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            "entidad" => "Universidade Federal dos Vales do Jequitinhonha e Mucuri &#40;UFVJM&#41;&#44; Departamento de Fisioterapia e SaSA&#44; Diamantina&#44; MG&#44; Brazil"
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      "pt" => array:1 [
        "titulo" => "Qualidade de uso de m&#237;dias interativas na primeira inf&#226;ncia e desenvolvimento infantil&#58; uma an&#225;lise multicrit&#233;rio"
      ]
    ]
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Correlation between the child&#39;s development and the quality of interactive media use&#46;</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Y</span>-axis&#44; Equivalent age on the Bayley scales in the different domains of child&#39;s development&#59; <span class="elsevierStyleItalic">X</span>-axis&#44; multicriteria analysis of the quality of interactive media use&#46; &#40;A&#41; Moderate correlation between language development and quality of interactive media use&#46; &#40;B&#41; Low correlation between cognitive development and quality of interactive media use&#46; &#40;C&#41; Low correlation between fine motor development and quality of interactive media use&#46; &#40;D&#41; Absence of correlation between gross motor development and quality of interactive media use&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Society has experienced a profound lifestyle change&#44; intensified in recent times with the advent of technology&#46; Media use has become common among people&#44; incorporated into life habits in different age groups and social contexts&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">There is extensive literature related to the use of television<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a> and a contemporary emergence of studies that address the impacts of interactive media&#44; a technology considered to be recent&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">3&#8211;5</span></a> Interactive media is understood as technology that responds with content to the users&#8217; actions&#44; making dialog and participation possible&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a> It can also be said that how this technology impacts child development is still little known&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The family environment is an important predictor of child development&#44; because it is the family&#39;s responsibility to provide a favorable environment&#44; adequate stimuli&#44; and learning material&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a> Currently&#44; in addition to books and toys&#44; there is also interactive media&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">1&#44;3</span></a> However&#44; there is little evidence on how to best use these devices&#46; Studies show that excessive use can lead to dependence&#44; compulsive use&#44; and difficulty in social interaction&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">1&#44;7</span></a> However&#44; some argue that&#44; when used with diligence&#44; it could represent a resource for child development stimulation&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">3&#44;8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Thus&#44; the aim of the present study was to develop an index that synthesizes the criteria presented in the literature&#44; which makes it possible to measure the quality of interactive media use by children in early childhood&#44; <span class="elsevierStyleItalic">i&#46;e</span>&#46;&#44; children from 0 to 3 years of age&#46; It also intended to verify if there is an association between the quality of the developed index and the children&#39;s development in different domains&#46; The results of the present study are expected to promote discussion and help both parents and specialists regarding the rational use of interactive media&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">9&#8211;11</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">This was a quantitative&#44; cross-sectional&#44; exploratory study&#44; approved by the Research Ethics Committee &#40;Opinion No&#46; 1830742&#41;&#46; Children with typical development&#44; aged between 24 and 42 months&#44; enrolled in public and private institutions in 2016 in a small Brazilian municipality&#44; were eligible for the study&#46; This study excluded children that&#58; &#40;a&#41; did not use interactive media &#40;smartphone&#47;tablet&#41;&#59; &#40;b&#41; whose parents provided incomplete answers to the interactive media questionnaire&#59; &#40;c&#41; had a medical diagnosis of congenital&#47;acquired disease that might interfere with the cognitive&#44; motor&#44; or language performance&#59; &#40;d&#41; did not participate in the child development assessment &#40;parental decision or child&#39;s refusal&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">For the sample size calculation&#44; the authors considered a prevalence of mobile interactive media use of 67&#37; among children aged 2 and 3 years in the study population<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a> with a desired accuracy of 10&#37;&#44; 95&#37; confidence interval&#44; and study design effect<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46; Considering the population of 432 children&#44; an adjustment for a finite number was performed&#44; resulting in 72 children&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In order to understand the habits related to interactive media use&#44; a questionnaire was applied&#44; based on the literature<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">3&#8211;5&#44;7&#44;9&#8211;11</span></a> &#40;Supplementary Material&#41;&#46; Additionally&#44; a