Influencia de la asistencia a guarderías en la frecuentación en Urgencias y Atención Primaria / Influence of nursery attendance in Emergency and Primary Care frequentation

Introducción: las guarderías surgen para atender una necesidad social, pero no están exentas de influir sobre la salud infantil. Pacientes y métodos: estudio longitudinal prospectivo de dos cohortes de niños entre 0 y 24 meses (se diferencian en asistencia o no a guardería) que acuden a las consultas de 33 pediatras del Servicio Público de Salud del Principado de Asturias. Los datos se obtuvieron de la historia clínica informatizada y entrevistas programadas (6, 12, 18 y 24 meses). Se compararon: número medio de visitas a Servicios de Urgencias y Pediatría e influencia de diferentes variables recogidas. Se analizaron: la morbilidad registrada (infecciones agudas y sibilancias recurrentes) entre hiperfrecuentadores (HF) y no HF. Resultados: el número medio de visitas a las consultas pediátricas es significativamente mayor para los niños que acuden a guardería en todos los tramos de edad estudiados. Hay mayor porcentaje de HF entre los que acuden a guardería: los niños de entre 0 y 6 meses que acuden tienen un riesgo relativo de ser HF a Servicios de Urgencias de hasta seis veces mayor que los que no acuden y cuatro veces mayor de ser HF en las consultas de Pediatría. Conclusiones: 1) la asistencia a guardería se asocia con mayor probabilidad de ser HF en Urgencias y en la consulta de Pediatría de Atención Primaria (AP); 2) los niños HF padecen más enfermedades respiratorias e infecciosas, que no son explicadas por su asistencia a guardería, y 3) lo anterior conlleva un mayor consumo de fármacos (AU)

Introduction: nurseries arise to attend a social need, but are not without influence on children’s health. Patients and methods: prospective longitudinal study of two cohorts of children aged 0-24 months (they differ in nursery assistance or not) who come to the consultations of 33 pediatricians at the Public Health Service of Asturias. The data were obtained from the clinical history and interviews scheduled (6, 12, 18 and 24 months). They were compared: average number of visits to Emergency and Paediatrics Services, and influence of different variables collected. We analyzed: the registered morbidity (acute infections and recurrent wheezing) between frequent attenders (HF) and not HF. Results: the average number of visits to pediatric visits is significantly higher for children attending kindergarten in all age groups studied. There is a higher percentage of HF among those attending nursery: children between 0 and 6 months that have a relative risk of HF to Emergency Services up to 6 times higher than those not attending and four times higher of being HF in consultations of a Primary Care center. Conclusions: 1) attendance at kindergarten is associated with increased probability of being HF in Emergency departments and Paediatrics Primary Care services; 2) the HF children suffer more respiratory and infectious diseases, which are not explained by their attendance at a nursery, y 3) the above carries a higher drug consumption (AU)

Brote por Salmonella serovar Poona en una guardería / Salmonella Serovar Poona outbreak in a nursery

Introducción: se describe un brote de gastroenteritis causada por Salmonella poona en una guardería infantil en la ciudad de Valladolid (España) en los primeros tres meses del año 2011. Objetivos: describir las características epidemiológicas del brote, su relación con un brote supracomunitario declarado en España en 2010 y analizar el mecanismo de transmisión. Métodos: se realizó un estudio descriptivo bidireccional. Partiendo del caso índice, se elaboró una base de datos con la totalidad de niños asistentes a la guardería y se completó con la información recibida de los pediatras y con la información microbiológica. Se calcularon tasas de ataque por aulas y curva epidémica. Resultados: se encontraron 13 casos, de edades comprendidas entre los cinco meses y los cinco años, tres de los cuales fueron asintomáticos. La tasa de ataque global en la guardería fue del 28,2%, no encontrándose diferencias significativas entre las diferentes aulas. Todas las salmonelas aisladas excepto dos fueron enviadas al Centro Nacional de Microbiología (CNM) para su caracterización, identificándose todas ellas como Salmonella poona 13,22:z:1,6, idéntica a la aislada en el brote nacional. Conclusiones: parece evidente que el brote ocurrido en la guardería fue producido por el mismo microorganismo que el que causó el brote supracomunitario y que la fórmula láctea implicada en dicho brote fue el vehículo de transmisión que permitió la introducción del microorganismo en la guardería, propagándose por otras vías entre los alumnos de la misma (AU)

