Low frequency of SARS-CoV2 infection in daycare centers during the reopening of school activities in the Southeast's poor area of Brazil

ABSTRACT SARS-Cov2 has already infected over 482 million people and caused more than 6.1 million deaths. The beginning of the pandemic has led the health authorities of several countries to adopt non-pharmacological preventive measures such as daycare closures. The reopening took place when the country had the highest rates of infection and mortality (mainly due to the gamma variant (P.1) outbreak) and the beginning of the vaccination program. Therefore, we aimed to investigate the prevalence of SARS-CoV2 in daycare after educational activities resumed. The study was conducted in seven childcare facilities. Swab samples from the nasopharynx were collected from children and staff members. The viral RNA was obtained through PureLink RNA extraction kit purification and SARS-CoV2 presence was detected using the All plex SARS-CoV2 kit. The study population included 201 participants, including daycare workers and children. The average age of the workers and children is 40 and 3 years old, respectively. Among the children, 47.5% are female and among the workers, 91.4%. One (0.5%) test came out positive for the presence of SARS-CoV-2, which was from a sample of an asymptomatic childcare worker, and no secondary infections were detected. Considering that the return to daycare activities occurred during a period with a high number of deaths and a lack of vaccines throughout the country, the small number of cases indicates the effectiveness of the several preventive measures used by daycare centers in preventing SARS-CoV2 transmission.

Revisão integrativa sobre doenças parasitárias em crianças de creches brasileiras / Integrative review on parasitic diseases in children in brazilian day care centers

As parasitoses intestinais constituem um importante problema de Saúde Pública, especialmente entre os pré-escolares, devido à imaturidade do sistema imune. Assim, este estudo objetivou realizar uma revisão integrativa dos estudos publicados entre os anos de 2010 a 2017 sobre parasitoses intestinais e os fatores associados ao desenvolvimento em crianças matriculadas em creches brasileiras. Foi realizada busca bibliográfica através das bases de dados Medline, Lilacs e SciELO, utilizando os descritores: infecção, parasitoses, diarreia e creches, e seus correspondentes em inglês: "infection", "parasitc diseases", "diarrhea" e "child day care centers". No caso das buscas no Medline o descritor Brazil também foi usado. Foram identificados 59 estudos, dos quais 11 foram incluídos no presente trabalho. Foi observado variação de 19,4% a 98,4% de parasitos e, a Giardia duodenalis foi o mais prevalente em crianças entre um e seis anos de idade, gênero masculino, com baixo peso, advindas de residências com alta densidade familiar e nível socioeconômico baixo. As análises mostraram a importância da compreensão dos fatores de risco para a incidência de parasitos, indicando a necessidade da promoção de estratégias efetivas para prevenção e controle das infecções parasitárias no país, visto que, tais infecções influenciam diretamente no desenvolvimento da criança, e em alguns casos, evoluindo a óbito.

Intestinal parasitosis is an important public health issue especially among pre-school children due to the immaturity of their immune system. Thus, this study aimed at carrying out an integrative review of studies published between 2010 and 2017 regarding intestinal parasites and associated factors in children registered in Brazilian day care centers. A bibliographic survey was performed through the Medline, Lilacs, and SciELO databases using the following descriptors: infection, parasitic diseases, diarrhea, and child day care centers, as well as their corresponding translations in Portuguese: "infecção", "parasitoses", "diarreia" and "creches". In the case of Medline searches, the descriptor Brazil was also used. Fifty-nine studies were identified, from which, 11 were included in this study. A variation of 19.4% to 98.4% of parasites could be observed, with Giardia duodenalis being the most prevalent in children between one and six years old, male, with low weight, coming from homes with high family density and low socioeconomic status. The analyzes showed the importance of understanding the risk factors for the incidence of parasites, showing the need to promote effective strategies for the prevention and control of parasitic infections in the country, since such infections have direct influence on the child's development, and in some cases, even evolving to death.

Vigilância do desenvolvimento de crianças em creche: um estudo sobre o olhar materno / Vigilancia del desarrollo infantil en la guardería: un estudio sobre la mirada materna / Surveillance of child development in a daycare center: a study on the maternal perspective

Resumo Objetivo Compreender a percepção materna acerca da vigilância do desenvolvimento de crianças menores de três anos que frequentam creche. Método Estudo qualitativo com nove mães de crianças menores de três anos, matriculadas em uma creche do município de João Pessoa-PB, vinculada a uma Unidade de Saúde da Família. Os dados foram coletados por meio de entrevistas semiestruturadas e submetidos à análise temática. Resultados A vigilância do desenvolvimento de crianças que frequentam creche encontra-se fragilizada, visto que a maioria das mães não costumam levar a criança para a unidade de saúde, para o acompanhamento do crescimento e desenvolvimento, e a inserção dos profissionais de saúde na creche ainda é limitada. Entretanto, as mães reconhecem a creche como cenário ideal para a promoção do desenvolvimento infantil e a importância da atuação dos profissionais de saúde nesse cenário. Conclusão e implicações para prática São necessárias ações conjuntas da creche com a Unidade de Saúde da Família para a atenção integral e vigilância do desenvolvimento infantil.

Resumen Objetivo Comprender la percepción materna sobre la vigilancia del desarrollo de los niños menores de tres años que asisten a la guardería. Metodo Estudio cualitativo con nueve madres de niños menores de tres años, inscriptos en una guardería de la ciudad de João Pessoa-PB, vinculada a una Unidad de Salud de la Familia. Los datos se recopilaron a través de entrevistas semiestructuradas y se sometieron a análisis temático. Resultados La vigilancia del desarrollo de los niños que asisten a la guardería se debilita, ya que la mayoría de las madres no llevan al niño a la guardería, para monitorear el crecimiento y desarrollo, y la inclusión de profesionales de la salud en la guardería aún es limitada. Sin embargo, las madres reconocen la guardería como un escenario ideal para la promoción del desarrollo infantil y la importancia del desempeño de los profesionales de la salud en este ámbito. Conclusión e implicaciones para la práctica Son necesarias acciones conjuntas de la guardería y la Unidad de Salud de la Familia para lograr la atención integral y vigilancia del desarrollo infantil.

