Introduction: There has been a lack of longitudinal studies on maternal and infant factors associated with feeding difficulties. Feeding difficulties are common, cause much anxiety for parents, and are associated with a range of child health and behavioural outcomes. This study aims to gain an understanding of the prevalence and type of feeding difficulties found in a community sample, the prevalence of maternal mental ill-health and identify maternal and infant factors predictive of feeding difficulties. A final aim is to identify factors associated with successful and unsuccessful feeding experiences from a maternal perspective. Method: A short questionnaire with questions about support and help-seeking was compiled, and several standardised measures were included in the pack; a measure of maternal mood (DASS-21), social support (SOS-S), and eating disorder symptomatology (EAT-26). Questionnaires were given to mothers in pregnancy, and again when infants were around 3 and 7 months old. An adapted version of the Child Feeding Assessment Questionnaire, and the food fussiness subscale from the Children’s Eating Behaviour Questionnaire examined feeding behaviour and maternal response. The Infant Temperament Questionnaire examined maternal perception of infant temperament. Content analysis was used to identify themes in mother’s narrative about factors which help feeding and barriers to a successful feeding experience. A within subjects design was employed to examine predictors of infant feeding difficulties. Results: 23% of mothers of 3 to 5 month old infants, and 13% of mothers of 7 to 10 month olds reported their child as having one or more feeding difficulties. Levels of stress remained stable across the length of the study, but prevalence of maternal anxiety and depression reduced. 47% of those mothers who breast fed found breast feeding difficult or very difficult. Maternally identified barriers to successful feeding with feeding were child illness, and painful or difficult breastfeeding. Mothers wanted an improvement in support and knowledge of health professionals, and a reduction in pressure from health professionals in relation to feeding method. Maternal depression and stress were correlated with severity of food refusal in infants, as well as maternal anxiety and food fussiness, prior to post-hoc analyses. Following post-hoc analyses these relationships were no longer significant. Discussion: Relationships between infant behaviour, maternal health and feeding difficulties are explored. The low prevalence of feeding difficulties and reasons for negative findings in relation to predictors of feeding difficulties are discussed. Implications for health services are presented in the light of maternal views about support and barriers to successfully feeding their child.

Pregnancy is a unique developmental period in a woman’s life, characterized by numerous psychological, behavioural, and biological changes. How a biologically female woman experiences her pregnancy is impacted by her previous life experiences, including early experiences of adversity. In particular, maternal history of Adverse Childhood Experiences (ACEs) before age 18, has been shown to exert distal effects on mental health and behaviour in pregnancy. The current study explored the associations between ACEs and mental health symptoms in pregnancy via structural equation modelling within a sample of 330 Canadian women. This statistical approach permitted the use of a latent ACE variable comprised of abuse, neglect, and household dysfunction as indicator variables, as well as a latent mental health variable comprised of symptoms of depression, anxiety, and fear of childbirth. A direct effect emerged whereby maternal ACEs predicted mental health symptoms. This permitted subsequent testing of the following mediating pathways: sleep, health-risk behaviours, resilience, and social support. In the mediation analyses, further support emerged for the total indirect effect of maternal ACEs on mental health symptoms in pregnancy, once mediation pathways were added. In reviewing individual indirect pathways, sleep and social support mediated the association between ACEs and mental health symptoms in pregnancy. However, health risk behaviours and resilience did not. In addition, social support mediated the relationship between resilience and mental health symptoms in pregnancy. This study contributes to the existing research on maternal ACEs and their relationship with mental health symptoms during pregnancy. The concurrent testing of several pathways in the structural model served to characterize possible mechanisms through which early adversity relates to current mental health symptoms in pregnancy. Implications of these findings include identification of possible targets for intervention in pregnancy, in order to lessen the burden of ACEs on maternal mental health. / Graduate

