Orientador: Maria Marluce dos Santos Vilela / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-15T14:05:39Z (GMT). No. of bitstreams: 1 Carniel_EmiliadeFaria_D.pdf: 3924865 bytes, checksum: 69afc983570e4078c9b9af49ed7e4fb9 (MD5) Previous issue date: 2009 / Resumo: Introdução: A possibilidade de combinar vacinas sem causar interferência com a segurança e a eficácia contribui para reduzir os custos, melhorar as dificuldades logísticas e para a adesão da população aos esquemas de imunização propostos. Com isso, o controle de doenças imunopreveníveis, objetivo do Programa Nacional de Imunizações, poderá ser facilitado. Objetivos: Avaliar a imunogenicidade e a segurança da vacina recombinante contra a hepatite B (Butang®) combinada com a vacina BCG, produzidas pelo Instituto Butantan (SP-Brasil). Métodos: Realizou-se um ensaio clínico aberto e randomizado comparando a vacina Butang® (HbsAg recombinante 10 µg; hidróxido de alumínio 0,625 mg; timerosal 0,05 mg; qsp 0,5ml) administrada separada ou combinada com a BCG (BCG em suspensão - cepa Moreau - Rio de Janeiro - 0,1mg; glutamato de sódio 1,1mg; NaCl 0,85%; qsp 0,1ml). Foram selecionados 552 recém-nascidos saudáveis, cujas mães eram HbsAg, HIV e sífilis negativas, que foram alocados aleatoriamente em dois grupos: Grupo I: Butang® combinada com a BCG por via intradérmica (ID) nas primeiras 24 horas de nascimento e Butang® por via intramuscular (IM) com um e seis meses de vida e Grupo II: uma dose de BCG ID e uma dose de Butang® IM nas primeiras 24 horas, após o nascimento, e Butang® IM com um e seis meses de vida. Foram colhidas amostras de sangue imediatamente antes da terceira dose de Butang® e aproximadamente 30 dias após, e realizadas análises quantitativas de anti-HBs (mIU/ml) usando Axsym Ausab® ABBOTT GmbH Diagnostika (Laboratories, Park IL, USA). Os dados foram analisados utilizando-se o programa SPSS v.11, Chicago IL, USA. Resultados: Das 552 crianças selecionadas, 498 cumpriram o protocolo do estudo. Dessas, 245 (116 do sexo masculino e 129 do sexo feminino) pertenciam ao Grupo I e 253 (146 do sexo masculino e 107 do sexo feminino) ao Grupo II. A estratégia de campo, adotada nesse ensaio, garantiu pouca interferência na rotina de vida das famílias, no seguimento pediátrico e na vacinação da criança e permitiu uma adesão de 90,2% dos participantes. Não foram observados eventos adversos. Foram encontrados títulos de anti-HBs > 10 mUI/mL em 99,6% dos vacinados do Grupo I e 99,2% do Grupo II após a terceira dose da Butang®. O intervalo de confiança da diferença entre as proporções de soroproteção mostrou que a vacina combinada não foi inferior às vacinas aplicadas separadamente. Conclusão: A vacina combinada mostrou adequada imunogenicidade e segurança, respaldando o seu uso em recém-nascidos / Resumo: Introdução: A possibilidade de combinar vacinas sem causar interferência com a segurança e a eficácia contribui para reduzir os custos, melhorar as dificuldades logísticas e para a adesão da população aos esquemas de imunização propostos. Com isso, o controle de doenças imunopreveníveis, objetivo do Programa Nacional de Imunizações, poderá ser facilitado. Objetivos: Avaliar a imunogenicidade e a segurança da vacina recombinante contra a hepatite B (Butang®) combinada com a vacina BCG, produzidas pelo Instituto Butantan (SP-Brasil). Métodos: Realizou-se um ensaio clínico aberto e randomizado comparando a vacina Butang® (HbsAg recombinante 10 µg; hidróxido de alumínio 0,625 mg; timerosal 0,05 mg; qsp 0,5ml) administrada separada ou combinada com a BCG (BCG em suspensão - cepa Moreau - Rio de Janeiro - 0,1mg; glutamato de sódio 1,1mg; NaCl 0,85%; qsp 0,1ml). Foram selecionados 552 recém-nascidos saudáveis, cujas mães eram HbsAg, HIV e sífilis negativas, que foram alocados aleatoriamente em dois grupos: Grupo I: Butang® combinada com a BCG por via intradérmica (ID) nas primeiras 24 horas de nascimento e Butang® por via intramuscular (IM) com um e seis meses de vida e Grupo II: uma dose de BCG ID e uma dose de Butang® IM nas primeiras 24 horas, após o nascimento, e Butang® IM com um e seis meses de vida. Foram colhidas amostras de sangue imediatamente antes da terceira dose