Desenvolvimento de uma intervenção para o manejo da raiva em crianças e validação da Emotion Regulation Checklist

A raiva decorre de frustração e injustiça cuja expressão desadaptativa pode culminar em agressão e danos. Esta tese teve dois estudos. O estudo I objetivou adaptar e validar o instrumento “Emotion Regulation Checklist” (ERC) que mensura a Regulação Emocional (RE) e a Labilidade/Negatividade Emocional (L/N) de crianças. Participaram da validação 561 pais e professores, que responderam ao instrumento com referência a crianças com idade entre 3 e 12 anos. Os pressupostos para AFE foram adequados (Bartlett: χ² = 3734.2, df = 253, p< .001; KMO = .880) e a solução bifatorial (RE e L/N) foi a indicada, explicando 57% da variância. As cargas fatoriais foram adequadas (L/N: range from .33 to .83; RE: range from .35 to .78). Obtiveram-se evidências de validade de critério de tipo convergente com a escala SSRS-BR que avalia habilidades sociais. No estudo II, avaliou-se o impacto e o processo de uma intervenção cognitivo-comportamental para manejo da raiva em crianças. A ERC foi utilizada no estudo II, como medida pré e pós-teste. A intervenção ocorreu semanalmente na escola, com 12 encontros de 90 minutos de duração, e foi conduzida com dois grupos de crianças com idade de 7 a 10 anos, um grupo com três meninos e outro com quatro meninas. Avaliou-se a efetividade da intervenção com instrumentos aplicados às crianças, cuidadores e professores no pré e pós-teste, e o processo com a análise de juízes de parâmetros relativos ao protocolo terapêutico, adesão infantil ao tratamento e variáveis da aliança terapêutica. A análise do impacto não revelou diferenças estatisticamente significativas, considerando os índices obtidos nos instrumentos pré e pós-teste. A análise do processo obteve pouca concordância entre os juízes quanto aos parâmetros avaliados

Práticas artísticas no ensino básico e secundário

O terceiro número da Revista Matéria-Prima afirma-se como mais uma plataforma de disseminação e de registo na área da educação e ensino artísticos. Ao propor-se o desafio da Matéria-Prima está a lançar-se um repto de intervenção e partilha a três tipos de intervenientes na educação pela arte: — Os professores, profissionais experimentados; — Os que se iniciam na profissão, através da frequência de mestrados e estágios formativos; — Os investigadores e professores universitários desta área. Esta chamada coloca em cima da mesa a partilha das experiências didácticas em sala de aula, a pesquisa sobre práticas profissionais. Experiências, algumas bem-sucedidas, outras menos, porventura, todas com um mérito substancial, que é a vontade de estabelecer comunidade entre os interessados pela educação artística. Este conjunto de textos poderá ajudar a cartografar práticas que se observam bastante distintas, entre as realidades dos países representados, Portugal, Espanha, Brasil, Argentina. Observa-se também que a prática dos educadores está longe de ser homogénea. É surpreendente determinar as diferenças entre contextos e regiões. Se umas são mais metódicas, e por isso consistentes, outras abrem-se à descoberta. Em todas um ponto de encontro: a revista Matéria-Prima, que assim assume cada vez mais o seu nome como um desígnio de intervenção.info:eu-repo/semantics/publishedVersio

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI &lt;18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For school&#x2;aged children and adolescents, we report thinness (BMI &lt;2 SD below the median of the WHO growth reference) and obesity (BMI &gt;2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesit

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure &lt;= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Bases atencionais do raciocínio emocional infantil em contextos sociais