Mental health has become a prominent issue in society. Yet, much remains unknown about the etiology of psychiatric disorders. The aim of the present thesis was to investigate the association between biological, psychological and social factors of risk and resilience and behavioral problems in a birth cohort of Swedish children. 1723 mothers and their children were followed from birth to the age of 12 as part of the South East Sweden Birth Cohort Study (the SESBiC study). Information was gathered through register data, standardized questionnaires and DNA samples. In study I, stability of maternal symptoms of depression and the impact on child behavior at age 12 were investigated. The prevalence of depressive symptoms was found to be 12.0 % postpartum. Symptoms of postpartum depression significantly increased the risk for subsequent depressive symptoms 12 years later in women. Children whose mothers reported concurrent symptoms of depression and anxiety had an increased risk for both internalizing and externalizing problems at age 12, but no long term effect on child behavior was seen for postpartum depressive symptoms. The greatest risk was seen for children whose mothers reported symptoms of depression on both occasions. In study II, the impact of gene-environment interaction of 5-HTTLPR and BDNF Val66Met and experience of life events together with symptoms of maternal depression and anxiety on child behavior at age 12 was studied. A main effect of 5-HTTLPR was noticed, but no geneenvironment effects were shown. Similarly to study I, concurrent symptoms of maternal depression and anxiety were an important predictor of child behavioral problems. A high degree of psychosocial stress around childbirth was found to have long lasting detrimental effects on child behavior, increasing the risk for internalizing problems at age 12. Study III investigated the impact of geneenvironment interactions of 5-HTTLPR and BDNF Val66Met and life events together with symptoms of maternal depression and birth characteristics on behavioral problems at age 3. Symptoms of postpartum depression were found to predict internalizing as well as externalizing problems in children three years later. Child experience of life events was a stable predictor of behavioral problems across the scales similar to sociodemographic factors such as parental immigration status and unemployment. No gene-environment interaction effects of 5-HTTLPR or BDNF Val66Met were shown. Study IV used the risk factors identified in studies I-III to investigate factors of resilience to behavioral problems at age 12. The l/l genotype of 5-HTTLPR was associated with a lower risk for behavioral problems at age 12, especially for children facing low adversity. Good social functioning was found to be a general resource factor, independent of the level of risk, while an easy temperament was associated with resilience for children with a high degree of adversity. However, effect sizes were small. In summary, the results from the present thesis emphasize the importance of maternal mental health and sociodemographic factors for child mental health at ages 3 and 12, which must be taken into account in clinical settings. Moreover, it adds to the null-findings of the gene-environment effect of 5-HTTLPR and BDNF Val66Met on behavioral problems in children, but indicates a main effect of 5-HTTLPR on internalizing symptoms at age 12.

Background: Postnatal depression (PND) is a global problem and an important public health issue. It is estimated that approximately 15% of women experience depression during the first postnatal year but there are problems in recognition because its clinical assessment can be complex. The incidence of postnatal depression continues to rise resulting in serious consequences for the mother, her child and the extended family and a risk of suicide (the leading cause of maternal death in England and Wales) and infanticide in some severely depressed mothers. Treatment programmes vary considerably but many studies are suggesting that psychological interventions can be as equally, if not more, clinically effective in the management of depression as routine care from a general practitioner or anti-depressants in the short term – and may be more cost effective. Method: The aim of this exploratory pilot study is to identify whether the support, on a one to one basis, from a Peer Support Worker (PSW) would assist in the reduction of PND in new mothers. Eight PSW’s were recruited. Each PSW had previously suffered from mild to moderate postnatal depression but had recovered and were not currently receiving any form of psychological support or taking any medication. They were employed, on a six month contract, by the local NHS Trust. References and enhanced criminal records clearance were obtained. A confidentiality statement was also signed by the PSW. Thirty mothers were recruited by their own Health Visitor. This was carried out using the Edinburgh Postnatal Depression Scoring documentation (EPDS) alongside a clinical assessment. The cut off score, as agreed by both the lead researcher and the Health Visitors involved in the study, was 11. Fully informed consent was obtained and participant information sheets given. The mothers were allocated into either a Control group or an Intervention group using number alternating. The PSW’s received formal training about child protection procedures/safeguarding children in addition to the relevance and importance of confidentiality. However, apart from this, a structured training programme was not adhered to. The PSW’s strongly felt, as a combined group, that they wanted to provide the intervention simply as a ‘fellow mum who had survived the rollercoaster journey of PND’. Each PSW wanted to identify the nature of the problem, find a possible solution, and design their own proposed ‘support package’ – from the outset of the study. The PSW visited the mother in their home environment, or a location of their choice, for a period of six weeks on a once weekly basis (intervention group). This was then compared to