Abstract Objective To understand the maternal perception about the surveillance of the development of children under three years old who attend a daycare center. Method A qualitative study with nine mothers of children under the age of three, enrolled in a daycare center in João Pessoa-PB, linked to a Family Health Unit. Data was collected through semi-structured interviews and subjected to thematic analysis. Results The monitoring of the development of children attending a daycare center is weakened, since most mothers do not take the child to childcare in order to monitor growth and development, and the inclusion of health professionals in the daycare center is still limited. However, the mothers recognize the daycare center as an ideal setting for the promotion of child development and the importance of health professionals in this setting. Conclusion and implications for the practice Joint actions of the daycare center with the Family Health Unit are necessary for comprehensive care and surveillance of child development.

Predominance of Giardia duodenalis AII sub-assemblage in young children from Salvador, Bahia, Brazil / Predominio del subconjunto AII de Giardia duodenalis en niños pequeños de Salvador, Bahía, Brasil

Introduction. Giardia duodenalis is an intestinal protozoan with a high prevalence in children of developing countries. Molecular studies revealed a great genetic diversity of G. duodenalis, with assemblages A and B found mainly in humans. Despite its importance, the information on the molecular epidemiology of human giardiasis is still limited in Brazil. Objective. To characterize G. duodenalis molecular isolates in children from Salvador, Bahia, Brazil. Materials and methods. Giardia duodenalis positive fecal samples were obtained from 71 children from two day care centers and 39 users of a clinical analysis laboratory. Samples were analyzed by PCR-RFLP of the glutamate dehydrogenase (gdh) and beta-giardin genes and by the sequencing of beta-giardin. Results. Of the 110 G. duodenalis samples, 80 (72.7%) amplified one or both target genes. Of these, 62 (77.5 %) were identified as assemblage A and 18 (22.5%) as assemblage B. The subassemblage AII was identified in 58.8% (n=47) of isolates followed by the sub-assemblage AI (18.8%, n=15), BIV (11.2%, n=9), and BIII (5.0%, n=4). The AII sub-assemblage was the most frequent in children of both day care centers whereas AI was found only in the group attended at the clinical laboratory. Sub-assemblage AII predominated in children under two years. Conclusions. The higher frequency of AII sub-assemblage suggests that anthroponotic transmission is more common in Salvador, but that zoonotic transmission pathways are also present and a change in susceptibility to different molecular patterns of Giardia may occur during child growth.

Introducción. Giardia duodenalis es un protozoo intestinal de gran prevalencia en los niños de los países en desarrollo. En estudios moleculares se ha evidenciado la gran diversidad genética de G. duodenalis y se han identificado los conjuntos A y B, principalmente en humanos. A pesar de su importancia, el conocimiento de la epidemiología molecular de la giardiasis humana aún es limitado en Brasil. Objetivo. Caracterizar los aislamientos moleculares de G. duodenalis de muestras tomadas a niños de Salvador, Bahía, Brasil. Materiales y métodos. Las muestras fecales positivas para G. duodenalis se obtuvieron de 71 niños de dos guarderías y de 39 usuarios de un laboratorio de análisis clínicos. Las muestras se analizaron mediante PCR-RFLP de los genes gdh y beta-giardin, y secuenciación de beta-giardin. Resultados. De las 110 muestras de G. duodenalis, en 80 (72,7 %) se amplificaron uno o ambos genes. De estos, 62 (77,5 %) se identificaron como pertenecientes al conjunto A y 18 (22,5 %) al B. El subconjunto AII se identificó en el 58,8 % (n=47) de los aislamientos, seguido del AI en el 18,8% (n=15), el BIV en el 11,2% (n=9) y el BIII en el 5,0% (n=4). El subconjunto AII fue el más frecuente en los niños de ambas guarderías, en tanto que el AI solo se encontró en el grupo atendido en el laboratorio clínico. El subconjunto AII predominó en los niños menores de dos años. Conclusiones. La mayor frecuencia del subconjunto AII sugiere que la transmisión antroponótica es más común en Salvador, pero también existen vías de transmisión zoonóticas, y que pueden ocurrir cambios en la sensibilidad frente a diferentes patrones moleculares de Giardia durante el crecimiento infantil.

Adequação nutricional e desperdício de alimentos em Centros de Educação Infantil / Nutritional adequacy and food waste in Early Childhood Education Centers

Resumo Analisar aspectos quantitativos e qualitativos da alimentação escolar constitui-se de etapa primordial para fazer do Programa Nacional de Alimentação Escolar (PNAE) um espaço efetivo para a promoção da alimentação saudável e formação de sujeitos de direitos. O objetivo deste estudo foi avaliar a adequação nutricional das refeições servidas e consumidas e quantificar o desperdício de alimentos em Centros de Educação Infantil de Maceió/AL. Foram analisadas por três dias não consecutivos, pelo método de pesagem direta, as refeições de 359 crianças (17 e 63 meses). O desperdício de alimentos foi determinado pelo índice de resto-ingestão e o valor nutricional das refeições servidas e consumidas foram comparadas com os valores de referência do PNAE para energia, carboidrato, proteína, lipídio, vitaminas A e C, ferro, cálcio, zinco, magnésio e fibra. Dos 85 alimentos/preparações presentes no cardápio, 58 (68%) apresentaram percentual de resto-ingestão, superior a 10%. As refeições servidas e consumidas atenderam aproximadamente 50% do recomendado para energia e macronutrientes. A diferença entre as médias dos nutrientes ofertados e consumidos foi estatisticamente significante (p < 0,05) para fibra, vitamina A, vitamina C, cálcio, ferro e zinco.

