Submitted by Irene Nascimento (irene.kessia@ufpe.br) on 2017-04-17T18:25:39Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dissertação-versão final.pdf: 1993829 bytes, checksum: 4034b8048d708b7d845851b0fc09f713 (MD5) / Made available in DSpace on 2017-04-17T18:25:39Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dissertação-versão final.pdf: 1993829 bytes, checksum: 4034b8048d708b7d845851b0fc09f713 (MD5) Previous issue date: 2016-02-26 / Os primeiros anos de vida são essenciais na formação dos hábitos alimentares, que sofrem influência da alimentação dos pais, condições socioeconômicas e culturais. Considerando a disponibilidade do manual “Dez passos para uma alimentação infantil saudável: guia alimentar para crianças menores de dois anos” para os profissionais e sua aplicabilidade no cenário da Atenção Básica, este estudo objetivou avaliar as práticas maternas na alimentação de crianças menores de um ano, segundo as recomendações dos dez passos. Estudo transversal e analítico, desenvolvido nas Unidades Básicas de Saúde do Distrito Sanitário IV, Recife-PE. Como resultado da dissertação, foram elaborados dois artigos: o primeiro, intitulado “Intervenções educativas na promoção da alimentação saudável em menores de dois anos: revisão integrativa” objetivando investigar intervenções educativas para promoção da alimentação saudável em crianças menores de dois anos. A busca foi realizada entre outubro e novembro de 2014, utilizando os descritores intervention study, health education, infant food e weaning indexados na LILACS, CINAHL e SCOPUS. A amostra, constituída de 24 publicações, evidenciou a orientação verbal como principal estratégia educativa. Recursos audiovisuais, sonoros e portáteis também mostraram-se eficazes na promoção da alimentação saudável. Intervenções educativas auxiliam na formação de conhecimentos, promovendo amamentação exclusiva até o sexto mês de vida e introdução oportuna e correta de alimentos. O segundo artigo, “Práticas maternas na implementação dos dez passos para alimentação infantil saudável em menores de um ano” foi desenvolvido com 151 mães/cuidadores de crianças de 12 a 23 meses e 29 dias. Os dados foram coletados entre julho e setembro de 2015 por meio de um formulário socioeconômico e outro de práticas alimentares, o qual foi submetido a processo de validação de conteúdo com oito especialistas. Para análise foi construído um escore de cumprimento dos dez passos, considerando a principal recomendação de cada passo. Os dados foram tabulados e validados no software EpiInfo versão 3.5.4 e analisados no IBM SPSS versão 18.0. A investigação da associação dos escores com as variáveis independentes foi realizada pelo teste qui-quadrado ou teste de Fisher. A regressão de Poisson com variância robusta investigou a influência das variáveis 26 sociodemográficas, maternas, nascimento, cuidado com a criança e educação em saúde na prática alimentar adequada, estimando-se as razões de prevalência e os respectivos intervalos de confiança. Estudo aprovado pelo Comitê de Ética em Pesquisa do Centro de Ciências da Saúde da Universidade Federal de Pernambuco, sob protocolo 1.052.807. Os resultados do manuscrito original evidenciaram uma mediana de apenas 20,0% na implementação dos dez passos. Os fatores determinantes para mãe/cuidador conseguir realizar o maior número de passos, que configuram a prática de alimentação saudável, foram Trabalho materno remunerado fora do lar, residir