a number of mothers who received support from their family Health Visitor (HV) alone (control group). Data collected was both qualitative and quantitative. The PSW's and the mothers from both the control group and the intervention group were asked to maintain a log book reflecting upon their feelings and thoughts after each visit (either from their PSW or their HV). Individual and group supervisory sessions were also offered by the lead researcher to both the mothers within the intervention group, and the control group, in addition to the PSW’s. A number of the participants were interviewed on a one to one basis when their infant was six months old. Data from the interviews was subsequently transcribed, coded and categorised, and key themes identified. Quantitative data was collated in the form of an Edinburgh Postnatal Depression Score (EPDS) – an assessment tool which is routinely used to identify mothers at risk or suffering from postnatal depression. The EPDS score was recorded prior to the support commencing by either a PSW or the Health Visitor, after completion of all six visits, and when the infant was six months old. Analysis: The EPDS scores recorded at 6 weeks, 12 weeks, and again when the infant was six months old, were analysed and summarised using graphs and charts. Non parametric analysis using Friedman’s Anova and the Wilcoxon paired test was carried out. A Mann Whitney test, Kolmogorov-Smirrov test and a Shapiro-Wilk test were also performed. A constant comparative method was used as a means of analysing the qualitative data collected from both log books and interview transcript (Denscombe 2008). The lead researcher consistently read and re-read text data, compared new codes and categories as they emerged and repeatedly compared them against existing versions. This process enabled the researcher to refine and improve the explanatory power of the concepts and theories generated from the data. Similarities and differences were highlighted and categories and codes were identified. On completion of this analysis, all participants were contacted to ensure validity of the findings and that each participant agreed with the researchers interpretation of the data collected. Results: Qualitative and quantitative findings from this study suggest that the input from a PSW does assist in the reduction of PND in new mothers. This is demonstrated in both the analysis of the quantitative data and the qualitative. The EPDS scores demonstrated little difference between the participants at 6 weeks but the statistics started to diverge at 12 weeks – the mean at 12 weeks for the control group is recorded at 12.46 and the intervention group is 10.33 – a difference of 2.13. The EPDS at six months demonstrates a difference between the two scores as 2.67 (the control group mean recording is 11.60 compared with the intervention mean which is 8.93). The key themes identified were the immeasurable value of ‘social support’ and ‘shared experiences’. The resounding factor that appears repeatedly throughout the analysis of data is the fact that the mothers could ‘truly relate to their Worker.’ Their PSW gave them ‘hope’, made them feel as if they were ‘not a failure’ and gave them an overwhelming ‘sense of normality’. This, in turn, increased their self-esteem, their positivity towards their parenting role, and their ability to therefore be ‘a good mother.’ A major strength of the work was the involvement of the PSW’s in both the planning and the implementing of the intervention. It was their design, their creation, and their feelings about what may really help their mother. A number of other themes were also identified that were, interestingly, commonalities across the entire data set (participants and PSW’s). These included recognition of their own changing perspective – a realisation that there simply is no ‘quick fix’ solution, that both time and support are required. The PSW’s described feelings of ‘personal benefit’, ‘self-awareness’ and the ‘provision of closure’ for themselves. The intervention group also talked, at length, about their ‘personal benefit’ from the PSW, and their own self-awareness about how they truly felt, their emotions and, in some instances, why they felt this way. The control group recognised the huge advantage from talking to other mothers and, although they did not have the formal support sessions from a PSW, they embraced the opportunity of sharing their thoughts and feelings with ‘fellow mums’. Each participant, and PSW, discussed the sharing of experiences, empathy, the feeling of ‘release’ and, particularly on the mothers’ part, the importance of knowing that, actually, they are not ‘alone’. Conclusion: The aim of this study was to provide early intervention to mothers who were classed as ‘at risk’ of suffering from PND, and, indeed, the support from the PSW’s did appear to have a positive impact upon the mothers’ mental health and wellbeing. However, this was a small scale, pilot study over a relatively short period of time. Larger, more longitudinal studies are certainly required. The importance of the pilot study presented here lies in its usefulness in shaping research to investigate and explore further whether there are indeed beneficial factors to post-natally depressed mothers who receive one to one support from a PSW. The positive results from this study can, potentially, have a huge impact within practice and, most importantly, upon the lives of those affected by postnatal depression.

