Validation of the internal structure of the Brazilian Dental Vulnerability Scale.

OBJECTIVE: This study aimed to evaluate evidence of validity of internal structure of the Brazilian Dental Vulnerability Scale (EVO-BR) when applied in Brazil. METHODS: This is a psychometric study that seeks to validate a scale elaborated by evidence of internal structure. Data collection was conducted in 18 basic health units that implement the Brazilian Healthcare Planning (PAS) methodology, across the five regions of Brazil. The initial version of the EVO-BR contained 41 items that measured dental vulnerability and was applied to users of the Brazilian Unified Health System (SUS) aged 18 years or older who were in basic health units for consultation with higher education professionals. To evaluate the evidence, the following statistical analyses were performed: exploratory factor analysis, confirmatory factor analysis, and network analysis. RESULTS: A total of 1,753 users participated in the study. To adjust the sample, we considered the factorability obtained from Kaiser-Meyer-Olkin (KMO) test = 0.65, Bartlett sphericity test = 8019.7, and a matrix determinant of 0.008. The initial parallel analysis indicated a four-dimensional model and had the items adjusted according to factor loading (ranging from 0.38 to 0.99), common factors (0.13 to 0.89), and Pratt's measure, until the model presented congruence in the statistical and interpretative principles simultaneously. The final model contained 15 items, maintaining the four dimensions indicated by the parallel analysis, and held an explained variance of 68.56%. CONCLUSIONS: The EVO-BR is a validated scale to measure dental vulnerability and, thus, can contribute to the organization of access to the oral health team in primary health care (PHC) by stratifying the population, as recommended in the Brazilian Healthcare Planning.

Validation of the internal structure of the Brazilian Dental Vulnerability Scale / Validação da estrutura interna da Escala Brasileira de Vulnerabilidade Odontológica

ABSTRACT OBJECTIVE This study aimed to evaluate evidence of validity of internal structure of the Brazilian Dental Vulnerability Scale (EVO-BR) when applied in Brazil. METHODS This is a psychometric study that seeks to validate a scale elaborated by evidence of internal structure. Data collection was conducted in 18 basic health units that implement the Brazilian Healthcare Planning (PAS) methodology, across the five regions of Brazil. The initial version of the EVO-BR contained 41 items that measured dental vulnerability and was applied to users of the Brazilian Unified Health System (SUS) aged 18 years or older who were in basic health units for consultation with higher education professionals. To evaluate the evidence, the following statistical analyses were performed: exploratory factor analysis, confirmatory factor analysis, and network analysis. RESULTS A total of 1,753 users participated in the study. To adjust the sample, we considered the factorability obtained from Kaiser-Meyer-Olkin (KMO) test = 0.65, Bartlett sphericity test = 8019.7, and a matrix determinant of 0.008. The initial parallel analysis indicated a four-dimensional model and had the items adjusted according to factor loading (ranging from 0.38 to 0.99), common factors (0.13 to 0.89), and Pratt's measure, until the model presented congruence in the statistical and interpretative principles simultaneously. The final model contained 15 items, maintaining the four dimensions indicated by the parallel analysis, and held an explained variance of 68.56%. CONCLUSIONS The EVO-BR is a validated scale to measure dental vulnerability and, thus, can contribute to the organization of access to the oral health team in primary health care (PHC) by stratifying the population, as recommended in the Brazilian Healthcare Planning.

