Clinical Factors Related to Abnormal General Movements Trajectories: Development of a Multicriteria Index.

PURPOSE: To create a multicriteria index with clinical factors associated with abnormal general movements (GMs) trajectories during a stay in the neonatal intensive care unit. METHODS: A longitudinal study assessed abnormal GMs trajectories in preterm infants in the neonatal intensive care unit. The multicriteria index included clinical factors such as intraventricular hemorrhage, respiratory support, gestational age, patent ductus arteriosus, and infection based on multi-attribute utility theory. RESULTS: A total of 52 preterm newborns, 57.7% male, were evaluated. The multicriteria index correlated with abnormal GMs trajectories and explained 26.5% of the variance in these trajectories. CONCLUSION: The developed multicriteria index, with the inclusion of combined clinical factors, allowed the identification of part of the abnormal trajectories of GMs in preterm infants. The multicriteria analysis can help clinicians to identify infants who have a greater chance of poor developmental trajectories before hospital discharge.

Expanding the Use of Six-Minute Walking Test in Patients with Intermittent Claudication.

BACKGROUND: Six-min walking test (6MWT) has been widely in patients with symptomatic peripheral artery disease (PAD) to quantify the walking impairment and the efficacy of different therapeutic interventions. Despite the aforementioned usefulness of 6MWT for PAD, the information provided by this test goes beyond the meters walked. The aim of this study was to describe the relative values of 6MWT and body weight-walking distance product (DW) in patients with symptomatic PAD. METHODS: Two hundred twenty-seven patients with symptomatic PAD participated in the study. The 6MWT was performed and absolute and claudication distances were obtained. The results of 6MWT were then relativized and expressed as a percentage of a healthy subject. DW was obtained by the product of 6MWT distance by weight. In both sexes, the relative 6MWT ranged from 57% to 64%. RESULTS: Absolute 6MWT total distance (P < 0.001) was lower in women than in men, whereas the relative 6MWT total distance was similar between sexes (P = 0.398). The absolute and relative 6MWT total distance were similar among age categories (P > 0.072). The DW was higher in men than in women (P < 0.05). In addition, in women, DW was higher in younger group than in other age groups (P < 0.05). CONCLUSIONS: Patients with symptomatic PAD achieve less than 70% of the distance achieved by an age-matched healthy subject. In patients with symptomatic PAD, the relative values of 6MWT total distance are similar between sexes and among different age groups, whereas DW are influenced by age and sex.

Heart rate recovery in asthmastic children and adolescents after clinical field test.

BACKGROUND: Inflammation caused by chronic lung disease in childhood may lead to delayed heart rate recovery (HRR) however, there is lack of evidence on HRR in this population. The aim was to assess HRR after functional capacity testing in asthmatic children and adolescents and to compare with severity and disease control. METHOD: This was a study secondary to a randomized control trial. The modified shuttle test (MST) was performed to assess functional capacity and HRR. This is an externally cadenced test in which the distance walked is the outcome. HRR was assessed after MST and was defined as HR at exercise peak minus HR in the second minute after the end of exercise. Asthma control was assessed by the Asthma Control Test (ACT). Data normality was tested by Shapiro Wilk and the comparison between groups was made by Student's t test or Mann Whitney test for numerical variables, and by Chi-square test for categorical variables. Statistical significance was considered when p < 0.05. SPSS version 20 was used in the analyzes. RESULTS: The sample included 77 patients diagnosed with asthma (asthma group - AG) who were regularly treated for asthma. Control group (CG) consisted of 44 volunteers considered healthy, matched in age and gender to AG. The median age of CG was 12 (10-14) years and in AG 11 (9-13 years) being classified as mild to moderate asthmatic, and 57% of the sample had controlled asthma by ACT. Distance walked in the CG was 952 ± 286 m and AG 799 ± 313 m, p = 0.001. HRR was more efficient in CG (79 ± 15 bpm) compared to AG (69 ± 12 bpm), p = 0.001. The mild (69 ± 12 beats) and severe (72 ± 15 beats) AG presented worse HRR compared to control group (79 ± 15 bpm), p < 0.05. CONCLUSIONS: Asthmatic children and adolescents have delayed HRR after modified Shuttle test compared to their peers, suggesting that asthma leads to autonomic nervous system imbalance. TRIAL REGISTRATION: Registered in Clinical Trials under number NCT02383069 and approved by the Universidade Nove de Julho - UNINOVE Research Ethics Committee, protocol number 738192/2014.

