Physical activity, depression, anxiety, and stress in adults and elderly in the COVID-19 pandemic in Brazil / Atividade física, depressão, ansiedade e estresse em adultos e idosos na pandemia COVID-19 no Brasil

The aim was to verify whether there is a relationship between physical activity habits and the indica-tion of associated risk for depression, anxiety, and stress in adults and the elderly during a period of the COVID-19 pandemic in Brazil. A cross-sectional study, with data collection between October and November 2021, was carried out using an online form, with questions about sociodemographic data, physical activity practice before and during the pandemic, health status, mental health through the Scale of Depression, Anxiety, and Stress (DASS-21), and level of physical activity through the International Physical Activity Questionnaire (IPAQ). Statistical analysis was performed using the chi-square test with a significance level of 5% and multiple correspondence analysis. The were 1044 men and women, aged between 18 and 75, from all over the national territory. Among them, 48.0%, 35.9%, and 61.1% showed an indication of associated risk for depression, anxiety, and stress, respec-tively. Adult participants 93.4%, female 66.8%, educational level up to undergraduate studies 54.2%, and single 57.5%, as well as those with a low level of physical activity 36.1% and who reported wors-ening in practice during the pandemic 53.9%, showed a greater risk indication for depression, anxiety and stress (p<0.05). In summary, physically active people who managed to maintain or improve their practice during the pandemic showed a lower indication of associated risk for problems related to mental health. It is important to consider the planning of public policies from the perspective of equity to help people with greater vulnerability in accessing physical activity

O objetivo foi verificar se há relação entre os níveis de atividade física e a indicação de risco associado para depressão, ansiedade e estresse em adultos e idosos durante um período da pandemia da COVID-19 no Brasil. Estudo transversal, entre outubro e novembro de 2021, foi realizado por meio de um formulário online, com perguntas sobre dados sociodemográficos, prática de atividade física antes e durante a pandemia, estado de saúde, saúde mental - Escala de Depressão, Ansiedade e Estresse (DASS-21) e nível de atividade física - Questionário Internacional de Atividade Física (IPAQ). A análise estatística foi realizada por meio do teste Qui-Quadrado com nível de significância de 5% e análise de correspondência múltipla. Participaram 1044 homens e mulheres, com idade entre 18 e 75 anos, de todo território nacional. Entre os participantes, 48,0%, 35,9% e 61,1% apresentaram indicação de risco associado para depressão, ansiedade e estresse, res-pectivamente. Os participantes adultos 93,4%, do gênero feminino 66,8%, nível de escolaridade até o ensino superior 54,2% e solteiros 57,5%, bem como os com nível baixo de atividade física 36,1% e que relataram piora na prática durante a pandemia 53,9% apresentaram maior indicação de risco para depressão, ansieda-de e estresse (p<0,05). Em síntese, pessoas fisicamente ativas e que conseguiram manter ou melhorar a prática durante a pandemia, apresentaram menor indicação de risco associado para problemas relacionados à saúde mental. É importante considerar o planejamento de políticas públicas sob a ótica da equidade, para auxiliar pessoas com maior vulnerabilidade no acesso à atividade física

Associação entre prática de atividade física com a saúde mental e a percepção da qualidade de vida em profissionais de enfermagem de Ribeirão Preto e região durante a pandemia da covid-19 / Association among physical activity practice with the mental health and the quality of life perception in nursing professionals from Ribeirao Preto and the region during the COVID-19 pandemic

Introdução: Na linha de frente da pandemia da COVID-19 encontram-se os profissionais de saúde que realizam um intenso trabalho, incluindo os profissionais de enfermagem, que representam uma grande parcela entre os profissionais de saúde que atuam nas instituições de saúde e hospitalares. As altas pressões no ambiente de trabalho com elevadas cargas e jornadas aumentaram as demandas, devido à responsabilidade de suas atribuições. Este contexto pode trazer repercussões negativas para a prática da atividade física, saúde mental e percepção de qualidade de vida destes profissionais. Objetivo: Analisar a associação entre a prática de atividade física, saúde mental e a percepção da qualidade de vida em profissionais de enfermagem de Ribeirão Preto, SP durante a pandemia da COVID-19. Métodos: Trata-se de um estudo transversal realizado com profissionais de enfermagem de Ribeirão Preto e região em 2021, por meio de formulário online na ferramenta Google Forms. Foram realizadas perguntas relacionadas aos dados sociodemográficos, atividade profissional, questionários para medir nível de atividade física e comportamento sedentário (IPAQ ­ versão curta), percepção da qualidade de vida (SF ­ 12v2) e saúde mental (DASS-21). Sobre a análise estatística, utilizou-se o teste Qui-quadrado para verificar a associação de duas variáveis categóricas entre si; teste t de Student para comparar duas médias e a ANOVA para comparar três médias provenientes de amostras não pareadas. O nível de significância foi de 5%. Resultados: Participaram do estudo 125 profissionais de enfermagem, sendo auxiliares, técnicos, enfermeiros(as) e enfermeiros(as) coordenadores(as). Desses, 79,2% foram mulheres e 56% atuavam no setor privado, 34,4% estavam acima do peso e 29,6% com obesidade. Os profissionais que praticavam exercício físico ou esporte apresentaram menor risco de depressão (57,9% entre os que não praticavam, 47,9% entre os que praticavam um tipo e 18,2% entre os que praticavam dois ou mais tipos de exercício ou esporte, p = 0,04). Profissionais com moderado ou alto nível de atividade física e que praticavam exercícios físicos ou esportes, apresentaram melhor pontuação em diversos domínios e nos componentes físico e mental da qualidade de vida, quando comparados aos com baixo nível de atividade física e que não praticavam exercícios físicos ou esportes, respectivamente. Conclusão: Profissionais de enfermagem que relataram praticar mais exercícios físicos ou esporte apresentaram menor risco relacionado à saúde mental, e os que relataram nível moderado ou alto de atividade física apresentaram melhor percepção de qualidade de vida (AU).

