Play into the domestic routine to promote child development: cross-sectional study.

OBJECTIVE: To analyze the association between the incorporation of play into the domestic routine of caregivers, and the child development of children under their care. METHOD: Cross-sectional study conducted with 129 caregiver-child dyads aged 12-23 months, living in the southern region of São Paulo. Child development was assessed using the Ages & Stages Questionnaire-3, and the incorporation of play into the domestic through a questionnaire and filming of the dyads in activities related to the domestic routine. RESULTS: Almost all the caregivers were the mother (98%), who, when answering the questionnaire, reported incorporating play into their domestic routine (93%), however in the video, only one third played with the child (34%). There was a positive association between playing in moments of domestic routine and domains of child development in children aged 18 months or less. CONCLUSIONS: A positive association was found between the incorporation of play into the domestic routine and child development.

The BEM Program: An innovative online parenting program for socioeconomically disadvantaged caregiver-child dyads in Brazil.

Objective: To describe the BEM Program, an innovative online parenting program for socioeconomically disadvantaged caregiver-child dyads in Brazil. Methods: The Template for Intervention Description and Replication checklist was used to describe the BEM Program in detail. Results: The BEM Program (an acronym for Brincar Ensina Mudar in Portuguese, "Play Teaches Change" in English) refers to the change in adult, child, and dyad outcomes that can be observed through incorporating playful interactions between the caregiver and their child into their daily household chores. Content consisting of 8 videos and 40 text and audio messages was sent entirely online through WhatsApp®. Thus, the Program could be accessed wherever caregivers wanted, if they had their smartphone and Internet access. Conclusions: The detailed description of an innovative online parenting program focused on caregiver-child interaction and child development contributes to the scarce evidence on this type of programs. Adherence to the program continues to represent one of the main challenges to overcome.

Effects of an Online Play-Based Parenting Program on Child Development and the Quality of Caregiver-Child Interaction: A Randomized Controlled Trial.

Background: Studies assessing the effects of parenting programs have focused on interventions delivered through face-to-face modalities. There is a need for research to evaluate the effects of online parenting programs on child development, such as the BEM Program ('Play Teaches Change' in English), an online play-based parenting program that teaches caregivers on how to introduce playful interactions into their daily household chores. Objective: To assess the effects of the BEM Program on child development and the quality of caregiver-child interaction. Method: A two-arm randomized controlled trial was conducted in a socioeconomically disadvantaged district of São Paulo city in Brazil. 129 children aged 12-23 months and their caregiver were randomly assigned to receive either the BEM Program for 8 weeks (intervention, n = 66) or standard child care (control, n = 63). Data were collected at baseline and endline of the intervention through home visits and online interviews. An intention-to-treat analysis was conducted. Results: The intervention showed positive effects on child development, by improving language development (Cohen's d = 0.20, 95%CI 0.08-0.47) and reduced intrusiveness (Cohen's d = 0.35, 95%CI 0.06-0.65) of caregiver-child interaction. No significant differences were observed in caregiver's repertoire and engagement in age-appropriate play activities with the child while doing the household chores, parenting sense of competence and perceived stress. Conclusions: Despite the small size and low adherence to the program, such promising results advance evidences for fully remote parenting programs and their effects on child development.

Play into the domestic routine to promote child development: cross-sectional study / El juego en la rutina doméstica para la promoción del desarrollo infantil: estudio transversal / O brincar na rotina doméstica para a promoção do desenvolvimento infantil: estudo transversal

ABSTRACT Objective: To analyze the association between the incorporation of play into the domestic routine of caregivers, and the child development of children under their care. Method: Cross-sectional study conducted with 129 caregiver-child dyads aged 12-23 months, living in the southern region of São Paulo. Child development was assessed using the Ages & Stages Questionnaire-3, and the incorporation of play into the domestic through a questionnaire and filming of the dyads in activities related to the domestic routine. Results: Almost all the caregivers were the mother (98%), who, when answering the questionnaire, reported incorporating play into their domestic routine (93%), however in the video, only one third played with the child (34%). There was a positive association between playing in moments of domestic routine and domains of child development in children aged 18 months or less. Conclusions: A positive association was found between the incorporation of play into the domestic routine and child development.

RESUMEN Objetivo: Analizar la asociación entre la incorporación del juego en la rutina doméstica, por parte de cuidadoras, y el desarrollo infantil de niños bajo su cuidado. Método: Estudio transversal con 129 díadas cuidadora-niño de 12-23 meses, en la ciudad de São Paulo. El desarrollo infantil se evaluó con el Ages & Stages Questionnaire-3 y la incorporación del juego a la rutina doméstica a través de cuestionario y filmaciones de las díadas en actividades relacionadas con la rutina doméstica. Resultados: Casi todas las cuidadoras fueron la madre (98%) que, al responder al cuestionario, refirieron incorporar el juego en su rutina doméstica (93%), pero en el video, solo un tercio jugó con el niño (34%). Hubo asociación positiva entre jugar en momentos de rutina doméstica y dominios del desarrollo de niños de 18 meses o menos. Conclusiones: Se encontró una asociación positiva entre la incorporación del juego en la rutina doméstica y el desarrollo infantil.

