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ABSTRACT Objective: to identify toddlers’ eating habits. Method: a cross-sectional study of quantitative analysis, with a sample of 808 toddlers who attended day care centers in the district of Viseu, Portugal, between November 2018 and September 2019. Data were collected using a questionnaire directed at parents. Results: the prevalence of children who ate six meals a day was 42.8%, and 42.5%, those who ate five meals. It was found that 2.0% of children consumed chocolates, 1.0%, desserts, and 0.4%, carbonated beverages, daily. On average, dairy product (M=5.61; SD=2.62) and meat/fish/egg (M=4.80; SD=3.57) consumption was higher than recommended, while fat (M=0.48; SD=0.40), legume (M=0.49; SD=0.45), vegetable (M=1.18; SD=0.87) and water (M=0 .51; SD=0.29) consumption was lower. Conclusions: there was a higher or lower consumption than recommended for some foods, highlighting the need to implement nursing intervention programs aimed at promoting healthy eating habits in toddlers and families.

Purpose Safe sleep practices (SSP) are among the main strategies to reduce sleep-related sudden unexplained infant death (SUID). Daycare personnel must be knowledgeable and trained in SSP related to SUID. This study explored the experience, knowledge, and confidence regarding SSP associated with SUID of daycare personnel. Methods A cross-sectional survey was conducted with 395 staff members at 61 daycare centers to measure their experience related to SSP (10 items), related to sleep position and location, bedding materials, and other topics; knowledge of SSP (18 items); and confidence in SSP (1 item) related to SUID. Results A substantial proportion (23.6%) of respondents used the lateral or prone positions for infant sleep. On average, 4.5 bedding materials were used for infant sleep. Participants showed a lack of knowledge about SSP as indicated by a 56.6% knowledge of SSP related to SUID correct answer rate. Personnel who received SUID education were more knowledgeable and had more confidence regarding SSP than those who did not. More knowledge and confidence related to SSP were associated with better adherence to SSP. Conclusion Standard SSP guidelines should be developed based on South Korea's culture of childcare for educating both childcare professionals and parents at home.

Objective: The relationship between parents’ sleep quality and sleep hygiene and preschool children’s sleep habits was examined. Material and Methods: The study population consisted of the parents of all preschool children at daycare centers located in Kermanshah Province. Through cluster sampling, 153 parents from 26 daycare centers were selected. In order to assess the quality of sleep and sleep health of parents, Pittsburg sleep quality index (PSQI) and sleep hygiene index (SHI) were used. As to the status of childrens sleep habits (CSH), the parents also completed child sleep habit questionnaire (CSHQ). Data analysis was performed in SPSS version 25. The non-parametric tests like U Mann-Whitney test, Kruskal-Wallis’s test, Spearman’s rho, and regression test were used. Results: The mean score of CSHQ from the parents’ viewpoint was 56.34±7.96, which meant a relatively improper sleep habits in the children. The CSH was significantly and directly related to parents’ sleep quality and all of its subscales except two sub-scales (SSQ and HSE). In addition, CSH was directly and significantly related to the parents’ sleep hygiene and its three subscales. The results of multiple linear regression showed that the impact coeffcient of parents’ sleep quality (B=1.02), given the t-value, predicted changes in CSH with 0.99 confidence. Conclusion: In general, the results showed that CSH was in a relatively bad state, while it had a direct relationship with parents’ sleep quality and hygiene. To improve CSH, it is possible to improve parents’ sleep quality through implementing proper programs and motivating parents to observe sleep hygiene.

Purpose This study investigated the practices of preventing infectious diseases by daycare center teachers. The focus was on the mediating effects of self-efficacy in the relationship between communication skills and practices of preventing infectious diseases. Methods This study used a descriptive correlational design. The participants were 164 daycare center teachers. Hierarchical regression was used to test the mediating effect of self-efficacy in the relationship between communication skills and practices of preventing infectious diseases. Data were analyzed using the independent t-test, one-way analysis of variance, Pearson correlation coefficients, and hierarchical regression. The mediation effect was analyzed using an SPSS Macro program, PROCESS. Results Significant relationships were found between communication skills and practices of preventing infectious diseases (β=.19, p

Introduction: the aim of this study was to determine the quantity and quality of indoor and outdoor air fungus bioaerosols in Khorramabad day care child centers. Materials and Methods: A total of 180 air samples were collected from 10 centers in 2018. The samples included 7 indoor and 2 outdoor sampling points. The total number of children was 580. Sampling of fungal bioaerosols was performed by the ZEFON pump (ZEFON factory, USA) with a flow rate of 28.3 L/min. The Sabouraud Dextrose Agar containing chloramphenicol was used as the culture medium. Relative humidity and temperature were measured by a Hygro-Thermometer (TES-1360A- Taiwan-made Humidity and temperature meter). Results: The results showed that 96.1 % of the samples were positive and had grown colonies. The highest amount of fungal agents in the indoor air and outdoor air were 175.58 CFU/m3 and 274.56 CFU/m3 in May, while the lowest rates were 3.4 CFU/m3 and 7.8 CFU/m3 in July, respectively. Aspergillus niger and Mucor were the most highly abundant fungus genera, while Fusarium was the lowest one. In all samples, the I/O (indoor/outdoor) ratio was more than 1; so, fungal bioaerosols in indoor environments were dominant than the outdoor fungal bioaerosols. The relationship of fungal bioaerosols with RH and T)°C( was significant (P-value = 0.001). Conclusion: Generally, the amount of contamination is considerable in the studied day care child centers. Therefore, ventilation modification is recommended by a purifier filter. Moreover, the ventilation conditions and favorable air standards should be monitored continuously by supervisory authorities.

BackgroundFeasibility of surveillance through continuous SARS-CoV-2 testing in pre-school children and childcare workers (CCWs) to prevent closure of day care centers (DCCs) was proven in the Wü-KiTa-CoV study. The purpose of this study was to describe the factors that facilitate or hinder the implementation of continuous SARS-CoV-2 testing from the perspective of parents and CCWs involved in the study.MethodsA total of 148 semi–structured telephone interviews, repeated before and after the implementation of the surveillance protocols, were conducted with parents and CCWs belonging to the DCCs involved in Wü-KiTa-CoV and analyzed using qualitative content analysis.ResultsFive main topical categories that influences implementation of surveillance protocols for SARS-CoV-2 in DCCs emerged: Generating valuable knowledge, Impact on daily life, Communication and information, Children’s wellbeing and the Sense of security. Smooth integration in daily routines, quickly delivered test results, and efficient communication and information between the study team and the participants were identified as factors that had a positive impact on implementation. To ensure children’s wellbeing, the introduction of non-invasive testing procedures such as saliva testing, parental involvement to motivate, and prepare children for the procedure, the creation of a child-friendly environment for testing, and use of child-friendly explanations were considered critical. The surveillance was found to increase the sense of security during the pandemic. Conversely, reliability of tests in the surveillance protocols, low participation rates, non-transparent communication, the need to travel to testing sites, fear of quarantine in case of positive test results, concerns about higher workloads, the fear of unpleasant feelings for children, their young age, and changing test teams were considered as hindering factors.ConclusionThis qualitative study of parents of children in day care and DCC staff under surveillance through continuous testing for SARS-CoV-2 in nine German DCCs identified several factors that facilitate or hinder its implementation. These should be considered when planning screening interventions to prevent the spread of SARS-CoV-2 or other infectious diseases in pre-school children DCCs.

Background: To determine the effects of an educational playful intervention on nasal hygiene behaviors among preschool (3-4 years old) children. Methods: A quasi-experimental before-after study was conducted with 39 children attending public daycare center in Sao Paulo, Brazil. A group-based intervention consisted of two educational sessions to promote healthy behaviors for nasal hygiene. It was adopted playful strategies such as a story told by puppets, card games and simulation of nasal hygiene in front of the mirror. The outcome was evaluated by observing six healthy behaviors for nasal hygiene one week before and after the intervention. Differences in the outcome before and after the intervention were tested using Wilcoxon signed rank test and McNemar’s test. Results: The median of healthy nasal hygiene behaviors went from 3.0 to 4.0 after the intervention, with a significant statistical difference (P=0.0004) and a difference of behaviors. After the intervention, forcing the air out of one opened nostril increased from 5.1%to 30.8% (P=0.001, CI 95%: 0-0.440), forcing the air out of the other nostril increased from 5.1% to 28.2% (P=0.003/CI 95%: 0-0.50), throwing the piece of toilet paper in the garbage increased from 53.8% to 87.21% (P=0.04, CI 95%: 0.035-0.65), and sanitizing the hands with soap and water increased from 15.4% to 43.6% (P=0.039-0.76). Conclusion: the educational playful intervention improved the autonomy of preschoolers to adopt healthy nasal hygiene behaviors.

ABSTRACT Objective: To identify the factors associated with excessive weight gain in preschool children enrolled at daycare centers in a capital of the Northeast region of Brazil. Methods: It was a cross-sectional study conducted at the five daycare centers located in the city’s district of most socioeconomic vulnerability. The study included 326 preschool children (17 to 63 months old) from both genders. The dependent variable was the conditional weight gain (CWG), that represents how much a child, according to their gender, deviated from their peers in relation to the expected weight gain, given sample’s birthweight, gender, and age at the survey. Univariate tests (t-test and analysis of variance) were used to compare CWG means according to environmental and biological factors, considering the independent variables with p

Abstract Introduction: A daycare center is a long-term place for infants, which means that early intervention programs should be thought of in this environment. There are still many gaps regarding the best way of stimulation/intervention, duration and description of effects and controlled outcomes. Aim: The objective of this clinical trial is to propose an early physical activity intervention program performed in infants of 4-18 months with risk/delay and with typical development at infant’s daycare. Method: The protocol of this study is indicated for a controlled trial, in a crossover format, to be applied in 4 groups composed by in 4-18 month-old infants who attend daycare: Intervention group 1 Typical, Intervention group 1 Risk/delay, group Intervention 2 Typical, group Intervention 2 Risk/delay, in 4-18 month old infants who attend daycare. The ICF criteria about functions and structure (through evaluation questionnaire) are considered, as well as activities and participation (AIMS, Denver II, and PedsQl™ evaluation), personal characteristics (questionnaire, ABEP and AHEMD-IS) and environmental factors (AHEMD-IS). Conclusion: This original proposal can highlight a low-cost intervention program performed in a daycare environment verifying the infant's NMD in a systematized way using theoretical basis.

Objective: To analyze the effectiveness of an educational intervention with mothers to stimulate children under two years of age at risk for neuropsychomotor development. Method: Before-after intervention study, conducted with 52 mothers of children under two years old, enrolled in reference centers in early childhood education. Initially, maternal knowledge regarding child development and stimulation was assessed through a structured instrument. Then, workshops were held with the mothers and, after three months, maternal knowledge was revised, reapplying the data collection instrument. In the analysis, descriptive and inferential statistics were used, applying the McNemar and Wilcoxon tests and the Rasch Model from the Item Response Theory. Results: after the intervention, there was a significant increase in scores regarding the following aspects: knowledge of mothers about child development and stimulation from 5.77 ± 1.85 to 18.60 ± 1.94 (p

Abstract Background The provision of affordable and reliable daycare services is a potentially important policy lever for empowering Indian women. Access to daycare might reduce barriers to labor force entry and generate economic opportunities for women, improve education for girls caring for younger siblings, and promote nutrition and learning among children. However, empirical evidence concerning the effects of daycare programs in low-and-middle-income countries is scarce. This cluster-randomized trial will estimate the effect of a community-based daycare program on health and economic well-being over the life-course among women and children living in rural Rajasthan, India. Methods This three-year study takes place in rural communities from five blocks in the Udaipur District of rural Rajasthan. The intervention is the introduction of a full-time, affordable, community-based daycare program. At baseline, 3177 mothers with age eligible children living in 160 village hamlets were surveyed. After the baseline, these hamlets were randomized to the intervention or control groups and respondents will be interviewed on two more occasions. Primary social and economic outcomes include women’s economic status and economic opportunity, women’s empowerment, and children’s educational attainment. Primary health outcomes include women’s mental health, as well as children’s nutritional status. Discussion This interdisciplinary research initiative will provide rigorous evidence concerning the effects of daycare in lower-income settings. In doing so it will address an important research gap and has the potential to inform policies for improving the daycare system in India in ways that promote health and economic well-being. Trial registration (1) The ISRCTN clinical trial registry (ISRCTN45369145), http://www.isrctn.com/ISRCTN45369145 , registered on May 16, 2016 and (2) The American Economic Association’s registry for randomized controlled trials (AEARCTR-0000774), http://www.socialscienceregistry.org/trials/774 , registered on July 15, 2015

Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) is able to colonize the human body, most frequently the nostrils, but also the hands, perineum and throat. Such colonization has been proposed as a risk factor to acquire future infections. Objective: To determine the prevalence, and the microbiological and molecular characteristics of MRSA in healthy children. Methodology: A cross-sectional descriptive study was done of 150 children from 13 day care centers in Montería, Colombia. Nasal and throat swabs were obtained. The isolates were identified and characterized by microbiological and molecular methods. Results: The MRSA colonization rate was 9.3% (14/150). 62.5% of the isolates carried the subtype IVc of SCCmec, and 87.5% had the genes encoding for PVL and Sek, while 81.2% carried the gene bsaB. Conclusion: The percentage of colonization found is one of the highest reported among children from the Colombian Caribbean region, and the isolates have virulence factors that have been associated with an aggressive clinical course.

