Despite decades of research about educational interventions to correct parents' childhood fever management their knowledge remains poor and practices continue to be based on beliefs about harmful outcomes. The purpose of this thesis was to 1) identify Australian parents' fever management knowledge, attitudes, practices and methods of learning to manage fever and 2) undertake a theoretical exploration of the determinants of parents' intentions to reduce fever using the Theory of Planned Behavior (TPB). Two studies were undertaken: a qualitative study with 15 parents; and survey of 401 Queensland parents with a child aged between 6 months and 5 years. Parents determine childhood fever through behavioural changes they have learnt to associate with fever. Few were aware of the immunological beneficial effects associated with fever and most believed fever harmful causing febrile convulsions and brain damage. To prevent harm they monitored temperatures, used antipyretics, dressed children in light clothing and sponged them with tepid, cool or cold water. Despite believing antipyretics harmful most parents reduced temperatures of 38.3 degrees Celsius ± 0.6 degrees Celsius with antipyretics, alternating two antipyretics when fever was not reduced or returned. In addition to temperature reduction antipyretics were used to reduce distress or general unwellness and pain or discomfort. Multiple factors were used to determine antipyretic dosage including temperature, irritability and illness severity. Over one-third of parents had overdosed their child with too frequent antipyretic administration; more frequently with ibuprofen than paracetamol, 12:1. Fever management information was learnt from numerous sources. Doctors were the most frequently reported followed by personal experience. With the variety of information sources nearly half received conflicting information about how to manage fever increasing concerns and creating uncertainty about how to best care for their child. Despite this many believed they knew how to manage fever. Some parents' practices changed over time as a result of either positive or negative experiences with fever indicating more positive or negative attitudes toward fever. Positive experiences reduced antipyretic and medical service use; negative ones had the adverse effect with increase in antipyretic use including alternating antipyretics and double dosing with one antipyretic. Child medication behaviours also influenced attitudes and practice intentions. Parents of children who readily took antipyretics had more negative attitudes and intended to reduce their child's next fever with antipyretics. Negative attitudes were a significant determinant of fever management intentions. Parents' practices were strongly influenced by their perception that doctors and partners expected them to reduce fever. This expectation from partners is understandable; from doctors it is not and indicates doctors' propensity to recommend reducing fever. There is an urgent need to identify doctors' fever management beliefs and rationales for practice recommendations. Parents also learn to manage fever from nurses and pharmacists; their beliefs and management rationales must also be determined and addressed. There is an urgent need to educate parents about evidence-based fever management and reduce their unnecessary antipyretic use. They must be encouraged to delay antipyretic administration using them to reduce pain rather than fever. Findings from this thesis have identified the determinants of parents' intentions to reduce fever; negative attitudes and normative influences and positive child medication behaviours. Future studies should examine the efficiency and cost effectiveness of fever management educational programs for parents using different presentation methods in multiple settings.

Text in English / This research explores the meaning of the first and second-order therapeutic stances with reference to the therapist's professional and personal development. The dominant positivist paradigm was reflected in the therapist's initial position of expert observer, outside of the observed. The observed phenomena were a group of children suffering from thalassemia major, a terminal genetic disease, and their mothers. The initial idea of short-term intervention and focus on the observed evolved into six-year journey where the observer and the observed became an interconnected unit of observation, understanding and change. A first-order stance led to therapeutic stuckness, where the therapist's confrontation with her therapeutic failure and the limitations of the dominant paradigm provoked a deconstruction of the expert position and promoted a self-reflexive therapeutic stance. The author's self-searching process took her back to her personal self, her family of origin and the ''wounded healer". The researcher moved from an initial disconnection between her professional and personal selves to an awareness of the interface between the two and, ultimately, to a unification of her professional and personal selves. Such development involved an individuation process moving from a narcissistic belief in her objective stance towards a therapeutic stance where she sees herself less as a powerful agent of change and moves to an increasingly higher order of integration of the professional and personal selves (Skovholt & Ronnestad, 1992). The process with the children and mothers shifted from a focus on compliance and medical issues to more personal and emotional stories. The therapist's participation and collaborative stance created a context for change, where greatly improved medical compliance was just one of the many transformations experienced by all the participants. The researcher speculates that development of a second-order stance requires second-order change, which comes "at the end of long, often frustrating mental and emotional labor" (Watzlawick et al., 1974, p. 23), promoting integration between the professional and personal selves of the therapist. The researcher therefore contends that this process has important implications for psychotherapy training, supervision and continuing education. / Psychology / D. Litt. et Phil. (Psychology)

