ABSTRACT
Resumo Objetivo Avaliar as oportunidades do domicílio para o desenvolvimento motor de lactentes verticalmente expostos ao HIV de acordo com os níveis interdependentes do meio ambiente. Métodos Estudo transversal que incluiu familiares capazes de realizar sozinhos os cuidados cotidianos de lactentes expostos ao HIV com três a 18 meses de idade, em acompanhamento nos serviços de saúde em oito municípios no Sul do Brasil. Foram excluídos lactentes institucionalizados, com perda de seguimento ambulatorial ou impossibilidade de contato telefônico. Participaram do estudo 168 familiares mediante coleta de dados presencial e telefônica com caracterização do familiar, do lactente e do ambiente. Foram aplicadas as escalas de oportunidades no ambiente domiciliar para o desenvolvimento motor com a escala bebê e insegurança alimentar. Foram realizadas análises descritivas e correlações entre as variáveis independentes, seguidas de regressão de Poisson com variância robusta. Resultados As oportunidades totais do ambiente domiciliar foram classificadas como moderadamente adequadas (37,4%), variedade de estimulação excelente (35,4%), espaço físico moderadamente adequado (44,5%), brinquedos de motricidade grossa (38,0%) e de motricidade fina (38,7%) como menos que adequado. Houve associação para escolaridade (p < 0,005), renda (p < 0,013) e segurança alimentar (p < 0,032) com o desfecho menos que adequado ou moderadamente adequado para as oportunidades domiciliares. Conclusão Menores condições escolares, financeiras e de segurança alimentar implicam em menores oportunidades para o desenvolvimento motor, as quais podem ser potencializadas pela fragilidade clínica do lactente com uma condição sorológica ainda indefinida e pela demanda de cuidados habituais para prevenção da transmissão vertical.
Resumen Objetivo Evaluar las oportunidades del domicilio para el desarrollo motor de lactantes expuestos a transmisión vertical del VIH de acuerdo con los niveles interdependientes del medio ambiente. Métodos Estudio transversal en el que participaron familiares capaces de realizar solos los cuidados cotidianos de lactantes expuestos al VIH de tres a 18 meses de edad, atendidos en los servicios de salud de ocho municipios del sur de Brasil. Se excluyeron los lactantes institucionalizados, que perdieron el seguimiento ambulatorio o que no tenían posibilidad de contacto telefónico. Participaron en el estudio 168 familiares mediante recopilación de datos presencial y telefónica con caracterización familiar, del lactante y del ambiente. Se aplicaron las escalas de oportunidades del medio ambiente domiciliario para el desarrollo motor con la escala bebé e inseguridad alimentaria. Se realizaron análisis descriptivos y correlaciones entre las variables independientes, seguidas de regresión de Poisson con varianza robusta. Resultados Las oportunidades totales del ambiente domiciliario fueron clasificadas como moderadamente adecuadas (37,4 %), la variedad de estimulación fue excelente (35,4 %), el espacio físico moderadamente adecuado (44,5 %), los juguetes de motricidad gruesa (38,0 %) y de motricidad fina (38,7 %) como menos que adecuados. Hubo relación de escolaridad (p<0,005), ingresos (p<0,013) y seguridad alimentaria (p<0,032) con el resultado menos adecuado o moderadamente adecuado de oportunidades domiciliarias. Conclusión Menores condiciones escolares, financieras y de seguridad alimentaria conllevan menores oportunidades para el desarrollo motor, que pueden potencializarse por la fragilidad clínica del lactante con una condición serológica aún indefinida y por la demanda de cuidados habituales para la prevención de la transmisión vertical.
Abstract Objective to evaluate the opportunities of the home for the motor development of vertically exposed infants according to the interdependent levels of the environment. Methods This was a cross-sectional study which included family members who were capable of carrying out the daily care of HIV-exposed infants aged between three and 18 months who were being monitored by health services in eight municipalities in southern Brazil. Infants who were institutionalized, had lost their outpatient follow-up or were unable to be contacted by telephone were excluded. A total of 168 family members took part in the study through face-to-face and telephone data collection, characterizing the family member, the infant and the environment. The scales of opportunities in the home environment for motor development, the infant and food insecurity scales were applied. Descriptive analyses and correlations between the independent variables were carried out, followed by Poisson regression with robust variance. Results The total opportunities of the home environment were classified as moderately adequate (37.4%), variety of stimulation as excellent (35.4%), physical space as moderately adequate (44.5%), toys for gross motor skills (38.0%) and fine motor skills (38.7%) as less than adequate. There was an association for schooling (p < 0.005), income (p < 0.013) and food security (p < 0.032) with the outcome less than adequate or moderately adequate for home opportunities. Conclusion Poorer schooling, financial conditions and food security imply fewer opportunities for motor development, which can be exacerbated by the clinical fragility of infants with an as yet undefined serological condition and the demand for regular care to prevent vertical transmission.
