A qualidade da educação infantil: um estudo em seis capitais Brasileiras

O artigo apresenta resultados de pesquisa de avaliação sobre a qualidade da educação infantil no Brasil, desenvolvida em parceria com a Fundação Carlos Chagas, o Ministério da Educação e o Banco Interamericano de Desenvolvimento. Os dados foram colhidos em 147 instituições de educação infantil em seis capitais brasileiras, durante o segundo semestre de 2009. Para a observação dos ambientes de creches e pré-escolas foram utilizadas versões adaptadas das escalas Infant/Toddler Environment Rating Scale Revised Edition e Early Childhood Environment Rating Scale Revised Edition. Foram também aplicados questionários a diretores das instituições e professoras das turmas avaliadas. Os principais resultados revelaram que: creches e pré-escolas apresentam em média níveis de qualidade insatisfatórios; os níveis de qualidade mais comprometidos se referem às atividades (creche e pré-escola), rotinas de cuidado pessoal (creche) e estrutura do programa (pré-escola); mudanças em determinadas características das instituições poderiam levar à melhoria da qualidade da educação infantil nos municípios investigados

Estudos em larga escala de educação infantil nos Estados Unidos

A versão revisada da escala Early childhood environment rating scale tem sido amplamente utilizada em pesquisas sobre os programas para crianças em idade pré-escolar, muitas das quais realizadas nos EUA. No artigo três grandes estudos são apresentados e discutidos no contexto da educação infantil nos Estados Unidos, e seus resultados indicam que a escala é um recurso valioso na análise da qualidade dos serviços prestados em vários tipos de configurações de educação infantil. É descrito o sucesso do uso de dados da referida escala para influenciar políticas públicas e esforços de melhoria dos programas, e são discutidos cuidados e lições aprendidas com o uso prolongado desse instrumento.

Method for evaluation of root hairs of common bean genotypes

The objective of this work was to test a simple method for root hair evaluation of 21 common bean (Phaseolus vulgaris) genotypes, most of them used in breeding programs in Brazil. Hairs of basal and primary roots of 5-day old seedlings, produced on germination paper with no phosphorus addition, were visually evaluated by a rating scale after staining with 0.05% trypan blue. The method reveals variability among the genotypes, and the standard error of the mean is relatively low.

Impacto da atividade física na qualidade de vida de mulheres de meia idade: estudo de base populacional

OBJETIVO: Avaliar o impacto da prática de atividade física na qualidade de vida de mulheres de meia idade. MÉTODOS: Estudo de base populacional e corte transversal, que incluiu uma amostra estratificada de 370 mulheres de meia idade entre 40 a 65 anos, recrutadas a partir de uma população de 20.801 mulheres atendidas no período de um ano nas redes básicas de saúde, inseridas nos quatro distritos (Norte, Sul, Leste e Oeste) que compõem o sistema de saúde da cidade de Natal, Rio Grande do Norte, de junho a setembro de 2011. O cálculo da amostra teve por base um nível de confiança de 95%, com poder do teste de 80%, erro de estimativa de 5% e considerou-se a proporção de pacientes classificadas com qualidade de vida adequada (indicador >26) da amostra piloto. Os dados foram coletados enquanto as mulheres aguardavam na sala de espera para a consulta de rotina. Para avaliar a qualidade de vida geral, utilizou-se a versão abreviada do WHOQOL (WHOQOL-Bref-WHO Quality of Life - BREF), e sua relação com os sintomas do climatério foi avaliada por meio do Menopause Rating Scale (MRS). O nível de atividade física foi avaliado pelo questionário International Physical Activity Questionnaire (IPAQ), versão curta, semana usual. Para obter-se a classificação dos níveis de atividade física, utilizaram-se três categorias: sedentária, moderadamente ativa e muito ativa. A análise estatística foi realizada utilizando o programa estatístico Minitab, versão 16. RESULTADOS: A média de idade das mulheres foi de 49,8 anos (±8.1), foram predominantemente caucasianas (72,7%), casadas (61,6%), não fumantes (93,5%) e com o Ensino Médio completo (47,8%). Considerando os domínios presentes no WHOQOL-Bref para avaliar qualidade de vida, os escores foram significativamente diferentes entre os grupos de mulheres sedentárias, moderadamente ativas e muito ativas (p<0,01). Em relação à atividade física e aos sintomas do climatério, foram observadas diferenças significativas para todos os domínios: psicológico (p<0,01), somático-vegetativo (p<0,01) e urogenital (p<0,01). CONCLUSÕES: A prática de atividade física melhora significativamente a qualidade de vida das mulheres de meia idade.

