"Survey of Wellbeing of Young Children (SWYC)": how does it fit for screening developmental delay in Brazilian children aged 4 to 58 months?

OBJECTIVE: To replicate the original normative study of the SWYC's Milestones Questionnaires for children in Brazil. Our goals were to compare the performance of Brazilian and North American children using this screening tool and to verify the reliability and validity of the Brazilian version. STUDY DESIGN AND SETTING: Cross-sectional study with children aged 1-65 months and their guardians, recruited in southern Brazil. Parents were interviewed using the Developmental Milestones questionnaire, which contains 10 questions about cognitive, motor, social, and language abilities. Item response theory was used to examine item validity. RESULTS: We interviewed 415 parents. SWYC provided the most information on the children's development between 10 and 30 months. The performance of Brazilian and North American children was quite similar when children are younger than 36 months old. Above 36 months, North American children performed almost all items earlier than Brazilians. Convergent validity was 0.73 and internal consistency 0.97. CONCLUSION: The Brazilian version of the Developmental Milestones questionnaire presented acceptable measurement qualities that support the SWYCs potential as a developmental screening tool. As we found important differences between North American and Brazilian children in achieving the milestones, especially among the oldest children, additional normative studies are needed.

Activities and participation in children with developmental coordination disorder: a systematic review.

PURPOSE: To systematically review all literature published in peer reviewed journals from January 1995 to July 2008 in order to summarize and describe the activity limitations and participation restrictions of children with developmental coordination disorder (DCD). METHODS: Multiple databases were systematically searched for articles related to DCD; only descriptive, intervention or qualitative articles were retained. Articles were coded using the International Classification of Function, Disability and Health (ICF) and descriptions of the activity and participation issues of individuals with DCD were identified. RESULTS: Data analysis revealed that, from 371 articles that met inclusion criteria, only 44 (14.4%) presented any data related to activity or participation issues. Information was inconsistent and only 18 articles used published measurement tools. Most frequently cited issues were poor handwriting, difficulties playing ball games, getting dressed and participating in organized sports. CONCLUSION: Evidence concerning activity and participation issues for children with DCD is limited in both volume and scope. Improved understanding of participation and of activity limitations in children with DCD is essential for clarifying diagnostic criteria, guiding assessment, and making evidence-based decisions regarding intervention. Researchers working with this population should make every effort to measure and consistently report the impact of children's motor impairments on function.

Cross-cultural adaptation of the Developmental Coordination Disorder Questionnaire for brazilian children / Adaptação transcultural do Questionário de Transtorno do Desenvolvimento da Coordenação para crianças brasileiras

BACKGROUND: Developmental Coordination Disorder (DCD) is considered a major health problem among school-aged children worldwide. Although there are several instruments to identify children with DCD, none of them are translated into Portuguese and validated to be used in Brazil. OBJECTIVES: Considering that a parent questionnaire is a simple and effective method to screen children with DCD, this study describes the adaptation of the Developmental Coordination Disorder Questionnaire (DCDQ) and the pilot testing with Brazilian children. METHODS:Translation of the DCDQ into Portuguese was conducted according to current guidelines for cross-cultural adaptation of instruments. The questionnaire was completed by parents of 15 children with motor coordination problems and parents of 30 children who were typically developing, matched for age. Five parents randomly selected from each group completed the questionnaire twice, to examine test-retest reliability. The parent's opinion regarding the quality of the questionnaire was recorded. RESULTS: 91 percent of Brazilian parents reported no difficulty in completing the DCDQ. Examination of psychometric properties revealed that two items had limitations due to cultural differences. After item substitution, sensitivity increased from 0.66 to 0.73 and test-retest reliability from 0.95 to 0.97. Internal consistency also increased from 0.91 to 0.92. CONCLUSIONS:The translated instrument shows potential as a screening tool for children in Brazil and should be further examined. Research with a larger sample is needed in order to define cut-off scores and verify the instrument's validity and clinical utility. The use of the DCDQ will allow the comparison of epidemiological data from different countries.

