Brazilian Adolescents Research Articles

Ultra-processed food consumption is related to screen time among Brazilian adolescents, adults, and older adults.

The aim of this study was to investigate the association between screen time and ultra-processed food consumption (UPF) across the lifespan. Data from the 2019 Brazilian National Health Survey, a cross-sectional and population-based study, was used. UPF consumption was evaluated using a score, calculated by summing the positive answers to questions about the consumption of 10 UPF subgroups on previous day. Scores ≥5 represented high UPF consumption. Daily time spent engaging with television or other screens was self-reported. Crude and adjusted models were obtained through Poisson regression and results were expressed in prevalence ratios by age group. The sample included 2,315 adolescents, 65,803 adults, and 22,728 older adults. Prevalence of UPF scores ≥5 was higher according to increased screen time, with dose-response across all age groups and types of screen time. Adolescents, adults, and older adults watching TV for ≥6 hours/day presented prevalence of UPF scores ≥5 1.8 (95% CI 1.2-2.9), 1.9 (95% CI 1.6-2.3) and 2.2 (95% CI 1.4-3.6) times higher, respectively, compared to those who did not watch TV. For other screens, prevalence of UPF scores ≥5 was 2.4 (95% CI 1.3-4.1) and 1.6 (95% CI 1.4-1.9) times higher for adolescents and adults using screens for ≥6 hours/day, respectively, while for older adults only screen times of 2-<3 and 3-<6 hours were significantly associated with UPF scores ≥5. Screen time was associated with high consumption of UPF in all age groups. Considering these associations when planning and implementing interventions would be beneficial for public health across the lifespan.

Functioning profile and related impairments of children and adolescents with cerebral palsy - PartiCipa Brazil preliminary results.

Limited information is available about functioning and related impairments of children and adolescents with Cerebral Palsy (CP) in low- and middle-income countries (LMIC) like Brazil. The aim of this study is to describe the characteristics, functioning, and impairments of Brazilian children and adolescents with CP. Cross-sectional preliminary study as part of the PartiCipa Brazil multicentered cohort study. Families of children and adolescents with CP from Brazil, 4 months to 15 years, were enrolled. They responded to an online survey with questions about their child's health condition, impairments, contextual factors, and functioning according to the Gross Motor Function Classification System (GMFCS) and the Manual Ability Classification System (MACS). Data were described as frequencies, percentages, means, and standard deviations, according to age bands. Of the 404 participants (6.5±3.6 years) enrolled in this preliminary analysis, 54.7% are male, 90.4% under 12 years of age, 77.7% have bilateral CP, 49% in GMFCS levels IV and V, and 50.7% in MACS levels II and V. Most participants are from Southeast (63.4%) and Centre-west (19.5%) of Brazil. Regarding the impairments and functioning limitations: 1 in 2 did not talk; 1 in 2 has epilepsy; 2 of 5 reports pain, 1 of 4 has visual impairments, 3 out of 5 did not feed themselves, 1 out of 20 has a hearing impairment and 1 of 4 did not go to school. This first preliminar Brazilian study shows a high prevalence of children at MACS levels II and V and GMFCS levels IV and V, representing almost half of the group, indicating more impairments and limitations than children/adolescents from high-income countries. This study provides a preliminary deeper understanding of the key impairments and limitations in activities among children and adolescents with CP from various Brazilian regions.

Calcium plus vitamin D supplementation during pregnancy has no impact on postpartum transient longitudinal changes in hip geometry in adolescent mothers: a secondary analysis of a randomised controlled trial.

We have previously demonstrated that calcium plus vitamin D supplementation during adolescent pregnancy reduces the magnitude of transient postpartum bone mass loss. In the present post hoc analysis, we further investigated the effect of calcium plus vitamin D supplementation during pregnancy in hip geometry throughout one year postpartum in Brazilian adolescents with low daily calcium intake (∼600 mg/d). Pregnant adolescents (14-19 years) were randomly assigned to receive calcium (600 mg/d) plus vitamin D3 (200 μg/d) or a placebo from 26 weeks of gestation until parturition. Dual-energy X-ray absorptiometry images were obtained at 5 (n 30 and 26 for calcium plus vitamin D and placebo, respectively), 20 (n 26 and 21) and 56 (n 18 and 12) weeks postpartum, and hip geometry parameters were analysed by Advanced Hip Assessment software. The effects of the intervention, time point and their interaction were assessed using repeated-measures mixed-effects models. No significant intervention effects or intervention × time interactions were observed on hip geometry parameters (P > 0·05). Time effects were observed in cross-sectional area, cross-sectional moment of inertia and section modulus parameters with decreases from the 5th to the 20th week postpartum followed by recovery from the 20th to the 56th week (P < 0·05). Our findings indicate that the postpartum period is associated with transient changes in the hip geometry of lactating adolescent mothers, regardless of the low calcium intake and the supplementation offered during pregnancy, suggesting that a physiological adaptation of these adolescents to low calcium intake is at play.