Introduction: At the forefront of the COVID-19 pandemic are health professionals who carry out intense work, including nursing professionals, who represent a large number of health professionals working in health and hospital institutions. The high pressures in the work environment with expended workloads and journeys increased the demands due to the responsibility of their attributions. This context can negatively affect these professionals' physical activity practices, mental health, and perceived quality of life. Objective: Analyze the association between physical activity practice, mental health, and perceived quality of life in nursing professionals from Ribeirao Preto, SP, during the COVID-19 pandemic. Methods: This cross-sectional study was performed with nursing professionals from the Ribeirao Preto and region area in 2021 through an online form on the Google Forms tool. Questions related to sociodemographic data, professional activity, questionnaires to measure physical activity levels and sedentary behavior (IPAQ - short version), quality of life perception (SF - 12v2), and mental health (DASS-21) were used. Regarding the statistical analysis, the Chi-square test was used to verify the association of two categorical variables; the Student's T-test to compare two means, and the ANOVA to compare three means from unpaired samples. The significance level was 5%. Results: 125 professionals participated in the study, such as assistants, technicians, nurses, and coordinating nurses. Among them, 79.2% were women, 56.0% worked in the private sector, 34.4% were overweight, and 29.6% were obese. Professionals who practiced physical exercise or sport had a lower risk of depression (57.9% among non-practicing professionals, 47.9% among practicing one type of exercise, and 18.2% among practicing two or more types of exercise or sports, p = 0.04). In addition, professionals with moderate or high physical activity levels and who practiced physical exercises or sports had a better score in multiple domains and physical and mental quality of life components compared with low physical activity levels and not practicing physical exercises or sports, respectively. Conclusion: Nursing professionals who reported practicing more physical exercises or sports had lower mental health-related risks, and those who reported moderate or high physical activity levels had a better perception of quality of life (AU).

Relação entre a idade, o risco de queda e o nível de confiança no equilíbrio corporal com a função dos canais semicirculares / Relationship between age, the risk of falling and level of confidence in body balance with semicircular canal function

RESUMO Objetivo verificar a relação entre o risco de queda, o nível de confiança nas atividades que envolvem equilíbrio e a idade com os valores de ganho e simetria dos canais semicirculares (CSCs), por meio do Vídeo Teste do Impulso Cefálico (vHIT), em pacientes com disfunção vestibular periférica. Método estudo transversal, composto por 12 indivíduos submetidos à avaliação funcional por meio da Activities-specific Balance Confidance Scale (ABC Scale) e do Dynamic Gait Index (DGI) e avaliação vestibular com o vHIT. Os resultados foram comparados por meio do Coeficiente de Correlação de Spearman. Resultados observou-se predomínio do gênero feminino (75%), com média de idade de 59 anos e 8 meses. A média de escore no DGI foi de 19,70 pontos e 43,65% na ABC Scale, característico de baixo nível de confiança. Observou-se correlação de grau moderado entre os parâmetros idade com o DGI, DGI e ABC Scale com os valores de ganho e simetria dos CSCs do vHIT. Conclusão Observaram-se relações entre o maior risco de queda em pacientes com hipofunção vestibular e idade avançada e entre o baixo nível de confiança para realizar atividades diárias diante da assimetria de ganho dos CSCs.

ABSTRACT Purpose to verify the relationship between the risk of falling, the level of confidence in activities involving balance, and age with the values of gain and symmetry of the semicircular canals (SSCs), using the Head Video Impulse Test (vHIT) in patients with peripheral vestibular dysfunction. Methods Cross-sectional study in 12 individuals submitted to functional evaluation using the Activities-specific Balance Confidence Scale (ABC Scale) and the Dynamic Gait Index (DGI), and vestibular evaluation with vHIT. The results were compared using Spearman's Correlation Coefficient. Results There was a predominance of females (75%), with a mean age of 59 years and 8 months. The mean score in DGI was 19.70 points and on the ABC Scale, 43.65%, which is characteristic of a low confidence level. A moderate correlation was observed between age and DGI and between DGI and ABC Scale and SCC gain and symmetry values with vHIT. Conclusion A relationship was observed between a higher risk of falling in patients with vestibular hypofunction and advanced age and between a low level of confidence to perform daily activities due to asymmetrical SCC gain.

Knowledge, attitudes, and psychosocial impacts among Brazilian Pediatric Dentists during COVID-19 pandemic.

In this study, we evaluated the knowledge, attitudes, and psychosocial impacts among Brazilian pediatric dentists during the COVID-19 pandemic. A cross-sectional study with primary data collection was carried out using an online structured questionnaire. Data were submitted to descriptive analysis by using absolute and relative frequencies. A chi-square test was used for association analysis and log-linear regression models to estimate the prevalence ratio (5%). The population comprised mostly women and knowledge regarding COVID-19 was satisfactory (above 80% in most items). N95 masks and faceshields were used, albeit 64.22% reported difficulty in providing dental care to children due to the need for extra Personal Protective Equipment. Thirty eight percent provided urgency/emergency dental care, 59.78% performed invasive procedures, 59.56% used high speed handpieces, 8.44% started using cariostatics, and 6.22% introduced the use of chemomechanical caries removal agents. Fear for the future (PR = 1.21) and use of medications (for anxiety, depression, or insomnia) increased (PR = 1.16) among the ones who had wage losses. Brazilian pediatric dentists have knowledge about COVID-19, and attitudes in their clinical routines changed due the pandemic. Financial life was harmed and a negative impact of the pandemic in psychosocial aspects of workers was found.