A figura do professor exerce grande influência sobre o comportamento dos alunos, pelo contato diário durante longo tempo. O objetivo do presente trabalho foi analisar o conhecimento dos professores de escolas estaduais e municipais de educação infantil no que diz respeito à saúde bucal. Foi realizado um estudo exploratório descritivo, com abordagem quanti-qualitativa com 164 professores, utilizando-se um questionário, autoaplicável, com perguntas sobre o tema. Os mesmos foram digitados e analisados pelo programa Epi Info, 3.5.1. Entre os resultados obtidos, pode-se observar que 94,5% relataram atuar em escolas que possuem atividades de educação em saúde bucal. Sobre as informações a respeito dos cuidados necessários para a manutenção da saúde bucal, 85,4% relataram ter recebido em algum momento. Segundo eles, a informação foi fornecida principalmente pelo cirurgião dentista (64,3%), alunos FOA-UNESP (16,4%), família (5,7%). 95,7% responderam saber o que é cárie dentária. Dentre esses indivíduos, 12,2% relacionaram-na a resíduos acumulados no dente. No que se refere à função do flúor em relação à cárie dentária, 88,4% indicaram conhecê-la. Destes, 50,3% atribuíram ao mesmo a função de proteção da estrutura dental. Pode-se concluir que embora a escola seja um espaço importante de informação, esta é ainda muito pouco aproveitada, os professores possuem pouco conhecimento a respeito dos cuidados necessários para a manutenção da saúde bucal e necessitam de maiores informações para abordarem com segurança estes temas em sala de aula.The teacher's image causes high influence on students' behavior, through daily contact during long time. The objective of this study was to examine the knowledge of teachers from state and municipal primary schools, about oral health. It was performed a descriptive and exploratory study with an quantitative and qualitative approach including 164 teachers, using as instrument, self-applied questions about the theme. The data was stored and analyzed by Epi Info Program version 3.5.1. Among the results, it was possible to observe that 94,5% related to work in primary schools that have activities about oral health education. In relation to information about necessary cares, 85,4% related to have received it during some moment. According to them, the information was given mainly by dentist (64,3%), students of Araçatuba Dental School (16,4%) and family (5,7%). 95,7% answered they know the meaning of dental caries and among them, 12,2% related it to food remaining on teeth, 88,4% said to know it. Among these perceptual, 50,3% attributed to the same role to protection of dental structure. It is possible to conclude that although the school is an important place for information, but it is not fully used; the teachers have little knowledge about the necessary care for maintenance of oral health, and need more information for approaching with security these themes during classes.

Poor growth and intestinal parasitic infections are widespread in disadvantaged urban children. This cross-sectional study assessed factors influencing poor growth and intestinal parasites in 376 children aged three to six years in daycare centers in Salvador, in the Northeast Region of Brazil. Data was obtained from seven daycare centers on child weight, height, socio-economic status, health and intestinal parasites in stool samples. Prevalence of moderate underweight (< -1SD > -2SD), wasting and stunting was 12%, 16% and 6% respectively. Socioeconomic status, birth order, and maternal weight were predictors of poor anthropometric status. Almost 30% of children were infected with more than one intestinal parasite. Helminths (17.8%), notably Trichuris trichiura (12%) and Ascaris lumbricoides (10.5%), and protozoan Giardia duodenalis (13%) were the most common types of parasites detected. One percent of children had hookworm and Cryptosporidium sp. and 25% had non-pathogenic protozoan cysts. Boys from families with very low socio-economic status had lower linear growth and presented a greater risk of helminth infection. Deworming is considered an alternative for reducing the prevalence of intestinal parasitic infections in this age group.Déficit de crescimento e parasitoses são comuns entre crianças residentes em periferias. Em estudo transversal com 376 pré-escolares (3-6 anos) de creches em Salvador, Nordeste do Brasil, avaliamos fatores predisponentes para déficit de crescimento e parasitose. Obtiveram-se dados em sete creches sobre peso da criança, altura, nível socioeconômico, estado de saúde e parasitos em amostras de fezes. Prevalência de baixo peso (-1 < DP > -2), desnutrição e baixa estatura foram 12%, 16%, e 6%, respectivamente; nível socioeconômico, ordem de nascimento e peso materno foram preditores da antropometria. Aproximadamente 30% estavam infectados com ≥ 1 parasita. Helmintos (17.8%), notavelmente Trichuris trichiura (12%) e Ascaris lumbricoides (10.5%) e protozoário Giardia duodenalis (13%) foram os mais comuns; < 1% tinha ancilostomíase e Cryptosporidium sp.; 25% apresentaram protozoários cistos não patogênicos. Meninos de famílias muito pobres tiveram menor crescimento e maior risco de helmintose. A desparasitação pode ser considerada uma alternativa para a redução da prevalência de parasitoses intestinais nesse grupo etário.

OBJETIVO: Avaliar a associação entre níveis de ruído presentes em centros de educação infantil e alterações vocais em educadoras. MÉTODOS: Estudo transversal com 28 educadoras de três instituições de educação infantil de São Paulo, SP, em 2009. Os níveis de pressão sonora foram mensurados segundo a Associação Brasileira de Normas Técnicas, com uso de medidor de nível de pressão sonora. As médias foram classificadas de acordo com os níveis de conforto, desconforto e dano auditivo propostos pela Organização Panamericana de Saúde. As educadoras tiveram a voz avaliada com: autoavaliação com escala analógica visual, avaliação perceptivo-auditiva com escala GRBAS e análise acústica com o programa Praat. Estatística descritiva e teste do qui-quadrado, com 10% de significância devido ao tamanho da amostra, foram usados para análise da associação entre ruído e avaliação vocal. RESULTADOS: As educadoras possuíam idades entre 21 e 56 anos. A média de ruído foi 72,7 dB, considerado dano 2. A autoavaliação vocal das profissionais apresentou média de 5,1 na escala, considerada alteração moderada. Na avaliação perceptivo-auditiva, 74% apresentaram alteração vocal, principalmente rouquidão; destas, 52% foram consideradas alterações leves. A maior parte apresentou frequência fundamental abaixo do esperado na avaliação acústica. Médias de jitter, shimmer e proporção harmônico-ruído estavam alteradas. Presença de ruído entre os harmônicos associou-se a alteração vocal. CONCLUSÕES: Há associação entre presença de ruído entre harmônicos e alteração vocal, com elevados níveis de ruído. Apesar de a maioria das educadoras ter apresentado voz alterada em grau leve, a autoavaliação mostrou alteração moderada, provavelmente pela dificuldade de projeção.OBJETIVO: Evaluar la asociación entre niveles de ruido presentes en centros de educación infantil y alteraciones vocales en educadoras. MÉTODOS: Estudio transversal con 28 educadoras de tres instituciones de educación infantil de Sao Paulo, Sureste de Brasil, en 2009. Los niveles de presión sonora se cuantificaron según Asociación Brasileña de Normas Técnicas, con uso de medidor de nivel de presión sonora. Los promedios se clasificaron según los niveles de conforto, incomodidad y daño auditivo propuestos por la Organización Panamericana de Salud. A las educadoras se les evaluó la voz: auto-evaluación con escala analógica visual, evaluación perceptivo-auditiva con escala GRBAS y análisis acústico con el programa Praat. Para análisis de asociación entre ruido y evaluación vocal, se utilizó estadística descriptiva y prueba de chi-cuadrado, con 10% de significancia debido al tamaño de la muestra. RESULTADOS: Las educadoras presentaban edades entre 21 y 56 años. El promedio de ruido fue 72,7dB, considerado daño 2. La auto-evaluación vocal de las profesionales presentó promedio de 5,1 en la escala, considerada alteración moderada. En la evaluación perceptivo-auditiva, 74% presentaron alteración vocal, principalmente ronquera; de estas, 52% fueron consideradas alteraciones leves. La mayor parte presentó frecuencia fundamental por debajo de lo esperado en la evaluación acústica. Promedios de jitter, shimmer y proporción armónico-ruido estaban alterados. Presencia de ruido entre los armónicos se asoció a alteración vocal. CONCLUSIONES: Hubo asociación entre presencia de ruido entre armónicos y alteración vocal, con elevados niveles de ruido. A pesar de que la mayoría de las educadoras presentaron voz alterada en grado reducido, la auto-evaluación mostró alteración moderada, probablemente por la dificultad de proyección.OBJECTIVE: To analyze the association between noise levels present in preschool institutions and vocal disorders among educators. METHODS: Cross-sectional study conducted in 2009 with 28 teachers from three preschool institutions located in the city of São Paulo (Southeastern Brazil). Sound pressure levels were measured according to Brazilian Technical Standards Association, with the use of a sound level meter. The averages were classified according to the levels of comfort, discomfort, and auditory damage proposed by the Pan American Health Organization. The educators underwent voice evaluation: self-assessment with visual analogue scale, auditory perceptual evaluation using the GRBAS scale, and acoustic analysis utilizing the Praat program. To analyze the association between noise and voice evaluation, descriptive statistics and the chi-square test were employed, with significance of 10% due to sample size. RESULTS: The teachers' age ranged between 21 and 56 years. The noise average was 72.7 dB, considered as damage 2. The professionals' vocal self-assessment ranked an average of 5.1 on the scale, being considered as moderate alteration. In the auditory-perceptual assessment, 74% presented vocal alteration, especially hoarseness; of these, 52% were considered mild alterations. In the acoustic assessment the majority presented fundamental frequency below the expected level. Averages for jitter, shimmer and harmonic-noise ratio showed alterations. An association between the presence of noise between the harmonics and vocal disorders was observed. CONCLUSIONS: There is an association between presence of noise between the harmonics and vocal alteration, with high noise levels. Although most teachers presented mild voice alteration, the self-evaluation showed moderate alteration, probably due to the difficulty in projection.

