This thesis examines the requirements of children and adolescents with severe spinal cord injuries. The requirements are expressed by the parents of the children and by adolescents and are in contrast to official views of their 'needs'. There is no literature on the needs of these children and adolescents. The thesis thus begins with a examination of the literature on the needs of people with disabilities and people with spinal cord injury. Proponents of the social model of disability, which is based on the experiences of people with disabilities, contend that the main requirements of people with disabilities is ending their social marginalisation, and it is hypothesised that the requirements of the children and adolescents will be related to ending social marginalisation. Open-ended unstructured interviews with parents, parents and adolescents and adolescents alone ( a total of 20 interviews) provided data for analysis. Analysis of the data shows that the requirements of the children and adolescents, like adults with spinal cord injuries, differ from those of people with disabilities in that there are important concerns in addition to marginalisation.

<p>The aims of the present thesis were to study: 1. reported eating attitudes, dieting behavior and body image over a 1-year period among preadolescent girls (age 7-8); 2. differences in eating attitudes and coping between groups of teenage girls differing in dieting frequency, and to assess changes with increasing age (age 13-17); and 3. to what extent eating attitudes, self-esteem and coping predict disturbed eating attitudes. A final aim was to explore differences in the reported wish to be thinner, dieting, and eating attitudes between two age-matched cohorts of girls in 1995 and 1999 (7-15 years).</p><p>The project is designed as a longitudinal prospective study, spanning seven years. 1300 girls in the ages (1995) 7, 9, 11, 13 and 15 years have been assessed annually for three consecutive years (1995-1997) (Main Cohort). An additional group matched for age with the original group was recruited in 1999 (Societal Cohort). The results suggest that dieting and the wish to be thinner starts as early as at 7 years of age, and that repeated dieting attempts correlate with disturbed eating attitudes. A marked increase of the wish to be thinner was evident in the 10- to 14-year age range, and significant increases in dieting attempts occurred mainly between ages 9 and 13. There were no differences between 1995 (Main Cohort) and 1999 (Societal Cohort) (except among 7 and 11-year-olds) with regard to dieting, the wish to be thinner and disturbed eating attitudes. Eating patterns and attitudes were shown to be the strongest predictors of disturbed eating attitudes three years later. Assessment of dieting, the wish to be thinner and eating attitudes is suggested BS a component in school health care.</p>

The aims of the present thesis were to study: 1. reported eating attitudes, dieting behavior and body image over a 1-year period among preadolescent girls (age 7-8); 2. differences in eating attitudes and coping between groups of teenage girls differing in dieting frequency, and to assess changes with increasing age (age 13-17); and 3. to what extent eating attitudes, self-esteem and coping predict disturbed eating attitudes. A final aim was to explore differences in the reported wish to be thinner, dieting, and eating attitudes between two age-matched cohorts of girls in 1995 and 1999 (7-15 years). The project is designed as a longitudinal prospective study, spanning seven years. 1300 girls in the ages (1995) 7, 9, 11, 13 and 15 years have been assessed annually for three consecutive years (1995-1997) (Main Cohort). An additional group matched for age with the original group was recruited in 1999 (Societal Cohort). The results suggest that dieting and the wish to be thinner starts as early as at 7 years of age, and that repeated dieting attempts correlate with disturbed eating attitudes. A marked increase of the wish to be thinner was evident in the 10- to 14-year age range, and significant increases in dieting attempts occurred mainly between ages 9 and 13. There were no differences between 1995 (Main Cohort) and 1999 (Societal Cohort) (except among 7 and 11-year-olds) with regard to dieting, the wish to be thinner and disturbed eating attitudes. Eating patterns and attitudes were shown to be the strongest predictors of disturbed eating attitudes three years later. Assessment of dieting, the wish to be thinner and eating attitudes is suggested BS a component in school health care.

Few mental health studies have explored the prevalence of disorders, risk factors, and availability of services in Antioquia, especially in urban children and adolescent populations. However, access studies have never been developed. Despite growing interest in access, researchers, bureaucrats and interest groups have not come to any consensus about which specific factors may be considered in order to improve access for children and adolescents, especially in provinces with high levels of violence, displacement and inequality. This thesis aims to generate such a consensus among a diverse group of mental health stakeholders around Antioquia. Consensus suggests that predisposing, enabling, need and behaviour factors simultaneously influence access. Additionally, social capital is the resource upon which several mental health programs focus for the development and promotion of mental health services. Finally, stakeholders have identified effectiveness criteria that should be used to evaluate their efficacy as a network in order to improve their work.