com o companheiro e realizar sete ou mais consultas em puericultura. Conclui-se que a prática alimentar materna na implementação dos dez passos para uma alimentação infantil saudável em menores de um ano é inadequada e sofre interferência de fatores relacionados a rede social, assistência e educação em saúde. / The first years of life are essential in the formation of eating habits, which are influenced by the power of parents, socioeconomic and cultural conditions. Considering the availability of the manual "Ten steps to a healthy infant feeding: food guide for children under two years" for professionals and their applicability in the primary care setting, this study aimed to evaluate maternal practices in the feeding of children under one year according to the recommendations of the ten steps. cross-sectional analytical study carried out in the Basic Health Units of Health District IV, Recife-PE. As a result of the dissertation, two articles were developed: the first, entitled "Educational interventions to promote healthy eating in children under two years: an integrative review" aiming to investigate educational interventions to promote healthy eating in children under two years. The search was carried out between October and November 2014, using the descriptors study intervention, health education, infant food and weaning indexed in LILACS, CINAHL, and Scopus. The sample consisted of 24 publications showed verbal guidance as the main educational strategy. audiovisual, sound and portable features also proved effective in promoting healthy eating. educational interventions help in the formation of knowledge, promoting exclusive breastfeeding until the sixth month of life and timely and correct introduction of food. The second article, "Maternal practices in the implementation of the ten steps to healthy infant feeding in children under one year" was developed with 151 mothers / caregivers of children 12-23 months and 29 days. Data were collected between July and September 2015 through a socioeconomic form and other feeding practices, which was submitted to content validation process with eight experts. For analysis it built a score of compliance with the ten steps, considering the main recommendation of each step. Data were tabulated and validated in Epi Info version 3.5.4 software and analyzed using SPSS version 18.0. The association research of scores with the independent variables was performed using the chi-square test or Fisher's exact test. Poisson regression with robust variance investigated the influence of sociodemographic variables, maternal, birth, care for the child and health education on proper feeding practices, estimating prevalence ratios and confidence intervals. This study was approved by the Ethics Committee on Health Sciences Center of the Federal University of Pernambuco, under protocol 28 1,052,807. The results of the original manuscript showed a median of only 20.0% in the implementation of the ten steps. The determining factors for mother / caregiver accomplish the greatest number of steps that constitute the practice of healthy eating were breast Paid work outside the home, living with a partner and carry seven or more queries on childcare. We conclude that maternal feeding practices in the implementation of the ten steps to a healthy infant feeding in infants under one year is inadequate and suffers interference factors related to social networking, care and health education.

