Anelise Sonza

Postural changes in children and adolescents are often associated with less optimal postural patterns during activities of daily living; therefore, valid, reliable, and responsive tools are needed to analyze dynamic posture in different contexts. This study developed and validated an instrument to assess the dynamic posture of children and adolescents during postural habits in activities of daily living, using video observation and applicable both in person and online. A methodological study conducted in two stages: instrument development and evaluation of its psychometric properties. First stage: (A) Literature review; (B) Field research; and (C) Development of the initial version. Second stage: (D) Content validation was performed with the Content Validity Index (CVI) by an expert panel; (E) Inter-rater reliability was performed for each biomechanical criterion of dynamic postures in the DAP-CA, measured by Fleiss’ Kappa coefficient (FKC), and intra-rater reliability was assessed by Kappa Coefficient (KC). The reliability of the overall DAP-CA score was analyzed using the Intraclass Correlation Coefficient (ICC) and also the Standard Error of Measurement (SEM) and the Minimal Detectable Change (MDC); and (F) sensitivity to pre–post change was evaluated before and after intervention using Student’s t-test (p≤0.05), Effect Size (ES), and Standardized Response Mean (SRM). The DAP-CA showed high content validity (CVI ≥ 0.90) and was considered applicable by experts. Inter-rater reliability ranged from substantial to almost perfect, and intra-rater reliability ranged from substantial to almost perfect, across both in-person and online modalities. The overall score demonstrated good to excellent reliability across the face-to-face and online modalities (ICC = 0.89–0.94), with SEM values ranging from 0.46 to 0.62 points and MDC values ranging from 1.27 to 1.72 points. The DAP-CA detected significant pre- to post-intervention changes (p<0.001), with large standardized effect sizes and standardized response means. The DAP-CA demonstrated evidence of content validity, substantial to almost perfect inter- and intra-rater agreement, and good to excellent reliability of the overall score. It also demonstrated sensitivity to pre- to post-intervention changes, supporting its potential use for assessing dynamic posture in children and adolescents.

Science often focuses on data, statistics, and numbers; however, these quantitative aspects represent only one dimension of research. Behind every data point, there are researchers— people whose motivations, ethics, and relationships with the subject shape the outcomes of scientific inquiries. Research is not merely a process of collecting facts; it is a dynamic interaction between researchers and their subjects, whether the subjects are a community, a biological process, or a physical phenomenon. This relationship reflects the personal commitment, empathy, and ethical responsibility researchers bring to their work, balancing pursuing knowledge and considering humans and their impact on society. The process of presenting the research findings involved a compromise. Researchers must decide how to interpret and report their results to ensure transparency, while addressing the complexities and uncertainties of their data. This responsibility extends beyond publishing conclusions. Researchers must provide feedback that is accessible, meaningful, and beneficial to the community. Effective communication involves acknowledging limitations, engaging in potential implications, and fostering ongoing dialogue with peers and the public. Science ultimately extends beyond the numbers. It involves recognizing the intertwined nature of data, human experience, and ethical responsibility. By embracing this holistic approach, research can foster a deeper understanding, inspire meaningful change, and contribute to societal well-being. This perspective underscores the importance of empathy and integrity in the pursuit of knowledge and highlights that broader impact science can extend beyond the confines of numerical data.

Background/Objectives: Traditional anthropometric indicators such as body mass index (BMI) may inadequately capture functional muscular impairment in obesity. To investigate a multidimensional composite muscle quality index (MQI) integrating relative strength and lower-limb functional power in adults with severe obesity. Methods: The study included 202 adults with severe obesity. The Composite MQI was calculated as the mean of standardized z-scores derived from handgrip strength (HG) normalized by fat-free mass (FFM) (HG/FFM) and sit-to-stand power (STS power) normalized by skeletal muscle mass (MM) (STS power/MM). Associations between the Composite MQI and demographic, anthropometric, and body composition variables were assessed using correlation analyses and multivariable linear regression. Participants were additionally stratified into quartiles of the Composite MQI to explore age-related differences. Results: The mean age of the study group was 44.9 ± 14.0 years, and the BMI was 42.5 ± 5.1 kg/m². Age showed a moderate inverse association with the Composite MQI (r = −0.41, p < 0.001), whereas BMI showed no significant correlation (r = −0.09). In multivariable regression models adjusted for sex and BMI, increasing age remained independently associated with lower Composite MQI (β = −0.022, p < 0.001), whereas BMI was not independently associated with Composite MQI (p = 0.373). Men exhibited higher relative and absolute HG than women, although no significant sex differences were observed for STS power/MM. Quartile analyses showed lower Composite MQI values among older participants. Conclusions: Among adults with severe obesity, age was associated with lower values of a multidimensional Composite MQI, whereas BMI showed limited association within this population. A composite approach integrating relative strength and functional power may provide a more comprehensive characterization of muscle performance relative to muscle quantity than traditional anthropometric measures.