Asthma, allergic sensitization and lung function in sickle cell disease.

BACKGROUND: Pulmonary disease is a frequent acute and chronic manifestation in sickle cell disease (SCD), presenting high morbidity and mortality. OBJECTIVES: To identify the prevalence and association of asthma, allergic sensitization and altered pulmonary function in patients with SCD (SS and Sßo). METHODS: A single-center, cross-sectional study was conducted, in which 70 patients with SCD and 44 controls, aged six to 18 years, responded to the questionnaire of the International Study of Asthma and Allergies in Childhood (ISAAC), complemented with an anamnesis regarding the associated clinical outcomes. All patients underwent immediate hypersensitivity skin tests with aeroallergens and a pulmonary function evaluation (spirometry). Regarding the statistical analysis, parametric and non-parametric methods were used, depending on the variables studied. Tests were considered significant when p<0.05. RESULTS: There was no significant difference between the patients and controls regarding the prevalence of asthma and allergic sensitization (p>0.05). The number of occurrences of acute chest syndrome per patient per year was significantly higher for asthmatic patients than for non-asthmatic patients (p=0.04). Obstructive pulmonary function occurred in 30.9% of the patients and in 5.4% of the controls, and restrictive pulmonary function occurred in 5.5% of the patients and 5.4% of the controls. Asthma and wheezing in the last 12months had significant associations with obstructive pulmonary function (p=0.014 and p=0.027, respectively). CONCLUSIONS: The occurrence of asthma, allergic sensitization and alteration in lung function in patients with SCD reinforces the importance of routine monitoring of these diagnoses, which allows for early treatment and prevention of the evolution of pulmonary disease in adulthood.

Lung Function in Infants with Sickle Cell Anemia.

Lung volumes and forced expiratory flows were evaluated in 22 infants with sickle cell anemia and compared with a control group. Forced expiratory flows showed significantly lower values in the sickle cell group. The majority of infants had normal lung function, and obstruction was the most common pattern of abnormality.

Cutoffs of Short-Term Heart Rate Variability Parameters in Brazilian Adolescents Male.

A low heart rate variability (HRV) has been associated with cardiovascular risk factors in adolescents. However, no cut-off points are known for HRV parameters in this age group, making it difficult to use in clinical practice. Thus, the aims of the current study were to establish cutoffs of HRV parameters and to examine their association with cardiovascular risk in Brazilian adolescents male. For this reason, this cross-sectional study included 1152 adolescent boys (16.6 ± 1.2 years old). HRV measures of time (SD of all RR intervals, root mean square of the squared differences between adjacent normal RR intervals, and the percentage of adjacent intervals over 50 ms), frequency domains [low (LF) and high (HF) frequency], and Poincaré plot (SD1, SD2 and SD1/SD2 ratio) were assessed. Cardiovascular risk was assessed by sum of abdominal obesity, high blood pressure, overweight, and low physical activity level. The proposed cutoffs showed moderate to high sensitivity, specificity, and area under curve values (p < 0.05). HRV frequency parameters were statistically superior when compared to time-domain and Poincaré plot parameters. The binary logistic regression analysis indicated that all proposed HRV cutoffs were independently associated with a clustering of cardiovascular risk factors, with greater magnitude of HF and SD1/SD2 ratio (two or more risk factors: OR = 3.59 and 95% CI 1.76-7.34). In conclusion, proposed HRV cutoffs have moderate to high sensitivity in detecting of the cardiovascular risk factor and HRV frequency-domain were better discriminants of cardiovascular risk than time-domain and Poincaré plot parameters.

Predicted Equation for VO2 Based on a 20-Meter Multistage Shuttle Run Test for Children.

