Academic achievement has been the focal point in education for decades. In 2001, an Act of Congress was proposed to improve individual outcomes in education through evidenced based research using measurable goals, higher standards, and accountability. This federal legislation, known as the No Child Left Behind Act of 2001, mandates that all teachers be highly qualified by 2006 and that all students become proficient by the 2013/14 school year, specifically in the area of literacy. Consequently, kindergarten readiness has become an area of concern, thus placing preschool teachers under pressure to prepare children for school. The purpose of this study was to examine multiple factors that have been identified in the literature as impacting achievement in elementary and secondary education to ascertain their contribution toward literacy development in preschool children. Such factors included child (gender, race, home SES, attendance, behavior) and childcare site (teacher education, teacher experience, class size, site SES, class environment). Additionally, within-child protective factors were examined for their role in literacy development for children with and without challenging behaviors. To examine early literacy and behavior in preschool children, hierarchical linear modeling (HLM) was conducted with literacy skills (expressive language and phonemic awareness) assessed at four points in time though the Individual Development and Growth Indicators (IGDI). A significant relationship was found between expressive language skills and race, attendance, classroom environment and class size. Phonemic awareness was significantly related to gender, home SES, and teacher education. Within-child protective factors positively impacted phonemic awareness skills for children in the non-challenging behavior group only. An in-depth description of the findings and limitations are discussed within this document. Overall, this study suggests that many of the factors impacting achievement in elementary and secondary education also impact literacy development in preschool children. These findings support the use of early intervention and preventative services for this population as a means to promote kindergarten readiness and future achievement.

<p>Istraživanje je sprovedeno sa ciljem da se primenom eksperimentalne metode naučno utvrdi da li dodatni &scaron;estomesečni program figičkog vežbanja u redovnim uslovima rada pred&scaron;kolske ustanove može regultirati gnačajnim promenama u morfolo&scaron;kim karakteristikama i motoričkim sposobnostima kod dece pred&scaron;kolskog ugrasta prosečne starosti 6,21&plusmn;0,56 decimalnih godina. Obuhvaćeno je ukupno 211 dece od toga devojčica (n=103) i dečaka (n=108) koji su na početku istraživanja (01. septembar 2014. godine) bili polaznici pred&scaron;kolskih grupa u Pred&scaron;kolskoj ustanovi &quot;Čukarica&quot; u Beogradu. Prema kriterijumu primene &scaron;estomesečnog figičkog vežbanja ispitanici su bili podeljeni u tri homogene grupe i to: eksperimentalnu (E) koju je činilo 36 dečaka i 28 devojčica, prvu kontrolnu (K1) sastavljenu od 31 dečaka i 37 devojčica i drugu kontrolnu grupu (K2) sačinjenu od 41 dečaka i 38 devojčica. E grupa je imala dodatni koncept programa koji je bio gasnovan na sadržajima visoke složenosti, sproveden kao figičko vaspitanje, a usmeren na razvoj biotičkih motoričkih gnanja. K1 grupa je takoe imala dodatni ali diferenciran program, usmeren kao trenažne sekvence, ga dečake polistrukturalnoaciklične aktivnosti, a ga devojčice estetskokonvencione aktivnosti. Dok K2 grupa pored redovnih aktivnosti ig figičkog vaspitanja nije bila podvrgnuta nijednom obliku dodatnog figičkog vežbanja. Koristio se kvagi&ndash; eksperimentalni nacrta istraživanja, tačnije nacrt sa neekvivalentnim grupama i pretestposttestom. Ugorak morfolo&scaron;kih mernih instrumenata bio je sačinjen po redukovanom modelu (Viskić, 1972; Kurelić i sar., 1975) preuget ig istraživanja Bale (1980). Motorički&nbsp;merni instrumenti proiglage takoe ig redukovanog teoretskog modela (Kurelića i sar., 1975; Gredelja i sar., 1975) preuzetog iz istraživanja Bale i Popovića (2007). Rezultati istraživanja ukaguju da je program dodatnog figičkog vežbanja E grupe dao dobre regultate u redukciji potkožnog masnog tkiva i volumena i mase tela kod dece. Najbolje rezultate dao je u pogledu mehanizma za strukturiranje kretanja. Deca iz K1 grupe, takoe su redukovala potkožno masno tkivo i volumen i masu tela, ali u pogledu motoričkih sposobnosti nije bilo pomaka u mehanizmu za strukturiranje kretanja. Kod dece u K2 grupi do&scaron;lo je do povećanja potkožnog masnog tkiva, volumena i mase tela kao i pada pojedinih motoričkih sposobnosti. U sve tri grupe izolovana su dva hipotetska morfolo&scaron;ka faktora koje je bolje interpretirati kao jedan Faktor mekog tkiva, i dva motorička koji se mogu interpretirati kao Generalni motorički Paktor. Kvalitativne promene u strukturi oba ekstrahovana faktora uočene su samo u K1 grupi u motoričkom prostoru, &scaron;to je posledica diferenciranog programa figičkog vežbanja. Regultati su ukagali da redovan program figičkog vaspitanja u pred&scaron;kolskim ustanovama nije dovoljan za pripremnu pred&scaron;kolsku grupu, kao i da se dodatnim programiranim figičkim vežbanjem postižu bolji rezultati pogotovo ako je usmeren ka razvoju biotičkih motoričkih znanja.