Abstract Analyzing quantitative and qualitative aspects of school meals represents the initial stage to ensure that the National School Food Program (PNAE) is an effective space for the promotion of healthy eating habits and establishing individual rights. The objective of this study was to evaluate the nutritional adequacy of meals served and consumed, as well as quantifying food waste in Child Daycare Centers in Maceió, in the state of Alagoas. All meals served and consumed by 359 children (aged 17 to 63 months) were analyzed by the direct weighing method for three non-consecutive days in all institutions. Food waste was determined by the leftover factor and the nutritional value of meals served and consumed was compared to the PNAE reference values regarding energy, carbohydrates, protein, lipids, vitamins A and C, iron, calcium, zinc, magnesium and fiber. Of the 85 meals/preparations featured on the menu, 58 (68%) revealed a high leftover percentage; in excess of 10%. The meals served and consumed met approximately 50% of the recommended energy and macronutrient values. The difference between the averages of the nutrients offered and consumed was statistically significant (p < 0.05) for fiber, vitamin A, vitamin C, calcium, iron and zinc.

Fatores associados ao ganho de peso rápido em pré-escolares frequentadores de creches públicas / Factors associated with rapid weight gain in preschool children in public day care centers

RESUMO Objetivo: Avaliar a prevalência e identificar os fatores associados ao ganho de peso rápido em pré-escolares. Métodos: Estudo transversal realizado entre fevereiro e dezembro de 2014, com 136 crianças entre 24 e 35 meses de idade frequentadoras de creches públicas do município de Mogi das Cruzes. Foram realizadas entrevistas com as mães para caracterização clínica, sociodemográfica e antropometria das crianças. Considerou-se ganho de peso rápido quando as crianças apresentaram diferença superior a 0,67 entre o escore Z de peso para idade do nascimento à avaliação. Foi ajustado modelo de regressão logística para fatores associados ao ganho de peso rápido. Resultados: Do total de crianças avaliadas, 50 (36,8%) apresentaram ganho de peso rápido e 36 (26,5%) excesso de peso. Destas, 22 crianças eram do grupo ganho de peso rápido. O maior tempo total do aleitamento materno (OR 0,94, IC95% 0,88-0,99; p=0,031) foi identificado como fator de proteção e o baixo nível socioeconômico (OR 4,18, IC95% 1,04-18,60; p=0,044), como fator de risco para ganho de peso rápido. Conclusões: Encontrou-se alta prevalência de ganho de peso rápido e de excesso de peso entre pré-escolares no terceiro ano de vida frequentadores de creches públicas. Incentivar a prática do aleitamento materno de crianças nos primeiros anos de vida e orientar a alimentação adequada, principalmente nas famílias de baixo nível socioeconômico, contribui potencialmente para a redução do ganho de peso rápido e, consequentemente, de futuras complicações metabólicas do excesso de peso.

ABSTRACT Objective: To evaluate the prevalence, and identify factors associated with rapid weight gain in preschool children. Methods: A cross sectional study was carried out with 136 children between 24 and 35 months of age attending public daycare centers in Mogi das Cruzes between February and December 2014. Interviews were conducted with the mothers for clinical, sociodemographic and anthropometric characterizations of the children. It was considered to be rapid weight gain when the children presented a difference greater than 0.67 between the weight for age Z score from birth to evaluation. A logistic regression model was adjusted for factors associated with rapid weight gain. Results: Fifty children (36.8%) presented rapid weight gain and 36 (26.5%) were overweight. Of these, 22 children were in the rapid weight gain group. The logistic model showed that longest total breastfeeding time (OR 0.94, 95%CI 0.88-0.99; p=0.031) was a protection factor, and low socioeconomic level (OR 4.18, 95%CI 1.04-18.60; p=0.044) was a risk factor for rapid weight gain. Conclusions: There was a high prevalence of rapid weight gain and being overweight among three year old preschoolers attending public day care centers in Brazil. Encouraging the practice of breastfeeding children in the first years of life, in addition to giving guidance about appropriate foods, especially for families with a low socioeconomic status, can potentially contribute to reduce rapid weight gain and, consequently, future metabolic complications of being overweight.

Concordância entre o estado nutricional aferido e o percebido pelas mães em crianças pré-escolares / Agreement between measured and perceived nutritional status reported by preschool children's mothers

RESUMO Objetivo: Verificar a concordância entre o estado nutricional percebido pelas mães e o diagnosticado em crianças pré-escolares, distinguindo diferenças segundo o sexo e a idade da criança. Métodos: Estudo com dados provenientes de uma coorte de 269 crianças pré-escolares assistidas em creches públicas de Campina Grande, Paraíba. Coletaram-se informações sobre a data de nascimento, sexo e estado nutricional das crianças (escores-Z de peso/estatura). Além disso, as mães foram questionadas em relação à percepção sobre o peso da criança. A concordância diagnóstica entre o estado nutricional aferido e o percebido pelas mães foi avaliada pelo teste Kappa ponderado, com significância de 5%. Resultados: O percentual de desacertos entre o estado nutricional percebido pelas mães e o diagnosticado foi de 32,7%, com Kappa de 0,122, considerado desprezível. Destacou-se, principalmente, o excesso de peso subestimado (69,6%). A percepção materna do sobrepeso e o diagnosticado apresentou maior concordância nas crianças de maior faixa etária (36-59 meses versus 24-35 meses) e nas meninas. Conclusões: O estudo da percepção materna do estado nutricional de crianças pré-escolares mostrou a dificuldade que as mães apresentam em reconhecer o real estado nutricional de seus filhos, principalmente a subestimação do sobrepeso. A percepção materna do sobrepeso das crianças é mais distorcida em meninos e nas crianças mais novas.

ABSTRACT Objective: To verify the agreement between nutritional status perceived by mothers and that diagnosed in preschool children, by providing the differences according to children's sex and age. Methods: Study with data from a cohort of 269 preschool children assisted in public daycare centers of Campina Grande, Paraíba (Northeast Brazil). Children's information about their date of birth, sex and nutritional status (weight/stature Z scores) was collected. Furthermore, the mothers were asked about their perception of children's weight. The diagnostic agreement between the measured nutritional status and that perceived by mothers was assessed through the weighted Kappa test, with a 5% significance level. Results: The percentage of disagreement between the measured nutritional status and that perceived by mothers was 32.7%, with Kappa of 0.122, which is considered insignificant. There was a remarkable overweight underestimation (69.6%). Agreement between maternal perception of overweight and the diagnosed nutritional status was higher for older children (36-59 months versus 24-35 months) and for girls. Conclusions: The study regarding maternal perception of preschool children's nutritional status showed the difficulty that mothers face in recognizing the real nutritional status of their children, especially the underestimation of overweight. Maternal perception of overweight in children is misrepresented in boys and in younger children with more importance.

