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except for asthma&#44; which was also observed in the South&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Asthma is characterized by a history of respiratory symptoms such as wheezing&#44; shortness of breath&#44; tightness in the chest&#44; and coughing&#44; which vary in time and intensity&#44; together with variable limitation of expiratory airflow&#46; Children with asthmatic respiratory symptoms have impaired lung function and&#44; therefore&#44; may be more susceptible to environmental factors&#44; as well as being at increased risk of declining lung function in adulthood&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> According to the Global Initiative for Asthma &#40;GINA&#41;&#44; asthma should be classified as well controlled&#44; partially controlled&#44; or uncontrolled&#44; based on symptom assessment&#46; Thus&#44; a patient with controlled asthma should be free of diurnal symptoms&#44; nocturnal awakenings&#44; need for rescue medication&#44; and the limitations in daily activities and the practice of physical activities&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Chronic diseases often significantly interfere with quality of life&#46; However&#44; individual characteristics and different lifestyles make the disease impact diverse&#59; it often does not correlate with the severity or prognosis of the disease itself&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Comparative studies of physical activity levels between young asthmatic and non-asthmatic individuals do not show similar results&#46; However&#44; higher levels of activity are associated with a higher rate of asthma reports or associated symptoms&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The practice of physical activity by asthmatic individuals&#44; when performed with adequate intensity and duration&#44; improves the physical capacity and decreases dyspnea&#46; Moreover&#44; it may result in improved medication administration and use&#44; reducing the severity of exercise-induced bronchospasm&#44; with a consequent improvement in the quality of life&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Another factor related to asthma is school performance&#44; whereupon many children with asthma miss school due to the asthma crises&#44; impairing their educational achievement&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Similarly&#44; activities that involve social interaction with peers&#44; such as games that require physical effort&#44; also tend to be avoided by children with asthma&#44; and depending on how teachers address the limitations of asthmatics&#44; they may feel socially excluded&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> In this context&#44; the present study investigated the prevalence and impact of asthma in schoolchildren from the municipality of Caxias do Sul&#47;RS&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">The present study comprised two phases&#58; the first was an observational descriptive &#40;cross-sectional&#41; study and the second one was an observational analytical &#40;case-control&#41; study&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">This study included children and adolescents regularly enrolled in elementary schools of the Municipal Education Network of Caxias do Sul-RS&#46; The inclusion criteria were defined as follows&#58; schoolchildren aged 7&#8211;16 years of both genders&#44; with an asthma diagnosis &#40;cases&#41;&#44; and without an asthma diagnosis and previously healthy &#40;controls&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Schoolchildren with cognitive or motor limitations&#44; or with other chronic diseases that could impair the assessment of asthma or quality of life&#44; were excluded&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">In study Phase I&#44; in which the objective was to investigate the prevalence of asthma and to characterize the sample economically&#44; parents or guardians answered the standard written questionnaire &#40;WQ&#41;&#44; which corresponds to the first part of the written questionnaire of the International Study of Asthma and Allergies in Childhood &#40;ISAAC&#41;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> and the economic classification questionnaire&#44; which used the Brazilian Economic Classification Criteria &#40;<span class="elsevierStyleItalic">Crit&#233;rio de Classifica&#231;&#227;o Econ&#244;mica do Brasil</span> &#91;CCEB&#93;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">In study Phase II&#44; in which the objective was to investigate the impact of asthma&#44; the following tools were used&#58; to evaluate health-related quality of life&#44; the KINDL &#40;<span class="elsevierStyleItalic">Kinder Lebensqualit&#228;t Fragebogen</span>&#41; QL-Generic Questionnaire was applied&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> The questionnaire consists of 24 questions covering six quality of life dimensions&#58; physical well-being&#44; emotional well-being&#44; self-esteem&#44; family&#44; friends&#44; and school routine&#46; Complementing the measurement of the quality of life data&#44; children&#47;adolescents diagnosed with asthma answered a specific questionnaire about asthma-related quality of life&#46; The KINDL QL-Specific Questionnaire&#44; validated in Brazil&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> consists of 15 questions regarding