sociodemographic questionnaire and the Brazilian Criteria of Economic Classification &#40;Crit&#233;rio de Classifica&#231;&#227;o Econ&#244;mica Brasil &#91;CCEB&#93;&#41; were applied for economic classification&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Child development was measured using the third edition of the Bayley Scale of Infant and Toddler Development &#40;Bayley-III&#41;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a> used in clinical practice and in research<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a> for the evaluation of child development&#46; For the study&#44; the following scales were applied&#58; cognitive development&#44; expressive language&#44; and fine and gross motor development&#44; scored based on the sum of tasks performed by the child&#44; generating crude scores&#46; Aiming at standardizing the scores of the different applied scales&#44; it was decided to use the equivalent age&#44; which represents the average age in months in which a given total crude value is typical&#46; Moreover&#44; Milne et al&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a> consider that the standardized scores of the Bayley-III scale overestimate the children&#39;s development and encourage the use of equivalent age as an alternative&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The questionnaires about the use of interactive media and the CCEB were sent home in the children&#39;s backpacks and answered by their parents&#46; The Bayley-III was applied in the school environment&#44; by four evaluators&#44; after training and verification of the inter-examiner reliability&#44; with an intraclass correlation index of 0&#46;95&#37;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The multi-attribute utility theory &#40;MAUT&#41; was used&#44; known as the multicriteria decision aid&#44; which is a tool used in case of multiple factors in the evaluation process&#44; making it possible to identify&#44; characterize&#44; and combine different variables&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">17&#44;18</span></a> The stages of MAUT are described as follows&#58;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Criteria selection</span><p id="par0055" class="elsevierStylePara elsevierViewall">According to the MAUT&#44; the selected criteria must faithfully represent what will be evaluated&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a> Therefore&#44; in the present study&#44; the selected criteria were based on the literature and are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> &#40;first column&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Establishing a usefulness scale for the scoring of each criterion</span><p id="par0060" class="elsevierStylePara elsevierViewall">This phase aims to compare the quantifications of the selected criteria on the same ordinal scale&#46; In the present study&#44; the selected criteria obtained responses that were quantified according to the attributes described in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> &#40;second column&#41;&#46; At this stage&#44; the responses were converted into numeric variables by means of an increasing ordinal scale ranging from 0 to 1 &#40;third column of <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">For the first criterion&#44; &#8220;media use by parents&#44;&#8221; the child scored 1 if the parent used the media as a model&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">1&#44;19&#44;20</span></a> The second criterion&#44; &#8220;daily time of interactive media use&#44;&#8221; the time of 2<span class="elsevierStyleHsp" style=""></span>hours was considered as the reference&#44; according to the American Academy of Pediatrics &#40;AAP&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a> For the third criterion&#44; &#8220;media type&#44;&#8221; it was decided to assign a higher score to the tablet in relation to the smartphone&#44; considering that its screen size facilitates media use and favors interactive activities&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">21&#44;22</span></a> The fourth criterion&#44; &#8220;what do you use the media for&#44;&#8221; scored 1 when the child used it for interactive activities&#44; such as playing games and 0&#46;25 for passive activities but with a certain possibility of interaction&#44; such as watching stories&#47;listening to music&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">3&#44;11</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">For the fifth criterion&#44; &#8220;who do you use the media with&#44;&#8221; it is known that children in early childhood make better use of media through parental mediation&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">23&#44;24</span></a> Therefore&#44; it received a total score if the child used the media with an adult &#40;parents&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">23&#44;24</span></a> and half if he&#47;she used it with another child&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a> The child scored 0 if he&#47;she used the media alone&#46; For the sixth criterion&#44; &#8220;monitoring&#44;&#8221; it measured whether an adult limited media use time&#44; inappropriate content&#44; and whether the parent encouraged&#47;interacted with the child during media use&#46; In this case&#44; the total score was given to those who answered affirmatively for all items&#44; and proportionally received a lower score if the answer was affirmative for one or two of the items&#46; As for the seventh criterion&#44; &#8220;purpose of use&#44;&#8221; the children whose parents answered that they used the resource to stimulate development or to