Prevalência e fatores associados à anemia em crianças de creches: uma análise hierarquizada / Prevalence and factors associated with anemia in children enrolled in daycare centers: a hierarchical analysis

RESUMO Objetivo: Determinar a prevalência e os fatores associados à anemia em crianças menores de cinco anos assistidas em creches públicas de um município no sudoeste da Bahia. Métodos: Estudo transversal com uma amostra de 677 crianças matriculadas nas creches públicas de Vitória da Conquista, Bahia. Para determinação da hemoglobina por meio de punção digital, utilizou-se hemoglobinômetro portátil, considerando-se valores de hemoglobina <11 g/dL como ponto de corte para o diagnóstico da anemia. Aplicou-se questionário aos pais ou responsáveis para coleta de informações socioeconômicas, características maternas e de saúde e nutrição da criança. Medidas antropométricas de peso e estatura foram utilizadas para avaliação do estado nutricional da criança. Análise de regressão de Poisson com variância robusta e seleção hierárquica das variáveis foi usada para verificar fatores associados com anemia. Resultados: A prevalência de anemia foi de 10,2% e houve mais prevalência nas crianças cujas moradias não apresentavam instalação sanitária (RP 3,36; IC95% 1,40-8,03); naquelas que não receberam aleitamento materno exclusivo (RP 1,80; IC95% 1,12-2,91); nas crianças com idade inferior a 36 meses (RP 1,85; IC95% 1,19-2,89) e com baixa estatura para a idade (RP 2,06; IC95% 1,10-3,85). Conclusões: A prevalência de anemia pode ser considerada um problema de Saúde Pública menor em crianças de creches populares nesse município. Crianças com condições sanitárias inadequadas, que não receberam leite materno exclusivo, bem como as em idades mais precoces e com déficit nutricional foram mais suscetíveis.

ABSTRACT Objective: To determine the prevalence and factors associated with anemia in children younger than five years old enrolled in public daycare centers in a city in southwestern Bahia, in the northeast of Brazil. Methods: This was a cross-sectional study that included a sample of 677 children enrolled in public daycare centers in Vitória da Conquista, Bahia, Brazil. A portable hemoglobinometer was used to measure hemoglobin. The concentration of <11 g/dL was considered the cutoff point for a diagnosis of anemia. A questionnaire was applied to parents/guardians in order to collect socioeconomic data, maternal characteristics and information on the child's health and nutrition. Height and weight were measured to assess the child's nutritional status. Poisson regression with robust variance and hierarchical selection of variables was used to identify factors associated with anemia. Results: The prevalence of anemia was 10.2% and was more frequent in children whose homes had no sanitary facilities (PR 3.36; 95%CI 1.40-8.03); in those who did not exclusively breastfeed (PR 1.80; 95%CI 1.12-2.91); in children aged less than 36 months (PR 1.85; 95%CI 1.19-2.89) and those who had low height for age (PR 2.06; 95%CI 1.10-3.85). Conclusions: The prevalence of anemia is considered to be a mild public health problem in the children, who are enrolled in daycare centers. Children with inadequate sanitary conditions, and that were not exclusively breastfed, as well as younger children and children with a nutritional deficit, were more likely to present the condition.

Perfil antropométrico de crianças segundo a estrutura das creches / Anthropometric profile of children in accordance with the structure of daycare centers

Resumo O artigo tem por objetivos avaliar a estrutura de creches públicas e o perfil antropométrico de crianças do município de Campina Grande, Paraíba. Estudo transversal que envolveu 793 crianças assistidas em creches. Contemplaram-se informações para caracterizar as creches (estrutura relacionada à capacidade de atendimento à demanda e à de processamento da alimentação escolar, regime de acolhida, zona de localização) e o estado antropométrico das crianças (Estatura/Idade, Peso/Estatura). Menores escores-Z de Estatura/Idade e Peso/Estatura apresentaram-se nas crianças que frequentavam creches com maior número de crianças por funcionário, em regimes de acolhida de tempo parcial e localizadas na zona rural. As crianças que conviviam em salas de aula e em salas de descanso com maior número de crianças apresentaram, também, menores escores-Z de Estatura/Idade. Constatam-se problemas na estrutura das creches relacionados à capacidade de recursos humanos para prestar atenção às crianças e aos modos de convivência (aglomeração), os quais podem marcar diferenças no estado nutricional. Por sua vez, a frequência à creche em tempo integral e a urbanização predispõem positivamente o crescimento das crianças.

Abstract The scope of this article is to evaluate the structure of public daycare centers and the anthropometric profile of children in the city of Campina Grande in the State of Paraíba, Brazil. It is a cross-sectional study that involved 793 children attended in daycare centers. Information to describe the daycare centers were included (structure related to the capacity of demand and the processing power of school meals, reception system of children, location area) and the anthropometric status of the children (Height/Age, Weight/Height). The mean Z-scores for Height/Age and Weight/Height were lower among children from daycare centers with a greater number of children per employee, attended on a part time basis and located in the rural zone. The Z-scores for Height/Age were also lower among children who studied in classrooms and were housed in rest rooms with a greater density of children. Problems were detected in the structure of daycare centers with respect to the capacity of human resources to look after the children and the ways of living together (coexistence), which can make a difference in the nutritional status of the children. For its part, full-time daycare attendance and urbanization predispose children positively to growth.

