Escrita em alunos com dificuldades de aprendizagem: Efeito Mateus / Writing in students with learning difficulties: Matthew effect

O estudo investigou a linguagem escrita de crianças do 2º e 4º anos com e sem sinais de transtorno específico de aprendizagem. Objetivou comparar as escritas entre dois os grupos de alunos, de modo a verificar se a diferença entre eles seria menor nas séries iniciais e tenderia a aumentar nas séries finais, como previsto teoricamente com base no efeito Mateus. Participaram do estudo 51 professores e 1085 alunos, sendo 49 indicados com sinais compatíveis com o transtorno específico de aprendizagem. O instrumento utilizado para analisar a escrita dos alunos foi o Teste de Desempenho Escolar (TDE-II). A partir das análises realizadas, observou-se que o total de palavras certas no ditado do TDE-II foi maior no 4º ano do que no 2º ano para a amostra total, como esperado, e que a diferença entre os alunos com e sem queixas de dificuldades foi maior no 4º ano do que no 2º ano. Análise de post-hoc revelou que não houve diferença estatisticamente significativa entre os alunos com queixas do 2º ano e do 4º ano, ou seja, a diferença entre eles foi tão pequena que não se mostrou significativa. Tal resultado corrobora o efeito Mateus, sugerindo que crianças com dificuldades ao início da escolarização tendem a apresentar menores ganhos e se distanciar cada vez mais dos colegas com habilidades mais desenvolvidas. Logo, estratégias e intervenções precisam ser desenvolvidas para facilitar o desenvolvimento da linguagem escrita das crianças e promover avanços logo ao início da escolarização.

The study investigated writing of 2nd and 4th grade children with and without signs of the specific learning disorder, and aimed to compare the difference in writing between these two groups of students, to analyze whether the difference between them would be smaller in the early grades and would tend to increase in the final grades, as theoretically predicted by Matthew effect. 51 teachers and 1085 students participated in this study, among which 49 had signs compatible with the specific learning disorder. The instrument used to analyze the students writing was the School Performance Test (TDE-II). It was observed that, in general, the total number of correct words in the TDE-II dictation was greater in the 4th grade, compared to the 2nd grade, as expected, and the difference between students with and without complaints of difficulties was greater among the students in 4th grade than among 2nd grade students. Post-hoc tests showed that there was no statistically significant difference between 2nd grade students with complaints and 4th grade students of with complaints, that is, the difference between them was so small that it was not significant. This result corroborates the "Matthew effect": children with difficulties at the beginning of schooling tend to present lower gains and, increasingly, distance themselves from colleagues with more developed skills. Thus, strategies and interventions must be designed to facilitate children's literacy and promote advances at beginning of schooling.

Adaptação de fórmula de nivelamento de livros infantis para o português brasileiro: resultados preliminares / Adaptación de la fórmula de nivelación infantil al portugués brasileño: resultados preliminares / Adaptation of children's leveling formula for Brazilian Portuguese: preliminary results

Introdução: Práticas para o ensino da leitura no Brasil podem ser representadas pela adaptação e validação de um instrumento de nivelamento de livros infantis já comprovadamente eficaz em outra língua e cultura. Objetivo: O presente estudo visa adaptar a fórmula de Hatcher para nivelar livros infantis para o uso no português brasileiro, disponibilizando-a como instrumento de trabalho aos profissionais de diferentes áreas no que concerne à seleção de livros adequados à idade e à etapa em que se encontram os leitores iniciantes em seus primeiros anos de alfabetização no Brasil. Método: A pesquisa seguirá as seguintes etapas para adaptação da fórmula de nivelamento de livros infantis: (1) tradução da fórmula do idioma de origem para o idioma-alvo, isto é, do Inglês para o português; (2) síntese das versões traduzidas; (3) avaliação da síntese por juízes experts; (4) avaliação da fórmula pelo público-alvo, considerados aqui professores dos anos iniciais do Ensino Fundamental; (5) tradução reversa do instrumento. Resultados: A fórmula traduzida de Nivelamento de Livros Infantis apresentou 72% de coeficiente de validade de conteúdo, em relação à clareza, e 80% de pertinência prática, demonstrando ser um documento útil, de fácil aplicação e adequado aos profissionais da área da saúde e da educação que poderão avaliar e nivelar os livros antes de indicá-los a leitores iniciantes. Espera-se, em estudos posteriores, realizar a aplicabilidade desta fórmula para facilitar o trabalho na seleção de títulos indicados ao público-alvo.

Introduction: Practices for the teaching of reading in Brazil can be represented by the adaptation and validation of a children's book leveling instrument already proven to be effective in another language and culture. Objective: The present study aims to adapt Hatcher's formula to level children's books for use in Brazilian Portuguese, making it available as a working tool to professionals in different areas with regard to the selection of books suitable for the age and stage in which readers are beginning their first years of literacy in Brazil. Method: The research will follow the following steps to adapt the leveling formula for children's books: (1) translation of the formula from the source language to the target language, that is, from English to Portuguese; (2) synthesis of the translated versions; (3) evaluation of the synthesis by expert judges; (4) evaluation of the formula by the target audience, considered here teachers from the early years of elementary school; (5) reverse translation of the instrument. Results: The translated formula for Children's Book Leveling presented 72% of content validity coefficient, in relation to clarity, and 80% of practical relevance, proving to be a useful document, easy to apply and suitable for health professionals and of education that will be able to evaluate and level the books before recommending them to beginning readers. It is expected, in later studies, to apply this formula to facilitate the work in selecting titles indicated to the target audience.

Introducción: Prácticas para la enseñanza de la lectura en Brasil puede ser representada por la adaptación y validación de un instrumento de nivelación de libros infantiles que ya ha demostrado su eficacia en otra lengua y cultura. Objetivo: Este estudio objetiva adaptar la fórmula de Hatcher para nivelar libros infantiles para uso en portugués, poniéndola a disposición como herramienta de trabajo para profesionales de diferentes áreas en lo que se refiere a la selección de libros adecuados a la edad y etapa en la que los lectores están comenzando sus primeros años de alfabetización en Brasil. Método: La investigación seguirá los siguientes pasos para adaptar la fórmula de nivelación para libros infantiles: (1) traducción de la fórmula del idioma de origen al idioma de destino, es decir, del inglés al portugués; (2) síntesis de las versiones traducidas; (3) evaluación de la síntesis por jueces expertos; (4) evaluación de la fórmula por parte del público objetivo, aquí considerados docentes de los primeros años de la enseñanza básica; (5) traducción inversa del instrumento. Resultados: Esta fórmula traducida presentó 72% de coeficiente de validez de contenido, en relación con la claridad, y 80% de pertinencia práctica, demostrando ser un documento útil, de fácil aplicación y adecuado para los profesionales de la salud y de la educación que serán capaz de evaluar y nivelar los libros antes de recomendarlos a lectores principiantes. Se espera, en estudios posteriores, aplicar esta fórmula para facilitar el trabajo en la selección de títulos al público indicado.