favor recreation scored 1&#44; and they scored zero when it was used to distract them &#40;regulate behavior&#41; in public&#47;at home&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a> Finally&#44; &#8220;the parents&#8217; positive opinion of the media&#8221; scored 1 point&#44; since when parents believe the use of interactive media favors development&#44; they tend to encourage the child to use it more frequently&#46; The parent who declared having no opinion about media use scored 0&#46;5&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">For the study&#44; equal weights were used for the different criteria&#44; assuming that each selected factor has the same degree of relevance in the process of quality of media use by children&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Calculation of the multicriteria index</span><p id="par0080" class="elsevierStylePara elsevierViewall">The multicriteria index refers to the weighted sum of the different evaluations of criteria&#46; As in this study the weights considered for each criterion were the same&#44; an average was calculated of the evaluations of all the criteria for each participating child&#44; to calculate the multicriteria index&#46; The final multicriteria score for each child ranged from 0 to 1 point&#46; Eq&#46; <a class="elsevierStyleCrossRef" href="#eq0005">&#40;1&#41;</a> shows how this calculation was performed &#40;<span class="elsevierStyleItalic">n</span> &#61; number of evaluated criteria&#41;&#58;<elsevierMultimedia ident="eq0005"></elsevierMultimedia></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Validation of results</span><p id="par0085" class="elsevierStylePara elsevierViewall">At this step&#44; it is verified whether the utilized multicriteria methodology met the proposed objective&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a> In the present study&#44; the authors aimed to verify whether children with higher values in the multicriteria index had better developmental results&#46; For this purpose&#44; a correlation analysis was performed between the multicriteria indices and the Bayley-III development scales&#46; As the variable multicriteria index did not have a normal distribution&#44; a Spearman correlation analysis was performed&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Then&#44; those variables that had a correlation &#62;0&#46;20 were submitted to a simple linear regression analysis aiming to verify how much the multicriteria index could explain the studied domains of child development&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">For the sample calculation&#44; this study used OpenEpi &#40;Open Source Epidemiologic Statistics for Public Health&#44; Vesion 3&#44; <a href="http://www.openepi.com/">www&#46;OpenEpi&#46;com</a>&#41;&#46; The Excel program &#40;Microsoft&#44; WA&#44; USA&#44; 2010&#41; was used to formulate the multicriteria model&#59; subsequently&#44; the data were transferred to SPSS software &#40;IBM SPSS Statistics for Windows&#44; Version 19&#46;0&#44; NY&#44; USA&#41;&#44; to perform the analysis of Spearman&#39;s correlation and the simple regression analysis &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; The calculation of the statistical power of the study was performed using the software GPower 3&#46;1 &#40;G Power&#44; Heinrich-Heine-Universit&#228;t D&#252;sseldorf&#44; Germany&#41;&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0100" class="elsevierStylePara elsevierViewall">The supplementary figure shows the detailed composition of the sample&#46; A total of 104 children from seven public and two private schools participated in this study&#46; For each Bayley-III subscale&#44; the sample composition was different&#44; considering that not all children performed the full scale&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The median of the children&#39;s chronological age was 36 &#40;23&#8211;42&#41; months&#44; distributed similarly between the genders&#44; and the majority attended public day care centers&#46; Most families were in classes C and B and the mothers were adults&#46; As for maternal schooling&#44; more than half have at least completed high school education&#46; There was a predominant use of smartphones in relation to tablets&#44; and although the median use of media was less than 60<span class="elsevierStyleHsp" style=""></span>min a day&#44; the range of media use time was broad &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">After calculating the multicriteria index for each child&#44; a correlation analysis of the quality of media use was performed with the results obtained in the Bayley-III development scales &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">The median of equivalent ages for the cognitive&#44; language&#44; fine motor&#44; and gross motor scales of Bayley-III were&#44; respectively&#44; 35 &#40;23&#8211;42&#41; months&#44; 39 &#40;20&#8211;42&#41; months&#44; 40 &#40;23&#8211;42&#41;&#44; and 33 &#40;21&#8211;42&#41; months&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">The children who achieved higher values of the multicriteria index reached higher scores in the language &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#44; cognitive &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#44; and fine motor &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C&#41; scales&#46; For language&#44; the correlation between the variables was statistically significant &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; positive&#44; and moderate &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;40&#41;&#44; with a statistical power of 91&#37;&#46; For the fine motor scale&#44; the correlation between the