Considerações prévias: distinctions between academic and intellectual goals for young children

Lilian Katz refere-se à crescente tendência nos Estados Unidos de introduzir objetivos de caráter “académico” nos programas destinados a crianças pequenas, em alternativa a programas centrados simplesmente no jogo espontâneo. Katz propõe uma terceira alternativa que desenvolva as competências de caráter intelectual nas crianças, de modo a estimular o desenvolvimento das suas mentes e as suas sensibilidades morais e estéticas. Katz propõe a introdução do trabalho de projeto com crianças desde os primeiros anos.

Expert opinion on best practice guidelines and competency framework for visual screening in children

PURPOSE: Screening programs to detect visual abnormalities in children vary among countries. The aim of this study is to describe experts' perception of best practice guidelines and competency framework for visual screening in children. METHODS: A qualitative focus group technique was applied during the Portuguese national orthoptic congress to obtain the perception of an expert panel of 5 orthoptists and 2 ophthalmologists with experience in visual screening for children (mean age 53.43 years, SD ± 9.40). The panel received in advance a script with the description of three tuning competencies dimensions (instrumental, systemic, and interpersonal) for visual screening. The session was recorded in video and audio. Qualitative data were analyzed using a categorical technique. RESULTS: According to experts' views, six tests (35.29%) have to be included in a visual screening: distance visual acuity test, cover test, bi-prism or 4/6(Δ) prism, fusion, ocular movements, and refraction. Screening should be performed according to the child age before and after 3 years of age (17.65%). The expert panel highlighted the influence of the professional experience in the application of a screening protocol (23.53%). They also showed concern about the false negatives control (23.53%). Instrumental competencies were the most cited (54.09%), followed by interpersonal (29.51%) and systemic (16.4%). CONCLUSIONS: Orthoptists should have professional experience before starting to apply a screening protocol. False negative results are a concern that has to be more thoroughly investigated. The proposed framework focuses on core competencies highlighted by the expert panel. Competencies programs could be important do develop better screening programs.

A survey about experiments on notions of time in children k-1 and k-2

In this paper we explore the importance of analyzing the exercises that the manuals have in Mathematics study, because the difficulty of identifying some errors on them can interfere with the capabilities of children. We work with some exercises related to the theme of temporal notions, based on a survey of textbooks from the 1st and 2nd grade (K-1 and K-2). Our concern is to alert about the importance of reflecting on the content of the books, in order to promote a teaching-learning process tailored to the needs of children. The activities present in the manuals should allow children to develop their logical- mathematical reasoning, for later be able to understand and apply Mathematics. To this end, we present some reflection about the exercises of manuals, and we give our opinion about what is the correct and incorrect. Also, some activities are suggested, among which were implemented with children of the 2nd grade, K- 2, along the experiments that support our work.

Estimate of DMFT index using teeth most affected by dental caries in twelve-year-old children

The objective of the study was to develop regression models to describe the epidemiological profile of dental caries in 12-year-old children in an area of low prevalence of caries. Two distinct random probabilistic samples of schoolchildren (n=1,763) attending public and private schools in Piracicaba, Southeastern Brazil, were studied. Regression models were estimated as a function of the most affected teeth using data collected in 2005 and were validated using a 2001 database. The mean (SD) DMFT index was 1.7 (2.08) in 2001 and the regression equations estimated a DMFT index of 1.67 (1.98), which corresponds to 98.2% of the DMFT index in 2001. The study provided detailed data on the caries profile in 12-year-old children by using an updated analytical approach. Regression models can be an accurate and feasible method that can provide valuable information for the planning and evaluation of oral health services.

The hospital survey on patient safety culture in Portuguese hospitals: instrument validity and reliability

Purpose – Quantitative instruments to assess patient safety culture have been developed recently and a few review articles have been published. Measuring safety culture enables healthcare managers and staff to improve safety behaviours and outcomes for patients and staff. The study aims to determine the AHRQ Hospital Survey on Patient Safety Culture (HSPSC) Portuguese version's validity and reliability. Design/methodology/approach – A missing-value analysis and item analysis was performed to identify problematic items. Reliability analysis, inter-item correlations and inter-scale correlations were done to check internal consistency, composite scores. Inter-correlations were examined to assess construct validity. A confirmatory factor analysis was performed to investigate the observed data's fit to the dimensional structure proposed in the AHRQ HSPSC Portuguese version. To analyse differences between hospitals concerning composites scores, an ANOVA analysis and multiple comparisons were done. Findings – Eight of 12 dimensions had Cronbach's alphas higher than 0.7. The instrument as a whole achieved a high Cronbach's alpha (0.91). Inter-correlations showed that there is no dimension with redundant items, however dimension 10 increased its internal consistency when one item is removed. Originality/value – This study is the first to evaluate an American patient safety culture survey using Portuguese data. The survey has satisfactory reliability and construct validity.