Primary Health Care Intervention Reduces Added Sugars Consumption During Childhood.

OBJECTIVE: To investigate the effectiveness of a training program for health workers regarding infant feeding practices to reduce sugar consumption in children. DESIGN: A cluster randomized trial was conducted at 20 health centers in southern Brazil randomly assigned to an intervention (n = 9) or control (n = 11) group. PARTICIPANTS: The 715 pregnant women enrolled were assessed when their children were aged 6 months, 3 years, and 6 years. INTERVENTION: A training session for primary care workers based on the Brazilian National Guidelines for Children. MAIN OUTCOME MEASURE: Mothers were asked when sugar was first offered to children. Added sugars intake was obtained from dietary recalls. ANALYSIS: The effectiveness of the intervention was modeled using generalized estimation equations and Poisson regression with robust variance. RESULTS: Children attending intervention health centers had a 27% reduced risk of sugar introduction before 4 months of age (relative risk, 0.73; 95% confidence interval [CI], 0.61-0.87) as well as lower added sugars consumption (difference, -6.36 g/d; 95% CI, -11.49 to -1.23) and total daily energy intake (difference, -116.90 kcal/d; 95% CI, -222.41 to -11.40) at 3 years of age. CONCLUSIONS AND IMPLICATIONS: Health care worker training in infant feeding guidelines may be an effective intervention to delay the introduction of added sugars and lower the subsequent intake of added sugars in infants and toddlers.

The general movement checklist: A guide to the assessment of general movements during preterm and term age

Abstract Objectives To develop a checklist describing features of normal and abnormal general movements in order to guide General Movement Assessment novices through the assessment procedure, to provide a quantification of General Movement Assessment; and to demonstrate that normal and abnormal GMs can be distinguished on the basis of a metric checklist score. Methods Three examiners used General Movement Assessment and the newly developed GM checklist to assess 20 videos of 16 infants (seven males) recorded at 31-45 weeks postmenstrual age (writhing general movements). Inter- and intra-scorer agreement was determined for General Movement Assessment (nominal data; Kappa values) and the checklist score (metric scale ranging from 0 to 26; Intraclass Correlation values). The scorers' satisfaction with the usefulness of the checklist was assessed by means of a short questionnaire (score 10 for maximum satisfaction). Results The scorers' satisfaction ranged from 8.44 to 9.14, which indicates high satisfaction. The median checklist score of the nine videos showing normal general movements was significantly higher than that of the eleven videos showing abnormal general movements (26 vs. 11, p < 0.001). The checklist score also differentiated between poor-repertoire (median = 13) and cramped-synchronized general movements (median = 7; p = 0.002). Inter- and intra-scorer agreement on (i) normal vs. abnormal general movements was good to excellent (Kappa = 0.68-1.00); (ii) the distinction between the four general movement categories was considerable to excellent (Kappa = 0.56-0.93); (iii) the checklist was good to excellent (ICC = 0.77-0.96). Conclusion The general movement checklist proved an important tool for the evaluation of normal and abnormal general movements; its score may potentially document individual trajectories and the effect of therapeutic intervention.

The general movement checklist: A guide to the assessment of general movements during preterm and term age.

OBJECTIVES: To develop a checklist describing features of normal and abnormal general movements in order to guide General Movement Assessment novices through the assessment procedure, to provide a quantification of General Movement Assessment; and to demonstrate that normal and abnormal GMs can be distinguished on the basis of a metric checklist score. METHODS: Three examiners used General Movement Assessment and the newly developed GM checklist to assess 20 videos of 16 infants (seven males) recorded at 31-45 weeks postmenstrual age (writhing general movements). Inter- and intra-scorer agreement was determined for General Movement Assessment (nominal data; Kappa values) and the checklist score (metric scale ranging from 0 to 26; Intraclass Correlation values). The scorers' satisfaction with the usefulness of the checklist was assessed by means of a short questionnaire (score 10 for maximum satisfaction). RESULTS: The scorers' satisfaction ranged from 8.44 to 9.14, which indicates high satisfaction. The median checklist score of the nine videos showing normal general movements was significantly higher than that of the eleven videos showing abnormal general movements (26 vs. 11, p<0.001). The checklist score also differentiated between poor-repertoire (median=13) and cramped-synchronized general movements (median=7; p=0.002). Inter- and intra-scorer agreement on (i) normal vs. abnormal general movements was good to excellent (Kappa=0.68-1.00); (ii) the distinction between the four general movement categories was considerable to excellent (Kappa=0.56-0.93); (iii) the checklist was good to excellent (ICC=0.77-0.96). CONCLUSION: The general movement checklist proved an important tool for the evaluation of normal and abnormal general movements; its score may potentially document individual trajectories and the effect of therapeutic intervention.

Effects of early interventions focused on the family in the development of children born preterm and/or at social risk: a meta-analysis / Efeitos da intervenção precoce com foco na família no desenvolvimento de criançasnascidas prematuras e/ou em risco social: metanálise

Abstract Objective To verify whether early intervention focused on the family improves the cognitive, motor, and language development of children born preterm and/or at social risk in the first 3 years of life. Source of data Meta-analysis of clinical trials published between 2008 and 2018, in the following databases: CINAHL, MEDLINE - PubMed, MEDLINE - BVS, LILACS - BVS, IBECS - BVS, PEDro and Cochrane Reviews. Experimental studies on early interventions focused on the family, whose target groups were children born preterm and/or at social risk, with assessment of cognitive and/or motor and/or language development up to 3 years were included. The studies were rated using the PEDro Scale. Data synthesis Twelve studies were included from a total of 3378 articles. Early intervention focused on the family contributed to the development of the cognitive (Standardized Mean Difference - SMD = 0.48, 95% CI: 0.34-0.61) and motor (SMD = 0.76, 95% CI: 0.55-0.96) domains of preterm infants. Regarding cognitive development, performance improvement was observed at 12, 24 and 36 months, while in the motor domain, the effect was observed only at 12 months in preterm infants. There was no benefit of the intervention in the cognitive, motor, and language outcomes of children with the social risk factor associated to biological risk. Conclusion Early intervention focused on the family has a positive effect on the cognition of preterm infants. The effect on motor development was lower, possibly due to the emphasis on interventions in family-child interaction. The effect of interventions on the development of children at social risk and on the language domain was inconclusive, due to the scarcity of studies in the area.

