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The prevalence of children and adolescents who are considered overweight or obese has grown drastically in the United States. Childhood overweight and obesity is associated with serious long-term health consequences, including an increased risk for cardiovascular disease, type 2 diabetes, strokes, and different types of cancers. Added sugar intake (AS), in the form of sugar-sweetened beverages (SSB), may contribute to weight gain and obesity development in children and adolescents. Due to the negative health implications of SSB consumption, a valid and reliable brief beverage intake assessment tool is needed for children and adolescents to advance research in this area. The BEVQ-15 food frequency questionnaire has been validated as a tool to assess habitual beverage intake in adults. By validating this tool in youth, there will be a rapid, feasibly administered method to assess beverage intake in children and adolescents. The purpose of this investigation was to determine the comparative validity and test-retest reliability of the BEVQ-15 for assessing usual beverage intake in children and adolescents. Participants (n=326) completed four laboratory sessions, which included providing demographic information, assessment of height/weight, and four record-assisted 24 hour dietary recalls (24HR) from January 2014-September 2015. The BEVQ was completed at 2 sessions (BEVQ1, BEVQ2). Validity was assessed by comparing beverage intake from dietary recalls (24HR) to the BEVQ1; reliability was assessed by comparing BEVQ responses at two sessions (BEVQ1, BEVQ2). Data analysis included descriptive statistics, paired sample t-tests, independent sample t-tests, and chi-squared test, and one-way ANOVA tests. Comparisons of validity and reliability were also made within two subsets; children (aged 6-11) and adolescents (aged 12-18). In the full sample, self-reported water and total sugar-sweetened beverage intake (in fl oz and kcal) were not different between BEVQ1 and 24HR. Responses between BEVQ1 and BEVQ2 were not different in intake (fl oz) or energy (kcal) for water, milk, and total sugar-sweetened beverages. In children, milk and energy (kcal) for total beverages were not different between BEVQ1 and 24HR. No differences were reported between BEVQ1 and BEVQ2 across beverage categories. In adolescents, water and energy (kcal) for total-sugar sweetened beverages were not different between BEVQ1 and 24HR. No differences were reported between BEVQ1 and BEVQ2 with the exception of sweetened juice drinks and total beverages. Overall, these results demonstrate that the BEVQ-15 appears to be a valid and reliable tool to assess habitual water and total SSB intake in children and adolescents. This tool could further epidemiological and clinical research examining the impact of SSB intake, as well as intake of other beverages, on health. / Master of Science

Obesity is a public health concern and cardiometabolic consequences are severe when obesity develops during youth and continues into adulthood. Treatment prior to adulthood confers health benefits, but adolescent obesity rates have continually increased, reaching 20.6% in 2013-2014. Quality and quantity of dietary intake contribute to the development of obesity, but limitations of self-reported dietary intake are evident in overweight or obese adolescents, who frequently misreport nutrients of concern. Added sugar, sodium, and protein intake may indicate diet quality in this population. The 2015-2020 Dietary Guidelines recommend decreasing consumption of added sugars, sodium, and processed protein due to their known contributions to overweight and obesity. Objective dietary intake assessment measures are necessary for investigating the association between dietary intake and health outcomes. Added sugar, sodium, and protein intake could be assessed objectively with a panel of urinary biomarkers. Prior research indicates the potential of these urinary biomarkers to reflect dietary intake, but to date, no controlled feeding study has been conducted in adolescents. Using a controlled feeding design, the current study aims to evaluate the validity of urinary sucrose, fructose, sodium, and nitrogen as objective indicators of dietary intake. It is hypothesized that urinary sucrose and fructose will reflect dietary added sugar intake, while urinary sodium and nitrogen will correspond to dietary sodium and protein intake, respectively, in a healthy adolescent population. These biomarkers, if valid, could be used in clinical and epidemiological research to improve understanding of the associations between dietary intake and health outcomes. / Master of Science

