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Objective and Approach The environment in and around children’s homes and schools can influence their health and educational outcomes. Better understanding of how these potentially modifiable environmental risk factors can affect children is crucial in enabling the creation of healthier and more equitable places. We aim to establish the Kids’ Environment and Health Cohort, a research-ready, de-identified, national longitudinal birth cohort of approximately 11 million children born in England from 2006 to 2023, updated annually. The cohort will link vital statistics, census, health, education, and environmental data, via unique property identifiers from longitudinal health service address records for children and their mothers during pregnancy. Data on environmental exposures around schools will be linked to the cohort via education records. The cohort will be held and accessed in a secure research environment at the Office for National Statistics (ONS). All geographical identifiers will be encrypted and stored separately from the main cohort by the ONS to ensure privacy and security. Results We have received ethics approval and have agreed the legal bases for establishing the cohort. We are now setting up data sharing agreements with each data provider. Delivery of the cohort is scheduled for late 2025. Conclusion The Kid’s Environment and Health Cohort will support policy-relevant research in exploring associations between environmental factors and children's health and educational outcomes, and assessing the effectiveness of policy interventions. It will also support interdisciplinary collaboration, guiding evidence-based decision-making for environmental, planning, and public health policies aimed at promoting children’s health and well-being.

Inclusion is considered a foundation for quality education, and teachers’ inclusive practices are essential for success in mainstream classrooms. Portugal has been making progressive improvements in its policies for inclusive education, although there is little consistency in school practices within or between schools. Moreover, data identifying the personal and career variables relevant to teachers’ inclusive practices in Portugal are scarce. Therefore, the purpose of this study was to determine the relationship between teachers’ inclusive practices and personal and career-based characteristics, including gender, level of teaching, years of experience, roles performed at school, and perception of inclusive resources. The participants were 924 teachers who worked in private and public schools in Portugal. Regression analysis showed that perceived inclusive resources, level of teaching, and gender predicted variance in inclusive practices. Mean difference analyses revealed that teachers at the lower levels of teaching, females, and teachers reporting more inclusive resources had the highest scores for inclusive practices. These findings are discussed in terms of their practical relevance for inclusive school systems.

IntroductionThe years preceding school entry are pivotal for children to develop fundamental skills that bolster their learning in literacy and math in the following years. Skills like counting and subitizing stand as key predictors of future math abilities. Hence, the availability of universal screening tools is vital to promptly identify children who are lacking in these skills, allowing for tailored classroom practices to meet their needs. This study aimed to develop a mathematical screening tool and assess its psychometric properties.MethodsThe tool encompasses both group and individual tasks, to evaluate counting, cardinality, subitizing, quantity discrimination, addition, and subtraction. The tool was administered twice to 257 children, aged 5-6, in their final year of kindergarten in Portugal, at both the start and end of the school year.ResultsThe findings reveal that the tasks generally present a low level of difficulty, especially by the end of kindergarten. Factor analysis demonstrated an adequate structure, and all dimensions showed high internal consistency (>0.80). There was a medium-to-high intercorrelation among the various tasks. Correlations between task scores at the beginning and end of the school year were high. Furthermore, scores across all tasks correlated with math achievement in the first grade of primary education.DiscussionThese outcomes suggest that the tool is both valid and reliable, making it a useful resource for assessing and intervening in math skills during the critical years before school entry.

Purpose: This article brings into debate young people’s meaning-making of climate justice in different geographic regions, and explores the roles of political, social, economic, and education actors in supporting youth’s climate agency in their communities. Design/methodology/approach: After selecting two schools located in Northern Portugal – in countryside/rural and in coastal/urban contexts – we conducted two focus group discussions with young students (aged between 16 and 19) and sixteen interviews with local stakeholders (policy-makers, economic agents, activists, and scientists). We performed content analysis, using climate justice’s dimensions as analytical axes. Findings: The data analysis reveals that young people do not feel heard in schools or in policy-making processes on climate. In contrast, adults unanimously recognize the importance of having more youth voices but fail to identify opportunities for youth participation in local climate policymaking. In addition to procedural and intergenerational dimensions, issues of recognitional and distributional climate injustice are identified by youngsters in their regions.

This study aims to analyze the born global startup’s internationalization process and the incubators’ practices in providing resources and mechanisms to support this process, to solve (1) the problems that these companies experience in terms of the resources and mechanisms provided by the business incubators, and (2) what are business incubators contributions to the startup internationalization process. An inductive approach and qualitative methodology were adopted in this study using the multiple case study method to analyze four incubators and four born global startups incubated. Interview and document analysis were selected as data collection techniques. Findings show that four factors were identified as influencers according to the incubators and incubates perspectives (entrepreneur, networks, mentoring, credibility). These prove that incubation influences born global startup’s internationalization process; however, this influence is perceived differently depending on the company’s experience. This study identifies the resources and mechanisms that serve to support the strategies definition for startups' entry into international markets. Additionally, it serves as a recommendation for governmental acceleration programmes, providing an understanding that business incubators can be used as a tool to stimulate the emergence of born global startups, thus fostering the country’s economy.