ABSTRACT
Objectives: This study aims to determine the differences in home physical conditions consisting of residential density, home ventilation, air humidity, room temperature and lighting, between TB and non-TB patients. Material and Method: This cross-sectional study used convenience sampling with 84 cases and 85 control group participants. The instruments used were an observation sheet, tape measure, digital thermohygrometer, and digital lux meter LX-90. Chi-square tests were used for data analysis. Results: Home environmental conditions were associated with the risk of TB transmission, namely residential density (p= 0.006/ OR= 3.811), house ventilation (p< 0.001/ OR= 51.066), air humidity (p= 0.001/ OR= 3.496), room temperature (p= 0.029/ OR= 3.046), and lighting (p< 0.001, OR= 54.175). Conclusions: The study found that all elements of the home physical environment have been shown to contribute significantly to tuberculosis transmission, so improving the home physical environment is necessary to control tuberculosis transmission.
Objetivos: Determinar las diferencias entre pacientes con y sin tuberculosis en las condiciones físicas de las residencias respecto a densidad residencial, ventilación residencial, humedad del aire, temperatura ambiente e iluminación. Material y Método: Este estudio transversal utilizó un muestreo intencional con 84 casos y 85 participantes del grupo control. Los instrumentos utilizados fueron hoja de observación, cinta métrica, termohigrómetro y luxómetro digitales LX-90. Se utilizaron pruebas de chi-cuadrado para el análisis de los datos. Resultados: Las condiciones ambientales del hogar están relacionadas con el riesgo de transmisión de tuberculosis, a saber: densidad residencial (p= 0,006/ OR= 3,811), ventilación de la casa (p< 0,001/ OR= 51,066), humedad del aire (p= 0,001/ OR= 3,496), temperatura ambiente (p= 0.029/ OR= 3,046) e iluminación (p< 0,001/ OR= 54,175). Conclusiones: Todos los elementos del entorno físico del hogar contribuyen significativamente a la transmisión de la tuberculosis, por lo que es necesario mejorar el entorno físico del hogar para controlar la transmisión de la tuberculosis.
O objetivo deste estudo é determinar as diferenças nas condições físicas das residências, consistindo em densidade residencial, ventilação residencial, umidade do ar, temperatura ambiente e iluminação entre pacientes com TB e não TB. Material e Método: Estudo transversal que utilizou amostragem intencional com 84 casos e 85 participantes do grupo controle. Os instrumentos utilizados foram folha de observação, fita métrica, termohigrômetro digital e luxímetro digital LX-90. Foram utilizados testes de qui-quadrado para análise dos dados. Resultados: As condições ambientais domiciliares estão relacionadas ao risco de transmissão de TB, nomeadamente densidade residencial (p= 0,006/ OR= 3,811), ventilação da casa (p <0,001/ OR= 51,066), umidade do ar (p= 0,001/ OR= 3,496), temperatura ambiente (p= 0,029/ OR= 3,046) e iluminação (p= <0,001/ OR= 54,175). Conclusões: O estudo concluiu que todos os elementos do ambiente físico da casa demonstraram contribuir significativamente para a transmissão da tuberculose, pelo que é necessário melhorar o ambiente físico da casa para controlar a transmissão da tuberculose.
