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

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

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

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

Growth hormone modulates in vitro endothelial cell migration and formation of capillary-like structures.

The generation of new blood vessels is a complex process mediated by a variety of growth factors, and the growth hormone (GH) has been shown to act as a proangiogenic factor. In fact, human GH deficiency or excess are associated with endothelial dysfunction. Moreover, mouse models have revealed the action of GH in both tissue repair and in the microvascular circulation of normal tissues. In this study, we investigated the in vitro effects of GH on endothelial cells. Using a murine endothelioma cell line (tEnd.1), we demonstrated that GH has a mitogenic effect. The hormone also affected the endothelial cellular morphology and augmented the deposition of the extracellular matrix molecules, laminin, and fibronectin, on tEnd.1 surface. GH could stimulate tEnd.1 cell fugetaxis, in transwell chambers migration assay, and increased the formation of capillary-like structures in Matrigel®-coated plates. Given the important role of angiogenesis during tissue injury, for example, at ischemic lesions, these findings shed light on therapeutic angiogenesis, particularly in pathologies where the cardiovascular system has been compromised.

Psychometric properties analysis of helping relationships skills inventory for Portuguese nurses and doctors.

This paper answered some authors' requests to analyze the Helping Relationships Skills Inventory psychometric properties, a four dimensions measure. At this level, the study contributed to accessing the first reliable and valid instrument headed to Portuguese nurses and doctors. Methods: An online survey with Portuguese nurses and doctors (n = 262) was managed to assess the psychometrics properties analysis of the Helping Relationships Skills Inventory. Data were analyzed using descriptive statistics, confirmatory factor analysis, the average variance extracted (AVE), the heterotrait-monotrait ratio of correlations (HTMT), Cronbach's Alpha, and McDonald's Omega were computed. Results: The four-factor of the original Helping Relationships Skills Inventory was only supported by Exploratory Factor Analysis, with good internal consistency. Our study accepted this correlational structure hypothesis, which demonstrated acceptable to good sensitivity, convergent validity (AVE: 0.84-0.67), and reliability (Cronbach's Alpha: 0.92-0.88; McDonald'Omega: 0.93-0.79). Also stays verified discriminant validity for the majority of the factors with some reserves between Generics and Emphatics dimensions (HTMT: 0.90), revealing high commonality among them (r = 0.84; p < .001) Conclusions: The findings support the sensitivity, construct validity, and reliability of the Helping Relationships Skills Inventory among Portuguese nurses and doctors. However, will be useful to associate qualitative methodologies to explore the phenomenon better.

Health Literacy and Its Association with the Adoption of the Mediterranean Diet: A Cross-Sectional Study.

Health literacy (HL) is a crucial factor influencing health-related decisions, including dietary patterns. The Mediterranean diet is widely recognized as one of the healthiest eating patterns. This study aims to explore the association between HL levels among adults in socially vulnerable contexts and their adoption of the Mediterranean diet. Conducted as part of a cluster-randomized trial in primary schools, the research involved 557 parents of children aged 6 to 10 who consented to participate. HL was assessed using the HLS questionnaire, while adoption of the Mediterranean diet was evaluated using the MEDAS questionnaire. Participants also provided anthropometric and sociodemographic data via a questionnaire, from which BMI was calculated (weight/height2). Education level was categorized as higher education or lower and professional status was classified based on occupational categories. Generalized linear models and logistic regression were employed for analysis. The findings indicate a direct association between HL level and adoption of the Mediterranean diet (B = 0.022, 95% CI 0.010-0.035, p < 0.001), underscoring the influence of HL on dietary choices. Specifically, the healthcare dimension of HL emerges as pivotal in shaping dietary behaviors, particularly towards the Mediterranean diet. These results underscore the importance of policies and programs aimed at enhancing HL, especially among socially vulnerable populations. Prioritizing public health interventions to improve HL is critical for promoting better dietary decision-making.