Influência do autocuidado utilizando as práticas integrativas e complementares durante a pandemia da COVID-19 em crianças e adolescentes de 4 a 13 anos com bruxismo e disfunção temporomandibular / Influence of self-care using complementary and integrative therapies during the COVID-19 pandemic in children and adolescents aged 4 to 13 years with bruxism and temporomandibular disorders

O Bruxismo é um comportamento da musculatura mandibular, caracterizado pelo apertamento e/ou rangimento dental, tanto em estado de vigília quanto no sono, que pode acarretar na Disfunção Temporomandibular (DTM). Altamente prevalente em crianças e etiologia multifatorial, destacam-se os aspectos psicossociais, principalmente o estresse e ansiedade. A necessidade de distanciamento social durante a pandemia da COVID-19 trouxe consequências para as crianças e fez surgir novos formatos de ações na Odontologia. Esse estudo avaliou a influência do autocuidado nas manifestações do Bruxismo/DTM em crianças que estavam em tratamento, antes da pandemia, no Serviço de Atendimento de Bruxismo e DTM na Infância (SABDI) da FORP/USP, por meio de intervenções assistidas, implementadas remotamente, de Práticas Integrativas e Complementares (PICs). Previamente às intervenções (T0), os pais responderam o questionário (Q1) sobre a criança (no formato Google Forms, enviado por WhatsApp e e-mail). As práticas propostas foram explicadas em reuniões virtuais (Google Meet) e foram realizadas durante 21 dias, registradas em um "Diário de Controle". Um novo questionário (Q2) foi preenchido para análise comparativa após as intervenções (T1). Das 37 crianças que estavam em tratamento, a amostra final das 18 que concluíram todas as etapas propostas apresentou diferença quantitativa nos itens: "dor na boca/rosto quando mastiga"; "dor ou dificuldade de abrir e fechar a boca"; "acorda com dor no rosto ou dor de cabeça" e, "dor de cabeça durante o dia ou à noite", "range os dentes em vigília"; "frequência que range os dentes em vigília"; "range os dentes enquanto dorme" e, "frequência que range os dentes enquanto dorme", "sono agitado"; "pesadelo" e "insônia". Observou-se evidência de diferença estatística com valor P<0,05, no item "aperta os dentes em vigília" (p=0,0057). Conclui-se que as intervenções propostas influenciaram as manifestações do Bruxismo favorecendo o seu controle.

Bruxism is a behavior of the mandibular muscles, characterized by clenching and/or dental grinding, both in wakefulness and in sleep, which can lead to Temporomandibular Disorders (TMD). Highly prevalent in children and possessing a multifactorial etiology, psychosocial aspects stand out, especially stress and anxiety. The need for social distancing during the COVID-19 pandemic has had consequences for children and has given rise to new formats of actions in Dentistry. This study evaluated the influence of self-care on the manifestations of Bruxism/TMD in children who were undergoing treatment, before the pandemic, Care Center for children with Bruxism and TMD, whose acronyms in Portuguese is SABDI, located in Ribeirão Preto School of Dentistry (FORP-USP), through assisted interventions, implemented remotely, of Complementary and Integrative Therapies (CIT). Prior to the interventions (T0), the parents answered the questionnaire (Q1) about the child (in Google Forms, sent by WhatsApp and e-mail). The proposed practices were explained in virtual meetings (Google Meet) and performed for 21 days and recorded in a "Control Diary". A new questionnaire (Q2) was completed for comparative analysis after the interventions (T1). Of the 37 children who were undergoing treatment, the final sample of 18 who completed all the proposed steps showed a quantitative difference in the items: "pain in the mouth/face when chewing"; "pain or difficulty opening and closing the mouth"; "waking up with pain in the face or headache" and "headache during the day or night"; "grinding teeth while awake"; "frequency grinding teeth while awake"; "grinding teeth while sleeping"; "frequency grinding teeth while sleeping"; "restless sleep"; "nightmare"; and "insomnia". Evidence of statistical difference was observed with a P value <0.05, in the item "clenches teeth while awake" (p=0.0057). It is concluded that the proposed interventions influenced the manifestations of Bruxism, favoring its control.

Knowledge, attitudes, and psychosocial impacts among Brazilian Pediatric Dentists during COVID-19 pandemic

Abstract: In this study, we evaluated the knowledge, attitudes, and psychosocial impacts among Brazilian pediatric dentists during the COVID-19 pandemic. A cross-sectional study with primary data collection was carried out using an online structured questionnaire. Data were submitted to descriptive analysis by using absolute and relative frequencies. A chi-square test was used for association analysis and log-linear regression models to estimate the prevalence ratio (5%). The population comprised mostly women and knowledge regarding COVID-19 was satisfactory (above 80% in most items). N95 masks and faceshields were used, albeit 64.22% reported difficulty in providing dental care to children due to the need for extra Personal Protective Equipment. Thirty eight percent provided urgency/emergency dental care, 59.78% performed invasive procedures, 59.56% used high speed handpieces, 8.44% started using cariostatics, and 6.22% introduced the use of chemomechanical caries removal agents. Fear for the future (PR = 1.21) and use of medications (for anxiety, depression, or insomnia) increased (PR = 1.16) among the ones who had wage losses. Brazilian pediatric dentists have knowledge about COVID-19, and attitudes in their clinical routines changed due the pandemic. Financial life was harmed and a negative impact of the pandemic in psychosocial aspects of workers was found.

