Promoción de la salud afectiva-sexual en primera infancia, contexto de cuido y educativo en Costa Rica. Una revisión crítica / Affective-sexual health promotion in early childhood: critical review in the context of childcare and education in Costa Rica

Resumen La presente revisión describe investigaciones sobre el desarrollo afectivo-sexual en primera infancia en el ámbito preescolar y de cuido; éstas se analizan desde el marco normativo y operativo en el cual se sustenta la educación sobre este tema en Costa Rica. Dicha revisión se realizó con 4 bases de datos internacionales y se sustentó en estudios empíricos y de revisión. Los estudios hallados apuntan a una diversidad de procesos a tomar en cuenta. Algunos de éstos se relacionan con el desarrollo de vínculos seguros y confiables, el uso de terminología genital desde temprana edad, abordajes asertivos de las manifestaciones afectivas-sexuales de infantes, así como a contemplar los aspectos culturales y socio-históricos. A nivel nacional se encuentra que existe un amplio marco normativo que respalda la comprensión integral del desarrollo afectivo-sexual para su abordaje. Sin embargo, se observa que en el programa nacional de preescolar, se prioriza el riesgo al abuso sexual. Además en este se devela una visión moralista por edades, considerando que los genitales deben nombrarse sólo en los últimos niveles de preescolar y no cuando se conocen las partes del cuerpo en los niveles iniciales. Desde un enfoque de promoción de la salud sexual en el ámbito de cuido y educativo nacional, aquí se propone una visión más amplia que tiene plenamente en cuenta las complejidades en torno a los determinantes sociales del desarrollo afectivo sexual. Por lo que se requiere una actualización del programa de preescolar, acompañado de formación continua para el personal y las familias de infantes.

Abstract This critical review describes research on affective and sexual development in early childhood in preschool and childcare settings. Studies are analyzed from the point of view of the regulatory and operational frameworks on which education on this topic in Costa Rica is based. The review was carried out using 4 international databases, examining empirical studies and review studies. Costa Rica has put in place a broad national-level policy framework that supports a comprehensive understanding of affective-sexual development from infancy. However, implementation of the policy in the national preschool program does not always meet the framework's standards. We find that the risk of sexual abuse tends to be prioritized in early sexual-affective education. Sexual-affective development is often addressed from a moralistic standpoint, advising for instance that the genitals should be named only in the last levels of preschool and not when the other parts of the body are first named. From a health-promotional perspective on national childcare and early education, we here propose a broader view that takes fully into account the complexities around the social determinants of sexual-affective development. We conclude that an update of the preschool program is required, accompanied by continuous training for staff and families of infants.

Pediatric medical psychology.

Paediatric medical psychology is a specialised field within clinical health psychology focussed on the behavioural, developmental, and psychological needs of children, adolescents, and families in healthcare contexts. Paediatric medical psychologists address a myriad of problems by employing evidence-based evaluations and interventions in order to support the well-being of paediatric patients and their families. In this paper, we provide an overview of paediatric medical psychology including the education and training required to be a paediatric psychologist followed by common problems addressed by paediatric psychology, the settings paediatric psychologists work in, and the services they provide. Discussion concludes with future application of integrating paediatric psychology throughout the continuum of care to optimise adjustment and health of paediatric patients.

Influencia de las relaciones familiares en la primera infancia / Influence of family relationships in early childhood

Las relaciones familiares influyen significativamente en el desarrollo físico y emocional del individuo, al ser la familia una de las principales instituciones de la sociedad. El objetivo de este artículo es analizar la influencia de las relaciones familiares en el desarrollo de la primera infancia. Para la metodología se utilizó el enfoque cualitativo, desde la perspectiva hermenéutica, bajo la modalidad del estado del arte, por medio de una revisión documental. En los hallazgos encontrados prevalece que la familia es un factor protector influyente durante la primera infancia, y permite la construcción de valores y la instauración de normas; de acuerdo a la calidad del vínculo surgen oportunidades que propician la construcción de sus propias experiencias. Una de las principales conclusiones es que cada familia es única y construye sus propias dinámicas con base en los límites y normas que allí se establecen, de acuerdo a sus creencias y cultura, que hacen que se diferencie una de otra.