This study compared maximum oxygen consumption (VO2max) on a 20-meter multistage shuttle run test (20-Srt) with a cardiopulmonary exercise test (CPET) to determine a VO2max prediction equation for a 20-Srt in children aged 6-10 years. Eighty healthy children performed the CPET on a treadmill, while the 20-Srt took place on a sports court. Heart rate (HR) was measured and the expired gases were continuously measured breath-by-breath using a portable gas analyzer. The VO2max was lower (p<0.05) in CPET than 20-Srt for all, female, and male participants, respectively (46.3±7.9 vs. 48.7±4.6; 42.7±7.8 vs. 46.7±4.8; 49.3±6.8 vs. 50.4±3.9, mL·kg-1·min-1). The standard error estimates were between 3.0 and 3.6 and considered as not clinically relevant if less than 5 mL·kg-1·min-1. The intraclass correlation coefficient between the VO2 in CPET and in 20-Srt was 0.74 (CI95% 0.55-0.84) and considered moderately reliable. The linear multiple regression excluded sex, body mass index and fat-free mass and retained the maximum speed and age in the predictive equation. The 20-Srt estimates the VO2max with moderate reliability and the predictive equation was VO2maxpred=4.302+(maximum speed*5.613)-(age*1.523) for children aged 6-10 years.

COPD Assessment Test (CAT) is a Valid and Simple Tool to Measure the Impact of Bronchiectasis on Affected Patients.

The COPD assessment test (CAT) is a short questionnaire developed to help patients and clinicians to assess the impact of symptoms in routine clinical practice. We aimed to validate and to test the reproducibility of CAT in patients with bronchiectasis and correlate with the severity of dyspnea, aerobic and functional capacity, and physical activity in daily life. This is a cross-sectional study, patients with bronchiectasis underwent spirometry, cardiopulmonary exercise test (CPET), incremental shuttle walk test (ISWT), Saint George`s Respiratory Questionnaire (SGRQ), and received pedometer. CAT was applied twice (CAT-1 and CAT-2, 7 to 10 days apart). The severity of bronchiectasis was assessed by E-FACED and bronchiectasis severity index (BSI). A total of 100 patients were evaluated (48 ± 14 years, 59 women, FVC: 67 ± 22% pred, FEV1: 52 ± 25% pred). According to CAT, 14% patients presented low, 40% medium, 32% high, and 14% very high impact. The higher the CAT, the worse the severity of bronchiectasis, dyspnea, quality of life, performance on the CPET, and smaller the distance walked (DW) on the ISWT and number of steps (NS) per day. There was significant correlation between CAT and SGRQ, E-FACED, BSI, NS, ISWT, oxygen uptake, and workload at CPET. CAT-1 and CAT-2 presented similar values: 21 (13-26) and 19 (13-26), respectively. The CAT is a valid and reproducible instrument in patients with bronchiectasis presenting good correlation with clinical, functional, and quality of life measurements. This easy-to-use, easy-to-understand, quick, and useful tool may play an important role to assess the impact of bronchiectasis on both daily medical practice and clinical trial settings.

Effects of periodontal treatment on exacerbation frequency and lung function in patients with chronic periodontitis: study protocol of a 1-year randomized controlled trial.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) has been associated with periodontal disease (PD), and periodontal treatment (PT) has been connected to reduction of lung disease exacerbations. Bronchiectasis has many clinical similarities with COPD but, although it is also a chronic lung disease, to date it has not been studied with relation to PD. The aim of this study is to evaluate whether PT associated with photodynamic therapy (PDT) reduces the number of exacerbations, improves pulmonary function, periodontal clinical parameters and quality of life after 1 year of periodontal treatment follow-up. METHODS: Bronchiectasis patients will undergo medical anamnesis and periodontal examination. Participants with periodontitis will be divided into two groups and PT will be performed as G1 control group (n = 32) - OHO (oral hygiene orientation) + supragingival treatment + simulation of using photodynamic therapy (PDT); G2 experimental (n = 32) - scaling and root planing + PDT + OHO. Lung function will be assessed both at baseline and after 1 year by spirometry, exacerbation history will be analyzed through clinical records monitoring. Three instruments for quality of life assessment will also be applied - Saint George's Respiratory Questionnaire and Impact Profile Analysis Oral health (OHIP-14). It is expected that periodontal treatment can improve the analyzed parameters after 1 year. DISCUSSION: Although only one study evaluates exacerbation in COPD after 1 year of PT, bronchiectasis has not been studied in the dentistry field to date. TRIAL REGISTRATION: NCT02514226. Version #1. This study protocol receives grant from FAPESP (São Paulo Research Foundation) #2015/20535-1. First received: July 22, 2015, 1st version. This protocol has been approved by the Research Ethics Committee of Nove de Julho University.