RESUMO Objetivo: Analisar a associação entre a incorporação do brincar na rotina doméstica de cuidadoras e o desenvolvimento infantil de crianças sob seu cuidado. Método: Estudo transversal conduzido com 129 díades cuidadora-criança de 12-23 meses, na região sul de São Paulo. O desenvolvimento infantil foi avaliado com a utilização do Ages & Stages Questionnaire-3, e a incorporação do brincar na rotina doméstica, por meio de questionário e filmagem das díades em atividades relacionadas à rotina doméstica. Resultados: Quase a totalidade das cuidadoras era a mãe (98%) que, ao responder ao questionário, referiu incorporar o brincar na rotina doméstica (93%), porém, no vídeo, apenas um terço brincou com a criança (34%). Verificou-se associação positiva entre brincadeiras em momentos da rotina doméstica e domínios do desenvolvimento em crianças com idade igual ou inferior a 18 meses. Conclusões: Constatou-se associação positiva entre a incorporação do brincar na rotina doméstica e o desenvolvimento infantil.

Effectiveness of Remotely Delivered Parenting Programs on Caregiver-child Interaction and Child Development: a Systematic Review.

Remotely delivered parenting interventions are suitable to promote child well-being and development, in a context of social isolation, as our society faced due to COVID-19. The objective of this systematic review was to assess the effectiveness of remotely delivered parenting interventions for typically developing children on caregiver-child interaction and child development. We carried out a systematic search to find studies from the inception of the database to September 2021 on six electronic databases: MEDLINE, CINAHL, Embase, Scopus, Web of Science Core Collection and Regional Portal Information and Knowledge for Health (BVS), and gray literature. Eligible study designs were experimental and quasi-experimental studies. We included parenting interventions as long as they were remotely delivered and focused on typically developing children. Two outcomes were considered: caregiver-child interaction and child development. Three randomized controlled trials (RCT) and one quasi-experimental study met the inclusion criteria. Results from two RCT revealed positive, small-to-medium effects on child development. One study showed that the new intervention had a not inferior effect compared to the results achieved by the traditional support. Children who participated in the quasi-experimental study showed significant elevations in language ability. One study reported positive caregiver-child interaction results. There is insufficient evidence to draw definitive conclusions regarding the effectiveness of remotely delivered parenting interventions on child development due to the heterogeneity of participant profiles, mode of delivery, and assessment tools. The results suggest the need to develop future methodologically rigorous studies assessing the effectiveness of remotely delivered parenting interventions for typically developing children on caregiver-child interaction and child development.

Effectiveness of different health delivery agents of parenting stimulation interventions on child development outcomes among children aged 0 to 36 months: a systematic review protocol.

OBJECTIVE: This review will evaluate the effectiveness of different health delivery agents of parenting stimulation interventions versus usual care, no intervention, or a different type of delivery agent on child development outcomes among children aged 0 to 36 months. INTRODUCTION: Stimulation interventions vary in terms of implementation. While some interventions are delivered by professionals, most are delivered by non-professionals. Several prior systematic reviews on this topic have been conducted; however, no known study has evaluated the effectiveness of stimulation interventions on child development by type of delivery agent. INCLUSION CRITERIA: This review will consider randomized controlled trials assessing parenting stimulation interventions delivered by different health delivery agents. These will be compared to usual care, no intervention, or a different delivery agent, targeted at caregiver-child dyads of children aged 0 to 36 months. The outcomes will include motor, language, cognitive, and socio-emotional development. The review will exclude studies including children with specific characteristics, interventions that do not focus on parenting, and protocols of randomized clinical trials. METHODS: The review will include both published and unpublished studies. The key information sources to be searched are: MEDLINE, APA (PsycNet), Embase, Scopus, Web of Science Core Collection, CINAHL, VHL Regional Portal, Google Scholar, Science Direct, Theses Canada Portal, and Library and Archives Canada. Studies in English, Spanish, and Portuguese will be included. Critical appraisal and data extraction will be conducted using standardized tools. Quantitative data, where possible, will be pooled in statistical meta-analysis, or if statistical pooling is not possible, the findings will be reported narratively. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42021245245.

Developmental surveillance, screening, and evaluation: An analysis of Brazil's public policies for childcare / Vigilancia, cribado y evaluación del desarrollo: un análisis de las políticas públicas de Brasil para el cuidado infantil

Abstract This essay analyzes the Brazilian laws, public policies, and programs for the promotion of child development, focusing on initiatives aimed at identifying developmental delays. Since 1984, the legislation about early childhood has included child development as part of the Brazilian childcare agenda. However, screening and developmental assessment were not considered among the most important actions aimed at childcare. It is necessary to formulate official instruments or scales and implement interventions for the detection of developmental disorders, delays, and risk conditions to reach more children and promptly identify their potential developmental delays.

Resumen Este ensayo analiza las leyes, políticas públicas y programas brasileños para la promoción del desarrollo infantil, centrándose en iniciativas destinadas a identificar retrasos en el desarrollo. Desde 1984, la legislación sobre la primera infancia ha incluido el desarrollo infantil como parte de la agenda brasileña de cuidado infantil. Sin embargo, la vigilancia y la evaluación del desarrollo no han ocupado un lugar destacado como una de las acciones más importantes dirigidas al cuidado infantil. Es necesario formular instrumentos o escalas oficiales, e implementar intervenciones para la detección de trastornos del desarrollo, retrasos y condiciones de riesgo que permitan llegar a más infantes, así como la identificación temprana de retrasos en el desarrollo.

Resumo Esse ensaio analisa as leis, políticas públicas e programas brasileiros de promoção do desenvolvimento infantil, com foco em iniciativas que visam identificar atrasos no desenvolvimento. Desde 1984, a legislação da primeira infância inclui o desenvolvimento infantil como parte da agenda brasileira de atenção à população infantil. No entanto, a vigilância e a avaliação do desenvolvimento não ocuparam uma posição importante como uma das ações voltadas para o cuidado da criança. É necessário criar instrumentos ou escalas oficiais e implementar intervenções para a detecção de transtornos do desenvolvimento, atrasos e condições de risco que possibilitem chegar a mais crianças e a identificação precoce de atrasos no desenvolvimento.