de Butang® e aproximadamente 30 dias após, e realizadas análises quantitativas de anti-HBs (mIU/ml) usando Axsym Ausab® ABBOTT GmbH Diagnostika (Laboratories, Park IL, USA). Os dados foram analisados utilizando-se o programa SPSS v.11, Chicago IL, USA. Resultados: Das 552 crianças selecionadas, 498 cumpriram o protocolo do estudo. Dessas, 245 (116 do sexo masculino e 129 do sexo feminino) pertenciam ao Grupo I e 253 (146 do sexo masculino e 107 do sexo feminino) ao Grupo II. A estratégia de campo, adotada nesse ensaio, garantiu pouca interferência na rotina de vida das famílias, no seguimento pediátrico e na vacinação da criança e permitiu uma adesão de 90,2% dos participantes. Não foram observados eventos adversos. Foram encontrados títulos de anti-HBs > 10 mUI/mL em 99,6% dos vacinados do Grupo I e 99,2% do Grupo II após a terceira dose da Butang®. O intervalo de confiança da diferença entre as proporções de soroproteção mostrou que a vacina combinada não foi inferior às vacinas aplicadas separadamente. Conclusão: A vacina combinada mostrou adequada imunogenicidade e segurança, respaldando o seu uso em recém-nascidos / Abstract: Background: the possibility of combining vaccines without affecting their safety and efficacy might reduce costs, overcome logistic difficulties and increase population acceptation to immunization schedules. As a consequence, preventable-vaccine diseases might be controlled. Objectives: to evaluate immunogenicity and safety of recombinant Hepatitis B vaccine (Butang®) combined with BCG vaccine, both produced by Instituto Butantan (Brazil). Methods: a randomized non-inferiority study was conducted to compare immunogenicity and safety of the Butang® (recombinant HbsAg 10 µg; aluminium hydroxide 0.625 mg; thimerosal 0.05 mg; qsp 0.5 mL) administered alone or combined with BCG (BCG suspension Moreau - Rio de Janeiro strain 0.1 mg; sodium glutamate 1.1 mg; NaCL 0.85%; qsp 0.1 mL). Five hundred and fifty two healthy newborn children from negative HbsAg, HIV and sifilis mothers were split in two groups, according to the following treatments applied up to 24 h after birth: Group I: Butang® combined with BCG administered intradermaly and Group II: Butang® administered intramuscularly and BCG intradermaly. Both groups received subsequent doses of Butang® at one and six months of age. Blood samples were collected immediately before applying the third dose of Butang® and 30 days after, in order to perform anti-HBs (mIU/mL) quantitative analysis using Axsym Ausab® ABBOTT GmbH Diagnostika (Laboratories, Park IL, USA). Data were analyzed by computer software named SPSS v.11, Chicago IL, USA. The subsequent Butang® applications and blood samples were taken in participants' home. Results: No adverse events occurred during experimental period. The field strategy used in this clinical trial allowed adoption by 90.2% of the participants and caused little interference in families' daily routine, pediatrics appointments and children's vaccine. Out of 552 randomized children, 498 completed the study protocol, in which 245 (116 males and 129 females) were allocated in Group I and 253 (146 males and 107 females) in Group II. Anti-HBs titers > 10 mUI/mL were found in 99% of both groups. The confidence interval of proportion difference in seroprotection was within the range to define equivalence between combined and alone vaccine application. Conclusion: Combined Butang® with BCG vaccine administration showed similar safety and efficacy, as compared to alone vaccine application in newborns / Doutorado / Saude da Criança e do Adolescente / Doutor em Saude da Criança e do Adolescente