Family relationships significantly influence the physical and emotional development of the individual, as the family is one of the main institutions of society. The objective of this article is to analyze the influence of family relationships on the development of early childhood. Qualitative approach was used as methodology, from the hermeneutic perspective, under the modality of the state of the art, through a documentary review. As a result of this investigation, it prevails that the family is an influential protective factor during early childhood, and allows the construction of values and the establishment of norms; according to the quality of the family bond, opportunities arise that favor the construction of their own experiences. One of the main conclusions is that each family is unique and builds its own dynamics based on the limits and norms established there, according to their beliefs and culture, which make them different from each other.

The multidisciplinary pediatric psycho-oncology workforce: A national report on supervision for staff and training opportunities.

OBJECTIVE: This paper presents data on licensure/certification status, supervision of multidisciplinary pediatric psychosocial staff, and training opportunities in pediatric cancer programs in the United States, data that are critical to provide care aligned with the Standards of Psychosocial Care in Pediatric Cancer (Psychosocial Standards). METHODS: An online survey of psychosocial care consistent with the Psychosocial Standards was completed from a national sample of pediatric cancer programs (144/200). Licensure/certification status, availability and format of supervision for multidisciplinary staff (social workers, psychologists, psychiatrists, child life specialists/recreational therapists), and types and number of psychosocial trainees were reported. RESULTS: Nearly all pediatric psychosocial providers were licensed/certified. Peer consultation was the most frequently endorsed form of staff supervision although a sizeable group of centers reported no systematic ongoing supervision. Trainees in social work and child life were most common although the size of trainee cohorts is generally small. Psychosocial trainees are more prevalent in sites with pediatric hematology/oncology medical fellowship programs and in larger programs. CONCLUSIONS: A properly trained and supported psychosocial workforce is essential to providing evidence-based care consistent with the Psychosocial Standards. Psychosocial providers are appropriately licensed. However, supervision opportunities are variable and may be inadequate for the intensity of the work. It is important to address the limited opportunities for trainees in pediatric cancer programs, which may influence the pipeline for ongoing and future work in this area.

Perceived Mentoring Practices in Developmental-Behavioral Pediatrics Fellowship Programs.

OBJECTIVE: Junior physicians describe mentoring relationships as integral to their career development and success. Current evidence suggests that mentoring is under-utilized despite interest from trainees. The purpose of this study is to describe the mentoring practices in developmental-behavioral pediatric (DBP) fellowship programs and identify mentoring needs of DBP fellows and recent graduates. METHODS: DBP fellows and recent graduates less than 5 years out of training from US-based DBP fellowship programs were contacted to complete a survey on their mentoring experiences in fellowship and early career. RESULTS: A total of 90 respondents completed the entire survey including 47 current DBP fellows and 43 recent graduates. Only 52% of respondents reported having a formal faculty mentor during their fellowship. Only 45% of recent graduates reported that they currently have a mentor, of those without a current mentor 83% said they would like to have a mentor. Adequate mentoring during fellowship was lowest for career development and research (34% and 27%). Satisfaction with mentoring was associated with having a formal mentor (p < .001) and receiving mentoring in multiple areas (p < .001). Qualitative responses suggested that effective mentoring addresses the mentee's career goals, provides insight into being a developmental-behavioral pediatrician, assists in navigating academics, and involves a personal relationship. CONCLUSION: Results suggest opportunities for improved mentoring in DBP fellowship programs, particularly in the areas of career development and research and that there is a significant need for mentorship among recent graduates. Findings from this study can inform program improvement in mentoring for DBP fellows and recent graduates.

[Test Reviews in Child Psychology: Test Users Wish to Obtain Practical Information Relevant to their Respective Field of Work]. / Testrezensionen in der Kinderpsychologie: Testanwender wünschen sich praxisnahe und zielgruppenspezifische Informationen.

Test Reviews in Child Psychology: Test Users Wish to Obtain Practical Information Relevant to their Respective Field of Work This study investigated to what extent diagnosticians use reviews of psychometric tests for children and adolescents, how they evaluate their quality, and what they expect concerning content. Test users (n = 323) from different areas of work (notably social pediatrics, early intervention, special education, speech and language therapy) rated test reviews as one of the most important sources of information. Readers of test reviews value practically oriented descriptions and evaluations of tests that are relevant to their respective field of work. They expect independent reviews that critically discuss opportunities and limits of the tests under scrutiny. The results show that authors of test reviews should not only have a background in test theory but should also be familiar with the practical application of tests in various settings.