Introduction: during the first three months of 2011, a gastroenteritis outbreak caused by Salmonella poona was described in one of the Valladolid´s nurseries. Objectives: to describe the epidemiologic characteristics of the outbreak, its relation between a supracommunity outbreak and its transmission mechanism. Methods: a descriptive bidireccional study. Starting from an index case a database from the nursery of the children records, the pediatrics and the microbiology records was done. The overall attack rate and the epidemic curve from each classroom was calculated. Results: thirteen cases between five months and five years old were found; all of them were asymptomatic. The overall attack rate was 28,2% without significant difference between the classrooms. Salmonella poona 13,22:z:1,6 was found, and it was identical to that isolated in the national outbreak. Conclusions: It seems that the nursery´s outbreak was caused by the same organism related to the supracommunity outbreak and the powdered infant formula was the vehicle involved in the transmission and it allowed the introduction of the organism in the nursery spreading through other pathways between students (AU)

Parental views on acute otitis media (AOM) and its therapy in children--results of an exploratory survey in German childcare facilities.

BACKGROUND: Acute otitis media (AOM) is one of the main reasons for medical consultation and antibiotic use during childhood. Although 80% of AOM cases are self-limiting, antibiotic prescription is still high, either for physician- or for parent-related factors. This study aims to identify parental knowledge about, beliefs and attitudes towards, and experiences with AOM and its therapy and thus to gain insights into parents' perspectives within the German health care system. METHODS: An exploratory survey was conducted among German-speaking parents of children aged 2 to 7 years who sent their children to a childcare facility. Childcare facilities were recruited by convenience sampling in different urban and rural sites in Germany, and all parents with children at those facilities were invited to participate. Data were evaluated using descriptive statistical analyses. RESULTS: One-hundred-thirty-eight parents participated. Of those, 75.4% (n = 104) were AOM-experienced and 75.4% (n = 104) had two or more children. Sixty-six percent generally agree that bacteria cause AOM. 20.2% generally agree that viruses cause AOM. 30.5% do not generally agree that viruses cause AOM. Eight percent generally agree that AOM resolves spontaneously, whereas 53.6% do not generally agree. 92.5% generally (45.7%) and partly (42.8%) agree that AOM needs antibiotic treatment. With respect to antibiotic effects, 56.6% generally agree that antibiotics rapidly relieve earache. 60.1% generally agree that antibiotics affect the gastrointestinal tract and 77.5% generally agree that antibiotics possibly become ineffective after frequent use. About 40% generally support and about 40% generally reject a "wait-and-see" strategy for AOM treatment. Parental-reported experiences reveal that antibiotics are by far more often prescribed (70.2%) than actively requested by parents (26.9%). CONCLUSIONS: Parental views on AOM, its therapy, and antibiotic effects reveal uncertainties especially with respect to causes, the natural course of the disease and antibiotic effects on AOM. These results indicate that more evidence-based information is needed if parents' health literacy in the treatment of children with AOM is to be enhanced. The discrepancy between reported parental requests for antibiotics and reported actual prescriptions contradicts the hypothesis of high parental influence on antibiotic use in AOM.

Parents' experiences of diagnostic processes of young children in Norwegian day-care institutions.

Framed by the sociology of childhood and Foucauldian-inspired perspectives, this article is focused on parents' experiences of parent-professional encounters in diagnostic processes of young children enrolled in Norwegian early childhood education and care (ECEC) institutions or schools. Based on qualitative interviews with parents, we explore how they participate and manoeuvre in encounters with professionals during processes in which their children were constructed as different in a space of normality and deviance, while also bringing their own understandings of their children to the fore. From our analysis, it appears that parents manoeuvre between complying with and adapting to, as well as negotiating and resisting the constructions put forward by the professionals.

The Amsterdam Sexual Abuse Case (ASAC)-study in day care centers: longitudinal effects of sexual abuse on infants and very young children and their parents, and the consequences of the persistence of abusive images on the internet.

