Aspectos esenciales para realizar los cuidados en guarderías privadas desde la perspectiva de las cuidadoras / Essential Aspects, from the Perspective of Childcare Workers, for Providing Care in Private Daycare Centers

Introducción: El nuevo modelo económico cubano ha posibilitado la aparición de guarderías privadas, pero se desconocen qué aspectos deben ser considerados como esenciales para ejercer los cuidados desde la perspectiva de las cuidadoras Objetivo: Explorar aspectos esenciales para realizar los cuidados en guarderías privadas desde la perspectiva de las cuidadoras. Métodos: Estudio cualitativo de tipo exploratorio, realizado entre junio y septiembre de 2021 con 12 cuidadoras que laboran en guarderías privadas del municipio Santa Clara, provincia Villa Clara, Cuba. Los datos se obtuvieron mediante dos rondas de entrevistas; las narrativas fueron procesadas mediante análisis de contenido. Resultados: De la primera entrevista se manifestaron las siguientes categorías: higiene y protección para el cuidado, alimentación del niño, rutinas (sueño), problemas relacionados con el cuidado y rutinas (juego). De la segunda entrevista emergieron tres categorías: necesidad de un manual para la preparación, necesidad de un sitio digital para consulta y necesidad de curso de formación. Conclusiones: Se destaca la necesidad de garantizar en la guardería la higiene adecuada y disminuir el riesgo de accidentes; la preparación de alimentos y dietas; las rabietas, caídas y la fiebre como problemas más comunes; las rutinas de descanso y la rutina de juego y su influencia para el desarrollo armónico de los niños, además que las cuidadoras deberían recibir formación a través de un manual específico para guarderías privadas; algún sitio de consulta en internet y un curso preparatorio(AU)

Introduction: The new Cuban economic model has made possible the appearance of private daycare centers, but there is lack of knowledge concerning what aspects, from the perspective of childcare workers, should be considered as essential to perform caregiving. Objective: To explore, from the perspective of childcare workers, essential aspects of care in private daycare centers. Methods: Qualitative and exploratory study carried out between June and September 2021 with twelve childcare workers from private daycare centers in Santa Clara Municipality, Villa Clara Province, Cuba. The data were obtained through two rounds of interviews; the answers were processed through content analysis. Results: The following categories emerged from the first interview: hygiene and protection for care, child feeding, routines (sleep), problems related to care and routines (playing). Three categories emerged from the second interview: the need for a training manual, the need for a virtual consultation site, and the need for a training course. Conclusions: The need is highlighted to guarantee adequate hygiene in the daycare center and reduce the risk of accidents; diet and food preparation; tantrums, falls and fever as the most common problems; rest and playing routines, as well as their influence on harmonious child development; together with the fact that childcare workers should receive training through a specific manual designed for private daycare centers, any type of virtual consultation site and training course(AU)

Who Is Caring for Health Care Workers' Families Amid COVID-19?

Amid the COVID-19 pandemic, women in medicine, including faculty, residents, medical students, and other health care workers (HCWs), are facing unparalleled challenges. The burdens of pandemic-associated increases in domestic and caregiving responsibilities, professional demands, health risks associated with contracting COVID-19, and the resulting psychosocial distress have exacerbated existing gender disparities at home, at work, and in academia. School and day care closures have created additional childcare needs, primarily for women, yet little support exists for parents and families. These increased childcare and domestic responsibilities have forced women HCWs, who make up the overwhelming majority of the workforce, to adapt their schedules and, in some cases, leave their jobs entirely. In this article, the authors detail how COVID-19 has exacerbated existing childcare accessibility and affordability issues as well as gender disparities. They argue that unless government and health care organization support for childcare increases, families, specifically women and children, will continue to suffer. Lack of access to affordable childcare can prevent HCWs from doing their jobs, including conducting and publishing academic scholarship. This poses incalculable risks to families, science, and society. COVID-19 should serve as a call to action to all sectors, including the government and health care organizations, to prioritize childcare provision and increase support for women HCWs, both now during the pandemic and going forward.

Child Temperament and Total Diurnal Cortisol in Out-of-Home Center-Based Child Care and in At-Home Parental Care.

The association between child temperament characteristics and total diurnal saliva cortisol in 84 children (M = 2.3 years, SD = 0.6) attending out-of-home, center-based child care and 79 children (M = 2.0 years, SD = 0.5) attending at-home parental care was examined. Saliva samples were collected during two consecutive days, that is, Sunday and Monday, with four samples taken per day. While children higher in surgency had higher total diurnal cortisol production, we did not find evidence that temperament moderated the associations between child-care context and total diurnal cortisol. Negative affectivity and effortful control were not related to cortisol output. Our findings suggest that temperamental surgency may be associated with higher total cortisol production in early childhood across child-care settings.