Submitted by Aline Batista (alinehb.ufpel@gmail.com) on 2018-05-21T17:25:38Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_Francine_Silva_dos_Santos.pdf: 1838087 bytes, checksum: 700caaad2ff94f716df68f1b0a742656 (MD5) / Approved for entry into archive by Aline Batista (alinehb.ufpel@gmail.com) on 2018-05-21T20:14:07Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_Francine_Silva_dos_Santos.pdf: 1838087 bytes, checksum: 700caaad2ff94f716df68f1b0a742656 (MD5) / Approved for entry into archive by Aline Batista (alinehb.ufpel@gmail.com) on 2018-05-21T20:14:14Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_Francine_Silva_dos_Santos.pdf: 1838087 bytes, checksum: 700caaad2ff94f716df68f1b0a742656 (MD5) / Made available in DSpace on 2018-05-21T20:14:14Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_Francine_Silva_dos_Santos.pdf: 1838087 bytes, checksum: 700caaad2ff94f716df68f1b0a742656 (MD5) Previous issue date: 2016-07-15 / Sem bolsa / A alimentação na primeira infância tem implicações nos demais ciclos da vida de um indivíduo. Contudo, evidenciam-se orientações inadequadas por parte dos profissionais de saúde em relação à alimentação complementar e práticas inadequadas das famílias durante este período. Entende-se que os agentes comunitários de saúde, devido suas características e atribuições, possam ser interlocutores, melhorando a alimentação complementar, em todo território nacional. Com isso, este trabalho teve por objetivo descrever o conhecimento dos agentes comunitários de saúde e os recursos que a unidade básica oferece para que estes tenham conhecimento sobre alimentação complementar. Foi realizado estudo transversal descritivo na cidade de Pelotas, RS, nas unidades básicas da zona urbana com Estratégia Saúde da Família ou Estratégia de Agentes Comunitários de Saúde. Dois instrumentos foram utilizados: um questionário proposto ao serviço de saúde e outro destinado aos agentes comunitários de saúde, dividido em duas partes, sendo a primeira aplicada por entrevistador treinado e a outra autopreenchida, compreendendo um teste de conhecimentos sobre alimentação complementar, obtendo escores de conhecimento geral e para cada módulo do instrumento. O conhecimento dos agentes de saúde para os módulos de conhecimento geral e de alimentação complementar apresentou associação estatística positiva com idade, tempo de profissão, visitas domiciliares a crianças com até 24 meses, realizar orientações, buscar informações sobre alimentação complementar, e receber treinamento apenas com o escore geral. Verificou-se desacordo entre as respostas do serviço de saúde e dos profissionais entrevistados quanto aos treinamentos, materiais governamentais e acompanhamento do crescimento infantil. Portanto, a unidade básica deve não só respaldar, mas facilitar o acesso a recursos que possibilitem o conhecimento sobre o assunto, como um fator importante na educação alimentar e nutricional da comunidade. / The feeding in early childhood has implications in other cycles of life of an individual. However, evidence is inadequate guidance by health professionals in relation to complementary feeding and practices inadequate household during this period. It is understood that the community health workers, due to its features and functions, can be interlocutor, improving complementary feeding, throughout the country. Therefore, this study aimed to describe the knowledge of community health workers and resources that the basic unit offers so that they have knowledge about complementary feeding. We conducted a descriptive cross-sectional study in the city of Pelotas, RS, in the basic units of the urban area with Family Health Strategy and Strategy Community Health Agents. Two instruments were used: a questionnaire proposed to the health service and another for the community health workers, divided into two parts, the first being applied by a trained interviewer and the other filled by the respondent comprising a knowledge test about complementary feeding, obtaining knowledge scores general and for each instrument module. Knowledge of health workers to the general knowledge modules and complementary feeding showed positive statistical association with age, occupation time, home visits to children up to 24 months, conduct guidelines, seek information about complementary feeding, and receive training only the general score. There was disagreement between the responses of the health service and the professionals interviewed about the training, government materials and monitoring of child growth. Therefore, the basic unit must not only endorse but facilitate access to resources that enable knowledge of the subject as an important factor in food and nutrition education community.