variables was statistically significant &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;04&#41;&#44; positive&#44; and weak &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;22&#41;&#44; with a statistical power of 55&#37;&#46; For the cognitive scale&#44; the correlation between the variables was statistically significant &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;04&#41;&#44; positive&#44; and weak &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;23&#41;&#44; with a statistical power of 53&#37;&#46; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>D shows the correlation between the multicriteria indices and the gross motor scale&#46; No statistically significant correlation &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41; was found &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;9&#41;&#44; indicating that no association was found between quality of interactive media use and gross motor development&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the results of the simple linear regression analysis&#46; It can be observed that the multicriteria index explains 20&#37; of the performance in the language scale&#46; For the cognitive and fine motor domains&#44; the coefficient of determination was not statistically significant&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0130" class="elsevierStylePara elsevierViewall">This study&#39;s aim was to create an index that synthesizes criteria for the quality of interactive media used by children in early childhood&#44; considering that children have access to interactive media at an increasingly early age&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a> Unlike the computer&#44; which requires visual coordination and manual skills to handle the keyboard and mouse&#44; interactive media has been shown to be more accessible&#44; and at 2 years of age the child has the capacity to make interactive and purposeful use&#44;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">4</span></a> although improvement in terms of accuracy and speed regarding the touching of the screen occurs during childhood&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">4&#44;10</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Most of the participants in the study belonged to the middle class&#44; followed by the upper-middle class in the economic classification&#44; and studied in public schools&#46; Considering the objectives of the present study&#44; those children who did not use interactive media were excluded&#46; However&#44; it is known that although interactive media are increasingly accessible to all ages and economic classes&#44;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a> economically disadvantaged children still have less access to this type of media&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">10&#44;12</span></a> Most mothers were adults and had at least completed high school education&#46; Many of these indicators point to a higher quality of care and the promotion of a more favorable environment for child development&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">The AAP<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> recommendation&#44; in addition to discouraging the use before 2 years of age&#44; limits the total screen time to two hours a day starting at 2 years of age&#46; The Brazilian Society of Pediatrics &#40;SBP&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a> in turn&#44; recommends that the time of exposure to the screens for the age group of 2 to 5 years should be up to one hour per day&#46; In the present study&#44; the median time in minutes of children&#39;s use of media was within the recommendations of the AAP and SBP&#44; although the time frame was broad&#44; and some children used the media for up to eight hours&#46; Studies carried out in other countries report that most children at 2 and 3 years of age exceed the recommended use time&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">The multicriteria index showed the potential to evaluate the quality of media use&#44; since in the validation phase it demonstrated statistically significant and positive correlation with the domains of language&#44; cognitive&#44; and fine motor development&#44; with a high study power for the former and moderate for the latter two&#46; It should be noted that the observed correlations were weak to moderate&#44; possibly justified by the fact that child development is a multifactorial construct&#44; with dynamic interactions between aspects of the environmental context and genetics&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Regarding cognitive development&#44; early contact with media can promote the development of digital literacy skills&#44; important for the cognitive aspects of development&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">26</span></a> Huber et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a> studying children from 4 to 6 years of age playing the Tower of Hanoi puzzle in the physical version and another group using the touchscreen version of the puzzle&#44; found significant improvement in the task resolution&#44; regardless of the version &#40;touchscreen <span class="elsevierStyleItalic">vs&#46;</span> physical version&#41;&#46; The authors concluded that children are able to transfer learning from touch-screen devices to the world of real objects&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Regarding the aspect of the media benefits in the development of fine motor skills&#44; a controversy remains&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">22&#44;26&#44;28</span></a> In an experimental study&#44; the authors compared the development