NOS3 Polymorphisms Can Influence the Effect of Multicomponent Training on Blood Pressure, Nitrite Concentration and Physical Fitness in Prehypertensive and Hypertensive Older Adult Women.

Associations of endothelial nitric oxide synthase (NOS3) polymorphisms with hypertension and response to exercise training in prehypertensive and hypertensive older adult women remain unclear. This study used a multicomponent program (various capacities and motor skills) in the physical training intervention. It analyzed the influence of NOS3 polymorphisms [-786T > C, 894G > T (Glu298Asp), and intron 4b/a] on the response of blood pressure (BP), nitrite concentration, and physical fitness in older adult women. Fifty-two participants aged between 50 and 80 underwent body mass index, BP, 6-min walk, elbow flexion, and sit and stand-up tests to assess physical fitness. The intervention duration was 12 weeks, twice a week, on non-consecutive days. Each session lasted 90 min, maintaining an intensity between 13 (moderate) and 15 (intense), controlled by the Subjective Effort Perception Scale. Plasma/blood samples were collected to assess nitrite concentration and genotyping. The statistical analysis included Fisher's exact test and linear mixed-effects models. The multicomponent training's positive effect was observed with a similar response in both prehypertensive and hypertensive groups. However, carriers of different genotypes demonstrated different responses to training: the decreases in systolic and diastolic BP and increases in nitrite expected from the physical training were smaller in variant genotype than ancestral genotype carriers, especially in the hypertensive group. At positions -786T > C and Glu298Asp, only the ancestral genotypes showed a decrease in diastolic BP (Δ% = -8.1, and Δ% = -6.5, respectively) and an increase on nitrite (Δ% = 19.1, and Δ% = 24.1, respectively) in the hypertensive group. Our results show that the benefits of a multicomponent training intervention seem to be genotype-dependent. It should be possible to consider genetic variants when selecting an exercise treatment intervention.

Avaliação de sintomas na distrofia muscular de Duchenne: uma estratégia de cuidado paliativo / Evaluation of symptoms in Duchenne muscular dystrophy: a palliative care strategy

A avaliação de sintomas na distrofia muscular de Duchenne (DMD) permite o adequado manejo terapêutico e o Edmonton Symptom Assessment System (ESAS) possui esta função: avaliar simultaneamente múltiplos sintomas de pacientes em cuidados paliativos (dor, cansaço, sonolência, náusea, apetite, falta de ar, depressão, ansiedade e bem-estar). Objetivo: Verificar se pacientes com DMD entendem os termos do ESAS e são capazes de graduar seus sintomas por este instrumento. Métodos: 10 pacientes com DMD foram avaliados transversalmente em relação à: compreensão dos itens do ESAS, caracterização dos sintomas (pelo ESAS e Escala de Faces) e medida da função motora. A graduação de sintomas do paciente, pelo ESAS, foi realizada também pelo avaliador. Os dados foram analisados descritivamente e por meio do coeficiente de correlação de Spearman. Resultados: Todos os pacientes compreenderam os sintomas dor, cansaço, sonolência, depressão (tristeza) e bem-estar, já os sintomas náusea, apetite, falta de ar e ansiedade não foram compreendidos por todos. A média geral de todos os sintomas avaliados pela escala ESAS foi abaixo de 5 pontos. Entre os resultados da escala ESAS e Escala de faces, houve correlação forte para os sintomas "depressão" (r= 0,64) e "ansiedade" (r= 0,65). Houve correlação perfeita (r= 1,0) entre ESAS preenchida pelo paciente e pelo avaliador para os itens "depressão" e "ansiedade" e correlação forte (r= 0,82) para "sonolência". Conclusão: Pacientes com DMD entenderam os termos do ESAS e graduaram seus sintomas por este instrumento, portanto, não há necessidade de alteração dos termos do ESAS para avaliação de pacientes com DMD

Symptom assessment, in Duchenne Muscular Dystrophy (DMD), allows an adequate treatment, and the Edmonton Symptom Assessment System (ESAS) assess it: evaluating clinical problems of patients in palliative care (pain, tiredness, drowsiness, nausea, appetite, shortness of breath, depression, anxiety, and well-being). Objective: To verify if patients with DMD understand the terms of the ESAS and if their symptoms could be assessed using this instrument. Methods: Ten patients with DMD were cross-sectional evaluated in relation to the understanding of the ESAS items, capacity to describe symptom (using the ESAS and the Faces Scale) and the Motor Function Measure. The patient's symptom by ESAS was also classified by evaluator. A descriptive and correlation (Spearman's correlation coefficient) analysis of data was performed. Results: All patients understood the symptoms of pain, tiredness, drowsiness, depression (sadness), and well-being. However, some patients did not understand the symptoms of nausea, appetite, shortness of breath. The general mean of all symptoms assessed by the ESAS was below 5 points. For the symptom 'depression' and 'anxiety', a strong correlation was found between the results of the ESAS and the Face scale (r= 0.64, and r= 0.65, respectively). Additionally, a perfect and strong correlation, respectively, was found between the ESAS completed by the patient and the evaluator for the items ''depression'," and 'anxiety' (r= 1.0)" and a 'drowsiness' (r= 0.82). Conclusion: DMD patients understood the ESAS terms and graded their symptoms using this instrument. Therefore, it is not necessary to change the ESAS terms to assess patients with DMD

HOW CAN NEW TECHNOLOGIES HELP REDUCE ABSENTEEISM IN PEDIATRIC CONSULTATION?

