Epidemiological characteristics of hemophilia in the pre-primary prophylaxis era: a historical cohort

Introduction: Epidemiological studies on hemophilia in the Brazilian population are historically scarce. Despite the continuous effort made by the National Program of Inherited Bleeding Disorders to map this condition, little information is available, especially on the period prior to program conception. Therefore, the present study aims to assess the epidemiological, serological, and clinical characteristics of patients with hemophilia in the state of Rio Grande do Sul, Brazil. Methods: A total of 455 patients had their medical records reviewed from January 1, 2003 to December 31, 2007. Results: We observed a remarkable prevalence of hepatitis C virus (HCV) infection in patients with both hemophilia A and B, and this prevalence significantly increased along with age (p < 0.001). No positive anti-HCV results were observed among children younger than 5 years old. There was a significant correlation between the severity of hemophilia and the number of arthropathies in all age categories. Considering the presence of inhibitors, a significant difference was observed between age groups, as older patients had higher inhibitor titers. There was a significant correlation between mean coagulation factor consumption and the number of arthropathies in patients over 5 years old. Conclusions: This profile analysis of patients with hemophilia reflects a gradual improvement in treatment safety and efficiency, as well as the need for continued investment in this population. (AU)

Emotional and behavioral problems in children of depressed mothers: a school-based study in Southern Brazil.

The present study aimed to verify the association between maternal depression and emotional and behavioral problems in school children in Pelotas, Southern Brazil, considering that maternal depression increases children's vulnerability for developing psychiatric disorders. This is a cross-sectional study with a school-based sample conducted between August 2015 and November 2016 and it is part of a major project entitled 'Healthy Childhood in Context: A Multidisciplinary Investigation'. Schoolchildren aged between 7 and 8 years and one of their respective parents or a primary caregiver were included in the study. Maternal depression was assessed using the Mini International Neuropsychiatric Interview (MINI). The presence of emotional and behavioral problems in children was verified by the Strengths and Difficulties Questionnaire (SDQ) - parents version. Children of depressed mothers exhibited higher mean scores in all SDQ domains and in the total score when compared to children of non-depressed mothers. Lower socio-economic status was also associated with higher SDQ scores. Our results showed the effects of both maternal depression and poverty on children emotional and behavioral problems, which evidence the need for child mental health preventive care, and free quality assistance for both mothers and their children.

Biological rhythm and emotional and behavioral problems among schoolchildren in Southern Brazil.

Emotional and behavioral problems have been considered an indicative of mental disorder in children. Mental health problems affect 10-20% of children and adolescents living in low-income and middle-income countries. Evidence suggests that disruptions in the biological rhythm may be a primary cause of emotional and behavioral changes, which affects several psychological functions and moods. Thus, this study aimed at verifying the association between biological rhythm and emotional and behavioral problems in schoolchildren living in Southern Brazil. This is a cross-sectional study with a school-based sample conducted between August 2015 and November 2016. The presence of emotional and behavioral problems in children was verified by the Strengths and Difficulties Questionnaire (SDQ), parents' version. This is a 25-item assessment questionnaire used to screen mental health problems in children and adolescents (from 4 to 17 years of age) in the last 6 months. The Biological Rhythm Interview of Assessment in Neuropsychiatry-Kids (BRIAN-K) was used to measure the degree of biological rhythm disruption. The BRIAN-K consists of 20 items; from among these, 17 items are added to generate a quantitative measure, with greater scores indicating more biological rhythm disruption. The final score can also be divided into four subscales: sleep, social rhythm, eating pattern and overall activities. A total of 609 children responded to the assessment instruments. With regard to parents or primary caregiver, 596 completed the assessment and 13 (2%) were not located or refused to participate in the study. Thus, 596 dyads were included in the analysis. Children with emotional and behavioral problems presented higher scores in all domains of BRIAN-K: sleep, social, activity, eating pattern and total score (p < 0.001). The following variables remained associated with emotional and behavioral problems after adjusted analysis: BRIAN-K total score (p < 0.001) and all subscales sleep (p < 0.001), social (p < 0.001), activity (p < 0.001) and eating pattern (p < 0.001). Children with emotional and behavioral problems presented higher biological rhythm disruption when compared with children without emotional and behavioral problems. Our study emphasizes the importance of biological rhythm and its influence on emotional and behavioral problems in schoolchildren. Early detection of any biological rhythm disruption may enhance further assessment of any eventual emotional and behavioral problem and even a psychopathology.