Reduced rank regression dietary patterns and dyslipidemia in Brazilian adolescents: results from the Study of Cardiovascular Risk in Adolescents (ERICA).

Evidence on the harmful effects of diet on serum lipids in adolescence has not been consistent. The present study sought to establish which dietary patterns are associated with biomarkers of dyslipidemia. Data from 36,217 Brazilian adolescents participating in the Study of Cardiovascular Risk in Adolescents were evaluated. Dietary patterns were identified using the reduced rank regression analysis. Linear regression models were applied to verify the association between dietary pattern scores and the biomarkers of dyslipidemia. The two first dietary patterns identified by reduced rank regression (RRR-DP1 and RRR-DP2) were kept for further analysis. The RRR-DP1 was highly and positively loaded for sweets and red meat and negatively loaded for beans, fruits, vegetables, and rice. The RRR-DP2 was positively loaded for beans and rice and negatively loaded for sugar-sweetened beverages, fruit juices, and sweets. Linear regression models estimated that one standard deviation (SD) increase in the RRR-DP1 score was only associated with a mean increase of 0.29 mg/dL in HDL-cholesterol (95% CI 0.06;0.53), while one SD increase in the RRR-DP2 score was associated with the lower mean of triglycerides (β = -2.24, 95% CI -3.57;-0.91), LDL-c (β = -0.82 95% CI -1.53;-0.12), and total cholesterol (β = -1.30 95% CI -1.94;-0.65). Higher adherence to the dietary patterns positively loaded for red meat and sweets was associated with increased HDL-c levels, while adherence to a more Brazilian traditional dietary pattern (RRR-DP2) was associated with a better lipids profile.

Prevalence of social jetlag and associated factors in Brazilian adolescents: Results from a country-wide cross-sectional study

ObjectivesSocial jetlag is a disturbance in the circadian rhythm caused by a desynchronization between an individual's biological rhythm and social commitments and responsibilities. It leads to sleep debt during the week and compensation on weekends. Social jetlag is associated with an increased risk of chronic diseases and cognitive dysfunction in adolescents. This study aims to assess the prevalence of social jetlag and associated factors in Brazilian adolescents. MethodsAdolescents of both sexes, aged between 12 and 17years, participating in the Study of Cardiovascular Risks in Adolescents (ERICA), were included. The sleep duration on a typical weekday and weekend day was collected through a self-reported questionnaire. The occurrence of social jetlag was defined as the difference between the midpoint of sleep on weekends and weekdays, with differences equal to or higher than 1hour considered as an indicator of positive social jetlag. Factors associated with the prevalence of social jetlag were investigated using Poisson regression models. ResultsThe sample included a total of 64,029 adolescents. Social jetlag affects more than 80% of Brazilian adolescents, with higher prevalence among girls in the age group of 16-17years, with white skin color, attending private schools, and those having morning classes. Additionally, unhealthy risk behaviors such as skipping breakfast, alcohol consumption, and increased screen time are associated with a higher prevalence of social jetlag. ConclusionThe prevalence of social jetlag was high in Brazilian adolescents, and, among its associated factors, studying in the morning shift and engaging in unhealthy risk behaviors stand out.

Evaluation of the Psychometric Properties of the Digital Health Literacy Instrument (DHLI-BrA) for Use in Brazilian Adolescents

Evaluation of the Psychometric Properties of the Digital Health Literacy Instrument (DHLI-BrA) for Use in Brazilian Adolescents

Accelerometer-Derived Sleep Metrics in Adolescents Reveal Shared Genetic Influences with Obesity and Stress in a Brazilian Birth Cohort Study.

