursement by SUS and the small number of other health professionals highlight the need for restructuring this treatment model to ensure its effectiveness, including a substantial increase in government investment.</p></div>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0021755724000354/pdfft?md5=3df111d29a4b03c136e508bd10c79cb6&pid=1-s2.0-S0021755724000354-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140611350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical significance and different strategies for re-elevation of plasma EBV-DNA during treatment in pediatric EBV-associated hemophagocytic lymphohistiocytosis","authors":"","doi":"10.1016/j.jped.2024.03.006","DOIUrl":"10.1016/j.jped.2024.03.006","url":null,"abstract":"<div><h3>Objective</h3><p>Monitoring the disease status of Epstein–Barr virus (EBV)–related hemophagocytic lymphohistiocytosis (HLH) patients is crucial. This study aimed to investigate the different strategies and outcomes of patients with EBV-HLH and re-elevated EBV-DNA.</p></div><div><h3>Method</h3><p>A retrospective analysis was conducted on 20 patients diagnosed with EBV-HLH. Clinical features, laboratory tests, treatments, plasma EBV-DNA levels, and outcomes were assessed. Three cases were highlighted for detailed analysis.</p></div><div><h3>Results</h3><p>Nine of the 20 patients had a re-elevation of EBV-DNA during treatment, and 55.5 % (5/9) experienced relapses. Patients with persistently positive plasma EBV-DNA (<em>n</em> = 4) and those with re-elevated EBV-DNA after conversion (<em>n</em> = 9) showed a significantly higher relapse rate compared to those with persistently negative EBV-HLH (<em>n</em> = 7) (<em>p</em> &lt; 0.05). Among the highlighted cases, Case 1 exhibited plasma EBV-DNA re-elevation after four weeks of treatment without relapse, maintaining stability with the original treatment regimen, and eventually, his plasma EBV-DNA turned negative. In Case 2, plasma EBV-DNA was elevated again with a recurrence of HLH after L-DEP. Consequently, she underwent allogeneic hematopoietic stem cell transplantation and eventually achieved complete remission (CR) with negative plasma EBV-DNA. Case 3 experienced plasma EBV-DNA re-elevation after L-DEP but remained in CR, discontinuing chemotherapy without relapse.</p></div><div><h3>Conclusion</h3><p>The re-elevation of plasma EBV-DNA during EBV-HLH treatment poses challenges in determining disease status and treatment strategies. Optimal management decisions require a combination of the level of elevated EBV-DNA, the intensity of hyperinflammation, and the patient's immune function.</p></div>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0021755724000366/pdfft?md5=5a2c04ff71b7e6b5898a3f3f732bd68b&pid=1-s2.0-S0021755724000366-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140792398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vitamin D status in children","authors":"Roger Bouillon,&nbsp;Leen Antonio,&nbsp;Nick Narinx","doi":"10.1016/j.jped.2024.04.001","DOIUrl":"10.1016/j.jped.2024.04.001","url":null,"abstract":"","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0021755724000378/pdfft?md5=158eed5cabf0b92cab7ffba0930d79ea&pid=1-s2.0-S0021755724000378-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140783200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Key clinical predictors in the diagnosis of ovarian torsion in children","authors":"Sai Chen,&nbsp;Zhigang Gao,&nbsp;Yunzhong Qian,&nbsp;Qingjiang Chen","doi":"10.1016/j.jped.2024.01.006","DOIUrl":"10.1016/j.jped.2024.01.006","url":null,"abstract":"<div><h3>Objective</h3><p>Ovarian torsion (OT) represents a severe gynecological emergency in female pediatric patients, necessitating immediate surgical intervention to prevent ovarian ischemia and preserve fertility. Prompt diagnosis is, therefore, paramount. This retrospective study set out to assess the utility of combined clinical, ultrasound, and laboratory features in diagnosing OT.</p></div><div><h3>Methods</h3><p>The authors included 326 female pediatric patients aged under 14 years who underwent surgical confirmation of OT over a five-year period. Logistic regression analysis was employed to pinpoint factors linked with OT, and the authors compared clinical presentation, laboratory results, and ultrasound characteristics between patients with OT (OT group) and without OT (N-OT group). The authors conducted receiver operating characteristic (ROC) curve analysis to gauge the predictive capacity of the combined features.