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exce&#231;&#227;o feita &#224; de asma&#44; que tamb&#233;m foi observada na regi&#227;o sul&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A asma &#233; caracterizada pelo hist&#243;rico de sintomas respirat&#243;rios&#44; como sibilos&#44; falta de ar&#44; aperto no peito e tosse&#44; que variam com o tempo e a intensidade&#44; juntamente com a limita&#231;&#227;o vari&#225;vel do fluxo a&#233;reo expirat&#243;rio&#46; Crian&#231;as com sintomas respirat&#243;rios de asma apresentam fun&#231;&#227;o pulmonar prejudicada&#44; por consequ&#234;ncia podem ser mais suscet&#237;veis a fatores ambientais e apresentar um risco aumentado de fun&#231;&#227;o pulmonar declinante na vida adulta&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a> De acordo com a <span class="elsevierStyleItalic">Global Initiative for Asthma</span> &#40;GINA&#41;&#44; a asma deve ser classificada em bem controlada&#44; parcialmente controlada e n&#227;o controlada&#44; com base na avalia&#231;&#227;o de sintomas&#46; Dessa forma&#44; o paciente com asma controlada deve estar livre de sintomas diurnos&#44; despertares noturnos&#44; necessidade de medica&#231;&#227;o de resgate e limita&#231;&#227;o de atividades di&#225;rias e a pr&#225;tica de atividades f&#237;sica&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a> As doen&#231;as cr&#244;nicas costumam interferir na qualidade de vida das pessoas de forma substancial&#46; No entanto&#44; as caracter&#237;sticas individuais e os estilos de vida diferentes fazem com que o impacto proporcionado pelas doen&#231;as seja diverso e muitas vezes n&#227;o se correlacione com a gravidade ou progn&#243;stico da doen&#231;a propriamente dita&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Estudos comparativos de n&#237;veis de atividade f&#237;sica entre jovens asm&#225;ticos e n&#227;o asm&#225;ticos n&#227;o apresentam resultados similares&#46; No entanto&#44; os n&#237;veis mais elevados de atividade est&#227;o associados a um maior relato de asma ou sintomas relacionados&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">5</span></a> A pr&#225;tica da atividade f&#237;sica por indiv&#237;duos asm&#225;ticos&#44; quando feita com intensidade e dura&#231;&#227;o adequadas&#44; melhora a capacidade f&#237;sica e diminui a dispneia&#46; Al&#233;m disso&#44; pode resultar na melhoria da administra&#231;&#227;o e do uso de medica&#231;&#227;o&#44; na diminui&#231;&#227;o da gravidade do broncoespasmo induzido pelo exerc&#237;cio&#44; com consequente melhoria da qualidade de vida&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Outro fator relacionado &#224; asma &#233; o rendimento escolar&#44; muitas crian&#231;as com asma faltam &#224;s aulas por causa das crises&#44; o que prejudica seu desempenho escolar&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a> Ainda no contexto escolar&#44; as atividades que envolvem intera&#231;&#227;o social com colegas&#44; como brincadeiras que exijam esfor&#231;o f&#237;sico&#44; tamb&#233;m tendem a ser evitadas por crian&#231;as com asma e&#44; a depender do modo como os professores abordam as limita&#231;&#245;es do asm&#225;tico&#44; ele pode vir a sentir&#8208;se socialmente exclu&#237;do&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a> Nesse enquadramento&#44; o presente estudo investigou a preval&#234;ncia e o impacto da asma escolares do munic&#237;pio de Caxias do Sul&#8208;RS&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todos</span><p id="par0025" class="elsevierStylePara elsevierViewall">Estudo composto dor duas fases&#44; a primeira observacional descritiva &#40;transversal&#41; e a segunda observacional anal&#237;tica &#40;caso&#8208;controle&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Deste estudo participaram crian&#231;as e adolescentes regularmente matriculados no Ensino Fundamental da rede municipal de ensino de Caxias do Sul&#47;RS&#46; Como crit&#233;rios de inclus&#227;o foram definidos escolares entre 7&#8208;16 anos&#44; de ambos os sexos&#44; com o diagn&#243;stico de asma &#40;casos&#41; e sem diagn&#243;stico de asma e previamente h&#237;gidas &#40;controles&#41;&#46; Foram exclu&#237;dos escolares com limita&#231;&#245;es cognitivas&#44; motoras ou com outras doen&#231;as cr&#244;nicas que pudessem comprometer a avalia&#231;&#227;o da asma ou da qualidade de vida&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Na Fase I do estudo&#44; na qual o objetivo foi investigar a preval&#234;ncia da asma e caracterizar economicamente a