A grounded theory exploration of cultural and spiritual influences on adjustment in adolescents with liver disease. The evidence-base for adjustment in adolescents with liver disease is minimal, but treatment non-adherence in adolescent liver transplant recipients is known to range between 17-53%, increasing medical complication risks. Evidence has also shown that spirituality impacts on illness perceptions and behaviours of adolescents with other diseases. In this study, ten semi-structured interviews were conducted with 16-24 years olds, recruited from a regional liver clinic in the UK. Half were liver transplant recipients. The study found that navigating cultural expectations was challenging, particularly around education, employment and socialising (e.g. participation with peers and avoiding alcohol). Several participants reported an illness-related spiritual or socio-cultural crisis, sometimes resulting in non-adherence. This seemed to be followed by a turning point, eventually leading to a state of acceptance, personal development and possibly, spiritual growth. Trusted individuals were often instrumental in helping participants to overcome difficulties. However, for some, adjustment was transitory. As such, this appeared to be a cyclical process, entangled with universal adolescent developmental tasks. The study concluded that more exploration is required on treatment adherence and overall functioning in adolescents with liver disease, taking into account socio-cultural and spiritual influences.

Section A critically reviews relevant theoretical literature and empirical studies exploring the particular impact of chronic illness on identity formation in adolescents. Theoretical conceptualisations of the adolescent period and of the process of identity formation are explored. Following this, empirical literature regarding the impact of chronic illness on the developmental tasks of adolescence and in particular identify formation will be critically examined. A number of clinical implications are discussed to enable clinicians to effectively support young people and future research directions are outlined. Section B reports a narrative analysis of young people's experiences of forming an identity with a diagnosis of an adolescent-onset chronic illness (CI). Identity formation is argued to be one of the key developmental tasks of adolescence. Despite implications for adolescent development, research into CI onset during this period has been notably sparse. This study aimed to explore how diagnosis impacts on the developmental tasks of adolescence, what role adolescent-onset CI plays in identity formation, and how adolescents incorporate the diagnosis into their identity. Individual semi-structured interviews were carried out with 8 young people aged 14-19 who lived with a diagnosis of a CI diagnosed between the ages of 12-16 years. Two illness types were studied; crohn’s disease and juvenile idiopathic arthritis. Interviews were audio-recorded, transcribed and analysed using narrative analysis. Participant narratives contained five core narrative themes: Walking a different path, tolerating contradiction, a changed interface with others, locating power and a fluid relationship. Narratives were considered to have been influenced by factors such as the interview context and dominant social narratives concerning health and illness. Adolescent-onset CI was found to have a significant, though not exclusively negative, impact on developmental tasks. The findings are discussed in relation to existing literature and potential clinical implications. Section C critically appraises the narrative study. A discussion begins with reflections on the research skills developed and insights into the research process. Areas of further learning are identified. Implications of clinical practice are explored and the section concludes with considerations for further research in this area.

Com a finalidade de contribuir para a compreensão da violência como um problema de saúde pública, o presente trabalho foi realizado através de um estudo de caso da violência familiar contra crianças e adolescentes de O a 18 anos de idade, efetuado no período de 1990 a 1993, na cidade de Maringá- PR. Através dos casos denunciados em instituições competentes, a identificação da violência foi feita dentro de um enfoque quantitativo. Num segundo momento, buscou-se a compreensão do significado desse tipo de violência através de uma abordagem qualitativa. Por meio de entrevistas e com o auxílio da técnica de associação de imagens, buscou-se compreender o significado que a violência física familiar tem para os atores sociais que a vivenciaram direta ou indiretamente, e suas justificativas frente a tais atos. Observou-se que 63,8 por cento dos casos denunciados são de violência fisica e que, destes, 48,2 por