An estimated 20.5% of adolescents ages 12 – 19 years were obese (≥95th percentile of BMI-for-age) in 2011 – 2014. Consumption of added sugars (AS) has been linked with adverse effects on weight and cardiovascular disease risk factors. Approximately 16% of adolescents’ calories come from AS, of which sugar-sweetened beverages (SSB) are a major contributor. However, the relationship between AS/SSB intake and obesity is controversial, partly due to limitations in self-reported dietary data. Objective dietary intake biomarkers may circumvent this problem. The δ13C biomarker for AS intake is based upon the fact that C4 plants– major source for sugar production in the United States – have elevated δ¹³C values compared to C3 plants, which includes most fruits and vegetables. The δ¹³C value of blood, which is influenced by diet, has been established as a valid, reliable, and sensitive biomarker, but when compared to selfreported AS intake. This investigation evaluated the sensitivity and reliability of the δ13C biomarker, assessed with fingerstick blood samples, in adolescents using a controlled feeding, crossover design. Fingerstick δ¹³C values significantly changed by -0.05‰ and +0.03‰ after subjects completed the 5% and 25% AS diets, respectively (F(1, 30) = 18.828, p < 0.001). High reliability was found between two consecutive fingerstick δ¹³C values on the low (ICC = 0.996) and high (ICC = 0.997) AS diets. Thus, fingerstick δ¹³C may be a sensitive and reliable indicator of AS intake in adolescents. Future investigations should develop an equation to estimate AS intake based on fingerstick δ¹³C / Master of Science

Submitted by admin tede (tede@pucgoias.edu.br) on 2018-06-20T12:54:05Z No. of bitstreams: 1 LETÍCIA MARTINS DO CARMO.pdf: 1711707 bytes, checksum: 774bf7df592a920436a3eb75b297c2fd (MD5) / Made available in DSpace on 2018-06-20T12:54:05Z (GMT). No. of bitstreams: 1 LETÍCIA MARTINS DO CARMO.pdf: 1711707 bytes, checksum: 774bf7df592a920436a3eb75b297c2fd (MD5) Previous issue date: 2018-03-09 / This dissertation is inserted in the Stricto Sensu Post-Graduation Program in Psychology, with emphasis in Social Psychology of Work and Organizations, Pontifical Catholic University of Goiás (PUC Goiás). It was sought to apprehend violence against children and adolescents in Brazilian dissertations and theses in Psychology from 2010 to 2015. The method of this research is anchored in historical and dialectical materialism, in the assumptions of Socio- Historical Psychology of Vygotsky. It presented, as general objective, to analyze the production of the dissertations and theses of the Graduate Programs in Psychology in Brazil that contemplate the aforementioned period. As specific objectives, we sought to analyze the contributions of dissertations and theses to the epistemological-scientific field and also to the socio-historical context; to apprehend the researched objects of violence and, especially, violence against children and adolescents; to describe the data presented in the surveys and to identify the theoretical and methodological aspects that guided these productions. For that, we chose the methodology of Qualitative Metassynthesis that allows a socio-historical analysis of the object of study investigated. Metassynthesis consists of five phases: exploration, crossing, refinement, description and interpretation. The research identified the Universities and Stricto Sensu Postgraduate Programs in Psychology in Brazil through the Sucupira Platform, located at CAPES, and dissertations and theses linked to the Programs in the period from 2010 to 2015 through the Catalog of Thesis and Dissertations of CAPES and / or the Brazilian Digital Libraries of Theses and Dissertations (BDTD) of the Institutions. We found: 7,269 dissertations (100%) and 2,324 theses (100%). Of this amount, 908 dissertations (12.5%) and 259 theses (11.1%) related to violence were identified through the reading of the titles, and, regarding violence against children and adolescents, 432 dissertations were found ( 5.9%) and 159 theses (6.8%). However, they did not specifically analyze children and adolescents. After the exclusions in light of the established criteria, we reached 10 dissertations (0.1%) and 02 theses (0.1%) that directly heard children and adolescents victims of violence. The results express the invisibility of violence against children and adolescents in psychology research in the period investigated. The three theoretical matrices present in these studies were: psychoanalysis, socio-historical psychology and cognitivism. Most of the researches (10) used the qualitative methodology with varied methodological procedures. The situations of violence investigated were: sexual (7); psychological (2) negligence (1); physical (1) and all forms of violence (1). It was also found that the meanings attributed to violence and violence against children are crossed by the epistemological perspective adopted by the research. / Esta dissertação está inserida no Programa de Pós-Graduação Stricto Sensu em Psicologia, com subênfase em Psicologia Social do Trabalho e das Organizações, da Pontifícia Universidade Católica de Goiás (PUC Goiás). Buscou-se apreender a violência contra crianças e adolescentes nas dissertações e teses brasileiras em Psicologia no período de 2010 a 2015. O método desta pesquisa está ancorado no materialismo histórico e dialético, nos pressupostos da Psicologia Sócio-Histórica de Vigotski. Apresentou, como objetivo geral, analisar a produção das dissertações e teses dos Programas de Pós-Graduação em Psicologia no Brasil que contemplam o período supracitado. Como objetivos específicos, buscou-se analisar as contribuições das dissertações e teses para o campo epistemo-científico e também para o contexto sócio-histórico; apreender os objetos de estudo pesquisados sobre violência e, especialmente, sobre a violência contra crianças e adolescentes; descrever os dados apresentados nas pesquisas e identificar os aspectos teóricos e metodológicos que nortearam essas produções. Para tanto, optou-se pela metodologia da Metassíntese Qualitativa que permite uma análise sócio-histórica do objeto de estudo investigado. A