Psychometric properties of the Movement Assessment Battery for Children (MABC-2): an analysis based on the Item Response Theory / A falta capacidade discriminatória em tarefas motoras do Movement Assessment Battery for Children ­ 2: O que a Teoria de Resposta ao Item revela?

Introduction: the American Psychiatric Association reveals that 6% of school-age children have developmental coordination disorder. Objective: this study aimed at assessing the suitability of the tasks proposed by the MABC-2 motor assessment instrument based on the psychometric properties of such an instrument and the analysis of the Item Response Theory. Methods: 582 children ranging in age from 3 to 5 years old of both sexes participated in the study. The motor tasks suitability for children was verified by using the Gradual Response Model, and applying the Maximum Likelihood Estimation method. Results: the motor task 'bicycle trail' showed a lower discriminatory power and was removed from the analysis. Considering the 'Aiming & Catching' dimension, 'Threading Beads' was the motor task with the highest degree of difficulty. Regarding balance, the 'One Leg Balance' task was classified as having a high degree of difficulty; on the other hand, the motor tasks 'Jumping on mats' and 'Catching Beanbag' required below average motor performance levels, that is, they are tasks with low discrimination capacity. The results showed that the low discriminative capacity of some MABC-2 items regarding this study sample makes it difficult to correctly classify the child's general motor performance level.Conclusion: the findings show that there is a need to review the suitability of the MABC-2 motor tasks in order to equate the difficulty and discriminatory capacity of the tasks so that standardization more appropriate to the reality of children from different populations is established.Keywords: psychometric properties, motor tasks, motor performance.

Introdução: a American Psychiatric Association revela que 6% das crianças em idade escolar apresentavam desordem coordenativa desenvolvimental. Objetivo: analisar a adequabilidade das tarefas propostas no instrumento de avaliação motora MABC-2 a partir da análise da teoria de resposta ao item.Método: participaram do estudo 582 crianças de 3 a 5 anos de idade, de ambos os sexos. A adequabilidade das tarefas motoras às crianças foi verificada por meio do modelo de resposta gradual, com método de estimação de máxima verossimilhança. Resultados: os resultados evidenciaram a existência de apenas dois fatores, sendo que as tarefas relativas ao "Equilíbrio" e "Lançar e "Receber", das dimensões propostas no modelo original foi agrupado em uma dimensão. Além disso, a tarefa motora "Caminho da bicicleta" não apresentou bom ajuste ao modelo, sendo eliminada das análises. Com isto, o modelo final apresentou bons índices de ajuste, e os parâmetros relacionados à tarefa indicaram a falta de equivalência de dificuldade e capacidade discriminatória entre as tarefas motoras do instrumento.Conclusão: os achados indicam que existe a necessidade de rever a adequabilidade das tarefas motoras do MABC-2 no sentido de equiparar a dificuldade e a capacidade discriminatória das tarefas a fim de criar uma padronização mais adequada a realidade de crianças de diferentes populações.

Access to care solutions in healthcare for obstetric care in Africa: A systematic review.

BACKGROUND: Emergency Medical Services (EMS) systems exist to reduce death and disability from life-threatening medical emergencies. Less than 9% of the African population is serviced by an emergency medical services transportation system, and nearly two-thirds of African countries do not have any known EMS system in place. One of the leading reasons for EMS utilization in Africa is for obstetric emergencies. The purpose of this systematic review is to provide a qualitative description and summation of previously described interventions to improve access to care for patients with maternal obstetric emergencies in Africa with the intent of identifying interventions that can innovatively be translated to a broader emergency context. METHODS: The protocol was registered in the PROSPERO database (International Prospective Register of Systematic Reviews) under the number CRD42018105371. We searched the following electronic databases for all abstracts up to 10/19/2020 in accordance to PRISMA guidelines: PubMed/MEDLINE, Embase, CINAHL, Scopus and African Index Medicus. Articles were included if they were focused on a specific mode of transportation or an access-to-care solution for hospital or outpatient clinic care in Africa for maternal or traumatic emergency conditions. Exclusion criteria included in-hospital solutions intended to address a lack of access. Reference and citation analyses were performed, and a data quality assessment was conducted. Data analysis was performed using a qualitative metasynthesis approach. FINDINGS: A total of 6,457 references were imported for screening and 1,757 duplicates were removed. Of the 4,700 studies that were screened against title and abstract, 4,485 studies were excluded. Finally, 215 studies were assessed for full-text eligibility and 152 studies were excluded. A final count of 63 studies were included in the systematic review. In the 63 studies that were included, there was representation from 20 countries in Africa. The three most common interventions included specific transportation solutions (n = 39), community engagement (n = 28) and education or training initiatives (n = 27). Over half of the studies included more than one category of intervention. INTERPRETATION: Emergency care systems across Africa are understudied and interventions to improve access to care for obstetric emergencies provides important insight into existing solutions for other types of emergency conditions. Physical access to means of transportation, efforts to increase layperson knowledge and recognition of emergent conditions, and community engagement hold the most promise for future efforts at improving emergency access to care.