Studies about emotional reasoning and parent-based reasoning had found that the emotional reply to fear in children evaluated through experimental task of script danger assessment happens as in relation to danger information, as safety information contained in them. Nevertheless, the attentional bias (psychopatological process which implies in selection of distorted information) has been investigated apart from emotional reasoning. Therefore, the aim of this work is to rate emotional reasoning in social contexts mediated by the parents or by peers at the same age and to correlate this task-based performance with the level of social skills measured through Multimedia System of Social Skills and also with the performance in the stroop selective attention task from those children. For this purpose children, from 8 to 12, were rated from one private school from Uberlândia (N=59) to test the hypothesis that emotional reasoning in childhood is a natural phenomenon of emotional and cognitive development. To analyse the data, parametric variance tests and correlations of the evaluated measures were used. The results had shown the occurrence of the emotional reasoning and parent-based emotional reasoning, Considering that the sample not only trusted in the dangerous information contained in scripts, but took the anxiety reply to figure the situation as dangerous or not. In this way, in the types of answers analysis (positive or anxiety ones) it was observed that the tales with anxiety reply information (M= 1,8) had been evaluated as more dangerous than the tales with positive reply information (M= 0,97) with F [(1,482) = 25.571, P <0.0001]. The Stroop task got an effect on the types of stimulation shown F [(2,98) = 161,894, P < 0.0001], however, this effect is not caused due to an attentional bias, but to a difference between neutral and emotional stimulations (18,22seg. e 17,59 respectively,) in relation to the controlled condition (13,49 second). Also the series effect was significant [F (8,98) =5,498, p < 0.001], considering that the second series spent significantly more time, in every condition, among all the series. In the Social Skills test, the girls had shown greater level of social skills compared to the boys and the variable social skill was correlated with many evaluated experimental conditions in the study. Similar to other studies this one also confirmed the occurrence of emotional reasoning and the parent-based emotional reasoning as a normal childhood phenomenon, it had shown that in its support, the interpretation bias and not the atencional bias can be found.Mestre em Psicologia AplicadaEstudos sobre raciocínio emocional e raciocínio emocional baseado no modelo dado pelos pais encontraram que a resposta emocional de medo em crianças avaliadas a partir da tarefa experimental de julgamentos da periculosidade de scripts ocorre tanto em relação à informação de perigo quanto à informação de segurança neles contidas. Entretanto o viés atencional (processo psicopatológico que implica na seleção de informações distorcidas) tem sido investigado separadamente do raciocínio emocional. Dessa forma, este trabalho objetivou avaliar as características do raciocínio emocional de crianças através do julgamento de scripts que apresentavam contextos sociais mediados pelos pais ou por pares da mesma idade e correlacionar o desempenho desta tarefa com o nível de habilidade social medido através do Sistema Multimídia de Habilidades Sociais e com o desempenho na tarefa de atenção seletiva do tipo Stroop emocional. Para tanto, foram avaliadas crianças de 7 a 12 anos de uma escola particular da cidade de Uberlândia (N=59) para testar a hipótese de que o raciocínio emocional na infância é um fenômeno natural do desenvolvimento emocional e cognitivo. Para a análise dos dados foram utilizados testes paramétricos de análise de variância e de correlações das medidas avaliadas. Os resultados mostraram a ocorrência do raciocínio emocional e raciocínio emocional baseado no modelo dado pelos pais, uma vez que a amostra confiou não somente na informação de perigo contida nos scripts, mas tomou a resposta de ansiedade para interpretar a situação como perigosa ou não. Neste sentido, na análise dos tipos de respostas (positiva ou de ansiedade) observou-se que as estórias contendo informação de resposta de ansiedade (M= 1,8) foram avaliadas como mais perigosas do que as estórias com informação de resposta positiva (M= 0,97) com F [(1,482) = 25,571, P < 0,0001]. Na tarefa Stroop obteve-se um efeito dos tipos de estímulo apresentados [F(2,98) = 161,894, P < 0,0001], contudo, esse efeito não se deve a um viés atencional, mas a uma diferença dos estímulos neutro e emocional (18,22seg. e 17,59 seg., respectivamente) em relação à condição controle (13,49 seg.). Também foi significativo o efeito da série [F(8,98)=5,498, p < 0,001], sendo que a segunda série gastou significativamente mais tempo, para todas as condições, do que as demais séries. No teste de Habilidades Sociais, as meninas apresentaram maior nível de habilidades sociais em relação aos meninos e a variável habilidade social se correlacionou com várias condições experimentais avaliadas no estudo. Semelhante a outros estudos este também confirmou a ocorrência do raciocínio emocional e do raciocínio emocional baseado no modelo dado pelos pais como um fenômeno normal da infância, além disso, mostrou também que em sua sustentação se encontra o viés interpretativo e não o viés atencional

