How to reduce the number of children awaiting the diagnosis of intellectual disability in Brazil?

Introduction

In Brazil there is high number of children with Intellectual Disability (ID) who begin basic education but did not receive a diagnosis. The basic education teachers can be important agents in identifying signs of ID in the student so that they can be referred to health services.

Objectives

To develop and implement a decision-making model for basic education teachers to identify students with predictive signs of ID.

Methods

The sample was composed by 51 teachers from 20 public schools and their 1758 students eligible for the study enrolled in a educational network in São Paulo state, Brazil. A standardized model was developed for the evaluation process using an open-source software named BONITA. For the screening of students with ID signs the teachers answered a checklist based on the diagnostic criteria of the DSM-5 and the students were evaluated with neuropsychological test WASI (Wechsler Abbreviated Scale of Intelligence) and neuropsychiatric assessment. A Classification Based on Association Rules (CBA) generated the predictive models of sensitivity for confirming ID from the items in the checklists.

Results

35 children had suspected ID. The CBA showed an accuracy of 82%, identifying only 1 false-negative case and 3 false-positive cases for ID. According to the teachers, the most accurate signs were deficits in abstract thinking skills, deficits in communication and conversation and difficulties in emotional regulation in social interactions.

Conclusions

The decision-making model by elementary school teachers to identify students with ID showed high levels of sensitivity and can help the waiting for diagnosis.

Disclosure

No significant relationships.

Physical exercise for individuals with dementia: potential benefits perceived by formal caregivers

Background

The social and economic impact of dementia for the development of accessible and sustainable care for individuals with dementia (IwD). Physical exercise has been seen as a beneficial non-pharmacological therapy in the prevention and management of dementia, and possible benefits may not only impact on participants, but also indirectly on their caregivers. Thus, this quasi-experimental non-randomized study aimed to analyze the effects of an exercise intervention on functional capacity, behavioural and psychological symptoms in dementia (BPSD) and quality of life of institutionalized older adults with dementia, perceived by their formal caregivers.

Methods

Sixty-four institutionalized older adults (from both genders, aged 65–93 yrs. old), clinically diagnosed with dementia, were divided into two groups: control group (CG, continued with usual care, n = 26) and exercise group (EG, 6-month supervised multicomponent exercise intervention, n = 38). Nine caregivers (female, aged 28–47 yrs. old) from nine different nursing homes, reported about their distress related to BPSD and proxy-reported about participants’ functional capacity (Katz index), quality of life (QoL-AD), BPSD (NPI) before and after 6 months of an exercise intervention (aerobic, muscular resistance, flexibility and postural exercises).

Results

A two-way ANOVA, with repeated measures, revealed significant group and time interactions on Total Katz index and QoL-AD. The CG’s performance functional capacity and quality of life score worsen over time while in EG maintains these values after the exercise intervention. Moreover, formal caregiver’s distress triggered by apathy and disinhibition increased in CG while after 6 months of an exercise intervention no alterations were seen regarding these distress causes in EG. No significant main effects were observed for total NPI score or NPI distress.

Conclusions

Overall results show that after the exercise intervention, IwD from the EG, was capable of preserving the functional capacity, quality of life and neuropsychiatric symptoms were attenuate, contributing to a lower load of distress for the caregivers.

Trial registration

clinicaltrials.gov, NCT04095962. Retrospectively registered on 19 September 2019

Physical fitness in institutionalized older adults with dementia: association with cognition, functional capacity and quality of life

This cross-sectional study investigated the association of physical fitness with cognitive function, functional capacity and quality of life among institutionalized older adults with dementia. One hundred and two older adults aged 78.0 ± 8.4 years, predominantly female (67.6%), with neurocognitive disorder due to Alzheimer’s disease (AD) (49.2%), vascular dementia (14.7%), Parkinson’s disease (2%), dementia with Lewy bodies (2%) or unspecified dementia (32.1%) participated in the present study. Regression analyses were used to examine associations between physical fitness components (Senior Fitness Test) and cognitive function (Mini-Mental State Examination), functional capacity (Katz Index of Independence in Activities of Daily Living) and Quality of Life (QoL)-Alzheimer's Disease scale. Univariate regression indicates that strength, flexibility, agility/dynamic balance and aerobic endurance are relevant for cognitive function, physical capacity and perceived QoL in institutionalized older people with dementia. After multiple regression analyses, adjusted for body mass index (BMI), results showed that aerobic endurance had a significant positive association with Total Katz Index. For both, caregiver perception of QoL-AD and global QoL-AD, BMI remained significantly and positively associated. Agility–dynamic balance presented a significant negative relation with global QoL-AD. Overall, our findings suggest that better physical fitness is important for cognition and autonomous functional capacity and that it has positive repercussions on the QoL in institutionalized older adults with dementia. Consequently, exercise-based therapeutic strategies aiming to improve physical fitness should be implemented.