cento mostram a violência física familiar, revelando que esta incide, principalmente, na faixa etaria compreendida entre 12 e 15 anos de idade, onde o pai surge como principal agressor e a mãe e o vitimizado são os principais agentes denunciantes. Verificou-se, ainda, que o tipo de violência varia de acordo com o sexo e a idade da vítima. Tanto as vítimas como os agressores assimilam a violência física familiar como práticas disciplinadoras e somente as identificam como violência quando ultrapassam seus parâmetros de normalidade, os quais parecem estar relacionados com o grau de violência sofrido anteriormente. / This study aims to contribute for the comprehension o f the violence as a Public Health\'s problem. It was developed through a case study of familiar violence against children and adolescents aged from O to 18 years. It takes in account the cases which have occurred during the period from 1990 to 1993, in the city of Maringá-PR-Brazil. The identification o f the violence was done by a quantitative model, through the denounced cases in competent institutions. In a second step, the comprehension of the meaning of this kind of violence was searched through a qualitative approach. The techniques of interview and the association of images were used to verify which meaning the familiar physical violence has for the social actors who direct or indirectly felt this violence. Their justification to this kind of acts was also considered. It was observed that 63,8 per cent of the denounced cases are related to physical violence and that 48,2 per cent of that cases present the familiar physical violence. This data show that this violence appears mainly in ages from 12 and 15 years, where the father is the main aggressor and the mother and the victim are the main informers. It was also verified that the sort of violence varies according to the victim\'s sex and age. Either the victim or the aggressors assimilate the familiar physical violence as disciplinary practices. The violence is only identified by them as violence when it surpasses their parameters of normality, that seem to be related to the degree of violence they have suffered before.

Esta pesquisa versa sobre o incesto, qual seja, o abuso sexual de crianças e adolescentes que acontece no ambiente familiar. Tem como propósito o aprofundamento reflexivo sobre a escuta aos sujeitos envolvidos na trama incestuosa, tendo em vista o aprimoramento das práticas profissionais na área. Para tanto, empreende um percurso de estudos com referenciais da Psicanálise embasados nas formulações fundadoras de Freud, Ferenczi e Lacan, numa profícua interlocução com comentadores como Piera Aulagnier, Abraham e Torok, Françoise Dolto, entre outros. A trajetória das discussões parte das elaborações teóricas sobre sexualidade infantil e interações parentais, a interdição ao incesto como fundamento da cultura, a dimensão traumática da interação sexual abusiva, perpassa os liames da transmissão psíquica e desdobra-se no enfoque sobre aquele que figura no lugar de autor da agressão sexual. Nesta vertente, a centralidade do debate aborda, num primeiro momento, a perversão como estrutura e a densidade de seus elementos constitutivos, como a recusa à castração, o desafio à lei, a dinâmica sadomasoquista e o mecanismo do desmentido. Num segundo momento, a atenção se volta para a perversão como uma nova modalidade de laço social. A partir daí, o campo de estudo se abre para o entendimento do que tem se configurado como a mais frequente casuística no trabalho com a escuta dessas situações: o sujeito neurótico capturado numa montagem social perversa. A autora, tomando como eixo norteador do presente estudo o material empírico de sua práxis na supervisão ao atendimento da família envolvida na trama incestuosa, tece como considerações finais que o aprimoramento do trabalho de escuta precisa, necessariamente, passar pelo conhecimento das dinâmica psíquicas e sociais que geram e mantém a dinâmica familiar abusiva e que a Psicanálise e o espaço de supervisão são estratégias de excelência na consecução deste objetivo / This study refers to incest, which is, the sexual abuse of children and adolescents that happens in the family environment. Its purpose is a deepening reflection on listening to all people involved in the incestuous plot, in order to improve professional practices in the area. Therefore, it undertakes a course of studies with references of Psychoanalysis based on the founding formulations of Freud, Ferenczi and Lacan, in a successful communication with commentators such as Piera Aulagnier, Abraham and Torok, Françoise Dolto, among others. The trajectory of the discussions starts from a theoretical preparation of the child sexuality and parental interactions, the interdiction on incest as the foundation of culture, the traumatic