Assessment of oral health-related quality of life and associated factors in children and preadolescents

Orientador: Maria Beatriz Duarte GaviãoTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: Nas últimas duas décadas, houve aumento substancial do interesse sobre a qualidade de vida relacionada à saúde bucal (QVRSB) de crianças e adolescentes, o que se deve ao fato das doenças bucais comprometerem significativamente os aspectos físicos, emocionais e sociais destes indivíduos. Assim, o objetivo geral desta pesquisa foi avaliar a QVRSB e fatores associados em crianças e pré-adolescentes, de oito a catorze anos, de ambos os gêneros, escolares da rede pública do município de Piracicaba, SP. Na avaliação de saúde bucal as seguintes variáveis foram consideradas: presença e severidade de cárie, maloclusão, fluorose, gengivite, de acordo com os critérios da Organização Mundial da Saúde, e sinais e sintomas de disfunção temporomandibular (DTM), por meio do Research Diagnostic Criteria/Temporomandibular Disorders - eixo I. A auto-percepção da QVRSB foi avaliada por meio de questionários específicos para os grupos etários, as versões brasileiras do Child Perceptions Questionnaire (CPQ), para crianças de oito a dez e onze anos (CPQ8-10) e pré-adolescentes de onze a catorze anos (CPQ11-14). Duas questões destes questionários também foram utilizadas para avaliar as percepções globais de saúde bucal (SB) e bem-estar (BE). Na avaliação dos fatores associados à QVRSB, as variáveis consideradas foram: características sociodemográficas (idade e gênero da criança, número de adultos em casa e nível educacional da mãe), utilização de serviços odontológicos (experiência passada e atual) e hábitos de higiene bucal (frequência de escovação). Os sintomas de ansiedade e depressão foram avaliados por meio das versões brasileiras do Revised Children's Manifest Anxiety Scale (RCMAS) e do Children's Depression Inventory (CDI), respectivamente. Para avaliar as concentrações de cortisol salivar foram coletadas amostras de saliva 30 minutos após acordar (jejum) e à noite (antes de dormir) para determinar o declínio diurno de cortisol salivar (?g/dl), calculado pela diferença entre os valores da primeira e segunda coletas. As concentrações de cortisol salivar foram determinadas por meio de análise imunoenzimática. Os dados obtidos foram discutidos em quatro estudos, denominados capítulos no presente trabalho. Os objetivos específicos do primeiro (Evaluating oral health-related quality of life measure for children and preadolescents with temporomandibular disorder) e segundo (Oral health-related quality of life in children and preadolescents with dental caries, malocclusions or temporomandibular disorders) capítulos foram, respectivamente, avaliar as propriedades psicométricas dos questionários para uso em crianças e pré-adolescentes com sinais e sintomas de DTM e comparar a percepção de QVRSB entre grupos com diferentes condições bucais (cárie, maloclusão e DTM) e grupo controle. O segundo estudo também objetivou identificar os conceitos associados às respostas sobre SB e BE em cada grupo clínico. Os questionários mostraram-se válidos e confiáveis para uso em crianças e pré-adolescentes com sinais e sintomas de DTM. Além disso, os instrumentos apresentaram propriedade discriminativa entre indivíduos com diferentes condições clínicas e o grupo controle, mas não entre os grupos clínicos. Por fim, os resultados sugeriram que as crianças e pré-adolescentes apresentam visão multidimensional sobre os conceitos de SB e BE. Estes resultados possibilitaram testar as propriedades psicométricas dos questionários em indivíduos com diferentes condições clínicas e iniciar uma série de estudos sobre os fatores associados à auto-percepção da QVRSB. Sendo assim, o terceiro estudo (Factors associated with oral health-related quality of life in children and preadolescents) objetivou avaliar os fatores associados à auto-percepção de QVRSB. Sinais e sintomas de DTM e sintomas de ansiedade em crianças e depressão em pré-adolescentes estiveram associadas com maior impacto na QVRSB destes indivíduos. Para melhorar o entendimento sobre a relação entre os fatores psicológicos e as percepções de SB e BE destes indivíduos, o quarto estudo (Relationships among oral conditions, global ratings of oral health, overall well-being and emotional statuses of children and preadolescents) objetivou avaliar a associação entre as condições bucais, percepções globais de SB e BE e variáveis psicológicas (sintomas de ansiedade e depressão) e fisiológicas (declínio diurno de cortisol salivar) desta população. O aumento na idade e maiores concentrações de cortisol salivar estiveram associados com maiores impactos na percepção global de saúde bucal, enquanto