RESUMO OBJETIVO Avaliar evidências de validade da estrutura interna da Escala Brasileira de Vulnerabilidade Odontológica (EVO-BR) quando aplicada no Brasil. MÉTODOS Trata-se de um estudo de natureza psicométrica, que busca validar uma escala elaborada por meio de evidências de estrutura interna. A coleta de dados foi realizada em 18 unidades básicas de saúde que executam a metodologia da Planificação da Atenção à Saúde (PAS), distribuídas nas cinco regiões do Brasil. A versão inicial da EVO-BR continha 41 itens que mediam vulnerabilidade odontológica e foram aplicadas em usuários com 18 anos ou mais, usuários do Sistema Único de Saúde (SUS), que estivessem nas unidades básicas de saúde para consulta com profissionais de nível superior. Para avaliação das evidências, foram utilizadas as seguintes análises estatísticas: análise fatorial exploratória, análise fatorial confirmatória e network analysis. RESULTADOS Participaram do estudo 1.753 usuários. Para adequação da amostra, considerou-se a fatorabilidade obtida de Kaiser-Meyer-Olkin (KMO) = 0,65, Bartlett sphericity = 8019,7 e determinante da matriz de 0,008. A análise paralela inicial indicou um modelo de quatro dimensões e teve os itens ajustados conforme cargas fatorais (variaram de 0,38 a 0,99), comunalidades (0,13 a 0,89) e Pratt's measure, até que o modelo tivesse congruência nos princípios estatístico e interpretativo simultaneamente. O modelo final apresentou 15 itens, manteve a indicação de quatro dimensões pela análise paralela e uma variância explicada de 68,56%. CONCLUSÕES A EVO-BR é uma escala validada para mensurar vulnerabilidade odontológica e, dessa forma, pode contribuir para organização do acesso a equipe de saúde bucal na atenção primária à saúde (APS) por meio da estratificação da população, como recomendado na planificação.

Eventos precoces da vida, padrões alimentares e sua relação com o perfil cardiometabólico de jovens / Early life events, dietary patterns and its association with cardiometabolic profile in youngsters

Introdução: O índice de massa corporal (IMC) materno pré-gestacional e o aleitamento materno (AM) parecem influenciar o perfil cardiometabólico da prole no curso da vida, interferindo na composição da microbiota intestinal e formação de hábitos alimentares. Objetivos: Examinar associações do IMC materno pré-gestacional e AM, assim como de padrões alimentares (PA) atuais com o perfil cardiometabólico da prole no longo prazo. Objetivos específicos, descritos nos artigos desta tese, foram: I) avaliar associação entre o IMC materno pré-gestacional e a composição corporal da prole feminina na vida adulta; II) identificar PA de mulheres jovens e analisar se são influenciados pela duração do AM; III) avaliar a associação do AM e dos PA atuais com marcadores do metabolismo glico-lipídico; IV) verificar se o tipo de AM durante os primeiros 6 meses de vida está associado com a diversidade e composição da microbiota oral de adolescentes. Métodos: Os objetivos I, II e III foram analisados com dados da linha de base do Nutritionists' Health Study, no qual graduandas de nutrição e nutricionistas <= 45 anos foram elegíveis. Aquelas com câncer, diabetes, ou sem informação para variáveis de interesse foram excluídas, restando 587 participantes. IMC materno pré-gestacional, AM, assim como aspectos atuais sociodemográficos, de estilo de vida e estado de saúde foram obtidos via questionários online. Questionário de frequência alimentar validado foi aplicado e PA foram identificados por análise fatorial por componentes principais. Uma sub-amostra compareceu à clínica para coleta de sangue para avaliação do metabolismo glicídico e lipídico (n=200) e da composição corporal por DXA (n=150). Modelos múltiplos de regressão linear e logística foram construídos considerando conjunto de ajustes mínimos suficientes sugeridos por gráficos acíclicos direcionados. O objetivo IV foi avaliado com dados de 423 adolescentes finlandeses, participantes do Finnish Health in Teens Study Cohort. O tipo de AM (apenas AM vs. AM+formula ou apenas formula) foi obtido retrospectivamente através dos pais. A microbiota da saliva foi analisada por sequenciamento de 16S rRNA. ANCOVA e PERMANOVA foram usadas para comparar a diversidade e modelos lineares generalizados para a abundância entre os grupos. Resultados: Participantes do NutriHS tinham mediana de idade de 22 (IIQ 20;27) anos, IMC de 22,2 (IIQ 20,4; 25,0) kg/m2 e parâmetros metabólicos em média dentro da normalidade. I) O IMC materno pré-gestacional se associou diretamente com adiposidade geral (% gordura corporal e índice de massa gorda) e central (razão gordura androide/ginoide e volume do tecido adiposo visceral) de suas filhas, mas não com a massa magra apendicular e óssea. II) Quatro PA foram identificados (Processado, Prudente, Brasileiro e Lactovegetariano) representando 27% da variância explicada da dieta. Mulheres que receberam AM por <6 meses apresentaram menor chance de apresentar adesão moderada-a-alta ao padrão Prudente em comparação às que receberam AM por >=12 meses. AM não foi associado aos demais PA. III) Mulheres que receberam AM por menos de 6 meses apresentaram maior chance de classificação no maior tercil de insulinemia comparadas às amamentadas por >=6 meses. AM predominante <3 meses foi diretamente associado com a insulinemia e HOMA-IR. Em relação aos PA atuais, o Processado se associou diretamente com a concentração de LDL-c, enquanto o Prudente inversamente com LDL-c e razão LDL-c/HDL-c. IV) Média de idade e IMC dos participantes foi 11,7 anos e de 18,0 kg/m2. Não houve diferença de diversidade na microbiota oral segundo o tipo de AM nos primeiros 6 meses de vida. Três OTUs (do inglês, Operational Taxonomic Unit) pertencentes aos gêneros Eubactéria e Veillonella (filo Firmicutes) foram mais abundantes no grupo que recebeu apenas AM comparado com os que receberam fórmula. Conclusão: O estado nutricional materno pré-gestacional e os hábitos alimentares desde o início da vida têm potencial para influenciar o perfil cardiométabólico de longo prazo. As evidências obtidas em participantes ainda jovens e aparentemente saudáveis reforçam a necessidade de prevenção e avaliação precoce de fatores de risco cardiometabólico.