Preditores da introdução de alimentos industrializados na infância: estudo em creches públicas / Predictors of introduction of industrialized foods in childhood: study in public child day care centers

O aleitamento materno exclusivo até o sexto mês, assim como a alimentação complementar adequada, são práticas importantes para o bom desenvolvimento infantil e contribuem para a formação de hábitos alimentares saudáveis.Diante desse contexto e reconhecendo a importância de práticas alimentares adequadas nos primeiros anos de vida,destaca-se que o objetivo do presente estudo foi avaliar a idade de introdução de alimentos industrializados na dieta de 575 crianças de 4 a 38 meses, frequentadoras de berçários de creches públicas de São Paulo, bem como quantificar eventuais mudanças temporais e fatores de risco da introdução precoce destes alimentos. O estudo foi baseado em duas observações transversais, realizadas em 2007 e 2010, e posterior análise de Clusters para agrupar a amostra em dois grupos, além de análise de regressão logística. No modelo logístico final, o ano de coleta de dados (2007),o menor tempo de aleitamento materno exclusivo e a menor escolaridade materna foram identificadas como riscos independentes e significantes para a introdução precoce dos alimentos industrializados. Diante dos resultados, faz se necessário a capacitação de mães/educadores em alimentação infantil, reforçando os benefícios do aleitamento materno e os malefícios da introdução precoce dos industrializados, principalmente no grupo de mães com menor escolaridade

Exclusive breastfeeding by the sixth month, as well as adequate complementary feeding, are important practices forhuman development and contribute to the formation of healthy eating habits. In this context, and recognizing theimportance of appropriate food practices in the first years of life, the objective of the present study was: to evaluatethe age at which processed food was introduced in the diet of 575 children aged 4 to 38 months, attending the nurseries of public child daycare centers in São Paulo, and to quantify possible temporal changes and risk factorsof premature introduction of these food types. The study was based on two cross-sectional observations, performedin 2007 and 2010, and later Cluster analysis was performed to divide the sample in two groups. A multiple logistic regression analysis was also performed. In the final logistic model, the data collection year (2007), the shorter durationof exclusive breastfeeding, and less maternal education were identified as independent and significant risks to prematureintroduction of processed food. In view of the results, it is necessary to prepare mothers/ educators to manage infantfeeding, reinforcing the benefits of breastfeeding and the disadvantages of the premature introduction of industrialized foods, mainly concerning the mothers' group with lower education levels

Índices antropométricos de crianças assistidas em creches e sua relação com fatores socioeconômicos, maternos e infantis / Anthropometric indices of children treated in daycare centers and the relationship with socioeconomic, maternal and child factors

Resumo Os índices antropométricos peso/estatura e peso/idade destacam-se, respectivamente, por sua importância na identificação de mudanças recentes de peso e de alterações no estado nutricional de forma precoce. O objetivo deste estudo foi analisar fatores associados ao peso/estatura e peso/idade em crianças pré-escolares. Trata-se de um estudo transversal com amostra probabilística que analisou 299 crianças assistidas em creches públicas municipais. As informações foram obtidas por meio de entrevista com as mães, mediante aplicação de um questionário com informações socioeconômicas, maternas e infantis. O peso e a estatura/comprimento das crianças foram medidos seguindo as recomendações da Organização Mundial de Saúde. Os resultados evidenciaram que nenhuma das variáveis maternas associou-se ao estado nutricional das crianças e que apenas o peso ao nascer, dentre as variáveis infantis, apresentou associação aos escores de peso/estatura (p = 0,0030) e peso/idade (p = 0,0018). O bloco de variáveis socioeconômicas, por sua vez, mostrou-se como o mais representativo fator de variação dos resultados encontrados, sobretudo no peso/idade. Conclui-se sobre a relevância do peso ao nascer no peso/estatura e peso/idade das crianças, bem como das condições socioeconômicas, marcadamente, no peso/idade.

Abstract Weight/height and weight/age anthropometric statistics are important, respectively, for identifying incipient changes in weight and alterations in nutritional status at an early stage. The scope of this study was to analyze weight/height- and weight/age-associated factors in preschool children. This is a cross-sectional study with a probabilistic sample scrutinizing 299 children enrolled in municipal daycare centers. Information was obtained through interviews with mothers together with a questionnaire analyzing socioeconomic, maternal and child information. Weight and height/stature of children were measured according to recommendations of the World Health Organization. The results showed that none of the maternal variables was associated with the nutritional status of children and that only birth weight among child variables revealed any association with weight/height (p = 0.0030) and weight/age scores (p = 0.0018). The block of socioeconomic variables, in turn, proved to be the most representative variation factor of results, especially in the weight/age index. The importance of birth weight in the weight/height and weight/age of children, as well as the socioeconomic conditions notably in weight/age indices, was clearly revealed.

Characterization of anthropometric assessment studies of brazilian children attending daycare centers / Caracterização dos estudos de avaliação antropométrica de crianças brasileiras assistidas em creches

Objective: To obtain an overview of available information on the anthropometric assessment of Brazilian children attending daycare centers. Data source: A literature search was carried out in the PubMed, LILACS and SciELO databases of studies published from 1990 to 2013 in Portuguese and English languages. The following search strategy was used: (nutritional status OR anthropometrics OR malnutrition OR overweight) AND daycare centers, as well as the equivalent terms in Portuguese. In the case of MEDLINE search, the descriptor Brazil was also used. Data synthesis: It was verified that the 33 studies included in the review were comparable from a methodological point of view. The studies, in general, were characterized by their restrictive nature, geographical concentration and dispersion of results in relation to time. Considering the studies published from 2010 onwards, low prevalence of acute malnutrition and significant rates of stunting and overweight were observed. Conclusions: Despite the limitations, considering the most recent studies that used the WHO growth curves (2006), it is suggested that the anthropometric profile of Brazilian children attending daycare centers is characterized by a nutritional transition process, with significant prevalence of overweight and short stature. We emphasize the need to develop a multicenter survey that will more accurately define the current anthropometric nutritional status of Brazilian children attending daycare centers.