que sinais e sintomas de disfunção temporomandibular e sintomas de depressão estiveram associados ao maior comprometimento do bem-estar geralAbstract: Over the past two decades, there has been substantial increase in concern about the impact of oral health-related quality of life (OHRQoL) of children and adolescents, which has been due to the fact that oral diseases significantly compromise the physical, emotional and social needs of these individuals. Thus, this research aimed to evaluate the OHRQoL and associated factors in 8- to 14-yr-old children and preadolescents, of both genders, students of public schools of Piracicaba, SP. To evaluate the oral health, the following variables were considered: presence and severity of dental caries, malocclusion, fluorosis, gingivitis according to World Health Organization, and signs and symptoms of temporomandibular disorder (TMD), using the Research Diagnostic Criteria/Temporomandibular Disorders - axis I. Self-perceived of OHRQoL was assessed using age-specific questionnaires, the Brazilian versions of the Child Perceptions Questionnaire (CPQ) for 8- to 10 yr-old children (CPQ8-10) and 11- to 14-yr-old preadolescents (CPQ11-14). Two questions of these questionnaires were also used to assess the global ratings of oral health (OH) and overall well-being (OWB). Sociodemographic characteristics (the child?s age and gender, the number of adults in the household and the mother's educational level), dental service utilization (past and current actual experience) and the child?s oral hygiene habits (tooth brushing frequency) were evaluated as part of the factors associated with OHRQoL. Symptoms of anxiety and depression were assessed using the Portuguese versions of the Revised Children's Manifest Anxiety Scale (RCMAS) and the Children's Depression Inventory (CDI), respectively. To evaluate the salivary cortisol concentrations, saliva sampling was collected 30 minutes after awakening (fasting) and at night (bedtime) to determine the diurnal decline of salivary cortisol (in ?g/dl), then, the difference between the values of the first and second samples were obtained. Salivary cortisol concentrations were determined by enzyme immunoassay analysis. The data were discussed in four studies, denominated as chapters in this work. The specific objectives of the first (Evaluating oral health-related quality of life measure for children and preadolescents with temporomandibular disorder) and second (Oral health-related quality of life in children and preadolescents with dental caries, malocclusions or temporomandibular disorders) chapters were to evaluate the psychometric properties of the questionnaires for using in children and preadolescents with signs and symptoms of TMD, to compare the OHRQoL of groups with different oral conditions (caries, malocclusion and TMD) and controls, respectively. The second study also aimed to identify the concepts associated with the responses of each clinical group to OH and OWB. The questionnaires showed to be valid and reliable for use in children and preadolescents with signs and symptoms of TMD. In addition, the questionnaires discriminated between individuals with different clinical conditions and controls, but not within clinical groups. Finally, the results suggested that children and preadolescents view their OH and OWB as multidimensional concepts. These results provide the opportunity to test the psychometric properties of the questionnaires among individuals presenting a variety of clinical conditions and to start a series of studies about the factors associated with the self-perception of OHRQoL. In this way, the third study (Factors associated with oral health-related quality of life in children and preadolescents) aimed to evaluate the factors associated with self-perception of OHRQoL. Signs and symptoms of TMD and symptoms of anxiety in children and depression in preadolescents were associated with higher impact on their OHRQoL. To improve the understanding about the relation between psychological factors and the perception of OH and OWB of these individuals, the fourth study ("Relationships among oral conditions, global ratings of oral health, overall well-being and emotional statuses of children and preadolescents") aimed to evaluate the associations between oral conditions, global ratings of OH and OWB and psychological (symptoms of anxiety and depression) and physiological (diurnal decline of salivary cortisol) variables. Older children and higher levels of salivary cortisol were associated with negative impacts on global ratings of OH, while signs and symptoms of TMD and symptoms of depression were associated with negative impacts on global ratings of OWBDoutoradoOdontopediatriaDoutor em Odontologi