This study investigated the validity of the Physical Activity Interview (PAI) for assessing children's self-reported physical activity. Third and fifth graders wore an accelerometer and were interviewed using the PAI to determine 12-hour recall accuracy for activity expressed as energy expenditure (EE). Caltrac estimates of EE for the 12-hour day (12-HEE) and activity EE were the validation criteria. 12-HEE correlations were significant (p<.001) between Caltrac and PAI for third (r=.79) and fifth grade (r=.80). Caltrac and PAI Total Activity were significant for fifth grade (r=.82, p<.001) but not for third grade (r=.36, p<.021). Analysis of tertiles based on the Caltrac demonstrated that the PAI significantly (p<.002) discriminated between activity levels for fifth graders but not for third. The use of PAI may be age-dependent.

No description available.

Övervikt och fetma är ett folkhälsoproblem som ökar i en oroväckande takt både i Sverige och i många andra delar av världen. Fetma räknas som en sjukdom i sig, men är även en riskfaktor för andra icke smittsamma sjukdomar. Våra levnadsvanor grundläggs redan under barndomen och inverkar på hälsan resten av livet. Att satsa på förebyggande åtgärder i tidig ålder kan således vara viktigt för att minska risken att barn senare i livet drabbas av överviktsrelaterade sjukdomar. Syftet med denna studie var att undersöka skolsköterskors och skolors erfarenheter av och förutsättningar för att arbeta med övervikt och fetma bland barn mellan sex och elva år. För att besvara syftet användes en kvalitativ metodansats. Totalt genomfördes sex enskilda semistrukturerade intervjuer med skolsköterskor. Intervjuerna analyserades med en manifest innehållsanalys. I resultatet framkom att övervikt och fetma är vanligt förekommande på skolorna. Övervikt och fetma anses vara ett viktigt, men också svårt, område för skolor att arbeta mot. Skolsköterskorna uppfattar flera hinder i sitt arbete, och önskar att de kunde göra mera för att hjälpa barn som drabbats. Skolsköterskorna har många idéer om hur de och skolorna skulle kunna arbeta förebyggande, men upplever en frustration över de bristande resurserna som ges till det. / Overweight and obesity is a public health problem that is increasing in an alarming rate both in Sweden and in many other parts of the world. Obesity is considered as a disease in itself, but is also a risk factor for other noncommunicable diseases. Our habits are established during childhood and have an impact on our health throughout our lives. Investing in preventive interventions at an early age may therefore be important for reducing the risk of children later in life suffer from obesity-related diseases. The aim of this study was to examine school nurses' and schools’ experiences of and presumptions for working with overweight and obesity among children at primary schools. A qualitative approach was chosen and a total of six individual semi-structured interviews with school nurses were conducted. The interviews were analysed with a manifest content analysis. The result showed that overweight and obesity are common in the primary schools. Overweight and obesity are considered an important, but also difficult, area for schools to work against. The school nurses perceive several obstacles in their work, and wish they could do more to help children who are affected. The school nurses have many ideas about how they and the schools could work preventive, but are frustrated over the lack of resources that are given to it.

Background: More than one-third of adults and 17% of children/adolescents in the US are overweight or obese contributing to significant morbidity and mortality, and healthcare costs. Little is known about obesity patterns in subethnic populations in the US with high prevalence of obesity or overweight reported in Hispanic youth (21.9%) compared to non-Hispanic blacks (19.5%) and non-Hispanic whites (14.7%). The purpose of this study is to assess the association of generation status with adolescent overweight or obesity in Hispanics in the US. Data from the 2011-2012 National Survey of Children’s Health were used to conduct this study, focusing on Hispanic adolescents aged 10 to 17 years. Adolescents were defined as being overweight or obese if they were above 85th or 95th percentile cut-off point values for BMI. Conclusion:Generation status of an adolescent was categorized into three groups depending on the adolescent and the parents’ place of birth. Multivariable models were conducted to test the association of generation status with adolescent obesity in Hispanics, adjusting for potential confounders. Comparing to 3rd generation adolescents, those belonging to 1st and 2nd generations were associated with increased odds of adolescent obesity in Hispanics OR 1.48, 95% CI 1.177 – 1.867 and OR 1.405, 95% CI 1.227-1.610 for 1st and 2nd generation, respectively. Generational status is associated with increased relative odds of overweight or obesity in Hispanic adolescents. Aggregated estimates not accounting for country of origin of an adolescent contribute to significant heterogeneity or disparities in obesity prevalence or patterns, with implications for generation-specific interventions

Childhood cancer is the second leading cause of death in children aged 0-19 years. Research efforts to identify factors associated with or influencing this growing health problem are limited. The purpose of this research study was to examine, in reference to Louisiana during the period 2004-2010, the annual number of children diagnosed with cancer; the types of cancers; the possible effects of the environmental aftermath resulting from Hurricanes Katrina, Rita, and Gustav; and any correlation between environmental contaminants following these hurricanes with the number of children diagnosed with cancer. This study employed correlational quantitative methodology using archival data from the Louisiana Tumor Registry that identified childhood cancer types and incidence for the years 2004-2010. Data were analyzed using logistic regression. Data analysis demonstrated statistically significant differences in the number of children diagnosed with cancer in Louisiana following Hurricanes Katrina, Rita, and Gustav, more specifically between the northern (p = .011) and southern (p =.013) regions. However, this may have no or limited practical significance. The sample size was large in this study, and given a large enough sample, regardless of insignificant population differences, almost any difference or any correlation will be statistically significant. The positive social change implication of this study is that it may lead to the development of preventive tools/measures for healthcare professionals and parents to help reduce childhood cancers associated with exposure to adverse environmental factors.

