Resilience is offered as a theoretical framework from which the competent functioning of a small proportion of survivors of childhood trauma can be understood. Despite the likely deleterious impact of abuse and neglect some individuals continue to thrive and achieve positive outcomes. The literature investigating protective factors implicated in resilience to childhood trauma is reviewed. Studies indicate that certain individual and environmental protective factors provide encouraging experiences and promote positive adaptation. Although current literature needs to move to a more process orientated approach for investigating resilience, existing findings offer valuable insights for the direction of prevention and intervention programmes for at-risk populations. This focus on strengths rather than deficits paves the way for innovative approaches especially with disenfranchised groups who might otherwise be less receptive, for instance individuals marginalised from society such as homeless individuals. On this basis, the empirical study investigated the relationship between childhood trauma and maladaptive coping and the relative influence of resilience, in homeless individuals. A significant relationship between childhood physical abuse and maladaptive coping existed, which was moderated by high levels of resilience. It is postulated that resilience in the homeless population may have a greater protective effect against maladaptive coping as severity of childhood physical abuse decreases. Studies replicating these findings in this and other disenfranchised groups are essential in order to fully understand the role of resilience and potential benefit of promoting and enhancing resilience and coping in reducing tenancy breakdown and therefore chronic and repeated homelessness.

Introdução: O período neonatal é uma época de adaptação em que as reações patológicas e fisiológicas às vezes se confundem, sendo as alterações cutâneas comuns neste período. A frequência dessas manifestações tem sido estudada por diversos autores e difere entre os distintos grupos raciais. Na literatura médica, dados recentes mostram que 57 a 99% dos recém-nascidos (RN) apresentam algum achado dermatológico. Métodos: Foram selecionados de forma aleatória aproximadamente 25% dos nascidos vivos nas três maiores maternidades de Porto Alegre, de junho de 2011 a julho de 2012, para serem submetidos ao exame dermatológico realizado por dermatologistas. Resultados: Um total de 2878 neonatos foram examinados em datas mensalmente sorteadas através de um programa estatístico. A maioria dos neonatos eram da raça branca, 95,4% tinham até 48 horas de vida no momento do exame, 50,9% eram do sexo masculino, 54,9% nasceram por parto vaginal e 92,5% das mães realizaram o pré-natal. Dos RN examinados, 96% apresentavam algum achado dermatológico (IC 95%: 95,3-96,6); destes, 89,6% tinham lesões cutâneas transitórias neonatal (IC: 88% a 91%), 40% marca congênita (IC: 38% a 42%), 24,5% tinham alguma pustulose benigna neonatal (IC: 23% a 27%), 1,4% malformação cutânea (IC: 1% a 2%), 3% lesões secundárias ao trauma - incluindo arranhadura (IC: 2 a 4%) e 0,1% doença infecciosa. O achado dermatológico mais frequente foi o lanugo, observado em 40,9% dos RN (IC: 39% a 43%), seguido pela hiperplasia de glândulas sebáceas (35,3% - IC: 34% a 37%), melanocitose dérmica (23,1% - IC: 22% a 25%), eritema tóxico neonatal (21% - IC: 19% a 22%), eritema da pele (19,7% - IC: 18 a 21%), hiperpigmentação da genitália (18,9% - IC: 17% a 20%), mancha salmão (18,8% - IC: 17% a 20%), edema palpebral (17,2% - IC: 16% a 