dimension of abusive sexual interaction, goes beyond the boundaries of psychic transmission and unfolds in the focus of the one who appears in the place of the author of the sexual aggression. In this aspect, the centrality of the debate deals, in a first moment, with perversion as structure and the density of its constitutive elements, such as refusal to castrate, challenge to the law, sadomasochistic dynamics and mechanism of denial. In a second moment, attention turns to perversion as a new mode of social bonding. From then on, the field of study opens up to the understanding of what has been configured as the most frequent casuistry in the work with the listening to these situations: the neurotic individual captured in a perverse social setup. The author, building her studies on the empirical material of her praxis in supervising the care of the incestuous family, makes as her final considerations that improvement on the work of listening must, necessarily, pass through knowledge of psychic and social dynamics which generate and maintain the abusive family dynamics and that the Psychoanalysis and the supervisory space are strategies of excellence in achieving this goal

A não adesão ao tratamento anti-retroviral implica no risco de falha terapêutica e queda da qualidade de vida. Objetivos. Estimar os níveis da adesão aos medicamentos anti-retrovirais (ARVs) na prática clínica e analisar fatores associados. Avaliar a concordância entre adesão auto-referida e as concentrações plasmáticas dos medicamentos ARV, numa sub-amostra. Métodos. Estudo de corte transversal, incluindo crianças e adolescentes não institucionalizadas, com idade entre um a 20 anos, atendidas no Instituto de Infectologia Emílio Ribas/São Paulo. Utilizou-se questionário estruturado e, para um sub-grupo, coletou-se sangue para dosagens plasmáticas de Efavirenz. Resultados. Dos 262 participantes do estudo, 40,1% não apresentaram adequada adesão aos ARVs, tomando até 89% das doses prescritas para o dia da entrevista e três anteriores. Os fatores que se mostraram associados à não adesão após o ajuste no modelo de regressão logística múltipla foram: ter dificuldades em usar ARVs por esquecer de tomar, residir com os avós, referir dificuldades em lidar com o tratamento ARV e como fator protetor, participar de atividades multiprofissionais. Foi demonstrada diferença significativa entre as médias das concentrações plasmáticas de Efavirenz para o grupo com e sem adesão adequada. Tendo como referência a mensuração da concentração plasmática do Efavirenz, o método da adesão auto-referida apresentou baixa sensibilidade e alta especificidade, sendo moderada a proporção de concordância entre os dois métodos (Kappa: 0,41). Conclusões. A dosagem das concentrações plasmáticas poderia ser incorporada na rotina de atendimento para acompanhamento da adesão ao Efevirenz. Considerando a baixa adesão aos medicamentos ARVs, torna-se importante estabelecer estratégias de acompanhamento envolvendo os fatores modificáveis associados à não adesão. / Non-adherence to anti-retroviral treatment results in therapeutic flaw risks and lower quality of life. Objectives: To evaluate the levels of adherence to anti-retroviral medicine (ARV) in clinical practice as well as to analyze associated factors. To evaluate conformity between self-reported adherence and plasmatic concentrations of ARV medicine in a subsample. Methods: A cross-sectional study, including non-institutionalized children and adolescents, ages from 1 to 20 years, who were assisted at the Infectology Institute Emílio Ribas / São Paulo. A structured questionnaire was used and, in one of the sub-groups, blood was collected for plasmatic dosages of Efavirenz. Results: Of the 262 study participants, 40,1% didn't not adhere to the ARVs, taking up to 89% of the prescribed doses for the interview day and for the three previous days. The factors which were linked to non-adherence after adjustment in the multiple logistics regression model were: difficulties in using ARVs due to forgetfulness, live with grandparents, difficulties with ARV treatment and as a protecting factor, participate in multiprofessional activities. As far as the Efavirenz there was a significant difference between the plasmatic concentrations of the groups with and without appropriate adherence. Using the plasmatic concentration of Efavirenz dosage as a reference, the self-reported adherence method had low sensibility and high specificity, and the conformity rates between the two methods were moderated (Kappa: 0, 41). Conclusion: The plasmatic concentrations dosages could be incorporate in the follow-up routine for adherence to Efevirenz. If we take in consideration the low adherence to ARVs, it will be important to establish follow-up strategies involving the modifiable factors associated to non-adherence.