Calidad de vida asociada con polifarmacia en personas con lesiones cutáneas crónicas.

OBJETIVO: Analizar la asociación entre el uso de polifarmacia y la calidad de vida de personas con lesiones cutáneas crónicas. MÉTODO: Estudio transversal con una muestra conformada por 146 personas afectadas por lesiones cutáneas crónicas, vinculadas con la atención primaria de salud. La recolección de datos se realizó entre julio de 2017 y febrero de 2018. La información se recopiló mediante un cuestionario sociodemográfico y el cuestionario Cardiff Wound Impact Schedule (CWIS). RESULTADOS: Hubo predominio de hipertensión arterial sistémica en 86 personas (58,9%) y de diabetes mellitus en 50 (34,2%). La etiología de la lesión cutánea predominante fue vasculogénica (38,4%), y se identificó polifarmacia en el 46,7% de los pacientes. En el cuestionario CWIS, el dominio con el puntaje promedio más bajo fue el bienestar (promedio de 46,2±17,9). Hubo asociación estadísticamente significativa (p<0.05) entre polifarmacia y las siguientes variables: dominio de "síntomas físicos/vida diaria", dominio de "vida social" y "autosatisfacción con la calidad de vida". CONCLUSIÓN: La polifarmacia está asociada con un detrimento en la calidad de vida de personas con lesiones cutáneas crónicas. Por lo tanto, los profesionales de la salud que trabajan en la atención primaria deberían considerar la terapia farmacológica en sus planes de atención, coordinar con asistencia médica y farmacéutica la elaboración de estrategias de monitoreo de los riesgos que involucran la polifarmacia, y evaluar sus impactos en la calidad de vida. CONFLICTO DE INTERÉS: Ninguno.

Calidad de vida asociada con polifarmacia en personas con lesiones cutáneas crónicas.

OBJETIVO: Analizar la asociación entre el uso de polifarmacia y la calidad de vida de personas con lesiones cutáneas crónicas. MÉTODO: Estudio transversal con una muestra conformada por 146 personas afectadas por lesiones cutáneas crónicas, vinculadas con la atención primaria de salud. La recolección de datos se realizó entre julio de 2017 y febrero de 2018. La información se recopiló mediante un cuestionario sociodemográfico y el cuestionario Cardiff Wound Impact Schedule (CWIS). RESULTADOS: Hubo predominio de hipertensión arterial sistémica en 86 personas (58,9%) y de diabetes mellitus en 50 (34,2%). La etiología de la lesión cutánea predominante fue vasculogénica (38,4%), y se identificó polifarmacia en el 46,7% de los pacientes. En el cuestionario CWIS, el dominio con el puntaje promedio más bajo fue el bienestar (promedio de 46,2±17,9). Hubo asociación estadísticamente significativa (p<0.05) entre polifarmacia y las siguientes variables: dominio de "síntomas físicos/vida diaria", dominio de "vida social" y "autosatisfacción con la calidad de vida". CONCLUSIÓN: La polifarmacia está asociada con un detrimento en la calidad de vida de personas con lesiones cutáneas crónicas. Por lo tanto, los profesionales de la salud que trabajan en la atención primaria deberían considerar la terapia farmacológica en sus planes de atención, coordinar con asistencia médica y farmacéutica la elaboración de estrategias de monitoreo de los riesgos que involucran la polifarmacia, y evaluar sus impactos en la calidad de vida. CONFLICTO DE INTERÉS: Ninguno.