ABSTRACT
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Summary As the environment is a crucial source in an infant's development, it is important to assess the proximal environment where a variety of social relationships take place. Experiences derived from the home environment allow the specific activities that a child builds actively. These opportunities have an outstanding impact on an infant's development. The home concept and its influence on development led to the discovery and interrelations of several dimensions and today's emphasis relies on identifying the mechanisms of the variability of environment that exert an influence on the variability of development. Under this perspective, at the end of the 1960's the Infant/Toddler HOME Inventory was developed by Caldwell and Bradley. Very soon, Cravioto adapted it for its use in a Mexican population according to the characteristics of typical families and cultural aspects. The purpose of this investigation was to establish the internal consistency of the Infant/Toddler HOME Inventory in the version adapted by Cravioto through the assessment of the precision of its scoring in terms of internal consistency. Cohort: 62 infants and their mothers were contacted in the first 72 hours after delivery through a Research Program from the Child Psychiatry Hospital Dr. Juan N. Navarro (Environmental Modulation of Infancy Development). They were born in two Mexico City hospitals: a state public hospital, Hospital de la Mujer (Women's Hospital) and in the Mother-infant Research Center from the Birth Study Group (CIMIGEN). All of them were low-risk infants who met the criteria for a one year follow up and whose parents gave their informed consent and accepted to be visited at their homes. The distribution of the infants group by sex was: 30 infants (48%) were female and 32 (52%) were male. Families were classified as follows: 72.5% were nuclear and 27.5% were extended. According to their socioeconomic profile, a high relationship was found between income and housing: seven (11.3%) of the highest income families lived in houses or apartments of their own or rented, where there were more rooms than inhabitants, whereas all others were living as follows: crowded houses or apartments (23 families, 37.1%), houses with of only one room (4 families, 6.5%) and the poorest houses with collective bathroom (28 families, 45.2%). All households had electrical lighting and most of them had also drinkable water inside their homes (98.4%); one shared water from a deep pond with their community. Bathrooms were: 35.5% with running water, 59.7% used a bucket for carrying water and 4.8% had latrine. Instrument: The Infant/Toddler HOME Inventory, version adapted by Cravioto, with 62 items in a binary format response was used. Subscale VII, Play Materials, asked about color, size, consistency or texture and type of toys. The instrument is administered by having a person calling the home at a time when the infant is awake and can be observed interacting with the mother or principal caregiver. The internal consistency of the Infant/Toddler HOME Inventory was monthly assessed for each of its subscales and the total scale, until the child's first year of life (12 months), applying Cronbach's alpha. Results showed that alpha coefficient's values higher than 0.60 throughout the 12 months were observed in the VII Play Materials shoed a range of 0.64 and 0.84, and 0.60 and 0.83 for the Total Scale. On the other hand, subscale VI, Physical Environment, showed a less than 0.60 value with an internal consistency coefficient of 0.56 in the first month of life; nevertheless the remaining months had values between 0.60 and 0.70. This was also observed with subscale II, Mental Development and Vocal Stimulation, with a 0.58 value for the first month of life and alpha values between 0.63 and 0.74 for the remaining eleven assessments. Subscale III, Emotional Climate, exhibited seven evaluations in a range between 0.61 and 0.76; this is the second with a 0.61, fourth with 0.69, sixth with 0.76, seventh with 0.67, ninth with 0.63, tenth with 0.69 and eleventh 0.63. Non-acceptable internal consistency, it is less than 0.60 in most of their scorings were observed for the following scales: I. Adult Contact, V. Breadth of Experience. Only in the sixth month's a value of 0.64 was observed, and the rest of scales exhibited a range within a 0.38 as inferior limit and 0.56 superior limit in the former and a 0.65 value in the tenth month and 0.60 in the eleventh. Subscale IV, Avoidance of Restriction, showed the lowest coefficient with values between 0.24 and 0.49. These results suggest that most of the subscales had adequate reliabilities, except for subscales I, Adult Contact; IV, Avoidance of Restriction; and V, Breadth of Experience. The purpose of this study was to evaluate the internal consistency of an instrument which measures the home environment quality in infants during their first year of life. Results showed the Infant/Toddler HOME Inventory had high internal consistency values in the Total Scale. These results are similar to those obtained by Banard, Bee & Hammond with a group of 179 children in Seattle, where they found 0.77 values at fourth months, 0.81 at eight and 0.86 at twelve. Our findings were within a rank of 0.68 and 0.83. Cronbach's alpha value obtained for the different subscales showed intersubscale differences. Subscales II, III, VI and VII showed internal consistency values equal or higher than 0.60 in most of the assessments during the 12 months of life. This implies measurements are precise and reliable when using them in low risk Mexican infants. Lower values found in subscales I, Adult Contact, IV, Avoidance of Restriction and V, Breadth of the Experience, may be due to the low number of items. According to Nunnally and Bernstein, it is recommended that measurements with a low internal consistency should be used with initial, non-crucial decisions, and with temporary and reversible effects susceptible to replication and rectification. It is very important to stress the fact that this Infant/Toddler HOME Inventory version is not comparable with other in the literature because the structure was notably modified. Limitations in this study are not only this modification, but the size sample, and future research efforts should overcome this fact by trying to sample infants from different Mexican regions. This study points out the need to adapt, develop and evaluate psychometrically instruments that measure specific aspects of the environment of infant's homes. Our results may be an initial step for those interested in measurements of Mexican families homes, or in those interested in the Infant/Toddler HOME Inventory as an indicator of the environmental aspects in early infancy.