Estado nutricional e qualidade de vida da mulher climatérica

OBJETIVO: Associar a qualidade de vida com o estado nutricional da mulher climatérica. MÉTODOS: Trata-se de estudo transversal, no qual foi incluída uma amostra com 200 mulheres climatéricas, de 40 a 65 anos, que responderam a um Recordatório Alimentar de 24 horas e questões sobre fatores socioeconômicos, história clínica atual, pregressa e familiar. Para a avaliação antropométrica, foram utilizados índice de massa corpórea (IMC), circunferência da cintura (CC) e relação cintura/quadril. Para avaliação da qualidade de vida, foi aplicado o MRS-menopause rating scale. RESULTADOS: A média do IMC e da CC foi de 30,1 kg/m² (obesidade grau 1) e 99 cm (risco muito aumentado para doença cardiovascular), respectivamente. Constatou-se consumo aumentado de proteínas e diminuído de fibras, cálcio e vitamina D. A comorbidade mais prevalente foi a hipertensão arterial, 48,5% faziam uso de medicação para doenças cardiovasculares e 23%, de medicações antidepressivas. Quanto à qualidade de vida, foram encontrados resultados significativos relacionados ao IMC, como também à pressão arterial. CONCLUSÕES: Uma intervenção nutricional visando corrigir ou melhorar o consumo alimentar e o perfil antropométrico poderá resultar em benefícios relativos à saúde da mulher climatérica. A prevalência de obesidade, associada com pior qualidade de vida e morbimortalidade, reforça a necessidade de existir um programa de reeducação alimentar no climatério.

Influência dos sintomas climatéricos sobre a função sexual de mulheres de meia-idade

OBJETIVO: Avaliar a influência dos sintomas climatéricos na função sexual de mulheres de meia-idade. MÉTODOS: Estudo populacional de corte transversal, com amostra de 370 mulheres entre 40 e 65 anos, atendidas nas Unidades Básicas de Saúde da cidade de Natal, no estado do Rio Grande do Norte, Brasil. Aplicou-se um questionário referente s características sociodemográficas, clínicas e comportamentais das mulheres. A função sexual foi avaliada pelo Female Sexual Function Index (FSFI), enquanto os sintomas do climatério pelo Menopause Rating Scale (MRS). RESULTADOS: No grupo estudado, 67% das mulheres apresentaram risco de disfunção sexual (FSFI≤26,5). Todos os domínios do FSFI (desejo, excitação, lubrificação, orgasmo, satisfação e dor) apresentaram escores mais baixos nas mulheres com risco de disfunção sexual (p<0,001). Os domínos excitação, orgasmo e dor foram os que mais contribuíram para os baixos escores do FSFI. Os sintomas somatovegetativos, urogenitais e psicológicos do MRS apresentaram-se mais elevados nas mulheres com risco de disfunção sexual, sendo significativos para todas as comparações (p<0,001). A análise de regressão logística revelou que as chances de mulheres com riscos de disfunção sexual apresentarem fogachos, humor depressivo, problemas sexuais e ressecamento vaginal foram, respectivamente, 2,1 (IC95% 1,2 - 3,5); 2,4 (IC95% 1,5 - 4,1); 2,3 (IC95% 1,4 - 3,8) e 2,2 (IC95% 1,3 - 3,6) vezes maior, quando comparadas quelas sem risco. CONCLUSÃO: Os sintomas climatéricos parecem influenciar a função sexual de mulheres na meia-idade.