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

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

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

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

Factors Associated with Parenting Adaptability in Facing the First COVID-19 Lockdown: A Study on Portuguese Parents.

Parenting was drastically challenged during the COVID-19 pandemic as families complied with the consequent containment for sanitary and social reasons. The purpose of this study is to explore the relationships among self-report measures (co-parenting, emotional experience and parental support network) and the employment condition (teleworking parents and at-home parents with governmental leave aid) that might be associated with the everyday life change, and their contribution towards family's daily routines during the first COVID-19 lockdown. A sample of 878 parents (90.2% mothers), aged from 21 to 61 years (39.58 ± 6.08), and mainly of Portuguese nationality (97.2%), was gathered through an online survey. Participants completed sociodemographic data and answered questions related to four positive parenting dimensions (Daily routines, Co-parenting, Emotional experience, and Support network) rating on a five-point Likert scale how much their behavior changed during the lockdown. Descriptive statistics and multilinear regression models were tested as well as a mediation model. The results showed that Emotional experience, Co-parenting, and Support network played an important role in family Daily routines, reinforcing that the first COVID-19 lockdown was lived differently by parents according to their employment conditions. Furthermore, the pathways model of factors associated with parental adaptability is suggestive that the direct effect of Emotional experience on Daily routines is partially mediated by Co-parenting and Support network. In line with previous studies on the complexity and dynamic ecology of parenting, the reported indicators showcase the interrelated facets of parenting and its corresponding support needs. Further, clear indicators for the design of family support interventions and family resilience enhancement to stressor events are discussed.

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

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

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

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

Parenting during the COVID-19 Lockdown in Portugal: Changes in Daily Routines, Co-Parenting Relationships, Emotional Experiences, and Support Networks.

The COVID-19 pandemic challenged parental resources pertinent to coping with lockdowns. The main objective of this work was to study parenting during the COVID-19 lockdown. Specifically at focus were parental behaviors concerning key domains for the family (daily routine, co-parenting, emotional experience, and support network) and changes related to the pandemic and associated with the parents' employment statuses. An online survey was carried out through an ad hoc questionnaire where participants completed questions about their sociodemographic data and rated how much their family routines, their co-parenting relationship, their emotional experiences, and the support available in the family network varied on a 5-point scale. The participants included 1384 parents, of which 286 responded to open questions regarding impactful experiences during the lockdown. The results showed differences in daily routine, co-parenting, emotional experience, and support network according to the parents' employment statuses. Between-group comparisons showed that at-home parents caring for children with governmental aids generally revealed more positive parenting behavior changes, while at-home parents who were teleworking reported more difficulties in parent-child activities and co-parenting. Furthermore, the content analysis of the data confirmed how important themes such as family dynamics, professional activities, and the relationship with the school community were throughout the participants' accounts of gains and losses. Overall, parents' employment statuses are associated with diverse experiences during lockdown. The COVID-19 pandemic highlighted the importance of family resources and parental resilience, particularly during circumstances jeopardizing the ever-sensitive work-family balance.

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

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

Escala de empoderamento juvenil pela educação em saúde: estudo de validação / Escala de empoderamiento juvenil por la educación para la salud: estudio de validación / Youth empowerment through health education scale: validity study

Resumo Objetivo Validar o conteúdo e a aparência da Escala de Empoderamento Juvenil pela Educação em Saúde (EJEduS) após uma intervenção educativa. Métodos Estudo metodológico realizado mediante a avaliação da Escala de Empoderamento Juvenil pela Educação em Saúde (EJEduS) pelos critérios de relevância, clareza e pertinência, por especialistas na temática como também por adolescentes escolares e de uma comunidade quilombola. A análise deu-se pelo Índice e pelo Coeficiente de Validade de Conteúdo, além do cálculo de Gwet AC2, para verificar a concordância inter e intraespecialistas. Resultados Dos 50 itens iniciais da escala, observou-se a necessidade de reformulação de 18 deles e a exclusão de 11 após discussão de consenso com os adolescentes. A concordância intraespecialistas se mostrou quase perfeita para os três critérios: relevância (Gwet: 0,894; IC95% 0,825-0,919), clareza (Gwet: 0,848; IC95% 0,816-0,879) e pertinência (Gwet: 0,896; IC95% 0,870-0,923). Na análise de concordância intra-adolescentes, observou concordância quase perfeita (Gwet: 0,96; IC95% 0,917-1), e com taxas de Índice e Coeficiente de Validade de Conteúdo aceitáveis de concordância, ambos com 0,91. Conclusão A escala apresentou Índices de Validade de Conteúdo e aparência satisfatórios para aferir o empoderamento juvenil pela educação em saúde.