Few mental health studies have explored the prevalence of disorders, risk factors, and availability of services in Antioquia, especially in urban children and adolescent populations. However, access studies have never been developed. Despite growing interest in access, researchers, bureaucrats and interest groups have not come to any consensus about which specific factors may be considered in order to improve access for children and adolescents, especially in provinces with high levels of violence, displacement and inequality. This thesis aims to generate such a consensus among a diverse group of mental health stakeholders around Antioquia. Consensus suggests that predisposing, enabling, need and behaviour factors simultaneously influence access. Additionally, social capital is the resource upon which several mental health programs focus for the development and promotion of mental health services. Finally, stakeholders have identified effectiveness criteria that should be used to evaluate their efficacy as a network in order to improve their work.

This thesis examines the requirements of children and adolescents with severe spinal cord injuries. The requirements are expressed by the parents of the children and by adolescents and are in contrast to official views of their 'needs'. There is no literature on the needs of these children and adolescents. The thesis thus begins with a examination of the literature on the needs of people with disabilities and people with spinal cord injury. Proponents of the social model of disability, which is based on the experiences of people with disabilities, contend that the main requirements of people with disabilities is ending their social marginalisation, and it is hypothesised that the requirements of the children and adolescents will be related to ending social marginalisation. Open-ended unstructured interviews with parents, parents and adolescents and adolescents alone ( a total of 20 interviews) provided data for analysis. Analysis of the data shows that the requirements of the children and adolescents, like adults with spinal cord injuries, differ from those of people with disabilities in that there are important concerns in addition to marginalisation.

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.

Submitted by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2013-10-10T19:43:35Z No. of bitstreams: 1 Tese Priscila Ribas Costa. 2013.pdf: 3957106 bytes, checksum: 444d2526710f6dda3c9d93c6ed1755a1 (MD5) / Approved for entry into archive by Maria Creuza Silva(mariakreuza@yahoo.com.br) on 2013-10-10T19:43:57Z (GMT) No. of bitstreams: 1 Tese Priscila Ribas Costa. 2013.pdf: 3957106 bytes, checksum: 444d2526710f6dda3c9d93c6ed1755a1 (MD5) / Made available in DSpace on 2013-10-10T19:43:57Z (GMT). No. of bitstreams: 1 Tese Priscila Ribas Costa. 2013.pdf: 3957106 bytes, checksum: 444d2526710f6dda3c9d93c6ed1755a1 (MD5) Previous issue date: 2013 / Introdução: estudos recentes têm identificado associações entre concentrações elevadas de homocisteína (Hcy) e cisteína (Cys) séricas e alterações negativas do perfil antropométrico e lipídico em adultos, mas são escassas informações sobre estas relações na faixa etária pediátrica. Objetivo: identificar a influência de concentrações elevadas de Hcy e Cys séricas, isoladas e simultaneamente elevadas, sobre a mudança nos parâmetros antropométricos e lipídicos de crianças e adolescentes ao longo de 12 meses de seguimento. Metodologia: estudo de coorte envolvendo 483 indivíduos de 07 a 15 anos de ambos os sexos. As variáveis desfecho foram representadas pelo IMC/Idade, circunferência da cintura (CC), colesterol total (CT), LDL-colesterol (LDL-c), HDL-colesterol (HDL-c) e triglicérides, e a exposição principal foi representada pelas concentrações de Hcy e Cys séricas, analisadas isoladas e conjuntamente. Utilizou-se a Equação de Estimação Generalizada (GEE) para identificar as mudanças sobre as variáveis desfecho. Resultados: independentemente da idade, sexo, situação socioeconômica, consumo alimentar e prática de atividade física, crianças e adolescentes que estavam no mais alto quintil de distribuição de Hcy (quinto quintil>=8.5!mol/L) no início do estudo tiveram incrementos de 0.50 (p<0.01) e 3.62cm (p<0.01) na média do escore-z do IMC/Idade e da CC, respectivamente, durante 12 meses de seguimento, quando comparados àqueles cujos valores destes parâmetros bioquímicos estavam no 1º quintil. Valores de Cys acima do quinto quintil (>463.4!mol/L) ao início do estudo aumentaram em 0.58 (p<0.01) e 5cm (p<0.01) o escore-z do IMC/Idade e a CC, respectivamente, durante os 12 meses do seguimento. Concentrações simultaneamente elevadas de Hcy e Cys no quinto quintil de distribuição aumentaram em 0.87 (p<0.01) e 6.57cm (p<0.01) as médias do z-escore do IMC/Idade e da CC em um período de 12 meses de acompanhamento. Para o perfil lipídico, observou-se que, independentemente da idade, sexo, situação socioeconômica, consumo alimentar e estado antropométrico, concentrações de Hcy e Cys séricas acima do 5º quintil ao início do seguimento reduziram, respectivamente, em 2.91mg/dl (p<0.01) e em 1.95mg/dl (p<0.01) a média do HDL-c, em 12 meses de seguimento. Enquanto que concentrações elevadas de Hcy e Cys, respectivamente, promoveram acréscimo de 1.58mg/dl p<0.01) e de 1.76mg/dl (p=0.03) na média dos triglicérides séricos ao longo dos 12 meses de seguimento. A presença de valores de Hcy e Cys séricas simultaneamente acima do 5º quintil de distribuição no início do estudo diminuiu em 3.65mg/dl (p<0.01) a média do HDL-c e elevou em 3.53mg/dl (p<0.01) o valor médio dos triglicérides nos 12 meses de seguimento. O CT e o LDL-c não se associaram com as variáveis de exposição. Conclusões: elevadas concentrações de Hcy e Cys séricas contribuíram para o aumento do IMC/Idade, da CC, dos triglicérides e para redução do HDL-c em 12 meses de acompanhamento, sendo estes incrementos mais acentuados quando estes dois parâmetros bioquímicos estavam simultaneamente elevados. / Salvador

