Experiencia piloto en atención primaria: intervención de terapia ocupacional en el contexto natural / Pilot experience in primary care: occupational therapy intervention in a natural context

Introducción: tanto la terapia ocupacional como la atención primaria centran sus intervenciones en las necesidades y preferencias individuales de la persona, y establecen una estrecha colaboración con ésta y con su entorno. Dentro del sistema sanitario público andaluz se contempla la figura de la terapia ocupacional en los dispositivos de apoyo, pero no está clara su estructura asistencial. El objetivo de este trabajo es profundizar en la necesidad e importancia de la figura de la terapia ocupacional en niveles asistenciales primarios. Métodos: durante el mes de octubre de 2021, cinco terapeutas ocupacionales contratados por el Distrito Sanitario Granada-Metropolitano para funciones de rastreo COVID-19, llevamos a cabo un trabajo externo relacionado con funciones propias de la disciplina en cinco centros de salud de la provincia. Recogimos datos a través de la Medida Canadiense del Desempeño Ocupacional y de una encuesta de elaboración propia. Conclusión: existe una base teórica muy amplia que sustenta los beneficios que puede aportar la terapia ocupacional a la atención primaria. La combinación entre ambas puede ayudar al sistema sanitario público andaluz a mejorar resultados en prevención, rehabilitación y reducción de costes.(AU)

Introduction: Both Occupational Therapy and primary care focus their interventions on the client’s individual needs and preferences and establish close collaboration with them and their environment. Within the Andalusian public health system, Occupational Therapy is included in the support devices, but the care structure is not clear. The aim of this study is to explore the need and importance of Occupational Therapy at the primary care level. Methods: During 2021 October, five occupational therapists contracted by the Granada-Metropolitan Health District for COVID-19 follow-up functions carried out external work related to the discipline’s own functions in five health centers in the province. Data were collected through the Canadian Occupational Performance Measure and a self-developed survey. Conclusion: There is a board theoretical basis for the benefits that Occupational Therapy can bring to primary care. The combination can help the Andalusian public health system to improve outcomes in prevention, rehabilitation and cost reduction.(AU)

Consistencia interna a lo largo de un año del Inventario HOME-infantes en un grupo de niños de la Ciudad de México y zona metropolitana

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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.