OBJETIVO: avaliar o desempenho em habilidades auditivas e as condições de orelha média de crianças de 4 a 6 anos de idade. MÉTODO: foram aplicados os testes de detecção sonora (audiômetro pediátrico em 20dBNA), a Avaliação Simplificada do Processamento Auditivo (ASPA) e as medidas de imitância acústica (handtymp com tom de 226Hz) em 61 crianças com média de idade de 5,65 anos. Para comparar os resultados das provas de habilidades auditivas e das medidas da imitância acústica foi aplicado o teste exato de Fisher com nível de significância de p< 0,05. RESULTADOS: houve alteração em pelo menos uma das habilidades auditivas investigadas em 24,6% das crianças. Houve alteração timpanométrica em 34,4% das crianças e 64% foram classificadas no critério "falha" para a pesquisa do reflexo acústico ispilateral. As crianças mais jovens apresentaram maior ocorrência de alterações de orelha média, mas não houve diferença estatisticamente significante entre as diferentes idades para as provas realizadas. CONCLUSÃO: as crianças mais jovens apresentaram maior ocorrência de alterações nas provas de habilidades auditivas e nas medidas de imitância acústica. Programas de investigação e acompanhamento das condições de orelha média e das habilidades auditivas em idade pré-escolar e escolar podem eliminar ou minimizar intercorrências que alterariam o desenvolvimento sócio-linguístico.PURPOSE: to evaluate the performance of auditory abilities and conditions in the middle ear of children from 4 to 6 year old. METHOD: we applied the tests in order to detect sound (pediatric audiometer in 20dBHL), the Simplified Assessment of Auditory Processing (SAAP) and the acoustic immittance measures (handtymp with a probe of 226Hz). In order to compare the results from the tests of auditory abilities and measures of acoustic impedance we applied Fisher's exact test with significance level of p

TEMA: o termo linguagem é definido como organizado sistema de símbolos, com propriedades particulares que desempenham a função de codificação, estruturação e consolidação dos dados sensoriais, o que permite que experiências sejam comunicadas e seus conteúdos transmitidos. O desenvolvimento da linguagem depende não somente das condições biológicas inatas de cada indivíduo, como também sofre influência de fatores ambientais presentes nos meios em que as crianças estão inseridas, como por exemplo, a família e a escola. OBJETIVO: descrever e analisar as produções científicas relevantes para o entendimento da influência do ambiente familiar e escolar na aquisição e desenvolvimento da linguagem em crianças por meio de revisão da literatura. CONCLUSÃO: as produções científicas apresentadas apontam a relevância da estimulação no âmbito familiar e escolaridade dos pais, porém pôde-se perceber a carência de estudos que relacionassem o desenvolvimento infantil com o ambiente escolar. Outro fator que chamou atenção foi a falta de estudos que correlacionem vocabulário e fonologia com os fatores ambientais escolares e familiares. A partir da revisão da literatura abrem-se novas perspectivas de trabalhos a serem realizados na Fonoaudiologia para que as lacunas existentes possam ser preenchidas com novos conhecimentos sobre desenvolvimento infantil.BACKGROUND: the term language is defined as organized system of symbols, with properties, that has a role in encoding, consolidation and structuring sensory data, allowing for experiments to be reported and their contents communicated. Language development depends not just on the innate biological conditions of each individual, but is also influenced by environmental factors in the environments where children are inserted, such as family and school. PURPOSE: to describe and analyze scientific studies relevant to understanding the influence of family and school environment in language acquisition and development in children through a literature review. CONCLUSION: the scientific studies point out to the importance of stimulation in the family and parents' education, but one can perceive a lack of studies in children's development within school en vironment. Another factor that drew attention was the lack of studies to correlate vocabulary and phonology with the school and familial environmental factors. From the literature review opens up new prospects for work to be performed in speech pathology so that such gaps can be filled up with new knowledge on child development.

Introduction: It is generally accepted that breast feeding has a beneficial effect on the health of infants and children. The evidence that breast feeding protects against obesity is inconclusive also the influence of breast feeding on blood pressure in later life is uncertain. The major aim of this study was to assess the association between method of infant breast feeding and components of the body mass index and blood pressure in pre-school children. Materials & Methods: In a cohort study, a total of 800 pre-school children, 359 (47.2%) males, and 402 (52.8%) females, born in 2003 in Yazd, Iran were selected based on a systematic stratified random model. Of eight hundred questionnaires sent, 761 (95%) were returned to the investigators. At 6 years, blood pressure was measured on the right arm at rest. Body mass index (BMI) was calculated by dividing the weight in kilograms by the square of height in meters (kg/m2).Data on infants feeding were collected respectively during first two years of life .Data were managed and analyzed using SPSS (SPSS, Inc, version 13.0) Results: Of the 761 subjects included in this study, 452 (59.4%) were exclusively breast fed, 136 (17.9%) were bottle fed and 173 (22.7%) were partially breast fed. Body mass index was not significantly different between bottle feeding, partial and exclusive breast feeding groups (P=0.398) ..No relationship was found between method and duration of breast feeding, and systolic blood pressure (P=0.244), diastolic blood pressure (P=0.781) and mean blood pressure (P=0.483). Conclusion: We did not find association between method of infant feeding, duration of breast feeding and systolic, diastolic mean blood pressures and also with body mass index

OBJETIVO: caracterizar a fala de crianças de 4 a 6 anos de duas creches públicas de Belo Horizonte e classificá-la segundo dois critérios de referência nacional. MÉTODO: foram avaliadas 60 crianças em relação à fala. Foram realizadas análises relativas ao inventário fonético, segundo a ordem de ocorrência proposta por dois autores, e à associação entre as classificações. RESULTADOS: a prevalência de inadequações de fala encontrada foi alta nas duas creches, sendo que 45% e 53,3% das crianças foram consideradas com fala inadequada segundo as classificações 1 e 2 respectivamente. Houve boa concordância entre as duas classificações (coeficiente de Kappa = 0,768). Não houve associação com significância estatística entre os sexos e as idades. As alterações de fala mais prevalentes foram presença assistemática e substituição, os únicos fonemas com 100% de ocorrência na amostra total de crianças avaliadas foram /t, k, m, n, ŋ/ , os de menor ocorrência foram, o arquifonema /R/ (30%) o fonema /ſ/ (63,3%) e /l/ (68,3%) em encotro consonantal. CONCLUSÃO: na faixa etária de 4 a 6 anos as crianças ainda produzem vários fonemas de maneira assistemática, ocorrendo alterações como substituições e omissões. Deve-se levar em conta fatores que podem ter influenciado os resultados, como local da pesquisa, classe econômica e características individuais. Outros estudos sobre a aquisição fonológica são necessários, contribuindo para programas de intervenção precoce e ações preventivas em ambientes escolares.PURPOSE: to characterize the speech of 4- to 6-year-old children in two public day care centers in Belo Horizonte and classify it according to two national benchmark references. METHOD: 60 children were evaluated regarding their speech. Analyses were made up on top of the phonetic inventory, according to the order of occurrence proposed by two authors, and the association among the classifications was studied. RESULTS: the rate found for speech mismatch was high in both centers, with 45% and 53.3% of the children showing inappropriate speech abilities according to the ratings 1 and 2, respectively. A good agreement between the two classifications was found (Kappa coefficient = 0.768). No statistically significant association between gender and age was found. The most noted speech disorders were unsystematic presence and replacement, the only phonemes with 100% of occurrence in the total sample of assessed children were /t, k, m, n, ŋ/. The less frequent phonemes were /R/ (30%), cc/ſ/(63.3%) and cc/l/ (68.3%). CONCLUSION: 4- to 6-year-old children still produce many phonemes in an unsystematic way, occurring speech changes such as replacement and omissions. Factors that might have influenced the results, such as, the research site, economic class and individual characteristics, that should be taken into account. Other studies of phonological acquisition are needed, contributing to early intervention programs and preventive actions in the school environments.

Se realizó un estudio observacional analítico de corte transversal a niños que asisten a círculos infantiles, del municipio Matanzas, en el segundo semestre de 2008, para identificar factores asociados al parasitismo intestinal. La muestra quedó constituida por 203 niños que asistían a dos círculos infantiles del mencionado municipio. A los padres de cada niño, previo consentimiento, se les realizó una encuesta que recogía datos de interés epidemiológico y se les solicitó la recogida de una muestra de heces fecales de sus hijos, las que fueron estudiadas por el examen directo de heces y el método de concentración de Willis-Malloy modificado. Para el cálculo de la prevalencia de los niños parasitados, se dividió el total de parasitados entre el total de niños en el estudio multiplicado por 100. Se realizó un análisis bivariado, donde se cruzaron en tablas de contingencias cada una de las variables independientes con la dependiente. Se calcularon frecuencias absolutas y relativas, el odds ratio (OR) con sus intervalos de confianza del 95 % y el Chi cuadrado. Se consideraron resultados estadísticamente significativos cuando el intervalo de confianza no incluyó el valor 1 y el valor de p del Chi cuadrado fue inferior al 0,05. Posteriormente, se controlaron los posibles factores de confusión utilizando la regresión logística mediante el programa SPSS. Fueron hallados como factores verdaderamente asociados al parasitismo intestinal de estos niños el no lavado de las verduras, caminar descalzo, comerse las uñas y succión digital.We carried out an analytic, observational, transversal study of children assisting day care centres in the municipality of Matanzas, in the second semester of 2008, to identify the factors associated to intestinal parasitism. The sample was formed by 203 children who assisted two day care centres of the municipality. The parents of each child, with their previous accord, answered a survey with some data of epidemiologic interest, and were asked to collect samples of their children's feces that were studied by direct examination of the feces and the modified Willis-Malloy concentration method. To calculate the prevalence of the parasited children, the total of the parasited children was divided among the total of children in the study multiplied by 100. We carried out a bivariate analysis, where, in contingency charts, we crossed each one of the independent variables with the dependent ones. We calculated absolute and relative frequencies, the odd ratio with its 95 % confidence intervals and the Chi squared. Statistically significant results were considered when the confidence interval did not included the value 1 and p value of Chi squared was less than 0,05. Then, the possible confusion facts were controlled using the logistic regression through the SPSS program. As facts truly associated to these children's intestinal parasitism we found not washing the vegetables, barefoot walking and digital suction.

A pesquisa objetiva avaliar o desenvolvimento de crianças de 0 a 24 meses matriculadas em uma creche de Ipatinga, Minas Gerais, através dos marcos do desenvolvimento infantil propostos pela Atenção Integrada às Doenças Prevalentes na Infância. Trata-se de um estudo descritivo com análise quantitativa dos dados. A amostra foi composta por 20 crianças de 0 a 24 meses, e os dados foram coletados no período de 13 de fevereiro a 6 de março de 2009. Das 20 crianças avaliadas, 4 (20%) foram classificadas com "Possível atraso"; 1 (5%), com "Provável atraso"; e 15 (75%), com "Desenvolvimento normal". Os resultados encontrados demonstraram que a ficha de acompanhamento do desenvolvimento proposta pelo Manual para Vigilância do Desenvolvimento Infantil constitui-se em um instrumento de triagem de fácil aplicação, de baixo custo operacional e capaz de realizar a detecção precoce dos atrasos, devendo, portanto, fazer parte das ações do enfermeiro na consulta de puericultura.La investigación tiene por objetivo evaluar el desarrollo de niños de 0 a 2 meses matriculados en una guardería en Ipatinga, Minas Gerais, a través de los hechos importantes del desarrollo infantil propuesto por la Atención Integrada a las Enfermedades Prevalentes de la Infancia. Este es un estudio descriptivo con el análisis de datos cuantitativos. La muestra comprende 20 niños de 0 a 24 meses y los datos fueron recolectados desde el 13 de febrero hasta el 06 de marzo del año de 2009. De los 20 niños evaluados, 4 (20%) fueron clasificados como "posible retraso", 1 (5%) como "probable retraso" y 15 (75%) como "desarrollo normal". Los resultados mostraron que la ficha de acompañamiento propuesta por el Manual para la Vigilancia del Desarrollo Infantil se constituye en una herramienta de triar de fácil aplicación, bajo costo operacional y capaz de llevar a cabo la detección precoz de retrasos y, por lo tanto, hacer parte de las acciones de la enfermera en la consulta de puericultura.The research objective to evaluate the development of children 0 to 24 months enrolled in a kindergarten of Ipatinga, Minas Gerais, through the milestones of child development proposed by Integrated Management of Childhood Illness. This is a descriptive study with quantitative data analysis. The sample comprised 20 children from 0 to 24 months and data were collected from February 13 to March 6, 2009. Of the 20 children evaluated, 4 (20%) were classified as "possible delay," 1 (5%) as "Probable delay and 15 (75%) as" normal development ". The results showed that the form of monitoring of the development proposed by the Manual for Monitoring of Child Development is itself a tool for easy screening of application, low cost operational and able to perform early detection of delays and should therefore do part of the actions of the nurse in consultation with childcare.