SOUZA, Aline Maria Freitas de. O processo de enfrentamento às violências contra crianças e adolescentes na atenção primária em saúde: uma avaliação em profundidade. 2013. 247f. – Dissertação (Mestrado) – Universidade Federal do Ceará, Programa de Pós-graduação em Avaliação de Políticas Públicas, Fortaleza (CE), 2013. / Submitted by Márcia Araújo (marcia_m_bezerra@yahoo.com.br) on 2015-12-16T13:48:31Z No. of bitstreams: 1 2013_amfsouza.pdf: 3563891 bytes, checksum: 7cbd535fa32e805dd012666d218b7a27 (MD5) / Approved for entry into archive by Márcia Araújo(marcia_m_bezerra@yahoo.com.br) on 2015-12-16T16:29:51Z (GMT) No. of bitstreams: 1 2013_amfsouza.pdf: 3563891 bytes, checksum: 7cbd535fa32e805dd012666d218b7a27 (MD5) / Made available in DSpace on 2015-12-16T16:29:51Z (GMT). No. of bitstreams: 1 2013_amfsouza.pdf: 3563891 bytes, checksum: 7cbd535fa32e805dd012666d218b7a27 (MD5) Previous issue date: 2013 / In this study we sought to understand the coping process to violence against children and adolescents in primary health care. It is an evaluation research with a trend towards in-depth evaluation. Initially presented an analysis of reported cases of domestic violence in health services in Fortaleza, in the period 2008-2013, in relation to sex, race, education, type of violence, through aggression, place of occurrence and likely aggressor. Then the cases were analyzed SER V, denser region and one of the lowest HDI of Fortaleza. The research was quantitative and qualitative approach and a critical and reflective analysis from technology used and documentary research, participant observation, focus group and in-depth interviews with professionals and family members of the committee. It was found that professionals and family members use the notification as a punitive act, not as breaking the chain of violence, as suggested by the official discourse of morbidity and mortality reduction policy due to violence. In the view of family, violence is associated with prejudice, lack of policies that assist children with substance abuse and the lack of access to quality public services. There was a significant lack of knowledge between work and family as well as the bodies of the safety net victims of violence. The Prevention Commission to Abuse in primary care proved to be a forum for discussion on the rights and duties of children and adolescents, but the institutions of the safety net the victim of violence can’t give an answer to the most complex cases. The tutelary Council estimates that the discontinuity of protection policies for children and adolescents and political interference hamper the autonomy of professionals regarding the approach and referral of cases. / Neste estudo buscou-se compreender o processo de enfrentamento às violências contra crianças e adolescentes na atenção primária em saúde. Trata-se de uma pesquisa avaliativa com tendência a uma avaliação em profundidade. Inicialmente apresentou-se uma análise dos casos notificados de violência doméstica nos serviços de saúde em Fortaleza, no período de 2008 a 2013, em relação ao sexo, raça, escolaridade, tipo de violência, meio de agressão, local de ocorrência e provável agressor. Em seguida foram analisados os casos da SER V, região mais densa e um dos mais baixos IDH de Fortaleza. A pesquisa teve abordagem quanti-qualitativa e uma análise crítico-reflexiva a partir de técnicas utilizadas como pesquisa documental, observação participante, grupo focal e entrevistas em profundidade com os profissionais e familiares da referida comissão. Verificou-se que os profissionais e familiares utilizam a notificação como um ato punitivo, não como quebra da cadeia de violência, como sugere o discurso oficial da política de redução de morbimortalidade por acidentes e violência. Na visão dos familiares, a violência está associada ao preconceito, a falta de políticas que assistam as crianças com dependência química e a falta de acesso aos serviços públicos de qualidade. Houve um desconhecimento significativo entre profissionais e familiares bem como sobre os órgãos da rede de proteção as vítimas de violência. A Comissão de Prevenção aos Maus-Tratos na atenção primária mostrou ser um espaço de discussão sobre os direitos e deveres de crianças e adolescentes, porém as instituições da rede de proteção a vítima de violências não conseguem dar uma resposta aos casos mais complexos . O Conselho tutelar avalia que a descontinuidade das políticas de proteção às crianças e adolescentes e a interferência política dificultam a autonomia dos profissionais em relação à abordagem e encaminhamento dos casos.

