Family-centered approach in Early Childhood Intervention of a vulnerable population from an Ecuadorian rural context.

Introduction: Studies about the implementation of the Family Centered Practices approach in Early Childhood Intervention refer as outcomes that have an impact on the Quality of Family Life, on children's development, and also on family empowerment. In Ecuador, despite an absence of Early Childhood Intervention policies and programs, a university has developed training in Family Centered Practices for graduate students. A formative component is to implement a Routines Based Model with families of children with disabilities. The aim of the study is to analyze the impact on the Family Quality of Life, children's development and self-perceived competence of families after the Routines Based Model has been implemented in their natural environment. Method: Eight families from a rural area and their children with disabilities were included in the study. The Family Quality of Life Scale-Early Childhood Intervention and the Screening of the Battelle Developmental Inventory were applied at the beginning and end of the process. A qualitative interview established the family perspective upon the outcomes in their family and their children. Results: There is evidence of a significant increase in the families' Quality of Life and in the children's development at the end of the process. At the interview the families declared themselves more competent to understand and contribute to the development of their children. Discussion: The results provide knowledge of the implementation of a Routine Based Model in vulnerable contexts. Also contributes in the understanding of the family perspective on the outcomes and perceived benefits for the children and the family itself as a measure of quality of the intervention and training. Implications of the results for initial and ongoing training of early care professionals with vulnerable populations are discussed.

Intervención basada en rutinas como apoyo a la participación familiar para el desarrollo del lenguaje en bebés prematuros / Routine based intervention to support family participation in language development in preterm babies

La prematuridad está asociada a riesgos en salud y neurodesarrollo, agravados por temores y desconocimiento de los padres para atender las necesidades del bebé. Por ello se requieren programas de atención temprana centrados en la familia y en entornos naturales, no disponibles en Ecuador. Este trabajo presenta la incidencia que puede presentar una intervención basada en rutinas (IBR) en la participación familiar para el desarrollo del lenguaje de sus bebés prematuros. Tres universidades internacionales y una organización no gubernamental que brinda servicio especializado, colaboraron en este estudio de casos que implementó durante 16 semanas la IBR con familias de bebés prematuros habitantes de sectores populares y usuarios de la ONG. Se recogieron datos cualicuantitativos pre- y postaplicación de la IBR. La ASQ-3 se aplicó para evaluar a los bebés y fortalecer el conocimiento de las familias sobre el desarrollo infantil. En una entrevista final, se analizan las percepciones de las madres sobre la incidencia de la intervención en participación familiar para el desarrollo del lenguaje de sus bebés. Los resultados evidencian cuantitativamente el avance de los bebés. Se destaca que las condiciones de desarrollo del bebé está mediada por las múltiples hospitalizaciones y poco conocimiento y temores de los padres sobre la condición de la prematuridad. Al finalizar, las familias manifiestan satisfacción con el proceso y reconocen el desarrollo del lenguaje de sus bebés como un resultado del incremento de la interacción familiar provocado por la IBR

Prematurity is associated with health and neurodevelopmental risks, aggravated by fears and lack of parental knowledge of their baby's needs. Therefore, early care programmes that focus on the family and natural environments, not available in Ecuador, are required. This paper presents the impact that a Routine Based Intervention (RBI) can have on family involvement in the development of their premature babies' language. Three international universities and a non-governmental organisation that provides specialist services collaborated in this case study, which implemented the IBR for 16 weeks with families of premature babies living in popular sectors and users of the NGO. Qualitative and quantitative data were collected pre- and post-implementation. The ASQ-3 was used to assess the babies and enhance the families' knowledge on child development. In a final interview, the mothers' perceptions of the impact of family involvement on their babies' language development were analysed. The results provide quantitative evidence of the babies' progress. It is noteworthy that the baby's developmental conditions were mediated by multiple hospitalisations and the parents' lack of knowledge about prematurity. At the end of the intervention, the families expressed their satisfaction with the process and recognised their babies' language development as a result of increased family interaction through the RBI

Fundamental Studies of the Singlet Oxygen Reactions with the Potent Marine Toxin Domoic Acid.