Com a finalidade de contribuir para a compreensão da violência como um problema de saúde pública, o presente trabalho foi realizado através de um estudo de caso da violência familiar contra crianças e adolescentes de O a 18 anos de idade, efetuado no período de 1990 a 1993, na cidade de Maringá- PR. Através dos casos denunciados em instituições competentes, a identificação da violência foi feita dentro de um enfoque quantitativo. Num segundo momento, buscou-se a compreensão do significado desse tipo de violência através de uma abordagem qualitativa. Por meio de entrevistas e com o auxílio da técnica de associação de imagens, buscou-se compreender o significado que a violência física familiar tem para os atores sociais que a vivenciaram direta ou indiretamente, e suas justificativas frente a tais atos. Observou-se que 63,8 por cento dos casos denunciados são de violência fisica e que, destes, 48,2 por cento mostram a violência física familiar, revelando que esta incide, principalmente, na faixa etaria compreendida entre 12 e 15 anos de idade, onde o pai surge como principal agressor e a mãe e o vitimizado são os principais agentes denunciantes. Verificou-se, ainda, que o tipo de violência varia de acordo com o sexo e a idade da vítima. Tanto as vítimas como os agressores assimilam a violência física familiar como práticas disciplinadoras e somente as identificam como violência quando ultrapassam seus parâmetros de normalidade, os quais parecem estar relacionados com o grau de violência sofrido anteriormente. / This study aims to contribute for the comprehension o f the violence as a Public Health\'s problem. It was developed through a case study of familiar violence against children and adolescents aged from O to 18 years. It takes in account the cases which have occurred during the period from 1990 to 1993, in the city of Maringá-PR-Brazil. The identification o f the violence was done by a quantitative model, through the denounced cases in competent institutions. In a second step, the comprehension of the meaning of this kind of violence was searched through a qualitative approach. The techniques of interview and the association of images were used to verify which meaning the familiar physical violence has for the social actors who direct or indirectly felt this violence. Their justification to this kind of acts was also considered. It was observed that 63,8 per cent of the denounced cases are related to physical violence and that 48,2 per cent of that cases present the familiar physical violence. This data show that this violence appears mainly in ages from 12 and 15 years, where the father is the main aggressor and the mother and the victim are the main informers. It was also verified that the sort of violence varies according to the victim\'s sex and age. Either the victim or the aggressors assimilate the familiar physical violence as disciplinary practices. The violence is only identified by them as violence when it surpasses their parameters of normality, that seem to be related to the degree of violence they have suffered before.

Submitted by Silvana Teresinha Dornelles Studzinski (sstudzinski) on 2015-06-29T19:11:57Z No. of bitstreams: 1 CamilaF.Machado.pdf: 354790 bytes, checksum: d72e882a1cfd874570d5ede8bd459b3c (MD5) / Made available in DSpace on 2015-06-29T19:11:57Z (GMT). No. of bitstreams: 1 CamilaF.Machado.pdf: 354790 bytes, checksum: d72e882a1cfd874570d5ede8bd459b3c (MD5) Previous issue date: 2013-08 / COMDEDICA - Conselho municipal de defesa dos direitos de crianças e adolescentes / Esta Dissertação de Mestrado em Psicologia teve como foco a situação da adoção de crianças e adolescentes no município de São Leopoldo. Foi realizado um estudo quantitativo com delineamento descritivo de levantamento documental. Os dados foram coletados no conjunto dos processos de adoção, julgados no ano de 2011, na Vara da Infância e Juventude, do Fórum do município em questão. O procedimento de coleta de dados foi orientado por um instrumento agrupando informações relativas ao processo, à família de origem, à família adotante, e à criança ou ao adolescente. Os dados foram trabalhados estatisticamente através de análises descritivas. Os principais resultados apontaram para a escassez de registros relativos às famílias de origem, o que limitou o conhecimento sobre as condições dessas famílias. As mães biológicas assumiram de forma preponderante o destino dos filhos, visto que muitos pais, embora os tivessem registrado, ocuparam papeis secundários em suas vidas. Constatou-se que, da transição entre o rompimento do vínculo familiar até a concretização da adoção, houve um significativo tempo percorrido, durante o qual as crianças permaneceram em situação parental indefinida. A proporção de adoções prontas nos processos analisados revelou uma prática paralela ao estabelecido pelo Estatuto da Criança e do Adolescente (ECA), sem o acompanhamento do judiciário e da equipe interdisciplinar. Embora a adoção direta não se configure como uma prática ilegal, torna-se necessário maior cautela nestes casos. / This Dissertation for an MA in Psychology is focused on the adoption of children and adolescents in a municipality called São Leopoldo. A quantitative study with a descriptive analysis of documents was conducted. Data were collected from all the processes of adoption which were analized in 2011, by the Childhood and Youth Forum of São Leopoldo. The procedure for data collection was guided by an instrument which gathered information concerning to the process, the biological family, the foster family and the child or adolescent. The data were processed statistically through descriptive analysis. The main results point to the lack of records related to the biological families. This fact limited knowledge of the condition of these families. The biological mothers assumed preponderantly the children's fate, whereas many fathers, although having registered the child, had secondary roles in their lives. It was found that during the transition between the breaking of family ties until the completion of the adoption process, there was significant elapsed time during which the children remained in an indefinite parental situation. The proportion of concluded adoptions processes analyzed revealed a parallel practice established by the Child and Adolescent Statute (ECA), without the monitoring of the judiciary and the interdisciplinary team. Although direct adoption is not an illegal practice, an intense caution is essential in such cases.