Este trabalho objetivou identificar e analisar conhecimentos e práticas, acerca da pediculose, dos trabalhadores de Centros de Educação Infantil (CEI) das áreas de abrangência de duas Unidades de Saúde da Família, Londrina, Paraná. Trata-se de estudo descritivo transversal. Foi aplicado formulário com questões sobre mitos, tabus, práticas, dúvidas e dificuldades na interrupção da infestação da pediculose em oito CEI. Posteriormente, realizou-se oficina com materiais educativos. Participaram 60,4% dos funcionários, aqueles que estavam presentes no dia determinado pela instituição. Quase a totalidade referiu infestação pela ectoparasitose, assim como em seus familiares. A problemática é enfrentada cotidianamente nos CEI (72,1%). Práticas adequadas de enfrentamento ainda são limitadas. Muitos mitos e tabus persistem (piolhos pulam, uso de sal, vinagre e querosene, etc.). As principais dúvidas estão relacionadas ao tratamento, e a maior dificuldade é a falta de colaboração dos pais. Ressalta-se, enfim, necessidade e importância de ações intersetoriais, preventivas e sistemáticas, no ambiente escolar.Este estudio tuvo como objetivo identificar y analizar los conocimientos y prácticas acerca de la pediculosis que tienen los empleados de los Centros de Educación Infantil (CEI), de las áreas que abarcan dos unidades de Salud de la Familia, Londrina, Paraná. Se trata de un estudio descriptivo transversal. Se aplicó un formulario con preguntas acerca de mitos y tabúes, prácticas, dudas y dificultades para poner fin a la infestación de piojos en ocho CEI. Posteriormente, se realizó un taller con materiales educativos. Participó el 60,4% de los empleados, los que estaban presentes en el día determinado por la institución. Casi todos reportaron la infestación parasitaria, así como en sus familias. El problema es enfrentado diariamente en los CEI (72,1%). Prácticas adecuadas para hacer frente as este problema aún son limitadas. Persisten muchos mitos y tabúes (que los piojos saltan, el uso de la sal, del vinagre y de la parafina, etc.) Las principales dudas se relacionan con el tratamiento y la mayor dificultad que se presenta es la falta de cooperación de los padres. Por último, cabe señalar la necesidad y la importancia de que se implementen acciones intersectoriales, preventivas y sistemáticas en el ambiente escolar.This study aimed to identify and analyze knowledge and practices, about pediculosis, from employees at Child Day Care Centers at two areas of coverage of the Family Health Units, Londrina, Paraná. It's descriptive transversal study. Form was applied with questions about myths, taboos, practices, doubts and difficulties in stopping the infestation of pediculosis in eight Child Day Care Centers. Subsequently, workshop was held with educational materials. 60.4% of employees participated, those who were present on the day determined by the institution. Almost all indicated the ectoparasitic infestation, as well as their families. The problem is faced daily in Child Day Care Centers (72.1%). Practice appropriate care is still limited. Many myths and taboos persist (lice jump, use salt, vinegar and kerosene, etc). The main questions are related to treatment and the greatest difficulty is the lack of cooperation from parents. It emphasizes, finally, the need and the importance of internal actions, preventive and systematic in the school environment.

CONTEXT: Mothers recall early-onset constipation in children attending gastroenterology clinics. OBJECTIVES: To study the bowel habit of young children in the community to determine, first, whether early-onset constipation is confirmed in this setting and, second, the agreement between recalled and recorded bowel habit. METHODS:Defecation data of 57 children aged 6.0-40.7 mo were obtained by maternal recall (questionnaire on predominant stool characteristics) and by record (1,934 defecations registered prospectively at home and in the nursery). The bowel habit was classified according to stool frequency and proportion of stool characteristics (soft, hard and/or runny). Two criteria were used to classify recorded data, since the cutoff point for hard stools to identify constipation is undefined in children: predominant criterion and adult criterion, respectively with >50% and >25% of stools with altered consistency. Bowel habit categories were: adequate, constipation, functional diarrhea and "other bowel habit". Nonparametric statistics, and the Kappa index for agreement between recalled and recorded bowel habit, were used. RESULTS: Constipation occurred in 17.5%, 10.5%, 19.3% of the children by recall, the predominant and the adult criteria, respectively. Constipation was the main recalled alteration, vs 12.3% "other bowel habit". Only one child classified as having functional diarrhea (by the adult criterion). Agreement between recalled and recorded bowel habit was fair for constipation, by the predominant and the adult criteria (K = 0.28 and 0.24, respectively), but only slight (K CONTEXTO: Mães relatam início precoce de constipação em crianças atendidas em clínicas de gastroenterologia. OBJETIVOS: Estudar o hábito intestinal em crianças de baixa idade na comunidade, para avaliar se início precoce da constipação é confirmado neste contexto e se há concordância entre o hábito intestinal relatado e o registrado prospectivamente. MÉTODOS: Obtiveram-se dados sobre evacuações de 57 crianças com idade 6.0-40.7 meses, mediante relato materno (questionário sobre características fecais predominantes) e, a seguir, foram registradas 1.934 evacuações em casa e na creche. O hábito intestinal foi classificado como adequado, constipação, diarréia funcional, "outro hábito intestinal", conforme frequência evacuatória e proporção das características fecais (macias, duras e/ou que escorrem). Usaram-se dois critérios para classificar o hábito intestinal registrado, devido indefinição no ponto de corte para fezes duras na identificação de constipação em crianças: critério predominante e critério adulto, respectivamente com >50% e >25% de evacuações com consistência alterada. Usou-se estatística não-paramétrica e, para concordância entre hábito intestinal relatado e registrado, o índice Kappa. RESULTADOS: Constipação ocorreu em 17.5%, 10.5%, 19.3% das crianças, respectivamente pelo relato e pelo registro segundo critérios predominante e adulto. Constipação foi o hábito intestinal mais frequentemente relatado, versus 12.3% "outro hábito intestinal". Só uma criança se classificou como tendo diarréia funcional (pelo critério adulto). Concordância entre o hábito intestinal relatado e o registrado foi razoável ("fair") para constipação, pelos critérios predominante e adulto (K=0.28 e 0.24, respectivamente), mas apenas leve ("slight") para os demais hábito intestinal (K

O objetivo do estudo foi avaliar a presença de helmintos em caixas de areia de creches públicas e privadas da cidade de Uberlândia, Minas Gerais em 2005. Foram selecionadas 14 creches particulares e 14 públicas que possuíam área de lazer. As coletas foram realizadas em duas estações do ano, uma na seca e a segunda na chuvosa. As amostras foram analisadas pelos métodos de Willis e Baermann. Na primeira coleta 17 (61%) creches foram positivas para larvas e 14 (50%) para ovos de helmintos e na segunda, em 18 (64%) e 10 (36%), respectivamente. Não foi observada influência da estação climática e da situação socioeconômica das creches.The objective of the study was to test for helminthes in sandboxes in day care centers in the city of Uberlândia, Southeastern Brazil in 2005. Fourteen private and 14 public day care centers with playgrounds were selected. One collection was carried out during the dry season (June and August), and the second one was in the rainy season (September and November). Samples were tested using Willis and Baermann methods. In the first collection, 17 (61%) day care centers were positive for helminthes larvae and 14 (50%) for eggs. In the second collection, 18 (64%) day care centers were positive for larvae and 10 (36%) for eggs. No influence of either season of the year or day care finance condition was seen.

OBJETIVO: Avaliar a eficácia de exercícios de sopro, sucção e respiração nasal, associados à limpeza nasal e manobra de Valsalva, nas disfunções da tuba auditiva e na prevenção de otite média de repetição. MÉTODOS: Participaram 22 crianças, de ambos os sexos, entre três e seis anos, que apresentavam história de otite média de repetição e, no momento do exame, curvas timpanométricas dos tipos A e C. Tais crianças foram submetidas diariamente aos procedimentos citados durante três meses. RESULTADOS: Ao final do trabalho, das 22 crianças analisadas, 18 apresentaram curvas do tipo A bilateralmente, não apresentando episódios de otite neste intervalo. CONCLUSÃO: Na amostra estudada, estes procedimentos mostraram-se eficazes na prevenção da disfunção tubária e otite média de repetição e podem ser utilizados de forma preventiva em crianças de creches.PURPOSE: To assess the effectiveness of blowing, suction, and nasal breathing exercises, associated with nose cleaning and Valsalva's maneuver, for Eustachian tube dysfunctions and preventing recurrent otitis media. METHODS: Twenty-two children of both genders, with ages between three and six years, who had a history of recurrent otitis media and, at the moment of the exam, types A and C tympanometric curves participated in the study. The subjects were submitted daily to the above-mentioned procedures for 3 months. RESULTS: At the end of the study, the last immitance audiometry of the 22 analyzed children showed that 18 of them had bilateral type A curves and no otitis episodes during this interval. CONCLUSION: In the studied sample, these procedures proved to be effective for preventing tube dysfunction and recurrent otitis media, and may be used preventively in children at day care centers.

OBJETIVO: Verificar a prevalência de alteração vocal auto-referida em educadoras de creche e fatores associados. MÉTODOS: Estudo observacional transversal, realizado em 2001, em oito creches da cidade de São Paulo, nas quais estavam sendo desenvolvidas ações do Programa Creche. Esse Programa faz parte de um laboratório de investigação fonoaudiológica em promoção da saúde. A coleta de dados foi feita por meio de questionário, com 93 educadoras, sobre características sociodemográficas, aspectos da organização e do ambiente físico do trabalho, comportamento vocal, histórico de doenças, estilo de vida e percepção acerca de alterações vocais. Foi realizada análise perceptivo-auditiva da voz das participantes. Para análise estatística foram utilizadas proporções, medidas de tendência central, teste do qui-quadrado, com correção de Yates e análise de regressão logística múltipla. RESULTADOS: Registrou-se 80% das educadoras referindo presença de alteração vocal, sendo que 26% delas procuraram algum tratamento. Grande parte (39%) referiu que o problema está presente há quatro anos ou mais, intermitente (82%) e de grau leve ou moderado (74%). Acreditam que o uso da voz seja a principal causa da alteração vocal (82%) e a rouquidão, o principal sintoma vocal (54%). Alteração vocal auto-referida foi estatisticamente associada à presença de alteração vocal constatada por avaliação e com o fato de já terem tido alguma orientação sobre uso da voz. CONCLUSÕES: A adequada percepção das educadoras para seus problemas de voz pode vir a se tornar uma ferramenta importante em futuros trabalhos com esta população, com vistas a diminuir a alta prevalência de alteração vocal encontrada.OBJECTIVE: To verify the prevalence of self-reported voice alteration among educators in crèches, and associated factors. METHODS: This was a cross-sectional observational study carried out in 2001, in eight crèches in the city of São Paulo at which actions within the Crèche Program were being developed. This program formed part of the health promotion activities of a speech therapy investigation laboratory. The data collection was done by means of a questionnaire that was filled out by 93 educators, with questions on sociodemographic characteristics, aspects of the organization and physical environment of the work, habitual voice utilization, history of illnesses, lifestyle and perceptions regarding voice alterations. Assessment of hearing perception was done on the participants' voices. The statistical analysis utilized proportions, central trend measurements, Chi-square test with Yates correction and multiple logistic regression analysis. RESULTS: Eighty percent of the educators reported that they had voice alterations, although only 26% had sought treatment. A large proportion (39%) reported that they had had their problem for four years or more, that it was intermittent (82%) and that they had it to a slight or moderate degree (74%). They believed that the main cause of voice alteration was their use of their voices (82%), and their principal symptom was hoarseness (54%). Self-reported voice alteration was statistically associated with presence of voice alteration observed during assessment and with having had some guidance on voice usage. CONCLUSIONS: Adequate perception among educators regarding their voice problems could become an important tool for future work among this population with a view to diminishing the high prevalence of voice alteration encountered.

OBJETIVOS: descrever os fatores associados ao estado nutricional de crianças assistidas em creches da Prefeitura do Município de São Paulo. MÉTODOS: foi selecionada amostra probabilística de crianças de 4 a 84 meses (n=556), utilizando procedimento de amostragem por conglomerados. Adotou-se o padrão de referência do National Centre for Health Statistics, para os índices peso/idade, peso/estatura e estatura/idade, considerando-se em déficit nutricional as crianças que apresentaram esses índices dois escores z abaixo do valor mediano da população de referência e sobrepeso com índice peso/estatura dois escores z acima. Foram construídos dois modelos de regressão logística multivariada para identificar quais as variáveis associa-das com o déficit de estatura e o sobrepeso. RESULTADOS: encontrou-se 5,2% de prevalência de déficit de estatura e 5,0% de sobrepeso. As variáveis número de irmãos e faixa etária da criança se associaram inversamente com os dois agravos em estudo, onde ter dois ou mais irmãos e idade inferior a dois anos é fator de risco para déficit de estatura e ter dois ou mais irmãos e idade inferior a cinco anos é fator de proteção para sobrepeso. CONCLUSÕES: verificou-se prevalência de déficit de estatura e sobrepeso acima do esperado para a população de referência, justificando intervenções nutricionais que contemplem esses dois agravos.OBJECTIVES: to describe the factors associated to the children's nutritional state assisted in day-care centers of the City hall of São Paulo Municipal district. METHODS: a probabilistic sample of 556 children between 4 and 84 months old was selected. The National Center of Health Statistics growth curve was used as the reference for the weight/age, weight/height and height/age indices. Children with indices two z scores below the median value of the reference population were considered undernourished and the ones presenting weight/height indices two z scores above, overweight. Two Models of Multivariate Logistic Regression were built: one to identify stunting associated variables and the other for overweight associated variables. RESULTS: 5.2% stunting and 5.0% overweight prevalence were determined. The variables of child's age group and the number of siblings were inversely associated to the two diseases in studies, in which to have two or more siblings and to be less than two years were risk factors for stunting, and to have two or more siblings and to be less than five years were protection factors for overweight. CONCLUSIONS: the prevalence of the stunting and the overweight above the expected for the reference population justifies nutritional interventions.