OBJECTIVE: To identify the most effective form of contact, as a possible intervention to reduce absenteeism in consultations of children with suspected or confirmed pulmonary tuberculosis. METHODS: A randomized clinical trial was conducted with prospective data collection, between March 2017 and February 2018. Patients were randomized into three groups to be reminded about the appointment: telephone contact, SMS or WhatsApp, or no intervention. A convenience sample was obtained, with a significance level of 5%. RESULTS: 78 children were included, with a median age of four years old (zero to 14); 59.0% of them were in treatment for a latent infection and 6.4% had active tuberculosis. Among the 78 children, 74.4% lived in Curitiba (Sourhern Brazil); 62.8% lived with both parents; 38.5% of the parents had formal employment and 47.4% of the mothers were housewives; 50.8% of the fathers and 55.7% of the mothers had more than nine years of schooling. In 78.2% of the families, per capita income was up to 0.5 minimum wages; 27.3% were enrolled in social programs; 28.2% lived in homes provided by the government. There was a total of 238 interventions made: 85 (35.7%) by telephone contact, 78 (32.8%) by text message (WhatsApp was 97.2% of these) and 75 (31.5%) had no further contact. There was no statistical difference among the sociodemographic and cultural characteristics studied. The absenteeism rate was 24.0% and the abandonment rate was 16.7%. Giving a reminder to the patient's guardian prior to the consultation, regardless of the intervention (p=0.021) and specifically by WhatsApp message (p=0.032) was associated with no absenteeism, though it was not associated with abandonment of the treatment. CONCLUSIONS: Using new tools, such as WhatsApp, to remind guardians of appointments reduces absenteeism. Consequently, it may lead to a reduction in abandoning treatment and it may improvetreatment outcome of children with a tuberculosis infection or disease.

The use of the gait profile score and gait variable score in individuals with Duchenne Muscular Dystrophy.

Therapeutic gait interventions for individuals with Duchenne Muscular Dystrophy (DMD) should be based on understanding how movement of the individual is affected and whether different clusters of individuals, determined by clinical severity, differ. Gait indexes have been developed to synthesize the data provided by the three-dimensional (3D) gait analysis such as the Gait Deviation Index (GDI) and the Gait Profile Score (GPS) where the gait variable score (GVS) can be calculated. The objective this study was to evaluate the potential use of the GDI and GPS and MAP using data from 3D gait analysis of DMD patients. The dimension 1 score of the Motor Function Measurement defined the groups that composed the cluster analysis. Twenty patients with DMD composed 2 groups according to the cluster analysis (Cluster 1, n = 10; Cluster 2, n = 10). Three-dimensional gait analysis was conducted where GDI, GPS and GVS (pelvic tilt/obliquity; hip flexion-extension/adduction-abduction/rotation; knee flexion-extension; ankle dorsiflexion-plantarflexion, foot progression angle) were calculated. Cluster 1 group presented lower hip flexion-extension and lower pelvic obliquity when compared with Cluster 2 group (p < 0.05). There was no difference between groups for GDI, GPS total and maximum isometric muscle strength of the lower limbs (p > 0.05). This study showed that GVS could detect alterations on the parameters obtained using three-dimensional gait analysis for those DMD patients separated according to motor function regarding pelvic and hip kinematic patterns. The rehabilitation of patients with DMD is recommended from the early stages of the disease (as Cluster 1, with >MFM) with the hip joint being the therapeutic target.

How can new technologies help reduce absenteeism in pediatric consultation? / Como as novas tecnologias podem auxiliar na redução do absenteísmo em consulta pediátrica?

ABSTRACT Objective: To identify the most effective form of contact, as a possible intervention to reduce absenteeism in consultations of children with suspected or confirmed pulmonary tuberculosis. Methods: A randomized clinical trial was conducted with prospective data collection, between March 2017 and February 2018. Patients were randomized into three groups to be reminded about the appointment: telephone contact, SMS or WhatsApp, or no intervention. A convenience sample was obtained, with a significance level of 5%. Results: 78 children were included, with a median age of four years old (zero to 14); 59.0% of them were in treatment for a latent infection and 6.4% had active tuberculosis. Among the 78 children, 74.4% lived in Curitiba (Sourhern Brazil); 62.8% lived with both parents; 38.5% of the parents had formal employment and 47.4% of the mothers were housewives; 50.8% of the fathers and 55.7% of the mothers had more than nine years of schooling. In 78.2% of the families, per capita income was up to 0.5 minimum wages; 27.3% were enrolled in social programs; 28.2% lived in homes provided by the government. There was a total of 238 interventions made: 85 (35.7%) by telephone contact, 78 (32.8%) by text message (WhatsApp was 97.2% of these) and 75 (31.5%) had no further contact. There was no statistical difference among the sociodemographic and cultural characteristics studied. The absenteeism rate was 24.0% and the abandonment rate was 16.7%. Giving a reminder to the patient's guardian prior to the consultation, regardless of the intervention (p=0.021) and specifically by WhatsApp message (p=0.032) was associated with no absenteeism, though it was not associated with abandonment of the treatment. Conclusions: Using new tools, such as WhatsApp, to remind guardians of appointments reduces absenteeism. Consequently, it may lead to a reduction in abandoning treatment and it may improvetreatment outcome of children with a tuberculosis infection or disease.

