text:
The Big Abortion Lie
In America, we fight to preserve the lives of unhatched sea turtles while we fight to end the lives of unborn babies.
By Drew Allen
The list of reasons I could never be a Democrat grows by the day. But if I had to choose just one issue that has prevented such an ill-chosen and indefensible association, it would be abortion. No issue better exposes the illogic, immorality, and delusion of the Democratic Party than the issue of abortion.
Democrats increasingly have called for the abolishment of capital punishment. Beto O'Rourke, for example, has said he opposes the death penalty "on moral grounds." California Governor Gavin Newsom has said, "the intentional killing of another person is wrong."
But while Democrats proclaim that the federal government should not be involved in taking the lives of guilty murderers, Democrats simultaneously demand that the federal government should be involved in taking the lives of innocent, unborn babies—via federally subsidized abortions.
The lives of murderers are precious. Taking their lives is immoral and wrong. But the lives of innocent unborn children are unimportant. The "intentional killing" of the unborn is both moral and a right.
To justify such obvious and undeniable illogic, Democrats have convinced themselves that "babies are not babies until they are born." This is what former NPR Standards and Practices editor Mark Memmott wrote in his "guidance reminder" memo, in which he instructed employees to avoid using terms like "unborn," because it "implies that there is a baby inside a pregnant woman, not a fetus."
When pesky things like reality and truth obstruct the Left's objectives, the Left simply substitutes new words to fit their false narratives and manipulate people's emotions to shift public opinion.
The unborn isn't a baby. It's just a "fetus." Looting isn't looting. It's just "smashing and grabbing." Firearms are "assault rifles." Illegal immigrants are "undocumented." Pro-abortion advocates are "pro-choice."
If the Left ever acknowledged that the unborn were babies, then abortion would have to be recognized as murder; both immoral and wrong.
Thirty eight states have fetal homicide laws. In these states, if someone other than the pregnant mother is responsible for taking the unborn child's life, it is considered murder. So if a man shoves a pregnant woman down the stairs and the injury results in the death of her unborn child, the man is held responsible and punished.
But if the same pregnant mother chooses to have an abortion and she is responsible for the death of her unborn child, this is considered a woman's right. In other words, the status of the unborn child, either as a precious human life or as a useless clump of cells, is wholly subjective.
If the pregnant mother wants to give birth, then the unborn baby is treated as a precious human being with rights. But if the pregnant mother doesn't want to have the child, then the unborn baby is treated as an invasive clump of cells. The status of the unborn is determined by the intention of the mother either to get pregnant or not.
A pregnant mother who suffers a miscarriage mourns the loss of her unborn child's life. But a pregnant mother who has an abortion celebrates her right to choose. This "right to choose" is built on a lie; the lie that the unborn is not a valuable human life.
The life of an unhatched sea turtle is viewed with greater reverence than the unborn human child. In Florida, disturbing a sea turtle, its nests or hatchlings is illegal. The life of the unhatched sea turtle is protected by law.
In many coastal counties, property owners must adhere to strict beach-lighting restrictions because "nighttime lighting tends to lure hatchling turtles to crawl inland instead of seaward after emerging from their beach nests." In Florida in 2014, those who violated the turtle lighting ordinance in Brevard County faced $500 fines and six months in county jail.
Pro-abortion activists are really anti-responsibility activists. They all talk as if pregnancy is due just happens to women without their participation or agency.
I hate to be the purveyor of harsh truths, but a woman can choose whether or not to engage in the sexual behavior that results in an unwanted pregnancy. Not having sex is proven to prevent unwanted pregnancy 100 percent of the time. But why engage in responsible sexual behavior that helps prevent most unwanted pregnancies when a woman can simply get an abortion?
According to the National Center for Health Statistics, only "19% of men aged 15-44 reported that they used a condom 'every time' they had intercourse in the past 12 months." If pro-abortion women are so upset about the unfair burden of being the gender that gets pregnant, why are women not demanding men wear condoms to prevent their pregnancy in the first place?
The truth is, we wouldn't be debating the right to kill babies if Americans viewed unborn babies with the same reverence as we do unhatched sea turtles. If a woman had to accept the responsibility of motherhood and men, fatherhood, both women and men would behave more responsibly.
There are more than 600,000 abortions reported each year in the United States because more than 600,000 women know they have the choice to abort them.
As Ronald Reagan said, "I've noticed that everyone who is for abortion has already been born."
About Drew Allen
Drew Allen is the host of "The Drew Allen Show" podcast. He is a Texas-bred, California-based and millennial author, columnist, and political analyst. His work can be read and seen and heard at drewthomasallen.com.


High School and Middle School Utah teachers from around the state ramped up for Greenpower at a recent workshop. The Greenpower Electric Car Challenge is a STEM project-based program that leverages the excitement of motorsport to inspire students from elementary school through college and university to excel in STEM education. Founded in the UK in 1999, this highly successful initiative emphasizes applied learning, sustainability, teamwork and technological literacy.
Hosted at Edith Bowen Laboratory School in Logan, UT, GreenpowerUSA and Utah State University's GEAR UP program provided 11 Utah middle and high schools educators an electric car building workshop. Teachers will take those real-world engineering skills back to the classroom to challenge their students to compete in Greenpower.
Thirty-two teachers were tasked with connecting Greenpower to new Electric Vehicle and Roadway (EVR) research being conducted on the USU Innovations Campus. The Greenpower battery powered vehicles will provide students with applied physics, mathematics, computer programming, digital prototyping, problem solving, leadership and teamwork.
The teachers are excited to have their students participate in the electric-powered race car project. Greenpower met the teachers' objective of providing relevance for the students while they are having fun.
Greenpower is looking for motivated teachers interested in bringing this challenge to students of all ages. Take a look at some of the project resources available and get involved at http://www.greenpowerusa.net.


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Albina Africano (nom complet: Albina Faria de Assis Pereira Africano, Luanda, Angola Portuguesa, 3 de juny de 1945) és una química i política angolesa.

Biografia

Formación
Albina va néixer el 1945, a Luanda, la capital de la Colònia portuguesa d'Angola. Va acabar els seus Estudis al Institut Industrial a la capital colonial.

Al 1972, Angola va assolir la seva independència, i Africano a Luanda va començar els seus estudis. Va completar la seva llicenciatura en ciències químiques per la Universitat Agostinho Neto, el 1982. Després d'aquest estudi, es va decidir a seguir Ciències de la producció de petroli, per especialitzar-se. S'estableix a Anvers (1984), després a l'Institut de Ciències de Petroli a França (1987), un període de Pràctiques de Lindsey a Gran Bretanya (1988) i al College of Pretroleum and Energy Studies, Oxford (1989).

Carrera profesional
A més a més de la seva formació acadèmica i la seva especialització, Africano va treballar en diverses posicions de l'Estat d'Angola. Després dels seus estudis va treballar com a professora (1968-1975), fins a 1983, que es va celebrar la independència d'Angola, amb la gestió del Laboratori Nacional per a l'anàlisi química.

Després es va canviar a la producció d'oli de Fina-Angola, on va treballar com a química durant dos anys abans d'ésser ascendida a cap de departament a la refineria de Fina a Angola (1985-1991). Des d'agost de 1991 a desembre de 1992 va ser Presidenta del Consell d'Administració de la productora petroliera estatal Sonangol. El desembre de 1992, es va traslladar al govern d'Angola, on va dirigir el Departament d'assumptes de petroli de 1999 a 2000 com a Ministra d'Indústria.

De llavors ençà, és assessora especial del president per a assumptes regionals. Ara com ara, és presidenta del Banc d'Aliments d'Angola.

Africano és una de les líders africanes més respectades i considerades per la seva gran experiència d'haver supervisat la tremenda expansió del sector petrolier. Chevron, Elf Aquitaine, BP i Exxon eren atretes pel potencial d'exploració de petroli a Angola. La tecnòcrata MPLA, Albina Assis no és directament responsable de la falta de transparència al sector petrolier d'Angola.

Premis
Al 2015, va rebre el Premi Mello Feminina - un premi a dones portugueses pels seus assoliments excel·lents. El premi és atorgat per l'empresa portuguesa Matriz Portuguesa.

Referències

Enllaços externs
 Reportatge a l'autora, 2015

Químics africans
Polítics del Moviment Popular per a l'Alliberament d'Angola
Persones de Luanda
Alumnes de la Universitat Agostinho Neto
Naixements del 1945

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This website will contain all the informations or documents linked to this project.
Modern recording technologies combine a variety of sources to convey content from the lec-ture hall: Slides or other presentations are combined with audio and video signals of the in-structor, the students and other relevant sources. All of these have to be synchronized tem-porally and structurally with Flash being the preferred technology to do so today. With the advent of HTML5, this integration has to be newly defined, developed and tested. The thesis is to contribute to this effort with an analysis of the status quo, the requirements and the chal-lenges of moving from monolithic Flash to modular HTML5. As a result, an implementation is to showcase the solution of at least one of the challenge elaborated.
If you need further informations, please don't hesitate to contact me.


