Effectiveness of a Nursing Educational Intervention in Adults to Promote Control Behaviors Against Dengue: Protocol for a Randomized Controlled Trial.

BACKGROUND: The increase in dengue cases can be attributed to social, demographic, environmental changes, or community-driven factors. In this regard, different strategies have been established in health education, using educational interventions as necessary tools for the reduction of the disease with the aim of reinforcing and stimulating the prevention and control of dengue. OBJECTIVE: This study aims to evaluate the effectiveness of a nursing educational intervention for dengue control. METHODS: A randomized controlled trial will be conducted with adults living in rural areas and participating in health promotion and disease prevention programs. We will enroll 116 adults. Adults will be randomized 1:1, with 58 adults assigned to the educational intervention group and 58 to the usual care group. Participants will receive 4 sessions over the course of a month, 1 week apart, and will be followed up for 1 month after the end of the educational intervention. Nursing Outcome Classification labels will be used to measure the outcomes: risk control (1902) and participation in health care decisions (1606). RESULTS: The participants in the intervention group are expected to achieve better dengue control behaviors than those in the usual care group. CONCLUSIONS: Risk factors are fostered by the community, largely caused by artificial reservoirs or unprotected tanks in homes; also, the lack of information hinders the identification of symptomatology and the poor implementation of effective measures, and the development of standardized educational strategies can contribute to efficient and cost-effective control of the disease. TRIAL REGISTRATION: ClinicalTrials.gov NCT05321264; https://clinicaltrials.gov/study/NCT05321264. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/54286.

Accuracy of prognostic serological biomarkers in predicting liver fibrosis severity in people with metabolic dysfunction-associated steatotic liver disease: a meta-analysis of over 40,000 participants.

Introduction: A prognostic model to predict liver severity in people with metabolic dysfunction-associated steatotic liver disease (MASLD) is very important, but the accuracy of the most commonly used tools is not yet well established. Objective: The meta-analysis aimed to assess the accuracy of different prognostic serological biomarkers in predicting liver fibrosis severity in people with MASLD. Methods: Adults ≥18 years of age with MASLD were included, with the following: liver biopsy and aspartate aminotransferase-to-platelet ratio (APRI), fibrosis index-4 (FIB-4), non-alcoholic fatty liver disease fibrosis score (NFS), body mass index, aspartate aminotransferase/alanine aminotransferase ratio, diabetes score (BARD score), FibroMeter, FibroTest, enhanced liver fibrosis (ELF), Forns score, and Hepascore. Meta-analyses were performed using a random effects model based on the DerSimonian and Laird methods. The study's risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2. Results: In total, 138 articles were included, of which 86 studies with 46,514 participants met the criteria for the meta-analysis. The results for the summary area under the receiver operating characteristic (sAUROC) curve, according to the prognostic models, were as follows: APRI: advanced fibrosis (AF): 0.78, any fibrosis (AnF): 0.76, significant fibrosis (SF): 0.76, cirrhosis: 0.72; FIB-4: cirrhosis: 0.83, AF: 0.81, AnF: 0.77, SF: 0.75; NFS: SF: 0.81, AF: 0.81, AnF: 0.71, cirrhosis: 0.69; BARD score: SF: 0.77, AF: 0.73; FibroMeter: SF: 0.88, AF: 0.84; FibroTest: SF: 0.86, AF: 0.78; and ELF: AF: 0.87. Conclusion: The results of this meta-analysis suggest that, when comparing the scores of serological biomarkers with liver biopsies, the following models showed better diagnostic accuracy in predicting liver fibrosis severity in people with MASLD: FIB-4 for any fibrosis, FibroMeter for significant fibrosis, ELF for advanced fibrosis, and FIB-4 for cirrhosis.Clinical trial registration: [https://clinicaltrials.gov/], identifier [CRD 42020180525].

Feeding therapy in a neurotypical child with feeding difficulties: A case report.

A feeding therapy developed in Brazil integrates aspects from diverse approaches and has increasingly been acknowledged as an adjunctive approach for addressing childhood feeding difficulties. In children, problems with eating are a common issue that affects their nutritional well-being, health, and overall quality of life, and can greatly hinder their social, emotional, and physical growth. In the realm of pediatrics, feeding therapy uses food and nutritional education, interactive games, and activities tailored to age groups and individualized treatment plans. The primary objective is to transform mealtime experiences and gradually foster children's acceptance of previously rejected foods. However, this treatment approach is new and recent in Brazil and lacks studies that explore and elucidate the topic. Therefore, this report aims to describe the follow-up and effects of feeding therapy in a 3-y and 8-mo-old neurotypical male patient with feeding difficulties who underwent feeding therapy conducted by a dietitian over a period of 19 wk. The feeding therapy consisted of 45-min sessions once a week in which food and nutrition education activities, games, and interactive activities, personalized according to the treatment plan, were carried out. The effects of feeding therapy were evaluated according to the patient's feeding progression throughout the sessions and their stepwise progress in the eating hierarchy. Based on our observations, the findings of this study suggest that feeding therapy practiced in Brazil can be a viable treatment approach for addressing feeding difficulties within this population. The feeding therapy originated in Brazil stands out from traditional nutritional care with its nurturing and compassionate approach that prioritizes respect for the child.

Doubts about the diagnosis and treatment of syphilis in pregnancy among primary care professionals in a telehealth service.

This cross-sectional study aims to describe doubts regarding the diagnosis and treatment of syphilis in pregnancy among primary care professionals in a telehealth service. All teleconsultations (TCs) offered through TelessaúdeRS-UFRGS to primary health care (PHC) services in the state of Rio Grande do Sul between 2018 and 2021 involving syphilis in pregnancy were included. A total of 356 (TCs) were analyzed. The main doubts about syphilis during pregnancy raised by primary care professionals were related to the need for retreatment (35%), diagnostic definition (23%) and initial treatment (16%). In addition, 95% of TCs were suitable for diagnosing and treating syphilis based on the 2020 Brazilian Ministry of Health guideline. This study suggests that TCs can identify failures in the diagnosis and treatment of public health problems and support decision making in PHC involving syphilis in pregnancy.