ABSTRACT Objective: To adapt the PROactive Physical Activity in COPD-clinical visit (C-PPAC) instrument to the cultural setting in Brazil and to determine the criterion validity, test-retest reliability agreement, and internal consistency of this version. Methods: A protocol for cultural adaptation and validation was provided by the authors of the original instrument and, together with another guideline, was applied in a Portuguese-language version developed by a partner research group from Portugal. The adapted Brazilian Portuguese version was then cross-sectionally administered twice within a seven-day interval to 30 individuals with COPD (57% were men; mean age was 69 ± 6 years; and mean FEV1 was 53 ± 18% of predicted) to evaluate internal consistency and test-retest reliability. Participants also completed the International Physical Activity Questionnaire (IPAQ), the modified Medical Research Council scale, the COPD Assessment Test, and Saint George’s Respiratory Questionnaire to evaluate criterion validity. Results: The C-PPAC instrument showed good internal consistency and excellent test-retest reliability: “amount” domain = 0.87 (95% CI, 0.73-0.94) and “difficulty” domain = 0.90 (95% CI, 0.76-0.96). Bland & Altman plots, together with high Lin’s concordance correlation coefficients, reinforced that agreement. Criterion validity showed moderate-to-strong correlations of the C-PPAC with all of the other instruments evaluated, especially with the IPAQ (rho = −0.63). Conclusions: The Brazilian Portuguese version of the C-PPAC is a reliable and valid instrument for evaluating the experience of Brazilian individuals with COPD with their physical activity in daily life.

Introduction Hospitalised patients with exacerbations of COPD (ECOPD) may have physical and functional impairments that impact morbidity and readmission. Therefore, it is crucial to properly identify reduced functionality in these patients to support a personalised rehabilitation. The objective of this study is to summarise and compare the measurement properties of functionality performance-based outcome measures for hospitalised patients with ECOPD. Methods A systematic review based on the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) was performed. The PubMed, Embase, PEDro and Cochrane databases were searched using terms related to functionality, hospitalised patients with ECOPD and measurement properties. Studies were selected and extracted by two researchers. The COSMIN Risk of Bias checklist was applied to assess the methodological quality of the studies and measurement property results were compared with the criteria for good measurement properties. Quality of evidence was graded using a modified Grades of Recommendation, Assessment, Development and Evaluation approach. Results 13 studies were included with nine outcome measures, namely the 6-min pegboard ring test, the de Morton mobility index, the incremental shuttle walk test (ISWT), the 6-min walk test (6MWT), maximum inspiratory pressure (MIP), the Berg balance scale, 4-m gait speed, handgrip strength and the 6-min stepper test. Construct validity was rated as sufficient, except for the ISWT. Responsiveness, assessed only for MIP, was considered insufficient and measurement errors for the ISWT and 6MWT were insufficient, with a very low quality of evidence for all measurement properties. Conclusion Measurement properties of performance-based outcome measures to assess functionality in patients hospitalised with ECOPD are still scarce, with very low evidence supporting validity and a lack of evidence of responsiveness and reliability. Further studies are needed to address this topic and guide assertive and personalised management.

In this article, we provide a brief overview of some of the outstanding sessions that were (co)organised by the Allied Respiratory Professionals Assembly during the 2022 European Respiratory Society International Congress, which was held in a hybrid format. Early Career Members from Assembly 9 summarised the content of the sessions, with the support of the Officers from the four Assembly groups: Respiratory Function Technologists and Scientists (Group 9.01); Physiotherapists (Group 9.02); Nurses (Group 9.03); and Psychologists and Behavioural Scientists (Group 9.04). The sessions covered the following topics: recent advances in cardiopulmonary exercise and challenge testing; the role and new trends in physiotherapy, exercise and physical activity promotion interventions in chronic respiratory diseases; development of the international curriculum for respiratory nurses and nursing aspects in disease management; and treatment adherence, e-health interventions and post-coronavirus disease 2019 challenges. This Highlights article targets delegates who attended the Congress sessions, as well as those who were unable to attend, and provides valuable insight into the latest scientific data and emerging areas affecting the clinical practice of Allied Respiratory Professionals.

