Estudo do efeito da utilização de uma plataforma robótica na intervenção em crianças com perturbações do espetro do autismo

Dissertação de mestrado integrado em Engenharia Biomédica (área de especialização em Eletrónica Médica)As perturbações do espetro do autismo (PEA) são uma desordem global do desenvolvimento que se caraterizam por alterações qualitativas na interação social, na comunicação verbal e não verbal e por dificuldades na imaginação social. A robótica é uma área em expansão que apresenta potencial para estabelecer a ponte entre a engenharia e a sociedade, nomeadamente em problemáticas complexas como é o caso das PEA. Vários estudos foram realizados e enquadrados em diferentes projetos, como é o caso do projeto AuRoRa, IROMEC, Free. Estes projetos utilizam uma plataforma robótica para desenvolver competências sociais, de interação e de comunicação. As alterações qualitativas, descritas anteriormente na tríade de incapacidades, repercutem-se de forma significativa nas aprendizagens e no desenvolvimento das crianças com PEA. Este fato sustenta esta investigação cuja finalidade é compreender o efeito da introdução de uma plataforma robótica na promoção de aprendizagens e competências na intervenção em crianças com PEA. O robô Lego Mindstorms NXT foi utilizado neste estudo, tendo um papel de reforço positivo e/ou mediador nas diferentes atividades. Assim, pretendeu-se no final da investigação compreender se o robô poderia ser um incentivar a aprendizagem, e ainda ser capaz de captar a atenção e promover a interação em crianças com PEA. A investigação foi desenvolvida em três instituições, em seis fases: Definição da Atividade, Familiarização, Pré-Teste, Treino, Re-Teste e Transferência de Competências. As atividades realizaram-se em sessões de dez minutos, num total de, em média, onze sessões. Estas foram gravadas em vídeo para análise posterior, permitindo assim obter os resultados da investigação. Neste estudo pretendeu-se desenvolver cinco competências diferentes, em setes crianças com PEA. O sucesso na aquisição da competência foi atingido em quatro das sete crianças da amostra. Para além das competências referidas, verificou-se ainda a melhoria de outras competências, como por exemplo: o tempo de permanência na atividade ou o contato visual com o investigador. Portanto, no final desta dissertação pode afirmar-se que a presença do robô pode ter sido uma ferramenta motivacional para algumas das crianças participantes neste estudo, maximizando as suas interações e/ou potencializando a aprendizagem de novas competências, o que poderá contribuir para melhorar a sua qualidade de vida.The autism spectrum disorder (ASD) is a global development disorder that is characterized by qualitative changes in the social interaction, verbal and non-verbal communication, and impairments in the social imagination. Robotics is a growing field that presents a potential able to establish the bridge between the engineering and the society, particularly in complex problems such as the PEA. Several studies were performed in different projects, such as AuRoRa, IROMEC, Free, which use a robotic platform to develop social skills, interaction and communication. The qualitative changes previously described in the Triad of Impairments are reflected substantially in the learning and development of children with ASD. This fact sustains this investigation which the goal is to understand the effect of the introduction of a robotic platform, in the promotion of learning and skills in the intervention of children with ASD. The used robot was the Lego Mindstorms NXT. It was used as a mediator and/or positive reinforcement of several activities. Thus, this research intended to understand if the robot could be a stimulator of the learning and still be able to capture the attention and promote the interaction in children with ASD. The research was performed in three institutions, in six phases: Definition of Activity, Familiarization, Pre-Test, Practice, Re-Test and Skills Transfer. The activities were performed in sessions of ten minutes, in a total average of eleven sessions. These were recorded for later analysis, which allowed us to obtain the results for this research. This study intended to develop five different skills, in seven children with ASD. The successful acquisition of competence was achieved in four of the seven children in the sample. However, there were other skills improved in the children, for example the time spent in the activity or visual contact with the researcher. So, at the end of this research can be stated that the presence of the robot could have been a motivational tool for some children, maximizing their interactions and/or promoting the learning of new skills. Therefore, it would be possible to improve their quality of life

Development of skills in children with ASD using a robotic platform

The interaction and communication skills are essential to live in society. However, individuals with autism spectrum disorders (ASD) have a gap in these abilities which affects their daily life. Previous studies suggest that children with ASD demonstrate some positive behaviors in presence of a robotic platform. This study intends to evaluate the effect of a robotic platform on children with ASD, checking if the platform can be a stimulating agent for children's interaction, as well as a skill learning promoter. So, it is used the robot Lego Mindstorms NXT as a mediator/reward to encourage children with ASD to interact with others and also to learn some cognitive skills.The authors are grateful to teachers and students of the primary and secondary schools of Aver-o-Mar and their parents for their participation in the project. The authors are also grateful to the Portuguese Foundation for funding through the R&D project RIPD/ADA/109407/2009

A leitura de histórias : qualidade das interações entre pais e filhos

Neste artigo é sucintamente descrito o programa JIL - Jogos Interativos de Leitura (Cruz, Ribeiro & Viana, no prelo), que tem como população alvo pais com crianças em idade pré-escolar, independentemente do seu nível socioeconómico e educacional. A avaliação do impacto deste programa (Cruz, 2011) mostrou que este apresentou um impacto significativo: a) ao nível das práticas de leitura e de escrita conjuntas entre a criança e os Pais, nas práticas de leitura e de escrita conjuntas entre a criança e os Pais e nas deslocações a bibliotecas; b) na frequência dos comportamentos dos adultos e das crianças durante a leitura de histórias, verificando-se um aumento de elocuções produzidas por adultos e crianças relacionadas com o conteúdo imediato e não imediato da história. Registou-se uma evolução estatisticamente significativa da atenção para o impresso por parte dos adultos e uma mudança na qualidade afetiva das interações entre pais e filhos e nas competências de literacia emergente.CIEC - Centro de Investigação em Estudos da Criança, UM (UI 317 da FCT