Made available in DSpace on 2015-05-08T14:47:33Z (GMT). No. of bitstreams: 1 ArquivoTotalIvna.pdf: 1194394 bytes, checksum: c16dde04067bb292fafdf46496f5ea31 (MD5) Previous issue date: 2013-03-27 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Immunization is a strategy of excellence in decreasing infant morbidity and mortality for immunopreventable diseases. The National Immunization Program is responsible for the standardization of the procedures to be adopted in the cold chain which aims to ensure the quality of immunobiological, keeping them at a temperature between +2 ° and +8 ° C. This study aimed to evaluate of local cold network of Family Health Units from Sanitary District III of the public health network in the city of João Pessoa - PB. This is a descriptive study with a quantitative approach, of normative-evaluative type, the items applied were: general aspects of vaccination room and cold network from the Supervision s Instrument of Immunization Rooms (PAISSV version 2.0, 2004) in 23 May and June 2012. Data were tabulated and analyzed using descriptive statistics. As a parameter for quality evaluation, 51 items were selected, where the positive responses obtained weight "1" and the negative "0", with subsequent summation of points and ranked according to a given score. The quality of cold network was evaluated between good and regular. It was found that 95,7% nursing technicians have training in vaccine, but 73.9% did not receive training in cold chain. In regards to the vaccination rooms: 30.4% were not exclusive to vaccination, 78.3% did not have adequate size and there was no protection against direct sunlight in 47.8% of the rooms, moreover, 95.7% had no air conditioning system. So, there is need on structural improvement in the local cold chain in intent to achieve the regulations established by the Health Ministry as well as systematic implementation of permanent education for professionals who work in the vaccination rooms. / O Programa Nacional de Imunização é o responsável pela normatização dos procedimentos a serem adotados na Rede de Frio, a qual tem como objetivo assegurar que todos os imunobiológicos oferecidos à população mantenham suas características iniciais, a fim de conferir imunidade, de forma segura para a população. Este estudo avaliou o serviço da Rede de Frio local do Distrito Sanitário III da rede pública de saúde do município João Pessoa PB. Trata-se de um estudo com abordagem quantitativa, descritivo, do tipo avaliativo-normativo; para avaliação da rede de frio, utilizou-se o instrumento do Programa de Avaliação do Instrumento de Supervisão de Salas de Vacinação (PAISSV versão 2.0, 2004). Participaram da pesquisa 23 salas de vacina das Unidades Isoladas de Saúde da Família do Distrito Sanitário III do município de João Pessoa. A coleta foi realizada, após aprovação pelo Comitê de Ética e Pesquisa do Centro de Ciências da Saúde da Universidade Federal da Paraíba entre maio e junho de 2012, utilizando os itens aspectos gerais da sala de vacina e rede de frio do questionário do PAISSV. Os dados foram tabulados e analisados no Programa Statistical Package Social Science 18.0 e analisados de forma quantitativa, utilizando estatística descritiva. Nas salas de vacina existem técnicos de enfermagem trabalhando sem capacitação específica; a estrutura física carece de manutenção e adequações para atender às normas; a temperatura do ambiente é inadequada; os refrigeradores mantêm boa manutenção, organização e registro da temperatura interna. Há necessidade implantação sistematizada da educação permanente e contínua para capacitar e atualizar os profissionais, assim como na melhoria estrutural da Rede de Frio Local a fim de atender às normativas preconizadas pelo Ministério da Saúde.