Evaluation of the Family Impact Scale for use in Brazil

OBJECTIVES: The objectives of this study were to assess the validity and reliability of the Family Impact Scale (FIS) applied in Brazilian parents after translations and cultural adaptations to Brazilian Portuguese language and to evaluate the nature and extent to which the family functioning is compromised by the child oral conditions. MATERIAL AND METHODS: Parents were recruited from general populations for pre-testing (n=20), validity (n=210) and test-retest reliability (n=20) studies. The children were examined for dental caries, gingivitis, fluorosis and malocclusion. RESULTS: The FIS discriminated among the categories of malocclusion and showed good construct validity. The Cronbach's alpha and intraclass correlation coefficients were 0.87 and 0.90, respectively. Almost 20% of the informants reported some family impact `sometimes' or `often/everyday' from the child's oral condition. Impact on FIS domains of this frequency ranged from 13.8% for financial difficulties to 24.4% for parental or family activities. CONCLUSIONS: The Brazilian Portuguese version of FIS is valid and reliable. The results suggest that child oral conditions have a negative impact on the family. Further research is required, as these findings were based on cross-sectional study and convenience samples

Tradução e adaptação brasileira do Parental-Caregiver Perceptions Questionnaire (P-CPQ)

The aim of this study was to translate the Parental-Caregiver Perceptions Questionnaire (P-CPQ) into Brazilian Portuguese and to make the necessary cultural adaptations for use in the Brazilian parent population. The whole translation process consisted of translation, back-translation and committee review. In the pre-testing stage, a sample of 20 parents answered the questionnaire in order to check for errors and deviations in the translations. Furthermore, in each question the alternative "I didn't understand" was added to identify the questions that were not understood by the parents, i.e. questions considered culturally inappropriate. The findings suggested that the instrument is adequate to the Portuguese language and to the Brazilian cultural identity. In the pre-testing stage, 20 subjects answered the questionnaire and showed good understanding of the instrument, since no question was considered incomprehensible by 15% or more of the parents. The Portuguese version of the P-CPQ proved to be easily understandable by the Brazilian parental population.O objetivo deste estudo foi traduzir o instrumento Parental-Caregiver Perceptions Questionnaire (P-CPQ) para a língua portuguesa do Brasil e realizar a adaptação cultural para aplicação na população de pais brasileiros. A tradução obedeceu às etapas de tradução, tradução reversa e revisão por um comitê de especialistas. No pré-teste, uma amostra de 20 pais respondeu ao questionário para avaliar os erros e desvios das traduções. Além disso, foi acrescentada a cada questão a alternativa "não entendi" para identificar questões que não fossem compreendidas pelos pais, isto é, consideradas culturalmente inadequadas. Os achados sugerem adequação do processo de adaptação cultural do instrumento para a língua portuguesa. No pré-teste, 20 indivíduos responderam ao questionário e apresentaram uma boa compreensão do instrumento, uma vez que nenhuma questão foi considerada incompreensível por 15% ou mais dos pais. A versão em português do P-CPQ mostrou ser de fácil compreensão pela população de pais brasileiros

Associações entre espessura do orbicularis oris e variáveis esqueléticas e dentárias na dentição mista