19%), cistos de mília (16,4% - IC 15% a 18%), descamação da pele (12,5% - IC: 11% a 14%), hipertrofia da genitália (11,4% - IC: 10% a 13%), xerose cutânea (10,7% - IC: 10% a 12%). Foi encontrada ainda uma prevalência de 3,4% de melanose pustulosa transitória neonatal (IC: 3% a 4%), 2,2% de mancha mongólica aberrante, 1,2% de nevo congênito, 0,7% de hemangioma ou precursor de hemangioma, 0,5% de pólipo anexial, 0,3% nevo sebáceo e 0,3% de bolhas de sucção. A presença ou não de afecções cutâneas neonatais foi semelhante nas diferentes estações do ano, porém alguns achados foram mais prevalentes em determinada época do ano. Conclusões: Os achados dermatológicos são frequentes em RN e alguns foram mais comuns do que o esperado. Evidenciando a importância do conhecimento das características da pele do bebê durante o período neonatal. A etnia do neonato e os fatores de risco gestacional influenciam na presença de achados dermatológicos neonatais. Enquanto outras características do neonato, como a idade gestacional e o gênero; bem como e as estações do ano podem influenciar na presença de determinadas lesões cutâneas no RN. / Introduction: Skin changes are common during the neonatal period due to physiological and environmental adjustments and to some pathological reactions. The frequency of these events differs among different regions and ethnicities. Recent data show that 57-99% of newborns (NB) have skin alterations. Methods: This study aims to evaluate skin changes in children born in the 3 three major maternities in Porto Alegre, Brazil, from June 2011 to July 2012. Results: A total of 2878 of the neonates were examined in monthly-randomized dates. The majory were Caucasian, 95,4% during the first 48h of life, 50,9% male, 54,9% born by vaginal delivery and 92.5% of the mothers received prenatal care. From the examined NB, 96% had some dermatologic finding (IC 95%: 95,3-96,6): 89.6% transient neonatal skin conditions (IC: 88% a 91%), 40% congenital birthmarks (IC: 38% a 42%), 24.5% had some benign neonatal pustulosis (IC: 23% a 27%), 1.4% had cutaneous malformations (IC: 1% a 2%), 3% of secondary trauma injuries – including scratch and 0.1% any infection. The most prevalent dermatologic findings were: lanugo (40.9% of the NB - IC: 39% a 43%), sebaceous hyperplasia (35,3% - IC: 34% a 37%), dermal melanocytosis (23,1% - IC: 22% a 25%), neonatal toxic erythema (21% - IC: 19% a 22%), erythema (19,7% - IC: 18 a 21%), genital hyperpigmentation (18,9% - IC: 17% a 20%), salmon patch (18,8% - IC: 17% a 20%), eyelid edema (17,2% - IC: 16% a 19%), milia (16,4% - IC 15% a 18%), desquamation (12,5% - IC: 11% a 14%), hypertrophy of the genitalia (11,4% - IC: 10% a 13%), skin xerosis (10,7% - IC: 10% a 12%). Other findings were transient neonatal pustular melanosis (3.4% - IC: 3% a 4%), aberrant Mongolian spot (2.2%), congenital nevi (1.2%), hemangioma or its precursors (0.7%), adnexal polyps (0.5%), naevus sebaceous (0.3%) and suction blisters (0.3%). Neonatal skin lesions occur with similar frequency in the different seasons (p=0.092), but some findings are more prevalent in certain time of the year. Conclusions: This study showed that skin changes are very frequent in neonates and some disorders are more common than expected. Prove the importance of a good knowledge of the NB skin. The ethnicity of the NB and the gestational risk factors influenced the presence of neonatal dermatological findings. While others neonatal characteristics, such as gestational age and NB gender, as well as the seasons can influence the presence of specific neonatal lesions skin.

