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BMC Public Health ; 19(1): 419, 2019 Apr 18.
Artigo em Inglês | MEDLINE | ID: mdl-30999881


BACKGROUND: Early childhood is a crucial time to foster healthy eating and physical activity (PA) habits, which are critical for optimal child health, growth and development. Child care facilities are important settings to promote healthy eating and PA and prevent childhood obesity; however, almost all prior intervention studies have focused on child care centers and not family child care homes (FCCH), which care for over 1.6 million U.S. children. METHODS: This paper describes Healthy Start/Comienzos Sanos, a cluster-randomized trial evaluating the efficacy of a multicomponent intervention to improve nutrition and PA environments in English and Spanish-speaking FCCH. Eligible child care providers complete baseline surveys and receive a two-day FCCH observation of the home environment and provider practices. Parent-consented 2-5 year-old children are measured (height, weight, waist circumference), wear accelerometers and have their dietary intake observed during child care using validated protocols. FCCH providers are then randomly assigned to receive an 8-month intervention including written materials tailored to the FCCH providers' need and interest, videos, peer support coaching using brief motivational interviewing, and periodic group meetings focused on either nutrition and PA (Intervention) or reading readiness (Comparison). Intervention materials focus on evidence-based nutrition and physical activity best practices. The initial measures (surveys, two-day observation of the FCCH and provider practices, child diet observation, physical measures, and accelerometer) are assessed again 8 and 12 months after the intervention starts. Primary outcomes are children's diet quality (Healthy Eating Index), time in moderate and vigorous PA and sedentary PA during child care. Secondary outcomes include FCCH provider practices and foods served, and PA environments and practices. Possible mediators (provider attitudes, self-efficacy, barriers and facilitators) are also being explored. Process evaluation measures to assess reach, fidelity and dose, and their relationship with dietary and PA outcomes are included. DISCUSSION: Healthy Start/Comienzos Sanos fills an important gap in the field of childhood obesity prevention by rigorously evaluating an innovative multicomponent intervention to improve the nutrition and physical activity environments of FCCH. TRIAL REGISTRATION: (# NCT02452645 ) Trial registered on May 22, 2015.

Cuidado da Criança/organização & administração , Promoção da Saúde/organização & administração , Hispano-Americanos/educação , Estado Nutricional , Obesidade Pediátrica/prevenção & controle , Criança , Cuidado da Criança/métodos , Creches , Pré-Escolar , Exercício , Feminino , Humanos , Pais/educação , Projetos de Pesquisa , Autoeficácia
Infant Behav Dev ; 55: 10-21, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30825714


Toddler emotion regulation develops within the context of relationships but is also influenced by toddlers' individual characteristics. Drawing on transactional and differential susceptibility frameworks, this study examined direct and interactive associations of intrusive parenting, teacher sensitivity, and negative emotionality on toddler emotion regulation development in a sample of Early Head Start families utilizing center-based child care. Latent growth models indicated that, after controlling for a series of family and child care covariates, intrusive parenting at 14 months had diminishing effects on trajectories of emotion regulation across toddlerhood (14 to 36 months), whereas teacher sensitivity in child care was promotive for emotion regulation growth. Toddlers with high negative emotionality were not more susceptible to the effects of intrusive parenting or teacher sensitivity on emotion regulation development, however, results suggested emerging evidence for individual differences in the protective nature of teacher sensitivity in the context of high intrusion at home. Results are discussed in terms of their implications for informing parents and early care and education providers in nurturing relationships with the children who may be the most challenging to care for but may stand to make the greatest gains in emotion regulation development in quality caregiving settings.

Cuidado da Criança/métodos , Cuidado da Criança/psicologia , Desenvolvimento Infantil/fisiologia , Emoções/fisiologia , Poder Familiar/psicologia , Professores Escolares/psicologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Mães/psicologia , Pais/psicologia , Professores Escolares/normas , Autoimagem , Comportamento Social
Pediatr. aten. prim ; 21(81): e25-e30, ene.-mar. 2019.
Artigo em Espanhol | IBECS | ID: ibc-184541


La teoría del apego formulada originariamente por John Bowlby en la década de los cincuenta ha permitido profundizar en el conocimiento del vínculo de los padres con el bebé, así como mostrar que este vínculo es esencial para que los niños se desarrollen sanamente. La calidad de este vínculo de apego con las personas que cuidan al niño influirá en el desarrollo de sus capacidades mentales. Los pediatras tienen un papel privilegiado para mostrar a padres y madres la manera adecuada de atender tanto las necesidades psicológicas como físicas del bebé y de los niños