Desenvolvimento da manipulação do bebê em diferentes idades motoras / Development of the baby in handling different motor ages

Verificar o desenvolvimento manipulativo de bebês de diferentes idades por meio de uma intervenção motora. Participaram do estudo 15 bebês que frequentavam escolas de Educação Infantil da cidade de Porto Alegre. A intervenção foi constituída de atividades de manipulação de uma rica variedade de objetos cotidianos, escolhidos no intuito de oferecer diferentes estímulos ao bebê. As avaliações dos bebês foram realizadas no início e ao final do período interventivo através da Escala do Desenvolvimento do Comportamento da Criança no Primeiro Ano de Vida. Foi utilizado o Teste de Wilcoxon para comparações do período pré para o pós-intervenção e descritivamente foi analisado o desenvolvimento dos bebês conforme o seu trimestre de vida. Os resultados sugerem que os bebês tiveram desempenho superior do período pré-intervenção para o pós-intervenção. Intervenções motoras e sensoriais nos primeiros anos de vida proporcionam mudanças positivas no desenvolvimento global dos bebês...(AU)

To assess the manipulative's development of babies from different ages beyound a motor intervention. Participants were 15 infants who attended early childhood education in Porto Alegre. The intervention consisted of handling activities with rich variety of everyday objects, chosen in order to provide different stimuli to the baby. The Scale of Child Development and Behavior performed the evaluations of the infants at the beginning and intervention's end in his/her First Life's Year. It was used the Wilcoxon test for comparisons in the pre and post-intervention and it was analyzed descriptively the babies development as their three months of life. The results suggest that infants have outperformed the pre-intervention and post-intervention. Sensory and motor interventions in the first ages of life provide positive changes in the overall development of infants...(AU)

The impact of anxious symptoms in the remission of depressive symptoms in a clinical trial for depression: follow-up of six months.

BACKGROUND: Studies show high comorbidity between anxiety disorder and depression. Little is known regarding how anxiety symptoms affect prognosis in depression treatment, suggesting the importance of studying the impact of anxiety symptoms in the treatment of depression. We evaluated the impact of anxiety symptoms in the remission of depressive symptoms after brief psychotherapies for depression. METHODS: This randomized clinical trial of 18-29-year-old adults included individuals who met the diagnostic criteria for depression as assessed by the Structured Clinical Interview for DSM (SCID). Depressive symptoms were assessed using the Hamilton Rating Scale for Depression (HRSD); anxiety symptoms were assessed using the Hamilton Anxiety Rating Scale (HARS). The protocols of psychotherapy used were: Cognitive Narrative Psychotherapy (CNP) and Cognitive Behavioral Psychotherapy (CBP). Both treatments included seven sessions. At the end of the treatment and six-month follow-up, an evaluation was made with the HRSD and HARS. The sample included 97 patients divided between the protocols of psychotherapy. RESULTS: There was a significant, positive, moderate correlation between the severity of anxiety symptoms at baseline and the remission of depressive symptoms at post-intervention (r=0.38 p<0.001) as well as a significant, positive, low correlation at follow up (r=0.20 p=0.049). We found remission of anxiety symptoms and depressive symptoms after brief psychotherapies, and the remission persisted at follow up. LIMITATION: We did not evaluate the diagnosis of anxiety disorders. CONCLUSION: The severity of anxiety symptoms did not compromise the treatment focused primarily on depressive symptoms.

High prevalence of suicide risk in people living with HIV: who is at higher risk?

A cross-sectional study was developed to evaluate suicide risk and associated factors in HIV/AIDS patients at a regional reference center for the treatment of HIV/AIDS in southern Brazil. We assessed 211 patients in regard to suicide risk, clinical and sociodemographic characteristics, drug use, depression, and anxiety. Suicide risk was assessed with Mini International Neuropsychiatric Interview, Module C. Multivariate analysis was performed using Poisson regression. Of the total sample, 34.1% were at risk of suicide. In the multivariate analysis, the following variables were independently associated with suicide risk: female gender; age up to 47 years; unemployment; indicative of anxiety; indicative of depression; and abuse or addiction on psychoactive substances. Suicide risk is high in this population. Psychosocial factors should be included in the physical and clinical evaluation, given their strong association with suicide risk.