the disease&#44; directed towards the patients&#8217; quality of life in the week preceding the interview&#46; The Asthma Control Test &#40;ACT&#41; questionnaires were used to investigate asthma control&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In the evaluation of pulmonary function&#44; the technical procedures and the acceptability and reproducibility criteria for performing pulmonary function tests followed the guidelines of the American Thoracic Society&#47;European Respiratory Society &#40;ATS&#47;ERS&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> A KoKo&#174; spirometer &#40;nSpire Health&#44; Inc&#59; KoKo&#174;&#44; CO&#44; USA&#41; was used with its own software&#46; The assessments were carried out in the field by two researchers trained and capable of carrying out the measurements&#46; The values found in the Brazilian Consensus of Spirometry were used as references for the percentage of the predicted values in liters&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The children answered the Physical Activity Questionnaire for Children &#40;PAQ-C&#41; and the adolescents&#44; the Physical Activity Questionnaire for Adolescents &#40;PAQ-A&#41;&#44; which identify the level of physical activity&#46; The tool investigates moderate and intense physical activities in the seven days prior to completing it&#46; This questionnaire consists of nine questions about the practice of sports and games&#44; physical activities at school&#44; and leisure&#46; Each question has a score ranging from 1 &#40;did not practice activity&#41; to 5 &#40;practiced every day of the week&#41; and the final score is the mean of the questions&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">As for the anthropometric measures&#44; the procedures were as follows&#58; body mass was obtained using a digital scale &#40;G-Tech&#44; Glass 1 FW &#8211; Rio de Janeiro&#44; Brazil&#41;&#44; with an accuracy of 100<span class="elsevierStyleHsp" style=""></span>g&#59; height was measured using a portable stadiometer &#40;AlturaExata&#44; TBW &#8211; S&#227;o Paulo&#44; Brazil&#41;&#44; with a precision of 1<span class="elsevierStyleHsp" style=""></span>mm&#59; for waist circumference&#44; a measurement tape was utilized&#44; measuring the mid-point between the lower rib and the iliac crest&#46; Based on these measurements&#44; the body mass index &#40;BMI&#41; was calculated by dividing body mass &#40;kg&#41; by height<span class="elsevierStyleSup">2</span> &#40;m&#41;&#44; and the classification was made according to the percentile for age&#44; considering the reference distribution of the Centers for Disease Control and Prevention &#40;CDC&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> The waist-to-height ratio was obtained by dividing waist circumference &#40;cm&#41; by height measurement &#40;cm&#41;&#46; A waist&#47;height ratio value &#8804;0&#46;50 was used as a cutoff point for low coronary risk&#44; whereas values &#8805;0&#46;51 were used for high risk&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">When evaluating school performance&#44; the School Performance Test &#40;Teste de Desempenho Escolar &#91;TDE&#93;&#41;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> was used&#44; which is a tool that aims to provide an objective assessment of the essential abilities for school performance&#44; specifically regarding writing&#44; arithmetic&#44; and reading&#46; It indicates&#44; in a comprehensive way&#44; which areas of school learning are preserved or impaired in the patient&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">In the descriptive analysis&#44; the categorical data were shown as absolute and relative frequencies&#44; and the continuous variables as means and standard deviations&#46; The Shapiro-Wilk test was applied to test for normality&#46; In the inferential analysis&#44; the continuous variables were analyzed by the Mann&#8211;Whitney test and the categorical variables by the chi-squared test&#46; All analyses were performed using the SPSS program &#40;SPSS Statistics for Windows&#44; Version 20&#46;0&#46; NY&#44; USA&#41;&#46; The differences were considered significant for <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The study was approved by the research ethics committee of the Universidade de Caxias do Sul &#40;UCS&#41;&#44; under opinion No&#46; 1&#44;453&#44;525&#46; The parents&#47;guardians signed the informed consent the children and adolescents signed the informed assent&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0080" class="elsevierStylePara elsevierViewall">Phase I of the study involved 1915 schoolchildren and Phase II&#44; 554 &#40;266 asthmatics and 288 controls&#41;&#46; The adherence rate was 83&#37; &#40;1915&#47;2307&#41;&#44; with an asthma prevalence rate estimated at 16&#46;1&#37; &#40;309&#47;1915&#41;&#44; according to the criteria established by the ISAAC protocol&#44; in which 920 &#40;48&#37;&#41; schoolchildren had a wheezing episode&#44; 700 &#40;36&#46;6&#37;&#41; had a confirmed medical diagnosis of asthma sometime during their lifetime&#44; and 372 had a wheezing episode in the previous 12 months &#40;19&#46;4&#37;&#41;&#46; Moreover&#44; 444 &#40;23&#46;2&#37;&#41; schoolchildren reported having used medication for the disease at least once in the previous twelve months&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Of the 1915 schoolchildren evaluated at this stage&#44; 953 &#40;49&#46;8&#37;&#41; were males&#44; with a mean age of 10&#46;77<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;55 years&#46; For the purpose of economic classification and level of schooling of the parents&#47;guardians&#44; 1833 &#40;95&#46;7&#37;&#41; belonged to classes B and C&#44; and 852 &#40;44&#46;5&#37;&#41; had finished high school&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">When comparing the groups &#40;asthmatics and controls&#41;&#44; the results showed significantly higher results among the asthmatics for the variables age &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;041&#41;&#44; rates of preterm birth &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; and diagnosis of another chronic disease at birth &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; as shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">In study Phase II&#44; 554 &#40;28&#46;9&#37;&#41; of the eligible students were included in the study&#44; of whom 266 &#40;48&#37;&#41; were asthmatics and 283 &#40;51&#46;1&#37;&#41; were males&#44; with a mean age of 10&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;4 years &#40;10&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;3 for asthmatics and 10&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;4 for controls&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;264&#41;&#46; Of the 262 asthmatics who answered the disease control questionnaire&#44; 129 &#40;49&#46;2&#37;&#41; reported having controlled disease and 133 &#40;50&#46;8&#37;&#41;&#44; uncontrolled disease&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Regarding pulmonary function &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#44; there were significant differences between the groups regarding forced expiratory volume in the first second &#40;FEV<span class="elsevierStyleInf">1</span>&#41;&#44; forced vital capacity &#40;FEV<span class="elsevierStyleInf">1</span>&#47;FVC&#41;&#44; and forced expiratory flow between the moments of 25&#37; and 75&#37; &#40;FEF<span class="elsevierStyleInf">25&#8211;75&#37;</span>&#41;&#44; showing that asthmatic patients had lower pulmonary function when compared to controls&#46; Furthermore&#44; asthmatics have bronchodilator response rates above that of controls&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">When analyzing the anthropometric profile data &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#44; 25&#46;9&#37; of the 266 asthmatics&#44; and 23&#46;6&#37; of the 288 controls were overweight&#47;obese&#44; based on the body mass index &#40;BMI&#41;&#46; As for the waist&#47;height ratio&#44; 31&#46;6&#37; and 21&#46;2&#37;&#44; respectively&#44; had high coronary risk&#46; Significant differences related to the disease were found only in the variable waist-to-height ratio &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;009&#41;&#46; Regarding physical activity&#44; the average weekly screen time among the 266 asthmatics comprised 32&#46;2<span class="elsevierStyleHsp" style=""></span>h in front of the television&#44; video game and&#47;or computer&#46; Among the 288 controls&#44; the total weekly screen time was 29&#46;4<span class="elsevierStyleHsp" style=""></span>h&#46; Therefore&#44; 79&#46;7&#37; and 74&#46;3&#37; of the assessed individuals&#44; respectively&#44; showed a sedentary lifestyle risk&#46; This information was confirmed&#44; in part&#44; since more than half of the asthmatic&#44; 146 &#40;54&#46;9&#37;&#41; and 49&#37; &#40;141&#41; of non-asthmatic individuals were classified as sedentary&#44; based on the number of minutes of weekly physical activity&#46; Even so&#44; the vast majority perceives their health as good or very good &#40;63&#46;5&#37; of asthmatics and 65&#46;6&#37; of controls&#41;&#44; with statistical differences between the groups regarding their health perception &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> shows the average scores in the assessed domains for health-related quality of life &#40;HRQoL&#41; among the studied groups&#46; The asthmatic group had a statistically significant difference in the physical well-being domain &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; and in the total quality of life score &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;016&#41; when compared to the control group&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">Regarding the quality of life related to the disease&#44; the total score of the asthma module was 78&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#46;5 points&#44; demonstrating that asthma does not interfere in the quality of life of asthmatic children&#44; as they show values that are clinically within acceptable standards &#40;&#62;70&#37; of the total score&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">When evaluating school performance&#44; no significant differences were observed between the groups &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;64&#41;&#46; However&#44; asthmatics scored lower on all tests&#46; The asthmatics obtained an average of 107&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>27&#46;0 points in the total score &#40;maximum possible score of 143 points&#41; and the controls obtained 109&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>23&#46;0 points&#46; Specifically in the subtests&#44; the observed values were 25&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;6 and 