AIM: To evaluate the association between orbicularis oris thickness and skeletal and dental variables in children with mixed dentition. MATERIAL AND METHOD: A convenience sample of 22 children, aged 7 to 12 years, with skeletal Class I and Class II malocclusion and subdivisions were selected. The upper and lower fascicles of the orbicularis oris thicknesses were measured using ultrasound (US) by one calibrated examiner, at rest and in the contracted state. Cephalometric radiograph measurements of the hard and soft tissues were calculated by one trained examiner. The results were analyzed by the Pearson and Spearman coefficients. RESULT: The upper and lower fascicles of the orbicularis oris in the contracted state showed a negative correlation with the distance between Ricketts' E-line and the labrale superius (E ┴ Ls). There were positive correlations between the lower face height and the distance between the AB plane and the labrale superius (AB-Ls) and between the ANB angle and the distance between E ┴ Ls and Ricketts' E-line and the labrale inferius (E ┴ Li). The lower-incisor distance from the N-Pg plane correlated positively with the distance between AB-Ls and the distance between the E ┴ Ls and E ┴ Li. Overbite and interincisal angle were negatively correlated with the distance between the pogonion and the soft tissue pogonion and the distance between E ┴ Li, respectively. CONCLUSION: Skeletal and dental variables were associated with upper and lower lip position and pogonion thickness, while the upper and lower fascicles of the orbicularis oris thicknesses in the contracted state were associated only with upper lip retrusion.OBJETIVO: Verificar a associação entre a espessura do orbicularis oris e as variáveis esqueléticas e dentárias em crianças com dentição mista. MATERIAL E MÉTODO: Foi selecionada uma amostra de conveniência de 22 crianças, de 7 a 12 anos, com maloclusões Classe I e Classe II esqueléticas e subdivisões. As espessuras dos fascículos superior e inferior do orbicularis oris foram mensuradas, em repouso e em contração, por um examinador treinado utilizando ultrassom. As medidas cefalométricas dos tecidos duros e moles foram calculadas por um examinador treinado. Os resultados foram analisados pelos coeficientes de Pearson e Spearman. RESULTADO: Houve correlação negativa entre os fascículos superior e inferior do orbicularis oris em contração e a distância entre a linha E de Ricketts e o lábio superior (E ┴ Ls). Houve correlação positiva entre a altura inferior da face e a distância entre o plano AB e o lábio superior (AB-Ls) e entre o ângulo ANB e a distância entre E ┴ Ls e a linha E de Ricketts e o lábio inferior (E ┴ Li). A distância do incisivo inferior do plano N-Pg correlacionou-se positivamente com a distância entre AB-Ls e a distância entre E ┴ Ls e E ┴ Li. A sobremordida e o ângulo interincisal correlacionaram-se negativamente com a distância entre o pogônio e o pogônio mole e a distância entre E ┴ Li, respectivamente. CONCLUSÃO: As variáveis esqueléticas e dentárias estiveram associadas à posição dos lábios superior e inferior e a espessura do pogônio, enquanto que as espessuras dos fascículos superior e inferior do orbicularis oris em contração estiveram associadas à retrusão do lábio superior.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Estadual de Campinas Faculdade de Odontologia de Piracicaba Departamento de Odontologia InfantilUniversidade Federal de São Paulo (UNIFESP) Departamento de Ciências BiológicasUniversidade Federal de Lavras Departamento de Medicina VeterináriaUNIFESP, Depto. de Ciências BiológicasSciEL

Associações entre espessura do orbicularis oris e variáveis esqueléticas e dentárias na dentição mista

AIM: To evaluate the association between orbicularis oris thickness and skeletal and dental variables in children with mixed dentition. MATERIAL AND METHOD: A convenience sample of 22 children, aged 7 to 12 years, with skeletal Class I and Class II malocclusion and subdivisions were selected. The upper and lower fascicles of the orbicularis oris thicknesses were measured using ultrasound (US) by one calibrated examiner, at rest and in the contracted state. Cephalometric radiograph measurements of the hard and soft tissues were calculated by one trained examiner. The results were analyzed by the Pearson and Spearman coefficients. RESULT: The upper and lower fascicles of the orbicularis oris in the contracted state showed a negative correlation with the distance between Ricketts' E-line and the labrale superius (E ┴ Ls). There were positive correlations between the lower face height and the distance between the AB plane and the labrale superius (AB-Ls) and between the ANB angle and the distance between E ┴ Ls and Ricketts' E-line and the labrale inferius (E ┴ Li). The lower-incisor distance from the N-Pg plane correlated positively with the distance between AB-Ls and the distance between the E ┴ Ls and E ┴ Li. Overbite and interincisal angle were negatively correlated with the distance between the pogonion and the soft tissue pogonion and the distance between E ┴ Li, respectively. CONCLUSION: Skeletal and dental variables were associated with upper and lower lip position and pogonion thickness, while the upper and lower fascicles of the orbicularis oris thicknesses in the contracted state were associated only with upper lip retrusion.OBJETIVO: Verificar a associação entre a espessura do orbicularis oris e as variáveis esqueléticas e dentárias em crianças com dentição mista. MATERIAL E MÉTODO: Foi selecionada uma amostra de conveniência de 22 crianças, de 7 a 12 anos, com maloclusões Classe I e Classe II esqueléticas e subdivisões. As espessuras dos fascículos superior e inferior do orbicularis oris foram mensuradas, em repouso e em contração, por um examinador treinado utilizando ultrassom. As medidas cefalométricas dos tecidos duros e moles foram calculadas por um examinador treinado. Os resultados foram analisados pelos coeficientes de Pearson e Spearman. RESULTADO: Houve correlação negativa entre os fascículos superior e inferior do orbicularis oris em contração e a distância entre a linha E de Ricketts e o lábio superior (E ┴ Ls). Houve correlação positiva entre a altura inferior da face e a distância entre o plano AB e o lábio superior (AB-Ls) e entre o ângulo ANB e a distância entre E ┴ Ls e a linha E de Ricketts e o lábio inferior (E ┴ Li). A distância do incisivo inferior do plano N-Pg correlacionou-se positivamente com a distância entre AB-Ls e a distância entre E ┴ Ls e E ┴ Li. A sobremordida e o ângulo interincisal correlacionaram-se negativamente com a distância entre o pogônio e o pogônio mole e a distância entre E ┴ Li, respectivamente. CONCLUSÃO: As variáveis esqueléticas e dentárias estiveram associadas à posição dos lábios superior e inferior e a espessura do pogônio, enquanto que as espessuras dos fascículos superior e inferior do orbicularis oris em contração estiveram associadas à retrusão do lábio superior.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Estadual de Campinas Faculdade de Odontologia de Piracicaba Departamento de Odontologia InfantilUniversidade Federal de São Paulo (UNIFESP) Departamento de Ciências BiológicasUniversidade Federal de Lavras Departamento de Medicina VeterináriaUNIFESP, Depto. de Ciências BiológicasSciEL