RESUMO Objetivo: Identificar a forma mais efetiva de contato, como possibilidade de intervenção, para diminuir o absenteísmo em consultas de crianças com suspeita ou com tuberculose pulmonar. Métodos: Ensaio clínico randomizado com coleta de dados prospectiva, entre março de 2017 e fevereiro de 2018. Os pacientes foram aleatorizados em três grupos para relembrar a consulta: contato telefônico; mensagens curtas (SMS) ou WhatsApp; e nenhuma intervenção. Amostra de conveniência, com nível de significância de 5%. Resultados: Incluídas 78 crianças, mediana de idade quatro anos (zero a 14); 59,0% em tratamento para infecção latente e 6,4% com tuberculose ativa; 74,4% moravam em Curitiba, Paraná; 62,8% residiam com ambos os pais; 38,5% dos pais possuíam emprego formal e 47,4% das mães eram do lar; 50,8% dos pais e 55,7% das mães possuíam mais de nove anos de estudo; em 78,2% das famílias a renda per capita foi de até 0,5 salário mínimo; 27,3% estavam inscritas em programas sociais; e 28,2% residiam em casa cedida. Foram 238 intervenções: 85 (35,7%) por contato telefônico, 78 (32,8%) por mensagem de texto (WhatsApp 97,2%) e 75 (31,5%) sem nenhum contato adicional. Nas características sociodemográficas e culturais estudadas não houve diferença estatística. O absenteísmo foi de 24,0% e o abandono, de 16,7%. Lembrar o responsável previamente à consulta, independente da intervenção (p=0,021) e especificamente por mensagem por WhatsApp (p=0,032) foi associado ao não absenteísmo, porém não associado ao abandono. Conclusões: O uso de novas ferramentas, como o aplicativo WhatsApp, pode reduzir o absenteísmo, diminuir a possibilidade de abandono no seguimento e melhorar o desfecho do tratamento de crianças com tuberculose, seja a infecção ou a doença.

Spatiotemporal distribution of acquired immunodeficiency syndrome incidence in Brazil between 2012 and 2016

Abstract INTRODUCTION: Acquired immunodeficiency syndrome (AIDS) remains a major public health issue in Brazil. This ecological study aimed to evaluate the spatiotemporal distribution of notified new AIDS cases in Brazil between 2012 and 2016. METHODS: A Bayesian spatiotemporal model based on the Poisson distribution was used to obtain smoothed incidence estimates of AIDS in each of the 133 Brazilian intermediate regions. RESULTS: Spatial distribution of new AIDS cases is highly heterogeneous. Regions with higher gross domestic product per capita tend to have higher incidence rates of AIDS. CONCLUSIONS: Strategies to prevent and control AIDS should consider regional differences.

Spatiotemporal distribution of acquired immunodeficiency syndrome incidence in Brazil between 2012 and 2016.

INTRODUCTION: Acquired immunodeficiency syndrome (AIDS) remains a major public health issue in Brazil. This ecological study aimed to evaluate the spatiotemporal distribution of notified new AIDS cases in Brazil between 2012 and 2016. METHODS: A Bayesian spatiotemporal model based on the Poisson distribution was used to obtain smoothed incidence estimates of AIDS in each of the 133 Brazilian intermediate regions. RESULTS: Spatial distribution of new AIDS cases is highly heterogeneous. Regions with higher gross domestic product per capita tend to have higher incidence rates of AIDS. CONCLUSIONS: Strategies to prevent and control AIDS should consider regional differences.

Spatiotemporal patterns of AIDS incidence among adults in São Paulo, Brazil.

INTRODUCTION: AIDS remains a major public health concern in Brazil. METHODS: This study investigated spatiotemporal patterns of reported AIDS cases among adults in São Paulo between 2000 and 2016, and their associations with human development index. RESULTS: In the early 20th century, the more developed administrative districts (ADs) indicated higher AIDS incidences among men. From the 2010s, ADs with lower development indicate higher rates of the disease among women. CONCLUSIONS: The results are useful to support the planning of actions aimed at controlling the incidence and transmission of AIDS in certain areas, based on diversification by gender and risk populations.

Spatiotemporal patterns of AIDS incidence among adults in São Paulo, Brazil

Abstract INTRODUCTION: AIDS remains a major public health concern in Brazil. METHODS: This study investigated spatiotemporal patterns of reported AIDS cases among adults in São Paulo between 2000 and 2016, and their associations with human development index. RESULTS: In the early 20th century, the more developed administrative districts (ADs) indicated higher AIDS incidences among men. From the 2010s, ADs with lower development indicate higher rates of the disease among women. CONCLUSIONS: The results are useful to support the planning of actions aimed at controlling the incidence and transmission of AIDS in certain areas, based on diversification by gender and risk populations.

Intervention in social skills and bullying.

OBJECTIVE: to verify if the improvement of social and emotional skills reduces bullying victimization in 6th grade students 12 months after the end of the intervention. METHOD: Quasi-experimental study with 78 students who were bullying victims. A cognitive behavioral intervention based on social skills was conducted with the intervention group. The eight sessions addressed politeness, making friendships, self-control, emotional expressiveness, empathy, assertiveness and solution of interpersonal problems. Data were analyzed using Poisson regression with random effect. RESULTS: Quasi-experimental study with 78 students who were bullying victims. A cognitive behavioral intervention based on social skills was conducted with the intervention group. The eight sessions addressed politeness, making friendships, self-control, emotional expressiveness, empathy, assertiveness and solution of interpersonal problems. Data were analyzed using Poisson regression with random effect. CONCLUSION: Social skills are important in anti-bullying interventions and can be the basis for intersectoral interventions in the health area, aimed at favoring the empowerment of victims by improving their social interactions and quality of life in school.