The study was a descriptive quantitative survey which endeavoured to identify challenges experienced by IMCI trained registered nurses in implementing the guidelines and procedures of the strategy when tending children under 5 years in Gaborone health district. The study also solicited for recommendations on how to address the identified challenges. The research population comprised of all the IMCI-1 trained registered nurses and systematic sampling was employed to randomly select study participants. Data were collected using a questionnaire and was analysed using Excel Advanced software package. Study findings identified challenges related to political support, cost of IMCI training, training coverage, health systems and features of the IMCI strategy. Recommendations for improving use of the strategy included garnering for more political support, adopting short duration training courses, scaling up both pre-service and in-service training as well as addressing the challenges related to health systems and the unique features of the strategy / Health Studies / M.A. (Public Health)

There is a dearth of smoking research involving young children despite the knowledge that the developmental proocess begins in early childhood. This paucity hinders the development of effective smoking prevention strategies, which need to be based on an accurate understanding of the perspectives of the target group. Therefore basic research is required, to discover where primary school children are at in their thinking about smoking before any potent anti-smoking initiatives can be devised. Such an endeavour however, is exacerbated by the lack of appropriate methods of data collection for this particular age group. The aim of this research study was to explore the perspectives that Liverpool primary schoolchildren in their early years (four to eight years of age) have about smoking by examining the beliefs, knowledge, perceptions and behavioural intentions that inform their attitudes about the habit and subsequently, to assess any changes in these factors over time. This work not only provides the understanding and insight fumdamental to the development of proactive health promotion programmes aimed at tackling the increasing prevalence of smoking among local children but also the empirical evidence needed to fill the significant gap in the existing literature on smoking as well. To achieve these aims ,a multi-method, child-centred participatory approach was used. This between-methods traingulation included questionnaires The Draw and Write Technique, semi-structured interviews and focus group interviews. For the cross-sectional study, a representative sample of primary schoolchildren in their early years from wards of varying socio-economic status participated. All were involved in the quantitative method and a subsample partook in the qualitative methods. For the longitudinal study, the same research design was used to track one birth cohort - the children from Reception for a period of three years to document any changes in perspective over time. The research findings from both studies demonstrated that the children in this investigation had considerable understanding about the nature of tobacco smoke, had as yet to take up the habit and generally expressed little intention to smoke in the future. Their perspectives were predominantly negative, very stable and relatively homogenous. They were grounded in a broad knowledge base that was primarily influenced by cognitive development and socio-cultural experiences. They acknowledged the importance of the family and perceived parents to be both preventers and promoters of the habit. The children also harboured some misconceptions, believing that the health implications from smoking were far greater for children than adults. This belief has cultivated a widespread notion that smoking is an intrinsic part of adulthood. The study findings have substantive implications for the development of proactive smoking interventions in primary schools. The results suggest that any prevention strategy devised must be implemented as early as possible in the school curriculum, that it should be developmental in nature and more than knowledge- based. A grass roots approach, one that fosters empowerment tbrough the active involvement of the children in both the development and implementation of the strategy, in collaboration with the school, the home and the community is recommended, as this work has confirmed that children in their early years can be reliable and valid participants in the research process.

This thesis reports on a study that aimed to add to the understandings about head lice that were already available in society. Previous accounts of infestation had focused largely on its social and expert medical perspectives and there was limited comment on the experience at a personal level. In order to address this Liverpool mothers and grandmothers were asked about their perceptions and understandings of what it meant to experience head lice. The women's experiences spanned most of the twentieth century and this provided the study's historical dimension. The inquiry used hermeneutic phenomenology as a way of investigating highly personal aspects of an experience that had not been explored before. By using an approach that drew on hermeneutic phenomenology and anthropology it was possible to explore aspects of the experience that generated culturally specific beliefs and understandings. Lambert and McKevitt, (2002) argue that in doing this a phenomenon defines itself. In this inquiry the boundaries of mother's understandings concerned with the experience of head lice were unknown. Hermeneutic phenomenology allowed these hidden understandings to emerge. Van Manen's (1997) framework for phenomenological inquiry was used to guide the study and Colaizzi's (1978) method for the interpretation of the women's stories was used to highlight the understandings that emerged. The women who took part were of different ages though all had lived, been mothers and experienced head lice during the twentieth century. They were asked to tell their stories and these were recorded, transcribed and interpreted. The interpretation of their narratives generated themes of understandings. These included understandings about the responsibilities of being mothers and giving care, beliefs and views about the insect and infestation and the meaning and impact of social stigma. The understandings that the women expressed were concerned with their individual responses to infestation. Essential