of fine motor skills in children who used tablets with those who performed fine motor activities in the real context&#46; The researchers found that fine motor accuracy and manual dexterity improved in children who did not use the tablet&#44; when compared to those who used it&#46; The authors justified it with the fact that real-life actions such as grabbing objects&#44; drawing&#44; and handling&#44; involve greater muscle strength&#44; coordination&#44; and dexterity in relation to fine motor activities on the tablet&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">However&#44; other authors found an association between tablet use and improvement in fine motor skills&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">22&#44;26</span></a> Price et al&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">26</span></a> highlighted similarities between the virtual environment of the tablet screen and the physical environment of the painting canvas&#46; The authors found similar movements in both environments&#44; such as tapping&#44; circular lines&#44; and straight lines&#46; Moreover&#44; the virtual environment allowed greater opportunity for the repetition and continuity of movements&#46; Thus&#44; the authors emphasize the importance of movement training in the virtual environment to learn the preparatory skills for painting in the physical context&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">As for the gross motor development&#44; no correlation was found with the quality of interactive media use&#46; In general&#44; the literature points out that there is an inverse association between the development of gross motor skills and the use of media&#44; since the assessed interactive media activities offer a reduced repertoire of exploration of environmental physical spaces&#44; which is a negative factor for gross motor skill&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">The domain of child development that showed the greatest correlation with the multicriteria index was language&#44; and the index of determination showed that the quality of the interactive media use can predict the child&#39;s language development by 20&#37;&#46; This result is interesting&#44; because the literature shows studies that associate media exposure to language development delay&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a> However&#44; this fact can be justified because the aforementioned studies mainly used television as the media source&#46; The present research focused on the quality of interactive media use that&#44; unlike TV&#44; allows interaction and communication between the child and the device&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a> Thus&#44; through interactive games&#44; applications&#44; and educational devices&#44; these media contribute to activities that precede literacy skills and increase vocabulary&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">8&#44;11&#44;29</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">A study performed with American children&#44; aged between 2 and 12 years&#44; using a touchscreen application&#44; found that children learned new object names while touching or dragging an object across the screen&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">29</span></a> Another study points out that children using e-books learn to read equally well&#44; and sometimes more than those using printed books&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a> The findings suggest that interactivity<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">30</span></a> and content may be more important factors to be considered than simply &#8220;screen time&#44;&#8221; which reinforces the importance of the quality of interactive media use for young children&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">In this sense&#44; the multicriteria analysis meets a current demand in the care of the pediatric population&#44; regarding the construction of parameters that indicate the quality of the media use&#46; The model and the parental beliefs regarding the media use&#44;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">19&#44;20</span></a> the media type and the purpose of its use&#44;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">11&#44;21</span></a> and the interaction with other people during the use&#44; especially the parents&#44;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">8&#44;23&#44;24</span></a> are criteria to be considered before providing these devices to young children&#44; who are positively or negatively influenced by the resources they use&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">As study limitations&#44; the fact that the study design does not allow a cause-effect association must be mentioned&#46; However&#44; the present study shows potential in this topic for the performance of future experimental research that will provide further supporting evidence&#46; Another point to highlight was the use of a questionnaire&#44; which potentiates a memory and social desirability bias&#59; however&#44; this has been the resource used in most studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">4&#44;5&#44;11&#44;22</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">The present multicriteria index&#44; designed to assess the quality of interactive media used by children in early childhood&#44; has shown potential for its application&#46; A positive and significant association was observed between the quality of interactive media use and children&#39;s development in the domains of language&#44; cognition&#44; and fine motor development&#44; especially regarding language&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Funding</span><p id="par0195" class="elsevierStylePara elsevierViewall">The study had its own funding and received an institutional scientific scholarship &#40;PRPPG-UFVJM&#41;&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflicts of interest</span><p id="par0200" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest&#46;</p></span></span>"