Introduction: Maternal pre-pregnancy body mass index (BMI) and breastfeeding seem to influence offspring cardiometabolic profile throughout life, interfering on gut microbiota composition and development of eating habits. Aim: To examine associations of maternal pre-pregnancy BMI and breastfeeding, as well as of current dietary patterns with long-term cardiometabolic profile. Specific aims, described in thesis manuscripts, were: I) to evaluate association of maternal pre-pregnancy BMI with female offspring body composition at adulthood; II) to identify dietary patterns of young women and analyse if adherence was influenced by breastfeeding duration; III) to evaluate association of breastfeeding and of current dietary patterns with biomarkers of glucose and lipid metabolism; IV) to verify if type of feeding during the first 6 months of life was associated with oral microbiota diversity and composition of adolescents. Methods: The aims I, II and III were evaluated using Nutritionists' Health Study baseline data, in which nutrition students and nutritionists <=45 years old were eligible. Those with cancer, diabetes, or missing information for variables of interest were excluded, resulting in 587 participants. Maternal pre-pregnancy BMI, total and predominant breastfeeding, as well as current sociodemographic, lifestyle and health aspects were obtained through online questionnaires. Validated food frequency questionnaire was applied, and dietary patterns were identified using factor analysis by principal components. A sub-sample visited the clinic for determinations of plasma glucose and lipid parameters (n=200) and body composition assessment by DXA (n=150). Multiple linear and logistic regression models were constructed considering minimum sufficient adjustments suggested by directed acyclic graphs. The aim IV was assessed with data from 423 adolescents from the Finnish Health in Teens Study Cohort. The type of breastfeeding (No Formula vs. Formula, combined or not with breastfeeding) was retrospectively obtained. Saliva microbiota was analysed by 16S rRNA sequencing. ANCOVA and PERMANOVA were used to compare diversity and generalized linear models to verify differential abundance between groups. Results: NutriHS participants had median age of 22 (IQR 20; 27) years, BMI of 22.2 (IQR 20.4; 25.0) kg/m2 and metabolic parameters were in average within normal range. I) Maternal pre-pregnancy BMI was directly associated with general (% body fat and fat mass index) and central (android-to-gynoid ratio and visceral adipose tissue) adiposity measures of their daughters, but not with appendicular muscle mass and bone mass. II) Four dietary patterns were identified (Processed, Prudent, Brazilian and Lacto-vegetarian), representing 27% of diet explained variance. Women who were breastfed for <6 months had lower chance to have moderate-tohigh adherence to the Prudent pattern compared to those who were breastfed for at least 12 months. Breastfeeding was not associated to other patterns. III) Women breastfed for <6 months had higher chance of being classified into the highest tertile of insulin compared to those breastfed for at least 6 months. Predominant breastfeeding <3 months was directly associated with insulin concentration and HOMA-IR. Regarding current dietary patterns, the Processed pattern was directly associated with LDL-c concentration, while the Prudent pattern was inversely associated with LDL-c and LDL-c/HDLc ratio. IV) Mean age and BMI of participants were 11.7 and 18.0 kg/m2. Diversity of oral microbiota was not different according to type of feeding during the first 6 months of life. Three Operational Taxonomic Units (OTU) belonging to Eubacteria and Veilonella genera (phylum Firmicutes) were more abundant in only breastfeeding group compared to participants who received infant formula. Conclusion: Maternal pre-pregnancy nutritional status and dietary habits since early life have potential to influence the cardiometabolic profile in the long term. Evidence obtained in young and healthy participants reinforce necessity of prevention and early assessment of cardiometabolic risk factors.