feature shared by them represented a complex interplay of guilt feelings about themselves as poor mothers and the importance of the responsibilities they felt they had to prrtect their children, their families and society from head lice. Their own mothers played a significant role in fashioning their understandings as did their childhood experiences. Images of others outside the family who had infestation were linked to stigma, poor mothering and to lay epidemiology. The women talked of other mothers' responsibilities to prevent and treat infestation and how this created a feeling of lack of control. They also told of the need to remove all traces of infestation from their home and with it the influence and presence of what constituted their image of an infested family. The women shared their stories, but as Widdershoven (1993) points out these have little value unless their relationships to other sources of experience are also considered in some way. Therefore the women's understandings were placed into context by examining the way in which they linked to other available discourses about head lice. A search was made of the social, historical and expert medical sources available during the twentieth century; local Liverpool sources were consulted wherever possible. The understandings that emerged from these were then considered alongside those of the women. There was a link between the women's understandings and those in the social discourse concerning the public health role of women during the twentieth century. Infestation was used as a measure of mothering by social discourses and the women alike. This gave healthcare practitioners and society the opportunity to comment on, influence and control what went on in the family. Stigma, exclusion and labelling were evident in both the social discourses explored and the women's stories particularly in relation to experiences of school and the school nurse. Personal and social discourses about prevention, detection and treatment reached no overall consensus with evidence based approaches being used alongside those influenced by myths and more socially constructed understandings.

Childhood obesity in the UK is a serious public health concern. In some ethnic minority groups obesity prevalence is significantly higher than the national average (The NHS Information Centre, 2010). Therefore, it is recommended that interventions to manage childhood obesity are tailored to the needs of ethnic minority groups (NICE, 2006). GOALS (Getting Our Active Lifestyles Started!) is a community based, childhood obesity management programme that focuses upon physical activity, nutrition and behaviour change in families (Watson et aI., 2011). However, monitoring data has suggested an unrepresentatively low proportion of ethnic minority families who are referred to GOALS choose to access the service. Therefore the aim of this research was to improve the cultural relevance of the GOALS programme, whilst also contributing to the evidence-base for local and national strategic planning surrounding obesity and ethnicity. Studies set out to explore perceptions surrounding childhood weight, diet and physical activity in different ethnic groups; identify cultural preferences, and barriers to participation in healthy lifestyle interventions; to implement and pilot a culturally accessible intervention, using the GOALS framework for development; and to assess the acceptability and effectiveness of the pilot intervention. A multi-method, pluralistic, research design was employed that recognised the complexity of the research aims. In total three empirical studies were conducted, and parents (of children aged 4 to 16 years) and school-aged children participated. A combination of process and outcome data was obtained. Quantitative methods were used for descriptive and explanatory purposes and included questionnaire (Study 1,2 and 3b) and BMI measures (Study 3b). Qualitative methods included focus groups (Study 2 and 3a), face-to-face interviews (Study 3b) and the write-and draw-technique (Study 3b). Exploratory data gave context and depth to the research. In Study 1, parents (n=808) identified their ethnic background as Asian British, Black African, Black Somali, Chinese, South Asian, White British and Yemeni. Ethnic background was significantly associated to parental perceptions of weight in childhood. Results showed Black Somali parents exhibited the lowest level of concern for overweight in childhood in comparison to other ethnic groups. In Study 2, parents (n=36) and children (n=31) from six ethnic groups (Asian Bangladeshi, Black African, Black Somali, Chinese, White British and Yemeni) identified intrapersonal, interpersonal and environmental barriers to healthy weight. Findings demonstrated that influences to health behaviours were sometimes specific to particular ethnic groups. For example, dominant cultural norms valuing overweight in childhood were apparent among Yemeni, Black African, Black Somali and Asian Bangladeshi parents and Asian Bangladeshi children. Results from Study 3a with parents (n=33) from ethnically diverse backgrounds, identified barriers and preferences to attending an intervention were often related to cultural and religious values of ethnic groups. Parents considered the ethnic composition of the group important, and suggested an intervention should be relevant to the ethnic background of all families attending. Based on these findings, 'surface' and 'deep' (Reniscow et al., 1999) structural modifications were made to the GOALS programme. Nine families from Asian British, Asian Bangladeshi, Yemeni and Black Somali backgrounds attended the pilot intervention to examine its appropriateness. Process and outcome data from Study 3b illustrated families benefited from a healthy lifestyles intervention that was designed to be culturally acceptable to multiple ethnic groups. This thesis has added to the limited evidence base surrounding the cultural relevance of family-based childhood obesity management programmes for ethnic minority groups. Differences in cultural norms between ethnic populations, and variations in assimilation to Western norms and acculturation within groups, highlight the complex task in addressing childhood obesity in multiple ethnic groups. Knowledge gained from the successful engagement of ethnic minority families in a culturally sensitive healthy lifestyle intervention, has lead to the development of key recommendations for policy and practice that extend beyond childhood obesity management to health promotion more widely.