Being a mother is often described as a difficult but rewarding experience. Maternal parenting reward (PR) may serve an important function, helping to facilitate responsive maternal care and healthy infant development. However, it should not be taken for granted that the rewards of parenting will emerge naturally for women, particularly women who were abused by their own caregivers in childhood, within family systems that enabled or perpetuated the abuse. Despite an abundance of research on the neurobiological correlates of PR, surprisingly little is known about mothers’ self-reported experience of PR, both in general and in relation to early adversity. The aims of this survey-based dissertation were to develop and psychometrically evaluate a PR self-report measure, and to determine the extent to which childhood abuse predicts short-term (family betrayal) and long-term (maternal depression, posttraumatic stress, and problematic substance use) sequelae of abuse that are associated with diminished PR. In Study 1, with 203 mothers of young children, the final 14-item questionnaire assessed PR in a way that was not confounded with social desirability or maternal demographic characteristics, and was distinct from the related constructs of parenting pleasure and satisfaction. On average, mothers reported being highly rewarded by parenting, though there were individual differences in PR within and across mothers. In Study 2, with 270 mothers of young children, maternal history of childhood psychological and sexual abuse by caregivers each predicted diminished PR indirectly. Childhood psychological abuse was strongly associated with family betrayal, or actions and inactions by the family of origin that enabled or perpetuated abuse, which in turn predicted recent maternal depression and posttraumatic stress, each of which predicted diminished PR. The association between childhood sexual abuse and diminished PR was mediated by increased maternal posttraumatic stress symptoms only, not by family betrayal or alcohol use problems related to posttraumatic stress, as hypothesized. Although alcohol use problems predicted diminished PR at the bivariate level, they did not predict PR in the full model. Maternal childhood abuse by caregivers is indirectly associated with disruptions to the social rewards of attachment, with potential intergenerational consequences for the mother-infant relationship and infant development. / 10000-01-01

Submitted by LUANA VALERA BOMBARDA null (lvbombarda@gmail.com) on 2016-08-09T22:14:16Z No. of bitstreams: 1 DISSERTAÇÃO FINAL -LUANA BOMBARDA.pdf: 3360499 bytes, checksum: a6ba716fd8ec19b2c0e4fefe88681470 (MD5) / Approved for entry into archive by Ana Paula Grisoto (grisotoana@reitoria.unesp.br) on 2016-08-12T13:54:50Z (GMT) No. of bitstreams: 1 bombarda_lv_me_bot.pdf: 3360499 bytes, checksum: a6ba716fd8ec19b2c0e4fefe88681470 (MD5) / Made available in DSpace on 2016-08-12T13:54:50Z (GMT). No. of bitstreams: 1 bombarda_lv_me_bot.pdf: 3360499 bytes, checksum: a6ba716fd8ec19b2c0e4fefe88681470 (MD5) Previous issue date: 2016-07-08 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Introdução: A obesidade infantil teve considerável aumento em sua prevalência nos últimos anos, acarretando prejuízos físicos, emocionais e sociais, caracterizando-se como um problema de saúde pública. Seu tratamento demanda ações e cuidados em todos os níveis da atenção à saúde, porém ainda são escassos os estudos que caracterizem as variáveis sociais e psicológicas presentes em crianças com diferentes graus de obesidade, estudos estes, que possam contribuir para o desenvolvimento de intervenções voltadas para este grave problema de saúde. Objetivos: Caracterizar, em relação a parâmetros sociodemográficos, clínicos e psicológicos, uma amostra clínica de crianças obesas, classificadas como obesas e super obesas, em tratamento para obesidade em um serviço de referência, de um hospital universitário do interior do estado de São Paulo; comparar os aspectos sociodemográficos, clínicos e psicológicos em relação ao sexo da criança e à gravidade da obesidade e ainda caracterizar e comparar o estilo parental, a percepção corporal e saúde mental materna ou de outros responsáveis pela criança e estudar a associação dessas características com indicadores da gravidade da obesidade da criança. Método: Foi realizado um estudo observacional, de corte transversal, descritivo e analítico, que avaliou 77 crianças com diagnóstico de obesidade e seus responsáveis. Essas crianças foram provenientes do Ambulatório de Obesidade Infantil do HCFMB/Unesp. Foram aplicados aos responsáveis pela criança um formulário que investigou características sociodemográficas e clínicas da criança, o SDQ (Questionário de Capacidades