Pregnancy planning does not interfere with child development in children aged from 11 to 23 months old.

OBJECTIVE: to analyze the correlation between child development and pregnancy planning and other associated aspects. METHOD: a cross-sectional study conducted with 125 mother-child dyads, the children aged from 11 to 23 months old and attending daycare centers located in socially disadvantaged areas. Child development according to domains was assessed using the Ages & Stages Questionnaire-BR and pregnancy planning was evaluated through the London Measure of Unplanned Pregnancy. The mothers were interviewed at their homes and non-parametric tests were used for data analysis. RESULTS: 17.6% of the pregnancies were unplanned, 24.8% were planned and 57.6% were ambivalent. Inadequate development in the different domains ranged from 21% to 40% and was not associated with pregnancy planning. However, the "communication" domain was associated with Bolsa Família and the "personal/social" and "communication" domains, with gender; while "personal/social", "broad motor coordination" and "fine motor coordination" were domains related to the child's age. CONCLUSION: no correlation between pregnancy planning and child development was observed; however, the low frequency of planned pregnancies and the high percentages of inadequate child development show the need to invest in the training of health professionals, both for contraceptive care and preconception health and for the promotion of child development, especially in socioeconomically disadvantaged contexts.

The association between body weight dissatisfaction with unhealthy eating behaviors and lack of physical activity in adolescents: A systematic review.

A systematic review examined the association between body weight dissatisfaction with unhealthy eating behaviors and lack of physical activity in adolescents, since it represents an alert to adolescent's health and well-being. Six electronic databases and gray literature were systematically searched from January 1980 to December 2018. A total of 11 articles met the inclusion criteria. Included studies assessed body weight dissatisfaction using different dimensions/components: satisfaction component of the attitudinal dimension was assessed in five studies, behavior component of the attitudinal dimension was assessed in two studies, perceptual dimension was assessed in two studies, and two studies were unclear about dimension. Behaviors: two assessed only unhealthy eating behaviors, six assessed lack of physical activity, and three assessed both behaviors. Only three studies found an association between body weight dissatisfaction with unhealthy eating behaviors, three with lack of physical activity, and one did not perform a statistical test for an association between body weight dissatisfaction with unhealthy eating behaviors and lack of physical activity. Few studies have reported an association between body weight dissatisfaction with one of these unhealthy behaviors. There was substantial heterogeneity related to unit of measures, both for body weight dissatisfaction and for behaviors studied.

Pregnancy planning does not interfere with child development in children aged from 11 to 23 months old / La planificación del embarazo no interfiere con el desarrollo infantil de los niños de 11 a 23 meses / Planejamento da gravidez não interfere no desenvolvimento infantil de crianças de 11 a 23 meses

Objective: to analyze the correlation between child development and pregnancy planning and other associated aspects. Method: a cross-sectional study conducted with 125 mother-child dyads, the children aged from 11 to 23 months old and attending daycare centers located in socially disadvantaged areas. Child development according to domains was assessed using the Ages & Stages Questionnaire-BR and pregnancy planning was evaluated through the London Measure of Unplanned Pregnancy. The mothers were interviewed at their homes and non-parametric tests were used for data analysis. Results: 17.6% of the pregnancies were unplanned, 24.8% were planned and 57.6% were ambivalent. Inadequate development in the different domains ranged from 21% to 40% and was not associated with pregnancy planning. However, the "communication" domain was associated with Bolsa Família and the "personal/social" and "communication" domains, with gender; while "personal/social", "broad motor coordination" and "fine motor coordination" were domains related to the child's age. Conclusion: no correlation between pregnancy planning and child development was observed; however, the low frequency of planned pregnancies and the high percentages of inadequate child development show the need to invest in the training of health professionals, both for contraceptive care and preconception health and for the promotion of child development, especially in socioeconomically disadvantaged contexts.

Objetivo: analizar la relación entre el desarrollo infantil y la planificación del embarazo y otros aspectos asociados. Método: estudio transversal realizado con 125 díadas madre e hijo de 11 a 23 meses, que concurren a guarderías infantiles ubicadas en zonas socialmente desfavorables. El desarrollo infantil de acuerdo con los dominios se evaluó mediante el Ages & Stages Questionnaire-BR y la planificación del embarazo mediante la London Measure of Unplanned Pregnancy. Las madres fueron entrevistadas en sus domicilios y se utilizaron pruebas no paramétricas para el análisis de los datos. Resultados: se registró que 17,6% de los embarazos no fue planificados, 24,8% fue planificado y 57,6% ambivalente. El desarrollo inadecuado en los diferentes dominios osciló entre el 21% y el 40% y no estaba asociado con la planificación del embarazo. Sin embargo, el dominio "comunicación" se asoció con Bolsa Familia; los dominios "personal/social" y "comunicación" con el sexo; mientras que los dominios "personal/social", "coordinación motora gruesa" y "coordinación motora fina" estaban relacionados con la edad del niño. Conclusión: no se observó relación entre la planificación del embarazo y el desarrollo infantil, sin embargo, la baja frecuencia de embarazos planificados y los altos porcentajes de desarrollo infantil inadecuado demuestran que es necesario invertir en la capacitación de los profesionales de la salud, tanto para la atención sobre anticoncepción y salud preconcepcional, como para la promoción del desarrollo infantil, especialmente en contextos socioeconómicos desfavorables.