BACKGROUND: Little research has been done on the signs of child sexual abuse (CSA) in infants and very young children, or on the consequences that such abuse - including the persistence of the abusive pornographic images on the internet - might have for the children and their parents. The effects of CSA can be severe, and a variety of risk- and protective factors, may influence those effects. CSA may affect the psychosocial-, emotional-, cognitive-, and physical development of children, their relationships with their parent(s), and the relations between parents. In the so called 'the Amsterdam sexual abuse case' (ASAC), infants and very young children were victimized by a day-care employee and most of the victims were boys. Research involving the children and their parents would enable recognition of the signs of CSA in very young children and understanding the consequences the abuse might have on the long term. METHODS/DESIGN: The proposed research project consists of three components: (I) An initial assessment to identify physical- or psychological signs of CSA in infants and very young children who are thought to have been sexually abused (n = 130); (II) A cross-sequential longitudinal study of children who have experienced sexual abuse, or for whom there are strong suspicions; (III) A qualitative study in which interviews are conducted with parents (n = 25) and with therapists treating children from the ASAC. Parents will be interviewed on the perceived condition of their child and family situation, their experiences with the service responses to the abuse, the effects of legal proceedings and media attention, and the impact of knowing that pornographic material has been disseminated on the internet. Therapists will be interviewed on their clinical experiences in treating children and parents. The assessments will extend over a period of several years. The outcome measures will be symptoms of posttraumatic stress disorder (PTSD), dissociative symptoms, age-inappropriate sexual behaviors and knowledge, behavioral problems, attachment disturbances, the quality of parent-child interaction, parental PTSD, parental partner relation, and biological outcomes (BMI and DNA). DISCUSSION: The ASAC-project would facilitate early detection of symptoms and prompt therapeutic intervention when CSA is suspected in very young children.

Screen-viewing among preschoolers in childcare: a systematic review.

BACKGROUND: Screen-viewing is one of the most common sedentary behaviors among preschoolers. Despite the high prevalence of sedentary behaviors in childcare, little research exists on the context and/or type of activities that account for these particular behaviors. Accordingly, if the amount of screen-viewing accumulated by preschoolers in childcare is not considered, researchers may be underestimating total screen time among this population, as only a portion of their day is being captured (i.e., the home environment). This systematic review provides a synthesis of research on the levels of screen-viewing among preschool-aged children (2.5-5 years) attending childcare (i.e., centre- and home-based childcare). This review also examined the correlates of screen-viewing among preschoolers in this setting. To provide additional contextual information, availability of screen activities was used to help ameliorate the understanding of preschoolers' screen-viewing behaviors in childcare. METHODS: Twelve electronic databases were searched to retrieve relevant articles for inclusion (dating from 2000 onwards). Additional studies were identified via manual searching techniques (i.e., hand searching and citation tracking). Only English, published peer-reviewed articles that examined preschoolers' screen-viewing behaviors in childcare (i.e., rates of screen-viewing and access to/opportunities for related activities) were included. No restrictions to study design were applied. RESULTS: Seventeen international studies (4 experimental; 12 cross-sectional; 1 mixed-methods) published between 2004 and 2014 were examined. Of those, eight studies reported rates of screen-viewing and found that preschoolers spent approximately 0.1 to 1.3 hrs/day and 1.8 to 2.4 hrs/day engaged in this behavior in center- and home-based childcare, respectively. High staff education (negative association) and type of childcare arrangement (notably, home-based childcare in comparison to center-based childcare; positive association) were identified as two correlates in relation to preschoolers' screen-viewing in childcare. Nine studies spoke to the availability of screen-viewing activities in childcare, and found the childcare environment to be conducive to this behavior. CONCLUSIONS: Despite some variability, preschoolers appear to engage in somewhat high levels of screen-viewing while in childcare, particularly within home-based facilities. This paper also highlighted the conduciveness of the childcare environment with regard to screen-viewing among preschoolers. Additional exploration into the correlates of screen-viewing in childcare is required. (PROSPORO registration: CRD42013005552).

Características cognitivas, emocionales y conductuales de niños preescolares del programa buen comienzo en el noroccidente de Medellín / Cognitive, emotional, and behavioral characteristics of preschoolers of the good start program in the northwestern area in Medellin

En el presente artículo derivado de investigación, se describen las características cognitivas, emocionales y conductuales de una muestra de 20 niños preescolares, que oscilan entren los 3 y 5 años de edad, de estrato socioeconómico bajo y que han sido beneficiados del programa estratégico de la Alcaldía de Medellín (Colombia), perteneciente a la Secretaría de Educación, denominado Buen Comienzo. El programa Buen Comienzo tiene como propósito la promoción del desarrollo integral,diverso e incluyente de niñas y niñas, desde en una perspectiva interdisciplinaria del ciclo vital, protección de los derechos y articulación interinstitucional.