Abstract Background and objective Profiles of people with chronic obstructive pulmonary disease (COPD) often do not describe treatable traits, lack validation and/or their stability over time is unknown. We aimed to identify COPD profiles and their treatable traits based on simple and meaningful measures; to develop and validate a decision tree and to explore profile stability over time. Methods An observational, prospective study was conducted. Clinical characteristics, lung function, symptoms, impact of the disease (COPD Assessment Test—CAT), health-related quality of life, physical activity, lower-limb muscle strength and functional status were collected cross-sectionally and a subsample was followed-up monthly over six months. A principal component analysis and a clustering procedure with k-medoids were applied to identify profiles. A decision tree was developed and validated cross-sectionally. Stability was explored over time with the ratio between the number of timepoints that a participant was classified in the same profile and the total number of timepoints (i.e., 6). Results 352 people with COPD (67.4 ± 9.9 years; 78.1% male; FEV1 = 56.2 ± 20.6% predicted) participated and 90 (67.6 ± 8.9 years; 85.6% male; FEV1 = 52.1 ± 19.9% predicted) were followed-up. Four profiles were identified with distinct treatable traits. The decision tree included CAT (

Pulmonary rehabilitation (PR) is a cost-effective intervention with well-known benefits to exercise capacity, symptoms and quality of life in patients with chronic respiratory diseases. Despite the compelling evidence of its benefits, PR implementation is still suboptimal, and maintenance of PR benefits is challenging. To overcome these pitfalls, there has been a growing interest in developing novel models for PR delivery. Digital health is a promising solution, as it has the potential to address some of the most reported barriers to PR uptake and adherence (such as accessibility issues), help maintain the positive results following a PR programme and promote patients’ adherence to a more active lifestyle through physical activity (tele)coaching. Despite the accelerated use of digital health to deliver PR during the coronavirus disease 2019 pandemic, there are still several factors that contribute to the resistance to the adoption of digital health, such as the lack of evidence on its effectiveness, low acceptability by patients and healthcare professionals, concerns about implementation and maintenance costs, inequalities in access to the internet and technological devices, and data protection issues. Nevertheless, the trend towards reducing technology costs and the higher availability of digital devices, as well as the greater ease and simplicity of use of devices, enhance the opportunities for future development of digitally enabled PR interventions. This narrative review aims to examine the current evidence on the role of digital health in the context of PR, including strengths and weaknesses, and to determine possible threats and opportunities, as well as areas for future work.

BACKGROUND: Individualized risk assessment using comorbidity adjustment is an important component in modern clinical practice and can be performed considering individual comorbidities or through the use of summary measures. The Charlson Comorbidity Index adjusted to age (CCIa) is the most widely validated and used comorbidity assessment tool. Studies have proved CCIa as a strong predictor of mortality for a variety of medical and surgical conditions; however, its utility in patients submitted to elective endovascular abdominal aortic aneurysm repair (EVAR) has not been studied. METHODS: Patients submitted to EVAR between January 1, 2017 and December 31, 2021 in our tertiary, academic Vascular Surgery Department were retrospectively evaluated and 123 patients fulfilled the inclusion criteria. Patient characteristics and peri-operative variables were collected and CCIa was calculated. Surgical complications were classified according to Clavien-Dindo. The area under the curve of the receiver operating characteristic curves was calculated to validate and determine the discriminating ability of CCIa in predicting complications and mortality and the Youden index used to determine the critical value. RESULTS: Mean age was 73.49±7.95 years and mean follow-up was 30.55±16.49 months. 30-day complication rate was 16%, 30-day mortality 1.63% and overall mortality 16%. Patients with higher CCIa had higher overall mortality (p=.002) but CCIa had no impact on 30-day complication rate and on 30-day mortality. Logistic regression showed that even after adjusting for patient ́s comorbidities individually, CCIa was the only independent mortality predictor (p=.003). The optimal cutoff associated with higher overall mortality was found to be ≥6. CONCLUSION: CCIa does not seem to predict complications and early mortality after EVAR but it seems to be a useful predictor of mid-term survival after EVAR. These results show the limited role of this score in predicting outcomes after surgery but may help identify a sub-population whose shorter life-expectancy should be considered towards the benefits of EVAR.

Tier-2 reading fluency interventions are specifically tailored for struggling readers, addressing their unique needs. The aim of this study was to examine the impact of a Tier-2 reading fluency intervention on reading capabilities and motivation among third-grade students identified as at risk. The intervention employed various strategies, including non-repetitive reading, exploration of challenging words, model reading, eco-reading, assisted reading, and both self- and hetero-assessment of reading proficiency. A two-group randomized controlled trial was employed, comprising an intervention group (N n = 162) and a delayed intervention control group (N = 183). Both groups underwent pre-test and post-test evaluations in reading accuracy and fluency. Additionally, a separate cohort of students without reading difficulties was assessed (N = 225). The intervention resulted in significantly improved word reading accuracy and reading fluency scores in the intervention group compared to the control group. While the gap between the intervention and control groups was slightly reduced, no significant effects on motivation were observed. These findings underscore the relevance of Tier-2 reading fluency interventions in preventing the development of persistent reading difficulties.