Glucose-6-Phosphate dehydrogenase deficiency in children from 0 to 14 years hospitalized at the Pediatric Hospital David Bernardino, Luanda, Angola

The Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common enzymatic defect in the world. The most common clinical manifestations are acute hemolytic anemia associated with drugs, infections, neonatal jaundice and hemolytic non-spherocytic chronic anemia. The main aim of this study was to determine the frequency of major genetic variants of G6PD leading to enzyme deficiency in children from 0 to 14 years at a Pediatric Hospital in Luanda, Angola. A cross-sectional and descriptive analytical study covered a total of 194 children aged from 0 to 14 years, of both genders and hospitalized at the Pediatric Hospital David Bernardino, Luanda between November and December, 2011. The G202A, A376G and C563T mutations of the G6PD gene were determined by real-time PCR with Taqman probes. The disabled A-/A- genotype was detected in 10 girls (10.9%). Among the boys, 21 (20.6%) presented the genotype A-. Considering all the samples, the A- variant was observed in 22.4% of cases. The Mediterranean mutation was not detected in the Angolan sample. Furthermore, no association was found between genotype and anemia, nutritional state and mucosa color. A significant association, however, was observed with jaundice. Based on the results obtained, there is a clear need to identify those with the disabled genotype in the Angolan population in order to avoid cases of drug-induced anemia, particularly in the treatment of malaria, so prevalent in Angola.

Teatro no currículo: avaliar o quê e para quê?

Nalgumas áreas curriculares disciplinares, como o Teatro, as aprendizagens e as competências não se adquirem nem desenvolvem, em geral, de acordo com a díade de estratégias que os professores parecem privilegiar, isto é: transmissão do conhecimento e, pouco depois, confirmação – na maioria das vezes através da modalidade de escrita – da aprendizagem desse conhecimento pelos alunos. Note-se, porém, que, mesmo naquelas áreas que os responsáveis políticos distinguem com um “exame nacional”, como o Português, nem todas as aprendizagens promovidas e realizadas são testáveis numa prova escrita e no imediato (como, a título de exemplo, as que se inscrevem nos domínios da comunicação oral e da leitura em voz alta, também amplamente abordadas em Teatro). Às áreas da educação artística, e do Teatro em particular, os professores associam essencialmente – ou exclusivamente – a criatividade, a imaginação e a expressividade. Sendo, embora, competências potencialmente desenvolvidas e avaliadas também nas áreas da educação artística, não são um exclusivo destas áreas. Cada área curricular disciplinar do âmbito da educação artística – e o Teatro não é exceção – assenta numa específica linguagem artística, que integra conteúdos, estratégias, atividades, recursos, técnicas, conceitos e terminologias próprios, que as crianças, com vista ao seu desenvolvimento completo e harmonioso, têm o direito de aprender e desenvolver. Daqui decorrem algumas questões: O que – e como – avaliar nas áreas da educação artística, em particular no Teatro? Que princípios poderão estar inerentes a um dispositivo de avaliação em Teatro, em contexto curricular? Terão as modalidades de avaliação não escrita estatuto de fiabilidade? O binómio teatro/currículo encerra um paradoxo a que pretendemos dar atenção: embora nem sempre abordado com regularidade e seguindo uma lógica dedesenvolvimento curricular, o Teatro constitui, apesar disso, uma das estratégias privilegiadas pelos professores de participação em projetos e iniciativas formais, na maior parte das vezes de cariz pontual (como momentos festivos ou de apresentação à comunidade), em que os alunos são sujeitos ao juízo avaliativo dos públicos. Partindo dos princípios de que (i) em contexto curricular cada atividade tem uma intencionalidade e que (ii) a “educação” artística não visa a identificação ou a valorização de “talentos”, pretendemos defender a seguinte ideia: Só depois de estabelecermos inequivocamente os objetivos da nossa ação educativa-pedagógica e, por conseguinte, uma estratégia de avaliação, é que podemos definir um percurso com sentido. Esta comunicação de natureza teórica, cuja base reflexiva decorre de mais de vinte anos de intervenção em contextos escolares, tanto do ensino básico como de formação de professores, tentará formular questões e problematizar algumas linhas de pensamento, mais do que encontrar respostas, no sentido de suscitar, principalmente da parte dos professores, a necessidade de uma mudança de atitude e de práticas face ao teatro na escola.