Percepção de competência motora e índice de massa corporal influenciam os níveis de atividade física? / Do perceived motor competence and body mass index effect physical activity levels?

A obesidade associada aos baixos níveis de atividade física (NAF) está aumentando. A obesidade é motivo de grande preocupação relacionada à saúde física e psicossocial. Crianças obesas são frequentemente excluídas de esportes, jogos e brincadeiras ativas, porque acreditam ser menos habilidosos, possivelmente afetando a percepção de competência motora (PCM). O objetivo deste estudo foi analisar as relações entre a PCM, o estado nutricional e o NAF nas aulas de educação física de meninas e meninos de 5-10 anos de idade (n = 259). A PCM foi avaliada com as escalas Percepção de Competência e Aceitação para Crianças Jovens e Escala de Auto Percepção para Crianças (HARTER, PIKE, 1984; HARTER, 1985); o estado nutricional foi avaliado a partir do índice de massa corporal (IMC) e categorizado conforme os critérios do Center of Disease Control (2008). Os NAF foram mensurados através da utilização de pedômetros em 4 aulas de educação física. Estatística descritiva, ANOVA oneway, Correlação de Pearson e regressão linear (p≤0,05) foram utilizados para analisar os dados. Crianças com alta PCM foram mais ativas nas aulas de educação física do que crianças com moderada e baixa PCM (P< 0,05). Não foram encontradas diferenças significativas entre os grupos para IMC (P<0,05) e NAF (P<0,05). Correlações significativas fracas a moderadas entre: NAF e PCM; PCM e IMC foram observadas. O modelo de regressão linear com PCM e IMC como preditoresfoi significativo somente para meninas e para crianças de 8-10 anos explicando 4% e 8% da variância de NAF, respectivamente. PCM foi o único preditor de NAF. A PCM é um fator importante de ser considerado ao delinear intervenções e aulas de educação física que almejam aumentar NAF especialmente para meninas e crianças de 8-10 anos de idade.

Obesity levels are increasing associated with lower levels of physical activity (PA) nowadays. The obesity levels are reason of great concern related to physical and psychosocial health related issues. Overweight and obese children are often excluded from sports, games and active play because they are believed to be less skillful, possibly affecting their perceived motor competence (PMC).The purpose of the study was to assess the relationship between PMC, nutritional status and PA in physical education classes of 5-10 year old students. The PMC was assessed with Pictorial Scale of Perceived Competence and Acceptance for Young Children and The Self-Perception Profile for Children(HARTER, PIKE, 1984; HARTER, 1985); the nutritional status was assessed and categorized according to Center of Disease Control (2008) guidelines; PA were assessed with pedometers in 4 physical education sessions. To analyze the data descriptive statistics, ANOVA one way, Pearson Correlations and linear regression (p≤0,05) were used. Children with high PMC were more active than children with moderate and low PMC. No differences were found in PA for children in different BMI categories. We found low to moderate correlations between: PA and PMC; PMC and BMI. Linear regression model with PMC and PA as predictors was significant for girls and 8-10 years old children and explained 4% and 8% of the variance of PA respectively. PMC was the only predictor of PA. PMC is an important factor to be considered for planning interventions and physical education classes with the goal to increase PA especially for girls and 8-10 year old children.

Estratégias de ensino nas aulas de dança: demonstração, dicas verbais e imagem mental / Teaching strategies in dance classes: modeling, verbal cues and mental imagery

Estratégias de ensino, como demonstração, dicas verbais e imagem mental, têm sido consideradas importantes mediadores no processo de ensino-aprendizagem. Esta revisão tem o objetivo de revisitar os estudos clássicos de aprendizagem motora, bem como a literatura atual com o foco na aprendizagem e no uso das estratégias de ensino na dança. O objetivo da revisão é discutir formas práticas de implementar o uso sistemático dessas estratégias no ensino da dança. Esta revisão conclui com reflexões críticas a respeito de como a teoria pode ser aplicada nas práticas cotidianas de um professor de dança.