School psychologists can support schools in implementing inclusive practices. In Portugal, the Decree-Law 54/2018 has set the country on the path to inclusive education based on whole-school approaches. This policy shift demands a change in school psychologists' practices to be agents for systems change versus traditional roles (such as assessing and counseling students). An e-learning training course was developed and implemented by nine psychologists through a partnership between the Ministry of Education and the Portuguese Psychology Association, focused on the Multi-tiered Systems of Support framework for constructing inclusive schools. The main aim was to empower school psychologists to support adequate, inclusive, and multi-tiered intervention responses in their schools, resourcing a collaborative and supervised approach. From all Portuguese regions, 327 psychologists participated in the training from October 2020 to April 2021. This article focuses on the trainers' experiences of training, collected through a focus group, reflecting on the challenges, opportunities, and necessary improvements for future training in school psychologists in Portugal on this topic. Trainers have identified organizational and pedagogical aspects as critical to the training delivery and quality that should be addressed in future training courses for school psychologists.

(1) Background: Increasing salinity, further potentiated by climate change and soil degradation, will jeopardize food security even more. Therefore, there is an urgent need for sustainable agricultural practices capable of maintaining high crop yields despite adverse conditions. Here, we tested if wheat, a salt-sensitive crop, could be a good reservoir for halotolerant bacteria with plant growth-promoting (PGP) capabilities. (2) Methods: We used two agricultural soils from Algeria, which differ in salinity but are both used to grow wheat. Soil halotolerant bacterial strains were isolated and screened for 12 PGP traits related to phytohormone production, improved nitrogen and phosphorus availability, nutrient cycling, and plant defence. The four ‘most promising’ halotolerant PGPB strains were tested hydroponically on wheat by measuring their effect on germination, survival, and biomass along a salinity gradient. (3) Results: Two halotolerant bacterial strains with PGP traits were isolated from the non-saline soil and were identified as Bacillus subtilis and Pseudomonas fluorescens, and another two halotolerant bacterial strains with PGP traits were isolated from the saline soil and identified as B. megaterium. When grown under 250 mM of NaCl, only the inoculated wheat seedlings survived. The halotolerant bacterial strain that displayed all 12 PGP traits and promoted seed germination and plant growth the most was one of the B. megaterium strains isolated from the saline soil. Although they both belonged to the B. megaterium clade and displayed a remarkable halotolerance, the two bacterial strains isolated from the saline soil differed in two PGP traits and had different effects on plant performance, which clearly shows that PGP potential is not phylogenetically determined. (4) Conclusions: Our data highlight that salt-sensitive plants and non-saline soils can be reservoirs for halotolerant microbes with the potential to become effective and sustainable strategies to improve plant tolerance to salinity. However, these strains need to be tested under field conditions and with more crops before being considered biofertilizer candidates.

Introdução: Apesar dos esforços das equipas de saúde, a taxa da amputação em doentes com Isquémia Crítica Ameaçadora de Membro (CLTI) é bastante elevada. Cada vez mais se torna relevante um tratamento individualizado do doente por forma a melhorar a sua qualidade de vida. Contudo, não existe uma escala de qualidade de vida validada para doentes amputados por isquémia crítica. Os autores propõem uma revisão sistemática da literatura com vista a sumarizar as escalas de avaliação de qualidade de vida após amputação. Métodos: Foi feita uma pesquisa por todos os estudos relacionados com avaliação funcional e da qualidade de vida após amputação na base de dados Pubmed. Resultados: Dos 228 artigos foram incluídos 28. Dos artigos analisados apenas 3 avaliaram exclusivamente doentes vasculares com CLTI. 24 escalas diferentes foram usadas 44 vezes: 11 escalas (44%) de avaliação de saúde e 14 escalas (56%) de qualidade de vida, das quais 2 escalas (18%) de avaliação de saúde e 4 das escalas (29%) de qualidade de vida são específicas para doentes amputados e uma escala para doença arterial periférica. Conclusões: A heterogeneidade de escalas torna difícil uma comparação de resultados. Na população de doentes amputados vasculares, escalas gerais podem não ser representar corretamente os domínios mais valorizados por esta população. Escalas específicas para protetisados ou de avaliação da progressão de doença arterial periférica também parecem não ser as mais adequadas para este subtipo de doentes mais idosos e com limitações prévias. São essenciais novos estudos para validar uma escala específica para esta população.

The COVID-19 pandemic challenged countries, regions, schools, and individuals. School closures due to lockdowns forced changes in the teaching practices and the learning support provided to children at home. This study aimed to provide insights on the changes between the first and the second lockdowns in Portugal, concerning remote teaching practices and family support to children's education. A self-report questionnaire was filled by 144 parents of third grade students. The results show that, between the two lockdowns, there was a significant decrease in the amount of support provided at home to school assignments and activities, as well as in the amount of time spent by students in TV broadcasted lessons and in reading training supported by the family. Inversely, families reported a significant increase in the amount of time spent by students in independent reading activities and in the time spent in training reading guided by teachers. The number of synchronous lessons with a teacher and the number of times students trained reading during a synchronous lesson also increased in the second lockdown. Additionally, in the second lockdown, parents perceived synchronous lessons to be more effective at improving their child's reading skills and perceived themselves as more capable of supporting their child in reading acquisition. These findings are used to discuss school responses and remote teaching and learning practices during the COVID-19 pandemic.