text:
Flood Warning is in effect
Young cancer patient's dream lives on in art exhibit displayed at Cummer Museum
Young cancer patient?s dream lives on in art exhibit displayed a Cummer Museum
By: Dani Bozzini, Action News Jax
Updated: January 22, 2020 - 11:49 PM
JACKSONVILLE, Fla. — More than 100 people got a chance to see an 18-year-old's beautiful artwork on display.
It was Alexis Mirkov's dream, but she passed away from ovarian cancer just two weeks ago.
The plan was for her to be there Thursday at the Cummer Museum of Art and Gardens, but the show went on in her honor.
"This was her dream, this is what she wanted" explained Kathy Moses, her fiancé's mother.
For Alexis, art was everything, whether it was a painting, a poem, or a drawing. Her fiancé Kyle Moses says it was her escape.
"For her it was her entire life," said Kyle Moses.
And seeing her artwork in a gallery, well, that was her biggest wish; one that Moses, his family and the Dreams Come True Jacksonville organization set out to make happen.
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Genene Jones: 'Angel of Death' PICU nurse gets life for 1981 murder of 11-month-old boy
"It makes me feel good, but it also makes me feel sad that she's not here with me to witness this because that's what the original plan was," said Moses.
For the past year, Alexis was battling ovarian cancer, going through chemotherapy, surgery, even radiation.
DREAM ART SHOW: "This was her dream."
Art was everything for 18-year-old Alexis Mirkov, & her biggest wish was to see it on display.
That dream came true tonight, and although she wasn't physically there to see it, her family says she was watching. More at 11 @ActionNewsJax pic.twitter.com/TsLsFrJHbE
— Dani Bozzini (@DaniANjax) January 23, 2020
Two weeks ago, the cancer become too intense to overcome, and she passed away.
But her spirit was there, inside that gallery with those she loved most.
"She's loving every minute of it, she's right here with me and my necklace. We all have a part of her with us, so she's here she's watching this," explained Kathy Moses.
About 120 people saw her dream come alive inside the Cummer Museum Art and Gardens.
Friends, family and loved ones got to share a glimpse of the beauty she created.
"It means everything! This is what she wanted and this was her dream. Art was her dream!" exclaimed Kyle.
STAY UPDATED: Download the Action News Jax app for live updates on breaking stories
Baby François' langur, or leaf monkey, born at Philadelphia Zoo
By Michelle Ewing, Cox Media Group National Content Desk

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text:
30 December 2021 |
Willmington name set to return to touring car racing
Braydan Willmington will take on a new challenge in 2022 and will compete in the Supercheap Auto TCR Australia Series.
The second-generation racer and his privateer team has secured the ex-Garry Rogers Motorsport Alfa Romeo Giulietta Veloce that Jordan Cox used successfully this year, recording four race wins and finishing third overall in the standings.
Willmington took delivery of the Alfa Romeo recently and shook it down at the 1.6km Pheasant Wood circuit in New South Wales.
His new commitment to the Supercheap Auto TCR Australia Series means an end of his S5000 competition that he has been involved in since 2019.
It will be a return of the Willmington name to Australian touring car racing. Braydan is the son of former driver Garry who was a perennial privateer in local touring car racing in the 1980s and 1990s, competing in 21 Bathurst 1000s.
While this will be Willmington's touring car racing debut, he is no stranger to front-wheel drive sedan racing, having competed in speedway and state-based circuit racing.
Willimington will get more testing in his Alfa Romeo TCR car at Sydney Motorsport Park ahead of the opening round of the Supercheap Auto TCR Australia Series at Symmons Plains Raceway on February 11-13.
CLICK HERE for tickets to Race Tasmania, featuring TCR, the S5000 Australian Drivers' Championship, the Turtle Wax Trans Am Series, plus three quality Tasmanian support classes.
Braydan Willmington
TCR Australia driver
"I'm used to driving these sorts of cars, so it should be a much easier learning curve compared to the S5000," said Willmington.
"I've done quite a bit of grass roots circuit racing, and almost all of that was front wheel drive. I do have a lot more knowledge of these types of cars, and dad is a lot more excited that we are going touring car racing too! Hopefully it will be easier for us because as much as we enjoyed the S5000, it was really an alien race car to us.
"My first impressions of the TCR is that they are very cool. They have a decent amount of power, very stable and the Alfa is really nice to drive. I enjoyed the test and I can't wait to get back in the car.
"I'd like to be in the top 10 at some point. Whether that's at the start or end of the season, we'll see. But we would like to consistently run in the top 10, be that this year or next year.
"I did enjoy the challenge of S5000. We were frustrated that we didn't have the results, but I didn't have the budget to risk damage. If I put it in the wall, our season was done.
"I feel like I was capable, but there was something on my mind that kept me from pushing it to the maximum with a fear from being out for the rest of the season."