Metassíntese é constituída de cinco fases: exploração, cruzamento, refinamento, descrição e interpretação. A pesquisa identificou as Universidades e os Programas de Pós-Graduação Stricto Sensu em Psicologia no Brasil por meio da Plataforma Sucupira (CAPES), e as dissertações e teses vinculadas aos Programas no período de 2010 a 2015 por meio do Catálogo de Teses e Dissertações da CAPES e/ou pelas Bibliotecas Digitais Brasileiras de Teses e Dissertações (BDTD) das Instituições. Foram localizadas: 7.269 dissertações (100%) e 2.324 teses (100%). Desse montante, por meio da leitura dos títulos identificaram-se 908 dissertações (12,5%) e 259 teses (11,1%) relacionadas à violência e, no que se refere à violência contra crianças e adolescentes, foram encontradas 432 dissertações (5,9%) e 159 teses (6,8%). Entretanto, não analisavam especificamente as crianças e os adolescentes. Após as exclusões à luz dos critérios estabelecidos chegou-se a 10 dissertações (0,1%) e 02 teses (0,1%) que ouviram diretamente crianças e adolescentes vítimas de violências. Os resultados expressam a invisibilidade da violência contra crianças e adolescentes nas pesquisas em Psicologia no período investigado. As três matrizes teóricas presentes nestes estudos foram: a psicanálise, a psicologia sócio-histórica e o cognitivismo. A maioria das pesquisas (10) utilizaram a metodologia qualitativa com procedimentos metodológicos variados. As situações de violência pesquisadas foram: sexual (7); psicológica (2) negligência (1); física (1) e todas as formas de violência (1). Constatou-se também que os significados atribuídos a violência e à violência contra a criança estão atravessados pela perspectiva epistemológica adotada pela pesquisa.

Background: The spirometric reference values are of great importance for diagnosis and treatment of lung diseases. At present, there are no spirometric reference values for First Nations children and adolescents living in Canada. Objectives: The objectives of the present study were (1) to identify the flexible and efficient statistical method to derive lung function reference equations that can be used to obtain the predicted values and Lower Limit of Normal (LLN) for lung function in children and adolescents, and (2) to obtain prediction equations for FVC, FEV1 and FEV1=FVC for First Nations children and adolescents living in rural Saskatchewan, Canada. Methods: Spirometric results from a prospective cohort study, "First Nations Lung Health Project" were used to identify 130 healthy non-smoking children and adolescents. The predicted values and LLN of spirometric indices [Forced Vital Capacity (FVC), Forced Expiratory Volume at one second (FEV1) and FEV1 and FVC ratio (FEV1=FVC)] were calculated for school-going children and adolescents ages 6-17 years. The subjects participating in the study were from two Cree First Nations on-reserve communities located in rural Saskatchewan, Canada. All lung function values were reviewed by a respirologist for acceptability of the test. Following an extensive literature review, the Generalized Additive Models for Location, Scale and Shape (GAMLSS) was identified as a flexible statistical tool to model the lung function variables. The lung function indices were assumed to follow a Box-Cox-Cole-Green (BCCG) distribution with median, , coe ffcient of variation and skewness . Akaike Information Criteria (AIC) approach was used to obtain the reference models. The LLN was calculated by taking the fifth percentile of the prediction equations of the lung function variables. The above approach is recommended for the prediction of lung function of multi-ethnic people aged 3-95 years from different ethnic groups by the Global Lung Function Initiative (GLI). Results: Significant differences were observed in lung function (FVC, FEV1 and FEV1=FVC) and anthropometric measurements between both boys and girls. Therefore, fitting separate equations for both sexes are justified. In GLI, polynomial bases of order 6-7 were used for modeling the meadian, coefficient of variation and skewness . In this study, lower order polynomial bases (up to order 4) were enough to obtain the reference models. In GLI, the polynomial bases were divided by 100 to let it lie within 0 to 1. In this study, the polynomials were divided by 20 to lie these between 0 and 1. The predicted values of FVC was higher than the values for FEV1 in both boys and girls. Therefore the values of FEV1=FVC ratios is less than 100% in this population. In girls, the difference between the curves of FVC and FEV1 was smaller compared to boys. Thus, the total volume of air for girls during exhalation are close to the volume of air exhaled at the first second. The estimated curves showed that the models fitted the lung function data reasonably well. Conclusions: The results in this study showed that the optimum model for the prediction of lung function were almost similar to the ones used by GLI for the prediction of lung function of all-age multi-ethnic populations.The predicted values and LLN values of the lung function variables reported in this study can be recommended to health-care providers for the use in diagnosis respiratory diseases in First Nations children and adolescents in rural Saskatchewan. Small sample (n < 150) was a limitation of this study. This study limitation can be overcome by including more individuals from the follow-up study, which will be conducted in 2016.

