An Evaluation of the Reliability of the Pictorial Scale of Perceived Water Competence and Its Relationship With Actual Water Competence.

In its recent development, the Pictorial Scale of Perceived Water Competence (PSPWC) showed good face and construct validity. However, additional reliability and validity research is needed, including test-retest reliability and a demonstration of the relationship between PSPWEC test scores and actual water competence. Toward that aim, we administered the PSPWC to 124 children, aged 5-8 years. We repeated this test administration after one week for a subset of 55 children to determine its test-retest reliability, and the remaining 69 children also performed the fully aligned Actual Aquatic Skills Test (AAST) in an indoor swimming pool to provide data for our investigation of the relationship between PSPWC scores and actual water competence. We found good test-retest reliability, both at the global level (ICC = 0.81, n = 55) and at the level of individual skills (Weighted kappa coefficients from 0.58 to 0.90), with no significant differences between these two test scores. We also found a moderate positive relationship between PSPWC and AAST total scores (r = .64, n = 69), with no significant difference between total scores of actual and perceived water competencies. Children overestimated their competence in three specific skills: the back star, swimming on the front, and diving in deep water. While these results underline specific situations in which children's higher self-perceptions of their water competence are a risk factor for their water safety, these data confirm that the PSPWC is reliable for measuring children's perceived competencies in aquatic education and drowning prevention, and there is further support for its validity through a moderate correlation with actual water competencies.

Guia prático para o uso de imunobiológicos em doenças alérgicas - ASBAI / Practical guide for the use of immunobiologic agents in allergic diseases - ASBAI

Os anticorpos monoclonais são uma nova classe de medicamentos que representa um marco na evolução da terapia de doenças alérgicas graves. Além de possibilitar uma terapia imunológica alvo específico, proporciona maior controle de sintomas, redução de exacerbações, melhoria da qualidade de vida e da segurança. A eficácia e a segurança dos anticorpos monoclonais no tratamento de doenças alérgicas estão bem documentadas nos estudos clínicos pivotais, de extensão e de vida real. No Brasil, estão licenciados atualmente pela Agência Nacional de Vigilância Sanitária (ANVISA) imunobiológicos para asma, dermatite atópica (DA), esofagite eosinofílica (EoE), granulomatose eosinofílica com poliangeíte (GEPA), rinossinusite crônica com pólipo nasal (RSCcPN), síndromes hipereosinofílicas (SHE) e urticária crônica espontânea (UCE). Com a incorporação do uso dessas novas terapias no dia a dia do médico alergologista e imunologista, naturalmente emergem aspectos práticos que exigem orientações práticas perante as evidências científicas mais atuais, a fim de se manter a boa prática médica, com uso criterioso e consciente pelo especialista capacitado. Assim, nesse guia prático, abordaremos os imunobiológicos aprovados até o momento para doenças alérgicas graves, com objetivo de auxiliar o especialista em Alergia e Imunologia na prescrição e manejo dessas medicações, incluindo indicações, contraindicações, monitoramento da eficácia e segurança, notificação de eventos adversos, bem como aspectos associados aos cuidados com vacinas, populações especiais, acesso, transporte, armazenamento e aplicação domiciliar.

Monoclonal antibodies are a new class of drugs that represent a milestone in the evolution of therapy for severe allergic diseases. In addition to allowing targeted immunologic therapy, they can improve symptom control, reduce exacerbations, and increase quality of life and safety. The efficacy and safety of monoclonal antibodies in the treatment of allergic diseases are well documented in pivotal, extension, and real-life clinical studies. In Brazil, immunobiologic agents are currently licensed by the National Health Surveillance Agency (ANVISA) for use in asthma, atopic dermatitis (AD), eosinophilic esophagitis (EoE), eosinophilic granulomatosis with polyangiitis (EGPA), chronic rhinosinusitis with nasal polyps (CRSwNP), hypereosinophilic syndrome (HES), and chronic spontaneous urticaria (CSU). With the incorporation of these new therapies into the daily practice of the allergist and immunologist, practical aspects will naturally emerge and require practical guidelines in light of the most current scientific evidence in order to maintain good medical practice, with judicious and conscious use by a qualified specialist. Therefore, in this practical guide, we will address the immunobiologic agents currently approved for severe allergic diseases, aiming to assist allergy and immunology specialists in the prescription and practical management of these medications, including indications, contraindications, efficacy and safety monitoring, adverse event reporting, as well as health care factors associated with vaccination, special populations, access, transport, storage, and home use.

