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Background The effectiveness of two treatment approaches (phonological therapy and articulation therapy) for treatment of 14 children, aged 4;0-6;7 years, with phonologically based speech-sound disorder (SSD) has been previously analysed with severity outcome measures (percentage of consonants correct score, percentage occurrence of phonological processes and phonetic inventory). Considering that the ultimate goal of intervention for children with phonologically based SSD is to improve intelligibility, it is curious that intervention studies focusing on children's phonology do not routinely use intelligibility as an outcome measure. It is therefore important that the impact of interventions on speech intelligibility is explored. Aims This paper investigates the effectiveness of the two treatment approaches (phonological therapy and articulation therapy) using intelligibility measures, both in single words and in continuous speech, as the primary outcome. Methods & Procedures Fourteen children with phonologically based SSD participated in the intervention. The children were randomly assigned to phonological therapy or articulation therapy (seven children in each group). Two assessment methods were used for measuring intelligibility: a word identification task (for single words) and a rating scale (for continuous speech). Twenty-one unfamiliar adults listened and judged the children's intelligibility. Reliability analyses showed overall high agreement between listeners across both methods. Outcomes & Results Significant improvements were noted in intelligibility in both single words (paired t(6) = 4.409, p = 0.005) and continuous speech (asymptotic Z = 2.371, p = 0.018) for the group receiving phonology therapy pre- to post-treatment, but no differences in intelligibility were found for those receiving the articulation therapy pre- to post-treatment, either for single words (paired t(6) = 1.763, p = 0.128) or continuous speech (asymptotic Z = 1.442, p = 0.149). Conclusions & Implications Intelligibility measures were sensitive enough to show changes in the phonological therapy group but not in the articulation therapy group. These findings emphasize the importance of using intelligibility as an outcome measure to complement the results obtained with other severity measures when exploring the effectiveness of speech interventions. This study presents new evidence for the effectiveness of phonological therapy in improving intelligibility with children with SSD. [ABSTRACT FROM AUTHOR]

What is already known about this subject? Obesity is at epidemic levels and presents a serious global public health challenge., Portugal is one of the European countries with the highest prevalence of childhood obesity., Childhood Obesity Surveillance Initiative (COSI) is a robust monitoring system covering similar age groups, using standardized methods that allows comparability with other WHO European Region Member States., What this study adds? In Portugal, one in every three of 6- to 8-year-old children are overweight., Compared with other COSI national surveys, a similar trend was observed in other southern European countries, particularly Italy., The reference method used to define overweight and obesity is important as it provides different estimates., Introduction Previous studies place Portugal among the five countries with the highest prevalence of childhood obesity in Europe. This paper describes the prevalence of thinness, overweight and obesity in Portuguese children of 6-8 years of age, based on the first data collection from Childhood Obesity Surveillance Initiative Portugal, which took place during the 2007/2008 school year. Methods This study uses a semi-longitudinal design with repeated cross-sectional national representative samples. Specific prevalence of overweight (including obesity) and obesity was determined using three different diagnostic criteria. Across the seven geographic regions, 3765 children were enrolled from 181 schools; 50.3% of participants were males. Results Using the International Obesity Task Force reference, the prevalence of thinness, overweight and obesity were 4.8%, 28.1% and 8.9%, respectively; using the Center for Disease Control and Prevention reference they were 2.1%, 32.2% and 14.6%, respectively; and according to the World Health Organization reference, they were 1.0%, 37.9% and 15.3%, respectively. Univariate analysis showed a higher risk of obesity in older children, in boys and in the Azores region. The islands of Madeira and the Azores were the regions with the highest prevalence of overweight at 39.4% and 46.6%, respectively, and Algarve was the one with the lowest (21.4%). Conclusion These findings demonstrate the need for urgent action in Portugal and provide policy-makers with comprehensive and detailed information to assist with this. [ABSTRACT FROM AUTHOR]