amostra&#44; os pais ou respons&#225;veis legais responderam o question&#225;rio escrito padr&#227;o &#40;QE&#41;&#44; que corresponde &#224; primeira parte do question&#225;rio escrito do <span class="elsevierStyleItalic">International Study of Asthma and Allergies in Childhood</span> &#40;ISAAC&#41;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a> e o question&#225;rio de classifica&#231;&#227;o econ&#244;mica que usa o Crit&#233;rio de Classifica&#231;&#227;o Econ&#244;mica do Brasil &#40;CCEB&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Na Fase II<span class="elsevierStyleSmallCaps">&#44;</span> na qual o objetivo foi investigar o impacto da asma&#44; os instrumentos usados foram&#58; para avaliar a qualidade de vida relacionada &#224; sa&#250;de foi aplicado o question&#225;rio KINDL &#40;<span class="elsevierStyleItalic">Kinder Lebensqualit&#228;t Fragebogen&#41;</span> QV&#8208;Gen&#233;rico&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> O question&#225;rio &#233; composto de 24 perguntas que abrangem seis dimens&#245;es da qualidade de vida&#58; bem&#8208;estar f&#237;sico&#44; bem&#8208;estar emocional&#44; autoestima&#44; fam&#237;lia&#44; amigos e rotina escolar&#46; Complementando a mensura&#231;&#227;o dos dados relativos &#224; qualidade de vida&#44; as crian&#231;as&#47;adolescentes com diagn&#243;stico de asma responderam um question&#225;rio espec&#237;fico sobre qualidade de vida relacionada &#224; asma&#46; O KINDL QV&#8208;Espec&#237;fico&#44; validado no Brasil&#44;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a> &#233; composto por 15 perguntas dirigidas a qualidade de vida dos pacientes em rela&#231;&#227;o &#224; doen&#231;a referentes &#224; semana antecedente &#224; entrevista&#46; Para investigar o controle da asma foram aplicados os question&#225;rios de controle da asma <span class="elsevierStyleItalic">Asthma Control Test</span> &#40;ACT&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Na avalia&#231;&#227;o da fun&#231;&#227;o pulmonar&#44; os procedimentos t&#233;cnicos e os crit&#233;rios de aceitabilidade e reprodutibilidade para a feitura dos exames de fun&#231;&#227;o pulmonar seguiram as diretrizes da <span class="elsevierStyleItalic">American Thoracic Societ</span><span class="elsevierStyleItalic">&#8211; European Respiratory Society</span>ATS&#47;ERS&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a> O espir&#244;metro usado foi o modelo KoKo&#174; e <span class="elsevierStyleItalic">software</span> pr&#243;prio&#46; As avalia&#231;&#245;es foram feitas em campo&#44; por dois pesquisadores treinados e capacitados para fazer as mensura&#231;&#245;es&#46; Para fins de refer&#234;ncia dos valores em litros para percentual do predito&#44; foram usados os valores referenciais do Consenso Brasileiro sobre Espirometria&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">As crian&#231;as responderam o <span class="elsevierStyleItalic">Physical Activity Questionnaire for Children</span> &#40;PAQ&#8208;C&#41; e os adolescentes o <span class="elsevierStyleItalic">Physical Activity Questionnaire for Adolescents</span> &#40;PAQ&#8208;A&#41;&#44; que identificam o n&#237;vel de atividade f&#237;sica&#46; O instrumento investiga atividades f&#237;sicas moderadas e intensas nos sete dias anteriores ao preenchimento&#46; Esse question&#225;rio &#233; composto de nove quest&#245;es sobre a pr&#225;tica de esportes e jogos&#44; atividades f&#237;sicas na escola e lazer&#46; Cada quest&#227;o tem valor de 1 &#40;n&#227;o praticou atividade&#41; a 5 &#40;praticou todos os dias da semana&#41; e o escore final &#233; a m&#233;dia das quest&#245;es&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Para as medidas antropom&#233;tricas os procedimentos foram&#58; a massa corporal foi obtida com uma balan&#231;a digital &#40;G&#8208;Tech&#44; Glass 1 FW&#44; Rio de Janeiro&#44; Brasil&#41;&#44; com precis&#227;o de 100 gramas&#59; a estatura&#44; com um estadi&#244;metro port&#225;til &#40;AlturaExata&#44; TBW&#44; S&#227;o Paulo&#44; Brasil&#41;&#44; com precis&#227;o de 1<span class="elsevierStyleHsp" style=""></span>mm&#59; para a circunfer&#234;ncia da cintura&#44; foi usada uma fita m&#233;trica&#44; a mensura&#231;&#227;o foi feita no ponto&#8208;m&#233;dio entre a costela inferior e a crista il&#237;aca&#46; A partir dessas aferi&#231;&#245;es&#44; o &#237;ndice de massa corporal &#40;IMC&#41; foi calculado pela divis&#227;o da massa corporal &#40;kg&#41; pela estatura<span class="elsevierStyleSup">2</span>&#40;m&#41; e a classifica&#231;&#227;o pelo