Reliability of SNIP Test and Optimal Number of Maneuvers in 6-11 Years Healthy Children

[Abstract] Background and purpose. Sniff nasal inspiratory pressure (SNIP) is a voluntary inspiratory maneuver measured through a plug occluding one nostril. The investigation of the number of maneuvers necessary to reach the highest peak of SNIP in pediatric populations has been inconsistent. Thus, this study aimed to assess the reliability of SNIP in healthy children aged 6 to 11 years according to sex and age group, and to determine the optimal number of SNIP maneuvers for this age group. Methods. This cross-sectional study included healthy children with normal pulmonary function. We performed 12 to 20 SNIP maneuvers, with a 30 s rest between each maneuver. The reliability was tested using the intraclass correlation coefficient (ICC), standard error of measurement (SEM), minimal detectable change (MDC), and Bland-Altman analysis for agreement. Results. A total of 121 healthy children (62 girls [51%]) were included in this study. The ICC and corresponding confidence interval (CI) between the highest measure and the first reproducible maneuver were 0.752 (0.656–0.824), SEM = 10.37 cmH2O, and MDC = 28.74 cmH2O. For children aged 6 to 7 years, the ICC was 0.669 (0.427–0.822), SEM = 10.76 cmH2O and MDC = 29.82 cmH2O; for children aged 8 to 11 years, the ICC was 0.774 (0.662–0.852), SEM = 9.74 cmH2O, and MDC = 26.05 cmH2O. For girls, the ICC was 0.817 (0.706–0.889), SEM = 9.40 cmH2O and MDC = 26.05 cmH2O; for boys, the ICC was 0.671 (0.487–0.798), SEM = 11.51 cmH2O, and MDC = 31.90 cmH2O. Approximately 80% of the total sample reached the highest SNIP before the 10th maneuver. Conclusions. SNIP demonstrated moderate reliability between the maneuvers in children aged 6 to 11 years; older children and girls reached the SNIP peak faster. Finally, results indicated that 12 maneuvers were sufficient for healthy children aged 6 to 11 years to achieve the highest SNIP peak

Reliability of maximal respiratory nasal pressure tests in healthy young adults

[Abstract] Introduction: Sniff nasal inspiratory (SNIP) and expiratory pressure (SNEP) may complement the assessment of respiratory muscle strength. Thus, specifying their reliability is relevant to improving the clinical consistency of both tests. Objective: To assess the reliability of SNIP and SNEP in healthy young adults. Methods: This cross-sectional study included self-reported healthy aged 18 to 29 years. SNIP was performed using a plug to occlude one nostril, while SNEP was conducted using a facemask. Participants performed 20 SNIP and SNEP maneuvers with 30-second intervals in between. The intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimum detectable change (MDC) assessed the reliability of SNIP and SNEP. Analyses were conducted between the highest peak pressure and the first reproducible maneuver in men and women. Results: The total sample comprised 32 participants: 16 men and 16 women. The ICC, SEM, and MDC for SNIP maneuvers were 0.994 (95%CI 0.988 to 0.997), 1.820 cmH2O, and 5.043 cmH2O, respectively. For SNEP, these parameters were 0.950 (95%CI 0.897 to 0.976), 6.03 cmH2O, and 16.716 cmH2O. The SNIP and SNEP in men showed ICC of 0.992 (95%CI 0.977 to 0.997) and 0.877 (95%CI 0.648 to 0.957), SEM of 2.07 and 7.66 cmH2O, and MDC of 5.74 and 21.23 cmH2O. In women, SNIP and SNEP presented ICC of 0.992 (95%CI 0.977 to 0.997) and 0.957 (95%CI 0.878 to 0.985), SEM of 1.15 and 6.11 cmH2O, and MDC of 3.19 and 16.95 cmH2O. Also, 60% of the highest SNIPs occurred among the 11th and 20th maneuvers in men and women. In men, 55% of the highest SNEPs occurred among the 11th and 20th maneuvers; this value was 50% in women. Conclusion: SNIP and SNEP showed excellent reliability. The reliability of SNIP and SNEP in men was good and excellent, respectively, whereas both tests had excellent reliability in women. Also, women reached the highest peak pressure faster than men in both tests.This study was financed in part by the Coordenaão de Aperfeiçoamento de Pessoal de Nível Superior – Brasil (CAPES) – Finance Code 001. GF 316937/2021-5 Conselho Nacional de Desenvolvimento Científico e Tecnológico - CNPq VR - 305960/2021-0 - Conselho Nacional de Desenvolvimento Científico e Tecnológico - CNPq The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Coordenaão de Aperfeiçoamento de Pessoal de Nível Superior (Brasil); 001. GF 316937/2021-5Conselho Nacional de Desenvolvimento Científico e Tecnológico (Brasil); CNPq VR - 305960/2021-