Domoic acid (DA), a potent marine toxin, is readily oxidized upon reaction with singlet oxygen (1O2). Detailed product studies revealed that the major singlet oxygenation reaction pathways were the [2 + 2] cycloaddition (60.2%) and ene reactions (39.8%) occurring at the Z double bond. Diene isomerization and [4 + 2] cycloaddition, common for conjugated diene systems, were not observed during the singlet oxygenation of DA. The bimolecular rate constant for the DA reaction with 1O2 determined by competition kinetics was 5.1 × 105 M-1 s-1. Based on the rate constant and steady-state concentrations of 1O2 in surface waters, the environmental half-life of DA due to singlet oxygen-induced transformations is between 5 and 63 days. The 1O2 reaction product mixture of DA did not exhibit significant biological activity based on ELISA studies, indicating that singlet oxygenation could be an important natural detoxification process. The characteristic oxidation products can provide valuable markers for the risk assessment of DA-contaminated natural waters.

Factores que influyen en la atribución de la pensión de sobrevivencia en una administradora de fondos de pensiones colombiana, 2006-2011 / Factors that influence the approval of the survivor's pension in a Colombian pension fund administrator, 2006-2011 / Fatores que influenciam a atribuição da pensão de sobrevivência em um gestor de fundos de pensão colombiano, 2006-2011

Resumen Objetivo: Identificar cómo influyen los factores sociodemográficos, ocupacionales, de siniestralidad y de afiliación en la aprobación o no de la pensión de sobrevivencia en una administradora de fondos de pensiones colombiana entre 2006 y 2011. Metodología: Estudio de corte a partir de los formularios de investigación causal del fallecimiento, pensión obligatoria y registro civil de defunción. Se analizaron estadísticamente los datos y mediante un modelo multivariado de regresión logística se evaluó el desenlace de aprobación de la solicitud pensional por sobrevivencia. Resultados: La edad promedio de los aprobados fue de 35,9 (± 9,6) y de 34,3 (± 10,4), siendo una diferencia significativa (valor p = 0,00). La mayoría de causantes fueron hombres (80,9 %), pero las mujeres tuvieron mayor porcentaje de aprobación, con diferencias significativas (valor p = 0,01). La aprobación de la solicitud fue mayor entre los 25 y 39 años. La mayoría de las reclamaciones fueron por accidentes (61,3 %), con una aprobación del 35,1 %. Las solicitudes por enfermedades fueron aprobadas en 43,5 %. Las causas externas constituyeron el principal motivo de muerte, con un 56,6 % del total, desagregadas principalmente como: muerte violenta (47,8 %), accidente no especificado (30,2 %) y accidente de tránsito (11,3 %). Conclusiones: Este trabajo aporta evidencia desde Colombia sobre cómo la aprobación de la pensión estuvo asociada con la edad del afiliado fallecido y con las características del siniestro, que lo catalogan como accidente o enfermedad, la hora de ocurrencia, la ocurrencia en horas laborales y la causa de la muerte.

Abstract Objective: To identify how sociodemographic, occupational, accident-related and affiliation factors influence the approval or non-approval of survivor's pension in a Colombian pension fund administrator between 2006 and 2011. Methodology: Cohort study based on the causal investigation forms relating to death, mandatory pension and death certificate. Data was statistically analyzed and the outcome regarding the approval of the survivor's pension request was evaluated through a multivariate logistic regression model. Results: The average age of approved cases was 35.9 (± 9.6) and 34.3 (± 10.4); a significant difference (value p = 0.00). Most of the deceased were men (80.9%), but women had a higher percentage of approval, with significant differences (p value = 0.01). Approval of the application was higher between 25 and 39 years of age. The majority of claims involved accidents (61.3%), with an approval of 35.1%. Applications involving diseases were approved in 43.5%. External causes were the main cause of death, with 56.6% of the total, divided mainly into: violent death (47.8%), unspecified accident (30.2%) and traffic collision (11.3%). Conclusions: This work provides evidence of how, in Colombia, the approval of the pension was associated with the age of the deceased member, the characteristics of the event (which is classified as an accident or a disease), the time of occurrence, the occurrence during working hours and the cause of death.