Quality of life and oral health in children - Part I: Brazilian version of the Child Perceptions Questionnaire 8-10

The scope of this study was to translate the Child Perceptions Questionnaire (CPQ8-10), related to quality of life and oral health, into the Portuguese language and make the necessary cultural adaptations for use with the Brazilian child population. The instrument saw the following steps: two translations into Brazilian Portuguese, back-translation, committee review and pre-test. For cross-cultural adaptation, in each question the alternative I didn't understand was added. The questionnaire was applied to 20 children recruited from Public Schools in Piracicaba. The two initial translations were similar, but for the back-translation it was decided to combine both forms and some questions were selected from one of the translations or a third alternative was even inserted. After the committee review, in some questions there were word substitutions with synonyms for clearer understanding by the population evaluated. Terms that were incompatible for the cultural context of the population analyzed were substituted. In the pre-test the Brazilian version of CPQ8-10 was clearly understood by the population studied. The Portuguese version of the CPQ8-10 proved to be fully comprehensible to the Brazilian child population.O objetivo deste estudo foi traduzir o instrumento Child Perceptions Questionnaire (CPQ8-10), relativo à qualidade de vida e saúde bucal, para a língua portuguesa e realizar a adaptação transcultural em crianças brasileiras. O instrumento foi submetido às seguintes etapas: duas traduções para o português brasileiro, tradução reversa, revisão por comitê e pré-teste. Para adaptação cultural, a cada uma das questões foi acrescentada a alternativa não entendi. O questionário foi aplicado em uma amostra de 20 crianças selecionadas de escolas públicas de Piracicaba. Na tradução inicial, as duas versões foram similares, mas, na tradução reversa optou-se por juntar as duas versões, usar uma questão oriunda de uma versão ou até mesmo utilizar uma terceira alternativa. Após revisão pelo comitê, em algumas questões foram feitas substituições de termos por palavras sinônimas para melhor entendimento pela população avaliada. Os termos incompatíveis com o contexto cultural da população foram substituídos. No pré-teste, a versão brasileira do CPQ8-10 foi bem compreendida pela população estudada. A versão em português do CPQ8-10 mostrou ser de fácil compreensão pela população de crianças brasileiras.40774085Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

[quality Of Life And Oral Health In Children - Part I: Brazilian Version Of The Child Perceptions Questionnaire 8-10].

The scope of this study was to translate the Child Perceptions Questionnaire (CPQ₈₋₁₀), related to quality of life and oral health, into the Portuguese language and make the necessary cultural adaptations for use with the Brazilian child population. The instrument saw the following steps: two translations into Brazilian Portuguese, back-translation, committee review and pre-test. For cross-cultural adaptation, in each question the alternative I didn't understand was added. The questionnaire was applied to 20 children recruited from Public Schools in Piracicaba. The two initial translations were similar, but for the back-translation it was decided to combine both forms and some questions were selected from one of the translations or a third alternative was even inserted. After the committee review, in some questions there were word substitutions with synonyms for clearer understanding by the population evaluated. Terms that were incompatible for the cultural context of the population analyzed were substituted. In the pre-test the Brazilian version of CPQ₈₋₁₀ was clearly understood by the population studied. The Portuguese version of the CPQ₈₋₁₀ proved to be fully comprehensible to the Brazilian child population.164077-8