Objetivo: Traçar um panorama da informação disponível sobre a avaliação antropométrica de crianças brasileiras assistidas em creches. Fontes de dados: Pesquisa bibliográfica nas bases de dados PubMed, LILACS e SciELO de estudos publicados de 1990 a 2013 nos idiomas português e inglês. Foi utilizada a seguinte estratégia de busca: (estado nutricional OR antropometria OR desnutrição OR sobrepeso) AND creches. No caso da busca no MEDLINE o descritor Brazil também foi usado. Síntese dos dados: Verificou-se que os 33 estudos incluídos apresentaram comparabilidade do ponto de vista metodológico. Os estudos, no seu conjunto, caracterizaram-se por sua natureza restritiva, concentração geográfica e dispersão dos resultados em relação ao tempo. Considerando os estudos publicados a partir de 2010, observam-se baixas prevalências de desnutrição aguda e taxas expressivas de déficit de estatura e de sobrepeso. Conclusões: Apesar das limitações, considerando os estudos mais recentes que utilizaram as curvas de crescimento OMS (2006), sugere-se que o perfil antropométrico de crianças brasileiras assistidas em creches caracteriza-se por um processo de transição nutricional com prevalências expressivas de sobrepeso e de baixa estatura. Ressalta-se a necessidade do desenvolvimento de um inquérito multicêntrico para delimitar de forma mais precisa o estado nutricional antropométrico atual das crianças brasileiras que frequentam creches.

Deficiências de micronutrientes em crianças brasileiras assistidas em creches: revisão da literatura / Micronutrient deficiencies in Brazilian children attending daycare centers: a review of the literature

Resumo Objetivos Revisar os artigos sobre o estado nutricional de ferro, vitamina A e zinco em crianças brasileiras assistidas em creches, enfocando métodos diagnósticos, prevalências das respectivas deficiências e fatores associados. Métodos A pesquisa de artigos foi efetuada nas bases PubMed, Lilacs e SciELO. Foram incluídos estudos observacionais com amostras representativas aleatórias que utilizaram indicadores bioquímicos para avaliar o estado nutricional de ferro, vitamina A e zinco de crianças assistidas em creches. Calcularam-se as prevalências médias ponderadas de anemia e de deficiência de vitamina A. Computaram-se as variáveis associadas à anemia. Resultados Foram incluídos 21 estudos, nos quais o estado nutricional de ferro, vitamina A e zinco foi analisado em 17, quatro e três, respectivamente. As prevalências médias ponderadas de anemia e de deficiência de vitamina A foram de 42,7% e 12,5%, respectivamente. Crianças de menor idade e de pior condição socioeconômica representaram as principais condições explicativas para a ocorrência de anemia. Conclusões Os resultados sugerem altas prevalências de anemia e de deficiência de vitamina A entre as crianças brasileiras assistidas em creches com perspectivas etiológicas centradas nas doenças infecciosas.

Abstract The scope of the study was to review the scientific publications on the nutritional status of iron, vitamin A and zinc among Brazilian children attending daycare centers, focusing on diagnostic methods, the prevalence of respective deficiencies and associated factors. A review of the literature was conducted in the PubMed, LILACS and SciELO databases. Observational studies with random representative samples using biochemical indicators to evaluate the nutritional status of iron, vitamin A and zinc of children attending public daycare centers were included. The average weighted prevalence for anemia and vitamin A deficiency was estimated. The variables associated with anemia were computed. Twenty-one observational studies were included, in which the nutritional status of iron, vitamin A and zinc were analyzed in 17, 4 and 3, respectively. The average weighted prevalence of anemia and vitamin A deficiency were 42.7% and 12.5%, respectively. Young children and children living in less favorable socioeconomic situations represented the main explanatory conditions predominantly associated with the occurrence of anemia. The results suggest a high prevalence of anemia, as well as vitamin A deficiency in Brazilian children attending daycare centers, with etiological prospects focused on infectious diseases.

Factors Affecting Daycare Center Teachers' Management of Childhood Fever

PURPOSE: The purposes of this study were to investigate daycare teachers'knowledge, anxiety and management of childhood fever and to identify factors affecting their management of childhood fever. METHODS: A descriptive correlation study was conducted. Participants were 109 daycare center teachers from G metropolitan city. A self-administered questionnaire was used for data collection. RESULTS: The mean percent of correct answers for knowledge about childhood fever was 42.9%. Levels of anxiety related to children's fever were high among day care teachers in this study. Many daycare center teachers used management practices which were not recommended for childhood fever management. There was a statistically significant difference in participants' knowledge about childhood fever by marital status and having a child. Moreover, there were statistically significant positive correlation between daycare center teachers' knowledge and management and negative correlation between daycare center teachers' anxiety and management of childhood fever. Knowledge and anxiety related to childhood fever accounted for 15.2% of variance for fever management. CONCLUSION: Results show that day care teachers' knowledge and anxiety related to fever are important factors in predicting their fever management. Development and evaluation of educational interventions to improve daycare teachers' childhood fever management are recommended.

Risk Factors for Functional Constipation in Young Children Attending Daycare Centers

Our objective was to determine the risk factors associated with the development of functional constipation (FC) in young children attending daycare centers. A cross-sectional survey using a questionnaire based on the Rome III criteria was conducted in children aged 25 to 84 months from 3 randomly selected daycare centers in January 2016. The items in a questionnaire were statistically compared in the constipated and non-constipated groups. A total of 212 children were included and FC was found in 8.5%. Multivariate logistic regression analyses revealed that maternal history of constipation (odds ratio [OR] = 4.1, 95% Confidence Interval [CI] 1.2-13.9), history of painful defecation before age 1 (OR = 10.4, 95% CI 1.1-101.3), history of painful defecation during toilet training (OR = 28.9, 95% CI 1.9-423.8), no or difficult defecation at a daycare center (OR = 5,804.6, 95% CI 134.4-250,718.4), no meat consumption (OR = 10.1, 95% CI 1.2-88.1), and 500 mL or less of water intake per day (OR = 9.9, 95% CI 0.9-99.5) were powerful predictors of FC in young children (P < 0.05). Additionally, the constipated group was significantly associated with 2 hours or less of outdoor play activities per day, entry into daycare centers before 24 months age, 6 hours or more of attendance at a daycare center per day, breastfeeding for less than 6 months, 3 meals or less per day, and 3 or fewer servings of fruits and vegetables per day (P < 0.05). The findings of this study can guide parents, daycare teachers, and clinicians in prevention, early recognition and early intervention for the risk factors associated with FC in young children.