A large proportion of UK children do not meet the recommended guidelines for participation in physical activity, which is a public health concern as the prevalence of overweight and obesity among children is rising. Increasing perceptions of competence and levels of fundamental movement skill proficiency are potential strategies to promote physical activity. The aims of this thesis were to, a) investigate the prevalence of skill proficiency and levels of perceived physical competence in UK children, b) examine the relationships between fundamental movement skill competence and physical self-perceptions with children's physical activity, fitness and body fatness, and c) determine the effectiveness of non-curricular interventions to increase fundamental movement skills and enhance perceptions of competence. The first stage of research presented is the cross-sectional study of 152 children (41% boys; Age mean 9.7?0.3 years), which were recruited from 8 primary schools. Children completed the Children and Youth Physical Self-Perception Profile (CYPSPP) and were assessed on 8 skills using video-analysis and process measures. In addition, cardiorespiratory fitness was directly measured during a treadmill protocol to exhaustion; body fat (%) was determined by dual-energy x-ray absorptiometry; and physical activity was assessed by accelerometers over 7 days. The results revealed that children generally had positive perceptions of their physical self. However, levels of physical self-perceptions did not significantly predict physical activity behaviour. Perceptions of physical condition and physical strength were weak predictors of cardiorespiratory fitness and percent body fat, collectively explaining 7% and 7.8% of variance. Children's perceptions of competence were not related to their actual competence levels. Prevalence of proficiency in fundamental movement skills was low-to-moderate in boys and low in girls. Chi-square tests revealed a significantly (P < 0.01) higher proportion of boys were rated as proficient than girls in the kick (x = 37.4), catch (x = 25.3), strike (x = 28.4) and throw (x = 44.1). Total skill score significantly (P < 0.01) accounted for 11% and 9.2% of the variance in physical activity and percent total body fat, respectively. Locomotor skills significantly (P<0.01) predicted 7.7% of unique variance in moderate-to vigorous physical activity, 5.6% of total physical activity, 13.4% of cardiorespiratory fitness, and 23.7% of variance in percent body fat. Object-control skills weakly predicted total body fat (2%; P=0.04) but did not account for variance in other outcomes. This study highlighted the importance of fundamental movement skills to children's health and identified the need for interventions to enhance skill competence in older children. The next stage of research sought to determine the efficacy of interventions to increase skill competence and physical self-perceptions. An exploratory study examined the effects of a 9 week afterschool multi-skills club on skill proficiency, physical self-perceptions and body mass index (BMI) in 8-9 year old children. Two schools were randomly assigned to either a comparison (n = 15) or multi-skill club (n = 19) group. The multi-skill club received 18 coaching sessions designed to improve movement skills, while the comparison group followed normal routines. Children completed the CY-PSPP and assessments of seven movement skills, and were measured for stature and mass to calculate BMI. It was found that children in the multi-skill club had higher BMI (P<0.05) and possibly lower perceptions of body attractiveness and physical condition than children in the comparison group at post-test. Participation in the multi-skill club delivered significant (P<0.01) improvements in proficiency at post-test in static balance, whilst potentially practically important improvements were observed in performance of the catch, throw and kick skills. It was concluded that an afterschool multi-skill club offers a viable opportunity for movement skill acquisition, but any such programme would need to run for a longer duration to identify if this type of activity could benefit all skills. The final study was unique in that it was the first study to assess the impact of three different 12 month interventions