e Dificuldades - Strengths and Difficulties Questionnaire) que visou rastrear a saúde mental da criança (características emocionais e comportamentais), o IEP (Inventário de Estilos Parentais) para avaliar práticas educativas, o IDATE (Inventário de Ansiedade Traço-Estado) e o BDI (Inventário de Depressão de Beck) que medem, respectivamente, sintomas de ansiedade e de depressão do cuidador, e a Escala de Silhuetas, para avaliar a percepção corporal, a insatisfação corporal da crianças e de seus responsáveis em relação ao corpo da criança e ainda a percepção ideal das crianças e de seus responsáveis em relação às crianças da mesma idade do sujeito. Dados clínicos foram obtidos do prontuário médico das crianças (peso, altura, IMC, percentil, escore z, comorbidades e tempo de tratamento). A análise estatística foi efetuada pelo programa STATA 12.0, tendo sido efetuadas análises descritivas, frequências absolutas e porcentagens, médias e respectivos desvios-padrão, mediana e suas faixas de variação; na análise bivariada, utilizou-se o teste de qui-quadrado para as variáveis qualitativas e os testes de Mann- Whitney e Kruskal Wallis para as variáveis quantitativas e, por fim, foi realizada análise multivariada utilizando-se a regressão múltipla. Resultados: As crianças avaliadas apresentaram idade média de 9,1 (DP±1,9) e seus cuidadores idade média de 38,1 (DP±9,6). Os responsáveis eram predominantemente do sexo feminino (96,1%) e mães (88,3%). Segundo o SDQ, 53,2% das crianças apresentaram sintomas emocionais e comportamentais. Na avaliação de estilos parentais, 35,1% apresentaram práticas educativas classificadas como regular ou de risco. Com relação à ansiedade e sintomas depressivos dos responsáveis, constatou-se que 48,1% apresentaram sintomas de ansiedade-estado, e 41,6% ansiedade–traço, 39,0% apresentaram sintomas depressivos. A Escala de Silhuetas indicou que 44,2% possuíam percepção corporal adequada, 48,0% subestimaram o tamanho corporal e 7,8% superestimaram, 94,8% desejavam diminuir o tamanho da silhueta e 51,9% não reconheceram qual seria o tamanho corporal ideal de acordo com a faixa etária. Entre os cuidadores, 53,2% reconheceram adequadamente o tamanho corporal de seus filhos, 94,8% desejavam que seus filhos diminuíssem o tamanho da silhueta e 59,7% reconheceram o tamanho corporal ideal de acordo com a idade de seu filho. Comparando-se as características das crianças em relação ao sexo, constatou-se que meninos e meninas diferiram de forma estatisticamente significativa em relação à renda per capita familiar (p=0,002), percentil do IMC (p=0,01), escore z do IMC (p=0,006), gravidade da obesidade (p=0,02) e percepção do peso ideal da criança (p=0,02). Estudando-se a associação entre o escore z e as variáveis explanatórias deste estudo, constatou-se que foram significativas as associações do escore z, apenas com a faixa etária da criança (p=0,003), situação conjugal do cuidador (p=0,04), SDQ- sintomas emocionais (p=0,02), percepção corporal da criança (p=0,03) e percepção do peso ideal da criança de acordo com a sua faixa etária (p=0,03), embora as médias e medianas do escore z tenham sido quase sistematicamente mais elevadas nas categorias que indicavam risco. O modelo final da regressão múltipla mostrou associação livre de confusão com sexo (masculino), faixa etária (crianças mais novas), ocupação dos pais (trabalha) e situação conjugal do responsável (sem companheiro). Conclusões: O presente estudo indicou que as crianças participantes apresentaram várias características que podem ser consideradas características indicativas de vulnerabilidade social e psicológica: elevadas prevalências de problemas psicológicos, alteração na imagem corporal da criança e dos responsáveis; cuidadores com altas prevalências de dificuldades emocionais e com práticas parentais regulares ou de risco, independentemente da gravidade da obesidade. Esses dados são indicativos da importância de se analisar essas características e desenvolver intervenções que abordem também os aspectos sociais e psicológicos às crianças e seus familiares, visando a integralidade do cuidado no tratamento da criança com obesidade. / Introduction: Childhood obesity has considerable increase in its prevalence in recent years, leading to physical, emotional and social damage, characterized as a public health problem. Treatment demand actions and care at all levels of health care, but there are still few studies that characterize the social and psychological variables present in children with different degrees of obesity, studies these, which can contribute to the development of interventions aimed this serious health problem. Objectives: Characterize in relation to sociodemographic, clinical and psychological