Physical Activity, Quality of Live and Well-Being in Individuals with Intellectual and Developmental Disability.

The practice of physical activity, exercise and sport has many benefits for the general population, but studies on the population with intellectual and developmental disabilities (IDD) are scarce and inconclusive. The aim of this systematic review is to analyze the state of the art on the role of physical activity, exercise and sport in the quality of life and well-being of people with IDD, seeking to understand the current panorama in this area and provide answers to these questions. The research was carried out between July and October 2023 using three databases: PubMed, Web of Science and Scopus. Fifteen articles met the eligibility criteria for this study, and these were methodologically assessed using the Downs and Black scale (1998). Higher values were identified in the total quality of life score and some domains of this variable (e.g., personal development, physical well-being and emotional well-being), in satisfaction with life and in the perception of well-being in individuals with IDD who have enjoyed or are involved in physical activity, physical exercise and/or sports programs. Thus, according to the studies included in this systematic review, we can conclude that the practice of physical activity, physical exercise and sport seems to contribute to improving the quality of life and well-being of people with IDD. Despite the growing research interest in this area, there is still a notable lack of studies exploring the impact of these programs, especially sports-based programs, on quality of life and well-being variables in the population under study.

Cognitive performance and all-cause mortality in community dwellers of Amerindian ancestry living in rural Ecuador: A population-based, longitudinal prospective study.

OBJECTIVE: There is limited information on mortality risk in individuals with cognitive impairment living in rural Latin America. In this study, we assess the association between cognitive impairment and all-cause mortality in adults of Amerindian ancestry living in rural Ecuador. PATIENTS AND METHODS: Middle-aged and older adults enrolled in the population-based Three Villages Study cohort were followed prospectively in order to estimate mortality risk according to their baseline cognitive performance as determined by the Montreal Cognitive Assessment (MoCA). Results were adjusted for demographics, level of education, traditional cardiovascular risk factors, symptoms of depression, severe tooth loss, and oily fish intake (factors previously associated with mortality in the study population). RESULTS: Analysis included 1022 individuals followed for an average of 7.8 ± 3.4 years. Mean MoCA score was 21.2 ± 5.4 points (median: 22 points), with 334 (32.7%) individuals showing cognitive impairment, as evidenced by a MoCA score ≤ 19 points (the cutoff for poor cognitive performance based on previous studies in the same population). A total of 150 (14.7%) individuals died during the follow-up. Crude mortality rate was 2.87 per 100 person-years (95% C.I.: 2.08 - 3.96). For individuals with normal cognition, the mortality rate was 1.21 (95% C.I.: 0.92 - 1.50) while for those with cognitive impairment the rate increased to 3.48 (95% C.I.: 2.73 - 4.23). A multivariate Cox-proportional hazards model, confirmed that individuals with cognitive impairment had a significantly higher mortality risk than those without cognitive impairment (HR: 1.52; 95% C.I.: 1.05 - 2.18). CONCLUSIONS: Cognitive impairment is associated with mortality in the study population.

Exploring the relationship between social support, resilience, and subjective well-being in athletes of adapted sport.

Introduction: Sports participation of people with disabilities provide an improvement in their skills, especially on access to social support, which could improve resilience and well-being. This study aims to analyze the association between types of social support (parents, coach, friend, and best friend), resilience and positive and negative affect, in 105 Portuguese athletes with disabilities aged between 13 and 61 years (32 ± 12.35 years). Methods: Participants answered a short sociodemographic questionnaire, the Portuguese version of the Positive and Negative Affect Schedule, and the Brief Resilience Scale, and a scale for assessing social support from parents, coach, friend, and best friend. Results: Social support provided by the best friend, coach, friends, and parents had a direct effect on resilience and positive and negative affect. Results showed a positive and significant association between resilience and positive affect (r = 0.28; p = 0.004) and a negative association between resilience and negative affect (r = -0.37; p ≤ 0.001). A strong relationship was found between resilience and affect, with no relationship being verified between the sources of social support and resilience or affect, as hypothesized. Discussion: For this group of athletes with disability, more than the social support they may have or may feel, resilience proved to be very important for the consequence of sports practice in terms of subjective well-being.

Well-Being, Resilience and Social Support of Athletes with Disabilities: A Systematic Review.