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    "fechaAceptado" => "2018-11-06"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;1&#41; To develop an index that allows the measurement of the quality of interactive media used by children in early childhood&#46; &#40;2&#41; To verify whether there is an association between the index and cognitive development&#44; expressive language&#44; and fine and gross motor development&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A quantitative&#44; cross-sectional&#44; exploratory study with 103 children&#44; aged 24 to 42 months&#44; evaluated by the Bayley Scale of Infant and Toddler Development&#46; The criteria for the index were selected from the literature&#58; &#40;1&#41; media use by parents&#59; &#40;2&#41; time of daily media use&#59; &#40;3&#41; media type&#59; &#40;4&#41; what do you use the media for&#59; &#40;5&#41; who do you use the media with &#40;6&#41; monitoring &#40;limits time&#44; content&#44; interacts during use&#41;&#59; &#40;7&#41; purpose of use&#59; &#40;8&#41; parents&#8217; opinion of the media&#46; For development of the multicriteria index&#44; the multi-attribute utility theory was applied&#44; and Spearman correlation and simple linear regression &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; were used to verify the association between the index and child development&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The index showed a positive and significant correlation with child development in the following domains&#58; language &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;40&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; cognitive &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;23&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;04&#41;&#44; and fine moto<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;22&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;04&#41;&#46; Simple linear regression analysis showed that the use of interactive media accounts for 22&#37; of language development &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The multicriteria index developed to verify the quality of interactive media used by children in early childhood showed that it has the potential to be used&#46; The positive and significant associations between the quality of interactive media use and child development was verified&#44; mainly regarding language&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">&#40;1&#41; Elaborar um &#237;ndice que possibilite mensurar a qualidade de uso de m&#237;dias interativas por crian&#231;as na primeira inf&#226;ncia&#46; &#40;2&#41; Verificar se h&#225; rela&#231;&#227;o entre o &#237;ndice e o desenvolvimento cognitivo&#44; linguagem expressiva&#44; motor fino e grosso&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudo quantitativo&#44; transversal&#44; explorat&#243;rio&#44; com 103 crian&#231;as de 24 a 42 meses avaliadas pela <span class="elsevierStyleItalic">Bayley Scale of Infant and Toddler Development</span>&#46; Os crit&#233;rios para o &#237;ndice foram selecionados a partir da literatura&#58; &#40;1&#41; uso de m&#237;dias pelos pais&#59; &#40;2&#41; tempo de uso de m&#237;dia&#47;dia&#59; &#40;3&#41; tipo de m&#237;dia&#59; &#40;4&#41; para que usa a m&#237;dia&#59; &#40;5&#41; com quem usa a m&#237;dia &#40;6&#41; acompanhamento dos pais &#40;limita tempo&#44; conte&#250;do&#44; interage durante&#41;&#59; &#40;7&#41; objetivo do uso&#59; &#40;8&#41; opini&#227;o dos pais sobre a m&#237;dia&#46; Para a elabora&#231;&#227;o do &#237;ndice multicrit&#233;rio foi aplicado o <span class="elsevierStyleItalic">Multi-Attribute Utility Theory</span> e para verificar a rela&#231;&#227;o entre o &#237;ndice e o desenvolvimento infantil a an&#225;lise de Correla&#231;&#227;o de Spearman e Regress&#227;o Linear Simples &#40;p &#706; 0&#44;05&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">O &#237;ndice apresentou correla&#231;&#227;o positiva e significativa com o desenvolvimento infantil nos dom&#237;nios&#58; linguagem &#40;r &#61; 0&#44;40&#44; p &#60; 0&#44;001&#41;&#44; cognitivo &#40;r &#61; 0&#44;23&#44; p &#61; 0&#44;04&#41;&#44; motor fino &#40;r &#61; 0&#44;22&#44; p &#61; 0&#44;04&#41;&#46; A an&#225;lise de regress&#227;o linear simples demonstrou que o uso de m&#237;dias interativas explica 20&#37; do desenvolvimento da linguagem &#40;p &#60; 0&#44;001&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#227;o</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">O &#237;ndice multicrit&#233;rio elaborado para verificar a qualidade das m&#237;dias interativas em crian&#231;as na primeira inf&#226;ncia mostrou ter potencial para aplica&#231;&#227;o&#46; Constatou-se a rela&#231;&#227;o positiva e significativa entre a qualidade de uso de m&#237;dias interativas e o desenvolvimento infantil&#44; principalmente para a linguagem&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as&#58; Nobre JN&#44; Vinolas Prat B&#44; Santos JN&#44; Santos LR&#44; Pereira L&#44; Guedes SC&#44; et al&#46; Quality of interactive media use in early childhood and child development&#58; a multicriteria analysis&#46; J Pediatr &#40;Rio J&#41;&#46; 2020&#59;96&#58;310&#8211;7&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0020">The manuscript is part of the Master&#39;s Degree Dissertation of the Postgraduate Program in Health&#44; Society&#44; and Environment &#40;SaSA&#41;&#44; Diamantina&#44; MG&#44; Brazil&#46;</p>"