Objetivo: analisar a relação entre desenvolvimento infantil e planejamento da gravidez e outros aspectos associados. Método: estudo transversal conduzido com 125 díades mãe-criança de 11 a 23 meses de idade, frequentadoras de creches localizadas em áreas socialmente desfavoráveis. O desenvolvimento infantil segundo domínios foi avaliado com aplicação do Ages & Stages Questionnaire-BR e o planejamento da gravidez por meio do London Measure of Unplanned Pregnancy. Mães foram entrevistadas nos domicílios e utilizou-se testes não paramétricos para análise dos dados. Resultados: verificou-se 17,6% de gravidez não planejada, 24,8% foram planejadas e 57,6% ambivalentes. O desenvolvimento inadequado nos diferentes domínios variou de 21-40% e não teve associação com o planejamento da gravidez. No entanto, o domínio "comunicação" associou-se com Bolsa Família; os domínios "pessoal/social" e "comunicação" com sexo; ao passo que "pessoal/social", "coordenação motora ampla" e "coordenação motora fina" foram domínios relacionados com a idade da criança. Conclusão: não foi observada relação entre o planejamento da gravidez e o desenvolvimento infantil, porém, a baixa frequência de gestações planejadas e os elevados percentuais de inadequado desenvolvimento infantil mostram a necessidade de se investir na capacitação dos profissionais de saúde, tanto para a atenção em contracepção e saúde pré-concepcional, quanto para a promoção do desenvolvimento infantil, especialmente em contextos socioeconômicos desfavoráveis.

Completude e atraso vacinal das crianças antes e após intervenção educativa com as famílias / Pleno cumplimiento y atraso vacunatorios en niños antes y después de una intervención educativa con las familias / Vaccination completion and delay in children before and after an educational intervention with their families

RESUMO Objetivo: avaliar a completude e o atraso vacinal das crianças de um centro de educação infantil antes e após uma intervenção educativa com as famílias. Método: estudo do tipo antes e depois, realizado em um centro de educação infantil em São Paulo de fevereiro a abril de 2017. A intervenção consistiu no envio de lembretes e folhetos às famílias sobre a importância da vacinação. A situação vacinal foi verificada através da Caderneta de Saúde da Criança. Foram utilizados os testes qui-quadrado e exato de Fisher. Resultados: participaram do estudo 151 crianças e suas famílias antes e 145 depois. A prevalência da completude vacinal passou de 81,5% para 93,1% após a intervenção (p=0,003). O atraso vacinal foi mais frequente entre crianças menores de dois anos e aquelas do sexo mascuilno. Conclusão: a intervenção contribuiu para o aumento da completude vacinal por meio da educação em saúde das famílias das crianças.

RESUMEN: Objetivo: evaluar el pleno cumplimiento y el atraso vacunatorios en niños de un centro de educación infantil antes y después de una intervención educativa con las familias. Método: estudio del tipo antes y después realizado en un centro de educación infantil de San Pablo entre febrero y abril de 2017. La intervención consistió en enviar recordatorios y folletos a las familias sobre la importancia de la vacunación. La situación de vacunas se verificó a través de la Libreta de vacunas infantiles. Se emplearon las pruebas de chi-cuadrado y Exacta de Fisher. Resultados: del estudio participaron 151 niños y sus familias antes de la intervención, y 145 después de ella. La prevalencia del pleno cumplimiento vacunatorio aumentó del 81,5% al 93,1% después de la intervención (p=0,003). El atraso en las vacunas fue más frecuente entre los niños de menos de dos años de edad y entre los del sexo masculino. Conclusión: la intervención contribuyó a mejorar el índice de pleno cumplimiento vacunatorio al ofrecer educación en salud a las familias de los niños.

ABSTRACT Objective: To assess vaccination completion and delay in children at a child education center before and after an educational intervention with their families. Method: A before-and-after study carried out at a child education center in São Paulo from February to April 2017. The intervention consisted of sending reminders and leaflets to the families about the importance of vaccination. The vaccination status was verified through the Child Health Handbook. Fisher's exact and chi-square tests were used. Results: 151 children and their families participated in the before-phase of the study, and 145 in its after-phase. The prevalence of vaccination completion rose from 81.5% to 93.1% after the intervention (p=0.003). Vaccination delay was more frequent among children under two years of age and those who were male. Conclusion: The intervention contributed to the increase of vaccination completion through health education of the children's families.

Developmental surveillance in primary health care: absence of child development milestones and associated factors / Vigilancia del desarrollo infantil en la atención primaria: ausencia de hitos y factores associados

Abstract Objectives: to identify the absence of one or more general child development milestones and by domains, and associated factors. Methods: cross-sectional study with 334 children under three years of age conducted out at Primary Health Care Facilities, São Paulo, Brazil. The dependent variable was the general child development and the fine motor, gross motor, social and psychic domains evaluated using the Developmental Surveillance Instrument of the Brazilian Ministry of Health. Data were obtained by interviewing the mothers and observing children. The chi-square test and logistic regression analyses were used. Results: absence of one or more milestones of general child development was found in 52.1% of children, especially, in the fine motor domain. We found an association between general child development with age (OR = 4.4; CI95%= 2.0-9.9) and the place of stay of the child who does not attend daycare (OR = 3.7; CI95%= 1.3-10.5). Conclusions: the absence of one or more milestones of general child development is high and associated with aspects of the child and the environment. This emphasizes the importance of promoting developmental surveillance in Primary Health Care Facilities among health professionals using the official instrument recommended by the Brazilian Ministry of Health.