Sport for people with disabilities appears to play a positive role in the well-being, resilience and social support of athletes with disabilities. Thus, this systematic review aims to evaluate the effect of adapted sport on the well-being, resilience and social support in a population with disabilities. The Pubmed, Web of Science, Scopus and SportDiscus databases were used, with several descriptors and Boolean operators. A total of 287 studies were identified through searching the databases. After the data extraction process, twenty-seven studies were included for analysis. In general, these studies show that adapted sport has a positive impact on the levels of well-being, resilience and social support resources for people with disabilities, contributing to their personal development, quality of life and integration into society. Considering the impact on the variables studied, these results are important to support and encourage the development of adapted sport.

Sphenoid sinus mucocele causing ptosis with pupil-spared ophthalmoplegia: a hint on carotid artery doppler ultrasound.

OBJECTIVE: Sphenoid sinuses mucocele (SSM) is an uncommon cause of orbital apex syndrome (OAS). Diagnosis of neurological complications in SSM might be delayed when the expansion of mucocele beyond the sinuses is not evident in conventional sinuses imaging. METHODS: We present a case of a 76-years old man with spared-pupil ophthalmoplegia associated with ptosis caused by a unilateral left SSM in which internal carotid artery Doppler ultrasound showed distal sub-occlusion waves pattern. RESULTS: Sinus occupation was noted in the magnetic resonance imaging (MRI) and was further evaluated in computed tomography (CT) scan and MR angiography. Nor CT or MR angiography showed clear evidence of neighboring structures compression. Doppler ultrasound of internal carotid showed high-resistance waveforms and decreased wave velocities helping diagnosis. Structures compression was confirmed intra-operatively and the patient was discharged asymptomatic after sphenoid sinus drainage. CONCLUSION: In this first report of carotid Doppler ultrasound findings in a patient with a neurological presentation of a sphenoid sinus mucocele, a high-resistance waveform of the internal carotid may help differentiate uncomplicated sinusitis from invasive mucocele.

Reações adversas aos anticorpos monoclonais para doenças alérgicas / Adverse reactions to monoclonal antibodies in allergic diseases

A utilização de agentes imunobiológicos em alergia e imunologia tem sido cada vez mais frequente nos últimos anos, emergindo como potencialmente eficazes para o tratamento de doenças alérgicas e de hipersensibilidade. O uso de imunobiológicos em doenças alérgicas está recomendado nas formas graves onde a eficácia, segurança e custo-efetividade estão comprovados. O objetivo deste artigo é sintetizar os efeitos adversos mais comuns ou significativos, incluindo as reações de hipersensibilidade aos principais anticorpos monoclonais aprovados para o tratamento de doenças alérgicas licenciados e comercializados no Brasil até o momento.

The use of immunobiological agents in allergy and immunology has increased in recent years, emerging as potentially effective strategies to treat allergic and hypersensitivity diseases. The use of immunobiological agents is recommended in the severe forms of allergic diseases, for which their efficacy, safety, and cost-effectiveness have been established. The purpose of this study was to summarize the most common or significant adverse effects, including hypersensitivity reactions to the main monoclonal antibodies approved for the treatment of allergic diseases that are currently licensed and marketed in Brazil.

Arterial stiffness and progression of white matter hyperintensities of presumed vascular origin in community-dwelling older adults of Amerindian ancestry: The Atahualpa Project Cohort.

OBJECTIVE: Arterial stiffness - as measured by the aortic pulse wave velocity (aPWV) - has been associated with biomarkers of cerebral small vessel disease (cSVD), in particular with white matter hyperintensities (WMH) of presumed vascular origin. Most studies have been conducted in White and Asian populations, and information on this relationship in other ethnic groups is limited. We designed a longitudinal prospective study to assess the impact of aPWV on WMH progression in individuals of Amerindian ancestry. PATIENTS AND METHODS: Participants of the Atahualpa Project Cohort were assessed at baseline with aPWV determinations, clinical interviews and brain MRIs. At the end of the study, brain MRIs were repeated in order to ascertain WMH progression. Poisson regression models adjusted for demographics and cardiovascular risk factors were fitted to assess WMH progression incidence rate by baseline levels of aPWV. RESULTS: The study included 260 individuals aged ≥60 years (mean age: 65.6 ± 6.1 years; 57 % women). The mean aPWV was 9.9 ± 1.5 m/s. Follow-up MRIs revealed WMH progression in 102 (39 %) individuals after a mean follow-up of 6.5 ± 1.4 years. Unadjusted analysis showed a higher baseline aPWV among subjects that developed WMH progression compared with those who did not (p < 0.001). Multivariate Poisson regression models showed an increased WMH progression rate among individuals in the second (IRR: 2.06; 95 % C.I.: 1.09-3.88) and third (IRR: 2.75; 95 % C.I.: 1.29-5.87) tertiles of aPWV compared with those in the first tertile. CONCLUSIONS: aPWV is associated with WMH progression, suggesting a link between atherosclerosis and cSVD in the study population.