REGULACIÓN EN SALUD: APLICABILIDAD PARA CONCRETIZACIÓN DEL PACTO DE GESTIÓN DEL SISTEMA ÚNICO DE SALUD (SUS)

O objetivo da pesquisa é analisar o conceito de regulação em saúde, descrito na Política Nacional de Regulação,para a concretização do Pacto pela Saúde 2006. A coleta de dados teve por base os conceitos que procederam as informaçõescolhidas de revistas indexadas, livros e portal do Ministério da Saúde, complementada por busca no banco de dados daBIREME, referente ao período de 2001 a 2006. Foram encontrados 19 artigos com os descritores regulação, saúde eusuário. Observou-se que o processo de regulação ainda é incipiente e torna-se necessário o enfrentamento de temas maiscomplexos e estruturantes, como o desafio de entender a natureza dessa regulação, seus avanços e limites, a dimensão daorganização do subsetor, o financiamento da oferta de serviços, as modalidades assistenciais, suas redes e a complexidadedessas relações.The objective of this study is to analyze the concept of regulation in health described in the National Politicsin Regulation, for the concretion of the Pact for Health 2006. The collection of data was based on the descriptors that ledto the information retrieval from indexed magazines, books and the Ministry of Health internet portal. The research wasalso carried from the BIREME database, referring to the period from 2001 to 2006. Nineteen articles were found, with thedescriptors: regulation, health and user. We observe that the regulation process is still incipient. It is necessary theconfrontation of more complex and structuring subjects such as the challenge of understanding the nature of thisregulation, its advances and limits, the dimension of the organization of the subsector, the financing of services, theassistance modalities, its networks, and the complexity of these relations.El objetivo de la investigación es analizar el concepto de regulación en salud, descripto en la Política Nacionalde Regulación, para la concretización del Pacto por la Salud 2006. La colecta de datos tuvo por base los conceptos queprocedieron las informaciones recogidas de revistas indexadas, libros y portal del Ministerio de la Salud, complementadapor búsqueda en el banco de datos de la BIREME, referente al periodo de 2001 a 2006. Fueron encontrados 19 artículos conlos descriptores Regulación, Salud y Usuario. Se observó que el proceso de regulación todavía es incipiente y se vuelvenecesario el enfrentamiento de temas más complejos y estructurados, como el desafío de comprender la naturaleza de esaregulación, sus avanzos y límites, la dimensión de la organización del subsector, el financiamiento de la oferta de servicios,las modalidades asistenciales, sus redes y la complejidad de esas relaciones

Atividade de extensão universitária com adolescentes na pandemia de COVID-19: Relato de experiência