We aimed to test the association between sleep-related polygenic scores (PGSs) and accelerometer-based sleep metrics among Brazilian adolescents, and to evaluate potential mechanisms underlying the association through the enrichment of obesity, and cortisol pathway-specific polygenic scores (PRSet). Utilizing data from The 2004 Pelotas (Brazil) Birth Cohort, sleep time window and sleep efficiency were measured at the 11-year-old follow-up using ActiGraph accelerometers. Three sleep-PGSs were developed based on the most recent genome-wide association study (GWAS) of accelerometer-based sleep measures. PRSet, calculated using variants linked to body mass index (BMI) and plasmatic cortisol concentration, aimed to assess pleiotropic effects. Linear regression models, adjusted for sex and the first 10 principal components of ancestry, were employed to explore the impact of sleep-PGS and specific-PRSet on sleep phenotypes. The number of nocturnal sleep episodes-PGS was positively associated with sleep time window (β =2.306, SE: 0.92, p=0.011). Nocturnal sleep episodes were also associated with sleep time window when restricted to BMI-PRSet (β=2.682, SE: 0.912, competitive-p=0.003). Both number of sleep episodes and sleep time window cortisol-PRSets were associated (β=0.002, SE: 0.001, p=0.013; β=0.003, SE: 0.001, p=0.003, respectively) and exhibited enrichment in molecular pathways (competitive-p=0.011; competitive-p=0.003, respectively) with sleep efficiency. Sleep polygenetic components observed in European adults may partially explain accelerometer-based sleep time window in Brazilian adolescents. Specific BMI molecular pathway strengthened the association between sleep-PGS and sleep time window, while cortisol concentration pathway had a significant impact on the genetic liability for sleep efficiency. Our results suggest genetic overlap as a potential etiological pathway for sleep-related comorbidities, emphasizing common genetic mechanisms.

The attributions of public policies in the educational system for the prevention of sexual violence against children and adolescents

Sexual violence against children and adolescents is a problem whose scars can last a lifetime. In this sense, the general objective of the research is to analyze the attributions of public policies in the educational system for the prevention of sexual violence against children and adolescents based on the existing guidelines in the BNCC regarding sexuality in schools. With this overall purpose, specific objectives were developed in the subdivisions of the research work: to verify the right to education for children and adolescents in Brazil; to contextualize how the BNCC addresses the theme of sexuality in schools and to demonstrate the role of the educational system in promoting rights to confront sexual violence against children and adolescents. The research question guiding the study is: given the existing guidelines in the BNCC (National Common Curricular Base) regarding sexuality in schools, what are the attributions of public policies in the educational system for the prevention of sexual violence against children and adolescents? The deductive approach is used as the method of analysis, with the monographic procedure as the method of investigation, while the bibliographic technique is employed for research. It is evident that the educational system, through schools, acts as an important instrument for public policies to confront various violations of rights occurring during childhood.

A nationwide longitudinal investigation on the role of prenatal exposure to infectious diseases on the onset of chronic conditions in children and adolescents in Brazil.

In utero exposure to infections might set the stage for a chain of events leading to a wide spectrum of long-term health outcomes observed in children and adolescents. This proposal aims to investigate whether syphilis, zika, dengue and chikungunya during pregnancy can increase the risk of the offspring developing a non-infectious chronic condition during childhood and adolescence. 1) Estimate the risk of non-infectious chronic conditions associated to syphilis, zika, dengue and chikungunya during pregnancy and when appropriate, explore if the risk varies by timing during pregnancy when the infection is acquired (first, second or third trimester) and severity (such as severe or mild dengue); 2) Investigate whether in uterus exposure to maternal infection affects the growth pattern of children and adolescents; 3) Examine the extent to which the relationship between maternal infection and non-infectious chronic outcomes are mediated by intrauterine growth restriction and preterm birth. We will compare health outcomes and growth trajectories of children and adolescents born to mothers with and without specific infections during pregnancy using conventional multivariable regression in the whole study population, in a within sibship design, using the subgroup of offspring with at least one sibling who is not exposed to the infection, and negative control outcome. Then we will decompose the direct and mediated effects (by preterm birth and small for gestational age) of maternal infection on chronic disorders. The results from this study will advance our understanding of the relationship between infections during pregnancy and chronic disorders, with widespread implications enabling targeting of critical points along the path from in utero exposure to outcomes to avoid or mitigate illness and disability over the life course.