</p> / <p>The research was conducted with the aim of applying experimental methods scientifically determine whether an additional six-month program of physical exercise in normal conditions of preschool institution may result in significant changes in the morphological characteristics and motor abilities in preschool children with mean age 6.21 &plusmn; 0.56 decimal years. A total of 211 children from that of girls (n=103) and boys (n=108) who were in the moment of research (01. September 2014) participants were preschool groups in preschool institution &quot;Čukarica&quot; in Belgrade. According to the criteria of application of the six-month physical exercise participants were divided into three homogeneous groups: experimental (E) which consisted of 36 boys and 28 girls, the first control (K1) made up of 31 boys and 37 girls, and another control group (K2) as made of 41 boys and 38 girls. E group had additional program concept which was based on the contents of higher complexity, implemented as physical education, which is focused on the development of biotic motor skills. K1 group also had additional or differentiated program, focused as the training sequence, for boys extracurricular- acyclic activities, and for girls estheticconventional activities. While K2 group in addition to the regular activities of physical education was&nbsp;not subjected to any form of additional physical exercise. It was used a quasi-experimental research designs, namely The draft with unequivalent groups and pretest-posttest. Morphological sample of measuring instruments was made through a reduced model (Viskić, 1972; Kurelić et al., 1975), taken from the research (Bala 1980). The motor measuring instruments derived also from the reduced theoretical model (Kurelić et al., 1975; Gredelj et al., 1975), taken from the research (Bala, &amp; Popovic 2007). The research results indicate that the program is additional physical exercise group E gave good results in the reduction of subcutaneous fat volume and body mass in children. The best results in terms of mechanisms for structuring movements. Children from the K1 group, also reduce the subcutaneous adipose tissue and the volume and mass of the body, but in terms of motor skills were no developments in the mechanism for structuring movements. Children the K2 group there was an increase in subcutaneous adipose tissue volume and body mass as well as the decline of some motor skills. In all three groups were isolated two hypothetical morphological factors that is better interpreted as a Factor of soft tissue, and two motor that can be interpreted as General motor factor. Qualitative changes in the structure of the two extracted factors were observed only in the K1 group in the motor area, which is the result of a differentiated program of physical exercise. The results have shown that regular physical education curriculum in preschool institutions is insufficient for the preparatory preschool group, as well as to further programmed physical exercise leads to better results especially if it is directed at the development of biotic motor skills.</p>

<p>Metotreksat kao antagonista folne kiseline ima &scaron;iroku upotrebu za lečenje brojnih maligniteta, primenjen u visokim dozama i u&nbsp; kombinciji&nbsp; sa leukovorinom. Iako&nbsp; je&nbsp; terapija&nbsp; visokim&nbsp; dozama&nbsp; metotreksata drastično pobolj&scaron;ala&nbsp; prognozu pacijenata sa malignitetom, te&scaron;ki neželjeni efekti terapije predstavljaju stalan klinički problem. Ciljevi istraživanja bili su određivanje serumske koncentracije metotreksata i izračunavanje farmakokinetičkih&nbsp; parametara&nbsp; metotreksata kod dece obolele od malignih&nbsp; bolesti&nbsp; koja su na terapiji visokim dozama metotreksata (2&nbsp; g/m² i&nbsp; 5&nbsp; g/m² ); ispitivanje postojanja uticaja primenjene doze metotreksata, demografskih i kliničkih karakteristika ispitanika&nbsp; na koncentracije i farmakokinetičke parametare. Ispitivano je prisustvo i stepen kliničkih i laboratorijskih znakova toksičnosti metotreksata, kao i uticaj primenjene&nbsp; doze&nbsp; metotreksata&nbsp; i demografskih karakteristika ispitanika&nbsp; na pojavu i stepen toksičnosti . U okviru retrospektivno - prospektivne&nbsp; studije&nbsp; ukjučeno&nbsp; je&nbsp; četrdeset&nbsp; i dva pedijatrijska&nbsp; pacijenta&nbsp; uzrasta od&nbsp; 0,75 do 17,75 godina (medijana 5,75&nbsp; godina). Svi pacijenti&nbsp; su lečeni&nbsp; u&nbsp; Službi&nbsp; za&nbsp; hematologiju i&nbsp; onkologiju&nbsp; Instituta&nbsp; za&nbsp; zdravstvenu za&scaron;titu dece i omladine Vojvodine (Novi Sad, Srbija) u periodu od juna 2004. godine do juna 2012. godine. Trideset i osam ispitanika&nbsp; je lečeno pod dijagnozom akutne limfoblastne leukemije&nbsp; prema dva&nbsp; uzastopna&nbsp; protokola ALL IC - BFM 2002 i ALL IC - BFM 2009 Internacionalne&nbsp; BFM studijske&nbsp; grupe &bdquo;I - BFM - SG&ldquo;&nbsp; (International Berlin -Frankfurt - M&uuml;nster Study Group) za proučavanje i lečenje dečje non-B akutne limfoblastne leukemije. Četvoro je&nbsp; imalo&nbsp; dijagnozu non - Hodgkin limfoma&nbsp; i bili su uključen i u&nbsp; protokol NHL - BFM&nbsp; 95. Istraživanje je obuhvatilo 113 ciklusa terapije metotreksatom (1&ndash; 4 ciklusa po pacijentu) sa 386 izmerenih serumskih koncentracija metotreksata. Raspon primenjenih doza metotreksata kretao se od 800 do 10.000 mg. Koncentracije metotreksata su merene 24, 36 i 42 sata nakon započinjanja infuzije metotreksata, a po potrebi i u dužim vremenskim intervalima. Za izračunavanje farmakokinetičkih parametara kori&scaron;ćen je dvokompartmanskih farmakokinetički&nbsp; model