text:
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THEMATIC SECTION: METHODOLOGICAL ASPECTS IN THE ENANI-2019 • Cad. Saúde Pública 37 (8) • 2021 • https://doi.org/10.1590/0102-311X00293320 copy
Methodological aspects of the anthropometric assessment in the Brazilian National Survey on Child Nutrition (ENANI-2019): a population-based household survey
Aspectos metodológicos da avaliação antropométrica no Estudo Nacional de Alimentação e Nutrição Infantil (ENANI-2019): inquérito domiciliar de base populacional
Aspectos metodológicos de la evaluación antropométrica en el Estudio Nacional de Alimentación y Nutrición Infantil (ENANI-2019): encuesta domiciliaria de base poblacional
Luiz Antonio dos Anjos
Departamento de Nutrição Social, Universidade Federal Fluminense, Rio de Janeiro, Brasil.http://orcid.org/0000-0002-5257-6912
Haroldo da Silva Ferreira
Faculdade de Nutrição, Universidade Federal de Alagoas, Maceió, Brasil.http://orcid.org/0000-0002-1789-3138
Nadya Helena Alves-Santos
Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil.http://orcid.org/0000-0002-0098-6047
Maiara Brusco de Freitas
Cristiano Siqueira Boccolini
Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.http://orcid.org/0000-0002-4804-5641
Elisa Maria de Aquino Lacerda
Inês Rugani Ribeiro de Castro
Instituto de Nutrição, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil.http://orcid.org/0000-0002-7479-4400
Virginia Gaissionok Mariz
Bruno Mendes Tavares
Instituto de Ciências Biológicas, Universidade Federal do Amazonas, Manaus, Brasil.http://orcid.org/0000-0003-0956-6484
Denise Pretucci Gigante
Faculdade de Nutrição, Universidade Federal de Pelotas, Pelotas, Brasil.http://orcid.org/0000-0001-7309-5838
Gilberto Kac
The article presents methodological aspects of anthropometric assessment of nutritional status in children under five years of age and their biological mothers. It discusses the strategies used for training and data collection in the Brazilian National Survey on Child Nutrition (ENANI-2019). ENANI-2019 is a population-based household survey conducted in 123 municipalities in Brazil's 26 states and the Federal District. The anthropometric measurements were body mass and length/stature. The equipment was purchased according to its measurement capacity and precision, portability, and cost-benefit ratio after an extensive market search. The study used internationally established procedures described in manuals, videos, and support material developed for the study by a group of experts. The interviewers were trained to perform the anthropometric measurements and were assessed according to technical measurement error, which was considered adequate (0.30cm) for the children's length/stature measurements. Measurement errors were identified, and the interviewers were retrained when necessary. Of the 14,558 children in the sample, body mass and length/stature measurements were taken in duplicate in 13,835 and 13,693 children, respectively. The standardized methodological aspects will be helpful in future population studies and were essential for obtaining greater reliability in the data for generating current evidence on the anthropometric assessment of the nutritional status of Brazilian children under five years of age, allowing new perspectives for public policy development.
Infant; Child; Preschool Child; Anthropometry; Body Weight
Este artigo apresenta aspectos metodológicos da avaliação antropométrica do estado nutricional de crianças menores de cinco anos e suas mães biológicas, e as estratégias utilizadas para o treinamento e a coleta de dados do Estudo Nacional de Alimentação e Nutrição Infantil (ENANI-2019). O ENANI-2019 é um inquérito populacional de base domiciliar realizado em 123 municípios dos 26 estados da Federação e o Distrito Federal. As medidas antropométricas coletadas foram a massa corporal e o comprimento/estatura. Os equipamentos foram adquiridos segundo a sua capacidade e precisão de medida, portabilidade e custo-benefício após ampla pesquisa de mercado. Utilizaram-se procedimentos estabelecidos internacionalmente e descritos em manuais, vídeos e material de apoio desenvolvidos para o estudo por um grupo de especialistas. Os entrevistadores foram treinados para a realização das medidas antropométricas e avaliados segundo o erro técnico de medição, que foi considerado adequado (0,30cm) para as medidas de comprimento/estatura das crianças. Os erros de medição foram identificados e os entrevistadores retreinados quando necessário. Nas 14.558 crianças identificadas, foram obtidas medidas de massa corporal e o comprimento/estatura em duplicata em 13.835 e 13.693 crianças, respectivamente. Os aspectos metodológicos padronizados serão úteis para estudos populacionais futuros e foram fundamentais para se obter maior grau de confiabilidade dos dados na geração de evidências atualizadas sobre a avaliação antropométrica do estado nutricional de crianças brasileiras menores de cinco anos, possibilitando novas perspectivas para o desenvolvimento de políticas públicas.
Lactente; Criança; Pré-Escolar; Antropometria; Peso Corporal
Este artículo presenta aspectos metodológicos de la evaluación antropométrica en el estado nutricional de niños menores de cinco años y sus madres biológicas, y las estrategias utilizadas para el entrenamiento y la recogida de datos del Estudio Nacional de Alimentación y Nutrición Infantil (ENANI-2019). El ENANI-2019 es una encuesta poblacional de base domiciliaria, realizada en 123 municipios de los 26 estados de la Federación y el Distrito Federal. Las medidas antropométricas recogidas fueron la masa corporal y la longitud/estatura. Los equipos se adquirieron según su capacidad y precisión de medida, portabilidad y coste-beneficio, tras una amplia investigación de mercado. Se utilizaron los procedimientos establecidos internacionalmente y descritos en manuales, vídeos y material de apoyo, desarrollados para el estudio por un grupo de especialistas. Los entrevistadores fueron entrenados para la realización de las medidas antropométricas, y fueron evaluados según el error técnico de medición, que fue considerado adecuado (0,30cm) para las medidas de longitud/estatura en los niños. Los errores de medición fueron identificados y los entrevistadores, reentrenados cuando era necesario. En los 14.558 niños identificados, se obtuvieron medidas de masa corporal y longitud/estatura por duplicado en 13.835 y 13.693 niños, respectivamente. Los aspectos metodológicos estandarizados serán útiles para estudios poblacionales futuros y fueron fundamentales para que se obtuviera un mayor grado de confiabilidad de los datos, así como en la generación de evidencias actualizadas sobre la evaluación antropométrica del estado nutricional de niños brasileños menores de cinco años, posibilitando nuevas perspectivas para el desarrollo de políticas públicas.
Palabras-clave:
Lactante; Niño; Preescolar; Antropometría; Peso Corporal
Health policies are established according to evidence that allows the analysis of the epidemiological relevance of diseases and other health-related events, providing support for priority-setting and preventive, monitoring, and control measures. However, the success of these policies depends on the quality of available information during the process, from the problem's identification to the assessment of the respective measurements 11. Ferreira CS, Cherchiglia ML, César CC. O Sistema de Vigilância Alimentar e Nutricional como instrumento de monitoramento da Estratégia Nacional para Alimentação Complementar Saudável. Rev Bras Saúde Mater Infant 2013; 13:167-77..
Various national or regional surveys have been conducted since the 1970s to assess the nutritional status of the Brazilian population, and that included children under five years of age 22. Instituto Brasileiro de Geografia e Estatística. Perfil estatístico de crianças e mães no Brasil: aspectos nutricionais 1974-1975. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 1982.,33. Monteiro M, Cervini R. Perfil estatístico de crianças e mães no Brasil: aspectos de saúde e nutrição de crianças no Brasil, 1989. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 1992.,44. Instituto Brasileiro de Geografia e Estatística. Pesquisa de Orçamentos Familiares 2008-2009: antropometria e estado nutricional de crianças, adolescentes e adultos no Brasil. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2010.,55. Instituto Brasileiro de Geografia e Estatística. Pesquisa de Orçamentos Familiares 2008-2009: análise do consumo alimentar pessoal no Brasil. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2011.,66. Instituto Brasileiro de Geografia e Estatística. Pesquisa sobre Padrões de Vida 1996-1997. Primeira infância. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2000.. Specifically for children and women, it is worth highlighting the three editions of the Brazilian National Demographic and Health Survey on Children and Women (PNDS). The most recent surveys with published results are the PNDS which occurred in 2006 77. Ministério da Saúde. Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher - PNDS 2006: dimensões do processo reprodutivo e da saúde da criança. Brasília: Ministério da Saúde/Centro Brasileiro de Análise e Planejamento; 2009., and the Brazilian National Health Survey (PNS) in 2013, which assessed the nutritional status of Brazilian adults and some aspects of health, food, and nutrition in children under five years of age (in the PNDS) and under two years (in the PNS) and in women 88. Instituto Brasileiro de Geografia e Estatística. Pesquisa Nacional de Saúde, 2013. Ciclos de vida: Brasil e grandes regiões. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2015..
Considering the nutritional, demographic, and epidemiological transition underway in Brazil 99. Batista Filho M, Rissin A. A transição nutricional no Brasil: tendências regionais e temporais. Cad Saúde Pública 2003; 19 Suppl 1:S181-91. and the impact of political and socioeconomic factors on the population health 1010. Rasella D, Hone T, de Souza LE, Tasca R, Basu S, Millett C. Mortality associated with alternative primary healthcare policies: a nationwide microsimulation modelling study in Brazil. BMC Med 2019; 17:82., the population's nutritional status has probably changed substantially since the most recent surveys. Therefore, the available data on the nutritional status of Brazilian mothers and children need to be updated to back the formulation or reformulation of the Brazilian National Food and Nutrition Policy (PNAN) 1111. Departamento de Atenção Básica, Secretaria de Atenção à Saúde, Ministério da Saúde. Política Nacional de Alimentação e Nutrição. 2ª Ed. Brasília: Ministério da Saúde; 2007.. The Brazilian National Survey on Child Nutrition (ENANI-2019) aimed to expand and update knowledge on the nutritional status of Brazilian children under five years of age and was organized in three domains: assessment of breastfeeding practices and dietary intake; anthropometric assessment of nutritional status; and assessment of micronutrient deficiencies 1212. Alves-Santos NH, Castro IRR, Anjos LA, Lacerda EMA, Normando P, Freitas MB, et al. General methodological aspects in the Brazilian National Survey on Child Nutrition (ENANI-2019): a population-based household survey. Cad Saúde Pública 2021; 37:e00300020.. The current article presents the methods, procedures, and strategies for training and data collection used in the ENANI-2019 for anthropometric assessment of the nutritional status of children under five years of age and their biological mothers.
Establishment of the Expert Group in the Anthropometry Domain
The project's Executive Committee defined as its strategy the organization of expert groups for each of the three domains of the ENANI-2019. The Anthropometry Group consisted of professors from public universities in Brazil's five major geographic regions and with experience in anthropometric studies. Most were responsible for courses in nutritional assessment. The group also included undergraduate, graduate, and postdoctoral students. The Executive Committee also consisted of professors and researchers from public universities and research institutes with expertise in conducting anthropometric surveys. The Anthropometry Group met regularly and was in charge, together with the Executive Committee, for deliberating on the choice of the best equipment for the measurements, the strategies for administering the training sessions for the field interviewers on standardization of the anthropometric measurements, and the development of field protocols for data collection.
The Anthropometry Group aimed to guarantee and control the quality of the anthropometric data by establishing standardized procedures and developing tools to prevent or minimize errors during the data collection. The procedures were based on international guidelines 1313. Cashin K, Oot L. Guide to anthropometry: a practical tool for program planners, managers, and implementers. Washington DC: Food and Nutrition Technical Assistance III Project (FANTA)/FHI 360; 2018.,1414. United Nations Children's Fund. Recommendations for data collection, analysis and reporting on anthropometric indicators in children under 5 years old. Geneva: World Health Organization/United Nations Children's Fund; 2019.,1515. Centers for Disease Control and Prevention. National Health and Nutrition Examination Survey (NHANES). Anthropometry procedures manual. Atlanta: Centers for Disease Control and Prevention; 2017.,1616. Perumal N, Namaste S, Qamar H, Aimone A, Bassani DG, Roth DE. Anthropometric data quality assessment in multisurvey studies of child growth. Am J Clin Nutr 2020; 112 Suppl 2:806S-15., and those of the Brazilian Ministry of Health 1717. Departamento de Atenção Básica, Secretaria de Atenção à Saúde, Ministério da Saúde. Orientações para a coleta e análise de dados antropométricos em serviços de saúde: norma técnica do Sistema de Vigilância Alimentar e Nutricional - SISVAN. Brasília: Ministério da Saúde; 2011. for collecting, quality control, and presentation of the anthropometric data.
Choice of equipment
The anthropometric equipment purchase considered an extensive search on the market, considering the manufacturer's experience and credibility and the equipment's model, availability in Brazil, measurement capacity and precision, weight, size, power source (battery, electricity, solar), and experience with its use in previous national household surveys. Since this was a household survey, one of the relevant factors was that the equipment should be portable, reliable, and sturdy. Therefore, the decision was made to use digital platform scales (for children over two years and mothers) and pediatric scales (for children under two years), both battery-fed. Furthermore, considering the cost-benefit ratio in the options on the domestic and international markets, the choice was made for the SECA brand equipment (https://www.seca.com/pt_br.html), organized in two anthropometric measurement kits (Box 1): (1) pediatric scale and anthropometer (infantometer) for children up to two years of age and (2) platform scale and stadiometer for children over two years and mothers. Both were carried in SECA protective backpacks with straps to facilitate transportation. Each complete kit, including the backpack, weighed approximately 8kg, so each interviewer received a foldable tote cart for holding and pulling the kit.
Technical description and number of units of equipment used. Brazilian National Survey on Child Nutrition (ENANI-2019).
The number of kits to be purchased was planned according to the number of field interviewers and supervisors for the data collection in the states in each of the seven waves of the ENANI-2019 survey 1212. Alves-Santos NH, Castro IRR, Anjos LA, Lacerda EMA, Normando P, Freitas MB, et al. General methodological aspects in the Brazilian National Survey on Child Nutrition (ENANI-2019): a population-based household survey. Cad Saúde Pública 2021; 37:e00300020. and the possibility of redeploying the equipment for use in the subsequent waves. Due to the lack of information on the equipment's durability and allowing for potential losses, thefts, or accidental damage, an extra 10% of scales and 20% of infantometers were purchased as a reserve margin. Thus, the purchases totaled 298 units of each scale, 359 units of each infantometer/stadiometer, and 657 backpacks.
Details of measurements
The Anthropometry Group prepared a manual with the procedures for anthropometric data collection of the children and their biological mothers, with strict step-by-step instructions to standardize the procedures. The manual consisted of reading and permanent reference material for everyone involved in the survey. The group also produced video demos, slides, and a quick reference guide and script for use during training and in the collection of anthropometric measurements. These materials are available on the ENANI-2019 website (https://enani.nutricao.ufrj.br/) and uploaded onto the interviewers' mobile data collection devices (MDCs) in the data collection. The measurements were taken in duplicate, read aloud by the interviewer according to international guidelines 1414. United Nations Children's Fund. Recommendations for data collection, analysis and reporting on anthropometric indicators in children under 5 years old. Geneva: World Health Organization/United Nations Children's Fund; 2019., and keyed into the MDC immediately after collection. The data stored in the MDC were sent daily to the central server in encrypted form.
The anthropometric measurements were body mass, i.e., weight, obtained in kg, directly for the children and biological mothers. Alternatively, this measurement could also be indirectly obtained for children of any age who were unable to remain steady on the scales for any reason or for those under 24 months of age that weighed over 15kg. In this case, the value was calculated by the difference in measurement of an adult standing on the digital scale with and without the child in his or her arms.
Measurements were taken with the children wearing as little clothing as possible. Children under two years were placed on the previously stabilized and zeroed pediatric scale. The weight was measured, and the child was removed from the scale before performing the second measurement. Older children were positioned barefoot in the middle of the platform to distribute their weight evenly on the equipment, with their body straight and arms hanging by their sides, head in the anatomical position, and back to the display. After the weight was measured, the child was removed from the scale, which was zeroed to repeat the procedure. Biological mothers were weighed barefoot, wearing light clothing and without any accessories (costume jewelry, hairpins, eyeglasses, and similar items) and anything in their pockets, following the same protocol for children over two years.
The height was obtained in centimeters (cm), with a precision of 0.1cm. This term encompasses measurement of length (performed with the infantometer in children under two years, in the supine position) and stature (obtained from the mothers and children at least two years old who could stand on the stadiometer). Some situations required measuring the length of children over two years (< 100cm) or the stature of children under two years. The interviewer recorded whether the measurement had been taken with the child standing or lying down, as recommended by the World Health Organization (WHO) 1818. World Health Organization. WHO Child Growth Standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age. Methods and development. Geneva: World Health Organization; 2006..
The data collection stages in the ENANI-2019 are described in Alves-Santos et al. 1212. Alves-Santos NH, Castro IRR, Anjos LA, Lacerda EMA, Normando P, Freitas MB, et al. General methodological aspects in the Brazilian National Survey on Child Nutrition (ENANI-2019): a population-based household survey. Cad Saúde Pública 2021; 37:e00300020.. Specifically, concerning anthropometry, the established protocol recommended the participation of two persons to measure stature in children and three persons to measure length. Since the survey planned the presence of a single interviewer per household, the strategy was to rely on the help of the mother or guardian to measure length. For children from 6 to 24 months of age, the interviewer scheduled the anthropometric measurement for the second visit, when blood samples were also drawn. The technician who drew the samples participated as the third person for the measurement. For children at least six months of age, the interviewer requested the participation of another resident in the household or scheduled for another interviewer or the supervisor to be present on the day of the expected measurement (Figure 1).
Flowchart of anthropometric measurements in the Brazilian National Survey on Child Nutrition (ENANI-2019).
For the measurement of length, the mother or guardian was asked to lay the child on the infantometer, previously positioned on a smooth surface. The child was measured undressed, barefoot, and without any object on the head, placed against the infantometer's fixed plate, with eyes positioned at a 90º angle with the equipment (Frankfurt plane 1414. United Nations Children's Fund. Recommendations for data collection, analysis and reporting on anthropometric indicators in children under 5 years old. Geneva: World Health Organization/United Nations Children's Fund; 2019.), neck straight, and chin away from the chest. The child's shoulders and back were maintained in contact with the horizontal surface and the arms positioned along the body or held over the abdomen by the mother or guardian. The interviewer held the child's legs, placing the index finger on the legs at the level of the knees and pressing carefully with the other fingers so that the knees remained extended. The interviewer moved the infantometer's footplate to the soles of the child's feet to form a right angle with the legs and then performed the reading. The mother or guardian removed the child from the infantometer, and the entire procedure was repeated.
To measure the child's stature, the mother or guardian was asked to remove the child's footwear (including stockings) and any object from the child's head. Next, the child was asked to stand with their feet firmly placed on the stadiometer platform (Figure 2), heels together, and feet open at an angle of about 60º 1515. Centers for Disease Control and Prevention. National Health and Nutrition Examination Survey (NHANES). Anthropometry procedures manual. Atlanta: Centers for Disease Control and Prevention; 2017.. Next, the child was positioned with back and buttocks touching the stadiometer's vertical shaft, with arms hanging loosely alongside the body and palms turned to the thighs and eyes at a 90º angle (Frankfurt plane). The interviewers positioned themselves on the side of the stadiometer to verify whether the child's position was correct and to perform the measurement by sliding the head plate down to the top of the head with sufficient pressure to hold the hair down. The reading was performed at the level of the interviewer's eyes. To maintain the child in the proper position, the mother was asked to squat and place light pressure on the child's knees and heels against the stadiometer's vertical shaft. After the recording, the child stepped down off the stadiometer, and the entire procedure was repeated.
Sticker developed with figures of feet for children and biological mothers and attached to stadiometer base. Brazilian National Survey on Child Nutrition (ENANI-2019).
To measure the biological mother's stature, she was asked to step onto the stadiometer barefoot, with heels together and resting against the equipment's vertical base, placing her feet to coincide with the figure attached to the horizontal platform and positioning herself as described for measuring the children. The measurement was taken with the mother holding her breath after inspiration, recorded immediately in the MDC, and repeated according to the previous procedures.
Training of interviewers
Two types of training were performed for interviewers and supervisors: central and anthropometric. Central training was conducted in seven state capitals and included content on data collection procedures, except anthropometry. Participation included the team from each data collection wave. A total of 27 training courses were performed in anthropometry, conducted in all the state capitals and Federal District and targeted to interviewers and supervisors in each state. The anthropometry training was undertaken generally immediately after the study's central training. The goal was to certify the interviewers and supervisors for the anthropometric measurements according to the procedures established by the Anthropometry Group and the Executive Committee. The training was conducted by the members of the Anthropometry Group or by a guest instructor with the collaboration of professors and researchers from local institutions. Details on the central training are available in Alves-Santos et al. 1212. Alves-Santos NH, Castro IRR, Anjos LA, Lacerda EMA, Normando P, Freitas MB, et al. General methodological aspects in the Brazilian National Survey on Child Nutrition (ENANI-2019): a population-based household survey. Cad Saúde Pública 2021; 37:e00300020..
For the anthropometry training, a professor from a university located in each state capital and the Federal District identified a site to perform the theoretical component of the training, schools or daycare centers that agreed to have the anthropometric measurements performed in the children enrolled there, distributed the Free and Informed Consent Form to the parents, and recruited undergraduate and graduate students with experience in anthropometric measurements of children and adults to participate as monitors. The study and the specific informed consent form for training in anthropometry were approved by the Institutional Review Board of the Clementino Fraga Filho University Hospital of the Federal University of Rio de Janeiro (UFRJ) and registered under number CAAE 89798718.7.0000.5257. Details on the study's ethical aspects are available in Alves-Santos et al. 1212. Alves-Santos NH, Castro IRR, Anjos LA, Lacerda EMA, Normando P, Freitas MB, et al. General methodological aspects in the Brazilian National Survey on Child Nutrition (ENANI-2019): a population-based household survey. Cad Saúde Pública 2021; 37:e00300020..
The training was planned to take place full-time for two or three days, depending on the number of interviewers to be trained. The three-day structure was used when the number was at least eight interviewers and included: 1st day - theoretical and practical training on anthropometric measurement of adults; 2nd day - training on measurement of children under two years; and 3rd day - training on measurement of children over two years. When fewer interviewers were trained, the measurement activities in children were concentrated in one day.
During the practical training, each interviewer had to measure at least 10 adults and 10 children, as recommended in international guidelines 1414. United Nations Children's Fund. Recommendations for data collection, analysis and reporting on anthropometric indicators in children under 5 years old. Geneva: World Health Organization/United Nations Children's Fund; 2019.. Interviewers followed the described protocols for measurements, except for reading the values out loud, which was completed in an individual form to avoid influencing the results of the other interviewers since more than one interviewer measured the same individual.
The practical training in measuring mothers in the ENANI-2019 survey was conducted among the interviewers themselves. The training to measure children was conducted by those associated with the selected daycare centers and schools and in children whose parents had signed and returned the informed consent. In both types of practical training, the plan was for each interviewer and instructor in charge of the training to measure the stature/length twice in each child/adult. When it was not possible for the instructor and interviewers to measure the same children, the instructor reinforced the details of the measurement technique with the interviewers. The procedure was only used to measure height since it is considered unnecessary for weight measurements 1414. United Nations Children's Fund. Recommendations for data collection, analysis and reporting on anthropometric indicators in children under 5 years old. Geneva: World Health Organization/United Nations Children's Fund; 2019., mainly when using a digital scale, which was the case in ENANI-2019.
Considering that measurement of length is relatively tricky, requiring greater attention when training the interviewer, besides the fact that there are usually not enough children under 24 months of age to conduct the practical activity, the attempt was made to optimize the training by using a doll (described in https://www.cotiplas.com.br/boneca-nino's-com-a-boca-aberta/p) with similar characteristics to those of an infant and with sufficient flexibility for the trainees to handle it, mimicking the procedure to be performed for measuring a real child's length.
After all the participants had concluded the height measurements, the data were keyed into an electronic spreadsheet 1414. United Nations Children's Fund. Recommendations for data collection, analysis and reporting on anthropometric indicators in children under 5 years old. Geneva: World Health Organization/United Nations Children's Fund; 2019. for computation of the technical error of measurement (TEM). TEM is used to calculate intra-evaluator variability, the variation in the measurements repeated in the same individual performed by the evaluator, and inter-evaluator variability, which is the variation of measurements performed by different evaluators. Intra-evaluator TEM was calculated for interviewers and instructors. Inter-evaluator TEM was calculated by the difference between the interviewer's and instructor's measurements.