Emotion Regulation Checklist (ERC) : estudios preliminares de adaptación y validación de cultura de Brasil

O Emotion Regulation Checklist (ERC) é um instrumento de heterorrelato que se propõe avaliar o nível de regulação emocional de crianças por meio de duas subescalas, a saber, Regulação Emocional (RE) e Labilidade/Negatividade Emocional (L/N). A RE estima a expressão das emoções, empatia e autoconsciência emocional e a L/N avalia falta de fl exibilidade, desregulação de raiva e labilidade do humor. Objetivou-se traduzir, adaptar e investigar evidências de validade da versão brasileira do ERC. Conduziram-se dois estudos: Estudo I: Tradução e Adaptação do ERC para a cultura brasileira; Estudo II: Investigação de evidências de validade do ERC. Participaram da pesquisa 561 informantes (pais e professoras) de crianças com idades de 3 a 12 anos. Os pressupostos para análise fatorial exploratória foram adequados e a solução bifatorial (RE e L/N) foi a indicada explicando 57% da variância (L/N α = 0,77 e RE α = 0,73). A subescala L/N apresentou correlações positivas com medidas de comportamentos problemáticos e a subescala RE apresentou correlações positivas com medidas de habilidades sociais. Os resultados suportaram primeiras evidências de validade do ERC para a cultura brasileira.The Emotion Regulation Checklist (ERC) is an instrument for the hetero-evaluation of the level of emotion regulation of children by means of two scales, Emotion Regulation (ER) and Emotional Lability/Negativity (L/N). ER assesses the expression of emotions, empathy, and emotional self-awareness, while L/N assesses the lack of fl exibility, anger dysregulation, and mood lability. The aim of this study is to perform the translation and cross-cultural adaptation of the ERC and investigate evidence of the validity of its Brazilian version. Two studies are conducted: Study I – Translation and cross-cultural adaptation of ERC for use in Brazil; and Study II – Investigation of evidence of the validity of the ERC. The sample includes 561 informants (parents and teachers) on children aged 3-12 years old. The exploratory factor analysis (EFA) assumptions are adequate, and the two-factor solution (ER and L/N) is shown to be the most adequate, explaining 57% of the variance (L/N α = .77 and ER α = .73). Subscale L/N is positively correlated with measurements of behavioral problems, while subscale ER is positively correlated with measurements of social skills. The present study provides the fi rst evidence of the validity of the ERC for use in the Brazilian context.El Emotion Regulation Checklist (ERC) es un instrumento de heterorrelato que propone evaluar el nivel de regulación emocional por medio de dos sub-escalas, Regulación Emocional (RE) y Labilidad/ Negatividad (LN). La RE mide la expresión de las emociones, empatía y autoconsciencia emocional y la L/N evalúa la ausencia de fl exibilidad, desregulación de rabia y labilidad del humor. Se tuvo como objetivo traducir, adaptar e investigar evidencias de validad de la versión brasileña del ERC. Fueron realizados dos estudios: Estudio I: Traducción y Adaptación del ERC para la cultura brasileña; Estudio II: Investigación de evidencias de validad del ERC. Participaron en esta investigación 561 informantes (padres y profesores) de niños con edad de 3 a 12 años. Los presupuestos para el análisis factorial exploratorio fueron adecuados y la solución bifactorial (RE y L/N) fue la indicada explicando el 57% de la varianza (L/N α = .77 y RE α = .73). La sub-escala L/N presentó correlaciones positivas con medidas de comportamientos problemáticos y la sub-escala RE presentó correlaciones positivas con medidas de habilidades sociales. Los resultados dan soporte a las primeras evidencias de validad del ERC para la cultura brasileña