OBJETIVOS: identificar e analisar conhecimentos e práticas de educadoras de uma creche, relativos à anemia. MÉTODOS: estudo desenvolvido em creche pública que atende população da periferia da cidade de São Paulo. A maioria das crianças freqüentava posto de saúde, creche há mais de seis meses e pertencia a famílias de baixa renda. Todas as 15 educadoras haviam concluído o segundo grau. As entrevistas foram gravadas, transcritas e submetidas à análise de conteúdo. RESULTADOS: os conhecimentos e práticas das educadoras decorriam do senso comum, sendo adquiridos no dia-a-dia, com a própria experiência. Muitas apresentaram conceitos equivocados, que podem prejudicar a prestação de cuidados. Para elas, o controle e a prevenção da anemia depende da "educação dos pais", perspectiva que pode dificultar a construção da parceria educadores/pais, pois impede a percepção de que os problemas são determinados socialmente e não decorrentes apenas dos cuidados prestados pela família. Algumas reconheciam crianças anêmicas e procuravam contribuir para seu controle, porém a maioria atribuía essa responsabilidade aos profissionais de saúde, não relacionando com as condições e práticas de cuidado de sua competência. CONCLUSÕES: aponta-se a necessidade de incluir conhecimentos sobre anemia e práticas de cuidados, tanto na formação inicial, quanto continuada dos educadores infantis.OBJECTIVES: identify and analyze anemia knowledge and practices of daycare center providers. METHODS: study performed in a public daycare center for low income families living in the outskirts of the city of São Paulo. The majority of the children was seen in the health clinic of the daycare center for over six months and came from low income families. All 15 care providers were high school graduates. The interviews were taped, transcribed and submitted to content analysis. RESULTS: care providers'knowledge and practices stemmed from common sense and day to day experience. Many had wrong concepts with potential harm in terms of care provision. Their perception was that anemia control and prevention depended on "parents education", a perspective that could interfere with the care providers/parents relationship in a sense that the problems are of a social nature and do not depend exclusively on family care. Some identified anemic children and attempted to help but the majority transferred the responsibility to healthcare professionals and did not feel they were related to care giving practices and conditions. CONCLUSIONS: there is a need to educate care providers on anemia and the care of this condition, not only in initial training programs as well as in ongoing training programs.

Dada a elevada freqüência de infecções respiratórias agudas em creches, o objetivo deste trabalho foi identificar conhecimentos e práticas de trabalhadoras de creches relativos à prevenção, detecção precoce e manejo desses agravos. Mediante quatorze entrevistas estruturadas em duas creches universitárias da cidade de São Paulo, verificou-se que as trabalhadoras: demonstram familiaridade com diversos agravos; apontam febre e respiração ruidosa como sinais de gravidade; consideram poluição e transmissão como principais causas; referem o cuidado com o ambiente como melhor forma de controle; cuidam mantendo observação contínua da criança e intervenções de higiene e conforto e maior cuidado emocional; consideram educação e cuidado interligados no atendimento infantil, manifestando necessidade de maior preparo para cuidar; têm na prática diária a fonte de seus conhecimentos.Dada la elevada frecuencia de infecciones respiratorias agudas en guarderías, el objetivo en este trabajo fue identificar conocimientos y prácticas de trabajadoras de guarderías relativos a la prevención, detección precoz y manejo de esas afecciones. Mediante catorce entrevistas estructuradas en dos guarderías universitarias de la ciudad de São Paulo, se verificó que las trabajadoras: demuestran familiaridad con las diversas afecciones; señalan fiebre y respiración ruidosa como signos de gravedad; consideran a la polución y transmisión como sus principales causas; refieren al cuidado del ambiente como la mejor forma de control; se preocupan con la observación continua del niño y con acciones de higiene, confort y cuidado emocional; consideran que la educación y el cuidado son necesarios para atender a los niños y desean mayor preparación para cuidar; tienen en la práctica diaria la fuente de sus conocimientos.Given the increasing frequency of acute respiratory infections in day care centers, the objective of this work was to identify knowledge and practices of day care center workers relative to the prevention, precocious detection and management of these illnesses. Through fourteen structured interviews in two university day care centers of the city of São Paulo, it was verified that the workers: demonstrate familiarity with several respiratory illnesses; indicate fever and noisy breath as danger signals; consider pollution and transmission as main causes; refer to environment care as the best form of control; keep continuous observation of the child and interventions of hygiene and comfort, and greater emotional care; consider education and care complementary in child attendance, revealing the need for better preparation for caring; have in daily activities the source of their knowledge.

Desenvolvimento é um direito fundamental de qualquer criança e depende da interação entre herança genética e condições ambientais. A partir desta premissa, triou-se o desenvolvimento de 66 crianças (37 meninos e 29 meninas) de 2 a 3 anos que freqüentavam 4 instituições públicas de educação infantil (IEIs) na cidade de São Paulo. Usou-se o Teste de Triagem de Desenvolvimento de Denver II. A maior parte da amostra (62,74%) ganha até 0,5 SM per capita por mês. As adequações de cada área do desenvolvimento foram: pessoal-social (N=54; 81,8%), motor fino (N= 53; 80,3%), motor grosso (N=53; 80,3%) e linguagem (N=49; 74,2%). Nas áreas de linguagem e pessoal-social, as crianças obtiveram os piores resultados e na motora grossa, os melhores. Levanta-se como hipóteses: os resultados de linguagem e pessoal-social foram prejudicados pelas condições das IEIS (escolaridade das educadoras e tamanho dos grupos de crianças) e talvez pela situação familiar. Quanto à área motora, vê-se que as crianças, mesmo pequenas, têm a possibilidade de brincar nas ruas. As hipóteses precisam ser comprovadas por novas pesquisas.Desarrollarse es un derecho que todo niño tiene y que depende de la herencia y lo ambiente. A seguir, se procedió a una selección de desarrollo de 66 niños (37 niños y 29 niñas) de 2 a 3 años que frecuentaban 4 instituciones publicas de educación infantil en la ciudad de São Paulo Brasil, en el período de agosto de 2003 a agosto de 2005. Fue utilizado el Test de Selección de Desarrollo de Denver II. La mayor parte de los seleccionados (62,74%) gana hasta 0,5 SM per cápita por mes. Las adecuaciones de cada área de desarrollo fueron: personal-social (N=54;81,8%), motriz fina (N=53; 80,3%), motriz gruesa (N=53; 80,3%) y lenguaje (N=49; 74,2 %). En las áreas de lenguaje y personal-social, los niños obtuvieron los peores resultados, y en la de motriz gruesa los mejores. Se levanta como hipótesis: los resultados de lenguaje y personal-social fueron perjudicados por las condiciones de los jardines infantiles (escolaridad de las educadoras y el tamaño de los grupos infantiles), y tal vez por la situación familiar. En cuanto al área motriz, se ve a los niños, mismo siendo pequeños, jugando en las calles. Estas hipótesis precisan ser comprobadas por nuevas pesquisas.To develop is an important right that any child has and occurs according the relationship between genetic background and environment. Following this statement, a screening of development was done in 66 children (37 boys and 29 girls) between 2 and 3 years' old who attended 4 public day-care centers in the city of Sao Paulo. The Denver II Development Selection Test was used. The better part of the sample (62.74%) earns up to 0.5 MS (minimum salary) per capita per month. The adequacies for each development area were: personal-social(N=54; 81.8%), fine engine (N=53; 80.3%), rough engine (N=53; 8.3%) and language (N=49; 72.4%). In the language and personal-social areas the children attained the worst results, and in the rough engine the best. It is hypothesized: the language and personal-social language were prejudiced by the day-care centers' conditions (educators' schooling and the children's groups' sizes) and maybe by the familiar situation. As to the motor area, one can see children, even though small, playing in streets. The hypotheses must be proven with new researches.

The aim was to describe the results of a developmental screening test in a cohort of 30 children attending 3 day-care centers in the city of São Paulo and develop hypotheses about these results. Thirty children were evaluated three times, during two years, by using the DDST. In the gross motor area the results improved (Tests of the Signs, 1st to the 3rd evaluation, p= 0.038*). There was a relationship between the age of the child (2 to 3 years) and worst results (Fisher's Exact test, p= 0.013*). In the fine motor area the results improved (Tests of the Signs, 1st to the 2nd evaluation, p= 0.031*). So, the development of motor abilities improved after the children started attending the day-care centers. We must undertake more researches in order to attribute the specific influences of each area: day-care center and/or family.El objetivo fue describir los resultados de las selecciones del desarrollo motriz de un grupo de niños que frecuenta tres (3) jardines infantiles de la ciudad de San Pablo y levantar hipótesis a respecto de estos resultados. Treinta niños fueron evaluados tres veces, a lo largo de dos años, utilizando el Test de Selección de Desarrollo de Denver ll. En el área motora gruesa los resultados mejoraron (Test de las Señales, 1a. para 3a. aplicación, p= 0,038*). Hubo relación entre la edad de los niños (2 a 3 años) y peores resultados (Test exacto de Fisher, p= 0,013*) En el área motora fina los resultados mejoraron (Test de las Señales, 1a. para 2a. aplicación, p= 0,031*) El desarrollo motriz mejoró después que los niños comenzaron a frecuentar los jardines infantiles. Son necesarias más investigaciones a fin de atribuir influencias específicas para cada área: jardines infantiles y/o familia.O objetivo foi descrever os resultados de triagens do desenvolvimento motor de uma coorte de crianças que freqüenta 3 creches da cidade de São Paulo e levantar hipóteses a respeito destes resultados. Trinta crianças foram avaliadas três vezes, ao longo de dois anos, usando-se o Teste de Triagem de Desenvolvimento de Denver II. Na área motora grossa os resultados melhoraram (Teste dos Sinais, 1ª para 3ª aplicação, p= 0,038*). Houve relação entre idade da criança (2 a 3 anos) e piores resultados (Teste exato de Fisher, p= 0,013*). Na área motora fina os resultados melhoraram (Teste dos Sinais, 1ª para 2ª aplicação, p= 0,031*). O desenvolvimento motor melhorou depois que as crianças começaram a freqüentar as creches. São necessárias mais pesquisas a fim de atribuir influências específicas a cada área: creche e/ou família.