Background: Pediatric obesity is characterized by substantial metabolic heterogeneity, including adiposity, insulin resistance, inflammation, and energy metabolism. Traditional categorical classifications may inadequately capture this complexity. Objective: To identify clinically meaningful metabolic phenotypes using unsupervised clustering and to compare the statistical performance and clinical interpretability of two- and three-cluster solutions. Methods: In this cross-sectional study, 758 children and adolescents with obesity underwent anthropometric, biochemical, and indirect calorimetry assessments. Fat-free mass was estimated using validated bioimpedance-based equations, and fat-free mass index (FFMI) was standardized before clustering. K-means clustering (k = 2 and k = 3) was performed using FFMI z-score, BMI-SDS, HOMA-IR, triglycerides, and HDL-cholesterol. Cluster validity was assessed using the Silhouette, Elbow, Davies–Bouldin index, Calinski–Harabasz index, and Gap statistic methods. Validation employed variables not included in clustering, such as glucose-insulin dynamics, inflammatory and hepatic markers, blood pressure, respiratory quotient, and resting energy expenditure (REE). Group comparisons were performed using Kruskal–Wallis and Dunn’s post-hoc tests with false discovery rate correction. Results: Both clustering solutions demonstrated significant separation across metabolic domains. The two-cluster model identified metabolically favourable and unfavourable phenotypes differing in adiposity, insulin resistance, inflammatory burden, hepatic markers, blood pressure, and REE. The three-cluster solution revealed a more granular metabolic stratification with an intermediate phenotype characterized by partial metabolic impairment. Validation confirmed robust differences across physiological variables (all FDR-adjusted p < 0.05). Although the two-cluster solution showed slightly superior internal validity, the three-cluster model provided greater clinical granularity and phenotypic resolution. Conclusions: Unsupervised clustering identified biologically coherent metabolic phenotypes in pediatric obesity. While the two-cluster solution provided statistically robust stratification, the three-cluster configuration captured a broader spectrum of metabolic heterogeneity and risk profiles, supporting the application of higher-resolution phenotyping approaches in pediatric endocrinology and metabolic risk assessment.

Introduction: Preterm birth is associated with an increased risk of early neurodevelopmental difficulties, but reported prevalence varies widely across studies and across degrees of prematurity. This review aimed to estimate the prevalence of motor, language, and cognitive delays in preterm infants according to the degree of prematurity. Methods: This review followed the PRISMA guidelines and was registered in the International Prospective Register of Systematic Reviews (PROSPERO CRD42021252388). PubMed, VHL, SciELO, Scopus, and Embase were searched for cohort and cross-sectional studies published from January 2012 to February 2023 in English, Portuguese, or Spanish. Eligible studies evaluated preterm infants from birth to 24 months of corrected age using the Bayley Scales of Infant and Toddler Development (BSID/BSITD), the Brunet-Lézine Scale, or the Denver Developmental Screening Test. Randomeffects proportional meta-analyses using the Freeman-Tukey double-arcsine transformation were conducted to estimate the prevalence of mild and significant motor, language, and cognitive delays. Results: 22 studies were included, and pooled analyses included 2,958–3,258 infants, depending on the outcome. The Bayley Scales were used in all included studies, whereas the Brunet-Lezine and Denver instruments were each reported in one study in combination with the Bayley. The pooled prevalence of mild delays was highest for language (22.73%; 95% CI: 13.92–32.93), followed by motor (18.15%; 95% CI: 10.72–26.91) and cognitive (11.90%; 95% CI: 5.80–19.71) domains. Significant delays were less frequent overall. Extremely preterm infants showed the highest prevalence across domains, especially for mild motor and language delays. Discussion: Considerable heterogeneity was observed across analyses, likely reflecting differences in assessment age, Bayley edition, clinical profiles, and study settings. Therefore, pooled estimates should be interpreted with caution. Conclusion: Preterm infants, particularly those born extremely preterm, present a substantial prevalence of neurodevelopmental delays during the first two years of life. These findings support early developmental surveillance, timely referral, and targeted intervention in this high-risk paediatric population.

Background and Purpose: Basketball has a high prevalence of lower limb injuries, particularly at the ankle. Reduced ankle dorsiflexion range of motion (ROM) has been identified as a potential risk factor. Acute interventions such as flossing (FL) and neural mobilization (NM) may influence ankle ROM and neuromuscular function; however, their immediate effects in adolescent athletes remain unclear. This study compared the acute effects of flossing and sciatic neural mobilization on ankle ROM, isometric strength, and dynamic postural balance in adolescent basketball athletes. Methods: Adolescent basketball athletes participated in two sessions of a randomized crossover design with a 1‐week washout period. In each session, either FL or NM was applied to the dominant ankle, while the contralateral limb served as a within participant control. Outcomes included the Weight Bearing Lunge Test (WBLT), two‐dimensional kinematic assessment of ankle dorsiflexion and plantarflexion, isometric ankle strength and the Modified Star Excursion Balance Test (mSEBT). Generalized estimating equations accounted for repeated measures and crossover effects. Period and carryover effects were tested and were not significant. Standardized effect sizes (Cohen's dz) and 95% confidence intervals were used to describe magnitude. Results: Small to moderate immediate increases in WBLT distance were observed following both interventions (NM: Δ ≈ 0.5 cm, dz ^z ≈ 0.49; FL: Δ ≈ 1.3 cm, dz ^z ≈ 0.73), with similar changes in control limbs. Changes in dorsiflexion angulation showed small to moderate standardized effects in both intervention and control conditions. Dynamic postural balance measures demonstrated trivial to small changes. No differences were observed in ankle muscle strength. Discussion: Both interventions produced small immediate changes in ankle dorsiflexion‐related outcomes. However, comparable responses in control limbs and the lack of meaningful changes in strength or dynamic postural balance indicate that these acute effects are likely limited and should be interpreted with caution.

