The Role of Parental Adherence to the Mediterranean Diet and Family Time Together in Children's Weight Status: The BeE-School Project.

The family context has been associated with children's weight status. This study aims to investigate the association of parents' adherence to the Mediterranean diet and family time with the weight status of children. The research is part of BeE-school, a cluster-randomized trial implemented in primary schools located in socially vulnerable contexts. A total of 735 children (380 boys and 355 girls) aged 6 to 10 participated in the study. Anthropometrics were assessed during school time, and weight status was categorized, while parents self-reported sociodemographic variables, adherence to the Mediterranean diet (MEDAS questionnaire), and family time. Children from families with higher education levels whose parents have a high adherence to the Mediterranean diet have lower odds of overweight/obesity (odds ratio (OR) 0.301, 95% CI 0.143-0.634, p = 0.002). Also, children from families with lower education levels who have more time together with their family have lower odds of overweight/obesity (OR 0.731, 95% CI 0.573-0.934, p = 0.012). The family environment, mainly family time together and adherence to the Mediterranean diet, exerts a significant influence on children's weight status. Professionals working in children's health should consider the family when fostering health-promoting behaviors.

Sleep Disorders and Subjective Well-Being in Portuguese Adults: Evidence from a Representative Study.

Objective The quality and quantity of sleep affect people's well-being, as chronic sleep disorders are associated with social, physical, and psychological problems, as well as low self-reported life satisfaction. The present cross-sectional study examined the associations of sleep disorders with self-reported life satisfaction in Portuguese adults. Materials and Methods Data from a representative sample of the Portuguese population (14,341 participants, aged ≥ 18 years) extracted from the Sixth Portuguese National Health Survey was analyzed. Data on subjective well-being and sleep disorders was collected through a questionnaire, and multivariable regression models were performed to examine the associations between these variables, adjusted for potential confounders such as age, gender, level of schooling, degree of urbanization, and family income. Results Sleep disorders were negatively associated with self-reported life satisfaction. Having at least one sleep disturbance in the last two weeks was significantly associated with a 3-point decrease in life satisfaction: ß = -3.0 (95% confidence interval = -3.2--2.7). Discussion Among Portuguese adults, sleep disorders were associated with a decline in life satisfaction. The present study provides new evidence from a representative sample to support the promotion of good sleep hygiene intervention programs.

The impact of a health promotion program on toddlers' socio-emotional development: a cluster randomized study.

BACKGROUND: The first 3 years of life are a critical period for the development of socio-emotional skills, highlighting the importance of socio-emotional development in early childhood. This study aimed to evaluate the effectiveness of a health promotion intervention program on the socio-emotional development of children aged 12 to 42 months during the COVID-19 pandemic. METHODS: A total of 344 children from 15 childcare centers participated in this study, with six centers in the intervention group and nine in the control group. Childcare teachers in the intervention group received a 6-month training program aimed at promoting healthy lifestyles, including topics such as diet, sleep, physical activity, and sedentary behavior. Sociodemographic and anthropometric measures were assessed at baseline, and socio-emotional development was assessed using the Bayley Scales of Infant and Toddler Development - Third Edition (Bayley-III) at baseline and post-intervention. RESULTS: After the intervention, a significant difference in socio-emotional development was observed between children with mothers of varying education levels. Specifically, children whose mothers had lower education levels demonstrated significantly greater socio-emotional development (B = 19.000, p = 0.028) compared to the control group. In contrast, there was no significant difference in socio-emotional development among children with mothers from higher education levels. CONCLUSION: These findings suggest that intervention programs for childcare teachers can effectively promote healthy socio-emotional development in children from socioeconomically disadvantaged backgrounds. Future intervention programs should consider tailoring their approaches to target disadvantaged populations. TRIAL REGISTRATION: This cluster randomized controlled trial was registered in the Clinical Trials database/platform on 09/09/2019 (number NCT04082247).

Neurodevelopment and Dietary Intake in Toddlers-A Cross-Sectional Study from the Healthy Children 2021 Project.

Little is known about the potential associations between neurodevelopment, dietary diversity and food processing in the toddler period. This study aimed to estimate the association between these dietary quality dimensions and neurodevelopment in toddlers. Data for this cross-sectional analysis came from the Healthy Children 2021 project and included 212 toddlers (51.9% females, aged 12-36 months) from 15 Portuguese childcare centers. Neurodevelopment was assessed through Bayley Scales of Infant and Toddler Development. Dietary intake was gathered by a two-day non-consecutive dietary recall. The food items were categorised with NOVA classification. Dietary diversity was explored through Minimum Dietary Diversity (MDD). Logistic regression models adjusted for potential confounders were performed. Girls with a higher energy contribution of unprocessed/minimally processed foods and with an above median MDD score had higher odds of achieving a higher neurodevelopment score (aOR:1.04; 95%CI 1.01; 1.08 and aOR:2.26; 95%CI 1.01; 5.06, respectively); no significant association was observed in boys. Our findings suggest that these dietary dimensions are associated with a higher neurodevelopment in toddler girls. This should be further studied as a possible early link between dietary factors and neurodevelopment. Promotion of healthy eating can be promising in improving neurocognitive development and might help to introduce public health recommendations for toddlers' nutrition.