Parenting stress is related to the characteristics of both the child and the parents, as well as to parent–child interactions. In adoptive families, parenting stress has been identified as an indicator of the family's adjustment to adoption. The stress experienced by parents of adopted adolescents deserves special consideration, as adolescence is a critical period in the adoptees' developmental pathway. The present study aims to identify the adoptee, parents and family related predictors of the adoptive parents' parenting stress, exploring direct and indirect effects. Fifty Portuguese adolescents' adoptive parents participated in this study. Parenting stress was measured by the Stress Index for Parents of Adolescents, and the Strengths and Difficulties Questionnaire was used to evaluate the adoptees' (mal)adjustment, according to the parents' perspective. Variables related to the parents' experience of adoption were assessed resorting to the Parent's Interview about the Adoption Process. Results showed that parents' satisfaction and adoptees' adjustment were sequential mediators of the relationship between the parents' experience of family life and parenting stress. These findings provide new insights into adoption research in parenting stress, highlighting the importance of adoption‐related variables such as the parents' adoption experience within the family and family relationships. [ABSTRACT FROM AUTHOR]

In Portugal, cardiovascular diseases stand out among the main causes of morbidity, disability, and mortality, with an expectation of growth up to the year 2025. A descriptive, exploratory study was carried out with patients in a cardiac rehabilitation program from an institution in the northern region of Portugal; 103 participants were randomly selected for the study. The data collection took place from February to April 2017. The majority of respondents presented a low level of literacy (inadequate and problematic). The profiles of the participants were characterized by the predominance of married males, with a mean age of 69 years. The participants considered doctors and nurses as the professionals who contribute the most to the increase of their health literacy. These health professionals have the opportunity and the responsibility to increase the health literacy levels of patients. It is known that low levels of health literacy are a problem throughout the European Union. Portugal's general population reflects this reality, and this study contributed to the conclusion that cardiac rehabilitation patients also present worrying levels of health literacy. [ABSTRACT FROM AUTHOR]

Professional support of families that are under temporary protection, with the goal of reunification, is necessary for helping families re‐establish their family dynamics. Without this support, the conditions that contributed to child abuse and neglect will likely persist. In this context, the attitude of professionals towards positive parenting and child participation is a decisive factor. The quantitative study presented here contributes knowledge regarding these 2 variables. The study was conducted with 106 professionals who work in the child protection system. The results show a high degree of consensus among professionals regarding the following practices: (a) incorporating positive parenting into family reunification processes; (b) training the biological parents in parenting skills; and (c) promoting the active participation of children in foster care and reunification. Regarding the latter point, the study found that older and more experienced professionals are more open and inclined to promote participation in family reunification processes. The practical implications of the results invite us to review attitudinal competencies training for professionals working in child protection services, focusing on encouraging a positive attitude towards the parental competencies of the biological family and the active participation of children in foster care and reunification. These professionals' attitudes are a key factor in mediating the process of family reunification. [ABSTRACT FROM AUTHOR]

This study examined the association of family and maternal characteristics with preschool children's dietary patterns. Trained interviewers evaluated subsample 3422 mothers and children enrolled in the population-based birth cohort Generation XXI (Porto, Portugal, 2005-2006). Maternal characteristics and behaviours (exercise, smoking habits, diet and child-feeding practices) and family characteristics were evaluated. Maternal diet was classified by a dietary score, and children's dietary patterns were identified by latent class analysis. Odds ratios (OR) and confidence intervals (95% CI) were estimated by multinomial regression models. The analysis was based on a framework with four conceptual levels: maternal socio-economic position (SEP) at 12 years, maternal socio-economic and demographic characteristics at child's delivery, family characteristics and maternal behaviours at child's 4 years. Three dietary patterns were identified in children: high in energy-dense foods (EDF); low in foods typically consumed at main meals and intermediate in snacks (Snacking); higher in healthy foods; and lower in unhealthy ones (Healthier, reference). Lower maternal SEP had an overall effect on children's diet (low vs. high SEP; EDF, OR = 1.76, 95% CI: 1.42-2.18; Snacking, OR = 1.73, 95% CI: 1.27-2.35), while maternal education was directly associated with it (≤9 vs. >12 schooling years, EDF, OR = 2.19, 95% CI: 1.70-2.81; Snacking, OR = 2.22, 95% CI: 1.82-3.55). Children whose mothers had worse dietary score were significantly more likely to follow unhealthier patterns (first vs. fourth quartile; EDF, OR = 9.94, 95% CI: 7.35-13.44, P-trend < 0.001; Snacking, OR = 4.21, 95% CI: 2.94-6.05, P-trend < 0.001). Maternal diet was the key factor associated with children's diet, above and beyond socio-economic and demographic characteristics, accounting for one-third of the determination coefficient of the fully adjusted model. At preschool age, interventions should give a particular focus on maternal diet and low SEP groups. [ABSTRACT FROM AUTHOR]