Resumen Objetivos: identificar la ausencia de uno o más hitos del desarrollo infantil global y por dominios, y factores asociados. Métodos: estudio transversal con 334 menores de tres años de edad, realizado en centros de atención primaria de una ciudad de São Paulo, Brasil. La variable dependiente fue el desarrollo infantil global y los dominios madurativo, psicomotor, social y psíquico, evaluados utilizando el Instrumento de Vigilancia del Desarrollo del Ministerio de Salud de Brasil. Los datos fueron obtenidos por entrevista a las madres y observación de los niños. Se utilizó prueba de chi-cuadrado y regresión logística. Resultados: 52,1% de los niños presentaron ausencia de uno o más hitos del desarrollo infantil global, con mayor proporción de ausencia de hitos en el dominio madurativo. Se encontró asociación del desarrollo infantil global con la edad (OR= 4,4; IC95%= 2,0-9,9) y lugar de permanencia del niño que no asiste a guardería (OR= 3,7; IC95%= 1,3-10,5). Conclusiones: la ausencia de uno o más hitos del desarrollo infantil global es elevada, asociada a factores infantiles y ambientales. Esto refuerza la importancia de promover entre los profesionales de la salud la vigilancia del desarrollo infantil en la atención primaria, utilizando el instrumento oficial estipulado por el Ministerio de Salud de Brasil.

Prueba costarricense: evaluación del desarrollo integral de la niña y el niño de 0 meses a 6 años de edad (EDIN II) / Costa Rican test: Evaluation of the children's integral development from 0 months to 6 years of age (EDIN II) / Teste da Costa Rica: Avaliação do desenvolvimento integral das crianças de 0 meses a 6 anos (EDIN II)

Resumen 19. La prueba para la Evaluación del Desarrollo Integral de la niña y el niño de 0 meses a 6 años de edad (EDIN II) es la versión actualizada de la prueba de tamizaje costarricense EDIN. El objetivo de este trabajo fue analizar la prueba EDIN II para su posterior aplicación y el tamizaje del desarrollo integral de los infantes. Fue un estudio de tipo descriptivo cuantitativo y cualitativo. Se utilizó la técnica de juicio de expertos y la aplicación de la prueba a una muestra de 380 niñas y niños. Los resultados más significativos de la prueba fueron el cambio en la calificación de acuerdo con el sistema de semáforo, la inclusión de un nuevo grupo de edad de 12 a 15 meses y de 15 a 18 meses, se incorpora la edad corregida para infantes menores de 2 años de edad, y la separación del apartado de valoración neurológica. Por otra parte, hubo cambios específicos en los ítemes, para los cuales fue necesario eliminar, realizar modificaciones de forma y también la creación de nuevos ítemes que consideraran los hitos de desarrollo, por lo que quedaron 287 ítemes (eran 284 ítemes) en cinco áreas del desarrollo y 20 grupos de edad. Se especificó la ejecución de los ítems en el instructivo y se sustituyó los materiales para evaluar las nuevas conductas. Se concluye que el EDIN II debe ser sometido a procesos de validación subsecuentes, con el fin de que pueda ser incluido en las políticas públicas de atención a la población infantil.

Abstract 23. The child development evaluation test for children between 0 months and 6 years (EDIN II) is an updated version of the Costa Rican EDIN development screening test. The objective was to analyze the EDIN II test, to continue to implement and screen the integral development of girls and boys. It was a descriptive quantitative-qualitative study. Data were collected through the expert judgment technique and the application of the test to a sample of 380 children. The main results obtained concerning the test were: classification according to the semaphore system, inclusion of a new age group of 12 to 15 months and 15 to 18 months, incorporation of the corrected age for under 2 years old children, and separation of the neurological assessment. On the other hand, the specific changes required by the items for which it was necessary to eliminate, make changes in the form and also the creation of new ones that contemplated development milestones, leaving 287 items in 5 areas of development and 20 groups old. For the instructive, it was necessary to specify better the execution of the items and to include expected answers that were not contemplated. And finally, some materials merited being replaced by others with better characteristics to evaluate the behaviors. It concluded to submit the test to subsequent validation processes so it can be included in the public policies for children.

Resumo 27. A prova de avaliação do desenvolvimento integral das crianças entre 0 meses a 6 anos de idade (EDIN II) é a versão atualizada da prova costarriquenha para a avaliação do desenvolvimento infantil. O objetivo foi analisar a prova com a intenção de continuar aplicando e valorando o desenvolvimento integral das crianças. O estudo foi descritivo: quantitativo-qualitativo. Os dados foram coletados por meio da técnica de opinião de pessoas especialistas no desenvolvimento e infantil e a aplicação do teste a 380 crianças. Os principais resultados em relação ao teste foram: a classificação de acordo com o sistema de semáforos, inclusão de uma nova faixa etária de 12 a 15 meses e 15 a 18 meses, incorporação da idade corrigida para as crianças menores de 2 anhos, e separação da seção de avaliação neurológica. E, além disso, as mudanças específicas necessárias dos itens para os quais foi necessário remover, fazer modificações de forma e criar novos que incluem metas de desenvolvimento, deixando 287 itens em cinco áreas de desenvolvimento e 20 grupos de idade. Enquanto isso, para o manual de instruções foi necessário especificar a execução dos itens e incluir respostas esperadas que não foram abordados. E, finalmente, alguns materiais mereceram ser substituídos por outros com melhores características para avaliar comportamentos. Conclui-se que é preciso fazer um processo de validação posterior para que a prova possa ser incluída nas políticas públicas de atenção às crianças.