Tradução e adaptação transcultural do Children's Eating Behaviour Questionnaire (CEBQ) para o Brasil / Translation and cross-cultural adaptation of the Children's Eating Behavior Questionnaire (CEBQ) for Brazil

Objetivo: tradução, adaptação transcultural e validade de conteúdo do Children's Eating Behaviour Questionnaire (CEBQ) para o português brasileiro.Métodos: o processo de tradução e adaptação do instrumento do inglês para o português do Brasil foi conduzido através de recomendações da literatura em seis etapas: tradução, síntese das traduções, retrotradução, síntese ii, pré-teste e devolutiva da versão final. A validade de conteúdo foi avaliada através do índice de validade de conteúdo (IVC). Resultados: o questionário pré-teste foi submetido à avaliação da população-alvo e revelou uma taxa de clareza dos itens superior a 80%. O IVC do questionário final obteve uma pontuação de 0,98, conforme avaliação realizada pelo painel de juízes. Entre as 35 questões do instrumento, foi possível identificar uma concordância máxima em relação à sua relevância por parte do comitê de especialistas em 31 dessas questões.Conclusão: por meio da tradução e adaptação transcultural do CEBQ para crianças e adolescentes brasileiros, além da validação de conteúdo do instrumento, foi possível adequá-lo de forma mais precisa à realidade da população, sem comprometer o seu propósito original.Palavras-chave: nutrição comportamental, nutrição infantil, processos de tradução

Objective: translation, cross-cultural adaptation, and content validity of the Children's Eating Behaviour Questionnaire (CEBQ) into Brazilian Portuguese. Methods: the process of translating and adapting the instrument from English to Brazilian Portuguese was conducted following recommendations from the literature in six steps: Translation, Synthesis of translations, Back-translation, Synthesis II, Pre-testing, and feedback of the final version. Content validity was assessed using the Content Validity Index (CVI). Results: the pre-test questionnaire was evaluated by the target population and revealed an item clarity rate exceeding 80%. The CVI of the final questionnaire obtained a score of 0.98, as assessed by the panel of judges. Among the 35 ins-trument questions, maximum agreement regarding their relevance was identified by the committee of experts in 31 of these questions.Conclusion: through the translation, cross-cultural adaptation of the CEBQ for Brazilian children and adolescents, along with the content validation of the instrument, it was possible to adjust it more accurately to the reality of the population without compromising its original purpose

Validation of the regret coping scale for healthcare professionals (RCS-HCP) in portuguese for Brazil

Introduction: assessing the ability to cope with regret can contribute to support strategies for health professionals. However, in Brazil only few instruments evaluate this ability in general. Objective: this study aimed was to adapt and validate the Regret Coping Scale for Healthcare Professionals (RCS-HCP) to Brazilian Portuguese . Methods: the instruments were translated, and the psychometric properties evaluated for validity and reliability. Three hundred and forty-one professionals participated, with an average age of 38.6 ± 9.2, and 87 participated in a retest survey 30 days later. Results: exploratory factor analysis showed adequacy of the structure (KMO = 0.786) composed of three factors. In the confirmation, the performance was close to acceptable. Reliability was good for the maladaptive strategies (α = 0.834) and adequate for the problem-focused initiatives (α = 0.717), but slightly too low for adaptive strategies (α = 0.595). Test- retest showed lower than expected values, with a Spearman- Brown coefficient of 0.703. Conclusion: the RCS-HCP scale showed satisfactory performance in relation to the properties evaluated.

Introdução: a avaliação da capacidade de lidar com o arrependimento pode contribuir para estratégias de apoio aos profissionais de saúde. No entanto, no Brasil existem poucos instrumentos que avaliam essa habilidade no contexto geral. Objetivo: o objetivo do estudo foi adaptar e validar a Regret Coping Scale for Healthcare Professionals (RCS-HCP) para profissionais de saúde brasileiros. Método: na validação, os instrumentos foram traduzidos e as propriedades psicométricas avaliadas quanto à validade e confiabilidade. Participaram 341 profissionais, com média de idade de 38,6 ± 9,2, e 87 participaram de uma pesquisa de reteste 30 dias depois. Resultados: a análise fatorial exploratória mostrou adequação da estrutura (KMO = 0,786) composta por três fatores. Na confirmação, o desempenho ficou próximo do aceitável. A confiabilidade foi boa para as estratégias mal adaptativas (α = 0,834) e adequada para as estratégias focadas no problema (α = 0,717), mas um pouco baixa demais para as estratégias adaptativas (α = 0,595). Teste-reteste apresentou valores abaixo do esperado, com coeficiente de Spearman-Brown de 0,703. Conclusão: a escala RCS-HCP apresentou desempenho satisfatório em relação às propriedades avaliadas.