Fuzzy Monte Carlo model for transmission power systems reliability based decision making

This thesis presents the Fuzzy Monte Carlo Model for Transmission Power Systems Reliability based studies (FMC-TRel) methodology, which is based on statistical failure and repair data of the transmission power system components and uses fuzzyprobabilistic modeling for system component outage parameters. Using statistical records allows developing the fuzzy membership functions of system component outage parameters. The proposed hybrid method of fuzzy set and Monte Carlo simulation based on the fuzzy-probabilistic models allows catching both randomness and fuzziness of component outage parameters. A network contingency analysis to identify any overloading or voltage violation in the network is performed once obtained the system states. This is followed by a remedial action algorithm, based on Optimal Power Flow, to reschedule generations and alleviate constraint violations and, at the same time, to avoid any load curtailment, if possible, or, otherwise, to minimize the total load curtailment, for the states identified by the contingency analysis. For the system states that cause load curtailment, an optimization approach is applied to reduce the probability of occurrence of these states while minimizing the costs to achieve that reduction. This methodology is of most importance for supporting the transmission system operator decision making, namely in the identification of critical components and in the planning of future investments in the transmission power system. A case study based on Reliability Test System (RTS) 1996 IEEE 24 Bus is presented to illustrate with detail the application of the proposed methodology.

Socioeconomic inequities in the health and nutrition of children in low/middle income countries

OBJECTIVE: To describe the effects of social inequities on the health and nutrition of children in low and middle income countries. METHODS: We reviewed existing data on socioeconomic disparities within-countries relative to the use of services, nutritional status, morbidity, and mortality. A conceptual framework including five major hierarchical categories affecting inequities was adopted: socioeconomic context and position, differential exposure, differential vulnerability, differential health outcomes, and differential consequences. The search of the PubMed database since 1990 identified 244 articles related to the theme. Results were also analyzed from almost 100 recent national surveys, including Demographic Health Surveys and the UNICEF Multiple Indicator Cluster Surveys. RESULTS: Children from poor families are more likely, relative to those from better-off families, to be exposed to pathogenic agents; once they are exposed, they are more likely to become ill because of their lower resistance and lower coverage with preventive interventions. Once they become ill, they are less likely to have access to health services and the quality of these services is likely to be lower, with less access to life-saving treatments. As a consequence, children from poor family have higher mortality rates and are more likely to be undernourished. CONCLUSIONS: Except for child obesity and inadequate breastfeeding practices, all the other adverse conditions analyzed were more prevalent in children from less well-off families. Careful documentation of the multiple levels of determination of socioeconomic inequities in child health is essential for understanding the nature of this problem and for establishing interventions that can reduce these differences.

Strabismus, visual acuity, and uncorrected refractive error in Portuguese children aged 6 to 11 years

Introduction: Visual anomalies that affect school-age children represent an important public health problem. Data on the prevalence are lacking in Portugal but is needed for planning vision services. This study was conducted to determine the prevalence of strabismus, decreased visual acuity, and uncorrected refractive error in Portuguese children aged 6 to 11 years. Methods and materials: A cross-sectional study was carried out on a sample of 672 school-age children (7.69 ± 1.19 years). Children received an orthoptic assessment (visual acuity, ocular alignment, and ocular movements) and non-cycloplegic autorefraction. Results: After orthoptic assessment, 13.8% of children were considered abnormal (n = 93). Manifest strabismus was found in 4% of the children. Rates of esotropia (2.1%) were slightly higher than exotropia (1.8%). Strabismus rates were not statistically significant different per sex (p = 0.681) and grade (p = 0.228). Decreased visual acuity at distance was present in 11.3% of children. Visual acuity ≤20/66 (0.5 logMAR) was found in 1.3% of the children. We also found that 10.3% of children had an uncorrected refractive error. Conclusions: Strabismus affects a small proportion of the Portuguese school-age children. Decreased visual acuity and uncorrected refractive error affected a significant proportion of school-age children. New policies need to be developed to address this public health problem.