The Psychological attachment theory originally formulated by John Bowlby in the fifties has allowed to deepen the knowledge of the link parents-baby and has showed that the bond of attachment is essential for children to develop healthily. The quality of this bond of attachment with the people who care for the child will influence the development of their mental capacities. Pediatricians have a privileged role to show fathers and mothers the proper way to meet both the psychological and physical needs of baby and children

Humanos , Criança , Cuidado da Criança/métodos , Educação Infantil/tendências , Poder Familiar , Desenvolvimento Infantil/classificação , Educação/tendências , Pediatria/tendências , Apego ao Objeto , Desempenho Psicomotor/classificação
PLoS One ; 14(2): e0209987, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30763342


This paper assesses the psychometric properties of four child care quality instruments administered in 404 child care centers in Ecuador: the Classroom Assessment Scoring System for Toddlers, the Infant/Toddler Environment Rating Scale-Revised Edition, the Child Care Infant/Toddler Home Observation for Measurement of the Environment, and the Missouri Infant/Toddler Responsive Caregiving Checklist. We examined their internal consistency, tested the underlying subscale structure by means of confirmatory factor analysis (CFA), verified construct validity by testing associations with quality-related factors (e.g., child-caregiver ratio), and checked concurrent validity of the instruments' total scores. We found high internal consistency of the instruments at the full scale level and moderate to high at the subscale/domain level. CFA showed high factor loadings, but goodness of fit statistics were low. Construct validity results varied from low to very low depending on the quality-related factor, and concurrent validity from low to very high depending on the instruments compared. This validity exercise provides useful information for policy-makers and researchers interested in using these instruments in the Ecuadorian context or elsewhere in the region. The findings will also inform future research and development of affordable and culturally-appropriate tools for monitoring process quality in child care centers in Latin American countries.

Cuidado da Criança , Psicometria/métodos , Cuidadores , Cuidado da Criança/métodos , Saúde da Criança , Pré-Escolar , Equador , Análise Fatorial , Humanos , Lactente
Psychiatry Res ; 273: 9-14, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30639565


Schizophrenia may affect a mother's ability to parent. We investigated out-of-home placements among children with a biological mother having schizophrenia, and their relation to maternal characteristics and adverse perinatal health outcomes of the offspring. For each Finnish woman born between 1 JAN 1965 - 31 DEC 1980 and diagnosed with schizophrenia before 31 DEC 2013 (n = 5214), five matched controls were randomly selected from the Finnish Central Population Register. Children born to these women were identified and followed till 31 DEC 2013. The Child Welfare Register, the Medical Birth Register and the Register of Congenital Malformations were used to gather information. Altogether 35.1% of children with an affected mother and 3.2% of control children were placed out of home during the follow-up. The incidence rate ratio (IRR) of out-of-home placement among children with an affected mother was 12.6 (95% confidence interval (CI) 10.80-13.46) when children with a non-affected mother served as a reference. Single motherhood (IRR 2.2, 95% Cl 1.88-2.60) and maternal smoking (IRR 1.9, 95% Cl 1.68-2.16), but not an adverse perinatal outcome of the offspring, increased the risk of out-of-home placement. To conclude, maternal schizophrenia is a strong risk factor for placement of children in out-of-home care.

Cuidado da Criança/métodos , Cuidado da Criança/psicologia , Mães/psicologia , Esquizofrenia/epidemiologia , Psicologia do Esquizofrênico , Adulto , Criança , Cuidado da Criança/tendências , Custódia da Criança/métodos , Bem-Estar da Criança/psicologia , Bem-Estar da Criança/tendências , Feminino , Finlândia/epidemiologia , Seguimentos , Humanos , Masculino , Pais/psicologia , Gravidez , Fatores de Risco , Esquizofrenia/diagnóstico , Mulheres/psicologia
Rev. pesqui. cuid. fundam. (Online) ; 11(1): 67-73, jan.-mar. 2019.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-968605


Objetivo: Conocer las percepciones de las familias atendidas por la primera infancia mejor sobre su impacto en el crecimiento y desarrollo del niño y el cuidado de la familia. Métodos: Estudio cualitativo realizado con 15 familias. Los datos fueron recogidos por entrevistas en Septiembre de 2016 seguido de análisis temático. Resultados: El crecimiento y el desarrollo son procesos que ocurren al mismo tiempo, reconocieron el apoyo de los visitantes, que las situaciones de vulnerabilidad y el cambio constante de los visitantes interfieren negativamente con el crecimiento y desarrollo del niño, el programa ofrece oportunidades para construir el aprendizaje y el fortalecimiento una atención familiar efectiva. Conclusión: Se recomienda que la enfermería se incluye con el equipo interdisciplinario y que lo primera infancia mejor se visto en la atención primaria como una estrategia para fortalecer la promoción de la salud y la atención integral a los niños y sus familias