Patterns of progression of cerebral small vessel disease markers in older adults of Amerindian ancestry: a population-based, longitudinal prospective cohort study.

BACKGROUND: Progression of cerebral small vessel disease (cSVD) markers has been studied in different races/ethnic groups. However, information from individuals of Amerindian ancestry is lacking. We sought to evaluate progression patterns of cSVD markers in community-dwelling older adults of Amerindian ancestry. METHODS: Following a longitudinal prospective study design, participants of the Atahualpa Project Cohort aged ≥ 60 years received a baseline brain MRI and clinical interviews. Those who also received a brain MRI at the end of the study were included. Poisson regression models were fitted to assess cSVD markers progression according to their baseline load after a median follow-up of 6.5 ± 1.4 years. Logistic regression models were fitted to assess interrelations in the progression of the different cSVD markers at the end of the study. RESULTS: The study included 263 individuals (mean age: 65.7 ± 6.2 years). Progression of white matter hyperintensities (WMH) was noticed in 103 (39%) subjects, cerebral microbleeds in 25 (12%), lacunes in 12 (5%), and enlarged basal ganglia-perivascular spaces (BG-PVS) in 56 (21%). Bivariate Poisson regression models showed significant associations between WMH severity at baseline and progression of WMH and enlarged BG-PVS. These associations became non-significant in multivariate models adjusted for clinical covariates. Logistic regression models showed interrelated progressions of WMH, cerebral microbleeds and enlarged BG-PVS. The progression of lacunes was independent. CONCLUSIONS: Patterns of cSVD marker progression in this population of Amerindians are different than those reported in other races/ethnic groups. The independent progression of lacunes suggests different pathogenic mechanisms with other cSVD markers.

Tokyo 2020: A Sociodemographic and Psychosocial Characterization of the Portuguese Paralympic Team.

The importance of practicing sports and its impact on the quality of life of people with disabilities is fundamental. Characterizing subjective well-being, resilience, and social influence in the practice of adapted sports, namely in those who participate in elite sport in Portugal, is truly important to support a set of initiatives to promote higher levels of practice. Thus, this study describes the Portuguese delegation at the Tokyo 2020 Paralympic Games through sociodemographic and psychosocial (positive and negative affect, life satisfaction, resilience, and social support) variables. The study involved 31 of the 33 athletes of the Portuguese Paralympic team aged between 15 and 58 years (34.45 ± 11.7 years), with 21 men and 10 women. Individual-level sociodemographic data gave us a clear insight into the reality of adapted sport in Portugal. The high values of life satisfaction, high positive affect and low negative affect, as well as high levels of resilience and social support seem to be important variables for these athletes. The data from the present study highlighted the importance of understanding the characteristics of Paralympic athletes, in order to better understand the reality of Paralympic sport in Portugal.

Decreased Nighttime Heart Rate Variability and Progression of White Matter Hyperintensities of Presumed Vascular Origin. A Prospective Study in Community-Dwelling Older Adults.

OBJECTIVES: Evidence on the role of autonomic dysfunction on white matter hyperintensities (WMH) progression is limited. This study aims to assess the impact of a low nighttime heart rate variability (HRV) on WMH progression in community-dwelling older adults. MATERIALS AND METHODS: Following a prospective longitudinal study design, all individuals aged ≥60 years enrolled in the Atahualpa Project Cohort from 2012 to 2019 were invited to receive baseline HRV determinations through 24-h Holter monitoring, together with clinical interviews and brain MRIs. These individuals were periodically followed by means of annual door-to-door surveys, and those who also received brain MRIs at the end of the study (May 2021) were included in the analysis. Poisson regression models, adjusted for relevant confounders, were fitted to assess the incidence rate ratio (IRR) of WMH progression according to nighttime standard deviation of normal-to-normal R-R intervals (SDNN). RESULTS: This study included 254 individuals aged ≥60 years (mean age: 65.4 ± 5.9 years; 55% women). The mean nighttime SDNN was 116.8 ± 36.3 ms. Follow-up MRIs showed WMH progression in 103 (41%) individuals after a median follow-up of 6.5 years. In unadjusted analyses, nighttime SDNN was lower among participants who developed WMH progression than in those who did not (p < 0.001). A Poisson regression model, adjusted for relevant covariates, disclosed a significantly inverse association between nighttime SDNN and WMH progression (IRR: 0.99; 95% C.I.: 0.98-0.99; p = 0.014). CONCLUSIONS: Study results show an inverse association between nighttime SDNN and WMH progression, and provide support for the role of sympathetic overactivity in this relationship.