Section A provides an overview of the role of family caregivers of individuals with chronic illness, and describes key conceptualisations and theories posited in the caregiver literature. This is followed by an overview of research conducted with caregivers of children with chronic kidney disease (CKD), a summary of the limitations of this research, and suggestions for future research. Section B Despite a recognised need to monitor caregiver burden in caregivers of children with CKD, there is no measurement tool currently available to meet this aim. The present research documents the development of a measure of caregiver burden specific to family caregivers of children with CKD. Methods: Interviews were conducted with 16 caregivers of children with CKD and 10 healthcare professionals in order to generate measure items. A provisional version of the measure was developed and piloted with 18 caregivers of children with CKD and five healthcare professionals. Results: An initial pool of 97 items was generated from the content of interviews, which was reduced to 60 items following review for item redundancy. A piloting exercise provided preliminary evidence for the usability, readability, and relevance of measure items; adaptations further to piloting resulted in the 51-item ‘Paediatric Renal Caregiver Burden Scale’ (PR-CBS). Conclusions: It is hoped that the PR-CBS will serve to identify areas of need amongst caregivers of children with CKD, and in turn improve outcomes for this caregiver population and children with CKD. Section C is a critical appraisal of the conducted research study, and includes an overview of research abilities acquired during its completion, reflections on how the research may have been conducted differently, implications for future clinical practice, and ideas for future research.

O presente trabalho consiste em uma análise das práticas educacionais desenvolvidas e voltadas para crianças e adolescentes em situação de abrigo ao longo da história nacional. Atualmente denominada como acolhimento institucional, esta prática é garantida pela Lei 8069/90 como uma medida de proteção e suas unidades de atendimento social são entendidas como espaços socioeducativos. A investigação empírica realizada em três instituições distintas durante a pesquisa apresenta evidências de que seu caráter educativo ainda está distante do ideal de desenvolvimento integral preconizado pela Lei, prevalecendo práticas pautadas no desrespeito à subjetividade daqueles que deveriam ser a razão de sua existência. Assim, este trabalho busca fazer um resgate histórico destas práticas, seguido pela apresentação da realidade atual constatada por meio da observação-participante, para uma posterior reflexão e proposição de um trabalho socioeducativo que seja realmente significativo para os acolhidos institucionalmente nestes espaços. / This study is an analysis of educational practices and programs for children and adolescents in a shelter along the national history. Currently known as shelter, this practice is guaranteed by Law 8069/90 as a measure of protection and their social service units are understood as socio-educational spaces. Empirical research carried out in three different institutions during the study presents evidence that its educational nature is still far from the ideal of integral development envisaged by the law, prevailing practices based on disrespect to the subjectivity of those who should be the reason for their existence. This study seeks to make a historical review of these practices, followed by the presentation of the current reality observed through participant observation, for further discussion and proposal of a social-educational work that is really significant for the institutionally accepted in these spaces.