Objective: To know the perceptions of the families served by best childhood first about their repercussions on children's growth and development and on the family care of children. Methods: Qualitative study carried in the household of 15 families. Data were collected by semi structured interviews in September 2016 followed by analysis of thematic content. Results: They identified that growing and developing are processes that occur together, acknowledged the support of the visitors, that situations of vulnerability and the constant exchange of visitors interfere in the growth and development of children, that the program offers the construction of learning and strengthening of Effective family care. Conclusion: It is recommended that nursing be included in the interdisciplinary team, and that the best childhood first be visualized in primary care as a strategy capable of strengthening the promotion of health and the integral care for the child and his family

Objetivo: Conhecer as percepções das famílias atendidas pelo Primeira Infância Melhor acerca de suas repercussões no crescimento e desenvolvimento infantil e no cuidado familial das crianças. Método: Estudo qualitativo realizado no domicílio de 15 famílias. Os dados foram coletados por entrevistas semi estruturadas, em setembro de 2016, seguidas da análise de conteúdo temática. Resultados: Identificaram que crescer e se desenvolver são processos que ocorrem em conjunto, reconheceram o apoio dos visitadores, que situações de vulnerabilidade e a troca constante dos visitadores interferem negativamente no crescimento e desenvolvimento infantil, que o programa oportuniza a construção do aprendizado e fortalecimento de um cuidado familial efetivo. Conclusão: Recomenda-se que a enfermagem esteja incluída junto à equipe interdisciplinar, e que o Primeira Infância Melhor seja visualizado na atenção primária como uma estratégia capaz de fortalecer a promoção da saúde e a integralidade do cuidado à criança e sua família

Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Adolescente , Adulto , Pessoa de Meia-Idade , Cuidado da Criança/métodos , Cuidado da Criança/provisão & distribução , Cuidado da Criança/tendências , Enfermagem Pediátrica/tendências , Família/psicologia , Políticas Públicas de Saúde
Matern Child Health J ; 23(3): 325-334, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30569300


Objectives We examined biologic and social determinants of school readiness in an urban population and whether childcare altered these associations. Methods A retrospective cohort study was conducted using school readiness data linked to birth certificates of first-time kindergarten students (n = 39,463) in a large, urban public-school district during 2002-2012. Multivariate linear regression models compared mean readiness scores (MRS) for students born low birthweight (LBW) or preterm (PTB) and by childcare type, adjusting for other student and parent risk factors. Results MRSs for moderately LBW (1000-2499 g), extremely LBW (< 1000 g), moderately PTB (28-36 weeks), early-term (37-38 weeks) and post-term (42 + weeks) students were significantly lower than scores for their normal weight or full-term peers, adjusting for childcare type and other student and parent characteristics. Childcare was an important predictor of MRSs. MRSs were highest for district prekindergarten (PK) students and for students of mothers with greater years of education. Conclusions for Practice Social and biologic differences in MRSs for children entering school in a large urban public-school district suggest the need for greater attention to family and child health backgrounds. Increased enrollment in formal childcare may improve school readiness in these settings.

Cuidado da Criança/normas , Instituições Acadêmicas/normas , População Urbana , Criança , Cuidado da Criança/métodos , Cuidado da Criança/estatística & dados numéricos , Estudos de Coortes , Feminino , Humanos , Recém-Nascido de Baixo Peso/crescimento & desenvolvimento , Recém-Nascido de Baixo Peso/psicologia , Recém-Nascido , Modelos Lineares , Masculino , Estudos Retrospectivos , Fatores de Risco , Instituições Acadêmicas/tendências , Determinantes Sociais da Saúde
Pediatr Diabetes ; 20(1): 93-98, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30471084