COVID-19 Transmission in US Child Care Programs.

OBJECTIVES: Central to the debate over school and child care reopening is whether children are efficient coronavirus disease 2019 (COVID-19) transmitters and are likely to increase community spread when programs reopen. We compared COVID-19 outcomes in child care providers who continued to provide direct in-person child care during the first 3 months of the US COVID-19 pandemic with outcomes in those who did not. METHODS: Data were obtained from US child care providers (N = 57 335) reporting whether they had ever tested positive or been hospitalized for COVID-19 (n = 427 cases) along with their degree of exposure to child care. Background transmission rates were controlled statistically, and other demographic, programmatic, and community variables were explored as potential confounders. Logistic regression analysis was used in both unmatched and propensity score-matched case-control analyses. RESULTS: No association was found between exposure to child care and COVID-19 in both unmatched (odds ratio [OR], 1.06; 95% confidence interval [CI], 0.82-1.38) and matched (OR, 0.94; 95% CI, 0.73-1.21) analyses. In matched analysis, being a home-based provider (as opposed to a center-based provider) was associated with COVID-19 (OR, 1.59; 95% CI, 1.14-2.23) but revealed no interaction with exposure. CONCLUSIONS: Within the context of considerable infection mitigation efforts in US child care programs, exposure to child care during the early months of the US pandemic was not associated with an elevated risk for COVID-19 transmission to providers. These findings must be interpreted only within the context of background transmission rates and the considerable infection mitigation efforts implemented in child care programs.

The relationship between temperamental dimensions and inhibitory control in early childhood: Implications for language acquisition.

The present study investigates the latent organization of inhibitory control in children aged between 2;3 and 3;0 years. In addition, it explores the relationships between temperament dimensions - social orientation, motor activity, and attention -, inhibitory control and language. One-hundred-twelve typically developing children were evaluated with tasks for inhibitory control and lexical skills, while ratings of temperament and language were collected from their caregivers. A Confirmatory Factor Analysis reveals that inhibitory control seems to be best described by a unitary dimension. A Structural Equation Model suggests that 78 % of the variance in vocabulary is explained by a model considering the language observed measures, the three temperamental dimensions, and inhibitory control and in which both temperamental attention and the latent dimension of inhibitory control are significantly related to vocabulary. In addition, inhibitory control does not mediate the relationship between temperament and language.

Integrative Review of Breastfeeding Support and Related Practices in Child Care Centers.

OBJECTIVE: To synthesize the extant research on the support of breastfeeding and breast milk feeding and related practices in child care centers (i.e., daycare centers) in the United States and globally. DATA SOURCES: We used key terms to search Ovid, CINAHL, and PubMed for articles that met eligibility criteria. When potentially relevant articles were identified in PubMed, we used the cited by and similar articles features to identify additional articles. We also examined the reference lists of reviewed studies. STUDY SELECTION: We included original research articles on breastfeeding or breast milk feeding in child care centers published in 2000 or after and available in English. We reviewed titles and/or abstracts of 1,984 articles and abstracted 37 for full-text review. Of these, 16 studies met eligibility criteria and were included in the review. DATA EXTRACTION: We abstracted data from the 16 articles to facilitate comparison and identification of patterns related to support of breastfeeding/breast milk feeding and related practices in child care centers. These data included year of publication, setting, design/methodology (and methodologic limitations), type of respondent/sampling unit (e.g., directors and staff members of child care centers, mothers), sample size, outcome measures, and pertinent study findings. DATA SYNTHESIS: We categorized study findings into three themes: Knowledge, Attitudes, and Experiences of Staff Members in Child Care Centers; Implementation and Adherence to Policies, Practices, and Regulations in Child Care Centers; and Prevalence of Breastfeeding in Child Care Centers. Findings indicated staff members generally had positive attitudes toward breastfeeding but tended to remain neutral regarding encouragement and support of breastfeeding. Training and knowledge about breastfeeding among staff members in child care centers appears limited and focused mainly on the storage and preparation of breast milk; however, staff members indicated the desire to obtain additional education about breastfeeding. Few U.S. child care centers or states have comprehensive, evidence-based policies and regulations to address support for breast milk feeding and breastfeeding. The prevalence of breastfeeding in U.S. child care centers is less than that in other child care settings (home-based child care, etc.), child care centers in other developed countries, and national breastfeeding averages. CONCLUSION: We found a general lack of policies and practices to support breastfeeding in child care centers, particularly in the United States. The degree to which this policy/practice deficit contributes to suboptimal breastfeeding rates among women who use child care centers requires further study.