Risk Factors for Functional Constipation in Young Children Attending Daycare Centers

Our objective was to determine the risk factors associated with the development of functional constipation (FC) in young children attending daycare centers. A cross-sectional survey using a questionnaire based on the Rome III criteria was conducted in children aged 25 to 84 months from 3 randomly selected daycare centers in January 2016. The items in a questionnaire were statistically compared in the constipated and non-constipated groups. A total of 212 children were included and FC was found in 8.5%. Multivariate logistic regression analyses revealed that maternal history of constipation (odds ratio [OR] = 4.1, 95% Confidence Interval [CI] 1.2-13.9), history of painful defecation before age 1 (OR = 10.4, 95% CI 1.1-101.3), history of painful defecation during toilet training (OR = 28.9, 95% CI 1.9-423.8), no or difficult defecation at a daycare center (OR = 5,804.6, 95% CI 134.4-250,718.4), no meat consumption (OR = 10.1, 95% CI 1.2-88.1), and 500 mL or less of water intake per day (OR = 9.9, 95% CI 0.9-99.5) were powerful predictors of FC in young children (P < 0.05). Additionally, the constipated group was significantly associated with 2 hours or less of outdoor play activities per day, entry into daycare centers before 24 months age, 6 hours or more of attendance at a daycare center per day, breastfeeding for less than 6 months, 3 meals or less per day, and 3 or fewer servings of fruits and vegetables per day (P < 0.05). The findings of this study can guide parents, daycare teachers, and clinicians in prevention, early recognition and early intervention for the risk factors associated with FC in young children.

Ultra-processed foods: Consumption among children at day-care centers and their classification according to Traffic Light Labelling system / Alimentos ultra-processados: consumo entre crianças em creches públicas e análise da composição nutricional segundo a ferramenta "Traffic Light Labelling"

Objective: To identify the age at which ultra-processed foods are introduced in the diet of infants enrolled in public daycare centers and analyze these foods' nutritional composition according to the Traffic Light Labelling system adapted to the Brazilian norms and recommendations.Methods: Cross-sectional study including 636 nursery age children attending day care centers. Their mothers were interviewed about the age of introduction of instant noodles, snack chips, encased meat, chocolate, ice cream, and stuffed cookies. The proximate composition of these foods was evaluated according to the Traffic Light Labelling adapted to the Brazilian norms and recommendations, which classifies total fat, saturated fat, trans fat, fiber, and sodium amounts as green, yellow, or red indicators.Results: It was found that before 12 months of age 70.6% of children had consumed instant noodles, 65.9% snack chips, 54.7% encased meat, 67.1% chocolate, 36.9% ice cream, and 68.7% stuffed cookies. In addition, all foods were classified as red for saturated fat and sodium and 50.0% were classified as red for total fat.Conclusion: The introduction of ultra-processed foods in the children's diets occurred early, but it is worth mentioning that such foods have an inadequate nutritional composition, contributing to the excess consumption of total fat, saturated fat, and sodium, as well as low fiber.

Objetivo: Identificar a idade de introdução de alimentos ultra-processados na alimentação de lactentes matriculados em creches públicas e analisar suas composições nutricionais segundo a ferramenta de classificação nutricional Traffic Light Labelling, adaptada às normas e recomendações brasileiras.Métodos: Estudo transversal com 636 crianças de berçários de creches, cujas mães foram entrevistadas sobre idade de introdução de macarrão instantâneo, salgadinhos, embutidos, chocolate, sorvete e bolacha recheada. Avaliaram-se as composições centesimais desses alimentos comparando-as com a ferramenta Traffic Light Labelling, adaptada às normas e recomendações brasileiras. Esta ferramenta classifica as quantidades de gordura total, gordura saturada, gordura trans, fibra e sódio em verde, amarelo ou vermelho.Resultados: Verificou-se que, antes dos 12 meses de idade, 70,6% das crianças haviam consumido macarrão instantâneo, 65,9% salgadinhos, 54,7% embutidos, 67,1% chocolate, 36,9% sorvete e 68,7% bolacha recheada. Em adição, todos os alimentos foram classificados como vermelho para gordura saturada e sódio, e 50,0% obteve classificação vermelha para gordura total.Conclusão: A introdução dos alimentos ultra-processados ocorreu precocemente na dieta das crianças, ressaltando que os mesmos apresentaram composição nutricional inadequada, fornecendo excesso de gordura total, gordura saturada, sódio e baixa quantidade de fibras.

Effects of Multiple Cleaning and Disinfection Interventions on Infectious Diseases in Children: A Group Randomized Trial in China / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To assess the effectiveness of multiple cleaning and disinfection interventions in the homes and kindergartens, in reducing gastrointestinal and respiratory illnesses of children.</p><p><b>METHODS</b>From October 2010 to September 2011, we performed a prospective, controlled study in China. 408 children under 5 years old were recruited and group randomized into intervention and control groups. Families and kindergartens in the intervention group were provided with antibacterial products for hand hygiene and surface cleaning or disinfection for one year. Each child's illness symptoms and sick leave were recorded every day.</p><p><b>RESULTS</b>A total of 393 children completed the study, with similar baseline demographics in each of the 2 groups. Except for abdominal pain, the odds of symptoms (fever, cough and expectoration, runny nose and nasal congestion, diarrhea), illness (acute respiratory illness and gastrointestinal illness), and sick leave per person each month were significantly reduced by interventions. The rates of fever, diarrhea, acute respiratory illness, gastrointestinal illness and sick leave per person per year were significantly decreased as well.</p><p><b>CONCLUSION</b>Not only the acute respiratory and gastrointestinal illness but the sick leave rate in children were significantly reduced by multiple interventions.</p>