Optimal care for children and adolescents with type 1 diabetes is well described in guidelines, such as those of the International Society for Pediatric and Adolescent Diabetes. High-income countries can usually provide this, but the cost of this care is generally prohibitive for lower-income countries. Indeed, in most of these countries, very little care is provided by government health systems, resulting in high mortality, and high complications rates in those who do survive. As lower-income countries work toward establishing guidelines-based care, it is helpful to describe the levels of care that are potentially affordable, cost-effective, and result in substantially improved clinical outcomes. We have developed a levels of care concept with three tiers: "minimal care," "intermediate care," and "comprehensive (guidelines-based) care." Each tier contains levels, which describe insulin and blood glucose monitoring regimens, requirements for hemoglobin A1c (HbA1c) testing, complications screening, diabetes education, and multidisciplinary care. The literature provides various examples at each tier, including from countries where the life for a child and the changing diabetes in children programs have assisted local diabetes centres to introduce intermediate care. Intra-clinic mean HbA1c levels range from 12.0% to 14.0% (108-130 mmol/mol) for the most basic level of minimal care, 8.0% to 9.5% (64-80 mmol/mol) for intermediate care, and 6.9% to 8.5% (52-69 mmol/mol) for comprehensive care. Countries with sufficient resources should provide comprehensive care, working to ensure that it is accessible by all in need, and that resulting HbA1c levels correspond with international recommendations. All other countries should provide Intermediate care, while working toward the provision of comprehensive care.

Serviços de Saúde do Adolescente , Cuidado da Criança , Diabetes Mellitus Tipo 1/economia , Diabetes Mellitus Tipo 1/terapia , Recursos em Saúde/estatística & dados numéricos , Adolescente , Serviços de Saúde do Adolescente/economia , Serviços de Saúde do Adolescente/estatística & dados numéricos , Criança , Cuidado da Criança/economia , Cuidado da Criança/métodos , Assistência Integral à Saúde/economia , Assistência Integral à Saúde/estatística & dados numéricos , Países em Desenvolvimento/economia , Países em Desenvolvimento/estatística & dados numéricos , Complicações do Diabetes/economia , Complicações do Diabetes/mortalidade , Complicações do Diabetes/terapia , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/epidemiologia , Humanos , Instituições para Cuidados Intermediários/economia , Instituições para Cuidados Intermediários/estatística & dados numéricos , Mortalidade , Pobreza/economia , Pobreza/estatística & dados numéricos , Unidades de Autocuidado/economia , Unidades de Autocuidado/estatística & dados numéricos
Am J Infect Control ; 47(1): 82-91, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30172610


BACKGROUND: Children in child care settings have a high infectious burden. They are frequently exposed to sanitizing and disinfecting agents, whose toxicities have not been studied in these settings. Current guidance on the preferred disinfection agents for child care is vague. METHODS: This article combines 2 different sources of information: the Environmental Protection Agency registration data on the efficacy of hospital-grade disinfectants and a review of the research on the toxicities of the most common of these disinfectants to summarize information that could be used for more evidence-based early care and education disinfection regulations and guidelines. RESULTS: Coverage of these organisms varied both between disinfectant classes (defined by active ingredient), as well as within classes. The 3 most common active ingredients in the database-quaternary ammonias, bleaches, and hydrogen peroxides-had 251, 63, and 31 products, respectively. Quaternary ammonias and bleaches are both known asthmagens, with the potential for toxic gas release when mixed. Quaternary ammonias may also cause reproductive toxicity. Disinfectant-grade peroxides have relatively low inhalational toxicity. CONCLUSIONS: A clear rationale is needed to establish policies for determining preferable disinfection products for use in child care settings, based on efficacy against relevant pathogens, toxicity, ease of use, and cost. When other factors are equal, the use of peroxide-based disinfectant products is recommended to minimize inhalational toxicity.

Cuidado da Criança/métodos , Desinfetantes/efeitos adversos , Desinfecção/métodos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Pré-Escolar , Desinfetantes/farmacologia , Humanos , Lactente , Medição de Risco , Estados Unidos
Rev. pesqui. cuid. fundam. (Online) ; 11(2, n. esp): 448-458, jan. 2019.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-969676


Objetivo: O estudo apresenta o relato de experiência de uma intervenção que teve como objetivo qualificar a puericultura em uma Estratégia de Saúde da Família no município de Boa Vista/Roraima. Método: A intervenção envolveu toda a equipe e teve a duração de 16 semanas, entre março a julho de 2015, nos quais foram instituídas ações direcionadas à organização e gestão do serviço, ao monitoramento e avaliação, à qualificação da prática clínica e ao engajamento público. Resultados: As ações permitiram qualificar o cuidado a 411 crianças, obtendo-se 98,6% da cobertura de atendimento, assim como a qualificação da prática clínica, adesão as ações com 100% de monitoramento do estado nutricional e desenvolvimento psicomotor, além da ampliação das atividades de promoção da saúde. Conclusão: A experiência contribuiu para melhorar a organização do serviço e integração da equipe alcançando resultados efetivos de cobertura e de qualidade da atenção relacionados a assistência a criança