posle obustavljanja&nbsp; intravenske&nbsp; infuzije,&nbsp; gde&nbsp; postoje relacije&nbsp; za&nbsp; farmakokinetičke&nbsp; tačke. Podaci o kliničkim i laboratorijskim znacima toksičnosti metotreksata prikupljani su iz medicinske dokumentacije, a za stepenovanje toksičnosti kori&scaron;ćen je skor sistem - Common Terminology Criteria for&nbsp; Adverse&nbsp; Events (CTCAE), Version 4.0, U.S. Department&nbsp; of&nbsp; health&nbsp; and&nbsp; human services, National Institute of Health, National Cancer Institute. U cilju utvrđivanju uticaja karakteristika ispitanika, primenjene doze i prisustva produžene eliminacije na posmatrane parametre, vr&scaron;eno je poređenje tri grupe&nbsp; pacijenata (doza 2 g/m² bez produžene eliminacije, 5 g/m² bez produžene liminacije i 5 g/m² sa produženom eliminacijom metotreksata). Za celokupnu grupu ispitanika,&nbsp; medijane&nbsp; koncentracije metotreksta&nbsp; bile&nbsp; su 25,82 &mu;mol/l u 24. satu, 0,68 &mu;mol/l u 36. satu i 0,24 &mu;mol/l u 42. satu merenja. Najizraženija interindividualna varijabilnost u koncentracijama metotreksata bila je u 42. satu merenja, dok je&nbsp; intraindividualna varijabilnost bila najizraženija u 36. satu merenja. Medijana&nbsp; klirensa&nbsp;&nbsp; metotreksata&nbsp;&nbsp; bila&nbsp; je 8,32&nbsp;&nbsp; l/h. Farmakokinetički parametri&nbsp; redom bili su:&nbsp; medijana&nbsp; volumena&nbsp; centralnog&nbsp; kompartmana V₁ 28,47&nbsp; l, medijane konstanti k₁₀ 0,206, k₁₂ 0,0245, k₂₁ 0,1114. Najizraženiji uticaj primenjene doze na koncentracije metotreksata pokazan je u 24.&nbsp; satu&nbsp; merenja, dok uticaj doze na klirens&nbsp; metotreksata nije&nbsp; pokazan. Prisustvo produžene eliminacije metotreksata dovodi do smanjenih vrednosti konstanta k₁₀ i k₂₁. Nije pokazana statistički značajna&nbsp; interakcija ispitivanih demografskih karakteristika (uzrast, telesna povr&scaron;ina i pol)&nbsp; i koncentracija metotreksata, kao ni klirensa metotreksata. Pokazana je značajna interakcija između koncentracija metotreksata i nivoa laktat dehidrogenaze, kao i klirensa metotreksata i nivoa kreatinina i laktat dehidrogenaze. Većina ispoljenih&nbsp; toksičnosti bila je umerenog stepena (&lt;3 stepena). Najzastupljeniji klinički znak toksičnosti bio je oralni mukozitis, koji je bio većeg stepena u grupi sa većom primenjenom dozom metotreksata&nbsp; (5g/m²). Najzastupljeniji&nbsp; laboratorijski toksični efekti&nbsp; metotreksata bili su leukopenija i anemija. Najteži stepeni laboratorijskih znakova toksičnosti (leukopenija, anemija, porast&nbsp; AST,&nbsp; ALT i GGT) nalazili su se u grupi sa većom dozom&nbsp; (5 g/m²) i&nbsp; sa produženom eliminacijom metotreksata. Osnov&nbsp; za&nbsp; kliničko&nbsp; vođenje&nbsp; pacijenata&nbsp; na&nbsp; terapiji visokim dozama metotreksata je terapijsko praćenje leka (therapeutic drug monitoring &ndash; TDM) zbog velikih&nbsp; interindividualnih i intraindividualnih&nbsp; varijabilnosti&nbsp; u&nbsp; farmakokinetici&nbsp; leka. Rutinsko praćenje koncentracija metotreksata važno je za identifikaciju pacijenata sa povećanim rizikom od razvoja toksičnosti ,&nbsp; te&nbsp; je TDM&nbsp; standardna&nbsp; praksa&nbsp; za smernice spasavanja leukovorinom, naročito za pacijente za koje se zna da imaju smanjen&nbsp;&nbsp; klirens metotreksata ili druge rizike povezane sa prolongiranim citotoksičnim koncentracijama (bubrežna ili jetrena o&scaron;tećenja, kolekcije tečnosti u &ldquo;trećem prostoru&rdquo;, gastrointestinalna opstrukcija). Veliki&nbsp; broj&nbsp; istraživanja&nbsp; kod pedijatrijskih pacijenata pokazao je vezu između sistemskog izlaganja metotreksatu i&nbsp; efikasnosti&nbsp; i&nbsp; toksiĉnosti&nbsp; metotreksata. Ipak, ne postoji dovoljno&nbsp; informacija o farmakokinetici metotreksata kod dece obolele od akutne limfoblastne leukemije. Takođe, ova istraživanja nisu do sada sprovođena kod dece koja su lečena u na&scaron;oj sredini.</p> / <p>Methotrexate&nbsp; is&nbsp; an&nbsp; antifolate&nbsp; drug&nbsp; widely&nbsp; used&nbsp; for&nbsp; treatment&nbsp; of&nbsp; various malignant&nbsp; tumours.&nbsp; It&nbsp; is&nbsp; used&nbsp; at&nbsp; high&nbsp; doses&nbsp; and&nbsp; in&nbsp; combination&nbsp; with leucovorin rescue.&nbsp; Although&nbsp; high - dose&nbsp; MTX&nbsp; therapy&nbsp; dramatically&nbsp; improves&nbsp; the&nbsp; prognosis&nbsp; of patients with malignancies, severe adverse events are constant clinical concern. The&nbsp; aims&nbsp; of&nbsp; this&nbsp; stydy&nbsp; were&nbsp; to&nbsp; determine&nbsp; the&nbsp; serum&nbsp; concentration&nbsp; of&nbsp; methotrexate&nbsp; and&nbsp; to&nbsp; calculate&nbsp; the&nbsp; pharmacokinetic&nbsp; parameters&nbsp; of&nbsp; methotrexate&nbsp; in children&nbsp; suffering&nbsp; from&nbsp; malignant&nbsp; deseases&nbsp; who&nbsp; are&nbsp; treated&nbsp; with&nbsp; high&nbsp; doses&nbsp; of metotrexate&nbsp; (2&nbsp; g/m² i&nbsp; 5&nbsp; g/m² );&nbsp; furthermore,&nbsp; to&nbsp; investigate&nbsp; the&nbsp; effects&nbsp; of&nbsp; the&nbsp; applied doses of methotrexate, and demographic and clinical characteristics of the examinees on&nbsp;&nbsp; the&nbsp;&nbsp; concentration&nbsp;&nbsp; and&nbsp;&nbsp; pharmacokinetic&nbsp;&nbsp; parameters&nbsp;&nbsp; of&nbsp;&nbsp; the&nbsp;&nbsp; drug.