26&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;6 in writing &#40;maximum possible score of 35 points&#41;&#59; 18&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;0 and 18&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;5 in arithmetic &#40;maximum possible score of 38 points&#41; and 63&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;0 and 64&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;3 in reading &#40;maximum possible score of 70 points&#41;&#44; for asthmatics and controls&#44; respectively&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0125" class="elsevierStylePara elsevierViewall">This study aimed to evaluate the prevalence of asthma in children&#47;adolescents of an industrial urban center in Serra Ga&#250;cha&#44; state of Rio Grande do Sul&#44; Brazil&#46; As a main result&#44; 16&#46;1&#37; of the assessed students were identified as asthmatics&#44; with more than half of them having uncontrolled disease&#46; Regarding the impact of asthma on schoolchildren&#39;s development&#44; there was a significant impact on lung function&#44; waist&#47;height ratio&#44; quality of life and one&#39;s perception of their own health&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">In the present study&#44; the prevalence of asthma was slightly lower &#40;16&#46;1&#37;&#41; than in other studies carried out with schoolchildren from all over Brazil<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> and with students from Porto Alegre&#47;RS&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> In a cross-sectional study carried out in 2012&#44; with a sample involving the five regions of Brazil&#44; 26 state capitals and the Federal District &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>109&#44;104&#41;&#44; the prevalence of asthma symptoms was 23&#46;2&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> In another study with schoolchildren from Porto Alegre&#44; the city capital of the state of Rio Grande do Sul &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2500&#41;&#44; the prevalence was 28&#46;2&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> It is important to note that all these studies used the same diagnostic criteria of the disease&#46; Environmental factors are the key to explain the variations and changes in the prevalence of asthma&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> Regarding disease control&#44; the prevalence of 50&#46;9&#37; of asthmatics with uncontrolled asthma in this study is similar to that found in Porto Alegre&#47;RS&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">The development of pulmonary function in children with persistent asthma are less favorable than that observed in the non-asthmatic population&#46; However&#44; studies indicate that more severe asthma may be associated with an increased decline in pulmonary function&#44; while milder asthma may be associated with near-normal rates of decline in pulmonary function&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> Another factor related to the prevalence of asthma and decreased pulmonary function is preterm birth&#46; In this study&#44; the prevalence of preterm birth was practically twice as high among asthmatics when compared with non-asthmatics&#46; A meta-analysis with 24&#44;938 children showed that children born with lower gestational age had reduced values of FEV<span class="elsevierStyleInf">1</span>&#44; FEV<span class="elsevierStyleInf">1</span>&#47;FVC&#44; and forced expiratory flow at the 75&#37; moment &#40;FEF<span class="elsevierStyleInf">75&#37;</span>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">In relation to the level of physical activity&#44; the prevalence of a sedentary lifestyle and number of hours of screen time was high in both assessed groups&#46; A similar outcome was found in a study that compared the level of physical activity of 155 asthmatic children and 158 controls in Portugal&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> The study concluded that although parents of asthmatic children state that their children&#39;s disease is an impediment to physical activity&#44; it seems there are no differences between the level of physical activity of the controlled asthmatic children and their peers&#46; Moreover&#44; the asthmatic students&#8217; total number of hours of screen time was comparable to that of the students without the disease&#46; A prevalence of excessive screen time of 79&#46;5&#37; was found among 2874 adolescents in a study carried out in the city of Jo&#227;o Pessoa-PA&#59; however&#44; the study found no association between excessive screen time and physical activity level and nutritional status&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">The prevalence of overweight and obesity in childhood has increased substantially worldwide in less than a generation&#46; In Brazil&#44; this figure increased from 15&#37; in 2002 to 25&#37; in 2010&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> In this study&#44; similar percentages of overweight&#47;obesity were observed among asthmatics and controls &#40;25&#46;9&#37; and 23&#46;6&#37;&#44; respectively&#41;&#46; Among the schoolchildren from Porto Alegre&#44; no significant differences were found between the study groups&#59; however&#44; the percentages were higher than in this study &#40;34&#46;8&#37; and 32&#46;7&#37;&#44; respectively&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> However&#44; significant