As redes de proteção social encontram na concepção dos determinantes sociais da saúde denso aporte conceitual para análise e intervenção sobre as violências contra crianças e adolescentes. De um lado, essa concepção permite a compreensão integral dos indivíduos, famílias e comunidades e, de outro, a proposição de políticas públicas intersetoriais. O presente estudo objetivou conhecer e analisar sob a ótica dos sujeitos sociais (do Conselho Tutelar, profissionais de instituições de saúde e de assistência social e integrantes do judiciário) a atuação da rede de proteção social à criança e ao adolescente no município de Uberaba-MG. Os objetivos específicos consistiram em: identificar e classificar os direitos violados atendidos pelo Conselho Tutelar em relação ao Sistema de Informação para a Infância e Adolescência (SIPIA); caracterizar a rede de atendimento à criança e ao adolescente quando da violação de direitos e avaliar, sob a ótica dos sujeitos sociais, os avanços e desafios da rede de proteção social. Trata-se de estudo de caso desenvolvido com a triangulação de métodos. A metodologia qualitativa conduziu a coleta e a análise de 42 entrevistas semi-estruturadas com profissionais da Saúde, da Assistência Social, do Terceiro Setor e do Ministério Público. A metodologia quantitativa permitiu o tratamento dos dados de fontes secundárias (relatórios consolidados do segundo semestre de 2007 ao primeiro semestre de 2010) e seu cotejamento com a classificação do SIPIA. Do total (N= 6441) das 32 violências tipificadas pelo Conselho Tutelar, os \"conflitos familiares\", que infringem do artigo 19 ao 52 do ECA, somaram, em média, 19,6%, seguidos do \"comportamento irregular\" (artigo 103 ao 105), com 15,3%. Nos maus-tratos, enquanto comunicações de \"abandono\", \"agressão\", \"conflitos familiares\", \"espancamento\", \"maus tratos\", \"omissão\" e \"situações de risco e irregular\", temos 41,1% dos fatos. Relativamente aos encaminhamentos (N= 8119), o serviço de psicologia do Conselho acolheu, em média, 3,5% dos fatos, seguido pelo acionamento de serviços do setor de saúde: CRIA/CAPS e CAPS-D (3,0%) e, do setor de assistência social, o CREAS acolheu 2,7%. Os depoimentos dos profissionais evidenciaram a permanência de ações fragmentadas face à agudização das vulnerabilidades e, por vezes, relações hierarquizadas entre os integrantes das redes de responsabilização, de defesa e de atendimento. As equipes dos CRAS e das ESF´s indicaram o volume de demandas, a extensão dos territórios e a falta de efetividade do contra-referenciamento como obstáculos à continuidade da atenção às crianças, aos adolescentes e aos arranjos familiares nos territórios. Observou-se, também, a sedimentação do fluxo entre as instituições por ocasião dos casos agudos das violências, especialmente entre CREAS, SEDS e o Ministério Público. Verificou-se forte tendência à individualização das violências e vulnerabilidades manifesta na responsabilização do indivíduo ou da família e nas dificuldades para a estruturação de ações preventivas. O estudo demonstrou, ainda, a emergência de práticas intersetoriais na rede de proteção e a relevância da atuação do Conselho para a efetivação da intersetorialidade. Refletir sobre o fazer do Conselho pode subsidiar a crítica às ações focalistas e emergenciais e contribuir para o redirecionamento das políticas municipais às demandas dos diversos territórios e sujeitos. / The social safety nets are in the design of social determinants of health dense conceptual input for analysis and action on violence against children and adolescents. On the one hand, this design allows a full understanding of individuals, families and communities and on the other, the proposition intersectoral public policies. This study aimed to identify and analyze from the perspective of social subjects (the Guardian Council, professionals from health and social care and members of the judiciary) the role of social safety net for children and adolescents in the municipality of Uberaba-MG . The specific objectives were: to identify and classify the rights violated by the Guardian Council met in relation to the Information System for Childhood and Adolescence (ISCA) characterize the network of services to children and teens when the violation of rights and assessment under the perspective of social subjects, advances and challenges of social safety net. It is a case study developed with the triangulation of methods. Qualitative methodology led to collection and analysis of 42 semi-structured interviews with professionals from Health, Social Assistance, the Third Sector and the Public Ministry. The methodology allowed the quantitative treatment of data from secondary sources (reports consolidated second half of 2007 to the first half of 2010) and their mutual comparison with the classification of ISCA. Of the total (N = 6441) of 32 violence typified by the Guardian Council, the \"family conflicts\", in breach of Article 19 to 52 of the SCA, amounted, on average, 19.6%, followed by the \"erratic behavior\" (Article 103 to 105), with 15.3%. In the ill-treatment, while communications \"abandonment,\" \"aggression,\" \"family conflicts\", \"beating\", \"abuse\", \"omission\" and \"situations of risk and irregular\", we have 41.1% of the facts. For referrals (N = 8119), the psychology service of the Council received an average of 3.5% of the facts, followed by the activation of services in the health sector: RCCA / CPS and PCC-AD (3.0%) and social assistance sector, 2.7% received the creases. The testimony of professionals showed the persistence of fragmented actions against the vulnerabilities and acute, sometimes hierarchical relationships between members of networks of accountability, advocacy and service. Teams of RCSA and the FHT\'s indicated the volume of demands, the extent of the territories and the lack of effectiveness of counterreferencing as obstacles to continuity of care for children, adolescents and family arrangements in the territories. There was also the sedimentation of the stream between the institutions during the acute cases of violence, especially among CSASR, DSD and prosecutors. There was a strong tendency to individualization of violence and vulnerability manifested in the accountability of the individual or family and the difficulties in the structuring of preventive actions. The study also shows the emergence of sector practices in the safety net and the relevance of the work of the Council for the effectiveness of intersectoral cooperation. Reflecting on the making of the Council may support the criticism of the focal and emergency actions and contribute to the diversion of municipal policies to the demands of the various territories and subjects.