percentil para idade&#44; segundo a distribui&#231;&#227;o de refer&#234;ncia do <span class="elsevierStyleItalic">Centers of Disease Control and Prevention</span> &#40;CDC&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a> A rela&#231;&#227;o cintura&#47;estatura foi obtida com a divis&#227;o da circunfer&#234;ncia da cintura &#40;cm&#41; pela medida da estatura &#40;cm&#41;&#46; Foi usado como ponto de corte um valor de raz&#227;o cintura&#47;estatura &#8804; 0&#44;50 para baixo risco coronariano e &#8805; 0&#44;51 para alto risco&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Na avalia&#231;&#227;o do desempenho escolar foi usado o Teste de Desempenho Escolar &#8211; TDE&#44;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">18</span></a> um instrumento que busca oferecer de forma objetiva uma avalia&#231;&#227;o das capacidades fundamentais para o desempenho escolar&#44; mais especificamente da escrita&#44; aritm&#233;tica e leitura&#46; Indica&#44; de uma maneira abrangente&#44; quais as &#225;reas da aprendizagem escolar que est&#227;o preservadas ou prejudicadas no examinando&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Na an&#225;lise descritiva&#44; os dados categ&#243;ricos foram apresentados por frequ&#234;ncias absolutas e relativas&#46; J&#225; as vari&#225;veis cont&#237;nuas&#44; por m&#233;dia e desvio&#8208;padr&#227;o&#46; Para fins de teste de normalidade&#44; foi aplicado o teste de Shapiro&#8208;Wilk&#46; Na an&#225;lise inferencial&#44; as vari&#225;veis cont&#237;nuas foram analisadas pelo teste de Mann&#8208;Whitney e as vari&#225;veis categ&#243;ricas pelo teste de qui&#8208;quadrado&#46; Todas as an&#225;lises foram feitas com o programa IMB&#8208;SPSS &#40;<span class="elsevierStyleItalic">International Business Machines &#8211; Statistical Product and Service Solutions</span>&#41;&#44; vers&#227;o 20&#46; As diferen&#231;as foram consideradas significativas para um p &#8804; 0&#44;05&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">O estudo foi aprovado pelo Comit&#234; de &#201;tica em Pesquisa da Universidade de Caxias do Sul &#40;CEP&#8208;UCS&#41;&#44; sob parecer consubstanciado n&#176; 1&#46;453&#46;525&#46; Os respons&#225;veis assinaram o Termo de Consentimento Livre Esclarecido e as crian&#231;as e adolescentes o termo de Assentimento Livre Esclarecido&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0075" class="elsevierStylePara elsevierViewall">Na Fase I do estudo participaram 1&#46;915 escolares e na Fase II&#44; 554 &#40;266 asm&#225;ticos e 288 controles&#41;&#46; A taxa de ades&#227;o foi de 83&#37; &#40;1&#46;915&#47;2&#46;307&#41;&#44; com preval&#234;ncia de asma estimada em 16&#44;1&#37; &#40;309&#47;1&#46;915&#41;&#44; segundo crit&#233;rios estabelecidos pelo protocolo ISAAC&#44; no qual 920 &#40;48&#37;&#41; escolares apresentaram chiado no peito e 700 &#40;36&#44;6&#37;&#41; tiveram confirma&#231;&#227;o de diagn&#243;stico m&#233;dico de asma alguma vez na vida e nos &#250;ltimos 12 meses 372 &#40;19&#44;4&#37;&#41; apresentaram chiado no peito&#46; Al&#233;m disso&#44; 444 &#40;23&#44;2&#37;&#41; escolares relataram ter usado medica&#231;&#227;o para a doen&#231;a ao menos uma vez nos &#250;ltimos 12 meses&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Dos 1&#46;915 escolares avaliados nessa fase&#44; 953 &#40;49&#44;8&#37;&#41; s&#227;o do sexo masculino&#44; com m&#233;dia de 10&#44;77<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;55 anos&#46; Para fins de classifica&#231;&#227;o econ&#244;mica e escolaridade dos respons&#225;veis&#44; 1&#46;833 &#40;95&#44;7&#37;&#41; pertencem &#224;s classes B e C e 852 &#40;44&#44;5&#37;&#41; t&#234;m ensino m&#233;dio completo&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Na compara&#231;&#227;o entre os grupos &#40;asm&#225;ticos e controles&#41; os resultados foram significativamente maiores dos asm&#225;ticos nas vari&#225;veis idade &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;041&#41;&#44; prematuridade ao nascimento &#40;p&#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&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; conforme apresentado na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Na Fase II do estudo&#44; do total de sujeitos eleg&#237;veis&#44; 554 &#40;28&#44;9&#37;&#41; escolares fizeram parte da amostra&#44; 266 &#40;48&#37;&#41; asm&#225;ticos&#44; 283 &#40;51&#44;1&#37;&#41; do sexo masculino e com m&#233;dia de 10&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;4 anos &#40;10&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;3 