CONTEXTUALIZAÇÃO: O transtorno do desenvolvimento da coordenação (TDC) é considerado, em vários países, um grande problema de saúde para crianças. Apesar de existirem vários instrumentos para identificar o TDC, nenhum deles foi traduzido e validado para uso no Brasil. OBJETIVOS: Considerando que um questionário de pais é um método simples e eficiente para fazer triagem de crianças com TDC, este estudo descreve a adaptação do Developmental Coordination Disorder Questionnaire (DCDQ) e o teste piloto com crianças brasileiras. MÉTODOS: A tradução do DCDQ para o português foi feita de acordo com normas atuais para adaptação transcultural de instrumentos. O questionário foi respondido pelos pais de 15 crianças com problemas de coordenação motora e 30 crianças com desenvolvimento típico, emparelhadas por idade. Cinco pais de cada grupo, selecionados aleatoriamente, responderam ao questionário duas vezes para examinar a confiabilidade teste-reteste. A opinião dos pais sobre a qualidade do questionário foi registrada. RESULTADOS: 91 por cento dos pais brasileiros reportaram que não tiveram dificuldade para responder ao DCDQ. Exame das propriedades psicométricas revelou que dois itens apresentavam limitações devido a diferenças culturais. Após a substituição desses itens, a sensibilidade aumentou de 0,66 para 0,73, e a confiabilidade teste-reteste passou de 0,95 para 0,97. A consistência interna aumentou de 0,91 para 0,92. CONCLUSÕES: O questionário final mostrou bom potencial para ser examinado como instrumento de triagem no Brasil e deve ser melhor examinado. É necessário coletar mais dados para definir o ponto de corte e verificar a validade e a utilidade clínica. O uso do DCDQ vai contribuir para a comparação de dados epidemiológicos de diferentes países.

Stimulatory sublethal response of a generalist predator to permethrin: hormesis, hormoligosis, or homeostatic regulation?

The assessment of pesticide effects in arthropods historically have relied heavily on acute lethal effects. Although the sublethal responses to such compounds are sometimes neglected, stimulatory effects associated with low doses of compounds toxic at higher doses, such as pesticides, have been widely reported in recent years and recognized as a general toxicological phenomenon. Evidence of such stimulatory response has also been reported among mites and a few insect pest-species exposed to pesticides and recognized as a one of the potential causes underlying pest resurgence and secondary pest outbreaks. However, fitness parameters and its implications were seldom considered in these studies and natural enemies are not usually target of attention. Here, we reported the stimulatory effect of sublethal doses (ranging from 0.02 to 172.00 ppb in addition to the control) of the pyrethroid permethrin topically applied to third instar nymphs of the spined soldier bug, Podisus distinctus (Stål) (Heteroptera: Pentatomidae). The parameters estimated from the fertility tables of insects exposed to the increasing doses of insecticide indicated a slight increase in the mean survival time for doses > or = 0.20 ppb and a peak in the net reproductive rate at 1.72 ppb. This trend is coincident and correlated with the intrinsic rate of population growth (n = 18, r = 0.78, P = 0.0001), which also shows a peak at 1.72 ppb, leading to higher reproductive values of insects exposed to this dose. The phenomenon is consistent with insecticide-induced hormesis, for which the potential implications are discussed.

Propriedades psicométricas da versão brasileira da escala de qualidade de vida específica para acidente vascular encefálico: aplicação do modelo Rasch / Psychometric properties of the Brazilian version of the Stroke Specific Quality of Life Scale: application of the Rasch model

CONTEXTUALIZAÇÃO: O acidente vascular encefálico (AVE) produz déficits importantes na qualidade de vida (QV) dos indivíduos. Medidas específicas de QV são necessárias para compreender e quantificar o impacto dessa patologia. OBJETIVO: O objetivo desse estudo foi adaptar transculturalmente o Stroke Specific Quality of Life Scale (SSQOL) para o Português (Brasil) e avaliar suas propriedades psicométricas. MATERIAIS E MÉTODOS: O SSQOL foi traduzido e adaptado seguindo instruções padronizadas e submetido a exame de confiabilidade teste-reteste (10 hemiplégicos). As propriedades psicométricas foram investigadas pela análise Rasch em 50 hemiplégicos. RESULTADOS: Foram detectados coeficientes de confiabilidade de 0,92 para itens e indivíduos. O índice de separação dos hemiplégicos foi 3,34 e dos itens, 3,36, ou seja, os itens separaram as pessoas em pelo menos três níveis de QV e em três níveis de QV - baixa, média e alta. Dos 49 itens, quatro não se enquadram no modelo, o que compromete a validade de constructo do instrumento, embora o padrão errático dos itens se justifique na amostra examinada. CONCLUSÕES: O instrumento mostrou-se clinicamente útil na população avaliada. Novos estudos em populações com outras características já estão em andamento.

