[Early child development inequalities and associated factors between public and private providers at metropolitan region in Chile]. / Desigualdades en desarrollo infantil temprano entre prestadores públicos y privados de salud y factores asociados en la Región Metropolitana de Chile.

Early child development is a population determinant of physical, mental and social health. To know the base line situation prior to the implementation of "Chile grows with you" (Chile Crece Contigo) is key to its evaluation. OBJECTIVE: To compare early child development and associated factors at baseline in pre-school children from public and private health sectors. PATIENTS AND METHOD: The sample consisted of 1045 children aged 30-58 months, 52% male, and 671 from the public and 380 from the private sector of the metropolitan region in Chile were evaluated using Battelle Developmental Inventory-1 and a household interview of primary carer. RESULTS: Abnormal child development was found in 14.4% of children in the private sector compared to 30.4% in the public sector. There were no differences in adaptive area (26.3% vs 29.2%), but there were statistically significant differents in cognitive (8.8% vs 12.1%), social-personal (13.2% vs 32.5%), motor (19.2% vs 35.3%), and communication (19% vs 36.8%) development. The logistic regression showed that, independent of socioeconomic level, the risk factors are: Apgar<7 (OR: 5.4; 95% CI: 1.24-23.84); having childhood chronic diseases (OR: 1.3; 95% CI: 1.11-1.42). Protective factor is: home with resources to learn and play (OR: 0.8; 95% CI: 0.76-0.89). CONCLUSION: These results are another input about early child development situation and its importance for paediatric social policy.

PATTERNS OF EMOTIONAL AVAILABILITY IN MOTHER-INFANT DYADS: ASSOCIATIONS WITH MULTIPLE LEVELS OF CONTEXT.

This study explored emotional availability (EA)- an individual's emotional responsiveness and attunement to another's needs and goals (R.N. Emde, 1980)- among a high social risk group of 226 adolescent mothers and their infants (average = 12 months old). The aim was to identify dyadic patterns of EA and to examine their association with multiple indicators of the ecological context. Maternal sensitivity, maternal nonhostility, and child responsiveness were assessed with the Emotional Availability Scales, Third Edition (Z. Biringen, J. Robinson, & R.N. Emde, 1998) during free play and teaching observations at home. Four EA patterns were identified using k-means cluster analysis: (a) "low functioning," (b) "high functioning," (c) "low functioning dyads with nonhostile mothers," and (d) "inconsistently sensitive mother and responsive child." These patterns had distinct associations with (a) mothers' parenting attitudes regarding children's power and independence and parent-child role reversal, (b) mothers' strategies in conflict resolution with their partners and their children, and (c) the dyads' living arrangements. This study makes a contribution to the understanding of the mother-child relationship from a systemic and relational perspective and explores the association of EA patterns with the dyads' relational context. Implications for programs and treatment approaches aimed at supporting dyads at social risk are discussed.

Supporting the caregiver-child dyad's relationship: An evaluation of implementation quality in the Chilean Crecer Jugando program.

This study presents an evaluation of the implementation quality of the Chilean program Crecer Jugando (CJ), a 16 weekly sessions group-based parenting program for children 0 to 4 years old and their primary caregivers aiming at promoting positive caregiver-child interaction. The implementation of CJ in two public health care centers (HCC) in Chile's Metropolitan Region was assessed based on Donabedian's theoretical model, focusing on the dimensions of the program's structure (e.g., infrastructure and supplies), processes (e.g., coordination of CJ team with the HCCs, participants' attendance, CJ team interaction with participating children), and preliminary outcomes (i.e., parenting stress, caregiver-child interaction). A total of 63 main caregiver-child dyads participated in the study, which took place over a six-month period. Results indicated that the CJ program was feasible to be implemented in two HCCs and would benefit from improving the coordination with the HCCs and the quality of interaction of the CJ team with participating children. After participation in the CJ program, caregivers showed a decrease in their parenting stress. Lessons learned are discussed.

Desigualdades en desarrollo infantil temprano entre prestadores públicos y privados de salud y factores asociados en la Región Metropolitana de Chile / Early child development inequalities and associated factors between public and private providers at metropolitan region in Chile

El desarrollo infantil temprano es un determinante de la salud física, mental y social de poblaciones. Conocer la situación de desarrollo de base, previo a la instalación de «Chile Crece Contigo¼, es clave para efectos de su evaluación. Objetivo: Comparar el desarrollo infantil temprano y factores asociados de preescolares del sector público y del sector privado de salud en la línea de base. Pacientes y método: Una muestra de 1.045 niños de la Región Metropolitana, de 30 a 58 meses, 52% hombres, 671 del sector público y 380 del privado de salud. Se evaluaron mediante el Inventario de Desarrollo Battelle-1 y una encuesta psicosocial en sus hogares aplicada al cuidador principal. Resultados: El 14,4% del sector privado y el 30,4% de la red pública tenían desarrollo alterado. No hubo diferencias en el área adaptativa entre ambos grupos (26,3% vs 29,2%). En las áreas cognitiva (8,8% vs 12,1%), personal-social (13,2% vs 32,5%), motriz (19,2% vs 35,3%) y comunicación (19,0% vs 36,8%) las diferencias fueron estadísticamente significativas. Mediante regresión logística se determinó que, independiente del nivel socioeconómico, son factores de riesgo: Apgar < 7 (OR: 5,4; IC 95%: 1,24-23,84), tener enfermedades crónicas de la infancia (OR: 1,3; IC 95%: 1,11-1,42); protector es: hogar con recursos para el aprendizaje y juego (OR: 0,8; IC 95%: 0,76-0,89). Conclusión: Estos resultados son un aporte al conocimiento de la situación del desarrollo infantil y para relevar su importancia para las políticas sociales en pediatría.

Early child development is a population determinant of physical, mental and social health. To know the base line situation prior to the implementation of "Chile grows with you" (Chile Crece Contigo) is key to its evaluation. Objective: To compare early child development and associated factors at baseline in pre-school children from public and private health sectors. Patients and method: The sample consisted of 1045 children aged 30-58 months, 52% male, and 671 from the public and 380 from the private sector of the metropolitan region in Chile were evaluated using Battelle Developmental Inventory-1 and a household interview of primary carer. Results: Abnormal child development was found in 14.4% of children in the private sector compared to 30.4% in the public sector. There were no differences in adaptive area (26.3% vs 29.2%), but there were statistically significant differents in cognitive (8.8% vs 12.1%), social-personal (13.2% vs 32.5%), motor (19.2% vs 35.3%), and communication (19% vs 36.8%) development. The logistic regression showed that, independent of socioeconomic level, the risk factors are: Apgar < 7 (OR: 5.4; 95% CI: 1.24-23.84); having childhood chronic diseases (OR: 1.3; 95% CI: 1.11-1.42). Protective factor is: home with resources to learn and play (OR: 0.8; 95% CI: 0.76-0.89).