differences were observed between the groups regarding abdominal fat&#44; evaluated by waist&#47;height ratio &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;009&#41;&#46; A study carried out with schoolchildren aged 6&#8211;12 years in the state of Bahia suggests that an increase in fat deposits&#44; whether in the abdominal region or elsewhere in the body&#44; increases the risk of wheezing episodes&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">It has been shown that asthma affects the health-related quality of life of asthmatics&#44; specifically in the physical well-being domain and also in the total score&#46; These findings are similar to those found in a sample of 480 schoolchildren from a city in the state of Rio Grande do Sul&#44; where the asthma group showed a worse score in the physical well-being domain &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; and in the total quality of life score &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;025&#41; when compared to the control group&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> In a sample from the capital city of Rio Grande do Sul&#44; 290 asthmatics showed lower scores than the 315 controls in the physical well-being domain &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; in addition to significant differences in emotional well-being and self-esteem&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">The school performance of asthmatics was lower than that of the control group&#44; but the differences were not significant&#46; One study with children and adolescents from the city of Macei&#243;-AL compared the school performance of 188 asthmatics and 213 controls and concluded that asthma did not interfere with school performance&#44; which was evaluated by the average of all first semester grades&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> Another study&#44; corroborating the present result&#44; showed that there were no significant differences in performance between asthmatics and non-asthmatics in 3812 schoolchildren from the United States aged 8&#8211;17 years&#46; However&#44; schoolchildren with persistent asthma showed lower values of academic achievement when compared to asthmatics with mild asthma&#46; The same study found a significant inverse correlation between absenteeism and school performance &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; This led the authors to conclude that the severity of asthma&#44; which is one of the main determinants of absenteeism&#44; may be an important factor in decreasing school performance&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">Even if the results do not prove the negative impact of asthma on all studied variables&#44; it is important to carry out further studies on this subject&#44; aiming to identify other associations between them&#46; Finally&#44; characteristics of the level of physical activity&#44; hours of screen time&#44; anthropometric profile&#44; and school performance need to be observed by school and health professionals and family&#44; aiming to develop a collective plan that will favor a better quality of life for non-asthmatic students&#44; but especially those with asthma&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Some study limitations are associated with the fact that the investigation of the impact of asthma was limited to obtaining information from the children and adolescents&#46; Thus&#44; this study did not obtain more precise data regarding disease control&#44; medical consultations&#44; hospitalizations&#44; school absenteeism&#44; treatment&#44; and quality of life&#44; where parents or guardians could provide more accurate information&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Funding</span><p id="par0170" class="elsevierStylePara elsevierViewall">Coordena&#231;&#227;o de Aperfei&#231;oamento de Pessoal de N&#237;vel Superior &#40;<span class="elsevierStyleGrantSponsor" id="gs0005">CAPES</span>&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflicts of interest</span><p id="par0175" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest&#46;</p></span></span>"
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            1 => "Prevalence"
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            0 => "Asma"
            1 => "Preval&#234;ncia"
            2 => "Espirometria"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To analyze the prevalence and impact of asthma in schoolchildren from the city of Caxias do Sul&#44; RS&#44; Brazil&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Cross-sectional observational and case-control study with children and adolescents between 7 and 15 years old&#44; from public schools in Caxias do Sul&#44; RS&#46; The study is composed of two phases&#58; Phase I analyzed the prevalence of asthma in the delimited population&#44; investigating 1915 schoolchildren&#59; Phase II quality of life questionnaires&#44; asthma control and classification &#40;for the asthmatic group&#41;&#44; physical activity&#44; school performance&#44; pulmonary function tests and anthropometric measures were applied to 266 asthmatics and 288 controls&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The estimated prevalence of asthma was 16&#46;1&#37;&#46; In the comparison between asthmatics and nonasthmatics premature birth &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; and diagnosis of