Made available in DSpace on 2016-08-10T10:32:05Z (GMT). No. of bitstreams: 1 LUCINEIDE FERREIRA DE SA ANTUNES.pdf: 2101590 bytes, checksum: 6f998d6e178f9f8946285da926d437d2 (MD5) Previous issue date: 2012-03-26 / This study aims to understand domestic violence and the influence of socio-historical, economic, political and cultural changes in the occurrence of domestic violence within the families that were attended at the Hospital das Clínicas of Federal University of Goiás in the period 2005 to 2010. To understand these factors we tried to analyze the historical configuration of structural violence in capitalist society and the construction of citizenship rights in family relations, as well as the establishment of social rights and social policies as a necessary relationship between state and family. We sought to examine also the history of violence against children and adolescents in Brazilian society, and the particularity of domestic violence against children and adolescents. In this process we performed a historical review of legal frameworks and policies for treatment of this segment. Based on these studies you can say that children and adolescents are victims of different types of violence (from the structural to the home) because they do not have public policies that ensure comprehensive social protection. Prevention, protection and care of children and adolescents in situations of domestic violence require intersectoral policies involving health, education, welfare, housing, sanitation, recreation and others. However, empirical research has demonstrated the precarious living conditions of families and the difficulty in obtaining assistance in various policies mentioned. It has also shown that the unmet basic needs for these policies can contribute to the occurrence of violence or to its perpetuation. Thus, it can be said that a quality service and universalized public policy can mean the protection of children and adolescents not only of structural violence as well as domestic violence. / A proposta deste estudo consiste em apreender a violência doméstica e a influência dos fatores sócio-históricos, econômicos, políticos e culturais na ocorrência da violência doméstica com as famílias atendidas no Hospital das Clínicas (HC/UFG), no período de 2005 a 2010. Para compreensão desses fatores, buscou-se analisar a configuração histórica da violência estrutural na sociedade capitalista e a construção dos direitos de cidadania na relação com a família, bem como a constituição dos direitos sociais e das políticas sociais como relação necessária entre Estado e família. Buscou-se analisar, ainda, o histórico da violência contra a infância e adolescência na sociedade brasileira, e a particularidade da violência doméstica contra crianças e adolescentes. Nesse processo, realizou-se um resgate histórico dos marcos legais e das políticas de atendimento desse segmento. Com base nesses estudos, pode-se afirmar que a infância e a adolescência são vítimas de diferentes tipos de violência (desde a estrutural até a doméstica), por não contarem com políticas públicas que assegurem proteção social integral. A prevenção, proteção e atendimento à criança e ao adolescente em situação de violência doméstica requerem ações intersetoriais que envolvam as políticas de: saúde, educação, assistência social, habitação, saneamento, lazer, dentre outras. Entretanto, a pesquisa empírica demonstrou a precariedade das condições de vida das famílias e a dificuldade na obtenção de atendimento no âmbito das diferentes políticas apontadas. Demonstrou, ainda, que o não atendimento das necessidades básicas por essas políticas pode contribuir para a ocorrência da violência ou para sua perpetuação. Dessa forma, pode-se afirmar que um atendimento de qualidade e universalizado por parte das políticas públicas pode significar a proteção de crianças e adolescentes não só da violência estrutural mas também da violência doméstica.