Familial amyloid polyneuropathy ( FAP) is a chronic debilitating multi-organic disorder, mainly assessed using ordinal-based impairment measures. To date, no outcome measure at the activity and participation level has been constructed in FAP. The current study aimed to design an interval activity/participation scale for FAP through Rasch methodology. A preliminary FAP Rasch-built overall disability scale (pre- FAP-RODS) containing 146 activity/participation items was assessed twice (interval: 2-4 week; test-retest reliability) in 248 patients with Val30Met FAP examined in Porto, Portugal, of which 65.7% have received liver transplantation. An ordinal-based 24-item FAP-symptoms inventory questionnaire ( FAP-SIQ) was also assessed (validity purposes). The pre- FAP-RODS and FAP-SIQ data were subjected to Rasch analyses. The pre- FAP-RODS did not meet model's expectations. On the basis of requirements such as misfit statistics, differential item functioning, and local dependency, items were systematically removed until a final 34-item FAP-RODS© was constructed fulfilling all Rasch requirements. Acceptable reliability/validity scores were demonstrated. In conclusion, the 34-item FAP-RODS© is a disease-specific interval measure suitable for detecting activity and participation restrictions in patients with FAP. The use of the FAP-RODS© is recommended for future international clinical trials in patients with Val30Met FAP determining its responsiveness and its cross-cultural validation. Its expansion to other forms of FAP should also be focus of future clinical studies. [ABSTRACT FROM AUTHOR]

Portugal is impacted by the rapid growth of the aging population, which has significant implications for its health care system. However, nurses have received little education focusing on the unique and complex care needs of older adults. This gap in the nurses′ education has an enormous impact in their knowledge and attitudes and affects the quality of nursing care provided to older adults. A cross-sectional study was conducted among 1068 Portuguese nurses in five hospitals (northern and central region) with the following purposes: (i) explore the knowledge and attitudes of nurses about four common geriatric syndromes (pressure ulcer, incontinence, restraint use and sleep disturbance) in Portuguese hospitals; and (ii) evaluate the influence of demographic, professional and nurses' perception about hospital educational support, geriatric knowledge, and burden of caring for older adults upon geriatric nursing knowledge and attitudes. The mean knowledge and attitudes scores were 0.41 ± 0.15 and 0.40 ± 0.21, respectively (the maximum score was 1). Knowledge of nurses in Portuguese hospitals about the four geriatric syndromes (pressure ulcers, sleep disturbance, urinary incontinence and restraint use) was found inadequate. The nurses' attitudes towards caring for hospitalized older adults were generally negative. Nurses who work in academic hospitals demonstrated significantly more knowledge than nurses in hospital centers. The attitudes of nurses were significantly associated with the hospital and unit type, region, hospital educational support, staff knowledge, and perceived burden of caring for older adults. The study findings support the need for improving nurses' knowledge and attitudes towards hospitalized older adults and implementing evidence-based guidelines in their practice. [ABSTRACT FROM AUTHOR]

Background Recent evidence suggests that specific language impairment (SLI) might be secondary to general cognitive processing limitations in the domain of executive functioning. Previous research has focused almost exclusively on monolingual children with SLI and offers little evidence-based guidance on executive functioning in bilingual children with SLI. Studying bilinguals with SLI is important, especially in the light of increasing evidence that bilingualism can bring advantages in certain domains of executive functioning. Aims To determine whether executive functioning represents an area of difficulty for bilingual language-minority children with SLI and, if so, which specific executive processes are affected. Methods & Procedures This cross-cultural research was conducted with bilingual children from Luxembourg and monolingual children from Portugal who all had Portuguese as their first language. The data from 81 eight-year-olds from the following three groups were analysed: (1) 15 Portuguese-Luxembourgish bilinguals from Luxembourg with an SLI diagnosis; (2) 33 typically developing Portuguese-Luxembourgish bilinguals from Luxembourg; and (3) 33 typically developing Portuguese-speaking monolinguals from Portugal. Groups were matched on first language, ethnicity, chronological age and socioeconomic status, and they did not differ in nonverbal intelligence. Children completed a battery of tests tapping: expressive and receptive vocabulary, syntactic comprehension, verbal and visuospatial working memory, selective attention and interference suppression. Outcomes & Results The bilingual SLI group performed equally well compared with their typically developing peers on measures of visuospatial working memory, but had lower scores than both control groups on tasks of verbal working memory. On measures of selective attention and interference suppression, typically developing children who were bilingual outperformed their monolingual counterparts. For selective attention, performance of the bilingual SLI group did not differ significantly from the controls. For interference suppression the bilingual SLI group performed significantly less well than typically developing bilinguals but not monolinguals. Conclusions & Implications This research provides further support to the position that SLI is not a language-specific disorder. The study indicates that although bilingual children with SLI do not demonstrate the same advantages in selective attention and interference suppression as typically developing bilinguals, they do not lag behind typically developing monolinguals in these domains of executive functioning. This finding raises the possibility that bilingualism might represent a protective factor against some of the cognitive limitations that are associated with SLI in monolinguals. [ABSTRACT FROM AUTHOR]