Resumo Objetivo: Identificar como fatores sócio demográficos, ocupacionais, acidentes e afiliação influenciam a aprovação ou não da pensão de sobrevivência em uma administradora de fundos de pensão colombiano entre 2006 e 2011. Metodologia: Estudo de coorte baseado nas formas de investigação causal da morte, pensão obrigatória e registro civil post mortem. Os dados foram analisados estatisticamente e, através de um modelo de regressão logística multivariada, foi avaliado o resultado da aprovação do pedido de pensão por sobrevivência. Resultados: A idade média dos aprovados foi de 35,9 (± 9,6) e 34,3 (± 10,4), com diferença significativa (valor p. (0,00 = A maioria dos pacientes eram do sexo masculino (80,9 %), mas as mulheres apresentaram maior percentual de aprovação, com diferenças significativas (valor p. (0,01 = A aprovação do pedido foi maior entre 25 e 39 anos. A maioria dos sinistros se deveu a acidentes (61,3 %), com aprovação de 35,1%. Os pedidos de doenças foram aprovados em 43,5 %. As causas externas foram a principal causa de morte, com 56,6 % do total, sendo desagregadas principalmente por: morte violenta (47,8%), acidente não especificado (30,2%) e acidente de trânsito (11,3%). Conclusões: Este estudo fornece evidências da Colômbia sobre a aprovação da pensão foi associada com a idade do membro falecido e as características do acidente, catalogando-o como um acidente ou doença, tempo de ocorrência, a ocorrência durante o horário de trabalho e causa da morte.

Caracterización de factores relacionados con la reclamación y aprobación de pensiones de invalidez por enfermedad común en población trabajadora colombiana entre 2006-2011 / Characterization of factors related to the application for and approval of pensions due to common diseases among the Colombian working population, 2006-2011

RESUMEN Introducción: mientras la discapacidad afecta hasta el 12 % de la población de un país según fuentes oficiales en Colombia, a pesar del sub registro, tendrá un comportamiento creciente en los próximos años. Las Administradoras de Fondos de Pensiones (AFP) están encargadas del manejo eficiente del fondo para el riesgo pensional en Colombia. Objetivo: caracterizar la reclamación de pensiones de invalidez por enfermedad común y los principales factores relacionados con su aprobación entre 2006 y 2011 en una AFP colombiana. Materiales y métodos: la fuente secundaria de la información fue la AFP a través del Manual Único para la Calificación de Invalidez. Estudio descriptivo y exploratorio inferencial de factores relacionados con los desenlaces de invalidez, y aprobación de la solicitud pensional. Resultados: ser declarado inválido estuvo asociado con ser hombre, el máximo nivel de estudio, y la deficiencia dada por las causales de solicitud: enfermedades poco prevalentes pero muy incapacitantes. Tener soporte social disminuye la probabilidad de ser declarado inválido. Discusión y conclusión: los factores aquí relacionados con la invalidez acorde con otros estudios deben considerarse en la formulación de políticas públicas que puedan impactar en la prevención de este desenlace y el bienestar de la población trabajadora.

SUMMARY Introduction: According to official sources, disability affects up to 12 % of a country's population. In Colombia, however, this percentage will continue to increase in the coming years regardless of the existing under-recording. Additionally, Pension fund administrators (PFAs) are in charge of efficiently managing the pension risk fund in Colombia. Objective: To characterize disability pension applications due to common diseases along with the main factors regarding their approval between 2006 and 2011 in a Colombian PFA. Materials and Methods: The PFA's Unique Manual for Disability Assessment was used as a secondary source of information. This was a descriptive study with an inferential exploration of the factors concerning two outcomes: disability and application approval. Results: Being declared as a disabled person was associated with being male, having the highest schooling level, and the impairment motivating the application: diseases that have low prevalence but are very disabling. Having social support decreased the probability of being declared disabled. Discussion and conclusion: The factors related to disability, which are consistent with those reported by other studies, should be considered when proposing public policies, which may have an impact on the prevention of this outcome and the well-being of the working population.

Stage progression and need for renal replacement therapy in a renal protection programme in Colombia. A cohort study. / Progreso de estadio y requerimiento de terapia de reemplazo renal en un programa de protección renal en Colombia. Estudio de cohorte.