BackgroundThe evidence is sparse regarding the associations between serious mental illnesses (SMIs) prevalence and environmental factors in adulthood as well as the geographic distribution and variability of these associations. In this study, we evaluated the association between availability and proximity of green and blue space with SMI prevalence in England as a whole and in its major conurbations (Greater London, Birmingham, Liverpool and Manchester, Leeds, and Newcastle).Methods and findingsWe carried out a retrospective analysis of routinely collected adult population (≥18 years) data at General Practitioner Practice (GPP) level. We used data from the Quality and Outcomes Framework (QOF) on the prevalence of a diagnosis of SMI (schizophrenia, bipolar affective disorder and other psychoses, and other patients on lithium therapy) at the level of GPP over the financial year April 2014 to March 2018. The number of GPPs included ranged between 7,492 (April 2017 to March 2018) to 7,997 (April 2014 to March 2015) and the number of patients ranged from 56,413,719 (April 2014 to March 2015) to 58,270,354 (April 2017 to March 2018). Data at GPP level were converted to the geographic hierarchy unit Lower Layer Super Output Area (LSOA) level for analysis. LSOAs are a geographic unit for reporting small area statistics and have an average population of around 1,500 people. We employed a Bayesian spatial regression model to explore the association of SMI prevalence in England and its major conurbations (greater London, Birmingham, Liverpool and Manchester, Leeds, and Newcastle) with environmental characteristics (green and blue space, flood risk areas, and air and noise pollution) and socioeconomic characteristics (age, ethnicity, and index of multiple deprivation (IMD)). We incorporated spatial random effects in our modelling to account for variation at multiple scales. Across England, the environmental characteristics associated with higher SMI prevalence at LSOA level were distance to public green space with a lake (prevalence ratio [95% credible interval]): 1.002 [1.001 to 1.003]), annual mean concentration of PM2.5 (1.014 [1.01 to 1.019]), and closeness to roads with noise levels above 75 dB (0.993 [0.992 to 0.995]). Higher SMI prevalence was also associated with a higher percentage of people above 24 years old (1.002 [1.002 to 1.003]), a higher percentage of ethnic minorities (1.002 [1.001 to 1.002]), and more deprived areas. Mean SMI prevalence at LSOA level in major conurbations mirrored the national associations with a few exceptions. In Birmingham, higher average SMI prevalence at LSOA level was positively associated with proximity to an urban green space with a lake (0.992 [0.99 to 0.998]). In Liverpool and Manchester, lower SMI prevalence was positively associated with road traffic noise ≥75 dB (1.012 [1.003 to 1.022]). In Birmingham, Liverpool, and Manchester, there was a positive association of SMI prevalence with distance to flood zone 3 (land within flood zone 3 has ≥1% chance of flooding annually from rivers or ≥0.5% chance of flooding annually from the sea, when flood defences are ignored): Birmingham: 1.012 [1.000 to 1.023]; Liverpool and Manchester: 1.016 [1.006 to 1.026]. In contrast, in Leeds, there was a negative association between SMI prevalence and distance to flood zone 3 (0.959 [0.944 to 0.975]). A limitation of this study was because we used a cross-sectional approach, we are unable to make causal inferences about our findings or investigate the temporal relationship between outcome and risk factors. Another limitation was that individuals who are exclusively treated under specialist mental health care and not seen in primary care at all were not included in this analysis.ConclusionsOur study provides further evidence on the significance of socioeconomic associations in patterns of SMI but emphasises the additional importance of considering environmental characteristics alongside socioeconomic variables in understanding these patterns. In this study, we did not observe a significant association between green space and SMI prevalence, but we did identify an apparent association between green spaces with a lake and SMI prevalence. Deprivation, higher concentrations of air pollution, and higher proportion of ethnic minorities were associated with higher SMI prevalence, supporting a social-ecological approach to public health prevention. It also provides evidence of the significance of spatial analysis in revealing the importance of place and context in influencing area-based patterns of SMI.

This paper provides an overview of some of the most memorable sessions that were (co)organised by the Allied Respiratory Professionals Assembly during the 2021 European Respiratory Society International Congress, which was held online for the second consecutive year due to the COVID-19 pandemic. Early Career Members from Assembly 9 summarised the content of the sessions (three oral communication sessions, two symposia and one Expert View) with the support of the chairs from the four Assembly groups: Respiratory Function Technologists and Scientists (Group 9.01); Physiotherapists (Group 9.02); Nurses (Group 9.03); and Psychologists and Behavioural Scientists (Group 9.04). The sessions covered the following topics: impact of COVID-19 on lung function and healthcare services, and the importance of quality assurance and technology in lung function assessment; diagnosis and management of sarcopenia in patients with chronic respiratory disease; maintenance of the effects of pulmonary rehabilitation; solutions outside the hospital for the management of patients with COVID-19 in need of health care; the nursing perspective during the COVID-19 pandemic; and psychological and behavioural issues in respiratory care. This highlights article provides valuable insight into the latest scientific data and emerging areas affecting clinical practice of allied respiratory professionals.