Resumo Objetivo Verificar se a intervenção precoce com foco na família melhora o desenvolvimento cognitivo, motor e a linguagem de crianças nascidas prematuras e/ou em risco social nos primeiros três anos de vida. Fontes de dados Metanálise de ensaios clínicos publicados entre 2008 a 2018, nas bases de dados CINAHL, Medline - Pubmed, Medline - BVS, Lilacs - BVS, IBECS - BVS, PEDro e Cochrane/Reviews. Foram incluídos estudos experimentais de intervenção precoce com foco na família cujo público-alvo eram prematuros e/ou crianças em risco social com avaliação do desenvolvimento cognitivo e/ou motor e/ou linguagem até os três anos. Os artigos foram pontuados pela Escala PEDro. Síntese dos dados Do total de 3378 artigos, 12 estudos foram incluídos. A intervenção precoce com foco na família contribuiu para o desenvolvimento dos domínios cognição (DMP = 0,48; 95%IC: 0,34-0,61) e motor (DMP = 0,76; 95% IC: 0,55-0,96) de prematuros. Na cognição, a melhora do desempenho foi observada aos 12, 24 e 36 meses, enquanto no domínio motor, o efeito foi observado apenas aos 12 meses nos prematuros. Não houve benefício da intervenção nos desfechos cognitivo, motor e linguagem de crianças com fator de risco social associado ao biológico. Conclusão Intervenção com foco na família tem efeito positivo sobre a cognição de crianças prematuras. O efeito no desenvolvimento motor foi menor, possivelmente devido à ênfase das intervenções na interação família-criança. O efeito das intervenções sobre o desenvolvimento de crianças em risco social e no domínio da linguagem foram inconclusivos, devido à escassez de estudos na área.

Effects of early interventions focused on the family in the development of children born preterm and/or at social risk: a meta-analysis.

OBJECTIVE: To verify whether early intervention focused on the family improves the cognitive, motor, and language development of children born preterm and/or at social risk in the first 3 years of life. SOURCE OF DATA: Meta-analysis of clinical trials published between 2008 and 2018, in the following databases: CINAHL, MEDLINE - PubMed, MEDLINE - BVS, LILACS - BVS, IBECS - BVS, PEDro and Cochrane Reviews. Experimental studies on early interventions focused on the family, whose target groups were children born preterm and/or at social risk, with assessment of cognitive and/or motor and/or language development up to 3 years were included. The studies were rated using the PEDro Scale. DATA SYNTHESIS: Twelve studies were included from a total of 3378 articles. Early intervention focused on the family contributed to the development of the cognitive (Standardized Mean Difference - SMD=0.48, 95% CI: 0.34-0.61) and motor (SMD=0.76, 95% CI: 0.55-0.96) domains of preterm infants. Regarding cognitive development, performance improvement was observed at 12, 24 and 36 months, while in the motor domain, the effect was observed only at 12 months in preterm infants. There was no benefit of the intervention in the cognitive, motor, and language outcomes of children with the social risk factor associated to biological risk. CONCLUSION: Early intervention focused on the family has a positive effect on the cognition of preterm infants. The effect on motor development was lower, possibly due to the emphasis on interventions in family-child interaction. The effect of interventions on the development of children at social risk and on the language domain was inconclusive, due to the scarcity of studies in the area.

Asociación entre programa de intervención educativa integral y control metabólico de usuarios diabéticos tipo 2 insulino requirentes de Centro de Salud Familiar Cardenal Raúl Silva Henríquez, período 2015-2016 Chile / The effect of an educational intervention on the metabolic control of diabetic patients

Background: Diabetic patients have a poor adherence to lifestyle changes and a low compliance with medications. Aim: To study the effect of an educational intervention on the metabolic control of patients with diabetes mellitus. Patients and Methods: We studied insulin requiring diabetic patients attended at a primary health care clinic, who were randomly divided in two groups. One group participated in four modules of an educative intervention, carried out in four occasions. The other group did not participate in the educational sessions. Clinical, anthropometric and laboratory variables of the participants were obtained from their medical records, at three and six months after the intervention. Results: We recruited 22 men aged 64 ± 14 years and 48 women aged 63 ± 10 years. Thirty-six of these received the educational intervention. Eighty four percent were overweight or obese. The proportion of compensated patients, defined as those having a glycosylated hemoglobin between 7 and 9%, increased significantly after the educational intervention (χ2 = 7.9 p < 0.01, odds ratio: 0.2). Conclusions: A educational intervention in patients with insulin requiring diabetes mellitus improved the metabolic control of their disease.

Efeito de visitas domiciliares na manutenção das atividades de vida diária de adultos em pós-operatório / Efecto de las visitas domiciliarias en el mantenimiento de las actividades de la vida diaria de los adultos en el postoperatorio / Effect of home visits in the maintenance of daily life activities of adults in postoperative period

Objetivo avaliar os efeitos da implantação de um programa de visitas domiciliares (VD) a pessoas adultas no domínio Atividades de Vida Diária (AVD). Método estudo quasi-experimental, com usuários de um centro hospitalar do Norte de Portugal, aos quais se aplicou a escala Hip Disability and Osteoarthritis Outcome Score LK2.0. O tratamento de dados foi realizado pelo SPSS. Resultados a maioria dos participantes era do sexo masculino (61,4%) e pertencia à faixa etária dos 65 anos ou mais (65,9%). Não se verificou um efeito significativo na interação do programa de VD, sobre o compósito multivariado (AVD Observação1 e AVD Observação2) MANOVA: p=0,164, mas a média da pontuação do domínio AVD nos dois grupos, em comparação, aumentou da Observação1 para a Observação2, sendo o aumento mais pronunciado no Grupo Experimental. Conclusão o programa de VD não teve efeito significativo na melhora do domínio AVD, mas contribuiu ligeiramente para a autonomia do usuário.

Objetivo evaluar los efectos de implementar un programa de visitas domiciliarias (VD) para adultos en el dominio de actividades de la vida diaria (AVD). Método estudio cuasiexperimental con usuarios de un hospital en el norte de Portugal, con la aplicación de la escala Hip Disability and Osteoarthritis Outcome Score LK2.0. El procesamiento de datos se realizó a través de SPSS. Resultados la mayoría de los participantes eran hombres (61,4%) y tenían 65 años o más (65,9%). No hubo un efecto significativo sobre la interacción del programa VD en el compuesto multivariado (AVD Observation1 y AVD Observation2) MANOVA: p=0.164, pero el puntaje promedio del dominio AVD en ambos grupos aumentó de Observation1 a Observation2, siendo el aumento más pronunciado en el Grupo Experimental. Conclusión el programa de VD no tuvo un efecto significativo en la mejora del dominio AVD, pero contribuyó ligeramente a la autonomía del usuario.