Objective: This paper aims to describe the experience report of an intervention used to qualify the childcare provided by a Family Health Strategy service in the municipality of Boa Vista, Roraima State, Brazil. Methods: The intervention involved the entire team and lasted 16 weeks, over the period from March to July 2015, in which actions were performed for the organization and management of the service, monitoring and evaluation, qualification of clinical practice and public engagement. Results: The actions allowed to qualify the care to 411 children, obtaining 98.6% of care coverage, as well as the qualification of the clinical practice, compliance with the actions with 100% of nutritional status monitoring and psychomotor development, and the intensification of activities for health promotion. Conclusion: The experience contributed to improve the service organization and team integration, then achieving an effective coverage and quality of childcare

Objetivo: Averiguar la exposición de los trabajadores de la salud a riesgos físicos presentes en un hogar de ancianos. Métodos: estudio exploratorio descriptivo, de campo con un enfoque cuantitativo y de carácter transversal utilizando un inventario, preparado de conformidad con los requisitos de las resoluciones de la Junta Colegiada de ANVISA No. 283/2005 y 50/2002. Resultados: El campo de estudio tiene inadecuaciones frente a las normas establecidas por las resoluciones específicas exponiendo los trabajadores de salud a riesgos físicos, tales como: inadecuada distribución de los muebles descargas eléctricas, de humedad, de niveles de presión sonora, de falta de espacio y alta temperatura, entre otros. Conclusión: la institución estudiada no está de acuerdo con la legislación pertinente, y es evidente la presencia de riesgo físico que puede afectar la salud de los trabajadores y comprometer su calidad de trabajo

Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Cuidado da Criança/métodos , Cuidado da Criança , Cuidado da Criança/tendências , Estratégia Saúde da Família , Saúde da Criança
Rev Bras Enferm ; 71(suppl 6): 2808-2817, 2018.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30540060


OBJECTIVE: to identify scientific evidence on the contribution of nurses' work to good practices in child care in the Brazilian literature. METHOD: integrative review of the literature, carried out in Latin American and Caribbean in Health Sciences Literature (LILACS), Medical Literature Analysis and Retrieval System Online (MEDLINE), Brazilian Nursing Database (BDENF), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scientific Electronic Library Online (SCIELO) database, from 2008 to 2018. RESULTS: 14 complete studies were selected for interpretative analysis. Two categories allowed responding to the initial questioning of the study, namely: Nurses' contributions in child care; and Limits for the nurse's role in child care. CONCLUSION: evidences show the importance of nurses in child care for the promotion of comprehensive care for children and their families. However, there are socioeconomic, cultural, institutional and technical factors that hinder the nurses' performance in this setting.

Cuidado da Criança/métodos , Enfermeiras e Enfermeiros , Cuidados de Enfermagem/métodos , Criança , Cuidado da Criança/tendências , Pré-Escolar , Humanos
Infant Ment Health J ; 39(6): 730-750, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30347426


Research on the intersections of young children's emerging communication skills and emotion regulation has increased, following recognition of the link between these skills as they emerge in toddlerhood and the long-term impact of these skills on academic success. However, little is known about how toddlers use gesture and emerging language for emotion regulation. The current study describes toddlers' use of both words and gestures in naturally occurring distressing routines in childcare (diaper change, separation from parents). Seventeen toddlers between 11 and 28 months old were observed over the course of 3½ months in a childcare setting where symbolic gestures ("infant signs") were used as part of daily routines. Results show that toddlers communicated more frequently using gestures than speech, and used a greater range of self-regulatory strategies through gesture than through speech. Moreover, older, verbal toddlers continued to use gestures during heightened distress when they could not find their words. Findings suggest that toddlers use symbolic communication to implement complex and diverse emotion regulation strategies during distressing daily routines, and that gestures provide children with opportunities to employ more diverse emotion regulation strategies than does speech alone, which may ultimately enhance children's abilities to regulate their emotions.