Durante a pandemia, as restrições relativas ao distanciamento social representaram as principais medidas para reduzir a propagação do COVID-19, com potenciais implicações sobre a rotina dos adolescentes. Objetivo: relatar a experiência do processo de adaptação de um projeto extensionista e as vivências no desenvolvimento das atividades remotas realizadas com adolescentes durante a pandemia. Métodos: Projeto de extensão envolvendo docentes e discentes de Farmácia, Nutrição e Medicina da Universidade Federal do Paraná. Através de reuniões virtuais, as etapas de planejamento, diagnóstico, intervenção e avaliação foram adequadas, adotando o uso de ferramentas online para elaboração de questionário para avaliação dos comportamentos relacionados à saúde e aplicação em adolescentes de uma escola estadual em Curitiba-PR, além de ações educativas com os participantes. Resultados: participaram do questionário 59 adolescentes, de ambos os sexos, com média de idade de 15,38 anos. Foi possível detectar o aumento do comportamento sedentário, e frequência expressiva do consumo de alimentos ultraprocessados como lanches. Nos momentos síncronos online, onde houve uma maior participação comparado à etapa anterior (n=77), resultaram em interação dialógica entre os alunos da UFPR e os adolescentes. A maioria dos adolescentes avaliou positivamente as atividades realizadas pelo projeto, e demonstrou intenção de realizar modificações nos hábitos alimentares e na redução do tempo de tela. Conclusão: Apesar das adversidades diante da suspensão das atividades presenciais, a equipe do projeto conseguiu desenvolver suas ações por meio do exercício da capacidade criativa da equipe e reinvenção de métodos, servindo de aporte de vivência para a formação humana e profissional

Geographic patterns of tree dispersal modes in Amazonia and their ecological correlates

Aim: To investigate the geographic patterns and ecological correlates in the geographic distribution of the most common tree dispersal modes in Amazonia (endozoochory, synzoochory, anemochory and hydrochory). We examined if the proportional abundance of these dispersal modes could be explained by the availability of dispersal agents (disperser-availability hypothesis) and/or the availability of resources for constructing zoochorous fruits (resource-availability hypothesis). Time period: Tree-inventory plots established between 1934 and 2019. Major taxa studied: Trees with a diameter at breast height (DBH) ≥ 9.55 cm. Location: Amazonia, here defined as the lowland rain forests of the Amazon River basin and the Guiana Shield. Methods: We assigned dispersal modes to a total of 5433 species and morphospecies within 1877 tree-inventory plots across terra-firme, seasonally flooded, and permanently flooded forests. We investigated geographic patterns in the proportional abundance of dispersal modes. We performed an abundance-weighted mean pairwise distance (MPD) test and fit generalized linear models (GLMs) to explain the geographic distribution of dispersal modes. Results: Anemochory was significantly, positively associated with mean annual wind speed, and hydrochory was significantly higher in flooded forests. Dispersal modes did not consistently show significant associations with the availability of resources for constructing zoochorous fruits. A lower dissimilarity in dispersal modes, resulting from a higher dominance of endozoochory, occurred in terra-firme forests (excluding podzols) compared to flooded forests. Main conclusions: The disperser-availability hypothesis was well supported for abiotic dispersal modes (anemochory and hydrochory). The availability of resources for constructing zoochorous fruits seems an unlikely explanation for the distribution of dispersal modes in Amazonia. The association between frugivores and the proportional abundance of zoochory requires further research, as tree recruitment not only depends on dispersal vectors but also on conditions that favour or limit seedling recruitment across forest types

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Geography and ecology shape the phylogenetic composition of Amazonian tree communities

AimAmazonia hosts more tree species from numerous evolutionary lineages, both young and ancient, than any other biogeographic region. Previous studies have shown that tree lineages colonized multiple edaphic environments and dispersed widely across Amazonia, leading to a hypothesis, which we test, that lineages should not be strongly associated with either geographic regions or edaphic forest types.LocationAmazonia.TaxonAngiosperms (Magnoliids; Monocots; Eudicots).MethodsData for the abundance of 5082 tree species in 1989 plots were combined with a mega-phylogeny. We applied evolutionary ordination to assess how phylogenetic composition varies across Amazonia. We used variation partitioning and Moran's eigenvector maps (MEM) to test and quantify the separate and joint contributions of spatial and environmental variables to explain the phylogenetic composition of plots. We tested the indicator value of lineages for geographic regions and edaphic forest types and mapped associations onto the phylogeny.ResultsIn the terra firme and várzea forest types, the phylogenetic composition varies by geographic region, but the igapó and white-sand forest types retain a unique evolutionary signature regardless of region. Overall, we find that soil chemistry, climate and topography explain 24% of the variation in phylogenetic composition, with 79% of that variation being spatially structured (R2 = 19% overall for combined spatial/environmental effects). The phylogenetic composition also shows substantial spatial patterns not related to the environmental variables we quantified (R2 = 28%). A greater number of lineages were significant indicators of geographic regions than forest types.Main ConclusionNumerous tree lineages, including some ancient ones (>66 Ma), show strong associations with geographic regions and edaphic forest types of Amazonia. This shows that specialization in specific edaphic environments has played a long-standing role in the evolutionary assembly of Amazonian forests. Furthermore, many lineages, even those that have dispersed across Amazonia, dominate within a specific region, likely because of phylogenetically conserved niches for environmental conditions that are prevalent within regions