on children's skill levels and perceived physical competence. One hundred and fifty-two 9-10 year old children were randomised by school to one of four conditions: a bi-weekly high-intensity physical activity afterschool club (HIPA; n=36); a bi-weekly multi-skill (fundamental movement skill) after-school club (FMS; n=37); a behaviour-modification programme (PASS; n=45); or a control-comparison (CON; n=34). Outcome measures, as employed within the cross-sectional study, were assessed at baseline, 9- and 12 months. It was found that participation in the FMS group was associated with moderate positive intervention effects on skill competence and increased the likelihood of attaining proficiency at post-test skill in 7 out of 8 skills. Participation in HIPA was associated with a small positive intervention effect on locomotor skill competence, and increased likelihood of proficiency in 5 skills, while PASS had no effect on skill competence but did increase the likelihood of attaining proficiency in 3 skills. In boys, participation in FMS and HIPA were associated with higher perceptions of sports competence, condition, and physical self-worth; HIPA elevated perceptions of strength, and, FMS increased perceived body attractiveness. PASS was associated with more positive perceptions of sports competence and body attractiveness at 9- but not 12-months. In girls, there were no positive intervention effects on CY-PSPP subscales, whilst all interventions were associated with more negative perceptions of body attractiveness. No group differences were found for body fat or physical activity, which increased from baseline to mid-test but fell sharply at post test in all conditions. Boys in HIPA improved fitness levels relative to controls, whilst girls participating in the FMS and PASS groups had lower fitness at post-test. It was concluded that multi-skill afterschool clubs are most effective at improving fundamental movement skills. Afterschool clubs may provide a means to augment boys' perceptions of competence, irrespective of activity mode; however, after-school clubs do not appear to enhance physical self-perceptions in girls. Behaviour-modification programmes appear least effective at improving actual and perceived competence, but a combined structured exercise and behaviour modification programme may be necessary to improve health outcomes. A subsequent follow-up study is required to assess long term impact of the interventions. The studies within this thesis have provided a detailed insight into the effects of different interventions on children's actual and perceived competence. To summarise, it was found that many children are not proficient at fundamental movement skills, which is important given their associations with important health outcomes. A multi-skill club programme can best impact such skills, whilst other forms of physical activity can also promote skill development. Perceptions of physical competence do not appear to have strong associations with children's health at this age. The influences of interventions on perceptions of competence appear complex and gender differences suggest that different forms of interventions may be necessary for girls.

Introdução: O período neonatal é uma época de adaptação em que as reações patológicas e fisiológicas às vezes se confundem, sendo as alterações cutâneas comuns neste período. A frequência dessas manifestações tem sido estudada por diversos autores e difere entre os distintos grupos raciais. Na literatura médica, dados recentes mostram que 57 a 99% dos recém-nascidos (RN) apresentam algum achado dermatológico. Métodos: Foram selecionados de forma aleatória aproximadamente 25% dos nascidos vivos nas três maiores maternidades de Porto Alegre, de junho de 2011 a julho de 2012, para serem submetidos ao exame dermatológico realizado por dermatologistas. Resultados: Um total de 2878 neonatos foram examinados em datas mensalmente sorteadas através de um programa estatístico. A maioria dos neonatos eram da raça branca, 95,4% tinham até 48 horas de vida no momento do exame, 50,9% eram do sexo masculino, 54,9% nasceram por parto vaginal e 92,5% das mães realizaram o pré-natal. Dos RN examinados, 96% apresentavam algum achado dermatológico (IC 95%: 95,3-96,6); destes, 89,6% tinham lesões