Assessment of Motor Skills in Children With Visual Impairment: A Systematic and Integrative Review.

This study aimed to review and examine the tools used to assess psychomotor performance of children with visual impairment. Databases, such as SCOPUS, MEDLINE/PubMed, Medline/EBSCO, Web of Science, LILACS, CINAHL, and ScienceDirect, were searched using Mesh terms. Data from manuscripts fully available in these databases between 1994 and 2017 (except CINAHL-2014) concerning the evaluation, tool development, or intervention for the improvement of motor skills in children (age, 7-10 years) with visual impairment were collected. The Critical Review Form-Quantitative Studies was used to evaluate the quality of the articles. As a result, 1113 articles were found, but only 24 met the inclusion criteria; 66.7% of the articles had moderate quality, with unsatisfactory results regarding the validity and reliability of the tools used to assess these children, as well as the absence of clinical importance and practical application in such studies. Only the Test of Gross Motor Development-2 and Movement Assessment Battery for Children-2 described data on the validation and reliability in visually impaired children. To minimize systematic errors and improve the quality of the investigations, increasing the number of studies regarding the tools, functionality of their activities, and testing the adaptions is necessary.

Relationship between perceived athletic competence, maturational status and physical activity in boys and girls / Relação entre competência atlética percebida, estado maturacional e atividade física em rapazes e moças

ABSTRACT The Organized Practice of physical activities (OP) is a kind of physical activity carried out in an organized program of frequency and duration, under the supervision of an adult (teacher or coach), and involve some kind of demonstration of performance which may be competitions and/or festivals. This study aimed to investigate the relationship between the Perceived Athletic Competence (PAC) and the time spent in Organized Practices in sports and dance, considering the adolescent maturational status and sex. In this cross-sectional and correlational study participated 213 boys and girls aged between 13 and 16 years. The Perceived Athletic Competence and the Organized Practices of the individuals was assessed by questionnaires. The maturational status was determined by calculating the peak growth rate. Bivariate and partial correlations were performed. The results showed that regardless of maturational status of individuals, there was a positive relationship between Perceived Athletic Competence and total Organized Practices for boys and girls (rho = 0.40, p < 0.01). In this study, the relationship between Perceived Athletic Competence and time spent in Organized Practices during childhood until adolescence appeared to be an independent event from maturational status.

RESUMO A Prática Organizada de atividades físicas (PO) é um tipo de atividade física realizada por programa organizado com frequência e duração, sob a supervisão de um adulto (professor ou treinador), e envolve algum tipo de demonstração do seu desempenho, que pode ser por meio de competições e/ou festivais. Este estudo teve como objetivo investigar a relação entre a Competência Atlética Percebida (CAP) e o tempo gasto em Práticas Organizadas em esportes, lutas e danças, considerando o estado maturacional e o sexo de adolescentes. Neste estudo transversal e correlacional participaram 213 rapazes e moças com idade entre 13 e 16 anos. A CAP e as PO dos indivíduos foram avaliadas por meio de questionários. O estado maturacional foi determinado pelo cálculo do pico de volocidade de crescimento. Correlações bivariadas e parciais foram realizadas para análise dos dados. Os resultados mostraram que independentemente do estado maturacional dos indivíduos, houve uma relação positiva entre a Competência Atlética Percebida e o Total de Práticas Organizadas para rapazes e moças (rho = 0,40, p <0,01). Neste estudo, a relação entre a Competência Atlética Percebida e o tempo gasto nas Práticas Organizadas, durante a infância até a adolescência, pareceu ser um evento independente do estado maturacional.