Quality of life and menopausal symptoms in women with liver transplants

PURPOSE: To assess quality of life and climacteric symptoms in women with and without liver transplants. METHODS: This was a cross-sectional study of 52 women undergoing follow-up at a university hospital in southeastern Brazil from February 4th, 2009 to January 5th, 2011. Twenty-four of these women were 35 years old or older and had undergone liver transplantation at least one year before study entry. The remaining 28 women had no liver disease and were matched by age and menstrual patterns to the patients with transplants. The abbreviated version of the World Health Organization (WHOQOL-BREF) questionnaire was used to assess quality of life. Menopausal symptoms were assessed using the Menopause Rating Scale (MRS). Statistical analysis was carried out by Student's t-test, Mann-Whitney test and analysis of variance. Correlations between MRS and the WHOQOL-BREF were established by correlation coefficients. RESULTS: The mean age of the women included in the study was 52.2 (±10.4) years and the mean time since transplantation was 6.1 (±3.3) years. Women with liver transplants had better quality of life scores in the environment domain (p=0.01). No difference was noted between the two groups in any domain of the MRS. For women in the comparison group, there was a strongly negative correlation between somatic symptoms in the MRS and the physical domain of the WHOQOL-BREF (p<0.01; r=-0.8). In contrast, there was only a moderate association for women with liver transplants (p<0.01; r=-0.5). CONCLUSIONS: Women with liver transplants had better quality of life scores in the domain related to environment and did not exhibit more intense climacteric symptoms than did those with no liver disease. Climacteric symptoms negatively influenced quality of life in liver transplant recipients, although less intensely than in women without a history of liver disease.

Epidemiologia da menopausa e dos sintomas climatéricos em mulheres de uma região metropolitana no sudeste do Brasil: inquérito populacional domiciliar

OBJETIVOS: Avaliar a idade da menopausa e os fatores associados aos sintomas menopausais em mulheres de uma região metropolitana do sudeste do Brasil.MÉTODOS: Um estudo exploratório de corte-transversal foi realizado com 749 mulheres entre 45 e 60 anos (pesquisa de base populacional). A variável dependente foi a intensidade dos sintomas menopausais avaliada através do escore total do questionário Menopause Rating Scale (MRS). As variáveis independentes foram características sociodemográficas, problemas e hábitos de saúde, auto-percepção de saúde e antecedentes ginecológicos. A análise estatística foi realizada com o teste do χ2 e regressão de Poisson.RESULTADOS: A média etária das mulheres entrevistadas foi 52,5 (±4,4) anos. Com relação ao estado menopausal, 16% das mulheres encontravam-se na pré-menopausa, o mesmo número na perimenopausa e 68% estavam na pós-menopausa. A média de idade de ocorrência da menopausa foi 46,5±5,8 anos. A intensidade dos sintomas menopausais foi definida de acordo com a mediana do escore total do MRS e foi considerada severa para valores acima de 8. Depressão/ansiedade (RP=1,8; IC95% 1,5-2,2; p<0,01), doenças osteoarticulares (RP=1,5; IC95% 1,2-1,7; p<0,01), auto-percepção do estado geral de saúde regular, ruim ou péssimo (RP=1,4; IC95% 1,2-1,7; p<0,01), antecedente de algum aborto (RP=1,3; IC95% 1,1-1,5; p<0,01), tratamento para menopausa atual ou prévio (RP=1,2; IC95% 1,1-1,4; p<0,01), estar na perimenopausa ou pós-menopausa (RP=1,4; IC95% 1,1-1,8; p=0,01), número de partos normais >1 (RP=1,2; IC95% 1,02-1,4; p=0,02) e asma (RP=1,2; IC95% 1,01-1,4; p=0,03) se associaram a maior severidade de sintomas menopausais. Apresentar maior idade (RP=0,96; IC95% 0,96-0,97; p<0,01) se associou a menor intensidade de sintomas da menopausa.CONCLUSÃO: A intensidade dos sintomas menopausais está relacionada a um amplo conjunto de fatores. Entender e controlar estes fatores pode auxiliar na redução dos sintomas menopausais, além de fornecer dados para definir grupos que necessitam maior atenção por parte dos serviços de saúde.