Objective to evaluate the effects of implementing a home visiting (HV) program for adults in the Daily Life Activities (DLA) domain. Method quasi-experimental study with users of a hospital center in north Portugal, with the application of the Hip Disability and Osteoarthritis Outcome Score LK2.0 scale. Data processing was performed through SPSS. Results most participants were male (61.4%) and were 65 years old or older (65.9%). There was no significant effect on HV program interaction, on multivariate composite (DLA Observation1 and DLA Observation2) MANOVA: p=0.164, but average DLA domain score in both groups increased from Observation1 to Observation2, with the most pronounced increase in the Experimental Group. Conclusion the HV program had no significant effect on improving the DLA domain, but slightly contributed to the user's autonomy.

Effect on the Metabolic Biomarkers in Schoolchildren After a Comprehensive Intervention Using Electronic Media and In-Person Sessions to Change Lifestyles: Community Trial.

BACKGROUND: Obesity is a chronic low-intensity state of inflammation with metabolic alterations that, when acquired during childhood, lead to severe illness in adults. Encouraging healthy eating habits and physical activity is the basis for preventing and treating obesity and its complications. OBJECTIVE: To evaluate how a comprehensive intervention promoting healthy eating habits and physical activities in schools affects children's metabolic biomarkers. METHODS: Of four Mexico City primary schools in this study, two groups of children that were recruited at their schools were assigned to a 12-month intervention group (IG) and the other two were assigned to control groups (CGs). The intervention had two components: (1) parents/schoolchildren attended in-person educational sessions promoting healthy eating and physical activity habits, and were provided printed information; and (2) parents were able to seek information through a website, and also received brief weekly mobile phone text messages. Anthropometric measurements and fasting blood samples were taken from both groups of children at baseline and again after 12 months. RESULTS: The study involved 187 children in the IG and 128 in the CG. Regardless of each child's nutritional status at the beginning of the study, the intervention improved metabolic parameters; the IG showed a negative effect on glucose concentrations (-1.83; CI 95% -3.06 to -0.60), low-density lipoprotein-cholesterol (-2.59; CI 95% -5.12 to -0.06), insulin (-0.84; CI 95% -1.31 to -0.37), and homeostasis model to assess the insulin resistance index (HOMA-IR; -0.21; CI 95% -0.32 to -0.09) in comparison to the CG. HOMA-IR improved in children who had higher than baseline body mass index z-scores. CONCLUSIONS: Intervention through multiple components that promoted healthier eating and physical activity habits improved the metabolic parameters of the children in the study after one year, regardless of their nutritional status.

Transtorno do espectro autista: detecção precoce pelo enfermeiro na estratégia saúde da família / Trastorno del espectro autista: detección precoz del enfermero en la estrategia salud de la familia / Autistic spectrum disorder: early detection by family health strategy nurses

Objetivo identificar a atuação do enfermeiro da Estratégia Saúde da Família na detecção precoce do Transtorno do Espectro Autista em crianças. Método pesquisa descritiva, exploratória, qualitativa realizada numa capital do Nordeste, Brasil. Participaram 10 enfermeiros efetivos, concursados e em exercício na Estratégia Saúde da Família. A coleta de dados ocorreu em 2014 por meio de entrevista individual, observação direta e diário de campo. Material tratado pela análise temática, interpretado pelo referencial das Diretrizes de Atenção à Reabilitação da Pessoa com Transtorno do Espectro Autista. Resultados foram áreas temáticas: percepção, estratégias e intervenções do enfermeiro sobre sinais e sintomas; dificuldades relatadas à detecção precoce; construção do conhecimento sobre a temática; e sentimentos dos profissionais ao acompanharem crianças com Transtorno do Espectro Autista. Conclusão enfermeiros da Estratégia Saúde da Família apresentaram deficiências na detecção precoce do Transtorno do Espectro Autista em crianças.

Objetivo identificar la actuación del enfermero de Estrategia Salud de la Familia en la detección precoz del Trastorno del Espectro Autista en niños. Método investigación descriptiva, exploratoria, cualitativa, realizada en capital del Noreste brasileño. Participaron 10 enfermeros efectivos, concursados y en ejercicio en la Estrategia Salud de la Familia. Datos recolectados en 2014 mediante entrevista individual, observación directa y registro de servicio. Material tratado por análisis temático, interpretado por referencial de Directrices de Atención a la Rehabilitación de la Persona con Trastorno del Espectro Autista. Resultados las áreas temáticas fueron: percepción, estrategias e intervenciones del enfermero ante señales y síntomas; dificultades informadas en la detección precoz; construcción de conocimiento sobre la temática; y sentimientos de los profesionales al trabajar con niños con Trastorno del Espectro Autista. Conclusión los enfermeros de la Estrategia Salud de la Familia muestran deficiencias para detectar precozmente el Trastorno del Espectro Autista en niños.

Objective to identify the role of Family Health Strategy nurses in the early detection of Autistic Spectrum Disorder in children. Method descriptive, exploratory, qualitative research carried out in a capital city in the Northeast region of Brazil. The participants were 10 nurses who took a test to have a permanent job and work in the Family Health Strategy. Data collection took place in 2014 through individual interview, direct observation, and field diary. Thematic analysis was used, with data interpreted by the framework of the Guidelines for Rehabilitation Care of Autistic Spectrum Disorder Patients. Results the thematic areas were: perception, strategies and interventions of nurses on symptoms and signs; difficulties related to early detection; construction of knowledge on the subject; and professionals’ feelings when accompanying children with the Autistic Spectrum Disorder. Conclusion the Family Health Strategy nurses had deficiencies in the early detection of the Autistic Spectrum Disorder in children.

Perfil da clientela de serviços de intervenção precoce: um enfoque na saúde ocular / Clientele profile of early intervention services: a focus on eye health

Resumo Objetivos: Descrever e analisar o perfil de crianças com alterações no desenvolvimento atendidas em serviços de intervenção precoce (IP) e de suas mães ou cuidadores, dando enfoque a aspectos relacionados a saúde ocular da criança. Métodos: Levantamento quantitativo, de caráter exploratório-descritivo. O instrumento de coleta de dados constituiu-se de um questionário aplicado com mães ou cuidadores de crianças atendidas em serviços de IP. Os dados obtidos foram transcritos em planilha do software Microsoft Excel e analisados com base em estatística descritiva simples. A amostra constituiu-se de 273 sujeitos. Resultados: Houve prevalência da participação das mães (84,2%) com idade entre 30 e 40 anos (38,8%). As crianças tinham entre 1 e 2 anos de idade (34,8%), e, na sua maioria, com Síndrome de Down (26,7%). A média de idade de entrada das crianças nos serviços de IP foi de 7,93 meses e da idade na primeira consulta com o oftalmologista - daqueles que já haviam realizado (82,8%) - foi de 6,8 meses, sendo que 45,6% apresentou alterações oftalmológicas, predominando o estrabismo (40,8%). Conclusões: Os resultados obtidos permitiram a identificação e a caracterização das mães ou cuidadores e das crianças que frequentam os serviços de IP, principalmente em questões referentes à saúde ocular. Compreender o panorama descrito deve subsidiar ações voltadas à educação em saúde ocular, prevenção e reabilitação e devem ser direcionadas aos serviços de IP, aos gestores, às famílias e às crianças.