Brazilian instrument for assessing of eating disorders in children and adolescents / Instrumento brasileño para la evaluación de los trastornos alimentarios en niños y adolescentes

Objective: This study aimed to develop the Brazilian instrument for assessing eating disorders in children and adolescents and test its psychometric quality using item response theory (IRT). Design: Cross-sectional study. Participants: Participants aged between five and twelve years old of both sexes. Main measures: IRT logistic model of two parameters was used to evaluate the item's severity and discrimination and test information curve of symptoms of eating disorders’ latent trait symptoms. Content validity and reliability were also assessed. The IRT evaluation suggested that the instrument contained items that performed differently concerning severity, discrimination, and test information curve presented good accuracy. Results: There was agreement on the clarity of language (83.3%) and theoretical relevance (91.7%), indicating good content validity. The value of the Cronbach's Alpha was 0.63 (95% confidence interval), and the result of the Spearman–Brown test was 0.65. Conclusion: These results indicate good performance of the screening tool in assessing the level of eating disorders in children and adolescents.(AU)

Objetivo: Este estudio tuvo como objetivo desarrollar un instrumento brasileño para la evaluación de los trastornos alimentarios en niños y adolescentes, y testar el análisis psicométrico utilizando la teoría de respuesta al ítem (TRI). Diseño: Estudio observacional, transversal. Participantes: Individuos de ambos sexos entre los 5 y 12 años de edad. Mediciones principales: Se utilizó el modelo logístico TRI de 2 parámetros para evaluar la gravedad y la discriminación del ítem, y probar la curva características del test (CCT) de los síntomas del rasgo latente de los trastornos alimentarios. También se evaluaron la validez de contenido y la confiabilidad. Resultado: La evaluación TRI sugirió que el instrumento contenía ítems que funcionaban de manera diferente en cuanto a severidad, discriminación y la CCT presentando una buena precisión. Hubo concordancia en la claridad del lenguaje (83,3%) y en la relevancia teórica (91,7%), indicando buena validez de contenido. El valor del alfa de Cronbach fue de 0,63 (intervalo de confianza del 95%) y el resultado de la prueba de Spearman-Brown fue de 0,65. Conclusión: Estos resultados indican un buen desempeño de la herramienta de detección en la evaluación del nivel de los trastornos alimentarios en niños y adolescentes.(AU)

Association between children and adolescents' body composition with family income / Associação entre a composição corporal de crianças e adolescentes e renda familiar

ABSTRACT Objective To evaluate the association between children and adolescents' body composition with family income. Methods Cross-sectional study, participants between 5 and 19 years were included. A standardized questionnaire assessed socioeconomic variables. The outcome variables were z-score of Body Mass Index and bioimpedance parameters (skeletal muscle mass, fat-free mass, and fat percentage) and predictor variables (age, sex, race, place of residence, father's education, birth weight and breastfeeding) were analyzed using the quantile regression model and data from the 50th percentile are presented. The tests were bidirectional and the differences were considered significant with p<0.05. Results Among the 529 participants included, 284 (53.6%) were female and the mean age was 11.41±3.9 years. The Body Mass Index z-score was the only outcome that did not show differences between sexes (p=0.158). In the crude model, lower family income was associated with lower skeletal muscle mass (Difference=-7.70; 95% CI -9.32 to -5.89), p<0.001), lower fat-free mass (Difference= -13.40; 95% CI -16.40 to -10.39, p<0.001) and the lowest percentage of fat was associated with lower family income (Difference= -5.01, 95% CI -9.91 to -0.11, p=0.027). The z-score of BMI was not associated with family income. Conclusion Family income is directly associated with lower fat-free mass, fat percentage, and skeletal muscle mass in children and adolescents.

RESUMO Objetivo Avaliar a associação entre a composição corporal de crianças e adolescentes com a renda familiar. Métodos Estudo transversal, foram incluídos participantes entre 5 e 19 anos. As variáveis socioeconômicas foram avaliadas por meio de questionário padronizado. As variáveis de desfecho foram escore Z do índice de massa corporal e parâmetros de bioimpedância (massa muscular esquelética, massa livre de gordura e percentual de gordura) e variáveis preditoras (idade, sexo, raça, local de residência, escolaridade do pai, peso ao nascer e aleitamento materno) foram analisados pelo modelo de regressão quantílica e são apresentados os dados do percentil 50. Os testes foram bidirecionais, e as diferenças foram consideradas significativas com p<0,05. Resultados Entre os 529 participantes incluídos, 284 (53,6%) eram do sexo feminino e a média de idade foi de 11,41±3,9 anos. O escore Z do índice de massa corporal foi o único desfecho que não apresentou diferenças entre os sexos (p=0,158). No modelo bruto, uma menor renda familiar foi associada a menor massa muscular esquelética (Diferença= -7,70; IC 95% -9,32 a -5,89), p<0,001), menor massa livre de gordura (Diferença= -13,40; IC 95% -16,40 a -10,39, p<0,001) e o menor percentual de gordura associou-se à menor renda familiar (Diferença= -5,01, IC 95% -9,91 a -0,11, p=0,027). O escore Z do IMC não foi associado à renda familiar. Conclusão A renda familiar está diretamente associada à menor massa magra, ao percentual de gordura e à massa muscular esquelética em crianças e adolescentes.

Effect of Tacrolimus and Cyclosporine Immunosuppressants on Peripheral Nerve Regeneration: Systematic Review and Meta-analysis / Efeito dos imunossupressores tacrolimus e ciclosporina na regeneração de nervos periféricos: Revisão sistemática e metanálises

Abstract Peripheral nerve damage is an important cause of seeking medical attention. It occurs when the continuity of structures is interrupted and the propagation of nervous impulses is blocked, affecting the functional capacity of individuals. To assess the effects of the immunosuppressants tacrolimus and cyclosporine on the regeneration of peripheral nerves, a systematic review of the literature was carried out. The articles included were published until September 2018 and proposed to evaluate the effects of the immunosuppressants tacrolimus and cyclosporine on nerve regeneration and neuroprotection, available in the MEDLINE, EMBASE, Cochrane Library, Web of Science, Oxford Pain Relief Database, and LILACS databases. The research analysed a total of 56 articles, of which 22 were included in the meta-analysis. Statistical analysis suggests the protective effect of tacrolimus in the regeneration of the number of myelinated axons (95% confidence interval [CI]: 0.93-2.39; p< 0.01); however, such effect was not observed in relation to cyclosporine (95%CI: - 0.38-1.18; p» 0.08) It also suggests that there is a significant relationship between the use of tacrolimus and myelin thickness (95%CI» 2.00-5.71; p< 0. 01). The use of immunosuppressants in the regeneration of peripheral nerve damage promotes an increase in the number of myelinated axons in general, regardless of the administered dose. In addition, it ensures greater myelin thickness, muscle weight and recovery of the sciatic functional index. However, heterogeneity was high in most analyses performed.