Background: Sex-related differences in insulin sensitivity during adolescence remain incompletely understood, particularly in the context of obesity. Whether these differences reflect variations in basal insulin resistance or dynamic insulin responses remains unclear. Objective: To investigate sex differences in glucose and insulin responses during the oral glucose tolerance test (OGTT) and to explore mechanisms underlying potential dissociation between glycemic and insulinemic profiles. Methods: A cross-sectional analysis of 753 adolescents with obesity who underwent a standard oral glucose tolerance test (OGTT). Plasma glucose and insulin were measured at fasting and at 30, 60, 90, and 120 min. Mixed-effects models were used to examine glucose and insulin trajectories over time, including sex-by-time interactions, and to adjust for body mass index standard deviation score (BMI_SDS), pubertal stage (Tanner), metabolic syndrome (MetS), and body composition (resistance index). Multiple linear regression models were fitted to assess associations of sex with HOMA-IR, HOMA-β, total area under the curve (AUC), and phase-specific insulin AUCs. Results: Glucose trajectories during OGTT were similar between sexes, with no significant sex or sex-by-time interaction effects after adjustment. In contrast, insulin trajectories differed significantly by sex (sex-by-time interaction β = −0.10, p < 0.001). Boys exhibited higher baseline insulin levels and greater total insulin exposure (β = −11.2, p < 0.001), independent of BMI_SDS, pubertal stage, MetS, and body composition. Sex differences were sustained across all OGTT phases. HOMA-IR did not differ by sex, whereas HOMA-β showed a sex-related difference. BMI was positively associated with both basal and dynamic insulin measures. Conclusions: In adolescents with obesity, sex differences are characterized by altered dynamic insulin responses rather than differences in glycemic control. Boys exhibit greater compensatory insulin exposure during glucose challenge, independent of BMI-based adiposity, BIA-derived body composition and pubertal development.

Background: Profound musculoskeletal alterations encompassing bones and soft tissues are common in people with anorexia nervosa (AN). This study aims to examine spinal posture and mobility in adolescents with AN, and to compare these outcomes with those obtained from normal-weight female controls. Methods: Spinal posture and movements were measured in 37 adolescents with AN and 31 normal-weight controls using the Idiag M360 scan tool, and between-group differences were analyzed using analysis of covariance. Results: Spinal postures and the lumbar-to-hip ratio were not different between subgroups. By contrast, AN had reduced thoracic (−21.8 degrees, p < 0.0001) and lumbar (−18.2 degrees, p < 0.0001) mobility in the frontal plane, as well as decreased hip flexion (−14 degrees, p = 0.001) and extension (−18.6 degrees, p < 0.0001) compared to the CG. Conclusions: Thoracic and lumbar spinal mobility, mainly in the frontal plane, and also hip mobility in the sagittal plane, are decreased in AN. These findings provide clinically relevant insights into spinal characteristics in adolescents with AN.

Introduction: The aim of the study was to investigate scientific evidence related to the protocols and effects of PEPs using theoretical and practical approaches and physical activity in school environments. Methods: This systematic review was conducted according to the PRISMA guidelines and registered on the PROSPERO platform. The search was conducted in five electronic databases until December 2024. Randomized controlled clinical trials, non-randomized clinical trials, and quasi-experimental, interventional, and longitudinal studies published over the last 10 years were included. The studies involved children and adolescents with typical development, participating in postural education interventions in school environments that involved physical activity. Methodological quality was assessed using the PEDro Scale, and the risk of bias was evaluated using ROB 2_cluster and ROBINSI. Results: From 1,147 identified records, 11 studies met the eligibility criteria, involving 35–4,695 participants aged 5–16 years. While most studies reported improvements in postural knowledge and health education, findings on postural habits, pain reduction, and muscular endurance were inconsistent. Randomized clinical trials and most other studies exhibited good and reasonable methodological qualities, respectively. High and moderate risks of bias were prevalent. Discussion: Variability in assessment methods, interventions, and physical activity components limits standardization, yet studies aim to prevent postural changes and promote postural care to improve health in children and adolescents. Conclusion: PEPs incorporating physical activity show promise in improving postural knowledge, though evidence on long-term benefits for low back pain and postural behaviors remains inconclusive. Future research should standardize protocols and assess sustained outcomes.