Abstract Objectives: To describe and analyze the profile of children with developmental disorders treated at early intervention services (IP) and their mothers or caregivers, focusing on aspects related to the child's ocular health. Methods: Quantitative survey, exploratory-descriptive. The data collection instrument consisted of a questionnaire applied with mothers or caregivers of children assisted in IP services. The data were transcribed in Microsoft Excel spreadsheet and analyzed based on simple descriptive statistics. The sample consisted of 273 subjects. Results: There was a prevalence of mothers (84.2%) between 30 and 40 years old (38.8%). The children were between 1 and 2 years of age (34.8%), and, for the most part, with Down's Syndrome (26.7%). The mean age of entry of children in IP services was 7.93 months and the age at first consultation with the ophthalmologist - of those who had already performed (82.8%) - was 6.8 months, with 45,6% presented ophthalmological alterations, predominating strabismus (40.8%). Conclusions: The results obtained allowed the identification and characterization of mothers or caregivers and children attending IP services, especially in questions related to ocular health. Understanding this scenario should support actions aimed at ocular health education, prevention and rehabilitation and should be directed to IP services, managers, families and children.

Evaluación del impacto de la intervención educativa-motivacional "Como Jugando" para prevenir la obesidad en escolares del Cercado de Lima: resultados al primer año / Impact evaluation of educational-motivational intervention "Como Jugando" to prevent obesity in school children of Cercado de Lima: results in the first year

RESUMEN Objetivo. Determinar el impacto, al primer año, de la intervención educativa-motivacional "Como Jugando" sobre el índice de masa corporal (IMC), conocimientos en alimentación, niveles de actividad física y patrones de consumo alimentario en escolares del 1.° al 4.° grado de primaria, de cuatro instituciones educativas (IE) del Cercado de Lima. Materiales y métodos. Estudio cuasiexperimental, controlado. Se evaluó el IMC, conocimientos en nutrición, frecuencia de consumo de alimentos y nivel de actividad física. "Como Jugando" incluyó actividades lúdicas y vivenciales para escolares e involucró a docentes y padres. El impacto se estimó aplicando la prueba de McNemar para muestras relacionadas y modelos de regresión de diferencias en diferencias ajustados por variables relativas al escolar y la madre. Resultados. El estudio incluyó a 696 escolares de 2 IE de intervención y 2 IE de control, el puntaje Z de IMC y las prevalencias de obesidad no variaron durante el periodo de estudio. La intervención mostró impacto en mejorar los conocimientos en nutrición (OR: 1,46; IC95%: 1,17-1,81) redujo el riesgo de tener un nivel malo de actividad física (OR: 0,63; IC95%: 0,46-0,87) y mejoró los patrones de consumo de todos los alimentos, salvo verduras (grupo intervención). Conclusiones. La intervención "Como Jugando", al primer año de implementación, no redujo el Puntaje Z del IMC, sin embargo, tuvo impacto sobre los conocimientos en nutrición, redujo la probabilidad de tener un nivel malo de actividad física y mantuvo o aumentó la frecuencia adecuada del consumo de frutas, agua sin azúcar, jugos envasados y galletas dulces y saladas. Es necesario continuar evaluando la intervención "Como Jugando" para estimar el impacto sobre indicadores biológicos.

ABSTRACT Objective. To determine the impact of the educational-motivational intervention "Como jugando" on the body mass index (BMI), knowledge on nutrition, physical activity levels, and eating patterns in students from the first to fourth grades of four educational institutions (EIs) of Cercado de Lima after the first year of the intervention. Materials and methods. This was a quasi-experimental, controlled study. BMI, knowledge on nutrition, frequency of food consumption, and level of physical activity were evaluated. The "Como jugando" program included playful and experiential activities for school children and involved both teachers and parents. The impact was estimated by applying the McNemar test for related samples and regression models for the analysis of differences in adjusted variables related to children and their mothers. Results. The study included 696 school children from two experimental EIs and two control EIs. The Z-score for BMI and the prevalence of obesity did not vary during the study period. The intervention improved the knowledge of nutrition [odds ratio (OR): 1.46; 95% confidence interval (CI): 1.17-1.81], reduced the likelihood of poor levels of physical activity (OR: 0.63; 95% CI: 0.46-0.87), and improved the consumption patterns for all food categories except vegetables in the intervention group. Conclusions. The "Como jugando" intervention, in the first year of implementation, did not reduce the Z-score for BMI but improved the knowledge of nutrition, reduced the probability of poor levels of physical activity, and maintained or increased the consumption of fruits, sugar-free water, packaged juices, and sweet and savory cookies. Therefore, the "Como jugando" intervention should be better studied in order to estimate its impact on biological indicators.

Efectividad de las intervenciones educativas para la atención de la salud. Revisión sistemática / Effectiveness of health care educational interventions. A systematic review

La influencia e impacto de los programas educativos en los estilos de vida y particularmente en la salud está reconocido por la literatura, sin embargo, son pocos los estudios que lo sistematizan. Con el objetivo de evaluar la efectividad de las intervenciones educativas se realizó esta revisión sistemática siguiendo las directrices PRISMA. Los artículos para ser incluidos se identificaron a través de las bases de datos MEDLINE, LILACS y EMBASE durante los meses de enero a mayo de 2016. Se seleccionaron 24 artículos. El total de sujetos participantes en los estudios evaluados fue de 3 426 y el 58 % fueron no mayores de 17 años. Se constata que este tipo de programa constituye un recurso adecuado para lograr cambios en los estilos de vida, particularmente en las edades tempranas, de igual manera se destaca que aquellas intervenciones que cuentan con el vínculo familiar son altamente efectivas.

The influence and impact of life style educational programs and in particular in health has been recognized by literature, however, studies which systematize it are limited. With the objective of assessing the effectiveness of educational interventions a systematic review was done following Prisma Guidelines. Articles to be included were identified by MEDLINE, LILACS and EMBASE Database between January and May 2016. Twenty four articles were selected. The total subjects participating in the assessed studies was 3 426 and 58% were younger than 17 years. It was corroborated that this kind of program is a suitable resource to produce lifestyle changes, particularly in early ages, so as it is emphasized that interventions involving the family are highly effective.