Is the association between sleep and socio-emotional development mediated by weight in toddlers aged 12 to 36 months?

Introduction: Childhood is an important stage for socio-emotional development. Understanding the associations of lifestyle habits with the healthy development of social and emotional skills is crucial for better interventions early in life. This study aims to analyze the association between sleep and socio-emotional development in toddlers aged 12 to 36 months and examine whether weight mediated these associations. Methods: This study is part of a cluster randomized controlled trial developed in Portuguese childcare centers. A sample of 344 children (176 females) enrolled in the study. Participants' anthropometrics were measured while at childcare centers using standardized procedures. Body mass index (BMI) was computed as the body weight/height2 (kg/m2) ratio. Sleep quality was collected with the Tayside Children's Sleep Questionnaire, a 10-item scale that evaluates the child's ability to initiate and maintain sleep. Two additional questions regarding sleep duration were added. Parental questionnaires assessed the child's sex and date of birth, socioeconomic status, and total energy intake (TEI). Motor (fine and gross) was assessed using Bayley-III scales and socio-emotional (SE) by the Greenspan Social-Emotional Growth Chart questionnaire. Linear regression models were used to examine the associations between sleep (duration and quality) and SE with adjustments for sex, age, BMI, mothers' education, motor development, and TEI. Mediation analysis was conducted using path analysis. Results: SE development was significantly associated with nighttime sleep duration even when adjusted for confounders (ß = 0.223; 95% CI: 0.001, 0.004 and ß = 0.168; 0.0003, 0.003; respectively). Sleep quality was not significantly associated with SE development, and the weight did not explain the associations between sleep and SE development. Conclusion: This study supports that sleep duration is directly associated with SE development in toddlers. From a public health perspective, sleep duration should be prioritized in intervention programs to improve socio-emotional development early in life.

O impacto do isolamento devido à COVID-19 em estudantes de enfermagem / The impact of isolation due to COVID-19 on nursing students / El impacto del aislamiento por COVID-19 en estudiantes de enfermería

Resumo Enquadramento: A pandemia de COVID-19 exigiu a implementação de medidas de isolamento nos casos de alto risco de doença. Objetivo: Avaliar o impacto do isolamento sobre a ansiedade, a satisfação com o apoio percebido, a aprendizagem e o aproveitamento escolar, de estudantes de enfermagem da região norte de Portugal. Metodologia: Estudo exploratório e quantitativo, realizado com 56 estudantes em isolamento devido à COVID-19. Foi aplicado um questionário de autopreenchimento para avaliação da evolução da ansiedade, da satisfação com o apoio percebido, ao nível pedagógico, emocional e do Serviço Nacional de Saúde e do impacto do isolamento na aprendizagem e aproveitamento escolar. Resultados: Foram reportados níveis de ansiedade com significado clínico. Foi referido maior satisfação com o apoio da instituição de ensino e menor com o Serviço Nacional de Saúde. A ausência às atividades letivas teve impacto negativo na aprendizagem e no aproveitamento escolar. Conclusão: O isolamento dos estudantes teve impacto na ansiedade e na aprendizagem. A saúde mental dos estudantes deve ser promovida pelas instituições de ensino superior.

Abstract Background: The COVID-19 pandemic demanded isolation measures in cases of high disease risk. Objective: To assess the impact of isolation on the anxiety, satisfaction with perceived support, learning and academic achievement of nursing students in the northern region of Portugal. Methodology: This exploratory and quantitative study was conducted with 56 students in isolation due to COVID-19. A self-completion questionnaire was applied to assess the evolution of the anxiety, the satisfaction with the perceived support at the pedagogical and emotional levels and from the Serviço Nacional de Saúde (SNS - National Health Service), and the impact of isolation on learning and academic achievement. Results: This study observed clinically significant levels of anxiety. The participants expressed greater satisfaction with the support received from the educational institution and less satisfaction with the SNS. The absence from school activities negatively impacted their learning and academic achievement. Conclusion: Student isolation impacted anxiety and learning. Higher education institutions must promote students' mental health.