In the end, the assessment of the interviewers' performance was conducted by the team that administered the training, considering the TEMs and the measurement observations. Thus, the individuals in charge of the training sessions identified the possible errors that led to inadequate TEM values and oriented the interviewers to review the measurement protocols and repeat the measurements to correct the errors.
Based on the ethical commitment and acknowledging the teaching institutions' collaboration in the training process, the children's nutritional diagnosis was performed. An individual copy was provided to the parents with the values for each measurement, plus a description of the nutritional diagnosis and plotting of the weight and height values on the growth curves recommended by the WHO 1818. World Health Organization. WHO Child Growth Standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age. Methods and development. Geneva: World Health Organization; 2006. and provided in the Child's Health and Growth Card used in the Brazilian Unified National Health System (SUS) 1717. Departamento de Atenção Básica, Secretaria de Atenção à Saúde, Ministério da Saúde. Orientações para a coleta e análise de dados antropométricos em serviços de saúde: norma técnica do Sistema de Vigilância Alimentar e Nutricional - SISVAN. Brasília: Ministério da Saúde; 2011.. Children with nutritional risk received a referral for care in a health unit.
Procedures for assessment of the training
Intra-evaluator and inter-evaluator TEMs were used as estimates of precision and accuracy 1919. World Health Organization; United Nations Children's Fund. WHO Child Growth Standards and the identification of severe acute malnutrition in infants and children: a joint statement by the World Health Organization and the United Nations Children's Fund. Geneva: World Health Organization/United Nations Children's Fund; 2009.. Interviewers had good precision when the intra-evaluator TEM was less than twice the instructor's intra-evaluator TEM. Intra-evaluator TEM values of height were considered adequate when they were ≤ 0.30cm, the reference value suggested by the United Nations Children's Fund (UNICEF) 1414. United Nations Children's Fund. Recommendations for data collection, analysis and reporting on anthropometric indicators in children under 5 years old. Geneva: World Health Organization/United Nations Children's Fund; 2019. based on data from the WHO Multicenter Growth Reference Study2020. WHO Multicentre Growth Reference Study Group. Reliability of anthropometric measurements in the WHO Multicentre Growth Reference Study. Acta Pædiatr Suppl 2006; 450:38-46.. In addition, interviewers had good accuracy when the intra-evaluator TEM was less than 2.8 times the instructor's intra-evaluator TEM.
The reliability coefficient (R) was calculated to estimate the proportion of variation between individuals that is not due to measurement error. The formula used to calculate the R was: 1 - [(TEM(inter-evaluator))2/(standard deviation2)]. For example, an R of 0.80 means that 80% of the total variability is true variation, while the remaining proportion is attributable to measurement error, called imprecision or lack of reliability 2020. WHO Multicentre Growth Reference Study Group. Reliability of anthropometric measurements in the WHO Multicentre Growth Reference Study. Acta Pædiatr Suppl 2006; 450:38-46..
Data quality was also assessed by estimating its "heaping", or tendency for a preference in the final digit, in the anthropometric measurements performed by the interviewers. The dissimilarity index was calculated for this purpose: calculating the sum of the differences (without the positive/negative sign) between the observed percentage and the predicted percentage (10%) for each of the last 10 possible digits divided by 2 1616. Perumal N, Namaste S, Qamar H, Aimone A, Bassani DG, Roth DE. Anthropometric data quality assessment in multisurvey studies of child growth. Am J Clin Nutr 2020; 112 Suppl 2:806S-15.. The value indicates the number of new measurements needed to achieve perfection, i.e., zero, the situation in which each of the last digits occurs in 10% of the measurements 1414. United Nations Children's Fund. Recommendations for data collection, analysis and reporting on anthropometric indicators in children under 5 years old. Geneva: World Health Organization/United Nations Children's Fund; 2019., a rare outcome in studies involving many interviewers.
In quality assurance and quality control, three possible sources of error should be considered: the instrument, the interviewee, and the interviewer. In the current study, all the instruments acquired were new since reutilization of equipment from other studies is not recommended 1414. United Nations Children's Fund. Recommendations for data collection, analysis and reporting on anthropometric indicators in children under 5 years old. Geneva: World Health Organization/United Nations Children's Fund; 2019., and larger than the number of interviewers. The equipment could be replaced in case of malfunctioning. Pieces of equipment transferred between states for the study had their conditions of use verified during the anthropometry training. In relation to the interviewees, the interviewers' training emphasized the need to provide peace of mind for the mothers or guardians through good measurement practices documented in the manual. The training sessions were scheduled and carried out to provide the entire structure for interviewers to acquire the appropriate techniques for obtaining reliable data. Interviewers who displayed any difficulty in measurement or large measurement errors compared to the instructor were identified and retrained.
During the collection, the quality control procedures for the anthropometric data included: verification of the equipment's proper functioning; regular verification of the scales using objects with a known mass, and instant identification of extreme values (implausible, as described below) for the children's weight and height and the measurement's repetition. In addition, weekly revisions were performed in the collected data, such as date of birth and date of the interview for calculating age; and recording in the MDC, by the interviewer, of any alteration observed during the measurement (agitated child, anatomical alteration, or procedure performed off-protocol).
To identify implausible values or outliers in the anthropometric measurements of children, interviewers were oriented to key the measurements into the MDC immediately after they were taken. The data capture system calculated the height-for-age (H/A) and weight-for-age (W/A) indices for each of the two measurements and indicated whether the information was implausible. The cutoff points for this identification were: H/A < -6 or > +6 and W/A < - 6 or > +5 Z-scores in the reference curve 1818. World Health Organization. WHO Child Growth Standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age. Methods and development. Geneva: World Health Organization; 2006.. Before recommending repetition of the measurement, the system asked the interviewer to confirm the child's date of birth. When the date was altered, it verified whether the anthropometric measurement was still implausible. In the affirmative case, the system asked to repeat the measurement. If the new measurement remained implausible, the system opened a procedure to take a photograph (only with the parent or guardian's authorization) and a field for a mandatory recording of observations, for example, children that were unusually small or large, overweight, or premature. Follow-up of the data collection by all the interviewers was performed by the supervisors, who monitored the collected data daily. In some cases, when errors were identified, the supervisors returned to the households and performed new measurements. These procedures were implemented to guarantee that the percentage of potentially implausible cases remained within the internationally recommended levels (< 1%) 1414. United Nations Children's Fund. Recommendations for data collection, analysis and reporting on anthropometric indicators in children under 5 years old. Geneva: World Health Organization/United Nations Children's Fund; 2019..
The training included 353 interviewers and supervisors in the state capitals and Federal District. Forty-nine schools, daycare centers, and philanthropic institutions supported the training activities. In total, 386 adults and 3,815 children were measured by the interviewers during the training, totaling 7,100 measurements. Of all the children, 3,267 were measured at least once by both the interviewer and the instructor, 2,023 were measured in duplicate by the interviewers, and 1,542 were measured twice by the interviewers and the instructor (Table 1). Each interviewer measured on average 15.1 adults and 11.2 children (6.3 children over two years and 4.9 children under two years).
Assessment of reliability of stature or length measurements performed by interviewers during anthropometry training in adults and children. Brazilian National Survey on Child Nutrition (ENANI-2019).
As expected, the instructors' intra-evaluator TEMs were lower than those of the interviewers. However, the interviewers' intra-evaluator TEMs for the measurement of adults and stature and length of children were considered adequate for the set of measurements taken in duplicate by the interviewers and the instructor. Intra-evaluator TEM was also within this reference for the set of interviewers that measured children in duplicate. The estimated reliability coefficient was greater than 99% for the measurements in duplicate and analysis, with only one measurement taken by the interviewer and instructor in the same child, except for length (97.5%). In half of the states, the percentage of interviewers with good precision was 77.3% for adults and 75% for children. In comparison, the percentages of interviewers with good accuracy were 96% and 75%, respectively. These results indicate that the set of interviewers in the country displayed good precision and accuracy in obtaining measurements of height in children and adults.
The estimated heaping showed that except for the measurement of length with the last digit 0, there was no major heaping in the percentage distribution of the final digits (Table 2). Analysis of the dissimilarity index revealed the need for new measurements in 5.3%, 7.4%, and 12.3% for the distribution of the final digits to be equal to the measurement of stature in the biological mothers and children and length, respectively. Measurement of weight did not show any tendency in preference for the final digit.
Assessment of last-digit preference in height measurements (stature or length) by interviewers during anthropometry training in adults and children. Brazilian National Survey on Child Nutrition (ENANI-2019).
Presentation of the data
The variables sex, age, weight, and height of the children will be analyzed in the WHO software programs Anthro and AnthroPlus (https://www.who.int/toolkits/child-growth-standards/software). For the anthropometric indices W/A, H/A, W/H (weight for height), and body mass index (BMI) for age (BMI/A), the Z-scores will be obtained in relation to the WHO reference 1818. World Health Organization. WHO Child Growth Standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age. Methods and development. Geneva: World Health Organization; 2006.. The interpretations of the nutritional significance will be performed according to the cutoff points applied to the anthropometric indices and the respective nomenclature for nutritional diagnosis adopted by the Brazilian Food and Nutritional Surveillance System (SISVAN) 1717. Departamento de Atenção Básica, Secretaria de Atenção à Saúde, Ministério da Saúde. Orientações para a coleta e análise de dados antropométricos em serviços de saúde: norma técnica do Sistema de Vigilância Alimentar e Nutricional - SISVAN. Brasília: Ministério da Saúde; 2011. and by the WHO to diagnose the severity of malnutrition 1919. World Health Organization; United Nations Children's Fund. WHO Child Growth Standards and the identification of severe acute malnutrition in infants and children: a joint statement by the World Health Organization and the United Nations Children's Fund. Geneva: World Health Organization/United Nations Children's Fund; 2009..
The Z-score distribution for all these indices will be recorded to allow various other definitions 2121. de Onis M, Borghi E, Arimond M, Webb P, Croft T, Saha K, et al. Prevalence thresholds for wasting, overweight and stunting in children under 5 years. Public Health Nutr 2019; 22:175-9.,2222. Ferreira HS. Anthropometric assessment of children's nutritional status: a new approach based on an adaptation of Waterlow's classification. BMC Pediatr 2020; 20:65., such as nutritional risk condition (Z < -1) and process severity (Z < -3 or > 3, for all deficiencies or in the case of indicators of obesity, respectively).
The nutritional status of mothers 20 years or older will be assessed with the WHO classification 2323. World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. Geneva: World Health Organization; 2000. (WHO Technical Report Series, 894)., based on BMI and recommended by the Brazilian Ministry of Health 1717. Departamento de Atenção Básica, Secretaria de Atenção à Saúde, Ministério da Saúde. Orientações para a coleta e análise de dados antropométricos em serviços de saúde: norma técnica do Sistema de Vigilância Alimentar e Nutricional - SISVAN. Brasília: Ministério da Saúde; 2011.. For mothers under 20 years of age, BMI/A will be used in relation to the reference population 2424. de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ 2007; 85:660-7..
Z-scores for the anthropometric measurements of premature children and those with gestational age from 189 to 454 days will be calculated with the growth curves generated by the Intergrowth study 2525. Villar J, Giuliani F, Bhutta ZA, Bertino E, Ohuma EO, Ismail LC, et al. Postnatal growth standards for preterm infants: the Preterm Postnatal Follow-up Study of the INTERGROWTH-21(st) Project. Lancet Glob Health 2015; 3:e681-91..
Database cleaning and organization
Until the data collection in the field was interrupted in March 2020 due to the COVID-19 pandemic, 14,558 children had been studied in 12,524 households 1212. Alves-Santos NH, Castro IRR, Anjos LA, Lacerda EMA, Normando P, Freitas MB, et al. General methodological aspects in the Brazilian National Survey on Child Nutrition (ENANI-2019): a population-based household survey. Cad Saúde Pública 2021; 37:e00300020.. Of this total, duplicate measurements of body mass and length/stature were obtained in 13,835 and 13,693 children, respectively. The percentage of implausible data was below the maximum allowable level recommended by international agencies both for measurement of weight (0.48 and 0.61% for the first and second measurements, respectively) and height (0.76 and 0.71%). Of all the children examined, 1,588 were premature. Among those within the possible gestational age group for evaluation according to the Intergrowth Study, no implausible weight or length values were identified. Of the total of 12,169 biological mothers, 11,150 and 11,218, respectively, had their body mass and stature measured in duplicate. Of the total, 52 biological mothers were pregnant, and 1,011 were adolescents (14 to 19 years old). The main reasons reported for non-measurement were absence or illness (40% and 41% of the children and mothers, respectively); refusal (35% and 35%); or other reasons (25% and 24%). Missing, inconsistent, or implausible anthropometric data will be imputed.
Many procedures implemented in the ENANI-2019 survey are unprecedented in national household surveys. Traditionally, in household surveys, the study's coordination trains the field coordinators to perform the anthropometric measurements for operational and budget reasons. Then, the field coordinators replicate the training of the interviewers without performing detailed practical training in anthropometric measurements in children. In the ENANI-2019 survey, members of the study's Executive Committee and members of the Anthropometry Group trained the interviewers directly. The training protocol ensured that they also practiced the measurements in children.
Specifically, concerning anthropometry, the authors are unaware of detailed documentation on the assessment of field interviewers in national household surveys. Nevertheless, the results presented here indicate that it is possible to guarantee the interviewers' good and accurate data production capacity, so long as appropriate training and quality control procedures are performed.
The data collection procedures in ENANI-2019 allowed consistency between the work by the interviewer and the phlebotomist for the measurement of children from 6 to 24 months of age. In addition, the development of a data capture system, which immediately checked the plausibility of the anthropometric measurement in children in their household, allowed generating reliable data on the anthropometric nutritional status of Brazilian children under five years of age.
The infantometers' resistance and durability were highly satisfactory. Since the stadiometer has a base that allows placing the feet at 90º from the vertical shaft and with a support stabilizer on the wall, it allowed measuring stature on walls with baseboards. Despite the stabilizer, the equipment did not touch some highly uneven walls, thus requiring extra care in their use. The digital platform scale levelers displayed insufficient resistance and durability. The pins fitting into the levelers broke fairly frequently so that some scales lost their stability and reliability and had to be replaced. Although the pediatric scales were delivered with a seal and stamp of approval from INMETRO (the Brazilian National Metrology Institute), eight scales had to be replaced during data collection due to inconsistency in the readouts.
Although the equipment was chosen with the lightest possible weight, carrying the kit placed an overload on the interviewers. In neighborhoods with irregular streets and sidewalks, steep stairways or byways, the tote carts for transporting the equipment could not be used. However, they were intended to facilitate the fieldwork.
ENANI-2019 is the first nationwide survey in Brazil that conducted an anthropometric assessment of nutritional status and the assessment of breastfeeding and feeding practices using a 24-hour dietary recall and 12 biomarkers of micronutrients in children under five years of age. Specific decentralized training in anthropometry in each state of Brazil by qualified instructors, real-time electronic monitoring of children's anthropometric measurements in the household, teamwork combining interviewers and phlebotomy technicians in obtaining the anthropometric measurements, and weekly data monitoring were successful experiences in the study. They can be considered strengths in the ENANI-2019. Implementing these standardized methodological procedures lends greater reliability both to the data and to the final results. It is thus expected that the care in obtaining anthropometric data in the ENANI-2019 survey will encourage this practice in future national household surveys.
The anthropometric results of ENANI-2019 will update the information on magnitude, distribution, and inequalities of nutritional problems (whether deficiencies or excesses) in children under five years of age. Furthermore, knowledge of anthropometric nutritional status, associated with under-five health outcomes, socioeconomic conditions, and quality of life, can reinforce public policy proposals according to current data, aimed at reducing nutritional disorders and increasing strategies for promotion, prevention, and care with adequate and healthy feeding practices starting in childhood, thus modifying the nutritional, epidemiological, and mortality profile of the Brazilian population.
To the professors of Brazilian universities who collaborated in conducting and recruiting student monitors for training. To the institutions that allowed the theoretical training to be carried out on their premises: São Lucas University Center - Rondônia State, National Supply Company (Conab) - Mato Grosso do Sul State; Social Service of Commerce (SESC) - Regional Departments in the states of Bahia, Goiás, Roraima, and Santa Catarina; Estácio Faculty - Amapá State; Oswaldo Cruz Foundation (Fiocruz) - Federal District; São Paulo Federal University (UNIFESP); Ceará State University (UECE); Rio de Janeiro State Univesity (UERJ); Acre Federal University (UFAC); Alagoas Federal University (UFAL); Amazonas Federal University (UFAM); Espírito Santo Federal University (UFES); Maranhão Federal University (UFMA); Minas Gerais Federal University (UFMG); Paraíba Federal University (UFPB); and Pernambuco Federal University (UFPE).
Ferreira CS, Cherchiglia ML, César CC. O Sistema de Vigilância Alimentar e Nutricional como instrumento de monitoramento da Estratégia Nacional para Alimentação Complementar Saudável. Rev Bras Saúde Mater Infant 2013; 13:167-77.
Instituto Brasileiro de Geografia e Estatística. Perfil estatístico de crianças e mães no Brasil: aspectos nutricionais 1974-1975. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 1982.
Monteiro M, Cervini R. Perfil estatístico de crianças e mães no Brasil: aspectos de saúde e nutrição de crianças no Brasil, 1989. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 1992.
Instituto Brasileiro de Geografia e Estatística. Pesquisa de Orçamentos Familiares 2008-2009: antropometria e estado nutricional de crianças, adolescentes e adultos no Brasil. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2010.
Instituto Brasileiro de Geografia e Estatística. Pesquisa de Orçamentos Familiares 2008-2009: análise do consumo alimentar pessoal no Brasil. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2011.
Instituto Brasileiro de Geografia e Estatística. Pesquisa sobre Padrões de Vida 1996-1997. Primeira infância. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2000.
Ministério da Saúde. Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher - PNDS 2006: dimensões do processo reprodutivo e da saúde da criança. Brasília: Ministério da Saúde/Centro Brasileiro de Análise e Planejamento; 2009.
Instituto Brasileiro de Geografia e Estatística. Pesquisa Nacional de Saúde, 2013. Ciclos de vida: Brasil e grandes regiões. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2015.
Batista Filho M, Rissin A. A transição nutricional no Brasil: tendências regionais e temporais. Cad Saúde Pública 2003; 19 Suppl 1:S181-91.
Rasella D, Hone T, de Souza LE, Tasca R, Basu S, Millett C. Mortality associated with alternative primary healthcare policies: a nationwide microsimulation modelling study in Brazil. BMC Med 2019; 17:82.
Departamento de Atenção Básica, Secretaria de Atenção à Saúde, Ministério da Saúde. Política Nacional de Alimentação e Nutrição. 2ª Ed. Brasília: Ministério da Saúde; 2007.
Alves-Santos NH, Castro IRR, Anjos LA, Lacerda EMA, Normando P, Freitas MB, et al. General methodological aspects in the Brazilian National Survey on Child Nutrition (ENANI-2019): a population-based household survey. Cad Saúde Pública 2021; 37:e00300020.
Cashin K, Oot L. Guide to anthropometry: a practical tool for program planners, managers, and implementers. Washington DC: Food and Nutrition Technical Assistance III Project (FANTA)/FHI 360; 2018.
United Nations Children's Fund. Recommendations for data collection, analysis and reporting on anthropometric indicators in children under 5 years old. Geneva: World Health Organization/United Nations Children's Fund; 2019.
Centers for Disease Control and Prevention. National Health and Nutrition Examination Survey (NHANES). Anthropometry procedures manual. Atlanta: Centers for Disease Control and Prevention; 2017.
Perumal N, Namaste S, Qamar H, Aimone A, Bassani DG, Roth DE. Anthropometric data quality assessment in multisurvey studies of child growth. Am J Clin Nutr 2020; 112 Suppl 2:806S-15.
Departamento de Atenção Básica, Secretaria de Atenção à Saúde, Ministério da Saúde. Orientações para a coleta e análise de dados antropométricos em serviços de saúde: norma técnica do Sistema de Vigilância Alimentar e Nutricional - SISVAN. Brasília: Ministério da Saúde; 2011.
World Health Organization. WHO Child Growth Standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age. Methods and development. Geneva: World Health Organization; 2006.
World Health Organization; United Nations Children's Fund. WHO Child Growth Standards and the identification of severe acute malnutrition in infants and children: a joint statement by the World Health Organization and the United Nations Children's Fund. Geneva: World Health Organization/United Nations Children's Fund; 2009.
WHO Multicentre Growth Reference Study Group. Reliability of anthropometric measurements in the WHO Multicentre Growth Reference Study. Acta Pædiatr Suppl 2006; 450:38-46.
de Onis M, Borghi E, Arimond M, Webb P, Croft T, Saha K, et al. Prevalence thresholds for wasting, overweight and stunting in children under 5 years. Public Health Nutr 2019; 22:175-9.
Ferreira HS. Anthropometric assessment of children's nutritional status: a new approach based on an adaptation of Waterlow's classification. BMC Pediatr 2020; 20:65.
World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. Geneva: World Health Organization; 2000. (WHO Technical Report Series, 894).
de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ 2007; 85:660-7.
Villar J, Giuliani F, Bhutta ZA, Bertino E, Ohuma EO, Ismail LC, et al. Postnatal growth standards for preterm infants: the Preterm Postnatal Follow-up Study of the INTERGROWTH-21(st) Project. Lancet Glob Health 2015; 3:e681-91.
Departamento de Nutrição Social, Universidade Federal Fluminense, Rio de Janeiro, Brasil.
Faculdade de Nutrição, Universidade Federal de Alagoas, Maceió, Brasil.
Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil.
Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
Instituto de Nutrição, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil.
Instituto de Ciências Biológicas, Universidade Federal do Amazonas, Manaus, Brasil.
Faculdade de Nutrição, Universidade Federal de Pelotas, Pelotas, Brasil.
G. Kac Departamento de Nutrição Social e Aplicada, Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro. Av. Brigadeiro Trompowsky s/n, Bloco J, 2º andar, Rio de Janeiro, RJ 21941-590, Brasil. gilberto.kac@gmail.com
L. A. Anjos and M. B. Freitas contributed to the study conception and design, data analysis and processing, and article's writing and review. H. S. Ferreira, N. H. Alves-Santos, C. S. Boccolini, E. M. A. Lacerda, I. R. R. Castro, V. G. Mariz, B. M. Tavares, D. P. Gigante, and G. Kac contributed to the study conception and design and article's writing and review. All authors approved the final version of the article.
ORCID: Luiz Antonio dos Anjos (0000-0002-5257-6912); Haroldo da Silva Ferreira (0000-0002-1789-3138); Nadya Helena Alves-Santos (0000-0002-0098-6047); Maiara Brusco de Freitas (0000-0003-1737-8918); Cristiano Siqueira Boccolini (0000-0002-4804-5641); Elisa Maria de Aquino Lacerda (0000-0002-1830-4278); Inês Rugani Ribeiro de Castro (0000-0002-7479-4400); Virginia Gaissionok Mariz (0000-0001-9442-4530); Bruno Mendes Tavares (0000-0003-0956-6484); Denise Petrucci Gigante (0000-0001-7309-5838); Gilberto Kac (0000-0001-8603-9077).
Box 1 Technical description and number of units of equipment used. Brazilian National Survey on Child Nutrition (ENANI-2019).
Figure 1 Flowchart of anthropometric measurements in the Brazilian National Survey on Child Nutrition (ENANI-2019).
Figure 2 Sticker developed with figures of feet for children and biological mothers and attached to stadiometer base. Brazilian National Survey on Child Nutrition (ENANI-2019).
Table 1 Assessment of reliability of stature or length measurements performed by interviewers during anthropometry training in adults and children. Brazilian National Survey on Child Nutrition (ENANI-2019).
Using two height measurements by interviewers and instructors
Number of observations 3,143 1,542 983 559
Intra-evaluator TEM (cm)
Interviewer * 0.301 0.282 0.299 0.250
Instructor 0.212 0.174 0.150 0.211
Inter-evaluator TEM (cm) ** 0.273 0.363 0.365 0.360
Reliability coefficient (R) 0.999 0.999 0.995 0.999
Using the first measurement by the interviewers and instructors
Number of observations 3,178 3,267 1,762 1,505
Inter-evaluator TEM (cm) 0.367 0.381 0.352 0.413
Using two measurements by the interviewer
Number of observations 3,157 2,023 1,214 809
Intra-evaluator TEM (cm) 0.301 0.271 0.286 0.247
TEM: technical error of measurement.
* Good precision when intra-evaluator TEM is < 2 times instructor's intra-evaluator TEM;
** Good accuracy when inter-evaluator TEM is < 2.8 times instructor's intra-evaluator TEM.
Table 2 Assessment of last-digit preference in height measurements (stature or length) by interviewers during anthropometry training in adults and children. Brazilian National Survey on Child Nutrition (ENANI-2019).
Final digit
Difference *
0 12.10 2.10 12.49 2.49 18.41 8.41
1 9.94 -0.06 9.02 -0.98 9.04 -0.96
2 10.45 0.45 9.14 -0.86 7.91 -2.09
4 10.12 0.12 12.32 2.32 9.30 -0.70
9 11.32 1.32 9.65 0.35 10.30 0.30
Dissimilarity index ** 5.3 7.4 12.3
* Difference: the difference between observed and predicted values (10%) for each of the last 10 possible final digits;
** Dissimilarity index = Sum of differences (without positive/negative sign)/2.
Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz Rua Leopoldo Bulhões, 1480 , 21041-210 Rio de Janeiro RJ Brazil, Tel.:+55 21 2598-2511, Fax: +55 21 2598-2737 / +55 21 2598-2514 - Rio de Janeiro - RJ - Brazil
Methodological aspects of the anthropometric assessment in the <i>Brazilian National Survey on Child Nutrition</i> (ENANI-2019): a population-based household survey