Intervención educativa para la aprehensión del enfoque de género en infantes / Educational intervention for apprehension of the gender approach in infants

Introducción: Es importante reconocer desde edades tempranas del género cómo un determinante social modificable contribuye a fomentar una cultura en salud. Objetivo: Desarrollar una intervención educativa para la aprehensión del enfoque de género por la salud en niñas y niños.bMétodos: Investigación acción realizada en la escuela primaria Felipe Poey del municipio Plaza de la Revolución entre el 2012-2013. El grupo de estudio estuvo constituido por 16 escolares de 4to. grado, entre 8 y 9 años de edad, seleccionados por criterios de intención. La investigación estuvo compuesta por tres fases, de cuatro sesiones dos de ellas y de cinco la última. La metodología empleada se basa en uno de los principios de la educación popular: práctica-teoría-práctica enriquecida. Resultados: Se constató que las creencias y experiencias personales de los infantes responden a representaciones sexistas discriminatorias, lo que se utilizó como punto de partida para guiar la teoría, que contribuyó al enriquecimiento de conocimientos sobre género y salud. Los nuevos conocimientos se pudieron comprobar en diferentes momentos de las sesiones propuestas. Conclusiones: La propuesta diseñada contribuye a la transformación de las percepciones sexistas de niñas y niños hacia modos de actuación, juicios y valoraciones que reflejan la aprehensión del enfoque de género, así como la disposición de los infantes para convertirse en promotores de género por la salud(AU)

Introduction: At early ages, recognizing the gender as a modifiable social determinant encourages health culture. The use of literature as a learning means is a new way of achieving flexible and equitable relationships of respect among infants, and at the same time, developing sensitivity towards several topics such as health. Objective: To develop educational intervention for apprenhension of gender approach for health in girls and boys. Methods: Research-action conducted in Felipe Poey elementary school in Plaza de la Revolución municipality from 2012 to 2013. The study group was made up of sixteen 4th grade school children aged 8 to 9 years, who were selected by intention criteria. This research consisted of three phases, the two first with three sessions, and the last one having five sessions. The methodology was based on one of the principles of people´s education, that is, practice-theory-upgraded practice. Results: It was confirmed that individual beliefs and experiences of infants came from discriminatory sexist representations, which was used as the starting point to guide theory and contributed to improve knowledge on gender and health. The new knowledge could be confirmed at different moments of the sessions. Conclusions: The proposal contributes to change the sexist perceptions by girls and boys related to the gender roles and stereotypes, into behaviors, criteria and assessments that show the aprenhension of gender approach as well as the infant´s willingness to become gender promoters for health(AU)

Teaching attachment behaviors to pregnant women: a randomized controlled trial of effects on infant mental health from birth to the age of three months.

BACKGROUND: Maternal-fetal attachment, which forms as soon as pregnancy starts, is essential to an infant's mental development. OBJECTIVE: This study aimed to explore the effect of teaching attachment behaviors to pregnant women on infant mental health from birth to 3 months of age. DESIGN: Randomized controlled trial. SETTING: Hafiz Hospital, Shiraz University of Medical Sciences, Iran, from February to November 2014. PATIENTS AND METHODS: The participants were randomly divided into an intervention and a control group at 28-34 weeks gestation. The participants in the intervention group attended six educational sessions each lasting for 60-90 minutes. After delivery, the infants of mothers in each group were compared in terms of mental health indexes (total mean scores and scores derived from a checklist of questions for infant mental health with results categorized as low, average and high). Maternal anxiety levels were also recorded at birth and at 3 months. MAIN OUTCOME MEASURE(S): Infant mental health index. RESULTS: In 190 pregnant women (96 in the intervention group and 94 in the control group), the total mean (SD) scores for infant mental health at birth were 16.66 (1.51) in the intervention group and 16.07 (1.74) in the control group (P=.013). At 3 months, the total mental health scores infants were 31.05 (1.88) in the intervention group and 30.25 (2.10) in the control group (P=.007). Differences in checklist scores between the groups at 3 months were not statistically significant, except for crying intensity at 3 months (P=.021). Women in the control group had higher anxiety levels at 3 months (P=.01). CONCLUSION: Teaching attachment skills to mothers increased the attachment between the mothers and their infants, and consequently, improved infant mental health. Thus, teaching attachment skills should be incorporated into routine prenatal care. LIMITATIONS: Use of phone calls by the researcher to assess mental health.