State Regulations to Support Children's Cultural and Religious Food Preferences in Early Care and Education.

OBJECTIVE: In July 2018 the Academy of Nutrition and Dietetics released a benchmark encouraging early care and education (ECE) programs, including child care centers and family child care homes, to incorporate cultural and religious food preferences of children into meals. We examined the extent to which states were already doing so through their ECE licensing and administrative regulations prior to the release of the benchmark. This review may serve as a baseline to assess future updates, if more states incorporate the benchmark into their regulations. METHODS: For this cross-sectional study, we reviewed ECE regulations for all 50 states and the District of Columbia (hereafter states) through June 2018. We assessed consistency with the benchmark for centers and homes. We conducted Spearman correlations to estimate associations between the year the regulations were updated and consistency with the benchmark. RESULTS: Among centers, eight states fully met the benchmark, 11 partially met the benchmark, and 32 did not meet the benchmark. Similarly for homes, four states fully met the benchmark, 13 partially met the benchmark, and 34 did not meet the benchmark. Meeting the benchmark was not correlated with the year of last update for centers (P = 0.54) or homes (P = 0.31). CONCLUSIONS: Most states lacked regulations consistent with the benchmark. Health professionals can help encourage ECE programs to consider cultural and religious food preferences of children in meal planning. And, if feasible, states may consider additional regulations supporting cultural and religious preferences of children in future updates to regulations.

Analysis of infant physical activity in the childcare environment: An observational study.

This study utilized behavior-mapping to describe behavior and levels of activity in infants attending Early Childhood Education and Care (ECEC). Descriptive statistics were used to determine proportion of time spent in certain locations, body positions, activities and engagement with others. To establish whether location, the presence of equipment or engagement with others influenced levels of activity, a paired t-test was used. Results indicated that of all locations, infants spent the greatest amount of time in the meals area (35%), with half of this period spent physically inactive (sedentary). The indoor play area was where infants were most active. Infants also spent a significantly greater proportion of their upright time (64%) supported by either furniture or equipment than without (MD 28, 95% CI 13-44, p < 0.01). Interestingly, infants displayed more sedentary behavior when engaged with others than when not engaged (MD 21, 95% CI 6-36, p < 0.01). The environment, presence of others and equipment availability appear to influence activity levels of infants in ECEC centers. Findings suggest that time spent in meal areas, provisions of furniture/equipment, and opportunities for infants to play independently warrant further exploration to determine their influence on activity levels in typically-developing infants.

Modeling the impact of changes in day-care contact patterns on the dynamics of varicella transmission in France between 1991 and 2015.

Annual incidence rates of varicella infection in the general population in France have been rather stable since 1991 when clinical surveillance started. Rates however show a statistically significant increase over time in children aged 0-3 years, and a decline in older individuals. A significant increase in day-care enrolment and structures' capacity in France was also observed in the last decade. In this work we investigate the potential interplay between an increase of contacts of young children possibly caused by earlier socialization in the community and varicella transmission dynamics. To this aim, we develop an age-structured mathematical model, informed with historical demographic data and contact matrix estimates in the country, accounting for longitudinal linear increase of early childhood contacts. While the reported overall varicella incidence is well reproduced independently of mixing variations, age-specific empirical trends are better captured by accounting for an increase in contacts among pre-school children in the last decades. We found that the varicella data are consistent with a 30% increase in the number of contacts at day-care facilities, which would imply a 50% growth in the contribution of 0-3y old children to overall yearly infections in 1991-2015. Our findings suggest that an earlier exposure to pathogens due to changes in day-care contact patterns, represents a plausible explanation for the epidemiological patterns observed in France. Obtained results suggest that considering temporal changes in social factors in addition to demographic ones is critical to correctly interpret varicella transmission dynamics.

Physical Activity Practices, Policies and Environments in Washington State Child Care Settings: Results of a Statewide Survey.