BACKGROUND: Stroke results in important deficits, which reduce individuals' quality of life (QOL). Specific QOL measurements are necessary to understand and quantify the impact of this pathological condition. OBJECTIVE: The aim of this study was to make a transcultural adaptation of the Stroke Specific Quality of Life Scale (SSQOL) into Brazilian Portuguese and to assess its psychometric properties. METHODS: The SSQOL was translated and adapted in accordance with standardized procedures and was subjected to test-retest reliability analysis with 10 hemiplegic subjects. The psychometric properties were investigated using Rasch analysis on 50 hemiplegics. RESULTS: Reliability coefficients of 0.92 were found for items and subjects. The separation index for the hemiplegics was 3.34, while, for the items, it was 3.36. These results indicated that the items separated the subjects into at least three levels of QOL: Low, medium, and high. Of the 49 items, four did not fit into the model, which partially invalidated the construct validity of the instrument, although the erratic patterns of these items could also be explained in the present sample. CONCLUSIONS: The instrument was shown to be clinically useful for the assessed population and other studies in populations with other characteristics are now underway.

Criação de protocolo de avaliação do equilíbrio corporal em crianças de quatro, seis e oito anos de idade: uma perspectiva funcional / Creation of a balance assessment protocol of balance for four, six and eight-year-old children: a functional perspective

OBJETIVO: O objetivo desse estudo foi criar um teste de equilíbrio corporal, em contexto funcional, e verificar sua adequação e aplicabilidade em um grupo de crianças brasileiras. MÉTODO: Os participantes foram 66 crianças, com desenvolvimento motor típico, idades cronológicas de quatro, seis e oito anos, selecionadas em três escolas de classe média. Cada grupo etário foi composto por 22 crianças, sendo 11 meninos e 11 meninas. O protocolo elaborado foi constituído por oito provas, distribuídas em dois circuitos. Todas as provas foram avaliadas por critérios quantitativos e qualitativos. Os critérios quantitativos referiram-se ao tempo gasto e ao número de passos e saltos corretamente executados nas provas correspondentes. A avaliação qualitativa, pontuada em escala ordinal de quatro pontos, foi baseada em verbos de ação. RESULTADOS: Os resultados da correlação intraclasse indicaram nível satisfatório de confiabilidade entre examinadores e a confiabilidade teste-reteste. Para a comparação do desempenho entre os três grupos etários foi utilizado o teste Kruskal-Wallis e, para localizar a diferença entre os grupos, o teste U Mann-Whitney. Crianças de quatro e oito anos apresentam diferença significativa de desempenho nas provas, tanto para critérios qualitativos quanto quantitativos. Observou-se, também, diferença no desempenho entre crianças de quatro e seis anos para algumas das provas avaliadas. Crianças de seis e de oito anos, de um modo geral, não apresentam diferenças nas provas de equilíbrio propostas. CONCLUSÃO: O instrumento tem potencial para uso clínico. Estudos futuros deverão verificar a utilidade clínica do protocolo em crianças que apresentam atraso no desenvolvimento motor.