Influência de fatores de risco sobre o desenvolvimento da linguagem e contribuições da estimulação precoce: revisão integrativa da literatura / Influence of risk factors on language development and contributions of early stimulation: an integrative literature review

RESUMO O objetivo do estudo foi identificar evidências na literatura a respeito da influência dos fatores de risco sobre o desenvolvimento da linguagem da criança e as contribuições da estimulação precoce. Trata-se de uma revisão integrativa, que utilizou as bases de dados Lilacs, PubMed e SciELO e os descritores: linguagem infantil, fatores de risco, prematuro, criança pós-termo, índice de Apgar, estimulação precoce. A partir dos achados, extraíram-se os seguintes dados: autores, ano de publicação, objetivo, desenho do estudo, participantes e critérios, variáveis estudadas, principais achados. Para a organização e análise foi utilizada a técnica de Análise de Conteúdo do tipo temática. Foram identificados 1.421 artigos, 29 atenderam os critérios de inclusão. Os estudos foram categorizados por resultados afins; A maioria dos artigos selecionados trata do efeito da prematuridade sobre o desenvolvimento da linguagem. Quatro estudos investigaram a associação entre fatores de risco e problemas no desenvolvimento da linguagem. Um dos estudos avaliou crianças em idade escolar e associou valores de Apgar com DEL. Foi unanime a recomendação acerca do acompanhamento e intervenção precoce. Conclui-se que os fatores de risco elencados influenciam negativamente no desenvolvimento da linguagem. Reforça-se a recomendação do atendimento precoce e qualificado dessas crianças, evitando e/ou minimizando alterações futuras.

ABSTRACT This study aimed to identify evidence in the literature regarding the influence of risk factors on child language development and point out the contributions of early stimulation. In this integrative literature review, the databases Lilacs, PubMed and SciELO and the descriptors Child language; Risk factors; Premature; Postterm child; Apgar score; Early intervention were used. From the findings, the following data were extracted: author, year of publication; objective and study design; participants and inclusion criteria; studied variables; main findings. For the organization and analysis of the studies, we used the thematic content analysis technique. We identified 1,421 articles; 29 met the inclusion criteria of this study. The studies were categorized by similar results. Most of the articles reveal the effect of prematurity on language development. Four studies investigated the association between risk factors in general and problems in language development. One study evaluated school-age children and associated Apgar scores with SLI. The authors' recommendation was unanimous about the monitoring and early intervention. We conclude that the risk factors listed in the study negatively influence children's language development. We reinforce the recommendation of early and qualified care for these children, as it contributes to proper development, in order to avoid and / or minimize risks and future changes.

Fatores de risco no desenvolvimento da linguagem de crianças menores de dois anos atendidas em serviço especializado / Risk factors in language development of children under two years of age at a specialized service

Estudo exploratório, transversal que objetivou identificar os fatores de risco para o desenvolvimento associados às alterações de linguagem em crianças aos 18 meses acompanhadas em um serviço especializado de um município paulista. Participaram crianças atendidas no Serviço de Estimulação Precoce entre 01 de janeiro de 2013 e 31 de dezembro de 2015. Os dados foram obtidos através dos prontuários do serviço. As variáveis estudadas foram: peso ao nascer, idade gestacional, índice de Apgar, ocorrências clínicas (pré-natal, parto e pós-parto) e anomalias congênitas. Na fase descritiva, caracterizou-se os participantes, a partir das variáveis de interesse, sendo calculadas frequências e porcentagens das variáveis. Na fase analítica, buscou-se associações entre a variável dependente (atraso no desenvolvimento) e as demais variáveis, utilizou-se ainda modelos de regressão logística multinomial para estimar a chance de ocorrência das variáveis categóricas. O projeto de pesquisa foi aprovado pelo Comitê de Ética em Pesquisa da Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo (CAAE 61587916.0.0000.5393; Ofício CEP-EERP-USP nº373/2016), após anuência da Secretaria Municipal de Saúde. Nos três anos elencados para o estudo observou-se que 78 prontuários (56,9%) eram de crianças que deram entrada no serviço no ano de 2013, 49 (35,8%) em 2014, e 10 (7,3%) no ano de 2015. A maioria das crianças era do sexo masculino, com nascimentos distribuídos em sua maioria, entre os hospitais 1 e 2 e grande parte foi identificada com mais de um risco ao nascimento. A média da idade materna foi de 28 anos, com registros que indicavam, em sua maioria, mais de uma intercorrência durante a gestação, parto e pós-parto. Após a caracterização inicial das variáveis, as crianças foram divididas em três grupos: G1 - detectadas com atrasos no desenvolvimento da linguagem, encaminhadas para terapia fonoaudiológica aos 18 meses; G2 - crianças que passaram pelo retorno aos 18 meses e foram reagendadas para retorno aos dois anos, devido a dúvida quanto ao atraso ou não nas habilidades esperadas, recebendo alta neste; G3 - encaminhadas antes dos 18 meses para terapia, devido atraso significativo no desenvolvimento global. A partir dessa distribuição, buscou-se verificar associação entre os grupos e as variáveis mencionadas. O teste exato de Fisher indicou associação significante (p<0,001) entre os grupos em relação à variável anomalias congênitas. A análise de regressão logística indicou que crianças sem registros de intercorrências durante a gestação e no parto e nascimento, tiveram menores chances de evoluir com atrasos no desenvolvimento da linguagem. Aquelas nascidas prematuras apresentaram chance 8,51 vezes maior de terem, como desfecho, atraso na linguagem do que as crianças nascidas a termo e pós-termo. Crianças com valores de Apgar inferior a 4 no primeiro minuto e 7 no 5º minuto tiveram maior chance de apresentar atrasos; o baixo peso ao nascer também aumentou as chances deste desfecho. Os resultados deste estudo apontam para a necessidade da pronta detecção e encaminhamento precoce dessas crianças para serviços especializados, visando minimizar e/ou até evitar agravos futuros

This exploratory, cross-sectional study aimed at identifying the developmental risk factors associated with language changes in children at 18 months followed at a specialized service in a city of São Paulo. Participants were children attending the Early Stimulation Service between January 1, 2013 and December 31, 2015. Data were obtained from the service charts. The variables studied were birth weight, gestational age, Apgar score, clinical occurrences (prenatal, delivery and postpartum) and congenital anomalies. In the descriptive phase, the participants were characterized by the variables of interest, and the frequencies and percentages were calculated. In the analytical phase, we sought associations between the dependent variable (developmental delay) and the other variables, and multinomial logistic regression models were used to estimate the chance of occurrence of the categorical variables. The study was approved by the Research Ethics Committee of the University of São Paulo at Ribeirão Preto College of Nursing (CAAE 61587916.0.0000.5393; CEP-EERP-USP no. 373/2016), after consent of the Municipal Health Department. In the three years listed for the study, it was observed that 78 medical records (56.9%) belonged to the children who entered the service in 2013, 49 (35.8%) in 2014, and 10 (7.3%), in the year 2015. Most of the children were male, with births mostly distributed between hospitals 1 and 2, and most of them were identified as having more than one birth risk. The mean of maternal age was 28 years, with records indicating, for the most part, more than one intercurrence during pregnancy, delivery and postpartum. After the initial characterization of the variables, children were divided into three groups: G1 - children who were detected with delays in language development, referred for speech therapy at 18 months. G2 was related to children who returned for appointment at 18 months of age, and were rescheduled for return with two years, due to doubts related to delay or due they had no expected abilities; those children received discharge at two years old; and G3 was for children who was referred before 18 months for therapy, due to significant delay in overall development. From this distribution, we sought to verify association between the groups and the mentioned variables. The Fisher exact test indicated a significant association (p<0.001) between the groups in relation to the variable congenital anomalies. Logistic regression analysis indicated that children with no records of intercurrences during gestation, delivery and childbirth were less likely to evolve with delays in language development. Those children born premature presented an 8.51 times greater chance of having, as an outcome, delay in language than children born at term and post-term. Children with Apgar values less than 4 in the first minute and 7 in the fifth minute had a greater chance of delays; low birth weight also increased the odds of this outcome. The results of this study point to the need for prompt detection and early referral of these children to specialized services, in order to minimize and / or avoid future disorders