Objectives Child care is an important setting for the promotion of physical activity (PA) in early childhood. The purpose of this study was to examine the associations between specific PA environments and recommended practices in child care settings as well as the degree to which child care settings met recommended standards for total PA time. Methods In 2013, all programs licensed to care for children ages 2-5 in WA state were surveyed about their PA related practices. Logistic regression was used to determine odds of meeting best-practice standards for outdoor time and PA. Results The response rate was 45.8 % from centers (692/1511) and 32.1 % from homes (1281/3991). Few programs reported meeting best-practice standards for the amount of time children spend being physically active (centers: 12.1 %, homes: 20.1 %) and outdoor time (centers: 21.8 %, homes: 21.7 %). Programs where children go outside regardless of weather and those reporting more adult-led PA had higher odds of meeting best-practice standards for both PA and outdoor time. Meeting best-practice standards for outdoor time was the strongest predictor of meeting best-practice standards for total PA time [centers: OR 15.9 (9.3-27.2), homes: OR 5.2 (3.8-7.1)]. Conclusions for Practice There is considerable room for improvement in licensed child care settings in WA to meet best-practice standards for young children's outdoor and PA time. Initiatives that create policies and environments encouraging outdoor play and adult-led PA in child care have the potential to increase physical activity in substantial numbers of young children.

Entering out-of-home care during childhood: Cumulative incidence study in Canada and Australia.

Cumulative incidence provides a more accurate indicator than annual incidence rates of the number of children who experience out-of-home care during childhood. The study utilises a cohort of all children born in Western Australia (WA) 1994-2005 and Manitoba 1998-2008 using de-identified linked data. Life tables were used to calculate the age-specific cumulative incidence over time and for at-risk groups. Cox regression was used to compare risk factors for entry to care. Manitoba had a larger proportion of children entering care compared to WA (9.4% vs 1.5% by age 12). Over time children entered care at a younger age in both WA (HR=1.5, CI:1.4-1.5) and Manitoba (HR=1.5, CI:1.5-1.6). Similar factors were associated with earlier age care entries in both countries including: socioeconomic disadvantage, young maternal age, maternal hospital admissions for mental health issues, substance misuse and assault. Supplementary analysis for WA showed a time trend with young children (<3years of age) who entered care spending an increasing proportion of their early years in care. Whilst Manitoba had a larger proportion of children entering care, over time in Western Australia children have been entering care at a younger age and spending more time in care. These latter factors contribute to an increased burden on the out-of-home care system. Manitoba had over five times greater cumulative incidence than WA, however risk factors for entry to out-of-home care were consistent in both countries. Knowledge of the risk factors for entry to out-of-home care can inform targeted support and prevention programs.

Protective environmental factors for neuromyelitis optica.

OBJECTIVE: To determine whether early environmental factors, such as cesarean delivery, breastfeeding, and exposure to smoking or herpes viruses, are associated with neuromyelitis optica (NMO) risk in children. METHODS: This is a case-control study of pediatric NMO, multiple sclerosis (MS), and healthy subjects. Early-life exposures were obtained by standardized questionnaire. Epstein-Barr virus, cytomegalovirus, and herpes simplex virus 1 antibody responses were determined by ELISA. Multivariate logistic regression models were used to adjust for age at sampling, sex, race, and ethnicity. RESULTS: Early-life exposures were obtained from 36 pediatric subjects with NMO, 491 with MS, and 224 healthy controls. Daycare (odds ratio [OR] 0.33, 95% confidence interval [CI] 0.14, 0.78; p < 0.01) and breastfeeding (OR 0.42, 95% CI 0.18, 0.99; p = 0.05) were associated with lower odds of having NMO compared with healthy subjects. Cesarean delivery tended to be associated with 2-fold-higher odds of NMO compared with having MS/clinically isolated syndrome (OR 1.98, 95% CI 0.88, 4.59; p = 0.12) or with being healthy (OR 1.95, 95% CI 0.81, 4.71; p = 0.14). Sera and DNA were available for 31 subjects with NMO, 189 with MS, and 94 healthy controls. Epstein-Barr virus, herpes simplex virus 1, cytomegalovirus exposure, and being HLA-DRB1*15 positive were not associated with odds of having NMO compared with healthy subjects. CONCLUSIONS: Exposure to other young children may be an early protective factor against the development of NMO, as previously reported for MS, consistent with the hypothesis that infections contribute to disease risk modification. Unlike MS, pediatric NMO does not appear to be associated with exposures to common herpes viruses.

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.