asm&#225;ticos e 10&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;4 controles&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;264&#41;&#46; Entre os 262 asm&#225;ticos que responderam o question&#225;rio sobre o controle da doen&#231;a&#44; 129 &#40;49&#44;2&#37;&#41; afirmaram t&#234;&#8208;la controlada e 133 &#40;50&#44;8&#37;&#41; como n&#227;o controlada&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Em rela&#231;&#227;o &#224; fun&#231;&#227;o pulmonar &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#44; 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&#8208;75&#37;</span>&#41;&#46; Demonstrou&#8208;se que os asm&#225;ticos apresentam fun&#231;&#227;o pulmonar menor quando comparados com os controles&#46; Al&#233;m disso&#44; os asm&#225;ticos apresentam percentuais de resposta ao broncodilatador acima dos controles&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Na an&#225;lise dos dados referentes ao perfil antropom&#233;trico &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#44; dos 266 asm&#225;ticos&#44; 25&#44;9&#37; e dos 288 controles&#44; 23&#44;6&#37; apresentaram sobrepeso&#47;obesidade&#44; teve&#8208;se como base o &#237;ndice de massa corporal &#40;IMC&#41;&#46; Na raz&#227;o cintura&#47;estatura&#44; 31&#44;6&#37; e 21&#44;2&#37;&#44; respectivamente&#44; apresentaram alto risco coronariano&#46; Diferen&#231;as significativas relacionadas &#224; doen&#231;a somente foram encontradas na vari&#225;vel raz&#227;o cintura&#47;estatura &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;009&#41;&#46; Para a atividade f&#237;sica&#44; a m&#233;dia semanal de tempo de tela dos 266 asm&#225;ticos foi de 32&#44;2 horas diante de televis&#227;o&#44; videogame e&#47;ou computador&#46; J&#225; entre os 288 controles&#44; o total semanal foi de 29&#44;4 horas&#46; Com isso&#44; 79&#44;7&#37; e 74&#44;3&#37; dos avaliados&#44; respectivamente&#44; apresentaram risco de sedentarismo&#46; Esse dado foi confirmado&#44; em partes&#44; pois mais da metade dos asm&#225;ticos 146 &#40;54&#44;9&#37;&#41; e 49&#37; &#40;141&#41; dos n&#227;o asm&#225;ticos foram classificados como sedent&#225;rios com base na quantidade de minutos de atividade f&#237;sica semanal&#46; Mesmo assim&#44; a grande maioria percebe a sua sa&#250;de como boa ou muito boa &#40;63&#44;5&#37; dos asm&#225;ticos e 65&#44;6&#37; dos controles&#41;&#44; com diferen&#231;as estat&#237;sticas entre os grupos quanto sua percep&#231;&#227;o de sa&#250;de &#40;<span class="elsevierStyleItalic">p</span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">Na <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a> s&#227;o apresentadas as m&#233;dias do escore nos dom&#237;nios avaliados de qualidade de vida relacionada &#224; sa&#250;de &#40;QVRS&#41; entre os grupos estudados&#46; O grupo de asm&#225;ticos apresentou diferen&#231;a estatisticamente significativa nos dom&#237;nios bem&#8208;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 de qualidade de vida &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;016&#41; quando comparado com o grupo controle&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Quanto &#224; qualidade de vida relacionada &#224; doen&#231;a&#44; o escore total do m&#243;dulo asma foi de 78&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#44;5 pontos&#44; demonstrou&#8208;se que a asma n&#227;o interfere na qualidade de vida das crian&#231;as asm&#225;ticas&#44; pois apresenta valores clinicamente dentro dos padr&#245;es aceit&#225;veis &#40;&#62; 70&#37; do escore total&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Na avalia&#231;&#227;o do desempenho escolar n&#227;o foram encontradas diferen&#231;as significativas entre os grupos &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;64&#41;&#46; Por&#233;m os asm&#225;ticos obtiveram pontua&#231;&#227;o inferior em todos os testes&#46; Os asm&#225;ticos obtiveram m&#233;dia de 107&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>27&#44;0 pontos no escore total &#40;valor m&#225;ximo poss&#237;vel 143 pontos&#41; e os controles&#44; 109&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>23&#44;0 pontos&#46; Especificamente nos subtestes&#44; os valores encontrados foram&#58; na escrita 25&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;6 e 26&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;6 &#40;valor m&#225;ximo poss&#237;vel de 35 pontos&#41;&#59; na aritm&#233;tica&#44; 18&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;0 e 