Genotype-phenotype correlations and BH4 estimated responsiveness in patients with phenylketonuria from Rio de Janeiro, Southeast Brazil

BACKGROUND

Genetic heterogeneity and compound heterozygosis give rise to a continuous spectrum of phenylalanine hydroxylase deficiency and metabolic phenotypes in phenylketonuria (PKU). The most used parameters for evaluating phenotype in PKU are pretreatment phenylalanine (Phe) levels, tolerance for dietary Phe, and Phe overloading test. Phenotype can vary from a "classic" (severe) form to mild hyperphenylalaninemia, which does not require dietary treatment. A subset of patients is responsive to treatment by the cofactor tetrahydrobiopterin (BH4 ). Genotypes of PKU patients from Rio de Janeiro, Brazil, were compared to predicted and observed phenotypes. Genotype-based estimations of responsiveness to BH4 were also conducted.

METHODS

Phenotype was defined by pretreatment Phe levels. A standard prediction system based on arbitrary assigned values was employed to measure genotype-phenotype concordance. Patients were also estimated as BH4 -responders according to the responsiveness previously reported for their mutations and genotypes.

RESULTS

A 48.3% concordance rate between genotype-predicted and observed phenotypes was found. When the predicted phenotypes included those reported at the BIOPKU database, the concordance rate reached 77%. A total of 18 genotypes from 30 patients (29.4%) were estimated as of potential or probable BH4 responsiveness. Inconsistencies were observed in genotypic combinations including the common "moderate" mutations p.R261Q, p.V388M, and p.I65T and the mild mutations p.L48S, p.R68S, and p.L249F.

CONCLUSION

The high discordance rate between genotype-predicted and observed metabolic phenotypes in this study seems to be due partially to the high frequency of the so-called "moderate" common mutations, p.R261Q, p.V388M, and p.I65T, which are reported to be associated to erratic or more severe than expected metabolic phenotypes. Although our results of BH4 estimated responsiveness must be regarded as tentative, it should be emphasized that genotyping and genotype-phenotype association studies are important in selecting patients to be offered a BH4 overload test, especially in low-resource settings like Brazil.

Mutation analysis of the PAH gene in phenylketonuria patients from Rio de Janeiro, Southeast Brazil

BACKGROUND

Phenylketonuria (PKU) is an autosomal recessive disease resulting from mutations in the PAH gene. Most of the patients are compound heterozygotes, and genotype is a major factor in determining the phenotypic variability of PKU. More than 1,000 variants have been described in the PAH gene. Rio de Janeiro's population has a predominance of Iberian, followed by African and Amerindian ancestries. It is expected that most PKU variants in this Brazilian state have originated in the Iberian Peninsula. However, rare European, African or pathogenic variants that are characteristic of the admixed population of the state might also be found.

METHODS

A total of 102 patients were included in this study. Genomic DNA was isolated from dried blood spots. Sanger sequencing was used for PAH gene variant identification. Deletions and duplications were also screened using MLPA analysis. Haplotypes were also determined.

RESULTS

Nine (8.8%) homozygous and 93 (91.2%) compound heterozygous patients were found. The spectrum included 37 causative mutations. Missense, nonsense, and splicing pathogenic variants corresponded to 63.7%, 2.9%, and 22.6% of the mutant alleles, respectively. Large (1.5%), and small deletions, inframe (5.4%) and with frameshift (3.9%), comprised the remainder. The most frequent pathogenic variants were: p.V388M (12.7%), p.R261Q (11.8%), IVS10-11G>A (10.3%), IVS2+5G>C (6.4%), p.S349P (6.4%), p.R252W (5.4%), p.I65T (4.4%), p.T323del (4.4%), and p.P281L (3.4%). One novel variant was detected: c.934G>T (p.G312C) [rs763115697].

CONCLUSION

The three most frequent pathogenic variants in our study (34.8% of the alleles) were also the most common in other Brazilian states, Portugal, and Spain (p.V388M, p.R261Q, IVS10-11G>A), corroborating that the Iberian Peninsula is the major source of PAH mutations in Rio de Janeiro. Pathogenic variants that have other geographical origins, such IVS2+5G>C, p.G352Vfs*48, and IVS12+1G>A were also detected. Genetic drift and founder effect may have also played a role in the mutation spectrum we observed.

Confirmatory factorial analysis of the children´s attraction to physical activity scale (capa)

AIM

Attraction to physical activity (PA) is an important contributor to children´s intrinsic motivation to engage in games, and sports. Previous studies have supported the utility of the children´s attraction to PA scale (CAPA) (Brustad, 1996) but the validity of this measure for use in Portugal has not been established. The purpose of this study was to cross-validate the shorter version of the CAPA scale in the Portuguese cultural context.

METHODS

A sample of 342 children (8--10 years of age) was used. Confirmatory factor analyses using EQS software ( version 6.1) tested t hree competing measurement models: a single--factor model, a five factor model, and a second order factor model.