&nbsp;&nbsp; The&nbsp;&nbsp; study investigated the&nbsp;&nbsp; presence&nbsp;&nbsp; and&nbsp;&nbsp; the&nbsp;&nbsp; degree&nbsp;&nbsp; of&nbsp;&nbsp; clinical&nbsp;&nbsp; and&nbsp;&nbsp; laboratory&nbsp;&nbsp; signs&nbsp;&nbsp; of metotrexate&nbsp; toxicity,&nbsp; as&nbsp; well&nbsp; as&nbsp; the&nbsp; effect&nbsp; of&nbsp; the&nbsp; applied&nbsp; doses,&nbsp; and&nbsp; demographic characteristics of the examinees on the appearance and the degree of toxicity. The retrospective - prospective study included 42&nbsp; pediatric patients aged from 0.75&nbsp; to&nbsp; 17.75&nbsp; years&nbsp; (median&nbsp; 5.75&nbsp; years).&nbsp; All&nbsp; patients&nbsp; were&nbsp; threated&nbsp; at&nbsp; the&nbsp; Children and Youth Health Care Institute of Vojvodina (Novi Sad, Serbia), Hemathology and Oncology&nbsp; Section,&nbsp; in&nbsp; the&nbsp; period&nbsp; from&nbsp; June&nbsp; 20 04&nbsp; to&nbsp; June&nbsp; 2012.&nbsp; 38&nbsp; examinees diagnosed as acute lymphoblastic leukemia were treated according to two subsequent protocols,&nbsp; ALL&nbsp; IC - BFM&nbsp; 2002&nbsp; and&nbsp; ALL&nbsp; IC - BFM&nbsp; 2009&nbsp; of&nbsp; the&nbsp; International&nbsp; BFM study&nbsp; group &bdquo;I - BFM - SG&ldquo; (International Berlin - Frankfurt - M&uuml;nster&nbsp; Study&nbsp; Group)&nbsp; for management&nbsp;&nbsp; of&nbsp;&nbsp; childhood&nbsp;&nbsp; non - B&nbsp;&nbsp; acute&nbsp;&nbsp; lymphoblastic&nbsp;&nbsp; leukemia.&nbsp;&nbsp; 4&nbsp;&nbsp; examinees diagnosed&nbsp; as&nbsp; non - Hodgkin&nbsp; lymphoma&nbsp; were&nbsp; treated&nbsp; according&nbsp; to&nbsp; the&nbsp; NHL - BFM&nbsp; 95 protocol. The study included 113 cycles of therapy with methotrexate (1-4 cycles per patient)&nbsp; with&nbsp; 3 86&nbsp; measured&nbsp; serum&nbsp; concentrations&nbsp; of&nbsp; methotrexate.&nbsp; The&nbsp; range&nbsp; of&nbsp; the applied doses was between 800 and 10,000 mg. The&nbsp; concentration&nbsp; of&nbsp; methotrexate&nbsp; was&nbsp; measured&nbsp; 24,&nbsp; 36&nbsp; and&nbsp; 42&nbsp; hours&nbsp; after the initiation of the methotrexate infusion, as well as in longer time intervals when needed.&nbsp; To&nbsp; calculate&nbsp; the&nbsp; pharmacokinetic&nbsp; parameters,&nbsp; the&nbsp; study&nbsp; applied&nbsp; the&nbsp; two - compartment&nbsp; pharmacokinetic&nbsp; model&nbsp; after&nbsp; the&nbsp; termination&nbsp; of&nbsp; intravenous&nbsp; infusion, when&nbsp; relations&nbsp; for&nbsp; pharmacokinetic&nbsp; points&nbsp; existed.&nbsp; Data&nbsp; on&nbsp; clinical&nbsp; and&nbsp; laboratory signs of methotrexate toxicity were collected&nbsp; from medical documentation, and the Common&nbsp; Terminology&nbsp; Criteria&nbsp; for&nbsp; Adverse&nbsp; Events&nbsp; (CTCAE),&nbsp; Version&nbsp; 4.0,&nbsp; U.S. Department&nbsp; of&nbsp; health&nbsp; and&nbsp; human&nbsp; services,&nbsp; National&nbsp; Institute&nbsp; of&nbsp; Health,&nbsp; National Cancer&nbsp; Institute, was&nbsp; used&nbsp; as&nbsp; the&nbsp; score&nbsp; system&nbsp; for&nbsp; toxicity&nbsp; ranking.&nbsp; In&nbsp; order&nbsp; to determine&nbsp; the&nbsp; effects&nbsp; of&nbsp; the examinees&rsquo;&nbsp; characteristics, applied&nbsp; doses&nbsp; and&nbsp; the presence&nbsp; of&nbsp; prolonged&nbsp; elimination on&nbsp; the&nbsp; parameters&nbsp; of&nbsp; interest,&nbsp; three&nbsp; groups&nbsp; of patients were&nbsp; compared (2 g/m² dose without prolonged elimination, 5 g/m² without prolonged elimination and 5 g/m² with prolonged elimination of methotrexate). In the&nbsp; entire&nbsp; group of&nbsp; examinees, the median&nbsp; concentration of methotrexate was&nbsp; 25.82 &mu;mol/l in the 24th hour, 0.68 &mu;mol/l in the 36th&nbsp; hour&nbsp; and 0.24 &mu;mol/l in the 42nd hour of&nbsp; observation. The largest inter - individual variability of methotrexate concentration&nbsp; was&nbsp; observed&nbsp; in&nbsp; the&nbsp; 24th&nbsp; hour&nbsp; while&nbsp; the&nbsp; largest&nbsp; intra - individual variability&nbsp; was&nbsp; recorded&nbsp; in&nbsp; the&nbsp; 36th&nbsp; hour&nbsp; of&nbsp; observation.&nbsp; The&nbsp; median&nbsp; clearance&nbsp; of methotrexate&nbsp; was&nbsp; 8.32l/h.&nbsp; Pharmacokinetic&nbsp; parameters&nbsp; were&nbsp; the&nbsp; following:&nbsp; median volume&nbsp; of&nbsp; the&nbsp; central&nbsp; compartment V₁ 28.47&nbsp; l,&nbsp; median&nbsp; constants k₁₀ 0,206, k₁₂ 0,0245, k₂₁ 0,1114, respectively. The&nbsp;&nbsp; strongest&nbsp;&nbsp; influence&nbsp;&nbsp; of&nbsp;&nbsp; the&nbsp;&nbsp; applied&nbsp;&nbsp; dose&nbsp;&nbsp; on&nbsp;&nbsp; the&nbsp;&nbsp; methotrexate concentration was recorded in the 24th hour of observation while no influence on the methotrexate&nbsp; clearance&nbsp; was&nbsp; found.&nbsp; The&nbsp; presence&nbsp; of&nbsp; prolonged&nbsp; elimination&nbsp; of methotrexate&nbsp;&nbsp; causes&nbsp;&nbsp; lower&nbsp; constants k₁₀ and&nbsp;&nbsp; k₂₁. There&nbsp;&nbsp; was&nbsp;&nbsp; no&nbsp;&nbsp; statistically significant&nbsp; interaction&nbsp; between&nbsp; the&nbsp; investigated&nbsp; demographic&nbsp; characteristics&nbsp; (age, body&nbsp; surface&nbsp; and&nbsp; gender)&nbsp; and&nbsp; the&nbsp; methotrexate&nbsp; concentration,&nbsp; nor&nbsp; between&nbsp; the demographic&nbsp;&nbsp; characteristics&nbsp;&nbsp; and&nbsp;&nbsp; the&nbsp;&nbsp; methotrexate&nbsp;&nbsp; clearance.&nbsp;&nbsp; A&nbsp;&nbsp; significant interaction was found between methotrexate concentration and lactat dehydrogenase level, as&nbsp;&nbsp; well&nbsp;&nbsp; as&nbsp;&nbsp; between&nbsp;&nbsp; methotrexate&nbsp;&nbsp; clearance&nbsp;&nbsp; and&nbsp;&nbsp; creatinine&nbsp;&nbsp; and&nbsp;&nbsp; lactate dehydrogenase level, respectively. Most of the observed toxicities were of moderate degree (&lt; 3 degrees). Oral mucositis&nbsp; was&nbsp; the&nbsp; most&nbsp; represented&nbsp; clinical&nbsp; sign&nbsp; of&nbsp; toxicity,&nbsp; and&nbsp; it&nbsp; was&nbsp; of&nbsp; higher degree&nbsp; in&nbsp; the&nbsp; group&nbsp; where&nbsp; the&nbsp; applied&nbsp; dose&nbsp; of&nbsp; methotrexate&nbsp; was&nbsp; higher&nbsp; (5&nbsp; g/m² ). Leucopenia&nbsp; and&nbsp; anemia&nbsp; were&nbsp; the&nbsp; most&nbsp; represented&nbsp; laboratory&nbsp; toxic&nbsp; effects.