Why You Should Always Compare Shipping Prices on International Shipments The Internet has changed the way that we do business, making it common for small businesses to ship internationally on a regular basis. Today, in the global economy, it is necessary to make international shipments if you want your business to grow. It doesn't matter whether you sending items personally or as part of your business, when you have to make international shipments it can get very expensive. Therefore it is so important to compare prices when it comes to making an international shipment. Whenever you are involved in an online business, it is essential to find a reliable and reasonably priced international shipping company. But choosing the right international shipping company is not necessarily as simple as checking a list of prices. Instead, you will want to evaluate the overall cost efficiency and job efficiency of each international shipping provider. Because of resources available online, it is now easier than ever to check the efficiency and value of each international shipping company available. These days, thanks to the Internet, it is much easier to compare the rates and services offered by international shipping companies. Not only can you find the information about shipping rates that you need, but you can also read the service reviews from various shipping companies that are posted by the customers that used these services. Customer reviews and price comparison tools can help you find the best international shipping services to meet your business shipping needs.
It doesn't matter if you are making business or personal shipments, it is always important to compare international shipping rates to make sure that you are getting the best deal possible on international shipping. When you visit an international shipping services comparison website, you will be able to read more about the pricing and quality of services that are available to you, making it possible to ensure that you are getting the best value to suit your business shipping needs. If you would like to learn more about international shipping rates and shipping services abroad, the best thing you can do is search the Internet for online ways to compare international shipping prices online. You can also get started by visiting the website of a shipping company like DHL which offers online resources that will allow you to compare prices on international shipping quickly and easily.