In this current article, derived from a piece of research, the cognitive, emotional, and behavioral characteristics, of a sample of 20 preschoolers, are described and whose ages range between 3 and 5 years. They belong to a low socio-economic level and they have benefited from the strategic program at the Mayor’s Office in Medellin (Colombia), belonging to the Secretariat of Education program called theGood Start. Such a program aims the promotion of comprehensive, diverse, and inclusive development of children, from an interdisciplinary perspective of the life cycle, the protection of rights and the inter-institutional coordination.

Strategies for inclusion in play among children with physical disabilities in childcare centers: an integrative review.

The purpose of this integrative review was to examine strategies that facilitate inclusion in play among children with physical disabilities in childcare centers. Nine databases were systematically searched for peer reviewed empirical studies investigating inclusion strategies for play in childcare settings among preschoolers with physical disabilities. Nine studies met the inclusion criteria and were appraised using the McMaster Critical Review Forms. The inclusion approaches identified were grouped into relevant strategies during analysis. Two main strategies were identified: role of the adult facilitator and environmental factors. substrategies within the role of the adult facilitator included: customize approach for specific child's needs; adult facilitator self-awareness of presence; prompting and praise; and promote fairness, equity, and play interaction. Substrategies within the environmental factors included: physical setting; type of toys; and type of play activity. The findings suggest play inclusion strategies in the childcare environment. Therapists are encouraged to apply inclusion strategies to improve play opportunities for children with disabilities, but future research is necessary to confirm the effectiveness of these strategies using higher quality study designs.

A randomised controlled trial of an active telephone-based recruitment strategy to increase childcare-service staff attendance at a physical activity and nutrition training workshop.

ISSUE ADDRESSED: Centre-based childcare services represent a promising setting to target the prevention of excessive weight gain in preschool-aged children. Staff training is a key component of multi-strategy interventions to improve implementation of effective physical activity and nutrition promoting practices for obesity prevention in childcare services. This randomised controlled trial aimed to examine whether an active telephone-based strategy to invite childcare-service staff to attend a training workshop was effective in increasing the proportion of services with staff attending training, compared with a passive strategy. METHODS: Services were randomised to an active telephone-based or a passive-recruitment strategy. Those in the active arm received an email invitation and one to three follow-up phone calls, whereas services in the passive arm were informed of the availability of training only via newsletters. The proportion of services with staff attending the training workshop was compared between the two arms. RESULTS: One hundred and twenty-eight services were included in this study. A significantly larger proportion (52%) of services in the active arm compared with those in the passive-strategy arm (3.1%) attended training (d.f.=1, χ2=34.3; P<0.001). CONCLUSIONS: An active, telephone-based recruitment strategy significantly increased the proportion of childcare services with staff attending training. Further strategies to improve staff attendance at training need to be identified and implemented. SO WHAT?: Active-recruitment strategies including follow-up telephone calls should be utilised to invite staff to participate in training, in order to maximise the use of training as an implementation strategy for obesity prevention in childcare services.

A hand hygiene intervention to decrease infections among children attending day care centers: design of a cluster randomized controlled trial.

BACKGROUND: Day care center attendance has been recognized as a risk factor for acquiring gastrointestinal and respiratory infections, which can be prevented with adequate hand hygiene (HH). Based on previous studies on environmental and sociocognitive determinants of caregivers' compliance with HH guidelines in day care centers (DCCs), an intervention has been developed aiming to improve caregivers' and children's HH compliance and decrease infections among children attending DCCs. The aim of this paper is to describe the design of a cluster randomized controlled trial to evaluate the effectiveness of this intervention. METHODS/DESIGN: The intervention will be evaluated in a two-arm cluster randomized controlled trial among 71 DCCs in the Netherlands. In total, 36 DCCs will receive the intervention consisting of four components: 1) HH products (dispensers and refills for paper towels, soap, alcohol-based hand sanitizer, and hand cream); 2) training to educate about the Dutch national HH guidelines; 3) two team training sessions aimed at goal setting and formulating specific HH improvement activities; and 4) reminders and cues to action (posters/stickers). Intervention DCCs will be compared to 35 control DCCs continuing usual practice. The primary outcome measure will be observed HH compliance of caregivers and children, measured at baseline and one, three, and six months after start of the intervention. The secondary outcome measure will be the incidence of gastrointestinal and respiratory infections in 600 children attending DCCs, monitored over six months by parents using a calendar to mark the days their child has diarrhea and/or a cold. Multilevel logistic regression will be performed to assess the effect of the intervention on HH compliance. Multilevel poisson regression will be performed to assess the incidence of gastrointestinal and respiratory infections in children attending DCCs. DISCUSSION: This is one of the first DCC intervention studies to assess HH compliance of both caregivers and children, as well as the incidence of gastrointestinal and respiratory infections in children, as outcome measures. When an effect of the intervention on improving HH compliance and/or reducing incidence of infections is shown, (inter)national dissemination of the intervention in other DCCs may be considered. TRIAL REGISTRATION: Netherlands trial registry: NTR3000.