Resumen Marco contextual: La pandemia de COVID-19 requirió la aplicación de medidas de aislamiento en casos de alto riesgo de enfermedad. Objetivo: Evaluar el impacto del aislamiento en la ansiedad, la satisfacción con el apoyo recibido, el aprendizaje y el rendimiento académico entre los estudiantes de enfermería de la región norte de Portugal. Metodología: Estudio exploratorio y cuantitativo, realizado con 56 estudiantes en aislamiento por COVID-19. Se utilizó un cuestionario de autocumplimentación para evaluar la evolución de la ansiedad, la satisfacción con el apoyo recibido a nivel educativo, emocional y del Sistema Nacional de Salud, y el impacto del aislamiento en el aprendizaje y el rendimiento académico. Resultados: Se notificaron niveles de ansiedad con significancia clínica. Se registró una mayor satisfacción con el apoyo de la institución educativa y una menor satisfacción con el Servicio Nacional de Salud. El absentismo escolar tuvo un impacto negativo en el aprendizaje y el rendimiento académico. Conclusión: El aislamiento de los estudiantes repercutió en la ansiedad y el aprendizaje. Los centros de enseñanza superior deben promover la salud mental de los estudiantes.

Promoção de estilos de vida saudáveis na primeira infância: A voz de familiares e peritos / Promotion of healthy lifestyles in early childhood: The perspectives of family members and experts / Promoción de estilos de vida saludables en la primera infancia: La voz de los familiares y los expertos

Resumo Enquadramento: é reconhecida a importância da promoção de estilos de vida saudáveis nos primeiros anos de vida. Na atualidade, a identificação de áreas prioritárias de intervenção em saúde que promovam estilos de vida saudáveis, são um desafio inadiável. Objetivo: Conhecer a perspetiva de familiares e peritos quanto às áreas prioritárias de intervenção relacionadas com a promoção de estilos de vida saudáveis na primeira infância. Metodologia: Estudo qualitativo, exploratório e descritivo, com recurso a sessões de grupos focais. Participaram no estudo sete peritos das áreas da saúde, social, educação, media e três familiares de crianças pequenas. Foram desenvolvidas entrevistas semi-estruturadas e a análise de conteúdo foi efetuada seguindo os pressupostos de Bardin. Resultados: Emergiram duas grandes áreas prioritárias, nomeadamente determinantes da alimentação e do movimento (atividade física, comportamento sedentário e sono). Conclusão: Os determinantes da alimentação e do movimento são áreas de intervenção que se revelam como prioritárias. O envolvimento dos cuidadores (ex., pais, educadores de infância) é indispensável para a promoção de estilos de vida saudáveis.

Abstract Background: The importance of promoting healthy lifestyles in the first years of life is recognized. Identifying priority areas for intervention related to the promotion of healthy lifestyles is an urgent challenge. Objective: To explore the perspectives of family members and experts on priority areas for intervention related to the promotion of healthy lifestyles in early childhood. Methodology: Qualitative, exploratory, and descriptive study, using focus group sessions. Seven experts from the health, social, education, and media areas and three family members of young children participated in the study. Semi-structured interviews were conducted, and Bardin's content analysis technique was used. Results: Two major priority areas emerged: determinants of diet and determinants of movement (physical activity, sedentary behavior, and sleep). Conclusion: The determinants of diet and movement are priority areas for intervention. The involvement of caregivers (e.g., parents, early childhood educators) is essential to promoting healthy lifestyles.

Resumen Marco contextual: Se reconoce la importancia de promover estilos de vida saludables en los primeros años de vida. Actualmente, la identificación de áreas prioritarias de intervención en la salud que promuevan estilos de vida saludables es un reto ineludible. Objetivo: Conocer la perspectiva de los familiares y de los expertos sobre las áreas prioritarias de intervención relacionadas con la promoción de estilos de vida saludables en la primera infancia. Metodología: Estudio cualitativo, exploratorio y descriptivo, mediante sesiones de grupos focales. En el estudio participaron siete expertos de los ámbitos sanitario, social, educativo, medios de comunicación y tres familias de niños pequeños. Se desarrollaron entrevistas semiestructuradas y se realizó un análisis de contenido siguiendo los supuestos de Bardin. Resultados: Se identificaron dos áreas prioritarias principales, a saber, determinantes de la dieta y del movimiento (actividad física, comportamiento sedentario y sueño). Conclusión: Los determinantes de la dieta y el movimiento son áreas prioritarias de intervención. La implicación de los cuidadores (por ejemplo, los padres, los educadores de las escuelas infantiles) es indispensable para la promoción de estilos de vida saludables.