Visita domiciliaria: un espacio para la adquisición y modificación de prácticas en salud / Home visit: a place for the acquisition and modification of health practices / Visita domiciliar: um espaço para a aquisição e modificação de práticas de saúde

Resumen La visita domiciliaria realizada por el asistente técnico de atención primaria en salud (ATAPS), corresponde a la principal actividad fundamental de atención primaria desarrollada en Costa Rica, cuya principal labor es proporcionar información y recomendaciones sobre educación en salud a las personas usuarias. Respecto de lo anterior, el objetivo de esta investigación es determinar los conocimientos y la modificación en los estilos de vidas que las personas realizan posterior a la visita del ATAPS.El diseño del estudio fue cualitativo, analítico y observacional. Para la recolección de los datos se aplicó entrevistas a profundidad a las personas usuarias visitadas y se realizó un grupo focal con los ATAPS. Para el análisis de los datos, se estableció categorías de análisis desde la metodología de la teoría fundamentada. Se identificó que las personas usuarias refieren un mayor adquisición de conocimientos cuando se abordó temas como dengue, la vacunación, el lavado de manos, la citología vaginal y una alimentación saludable y un predominio significativo del ama de casa en la participación de esta actividad, lo que al final limita la transmisibilidad de la información al resto de los integrantes. Con respecto a la modificación de prácticas, la mayoría de las personas expresan cambios en estilos de vida saludable y mayores facilidades para el acceso a los servicios de salud. Se concluye que es importante entender la visita domiciliaria como un medio de aproximación entre las familias y el sistema de salud, que favorezca el acceso a los servicios de salud, mientras se constituye en un instrumento que humaniza la atención de las necesidades.

Abstract The home visit made by the technical assistant of primary health care (ATAPS), corresponds to the main primary care activity developed in Costa Rica, whose main task is to provide information and recommendations on health education to users. Regarding the above, the objective of this research is to determine the knowledge and the modification in the lifestyles that people make after the ATAPS visit. The design of the study was qualitative, analytical and observational. For the data collection, in-depth interviews were applied to the users visited and a focus group was made with the ATAPS. For the analysis of the data, categories of analysis were established from the methodology of the grounded theory. It was identified that users report a greater acquisition of knowledge when addressing issues such as dengue, vaccination, hand washing, vaginal cytology and healthy eating and a significant predominance of the housewife in the participation of this activity, which in the end limits the transmissibility of the information to the rest of the members. With respect to the modification of practices, most people express changes in healthy lifestyles and greater facilities for access to health services. It is conclude that it is important to understand the home visit as a means of approximation between families and the health system, which favors access to health services, while providing an instrument that meets the needs.

Resumo A visita domiciliária feita pelo auxiliar técnico de cuidados de saúde primários (ATAPS) corresponde à principal atividade de atenção primária desenvolvida na Costa Rica, cuja principal tarefa é fornecer informações e recomendações sobre educação em saúde aos usuários. No que se refere ao acima, o objetivo desta pesquisa é determinar o conhecimento e a modificação nos estilos de vida que as pessoas fazem após a visita ATAPS. O design do estudo foi qualitativo, analítico e observacional. Para a coleta de dados, foram aplicadas entrevistas em profundidade aos usuários visitados e um grupo focal foi feito com o ATAPS. Para a análise dos dados, as categorias de análise foram estabelecidas a partir da metodologia da teoria fundamentada. Foi identificado que os usuários relatam uma maior aquisição de conhecimento ao abordar questões como dengue, vacinação, lavagem das mãos, citologia vaginal e alimentação saudável e uma significativa predominância significativa da dona de casa na participação desta atividade, que no final limita a transmissibilidade da informação ao resto dos membros. Com respeito à modificação de práticas, a maioria das pessoas expressa mudanças em estilos de vida saudáveis ​​e maiores facilidades para acesso a serviços de saúde.Conclui-se que é importante compreender a visita domiciliar como meio de aproximação entre as famílias e o sistema de saúde, o que favorece o acesso aos serviços de saúde, ao mesmo tempo que fornece um instrumento que atenda ás necessidades.

Visita domiciliaria: un espacio para la adquisición y modificación de prácticas en salud / Domiciliary attention: a space for acquiring and modifying health practices

Resumen La visita domiciliaria realizada por el Asistente Técnico de Atención Primaria (ATAPS), constituye una de las principales herramientas de la estrategia de Atención Primaria desarrolladas en Costa Rica; buscando acercar los servicios de salud hasta la vivienda, informando a las familias sobe temas que mejore sus prácticas en salud. El objetivo de esta investigación es determinar los conocimientos y la modificación en los estilos de vidas que las personas realizan posterior a la visita del ATAPS. La metodología de elección fue cualitativa. Para la recolección de los datos se aplicaron entrevistas a profundidad a las personas usuarias visitadas y se realizó un grupo focal con los ATAPS. Para el análisis de los datos establecieron categorías de análisis bajo la metodología de la Teoría Fundamentada. La principal categoría relacionada a la adquisición de conocimientos fue la "educación en salud", en donde se identificó una mayor afinidad de la población hacia temas como dengue, la vacunación, el lavado de manos, la citología vaginal y una alimentación saludable y un predominio importante del ama de casa en la participación de esta actividad, lo que al final limita la transmisibilidad de la información al resto de los integrantes. Las personas participantes afirmaron que los temas tratados les permiten refrescar conocimientos y mantenerse actualizados, reafirmando la importancia de las temáticas abordadas por el ATAPS. Con respecto a la modificación de prácticas, la mayoría de las personas expresan cambios en estilos de vida saludable y mayores facilidades para el acceso a los servicios de salud.