OBJETIVOS: estimar a prevalência de anemia em crianças matriculadas em creches municipais do Rio de Janeiro e identificar os subgrupos de maior risco. MÉTODOS: foram avaliadas 865 crianças. A hemoglobina (Hb) foi dosada em fotômetro portátil (HemoCue) e a anemia foi definida quando Hb OBJECTIVES: to assess anemia prevalence in children enrolled in daycare centers in the city of Rio de Janeiro to determine the more at risk subgroups. METHODS: 865 children were assessed. Hemoglobin (Hb) was measured in a portable photometer (HemoCue) and anemia was defined with Hb

Objetivos: Analizar las diferencias entre niños españoles de etnia gitana e inmigrantes extranjeros ingresados en centros de protección, respecto a las características del maltrato, los factores familiares y el estado de salud. Métodos: Se revisaron los expedientes sociosanitarios de 83 niños gitanos españoles y 105 niños inmigrantes que ingresaron desde enero de 1994 hasta diciembre de 2003 por maltratos en centros de protección del Instituto Aragonés de Servicios Sociales (IASS). El maltrato, sus tipos e indicadores se definieron y evaluaron según guías elaboradas por el IASS. Los factores familiares de riesgo sociosanitario asociados con el maltrato se determinaron según estudios nacionales. El estado de salud se evaluó según los protocolos elaborados por el IASS. Se realizó un estudio estadístico descriptivo y comparativo. Resultados: En los niños gitanos españoles predomina el grupo de edad de 0-5 años, mientras que en los inmigrantes es más frecuente el grupo de 12-17 años. En los niños gitanos españoles es también más frecuente la situación de negligencia física, emocional y/o abandono (p < 0,001) y la pertenencia a familias con problemas de delincuencia (odds ratio [OR] = 16,5; intervalo de confianza [IC] del 95%, 6,7-40,7), toxicomanía o alcoholismo (OR = 8,8; IC del 95%, 3,7-21,0) y multiproblemáticas (OR = 9,3; IC del 95%, 3,8-22,8). En los niños gitanos es más frecuente también la presencia de trastornos neurológicos, enfermedades discapacitantes, inmunizaciones ausentes o incompletas y enfermedades dermatológicas. Por su parte, los niños inmigrantes presentaron una frecuencia superior de maltrato físico, psicológico y/o sexual (p < 0,001), así como una procedencia de familias monoparentales (OR = 7,9; IC del 95%, 2,2-27,7). Conclusiones: Conocer las diferencias entre estos 2 grupos de niños maltratados puede ser de utilidad para los profesionales de los servicios sociales comunitarios responsables de desarrollar estrategias de intervención para la prevención y la detección precoz del maltrato, y para los responsables de la salud de estos menores mientras permanecen en un centro de protección.Objectives: To determine whether there are differences between Spanish gypsy and foreign immigrant children admitted to protection centers in the characteristics of the maltreatment, social and familial factors linked to maltreatment, and health status. Methods: The social and health reports of 83 Spanish gypsy and 105 foreign immigrant children admitted to protection centers of the Aragonese Institute for Social Services (Instituto Aragonés de Servicios Sociales [IASS]) because of maltreatment from January 1994 to December 2003 were reviewed. Maltreatment, its types, and warning signs were defined and assessed according to the guidelines drawn up by the IASS. The social and familial risk factors associated with maltreatment were determined according to national studies. Health status was assessed following protocols used by the IASS. A descriptive and comparative statistical study was performed. Results: The Spanish gypsy children were mostly in the age group of 0-5 years, while foreign immigrants were mostly in the age group of 12-17 years. Spanish gypsy children showed a greater frequency of physical and emotional neglect and/or abandonment (p < 0.001) and were more likely to have families with problems of crime (odds ratio [OR] = 16.5; 95% confidence interval [95%CI], 6.7-40.7), drug/alcohol abuse (OR = 8.8; 95%CI, 3.7-21) and families with more than one social and health risk factor (OR = 9.3; 95%CI, 3.8-22.8). Spanish gypsy children showed a greater frequency of neurological disorders, disabling diseases, absent or incomplete immunizations, and dermatologic diseases. Foreign immigrant children showed a greater frequency of physical and psychological and/or sexual abuse (p < 0.001) and were more likely to live in a single parent family (OR = 7.9; 95%CI, 2.2-27.7). Conclusions: Identifying the differences between these two groups of maltreated children could be useful for professionals working in the community social services in charge of developing intervention strategies for the prevention and early detection of maltreatment, as well as for professionals in charge of the health of these children during their stay in a protection center.

O presente estudo relata o estado nutricional de crianças freqüentadoras de creches da rede municipal de São Paulo, Brasil. Foi avaliada uma amostra representativa das crianças atendidas, totalizando 827 crianças menores de 84 meses. Características sócio-econômicas, dados de morbidade e o estado nutricional (altura/idade e/ou peso/altura) foram obtidos. Verificou-se que 7,0% (IC95%: 3,60-10,40) das crianças apresentavam déficit de altura. Na análise univariada, os fatores que se associaram ao déficit nutricional foram: idade da criança (< 24 meses), RC = 2,10 (IC95%: 1,11-3,98); relato de diarréia no mês anterior, RC = 2,84 (IC95%: 1,42-5,66); escolaridade do responsável até três anos de estudo, RC = 3,87 (IC95%: 1,10-13,68); número de moradores no domicílio (sete ou mais), RC = 3,02 (IC95%: 1,46-6,22); número de irmãos (dois ou mais), RC = 4,81 (IC95%: 1,72-13,44). Na análise multivariada, a ocorrência de diarréia no mês anterior e número de irmãos mantiveram-se associados ao retardo de crescimento (RC = 2,54; IC95%: 1,20-5,38 e RC = 7,40; IC95%: 2,20-24,93, respectivamente).This study reports the nutritional status of children attending daycare centers in the Municipality of São Paulo, Brazil. A representative sample of 827 children under 84 months of age was evaluated. Anthropometric measurements and information on socioeconomic characteristics and morbidity were collected. The most prevalent nutritional deficit was stunting (7.0%; 95%CI: 3.60-10.40). Univariate analysis showed a significant association between stunting and age (< 24 months), OR = 2.10 (95%CI: 1.11-3.98); diarrhea one month prior to the data collection, OR = 2.84 (95%CI: 1.42-5.66); mother's or caregiver's schooling (< 3 years), OR = 3.87 (95%CI: 1.10-13.68); number of household members (> 7), OR = 3.02(95%CI: 1.46-6.22); and number of siblings (> 2) OR = 4.81 (95%CI: 1.72-13.44). In the multivariate analysis, only diarrhea one month prior to the data collection, OR = 2.54 (95%CI: 1.20-5.38) and > 2 siblings, OR = 7.40 (95%CI: 2.20-24.93), remained associated with stunting.

OBJETIVO: Descrever o comportamento da mortalidade em crianças usuárias de creches. MÉTODOS: Trata-se de estudo descritivo da mortalidade de crianças da faixa etária de zero a seis anos e 11 meses, matriculadas em toda a Rede Pública Municipal de Creches de São Paulo (Br), no período de 1995 a 1999. As variáveis de interesse foram sexo, idade, causa básica de morte, tempo de permanência na creche e sazonalidade. RESULTADOS: O coeficiente médio de mortalidade observado para o período foi de 36,4 por cem mil crianças. Do total das mortes, 32,7% ocorreram em menores de um ano e 78,4% em crianças com até três anos. Quanto ao tempo de permanência, 54,2% não chegaram a completar seis meses, destacando os três meses iniciais que concentraram 36,3% das mortes. A maioria dos óbitos ocorreu nos meses de inverno e outono, respectivamente, 31,8% e 29,6%. As causas de morte mais freqüentes foram de origem infecciosa: pneumonias (29,6%), infecção meningocócica (13,0%), meningites não meningocócicas (8,5%), gastroenterites (7,6%), varicela (5,4%). As causas externas representaram 13,5% devido a quedas, atropelamentos, afogamentos, queimaduras e agressões. CONCLUSÕES: A maior parte das mortes ocorreu em menores de três anos e decorreu de causas evitáveis, algumas delas preveníveis por vacinas.OBJECTIVE: To describe the mortality pattern among children enrolled in public day care centers. METHODS: This was a descriptive study of the mortality pattern among children aged from 0 to 6 years and 11 months who were enrolled in all the public day care centers in the city of São Paulo, Brazil, from 1995 to 1999. The variables of interest were sex, age, underlying cause of death, duration of day care attendance and seasonality. RESULTS: The average mortality rate for the period was 36.4 per 100,000 children. Of the total number of deaths, 32.7% were among children under 1 year old and 78.4% under 3 years old. The deaths of 54.2% of these children occurred before completing six months in the day care center, with a concentration of 36.3% during the first three months. The majority of the deaths occurred during the winter and autumn seasons: 31.8% and 29.6%, respectively. The main underlying causes of death were infections: pneumonia (29.6%), meningococcal disease (13.0%), non-meningococcal meningitis (8.5%), gastroenteritis (7.6%) and chickenpox (5.4%). External causes were responsible for 13.5% of the deaths and included falls, being run over, drowning, burns and physical aggression. CONCLUSIONS: The study indicated that younger children (0-3 years) were the most vulnerable group and that the majority of deaths derived from avoidable causes, some of which preventable by vaccination nowadays.

OBJECTIVE: To quantify the influence of the type of child-care on the occurrence of acute diarrhea with special emphasis on the effect of children grouping during care. METHODS: From October 1998 to January 1999 292 children, aged 24 to 36 months, recruited using a previously assembled cohort of newborns, were evaluated. Information on the type of care and occurrence of diarrhea in the previous year was obtained from parents by telephone interview. The X² and Kruskal-Wallis tests were used to compare proportions and quantitative variables, respectively. The risk of diarrhea was estimated through the calculation of incident odds ratios (OR) and their respective 95% confidence intervals (95% CI), crude and adjusted by unconditional logistic regression. RESULTS: Using as reference category children cared individually at home, the adjusted ORs for diarrhea occurrence were 3.18, 95% CI [1.49, 6.77] for children cared in group at home, 2.28, 95% CI [0.92, 5.67] for children cared in group in day-care homes and 2.54, 95% CI [1.21, 5.33] for children cared in day-care centers. Children that changed from any other type of child-care setting to child-care centers in the year preceding the study showed a risk even higher (OR 7.65, 95% CI [3.25, 18.02]). CONCLUSIONS: Group care increases the risk of acute diarrhea whatsoever the specific setting.OBJETIVO: Quantificar a associação entre o tipo de cuidados infantis e a ocorrência de diarréia aguda, sendo dada especial atenção aos diferentes tipos de cuidados infantis prestados a grupos de crianças. MÉTODOS: De outubro de 1998 a janeiro de 1999, foram avaliadas 292 crianças, com idades entre 24 e 36 meses, recrutadas com base numa coorte de recém-nascidos previamente constituída. Foi obtida informação acerca do tipo de cuidados infantis e da ocorrência de diarréia no ano anterior ao estudo por meio de entrevista telefônica aos pais das crianças participantes. Foram utilizadas as provas do X² e de Kruskal-Wallis para comparar proporções e variáveis quantitativas, respectivamente. O risco de diarréia foi estimado pelo cálculo de odds ratios (OR) incidentes e respectivos intervalos de confiança a 95% (IC 95%), brutos e ajustados por regressão logística não condicional. RESULTADOS: Utilizando como classe de referência as crianças cuidadas sozinhas na própria casa, o OR para a ocorrência de diarréia foi 3,18, IC 95% [1,49-6,77] para as crianças cuidadas na própria casa mas em grupo, 2,28, IC 95% [0,92-5,67] para as cuidadas em casas de amas, em grupo, e 2,54, IC 95% [1,21-5,33] para as cuidadas em creches (instituições de prestação de cuidados infantis, em grupo). Nas crianças que mudaram de qualquer outro tipo de cuidados infantis para creches no ano que antecedeu a entrevista o risco de diarréia foi 7,65, IC 95% [3,25-18.02]. CONCLUSÕES: Os cuidados infantis em grupo associaram-se a um maior risco de diarréia aguda, quer fossem prestados na própria casa, em casas de amas ou em creches.

Nos primeiros anos de vida, é essencial para o crescimento e desenvolvimento da criança uma alimentação adequada. Uma alimentação bem planejada pela creche deve fazer parte das metas do Estado e do município dentro de suas políticas públicas, havendo a necessidade da existência de métodos que avaliem, de forma rápida e simples, o consumo alimentar. OBJETIVO: Avaliar a concordância dos dados de consumo alimentar pelo "método da pesagem direta de alimentos-individual" e "método da pesagem direta de alimentos-total". MATERIAIS E MÉTODOS: Os dados foram obtidos em três creches pelos métodos "pesagem direta de alimentos-individual" e "pesagem direta de alimentos-total" servidos às crianças. Quantificou-se a porção em gramas dos alimentos, assim como as sobras alimentares. A comparação foi feita só por gramas (quantidade consumida). Utilizou-se o coeficiente de concordância de acordo com o Modelo de Lin e a metodologia descrita por Bland & Altman para a representação gráfica na comparação dos métodos. RESULTADOS: A concordância observada na comparação do "Método da pesagem direta de alimentos-individual" com "Método da pesagem direta de alimentos-total" foi de ro = 0,676. CONCLUSÃO: A comparação entre o "Método da pesagem direta de alimentos-individual" e o "Método da pesagem direta de alimentos-total" nas creches apresenta baixa concordância. Não se recomenda, portanto, a utilização do "Método da pesagem direta de alimentos-total" para avaliar o consumo alimentar das crianças em creches.In the first years of life, children must have a balanced diet in order to ensure their healthy growth and physical development. Therefore, it is important to have quick and simple methods to evaluate food consumption. OBJECTIVES: to evaluate the agreement of the information obtained by the "individual direct food weighing method" and by the "total direct food weighing method". METHODS: The methods were the "individual direct food weighing method" and "total direct food weighing method" used in every meal served to children in a child day care center so as to collect food intake information. Each food portion served to the children, as well as leftovers, was quantified in grams. The agreement coefficient was used in accordance with LIN's model and BLAND & ALTMAN's model for the graphic representation of comparison of both direct food-weighing methods. RESULTS: The agreement observed for the comparison of the Direct Weighing Methods was rho = 0.676. CONCLUSION: The comparison between the "individual direct weighing method" and the "total direct weighing method" in the day care center presented low agreement. Using the "total direct weighing method" to evaluate children's food consumption in day care centers is not therefore recommended.