O presente estudo teve como objetivo geral analisar as experiências dos profissionais de saúde da estratégia saúde da família (ESF) para o acompanhamento de crianças menores de cinco anos de idade com asma, na perspectiva do cuidado integral à saúde, fornecendo subsídios para a atenção primária em saúde da criança. Os objetivos específicos foram: descrever o perfil sociodemográfico dos profissionais na estratégia saúde da família nas unidades investigadas; descrever os sinais e sintomas, as medidas preventivas e promocionais e o tratamento relacionado à asma em crianças que os profissionais de saúde relatam na ESF; identificar e analisar as experiências dos profissionais de saúde no acompanhamento da saúde de crianças menores de cinco anos de idade com asma no contexto da ESF, na perspectiva do cuidado integral em saúde. Estudo descritivo e exploratório com análise qualitativa dos dados, desenvolvido em Ribeirão Preto-SP, em quatro unidades com ESF, selecionadas com base no número de crianças até cinco anos de idade cadastradas e em acompanhamento, a partir de dados do Sistema de Informação da Atenção Básica. Os participantes foram 25 profissionais de saúde (médicos, enfermeiros, auxiliares e técnicos de enfermagem e agentes comunitários de saúde), que estavam trabalhando nas unidades há pelo menos um ano, após aprovação em comitê de ética em pesquisa. Foram realizadas entrevistas semiestruturadas gravadas e individuais e a análise dos dados foi pautada na análise temática. Os resultados trazem aspectos relevantes sobre o acompanhamento da saúde da criança, destacando elementos da organização da assistência à criança na ESF, do tratamento medicamentoso e não medicamentoso, do seguimento especializado e das relações com a família no cuidado cotidiano da criança com asma. No cuidado em saúde o diálogo é fundamental, com construção da empatia, confiança, vínculo e co-responsabilidade entre os profissionais e as mães e famílias, buscando o alcance da adesão, um tratamento eficaz, a promoção da saúde e qualidade de vida da criança e sua família. Assim, são muito importantes as ações de promoção, prevenção, tratamento e reabilitação da saúde da criança, centradas na continuidade e integralidade da assistência. / This study aimed to analyze the experiences of health professionals from the Family Health Strategy (FHS) regarding the monitoring of children under five years old with asthma from the perspective of comprehensive health care, providing support for children\'s primary health care. The specific objectives were: to describe the sociodemographic profile of professionals in family health strategy in the units investigated; to describe the signs and symptoms, preventive and promotional measures and treatment related to asthma in children that health professionals report in the family health strategy; to identify and analyze the experiences of health professionals in monitoring the health of children under five years old with asthma in the context of the family health strategy from the perspective of comprehensive health care. This descriptive and exploratory study with qualitative data analysis was developed in the city of Ribeirão Preto, state of São Paulo, in four Family Health Strategy Units, selected based on the number of children under five years old registered and monitored from data Information System of Primary Care. Participants were 25 health professionals (physicians, nurses, nursing auxiliaries and technicians and community health workers) who were working in the units for at least one year, after the approval by the research ethics committee. Individual semi-structured interviews were conducted and recorded and data analysis was based on thematic analysis. The results bring up relevant issues on children\'s health, highlighting elements of the organization of health care in the FHS, of the drug and non-drug treatment, of the specialized follow-up, and of the relations with the family in the daily care of children with asthma. In health care the dialogue is essential in building empathy, trust, bonding and co-responsibility between professionals and mothers and families, aiming the adhesion, an effective treatment, the health promotion and quality of life of the children and their family. Thus, actions in health promotion, prevention, treatment and rehabilitation of child are very important, focusing on continuity and comprehensive care.

Text in English / This research explores the meaning of the first and second-order therapeutic stances with reference to the therapist's professional and personal development. The dominant positivist paradigm was reflected in the therapist's initial position of expert observer, outside of the observed. The observed phenomena were a group of children suffering from thalassemia major, a terminal genetic disease, and their mothers. The initial idea of short-term intervention and focus on the observed evolved into six-year journey where the observer and the observed became an interconnected unit of observation, understanding and change. A first-order stance led to therapeutic stuckness, where the therapist's confrontation with her therapeutic failure and the limitations of the dominant paradigm provoked a deconstruction of the expert position and promoted a self-reflexive therapeutic stance. The author's self-searching process took her back to her personal self, her family of origin and the ''wounded healer". The researcher moved from an initial disconnection between her professional and personal selves to an awareness of the interface between the two and, ultimately, to a unification of her professional and personal selves. Such development involved an individuation process moving from a narcissistic belief in her objective stance towards a therapeutic stance where she sees herself less as a powerful agent of change and moves to an increasingly higher order of integration of the professional and personal selves (Skovholt & Ronnestad, 1992). The process with the children and mothers shifted from a focus on compliance and medical issues to more personal and emotional stories. The therapist's participation and collaborative stance created a context for change, where greatly improved medical compliance was just one of the many transformations experienced by all the participants. The researcher speculates that development of a second-order stance requires second-order change, which comes "at the end of long, often frustrating mental and emotional labor" (Watzlawick et al., 1974, p. 23), promoting integration between the professional and personal selves of the therapist. The researcher therefore contends that this process has important implications for psychotherapy training, supervision and continuing education. / Psychology / D. Litt. et Phil. (Psychology)