&nbsp; The most severe laboratory signs of toxicity&nbsp; (leucopenia, anemia, increase in AST, ALT and&nbsp; GGT&nbsp; activity)&nbsp; were&nbsp; observed&nbsp; in&nbsp; the&nbsp; group&nbsp; with&nbsp; the&nbsp; higher&nbsp; dose&nbsp; (5&nbsp; g/m² )&nbsp; and prolonged methotrexate elimination. Due to high inter- and&nbsp;&nbsp; intra-individual&nbsp;&nbsp;&nbsp; variability&nbsp; of&nbsp; the drug pharmacokinetics,&nbsp; the&nbsp; basis&nbsp; for&nbsp; the&nbsp; clinical&nbsp; care&nbsp; of&nbsp; patients&nbsp; on&nbsp; high&nbsp; methotrexate dosage&nbsp; therapy&nbsp; is&nbsp; therapeutic&nbsp; drug&nbsp; monitoring &ndash; TDM.&nbsp; Routine&nbsp; monitoring&nbsp; of methotrexate serum concentration is important for the identification of patients with a high&nbsp; risk&nbsp; of&nbsp; toxicity,&nbsp; and&nbsp; thus&nbsp; TDM&nbsp; is&nbsp; used&nbsp; as&nbsp; a&nbsp; standard&nbsp; procedure&nbsp; which&nbsp; provides guidelines&nbsp; for&nbsp; leucovorin&nbsp; rescue,&nbsp; particularly&nbsp; for&nbsp; patients&nbsp; with&nbsp; a&nbsp; lower&nbsp; methotrexate clearance or other risks associated with prolonged cytotoxic concent rations (kidney or liver&nbsp; damage,&nbsp; body&nbsp; fluid&nbsp; accumulation&nbsp; in&nbsp; the&nbsp; &ldquo;third&nbsp; space&rdquo;,&nbsp; gastrointestinal obstruction). Numerous studies involving pediatric patients have documented the link between&nbsp; a&nbsp; systemic&nbsp; methotrexate&nbsp; exposure&nbsp; on&nbsp; one&nbsp; hand,&nbsp; and&nbsp; the&nbsp; efficiency&nbsp; and toxicity of&nbsp; ethotrexate on the other hand. However, there is no sufficient data on the methotrexate&nbsp;&nbsp;&nbsp; pharmacokinetics&nbsp;&nbsp; in&nbsp;&nbsp; children&nbsp;&nbsp; suffering&nbsp;&nbsp; from&nbsp;&nbsp; acute&nbsp;&nbsp; lymphoblastic leukemia.&nbsp;&nbsp; Moreover,&nbsp;&nbsp; this&nbsp;&nbsp; type&nbsp;&nbsp; of&nbsp;&nbsp; research,&nbsp;&nbsp; involving&nbsp;&nbsp; children&nbsp;&nbsp; treated&nbsp;&nbsp; in&nbsp;&nbsp; the geographical region of this study, have not been conducted.</p>

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2017-10-19T12:01:37Z No. of bitstreams: 1 Mônica Andrigo Moreira de Ulhoa Coelho.pdf: 2869552 bytes, checksum: e62b5c2bb3ae86f54aac6a298dd0f093 (MD5) / Made available in DSpace on 2017-10-19T12:01:39Z (GMT). No. of bitstreams: 1 Mônica Andrigo Moreira de Ulhoa Coelho.pdf: 2869552 bytes, checksum: e62b5c2bb3ae86f54aac6a298dd0f093 (MD5) Previous issue date: 2017-09-29 / Fundação São Paulo - FUNDASP / The subject of this master´s dissertation is related to early childhood and resilience in infants (four weeks to 18 months old) and toddlers (18 to 36 months old). The study aimed at translating into Portuguese and transculturally adapting the early childhood assessment for infants and toddlers named ―Devereux Early Childhood Assessment for Infants and Toddlers‖ (DECA I/T), developed by Gregg Powell, Mary Mackrain and Paul LeBuffe, owned by The Devereux Foundation, edited and published by Kaplan Early Learning Corporation in 2007. DECA I/T assessment measures the social and emotional protective factors (attachment/relationship, initiative and self-regulation) to evaluate and indicate the strength of such factors in infants and toddlers. For the translation and transcultural adaptation of the assessment, the guidelines of Hambleton and Patsula (1998) and Souza and Rojjanasrirat (2010) were generally used. The procedure consisted of the following steps: (a) translation of the original instrument in English into Portuguese by two Brazilian, bilingual, independent translators, being one of them a sworn-translator, both of them familiarized with the Brazilian and American cultures, and without knowledge in Psychology; (b) comparison and consolidation of both translated versions by the researcher, who acted as a third translator, and review of the synthetized version; (c) back-translation of the consolidated version in Portuguese into English by another American, bilingual, independent translator, fluent in Portuguese, familiarized with the Brazilian and American cultures and not working in the Psychology area, followed by review and approval of the final version of the assessment in Portuguese by an Expert Committee; (d) application of the Portuguese final version in a pilot project. The translated DECA I was applied to and responded by 13 evaluators (six mothers, one grandmother, one father and five nursery caregivers of infants). A total of 12 infants were evaluated (one of them was evaluated by the father and the nursery caregiver). The translated DECA T was applied to and responded by 13 evaluators (six mothers, one grandmother, two room assistants, two educators e two teachers of toddlers). A total of 19 toddlers were evaluated (two room assistants evaluated two toddlers each, two educators evaluated three toddlers each, and two teachers evaluated three toddlers each). After application of the pilot project, the translation into Portuguese of DECA I/T was considered culturally adapted and apt for future validation / O tema da dissertação de mestrado é ligado à primeira infância e à resiliência em bebês (de quatro semanas a 18 meses de