Na década de 1990 as organizações não-governamentais (ONGs) começaram a atuar de forma diferente em relação à sua gênese: passaram a trabalhar em parceria com o Estado na execução de políticas públicas. Investigo neste trabalho as bases das transformações da atuação das ONGs e as relações que hoje as organizações não-governamentais que trabalham com meninos(as) de rua no centro de São Paulo estabelecem na parceria com o governo, focalizando a participação nas políticas públicas e a autonomia das organizações diante da administração municipal. Com o objetivo de entender de forma mais clara o trabalho das instituições e a formulação de políticas públicas, apresento um histórico do atendimento às crianças e aos adolescentes em situação de risco no Brasil e descrevo, ainda que de forma sumária, as principais questões relacionadas com os meninos(as) que vivem nas ruas. Para a obtenção dos dados empíricos, utilizei as técnicas do questionário, da entrevista e da observação direta. / During the 1990 decade, the non governmental organizations (NGOs) started working differently from their original proposals: they started working in partnerships with the Government in the execution of public policies. In this essay, I investigate the basis of the transformation in the work of the NGOs, the relation between the NGOs that work with street kids in the centre of Sao Paulo and the Government, focusing the participation in the public policies and the autonomy of these organizations. For a better understanding of the work of these institutions and the establishment of public policies destined to street kids, I present a report of the attendance given to the children and adolescents who live in risk situation in Brazil and describe, in a summary way, the main aspects related to the children who live on the streets. To obtain the empiric data, I made use of questionnaire technics, interviews and direct observation.

It is essential that research be conducted regarding both the needs of and the outcomes for children placed outside of their biological homes. According to AFCARS (Adoption and Foster Care Analysis and Reporting System Report), approximately 408,425 children in the United States were in foster care in 2010 (U.S. Department of Health and Human Services [DHHS], 2011a). In addition to the large number of children and adolescents in foster care, there are a disproportionate number of U.S. racial/ethnic minority children in foster care and other out-of-home placements (Committee for Hispanic Children and Families, 2004; Schwartz, 2007; Smith & Devore, 2004). Specifically, African American children are overrepresented in the foster care system compared to either other racial/ethnic groups (U.S. DHHS, 2011b). Approximately 45% of foster parents report caring for children of a different racial ethnic background than their own (Coakley & Orme, 2006). The majority of actual outcome studies regarding transracial placements for children focus on psychological adjustment, and the results are mixed (Brown, George, Sintzel, & Arnault, 2009; Burrow & Finley, 2004; Keller et al., 2001; Moffatt & Thoburn, 2001).However, there is very limited research on the relationship between race/ ethnicity of caregivers in residential settings and the outcomes for children of different racial/ethnic groups. The purpose of the current study was to extend the Jewell et al. (2010) investigation by measuring the youth's behavioral functioning in a family teaching home throughout their stay in a residential setting. The major aims of this study were to (a) investigate the relations between type of family home placement (inracial vs. transracial) and behavioral outcomes for the youth and (b) identify the key variables to consider for placement of racial/ethnic minority youth in a family-style residential treatment center. Results of the study indicate that overall youth placed in inracial family teaching homes had better behavioral outcomes than youth placed in transracial family teaching homes. The current study suggests that both racial/ethnic groups (African American and European American) benefitted from being placed in inracial versus transracial family home settings. Age, gender and race/ethnicity did not appear to be contributing to the behaviors of the youth as much as type of placement (inracial versus transracial).