Abstract The home visit by the Technical Assistant Primary Care (ATAPS), is one of the main tools of the Primary Care Strategy developed in Costa Rica; seeking to bring health services to the housing, reporting a sobe Families Topics improve its health practices. The objective of esta research is to determine the knowledge and the change in the lifestyles that people do after the visit of ATAPS. The methodology was qualitative choice. To collect the data is applied a depth Interviews To the users visited and UN focal group was made with the ATAPS. For the Analysis of Data Analysis categories established under the methodology of grounded theory. The director Related to the acquisition of knowledge category was the "Health education", where a mayor affinity of the population identified toward topics like dengue, vaccination, hand washing, vaginal cytology and healthy eating Prevalence UN and additional The Housewife in the share of this activity, which ultimately limits the Transferability of cabbage Information other members. The participants said that the topics covered allow them to refresh knowledge and keep updated, reaffirming the importance of the topics addressed by the ATAPS. With regard to the modification of practices, most of the personalities expressed Changes Healthy Lifestyles and older para facilities Access to Health Services.

Dolor al administrar medicamento por inyección intramuscular: ventroglútea vs dorsoglútea / Pain in the administration of drugs by intramuscular injection: ventrogluteal vs dorsogluteal / Dor na administração intramuscular de drogas: ventroglúteo vs dorsogluteal

ResumenIntroducción. La inyección intramuscular es una técnica que causa dolor e incomodidad a las personas. Con el objetivo de determinar la zona de punción menos dolorosa para la administración de medicamentos intramusculares en glúteo, se realizó una revisión de literatura en busca de la evidencia de mayor calidad. Método. Se empleó el método propuesto por el enfoque de la Práctica Clínica de Enfermería Basada en la Evidencia. Se recopiló estudios de EBSCOhost, Google, Google Académico, Cochrane Library y PubMed. Se aplicó los filtros propuestos para la selección: se sometió los dos artículos seleccionados a lectura crítica mediante la plataforma FLC 2.0 con la cual se valoró la calidad de los estudios. El riesgo de sesgo se valoró con The Cochrane Collaboration's tool for assessing risk of bias. A través del sistema de clasificación GRADE se determinó la calidad de la evidencia y la fuerza de la recomendación de la intervención.Resultado. Los artículos incluidos en el estudio respondieron parcialmente a la pregunta clínica planteada. La percepción de dolor durante la administración de inyectables en el sitio ventroglúteo es menor que en el dorsoglúteo, los hallazgos tuvieron un nivel de evidencia moderado y la fuerza de recomendación fue 1B.Conclusión. No hay evidencia contundente para preferir la elección del sitio ventroglúteo sobre el dorsoglúteo para disminuir el dolor asociado a la administración intramuscular de analgésicos antiinflamatorios, aunque el primer sitio posee mayores ventajas en comparación con el segundo.

AbstractIntroduction. Intramuscular injection is a technique that causes pain and discomfort to people. In order to determine the least painful puncture site for the administration of intramuscular gluteal medications, a literature review was conducted in search of the highest quality evidence.Method.The method used in this research was the Evidence-Based Nursing approach. The studies were collected from EBSCOhost, Google, Google Scholar, Cochrane Library and PubMed. Filters of the selection criteria were applied to the papers and then were subjected to critical appraisal using the web platform FLC 2.0 leaving 2 articles remaining. The Cochrane Collaboration's tool for assessing risk of bias was applied and afterwards the GRADE approach was used to determine the quality of the evidence and strength of recommendation.Result. Papers included in the study responded partially the clinical question posed. The ventrogluteal IM injection site seems to be less painful than in the dorsogluteal site during the administration of analgesic antiinflammatory drugs, the findings had a moderate level of evidence and strength of recommendation was 1B. Conclusion. No strong evidence was found to prefer the ventrogluteal site rather than the dorsogluteal site in order to reduce pain associated with intramuscular administration of anti-inflammatory analgesics drugs. Although the first injection site has major advantages compared to the second

ResumoIntrodução: A injeção intramuscular é uma técnica que causa dor e desconforto para as pessoas. Com o objetivo de determinar o local da punção menos doloroso para a administração de medicamentos intramusculares no glúteo, realizou-se uma revisão de literatura em busca de evidência de maior qualidade.Materiais e método: Empregou-se o método proposto pelo enfoque de Prática Clínica de Enfermagem Baseada em Evidência. Realizaram-se estudos de EBSCOhost, Google, Google Acadêmico, Cochrane Library e PubMed. Aplicaram-se os filtros propostos para a seleção: foram submetidos dois artigos selecionados para a leitura crítica mediante a plataforma FLC 2.0 com a qual se estabeleceu um valor para a qualidade dos estudos. O risco de inclinação se determina com The Cochrane Collaboration's tool for assessing risk of bias. Através do sistema de classificação GRADE se determinou a qualidade de evidência e a necessidade da recomendação da intervenção. Resultados: Os artigos incluídos no estudo responderam parcialmente a pergunta clínica planteada. A percepção da dor durante a administração de injetáveis no local ventroglúteo é menor que no dorsoglúteo, as descobertas tiveram um nível de evidência moderado e a necessidade de recomendação foi 1B.Conclusões:Não há evidência contundente para preferir a escolha do local ventroglúteo sobre o dorsoglúteo para diminuir a dor associada a administração intramuscular de analgésicos antiinflamatórios, embora o primeiro local possua maiores vantagens em comparação com o segundo.