Association between molar incisor hypomineralisation and tooth agenesis: a cross-sectional study in Brazilian children and adolescents.

The aim of the present was to assess the association between MIH and tooth agenesis (TA) in orthodontic patients from the Federal University of Rio Grande do Norte, Natal, Brazil. A cross-sectional study was performed to evaluate the presence of MIH and TA in a sample of 371 pretreatment orthodontic records from patients aged 9-18years. Statistical analyses were performed using the Chi-square and Fisher's exact tests, and logistic regressions. There was a statistically significant association between the prevalence of tooth agenesis and MIH. A higher percentage of third molar agenesis, maxillary premolar agenesis, and mandibular second premolar agenesis was observed among children with MIH-affected teeth. Patients with MIH had a 2.43 times greater chance of third molar agenesis, and a 5.88 times higher likelihood of mandibular premolar agenesis. There is a weak association between MIH and TA. Furthermore, the presence of hypomineralised molars increases the risk of tooth agenesis.

Affect heuristics and peer effect on substance use among adolescents in Brazil

Significant changes are observed during adolescence with respect to health-related habits and risky behaviors. Among the behavioral changes, the consumption of substances such as alcoholic beverages, cigarettes, and illicit drugs, and social interactions are relevant factors for the intake of such substances. This study aims to analyze the relationship between the joint decisions of substance use by adolescents and their peers from the perspective of the affect heuristics. To this end, a multivariate probit model was estimated, based on microdata from the 2019 National School Health Survey. The results showed that substance use by adolescents was positively related to substance use by their peers; therefore, having friends who consume alcohol, illicit drugs, and cigarettes or having parents who consume alcohol or cigarettes increases the likelihood of an adolescent consuming these substances. The study also identified that the substance consumption decision was governed by an unobserved common factor compatible with the affect heuristic.

7669 Higher Serum Uric Acid Levels Are Associated With a Deleterious Metabolic and Inflammatory Profile in Brazilian Adolescents: An Exploratory Cross-Sectional Analysis

Abstract Disclosure: F.Q. Iorra: None. M.P. Guahnon: None. P.G. Rodrigues: None. A.T. Barcelos: None. F.V. Cureau: None. M. Drehmer: None. B.D. Schaan: None. Introduction: The association of high serum uric acid (sUA) with metabolic syndrome (MetS) and its components have been widely studied, but there are still gaps in how this breakdown product of purine metabolism might refine cardiovascular risk assessment and correlate with other cardiovascular disease biomarkers, especially in children and adolescents. Objective: To evaluate if sUA is associated with metabolic syndrome components and inflammatory markers in Brazilian adolescents. Methods: For this cross-sectional study, 786 individuals aged 12 to 17 years old, previously enrolled in the Study of Cardiovascular Risk in Adolescents (ERICA) - a Brazilian nationwide school based study, and who were from the city of Porto Alegre, had their sUA measured from blood samples that were stored in a biorepository. Anthropometric, biochemical and blood pressure data were collected. MetS diagnosis was based on the International Diabetes Federation age-specific criteria (2005), and insulin resistance was assessed by the HOMA-IR. In accordance with a non-parametric distribution, sUA was divided into quartiles (3.7 mg/dL, 4.4 mg/dL, 5.3 mg/dL for the 25th, 50th, and 75th percentiles, respectively) for the analysis. A linear regression model and a Poisson regression model with robust error variance were used, both adjusted for age, sex and skin color. Results: Participants were 14.8 ± 1.5 years-old, predominantly women (61.7%), self-identified as white skin color (72%) and eutrophic (66.9%). Through the linear regression model, significant positive associations were found between high sUA levels and body mass index Z-score, waist circumference, systolic and diastolic blood pressure, total cholesterol, triglycerides, HOMA-IR and C-reactive protein, and significant negative associations were observed for HDL cholesterol and adiponectin. No association was found between sUA and glucose or HbA1c. We also computed a metabolic risk score as the mean Z score of waist circumference, systolic blood pressure, HDL cholesterol (negative Z score), triglycerides and glucose, which was positive related to sUA (β ± SE = 0.13 ± 0.02; p &amp;lt; 0.001). Finally, the Poisson regression model was applied to estimate the prevalence ratios (PR) for MetS and its components, between adolescents with sUA in the 4th quartile to those in the 1st quartile. An association was observed for MetS (PR 6.37, 95% CI 1.39 - 29.21, p 0.017), high waist circumference (PR 4.61, 95% CI 2.55 - 8.36, p &amp;lt; 0.001) and increased triglycerides (PR 4.76, 95% CI 1.47 - 15.44, p 0.009). Conclusion: High sUA levels were associated with a worse metabolic and inflammatory profile, as well as a greater prevalence of MetS and some of its components in adolescents. Therefore, uric acid should be considered as a potential additional marker of cardiovascular risk in this population. Support: CNPq, CAPES, FIPE, FAPERGS. Presentation: 6/1/2024