In the last decade, ICT-based interventions for developing reading skills in children with reading disabilities have become increasingly popular. This study had three goals: (a) to assess the existence of gains in word reading, oral reading fluency and listening comprehension after a Tier 2 intervention using the digital tool “I’m still learning,” which was delivered partially in a remote modality during the COVID-19 pandemic; (b) to investigate whether the gains depended on the students’ gender, the number of sessions attended and the interventionist; and (c) to investigate parents’ perceptions about the suitability and perceived effects of the intervention. A single group design with pre-test and post-test was used. The intervention was delivered to second graders (N = 81) flagged as being at-risk for reading disabilities in a universal screening. The analyses showed significant gains in all three outcome variables after the intervention. The gains did not depend on students’ gender, number of intervention sessions attended or interventionist. Parents’ perceptions of the remote intervention were positive. The study findings highlight the potentialities of using technology-based interventions to foster reading skills and suggest that these may be especially useful during lockdowns.

The debate about inclusive education has gained considerable attention in policy, research, and practice in the last decades. Therefore, there is also a growing interest in assessing how inclusive education occurs in schools. Self-assessment and self-reflection tools are strategic to examine schools’ inclusion and guide needed changes. This study attempts to provide Portuguese schools with self-assessment tools for improvement. Themis Inclusion Tool was translated and adapted into a Portuguese version named Resources and Practices for Inclusive Education and evaluated the instrument’s psychometric structure. A web survey was completed online by 924 participants. An EFA suggested two different factors: Inclusive Resources, human, technical and technological resources used to promote learning and; Inclusive Practices, beliefs and behaviors that can be implemented to promote learning. These two factors were supported by confirmatory analysis. Overall, the Resources and Practices for Inclusive Education presented a robust factorial structure and good psychometric properties, appearing to be a valid and reliable measure for assessing inclusive education in Portuguese schools.

A unha em pinça é uma deformidade ungueal, hereditária ou adquirida, que se manifesta como uma hipercurvatura transversal do prato ungueal, sobretudo na sua porção distal, o que provoca uma compressão do leito ungueal, podendo causar dor com incapacidade funcional, assim como infecções secundárias. O tratamento conservador associa-se a uma elevada taxa de recorrência, motivo pelo qual a reconstrução cirúrgica é geralmente necessária. Descrevem-se quatro casos clínicos exemplares de diferentes opções corretivas da unha em pinça.

It is important to identify children who are struggling with emergent literacy skills as early as possible to provide them with the support they need to prevent future academic failure. Screening tools administered in groups are more cost-effective than those administered individually, but few are available in Portugal. The goal of this study was to explore the psychometric properties (difficulty, reliability, and validity) of a group emergent literacy screening test for Portuguese-speaking children. The test includes two phonological awareness tasks, one vocabulary task, and one concepts of print task. The sample comprised 1379 children from pre-K (n = 314), kindergarten (n = 579), and first grade of primary education (n = 486). Measures of emergent literacy, reading and writing skills, and academic achievement were used to test the validity of the screening test. The Rasch model results suggest that the tasks were suitably difficult for the kindergarten group, but had varying levels of difficulty for pre-K and first grade. Reliability was adequate for the tasks with an appropriate level of difficulty. Scores for the screening test were highly correlated with measures of literacy and with academic achievement. These findings suggest that the presented emergent literacy screening test is valid and reliable, making it a useful tool for practice and research.

Fluency is a central skill for successful reading. Research has provided evidence that systematic reading fluency interventions can be effective. However, research is scarce on the effects of interventions delivered remotely versus face-to-face. This study investigated the efficacy of a systematic and standardized intervention for promoting reading fluency in third-grade students (N = 207) during the COVID-19 pandemic. The study had a pretest, posttest, and follow-up design, with two intervention groups (remote vs face-to-face) and a control group. The intervention groups experienced 20 intervention sessions (2 sessions per week), each lasting approximately 50 min. Word reading accuracy, text reading accuracy, and fluency were measured in the three rounds of assessment. In both intervention groups, all measures of reading showed gains from pretest to posttest. The results also suggested that the efficacy of the intervention was similar in the remote and face-to-face modalities. These findings highlight the relevance of systematic interventions in increasing reading fluency and support the use of remote interventions as an adequate alternative to face-to-face interventions.