18&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;5 &#40;valor m&#225;ximo poss&#237;vel 38 pontos&#41;&#59; e na leitura&#44; 63&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#44;0 e 64&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#44;3 &#40;valor m&#225;ximo poss&#237;vel 70 pontos&#41;&#44; para asm&#225;ticos e controles&#44; respectivamente&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discuss&#227;o</span><p id="par0120" class="elsevierStylePara elsevierViewall">Este estudo se prop&#244;s a avaliar a preval&#234;ncia de asma em crian&#231;as&#47;adolescentes de um centro urbano industrializado da Serra Ga&#250;cha&#46; Como resultado principal pudemos constatar que 16&#44;1&#37; dos escolares avaliados foram identificados como asm&#225;ticos&#59; entre esses mais da metade tem a doen&#231;a n&#227;o controlada&#46; Em rela&#231;&#227;o ao impacto da asma no desenvolvimento dos escolares&#44; foram constatados impactos significativos na fun&#231;&#227;o pulmonar&#44; na raz&#227;o cintura&#47;estatura&#44; na qualidade de vida e na percep&#231;&#227;o da pr&#243;pria sa&#250;de&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Em rela&#231;&#227;o &#224; preval&#234;ncia&#44; no presente estudo a asma se apresenta levemente inferior &#40;16&#44;1&#37;&#41; a outros estudos feitos com escolares de todo o Brasil<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">19</span></a> e com escolares de Porto Alegre&#47;RS&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a> Em um estudo transversal feito em 2012 com amostra que envolveu as cinco regi&#245;es&#44; 26 capitais de estado e o Distrito Federal &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>109&#46;104&#41;&#44; a preval&#234;ncia de sintomas da asma foi de 23&#44;2&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">19</span></a> Em outro estudo com escolares da capital do Rio Grande do Sul &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;500&#41; a preval&#234;ncia foi de 28&#44;2&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a> Importante ressaltar que em todos os estudos apresentados foram usados os mesmos crit&#233;rios de diagn&#243;stico da doen&#231;a&#46; Fatores ambientais s&#227;o a chave para explicar as varia&#231;&#245;es e mudan&#231;as na preval&#234;ncia de asma&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a> Em rela&#231;&#227;o ao controle da doen&#231;a&#44; a preval&#234;ncia de 50&#44;9&#37; de asm&#225;ticos com asma n&#227;o controlada deste estudo se assemelha &#224; encontrada em Porto Alegre&#47;RS&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">O desenvolvimento da fun&#231;&#227;o pulmonar em crian&#231;as com asma persistente &#233; menos favor&#225;vel do que o observado na popula&#231;&#227;o n&#227;o asm&#225;tica&#46; Por&#233;m&#44; estudos indicam que a asma mais grave pode estar associada a um decl&#237;nio superior na fun&#231;&#227;o pulmonar&#44; enquanto que a asma mais leve pode estar associada a taxas quase normais de decl&#237;nio da fun&#231;&#227;o pulmonar&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a> Outro fator relacionado &#224; preval&#234;ncia da asma e fun&#231;&#227;o pulmonar reduzida &#233; a prematuridade ao nascer&#46; Neste estudo a preval&#234;ncia de prematuridade foi praticamente o dobro entre os asm&#225;ticos comparados com os n&#227;o asm&#225;ticos&#46; Uma metan&#225;lise com 24&#46;938 crian&#231;as demostrou que crian&#231;as nascidas com idade gestacional inferior apresentaram valores reduzidos de VEF<span class="elsevierStyleInf">1</span>&#44; VEF<span class="elsevierStyleInf">1</span>&#47;CVF e fluxo expirat&#243;rio for&#231;ado no momento 75&#37; &#40;FEF<span class="elsevierStyleInf">75&#37;</span>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Em rela&#231;&#227;o ao n&#237;vel de atividade f&#237;sica&#44; a preval&#234;ncia de sedentarismo e quantidade de horas diante de telas &#233; elevada nos dois grupos investigados&#46; Comportamento semelhante foi encontrado em estudo que comparou o n&#237;vel de atividade f&#237;sica de 155 crian&#231;as asm&#225;ticas e 158 controles em Portugal&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a> O estudo concluiu que apesar de os pais de crian&#231;as asm&#225;ticas afirmarem que a doen&#231;a dos seus filhos seja uma barreira &#224; atividade f&#237;sica&#44; n&#227;o parece haver diferen&#231;as entre o n&#237;vel de atividade f&#237;sica das crian&#231;as asm&#225;ticas controladas e dos seus pares&#46; Al&#233;m disso&#44; o total de horas diante de telas dos escolares