Caracterização de um programa de intervenção nas dificuldades iniciais na aprendizagem da leitura/escrita

A intervenção precoce nos alunos que apresentam dificuldades iniciais na aprendizagem da leitura e da escrita apresenta-se como uma das variáveis preditoras do sucesso das intervenções educativas. Neste poster apresenta-se um programa de intervenção estruturado construído visando crianças com dificuldades específicas na aprendizagem da leitura/escrita sinalizadas numa fase precoce. O programa foi aplicado ao longo de 15 sessões com a duração aproximada de 60 minutos. A descodificação leitora foi trabalhada a partir da exploração de livros, procurando associar descodificação e compreensão leitora. Cada sessão incluía a audição de uma música baseada nas sílabas trabalhadas na sessão, a leitura e exploração de uma história, o treino da leitura e escrita de sílabas, o registo do desempenho leitor de cada aluno e um jogo tradicional, que exigia a discriminação auditiva das sílabas trabalhadas na sessão. Gradualmente foi introduzido o treino da leitura e escrita de palavras constituídas pelas sílabas trabalhadas anteriormente e frases formadas por estas palavras. O treino das competências de leitura e escrita baseou-se em diferentes procedimentos: Utilização de uma metodologia multissensorial, que possibilita a interacção das diferentes modalidades sensoriais como forma de fortalecer a aprendizagem (Defior, 1996; Thomson, 1992); recurso ao método das leituras repetidas.The early intervention on students who have difficulties in the initial learning of reading and writing presents as a predictive variables of the success of educational interventions. In this poster we present a structured intervention program built for children with specific difficulties in learning to read and write, identified in early stage. The program was implemented over of 15 sessions, with a duration of approximately 60 minutes. The decoding was worked by exploitation of books, in intend to associate decoding and comprehension. Each session included the hearing of a song based on syllables worked in the session, the reading and exploration of a story, the training of reading and writing of syllables, the individual record of performance in a reading task, and a traditional game, which required the auditory discrimination of the syllables worked in the session. Gradually, we introduce the training of reading and writing words formed by previously worked syllables and phrases formed by these words. The training of reading and writing was based on different procedures. We use a multissensorial methodology, which enables the interaction of different sensory modalities as a way of strengthening the learning (Defior, 1996; Thomson, 1992) and a method of reading repeated. The dimension of the comprehensive reading was contemplated by reading stories. The literature has referenced this activity as crucial in the promotion of cognitive, language and emotional capacities (Morais, 1997; Viana, 2001). Moreover, research shows a positive relationship between the reading of stories and learning of reading and writing (Villas-Boas, 2002).Fundação para a Ciência e a Tecnologia (FCT

Dificuldades iniciais de aprendizagem de leitura/escrita: caracterização das competências e avaliação dos efeitos de um programa de intervenção

Neste poster apresentam-se os resultados da avaliação de um projecto de intervenção destinado a alunos do 1º ano do ensino básico sinalizados pelos respectivos professores como apresentando atrasos na aprendizagem da leitura e escrita. O projecto de intervenção foi implementado num grupo de 5 alunos, dos quais 2 são do sexo feminino e os restantes do sexo masculino. Na avaliação dos alunos utilizaram-se as provas: nomeação verbal e definição verbal (Sim-Sim, 2004), Prova de reconhecimento e escrita de letras, Prova de reconhecimento e escrita de sílabas, Prova de reconhecimento e escrita de palavras e frases, Bateria de Provas Fonológicas (Silva, 2002). Na avaliação dos efeitos recorreu a um design de medidas repetidas no tempo. Foram realizadas 15 sessões de intervenção com os alunos, com a duração aproximada de 60 minutos, durante o horário lectivo. Na apreciação dos resultados consideraram-se os resultados médios do grupo nos vários momentos de avaliação, assim como a análise dos perfis individuais. Os resultados obtidos indicam um padrão diferencial em relação às percentagens de ganhos alcançados por cada um dos sujeitos, sendo as percentagens de ganhos mais elevadas nas variáveis de leitura e escrita de palavras e frases e leitura de ditongos. Os ganhos são significativos para todas as variáveis, com excepção da leitura e escrita de vogais, leitura de sílabas, escrita de vogais e frases.In this poster we present the results of the evaluation of an intervention project design for students of the first year of basic education, identified by their teachers as presenting delays in learning to read and write. The project was implemented in a group of five students (two girls and three boys). In the assessment of children’s we used the measures: verbal designation verbal and verbal definition (Sim-Sim, 2004), reading and writing of letters, reading and writing of syllables, reading and writing of words, reading and writing of phrases, test of phonological awareness (Silva 2002). In the assessment of the effects were used the design of repeated measures in time. Were held 15 sessions of intervention with the students, with the approximate duration of 60 minutes, during school hours. In analysis of the results we considered the average performance of the group as well as the analysis of individual profiles. The results indicate a differential pattern on percentages of gains of each participant. The major gains where he in the variables of reading and writing of words and phrases and reading diphthongs. The gains are significant in all variables, except for the reading and writing of vowels, reading syllables, vowels and writing of sentences.Fundação para a Ciência e a Tecnologia (FCT

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

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

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.Peer reviewe

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants.

BACKGROUND: Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. METHODS: We used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. FINDINGS: The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. INTERPRETATION: Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. FUNDING: WHO