Reducing and preventing internalizing and externalizing behavior problems in children with type 1 diabetes: a randomized controlled trial of the Triple P-Positive Parenting Program.

BACKGROUND: Children with type 1 diabetes are at increased risk of mental health problems, which in turn are associated with poor glycemic control, diabetes-related complications, and long-term psychiatric morbidity. We tested the efficacy of the Triple P-Positive Parenting Program in reducing or preventing mental health problems and improving glycemic control in children with type 1 diabetes in a randomized controlled trial. METHODS: Participants were recruited from the Diabetes Clinic, Royal Children's Hospital, Melbourne, Australia, and randomized to Triple P or standard diabetes care. The primary outcome was child internalizing and externalizing behavior problems 3 and 12 months postrandomization. Secondary outcomes were glycemic control, parent mental health, parenting skills, and family functioning at 3 and 12 months, and glycemic control at 24 months. RESULTS: A total of 76 participants were randomized (38 to intervention and 38 to control), 60 completed 3-month, and 57 completed 12-month assessments. Benefits of Triple P were evident at 3 months for parent mental health, parenting skills, and family functioning (p < 0.05), but not for child mental health or glycemic control, with little effect at 12 months. Prespecified subgroup analyses for children with pre-existing internalizing or externalizing behavior problems indicated greater improvements in child mental health, parent mental health, parenting skills, and diabetes family conflict (p < 0.05), but lower parenting self-efficacy at 3 months. Improvements in parent mental health and parenting competency associated with Triple P were sustained to 12 months for children with pre-existing mental health problems. CONCLUSIONS: This study provides some support for the efficacy of Triple P in improving parent and family outcomes, and reducing child internalizing and externalizing behavior problems primarily in children who have pre-existing mental health problems.

Complejidad, conflicto armado y vulnerabilidad de niños y niñas desplazados en Colombia / Complexity, armed conflict, and vulnerability of displaced children in Colombia

Este trabajo tiene como objetivo realizar una reflexión acerca de la vulnerabilidad de los niños y niñas víctimas del conflicto armado en Colombia. Para ello se recurriro al principio de auto-eco-organización y de Bucle inter-retroactivo. La violencia es un fenómeno complejo de múltiples interacciones, de características no-lineales y tendencia auto-eco-organizativa que afecta la noción de sujeto y altera el modo como los niños y niñas interpretan el mundo y sus interacciones.

This paper aims to carry out a reflection on the vulnerability of children, who are victims of the armed conflict in Colombia. This was used at the beginning of the self-eco-organization and the inter-retroactive loop. Violence is a complex phenomenon of multiple interactions, non-linear features, and a self-eco-organizational tendency, which affects the notion of subject and alters the way that children interpret the world and their interactions.

Feasibility and impact of multidisciplinary training of an evidence-based intervention within a pediatric psychiatry consultation service.

OBJECTIVE: To train clinicians on a multidisciplinary pediatric consultation-liaison (CL) psychiatry service to administer an evidence-based intervention, biofeedback-assisted relaxation training (BART), in the inpatient medical setting and obtain their opinions about BART's utility and feasibility in the CL setting. METHODS: Attendings and trainees on a multidisciplinary pediatric CL service received 3 h of BART training and completed a 10-item questionnaire designed to assess opinions about BART at two time points: after training but prior to using the intervention with patients and again 3 months after implementing the intervention in their clinical practice. RESULTS: Nineteen clinicians administered BART with 28 patients across the study period, and clinicians rated BART positively after training and significantly more positively after utilizing BART in the clinical setting. From post-training to post-implementation, trainees reported significant increases in their opinions that BART increased parent and patient receptiveness to psychiatric consultation (p<0.05) and attendings reported significant increases in their opinions that BART enhanced clinical intervention (p<0.05). CONCLUSIONS: BART training on a multidisciplinary CL service was well received by clinicians and patients and may enhance psychiatry trainees' repertoire of cognitive-behavioral and evidence-based interventions.