parameters, a clinical sample of obese children classified as obese and super obese, undergoing treatment for obesity in a reference service of a university hospital in the state of São Paulo; compare sociodemographic, clinical and psychological aspects in relation to the sex of the child and the severity of obesity and further characterize and compare the parenting style, body perception and maternal mental health or others responsible for the child and to study the association of these characteristics with indicators child obesity gravity. Method: An observational study was conducted, cross sectional, descriptive and analytical, which evaluated 77 children diagnosed with obesity and their parents. These children were from the Childhood Obesity Clinic of HCFMB/Unesp. They were applied to those responsible for child a form that investigated sociodemographic and clinical characteristics of the child, the SDQ - Strengths and Difficulties Questionnaire) which aimed to track the child's mental health (emotional and behavioral characteristics), the IEP (Inventory Parental Styles) to evaluate educational practices, the IDATE (Trait anxiety Inventory-State) and the BDI (Beck depression Inventory) that measure, respectively, anxiety symptoms and caregiver depression, and the Silhouette Scale to assess body perception, body dissatisfaction of children and their guardians regarding the child's body and also the ideal perception of children and their caregivers in relation to children of the same age of the subject. Clinical data were obtained from medical records of children (weight, height, BMI, percentile, z score, comorbidities and treatment time). Statistical analysis was performed using STATA 12.0 software, having been made descriptive analysis, absolute frequencies and percentages, averages and standard deviations, median and their variation ranges; in the bivariate analysis, we used the chi-square test for qualitative variables and the Mann-Whitney and Kruskal Wallis test for quantitative variables and, finally, multiple regression analysis was performed. Results: The evaluated children had a mean age of 9,1 (SD±1,9) and their average age caregivers of 38,1 (SD±9,6). Those responsible were predominantly female (96,1%) and mothers (88,3%). According to the SDQ, 53,2% of children had emotional and behavioral symptoms. In the evaluation of parenting styles, 35,1% were classified as regular educational practices or risk. With regard to anxiety and depressive symptoms of those responsible, it was found that 48,1% had symptoms of anxiety-state and 41,6% trait anxiety, 39,0% had depressive symptoms. The Silhouette Scale indicated that 44,2% had adequate body awareness, 48,0% underestimated their body size and 7,8% overestimated, 94,8% wanted to reduce the size of the silhouette and 51,9% did not recognize what the ideal body size according to age. Among the caregivers, 53,2% adequately recognized body size of their children, 94,8% wanted their children reduced the size of the silhouette and 59,7% recognized the ideal body size according to the age of your child. Comparing the characteristics of children about sex, it was found that boys and girls differ statistically significantly in relation to per capita family income (p = 0,002), BMI percentile (p = 0,01), z score BMI (p = 0,006), severity of obesity (p = 0,02) and perceived ideal child's weight (p = 0,02). Studying the association between the score z and the explanatory variables of this study, it was found that the associations of the z score were significant only with the age of the child (p = 0,003), marital caregiver status (p = 0,04 ) SDQ- emotional symptoms (p = 0,02), child's body perception (p = 0,03) and perception of the child's ideal weight according to your age (p = 0,03), although average and medians of the z score were almost systematically higher in categories indicating risk. The final multiple regression model showed free association of confusion with sex (male), age (younger children), parents' occupation (does work) and marital status of the head (without partner). Conclusions: The present study indicated that the participating children showed several features that can be considered indicative features of social and psychological vulnerability: high prevalence of psychological problems, changes in the child's body image and responsible; caregivers with high prevalence of emotional difficulties and with regular or risk parenting, regardless of the severity of obesity. These data are indicative of the importance of analyzing these features and develop interventions that also address the social and psychological aspects of children and their families, aiming at comprehensive care in the treatment of children with obesity.