BACKGROUND: Due to the global burden represented by chronic kidney disease (CKD), the World Health Organization encouraged the implementation of renal protection programmes (RPP) to affect its incidence through prevention and control measures. OBJECTIVES: To assess the effectiveness of a Colombian RPP in terms of its effect on the stage progression of CKD and the need for renal replacement therapy (RRT). METHODS: An analytical study that monitored 2cohorts of patients diagnosed with CKD. The study compares the behaviour of clinical and renal impairment indicators from patients exposed to a RPP with that of patients following conventional treatment (CT). The population of both intervention groups was considered when determining the sample size. The incidence rate was calculated as well as patient survival (Kaplan Meier). In addition, a multivariate analysis (Cox) was used to calculate the influence that exposure to the RPP had on the outcomes of the patients following the RPP and those following CT. RESULTS: The patients exposed to the RPP took longer to advance to the next CKD stage and require RRT. The incidence rate for progression is higher for the patients following CT (0.050, IC 95%: 0.040-0.064) compared to those in the RPP (0.034, IC 95%: 0.030-0.039). The ratio of incidence rates was 1.480 (IC 95% 1.21-1.90). The hazard of progression was lower for the RPP (HR: 0.855, IC 95%: 0.74- 0.98), as was the hazard of requiring RRT (HR: 0.797, IC 95%: 0.606-1.049). CONCLUSIONS: The RPP is a secondary prevention strategy against CKD which has an effect on the stage progression of CKD and the need for RRT. Early patient detection has a positive effect on the outcomes studied.

Progreso de estadio y requerimiento de terapia de reemplazo renal en un programa de protección renal en Colombia. Estudio de cohorte / Stage progression and need for renal replacement therapy in a renal protection programme in Colombia. A cohort study

Antecedentes: Debido a la carga global de la enfermedad renal crónica (ERC), la Organización Mundial de la Salud fomentó programas de protección renal (PPR) para impactar en su incidencia con medidas de prevención y control. Objetivos: Evaluar la efectividad de un PPR en Colombia sobre el progreso de estadio en ERC y el requerimiento de terapia de reemplazo renal (TRR). Métodos: Estudio analítico de seguimiento a 2cohortes de pacientes con diagnóstico de ERC, que compara el comportamiento de indicadores clínicos y de deterioro renal entre pacientes expuestos a un PPR versus el tratamiento convencional (TC). Como tamaño de muestra se tuvo en cuenta el censo de la población de ambas aseguradoras. Se calculó la tasa de incidencia, la supervivencia (Kaplan Meier) y la influencia de la exposición al PPR sobre los desenlaces entre PPR y TC mediante un análisis multivariado (Cox). Resultados: Los pacientes expuestos al PPR se demoraron más en hacer el primer progreso de estadio y en requerir TRR. La tasa de incidencia para progreso es mayor en TC (0,050; IC 95%: 0,040-0,064) que en PPR (0,034: IC 95%: 0,030-0,039). Razón de tasas de incidencia: 1,480 (IC 95%: 1,21-1,90). El riesgo instantáneo de progreso fue menor en PPR (HR: 0,855; IC 95%: 0,74-0,98), al igual que el riesgo de requerir TRR (HR: 0,797; IC 95%: 0,606-1,049). Conclusiones: El PPR representa una estrategia de prevención secundaria en ERC que impacta en el progreso de estadio y requerimiento de TRR. La captación temprana de pacientes mejora dichos desenlaces (AU)

Background: Due to the global burden represented by chronic kidney disease (CKD), the World Health Organization encouraged the implementation of renal protection programmes (RPP) to affect its incidence through prevention and control measures. Objectives: To assess the effectiveness of a Colombian RPP in terms of its effect on the stage progression of CKD and the need for renal replacement therapy (RRT). Methods: An analytical study that monitored 2cohorts of patients diagnosed with CKD. The study compares the behaviour of clinical and renal impairment indicators from patients exposed to a RPP with that of patients following conventional treatment (CT). The population of both intervention groups was considered when determining the sample size. The incidence rate was calculated as well as patient survival (Kaplan Meier). In addition, a multivariate analysis (Cox) was used to calculate the influence that exposure to the RPP had on the outcomes of the patients following the RPP and those following CT. Results: The patients exposed to the RPP took longer to advance to the next CKD stage and require RRT. The incidence rate for progression is higher for the patients following CT (0.050, IC 95%: 0.040-0.064) compared to those in the RPP (0.034, IC 95%: 0.030-0.039). The ratio of incidence rates was 1.480 (IC 95% 1.21-1.90). The hazard of progression was lower for the RPP (HR: 0.855, IC 95%: 0.74- 0.98), as was the hazard of requiring RRT (HR: 0.797, IC 95%: 0.606-1.049). Conclusions: The RPP is a secondary prevention strategy against CKD which has an effect on the stage progression of CKD and the need for RRT. Early patient detection has a positive effect on the outcomes studied (AU)