Reference Equation for the Incremental Shuttle Walk Test in Children and Adolescents.

OBJECTIVE: To determine a prediction equation for distance walked of incremental shuttle walk test (ISWT) and test its reliability in children and adolescents. STUDY DESIGN: Cross-sectional study, which included 108 healthy volunteers between 6 and 18 years old. Those who had an abnormal spirometry or had a history of chronic disease were excluded. Two ISWT were performed. Heart rate and peripheral capillary oxygen saturation (SpO2) were continuously measured during the test. Dyspnea and lower limb fatigue were assessed by Borg scale before and after the tests. RESULTS: Boys walked longer distances compared with girls (1066.4 ± 254.1 m vs 889.7 ± 159.6 m, respectively, P < .0001). Except for dyspnea, there were no significant differences in the other outcomes measured (heart rate, lower limb fatigue, SpO2, and distance walked) at the peak of the two ISWT. The variables included in the predicted equation were age, body mass index, and sex. The predicted equation is: ISWTpred = 845.559 + (sex * 193.265) + (age * 47.850) - (body mass index * 26.179). The distance walked had an excellent reliability between the two ISWT, 0.98 (95% CI 0.97-0.99). The Bland-Altman plot shows agreement between tests (range from -40 to 45 m). CONCLUSIONS: We established a prediction equation for ISWT. It can be used as a reference to evaluate exercise capacity for children and adolescents. ISWT has excellent repeatability and it is a maximal-effort field test for this age group.

Incremental shuttle walking test: a reproducible and valid test to evaluate exercise tolerance in adults with noncystic fibrosis bronchiectasis.

OBJECTIVE: To analyze the reliability, validity, and determinants of the incremental shuttle walk test (ISWT) in adults with noncystic fibrosis bronchiectasis. DESIGN: Cross-sectional study. SETTING: Outpatient clinic. PARTICIPANTS: Subjects (N=75; 26 men) underwent, on different days, cardiopulmonary exercise testing (CPET) and 2 ISWTs, 30 minutes apart. The number of steps in daily life was recorded. Concurrent validity was tested by the relation between distance walked with peak load and oxygen consumption (V˙o2). INTERVENTIONS: None. MAIN OUTCOME MEASURES: Distance walked (m) was compared between the first and second ISWTs; greatest distance walked was correlated with peak load and Vo2peak obtained from CPET, steps per day, and dyspnea evaluated by the Medical Research Council (MRC) scale; and desaturation was compared between CPET and the ISWT. RESULTS: Distance walked was equivalent between the first ISWT (441±152m) and the second ISWT (445±153m) with an excellent intraclass correlation coefficient (.995; 95% confidence interval, .99-.997). There were significant correlations between distance walked and peak load (r=.82), V˙o2 (r=.72), steps per day (r=.61), and the MRC scale (r=-.69). Age, body mass index, sex, forced vital capacity (% predicted), dyspnea, and steps per day explained 70% of the variation in distance walked (m) and 60% of the variance when expressed as percent predicted. Higher desaturation was observed during the ISWT (-4%±4%) than cycling (-2±3%) (P<.001). CONCLUSIONS: The ISWT is reliable, represents functional capacity, and induces greater desaturation than cycling. Age, body composition, pulmonary function, dyspnea, and physical activity in daily life are determinants of the distance walked on the ISWT.

[Evaluation of the primary care in leprosy control: proposal of an instrument for users]. / Avaliação da atenção primária no controle da hanseníase: proposta de uma ferramenta desttinada aos usuários.

OBJECTIVE: Developing an instrument to evaluate the performance of primary health care in the leprosy control actions, from the perspective of users and do the face and content validation. METHOD: This is a methodological study carried out in four stages: development of instrument, face and content validation, pre-test, and analysis of test-retest reliability. RESULTS: The initial instrument submitted to the judgment of 15 experts was composed of 157 items. The face and content validation and pre-test of instrument were essential for the exclusion of items and adjustment of instrument to evaluate the object under study. In the analysis of test-retest reliability, the instrument proved to be reliable. CONCLUSION: The instrument is considered adequate, but further studies are needed to test the psychometric properties.