Developmental norms for eight instruments used in the neuropsychological assessment of children: studies in Brazil

Norms for a battery of instruments, including Denckla's and Garfield's tests of Motor Persistence, Benton's Right-Left Discrimination, two recall modalities (Immediate and Delayed) of the Bender Test, Wechsler's Digit Span, the Color Span Test and the Human Figure Drawing Test, were developed for the neuropsychological assessment of children in the greater Rio de Janeiro area. Additionally, the behavior of each child was assessed with the Composite Teacher Rating Scale (Brito GNO and Pinto RCA (1991) Journal of Clinical and Experimental Neuropsychology, 13: 417-418). A total of 398 children (199 boys and 199 girls balanced for age) with a mean age of 9.3 years (SD = 2.8), who were attending a public school in Niterói, were the subjects of this study. Gender and age had significant effects on performance which depended on the instrument. Nonachievers performed worse than achievers in most neuropsychological tests. Comparison of our data to the available counterparts in the United States revealed that American children outperformed Brazilian children on the Right-Left Discrimination, Forward Digit Span, Color Span and Human Figure Drawing Tests. Further analysis showed that the neurobehavioral data consist of different factorial dimensions, including Human Body Representation, Motor Persistence of the Legs, Orbito-Orobuccal Motor Persistence, Attention-Memory, Visuospatial Memory, Neuropsychomotor Speed, Hyperactivity-Inattention, and Anxiety-Negative Socialization. We conclude that gender and age should be taken into account when using the normative data for most of the instruments studied in the present report. Furthermore, we stress the need for major changes in the Brazilian public school system in order to foster the development of secondary cognitive abilities in our children

Translation, adaptation and validation of the Roland-Morris questionnaire - Brazil Roland-Morris

The purpose of the present study was to translate the Roland-Morris (RM) questionnaire into Brazilian-Portuguese and adapt and validate it. First 3 English teachers independently translated the original questionnaire into Brazilian-Portuguese and a consensus version was generated. Later, 3 other translators, blind to the original questionnaire, performed a back translation. This version was then compared with the original English questionnaire. Discrepancies were discussed and solved by a panel of 3 rheumatologists and the final Brazilian version was established (Brazil-RM). This version was then pretested on 30 chronic low back pain patients consecutively selected from the spine disorders outpatient clinic. In addition to the traditional clinical outcome measures, the Brazil-RM, a 6-point pain scale (from no pain to unbearable pain), and its numerical pain rating scale (PS) (0 to 5) and a visual analog scale (VAS) (0 to 10) were administered twice by one interviewer (1 week apart) and once by one independent interviewer. Spearman's correlation coefficient (SCC) and intraclass correlation coefficient (ICC) were computed to assess test-retest and interobserver reliability. Cross-sectional construct validity was evaluated using the SCC. In the pretesting session, all questions were well understood by the patients. The mean time of questionnaire administration was 4 min and 53 s. The SCC and ICC were 0.88 (P<0.01) and 0.94, respectively, for the test-retest reliability and 0.86 (P<0.01) and 0.95, respectively, for interobserver reliability. The correlation coefficient was 0.80 (P<0.01) between the PS and Brazil-RM score and 0.79 (P<0.01) between the VAS and Brazil-RM score. We conclude that the Brazil-RM was successfully translated and adapted for application to Brazilian patients, with satisfactory reliability and cross-sectional construct validity.