asm&#225;ticos se comparou ao tempo dos escolares sem a doen&#231;a&#46; Em estudo feito no munic&#237;pio de Jo&#227;o Pessoa&#47;PA&#44; uma preval&#234;ncia de tempo excessivo de tela de 79&#44;5&#37; foi encontrada entre 2&#46;874 adolescentes&#46; Contudo&#44; o estudo n&#227;o encontrou associa&#231;&#227;o entre o tempo excessivo de tela e o n&#237;vel de atividade f&#237;sica e o estado nutricional&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">A preval&#234;ncia de sobrepeso e obesidade na inf&#226;ncia aumentou substancialmente em todo o mundo em menos de uma gera&#231;&#227;o&#46; No Brasil esse valor subiu de 15&#37; em 2002 para 25&#37; em 2010&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">26</span></a> Neste estudo foram observados percentuais semelhantes de sobrepeso&#47;obesidade entre asm&#225;ticos e controles &#40;25&#44;9 e 23&#44;6&#37;&#44; respectivamente&#41;&#46; Em escolares de Porto Alegre tamb&#233;m n&#227;o foram encontradas diferen&#231;as significativas entres os grupos de estudo&#44; por&#233;m os percentuais foram superiores aos deste estudo &#40;34&#44;8 e 32&#44;7&#37;&#44; respectivamente&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a> Por outro lado&#44; foram observadas diferen&#231;as significativas entre os grupos de estudo na gordura abdominal&#44; avaliada pela raz&#227;o cintura&#47;estatura &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;009&#41;&#46; Estudo feito com escolares de seis a 12 anos na Bahia sugere que um aumento nos dep&#243;sitos de gordura&#44; seja na regi&#227;o abdominal ou em outra parte do corpo&#44; aumenta o risco de chiado no peito&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">A asma demonstrou afetar a qualidade de vida relacionada &#224; sa&#250;de dos asm&#225;ticos&#44; especificamente no dom&#237;nio bem&#8208;estar f&#237;sico e tamb&#233;m no escore total&#46; Esses achados s&#227;o semelhantes aos encontrados em uma amostra de 480 escolares de uma cidade no interior do Rio Grande do Sul&#44; na qual o grupo com asma demonstrou pior escore nos dom&#237;nios bem&#8208;estar f&#237;sico &#40;<span class="elsevierStyleItalic">p</span> &#706; 0&#44;001&#41; e no escore total de qualidade de vida &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;025&#41; quando comparado com o grupo controle&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a> Em uma amostra na capital do Rio Grande do Sul os 290 asm&#225;ticos apresentaram pontua&#231;&#227;o inferior aos 315 controles no dom&#237;nio bem&#8208;estar f&#237;sico &#40;<span class="elsevierStyleItalic">p</span> &#706; 0&#44;001&#41; al&#233;m de diferen&#231;as significativas no bem&#8208;estar emocional e autoestima&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">O desempenho escolar dos asm&#225;ticos foi inferior ao desempenho dos escolares do grupo controle&#44; por&#233;m as diferen&#231;as n&#227;o foram significativas&#46; Um estudo com crian&#231;as e adolescentes de Macei&#243;&#47;AL comparou o desempenho escolar de 188 asm&#225;ticos e 213 controles e concluiu que a asma n&#227;o interferiu no desempenho escolar&#44; avaliado por m&#233;dia de todas as notas do primeiro semestre escolar&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">29</span></a> Outro estudo que corrobora o presente resultado indicou n&#227;o haver diferen&#231;as significativas no desempenho entre asm&#225;ticos e n&#227;o asm&#225;ticos em 3&#46;812 escolares americanos entre oito e 17 anos&#46; Por&#233;m&#44; escolares com asma persistente apresentaram valores inferiores de rendimento em compara&#231;&#227;o com os asm&#225;ticos com asma leve&#46; O mesmo estudo encontrou correla&#231;&#227;o inversa significativa entre absente&#237;smo e desempenho escolar &#40;<span class="elsevierStyleItalic">p</span> &#706; 0&#44;001&#41;&#46; Isso levou os autores a concluir que a gravidade da asma&#44; um dos principais determinantes do absente&#237;smo&#44; pode ser um fator importante para diminuir o desempenho escolar&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">30</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">Mesmo que os resultados n&#227;o comprovem o impacto negativo da asma em todas as vari&#225;veis estudadas&#44; &#233; importante aprofundar os estudos que envolvem o tema a fim de identificar outras rela&#231;&#245;es entre elas&#46; Por fim&#44; caracter&#237;sticas do n&#237;vel de atividade f&#237;sica&#44; horas diante de tela&#44; perfil antropom&#233;trico e desempenho escolar precisam ser observados pelos profissionais