Objective Orthodontic-induced external apical root resorption ( EARR) is a complex phenotype determined by poorly defined mechanical and patient intrinsic factors. The aim of this work was to construct a multifactorial integrative model, including clinical and genetic susceptibility factors, to analyze the risk of developing this common orthodontic complication. Materials and Methods This retrospective study included 195 orthodontic patients. Using a multiple-linear regression model, where the dependent variable was the maximum% of root resorption (% EARRmax) for each patient, we assessed the contribution of nine clinical variables and four polymorphisms of genes involved in bone and tooth root remodeling (rs1718119 from P2 RX7, rs1143634 from IL1B, rs3102735 from TNFRSF11B, encoding OPG, and rs1805034 from TNFRSF11A, encoding RANK). Results Clinical and genetic variables explained 30% of% EARRmax variability. The variables with the most significant unique contribution to the model were: gender ( P < 0.05), treatment duration ( P < 0.001), premolar extractions ( P < 0.01), Hyrax appliance ( P < 0.001) and GG genotype of rs1718119 from P2 RX7 gene ( P < 0.01). Age, overjet, tongue thrust, skeletal class II and the other polymorphisms made minor contributions. Conclusion This study highlights the P2 RX7 gene as a possible factor of susceptibility to EARR. A more extensive genetic profile may improve this model. [ABSTRACT FROM AUTHOR]

Background Poor oral health has been related with cardiovascular diseases. Specifically, periodontitis has been implicated in the pathogenesis of atherosclerosis. Our aim was to evaluate the relationship between the degree of carotid atherosclerosis and severity of periodontitis in a patient cohort. Methods Fifty adult patients receiving carotid duplex scans in a cerebral hemodynamics lab were included in the study. Ultrasound protocol included measurement of carotid intima-media thickness ( IMT), which is a marker of atherosclerosis, and characterization of any atherosclerotic plaques in the cervical common and internal carotid arteries. Patients were divided into two main groups: the test group had IMT ≥ 1 mm or the presence of any carotid atherosclerotic plaque, and the control group had IMT < 1 mm and absence of atherosclerotic plaques. Periodontal evaluation was performed in all the teeth and characterized according to the clinical attachment level, which between 1 mm and 2 mm was classified as slight, 3 mm and 4 mm as moderate and ≥5 mm as severe. Results The control group included 15 (30%), while the test group included 35 (70%) subjects. The most common diagnosis was severe periodontitis (40%); moderate and slight periodontitis were also frequent occurrences (32% and 28%, respectively). In the control group, 53.3% had slight, 33.3% had moderate and 13.3% had severe periodontitis. In the test group, those percentages were respectively 22.2%, 44.4% and 33.3%. Patients with atheroma plaque had the highest percentage of severe periodontitis (70.6%). More severe periodontitis was related to atherosclerosis ( P = 0.007). Conclusion This study showed an association between periodontitis severity and carotid atherosclerosis, suggesting that periodontal disease might be a risk indicator for atherosclerotic disease. [ABSTRACT FROM AUTHOR]

