children in this group with any kind of objects or

diversions. Entertainers also visited the NPG chil-

dren’s beds on the first day of hospitalization and

invited the patients for a stroll. If the child so desired,

his or her parent or guardian could accompany them.

The strolling activities occurred every day, twice a

day, while hospitalization lasted.

On the first day of hospitalization, entertainers

visited the PG children’s beds and invited them to

play in the toy library, interacting with the profes-

sionals, other children, or parents/guardians as they

wished. Play activities were unstructured so that they

would not act as added stressors to the hospitalization

process and they also allowed children to maintain

their own play routines.

Student researchers explained the procedures

for the first 24-hour urine collection (performed on

the first day of hospitalization) and left adequate

receptacles with the parent or guardian for both

groups.

The play routines as well as the strolling routine

were performed each day of hospitalization. On the

fifth day of hospitalization, the 24-hour urine collec-

tion was repeated for all children.

Data collection

On the first visit to the child’s bed, one of the trained

researchers (an OT student) completed the Pelotas

Social Scale and the CDI for both the PG and the NPG

Additionally, urine was collected for 24 hours in

appropriate vessels following hospital routines; the

entire production of urine during this period was

analyzed. The first sample was collected to obtain

baseline values of cortisol. Baseline samples were

collected on the first day of hospitalization, before

intervention. The second sample of urine, collected

on the fifth day of hospitalization, was used to compare

the influence of the intervention of playing on LC.

Data analysis

LC were studied using the chemioluminescence

method. The material was collected at CFCH and

the sample analysis was performed at Centro Estadual

de Análises Clínicas, a central laboratory that per-

forms all clinical analysis for public hospitals in the

eastern area of town; this facility was not aware of the

study. We chose to analyze CL in urine to avoid added

invasive procedures during hospitalization caused by

another blood drawing, for example. We also did not

have access to salivary analyses of cortisol. Measure-

ment of urinary free cortisol, or LC in the 24-hour

production of urine, has the advantage of supplying an

integrated 24-hour result (25).

Statistical analysis.. After analyzing data for normality,

t-tests were used to compare children’s LC (dependent

variable) of those who played or did not play (inde-

pendent variable), according to gender, age, socio-

economic level, depression indicators, and previous

experience of hospitalization (controlling variables).

Chi-squared tests and Fisher’s exact tests were used

to study categorical variables, such as children’s

distribution in the sample. ANOVA tests with

Newman-Keuls post-test and Kruskal-Wallis tests

with Dunn’s post-test were used to compare LC in

relation to gender, age, social classification, CDI

scores, and previous experience of hospitalization as

well as the intervention play. The software used for

statistical valuations was SPSS 13.0 and Prism 3.0. To

measure the impact of our intervention in reducing LC

by at least 20% at the end of the intervention period

(study versus control groups), we calculated the abso-

lute risk (AR), relative risk (RR), confidence interval

(CI) 95%, and the necessary number to treat (NN