da escola&#44; sa&#250;de e parentes&#44; deve&#8208;se desenvolver um trabalho coletivo&#44; que favore&#231;a uma melhor qualidade de vida dos escolares n&#227;o asm&#225;ticos&#44; mas principalmente dos que t&#234;m asma&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Algumas limita&#231;&#245;es do estudo est&#227;o relacionadas ao fato de a investiga&#231;&#227;o do impacto da asma ter sido limitada a levantar informa&#231;&#245;es junto &#224;s crian&#231;as e aos adolescentes&#46; Com isso&#44; n&#227;o foram identificadas informa&#231;&#245;es mais precisas com rela&#231;&#227;o ao controle da doen&#231;a&#44; consultas m&#233;dicas&#44; interna&#231;&#245;es&#44; absente&#237;smo escolar&#44; tratamento e qualidade de vida&#44; que os pais ou respons&#225;veis poderiam fornecer&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Financiamento</span><p id="par0185" class="elsevierStylePara elsevierViewall">Coordena&#231;&#227;o de Aperfei&#231;oamento de Pessoal de N&#237;vel Superior &#40;Capes&#41;&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflitos de interesse</span><p id="par0190" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflitos de interesse&#46;</p></span></span>"
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            1 => "Prevalence"
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            3 => "Quality of life"
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            0 => "Asma"
            1 => "Preval&#234;ncia"
            2 => "Espirometria"
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        "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&#8208;sectional observational and case&#8208;control study with children and adolescents between 7 and 15 years old&#44; from public schools in Caxias do Sul&#47;RS&#46; The study is composed of two phases&#58; Phase I analyzed the prevalence of asthma in the delimited population 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;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; and diagnosis of another chronic disease at birth &#40;p &#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; moments &#40;FEF<span class="elsevierStyleInf">25&#8208;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 waist&#8208;to&#8208;height ratio &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;009&#41; and in the perception of health &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; Quality of life is lower in asthmatics in the physical well&#8208;being domain &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; and in the total score &#40;p<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 study 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>"
        "secciones" => array:4 [
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        "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&#8208;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&#8208;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&#8208;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&#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&#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&#8208;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&#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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            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
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            "identificador" => "abst0035"
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          3 => array:2 [
            "identificador" => "abst0040"
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      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Como citar este artigo&#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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        "descripcion" => array:1 [
          "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">N&#237;vel de qualidade de vida entre asm&#225;ticos &#40;n &#61; 262&#41; e controles &#40;n &#61; 275&#41;&#46;</p>"