Risk for Subsequent SARS-CoV-2 Infection and Severe COVID-19 Among Community-Dwellers With Pre-Existing Cervicocephalic Atherosclerosis: A Population-Based Study.

BACKGROUND: COVID-19 patients may develop atherosclerosis-related complications. Whether a proportion of these patients already had asymptomatic cervicocephalic atherosclerosis before SARS-CoV-2 infection is not known. This study assessed whether pre-existing cervicocephalic atherosclerosis increased the susceptibility to SARS-CoV-2 infection or resulted in more severe or fatal COVID-19. METHODS: Individuals enrolled in the Atahualpa Project cohort who received head CT (for assessing carotid siphon calcifications) and B-mode ultrasounds (for measurement of the carotid intima-media thickness) prior to the pandemic were eligible for this study. Among this cohort, those who also received serological tests for detection of SARS-CoV-2 antibodies and clinical evaluations for assessment of COVID-19 severity were enrolled. Multivariate logistic regression and exposure-effect models were fitted to assess the association between pre-existing atherosclerosis biomarkers, and SARS-CoV-2 seropositivity and COVID-19 severity. RESULTS: Overall, 154 of 519 study participants (30%) had evidence of cervicocephalic atherosclerosis. A total of 325 (63%) individuals became SARS-CoV-2 positive, and 65 (23.5%) of seropositive individuals had severe or fatal COVID-19. The risk of SARS-CoV-2 seropositive status did not differ across individuals with and without atherosclerosis biomarkers (P = .360). Likewise, seropositive individuals with pre-existing atherosclerosis were not more prone to develop severe or fatal COVID-19 than those without evidence of atherosclerosis (P = .274). Average estimated exposure effects of pre-existing cervicocephalic atherosclerosis versus no atherosclerosis over SARS-CoV-2 seropositivity and COVID-19 severity were not significant. CONCLUSIONS: Pre-existing cervicocephalic atherosclerosis does not increase the risk of acquiring SARS-CoV-2 infection nor the severity of COVID-19 among seropositive individuals.

Face and Content Validity of the Pictorial Scale of Perceived Water Competence in Young Children.

An international group of experts have developed a pictorial tool to measure perceived water competence for children aged from 5 to 8 years old: the Pictorial Scale of Perceived Water Competence (PSPWC). The aim of the present study was to verify the validity of this tool. In the first part of the study, 120 children were interviewed to investigate face validity of the PSPWC to ensure that all pictorial items were understandable. In the second part of the study, 13 scientific and/or pedagogical international experts were invited to assess the tool's content validity via an online survey. Face validity results revealed that children were able to understand and sequence correctly the aquatic situations in 92% of the cases. The average Content Validity Index (CVI) of the PSPWC ranged from 0.88 to 0.95, showing acceptable content validity. Feedback from experts and children resulted in a major improvement of the "exit water" situation and minor improvements concerning some other items. Experts confirmed that the PSPWC was globally appropriate for different countries and cultures, except for the situation "water entry by slide" which was not considered usual practice in some countries. The PSPWC opens up to new fields of research; useful both for the prevention of drowning and for the support of children's aquatic education.

Factors Associated With a Persistent Seronegative Status 1 Year After a SARS-CoV-2 Massive Infection Outbreak in Community Dwellers Living in Rural Ecuador: A Prospective Population-based Study.