Infodemic Preparedness and COVID-19: Searching about Public Health and Social Measures Is Associated with Digital Health Literacy in University Students.

We aimed to evaluate the associations between information searching about public health and social measures (PHSM) and university students' digital health literacy (DHL) related to the new coronavirus (SARS-CoV-2) and COVID-19. METHODS: This cross-sectional study included 3,084 Portuguese university students (75.7% females), with an average age of 24.2 (SD = 7.5). Sociodemographic data, DHL questionnaire and online information concerning PHSM were gathered. Cox proportional hazards models were performed. RESULTS: Students who searched for personal protective measures achieved in shorter time sufficient "evaluating reliability" (HR = 1.4; 95% CI = 1.1; 1.7) and "determining relevance" (HR = 1.5; 95% CI = 1.2; 1.8). Searching for surveillance and response measures was associated with sufficient "determining relevance" (HR = 1.4; 95% CI = 1.1; 1.9). Finally, those students who searched for environmental, economic and psychosocial measures achieved in shorter time "determining relevance" (HR = 1.2; 95% CI = 1.0; 1.4). CONCLUSIONS: Searching for PHSM was significantly associated with an increased likelihood of achieving sufficient DHL subscales in a shorter time. Further studies are needed, including developing strategies to increase the availability of high-quality information concerning public health and social measures and to improve (digital) health literacy.

Adaptation and validation of the Digital Health Literacy Instrument for Portuguese university students.

BACKGROUND: Health literacy is an important skill to deal with information and positively influences individual and community health. Information concerning health is available from a plethora of online resources. The concept of digital health literacy has gained prominence with the pandemic. The absence of valid tools to analyse digital literacy levels are scant. This study aims to translate, adapt and validate the Portuguese version of the Digital Health Literacy Instrument (DHLI) as used in the global COVID-HL Network. METHODS: Participants were mostly students from social sciences, psychology, education and health sciences. The Portuguese version of the DHLI contained five dimensions each consisting of three items. An online survey with university students (n = 1815, 75.1% female, average age: 24.15 years) was administered to test the validity of the Portuguese version of the DHLI. Data were analysed using exploratory and confirmatory factor analysis. Pearson correlations were also studied. RESULTS: Two items revealed symmetry and kurtosis problems. We chose to eliminate them from the analysis. Different exploratory factor analysis attempts were made, obtaining two possible models to be tested in the confirmatory factor analysis: a three-factor model and a four-factor model. A four-factor structure of the instrument (information searching, adding self-generated content, evaluating reliability, determining relevance) was supported by confirmatory factor analysis and had good internal consistency. CONCLUSIONS: The Portuguese version of the Digital Health Literacy Instrument met adequate psychometric criteria. Therefore, it can be confidently used in Portuguese students' assessment of digital health literacy. Representative studies are needed to shed light on different target groups and their COVID-19-related DHLI.

Associations between COVID-19-Related Digital Health Literacy and Online Information-Seeking Behavior among Portuguese University Students.

We aim to evaluate the associations between digital health literacy (DHL) related to COVID-19 and online information-seeking behavior among university students. METHODS: A total of 3.084 students (75.7% women), with an average age of 24.2 (SD = 7.5) participated in this cross-sectional study, most of whom (36.5%) were from social sciences and pursued a bachelor's degree (50.7%). Data on COVID-19-related DHL and online information-seeking behavior were collected using an online questionnaire. Logistic regression models were performed. RESULTS: As the pandemic progressed, participants showed a lower chance of achieving a sufficient DHL (OR = 0.7; 95% CI = 0.6; 0.9). Using search engines more often (e.g., Google) (OR = 0.7; 95% CI = 0.5; 0.9), Wikipedia (OR = 0.7; 95% CI = 0.6; 0.9) and social media (e.g., Facebook) (OR = 0.7; 95% CI = 0.6; 0.9) decreased the likelihood of achieving sufficient DHL related to COVID-19. More frequent use of websites of public bodies (OR = 1.7; 95% CI = 1.1; 2.5) increased the odds of reporting sufficient DHL. CONCLUSION: DHL is associated with university students' online information-seeking behavior in the time of COVID-19. From a community and public health perspective, programs aiming at improving DHL should be highlighted.