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            "apendice" => "<p id="par0210" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article&#58;<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary data"
            "identificador" => "sec0060"
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        "tipo" => "MULTIMEDIAFIGURA"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Correlation between the child&#39;s development and the quality of interactive media use&#46;</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Y</span>-axis&#44; Equivalent age on the Bayley scales in the different domains of child&#39;s development&#59; <span class="elsevierStyleItalic">X</span>-axis&#44; multicriteria analysis of the quality of interactive media use&#46; &#40;A&#41; Moderate correlation between language development and quality of interactive media use&#46; &#40;B&#41; Low correlation between cognitive development and quality of interactive media use&#46; &#40;C&#41; Low correlation between fine motor development and quality of interactive media use&#46; &#40;D&#41; Absence of correlation between gross motor development and quality of interactive media use&#46;</p>"
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                  \t\t\t\t">- &#60;2<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Time in minutes&#47;120<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Media type</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Tablet&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Smartphone&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#47;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">What do you use the media for&#63;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Playing games&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Use of educational applications&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Read stories&#47;listen to songs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#47;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Who do you use the media with&#63;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Parent&#47;adult caregiver&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Another child&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#47;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Alone&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Parental monitoring</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Time limit&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#47;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Content limit &#40;inappropriate&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#47;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Stimulates&#44; interacts&#44; plays together&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#47;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Purpose of use</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Recreation or stimulate the development&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Distract in public&#47;at home&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Parent&#39;s opinion of the media</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Does not have an opinion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#47;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Phases of the multi-attribute utility theory for the quality of interactive media&#46;</p>"
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        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
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          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
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        "tabla" => array:2 [
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Characteristics &#40;n &#61; 104 children&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Economic classification&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Level ALevel BLevel C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;6&#46;7&#41;36 &#40;34&#46;6&#41;47 &#40;45&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Level D-E&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;13&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Gender&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MaleFemale&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47 &#40;45&#46;2&#41;54 &#40;54&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mother&#39;s age&#44; years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Up to 20Equal to or older than 20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;5&#46;8&#41;98 &#40;94&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Maternal schooling <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>103 children&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Up to 4th grade of elementary schoolComplete elementary schoolComplete high schoolComplete College&#47;universityComplete postgraduate school&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;1&#46;9&#41;18 &#40;17&#46;3&#41;49 &#40;47&#46;1&#41;24 &#40;23&#46;1&#41;10 &#40;9&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>School type&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PrivatePublic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32 &#40;30&#46;8&#41;72 &#40;69&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Smartphone use&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12 &#40;11&#46;5&#41;92 &#40;88&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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