Emoções , Gestos , Comunicação não Verbal/psicologia , Autocontrole/psicologia , Fala , Técnicas de Observação do Comportamento/métodos , Cuidado da Criança/métodos , Cuidado da Criança/psicologia , Pré-Escolar , Feminino , Humanos , Lactente , Masculino
Acta pediatr. esp ; 76(9/10): e129-e135, sept.-oct. 2018. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-177421


Introducción: El adecuado seguimiento de los pacientes con una enfermedad renal crónica desde pediatría a la nefrología de adultos y/o atención primaria constituye un reto de coordinación y planificación. El objetivo de este trabajo es presentar el diseño del programa de transición de nefrología "Conduce tu salud", elaborado en el Hospital Clínico Universitario Virgen de la Arrixaca de Murcia. Material y métodos: Los pacientes incluidos en la transición son adolescentes seguidos en la consulta de nefrología pediátrica que comienzan el programa a partir de los 15-16 años. Es un programa integrativo y multidisciplinario que realiza una valoración global de la familia y de las necesidades del paciente de forma conjunta entre el nefrólogo pediatra y el de adultos. Incluye una valoración psicosocial y medioambiental para establecer patrones y planificar necesidades específicas del adolescente y su familia. En función de las habilidades y la madurez del paciente para "conducir su salud", el tránsito se realiza entre los 15 y los 18 años de edad (formularios evolutivos de bicicleta, moto y coche). Conclusiones: El programa "Conduce tu salud" establece un proceso planificado, coordinado y multidisciplinario, que se realiza de forma personalizada, integrativa, progresiva y consensuada con el adolescente, la familia y los profesionales. El programa permite una adecuada transferencia de una unidad pediátrica a una de adultos, especializada y de atención primaria

Introduction: The adequate follow-up of patients with chronic kidney disease from pediatrics to adult nephrology and/or primary care is a challenge of coordination and planning. Objective: Present the design of the nephrology transition program "Conduce tu salud" drawn up at the Hospital Clínico Universitario Virgen de la Arrixaca in Murcia. Material and methods: Patients included in the transition are adolescents followed in the pediatric nephrology clinic who begin the program from 15-16 years of age. It is an integrative and multidisciplinary program that makes a global assessment of the family and the needs of the patient together with a pediatric and adult nephrologist. It includes a psychosocial and environmental assessment to establish patterns and plan specific needs of adolescents and their families. Depending on the abilities and maturity of the patient to "lead their health", the transition is performed between 15 and 18 years of age (evolutionary forms of bicycle, motorcycle and car). Conclusions: The program "Conduce tu salud" establishes a planned, coordinated and multidisciplinary process that is carried out in a personalized, integrative, progressive and consensual way with the adolescent, family and professionals. The program allows adequate transition from pediatric to adult unit, specialized and primary care

Humanos , Adolescente , Cuidado Transicional/tendências , Insuficiência Renal Crônica/epidemiologia , Serviços de Saúde do Adolescente/organização & administração , Cuidado da Criança/métodos , Serviços de Saúde do Adolescente/normas , Espanha/epidemiologia , Inquéritos e Questionários , Cuidado da Criança/organização & administração
Enferm. glob ; 17(52): 252-264, oct. 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-173986


Objetivo: Describir los alcances que ha tenido la Estrategia Atención Integral de las Enfermedades Prevalentes de la Infancia sobre la morbilidad y mortalidad en menores de cinco años residentes en el sector sur del municipio de Montería (Córdoba, Colombia). Metodología: Estudio descriptivo, de enfoque social, cuantitativo. Se realizó entrevista a 145 cuidadores de niños y niñas para evaluar conocimientos, aplicabilidad de las 18 prácticas claves y morbilidad sentida de las enfermedades sujeto de la estrategia en 87 familias con viviendas ubicadas en estrato 1 y 2. La información oficial sobre las tasas de mortalidad infantil (2005-2015) del municipio se utilizó para analizar la tendencia de este indicador. Resultados: Las prácticas claves más utilizadas son las relativas a las competencias para control de las enfermedades sujetos de la estrategia (80% a 99,3%), sin embargo, un alto porcentaje (66,9%) no reconoce los signos de alarma; las prácticas claves menos utilizadas se relacionan con la promoción de la salud y prevención de las enfermedades prevalentes (23%-57,9%). La movilización social con enfoque etno-cultural tiene un nivel intermedio de frecuencias de uso (60% a 79%). Predominan las diarreas y neumonías, los aprendizajes más permanentes se relacionan con las prácticas clave 11,12 y 17; las menos aplicadas son las prácticas 3, 7, 8, 9 y 10. Después de la implementación de la estrategia se observó un descenso sostenido de la mortalidad infantil. Conclusiones: Los padres y cuidadores de niños y niñas dan importancia y aplicabilidad diferencial para el control de las enfermedades, no a su prevención