Adaptation and validation of the Inventory of Family Protective Factors for the Portuguese culture / Adaptação e Validação do Instrumento Inventory of Family Protective Factors para a cultura portuguesa / Adaptación y Validación del Instrumento Inventory of Family Protective Factors para la cultura portuguesa

OBJECTIVES: to adapt and validate the Inventory of Family Protective Factors (IFPF) for the Portuguese culture. This instrument assesses protective factors that contribute to family resilience. Studies addressing resilience are embedded within the salutogenic paradigm, i.e. it addresses protective factors of individuals or groups without underestimating risk factors or vulnerability. METHOD: in order to assess the IFPF's linguistic and conceptual equivalence, the instrument was translated, retro-translated and the think-aloud protocol was used. We then verified the instrument's sensitiveness, reliability and validity of results to assess its psychometric characteristics. A factor analysis was performed of the principal components with varimax rotation of the scale's items and Cronbach's alpha coefficient was calculated for each dimension. A total of 85 families with disabled children, selected through simple random sampling, self-administered the instrument. RESULTS: the IFPF presents psychometric characteristics that are appropriate for the Portuguese population (Cronbach's alpha = .90). CONCLUSION: the IFPF was adapted and validated for the Portuguese culture and is an instrument to be used in studies intended to assess protective factors of family resilience. .

OBJETIVOS: adaptar e validar o Inventory of Family Protective Factors para a cultura portuguesa. Esse instrumento avalia os fatores protetores que contribuem para a resiliência familiar. Os estudos sobre resiliência inserem-se no paradigma salutogênico, abordando os fatores protetores dos indivíduos, ou grupos, sem subestimar os fatores de risco ou vulnerabilidade. MÉTODO: para avaliar a equivalência linguística e conceitual do Inventory of Family Protective Factors realizou-se a tradução, retroversão e reflexão falada; para aferir as características psicométricas do instrumento, verificou-se a sensibilidade, confiabilidade e a validade dos resultados. Foi realizada uma análise fatorial de componentes principais com rotação Varimax dos itens da escala e calculou-se o coeficiente alfa de Cronbach para cada dimensão. Através de uma amostragem aleatória simples, aplicou-se esse instrumento a 85 famílias de crianças com necessidades especiais que o autopreencheram. RESULTADOS: o Inventory of Family Protective Factors apresenta características psicométricas adequadas para a população portuguesa (alfa de Cronbach de .90). CONCLUSÃO: o Inventory of Family Protective Factors foi adaptado e validado para a cultura portuguesa. Considera-se que se trata de um instrumento útil para estudos nos quais há a proposta de avaliar os fatores protetores da resiliência familiar. .

OBJETIVOS: adaptar y validar el Inventory of Family Protective Factors (IFPF) para la cultura portuguesa. Este instrumento evalúa los factores protectores que contribuyen para la resiliencia familiar. Los estudios sobre resiliencia se insieren en el paradigma salutogénico, abordando los factores protectores de los individuos o grupos, sin subestimar los factores de riesgo o vulnerabilidad. MÉTODO: para evaluar la equivalencia lingüística y conceptual del IFPF realizamos la traducción, retrotraducción y reflexión hablada; para evaluar las características psicométricas del instrumento verificamos la sensibilidad, confiabilidad y la validez de los resultados. Realizamos un análisis factorial de los componentes principales con rotación varimax de los ítems de la escala y calculamos el coeficiente Alpha de Cronbach para cada dimensión. A través de un muestreo aleatorio simple, aplicamos este instrumento a 85 familias de niños con necesidades especiales que lo autollenaron. RESULTADOS: el IFPF presenta características psicométricas adecuadas para la población portuguesa (alfa de Cronbach de 0,90). CONCLUSIÓN: el IFPF fue adaptado y validado para la cultura portuguesa. Consideramos que se trata de un instrumento útil para estudios que se propongan evaluar los factores protectores de la resiliencia familiar. .

Adaptation and validation of the Inventory of Family Protective Factors for the Portuguese culture.

OBJECTIVES: to adapt and validate the Inventory of Family Protective Factors (IFPF) for the Portuguese culture. This instrument assesses protective factors that contribute to family resilience. Studies addressing resilience are embedded within the salutogenic paradigm, i.e. it addresses protective factors of individuals or groups without underestimating risk factors or vulnerability. METHOD: in order to assess the IFPF's linguistic and conceptual equivalence, the instrument was translated, retro-translated and the think-aloud protocol was used. We then verified the instrument's sensitiveness, reliability and validity of results to assess its psychometric characteristics. A factor analysis was performed of the principal components with varimax rotation of the scale's items and Cronbach's alpha coefficient was calculated for each dimension. A total of 85 families with disabled children, selected through simple random sampling, self-administered the instrument. RESULTS: the IFPF presents psychometric characteristics that are appropriate for the Portuguese population (Cronbach's alpha = .90). CONCLUSION: the IFPF was adapted and validated for the Portuguese culture and is an instrument to be used in studies intended to assess protective factors of family resilience.