Immune and hormonal activity in adults suffering from depression

An association between depression and altered immune and hormonal systems has been suggested by the results of many studies. In the present study we carried out immune and hormonal measurements in 40 non-medicated, ambulatory adult patients with depression determined by CID-10 criteria and compared with 34 healthy nondepressed subjects. The severity of the condition was determined with the Hamilton Depression Rating Scale. Of 40 depressed patients, 31 had very severe and 9 severe or moderate depression, 29 (72.5%) were females and 11 (27.5%) were males (2.6:1 ratio). The results revealed a significant reduction of albumin and elevation of alpha-1, alpha-2 and ß-globulins, and soluble IL-2 receptor in patients with depression compared to the values obtained for nondepressed subjects (P<0.05). The decrease lymphocyte proliferation in response to a mitogen was significantly lower in severely or moderately depressed patients when compared to control (P<0.05). These data confirm the immunological disturbance of acute phase proteins and cellular immune response in patients with depression. Other results may be explained by a variety of interacting factors such as number of patients, age, sex, and the nature, severity and/or duration of depression. Thus, the data obtained should be interpreted with caution and the precise clinical relevance of these findings requires further investigation.

Diagnostic profile of inpatients as a determinant of length of stay in a general hospital psychiatric unit

The aim of this study was to determine if the diagnostic profile of inpatients of a psychiatric unit in a general hospital influences the length of stay. The results of a retrospective survey comprising the first 16 years of operation of the Psychiatric Unit of the Ribeirão Preto General Hospital (PURP) showed that the progressive increase observed in the length of stay correlated with the increase in percentage of schizophrenia diagnosis, after the 8th year of hospital operation, and of affective disorders, after the 12th year. The length of hospitalization kept increasing until the 16th year, even though there was no change in the diagnostic profile of the patients admitted to the unit. In a prospective study encompassing the next six months, 61 inpatients were evaluated with the Structured Clinical Interview for DSM-III-R and the Brief Psychiatric Rating Scale (BPRS). The results showed that 82% of the inpatients fulfilled the diagnostic criteria for the schizophrenic or affective disorder spectrum at admission, with a discharge rate slower than for other diagnoses, although the length of hospitalization did not significantly differ among diagnostic categories. The results further demonstrated that in every diagnostic category more than 50% of the patients stayed in hospital for more than one week after reaching a BPRS score equal to 6, indicative of discharge. Overall, these data suggest that the increase in length of hospitalization may be due to a higher percentage of patients with a diagnosis of schizophrenia and affective disorder admitted to the PURP. In addition, patients with low symptomatic levels remained in hospital longer than they should have.

Neuropsychological rehabilitation of memory deficits and activities of daily living in patients with Alzheimer's disease: a pilot study

Patients with Alzheimer's disease (AD) gradually lose their cognitive competence, particularly memory, and the ability to perform daily life tasks. Neuropsychological rehabilitation is used to improve cognitive functions by facilitating memory performance through the use of external aids and internal strategies. The effect of neuropsychological rehabilitation through memory training - motor movements, verbal association, and categorization - and activities of daily living (ADL) training was tested in a sample of 5 elderly out-patients (mean age: 77.4 ± 2.88 years), with mild AD (Mini-Mental State Examination score: 22.20 ± 2.17) and their caregivers. All patients had been taking rivastigmine (6-12 mg/day) for at least 3 months before being assigned to the rehabilitation sessions, and they continued to take the medication during the whole program. Just before and after the 14-week neuropsychological rehabilitation program all patients were assessed by interviewers that did not participate in the cognitive training, using the Mini-Mental State Examination, Montgomery-Alsberg Depression Rating Scale, Hamilton Anxiety Scale, Interview to Determine Deterioration in Functioning in Dementia, Functional Test, Memory Questionnaire of Daily Living for patient and caregiver, Quality of Life Questionnaire for patient and caregiver, and a neuropsychological battery. The results showed a statistically significant improvement in ADL measured by Functional Test (P = 0.04), and only a small improvement in memory and psychiatric symptoms. Our results support the view that weekly stimulation of memory and training of ADL is believed to be of great value in AD treatment, not only delaying the progress of the disease, but also improving some cognitive functions and ADL, even though AD is a progressively degenerative disease.