OBJECTIVE: To create a body balance test within a functional context and verify its adequacy and applicability among a group of Brazilian children. METHOD: The participants were 66 children with typical motor development and chronological ages of four, six and eight years old, who were selected at three schools with middle-class intake. Each age group was composed of 22 children (11 girls and 11 boys). The test protocol was composed of eight tasks distributed in two circuits. All the tasks were scored by quantitative and qualitative criteria. The quantitative criteria were based on the time taken and the number of steps/jumps correctly performed in the corresponding items. The qualitative assessment was scored on a four-point ordinal scale, based on action verbs. RESULTS: The intraclass correlations between examiners and the test-retest reliability were satisfactory. To compare the performance between the three age groups, the Kruskal-Wallis test was utilized, and to locate the differences between groups, the Mann-Whitney U test was used. There were significant differences in performance between the four and eight-year-old children in the tasks, both for qualitative and quantitative criteria. Differences in performance between the four and six-year-old children were also observed for some of the tasks assessed. Most of the differences between the six and eight-year-old children in the balance tasks examined were not significant. CONCLUSION: The assessment tool has potential for clinical use. Future studies should verify the clinical utility of the protocol among children presenting delayed motor development.

Study of the elderly females' voice by phonetography.

This study was carried out to investigate the voice characteristics of 40 healthy females with no voice disorders, ranging in age from 60 to 84 years (X = 68.2+/-5.74 years). Measurements over all the entire phonational range were obtained by phonetography. The subjects were asked to sustain the vowel /a/ in modal register for a minimum of 5 seconds in the highest and lowest intensities after hearing the semitones C, E, G, and A, over all phonational ranges. The results indicated expansion of the low and reduction of high ends of the pitch range, decrease of the pitch numbers of the vocal range, restriction of the lowest and highest limits of the intensity, and reduction of either the maximum phonational range and the phonetogram area. The phonetography technique has shown efficacy to investigate the voice characteristics of elderly females.

Omeprazole, clarithromycin and furazolidone for the eradication of Helicobacter pylori in patients with duodenal ulcer.

AIM: To evaluate the efficacy of omeprazole plus clarithromycin and furazolidone in Helicobacter pylori eradication and duodenal ulcer healing in Brazilian patients. METHODS: Forty H. pylori-positive patients with duodenal ulcer were randomized to receive 20 mg omeprazole o.m. or b.d. for 1 month plus 500 mg clarithromycin (b.d. ) and 200 mg furazolidone (b.d.) for 1 week. RESULTS: Three months after the end of the treatment the eradication rates were 90% by intention-to-treat analysis, and 97% by per protocol analysis. Mild side-effects were observed in 25 patients, none of whom abandoned the protocol. No difference was observed between the 20 mg and 40 mg omeprazole daily doses. Cure or significant improvement of the symptoms and of the histological alterations were observed after H. pylori eradication. CONCLUSION: Our results demonstrate that clarithromycin and furazolidone in combination with omeprazole are a good alternative for H. pylori eradication in Brazilian patients with duodenal ulcer.

The Volitional Questionnaire: psychometric development and practical use.

This article describes the Volitional Questionnaire and presents recent empirical efforts to develop and validate this instrument. The Volitional Questionnaire is an observational method of gathering data on motivation that is designed for persons who are unable to self-report their own motives. Studies to date suggest that the instrument can provide a valid measure of volition, though a number of limitations of the tool are noted. Implications for use of the Volitional Questionnaire in practice and for further refinement and future research are discussed.

[Reliability of arterial blood pressure measurement in an arterial hypertension study]. / Confiabilidade da medida de pressão arterial sangüínea em um estudo de hipertensão arterial.

PURPOSE: To evaluate the relaibility of the blood pressure measurements in an arterial hypertension study. METHODS: It was evaluated 502 nurse workers of a public hospital. After careful training and selection of the observers for the quality control at the fieldwork, it was analyzed the correlation between the 1st and 2nd measurements, final digit preference and mean systolic (SBP) and diastolic pressure (DBP). 5% of the sample had their measures compared with those checked by an expert. RESULTS: There was a great confiability intra-observer (96.2% in the SBP and 93.4% in the DBP). The final digit distribution was almost identical. At the 5% sample, there was a strong correlation between them (96.0% in the SBP and 93.9% in the DBP). CONCLUSION: This methodology is feasible in national studies and confers validity to the results.