idade) e crianças (de 18 a 36 meses de idade). O objetivo do trabalho foi traduzir para o português e realizar a adaptação transcultural da escala de avaliação da primeira infância para bebês e crianças denominada Devereux Early Childhood Assessment for Infants and Toddlers (DECA I/T), criada e desenvolvida por Gregg Powell, Mary Mackrain e Paul LeBuffe, detida pela The Devereux Foundation, editada e publicada por Kaplan Early Learning Corporation em 2007. A escala DECA I/T mede os fatores de proteção sociais e emocionais (apego/relacionamento, iniciativa e autorregulação) para avaliar e indicar a força desses fatores em bebês e crianças. Para realização da tradução e adaptação transcultural foram utilizadas, em linhas gerais, as diretrizes e orientações de Hambleton e Patsula (1998) e Souza e Rojjanasrirat (2010). O procedimento consistiu das seguintes etapas: (a) tradução do instrumento original em inglês para o português por duas tradutoras brasileiras independentes e bilíngues, sendo uma delas juramentada, ambas familiarizadas com a cultura brasileira e americana e sem conhecimento em psicologia; (b) comparação e unificação das duas versões traduzidas pela pesquisadora, que atuou como terceira tradutora, e revisão da versão unificada; (c) retrotradução da versão unificada para o inglês por outro tradutor independente bilíngue, estadunidense, fluente em português, familiarizado com a cultura brasileira e a americana e não atuante na área de psicologia, seguida de revisão e aprovação da versão final da escala em português por Comitê de Especialistas; (d) aplicação da versão final em português em um projeto piloto. A DECA I traduzida foi aplicada e respondida por 13 avaliadores (seis mães, uma avó, um pai e cinco berçaristas de bebês). No total foram avaliados 12 bebês, sendo um deles avaliado pelo pai e pela berçarista. A DECA T foi aplicada e respondida por 13 avaliadores (seis mães, uma avó, duas assistentes de sala, duas educadoras e duas professoras de crianças). No total foram avaliadas 19 crianças, pois duas assistentes de sala avaliaram duas crianças cada, duas educadoras avaliaram, cada uma, três crianças, e duas professoras avaliaram, cada uma, três crianças. Após a aplicação do projeto piloto, a tradução para o português da DECA I/T foi considerada culturalmente adaptada e apta para futura validação

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<p>Uvod:Apendicitis je oboljenje, koje se najče&scaron;će javlja u dečjem uzrastu. Poslednjih godina se laparoskopska apendektomija sprovodi sve če&scaron;će u ovom uzrastu, međutim ne postoji jasan konsenzus o optimalnom izboru anestetika za održavanje op&scaron;te anestezije u toku ove hirur&scaron;ke metode u dečjem uzrastu. Cilj istraživanja: Utvrditi uticaj vrste anestezije i vrste hirur&scaron;ke procedure na odgovor organizma na hirur&scaron;ki stres tokom operacije crvuljka. Metodologija: Klinički prospektivno istraživanje je sprovedeno na Klinici za dečiju hirurgiju, na Institutu za zdravstvenu za&scaron;titu dece i omladine Vojvodine. Istraživanjem je obuhvaćeno 120 dece, uzrasta od 7 do 17 godina, bez postojećih komorbiditeta, koji su operisani zbog zapaljenja crvuljka. U zavisnosti od vrste operativnog zahvata i vrste primenjene anestezije deca su podeljena u četiri grupe bolesnika. Kod sve četiri ispitivane grupe uzimana je venska i kapilarna krv, nekoliko minuta nakon uvoda u anesteziju, u momentu vađenja crvuljka iz trbuha i 12 časova nakon kraja hirur&scaron;ke intervencije. Laboratorijski su određeni markeri oksidativnog stresa (TBARS), metaboličkog odgovora na hirur&scaron;ki stres (laktat, glikemija), inflamatornog odgovora organizma (IL-6, leukociti), gasne analize, parametri oksigenacije i ventilacije, i hemodinamski parametri ispitanika. Rezultati:U istraživanju je dobijen rezultat da je zapaljenje crvuljka oboljenje koje se če&scaron;će javlja kod dečaka. Tokom apendektomije u dečjem uzrastu, sevofluran je bolje kontrolisao arterijsku tenziju, dok na srčanu frekvencu vrsta anestezije nije imala uticaja. Sevofluran je anestetik tokom čije primene je manji inflamatorni odgovor tokom laparoskospske apendektomije. Propofol deluje suprimirajuće na oksidativni stres, ali nije nađena statistička značajnost u odnosu na vrednosti dobijene analizom uticaja sevoflurana na parametre oksidativnog stresa. Zaključak: Laparoskopska apendektomija u odnosu na laparotomiju nije praćena većim stepenom hirur&scaron;kog stresa, a sevofluran je anestetik koji tokom anestezije za laparoskopsku apendektomiju u dečijem uzrastu daje bolju kontrolu kliničkog, metaboličkog i inflamatornog odgovora.</p> / <p>Introduction: Appendicitis is a disease which appears most commonly in children. In recent years appendectomy in children is performed by laparoscopy, but there is no consensus yet on the optimal choice of anesthetics during general anesthesia for this procedure. Aim: To determine the influence of type of anesthesia and type of surgical procedure for appendectomy, on surgical stress in children. Methodology: A prospective clinical trial in Clinic of pediatric surgery in Novi Sad, Vojvodina. The study included 120 children aged from 7 to 17 years, with no commorbidities, who underwent appendectomy. Children were divided in four groups based on the type of anesthesia and type of surgery they received. In all participants, venous and capillary blood was sampled for analyzis 10 minutes after induction of anesthesia, at the moment of appendix removal and 12 hours after