Emergency Care Sensitive Conditions in Brazil: A Geographic Information System Approach to Timely Hospital Access.

Background: The benefits of treatment for many conditions are time dependent. The burden of these emergency care sensitive conditions (ECSCs) is especially high in low- and middle-income countries. Our objective was to analyze geospatial trends in ECSCs and characterize regional disparities in access to emergency care in Brazil. Methods: From publicly available datasets, we extracted data on patients assigned an ECSC-related ICD-10 code and on the country's emergency facilities from 2015-2019. Using ArcGIS, OpenStreetMap, and WorldPop, we created catchment areas corresponding to 180 minutes of driving distance from each hospital. We then used ArcGIS to characterize space-time trends in ECSC admissions and to complete an Origin-Destination analysis to determine the path from household to closest hospital. Findings: There were 1362 municipalities flagged as "hot spots," areas with a high volume of ECSCs. Of those, 69.7% were more than 180 minutes (171 km) from the closest emergency facility. These municipalities were primarily located in the states of Minas Gerais, Bahia, Espiríto Santo, Tocantins, and Amapá. In the North region, only 69.1% of the population resided within 180 minutes of an emergency hospital. Interpretations: Significant geographical barriers to accessing emergency care exist in certain areas of Brazil, especially in peri-urban areas and the North region. One limitation of this approach is that geolocation was not possible in some areas and thus we are likely underestimating the burden of inadequate access. Subsequent work should evaluate ECSC mortality data. Funding: This study was funded by the Duke Global Health Institute Artificial Intelligence Pilot Project.

Nível Socioeconômico e affordances do ambiente domiciliar: implicações para o desempenho motor infantil / Socioeconomic level and home environment affordances: implications for infant motor performance

Este estudo objetivou analisar o impacto do nível socioeconômico (NSE) sobre o desempenho motor mediado pelas affordances do ambiente domiciliar de crianças com idade média de 42 meses. Foram sujeitos 86 crianças (39 meninas e 47 meninos) matriculadas em 24 Centros Municipais de Educação Infantil. Como instrumentos de medida foram utilizados a Classificação da Associação Brasileira de Empresas de Pesquisa (ABEP), a Affordances for Home Environment Motor Development (AHEMD-SR) e a Bateria de Avaliação do Movimento para Crianças (MABC-2). Na análise dos dados foram utilizados o teste de Kolmogorov-Smirnov, "U" de Mann-Whitney e Análise de equações estruturais (p<0,05). Os resultados evidenciaram que as crianças de classe média alta possuem mais affordances em comparação às crianças de classe média baixa, no entanto, não houve diferença significativa no desempenho motor entre os grupos. O nível socioeconômico mais elevado não implica positivamente sobre o desempenho motor, entretanto, quando mediado pelas affordances domiciliares (materiais de motricidade fina e estimulação do espaço interno) demonstra um efeito positivo embora fraco no desempenho motor das crianças. Concluiu-se que o alto nível socioeconômico familiar não é suficiente para estruturar um ambiente domiciliar que oportunize o aperfeiçoamento do desempenho motor infantil, além do que as affordances presentes nos ambientes domiciliares parecem não estimular adequadamente o desempenho motor das crianças.

This study aimed to analyze the impact of the socio economic level on motor performance mediated by the home environment affordances among kids with the age of 42 months. Subjects were 86 kids (39 girls and 47 boys) enrolled in 24 Childhood Education Center of the city of Maringá-PR. The instruments used were the Classification of the Brazilian Association of Research Companies/ABEP, the Affordances for Home Environment Motor Development (AHEMD-SR) and the Movement Assessment Battery for Children-2/MABC-2. For data analysis, Kolmogorov-Smirnov, Mann-Whitney and Structural Equation Analysis were conducted (p<0,05). The results showed that children from upper middle class have more affordances compared to children from lower middle class; however, there was no significant difference in motor performance between the groups. The higher socioeconomic status does not have a direct impact on the motor performance, however, when mediated by household affordances (fine motor materials and internal space stimulation) it shows a positive, although weak effect on kids' motor performance. It was concluded that high family socioeconomic status is not enough to support a home environment that provides the enhancement of infant motor performance; in addition, the affordances in the domestic environment does not seem to stimulate adequately the kids' motor performance.