La asistencia a la guardería aumenta no solo la morbilidad, sino también el uso de recursos sanitarios / Daycare attendance not only increases morbidity, also the use of healthcare resources

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Indoor versus outdoor time in preschoolers at child care.

BACKGROUND: Being outdoors may have health benefits including being more physically active. Understanding the relationship between outdoor time and health is hampered by the difficulty of measuring outdoor time. PURPOSE: To examine the accuracy and validity of light-sensor and GPS methods for quantifying outdoor time among those aged 3-5 years at child care. METHODS: A total of 45 children (mean age 4.5 years, 64% boys) from five child care centers wore portable accelerometers with built-in light sensors and a separate GPS device around their waists during child care, providing 80,648 episodes (15 seconds each) for analysis. Direct observation (gold standard) of children being outdoors versus indoors was conducted for 2 days at each center. GPS signal-to-noise ratios, processed through the Personal Activity and Location Measurement System were used to define indoor versus outdoor locations. Receiver operating characteristic (ROC) analyses were used to determine thresholds for defining being indoors versus outdoors. Data were collected in Fall 2011, analyzed in 2012. RESULTS: Mean observed outdoor time was 63 [±44; range: 18-152] minutes/day. Mean light-sensor levels were significantly higher outdoors. The area under the ROC curve for location based on light sensor for all weather conditions was 0.82 (range: 0.70 on partly cloudy days to 0.97 on sunny days); for GPS, it was 0.89. The light sensor had a sensitivity of 74% and specificity of 86%. GPS had a sensitivity of 82% and specificity of 88%. CONCLUSIONS: A light sensor and a GPS device both distinguish indoor from outdoor time for preschoolers with moderate to high levels of accuracy. These devices can increase the feasibility and lower the cost of measuring outdoor time in studies of preschool children.

Design and baseline characteristics of the Short bouTs of Exercise for Preschoolers (STEP) study.

BACKGROUND: Most preschool centers provide two 30-min sessions of gross-motor/outdoor playtime per preschool day. Within this time frame, children accumulate most of their activity within the first 10 min. This paper describes the design and baseline participant characteristics of the Short bouTs of Exercise for Preschoolers (STEP) study. The STEP study is a cluster randomized controlled study designed to examine the effects of short bouts of structured physical activity (SBS-PA) implemented within the classroom setting as part of designated gross-motor playtime on during-school physical activity (PA) in preschoolers. METHODS/DESIGN: Ten preschool centers serving low-income families were randomized into SBS-PA versus unstructured PA (UPA). SBS-PA schools were asked to implement age-appropriate 10 min structured PA routines within the classroom setting, twice daily, followed by 20 min of usual unstructured playtime. UPA intervention consisted of 30 min of supervised unstructured free playtime twice daily. Interventions were implemented during the morning and afternoon designated gross-motor playtime for 30 min/session, five days/week for six months. Outcome measures were between group difference in during-preschool PA (accelerometers and direct observation) over six-months. Ten preschool centers, representing 34 classrooms and 315 children, enrolled in the study. The average age and BMI percentile for the participants was 4.1 ± 0.8 years and 69th percentile, respectively. Participants spent 74% and 6% of their preschool day engaged in sedentary and MVPA, respectively. DISCUSSION: Results from the STEP intervention could provide evidence that a PA policy that exposes preschoolers to shorter bouts of structured PA throughout the preschool day could potentially increase preschoolers' PA levels.

Toddlers and preschoolers consume more dietary fiber when high-fiber lunch items are served.