Job Satisfaction of Children Foodservice Employees at Daycare Centers

The research was conducted by center for children's foodservice management in Hanam-si. In order to improve job satisfaction, a survey was carried out by working conditions and job satisfaction in children foodservice employees working at child daycare centers registered from January to April. Ninety-five surveys out of 120 were collected, and 76 surveys were analyzed. Job satisfaction consisted of four elements, working environment, welfare, human relationships, and job-itself, analyzed by general characteristics. Pearson's correlation was carried out between job satisfaction and intention to change job by Likert 5 scales using SPSS statistic program. The percentages of child daycare centers owned by civilians was 52.6%, high school education level was 65.8%, permanent workers was 68.4%, and less than 1 year of foodservice was 34.2%. Average scores of job satisfaction were as follows: working environment scored 20.6 out of 25 points, welfare scored 10.3 out of 15 points, human relationships scored 17.5 out of 20 points, and job-itself scored 13.2 out of 15 points. The lowest job satisfaction average was 'I get paid fairly regarding the working hours and the amount of work' with a score of 3.6 points. Job satisfaction based on facility type, age, education level, and working period did not show significant differences, whereas hired status, numbers of foodservice children, and intention to change jobs showed significant differences. Hired status showed significant differences with welfare satisfaction (P<0.05). Numbers of children showed a significant difference with welfare and human relationship satisfaction (P<0.01, P<0.05). Intention to change job showed a significant difference with four elements of job satisfaction (P<0.05, P<0.01, P<0.01). In conclusion, to improve job satisfaction of children foodservice employees, working conditions and welfare satisfaction should be increased.

Cuidado infantil e infecções parasitárias / Child care and parasitic infections / Cuidado infantil e infecciones parasitarias

As parasitoses constituem um problema de saúde pública no Brasil, principalmente nos ambientes destinados ao cuidado infantil. Este estudo objetivou determinar a prevalência de parasitoses em creches de Aracaju, Estado de Sergipe, bem como os fatores de risco relacionados. Realizaram-se exames coproparasitológicos e avaliação clínica/antropométrica em 276 crianças. Os fatores de risco foram identificados por meio de questionários e avaliação iconográfica. Os dados foram avaliados pelo teste de Qui-quadrado e o teste exato de Fisher (p0,05). Observou-se prevalência de 44,5% para enteroparasitos (ascaridíase/21,7%) e 31,2% para ectoparasitos (pediculose/18,2%). Verificou-se correlação significativa entre enteroparasitoses e baixo peso, faixa etária de 3 a 4 anos, ruas não pavimentadas e renda familiar, como também entre ectoparasitoses e baixo peso. O perfil socioeconômico revelou que 51,6% das residências eram próprias, de alvenaria (88,6%), com água potável (97,5%) e renda de um a dois salários mínimos (42%). O grau de escolaridade dos pais (ensino médio incompleto) pode ter influenciado no desconhecimento sobre profilaxia de parasitoses (73,8%). Aspectos estruturais/comportamentais mostraram-se relevantes na ocorrência de parasitoses: uso coletivo de sabonete, acondicionamento inadequado de brinquedos e escovas dentárias e instalações sanitárias deficientes. Estes dados mostram a necessidade de novas reflexões sobre a higiene infantil e educação em saúde.

Parasitic diseases are a public health problem in Brazil, especially in environments intended for childcare. This study aimed to assess the prevalence of parasitic diseases in daycare centers in Aracaju (SE) and related risk factors. Coproparasitological tests and clinical and anthropometric evaluations were performed on 276 children. Risk factors were identified using questionnaires and visual assessment. Data were analyzed using Pearson's chi-squared test and Fisher's exact test (p < 0.05). Prevalences of 44.5% and 31.2% were found for intestinal parasites (21.7% ascariasis) and for ectoparasites (18.2% pediculosis), respectively. There was a significant correlation between intestinal parasitic infections and low weight, age group (3-4 years), unpaved streets and family income and between ectoparasitic diseases and low weight. The socioeconomic profile revealed 51.6% owner-occupied, brick (88.6%) houses with drinking water (97.5%) and a family income of 1-2 minimum wages (42%). The level of parental education may be responsible for the lack of knowledge regarding the prevention of parasitic diseases (73.8%). Structural and behavioral characteristics were relevant for the presence of parasitic diseases, including the collective use of soap, improper storage of toys and toothbrushes and deficient toilet facilities. These data underscore the need for new studies on child hygiene and health education.

Las parasitosis constituyen un problema de salud pública en Brasil, principalmente en los ambientes destinados al cuidado infantil. Este estudio tuvo el objetivo de determinar la prevalencia de parasitosis en guarderías de Aracaju, Estado de Sergipe, así como los factores de riesgo relacionados. Fueron realizados exámenes coproparasitológicos y evaluación clínica/antropométrica en 276 niños. Los factores de riesgo fueron identificados a través de cuestionarios y evaluación iconográfica. Los datos fueron evaluados por la prueba ji-cuadrado y la prueba exacta de Fisher (p  0,05). Se observó prevalencia de un 44,5% para enteroparásitos (ascaridíasis/21,7%) y un 31,2% para ectoparásitos (pediculosis/18,2%). Se verificó correlación significativa entre enteroparasitosis y bajo peso, franja de edad de 3 a 4 años, calles no pavimentadas y renta familiar, así como entre ectoparasitosis y bajo peso. El perfil socioeconómico reveló que 51,6% de las residencias eran propias, de albañilería (88,6%), con agua potable (97,5%) y renta de uno a dos salarios mínimos (42%). El grado de escolaridad de los padres (enseñanza media incompleta) puede haber influido en el desconocimiento sobre profilaxis de parasitosis (73,8%). Aspectos estructurales/comportamentales se mostraron relevantes en la ocurrencia de parasitosis: uso colectivo de jabón, acondicionamiento inadecuado de juguetes y cepillos dentarios e instalaciones sanitarias deficientes. Estos datos muestran la necesidad de nuevas reflexiones sobre la higiene infantil y educación en salud.