Are you surprised by that title? From my 13 years as a lawyer practising Family Law I know that the one thing all troubled marriages have in common is ongoing disputes about how money is earned, spent or saved.
According to Statistics Canada, in 2010 the average Canadian 2-income family had an after-tax disposable income of $89,600. That sounds like lots of money. But the average family also has a substantial mortgage, car loans, consumer credit card debt, and all the usual monthly bills. How is such a family to meet month to month financial obligations and also save for the children's education and for their own retirement?
Let's look at one client couple, we'll call them 'Frank' and 'Joan', in their mid 30s with two children, born in 2004 and 2006. Frank and Joan were both employed, but the family was living paycheque to paycheque. They worried that they would never be able to help their children with college or save for their own retirement. Neither could say easily where their money was going. They had begun to hide credit card statements from each other and were quarrelling daily about money.
We began with Frank and Joan each keeping a detailed 'spending diary' for one month, recording every expenditure, no matter how small, and no matter what it was for. Then we met to analyse their diaries.
Frank and Joan both habitually bought their morning coffees and breakfasts at fast food outlets on the way to work. Each was paying about $6.00 for breakfast 20 days per month for a combined $6 x 2 people x 20 days = $240.00 every month.
That's a whopping $2,880 per year in after-tax dollars. Frank and Joan needed to earn about $3,500 in gross income just to eat fast food breakfasts in their cars on weekday mornings. They were astounded. And that was not the only money 'leakage' we found.
Now Frank, Joan and the children get up a little earlier in the morning. They eat breakfast together at home where eggs and toast or cereal with milk costs the four of them less than $4.00 a day. The whole family are now planning and packing their homemade lunches to work and school for even more annual savings.
As a Certified Financial Planner I helped Frank and Joan to establish a family budget that reflects their shared priorities and eliminates financial waste. The word 'budget' is not very popular. It sounds to many people like the word 'diet', and as such it sounds restrictive and no fun at all. So I suggested that we call it something positive.We came up with 'Income Allocation Blueprint' instead.
Using the budget/blueprint they have identified their individual and shared financial goals. They no longer quarrel about money. They feel like they are both pulling in the same direction. Money that once went for fast food breakfasts is paying down credit card debt and building a Registered Educational Savings Plan for each child.
For help establishing your family's Income Allocation Blueprint and learning how you can afford to save for your children's education telephone me at 905-984-2100 Ext 27 or drop me an email at p_boyko@donro.on.ca to set up a free one hour no-obligation consultation.We can meet at my office or at your home as you prefer.