Intervention in social skills and bullying / Intervención en habilidades sociales y acoso escolar (bullying) / Intervenção em habilidades sociais e bullying

ABSTRACT Objective: to verify if the improvement of social and emotional skills reduces bullying victimization in 6th grade students 12 months after the end of the intervention. Method: Quasi-experimental study with 78 students who were bullying victims. A cognitive behavioral intervention based on social skills was conducted with the intervention group. The eight sessions addressed politeness, making friendships, self-control, emotional expressiveness, empathy, assertiveness and solution of interpersonal problems. Data were analyzed using Poisson regression with random effect. Results: Quasi-experimental study with 78 students who were bullying victims. A cognitive behavioral intervention based on social skills was conducted with the intervention group. The eight sessions addressed politeness, making friendships, self-control, emotional expressiveness, empathy, assertiveness and solution of interpersonal problems. Data were analyzed using Poisson regression with random effect. Conclusion: Social skills are important in anti-bullying interventions and can be the basis for intersectoral interventions in the health area, aimed at favoring the empowerment of victims by improving their social interactions and quality of life in school.

RESUMEN Objetivo: Comprobar si la mejoría de las habilidades sociales reduce la victimización por acoso escolar (bullying) en estudiantes del 6º año de primaria, después de 12 meses de concluida la intervención. Método: Estudio de intervención cuasi-experimental entre 78 estudiantes víctimas de acoso escolar (bullying). Se llevó a cabo una intervención cognitivo-comportamental basada en habilidades sociales con ocho sesiones enfocadas en habilidades de civilidad, hacer amigos, autocontrol y expresividad emocional, empatía, asertividad y solución de problemas interpersonales. Los datos se analizaron a través de la Regresión de Poisson con efecto aleatorio. Resultado: El grupo intervención mejoró con respecto a las habilidades sociales; la victimización se redujo significativamente en ambos grupos (intervención y comparación), aunque en mayor cantidad en el grupo intervención. Conclusión: las habilidades sociales son importantes en mediaciones contra el acoso escolar y pueden fundamentar intervenciones intersectoriales en el área de la salud, con el fin de favorecer el empoderamiento de las víctimas mediante la mejoría de sus interacciones sociales y de la calidad de vida en la escuela.

RESUMO Objetivo: Verificar se a melhoria de habilidades sociais reduz a vitimização por bullying em estudantes do 6º ano escolar após 12 meses da finalização da intervenção. Método: Estudo de intervenção quase-experimental com 78 estudantes vítimas de bullying. Realizou-se uma intervenção cognitivo comportamental baseada em habilidades sociais com o grupo intervenção. As oito sessões realizadas enfocaram habilidades de civilidade, fazer amizades, autocontrole e expressividade emocional, empatia, assertividade e solução de problemas interpessoais. Os dados foram analisados mediante regressão de Poisson com efeito aleatório. Resultado: O grupo da intervenção melhorou significativamente as habilidades sociais. A vitimização reduziu-se significativamente em ambos os grupos (intervenção e comparação), porém, em maior quantidade no grupo intervenção. Conclusão: As habilidades sociais são importantes em intervenções antibullying e podem fundamentar intervenções intersetoriais na área da saúde, visando favorecer o empoderamento das vítimas mediante a melhoria de suas interações sociais e qualidade de vida na escola.

Resultados de Intervenções em Habilidades Sociais na Redução de Bullying Escolar: Revisão Sistemática com Metanálise / Resultados de Intervenciones en Habilidades Sociales Aplicadas a la Reducción del Acoso Escolar: Revisión Sistemática con Metaanálisis / Results from Interventions Addressing Social Skills to Reduce School Bullying: A Systematic Review with Meta-Analysis

Resumo O bullying, considerado problema de saúde pública, afeta o relacionamento social, o desempenho escolar e a saúde de crianças e adolescentes. Esta revisão de literatura com metanálise objetivou verificar se intervenções em habilidades sociais reduzem a vitimização e/ou agressão por bullying. Foram consultadas as bases de dados: LILACS, PsycINFO, Scielo, SCOPUS e Web of Science. Na metanálise, empregou-se o modelo de efeitos aleatórios e o método de DerSimonian-Laird. Selecionou-se os seis estudos que atenderam aos critérios de inclusão, cuja qualidade metodológica foi avaliada pela escala de Downs e Black. Os resultados indicaram efeitos das intervenções em habilidades sociais na redução de agressão e vitimização, porém em níveis não significativos. Intervenções em habilidades sociais podem ser mais eficazes se desenvolvidas em conjunto com outras que envolvam também a variedade de situações, contextos e sujeitos implicados no bullying, como equipe escolar e família.

Resumen El Bullying o acoso escolar, considerado un problema de salud pública, afecta a las relaciones sociales, al desarrollo escolar y a la salud en general de niños y adolescentes. Esta revisión sistemática de literatura con metaanálisis tiene como objetivo comprobar si las intervenciones en habilidades sociales reducen la victimización y/o la agresión en los casos de acoso escolar. Se consultaron las bases de datos LILACS, PsycINFO, Scielo, SCOPUS y Web of Science. En el metaanáisis se empleó el modelo de efectos aleatórios y el modelo de DerSimonian-Laird. Se seleccionaron los seis estudios que corresponden a los critérios de exclusión cuya calidad metodológica fue evaluada en la escala de Downs y Black. Los resultados indicaron efectos positivos en las intervenciones pero a un nivel muy poco significativo. Las intervenciones podrían ser más eficaces si se desarrollan en conjunto con otras que aporten variedad en cuanto a situaciones, contextos y sujetos implicados en el acoso escolar tales como el personal docente y la familia.