Objective: Describe the scope that has been the strategy Integrated management in childhood Illness (IMCI) on morbidity and mortality in children under five years living in the South of the municipality of Monteria (Cordoba, Colombia). Methodology: Descriptive study, social, quantitative approach. It was interview with 145 caregivers of children to assess knowledge, applicability of the 18 key practices, and felt morbidity of diseases subject of strategy in 87 families with homes in strata 1 and 2. The official information on the rates of infant mortality (2005-2015) of the municipality was used to analyze the trend of this indicator.Results: The most used practices are those relating to competences for disease control subject of the strategy (80% to 99.3%), however, a high percentage (66.9%) does not recognize the warning signs; lesser used practices related to the promotion of health and prevention of diseases prevalent (23%-57,9%). Social mobilization with ethno-cultural approach has an intermediate level of frequency of use (60% to 79%). Diarrhea and pneumonia predominate, more permanent learning relate to key practices 11, 12 and 17; the less applied are key practices 3, 7, 8, 9 and 10. Lower sustained mortality was observed after the implementation of the strategy IMCI. Conclusions: The parents and caregivers of children give more importance and differential applicability for the control of diseases than for their prevention

Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Estratégia Saúde da Família , Controle de Doenças Transmissíveis/organização & administração , Prevenção de Doenças , Cuidado da Criança/métodos , Avaliação de Eficácia-Efetividade de Intervenções , Epidemiologia Descritiva , Conhecimentos, Atitudes e Prática em Saúde , Cuidadores/estatística & dados numéricos
Pediatr. aten. prim ; 20(79): 237-243, jul.-sept. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-180945


Introducción: en las consultas de Pediatría de Atención Primaria, una de las principales reivindicaciones de las madres es la necesidad de sentirse comprendidas en el afrontamiento de su nuevo rol. Objetivo: el presente estudio trata de conocer las vivencias que un grupo de mujeres relatan sobre la maternidad para identificar los aspectos que tener en cuenta en la promoción de la salud infantil. Material y métodos: estudio cualitativo con enfoque fenomenológico. Siete madres configuran la muestra. Los grupos de discusión fueron grabados y transcritos para realizar el análisis de contenido. Este se llevó a cabo de forma colaborativa siguiendo los cánones de la codificación abierta hasta la saturación teórica. Resultados: las vivencias más relevantes se organizan en tres categorías. En cuanto a la relación con sus hijos, subrayan que dicha relación les reporta "felicidad", aunque señalan el "trabajo" como un obstáculo importante para ello. En referencia a ellas mismas se describen en "alarma constante", "preocupadas", con "miedo" frente a la crianza, y con la necesidad de tener "tiempo para ellas". Respecto al apoyo social, aseguran que, aunque sus parejas se "implican", suelen "sentirse mal" por comentarios de sus madres, y "presionadas" por los pediatras. Conclusiones: la formación, si otorga importancia a la comunicación, puede hacer emerger en las consultas de Pediatría de Atención Primaria, relaciones que facilitan la reflexión de las madres sobre la crianza, y que no culpabilizan para asegurar así la adhesión a las recomendaciones pediátricas y la promoción de la salud infantil

Introduction: one of the main demands of mothers in paediatric primary care is to feel understood as they take on this new role. Objective: the study aims at exploring the experiences of motherhood described by a group of women to identify the aspects that need considering for the purpose of child health promotion. Materials and methods: we conducted a qualitative study with a phenomenological approach. The sample consisted of seven mothers. The discussion groups were recorded and their contents transcribed for subsequent analysis. The latter was performed collaboratively following the methodology of open coding until theoretical saturation was achieved. Results: the most relevant experiences could be fitted into three categories. When it came to their relationship with their children, mothers highlighted that it gave them "happiness," although they pointed out "work" as a significant barrier to it. When it came to themselves, they reported feeling "constant alarm," "worried" and "fearful" in regard to childrearing and needing "time for themselves". As for social support, they stated that while their partners were "involved," they tended to "feel bad" in response to comments made by their own mothers and also "pressured" by paediatricians. Conclusions: emphasising communication skills during training could aid the development of doctor-patient rapport in paediatric primary care so that mothers can reflect on childrearing and not feel blamed, thus promoting adherence to paediatric recommendations and consequently child health

Humanos , Feminino , Adulto , Promoção da Saúde/métodos , Cuidado da Criança/métodos , Poder Familiar/tendências , Atenção Primária à Saúde/métodos , Educação Infantil/tendências , Mulheres Trabalhadoras/estatística & dados numéricos , Relações Mãe-Filho , Grupos Focais/estatística & dados numéricos
BMC Pediatr ; 18(1): 228, 2018 07 11.
Artigo em Inglês | MEDLINE | ID: mdl-29996805