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Interviews, Spanish economy 4th September 2021
"All Neighbouring Electricity Markets Have Been At Record Highs For Days. The Rules Are The Same Throughout Europe, And They Are Not Going To Change Them"
Almudena Díez | Red Electrica's Director -Socorro Fernández Larrea- explains why the current price of electricity in Spain (140€ MW/h) has been at record highs for days: Q: How do you explain to consumers that the system can have such sharp fluctuations in the price of electricity that directly affect their pockets? A: Very easily, by telling the truth, if you like. The problem arises because the price of energy…
Ibex, Markets 29th January 2020
The Chairman Of REE Resigns Because Of Disagreements With The Government
According to articles in the press, the decision of Jordi Sevilla, president of REE (Red Eléctrica de España) responds to his growing disagreements with Teresa Ribera, one of four vice presidents of the Government and Minister for Ecological Transition.
Ibex 13th August 2019
After the response of the Ministry of Ecological Transition, Enagas and REE remain underweight
Santander Corporate & Investment | The Ministry of Ecological Transition has published its response to the regulator´s (CNMC) proposals for changes to the rules on the gas and electricity transportation and distribution networks and gas storage installations. Based on the four documents presented in CNMC before the 9 August deadline, the Ministry values the regulator´s proposals favourably.
Ibex 10th April 2019
REE downgraded by Fitch after Hispasat purchase
Fitch downgraded Red Eléctrica (REE, A- from A, and elevates the perspective to stable from negative) after the firm's acquisition of Hispasat. The credit rating agency says that the 2018-2022 strategic plan announced by the group in February "does not support a capital structure consistent with the 'A' rating level in the medium term."
Ibex 8th April 2019
Boom in Renewables: significant percentage of network access without an industrial project
Bankinter | Red Eléctrica (REE) demands normative adjustments to facilitate the implantation of renewable energies. The director-general of Red Eléctrica, Miguel Duvison, has declared that currently access has been approved in Spain for 84% of the energy potential which needed for 2030.
Spanish economy 13th February 2019
REE Finally Buys 89,68% Of Hispasat From Abertis
Red Eléctrica, the company which manages Spain's high tension electricity cables, has agreed to buy 89.68% of Hispasat, the largest operator of satellite infrastructure by volume in Spain and Portugal, for 949 M€ from Abertis Infraestructuras. REE had already tried to buy Hispasat at the beginning of last year, even reaching a pre-agreement with Abertis. But the deal was frustrated by the corporate operations in Abertis and the disagreement of the previous government.
Spanish economy 10th May 2018
Spain Energy Market Regulator recommends lowering regulated revenues for the sector
Spain's energy market authorities has published an economic-financial analysis of the energy transport activity which Red Eléctrica carried out during the period 2013-2016. In this report, it has recommended a downwards revision to the financial remuneration rate for electricity transport for the next regulatory period beginning 1 January 2020.
Ibex, Markets 16th October 2017
Red Electrica: Still Eyeing Potential Acquisition Of Hispasat
Abertis and Red Eléctrica are keeping talks open regarding an eventual corporate deal involving Hispasat. According to the press, Abertis, which holds 90.4% of the satellites firm, is asking for a control premium in addition to the valuation it made of the company in May.
Spanish Small & Mid Caps 10th March 2017
EC Starts Proceedings Against Spain For Voting Rights Limits On REE, Enagás
The European Commission has initiated proceedings against Spain for the limits it imposes on direct or indirect participation in Red Eléctrica (REE) and Enagás and for restricting voting rights. Brussels could take Spain to the European Court of Justice if the Spanish government's response is not convincing and there could be a fine in the end.