A double-blind comparison of the effect of the antipsychotics haloperidol and olanzapine on sleep in mania

The effects of haloperidol and olanzapine on polysomnographic measures made in bipolar patients during manic episodes were compared. Twelve DSM-IV mania patients were randomly assigned to receive either haloperidol (mean ± SD final dosage: 5.8 ± 3.8 mg) or olanzapine (mean ± SD final dosage: 13.6 ± 6.9 mg) in a 6-week, double-blind, randomized, controlled clinical trial. One-night polysomnographic evaluation was performed before and after the haloperidol or olanzapine treatment. Psychopathology and illness severity were rated respectively with the Young Mania Rating Scale (YMRS) and the Clinical Global Impressions - Bipolar version (CGI-BP). There was a significant improvement in the YMRS and CGI-BP scores at the end of the study for both groups. Mixed ANOVA used to compare the polysomnographic measures of both drugs demonstrated significant improvement in sleep measures with olanzapine. In the olanzapine group, statistically significant time-drug interaction effects on sleep continuity measures were observed: sleep efficiency (mean ± SEM pre-treatment value: 6.7 ± 20.3%; after-treatment: 85.7 ± 10.9%), total wake time (pre-treatment: 140.0 ± 92.5 min; after-treatment: 55.2 ± 44.2 min), and wake time after sleep onset (pre-treatment: 109.7 ± 70.8 min; after-treatment: 32.2 ± 20.7 min). Conversely, improvement of polysomnographic measures was not observed for the haloperidol group (P > 0.05). These results suggest that olanzapine is more effective than haloperidol in terms of sleep-promoting effects, although olanzapine is comparatively as effective as haloperidol in treating mania. Polysomnography records should provide useful information on how manic states can be affected by psychopharmacological agents.

A randomized crossover clinical study showing that methylphenidate-SODAS improves attention-deficit/hyperactivity disorder symptoms in adolescents with substance use disorder

Our objective was to evaluate the effectiveness of a long-acting formulation of methylphenidate (MPH-SODAS) on attention-deficit/hyperactivity disorder (ADHD) symptoms in an outpatient sample of adolescents with ADHD and substance use disorders (SUD). Secondary goals were to evaluate the tolerability and impact on drug use of MPH-SODAS. This was a 6-week, single-blind, placebo-controlled crossover study assessing efficacy of escalated doses of MPH-SODAS on ADHD symptoms in 16 adolescents with ADHD/SUD. Participants were randomly allocated to either group A (weeks 1-3 on MPH-SODAS, weeks 4-6 on placebo) or group B (reverse order). The primary outcome measures were the Swanson, Nolan and Pelham Scale, version IV (SNAP-IV) and the Clinical Global Impression Scale (CGI). We also evaluated the adverse effects of MPH-SODAS using the Barkley Side Effect Rating Scale and subject reports of drug use during the study. The sample consisted of marijuana (N = 16; 100%) and cocaine users (N = 7; 43.8%). Subjects had a significantly greater reduction in SNAP-IV and CGI scores (P < 0.001 for all analyses) during MPH-SODAS treatment compared to placebo. No significant effects for period or sequence were found in analyses with the SNAP-IV and CGI scales. There was no significant effect on drug use. MPH-SODAS was well tolerated but was associated with more severe appetite reduction than placebo (P < 0.001). MPH-SODAS was more effective than placebo in reducing ADHD symptoms in a non-abstinent outpatient sample of adolescents with comorbid SUD. Randomized clinical trials, with larger samples and SUD intervention, are recommended.