Plants and their associated microbiota share ecological and evolutionary traits that are considered to be inseparably woven. Their coexistence foresees the use of similar metabolic pathways, leading to the generation of molecules that can cross-regulate each other’s metabolism and ultimately influence plant phenotype. However, the extent to which the microbiota contributes to the overall plant metabolic landscape remains largely unexplored. Due to their early presence in the seed, seed-borne endophytic bacteria can intimately colonize the plant’s endosphere while conferring a series of phytobeneficial services to their host. Understanding the dynamics of these endophytic communities is a crucial step toward the formulation of microbial inoculants that can modulate the functionality of the plant-associated microbiota for improved plant fitness. In this work, wheat (Triticum aestivum) roots non-inoculated and inoculated with the bacterium Herbaspirillum seropedicae strain RAM10 were analyzed to explore the impact of inoculant–endophyte–wheat interrelationships on the regulation of tryptophan (Trp) metabolism in the endosphere environment. Root inoculation with H. seropedicae led to phylum-specific changes in the cultivable seed-borne endophytic community. This modulation shifted the metabolic potential of the community in light of its capacity to modulate the levels of key Trp-related metabolites involved in both indole-3-acetic acid (IAA) biosynthesis and in the kynurenine pathway. Our results support a mode of action of H. seropedicae relying on a shift in both the composition and functionality of the seed-borne endophytic community, which may govern important processes such as root growth. We finally provide a conceptual framework illustrating that interactions among roots, inoculants, and seed-borne endophytes are critical to fine-tuning the levels of IAA in the endosphere. Understanding the outcomes of these interactions is a crucial step toward the formulation of microbial inoculants based on their joint action with seed-borne endophytic communities to promote crop growth and health in a sustainable manner.

Effectiveness of technology-based interventions to improve physical activity (PA) in people with COPD is controversial. Mixed results may be due to participants' characteristics influencing their use of and engagement with mobile health apps. This study compared demographic, clinical, physical and PA characteristics of patients with COPD using and not using mobile apps in daily life. Patients with COPD who used smartphones were asked about their sociodemographic and clinic characteristics, PA habits and use of mobile apps (general and PA-related). Participants performed a six-minute walk test (6MWT), gait speed test and wore an accelerometer for 7 days. Data were compared between participants using (App Users) and not using (Non-App Users) mobile apps. A sub-analysis was conducted comparing characteristics of PA–App Users and Non-Users. 59 participants were enrolled (73% Male; 66.3 ± 8.3 yrs; FEV1 48.7 ± 18.4% predicted): 59% were App Users and 25% were PA-App Users. Significant differences between App Users and Non-App Users were found for age (64.2 ± 8.9 vs. 69.2 ± 6.3yrs), 6MWT (462.9 ± 91.7 vs. 414.9 ± 82.3 m), Gait Speed (Median 1.5 [Q1–Q3: 1.4–1.8] vs. 2.0 [1.0–1.5]m/s), Time in Vigorous PA (0.6 [0.2–2.8] vs. 0.14 [0.1–0.7]min) and Self-Reported PA (4.0 [1.0–4.0] vs. 1.0 [0.0–4.0] Points). Differences between PA–App Users and Non-Users were found in time in sedentary behavior (764.1 [641.8–819.8] vs. 672.2 [581.2–749.4] min) and self-reported PA (4.0 [2.0–6.0] vs. 2.0 [0.0–4.0] points). People with COPD using mobile apps were younger and had higher physical capacity than their peers not using mobile apps. PA-App Users spent more time in sedentary behaviors than Non-Users although self-reporting more time in PA.

O artigo pretende discutir uma particular maneira de espacialização do capital. Para isso, analisa a presença do Airbnb enquanto elemento na produção de espacialidades rurais, constituindo-se em uma evidência de urbanidades no rural num contexto de globalização e planetarização do urbano, tomando-se como exemplo o município de Nova Friburgo, no estado do Rio de Janeiro. Demonstra-se como o espaço se integra e, ao mesmo tempo em que se desafiam as análises dicotômicas existentes, reafirmam-se assimetrias. Destaca-se como a presença de redes técnicas intensificam e aceleram um processo de inserção do lugar rural na escala global, através do seu modelamento para o consumo (como uma representação de espaço de lazer e turismo “antiurbano”, porém, permeado de urbanidades) e sua apropriação por empresas globais, das quais o Airbnb é um exemplo.