Geography and ecology shape the phylogenetic composition of Amazonian tree communities

Aim: Amazonia hosts more tree species from numerous evolutionary lineages, both young and ancient, than any other biogeographic region. Previous studies have shown that tree lineages colonized multiple edaphic environments and dispersed widely across Amazonia, leading to a hypothesis, which we test, that lineages should not be strongly associated with either geographic regions or edaphic forest types. Location: Amazonia. Taxon: Angiosperms (Magnoliids; Monocots; Eudicots). Methods: Data for the abundance of 5082 tree species in 1989 plots were combined with a mega-phylogeny. We applied evolutionary ordination to assess how phylogenetic composition varies across Amazonia. We used variation partitioning and Moran\u27s eigenvector maps (MEM) to test and quantify the separate and joint contributions of spatial and environmental variables to explain the phylogenetic composition of plots. We tested the indicator value of lineages for geographic regions and edaphic forest types and mapped associations onto the phylogeny. Results: In the terra firme and várzea forest types, the phylogenetic composition varies by geographic region, but the igapó and white-sand forest types retain a unique evolutionary signature regardless of region. Overall, we find that soil chemistry, climate and topography explain 24% of the variation in phylogenetic composition, with 79% of that variation being spatially structured (R$^{2}$ = 19% overall for combined spatial/environmental effects). The phylogenetic composition also shows substantial spatial patterns not related to the environmental variables we quantified (R$^{2}$ = 28%). A greater number of lineages were significant indicators of geographic regions than forest types. Main Conclusion: Numerous tree lineages, including some ancient ones (>66 Ma), show strong associations with geographic regions and edaphic forest types of Amazonia. This shows that specialization in specific edaphic environments has played a long-standing role in the evolutionary assembly of Amazonian forests. Furthermore, many lineages, even those that have dispersed across Amazonia, dominate within a specific region, likely because of phylogenetically conserved niches for environmental conditions that are prevalent within regions

Mapping density, diversity and species-richness of the Amazon tree flora

Using 2.046 botanically-inventoried tree plots across the largest tropical forest on Earth, we mapped tree species-diversity and tree species-richness at 0.1-degree resolution, and investigated drivers for diversity and richness. Using only location, stratified by forest type, as predictor, our spatial model, to the best of our knowledge, provides the most accurate map of tree diversity in Amazonia to date, explaining approximately 70% of the tree diversity and species-richness. Large soil-forest combinations determine a significant percentage of the variation in tree species-richness and tree alpha-diversity in Amazonian forest-plots. We suggest that the size and fragmentation of these systems drive their large-scale diversity patterns and hence local diversity. A model not using location but cumulative water deficit, tree density, and temperature seasonality explains 47% of the tree species-richness in the terra-firme forest in Amazonia. Over large areas across Amazonia, residuals of this relationship are small and poorly spatially structured, suggesting that much of the residual variation may be local. The Guyana Shield area has consistently negative residuals, showing that this area has lower tree species-richness than expected by our models. We provide extensive plot meta-data, including tree density, tree alpha-diversity and tree species-richness results and gridded maps at 0.1-degree resolution