Esta pesquisa se propôs a conhecer a experiência materna no cotidiano de cuidados dos bebês de risco no domicilio, considerando que esses cuidados são determinantes para o desenvolvimento infantil. Foram realizadas histórias orais temáticas com três mães de bebês atendidos em um núcleo de reabilitação da periferia da zona leste de São Paulo, selecionadas por conveniência. As entrevistas foram gravadas, transcritas, textualizadas e transcriadas e posteriormente analisadas segundo método da hermenêutica-crítica. Por meio de análise temática foram identificadas duas categorias como resultado: Tornando-se mãe de um bebê de risco em meio às durezas do cuidado especializado e O cotidiano de cuidados de um bebê de risco, cada qual subdividida em quatro temas. O nascimento dos bebês veio acompanhado da notícia de sua condição de risco e da necessidade de internação hospitalar, o que gerou sofrimento para as mulheres. A interação com os bebês de risco não se configurou de forma espontânea, o que trouxe marcas no processo de tornar-se mãe das mulheres. O período de internação hospitalar dos bebês se configurou para as mães como um vazio, resultando em seu investimento para a concretização da alta, de modo a poderem dar continuidade à vida e à maternidade. As mulheres assumiram o papel de acompanhantes de suas bebês durante o período de hospitalização e passaram a se apropriar de informações acerca dos cuidados envolvidos, vivendo também uma expectativa pela alta. A chegada dos bebês ao domicílio no pós-alta hospitalar configurou-se como um momento que as mães assumiram o papel de cuidadora quase exclusiva, lidando com a instabilidade da condição de saúde do bebê. A ineficiência da rede de assistência tornou essa experiência solitária, frente à descontinuidade do cuidado oferecido. Mesmo com a sensação de insegurança, as mães assumiram o cuidado rotineiro, os procedimentos especializados e o acompanhamento ambulatorial dos bebês. Com a precária oferta de programas e políticas que garantissem a continuidade dos cuidados, as mães empreenderam a construção pessoal de uma rede de cuidados. A investigação do diagnóstico das bebês constituiu-se como um processo longo, com realização de exames e encaminhamentos em serviços diversos de saúde e de reabilitação. A preocupação com o futuro das filhas, o cuidado de si e os projetos pessoais passaram a se configurar como temas para as mulheres. Com muitas tarefas a cumprir e com tempo escasso para cuidar de si, as mulheres vivenciaram desgaste físico e emocional resultante dos cuidados requeridos por seus bebês, mas em geral também referiram a experiência como prazerosa, intensa e vivida com muito afeto e interesse nesse cuidado. O fato das mães colaboradoras serem todas primíparas contribuiu para a compreensão da experiência de vivenciar a maternidade pela primeira vez na condição de torna-se mãe de um bebê de risco. Contudo, outros estudos são necessários para se conhecer as diferenças nas experiencias de mães que tiveram outros filhos anteriormente / This research aimed to know the maternal experience in the daily care of babies at risk at home, considering that a good care is determinant for child development. Thematic oral histories were carried out with three mothers of babies attended in a rehabilitation nucleus of the periphery of the east zone of São Paulo, selected by convenience. The interviews were recorded, transcribed, textualized and transcreated and later analyzed according to the method of critical hermeneutics. By means of thematic analysis, two categories were identified as a result: Becoming the mother of a baby at risk amidst the hardships of specialized care and The daily care of a baby at risk, each subdivided into four themes. The birth of the babies was accompanied by the news of their risk condition and the need for hospitalization, which caused suffering for the women. Interaction with at-risk babies did not develop spontaneously, which has impacted the process of becoming a mother. The period of the hospitalization of the babies was experienced by the mothers as an emptiness, making them to invest their strength in the babies\' discharge, to give continuity to life and motherhood. The women assumed the role of supporting their babies during the hospitalization period and began to get information about the care involved, also living an expectation of discharge. The arrival of the babies at home after hospital discharge was set up as a time when mothers assumed almost exclusively the role of caregiver, dealing with the instability of the baby\'s health condition. The inefficiency of the assistance network made this experience solitary, in the face of the discontinuity of care offered. Even with the feeling of insecurity, the mothers took on the routine care, the specialized procedures, and the out-patients follow-up of the babies. With the precarious supply of programs and policies that could ensure the continuity of healthcare, the mothers undertook a personal construction of a support network. The investigation of the diagnosis of the babies constituted a long process, with examinations and referrals in various health and rehabilitation services. The concern for the future of the daughters, the care of themselves and the personal projects began to be configured as themes for the women. With many tasks to accomplish and with limited time to take care of themselves, the women experienced physical and emotional exhaustion resultant of the care required by their babies, but in general they also referred the experience as pleasant, intense, and lived with great affection and interest. The fact that the participants were all primiparous contributed to the understanding of this experience of experiencing motherhood for the first time under the condition of becoming a mother of a baby at risk. However, other studies are necessary to understand the differences of experiences regarding mothers who had other children previously

Frequent absences resulting from a chronic illness can disrupt adolescent school involvement, impacting academic achievement and psychosocial development as a result. This study explores whether certified child life specialists (CCLSs) could be a resource for parents as they address their adolescents' academic disruptions. Specifically, this study assesses an online training program designed to increase CCLSs' knowledge and self-efficacy as related to adolescents' academic adjustment following frequent absences. This knowledge and skill based training was designed as a three part module with sections including: academic considerations, psychosocial considerations, and availability of school resources in promoting successful adolescent academic adjustment. 62 CCLSs were recruited to participate and complete measures evaluating knowledge, in relation to content included in each module, and self-efficacy, involving communication with parents in regards to adolescent academic adjustment. T-tests were conducted to determine whether there were differences in reports of self-efficacy and knowledge following participation in the intervention between and within the treatment and control groups. Results indicate statistical significance for enhanced knowledge and self-efficacy for the treatment group at post-test. Therefore, the outcomes from this study support the effectiveness of brief online training in fostering knowledge and feelings of efficacy for CCLSs in a context not typically included in child life education or certification. As a result, findings from this study may be used to expand intervention programs in the clinical setting to provide more comprehensive psychosocial care to adolescents diagnosed with a chronic illness.