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                  \t\t\t\t">28 &#40;9&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">138 &#40;44&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">714 &#40;44&#44;5&#41;&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">155 &#40;9&#44;7&#41;&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">18 &#40;1&#44;1&#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">0&#44;93&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \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>Obeso&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&#44;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&#44;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">Classifica&#231;&#227;o raz&#227;o cintura&#47;estatura</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>Baixo risco coronariano&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&#44;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&#44;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">0&#44;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>Alto risco coronariano&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&#44;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&#44;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 minutos de atividades &#40;M<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DP&#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&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>274&#44;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&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>309&#44;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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;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">Classifica&#231;&#227;o do n&#237;vel de atividade f&#237;sica</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>Fisicamente ativo&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&#44;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&#44;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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;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>Parcialmente ativo&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&#44;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&#44;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>Sedentarismo&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&#44;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>Tempo total frente a telas &#40;M<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DP&#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">4&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;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">4&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;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">0&#44;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
                  \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">Classifica&#231;&#227;o total frente a telas</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>&#60;<span class="elsevierStyleHsp" style=""></span>2h&#47;dia &#8211; Sem risco de sedentarismo&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">54 &#40;20&#44;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">74 &#40;25&#44;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">0&#44;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
                  \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><span class="elsevierStyleHsp" style=""></span>&#62;2h&#47;dia &#8211; Risco de sedentarismo&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 &#40;79&#44;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">214 &#40;74&#44;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="" 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">Percep&#231;&#227;o da sa&#250;de</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>Ruim&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">7 &#40;2&#44;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">3 &#40;1&#44;0&#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>Regular&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 &#40;25&#44;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">45 &#40;15&#44;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>Boa&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">128 &#40;48&#44;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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">134 &#40;46&#44;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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&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>Muito boa&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">41 &#40;15&#44;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">55 &#40;19&#44;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>Excelente&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">18 &#40;6&#44;8&#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
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