A presente dissertação de mestrado pretende estudar o desdobramento da garantia do direito à origem de crianças e adolescentes no contexto da adoção, marcada pelo rompimento dos vínculos com a família biológica e pela irrevogabilidade, ressaltando o possível reflexo dessa opção legislativa na formação da identidade e personalidade desses sujeitos de direito. Assume-se, com tal propósito, a necessidade de uma nova visão do instituto, que contemple não apenas o seu caráter construtivo e garantista, ou seja, formação e garantia de uma família à criança ou adolescente, mas também o seu traço de desconstrução, muitas vezes pouco estudado: significa a desconstrução de um nome, uma filiação, uma origem, um passado e uma história, enquanto outros serão formados de modo ficcional. A análise da adoção sob o enfoque de solidariedade social pressupõe o conhecimento e a escuta atenta das famílias que tem seus filhos afastados do convívio e submetidos a medidas de acolhimento institucional, com o fim de aferir o sensível descompasso entre teoria e prática da doutrina da proteção integral contemplada pelo Estatuto da Criança e do Adolescente. A ampliação dos espaços para escuta de todos os atores pressupõe, ainda, o fortalecimento das capacidades de crianças e adolescentes posicionarem-se como verdadeiros sujeitos de direito quanto às questões afetas aos seus próprios destinos. Nessa linha de raciocínio, conceitos corriqueiramente invocados nos discursos forenses para fins de afastamento de pais e filhos passam por uma profunda revisão norteada pelos conhecimentos de outras áreas de ciências humanas, de modo interdisciplinar, tais como história, psicologia e sociologia. Observa-se, com destaque, a dificuldade de garantia de permanência e estabilidade em um mundo marcado por relações fluidas e voláteis, notadamente quando se trata do Direito da Infância e Juventude, formado, de um lado, por pessoas em franco processo de desenvolvimento crianças e adolescentes e, de outro, por suas famílias, como típico fenômeno social, inseridas em um processo aflitivo de afirmação de direitos. Ao final, caminha-se para a conclusão de que a figura da filiação múltipla poderia auxiliar na compatibilização do passado e do futuro de crianças e adolescentes adotados, preservando suas identidades e personalidades. / This PhD thesis intends to study the development, as far as adoption is concerned, of children and adolescents right to origin, marked by the sunder of bonds with the biological family as well as by its irrevocability, denouncing the possible reflex of such legislative options on the development of identity and personality of those legal subjects. It is hereby assumed, thus, the necessity of a new envision of this institute, contemplating not only its constructive and safeguarding character, i.e., the formation and safeguarding of the right of a family to a child or adolescent, but also its deconstructive feature, often less studied: that is, the deconstruction of a name, affiliation, past and history, while others are conceived fictionally. The study of adoption under a social solidarity scope presumes the acknowledgement and the focused listening of families which had their children separated from of their lives and submitted to institutional sheltering measures, with the purpose of identifying the reasonable gap between theory and practice, regarding the integral protection doctrine contemplated by the Children and Adolescents Statute. The amplification of spaces for listening to those actors presumes, also, the strengthening of children and adolescents capacity to position themselves as true legal subjects, in relation to questions concerning their own destinies. In that line of reasoning, commonly referred by legal opinions regarding the separation of parents and children, a profound review based on concepts of other humanities sciences is interdisciplinarily conducted, involving history, psychology and sociology. It is observed, apropos, the difficulty of safeguarding permanence and stability in a world distinguished by fluid and volatile relationships, specially as far as the Children and Adolescents Law is concerned, being composed, on one hand, by people during a direct process of development children and adolescents and, on the other, by their families, in a typical social phenomenon inserted in a distressing process of confirmation of rights. In conclusion, it is submitted that the concept of multiple affiliation could help the harmonization of adopted children and teenagers past and future, preserving their identities and personalities.