Thesis (M. A. (Nursing)) -- University of Limpopo, 2021 / Indigenous practices are performances that occur naturally in a region or a growing living environment. Most women believe in indigenous practices because of their cultures and social structure. In South Africa regardless of the availability and accessibility of maternal and child health services, 50% of women were found that they still consult traditional birth attendants as their first choice during pregnancy, labour, delivery, and postnatal care. The purpose of the study was to determine the indigenous practices of women during pregnancy, labour and puerperium amongst cultural groupings at selected hospitals in Limpopo Province, South Africa. A Convergent parallel mixed method design was used in the study to collect both qualitative and quantitative data at the same time. Non-probability purposive sampling was used to select 15 participants and Probability simple random sampling was used to select 125 women who were pregnant, in labour and puerperium using slovin’s formula. Data were collected through a semi-structured interview with a guide for qualitative strand and a self-administered structured questionnaire for quantitative srtand. Data were analysed qualitatively using tech’s open coding method and quantitatively using Statistical Package for the Social Sciences (SPSS) Version 25 with the assistance of the University of Limpopo’s Bio-statistician. The results of the study showed that most women use indigeneous practices for protection against witchcraft, fear of giving birth in caesarian section and many other reasons.THPs and church leaders are regarded as the most principled people in their community. Indigenous women are aware of the sign and symptoms during pregnancy, labour, and puerperium which may determine consultation to healthcare practitioners, but they choose THPs and church leaders. Most women still rely on their religious beliefs to assist during their labour. Pregnant women, those in labour and puerperium should be supported to practice their religious beliefs and practices. THPs and church leaders are obliged to teach their clients and ensure that they know the names and components of the traditional medicines and church rituals they use.The nursing education should include indigenous practices in the curriculum so, that healthcare practitioners know about the indigenous practices and can serve as assistance in the training and development of health practitioners who continuously care for women during pregnancy, labour, and puerperium and as a result, may reduce maternal and child morbidity and mortality in Limpopo Province, South Africa.

Thesis(M. A. (Nursing)) -- University of Limpopo, 2021 / BACKGROUND The quality Kangaroo Mother Care (KMC) continues to be sub-standard as it is not managed properly, despite the maternal and neonatal services provided by the midwives during postpartum and neonatal period, as this can lead to increased neonatal mortality rate and maternal depression at selected hospitals of Limpopo Province, therefore the researcher is interested in developing strategies to enhance quality KMC at selected hospitals of Limpopo Province. KMC has been found to have physiological, behavioural, psychosocial and cognitive developmental benefits, and it enhances motherinfant bonding. The aim of the study was to develop strategies to enhance quality Kangaroo Mother Care in selected hospitals of Limpopo Province. RESEARCH METHOD A quantitative descriptive cross-sectional research method was used to collect numerical data with regard to the factors that hinders the quality Kangaroo Mother Care in selected hospitals of Limpopo Province. Population size was 77, Simple Random Probability Sampling was used in this study with the sample size of 65 midwives. Data were collected using self-administered questionnaires and analysed using Statistical Package for Social Sciences (SPSS) version 24. Quantitative analysis is the numerical representation and manipulation of observations for the purpose of describing and explaining the phenomenon reflected on observations (Babbie & Roberts, 2018). RESULTS The study revealed that the factors that hinders quality of Kangaroo Mother Care are lack of education and training to midwives regarding Kangaroo Mother Care, and other sources suggested that all categories of nurses should also be trained. The midwives are knowledgeable with regard to KMC, however, the problem remains the work overload when they have to monitor both the mother and neonate during feeding. It was further indicated that family members can also assist with regard to KMC. Strategies were developed, as optimal KMC environment, optimal KMC interventions, enhance optimal mother attitude to KMC crate gender sensitive environment. CONCLUSION The study concluded that the quality of KMC should be enhanced through both the promotion of education and training to all midwives, and involvement of families to assist in KMC at selected hospitals of Limpopo Province