Abstract Bullying, a public health problem, affects social relationships, school performance and students' health. The objective of this literature review was to verify whether interventions addressing social skills reduce victimization and/or aggression resulting from bullying. The following databases were consulted: LILACS, PsycINFO, Scielo, SCOPUS and Web of Science. The random-effects model and DerSimonian-Laird method were used. Six studies that met the inclusion criteria were selected, the methodological quality of which was assessed using the Downs and Black scale. Results indicated that interventions addressing social skills reduced bullying and victimization, however, at non-significant levels. Interventions addressing social skills may be more effective if developed together with other types of intervention which may include a wide range of situations, contexts, as well as the different individuals involved in the bullying incident, such as school staff and family.

The Use of a Wheelchair Propulsion Field Test to Determine Peak Heart Rate in Children and Adolescents With Myelomeningocele.

PURPOSE: We analyzed the evolution and pattern of heart rate (HR) during the 12-minute wheelchair propulsion field test (WPFT) and compared the peak HR (HRpeak) from the WPFT to the HRpeak obtained in the progressive cardiopulmonary exercise test on arm cranking ergometer (ACT). We aimed to determine if the field test detects the HRpeak consistently and could be used in clinical practice. METHODS: Eleven wheelchair-using children and adolescents with myelomeningocele (aged 8-15 y) performed a maximal ACT and a 12-minute WPFT. HR was recorded continuously at rest, during each minute of the tests, and at recovery. Mixed analysis of variance was used to compare the variables at rest and peak. Bland-Altman plot and Lin's concordance correlation coefficient were used to show agreement between the tests. RESULTS: During minute 2 of the WPFT, participants reached 73%-96% of the HRpeak values recorded in the ACT. From minutes 4 to 12, participants reached HRpeak values ranging 86%-109% of the values recorded in the ACT. There is agreement between the ACT and the WPFT tests. CONCLUSION: WPFT with minimal duration of 4 minutes may be an alternative tool to obtain HRpeak in children and adolescents with myelomeningocele.

Exercício Físico Supervisionado, Aptidão Física e Fatores de Risco para Doenças Cardiovasculares em Adultos e Idosos / Supervised Physical Exercise, Physical Fitness and Risk Factors for Cardiovascular Diseases in Adults and Elderly

Objetivos: Verificar se o tempo de prática de exercícios físicos e a supervisão do profissional de Educação Física estão relacionados à melhores resultados na aptidão física e, investigar a relação entre aptidão física e fatores de risco para doenças cardiovasculares (DCVs) em adultos e idosos. Método: 213 participantes (idade entre 50 e 80 anos) realizaram as seguintes avaliações: índice de massa corporal (IMC), perfil lipídico sanguíneo, pressão arterial sistólica (PAS) e diastólica (PAD); e, aptidão física (bateria de testes motores que permitiu o cálculo índice de aptidão funcional geral (IAFG). A análise estatística foi realizada por meio de modelo linear generalizado (IAFG) e Análise de Variância (tempo de prática e supervisão). Resultados: Os dois grupos com tempo de prática de exercícios físicos >6 meses apresentaram melhores resultados no IAFG em comparação ao grupo com prática <6 meses (<6 meses ­ 228 (88,4) pontos; >6 meses sem supervisão - 274,6 (116,9) pontos; > 6 meses com supervisão - 355,2 (80,9) pontos), sendo possível observar resultados melhores para o grupo com supervisão em comparação ao grupo sem supervisão (p<0,05). Observou-se ainda diferenças entre os grupos quanto ao IAFG, para IMC, triglicerídeos, PAS e PAD, sendo que os grupos com maior IAFG apresentaram melhores resultados. Conclusão: Os melhores resultados do IAFG estão associados ao tempo de prática e à supervisão; bons níveis aptidão física estão associados com melhor saúde cardiovascular. Sugerem-se estratégias objetivando melhoras na aptidão física, destacando o profissional de Educação Física para uma prática eficaz e segura. (AU)

Objective: To determine whether the physical exercise time and the supervision by a physical education professional are related to better results in physical fitness. This study further investigated the relationship between physical fitness and risk factors for cardiovascular diseases (CVD) in adults and elderly people. Material and Methods: 213 participants (aged between 50 and 80 years) underwent the following assessments: variables related to risk factors for CVD - body mass index (BMI), blood lipid profile, systolic (SBP) and diastolic blood pressure (DBP); and factors related to physical fitness - motor test battery which allowed calculation of general functional fitness index (GFFI). Statistical analysis was performed using generalized linear model (GFFI) and Analysis of Variance (practice time and supervision). Results: The two groups with physical exercise time >6 months presented better results in the GFFI compared to the group with practice <6 months (<6 months - 228 (88.4) points; >6 months without supervision ­ 274.6 (116.9) points, >6 months with supervision - 355.2 (80.9) points, with better results for the group with supervision compared to the group without supervision (p <0.05). Higher values in GFFI groups were associated with better results in BMI, triglycerides, SBP and DBP. Conclusion: High values of GFFI are associated with the practice time and the supervision, and good levels of physical fitness are associated with better cardiovascular health. Strategies aiming at improvement in physical fitness are suggested, highlighting the physical education professional as a supervisor for an effective and safe practice. (AU)