Motor competence and health related physical fitness in youth: A systematic review.

OBJECTIVES: This study aimed to review the scientific evidence on associations between motor competence (MC) and components of health related physical fitness (HRPF), in children and adolescents. DESIGN: Systematic review. METHODS: Systematic search of Academic Search Premier, ERIC, PubMed, PsycInfo, Scopus, SportDiscus, and Web of Science databases was undertaken between October 2012 and December 2013. Studies examining associations between MC and HRPF components (body weight status, cardiorespiratory fitness, musculoskeletal fitness and flexibility) in healthy children and adolescents, published between 1990 and 2013, were included. Risk of bias within studies was assessed using CONSORT and STROBE guidelines. The origin, design, sample, measure of MC, measure of the HRPF, main results and statistics of the studies were analyzed and a narrative synthesis was conducted. RESULTS: Forty-four studies matched all criteria; 16 were classified as low risk of bias and 28 as medium risk. There is strong scientific evidence supporting an inverse association between MC and body weight status (27 out of 33 studies) and a positive association between MC and cardiorespiratory fitness (12 out of 12 studies) and musculoskeletal fitness (7 out of 11 studies). The relationship between MC and flexibility was uncertain. CONCLUSIONS: Considering the noted associations between various assessments of MC and with multiple aspects of HRPF, the development of MC in childhood may both directly and indirectly augment HRPF and may serve to enhance the development of long-term health outcomes in children and adolescents.

Risk factors associated with falls in adult patients after stroke living in the community: baseline data from a stroke cohort in Brazil.

BACKGROUND: Individuals with stroke have a high risk of falling, and their fall predictors may differ from those of other populations. PURPOSE: To estimate fall frequency and identify factors related to fall occurrence in a sample of patients with stroke residing in the community. METHODS: Clinical data were collected from 150 consecutive stroke patients with independent gait, and the following scales were applied: modified Barthel Index (mBI), Timed Up & Go Test (TUG), and National Institutes of Health Stroke Scale (NIHSS). Univariate analysis was performed; variables with possible association (P < .1) were included in a logistic regression model. Receiver operating characteristic curves were used to identify the best cutoff point for TUG. RESULTS: Falls occurred in 37% of patients. In multivariate analysis, right hemisphere injury (odds ratio [OR], 2.621; 95% CI, 1.196-5.740; P = .016), time in TUG (OR, 1.035 for every increase in 1 second; 95% CI, 1.003-1.069; P = .034), and longer time since stroke onset (OR, 1.012 for every month increase; 95% CI, 1.002-1.021; P = .015) remained predictors. When we grouped individuals according to affected cerebral hemisphere, both hemispheres had similar accuracy, but TUG cutoff point was lower in individuals with right- versus left-hemisphere lesions. CONCLUSIONS: Patients with poor TUG performance, longer times since stroke onset, and right-hemisphere injury have particularly high fall rates, and TUG cutoff points for fall prediction vary according to cerebral hemisphere.

A influência do gênero e idade no desempenho das habilidades locomotoras de crianças de primeira infância / The influence of gender and age on locomotor skill performance in children of early childhood

Na primeira infância é esperada uma melhora no desempenho de habilidades locomotoras com o avanço da idade. Pode também haver diferenças entre meninos e meninas devido à especificidade da tarefa motora. Este estudo teve como objetivo analisar o desempenho de crianças em habilidades locomotoras de acordo com idade e gênero. O desempenho locomotor de 389 pré-escolares de três a cinco anos da cidade do Recife - PE foi avaliado mediante o TGMD-2. Os resultados mostraram que: crianças mais velhas apresentaram melhor desempenho motor; no geral, meninos obtiveram melhor desempenho no correr, salto horizontal, deslize lateral e escore total locomotor, e meninas no saltitar com um pé aos cinco anos de idade; na análise da progressão do desenvolvimento motor, comportamentos motores mais complexos ocorreram após aqueles considerados menos complexos. Conclui-se que o desenvolvimento locomotor dos pré-escolares recifenses obedeceu aos princípios da progressividade e do aumento da complexidade, entretanto, meninos e meninas mostraram diferenças no seu desempenho dependendo da tarefa.