The aim of this work is to analyze the factors that contribute to increase the sexual exploitation of children and adolescents in the state of Alagoas and Maceió, both in relation to aspects of macro-structural modernization as compared to the sector modernization in the field of tourism development, giving visibility to institutional silences that block the formulation and implementation of adequate public policies to the monitoring and defense of this population segment. The investigation involves historical analysis, bibliographic search and document analysis for understanding processes related to modernization and its impact on the phenomenon of sex tourism and sexual exploitation of children and adolescents at the federal level and in the State of Alagoas. The research identified problems and gaps in the Tourism Development Program in the Northeast - Prodetur I and II and gaps in the Strategic Plan for Tourism Development in the State of Alagoas for the formulation of structural policies to contain the negative effects of modernization on vulnerable segments of the population, especially children and adolescents. The results of the documentary research presented here are restricted exclusively to the formal content of the analyzed documents. / O objetivo desta dissertação é evidenciar os fatores que concorrem para a proliferação da exploração sexual de crianças e adolescentes no Estado de Alagoas e em Maceió, tanto em relação aos aspectos ligados à modernização macroestrutural como em relação à modernização setorial no campo do desenvolvimento turístico e dar visibilidade aos silêncios institucionais que bloqueiam a formulação e execução de políticas públicas adequadas ao monitoramento e defesa desse segmento populacional. A investigação envolve análise histórica, pesquisa bibliográfica e análise documental de processos relacionados à modernização e seus impactos sobre o fenômeno do turismo sexual e da exploração sexual de crianças e adolescentes no âmbito federal e no Estado de Alagoas. A pesquisa identificou problemas e lacunas nos Programas de Desenvolvimento do Turismo no Nordeste – Prodetur I e II e lacunas no Plano Estratégico de Desenvolvimento do Turismo no Estado de Alagoas com relação à elaboração de políticas públicas estruturantes para conter os efeitos negativos da modernização sobre segmentos vulneráveis da população, em especial crianças e adolescentes. Os resultados da pesquisa documental aqui apresentados restringem-se exclusivamente ao conteúdo formal dos documentos analisados.