Resumo As lesões nervosas periféricas são uma causa importante de busca por atendimento médico. Elas ocorrem quando há a interrupção da continuidade das estruturas e do bloqueio da propagação dos impulsos nervosos, afetando a capacidade funcional dos indivíduos. Para avaliar os efeitos dos imunossupressores tacrolimus e ciclosporina na regeneração de nervos periféricos, foi realizada uma revisão sistemática da literatura. Foram incluídos artigos publicados até setembro de 2018, que se propunham avaliar os efeitos dos imunossupressores tacrolimus e ciclosporina na regeneração nervosa e neuroproteção, disponíveis nas bases de dados MEDLINE, EMBASE, Cochrane Library, Web of Science, Oxford Pain Relief Database e LILACS. A pesquisa analisou um total de 56 artigos, dos quais 22 foram para metanálise. A análise estatística sugere o efeito protetor do tacrolimus na regeneração do número de axônios mielinizados (intervalo de confiança [IC] 95%: 0,93-2,39; p< 0,01); todavia tal efeito não foi observado em relação à ciclosporina (IC95%: - 0,38-1,18; p» 0,08). Ela também sugere haver uma relação significativa entre o uso do tacrolimus e a espessura da mielina (IC95%: 2,00-5,71; p< 0,01). O uso de imunossupressores na regeneração de lesão nervosa periférica promove um aumento no número de axônios mielinizados de forma geral, independentemente da dose administrada. Além disso, garante uma maior espessura da mielina, um maior peso muscular e restabelecimento do índice da função do nervo ciático. Todavia, a heterogeneidade foi alta na maioria das análises realizadas.

Reference percentiles for bioimpedance body composition parameters of healthy individuals: A cross-sectional study

Abstract Objectives: The aim of this study was to estimate the percentage distribution of body composition parameters for healthy people at different ages from the assessment of electrical bioimpedance. Methods: A cross-sectional study of healthy Brazilian aged 5 years and older. Were evaluated: total body fat; percent body fat; fat-free mass; percent lean mass; fat mass index; and fat-free mass index. Results: Of 1240 participants, with a median age of 27.0 years, 52.5% were female, and 73.7% were Caucasian. Most of the body composition variables were associated with age. The fat-free mass increased from youth to adult and decreased in the elderly in both sexes, with higher values in males than in females. In males, the percentage of lean mass has higher values in adolescence compared to childhood, and in adults compared to the elderly, when analyzed from the 50th percentile. In women, fat-free mass compared to adulthood, values were higher in childhood and lower in older ages. Conclusions: The study is the first to describe the Brazilian reference values for most clinical parameters of bioimpedance in percentiles stratified by different life cycles and sex. These findings can be very useful in clinical practice for health promotion and monitoring the nutritional status of the individual.

COVID-19 Prevention Policies Reduce Pediatric Hospital Mortality Due to Community-acquired Pneumonia

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Validation of the Family Health Behavior Scale for the Brazilian population

Abstract Objective: To validate the Family Health Behavior Scale (FHBS) for Brazilian families. Methods: The sample included 272 children aged 5 to 12 years old. Caregivers and their healthy answered the FHBS and questions about physical activity. In addition, anthropometric measurements of the children's weight and height were performed, as well as the bioimpedance exam. The scale was translated and the following validities were assessed: content (qualitative analysis and content validity index), construct (factor analysis) and concurrent validity (difference between domains and the total score with the categories of BMI, fat percentage and physical activity). Reliability (Cronbach's alpha, ceiling-floor effect, two-half test, intraclass correlation and Bland - Altman) was also assessed. Results: FHBS instrument performed well with regard to the psychometric properties in the Brazilian population. The content validity index was 0.987. Fit indices of the factor analysis were considered satisfactory, according to Bartlett's sphericity test (χ 2 = 1927, df = 351; p < 0.001) and the Kaiser-Meyer-Olkin index (KMO = 0.789). Concurrent validity, the differences between the mean of the domains and the total score between the categories of BMI (p = 0.011), percentage of fat (0.004) and physical activity (p < 0.001) were all significant. The reliability results were Cronbach's alpha internal consistency = 0.83, adequate ceiling-floor effect, 0.8105 (0.09 SD) two-half test, 0.626 intraclass correlation (95% CI: 0.406 to 0.777) and Bland - Altman -0.840 (-22.76 to 21.07). Conclusion: The FHBS adapted for the Brazilian population showed evidence of adequate psychometric performance.

Prevalence and factors associated with no intention to exclusively breastfeed for the first 6 months of life

Abstract Objective: To investigate the prevalence and factors associated with no intention to exclusively breastfeed for the first 6 months of life in a sample of women in the first 24 h postpartum during the hospital stay. Methods: Cross-sectional study with data from screening phase of a birth cohort. The proportion of mothers who did not intend to breastfeed exclusively for 6 months (primary outcome) derived from a negative response to the question "Would you be willing to try to breastfeed exclusively for the first 6 months?", in an interview conducted by previously trained interviewers. Crude and adjusted prevalence ratios (PR) with 95% confidence intervals were obtained by Poisson regression with robust variance. Results: A total of 2964 postpartum women were interviewed. The overall prevalence of mothers who did not intend to breastfeed exclusively for 6 months was 17.8% (16.4-19.1%). After adjusting for maternal age and type of pregnancy (singleton or multiple), no intention to exclusively breastfeed was higher in mothers with a monthly household income < 3 minimum wages (PR, 1.64; 1.35-1.98) and in those who intended to smoke 4-7 days/week after delivery (PR, 1.42; 1.11-1.83). The presence of significant newborn morbidity (PR, 0.32; 0.19-0.54) and intention to breastfeed up to 12 months (PR, 0.46; 0.38-0.55) had a protective effect against not intending to breastfeed exclusively for 6 months. Conclusions: Approximately 1 in every 5 mothers did not intend to breastfeed exclusively for 6 months. Strategies aimed at promoting exclusive breastfeeding should focus attention on mothers from lower economic strata and smokers.