Normal values for maximal respiratory pressures in children and adolescents: A systematic review with meta-analysis.

BACKGROUND: The non-invasive assessment of maximal respiratory pressures (MRP) reflects the strength of the respiratory muscles. OBJECTIVE: To evaluate the studies which have established normative values for MRP in healthy children and adolescents and to synthesize these values through a meta-analysis. METHODS: The searches were conducted until October 2023 in the following databases: ScienceDirect, MEDLINE, CINAHL, SciELO, and Web of Science. Articles that determined normative values and/or reference equations for maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) in children and adolescents published in English, Portuguese, or Spanish regardless of the year of publication were included. Two reviewers selected titles and abstracts, in case of conflict, a third reviewer was consulted. Articles that presented sufficient data were included to conduct the meta-analysis. RESULTS: Initially, 252 studies were identified, 28 studies were included in the systematic review and 19 in the meta-analysis. The sample consisted of 5798 individuals, and the MIP and MEP values were stratified by sex and age groups of 4-11 and 12-19 years. Values from females 4-11 years were: 65.8 cmH2O for MIP and 72.8 cmH2O for MEP, and for males, 75.4 cmH2O for MIP and 84.0 cmH2O for MEP. In the 12-19 age group, values for females were 82.1 cmH2O for MIP and 90.0 cmH2O for MEP, and for males, they were 95.0 cmH2O for MIP and 105.7 cmH2O for MEP. CONCLUSIONS: This meta-analysis suggests normative values for MIP and MEP in children and adolescents based on 19 studies.

Sometimes, the size matters: Wing geometric morphometrics as a tool to assess domiciliation by Triatoma sordida (Stäl 1859).

BACKGROUND: Domiciliation by Triatoma sordida is a public health concern in South America. This study aimed to evaluate the morphometric changes in the domestic and peridomestic populations of T. sordida. METHODS: Specimen hemelytra were mounted, digitized, and processed for geometric morphometric analyses. RESULTS: The specimens captured in houses were smaller than those captured in peridomiciles. A large size reduction effect was observed in female peridomicile populations compared with female house populations. CONCLUSIONS: T. sordida house populations were smaller than peridomestic populations. Wing geometric morphometry can be used as a tool to indicate T. sordida domiciliation.

IgG Isotypes Targeting a Recombinant Chimeric Protein of Trypanosoma cruzi in Different Clinical Presentations of Chronic Chagas Disease.

Chagas disease (CD) is caused by the protozoan Trypanosoma cruzi, which leads to a spectrum of clinical presentations that range from asymptomatic to severe cardiac involvement. The host immune response plays a pivotal role in disease progression. Ig isotypes may contribute to disease pathogenesis. Investigating these components can provide insights into the immunopathogenic mechanisms underlying CD. This cross-sectional study aims to establish a correlation between the Ig profile of individuals infected with T. cruzi with the clinical forms of chronic CD. Serum samples were collected from partner institutions in different states of Brazil. Individuals diagnosed with chronic CD were categorized based on the clinical form of the disease. The indirect ELISA method using the recombinant chimeric Molecular Biology Institute of Paraná membrane protein 8.4 as the antigen was used to determine the Ig profile, including total IgG, IgG1, IgG2, IgG3, and IgG4. Ninety-seven serum samples from patients classified as negative (NEG, n = 38), indeterminate (IND, n = 24), mild cardiac (MC, n = 20), and severe cardiac (SC, n = 15) forms were analyzed. IgG1 exhibited greater levels compared with the other isotypes, showing a significant difference between the MC and IND groups. IgG3 levels were greater in individuals from the MC group compared with the SC group. IgG1 and IgG3 isotypes can serve as biomarkers to evaluate the progression of CD because they exhibit variations across clinical groups. Additional longitudinal studies are necessary to explore the relationship between antibody kinetics and the development of tissue damage.

Clinical features and physiotherapy management for COVID-19 in children.