Introduction: More than one-third of adults and 17% of children/adolescents in the US are overweight or obese contributing to significant morbidity and mortality, and healthcare costs. Studies have reported the persistence of adolescent obesity to adulthood, resulting in increased risk of chronic diseases such as asthma, type 2 diabetes mellitus, cardiovascular, and liver diseases. Little is known about obesity patterns in subethnic populations in the US with high prevalence of obesity or overweight reported in Hispanic youth (21.9%) compared to non-Hispanic blacks (19.5%) and non-Hispanic whites (14.7%). Several genetic, uterine, and nutritional factors, and unhealthy behaviors were identified as risk factors. Evidence is emerging about the possible role of generational status in influencing adolescent obesity. The purpose of this study is to assess the association of generation status with adolescent overweight or obesity in Hispanics in the US. Methods: Data from the 2011-2012 National Survey of Children's Health (NSCH)were used to conduct this study. Only Hispanic adolescents aged 10 to 17 years were included as study population. Using the age-sex-race specific cut-off points, we defined adolescent as being overweight or obese if they were above 85th or 95th percentile cut off point values for BMI. Generation status of an adolescent was categorized into three groups: a) generation 1 for those who were not born in US or to US citizens abroad, and migrated to US as children, b) generation 2 are those born in US but have at least one parent who is foreign born, and c) generation 3 or higher adolescents are those born in US to native-born parents. Multivariable models were conducted to test the association of generation status with adolescent obesity in Hispanics, adjusting for potential confounders. Results: A total of 5,217 Hispanic adolescents were included in the study. Approximately 1,650 and 31.7% of adolescents reported being overweight or obese. Approximately 857, 2,216 and 2,144 of adolescents are 1st, 2nd and 3rd generation Hispanic youth. Comparing to 3rd generation adolescents, those belonging to 1st and 2ndgenerations were associated with increased odds of adolescent obesity in Hispanics OR1.48, 95% CI 1.177 – 1.867 and OR 1.405, 95% CI 1.227-1.610 for 1st and 2nd generation, respectively. Conclusion: Generational status is associated with increased relative odds of overweight or obesity in Hispanic adolescents. Aggregated estimates not accounting for nativity or county of origin of an adolescent contribute to significant heterogeneity or disparities in obesity prevalence or patterns, with implications for generation-specific interventions.

Building on the conceptual lens of Hero and Tolbert (1999), this study examines differences between policy restrictiveness in states with high minority populations and states with low minority populations for three policies areas: felony voting policies, Unemployment Insurance (UI) and the State Children's Health Insurance Program (SCHIP). This study examines whether states with minority populations greater than the national average have public policies that are more restrictive than states with minority populations at or below their national average and the patterns that emerged. Overall, I found higher levels of restrictive policies for states with high minority populations in the instances of felony voting policies and the Unemployment Insurance program. The findings imply a need for accountability and uniformity from the state to improve the outcomes for racial and ethnic minorities. / Ph. D.

This research investigated physician and emergency room use among representative samples of children in the Dallas metropolitan area (N = 1606) and among patients who used Children's Medical Center of Dallas' First Care services (N = 612). Through telephone interviewing, caregivers to children under fifteen years of age were asked about an array of health service use behaviors, social-psychological issues related to acquiring health care for their children, and demographic characteristics as outlined by the Andersen & Newman model of health care service use. Children's use of physician services is best predicted by whether or not they have medical insurance, their level of income, and whether or not they have medical homes. Although having commercial managed care and fee-for-service Medicaid insurance consistently predicted increased physician use, neither independently reduced reliance on emergency rooms for non-emergent care. Managed care insurance and Medicaid did, however, significantly improve the odds that children would have medical homes, which significantly decreased emergency room use for non-emergent care. Further, increasing physician use and reducing reliance on hospital emergency rooms for non-emergent care will require ensuring that children have medical homeseither private physicians or community health centersat which they can readily and consistently receive sick and well care. Although some ethnic differences were observed, few of the broad array of factors in the Behavioral Model significantly predicted either physician or emergency room use. Moreover, educational levels and health beliefs rarely, and if significant negligibly, influenced physician and emergency room use. Health policy for children would best be served by focusing on programs that facilitate parent's ability to secure health insurance for their children and allocating children to medical homes where they can readily and consistently access sick and well care.