cutâneas transitórias neonatal (IC: 88% a 91%), 40% marca congênita (IC: 38% a 42%), 24,5% tinham alguma pustulose benigna neonatal (IC: 23% a 27%), 1,4% malformação cutânea (IC: 1% a 2%), 3% lesões secundárias ao trauma - incluindo arranhadura (IC: 2 a 4%) e 0,1% doença infecciosa. O achado dermatológico mais frequente foi o lanugo, observado em 40,9% dos RN (IC: 39% a 43%), seguido pela hiperplasia de glândulas sebáceas (35,3% - IC: 34% a 37%), melanocitose dérmica (23,1% - IC: 22% a 25%), eritema tóxico neonatal (21% - IC: 19% a 22%), eritema da pele (19,7% - IC: 18 a 21%), hiperpigmentação da genitália (18,9% - IC: 17% a 20%), mancha salmão (18,8% - IC: 17% a 20%), edema palpebral (17,2% - IC: 16% a 19%), cistos de mília (16,4% - IC 15% a 18%), descamação da pele (12,5% - IC: 11% a 14%), hipertrofia da genitália (11,4% - IC: 10% a 13%), xerose cutânea (10,7% - IC: 10% a 12%). Foi encontrada ainda uma prevalência de 3,4% de melanose pustulosa transitória neonatal (IC: 3% a 4%), 2,2% de mancha mongólica aberrante, 1,2% de nevo congênito, 0,7% de hemangioma ou precursor de hemangioma, 0,5% de pólipo anexial, 0,3% nevo sebáceo e 0,3% de bolhas de sucção. A presença ou não de afecções cutâneas neonatais foi semelhante nas diferentes estações do ano, porém alguns achados foram mais prevalentes em determinada época do ano. Conclusões: Os achados dermatológicos são frequentes em RN e alguns foram mais comuns do que o esperado. Evidenciando a importância do conhecimento das características da pele do bebê durante o período neonatal. A etnia do neonato e os fatores de risco gestacional influenciam na presença de achados dermatológicos neonatais. Enquanto outras características do neonato, como a idade gestacional e o gênero; bem como e as estações do ano podem influenciar na presença de determinadas lesões cutâneas no RN. / Introduction: Skin changes are common during the neonatal period due to physiological and environmental adjustments and to some pathological reactions. The frequency of these events differs among different regions and ethnicities. Recent data show that 57-99% of newborns (NB) have skin alterations. Methods: This study aims to evaluate skin changes in children born in the 3 three major maternities in Porto Alegre, Brazil, from June 2011 to July 2012. Results: A total of 2878 of the neonates were examined in monthly-randomized dates. The majory were Caucasian, 95,4% during the first 48h of life, 50,9% male, 54,9% born by vaginal delivery and 92.5% of the mothers received prenatal care. From the examined NB, 96% had some dermatologic finding (IC 95%: 95,3-96,6): 89.6% transient neonatal skin conditions (IC: 88% a 91%), 40% congenital birthmarks (IC: 38% a 42%), 24.5% had some benign neonatal pustulosis (IC: 23% a 27%), 1.4% had cutaneous malformations (IC: 1% a 2%), 3% of secondary trauma injuries – including scratch and 0.1% any infection. The most prevalent dermatologic findings were: lanugo (40.9% of the NB - IC: 39% a 43%), sebaceous hyperplasia (35,3% - IC: 34% a 37%), dermal melanocytosis (23,1% - IC: 22% a 25%), neonatal toxic erythema (21% - IC: 19% a 22%), erythema (19,7% - IC: 18 a 21%), genital hyperpigmentation (18,9% - IC: 17% a 20%), salmon patch (18,8% - IC: 17% a 20%), eyelid edema (17,2% - IC: 16% a 19%), milia (16,4% - IC 15% a 18%), desquamation (12,5% - IC: 11% a 14%), hypertrophy of the genitalia (11,4% - IC: 10% a 13%), skin xerosis (10,7% - IC: 10% a 12%). Other findings were transient neonatal pustular melanosis (3.4% - IC: 3% a 4%), aberrant Mongolian spot (2.2%), congenital nevi (1.2%), hemangioma or its precursors (0.7%), adnexal polyps (0.5%), naevus sebaceous (0.3%) and suction blisters (0.3%). Neonatal skin lesions occur with similar frequency in the different seasons (p=0.092), but some findings are more prevalent in certain time of the year. Conclusions: This study showed that skin changes are very frequent in neonates and some disorders are more common than expected. Prove the importance of a good knowledge of the NB skin. The ethnicity of the NB and the gestational risk factors influenced the presence of neonatal dermatological findings. While others neonatal characteristics, such as gestational age and NB gender, as well as the seasons can influence the presence of specific neonatal lesions skin.