Abstract Background Pulmonary rehabilitation (PR) has demonstrated patients’ physiological and psychosocial improvements, symptoms reduction and health-economic benefits whilst enhances the ability of the whole family to adjust to illness. However, PR remains highly inaccessible due to lack of awareness of its benefits, poor referral and availability mostly in hospitals. Novel models of PR delivery are needed to enhance its implementation while maintaining cost-efficiency. We aim to implement an innovative community-based PR programme and assess its cost-benefit. Methods A 12-week community-based PR will be implemented in primary healthcare centres where programmes are not available. Healthcare professionals will be trained. 73 patients with CRD and their caregivers (dyads patient-caregivers) will compose the experimental group. The control group will include dyads age- and disease-matched willing to collaborate in data collection but not in PR. Patients/family-centred outcomes will be dyspnoea (modified Medical Research Council Questionnaire), fatigue (Checklist of individual strength and Functional assessment of chronic illness therapy – fatigue), cough and sputum (Leicester cough questionnaire and Cough and sputum assessment questionnaire), impact of the disease (COPD Assessment Test), emotional state (The Hospital Anxiety and Depression Scale), number of exacerbations, healthcare utilisation, health-related quality of life and family adaptability/cohesion (Family Adaptation and Cohesion Scale). Other clinical outcomes will be peripheral (biceps and quadriceps-hand held dynamometer, 1 or 10 repetition-maximum) and respiratory (maximal inspiratory and expiratory pressures) muscle strength, muscle thickness and cross sectional area (biceps brachialis, rectus femoris and diaphragm-ultrasound imaging), exercise capacity (six-minute walk test and one-minute sit to stand test), balance (brief-balance evaluation systems test) and physical activity (accelerometer). Data will be collected at baseline, at 12 weeks, at 3- and 6-months post-PR. Changes in the outcome measures will be compared between groups, after multivariate adjustment for possible confounders, and effect sizes will be calculated. A cost-benefit analysis will be conducted. Discussion This study will enhance patients access to PR, by training healthcare professionals in the local primary healthcare centres to conduct such programmes and actively involving caregivers. The cost-benefit analysis of this intervention will provide an evidence-based insight into the economic benefit of community-based PR in chronic respiratory diseases. Trial registration The trial was registered in the ClinicalTrials.gov U.S. National Library of Medicine, on 10th January, 2019 (registration number: NCT03799666).

O artigo tem como objetivo refletir sobre as primeiras evidências de transformações nas relações urbano-rurais aceleradas e intensificadas pela mobilidade capital-interior que ocorrem em decorrência dos efeitos da pandemia de Covid-19. Observa-se o estabelecimento de uma relação com o espaço urbano marcada pelo distanciamento, isolamento e medo – produzindo novas espacialidades que enfatizam antigas assimetrias. Com foco no caso fluminense, reflete-se sobre os elementos que compõem uma “fuga para o campo” para aqueles com acesso à “hipermobilidade”, ao passo em que a frágil mobilidade (ou, ao revés: a obrigação de mover-se sob o risco de contágio) segue ainda como norma para muitos.

AbstractIntroduction Chronic obstructive pulmonary disease (COPD) often leads to an increased dependence on the informal carer, which can result in higher levels of distress, anxiety or depression associated with the burden of caregiving and, consequently, reduced quality of life [1]. Several instruments have been used to assess carer burden in COPD; however, their measurement properties have been poorly assessed in this population [2]. The Questionário de Avaliação de Sobrecarga do Cuidador Informal (QASCI) is a Portuguese questionnaire, originally created for carers of patients with stroke [3] and later validated in a sample with various chronic diseases, including respiratory diseases [4]. However, its reliability and validity in informal carers of patients with COPD have yet to be established. Therefore, this study aimed to assess the reliability and validity of the QASCI questionnaire for informal carers of patients with COPD.Materials and methods The Portuguese questionnaire QASCI evaluates the distress associated with burden of caregiving (scores range from 0 to 100, with higher scores indicating higher levels of burden). It has 32 items divided in 7 subscales (emotional burden; personal life implications; financial burden; reactions to demands; mechanism of efficacy and control; familiar support; and satisfaction with the role). Each item is scored with a 5-point Likert scale. Reliability included internal consistency assessment using the Cronbach’s alpha. Construct validity was assessed using the following questionnaires: Zarit Burden Interview (ZBI) for concurrent validity; the Hospital Anxiety and Depression Scale (HADS) (anxiety and depression) and WHOQOL-Bref (quality of life) for convergent validity. Pearson’s (r) or Spearman’s (ρ) correlation coefficients were used according to the distribution of each variable. QASCI was expected to present a stronger (positive) correlation with ZBI than with HADS (r ≥ 0.5) and a negative correlation with WHOQOL-Bref (r≤–0.4) [3,4].Results Forty-one carers (62.4 ± 10.1 years, 90.2% female; patients’ FEV1=43.7 ± 19.7%pred) completed the questionnaires. Cronbach’s alpha of the full QASCI scale was 0.767 and the subscales presented values between .633 and .929. QASCI and ZBI had a very strong positive correlation (r = 0.914; p=.01). QASCI had a strong positive correlation with HADS anxiety (r = 0.608; p=.01) and depression (ρ = 0.617; p=.01) subscales and moderate to strong negative correlations with all the WHOQOL-Bref subscales (–0.418 to 0.723, p=.01).Discussion and conclusions QASCI presented good internal consistency and construct validity results. QASCI seems to be a promising measure to evaluate distress levels associated with burden of caregiving in informal carers of patients with COPD.