BACKGROUND: Increasing fiber intake by consuming high fiber foods, which are also high in other nutrients, can improve diet quality and reduce the risk for disease. However, most children do not meet fiber intake recommendations. Food provided at child care centers is a major source of daily nutrients, including fiber, for a large portion of children in the U.S. The aim of this study was to determine if serving novel, high fiber lunch items would successfully increase fiber intakes in toddlers and preschoolers. METHODS: Four high-fiber entrées were developed and served to children (n=54) at lunch in a local child care center. Consumption was compared to usually served lunches and fiber intake recommendations. RESULTS: Toddlers consumed 89% of their recommended calories at the lunch meal and an average of 72% of the entrees; preschoolers consumed 74% of their recommended calories and 59% of the entrée, on average. Each entrée was high in fiber, providing, on average, 3.2 ± 1.6g fiber for toddlers and 4.1 ±1.9g fiber for preschoolers. These high fiber lunches contributed significantly more fiber than the usual lunch foods for most children. CONCLUSIONS: Data indicate that children are accepting of high fiber, novel lunch items, thus indicating that serving high fiber lunch items at child care may increase dietary fiber intake in children.

Animation of graphic symbols representing verbs and prepositions: effects on transparency, name agreement, and identification.

PURPOSE: The effects of animation on transparency, name agreement, and identification of graphic symbols for verbs and prepositions were evaluated in preschoolers of 3 age groups. Methods A mixed-group design was used; in each age group, half of the children were randomly allocated to 1 of 2 orders of symbol formats. The 52 children were asked to guess the meaning of symbols and to identify a target symbol among foils given the spoken label. RESULTS: Animated symbols were more transparent than static symbols, although this was more pronounced for verbs. Animated verbs were named more accurately than static verbs, but there was no difference between animated and static prepositions. Verbs were identified more accurately compared with prepositions, but there was no difference between symbol formats. Older children guessed, named, and identified symbols more effectively than younger children. CONCLUSION: Animation enhances transparency and name agreement, especially for verbs, which reduces the instructional burden that comes with nontransparent symbols. Animation does not enhance identification accuracy. Verbs are easier to identify than prepositions. A developmental effect was observed for each measure. Limitations and implications for future research are discussed.

Parental administration of antipyretics to children with upper respiratory tract infections without consultation with a physician.

AIM: To evaluate the administration of antipyretics to children with upper respiratory tract infections (URTI) by their parents or guardians without consultation with physicians, and compare epidemiological and clinical characteristics of patients who received antipyretics and of untreated patients. METHODS: A prospective observational study was performed in three pediatric clinics in Zagreb, Croatia, from March to June 2002. A total of 171 children aged from 2 to 14 years with symptoms and signs of URTI lasting more than 2 days and fever above 38 °C lasting more than 2 days were included in the study. Data were collected on the usage of antipyretics, patients' demographic and epidemiological characteristics, and clinical signs and symptoms. RESULTS: Antipyretics, predominantly paracetamol, were used in 29.8% of patients. Their usage was less frequent in children attending day-care centers (49% of treated and 70% of untreated children, P = 0.014) and in children with reiterated URTIs (33.3% of treated and 55.8% of untreated children, P = 0.008). However, it was more frequent in children with recent URTIs in the family (33.3% of treated and 7.5% of untreated children, P < 0.001). Overall, most clinical signs and symptoms of URTI were notably less pronounced in patients treated with antipyretics. CONCLUSIONS: Antipyretics use correlated with less pronounced clinical signs and symptoms of infection, which indicates their anti-inflammatory activity, but also with negative effects such as lethargy. It is necessary to educate parents on the positive and negative aspects of antipyretics use and on the optimal choice of an antipyretic drug.

Health promotion intervention in Arab-Israeli kindergarten children.