O presente estudo teve como objetivo geral analisar as experiências dos profissionais de saúde da estratégia saúde da família (ESF) para o acompanhamento de crianças menores de cinco anos de idade com asma, na perspectiva do cuidado integral à saúde, fornecendo subsídios para a atenção primária em saúde da criança. Os objetivos específicos foram: descrever o perfil sociodemográfico dos profissionais na estratégia saúde da família nas unidades investigadas; descrever os sinais e sintomas, as medidas preventivas e promocionais e o tratamento relacionado à asma em crianças que os profissionais de saúde relatam na ESF; identificar e analisar as experiências dos profissionais de saúde no acompanhamento da saúde de crianças menores de cinco anos de idade com asma no contexto da ESF, na perspectiva do cuidado integral em saúde. Estudo descritivo e exploratório com análise qualitativa dos dados, desenvolvido em Ribeirão Preto-SP, em quatro unidades com ESF, selecionadas com base no número de crianças até cinco anos de idade cadastradas e em acompanhamento, a partir de dados do Sistema de Informação da Atenção Básica. Os participantes foram 25 profissionais de saúde (médicos, enfermeiros, auxiliares e técnicos de enfermagem e agentes comunitários de saúde), que estavam trabalhando nas unidades há pelo menos um ano, após aprovação em comitê de ética em pesquisa. Foram realizadas entrevistas semiestruturadas gravadas e individuais e a análise dos dados foi pautada na análise temática. Os resultados trazem aspectos relevantes sobre o acompanhamento da saúde da criança, destacando elementos da organização da assistência à criança na ESF, do tratamento medicamentoso e não medicamentoso, do seguimento especializado e das relações com a família no cuidado cotidiano da criança com asma. No cuidado em saúde o diálogo é fundamental, com construção da empatia, confiança, vínculo e co-responsabilidade entre os profissionais e as mães e famílias, buscando o alcance da adesão, um tratamento eficaz, a promoção da saúde e qualidade de vida da criança e sua família. Assim, são muito importantes as ações de promoção, prevenção, tratamento e reabilitação da saúde da criança, centradas na continuidade e integralidade da assistência. / This study aimed to analyze the experiences of health professionals from the Family Health Strategy (FHS) regarding the monitoring of children under five years old with asthma from the perspective of comprehensive health care, providing support for children\'s primary health care. The specific objectives were: to describe the sociodemographic profile of professionals in family health strategy in the units investigated; to describe the signs and symptoms, preventive and promotional measures and treatment related to asthma in children that health professionals report in the family health strategy; to identify and analyze the experiences of health professionals in monitoring the health of children under five years old with asthma in the context of the family health strategy from the perspective of comprehensive health care. This descriptive and exploratory study with qualitative data analysis was developed in the city of Ribeirão Preto, state of São Paulo, in four Family Health Strategy Units, selected based on the number of children under five years old registered and monitored from data Information System of Primary Care. Participants were 25 health professionals (physicians, nurses, nursing auxiliaries and technicians and community health workers) who were working in the units for at least one year, after the approval by the research ethics committee. Individual semi-structured interviews were conducted and recorded and data analysis was based on thematic analysis. The results bring up relevant issues on children\'s health, highlighting elements of the organization of health care in the FHS, of the drug and non-drug treatment, of the specialized follow-up, and of the relations with the family in the daily care of children with asthma. In health care the dialogue is essential in building empathy, trust, bonding and co-responsibility between professionals and mothers and families, aiming the adhesion, an effective treatment, the health promotion and quality of life of the children and their family. Thus, actions in health promotion, prevention, treatment and rehabilitation of child are very important, focusing on continuity and comprehensive care.

Bibliography: leaves 149-178 / Anxiety Disorder is one of the most common disorders experienced by children and, if not managed, can extend into adulthood. Research has established a link between unintegrated primitive reflexes (UPR) and Learning Disorders. Learning Disorders are often co-morbid with symptoms of anxiety, however, the relationship between symptoms of anxiety and UPR have not been studied. This study aims to explore the relationship between the UPR and symptoms of anxiety in children between 10 – 13 years of age. No correlation was found between the total primitive reflex score and total symptoms of anxiety score; however, a significant relationship was found between symptoms of anxiety and the Moro, Plantar and Spinal Galant reflex. These UPR play an important role in balance. Research on balance dysfunction indicates a relationship with symptoms of anxiety. Prenatal maternal stress, common childhood illness and comorbidity with ADHD were also found to be factors in symptoms of anxiety in children. / Psychology / M.A. (Psychology)