Confiabilidade da medida de pressão arterial sanguínea em um estudo de hipertensão arterial / Reliability of arterial blood pressure measurements in an arterial hypertension study

Purpose - To evaluate the reliability of the blood pressure measurements in an arterial hypertension study. Methods - It was evaluated 502 nurse workers of a public hospital. After careful training and selection of the observers, for the quality control at the field work, it was analyzed the correlation between the 1st and 2st measuments, final digit preference and mean systolic (SBP) and diastolic pressure(DBP). 5% of the sample had their measures compared with those checked by an expert. Results - There was a great confiability intraobserver (96.2% in the SBP and 93.4% in the DBP). The final digit distribution was almost identical. At the 5% sample, there was a strong correlation between them (96. 0% in the SBP and 93.9% in the DBP). Conclusion - This methodology is feasible in national studies and confers validity to the results

Objetivo - Avaliar a confiabilidade das medidas de pressão arterial sanguínea em um estudo sobre hipertensão arterial (HA). Métodos - Foram examinadas 502 trabalhadoras de enfermagem em hospital de Salvador. Após cuidadoso processo de treinamento e seleção para controle de qualidade do trabalho de campo, os valores aferidos foram analisados, quanto à correlação entre as medidas e à distribuição dos dígitos terminais e das médias de pressão arterial sistólica (PAS) e diastólica (PAD). Comparou-se amostra de 5% das medidas com as efetuadas, de modo cego, na mesma ocasião, por supervisora médica. Resultados - Observou-se grande confiabilidade intra-observadora (96,2% na PAS e 93,4% na PAD). A distribuição entre os dígitos terminais foi praticamente eqüitativa. Na amostra, houve grande correlação entre as medidas (96,0% na PAS e 93,9% na PAD). Conclusão - As estratégias adotadas para a uniformização das medidas foram satisfatórias, garantindo a confiabilidade dos resultados e factíveis em estudos nacionais

Functional scale discrimination at admission and discharge: Rasch analysis of the Level of Rehabilitation Scale-III.

OBJECTIVE: To determine the construct validity of the Level of Rehabilitation Scale-III (LORS-III) with a special focus on this instrument's capability to discriminate rehabilitation inpatient activities of daily living (ADL)/mobility and communication/cognition ability at admission and discharge. DESIGN: Rasch analysis of existing data sets in the LORS-III American Data System (LADS). PATIENTS: Existing admission and discharge data from 3056 rehabilitation inpatients (musculoskeletal injury, cerebrovascular accident, multiple injuries/diseases, brain injury, neuromuscular disorder, and spinal cord injury) entered into LADS between April 1992 and January 1993. MAIN OUTCOME MEASURE: LORS-III consists of 17 measurement areas representing abilities in ADL, mobility, communication, cognition, and memory. Fourteen of the measurement areas are concurrently scored by a nurse and a specified rehabilitation therapist, resulting in a total of 31 items. RESULTS: Consistent with findings reported for other functional status measures, the analysis indicated that the LORS-III consists of two unidimensional scales, an ADL/mobility scale, and a communication/cognition scale. Although all scales fit the Rasch measurement model, the ADL/mobility scale used at admission was most appropriately targeted to the ability level of the sample. At discharge, the ADL scale was generally too easy because the ability level of the sample moved upward towards functional independence. The communication/cognition scale at both admission and discharge showed a similar "ceiling" effect. CONCLUSIONS: These findings indicate the importance of determining the measurement qualities of functional status measures for both admission and discharge ratings. Analyses, such as Rasch, can provide a logical direction for instrument refinement.

Bilateral motor coordination in 5- to 9-year-old children: a pilot study.

The purpose of this study was to collect normative data on and to assess the clinical usefulness of scales designed to measure the quality of children's ability to perform three bilateral motor coordination tasks: jumping jacks, symmetrical stride jumps, and reciprocal stride jumps. One hundred children, aged 5 to 9 years, were tested according to the scales developed for this study. Results indicated that scores tended to increase with age and that sex differences were not significant. Jumping jacks were found to be the most reliable and the easiest of the three tasks. Reciprocal stride jumps were the most difficult. Quality of performance was assessed, and the number of jumps in a 10-sec trial was recorded for each age. The data from this study may be useful in comparing the performance of children with motor deficits to the performance of normal children of the same age.