</p></div><div><h3>Results</h3><p>Among 326, OT was confirmed in 24.23 % (79 cases) of the patients. The OT group had a higher incidence of prenatal ovarian masses than the N-OT (22 cases versus 7 cases) (<em>p</em> &lt; 0.0001). Similarly, the authors observed significant differences in the presence of lower abdominal pain, suspected torsion on transabdominal ultrasound, and a high neutrophil-lymphocyte ratio (NLR &gt; 3) between the OT and non-OT groups (p ˂ 0.05). Furthermore, when these parameters were combined, the resulting area under the curve (AUC) was 0.868, demonstrating their potential utility in OT diagnosis.</p></div><div><h3>Conclusion</h3><p>This study demonstrates a prediction model integrating clinical, laboratory, and ultrasound findings that can support the preoperative diagnosis of ovarian torsion, thereby enhancing diagnostic precision and improving patient management. Future prospective studies should concentrate on developing clinical predictive models for OT in pediatric patients.</p></div>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0021755724000317/pdfft?md5=3c105c2a2dd33a9dd4f65b25f209667a&pid=1-s2.0-S0021755724000317-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140610997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Substance use and adolescent mental health during the COVID-19 pandemic in Brazil: a longitudinal approach","authors":"Rodrigo Garcia-Cerde,&nbsp;Gabriela A. Wagner,&nbsp;Juliana Y. Valente,&nbsp;Zila M. Sanchez","doi":"10.1016/j.jped.2024.01.005","DOIUrl":"10.1016/j.jped.2024.01.005","url":null,"abstract":"<div><h3>Objective</h3><p>To describe the changes in alcohol and drug use by Brazilian adolescents during the COVID-19 pandemic (April-August 2021), and to analyze the relationship between alcohol use changes and psychiatric symptomatology.</p></div><div><h3>Methods</h3><p>A secondary analysis with a longitudinal approach was performed with data from a cluster-randomized controlled trial, conducted in 73 public middle schools in three Brazilian cities, to evaluate the effectiveness of a drug use prevention program. The sample included 535 students (61% girls; <em>M</em>_age = 15.2 years). Data were collected pre-intervention (February-March 2019), after 9 months (November-December 2019), and after 26 months (April-August 2021), when the students were in their first year of high school. The authors analyzed drug use prevalence (alcohol, binge drinking, tobacco, inhalants, marijuana, cocaine, and crack) in a lifetime, past year, and past month periods, and the association between alcohol use change subsamples with psychiatric symptoms. Logistic regressions were adjusted by sex, age, socioeconomic status, city, and group (control and intervention).</p></div><div><h3>Results</h3><p>The present findings suggest that the COVID-19 pandemic led to a decrease in past-year substance use and in past-month substance use frequency, despite the gradually increased (but decelerating) prevalence of lifetime use. However, some adolescents initiated, maintained, or increased the frequency of their alcohol use. Mainly, they were more likely to present behavioral problems, as well as symptoms of inattentive hyperactivity, and peer and emotional problems.</p></div><div><h3>Conclusions</h3><p>Despite the extensive decline in substance use during the pandemic period, these results suggest an association between previous mental health conditions and behavioral risk factors, leading to increased alcohol consumption and behavioral disorders manifestations.</p></div>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0021755724000305/pdfft?md5=3708b360028a522ca50d1ac5558e49f2&pid=1-s2.0-S0021755724000305-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140617957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of parental stress on emotional and behavioral problems in offspring: a systematic review with meta-analysis.","authors":"L. H. Ribas, B. Montezano, Maria Nieves, Luiza B. Kampmann, Karen Jansen","doi":"10.1016/j.jped.2024.02.003","DOIUrl":"https://doi.org/10.1016/j.jped.2024.02.003","url":null,"abstract":"","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140782304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inborn errors of immunity and its clinical significance in children with lymphoma in China: a single-center study","authors":"Chao Yang ,&nbsp;Nan Li ,&nbsp;Meng Zhang ,&nbsp;Shuang Huang ,&nbsp;Ling Jin ,&nbsp;Shu-Guang Liu ,&nbsp;Chun-Ju Zhou ,&nbsp;Zhi-Gang Li ,&nbsp;Yan-Long Duan","doi":"10.1016/j.jped.2024.02.002","DOIUrl":"10.1016/j.jped.2024.02.002","url":null,"abstract":"<div><h3>Objective</h3><p>To investigate the incidence, clinical and genetic characteristics of pediatric lymphoma patients of China with inborn errors of immunity (IEI)-related gene mutations, which have not been fully studied.