This cross-sectional study looks at the health profiles of street children both in institutions and on the street between May and November 1989. The former group had a clinical examination, with blood and urine investigations done where possible; the latter group were only interviewed. 159 street children were interviewed of whom 47 were interviewed on the street. 73 children had clinical examinations; 64 of these had blood and urine investigations. The age range was 8 years to 19.8 years. 18.2% were females and 28.3% were black. 59,6% of those interviewed on the street had not been in an institution or shelter for street children. 27, 2% of the total group had been on the street for more 3 years. 3 7, 1 % perceived colds and chest complaints as their main physical health problem. This was confirmed by the fact that 69,2% had a history of respiratory problems. 44,7% said that they would go to a hospital if they injured themselves or were ill; however, 36,5% said they would not use or get any medication for problems such as a headache or a bad cold. 37·, 7% of children used a hospital while they were on street but 59, 7% had not used any facility while on the street. Most street children (72,8%) washed themselves at least occasionally and 61% washed their clothes. 47,2% had suffered trauma significant enough to seek hospital attention. 56% had skin problems (including lice and scabies) while on the street. 15,7% complained of visual problems and 10,7% complained of reduced hearing. Dental problems appeared to be of major concern with 37,7% complaining of either toothache or dental caries (23,3% had obvious caries on examination). 73,4% admitted to solvent abuse, 49,9% had never taken alcohol and 12,7% had never smoked. 43% had tried dagga, 10,8% white pipe (mixture of dagga and "Mandrax" which is smoked) and only 7,6% "Mandrax" alone. 10, 9% of boys and 10, 0% of girls indicated that they had been sexually exploited. Of the 67 examined 32,8% were below 90% of expected height for age, 44,8% were below 80% of expected weight for age and 8,6% had a circumference of head below 95% of standard. There is a 9,4% Hepatitis Bs ag carrier rate. No HIV (human immunodeficiency virus) antibodies were detected in 64 sera tested. On the basis of these results, the following are recommended: 1) Improving accessibility of health care resources. 2) Improving the availability of health care resources. 3)· Initiating contacts with street children by employing field health workers. 4) Drawing up a health care policy for street children institutions and field care workers. 5) Limit venereal disease management to single dose treatment where possible. 6) Further studies need to be undertaken in the following areas: - solvent abuse - utilisation of health care resources utilisation institutions of street children shelters and Further breakdown of habits, physical problems and results of examinations are presented.

Bakgrund: Barnhälsovården är en stor del i folkhälsoarbetet där mycket av arbetet handlar om att tillgodose barns rätt till hälsa. Covid-19-pandemin har orsakat störningar i hälso- och sjukvården samt påverkat familjer och barn och riskerar att påverka folkhälsan negativt. Ett eventuellt minskat utbud och efterfrågan av barnhälsovård kan påverka barns hälsa på både kort och lång sikt. Tidigare forskning är fortfarande ganska ny men visar på att barn och föräldrars mående blivit påverkat av pandemin. För att få ytterligare förståelse för hur BHV-sjuksköterskan kan arbeta hälsofrämjande i liknande situationer vid framtida kriser krävs fler studier ur BHV-sjuksköterskans synvinkel. Syfte: Att beskriva BHV-sjuksköterskans erfarenhet av att arbeta hälsofrämjande under covid-19-pandemin. Metod: En enkätstudie genomfördes, en webb-enkät delades på sociala medier. Enkäten innehöll både slutna och öppna frågor och sammanställdes med hjälp av beskrivande statistik samt analyserades med kvalitativ innehållsanalys. Resultat: I resultatet framkom tre huvudkategorier: Påverkan på arbetet genom ändrade arbetssätt, Arbete i enlighet med riktlinjer och rekommendationer & Ändrade relationer och behov hos barn och föräldrar, vilka är underbyggda av nio underkategorier. Slutsats: Pandemin har påverkat BHV-sjuksköterskans arbete. Nya arbetssätt har fått tagits fram, vissa har fungerat bättre än andra. Det hälsofrämjande arbetet har kunnat fortsätta trots försvårande omständigheter. / Background: Child Health Services is a major part of public health and the main focus is to meet children´s right to health. Whereas the COVID-19 pandemic has caused disruptions to health services, affecting families and children and threatens to have a negative impact on public health. A possible reduced supply and demand of Child Health Services can affect children´s health in both short and long term. Previous research is still fairly new but shows that children and parent´s