Intervenciones que promueven el inicio, duración y exclusividad de la lactancia materna: Una revisión de revisiones / Interventions that promote iniciation, duration and exclusivity of breastfeeding. An umbrella review

El propósito de este estudio es aportar una síntesis de los resultados de revisiones sistemáticas (RS) disponibles en torno a la efectividad de intervenciones destinadas a promover la LM, a través de la realización de una revisión de revisiones (RR). Para ello, se realizó una búsqueda bibliográfica utilizando las palabras clave: "breastfeeding", "promotion", "intervention" y "systematic review", encontrándose nueve RS que cumplieron con los criterios de inclusión. Los resultados se presentan en relación a nueve dimensiones de análisis, que se aplicaron a cada una de las RS seleccionadas: objetivos, participantes, criterios de inclusión/exclusión, número y tipos de estudios incluidos, tipos de intervenciones realizadas, escenarios donde se desarrollaron las intervenciones, marco conceptual que sustentó la intervención, resultados evaluados e instrumentos de medida y conclusiones de cada una de las RS. Los resultados de esta RR no permiten extraer información concluyente en cuanto a la evidencia del impacto que tienen las intervenciones sobre la promoción, el inicio, la duración y la exclusividad de la LM. Lo anterior, debido a la diversidad de intervenciones realizadas, la multiplicidad de variables intervinientes y por falta de rigurosidad metodológica y sustento teórico de algunas de las RS analizadas.

The aim of this study is to provide a synthesis of the results available of systematic reviews (SR) on the effectiveness of interventions of breastfeeding (BF) promotion, through an umbrella review (UR). A bibliographic search was carried out using the keywords: "breastfeeding", "promotion", "intervention" and "systematic review", finding nine SR that met the inclusion criteria. The results are presented in relation to nine dimensions of analysis, which were applied to each of the SR selected: objectives, participants, inclusion/exclusion criteria, number and types of studies included, types of interventions performed, settings, conceptual framework that supported the intervention, results and instruments, and conclusions of each SR. The results of this UR do not allow the extraction of conclusive information about the evidence of the impact of the interventions on the promotion, initiation, duration and exclusivity of BF. This, due to the diversity of interventions, the multiplicity of intervening variables and the lack of methodological rigor and theoretical support of some SRs analyzed.

Fatores de risco no desenvolvimento da linguagem de crianças menores de dois anos atendidas em serviço especializado / Risk factors in language development of children under two years of age at a specialized service

Estudo exploratório, transversal que objetivou identificar os fatores de risco para o desenvolvimento associados às alterações de linguagem em crianças aos 18 meses acompanhadas em um serviço especializado de um município paulista. Participaram crianças atendidas no Serviço de Estimulação Precoce entre 01 de janeiro de 2013 e 31 de dezembro de 2015. Os dados foram obtidos através dos prontuários do serviço. As variáveis estudadas foram: peso ao nascer, idade gestacional, índice de Apgar, ocorrências clínicas (pré-natal, parto e pós-parto) e anomalias congênitas. Na fase descritiva, caracterizou-se os participantes, a partir das variáveis de interesse, sendo calculadas frequências e porcentagens das variáveis. Na fase analítica, buscou-se associações entre a variável dependente (atraso no desenvolvimento) e as demais variáveis, utilizou-se ainda modelos de regressão logística multinomial para estimar a chance de ocorrência das variáveis categóricas. O projeto de pesquisa foi aprovado pelo Comitê de Ética em Pesquisa da Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo (CAAE 61587916.0.0000.5393; Ofício CEP-EERP-USP nº373/2016), após anuência da Secretaria Municipal de Saúde. Nos três anos elencados para o estudo observou-se que 78 prontuários (56,9%) eram de crianças que deram entrada no serviço no ano de 2013, 49 (35,8%) em 2014, e 10 (7,3%) no ano de 2015. A maioria das crianças era do sexo masculino, com nascimentos distribuídos em sua maioria, entre os hospitais 1 e 2 e grande parte foi identificada com mais de um risco ao nascimento. A média da idade materna foi de 28 anos, com registros que indicavam, em sua maioria, mais de uma intercorrência durante a gestação, parto e pós-parto. Após a caracterização inicial das variáveis, as crianças foram divididas em três grupos: G1 - detectadas com atrasos no desenvolvimento da linguagem, encaminhadas para terapia fonoaudiológica aos 18 meses; G2 - crianças que passaram pelo retorno aos 18 meses e foram reagendadas para retorno aos dois anos, devido a dúvida quanto ao atraso ou não nas habilidades esperadas, recebendo alta neste; G3 - encaminhadas antes dos 18 meses para terapia, devido atraso significativo no desenvolvimento global. A partir dessa distribuição, buscou-se verificar associação entre os grupos e as variáveis mencionadas. O teste exato de Fisher indicou associação significante (p<0,001) entre os grupos em relação à variável anomalias congênitas. A análise de regressão logística indicou que crianças sem registros de intercorrências durante a gestação e no parto e nascimento, tiveram menores chances de evoluir com atrasos no desenvolvimento da linguagem. Aquelas nascidas prematuras apresentaram chance 8,51 vezes maior de terem, como desfecho, atraso na linguagem do que as crianças nascidas a termo e pós-termo. Crianças com valores de Apgar inferior a 4 no primeiro minuto e 7 no 5º minuto tiveram maior chance de apresentar atrasos; o baixo peso ao nascer também aumentou as chances deste desfecho. Os resultados deste estudo apontam para a necessidade da pronta detecção e encaminhamento precoce dessas crianças para serviços especializados, visando minimizar e/ou até evitar agravos futuros