</p></div><div><h3>Method</h3><p>From Jan. 2020 to Mar. 2023, IEI-related genetic mutations were retrospectively explored in 108 children with lymphomas admitted to Beijing Children's Hospital by NGS. Genetic rule and clinical characteristics as well as treatment outcomes were compared between patients with or without IEI-related gene mutations.</p></div><div><h3>Results</h3><p>A total of 17 patients (15.7 %) harbored IEI-associated mutations, including 4 cases with X-linked lymphoproliferative syndrome (XLP), 3 cases had mutations in tumor necrosis factor receptor superfamily 13B (TNFRSF13B), 2 cases with Activated p110 syndrome (APDS). Patients with IEI all had alteration of immunocompetence with decreased levels of immunoglobulin and lymphocyte subsets. Recurrent infection existed in 41.2 % of patients. The 18-month event-free survival (EFS) and the overall response rate (ORR) of patients with IEI are significantly lower than those without IEI (33.86% vs. 73.26 %, <em>p</em> = 0.011; 52.94% vs. 87.91 %, <em>p</em> = 0.002, respectively). In addition, patients with IEI had a higher progression disease (PD) rate of 23.5 % than those without IEI of 4.4 % (<em>p</em> = 0.006).</p></div><div><h3>Conclusion</h3><p>The present study demonstrated that IEI-associated lymphomas were much more common than originally appreciated in pediatric lymphomas, and those were insensitive to treatment and more likely to progress or relapse. The genomic analysis and a thorough review of the medical history of IEI can be used to distinguish them from pediatric lymphomas without IEI, which are beneficial for the early diagnosis and direct intervention.</p></div>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0021755724000299/pdfft?md5=5cb41ba03c64fd541d0083b9ebd64523&pid=1-s2.0-S0021755724000299-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140318338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nutritional status and age at menarche in Amazonian students","authors":"Kettyuscia Coelho e Oliveira ,&nbsp;José Cardoso Neto ,&nbsp;Davi C. Aragon ,&nbsp;Sonir R. Antonini","doi":"10.1016/j.jped.2024.03.002","DOIUrl":"10.1016/j.jped.2024.03.002","url":null,"abstract":"<div><h3>Objectives</h3><p>Age at menarche (MA) is a proxy for biological maturation and a parameter of socioeconomic changes. Worldwide, anticipation of menarche is associated with nutritional transition and excess weight. The objective of this study was to evaluate the MA in Amazonian students and its association with nutritional status, ethnicity, and socioeconomic level.</p></div><div><h3>Methods</h3><p>Cross-sectional study with 1,017 students aged 6 to 17 living in the city of Manaus, Brazil. MA was analyzed by status quo and recall; its association with body mass index (BMI), race, socioeconomic status, and adult height was examined.</p></div><div><h3>Results</h3><p>559 (51.9%) participants had already experienced menarche. In 91.7%, menarche occurred between 10 and 14 years of age; the mean age at the onset of menarche was 11.9 years. Overweight (11.6 years) and obese (11.4 years) participants reached menarche earlier than those with normal weight (12 years) and lean (12.7 years) participants. The associations between MA and nutritional status showed that overweight and obesity are risk factors for the early occurrence of menarche. MA was not associated with socioeconomic status/parental education or race. However, excess weight was associated with earlier MA in all races and social classes. The adult height was slightly lower in girls with menarche before 12 years old (157.9 vs 159.4 cm).</p></div><div><h3>Conclusion</h3><p>Regardless of socioeconomic level or ethnicity, excess weight was associated with earlier menarche in Amazonian students.</p></div>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0021755724000263/pdfft?md5=62a474952cf3798d69e97b3b98955ead&pid=1-s2.0-S0021755724000263-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140206974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}