9193 Higher Serum Uric Acid Levels Are Associated With a Deleterious Metabolic and Inflammatory Profile in Brazilian Adolescents: An Exploratory Cross-Sectional Analysis

Abstract Disclosure: F.Q. Iorra: None. M.P. Guahnon: None. P.G. Rodrigues: None. A.T. Barcelos: None. F.V. Cureau: None. M. Drehmer: None. B.D. Schaan: None. Introduction: The association of high serum uric acid (sUA) with metabolic syndrome (MetS) and its components have been widely studied, but there are still gaps in how this breakdown product of purine metabolism might refine cardiovascular risk assessment and correlate with other cardiovascular disease biomarkers, especially in children and adolescents. Objective: To evaluate if sUA is associated with metabolic syndrome components and inflammatory markers in Brazilian adolescents. Methods: For this cross-sectional study, 786 individuals aged 12 to 17 years old, previously enrolled in the Study of Cardiovascular Risk in Adolescents (ERICA) - a Brazilian nationwide school based study, and who were from the city of Porto Alegre, had their sUA measured from blood samples that were stored in a biorepository. Anthropometric, biochemical and blood pressure data were collected. MetS diagnosis was based on the International Diabetes Federation age-specific criteria (2005), and insulin resistance was assessed by the HOMA-IR. In accordance with a non-parametric distribution, sUA was divided into quartiles (3.7 mg/dL, 4.4 mg/dL, 5.3 mg/dL for the 25th, 50th, and 75th percentiles, respectively) for the analysis. A linear regression model and a Poisson regression model with robust error variance were used, both adjusted for age, sex and skin color. Results: Participants were 14.8 ± 1.5 years-old, predominantly women (61.7%), self-identified as white skin color (72%) and eutrophic (66.9%). Through the linear regression model, significant positive associations were found between high sUA levels and body mass index Z-score, waist circumference, systolic and diastolic blood pressure, total cholesterol, triglycerides, HOMA-IR and C-reactive protein, and significant negative associations were observed for HDL cholesterol and adiponectin. No association was found between sUA and glucose or HbA1c. We also computed a metabolic risk score as the mean Z score of waist circumference, systolic blood pressure, HDL cholesterol (negative Z score), triglycerides and glucose, which was positive related to sUA (β ± SE = 0.13 ± 0.02; p &amp;lt; 0.001). Finally, the Poisson regression model was applied to estimate the prevalence ratios (PR) for MetS and its components, between adolescents with sUA in the 4th quartile to those in the 1st quartile. An association was observed for MetS (PR 6.37, 95% CI 1.39 - 29.21, p 0.017), high waist circumference (PR 4.61, 95% CI 2.55 - 8.36, p &amp;lt; 0.001) and increased triglycerides (PR 4.76, 95% CI 1.47 - 15.44, p 0.009). Conclusion: High sUA levels were associated with a worse metabolic and inflammatory profile, as well as a greater prevalence of MetS and some of its components in adolescents. Therefore, uric acid should be considered as a potential additional marker of cardiovascular risk in this population. Support: CNPq, CAPES, FIPE, FAPERGS. Presentation: 6/1/2024

Joint associations of sports participation and smartphone screen time with anxiety among school adolescents