BACKGROUND: Obesity is the most common chronic pediatric disease in westernized societies, with minorities and children from low socioeconomic status being mostly affected. Arab-Israelis are the largest minority population in Israel. OBJECTIVE: The aim of this study is to examine the prevalence of obesity and to prospectively study the effects of a health promotion, school-based intervention on nutrition and physical activity knowledge and preferences, anthropometric measures, and fitness in Arab-Israeli kindergarten children. PARTICIPANTS: One hundred fifty-four children completed a school year with combined dietary-behavioral-physical activity intervention and were compared with 188 controls (age 4.2-6.5 years). RESULTS: The prevalence of overweight and obesity among Arab-Israeli kindergarten children was 28.9%. Compared with control, the intervention led to a significantly greater (control vs. intervention, respectively, p < 0.05) increase in nutrition knowledge (51.2+/- 1.5%-48.9 +/- 1.6% vs. 48.9 +/- 1.6%-85.9 +/- 1.4%) and preferences (47.4 +/- 1.5%-47.7 +/- 1.6% vs. 45.2 +/- 1.8%-87.1 +/- 1.4%), increase in physical activity knowledge (47.2 +/- 1.3%-47.0 +/- 1.7% vs. 49.2 +/- 1.7%-90.8 +/- 1.3%) and preferences (52.3 +/- 1.3%-54.2 +/- 1.8% vs. 56.2 +/- 1.4%-92.8 +/- 1.0%), and improvement in fitness (-10.2 +/- 1.6 vs. 11.6 +/- 1.4 shuttle run laps). The intervention was associated with favorable changes in height gain (5.0 +/- 0.1 vs. 6.2 +/- 0.1cm), body mass index (BMI-0.41 +/- 0.06 vs. -0.71 +/- 0.06 kg/m2) and BMI percentile (-10.0 +/- 1.3% vs. -16.2 +/- 1.2%) in the control and intervention groups, respectively. CONCLUSIONS: A kindergarten dietary-physical activity intervention applied by the kindergarten teachers led to a decrease in BMI, BMI percentile, improved nutrition and physical activity knowledge and preferences, and improved fitness. Such programs may play important role in health promotion, prevention, and treatment of childhood obesity in minority communities from early age.

Child care setting affects salivary cortisol and antibody secretion in young children.

Elevated afternoon levels of cortisol have been found repeatedly in children during child care. However, it is unclear whether these elevations have any consequences. Because physiologic stress systems and the immune system are functionally linked, we examined the relationship between salivary cortisol concentration and antibody secretion across the day at home and in child care, and their relationships with parent-reported illnesses. Salivary antibody provides a critical line of defense against pathogens entering via the mouth, but little is known about its diurnal rhythm in young children or the effect of different environmental contexts. Saliva samples were taken at approximately 10:30 a.m., 3:30 p.m. and 8:00 p.m. on two child care and two home days in a sample of 65 3-5-year-old children attending very high quality, full time child care centers. Results indicated that (1) a rising cortisol profile at child care, driven by higher afternoon levels, predicted lower antibody levels on the subsequent weekend, (2) higher cortisol on weekend days was related to greater parent-reported illness, and (3) a declining daily pattern in sIgA was evident on weekend and child care days for older preschoolers, but only on weekend days for younger preschoolers. The results suggest that elevated cortisol in children during child care may be related to both lowered antibody levels and greater illness frequency.

Educação infantil e intervenção motora: um olhar a partir da teoria bioecológica de Bronfenbrenner / Educación infantil e intervención motriz: una mirada a partir de la teoría bioecológica de Bronfenbrenner / Children education and motor intervention: a look from the bioecological theory of Bronfenbrenner perspective

Este estudo investigou a relação entre o enriquecimento do contexto da creche e a legislação vigente. Três estudos de caso com bebês foram conduzidos no paradigma da Teoria Bioecológica. Os resultados demonstraram que os bebês apresentaram novas competências de manipulação, controle postural e interação social. Entretanto a qualidade dos cuidados oferecidos na creche era restrita à higiene e alimentação. A intervenção pode ser implementada no espaço da creche; entretanto faz-se necessário se fazer cumprir a legislação no que diz respeito à formação e capacitação de educadores e à razão criança-educadores para efetivamente transformar o caráter assistencialista da educação infantil.

This study investigated the relations between the enrichment of the daycare context and legislation. Three case studies of babies took place with the theoretical support of the Bioecological theory of human development, designed by Bronfenbrenner. The results showed that the babies developed: many new competencies, manipulative, postural control and social interaction skills. However the quality of care offered by the daycares was restricted to hygiene and feeding. The motor intervention can be implemented in the day care context; however it is necessary to assure that the legislation is held liable when it comes to teacher education and children-teacher ratio to effectively change the assistance character of children education.

El estudio ha investigado la relación entre enriquecimiento del contexto de la guardería infantil y la legislación vigente. Tres estudios de caso con bebés fueron conducidos en el paradigma de la Teoría Bioecológica. Los resultados han demostrado que los bebés presentaron nuevas competencias de manipulación, control postural e interacción social. Sin embargo, la calidad de los cuidados que brinda la guardería era restricta a higiene y alimentación. La intervención puede ser implementada en el espacio de la guardería; pero es necesario hacer cumplir la legislación con respecto a la formación y capacitación de educadores y razón niños educadores para efectivamente transformar el carácter asistencialista de la educación infantil.