BACKGROUND: The SARS-CoV-2 pandemic is affecting millions of people living in rural areas of Low- and Middle-Income Countries and is causing an already anticipated devastating effect on the health and economics of these populations. More information is needed to modify behaviors that may counterbalance the consequences of mass spread of the virus in these underserved communities. This study aimed to identify factors associated with a persistent SARS-CoV-2 seronegative status 1 year after a massive infection outbreak in middle-aged and older adults living in rural Ecuador. METHODS: Individuals enrolled in the Atahualpa Project Cohort as of March 2020 received 5 rounds of tests for determination of SARS-CoV-2 antibodies in blood. Individuals who remained seronegative up to April 2021 were considered "persistently seronegative." An adjusted Poisson regression model was fitted to estimate the incidence risk ratio of factors directly or inversely associated with a persistent seronegative status. RESULTS: A total of 673 individuals received baseline tests. Thirty-one declined consent or died and 429 seroconverted, leaving 213 seronegative subjects. Average SARS-CoV-2 incidence rate was 9.87 events (95% C.I.: 8.91-10.83) per 100 person-months of observation. The use of flushing toilet systems (instead of open latrines) increased 1.5 times the possibility of remaining seronegative. Likewise, every additional bedroom in the house increased by 15% the possibility of remaining seronegative. In contrast, every additional person in the house and having high cholesterol levels significantly reduced the possibility of remaining seronegative. CONCLUSIONS: The use of flushing toilet systems and the number of bedrooms in the house directly influenced the possibility of remaining seronegative among individuals living in this rural setting. Study results also demonstrated a sustained transmission of the virus even after a significant proportion of the population has been infected. Our findings reinforce the mass spread of SARS-CoV-2 in rural communities.

Hypertensive Retinopathy and All-Cause Mortality in Older Adults of Amerindian Ancestry. A Population-based Longitudinal Prospective Study.

INTRODUCTION: Hypertensive retinopathy (HTRP) predicts all-cause mortality in Asian and Caucasian populations. However, little is known about HTRP impact in other ethnic groups. AIM: We sought to estimate the mortality risk according to HTRP severity in older adults of Amerindian ancestry living in rural Ecuador. METHODS: This prospective study enrolled individuals aged ≥ 60 years with baseline blood pressure ≥ 120/≥ 80 mmHg from the ongoing Atahualpa Project cohort who received retinal photographs (for HTRP grading) and a brain MRI. We ascertained all-cause mortality after a mean of 5.2 ± 1.2 years of follow-up. Cox-proportional hazards models adjusted for demographics, cardiovascular risk factors, neuroimaging signatures of cerebral small vessel disease, blood pressure determinations during follow-up and incident strokes, were obtained to estimate mortality risk according to HTRP severity. RESULTS: Analysis included 236 participants (mean age 69.3 ± 7.3 years). HTRP Grade 2 or higher was determined in 42 (18%) individuals. Fifty participants (21%) died during the follow-up, resulting in an overall unadjusted crude mortality rate of 4.1 per 100 person-years. Mortality rate in subjects with HTRP Grade 2 or higher was 7.2 and in those with no HTRP or Grade 1 only was 3.4 per 100 person-years. An adjusted Cox-proportional hazard model showed that individuals with HTRP Grade 2 or higher maintained a greater than two-fold mortality risk (HR 2.08; 95% C.I. 1.04-4.15; p = 0.038) when compared to those with no HTRP or Grade 1 only. CONCLUSION: Study results show that HTRP severity predicts mortality in this population of older adults.

Differences between Young Children's Actual, Self-perceived and Parent-perceived Aquatic Skills.

As drowning is a leading cause of unintentional injury/death in children worldwide, perceptions of their actual aquatic skills are of critical importance. Children's self-perceptions may influence the risks they take, and parental perceptions may influence the degree of supervision deemed to be necessary for children in and around water. Accordingly, we examined the differences between young children's actual, self-perceived and parent-perceived aquatic skills. Using a three-way repeated measures ANCOVA, we analyzed data from 134 child-parent dyads (56.0% boys; M age = 7.1, SD = 1.1 years; and 71.6% mothers). We measured self and parental perceptions of the child's aquatic skills with the 'Pictorial Scale of Perceived Water Competence' (PSPWC), and we applied the exact same 17 test items of the PSPWC to assess the child's actual aquatic skill level in the water. Controlling for years of swimming school experience, within-subject differences between the total scores on the 'Actual Aquatic Skills Test' (AAST) and both the child- and parent-completed PSPWC indicated lower than actual estimates of the children's aquatic skill level. The degree of disagreement against the AAST was more pronounced in parents than in 6-7 year-old children but was similar between parents and 8-9 year-old children, with these patterns being evident regardless of the children's sex. Our study contributes to an ongoing validation of the PSPWC and represents a key advance in assessing and comparing children's actual and perceived aquatic skill competence, using perfectly aligned instruments. Future research and practice might explore children's actual aquatic skills in different contexts (e.g., open water), include perspectives of non-parent caregivers and assess perceived and actual water competence across development.