Association between Periodontitis and Myocardial Infarction: Systematic Review and Meta-Analysis

Abstract The association between periodontitis and myocardial infarction remains unclear in the literature. Few studies have addressed periodontitis exposure as a predisposing factor for the development of myocardial infarction. Therefore, the present systematic review aims to analyze the association between periodontitis and myocardial infarction. This meta-analysis systematically searched MEDLINE, EMBASE, The Cochrane Controlled Trials Register, SCIELO, LILACS, CINAHL, Scopus, Web of Science and grey literature for studies estimating the association between periodontitis and myocardial infarction. Quality of evidence was assessed for all studies. The meta-analysis was conducted using random-effects models. Four of the six studies selected were included in the meta-analysis, including 1,035,703 subjects. The association between periodontitis and myocardial infarction was: RR: 5.99 (95% CI: 1.17-30.68), but with high heterogeneity (I2 = 100%; p <0.01). The results including only the highest quality articles, was lower: RR: 2.62 (95% CI: 1.47-4.70 3.83), but with lower heterogeneity (I2 = 85.5%; p < 0.01).The present systematic review with meta-analysis showed an association between periodontitis and acute myocardial infarction, but with a high level of heterogeneity.

Portuguese validation of the Regret Intensity Scale (RIS-10) for measuring the intensity of regret associated with the provision of attention in health / Validación al portugués de la Escala de Intensidad de Arrepentimiento (RIS-10) para medir la intensidad del arrepentimiento asociado a la prestación de atención en salud / Validação da versão em português da escala Regret Intensity Scale (RIS-10) para medir a intensidade do arrependimento associada à prestação de atenção em saúde

Objective. The aim of the study was to adapt and validate the Regret Intensity Scale-10 (RIS-10) for Brazilian health professionals. Methods. The validation study took place in two phases, in which the first was the translation of the instruments and the second, the field validation using psychometric properties validity and reliability of the scale with 341 professionals (doctors, nurses and physiotherapists) linked to hospitals. Validity was assessed using content validities (six judges evaluation), criteria (correlation with the Life Satisfaction Scale - SWLS and Self-Reporting Questionnaire 20 -SRQ-20) and construct (exploratory analysis using the rotation method Promax, based on the slope graph and the Kaiser criterion and confirmatory using the structural equation model) after applying the questionnaire to professionals.Reliability was measured by Cronbach's α coefficient and retest test over a maximum period of 30 days. Reproducibility was calculated by intraclass correlation. Results. A total of 341 professionals participated, with an average age of 38.6 ± 9.2 years. The content validity index (CVI) was 1.00, for all items of the scale in the proportion of agreement of the judges. Exploratory factor analysis showed a satisfactory correlation (Kaiser-Meyer-Olkin = 0.88), suggesting a two-factor model, which comprises the main components of the emotion of regret (Factor I ­ emoticons, Factor II - feelings), accounting for 64% of the total variation of the first factor. In the confirmation, the index standardized root mean squared residual = 0.063 was close to the acceptable and other values were below. The scale correlated positively with SRQ-20 (p < 0.001) and negatively with SLWS (p = 0.003). Reliability showed (Cronbach's α = 0.863) and test­retest reliability showed lower values than expected. The Bland-Altman graph showed a mean bias of -1.5 with lower and upper limits of 15.8 to 12.8 respectively. Conclusion. The RIS-10 adapted for the population performed adequately in the psychometric properties evaluated for the assessment of the intensity of regret related to the provision of health care.

Objetivo. Adaptar y validar la Escala de Intensidad de Arrepentimiento-10 (RIS-10) para profesionales de la salud brasileños. Métodos. Este estudio de validación se realizó en dos fases: la primera fue la traducción de los instrumentos y la segunda, la validación de campo evaluando las propiedades psicométricas de validez y confiabilidad de la escala con 341 profesionales (médicos, enfermeras y fisioterapeutas) vinculados a hospitales. La validez se evaluó mediante la validez de contenido (evaluación de seis jueces), criterios (correlación con la Escala de Satisfacción de Vida - SWLS y Self-Reporting Questionnaire 20 -SRQ-20) y constructo (análisis exploratorio mediante el método de rotación Promax, basado en el gráfico de pendiente (Criterio de Kaiser y confirmatorio por el modelo de ecuación estructural) luego de aplicar el cuestionario a los profesionales. La confiabilidad se midió mediante el coeficiente α de Cronbach y la prueba de reprueba en un período máximo de 30 días. La reproducibilidad se calculó por correlación intraclase. Resultados. Participaron 341 profesionales, con una edad media de 38.6 ± 9.2 años. El índice de validez de contenido (IVC) fue de 1.00 para todos los ítems de la escala en proporción de acuerdo con los jueces. El análisis factorial exploratorio mostró una correlación satisfactoria (Kaiser-Meyer-Olkin = 0.88), sugiriendo un modelo de dos factores, que comprende los componentes principales de la emoción de arrepentimiento (Factor I - emociones, Factor II - sentimientos), correspondiente al 64% de la variación total del primer factor. Tras la confirmación, el índice cuadrático medio residual estandarizado = 0.063 estuvo cerca de ser aceptable y los otros valores estaban por debajo. La escala se correlacionó positivamente con SRQ-20 (p<0.001) y negativamente con SLWS (p = 0.003). La confiabilidad mostró un α de Cronbach = 0.863 y la confiabilidad test-retest mostró valores más bajos de lo esperado. El gráfico de Bland-Altman mostró un sesgo medio de -1.5 con límites inferior y superior de 15.8 a 12.8, respectivamente. Conclusión. El RIS-10 adaptado a la población mostró un desempeño adecuado en las propiedades psicométricas utilizadas para evaluar la intensidad del arrepentimiento relacionado con la prestación de atención a la salud.