Recommendations for training in pediatric psychology: defining core competencies across training levels.

OBJECTIVE: As a field, pediatric psychology has focused considerable efforts on the education and training of students and practitioners. Alongside a broader movement toward competency attainment in professional psychology and within the health professions, the Society of Pediatric Psychology commissioned a Task Force to establish core competencies in pediatric psychology and address the need for contemporary training recommendations. METHODS: The Task Force adapted the framework proposed by the Competency Benchmarks Work Group on preparing psychologists for health service practice and defined competencies applicable across training levels ranging from initial practicum training to entry into the professional workforce in pediatric psychology. RESULTS: Competencies within 6 cluster areas, including science, professionalism, interpersonal, application, education, and systems, and 1 crosscutting cluster, crosscutting knowledge competencies in pediatric psychology, are presented in this report. CONCLUSIONS: Recommendations for the use of, and the further refinement of, these suggested competencies are discussed.

Mediação e conceitos cotidianos: os aportes de Feuerstein e Vygotsky para investigar as dificuldades de aprendizagem / Mediation and everyday concepts: the contributions of Feuerstein and Vygotsky to investigate learning difficulties / Mediación y conceptos cotidianos: las contribuciones de Feuerstein y Vygotsky para investigar las dificultades de aprendizaje

A pesquisa propôs analisar, com base nos referenciais teóricos de Feuerstein e Vygotsky, as dificuldades de aprendizagem apresentadas por duas crianças (meninos, gêmeos de 10 anos, no 3º ano do ensino fundamental). As ideias centrais assumidas desses autores são referentes à mediação e formação de conceitos. A investigação prática desenvolveuse durante um semestre e organizou-se a partir de observação de aulas, intervenção pedagógica (atendimento educacional) com as crianças e entrevistas com os professores e a mãe. Tomando os princípios teóricos adotados como possibilidade de interpretação e compreensão do caso, evidenciou-se que a escassez de experiências de aprendizagem mediada acarretou incipiente desenvolvimento dos conceitos cotidianos nas duas crianças e que esses conceitos estão também na raiz das dificuldades escolares que elas enfrentam...

The proposed research is an analysis of learning difficulties presented by two children - 10 year-old twin boys, in the 3rd year of primary school - from the Vygotsky and Feuerstein's theoretical framework. The central ideas by these authors are refer to mediation and concept formation. Research practice was developed during one semester and was organized by observing lessons, pedagogical intervention (educational services) with the children and interviews with their teachers and mother. Taking the theoretical principles adopted as a possibility for interpretation and understanding of the case, it became clear that the lack of mediated learning experiences led to incipient development of everyday concepts in both children and that these concepts were also at the root of learning difficulties they faced...

La investigación se propone analizar las dificultades de aprendizaje presentadas por dos niños (gemelos de 10 años, de 3º de primaria) basados en el marco teórico de Vygotsky y Feuerstein. Las ideas centrales de estos autores se refieren a la mediación y la formación de conceptos. La investigación práctica se desarrolló a lo largo de un semestre y se organizó a partir de la observación en clase, intervención pedagógica (servicios educativos) con los niños y entrevistas con los profesores y su madre. Tomando los principios teóricos adoptados como posibilidad para la interpretación y comprensión del caso, se hizo evidente que la falta de experiencias de aprendizaje mediado supuso incipiente desarrollo de los conceptos cotidianos en los niños y que estos conceptos también están en la raíz de las dificultades escolares que enfrentan...

Six degrees of separation: an exploratory network analysis of mentoring relationships in pediatric psychology.

OBJECTIVE: The present study is an exploratory social network analysis of mentee-mentor relationships in the field of pediatric psychology. METHOD: An online survey was distributed to members of the Division 54 Society of Pediatric Psychology (SPP) listserv asking them to name up to 10 psychologists from whom they had "received mentoring" and who influenced their careers. Directed network analyses were conducted to examine features of the resulting mentoring network. RESULTS: Participants reported receiving mentoring in a wide variety of relationships and settings. The average "degrees of separation" between individuals in the network was 5.30. CONCLUSION: : The field of pediatric psychology is interconnected with professionals learning from multiple mentors in multiple settings, extending beyond just graduate student advisors. Overall, many different mentors were listed, and there does not appear to be only one or two individuals providing the majority of mentoring within the field.