RESULTS

The single--factor model and the second order model showed a poor fit to the data. It was found that a five-factor model similar to the original one revealed good fit to the data (S--B χ 2 (67) =94.27,p=0.02; NNFI=0.93; CFI=0.95; RMSEA=0.04; 90%CI=0.02;0.05).

CONCLUSIONS

The results indicated that the CAPA scale is valid and appropriate for use in the Portuguese cultural context. The availability of a valid scale to evaluate attraction to PA at schools should provide improved opportunities for better assessment and understanding of children´s involvement in PA.

Physical fitness percentile charts for children aged 6-10 from Portugal

AIM

The present study aims (1) to provide reference percentile charts for the following measures of Physical Fitness (PF): the sit-and-reach, handgrip, standing long jump, 50 yards' dash, 4x10m shuttle run and 1-mile run/walk tests in children aged 6 to 10 years, and (2) to compare the performance of the Portuguese children with their age- and sex peers.

METHODS

A total of 3804 Portuguese children (1985 boys and 1819 girls) aged 6-10 years old participated in this study. The sample was stratified from 20 public elementary schools and children were randomly selected in each school. Charts were separately built for each sex using the LMS method.

RESULTS

Boys showed better results than girls in handgrip, standing long jump, 50 yards' dash, 4x10 m shuttle run and 1-mile run/walk, while girls are better performers than boys in sit-and-reach.

CONCLUSION

Age- and gender- percentiles for a set of physical fitness tests for 6-10 year old (primary school) Portuguese children have been established. Boys showed greater overall PF than girls, except in the flexibility test, in which girls performed better. The reported normative values provide ample opportunities to accurately detect individual changes during childhood. These reference values are especially important in healthcare and educational settings, and can be added to the worldwide literature on physical fitness values in children.

Anthropometric characteristics, physical fitness and technical performance of under-19 soccer players by competitive level and field position

Anthropometric characteristics, physical fitness and technical skills of under-19 (U19) soccer players were compared by competitive level (elite, n=95; non-elite, n=85) and playing position (goalkeeper, central defender, fullback, midfield, forward). Fitness tests included 5- and 30-m sprints, agility, squat jump (SJ) and countermovement jump (CMJ), strength and Yo-Yo intermittent endurance test level 2 (Yo-Yo IE2). Soccer-specific skills included ball control and dribbling. Independent of position, elite players presented more hours of training per year than non-elite players (d>1.2). Stature and body mass discriminated elite from non-elite players among goalkeepers and central defenders (d>0.6). Major differences were noted between elite and non-elite goalkeepers for SJ, CMJ, Yo-Yo IE2, and ball control (d>1.2). Elite central defenders performed better than their non-elite counterparts in SJ and ball control tests (d>1.2). Elite players presented better agility and Yo-Yo IE2 performances than non-elite players within all positional roles (d>0.6). In conclusion, U19 players differed in anthropometric characteristics, physical fitness and technical skills by competitive level within field positions.

[A new experimental model for inducing interstitial cystitis by oxidative stress using bladder instillation of a nitric oxide donor gel]

PURPOSE

The aim of this study is to develop a new experimental model of inducing interstitial cystitis (IC) through vesical instillation of a polymeric solution containing the NO donor S-nitrousglutathione (GSNO) and to compare it to the experimental interstitial cystitis induced by vesical instillation of protamine and potassium chloride.

MATERIAL AND METHOD

For that purpose 40 female Wistar rats were used, divided in four groups: 1. saline solution + GSNO; 2. saline solution + polymeric solution (without GNSO); 3. protamine sulphate + KCl; 4. protamine sulphate + GSNO. The rats received one application (5 animals) or 3 applications (5 animals) of the corresponding substance through intravesical instillation, and after 6 days (5 animals) or 9 days (5 animals) they were euthanized and their bladders were removed for macroscopic evaluation and histological study.

RESULTS

In the macroscopic evaluation we observed edema and hyperemia of the mucosa in 2 (22%) of the animals in group 1, in 0 (0%) of the animals in group 2, in 10 (100%) of the animals in group 3, and in 5 (50%) of the animals in group 4. In the protamine + KCl group and in saline + GSNO similar effects were observed on the bladder wall. The animals in group 2 (saline + polymeric) showed vascular congestion, significantly smaller than the rest after 9 days instillations (p=0.0035). Significant increased fibrosis was observed after instillations in groups 3 and 4, after 6 days (p=0.3781) and 9 days (p=0.0459) respectively, when compared to control (group 2). All groups presented neutrophilic infiltrate of variable intensity 6 days after instillations (p=0.7277). After 9 days, there was a regression of the infiltrate, with no evidence of accentuated neutrophilic reaction in all the groups (p=0.2301).

CONCLUSION

The inflammatory response to bladder instillation of an aqueous solution of S-nitrousglutathione was very similar to that induced by bladder instillation of protamine and KCl. Instillation of an aqueous solution of GSNO can be considered a new model for experimental induction of interstitial cystitis.