well-being has been affected by the pandemic. To gain further understanding of how the Child Health Care nurses can work to promote health in similar situations in future crises, more studies are required from the Child Health Care nurse´s point of view. Aim: To describe Child Health Care nurse´s experience of working to promote health during the COVID-19-pandemic. Method: A survey study was conducted; a web survey was shared on social media. The questionnaire contained both closed and open questions. The closed questions were compiled with descriptive statistics and the open questions were analyzed with qualitative content analysis. Results: The results revealed three main categories: Impact on work through changed working methods, Work in accordance with guidelines and recommendations & Changed relations and needs of children and parents, which are substantiated by nine subcategories. Conclusion: The COVID-19 pandemic has affected the work of Child Health Care nurses. New ways of working have been developed where some ways were better than others. The health promotion work has been able to continue despite aggravating circumstances

The objectives of this study are to provide a comprehensive assessment of inequalities in infant and under-five years¿ child survival, access to and utilisations of child health services among different socio-economic groups in Ethiopia; and identify issues for policies and programmes at national and sub-national levels. This thesis examines the effect of parental socioeconomic status, maternal and delivery care services, mothers¿ bio-demographic and background characteristics on the level of differences in infant and under-five years¿ child survival and access to and utilisation of child health services. Descriptive and multivariate analyses were carried out for selected variables in the literature which were consider as the major determinants of infant mortality rate (IMR) and under-five years¿ child mortality rate (U5MR); access to and utilisations of child health services based on data from Ethiopian demographic and health survey (EDHS), covering the years 2000-2005. In the multivariate analysis a logit regression model was used to estimates inequalities in infant and under-five years¿ child survival, and inequalities in access to and utilisation of child health services. In Ethiopia, little was known about inequalities in IMR and U5MR, and inequalities in access to and utilisation of child health services. Besides, there is no systematic analysis of health inequalities and into its determinants using logistic regression. According to the available literature, this is the first comprehensive and systematic analysis of inequality of health in Ethiopia. The findings show that compared to under-five years¿ children of mothers¿ partners¿ with no work, mothers¿ partners¿ in professional, technical and managerial occupations had 13 times more chance of under-five years¿ child survival for 2000 weighted observations. In addition, compared to infants of mothers who were gave birth to one child in last 5 years preceding the survey, infants of mothers who were gave birth to 2 children in last 5 years preceding the survey had 70% less chance of infant survival while infants of mothers who were gave birth to 3 or more children had 89% less chance of infant survival for 2000 weighted observations. Moreover, this study finding also indicates that inequalities increased significantly in the five years period between 2000 and 2005 among mothers with different birth interval. Most of the relations between birth interval and receiving childhood immunisation for vaccine-preventable diseases were statistically significant. Moreover compared to non-educated mothers, mothers who completed secondary and higher education were nearly 10 times more likely to receive DPT3 immunisation for their young children. This study concludes that policy measures that tackle health inequalities will have a positive impact in the implementation of health sector strategy of Ethiopia. Health inequalities studies in Ethiopia and Sub-Saharan Africa (SSA) countries should focus on systematic analysis of different socio-economic groups. The finding of this study support investing in the Ethiopia¿s health extension package (HEP) is a necessary but not sufficient condition for addressing rural poor health problem. HEP is successful in increasing primary health care coverage in rural Ethiopia to 89.6% (FMOH, 2009) but unable to reduce Ethiopia¿s higher level of IMR and U5MR. HEP is one of the success stories that address the rural poor health problem and can also be adapted to developing countries of SSA. The finding also shows that the success stories such as health insurance programs like Rwanda (World Bank, 2008a) and Ethiopia (FMOH, 2009/10) will play a key role in achieving country¿s health care financing goal of universal coverage. This can also be replicated in the developing SSA countries.