Moutinho RP, Coelho L, Silva A, Lobo Pereira JA, Pinto M, Baptista IP. Validation of a dental image-analyzer tool to measure the radiographic defect angle of the intrabony defect in periodontitis patients. J Periodont Res 2012; 47: 695-700. © 2012 John Wiley & Sons A/S Background and Objective: A report describing the software Dental Image Analyzer (DIA) was published in this journal in 2009. A new function - measurement of the periodontal intrabony defect angle - was added to the software in 2010. The purpose of this study was to investigate whether measurements of the radiographic intrabony defect angle using digital radiographs and the newly developed DIA tool were comparable with measurements obtained using the conventional protractor method. Material and Methods: The baseline radiographic defect angle of intrabony defects was measured conventionally, using a protractor, in 60 selected teeth from 47 patients and then digitally using the newly developed DIA tool. The measurements were made independently by four experienced dentists. The radiographic defect angle of intrabony defects was measured after the three anatomical landmarks were identified, namely the cemento-enamel junction, the top of the crest and the bottom of the defect. Results: Both methods showed a high interexaminer reliability for measurements of the radiographic defect angle of intrabony defects (intraclass correlation coefficient > 0.97). Moreover, both methods showed high reliability (intraclass correlation coefficient > 0.96). On the other hand, the new DIA tool, compared with the conventional method, exhibited high sensitivity (0.92) and high specificity (0.91) in selecting defects of ≥ 37° or < 37°. Analysis of the time taken for measurements revealed significant differences between the two methods, with the protractor method being more time consuming. Conclusions: This study provided evidence for the lack of a significant difference between the conventional method and the DIA tool for radiographic measurement of intrabony defects. However, digital analysis was significantly faster. [ABSTRACT FROM AUTHOR]

Emotion over-regulation in infancy has seldom been the focus of empirical research. This study analysed the specificities of over-regulation when compared with under-regulation (maladaptive) and adaptive regulation by testing its association with attachment, dyadic emotional interaction, and temperament. The sample consisted of 52 low-risk mother-infant dyads. During a home visit, dyadic emotional interaction was assessed in the daily routines and free play of 10-month-old infants. The infant's emotion regulation was assessed using the Shape Sorter Task, and a temperament questionnaire was completed by the mother. Attachment was assessed at 12 or 16 months using the Strange Situation. As hypothesized, (i) emotion over-regulation (versus adaptive regulation) was predicted by a lower quality of dyadic emotional interaction and marginally by avoidant attachment; (ii) over-regulation (versus under-regulation) was predicted by avoidant attachment; and (iii) the predictive role of avoidant attachment was substantiated after controlling for another measure of mother-infant interaction. Contrary to expectations, temperament did not distinguish between emotion regulation styles. The link between over-regulation and lower quality of mother-infant emotional interaction and avoidant attachment was demonstrated. There is empirical support to the claim that it is possible to identify emotion over-regulation in infancy and that it is a maladaptive style of emotion regulation. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to explore the association between nurses' characteristics (educational level, country, work title, gender, type of work, age, and length of working experience) and their assessments of individualized care. Design: A cross-sectional comparative survey using questionnaires was employed to sample nurses from seven countries. Methods: Data were collected from orthopedic and trauma nurses from Cyprus, Finland, Greece, Portugal, Sweden, Turkey, and the United States ( N= 1,163, response rate 70%) using the Individualized Care Scale-Nurse (ICS-Nurse) and a sociodemographic questionnaire in 2008. Data were analyzed using descriptive statistics and general linear models. Results: When compared with practical nurses, registered nurses, length of working experience, and the country of the nurses were associated with assessments of the support of patient individuality in specific nursing activities (ICS-A-Nurse) and country assessments of individuality in the care provided (ICS-B-Nurse). The background and experience within nursing teams together with the country affect the delivery of individualized care. Conclusions: Overall, our findings suggest that nurses' personal attributes have important effects on their assessments of individualized nursing care that will be useful when making context-dependent recruitment decisions. Clinical Relevance: The characteristics of nurses contribute to the care delivered in healthcare organizations. Recognition of these nurse-related factors may help nurse leaders in the development and management of clinical practice. Journal of Nursing Scholarship, 2012; 44:3 ©2012 Sigma Theta Tau International. [ABSTRACT FROM AUTHOR]

Schooling in a Western cultural environment has been shown to promote context-free (analytic) at the expense of context-dependent (holistic) processing. In the present study, we examined whether these differences in processing styles also induce a tendency to use more abstract (i.e., dispositional) language when describing human behaviors. Portuguese literate, illiterate, and ex-illiterates were asked to freely describe behaviors presented visually. Using the linguistic category model, we found that literates relied on more abstract descriptions than ex-illiterates and illiterates. This effect of schooling was strongly associated with their relative superiority on an analytic (vs. holistic) task. These findings suggest that schooling influences the elaboration of social information. Copyright © 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]