Research shows that the integration of physical and mental healthcare in paediatric settings is beneficial in terms of clinical and cost effectiveness (Kahana, Drotar, & Frazier, 2008; Douglas & Benson 2008, Griffin & Christie, 2008). Due to the high rates of mental health problems within this population, several studies have shown that referral to paediatric psychology should be increased (e.g. Wagner & Smith, 2007). However, there are few studies investigating factors influencing healthcare professionals’ referral behaviour. The current study used theory of planned behaviour (Ajzen, 1988; 1991) to develop a questionnaire which explores factors influencing the referral of children and families to paediatric psychology. Psychometric properties of the questionnaire were examined. Findings indicate that the questionnaire holds good reliability and validity and that the main constructs of theory of planned behaviour are useful in predicting intention to refer to paediatric psychology. Specific beliefs about referral were also shown to influence intention to refer. Findings that individual referrer factors such as attitudes and beliefs can impact healthcare professionals’ referral behaviour indicates that multidisciplinary interventions and inter-professional education relating to the psychological aspects of illness are required. Recommendations for future research are discussed.

Philosophiae Doctor - PhD / The existing District Health Information System in South Africa can be described as a facility based Information System, focusing on the clinics and hospitals and not on the community. Consequently, only those who access health services through these facilities are included in the system. Many children do not have access to basic health and social services and consequently, are denied their right to good health. Additionally, they are excluded from the routine Health Information System. Policy and resource decisions made by the District Managers, based on the current health facility information, reinforces the exclusion of these already marginalised children. The premise behind this research is that vulnerability of children can be tackled using two interconnected strategies. The first is through the creation of awareness of the situation of children and the second through mobilising the commitment and action of government and society to address this situation. These strategies can be supported by designing an Information System for action; an Information System that can be used to advocate and influence decisions and policies for the rights of these children; an Information System that includes all children. An interpretive participatory action research approach, using a case study in a rural municipality in South Africa, was adopted for the study of a child-health Community-Based Information System. The context in which the community is placed, as well as the structures which are embedded in it, was examined using Structuration Theory. This theory also influenced the design of the Information System. As the aim of the research is to change the Information System to include vulnerable children, a Critical Social Theoretical and longitudinal perspective was adopted. In particular, concepts from Habermas, such as the creation of a public sphere and the &rsquo;Ideal Speech Situation&rsquo;, informed the methodology chosen and were used to analyse the research undertaken. Based on the research conducted in this municipality, four main changes to the Health Information System were made. These were: &bull; determination of the community&rsquo;s own indicators; &bull; changes in data collection forms; &bull; creation of forums for analysis and reflection, and; &bull; changes in the information flows for improved feedback. Other practical contributions of the research are the development of local capacities in data collection and analysis, the development of practical guidelines on the design of a child-health Community-Based Information System, and the development of strategies for enabling participation and communication. In line with the action research approach adopted, and the desire to link theory and practice, the research also contributed on a theoretical level. These contributions include extending the use of Structuration Theory, in conjunction with Habermas&rsquo; Critical Social Theory, to the empirical context of South Africa; addressing the gap of Community-Based Information Systems in Information System design; extending the debate on participation and communication in Information Systems to &rsquo;developing&rsquo; countries, and developing generalisations from a qualitative case study. / South Africa