the procedure. The laboratory analysis included markers of oxidative stress (TBARS), metabolic response to surgical stress (lactate, blood glucose), inflammatory response (IL-6, leucocites), bloodgas analyses, parameters of oxygentation and ventilation and haemodynamic parameters of the participants. Results: In the study appendicitis was more common in boys. During laparoscopic appendectomy sevoflurane controlled better the blood pressure, but not the heart rate. Sevoflurane maintained a better control of parameters of the inflammatory response. Propofol decreased the oxidative stress, but there was no statistical difference compared to the effects of sevoflurane on oxidative stress. Conclusion: Laparoscopic appendectomy shoved no difference in the level of surgical stress compared to laparotomy, and sevoflurane appeared as an anaesthetic which had a better control of the metabolic, clinical and inflammatory response.</p>

<p>UVOD: Blastocistis hominis (Bh) je najrasprostranjeniji protist na na&scaron;oj planeti, ali pri tome najkontraverzniji. Infekcija Bh počinje ingestijom hrane ili tečnosti koja je kontaminirana cističnom formom Bh. Nakon gutanja, iz ciste se razvijaju u debelom crevu čoveka vakuolarne forme protista. Fekalno - oralni prenos je najče&scaron;ći put &scaron;irenja infekcije. Oboljenje koje Bh izaziva kod ljudi naziva se blastocistoza. Najče&scaron;će inficirani imaju gastrointestinalne tegobe, pre svega bol u trbuhu i proliv. Blastocistoza se danas povezuje sa dva klinička entiteta koji predstavljaju poremećaj rada creva, odnosno sindromom iritabilnog creva i hroničnom inflamatornom bolesti creva (HIBC). CILJ RADA I HIPOTEZE: Predmet istraživanja je da se utvrdi povezanost prisustva infekcije Blastocistis hominisom i postojanja zapaljenja sluzokože debelog creva (kolitisa) kod dece sa gastrointestinalnim tegobama, zatim da se utvrdi udeo dece sa posebnom formom kolitisa, hroničnom inflamatornom bolesti creva, među inficiranim Blastocistis hominisom, a da bi se omogućilo bolje razumevanje blastocistoze kod dece. Osnovne hipoteze u istraživanju su statistički značajno veća učestalost pojave kolitisa i hronične inflamatorne bolesti creva kod dece uzrasta od 1 meseca do 18 godina, hospitalizovane zbog bola u trbuhu i/ili proliva koji su inficirani Blastocistis hominisom, kao i statistički značajno veća učestalost kolitisa u odnosu na hroničnu inflamatornu bolest creva u istom uzorku. MATERIJAL I METODE: Prospektivnim ispitivanjem su obuhvaćeni pedijatrijski bolesnici, hospitalizovani na Odeljenju za gastroenterologiju, hepatologiju i ishranu, Instituta za zdravstvenu za&scaron;titu dece i omladine Vojvodine, zbog bola u trbuhu i/ili proliva, iz čije stolice je dokazan Blastocistis hominis. U toku ispitivanja primenjene su standardne metode uzimanja anamneza od bolesnika, fizički pregledi, odgovarajuće standardne laboratorijske analize krvi i stolice, ultrazvučni pregled abdomena, kolonoskopija i patohistolo&scaron;ki pregled biopsija debelog creva. Svi bolesnici su lečeni metronidazolom u trajanju 10 dana, prema važećim terapijskim protokolima. REZULTATI: Ispitivanjem je obuhvaćeno 102 bolesnika, koji su an osnovu patohistolo&scaron;kog nalaza podeljeni u tri grupe: 1. Grupa (bolesnici koji nemaju kolitis, obuhvatila je 4 bolesnika (4.4%)), 2. Grupa &ndash; (bolesnici koji imaju nespecifični kolitis, obuhvatila je 56 bolesnika (56.55%)) i 3. Grupa &ndash;(bolesnici koji imaju hroničnu inflamatornu bolest, obuhvatila je 42 bolesnika (42.41%)). Među ispitanicima je bio podjednak broj dece mu&scaron;kog i ženskog pola, odnosno 51 dečak i 51 devojčica. Uzrast ispitanika koji imaju infekciju Blastocistisom hominisom se kretao u interval od 11 meseci do 17 godina i 7 meseci. Medijana je iznosila 12.54 godine, a prosečna starost 11.25 godine. Blastocistoza nema sezonski karakter (&chi;2=0.667; df=3; p=0,881). Značajno vi&scaron;e inficiranih Blastocistis hominisom živelo u kući, nego u stanu i posedovalo domaće životinje i/ili kućne ljubimce, ali ne postojanje odgovarajućih higijenskih uslova, kanalizacije i vodovoda nije prediktivni faktor za razvoj infekcije Blastocistis hominisom, kao ni pohađanje kolektiva ili život u ruralnom sredinama. Stariji uzrast deteta (p=0,020) i život u kući (p = 0,033) su prediktivni faktori za pojavu hronične inflamatorne bolesti creva kod dece sa kolitisom. Deca sa blastocistozom su imala antropometrijske parametre u granicama normale.Ispitanici najče&scaron;će bili primljeni u bolnicu pod djagnozom gastroenterokolitisa, zbog proliva i bola u trbuhu, a da prisustvo gastrointestinalnih tegoba i prisustvo op&scaron;tih znakova infekcije nisu jedan od sigurnih kliničkih značajnih znakova infekcije Blastocistis hominisom. Prisustvo patolo&scaron;kih primesa u stolici nije jedan od sigurnih klinički značajnih znakova infekcije Blastocistis hominisom.Na osnovu laboratorijskog, kliničkog i endoskopskog skora za aktivnost HIBC većina bolesnika je imala umerenu aktivnost.Inficirani sa Bh imaju najče&scaron;će C-reaktivni protein u okvirima refentnih vrednosti, izuzev ukoliko nemaju i HIBC. Povi&scaron;ena sedimentacija eritrocita je karakteristična za bolesnike sa HIBC. Oboleli od blastocistoze imaju najčesce imunoglobulin A, leukocite, neutrofile i eozinofile u krvi u referentnim granicama.Vrednosti feremije upućuju da je većina ispitanika bila anemična, a naročito deca koja su imala i infekciju sa Bh i HIBC. Kod bolesnika sa blastocistozom, postojanje pozitivnog testa na okultnu krv u