Diagnosis of iron deficiency anemia in children of Northeast Brazil

OBJECTIVE: To diagnose iron deficiency anemia in children. METHODS: The study was conducted with a sample of 301 children aged six to 30 months attending public daycare centers in the city of Recife, Northeast Brazil, in 2004. The diagnoses of anemia were based on a combination of different hematological and biochemical parameters: hemoglobin, mean corpuscular volume, ferritin, C-reactive protein, transferrin saturation and transferrin receptor. The chi-square test and ANOVA were used in the statistical analysis. RESULTS: Of all children studied, 92.4% had anemia (Hb <110 g/L) and 28.9% had moderate/severe anemia (Hb <90 g/L). Lower levels of hemoglobin were found in children aged 6-17 months. Iron deficiency was found in 51.5% of children using ferritin (<12 μg/L) as parameter. Taking into consideration the combination of hemoglobin level, ferritin and transferrin receptor, 58.1% had anemia with iron deficiency, 34.2% had anemia without iron deficiency and 2.3% had iron deficiency without anemia. Mean ferritin concentration was significantly higher in children with high C-reactive protein when compared with those with normal levels (22.1 vs. 14.8 µg/L). CONCLUSIONS: The use of several biochemical and hematological parameters allowed to diagnosing iron deficiency anemia in two thirds of children, suggesting a need to identify other determinants of anemia without iron deficiency.

Reliability of a questionnaire on substance use among adolescent students, Brazil

OBJECTIVE: To analyze reliability of a self-applied questionnaire on substance use and misuse among adolescent students. METHODS: Two cross-sectional studies were carried out for the instrument test-retest. The sample comprised male and female students aged 1119 years from public and private schools (elementary, middle, and high school students) in the city of Salvador, Northeastern Brazil, in 2006. A total of 591 questionnaires were applied in the test and 467 in the retest. Descriptive statistics, the Kappa index, Cronbach's alpha and intraclass correlation were estimated. RESULTS: The prevalence of substance use/misuse was similar in both test and retest. Sociodemographic variables showed a "moderate" to "almost perfect" agreement for the Kappa index, and a "satisfactory" (>0.75) consistency for Cronbach's alpha and intraclass correlation. The age which psychoactive substances (tobacco, alcohol, and cannabis) were first used and chronological age were similar in both studies. Test-retest reliability was found to be a good indicator of students' age of initiation and their patterns of substance use. CONCLUSIONS: The questionnaire reliability was found to be satisfactory in the population studied.

Reply to letter to the Editor: Expert opinion on best practice guidelines and competency framework for visual screening in children

The aim of this study was to describe experts’ perception of best-practice guidelines and competency framework for visual screening in children. This study uses qualitative data and shows individual/ group conceptualization. The use of evidence from qualitative studies has traditionally been a fundamental source of knowledge in the clinical and social sciences.

Effect of deworming on hemoglobin concentration in children from 2 to 15 years from the Bengo Province, Angola

The most common causes of anemia are micronutrient deficiencies, but other factors may influence namely inflammation, parasitic infections and inherited disorders. One strategy to combat micronutrient deficiencies is supplementation, yet, in zones with high prevalence of Schistosomiasis or Soil Transmitted Helminthes (STH), supplementation could be not sufficient. The aim of this study was to evaluate the effects of deworming, on hemoglobin concentration, in children from 2 to 15 years, from Bengo.

Reading performance in children with visual function anomalies

Aims - To compare reading performance in children with and without visual function anomalies and identify the influence of abnormal visual function and other variables in reading ability. Methods - A cross-sectional study was carried in 110 children of school age (6-11 years) with Abnormal Visual Function (AVF) and 562 children with Normal Visual Function (NVF). An orthoptic assessment (visual acuity, ocular alignment, near point of convergence and accommodation, stereopsis and vergences) and autorefraction was carried out. Oral reading was analyzed (list of 34 words). Number of errors, accuracy (percentage of success) and reading speed (words per minute - wpm) were used as reading indicators. Sociodemographic information from parents (n=670) and teachers (n=34) was obtained. Results - Children with AVF had a higher number of errors (AVF=3.00 errors; NVF=1.00 errors; p<0.001), a lower accuracy (AVF=91.18%; NVF=97.06%; p<0.001) and reading speed (AVF=24.71 wpm; NVF=27.39 wpm; p=0.007). Reading speed in the 3rd school grade was not statistically different between the two groups (AVF=31.41 wpm; NVF=32.54 wpm; p=0.113). Children with uncorrected hyperopia (p=0.003) and astigmatism (p=0.019) had worst reading performance. Children in 2nd, 3rd, or 4th grades presented a lower risk of having reading impairment when compared with the 1st grade. Conclusion - Children with AVF had reading impairment in the first school grade. It seems that reading abilities have a wide variation and this disparity lessens in older children. The slow reading characteristics of the children with AVF are similar to dyslexic children, which suggest the need for an eye evaluation before classifying the children as dyslexic.