Resumen Objetivo Validar el contenido y la apariencia de la Escala de Empoderamiento Juvenil por la Educación para la Salud (EJEduS) después de una intervención educativa. Métodos Estudio metodológico realizado mediante la evaluación de la Escala de Empoderamiento Juvenil por la Educación para la Salud (EJEduS), según criterios de relevancia, claridad y pertinencia, tanto por especialistas del tema, como también por adolescentes escolares y de una comunidad quilombola. El análisis se realizó a través del Índice y del Coeficiente de Validez de Contenido, además del cálculo de Gwet AC2, para verificar la concordancia inter e intraespecialistas. Resultados De los 50 ítems iniciales de la escala, se observó la necesidad de reformular 18 de ellos y de excluir 11 luego de una discusión de consenso entre los adolescentes. La concordancia intraespecialistas demostró ser casi perfecta en los tres criterios: relevancia (Gwet: 0,894; IC95 % 0,825-0,919), claridad (Gwet: 0,848; IC95 % 0,816-0,879) y pertinencia (Gwet: 0,896; IC95 % 0,870-0,923). En el análisis de concordancia intraadolescentes, se observó concordancia casi perfecta (Gwet: 0,96; IC95 % 0,917-1) y con valores aceptables de concordancia del Índice y Coeficiente de Validez de Contenido, ambos 0,91. Conclusión La escala presentó Índices de Validez de Contenido y apariencia satisfactorios para determinar el empoderamiento juvenil por la educación para la salud.

Abstract Objective To validate the Youth Empowerment Through Health Education Scale (EJEduS) content and appearance after an educational intervention. Methods This is a methodological study carried out through EJEduS assessment by relevance, clarity and pertinence criteria by experts in the subject as well as by school adolescents and from a quilombola community. The analysis was performed using the Content Validity Coefficient and Content Validity Index, in addition to calculating the Gwet AC2 to verify inter- and intra-expert agreement. Results Of the initial 50 items on the scale, 18 needed to be reformulated and 11 were excluded after consensus discussion with adolescents. The intra-expert agreement was almost perfect for the three criteria: relevance (Gwet: 0.894; 95%CI 0.825-0.919), clarity (Gwet: 0.848; 95%CI 0.816-0.879) and pertinence (Gwet: 0.896; 95%CI 0.870-0.923). In the intra-adolescent agreement analysis, an almost perfect agreement was observed (Gwet: 0.96; 95%CI 0.917-1), with acceptable agreement rates of Content Validity Coefficient and Content Validity Index, both with 0.91. Conclusion The scale presented satisfactory Content Validity Indexes and appearance to measure youth empowerment through health education.

Phagocytic cells of the thymic reticulum interact with thymocytes via extracellular matrix ligands and receptors.

We previously showed that, in the context of thymic epithelial cells, thymocyte migration is partially controlled by extracellular matrix (ECM)-mediated interactions. Herein we evaluated whether these interactions could be involved in cell migration related events in the context of non-epithelial cells of the thymic microenvironment, the phagocytic cells of the thymic reticulum (PTR). We first showed, by immunocytochemistry, cytofluorometry, and RT-PCR, that PTR produce ECM components, including fibronectin and laminin, and express the corresponding integrin-type receptors, VLA-4, VLA-5, and VLA-6. Thymocytes adhere onto PTR monolayers, with immature CD4(+)CD8(+) cells being predominant. Importantly, such an adhesion is partially mediated by ECM ligands and receptors, since it was impaired by anti-ECM or anti-ECM receptor antibodies. Conjointly, our data reveal that the ECM-dependence for thymocyte adhesion onto the thymic microenvironment is not restricted to the epithelial cells, being also seen when they encounter non-epithelial phagocytic cells.