another chronic disease at birth &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; were found&#46; Regarding pulmonary function&#44; significant differences were found in the values between groups in FEV<span class="elsevierStyleInf">1</span>&#44; FEV<span class="elsevierStyleInf">1</span>&#47;FVC and forced expiratory flow in the 25 and 75&#37; &#40;FEF<span class="elsevierStyleInf">25&#8211;75&#37;</span>&#41;&#44; being that asthmatics presented lower values&#46; Among asthmatics&#44; 133 &#40;50&#46;8&#37;&#41; did not have the disease controlled&#46; In the anthropometric variables&#44; significant differences were observed&#44; with higher values in controls&#44; in the the waist-to-height ratio &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;009&#41; and in the perception of health &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; Quality of life is lower in asthmatics in the physical well-being domain &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; and in the total score &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;016&#41;&#46; The total school performance score did not present a statistically significant difference between the groups&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The prevalence of asthma is similar to that of other industrialized urban centers and may negatively affect some areas of the development of schoolchildren&#46;</p></span>"
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        "titulo" => "Resumo"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Analisar a preval&#234;ncia e o impacto da asma em escolares do munic&#237;pio de Caxias do Sul-RS&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudo anal&#237;tico observacional transversal e caso-controle&#44; com crian&#231;as e adolescentes entre sete e 15 anos&#44; de escolas da rede p&#250;blica de Caxias do Sul-RS&#46; O estudo &#233; composto por duas fases&#58; Fase I analisou a preval&#234;ncia da asma na popula&#231;&#227;o delimitada e investigou 1&#46;915 escolares&#59; Fase II foram aplicados a 266 asm&#225;ticos e 288 controles&#44; question&#225;rios de qualidade de vida&#44; classifica&#231;&#227;o e controle da asma &#40;para o grupo asm&#225;tico&#41;&#44; atividade f&#237;sica&#44; desempenho escolar&#44; espirometria e antropometria&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A preval&#234;ncia de asma estimada foi de 16&#44;1&#37;&#46; Na compara&#231;&#227;o entre asm&#225;ticos e n&#227;o asm&#225;ticos foram encontradas diferen&#231;as na prematuridade &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; e ter diagn&#243;stico de outra doen&#231;a cr&#244;nica ao nascer &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Na espirometria foram encontradas diferen&#231;as significativas entre os grupos nos valores de VEF<span class="elsevierStyleInf">1</span>&#44; VEF<span class="elsevierStyleInf">1</span>&#47;CVF e fluxo expirat&#243;rio for&#231;ado nos momentos 25 e 75&#37; &#40;FEF<span class="elsevierStyleInf">25-75&#37;</span>&#41;&#59; os asm&#225;ticos apresentaram valores inferiores&#46; Entre os asm&#225;ticos&#44; 133 &#40;50&#44;8&#37;&#41; n&#227;o tem a doen&#231;a controlada&#46; Nas vari&#225;veis antropom&#233;tricas foram observadas diferen&#231;as significativas&#44; com valores superiores entre os controles&#44; na classifica&#231;&#227;o raz&#227;o cintura&#47;estatura &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;009&#41; e na percep&#231;&#227;o da pr&#243;pria sa&#250;de &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; A qualidade de vida &#233; menor nos asm&#225;ticos no dom&#237;nio bem estar f&#237;sico &#40;p<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; e no escore total &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;016&#41;&#46; O escore total do desempenho escolar n&#227;o apresentou diferen&#231;a estatisticamente significativa entre os grupos de estudo&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#227;o</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A preval&#234;ncia de asma se assemelha &#224; de outros centros urbanos industrializados e pode impactar negativamente alguns dom&#237;nios do desenvolvimento dos escolares&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Zacaron D&#44; Roncada C&#44; Molin RS&#44; Jones MH&#44; Pitrez PC&#46; Prevalence and impact of asthma in schoolchildren in the city of Caxias do Sul-RS&#46; J Pediatr &#40;Rio J&#41;&#46; 2020&#59;96&#58;479&#8211;86&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Level of quality of life among asthmatics &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>262&#41; and controls &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>275&#41;&#46;</p>"