Teaching strategies such as modeling, verbal cues and mental imagery have been regarded as important mediators of the learning process. This review has the goal of revisiting the classical studies of motor learning as well as current literature focusing on learning and the use of these strategies in dancing. The goal of the review is to focus on practical ways to implement the use of these strategies systematically in dance instruction. This review concludes with critical insights on how this theoretical framework can be applied in everyday practices of dance teachers.

O impacto interventivo nas habilidades motoras fundamentais, na escrita e no autoconceito: estudo de caso / The impact of intervention on fundamental motor skills, written skills and self-concept: a case study

O objetivo deste estudo foi avaliar o impacto de uma intervenção terapêutica individualizada, com enfoque nas habilidades motoras fundamentais, no desempenho motor grosso, na motricidade fina e no autoconceito de uma menina de sete anos, portadora de sequelas de epilepsia rolândica, com atraso no desenvolvimento motor global. Durante a intervenção de três meses, foram praticadas oito habilidades motoras de locomoção e quatro manipulativas. A escrita foi avaliada em características referentes à disgrafia. Para avaliação da motricidade foram utilizados padrões de movimento, e para a do autoconceito foi utilizada a Pictorial Scale of Perceived Competence and Acceptance for Young Children. Os resultados foram positivos e significativos em relação às habilidades motoras fundamentais, à escrita e à percepção de competência. (AU)

The purpose of this study was to evaluate the impact of an individualized therapeutic intervention focusing on fundamental motor skills, performance of gross motor skills, fine motor skills and on the self-concept of a 7 year old girl with rolandic epilepsy sequels, showing global motor development delays. During the intervention along three months, eight motor skills of locomotion and four manipulative skills were practiced. Written skills were evaluated considering characteristics related to dysgraphia. Motor patterns were used to assess motor development and the Pictorial Scale of Perceived Competence and Acceptance for Young Children was apllied for assessing self-concept. The results were positive showing significant changes in relation to fundamental motor skills, writing and self-concept. (AU)

O impacto interventivo nas habilidades motoras fundamentais, na escrita e no autoconceito: estudo de caso / The impact of intervention on fundamental motor skills, written skills and self-concept: a case study

O objetivo deste estudo foi avaliar o impacto de uma intervenção terapêutica individualizada, com enfoque nas habilidades motoras fundamentais, no desempenho motor grosso, na motricidade fina e no autoconceito de uma menina de sete anos, portadora de sequelas de epilepsia rolândica, com atraso no desenvolvimento motor global. Durante a intervenção de três meses, foram praticadas oito habilidades motoras de locomoção e quatro manipulativas. A escrita foi avaliada em características referentes à disgrafia. Para avaliação da motricidade foram utilizados padrões de movimento, e para a do autoconceito foi utilizada a Pictorial Scale of Perceived Competence and Acceptance for Young Children. Os resultados foram positivos e significativos em relação às habilidades motoras fundamentais, à escrita e à percepção de competência.

The purpose of this study was to evaluate the impact of an individualized therapeutic intervention focusing on fundamental motor skills, performance of gross motor skills, fine motor skills and on the self-concept of a 7 year old girl with rolandic epilepsy sequels, showing global motor development delays. During the intervention along three months, eight motor skills of locomotion and four manipulative skills were practiced. Written skills were evaluated considering characteristics related to dysgraphia. Motor patterns were used to assess motor development and the Pictorial Scale of Perceived Competence and Acceptance for Young Children was apllied for assessing self-concept. The results were positive showing significant changes in relation to fundamental motor skills, writing and self-concept.