Programa de visita domiciliaria del sistema de salud costarricense: lineamientos para su mejora / Program home visit Costa Rica's health system: guidelines for improvement

ResumenIntroducción:La visita domiciliaria se constituye en la principal estrategia de atención primaria al acercar los servicios de salud a los domicilios y lugares de trabajo de las personas, lo cual permite conocer de primera mano las necesidades de la población. La visita domiciliaria efectuada por el ATAP representa el primer contacto del individuo, familia y comunidad con el sistema de salud, con importantes beneficios tanto a nivel individual como colectivo. La presente investigación responde a la necesidad de identificar los elementos que el programa de visita domiciliaria requiere mejorar, modificar o sustituir con el fin de maximizar la prestación de este servicio.Método:Se diseñó un estudio cualitativo, analítico observadonal. Se recolectó los datos mediante revisión bibliográfica, entrevista a informantes claves y grupo focal. El análisis se realizó a partir de la teoría fundamentada.Resultados:Los datos evidenciaron la existencia de elementos a nivel de sistema de salud, programa de visita domiciliaria y figura del ATAP que deben ser revisados, modificados o sustituidos con el fin de que la visita domiciliaria tenga mayores y mejores alcances para la población y el sistema de salud.Conclusión:El programa de visita domiciliaria representa una fortaleza del sistema de salud costarricense al abordar las inequidades en salud. Sin embargo, es imperativa la toma de decisiones e implementación de acciones que promuevan el mejoramiento y aumento de los alcances que tiene la visita domiciliaria en el abordaje de la población a nivel familiar y comunitario.

AbstractIntroduction:Home visit is the main strategy of primary care by bringing health services to the homes and workplaces of people, which allows knowing the needs of the population firsthand. Thus, home visit by the ATAP represents the first contact of the individual, family and community with the health system, with significant benefits both individually and collectively. This research responds to the need to identify the elements that the home visiting program needs to improve modify or replace in order to maximize the provisión of this service.Method:It is a qualitative, observational analytic study. Data were collected through documentary research, key informant interviews and focus group. The analysis was performed from the grounded theory.Results:The main results showed the existence of elements at the level of the health system, home visiting program and the figure of the ATAP that should be reviewed, modified or replaced to the home visit, thus it has bigger and better results for the population and the health system.Conclusión:The Home Visiting Program is strength of the Costa Frican health system to address health inequities. However, it is imperative to make decisions and implementation of actions that promote the improvement and increased results of the home visit at a family and community level.

Validación de la prueba general para la evaluación del desarrollo para infantes y adolescentes entre los 6 y los 14 años de edad (EVADE) / Validation of the general test for the evaluation of development for children and adolescents aged 6 to 14 years oíd (EVADE)

ResumenIntroducción:En este artículo se presenta los resultados obtenidos de la validación de la Prueba General para la Evaluación del Desarrollo para infantes y adolescentes (EVADE), acorde con el crecimiento, necesidades, intereses y desarrollo de la población costarricense en edades entre los 6 y 14 años.Metodología:La metodología fue de carácter cualitativo, transversal y exploratorio: se llevó a cabo un proceso de validación que incluyó la técnica de juicio de expertos de tipo agregados individuales. En la primera fase de análisis de resultados, se utilizó la triangulación de la que se obtuvo como resultado el EVADE modificado. Posteriormente, se elaboró una prueba piloto con 300 infantes y adolescentes entre los 6 y 14 años de edad, de escuelas y colegios tanto públicos como privados del Area Metropolitana, San José, Costa Rica, para lo cual se empleó una guía de observación para recopilar los datos aportados en dicha prueba. En la segunda fase, con los resultados de la triangulación teórica, se estructuró una nueva versión del EVADE.Resultados:Hay escasez bibliográfica relacionada con pruebas de evaluación del desarrollo de la niñez intermedia y adolescencia; la técnica de juicio de expertos permitió confirmar la inconsistencia de algunos ítems del EVADE, por lo que fue necesario crear un instructivo y materiales estandarizados para la aplicación de la prueba.Conclusión:Esta investigación provee dos insumos fundamentales: un libro con el instructivo para la interpretación y aplicación del EVADE, y los materiales estandarizados para su implementación.

AbstractIntroduction:In this paper the results of the validation of the General Test Development Evaluation children and adolescents are presented (CIRCUMVENT), consistent with the growth needs, interests and development of the Costa Rican population between the ages of 6 and 14 years.Methodology:The methodology was qualitative, transversal and exploratory. For this purpose, conducted a valid ation process that included: technical expert judgment type aggregates individual; in the first phase results analysi s, triangulation was used, resulting in the modified CIRCUMVENT. Subsequently, a pilot with 300 children and a dolescents aged 6 to 14 years oíd, schools and colleges both public and prívate Metropolitan Area, San José, Cost a Rica was made; using an observation guide for the collection of the data provided in this test. In the second phas e, the results obtained with the theoretical triangulation, a new versión of CIRCUMVENT was structured.Results:There is limited literature regarding developmental screening tests in middle childhood and adolescence; technical expert judgment confirmed the inconsistency of some items of CIRCUMVENT; was necessary to créate standardized instructional materials for the application of the test.Conclusión:This research provides two significant inputs: a book with instructions for the interpretadon and application of CIRCUMVENT, and standardized materials for implementation.