Made available in DSpace on 2014-06-11T19:29:34Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-09-03Bitstream added on 2014-06-13T20:38:52Z : No. of bitstreams: 1 ribeiro_dg_me_botfm.pdf: 1045702 bytes, checksum: ae6ee0f304ea97e493150c73195494a2 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Entre as prioridades do atual modelo de saúde brasileiro, após a implantação do Sistema Único de Saúde, estão o cuidado e a atenção integral á criança, seu acompanhamento sistemático, com o objetivo de prevenir doenças e promover seu crescimento e desenvolvimento. Especificamente na atenção primária, a vigilância ao desenvolvimento tem por objetivo detectar problemas no processo evolutivo, identificar fatores de risco e proteção, visando aliviar e neutralizar efeitos das adversidades e criar ações promotoras do desenvolvimento. Nessa perspectiva, o presente estudo teve como objetivo identificar os fatores de risco e proteção psicossociais e biológicos para o desenvolvimento neuropsicomotor, de 65 crianças não clínicas, com um ano de vida, cadastradas em duas unidades de ESF, de Botucatu. Realizou-se um estudo transversal, no qual foram avaliadas as condições socioeconômicas da família, condições pré, peri e pós-natais, saúde mental materna e as formas de interação mãe/filho, para identificar possíveis associações com o desenvolvimento infantil. De início, as mães responderam ao Roteiro de Entrevista para Risco Biopsicossocial e ao Self Report Questionaire-20 para avaliar a saúde mental materna. A seguir, foi aplicado, na criança, o teste de Triagem de Desenvolvimento DENVER II e, foi gravado, em sala da unidade, um episódio da mãe brincando com o filho, de aproximadamente sete minutos, avaliado segundo o Protocolo de Avaliação da Interação Diádica. Dois observadores independentes categorizaram as observações e foi calculado o índice de fidedignidade. Primeiramente, foi realizada a análise descritiva dos dados, baseada no cálculo de frequência, porcentagem, incidência ou mediana, de acordo com a natureza deles. Para as análises das variáveis categóricas utilizou-se o teste Qui-quadrado e o teste Exato de Fisher... / Among the priorities of the current Brazilian healthcare model, following the implementation of the Healthcare Unified System, is the provision of care and full assistance, as well as the systematic follow up of children viewing the prevention of diseases and the promotion of growth and development. Specifically at the primary level, the surveillance of growth aims at detecting problems in the evolutive process, identifying protection and risk factors in order to alleviate and neutralize the effects of adversities and to create actions to promote development. Within this framework, the purpose of this study was to identify the psychosocial and biological factors of risk and protection for neuropsychomotor development in 65 non-clinic one-year-old children attending two ESF units in Botucatu. This cross-sectional study assessed family socioeconomical status; pre-, peri- and post-natal status,; maternal mental health; and mother/child interaction, to identify possible associations with child development. First, all mothers responded to bio-psycho-social questionnaires and the Self Report Questionaire-20 for the assessment of maternal mental health. Subsequently, the children underwent DENVER II Developmental Screening testing, and a 7-min session of mother-child free-play was taped and evaluated according to a Dyadic Interaction Protocol. Two independent observers categorized observations and the reliability index was estimated. A descriptive analysis was performed based on estimates of frequency, percents, incidence or median values, depending on the nature of the data. The Chi-square test and the exact test of Fisher were used in the analysis of categorical variables, while the tests of Mann-Whitney (for differences between two independent groups) and Kruskal-Wallis (for differences among more than two independent groups) were used for continuous variables... (Complete abstract click electronic access below)