Objetivo. O objetivo do estudo foi adaptar e validar a Regret Intensity Scale-10 (RIS-10) para profissionais de saúde brasileiros. Métodos. O estudo de validação ocorreu em duas fases, sendo a primeira a tradução dos instrumentos e a segunda, a validação de campo utilizando as propriedades psicométricas validade e confiabilidade da escala com 341 profissionais (médicos, enfermeiros e fisioterapeutas) vinculados a hospitais. A validade foi avaliada por meio de validades de conteúdo (avaliação de seis juízes), critérios (correlação com a Escala de Satisfação de Vida - SWLS e Self-Reporting Questionnaire 20 -SRQ-20) e construto (análise exploratória usando o método de rotação Promax, com base no gráfico de inclinação e critério de Kaiser e confirmatório pelo modelo de equações estruturais) após aplicação do questionário aos profissionais. A confiabilidade foi medida pelo coeficiente α de Cronbach e teste de reteste em um período máximo de 30 dias. A reprodutibilidade foi calculada por correlação intraclasse. Resultados. Participaram 341 profissionais, com média de idade de 38.6 ± 9.2 anos. O índice de validade de conteúdo (IVC) foi de 1,00, para todos os itens da escala na proporção de concordância dos juízes. A análise fatorial exploratória mostrou correlação satisfatória (Kaiser-Meyer-Olkin = 0.88), sugerindo um modelo de dois fatores, que compreende os principais componentes da emoção de arrependimento (Fator I - emoções, Fator II - sentimentos), correspondendo a 64% da variação total do primeiro fator. Na confirmação, o índice raiz quadrada média residual padronizada = 0.063 ficou próximo do aceitável e os demais valores ficaram abaixo. A escala correlacionou-se positivamente com SRQ-20 (p <0.001) e negativamente com SLWS (p = 0.003). A confiabilidade apresentou (α de Cronbach = 0.863) e a confiabilidade teste-reteste apresentou valores menores do que o esperado. O gráfico de Bland-Altman mostrou um viés médio de -1.5 com limites inferior e superior de 15.8 a 12.8, respectivamente. Conclusão. O RIS-10 adaptado para a população apresentou desempenho adequado nas propriedades psicométricas avaliadas para avaliação da intensidade do arrependimento relacionado à prestação de cuidados de saúde

Whole-body magnetic resonance imaging for the diagnosis of metastasis in children and adolescents: a systematic review and meta-analysis / A ressonância magnética de corpo inteiro no diagnóstico de metástases em crianças e adolescentes: uma revisão sistemática e meta-análise

Abstract Whole-body magnetic resonance imaging (WB-MRI) is a noninvasive imaging method that can be used to diagnose and stage tumors, as well as to assess therapeutic responses in oncology. The objective of this meta-analysis was to evaluate the accuracy of WB-MRI for the diagnosis of metastases in pediatric patients. The following electronic databases were searched: Medline, Embase, Cochrane Central Register of Controlled Trials, Scientific Electronic Library Online, Latin-American and Caribbean Health Sciences Literature, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and ClinicalTrials.gov. All of the selected studies included children and adolescents with histopathological confirmation of a primary tumor. Collectively, the studies included 118 patients ranging in age from 7 months to 19 years. The pooled sensitivity and specificity of WB-MRI were, respectively, 0.964 (95% CI: 0.944-0.978; I2 = 0%) and 0.902 (95% CI: 0.882-0.919; I2 = 98.4%), with an area under the curve (AUC) of 0.991. We found that WB-MRI had good accuracy for the diagnosis of metastases in pediatric patients and could therefore provide an alternative to complete the staging of tumors in such patients, being a safer option because it does not involve the use of ionizing radiation.

Resumo A ressonância magnética de corpo inteiro (WB-MRI) é um método de imagem não invasivo que pode ser usado para diagnosticar, estadiar e avaliar a resposta terapêutica em oncologia. O objetivo desta meta-análise foi avaliar a precisão do diagnóstico de WB- MRI no diagnóstico de metástases em crianças. Foram pesquisadas as seguintes bastes de dados: Medline, Embase, Cochrane Central Register of Controlled Trials, Scientific Electronic Library Online, Latin-American and Caribbean Health Sciences Literature, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and ClinicalTrials.gov. Todos os estudos incluíram crianças e adolescentes com prova histopatológica de um tumor original. Os estudos selecionados incluíram 118 pacientes com idade variando de 7 meses a 19 anos. A sensibilidade e especificidade combinadas de WB-MRI foram, respectivamente, 0,964 (IC 95%: 0,944-0,978; I2 = 0%) e 0,902 (IC 95%: 0,882-0,919; I2 = 98,4%), com AUC de 0,991. A WB-MRI tem uma boa precisão para o diagnóstico de metástases em pediatria e pode potencialmente fornecer um método alternativo não ionizante mais seguro para completar o estadiamento da doença maligna em crianças.

Can skinfold thickness equations be substituted for bioimpedance analysis in children?