To investigate the joint association of sports participation and smartphone screen time (ST) with anxiety symptoms in school adolescents. This cross-sectional study included 142 Brazilian high school adolescents from a federal public school. Anxiety symptoms were assessed using the Screen for Child Anxiety Related Disorders, with a cutoff point of ≥ 30. Sports participation was measured using the Habitual Physical Activity Questionnaire for Adolescents, classifying participants as sports participation or non-sports participation. ST was measured using the digital well-being function of the smartphone, categorizing participants into low ST and high ST based on the median. Participants were distributed into four groups: sports participation + low ST, sports participation + high ST, non-sports participation + low ST, and non-sports participation + high ST (reference group). Analysis was performed using Poisson regression with robust variance to calculate prevalence ratio (PR) and 95% confidence intervals (CI) for anxiety among groups. The prevalence of anxiety was 41.5% (95% CI 33.6, 50.0). The sports participation + low ST group exhibited a lower prevalence of anxiety compared to the reference group (PR 0.52; 95% CI 0.28, 0.94; p = 0.031). The other groups showed no significant association with the reference group (p &gt; 0.05). In conclusion, sports participation associated with low smartphone ST is related to a lower prevalence of anxiety symptoms in school adolescents. Keywords: Sports. Exercise. Sedentary time. Mental health. Adolescence.

Pediatrics ACES and related life event screener (PEARLS): translation, transcultural adaptation, and validation to Brazilian Portuguese

ObjectiveAdverse Childhood Experiences (ACEs) have been associated with negative health outcomes. Screening for ACEs is crucial for improving health results, however, there is a shortage of standardized tools designed for children in Brazilian Portuguese. This study aimed to translate, culturally adapt, and validate the Pediatrics ACES and Related Life Event Screener (PEARLS) for use in Brazil. MethodThe study followed a methodological design for cross-cultural adaptation and psychometric evaluation. The PEARLS was translated and culturally adapted following a methodology that includes translation, synthesis, expert committee evaluation, target audience evaluation, and back-translation. After adaptation, a pilot cross-sectional study was conducted at a Multidisciplinary Health Care Clinical Center and a General Hospital-Reference Center for Child and Adolescent Care to assess the instrument's internal consistency, convergent validity, content validity and test-retest reliability. ResultsThe PEARLS-Br versions for Children, Teens, and Teen Self-Report were developed and subjected to pilot testing with 202 subjects. Participants demonstrated excellent comprehension, with Verbal Rating Scale median scores of 4 (IQR 4–5). Internal consistency was high, with Cronbach's alpha coefficients ranging from 0.78 to 0.81. Content validity, assessed by Kappa, indicated slight to almost perfect agreement across constructs. Test-retest reliability, assessed by Spearman's correlation coefficient, ranged from 0.89 to 0.94. ConclusionsPEARLS-BR (Child, teen, and teen self-report versions) were successfully translated, culturally adapted, and validated for assessing ACEs in Brazilian children and adolescents. This tool fills a crucial gap in ACE assessment in the Brazilian context, aligning with global recommendations for screening ACEs to improve overall health outcomes.

Courage Measure (CM) – Cross-Cultural Adaptation and Psychometric Properties for Brazilian Adolescents

Abstract: The objective of the study was to adapt the Courage Scale and estimate validity evidence based on content and internal structure. The study included 510 young people, between 14 and 19 years old. The results of the content validity coefficient suggested the adequacy of the content. Confirmatory factor analysis (CFA) was used to test three factor models, namely one-factor, two-factor, and the random intercept model. The results indicated that it is possible to measure courage through a factor, when the acquiescent response style is controlled, corroborating the theoretical perspective, given that the random intercept model adjusted well to the sample data. In other words, the findings indicate that the scale is capable of measuring courage in the Brazilian context and that acquiescence control is an important method in evaluating the construct.

Patterns of Alcohol Access Among Brazilian Adolescents: A Latent Class Analysis

Patterns of Alcohol Access Among Brazilian Adolescents: A Latent Class Analysis

Internet addiction, sleeping habits and psychological distress in Brazilian adolescents and young adults.