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Cardosas is een plaats (freguesia) in de Portugese gemeente Arruda dos Vinhos en telt 746 inwoners (2001).

Plaats in Portugal


The Practical Life area in the classroom is full of opportunities for a child to exercise their mind, their body and their will.
Real materials mean real work - this is not make-believe. They are porcelain, glass and wood - textured, weighted, breakable and beautiful. We are not handling the materials carefully because we have simply been told to do so. We know that if we tip the tray and the jug falls then it will break. There is one of each tray on the shelf - if you would like to work with something that is unavailable then you need to wait. When you return a material to the shelf it must be neat and ordered (and in the correct place) for the next person to enjoy.
There is an order to each activity -- a logical sequence of steps which needs to be followed in order to complete the activity. Each piece of work has all of the components needed for the work. If the child has used tissues or cotton balls or has dirtied a cloth in the process of their work then they must restock the material for the next person to enjoy a complete tray.
We want to entice the children to the work. Children have an internal order at this age - they like to organise; neatness and beauty are extremely attractive to them. Colour coding trays or choosing bright and matching patterns for the various elements of one activity will draw the child and encourage repetition. The beauty of a material also encourages the children to maintain the quality and presentation of the material and the tray.
The children are developing skills which will enable them to live fully and more independent lives within the context of their culture and their environment. The materials are directly related to the child's home and social environment.
The materials are designed to support the physical development needed for writing - strengthening pincer grip and fine motor skills - as well as enriching vocabulary and encouraging the development of strong communication skills. The sequential nature of the later exercises as well as the carefully ordered presentations indirectly prepare the child for Mathematics and Science work. By developing concentration and focus we are helping the child to build a foundation for all areas of academic work.
The Preliminary Exercises open the door to the new environment by giving the child a clear understanding of what is expected of them. These exercises give the children simple instructions on how to fulfill those expectations. These lessons might seem basic but they are vital for building a foundation of confidence and trust. The child has all of the information needed to be successful in this new space and with all of these new people.
• How to go to and from the toilet.
All future activities in the classroom depend on mastery of these exercises. For example, in order for a child to work with a material on the shelf the child must first know that walking over to the material and selecting it by himself is permitted. Then; the child needs to hold the material and carry to an empty seat (carrying material with 2 hands), putting the material on the table, pulling out the chair out with 2 hands, sitting properly on the chair so the legs are facing the right way and starting the exercise. These acts sound simple to an adult, but to a child they are complex tasks. Knowledge of the ground rules and having the ability to perform basic tasks unaided allows the child to move (and consequently learn and develop) confidently in his classroom environment.
By working with the materials in this section, the child is refining the skills needed to care for the body and to meet the body's basic needs. The child is taking further steps towards independence - building confidence, self-awareness and self-esteem and further establishing the 'can-do' attitude to work and to everyday challenges.
• Dressing Frames - featuring a variety of increasingly difficult fastenings eg. Buttons, clips, zips, velcro, bows.
• Washing hands and nails.
Your child is a member of a vibrant mixed-age community in a child-sized environment. The children are the caretakers of this environment and they have responsibilities towards the other members of their community. They help each other to tidy up and to keep the classroom clean. They make choices regarding the decoration of the classroom. They notice when the polishing cloths are dirty and will wash and dry the cloths in order to replenish the shelves. There is great value in having the skills and tools to identify and solve problems without waiting for adult instruction. There is even greater value and satisfaction when one is working for the common good.
Many of the Grace & Courtesy lessons are given in the first hours of a child's first day in Casa dei Bambini. Just as the Preliminary Exercises give clear guidelines for the physical behaviour within the classroom, the Grace & Courtesy lessons give clear guidelines for the social behaviour within the community. Grace & Courtesy lessons guide the child in how to treat other human beings, both adults and children, while taking their own needs into consideration. They practice the language and the steps for interacting positively with the other independent bodies moving through the environment. These lessons guide the children in moments of conflict and provide vocabulary for their emotions in times of confusion or excitement. They show the child how to be responsive to the needs of others, fostering awareness and developing empathy. The Grace & Courtesy lessons continue throughout the child's three years in Casa dei Bambini and are eventually incorporated into everyday life. Grace and Courtesy make the world a better place.
• Walking balancing on object on one's head.
Montessori also recognised the importance of developing the skills needed to be silent and still. Constant noise and motion can take it's toll on all human beings. Finding peace and calm in a turbulent world is an important skill for maintaining mental health. Children do not often experience silence with the modern day hum of electronics and the constant distractions from smart-phones and tablets. In the Casa dei Bambini environment, the children practice the Silence Game once the teacher has observed that they have reached a level of self-control where they can be successful at being still and silent for just a few moments. As the children practice and seek out this activity without the teacher, they will learn to cultivate mindfulness and exercise self-control.