Objective: To evaluate the applicability of a simplified method forquantitative determination of glucose-6-phosphate dehydrogenaseactivity in normal children; to determine the mean, standarddeviation and threshold value under which the enzyme activity isconsidered deficient. Methods: Blood samples were collected from201 children from two day-care centers in the city of São Paulo.The subjects were considered normal based on physicalexamination and laboratory tests. The enzyme activity wasdetermined in red blood cells of normal children using the “TestCombination G-6-PDH®” kit. The following statistical analyses werecarried out: the results were submitted to Student’s t test,Kolmogorov-Smirnov test, lower confidence interval (one-tailedtest) and Spearman’s correlation coefficient. Results: The meanhemoglobin value for girls was slightly higher than the mean valuefor boys, but this difference was not statistically significant. Therewas no statistical difference in mean enzyme activities for Caucasianand non-Caucasian children. There was no significant correlation amongenzyme activity levels, red blood cells, hemoglobin levels,hematocrit, reticulocytes, white blood cells and age of patients.The mean enzyme activity for boys was 4.448 U/g Hb, standarddeviation = 1.380 U/g Hb. For girls, the mean enzyme activity was4.531 U/g Hb, standard deviation = 1.386 U/g Hb, and the differencewas not statistically significant. Therefore, the two populationgroups were considered as one single population, presenting amean enzyme activity of 4.490 U/g Hb, standard deviation = 1.380 U/g Hb.Since the distribution curve of enzyme activity values was normal,a lower confidence interval was determined (one-tailed test), witha cutoff point of 2.227 U/g Hb. Conclusion: The method used bySolem proved to be simple, fast, very accurate and useful to detectglucose-6-phosphate dehydrogenase activity and to identifychildren with enzyme deficiency.

OBJECTIVE: To quantify the influence of the type of child-care on the occurrence of acute diarrhea with special emphasis on the effect of children grouping during care. METHODS: From October 1998 to January 1999 292 children, aged 24 to 36 months, recruited using a previously assembled cohort of newborns, were evaluated. Information on the type of care and occurrence of diarrhea in the previous year was obtained from parents by telephone interview. The X² and Kruskal-Wallis tests were used to compare proportions and quantitative variables, respectively. The risk of diarrhea was estimated through the calculation of incident odds ratios (OR) and their respective 95% confidence intervals (95% CI), crude and adjusted by unconditional logistic regression. RESULTS: Using as reference category children cared individually at home, the adjusted ORs for diarrhea occurrence were 3.18, 95% CI [1.49, 6.77] for children cared in group at home, 2.28, 95% CI [0.92, 5.67] for children cared in group in day-care homes and 2.54, 95% CI [1.21, 5.33] for children cared in day-care centers. Children that changed from any other type of child-care setting to child-care centers in the year preceding the study showed a risk even higher (OR 7.65, 95% CI [3.25, 18.02]). CONCLUSIONS: Group care increases the risk of acute diarrhea whatsoever the specific setting.

OBJETIVOS: avaliar a situação de aleitamento materno entre crianças menores de dezoito meses que freqüentam creches e identificar as variáveis associadas ao desmame. MÉTODOS: foram entrevistadas, no mês de fevereiro de 2000, mães de 235 crianças menores de dezoito meses que freqüentavam as creches ligadas à Secretaria da Assistência Social do Município de São Paulo, São Paulo, Brasil, (região Freguesia do Ó). Foi investigado a associação do aleitamento com idade e escolaridade maternas, tipo de parto e peso ao nascer das crianças. O teste chi2 foi empregado para comparação das proporções quando se estudaram os fatores associados ao desmame precoce. Foi calculado o risco relativo (RR) para as prevalências. Para a análise da duração do aleitamento materno utilizou-se a técnica da tábua de vida. RESULTADOS: a prevalência de amamentação das crianças que foram amamentadas alguma vez por suas mães foi 92,7% com uma duração media de 5,6 meses. 80,4% das crianças foram amamentadas no primeiro mês de vida e no final do quarto mês, 50% já se encontravam desmamadas. CONCLUSÕES: nenhuma das variáveis estudadas apresentou condições para entrada em um modelo multivariado; também não mostraram associação com o desmame.OBJECTIVES: to evaluate breast-feeding in children, under 18 months old in day care centers and identify the variables associated to the weaning process. METHODS: two hundred and thirty five mothers of under -18 months' old infants, in day care centers of the Social Welfare Department of the Municipality of São Paulo, São Paulo, Brazil (Freguesia do Ó area) were interviewed in February 2000. Association of breast-feeding to maternal age and education level, delivery type and birthweight was made. The chi2 test was conducted to compare the proportions when factors associated to precocious weaning were studied. Relative risk (RR) was calculated for prevalence. The survival analysis was used to calculate breast-feeding duration. RESULTS: initial breast-feeding prevalence was 92,7% and the mean duration was 5,6 months. 80,4% of the children were breast-feeding during the first month of life and 50% were weaned by the end of the forth month. CONCLUSIONS: none of the variables studied had the requirements to enable inclusion in a multivariate model and did not show any association to weaning.

OBJETIVES: To detect anti-Giardia lamblia serum antibodies in healthy children attending public day care centers and to assess serological tests as tools for estimating the prevalence of G. lamblia in endemic areas. METHODS: Three separate stool specimens and filter paper blood samples were collected from 147 children ranging from 0 to 6 years old. Each stool sample was processed using spontaneous sedimentation and zinc sulfate flotation methods. Blood samples were tested by indirect immunofluorescence (IIF) and enzyme-linked immunosorbent assay (ELISA) for Giardia IgG. RESULTS AND CONCLUSIONS: Of 147 individuals tested, 93 (63.3%) showed Giardia cysts in their feces. Using IIF and ELISA, serum antibodies were detected in 93 (63.3%) and 100 (68%) samples , respectively. Sensitivity of IIF and ELISA was 82% and 72%, respectively. However, ELISA revealed to be less specific (39%) than IIF (70%). IIF also showed a higher concordance with microscopic examination than ELISA.OBJETIVOS: Detectar anticorpos séricos anti-Giardia lamblia entre crianças atendidas em creches e estimar a freqüência de infecção por Giardia lamblia em área endêmica. MÉTODOS: Foram coletadas três amostras de fezes de cada uma das 147 crianças de três creches da rede municipal de Botucatu, SP, com idade variando de 0 a 6 anos, e as amostras foram processadas pelos métodos de sedimentação espontânea e flutuação pelo sulfato de zinco. Amostras de sangue foram obtidas da polpa digital, coletadas em papel de filtro e testadas pelos métodos de imunofluorescência indireta (IFI) e de reação imunoenzimática (Elisa) para pesquisa de IgG anti-Giardia. RESULTADOS E CONCLUSÕES: De um total de 147 crianças, 93 (63,3%) apresentaram cistos de Giardia nas fezes. Dos 147 eluatos testados, 93 (63,3%) e 100 (68%) foram positivos para Giardia em IFI e em Elisa, respectivamente. A sensibilidade de IFI foi de 82% e de Elisa, 72%. Contudo, Elisa foi menos específica (39%) do que IFI (70%). A imunofluorescência indireta apresentou maior concordância com o exame de fezes do que Elisa.

A pesar de las mejorías sanitarias que existen en muchos países del mundo, la hepatitis viral A continúa siendo un problema de salud que se presenta en forma de brotes y estos con mayor frecuencia en instituciones cerradas como son los círculos infantiles, los jardines de la infancia, las escuelas semiinternas y de régimen interno, así como en campamentos y unidades militares, entre otras. En este artículo se realiza una revisión documental sobre el tema, y se resumen las principales medidas que el personal de la Atención Primaria de Salud debe tomar en el control de foco de la hepatitis viral A en instituciones cerradas.In spite of the sanitation improvement in many countries, viral hepatitis A remains a health problem that occurs in the form of outbreaks which very frequently affect enclosed institutions such as day-care centers, kindergartens, boarding schools, camps, and military barracks, among others. This article makes a documentary review on the topic and summarizes the main measures that the primary health care personnel should take to control viral hepatitis A foci in enclosed institutions.

Objective. To define epidemiologic relationships to determine the prevalence and potential risk factors for nasopharyngeal colonization by antibiotic-resistant pneumococci, their serotypes and their antibiotic susceptibility patterns in children attending a daycare center (DCC). Material and Methods. A prospective cohort study was conducted among children (n=53) attending the DCC at Hospital Infantil de México Federico Gómez, which is staffed by 20 employees. Patients were enrolled in the study during a two-year period from September 1997 to September 1999. All the participants were followed prospectively, swabbing them every four months. The strains recovered were typed and screened for susceptibility to several antibiotics. The daycare records were reviewed also. Odds ratios and fisher's exact test: or chi square test of significance were computed from contingency tables as appropriate. Exact 95% confidence intervals were computed for odds ratios. Data analysis was performed using Epi statistics program version 6.04 a. Results. Pneumococci were recovered from 45/53 of the infants at one or more visits. A total of 178 isolates were carried. The carriage rate was 47%. Only 7 adults acquired pneumococci during the study. Types 6,14,19 and 23 were prevalent and represented 77% of the total. Antibiotic-resistant strains were higher to penicillin and erythromycin. Conclusions. Children were frequent carriers of pneumococci, the rate of carriage was high in infancy and tended to decrease with age. The types commonly carried by children were the same as those causing invasive disease. There is a high proportion of carriers with antibiotic-resistant S. pneumoniae strains. Children who have had frequent antimicrobial courses are at particular risk.Objetivo. Analizar longitudinalmente la dinámica de colonización por Streptococcus pneumoniae, determinar la prevalencia, los factores de riesgo potencial para la colonización nasofaríngea con cepas de neumococo resistentes, determinar los serotipos y el perfil de sensibilidad a varios fármacos antimicrobianos. Material y métodos. Estudio prospectivo de una cohorte de niños de guardería, hecho de septiembre de 1997 a septiembre de 1999 entre 53 niños asistentes a la guardería del Hospital Infantil de México Federico Gómez, atendida por 20 empleados. Todos los participantes fueron seguidos en forma prospectiva, tomándose exudado nasofaríngeo cada cuatro meses. Los S. pneumoniae aislados se tipificaron y sometieron a pruebas de sensibilidad a diversos fármacos. Las razones de momios y la prueba exacta de Fisher o ji cuadrada se efectuaron a través de tablas de contingencia; se utilizaron intervalos de confianza a 95% para las razones de momios. Para el análisis se empleó el programa estadístico EPI INFO, versión 6.04 a. Resultados. S. pneumoniae se recuperó de 45/53 niños en una o más de las tomas. Se aisló un total de 178 cepas. El promedio de portador fue de 47%. Sólo siete adultos adquirieron un neumococo durante el estudio. Los tipos 6, 14, 19 y 23 representaron 77% del total. Se encontró elevada resistencia a la penicilina y eritromicina. Conclusiones. El estado de portador nasofaríngeo de S. pneumoniae, es un proceso dinámico. La colonización ocurre durante los primeros meses de vida y comprende solamente unos cuantos serotipos de neumococo. El estado portador disminuye conforme avanza la edad. Se encontró alta proporción de portadores con cepas resistentes de neumococo. Los niños que recibieron varios cursos de antimicrobianos, fueron los que mostraron mayor riesgo de presentar estado portador.