BACKGROUND: COVID-19 has quickly become a worldwide threat to health, travel, and commerce. Studies adressing the clinical-functional presentation of viral infection and physiotherapy management in children are scarce. The purpose statement was to provide current perspectives on the physiotherapy interventions for managing children based on COVID-19 evidence. METHODS: In this review, databases were searched between January 1, and March 26, 2020. The following descriptors were considered in the electronic databases National Library of Medicine (PubMed/Medline), Scientific Electronic Library Online (SciELO) and Physiotherapy Evidence Database (PEDro): (novel Coronavirus), (novel corona virus), Coronavirus, (corona vírus), 2019-nCoV, nCovor, COVID-19, SARS-CoV-2. The results were described through the International Classification of Functioning, Disability and Health. RESULTS: Sixteen papers were included in this review. COVID-19 seems to lead to restriction of participation and interfere in tasks, such as recreation and leisure activities, respiratory muscle function and exercise tolerance. Personal protective equipments and contact precautions are important part of treatment. Effective oxygen therapy should be given immediately in presence of hypoxia. Nasal high-flow oxygen therapy, noninvasive ventilation, lung-protective ventilation strategies and prone position, should be undertaken when necessary under appropriate conditions. Airway clearance techniques should be administered only strictly needed and early activities must be encouraged. CONCLUSIONS: Potential physiotherapy interventions for children with COVID-19/SARS-CoV-2 consist of ventilatory management, airway clearance techniques and early activities and mobilization.

Functional capacity and quality of life in children and adolescents with sickle cell anemia.

OBJECTIVE: To evaluate the functional and exercise capacity, lung function, quality of life of children and adolescents with sickle cell anemia (SCA HbSS) and to test the reproducibility of functional capacity tests in this population. METHOD: Cross-sectional study with volunteers with SCA Hb-SS (SCAG), aged 6-18 years matched in age and gender to the control group (CG) with healthy individuals. Spirometry, 5-repetition sit-to-stand test (5STS-test), modified shuttle test (MST), and Pediatric Quality of Life Questionnaire (PedsQL) were performed. The reproducibility of 5STS-test and MST was evaluated: RESULTS: Forty eight volunteers of SCAG and 48 of CG were evaluated. Lung function of SCAG (FVC: 92 ± 15% pred.; FEV1 /FVC: 84 ± 8% pred.) was worse than the CG (104 ± 15% pred.; FEV1 /FVC: 90 ± 6% pred.) p < 0.05. SCAG had worse functional capacity registered by distance walked: 576 m (515-672 m) and 5STS-test: 8 s (7.4-8.9 s) compared with the CG who showed distance walked: 1010 m (887-1219 m) and 5STS-test: 7 s (7.0-8.1 s), p < 0.001. SCAG had worse quality of life compared to CG, p < 0.05. The reproducibility of MST (ICC 0.99 (0.98-0.99 IC-95%)) and 5STS-test (ICC 0.80 (0.69-0.88) was considered good, p < 0.001. CONCLUSION: Children and adolescents with sickle cell anemia presented worse capacity to walk or run, and to perform sit-to-stand test when compared with their control peers. Additionally, they have poorer quality of life. The MST and 5STS-test showed good reproducibility to be applied in pediatric individuals with SCA.

Simulation-based training in Leprosy: development and validation of a scenario for community health workers.

OBJECTIVES: To build and validate a clinical simulation scenario designed to instruct community health workers (CHWs) in active leprosy case detection. METHODS: Methodological study involving the development of a simulated clinical scenario and content validation by experts. The Content Validity Index (CVI) was used to determine the level of agreement among the judging commitee, and a descriptive analysis of their recommendations was performed. RESULTS: A simulated scenario with a simulated participant was developed - a simulation characterized by low complexity, moderate physical/environmental fidelity, moderate to high psychological fidelity, and high conceptual fidelity, lasting 50 minutes and capable of training up to 10 CHWs simultaneously. The scenario was validated by 14 experts, with a CVI exceeding 80% for all components. CONCLUSIONS: The validated clinical simulation possesses attributes that make it highly reproducible in various national health contexts, thereby contributing to the global "Towards Zero Leprosy" strategy.