In early childhood the performance of locomotor skills is expected to be improved in with advancing age. Differences between boys and girls due to the specificity of motor task may exist. This study aimed to analyze the locomotor skills performance of children regarding age and gender. The locomotor performance of 389 preschool children from three to five years from the city of Recife - PE was evaluated by TGMD-2. The results showed that: older children outperformed the younger ones; in general, the boys outperformed the girls in the skills to run, horizontal jump, slide and in the locomotor total score, and the girls had a better performance in the skill to hop at five years; at the analysis of the progression of motor development, more complex motor behaviors occurred after those considered less complex. It is concluded that the locomotor development of preschoolers from Recife followed the principles of progressivity and complexity, however, boys and girls showed differences on the performance depending on the task.

Aprendizagem de uma habilidade motora seriada em diferentes estágios de desenvolvimento / Learning of a motor serial skill in different stages of development

Este estudo investigou a aprendizagem de uma tarefa motora seriada em diferentes estágios de desenvolvimento. Quinze crianças, 14 adultos e 13 idosos praticaram a tarefa de rastrear uma sequência de seis estímulos luminosos durante 10 blocos de tentativas ou até descobrir a sequência, constituindo a fase de estabilização e mais dois blocos de tentativas, referentes as fases de adaptação I e II. O desempenho foi mensurado por meio das respostas funcionais e não-funcionais e das sequências funcionais. Os resultados indicaram que os adultos foram superiores aos demais participantes, e idosos apresentaram melhor desempenho que crianças apenas no início da prática, sugerindo que o estágio de desenvolvimento interage com o processo de aprendizagem motora.

This study investigated the learning of a serial tracking task in different developmental stages. Fifteen children, fourteen adults and thirteen elderly practiced the task of tracking a sequence of six light stimuli for ten blocks of trial or until discover the sequence, during the stabilization phase, and two blocks of trial at the adaptation tests I and II. Performance was measured by the functional and non-functional responses and functional sequences. The results showed that adults were superior to the other participants, and elderly participants performed better than children only in the early practice, suggesting that the development stage interacts with the process of motor learning.

Natriuretic effect of bufalin in isolated rat kidneys involves activation of the Na+-K+-ATPase-Src kinase pathway.

Bufadienolides are structurally related to the clinically relevant cardenolides (e.g., digoxin) and are now considered as endogenous steroid hormones. Binding of ouabain to Na(+)-K(+)-ATPase has been associated, in kidney cells, to the activation of the Src kinase pathway and Na(+)-K(+)-ATPase internalization. Nevertheless, whether the activation of this cascade also occurs with other cardiotonic steroids and leads to diuresis and natriuresis in the isolated intact kidney is still unknown. In the present work, we perfused rat kidneys for 120 min with bufalin (1, 3, or 10 µM) and measured its vascular and tubular effects. Thereafter, we probed the effect of 10 µM 3-(4-chlorophenyl)1-(1,1-dimethylethyl)-1H-pyrazolo[3,4-d]pyrimidin-4amine (PP2), a Src family kinase inhibitor, and 1,4-diamino-2,3-dicyano-1,4-bis[2-aminophenylthio] butadiene (UO126), a highly selective inhibitor of both MEK1 and MEK2, on bufalin-induced renal alterations. Bufalin at 3 and 10 µM profoundly increased several parameters of renal function in a time- and/or concentration-dependent fashion. At a concentration that produced similar inhibition of the rat kidney Na(+)-K(+)-ATPase, ouabain had a much smaller diuretic and natriuretic effect. Although bufalin fully inhibited the rat kidney Na(+)-K(+)-ATPase in vitro, its IC(50) (33 ± 1 µM) was threefold higher than the concentration used ex vivo and all its renal effects were blunted by PP2 and UO126. Furthermore, the phosphorylated (activated) ERK1/2 expression was increased after bufalin perfusion and this effect was totally prevented after PP2 pretreatment. The present study shows for the first time the direct diuretic, natriuretic, and kaliuretic effects of bufalin in isolated rat kidney and the relevance of Na(+)-K(+)-ATPase-mediated signal transduction.