BACKGROUND: It was unclear how and to what extent the "Child Care" intervention (CCI) in rural Primary Health Care Program affected the prevalence of childhood diarrhea in rural western China. METHODS: The available data of 10,829 and 10,682 households was collected from shared 34 counties of 9 provinces of western China in 2001 and 2005 respectively. A log-binomial regression model was used to predict the effect of CCI on prevalence of childhood diarrhea. RESULTS: In 2001, the prevalence rate of diarrhea among children less than 36 months of age was 17.01% in intervention group and 17.72% in control group, and in 2005 this crude rate declined to 4.85% in the former and 6.84% in the latter. Log-binomial regression analysis showed that CCI decreased the overall prevalence of childhood diarrhea by 27% (adjusted relative prevalence ratio (rPR) = 0.73 95% CI 0.59, 0.89). The stratification regression by social-economic status (SES) of the households showed that this effect varied with SES of the households. In the medium or rich households, this intervention was effective significantly (the medium: adjusted rPR = 0.63,95%CI 0.41,0.95; the rich: adjusted rPR = 0.72,95%CI 0.54,0.97), but in poor households it seemed to be less effective (adjusted rPR = 0.86,95%CI 0.55,1.36). CONCLUSION: In rural Primary Health Care Program, CCI was effective in improving childhood diarrhea but this effect was inequitable among SES of the households. So, attention should be paid to the inequality when CCI was adopted to reduce childhood diarrhea in rural China.

Cuidado da Criança/métodos , Diarreia/epidemiologia , Diarreia/prevenção & controle , Atenção Primária à Saúde/métodos , Pré-Escolar , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Prevalência , População Rural , Fatores Socioeconômicos , Abastecimento de Água/normas
Child Care Health Dev ; 44(5): 746-752, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29873093


BACKGROUND: Family childcare homes (FCCHs) are the second largest provider of childcare in the United States, yet little is known about how this setting influences children's physical activity, particularly related to the physical environment. Thus, the purpose of this study was to determine what aspects of the FCCH physical environment facilitate or hinder children's physical activity. METHODS: Data were collected from 166 FCCH providers and 496 preschool-aged children in 2013-2014 as part of the Keys to Healthy FCCHs study. Children's moderate-to-vigorous physical activity (MVPA) was measured using Actigraph GT3X+ accelerometers. Wear data from the childcare day were isolated, and cut-points were applied in order to calculate children's minutes of MVPA per hour. FCCH-level estimates of child MVPA per hour were calculated. Indoor and outdoor physical environment characteristics were assessed during a 2-day observation using the Environment and Policy Assessment and Observation modified for FCCHs. General linear models were used to examine the relationship between indoor, portable play equipment, and outdoor FCCH physical environment characteristics and children's MVPA per hour. RESULTS: Only indoor play space was significantly associated with children's MVPA (ß = 0.33; p = .034), indicating that when provided with more indoor space for active play, children were more physically active. No significant associations were noted between portable play equipment or the outdoor environment and children's MVPA. CONCLUSIONS: Indoor space was the only physical environment characteristic associated with children's MVPA, suggesting that teaching FCCH providers how to best utilize their indoor play space for active play may be a way to promote children's physical activity. Futures studies should explore the impact of other environmental characteristics of the FCCH (e.g., provider practices and policies) on children's physical activity.

Cuidado da Criança/métodos , Creches , Exercício/fisiologia , Promoção da Saúde , Jogos e Brinquedos , Acelerometria , Pré-Escolar , Análise por Conglomerados , Feminino , Humanos , Masculino
Rev. pesqui. cuid. fundam. (Online) ; 10(3, n. esp): 276-281, jun. 2018.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-906185


Conclusão: A vivência de mães de crianças com SD é difícil, mas prazerosa, visto que dela depende todos os cuidados direcionados a criança. Desde o impacto do diagnóstico até o cotidiano do cuidado, muitas são as dificuldades enfrentadas por elas, incluindo a descriminação e os cuidados diários que exige muito amor e determinação. Suas crianças necessitam participar de inúmeras atividades que lhes estimulem ao máximo, para que possam desenvolver suas habilidades. Além disso, as idas e vindas a diferentes especialistas também contribuem para a sobrecarga de trabalho. Para tanto, estas mães devem receber apoio tanto da família, quanto da equipe multiprofissional e dos grupos de apoio, com vista a empoderá-las para o cuidado.

Humanos , Feminino , Recém-Nascido , Lactente , Síndrome de Down/enfermagem , Cuidado do Lactente/métodos , Serviços de Saúde Materno-Infantil , Cuidado da Criança/métodos