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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Vigilância à saúde das crianças em creche municipal: enfoque no perfil nutricional / Monitoring children’s health in a public daycare center: focus on their nutritional profile

Objetivou-se identificar o perfil nutricional de crianças de uma creche municipal na cidade de Cuité-Paraíba, sob a ótica da vigilância à saúde. Pesquisa transversal, exploratória-descritiva, de campo, com abordagem quantitativa, realizada em 2011, com 55 crianças de 6 a 60 meses de vida, assistidas em tempo integral em uma creche municipal, que atenderam aos critérios de seleção: estar frequentando a creche; e não apresentar deficiência. Utilizou-se para avaliação às medidas antropométricas de peso, estatura e Índice de Massa Corporal, conforme a curva de crescimento preconizada pelo Ministério da Saúde. Identificou-se que 96,4% apresentaram estado nutricional adequado, porém, 7,3% risco para sobrepeso e 3,6% magreza, especialmente as meninas. É imperativa a sensibilização de gestores, profissionais e pais quanto à vigilância à saúde de crianças em creches, para identificação e intervenção frente a alterações nutricionais, favorecendo um crescimento infantil adequado.

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.

Aplicación de los criterios de Oporto para el diagnóstico de enfermedad inflamatoria intestinal pediátrica en un centro pediátrico de referencia / Application of the Porto criteria for the diagnosis of paediatric inflammatory bowel disease in a paediatric reference centre

Introducción: El término enfermedad inflamatoria intestinal (EII) ha englobado clásicamente dos entidades: enfermedad de Crohn (EC) y colitis ulcerosa (CU). La diferenciación correcta entre ambas enfermedades tiene importantes implicaciones. El término EII tipo no clasificada (EIInC) describe aquellas situaciones de inflamación colónica que no pueden ser identificadas con seguridad como EC ni como CU. Esta situación se ha descrito hasta en el 20-30% de la EII pediátrica en el momento del diagnóstico. Con el fin de alcanzar un diagnóstico de seguridad ante la sospecha de EII en niños, la European Society for Pediatric Gastroenterology, Hepatology and Nutrition (EPSGHAN) estableció en julio de 2005 los denominados criterios de Oporto (CO). Dichas recomendaciones incluyen la realización de: a) colonoscopia completa con ileoscopia, b) endoscopia digestiva alta; c) biopsias múltiples de todos los trayectos explorados, y d) exploración completa del intestino delgado. Objetivo: Evaluar los procedimientos diagnósticos utilizados en nuestros pacientes con EII en relación a los CO. Pacientes y métodos: Revisión retrospectiva de los datos de nuestros pacientes con EII diagnosticados en los últimos diez años (1999-2008) en un hospital terciario español diferenciando dos periodos: antes y después de la publicación de los CO. Resultados: Ciento ocho pacientes han sido diagnosticados de EII en nuestro centro en dicho periodo (51 CU, 52 EC, 5 EIInC), 43 niñas (39,8%), 65 niños (60,1%). Según la clasificación de Montreal: a) CU, 40 (78,4%) colitis extensa, 5 colitis izquierda (9,8%), 6 proctitis (11,7%); b) EC: 44 ileo-colónico (84,6%), 13 ileal (25%) y 7 colónico (13,4%). Edad mediana al diagnóstico: 13 años 1 mes (p25-p75: 10 años 3 meses- 14 años 9 meses). Los CO se cumplieron en el 49% de los casos (en el 33,3% antes de su publicación, en el 64,8% tras ésta; p=0,001). Se realizó una endoscopia digestiva alta en 62 pacientes (58%): en 38,9% antes frente a 72,2% después, p<0,001. Se encontró afectación endoscópica o histológica relevante en tramos altos en el 51% de los pacientes con EC. Se realizó colonoscopia completa con ileoscopia en el 85,2% de los casos. El número medio de segmentos ileo-colónicos biopsiados fue de 6,6 de entre 7 segmentos posibles. Se objetivaron granulomas en el 38% de los pacientes con EC. Hasta el 38% de los pacientes con EC presentaban signos microscópicos de inflamación en segmentos de aspecto endoscópico normal. Durante el seguimiento a los pacientes con EIInC, se procedió al cambio del diagnóstico inicial en 1 paciente a EC y en 1 caso a CU, manteniéndose el diagnóstico inicial en los otros 3 pacientes. Conclusiones: Nuestra práctica clínica en el diagnóstico de EII ha cambiado tras la publicación de los CO. La endoscopia digestiva alta constituye una herramienta útil en el diagnóstico de afectación de tramos altos en la EC. La colonoscopia completa con ileoscopia y la realización de biopsias múltiples son fundamentales para delimitar la extensión de los cambios inflamatorios. No hemos observado cambios en el diagnóstico final en nuestros pacientes con EC o CU tras un seguimiento medio de 4 años (AU)