Orientador: Ana Teresa de Abreu Ramos-Cerqueira / Resumo: Introdução: A obesidade infantil teve considerável aumento em sua prevalência nos últimos anos, acarretando prejuízos físicos, emocionais e sociais, caracterizando-se como um problema de saúde pública. Seu tratamento demanda ações e cuidados em todos os níveis da atenção à saúde, porém ainda são escassos os estudos que caracterizem as variáveis sociais e psicológicas presentes em crianças com diferentes graus de obesidade, estudos estes, que possam contribuir para o desenvolvimento de intervenções voltadas para este grave problema de saúde. Objetivos: Caracterizar, em relação a parâmetros sociodemográficos, clínicos e psicológicos, uma amostra clínica de crianças obesas, classificadas como obesas e super obesas, em tratamento para obesidade em um serviço de referência, de um hospital universitário do interior do estado de São Paulo; comparar os aspectos sociodemográficos, clínicos e psicológicos em relação ao sexo da criança e à gravidade da obesidade e ainda caracterizar e comparar o estilo parental, a percepção corporal e saúde mental materna ou de outros responsáveis pela criança e estudar a associação dessas características com indicadores da gravidade da obesidade da criança. Método: Foi realizado um estudo observacional, de corte transversal, descritivo e analítico, que avaliou 77 crianças com diagnóstico de obesidade e seus responsáveis. Essas crianças foram provenientes do Ambulatório de Obesidade Infantil do HCFMB/Unesp. Foram aplicados aos responsáveis pela criança ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Childhood obesity has considerable increase in its prevalence in recent years, leading to physical, emotional and social damage, characterized as a public health problem. Treatment demand actions and care at all levels of health care, but there are still few studies that characterize the social and psychological variables present in children with different degrees of obesity, studies these, which can contribute to the development of interventions aimed this serious health problem. Objectives: Characterize in relation to sociodemographic, clinical and psychological parameters, a clinical sample of obese children classified as obese and super obese, undergoing treatment for obesity in a reference service of a university hospital in the state of São Paulo; compare sociodemographic, clinical and psychological aspects in relation to the sex of the child and the severity of obesity and further characterize and compare the parenting style, body perception and maternal mental health or others responsible for the child and to study the association of these characteristics with indicators child obesity gravity. Method: An observational study was conducted, cross sectional, descriptive and analytical, which evaluated 77 children diagnosed with obesity and their parents. These children were from the Childhood Obesity Clinic of HCFMB/Unesp. They were applied to those responsible for child a form that investigated sociodemographic and clinical characteristics of the child, th... (Complete abstract click electronic access below) / Mestre

Background: According to the World Health Organization (WHO), perinatal depression (PD) is the most common childbirth complication. About 10% of pregnant women and about 13% of postpartum women experience a mental health disorder, primarily depression (WHO, 2016). One of the WHO (2015 a) goals for maternal mental health includes providing strategies for the promotion of psychosocial well-being and prevention of mental disorders of mothers during and after delivery. Purpose: The purpose of this performance improvement project was to establish a perinatal depression risk screening protocol and improve nursing knowledge on PD at a community-based hospital in Miami. Theoretical Framework: Beck’s postpartum depression theory Method: The project gained support and buy-in from the administration and management team of the healthcare institution. It included a comprehensive literature review used as a guide to establishing a perinatal depression screening protocol. Finally, staff nurses received education on PD, followed by an assessment for improved knowledge and retention of information. Result: A paired-samples t-test was conducted to compare pretest and posttest results for Registered nurses after receiving education on perinatal depression, N = 70. The results suggested improved knowledge and retention of new information. Conclusion: The perinatal depression screening protocol provided a framework for the assessment and first-line management for perinatal depression. There was evidence of improved nursing knowledge and retention of information on maternal mood disorders, especially perinatal depression.

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