This exploratory, cross-sectional study aimed at identifying the developmental risk factors associated with language changes in children at 18 months followed at a specialized service in a city of São Paulo. Participants were children attending the Early Stimulation Service between January 1, 2013 and December 31, 2015. Data were obtained from the service charts. The variables studied were birth weight, gestational age, Apgar score, clinical occurrences (prenatal, delivery and postpartum) and congenital anomalies. In the descriptive phase, the participants were characterized by the variables of interest, and the frequencies and percentages were calculated. In the analytical phase, we sought associations between the dependent variable (developmental delay) and the other variables, and multinomial logistic regression models were used to estimate the chance of occurrence of the categorical variables. The study was approved by the Research Ethics Committee of the University of São Paulo at Ribeirão Preto College of Nursing (CAAE 61587916.0.0000.5393; CEP-EERP-USP no. 373/2016), after consent of the Municipal Health Department. In the three years listed for the study, it was observed that 78 medical records (56.9%) belonged to the children who entered the service in 2013, 49 (35.8%) in 2014, and 10 (7.3%), in the year 2015. Most of the children were male, with births mostly distributed between hospitals 1 and 2, and most of them were identified as having more than one birth risk. The mean of maternal age was 28 years, with records indicating, for the most part, more than one intercurrence during pregnancy, delivery and postpartum. After the initial characterization of the variables, children were divided into three groups: G1 - children who were detected with delays in language development, referred for speech therapy at 18 months. G2 was related to children who returned for appointment at 18 months of age, and were rescheduled for return with two years, due to doubts related to delay or due they had no expected abilities; those children received discharge at two years old; and G3 was for children who was referred before 18 months for therapy, due to significant delay in overall development. From this distribution, we sought to verify association between the groups and the mentioned variables. The Fisher exact test indicated a significant association (p<0.001) between the groups in relation to the variable congenital anomalies. Logistic regression analysis indicated that children with no records of intercurrences during gestation, delivery and childbirth were less likely to evolve with delays in language development. Those children born premature presented an 8.51 times greater chance of having, as an outcome, delay in language than children born at term and post-term. Children with Apgar values less than 4 in the first minute and 7 in the fifth minute had a greater chance of delays; low birth weight also increased the odds of this outcome. The results of this study point to the need for prompt detection and early referral of these children to specialized services, in order to minimize and / or avoid future disorders

Atenção à saúde ocular de crianças com alterações no desenvolvimento em serviços de intervenção precoce: barreiras e facilitadores / Eye health attention of children with developmental disorders in early intervention services: barriers and facilitators

RESUMO Objetivo: Identificar fatores que influenciam na detecção precoce de deficiência visual e o início da intervenção precoce de crianças com alterações no desenvolvimento. Métodos: O estudo constituiu-se de levantamento, exploratório e descritivo, que contou com a aplicação de questionários com representantes institucionais, profissionais da equipe dos serviços de intervenção precoce e mães ou cuidadores das crianças atendidas. Os dados receberam tratamento estatístico através dos softwares Sistema de Análise Estatística SAS 9.3, Wolfram Mathematica e Microsoft Excel.A amostra constituiu-se de 434 sujeitos (19 representantes institucionais, 142 profissionais dos serviços e 273 mães/cuidadores das crianças atendidas). Resultados: A análise dos resultados revelou valores estatísticos de p-valor=0,0119 para a realização do teste do olhinho no que se refere ao início da intervenção precoce. A mãe recebe orientação quanto ao desenvolvimento da visão que obteve valores de p-valor=0,0106 para início da intervenção oportuna e valores de p-valor=0,0061 para primeira consulta ao oftalmologista. Conclusão: Realizar o teste do olhinho constituiu-se fator facilitador para o início da intervenção precoce e ter uma deficiência exclusivamente visual e frequentar instituição privada como barreira.A entrada tardia em serviço de intervenção precoce afeta negativamente a idade da primeira consulta oftalmológica. A mãe recebe orientação quanto ao desenvolvimento da visão que revelou-se fator facilitador para a primeira consulta ao oftalmologista e para início da intervenção oportuna. O campo da saúde ocular constitui-se demanda da saúde pública e requer ações e programas educativos direcionados aos familiares, profissionais e gestores institucionais.

ABSTRACT Objective: To identify factors that influence on the early detection of visual impairment and in early intervention onset for children with developmental disorders. Methods: The study consisted of a exploratory and descriptive survey, which included the use of questionnaires with institutional representatives, professional team of early intervention and mothers or caregivers of children served in these services. The data received statistical analysis through software SAS Statistical Analysis System 9.3, Wolfram Mathematica and Microsoft Excel. The sample consisted of 434 subjects (19 institutional representatives, 142 professionals of the early intervention services and 273 mothers/ caregivers of children served). Results: The results showed statistical values of p=0.0119 for the realization of eye test with regard to the beginning of early intervention. The mother receive guidance on the development of vision obtained values of p-value=0.0106 for early intervention start and values of p=0.0061 for the first visit to the ophtalmologist. Conclusion: Realise the eye test constitutes as a facilitating factor for the onset of early intervention and have an exclusively visual impairment and attend private institution as a barrier. Late entry into early intervention service adversely affects the age of first ophthalmologic consultation.The mother receive guidance on the development of vision showed as a facilitating factor for the first visit to the ophtalmologist and start of timely intervention.The field of eye health constitutes as public health demand and requires attention to actions and educational programs directed to families, professionals and institutional managers who provide services to children.

Decreased Body Mass Index in Schoolchildren After Yearlong Information Sessions With Parents Reinforced With Web and Mobile Phone Resources: Community Trial.

BACKGROUND: The obesity pandemic has now reached children, and households should change their lifestyles to prevent it. OBJECTIVE: The objective was to assess the effect of a comprehensive intervention on body mass index z-score (BMIZ) in schoolchildren. METHODS: A yearlong study was conducted at 4 elementary schools in Mexico City. Intervention group (IG) and control group (CG) were split equally between governmental and private schools. Three educational in-person parents and children sessions were held at 2-month intervals to promote healthy eating habits and exercise. To reinforce the information, a website provided extensive discussion on a new topic every 2 weeks, including school snack menus and tools to calculate body mass index in children and adults. Text messages were sent to parents' mobile phones reinforcing the information provided. The IG contained 226 children and CG 181 children. We measured their weight and height and calculated BMIZ at 0, 6, and 12 months. RESULTS: The CG children showed a change of +0.06 (95% CI 0.01, 0.11) and +0.05 (95% CI 0.01, 0.10) in their BMIZ at 6 and 12 months, respectively. The BMIZ of IG children decreased by -0.13 (95% CI -0.19 to -0.06) and -0.10 (95% CI -0.16 to -0.03), respectively, and the effect was greater in children with obesity. CONCLUSIONS: The comprehensive intervention tested had beneficial effects, preserved the BMIZ of normal weight children, and reduced the BMIZ of children with obesity.