Bakgrund: Ett barn kan behöva vård på NVA av olika anledningar. För att familjen ska känna trygghet inför transitionen till hemmet krävs god planering och samverkan i hela vårdkedjan, från NVA till BHV. Det skapar förutsättning för att främja hälsa hos familjen. Föräldrar är med stöd av specialistsjuksköterskan viktiga för barnets utveckling och välbefinnande. Tidigare forskning visar att föräldrar som är delaktiga i sitt barns omvårdnad blir trygga att själva vårda barnet vilket stärker anknytningen och kan leda till en kortare vårdtid på NVA. Specialistsjuksköterskan är den som har kunskap om transitionens innebördoch kan anpassa stöd efter familjens behov för att bibehålla hälsa. Syfte: Syftet var att beskriva föräldrars erfarenheter av transition från neonatal vårdavdelning till hemmet. Metod: En scoping review som analyserades med kvalitativ innehållsanalys. Resultat: Tre huvudteman framkom; Utskrivningens betydelse för framtiden, En förändrad livsvärld och Föräldrars behov. Det första temat består av tre subteman; Att känna glädje och oro inför hemgång som belyser föräldrars ambivalenta känslor kopplade till transition till hemmet och vikten av kompetent vårdpersonal för att föräldrar ska känna trygghet. Att inte känna sig inkluderad som pappa visar på pappors känslor av att inte bli inkluderade i sitt barns vård som gör att de upplever en svårighet att stötta sin partner och barn. Att förbättra transitionen till hemmet belyser föräldrars olika perspektiv av förberedelse inför transition. Det andra temat innehåller tre subteman; Att vara i sin hemmiljö beskriver föräldrars erfarenheter av att komma hem med sitt barn. Att få nya perspektiv på livet belyser föräldrars upplevelse av att bli föräldrar först när barnet kommer hem men också upplevelser av att kunna leva vidare efter transitionen. Att vilja skydda barnet innehåller upplevelser och erfarenheter av att skapa en vardag med barnet. I det tredje temat framkom två subteman; Att få stöd i sin föräldraroll beskriver olika former av stöd som föräldrar upplever i transitionen och Strategier för att hantera situationen tar upp metoder som föräldrar fann stöd genom. Slutsats: Det kan innebära en stor utmaning för föräldrar att få ett barn som behöver vård på NVA. Transitionen till hemmet behöver förberedelse. Föräldrar upplevde trygghet och kände mindre ambivalens när de fick stöd och vägledning från vårdpersonal. Föräldrar som gjorts delaktiga i sitt barns omvård på NVA kunde uppleva transitionen mer glädjefylld än de som inte fått den erfarenheten. Specialistsjuksköterskan har en viktig roll i att underlätta transitionen för föräldrar för att de ska känna sig trygga och säkra i att själva vårda barnet hemma. Ytterligare kompetens och stöd från specialistsjuksköterskan behövs för att transitionen ska upplevas trygg och säker för föräldrar. / Background: There can be various reasons for a child needing care in neonatal care unit. Forthe family to feel secure before the transition to home, good planning and cooperation is required throughout the continuity of patientcare, from neonatal care unit to children healthcare services. It creates conditions for promoting health in the family. Parents, with the support of the nurse specialist, are important for the child’s development and well-being. Previous research shows that parents who are involved in their child’s care become confident in caring for the child themselves, which strengthens the connection and can lead to a shorter period of care at the neonatal care unit. The nurse specialist is the one who has knowledge of the meaning of the transition and can adapt support to the family’s needs to maintain health. Aim: The aim was to describe parents’ experiences of the transition from neonatal care unit to home. Method: A scoping review that was analysed with qualitative content analysis. Results: Three main themes emerged in the result; The importance of the transition, A changed life world and Parents’needs. The first theme consists of three subthemes; Feeling joy and anxiety before going homewhich highlights parent’s ambivalent feelings connected to the transition home and the importance of competent healthcare professionals for parents to feel security. Not feeling included as a father shows fathers’ feelings of not being included in their child’s care, which makes them experience difficulty in supporting their partners and child. Improving the transition to the home highlights parents’ different perspectives of preparation for transition.The second theme contains three subthemes; Being in their home environment describes parents’ experiences of coming home with their child. Gaining new perspectives in lifehighlights parents’ experiences of becoming parents when the child comes home, but also experiences of being able to continue living after the transition. Wanting to protect the childincludes experiences and perspectives of creating a daily life with the child. In the third theme, two subthemes emerged; Getting support in the parental role describes different types of support that parents experience during the transition and Strategies to handle the situationexplain methods that parents found support through. Conclusion: It might imply a great challenge when parents get a child in need of care at neonatal care unit. The transition to home needs preparation. Parents experienced security and felt less ambivalence when they get through nursing staff got support and guidance. Parents who been involved in their child’s care in the neonatal care unit experienced the transition more joyous than parents who was not involved. The nurse specialist has an important role in facilitating the transition. To make the parents secure and safe taking care of their child at home. Further competence of parents’experiences requires in both neonatal care units and in child health services.