Abstract Objective: The aim of the present study was to evaluate the agreement between the most used skinfold thickness equations with multi-frequency bioimpedance analysis in the prediction of body fat levels in children. Method: A cross-sectional study of healthy Brazilian community-dwelling individuals. The anthropometric assessment included height, body mass, arm circumference, and waist circumference. The percentage of body fat was obtained by measuring skinfold thickness equations and using bioimpedance analysis, and skinfold thickness was measured using a scientific skinfold caliper. Bland-Altman plot analysis was used to verify the agreement between the methods. Results: There were 439 children and adolescents evaluated, with a mean age of 11.6 ± 3.7 years. The mean body fat by bioimpedance analysis was 22.8% ± 10.4%, compared to 22.4% ± 8.8% by Slaughter (1), 20.4% ± 9.2% by Slaughter (2), 19.6% ± 4.4% by Goran, and 24.7% ± 10.0% by Huang equations. Bland-Altman plot analysis revealed limits of agreement greater than 8% between the bioimpedance analysis approach and equations, exceeding the clinically acceptable limit predefined a priori. None of the equations had good agreement with bioimpedance analysis. Conclusion: It was concluded that skinfold thickness and bioimpedance analysis should not be used interchangeably in children and adolescents.

Brazilian version of the shriners hospital upper extremity evaluation (shuee): translation, cultural adaptation, and evaluation of psychometric properties / Versão brasileira do shriners hospital upper extremity evaluation: tradução, adaptação cultural e validação das propriedades psicométricas

ABSTRACT Objective: To validate the upper limb assessments tool, Shriners Hospital Upper Extremity Evaluation (SHUEE), for individuals with hemiplegic cerebral palsy in the Brazilian population. Methods: Validation study to translate and culturally adapt the Manual and the instrument. The psychometric properties evaluated were reliability and convergent validity. Reliability was determined by internal consistency (Cronbach's α coefficient), ceiling and floor effect, sensitivity to changes, and intra- and interobserver agreement. Convergent validity was performed using the Pediatric Motor Activity Log, the self-care scale of the Pediatric Evaluation of Disability Inventory, and the Manual Ability Classification System. Results: We evaluated 21 individuals with hemiplegic cerebral palsy, with a mean age of 8.7±4.0 years. After the instrument was translated, there was no need for cultural adaptation. The total Cronbach's α coefficient was 0.887 (95% confidence interval [95%CI] 0.745-0.970). We calculated sensitivity to changes in five subjects who underwent treatment with Botulinum Toxin Type A and physical therapy, with a significant difference between pre- and post-treatment evaluations in the Spontaneous Functional Analysis and Dynamic Positional Analysis. Convergent validity showed a significant correlation of the Spontaneous Functional Analysis and Dynamic Positional Analysis with the scales evaluated. All items of SHUEE presented high intra- and interobserver agreement. Conclusions: The results revealed that the Brazilian version of the SHUEE demonstrated good reliability and convergent validity, suggesting that it is an adequate and reliable tool for individuals with hemiplegic cerebral palsy in the Brazilian population.

RESUMO Objetivo: Validar o instrumento de avaliação do membro superior, Shriners Hospital Upper Extremity Evaluation (SHUEE), para indivíduos com paralisia cerebral hemiplégica da população brasileira. Métodos: Estudo de validação no qual foi realizada tradução e adaptação cultural do manual e do instrumento. As propriedades psicométricas avaliadas foram confiabilidade e validade convergente. A confiabilidade foi determinada através da consistência interna (coeficiente α de Cronbach), efeito teto e chão, sensibilidade à mudança e concordância intra e interobservador. A validade convergente foi realizada utilizando-se o Pediatric Motor Activity Log, a escala de autocuidados do Pediatric Evaluation of Disability Inventory e o Manual Ability Classification System. Resultados: Foram avaliados 21 indivíduos com paralisia cerebral hemiplégica com idade média de 8,7±4,0 anos. Após a tradução do instrumento, não houve necessidade de adaptação cultural. O coeficiente α de Cronbach total foi de 0,887 (intervalo de confiança de 95% [IC95%] 0,745-0,970). A sensibilidade à mudança foi calculada em cinco indivíduos que realizaram aplicação de Toxina Botulínica tipo A e fisioterapia, apresentando diferença significativa entre a avaliação pré e pós-tratamento na Análise Funcional Espontânea e Análise Posicional Dinâmica. A validade convergente mostrou correlação significativa da Análise Funcional Espontânea e Análise Posicional Dinâmica com as escalas avaliadas. Todos os itens do SHUEE apresentaram concordâncias fortes, tanto na avaliação intra quanto na interobservador. Conclusões: A versão brasileira do SHUEE demonstrou um bom desempenho em relação à confiabilidade e validade convergente, sugerindo ser uma ferramenta adequada e confiável para os indivíduos com paralisia cerebral hemiplégica na população brasileira.

Validation of the Brazilian version of the Pediatric Obstructive Sleep Apnea Screening Tool questionnaire / Validação da versão brasileira do questionário Pediatric Obstructive Sleep Apnea Screening Tool

Abstract Objective: To validate the Pediatric Obstructive Sleep Apnea Screening tool for use in Brazil. Materials and methods: The Brazilian version of this questionnaire, originally validated and tested in the United States, was developed as follows: (a) translation; (b) back-translation; (c) completion of the final version; (d) pre-testing. The questionnaire was applied prior to polysomnography to children aged 3-9 years from October 2015 to October 2016, and its psychometric properties (i.e., validity and reliability) were evaluated. The accuracy was assessed from comparisons between polysomnographic results and corresponding questionnaire scores. Results: Sixty patients were enrolled, and based on polysomnographic findings, 48% patients had normal apnea-hypopnea index, while the remaining 52% met the criteria for obstructive sleep apnea. Minimum O2 saturation level was significantly lower among obstructive sleep apnea children (p = 0.021). Satisfactory concordance was found between individual apnea-hypopnea index and questionnaire scores. Bland-Altman plot-derived bias was 0.1 for the difference between measures, with 5.34 (95% CI: 4.14-6.55) and −5.19 (95%CI: −6.39 to −3.98) for the upper and lower agreement range. Internal consistency derived from Cronbach's alpha was 0.84 (95%CI: 0.78-0.90). Conclusion: The questionnaire was translated to and validated into Brazilian-Portuguese version, and showed good reliability and concordance with apnea-hypopnea index. This questionnaire offers a reliable screening option for sleep-disordered breathing in children.