The internet is widespread in modern society and has raised concerns about excessive usage and its consequences for different aging groups. This study explores the relationships between internet addiction, sleep patterns, and psychological distress in adolescents and young adults. In order to assess this phenomenon, an exploratory cross-sectional study was conducted in southern Brazil from October to December 2023. A questionnaire, administered via Google Forms, collected data from 618 participants aged 15-36. The participants consisted of a non-probabilistic community sample selected based on convenience criteria. Instruments included a sociodemographic questionnaire, the Internet Addiction Test, Depression, Anxiety, and Stress Scale, and Social Media Engagement Questionnaire. It was categorized 48.1% as having moderate internet addiction, and classified 0.8% as having severe internet addiction. Correlation analysis revealed positive associations between internet addiction and depression, anxiety, and stress. Logistic regression identified internet addiction and overall psychological distress as predictors of sleep difficulties, along with unemployment status. The findings highlight the detrimental impact of excessive internet use on sleep quality and mental health. The bidirectional relationship between internet addiction and psychological distress underscores the complex interplay between these variables. This study underscores the urgent need for interventions targeting internet addiction and its associated consequences in adolescents and young adults. Addressing internet addiction levels and promoting healthy internet usage habits are crucial steps in mitigating the adverse effects on mental health and sleep quality. There is a need for targeted interventions, protocols, and preventive measures to mitigate the adverse effects of excessive internet use on mental health and sleep quality. Public health strategies should include IA and its consequences in health programs with multidisciplinary approaches and protocols for treatments for behavioral addictions. The study emphasizes the multifaceted nature of internet addiction and its implications for mental health and sleep patterns.

A Population-Based Epidemiologic Study of Symptomatic SARS-CoV-2 Infections and Fatalities in Brazilian Children over 3 Years

To provide a comprehensive overview of the epidemiologic characteristics, outcomes, and risk factors of COVID-19-related deaths in children and adolescents in Brazil. We conducted a population-based, retrospective cohort study that included all patients aged <18years with laboratory-confirmed, symptomatic SARS-CoV-2 infection as registered in official Brazilian national surveillance systems for COVID-19 between February 2020 and February 2023. The primary outcome was COVID-19-related deaths. Odds ratios (ORs) of risk factors associated with death were estimated using multivariable logistic regression. Over a 3-year period, 2855704 pediatric patients with symptomatic SARS-CoV-2 infection were registered in Brazil. Of these, 59179 (2.1%) were hospitalized, 13844 (0.48%) were admitted to the intensive care unit, and 4943 (0.17%) received mechanical ventilation. A total of 4740 (0.17%) patients had fatal outcomes. The case fatality rate increased to 7.9% among patients who required hospitalization; 2102 (44.3%) patients who died did not receive advanced critical support. Notably, 2 (65%, 95% CI 58-71) or 3 doses (86%, 95% CI 81-89) of the vaccine provided strong protection against death. The following adjusted covariates were significantly associated with increased odds of death: age (0-4 and 11-17years), ethnicity (Brown and Indigenous), region (Northeast or North), dyspnea, nosocomial infection, and comorbidities. Conversely, living in the South or Central-West regions, admission in the later period of the pandemic, and receiving a vaccine were all associated with protection against death. Our findings suggest that a complex interplay between individual factors and social inequities has shaped the impact of COVID-19 on Brazilian children and adolescents.

Cardiovascular health of Brazilian adolescents within the framework of Life's Essential 8: Findings from the ERICA study

The Life's Essential 8 (LE8) is an official cardiovascular health (CVH) assessment tool, however, its use remains limited within the adolescent population. We aim to describe the prevalence of CVH in Brazilian adolescents using the LE8 framework and to analyze its distribution considering sociodemographic factors. The sample comprised 36,956 adolescents aged 12 to 17years, who participated in the Study of Cardiovascular Risks in Adolescents, a nationwide, cross-sectional, school-based study. CVH was assessed by the LE8 score (0-100 points), comprising eight metrics categorized into two domains: health behaviors (diet, physical activity, nicotine exposure, and sleep) and health factors (body mass index, non-HDL cholesterol, blood glucose, and blood pressure). Sociodemographic factors were sex, age, type of school, skin color, and region of residence. The results were expressed as means with 95% confidence intervals (95% CI). The overall average score was 75.8 points (95% CI: 75.3-76.3), classified as moderate CVH. The general score was higher among males (76.8; 95% CI: 76.6-77.7) and younger adolescents (12-14years old) (78.5; 95% CI: 77.7-79.4). The health factors had a higher mean than behavioral factors (87.6, 95% CI: 87.3-87.9 vs. 64.0, 95% CI: 63.3-64.7). The best score was blood glucose (94.7; 95% CI: 94.2-95.2), while the diet score was the lowest (48.5; 95% CI: 46.3-50.6). The CVH of Brazilian adolescents is classified as moderate and varied according to sociodemographic characteristics. Intervention actions should prioritize behavioral factors to improve the LE8 score and consequently prevent cardiovascular events in adulthood.