Introduction: Inflammatory bowel diseases (IBD) have classically included two entities: Crohn's disease (CD) and ulcerative colitis (UC). The correct differentiation between these two diseases has important implications. The term inflammatory bowel disease unclassified (IBDu) describes inflammatory changes of the colon that cannot be classified as ulcerative colitis or Crohn's disease. This situation has been described in 20-30% of paediatric IBD at diagnosis. In order to reach a definitive diagnosis of suspicion of inflammatory bowel disease in children, the ESPGHAN (European Society for Paediatric Gastroenterology, Hepatology and Nutrition) established the Porto criteria (PC) in July 2005. The recommendations include: 1) total colonoscopy with ileal intubation, 2) upper endoscopy, 3) multiple biopsies and 4) complete small bowel exploration. Aim: To evaluate the diagnostic procedures used in our IBD patients regarding the PC. Patients and methods: Retrospective review of the data of our IBD patients diagnosed in the last ten years (1999-2008) in a Spanish tertiary hospital, differentiating two periods: before and after the publication of the PC. Results: A total of 108 IBD patients had been diagnosed (51 UC, 52 CD, 5 IBDu), 43 girls (39.81%), 65 boys (60.18%). According to the Montreal classification: 1) UC, 40 (78%) extensive colitis, 5 left-sided colitis (9.8%), 6 proctitis (11%), 2) CD: 44 ileo-colonic (84%), 13 ileal, 7 colonic. Median age at diagnosis: 13 years 1 month (p25-p75: 10 years 3 months- 14 years 9months). The Porto criteria were followed in 49% of the cases (33.3% before its publication, 64.8% after, P=.001). Upper endoscopy was performed in 62 patients (58%): 38.9% versus 72.2%, P<0.001. Upper involvement was found in 51% of our CD patients. Total colonoscopy with ileoscopy was achieved in 85.2% of the cases. The mean number of ileo-colonic segments biopsied was 6.6 (7 different segments). Granulomas at biopsies were present in 38% of our CD patients. Up to 38% of the CD patients had microscopic inflammation in endoscopically normal appearing segments. During the follow-up, initial diagnosis among the IBDu patients, was changed to CD in 1, to UC in 2 and the other 3 remained with the same diagnosis. We did not observe other changes in diagnosis in the remaining 103 patients (median follow-up: 4y 8mo). Thirty patients were discharged when becoming adults. Conclusions: Our clinical practice in IBD diagnosis has changed after the PC. Upper endoscopy is a useful tool to find upper involvement in CD. Total colonoscopy with ileoscopy and performance of multiple biopsies are essential to determine extension of the inflammatory changes. We have not observed changes in the final diagnosis in our CD and UC patients after a median follow-up of 4 years (AU)

Wide variability in physical activity environments and weather-related outdoor play policies in child care centers within a single county of Ohio.

OBJECTIVES: To examine the variability of physical activity environments and outdoor play policies in child care centers and to determine whether this variability is associated with the demographic characteristics of the child care centers surveyed. DESIGN: Early Learning Environments Physical Activity and Nutrition Telephone Survey. SETTING: Child care centers in Hamilton County (greater Cincinnati area), Ohio, during the period from 2008 to 2009. PARTICIPANTS: Directors of all 185 licensed full-time child care centers in Hamilton County. OUTCOME MEASURES: Descriptive measures of playground and indoor physical activity environments and weather-related outdoor play policies. RESULTS: Of 185 eligible child care centers, 162 (88%) responded to our survey. Of the 162 centers that responded, 151 (93%) reported an on-site playground, but slightly more than half reported that their playgrounds were large, that they were at least one-third covered in shade, or that they had a variety of portable play equipment. Only half reported having a dedicated indoor gross motor room where children could be active during inclement weather. Only 32 centers (20%) allowed children to go outside in temperatures below 32°F (0°C), and 70 centers (43%) reported allowing children outdoors during light rain. A higher percentage of children receiving tuition assistance was associated with lower quality physical activity facilities and stricter weather-related practices. National accreditation was associated with more physical activity-promoting practices. CONCLUSION: We found considerable variability in the indoor and outdoor physical activity environments offered by child care centers within a single county of Ohio. Depending on the outdoor play policy and options for indoor physical activity of a child care center, children's opportunities for physical activity can be curtailed as a result of subfreezing temperatures or light rain. Policy changes and education of parents and teachers may be needed to ensure that children have ample opportunity for daily physical activity.

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.