Educação infantil e intervenção motora: um olhar a partir da teoria bioecológica de Bronfenbrenner / Educación infantil e intervención motriz: una mirada a partir de la teoría bioecológica de Bronfenbrenner / Children education and motor intervention: a look from the bioecological theory of Bronfenbrenner perspective

Este estudo investigou a relação entre o enriquecimento do contexto da creche e a legislação vigente. Três estudos de caso com bebês foram conduzidos no paradigma da Teoria Bioecológica. Os resultados demonstraram que os bebês apresentaram novas competências de manipulação, controle postural e interação social. Entretanto a qualidade dos cuidados oferecidos na creche era restrita à higiene e alimentação. A intervenção pode ser implementada no espaço da creche; entretanto faz-se necessário se fazer cumprir a legislação no que diz respeito à formação e capacitação de educadores e à razão criança-educadores para efetivamente transformar o caráter assistencialista da educação infantil.

This study investigated the relations between the enrichment of the daycare context and legislation. Three case studies of babies took place with the theoretical support of the Bioecological theory of human development, designed by Bronfenbrenner. The results showed that the babies developed: many new competencies, manipulative, postural control and social interaction skills. However the quality of care offered by the daycares was restricted to hygiene and feeding. The motor intervention can be implemented in the day care context; however it is necessary to assure that the legislation is held liable when it comes to teacher education and children-teacher ratio to effectively change the assistance character of children education.

El estudio ha investigado la relación entre enriquecimiento del contexto de la guardería infantil y la legislación vigente. Tres estudios de caso con bebés fueron conducidos en el paradigma de la Teoría Bioecológica. Los resultados han demostrado que los bebés presentaron nuevas competencias de manipulación, control postural e interacción social. Sin embargo, la calidad de los cuidados que brinda la guardería era restricta a higiene y alimentación. La intervención puede ser implementada en el espacio de la guardería; pero es necesario hacer cumplir la legislación con respecto a la formación y capacitación de educadores y razón niños educadores para efectivamente transformar el carácter asistencialista de la educación infantil.

Teste de Desenvolvimento Motor Grosso: Validade e consistência interna para uma população Gaúcha / Test of Gross Motor Development: expert validity, confirmatory validity and internal consistence

O Teste de Desenvolvimento Motor Grosso (TDMG-2) é um instrumento usado para avaliar o nível de desenvolvimento motor de crianças. O objetivo deste estudo foi o de traduzir e verificar a validade dos critérios motores quanto à clareza e pertinência por juizes; a validade fatorial confirmatória; e, a consistência interna teste-reteste da versão portuguesa do TGMD-2. A versão na língua portuguesa foi obtida a partir do método de tradução cross-cultural. Participaram do estudo 7 profissionais e 587 crianças de 27 escolas (ensino infantil e fundamental), com idades entre 3 e 10 anos (51.1% meninos, e, 48,9% meninas). Cada criança foi filmada realizando o teste duas vezes. Os escores foram obtidos a partir do vídeotape. Os resultados indicam que a versão portuguesa do TGMD-2 contém critérios motores claros e pertinentes; apresenta índices satisfatórios de validade fatorial confirmatória (χ2/gl = 3,38; Goodness-of-fit Index = 0,95; Ajusted Goodness-of-fit index = 0,92 e Tucker e Lewis´s Index of Fit = 0,83) e consistência interna teste-reteste (locomoção: r= 0,82; objeto: r = 0,88). A versão em português do TGMD-2 mostrou-se válida e fidedigna na amostra estudada.

The Test of Gross Motor Development (TGMD-2) is an instrument used to evaluate children’s level of motor development. The objective of this study was to translate and verify the clarity and pertinence of the TGMD-2 items by experts and the confirmatory factorial validity and the internal consistence by means of test-retest of the Portuguese TGMD-2. A cross-cultural translation was used to construct the Portuguese version. The participants of this study were 7 professionals and 587 children, from 27 schools (kindergarten and elementary) from 3 to 10 years old (51.1% boys and 48.9% girls). Each child was videotaped performing the test twice. The videotaped tests were then scored. The results indicated that the Portuguese version of the TGMD-2 contains clear and pertinent motor items; demonstrated satisfactory indices of confirmatory factorial validity (χ2/gl = 3.38; Goodness-of-fit Index = 0.95; Adjusted Goodness-of-fit index = 0.92 and Tucker and Lewis’s Index of Fit = 0.83) and test-retest internal consistency (locomotion r = 0.82; control of object: r = 0.88). The Portuguese TGMD-2 demonstrated validity and reliability for the sample investigated.