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                  \t\t\t\t">145 &#40;46&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;04&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">134 &#40;8&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">109 &#40;6&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Classification of parents&#47;guardians</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Parents&#8217;&#47;guardians&#8217; level of schooling&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>High school&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">138 &#40;44&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">714 &#40;44&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">113&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#46;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Body mass&#44; kg &#40;M</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#177;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Height&#44; cm &#40;M</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#177;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">145&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">145&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Waist&#44; cm &#40;M</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#177;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Body mass index &#40;M</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#177;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Waist&#47;height ratio &#40;M</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#177;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;48<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;47<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">BMI classification</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Normal weight&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">194 &#40;72&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">211 &#40;73&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Overweight&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48 &#40;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55 &#40;19&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Obese&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;7&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Waist-to-height ratio classification</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Low coronary risk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">179 &#40;67&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">218 &#40;75&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>High coronary risk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84 &#40;31&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61 &#40;21&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total minutes of activity &#40;<span class="elsevierStyleItalic">M</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">212&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>274&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">236&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>309&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Classification of physical activity level</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Physically active&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73 &#40;27&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">82 &#40;28&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Partially active&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47 &#40;17&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65 &#40;22&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sedentary lifestyle&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">146 &#40;54&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">141 &#40;49&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total screen time &#40;<span class="elsevierStyleItalic">M</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;129&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Total screen time classification</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#60;2&#8211;h&#47;day &#8211; no risk of sedentary lifestyle&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">54 &#40;20&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74 &#40;25&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;158&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">212 &#40;79&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7 &#40;2&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                            0 => "Global Initiative for Asthma &#40;GINA&#41;"
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                    0 => array:2 [
                      "titulo" => "Prevalence of symptoms of asthma&#44; rhinitis&#44; and atopic eczema among Brazilian children and adolescents identified by the International Study of Asthma and Allergies in Childhood &#40;ISAAC&#41;&#58; phase 3"
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                        "tituloSerie" => "J Pediatr &#40;Rio J&#41;"
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                            2 => "S&#46;E&#46;C&#46; Macedo"
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                      "doi" => "10.1590/s1806-37132008001000003"
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                        "tituloSerie" => "J Sch Health"
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                      "titulo" => "International Study of Asthma and Allergies in Childhood &#40;ISAAC&#41; written questionnaire&#58; validation of the asthma component among Brazilian children"
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                          "etal" => false
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                            2 => "E&#46; Yamada"
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                            4 => "C&#46; Naspitz"
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                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Investig Allergol Clin Immunol"
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