Translation, Cross-cultural Adaptation and Psychometric Properties of the Parental Feeding Style Questionnaire into Brazilian Portuguese Language

Objective: To translate, cross-culturally adapt and test the psychometric properties of the Parental Feeding Style Questionnaire (PFSQ) to Brazilian Portuguese language. Material and Methods: Three stages were carried out: 1st, the 27-item of PFSQ was translated, back-translated, reviewed by a Committee of Experts and pre-tested (n=60), obtaining the cross-culturally adapted version. 2nd, the final version was self-applied by 42 mothers for internal consistency (Cronbach’s Alpha). After 2-weeks, 19 mothers answered the PFSQ again for reproducibility (Intraclass Correlation Coefficient, ICC). 3rd, 204 mothers of children aged 4-5 years answered the PFSQ for translation validation [convergent validity and exploratory factor analysis (EFA)]. Results: For subscales, Cronbach’s alpha ranged from 0.65 to 0.82; the overall reliability was 0.69, indicating substantial internal consistency. The ICC for overall PFSQ was 0.78 and for domains 0.56-0.89, indicating moderate to excellent reproducibility. ‘Control over eating’ correlated positively with ‘prompting/encouragement to eat’ and negatively with ‘instrumental feeding’; ‘prompting/encouragement to eat’ correlated positively with ‘emotional feeding’. By EFA, PFSQ items were loaded on four factors. ‘Control over eating’ and ‘prompting/encouragement to eat’ settled into two factors, whereas the ‘emotional’ and ‘instrumental feeding’ domains into one factor each. Conclusion: Despite the different factors found by AFE related to the original PFSQ, the reliability was satisfactory, making the Brazilian Portuguese version of the PFSQ adequate to assess parental feeding style

MECHANIZED WOOD HARVESTING APTITUDE ZONING

The need to increase forest enterprises productivity has demanded higher levels of mechanization. The objective of this study was to evaluate the suitability of areas in Espírito Santo State to implement mechanized wood harvesting using short log system. To prospect suitable areas for mechanization, algebra map of Eucalyptus edaphoclimatic zoning, land use and occupation, slope, conservation units and their respective buffer zones was performed. Thus, suitability zones were defined based on edaphoclimatic conditions for evaluated species, with temperatures between 19 and 26ºC, water deficit from 30 to 210 mm and annual average rainfall between 900 and 1800 mm defined as suitable. Land use and occupation was classified as fit, fit with type II limitation, fit with type III limitation and unfit. For slope classes, three categories were created: fit (0 - 27º), fit with limitation type I (27.1 - 35º) and unfit (> 35º). Results showed that State has 39.45% of its entire area able to implement mechanized wood harvesting for Eucalyptus and 47.91% is unfit. With results, authors concluded that Northeast micro-region stood out with large areas suitable for Eucalyptus harvest mechanization and employed methodology has potential for use and adaptation in other study areas around world

Translation and Cultural Adaptation of the Modified Child Dental Anxiety Scale - Faces (MCDASf) into Brazilian Portuguese

Objective: To translate and culturally adapt the Modified Child Dental Anxiety Scale - Faces (MCDASf) into Brazilian Portuguese. Material and Methods: The MCDASf consists of eight questions about anxiety toward dental procedures that are answered on a five-point Likert scale ranging from “not worried” (1 point) to “very worried” (5 points). The answers correspond to a scale of face drawings ranging from extremely negative to extremely positive. The process consisted of initial translation, back-translation, expert committee review, and pretesting. Results: The first revised version was applied to 32 children aged 5 to 12 years, 16 from the city of Governador Valadares, Brazil (southeastern region) and 16 from the city of Pelotas, Brazil (southern region). In the first pretest, Item 5 was misunderstood by 6.25% of children in the southern region; Item 6 by 6.25% in both regions; Items 7 and 8 by 87.5% and 100% of those from the southeastern region, respectively, and by 12.5% and 25% of those from the southern region, respectively. Items 7 and 8 were modified by the expert committee, and the second revised version was applied to 32 children, 16 from each region. The only misunderstood items were 4 and 5, both by a 7-year-old boy in Governador Valadares. Conclusion: The Brazilian Portuguese version of the MCDASf was well understood by the sample of children.&nbsp