OBJETIVES: To detect anti-Giardia lamblia serum antibodies in healthy children attending public day care centers and to assess serological tests as tools for estimating the prevalence of G. lamblia in endemic areas. METHODS: Three separate stool specimens and filter paper blood samples were collected from 147 children ranging from 0 to 6 years old. Each stool sample was processed using spontaneous sedimentation and zinc sulfate flotation methods. Blood samples were tested by indirect immunofluorescence (IIF) and enzyme-linked immunosorbent assay (ELISA) for Giardia IgG. RESULTS AND CONCLUSIONS: Of 147 individuals tested, 93 (63.3%) showed Giardia cysts in their feces. Using IIF and ELISA, serum antibodies were detected in 93 (63.3%) and 100 (68%) samples , respectively. Sensitivity of IIF and ELISA was 82% and 72%, respectively. However, ELISA revealed to be less specific (39%) than IIF (70%). IIF also showed a higher concordance with microscopic examination than ELISA.

Objective. To define epidemiologic relationships to determine the prevalence and potential risk factors for nasopharyngeal colonization by antibiotic-resistant pneumococci, their serotypes and their antibiotic susceptibility patterns in children attending a daycare center (DCC). Material and Methods. A prospective cohort study was conducted among children (n=53) attending the DCC at Hospital Infantil de México Federico Gómez, which is staffed by 20 employees. Patients were enrolled in the study during a two-year period from September 1997 to September 1999. All the participants were followed prospectively, swabbing them every four months. The strains recovered were typed and screened for susceptibility to several antibiotics. The daycare records were reviewed also. Odds ratios and fisher's exact test: or chi square test of significance were computed from contingency tables as appropriate. Exact 95% confidence intervals were computed for odds ratios. Data analysis was performed using Epi statistics program version 6.04 a. Results. Pneumococci were recovered from 45/53 of the infants at one or more visits. A total of 178 isolates were carried. The carriage rate was 47%. Only 7 adults acquired pneumococci during the study. Types 6,14,19 and 23 were prevalent and represented 77% of the total. Antibiotic-resistant strains were higher to penicillin and erythromycin. Conclusions. Children were frequent carriers of pneumococci, the rate of carriage was high in infancy and tended to decrease with age. The types commonly carried by children were the same as those causing invasive disease. There is a high proportion of carriers with antibiotic-resistant S. pneumoniae strains. Children who have had frequent antimicrobial courses are at particular risk.

OBJETIVO: O estudo foi realizado com o objetivo de verificar a prevalência de anemia e seus possíveis determinantes em crianças de 0 a 36 meses de idade que freqüentam escolas municipais infantis. MÉTODOS: Realizou-se um estudo transversal pelo qual foram estudadas 557 crianças de 0 a 36 meses de idade de todas as escolas municipais infantis de Porto Alegre, RS. Foi feita antropometria e dosagem de hemoglobina pelo fotômetro portátil HemoCue, considerando-se anemia níveis inferiores a 11 g/dl. As informações sobre as crianças foram obtidas por questionário aplicado às mães. A associação das variáveis estudadas com a anemia foi analisada pela técnica de regressão log-binomial aplicada ao modelo hierárquico. RESULTADOS: Encontrou-se uma prevalência de anemia de 47,8% entre toda a população estudada, cujos determinantes foram: famílias com renda per capita igual ou inferior a um salário-mínimo (razão de prevalência [RP] = 1,6), faixa etária de 12 a 23 meses (RP=1,4) e presença de dois ou mais irmãos com menos de cinco anos (RP=1,4). CONCLUSÕES: A prevalência de anemia na população estudada é bastante elevada, especialmente nas crianças de nível socioeconômico mais baixo, na faixa etária de 12 a 23 meses, e nas crianças com dois ou mais irmãos com menos de cinco anos, indicando a necessidade urgente de medidas efetivas visando o seu combate e a sua prevenção.OBJECTIVE: To verify the prevalence of anemia among children aged 0 to 36 months, who attend public day care centers in Porto Alegre, Brazil, and assess its possible risk factors. METHODS: A cross-sectional study was carried out in 557 children aged 0 to 36 months of all public day care centers in Porto Alegre. Anthropometric measurements and hemoglobin levels were performed. The portable HemoCue photometer was employed to measure hemoglobin levels, and anemia was considered when the hemoglobin level was below 11 g/dl. Information regarding each child was obtained by means of a questionnaire applied to the mother. The association of the variables studied to anemia was analyzed using the log-binomial regression technique applied to the hierarchical model. RESULTS: A 47.8% prevalence of anemia was found in this population. The risk factors for anemia in the studied group were: families with per capita income equal or less than one monthly minimal wage (prevalence ratio -- RP =1.6), age between 12 and 23 months (RP=1.4), and having 2 or more siblings younger than 5 years old (RP=1.4). CONCLUSIONS: There is a high prevalence of anemia among children aged 0 to 36 months in public day care centers, especially among children with the lowest socioeconomic level, in the 12 to 23 months age group, and who have 2 or more siblings under 5 years of age, indicating that there is an urgent need for effective measures to fight and prevent this condition.

The efficacy of a well-operated day care center in providing better nutrition to poor children in Brazil was assessed. We collected data for 9 months from 180 under-five children attending a day care center located in a slum. Every working day each child received at least 100% of the age-group recommended dietary allowances plus iron fortified milk and, every six months, treatment for helminth infections. Statistical analyses were restricted to the 168 children (93%) who had measurements from at least five months. As outcome variables, weight-for-height, height-for-age, and weight-for-age Z scores were dichotomized so that a Z score < -1 indicated a child was at risk of malnutrition. We examined the proportion of children at nutritional risk in each month and used multivariate statistical techniques to adjust for confounding and to account for intra-subject correlation. The percentage of children at nutritional risk decreased over time, from 10.1% to 3.4% for weight for height, 29.8% to 15.2 % for weight for age, and from 50.0% to 44.8% for height for age. Most of the reduction took place between the third and fourth months of enrollment. The correlated data models for the three dichotomized outcomes showed a two to three-fold reduction in the occurrence of wasting and underweight. We concluded that attendance to well-operated daycare protects against nutritional risk, and approximately four months are required for a benefit to be seen.Avaliou-se a eficácia da freqüência a creche padrão em promover recuperação nutricional de crianças pertencentes a famílias de baixa renda. Foram coletados dados, por um período de nove meses, de 180 crianças que frequentavam uma creche localizada em uma favela. Em todos os dias úteis cada criança recebia no mínimo 100% das recomendações dietéticas diárias, acrescidas de leite fortificado com ferro e, semestralmente, tratamento para parasitoses intestinais. As análises estatísticas se limitaram a 168 crianças (93%) para as quais se dispunham de medidas de pelo menos cinco meses. Como variáveis resposta, os escores Z das relações peso para estatura, estatura para idade e peso para idade foram dicotomizados de forma que escore Z < - 1 indicava risco nutricional. Foram estudadas as proporções de crianças em risco nutricional a cada mês e utilizadas técnicas estatística multivariadas para controlar eventuais fatores de confundimento e correlacão entre as medidas subsequentes da mesma criança. O percentual de crianças em risco nutricional diminuiu no decorrer do acompanhamento, de10.1% para 3.4% na relação peso estatura, de 29.8% para 15.2 % na peso idade, e de 50.0% para 44.8% na estatura idade. A maior parte das reduções ocorreram entre os terceiro e quarto meses de frequência. Os modelos de dados correlacionados para as três variáveis resposta dicotomizadas evidenciaram reduções de duas a três vezes nos riscos nutricionais descritos pelos indicadores de peso-estatura (wasting) e peso-idade (underweight). Concluimos que a creche padrão diminui riscos nutricionais, sendo necessários aproximadamente quatro meses para que os benefícios sejam identificados.

El Ministerio de Salud Pública de Cuba se ha propuesto la eliminación para el año 2000 de la hepatitis viral tipo B. Para cumplir este objetivo lleva a cabo un Programa Nacional que comenzó en 1991 con la vacunación de los niños nacidos de madres portadoras de hepatitis B y posteriormente se amplió a todos los recién nacidos a partir de 1992. Uno de los parámetros para evaluar la inmunogenicidad de una vacuna es la durabilidad de la respuesta posvacunal, que permite demostrar, además, la necesidad o no de una dosis refuerzo. Tomando en consideración la importancia de este tipo de estudio se realizó la cuantificación de los niveles de anticuerpos contra el VHB (anti-AgsHB) en niños pertenecientes a un círculo infantil, vacunados según el Programa Nacional de Vacunación. Éstos estaban distribuidos por años de vida: primer año (I): 19 niños, segundo año (II): 10, tercer año (III): 31, cuarto año (IV): 24, y en el quinto año (V): 22, para un total de 106 niños. Las muestras serológicas se evaluaron mediante el método inmunoenzimático ELISA, en el Departamento de Inmunología del Instituto de Ciencias Básicas y Preclínicas "Victoria de Girón" (ICBP). En cada grupo estudiado se determinó la proporción de niños con seroprotección (I0 Ul/L o más) e hiperrespuesta (100 Ul/L o más). Se calculó además la media aritmética. Los niveles de seroprotección e hiperrespuesta fueron superiores a 93 y 76 %, respectivamente. La media aritmética (X) estuvo por encima de 181 Ul/L en todos los grupos estudiadosThe Ministry of Public Health of Cuba sets out to wipe out viral hepatitis B for the year 2000. To attain this goal, it implemented a National Program which started in 1991 with the immunization of children from Hepatitis B carrier mothers and was extended to all neonates from 1992 on. One of the parameters to evaluate immunogenicity of a vaccine is durability of post-vaccine response that permits to prove whether a reinforcement dose is needed or not. Taking the importance of this type of study into account, the levels of antibodies to HBV (anti-HbsAg) were quantified in the children of a day-care center who were vaccinated as part of the National Immunization Program. These children were distributed by years of life: First year(I), 19 children; second year (II) 10; third year (III) 31; fourth year (IV) 24; and firth year (V) 22, totalling 106 children. The serological samples were assessed by ELISA in the Department of Immunology of the "Victoria de Girón" Institute of Basic and Pre-clinical Sciences. In each studied group, the number of children with seroprotection (10 UI/L or higher) and hyperesponse (100 UI/L or higher) were determined. Additionally, the arithmetic mean was calculated. The levels of seroprotection and hyperesponse were over 93 and 76% respectively. The arithmetic mean was over 181 UI/L in all the studied groups

Se realizó un estudio descriptivo de eficacia en el Círculo Infantil "XX Aniversario", del Policlínico "Ignacio Agramonte" del municipio Camagüey, entre septiembre y diciembre de 1993, en 23 niños que comenzaron el proceso de adaptación para conocer su comportamiento. Se incluuyeron variables sobre las incidencias de la planificación, realización, control y atención y orientación a los padres, causas de las dificultades y medidas tomadas. Entre los niños estudiados predominaron los del 2do. año de vida (56,5 %), del sexo masculino (65,2 %), de padres con buen nivel económico (100 %) y de escolaridad (93 %), procedentes de familias integradas (60,8 %). El uso del chupete (30,4 %) y la alteración de los hábitos alimentarios (21,7 %) predominaron entre los hábitos negativos; mientras que las enfermedades respiratorias crónicas (47,7 %) y las alteraciones del lenguaje (43,4 %) entre los antecedentes patológicos personales. Finalmente las dificultades encontradas fueron: inadecuada planificación y realización del proceso, repercusión negativa de las infecciones respiratorias agudas y el manejo inadecuado por la familia, y presentación frecuente de adaptaciones difícilesA descriptive efficacy study was conducted at the " XX Aniversario" Day Care Center of the " Ignacio Agramonte" Polyclinic, in the municipality of Camagüey, from September to December, 1993. 23 children that started the process of adaptation were studied to know their behaviour. Variables on the incidences of planning, making, control and attention and guidance of parents, as well as the causes of the dificulties and the measures taken were included. 2-year-old children ( 56. 5 %) predominated among the studied children. 65. 2 % were males, 100 % had parents with a good economic level, 93 % had parents with an adequate educational level and 60. 8 % were from families integrates into society. The use of pacifier (30.4 %) and the alteration of the nutritional habits ( 21. 7 %) prevailed among the negative habits, whereas the chronic respiratory diseases ( 47.7 %) and the speech disorders ( 43.4 %) predominated among the personal pathological histories. Finally, the difficulties found were: inadequate planning an making of the process, negative repercussion of acute respiratory infections and the inappropiate management by the family, and the frequent difficulties presented by children to adapt themselves to the day care center