Resumo Objetivo: Validar o questionário Pediatric Obstructive Sleep Apnea Screening Tool para o seu uso no Brasil. Materiais e métodos: A versão brasileira desse questionário, originalmente validado e testado nos Estados Unidos, foi desenvolvida a partir das seguintes etapas: a) tradução; b) retrotradução; c) conclusão da versão final; d) pré-teste. O questionário foi aplicado previamente ao início da polissonografia em crianças de 3 a 9 anos incluídas no estudo de outubro de 2015 a outubro de 2016. As propriedades psicométricas avaliadas foram validade e confiabilidade. A acurácia foi avaliada pela comparação entre os resultados da polissonografia com o escore do questionário. Resultados: Foram incluídos no estudo 60 pacientes. Conforme a polissonografia, 48% dos pacientes apresentaram índices de apneia e hipopneia normais e 51% apresentaram resultados alterados. A SpO2 mínima foi significativamente menor (p = 0,021) nas crianças com diagnóstico de síndrome de apneia obstrutiva do sono. O índice de apneia e hipopneia apresentou concordância satisfatória com os resultados do questionário. O viés médio de Bland-Altman foi de 0,1 para a diferença entre as medidas, com um limite superior de 5,34 (IC95%4,14 a 6,55) e um limite inferior de -5,19 (IC95%-6,39 a -3,98). A consistência interna do questionário avaliada pelo α de Cronbach foi de 0,84 (IC95%0,78 a 0,90). Conclusão: O questionário foi traduzido e validado adequadamente para a versão em português brasileiro, apresentando boa confiabilidade e concordância com o índice de apneia e hipopneia. Esse questionário oferece uma opção confiável de triagem de distúrbios respiratórios do sono em crianças.

Validation of the Inventaire du Milieu Familial Questionnaire (French version of the Infant/Toddler HOME) into the Brazilian Portuguese language / Validação do questionário Inventaire du Milieu Familial (versão francesa do Infant Toddler Home) para a língua portuguesa

Abstract Objective: To validate the Brazilian Portuguese version of the Family Environment Assessment questionnaire (Inventaire du Milieu Familial). Methods: The validation process was carried out in two stages. First, translation and back-translation were performed, and in the second phase, the questionnaire was applied in 72 families of children between 0 and 24 months for the validation process. The tool consists of the following domains: mother's communication ability; behavior; organization of the physical and temporal environment; collection/quantity of toys; maternal attitude of constant attention toward her baby; diversification of stimuli; baby's behavior. The following was performed for the scale validation: 1 - content analysis (judgment); 2 - construct analysis (factorial analysis - Kaiser-Meyer-Olkin, Bartlett, and Pearson's correlation tests); 3 - criterion analysis (calculation of Cronbach's alpha coefficient, intraclass correlations, and split-half correlations). Results: The mean age of the children was 9 ± 6.7 months, and of these, 35 (48.6%) were males. Most correlations between items and domains were significant. In the factorial analysis of the scale, Kaiser-Meyer-Olkin values were 0.76, Bartlett's test showed a p-value < 0.001, and correlation between items and domains showed a p-value < 0.01. Regarding the validity, Cronbach's alpha was 0.92 (95% CI: 0.89-0.94). The intraclass correlation among the evaluators was 0.97 (0.96-0.98) and split-half correlations, r: 0.60, with p < 0.01. Conclusions: The Portuguese version of the Inventaire du Milieu Familial showed good to excellent performance regarding the assessed psychometric properties.

Resumo Objetivo: Validar a versão em português do Questionário de Avaliação do Ambiente Familiar (Inventaire du Milieu Familial). Métodos: O processo de validação foi feito em duas etapas. Primeiramente, realizou-se a tradução e retrotradução e, na segunda fase, o questionário foi aplicado em 72 famílias de crianças entre zero e 24 meses para o processo de validação. O instrumento é formado pelos seguintes domínios: Capacidade de comunicação da mãe; Comportamento; Organização do ambiente físico e temporal; Acervo/quantidade de brinquedos; Implicação da mãe com seu bebê; Diversificação de estímulos; Comportamento do bebê. Para a validação da escala foi realizada: 1- análise de conteúdo (julgamento); 2- análise de construto (análise fatorial - testes Kaiser-Meyer-Olkin, Bartlett e correlação de Pearson); 3- análise de critério (cálculo do coeficiente alfa de cronbach, correlações intraclasse e correlações split-half). Resultados: A média de idade das crianças foi 9 ± 6,7 meses e, dessas, 35 (48,6%) eram do sexo masculino. A maioria das correlações entre os itens e os domínios foi significativa. Na análise fatorial da escala, os valores de Kaiser-Meyer-Olkin foram 0,76, teste de Bartlett com p < 0,001 e correlação entre os itens e domínios p < 0,01. Em relação à validade, o alfa de Cronbach foi de 0,92 (IC 95% 0,89-0,94). A correlação intraclasse entre os avaliadores foi de 0,97 (0,96-0,98) e correlações split-half r: 0,60 p < 0,01. Conclusões: A versão portuguesa do Inventaire du Milieu Familial apresentou um bom à excelente desempenho nas propriedades psicométricas avaliadas.