Comparaçäo da saturaçäo do oxigênio, medido pela gasometria arterial e pela oximetria de pulso / Comparison of measurement of oxygen saturation by blood gas analysis and by pulse oximetry

O presente estudo visa correlacionar a saturaçao do oxigênio medido pela gasometria arterial e a oximetria de pulso, e identificar discrepâncias entre os dois métodos. Foi realizado estudo prospectivo em pacientes adultos da UTI do Hospital Fátima, de setembro a dezembro de 1955, nos quais foram solicitadas gasometria arterial. O oximetro utilizado foi o Nellcor N-185 Pulse Oximeter e o gasômetro, o Corning 165-2 Blood Gas Analyzer. O total foi de 28 pacientes, 73 amostras de gasometrias (2,6 gasometrias por paciente), idades de 21 a 98 anos (média de 59,08). Observaram-se 21 resultados com diferença superior a 5 por cento entre os métodos. Oito pacientes com instabilidade hemodinâmica apresentaram discrepância na saturaçao medida pelos dois métodos. Existe discrepância estatisticamente significativa entre os valores da saturaçao do oxigênio medidos pela gasometria arterial e pela oximetria de pulso, em pacientes criticos, com maior tendência para aqueles com instabilidade hemodinâmica.

Expressão e papel funcional de receptores de fibronectina no timo de camundongos / Expression and functional paper of fibronectin receptors in the thymus of mice

Nesta tese, objetivamos estudar a expressão e papel funcional de receptores de fibronectina no timo incluindo aspectos fisiológicos e patológicos desse órgão. Ao avaliarmos o papel de duas proteínas de ECM (fibronectina e laminina) em interações envolvendo células fagocitárias do retículo tímico (PTR) e timócitos, vimos que as PTR expressam ambas as proteínas de ECM e seus respectivos receptores, e que a formação de rosetas de timócitos às PTR dependem de interações dos pares ligante/receptor correspondentes. Por outro lado, experimentos in vivo, nos quais procuramos bloquear a saída de recém emigrantes do timo pelo uso de peptídeos bloqueadores de receptores de fibronectina, sugerem que o endereçamento de recentes emigrantes tiímicos (RTE)para o baço aparentemente depende, ainda que de forma parcial, de interação entre fibronectina e a5b1. O modelo patológico investigado nesta tese foi uma linhagem de camundongos (C57BL10ScSnmdx, ou mdx) que desenvolvem uma distrofia muscular semelhante à distrofia muscular de Duchenne a qual ocorre em humanos. Estes animais apresentaram uma intensa atrofia tímica, representada pela baixa celularidade e por uma queda expressiva nas proporções de timócitos corticais de fenótipo CD4+CD8+. Vimos ainda uma diminuição significativa na expressão do receptor de fibronectina a5b1 em timócitos de mdx quando comparados aos controles. Interessantemente, testes funcionais demonstraram que os timócitos dos camundongos mdx apresentam diminuição tanto de sua capacidade de adesão a células epiteliais tímicas, quanto da migração induzida por fibronectina. Em conjunto, os dados aqui apresentados mostram que as interações intratímicas mediadas por fibronectina e seus receptores a4b1 e a5b1 abrangem diferentes componentes do microambiente tímico, e participam do controle de fenômenos de adesão/migração de timócitos. Vimos ainda que alterações das interações fibronectina/a5b1, podem levar a distúrbios no padrão de migração, cujo significado patológico especificamente no que diz respeito à fisiopatologia da distrofia muscular observada nos camundongos mdx, necessita ser avaliada.