stolici, treba da pobudi sumnju na udruženu HIBC. Ispitanici sa infekcijom Bh i sa HIBC su imali najče&scaron;će kvantitativno veći broj Bh u stolici. Mezenterajalni limfadenitis i splenomegalija su nespecifični ultrazvučni nalaz kod inficiranih sa Bh, iako su bili najče&scaron;će opisane patolo&scaron;ke promene na ultrazvuku abdomena. Zaključujemo da su ispitanici najče&scaron;će imali nespecifične endoskopske promene i patohistolo&scaron;ke promene u debelom crevu. Metronidazol je bezbedan i efikasan, u dozi 15-50 mg/kg/dan, u trajanju od 10 dana, u terapiji infekcije sa Bh kod dece. ZAKLJUČAK: Deca inficirana sa Bh imaju najče&scaron;će colitis od patolo&scaron;kih promena na debelom crevu, bez značajne razlike između nespecifičnog kolitisa i HIBC. Značajno manje inficiranih sa Bh ima uredan kolonoskopski nalaz.Utvrđivanja značaja Blastocistis hominisa u nastanku kolitisa i hronične inflamatorne bolesti creva kod dece, doprinosi prihvatanju Blastocistisa hominisa kao patogena i ukazuje na nephodnost njegovog lečenja.</p> / <p>INTRODUCTION: Blastocystis hominis (Bh) is the most outspread protist on our planet, but also the most controversial. Infection Bh starts by digestion of the eaten food or liquid which has been contained by a cyst form Bh. After swallowing, from the cyst they grow (progress) in the colon of the human, with a vacuolar form of a protest. Oral transmission is the most common way of spreading the infection. The disease caused by Bh on humans is called blastocystisis. In most cases the infected humans have gastrointestinal complaints, the most common are abdominal pain and diarrhea. Blastocystis is nowadays connected to two clinical disease, the irritable bowel syndrome and inflammatory bowel disease (IBD). THE AIM AND HYPOTHESESS: The subject of research is to establish the connection between the presence of the infection Bh and the existence of mucosal inflammation of the colon in children with gastrointestinal complaints, as well as to establish the group of the children with a special form of colitis, inflammatory bowel disease and the ones infected by Bh, wich would insure better understanding of the blastocystosis in children. The basic hypothesis in the study were statistically significantly higher incidence of chronic colitis and inflammatory bowel disease in children aged 1 month to 18 years, hospitalized for abdominal pain and/or diarrhea who are infected Bh, as well as significantly higher incidence of colitis compared in chronic inflammatory bowel disease in the same sample. MATERIALS AND METHODS: The prospective study included pediatric patients with abdominal pain and/or diarrhea, and stool positive on Bh, that have been hospitalized on the Department for gastroenterology, hepatology and nutrition, in the Institution for Health Care of Children and Youth in Vojvodina. The standard testing methods were used: anamnesis, physical examination, laboratory analysis of blood and stool, ultrasound examination of the abdomen, colonoscopy and histopathological examination of the biopsy of the colon. All patients have been treated with metronidazole for 10 days, according to the applicable protocols. RESULTS: The study included 102 patients, which are divided into three groups : 1. group (patients that have no colitis, included 4 patients (4.4%)), 2. group (patients with unspecified colitis, included 56 patients (56.55%)) and 3. group (patients with inflammatory bowel disease, included 42 patients (42.41%)). Among them, there was an equal number of children that were male and female, 51 boys and 51 girls. Age of respondents who have Bh infection ranged from 11 months to 17 years and 7 months. The median is 12.54 years, and the average age of 11.25 years. Blastocistosis no have seasonal character (&chi;2 = 0.667, df = 3, p = 0.881). Significantly more infected Blastocistis hominid lived in the house, but in an apartment owned and domestic animals and / or pets,yet the existence of appropriate hygiene, sanitation and water supply is not a predictive factor for the development of infection Bh, as well as attending the collective or life in rural areas . The older child&#39;s age (p = 0.020) and life at home (p = 0.033) were predictive factors for development of inflammatory bowel disease in children with colitis. Children with blastocistosis had anthropometric parameters within normal limits. Respondents most frequently been admitted to hospital under diagnosis gastroenteritis due to diarrhea and abdominal pain, and that the presence of gastrointestinal symptoms and general signs of infection are not a significant clinical signs of infection Bh. The presence of pathological findings in stool is not one of reliable signs of clinically infection Bh. Based on laboratory findings, clinical and endoscopic activity score for IBD most patients had moderate activity of desease. Children with Bh infection usually have normal C-reactive protein in terms of value, unless if have IBD. Elevated erythrocyte sedimentation rate is characteristic of patients with IBD. Children with blastocistosis usually have normal level of Immunoglobulin A, leukocytes, neutrophils and eosinophils. Serum iron indicate that most subject were anemic, especially children who have had an infection with the Bh and IBD.Children with blastocistosis, the existence of a positive test for occult blood in the stool, should arouse suspicion of association IBD. Subject with IBD had mostly quantitatively greater number of Bh in the stool. Mesenterial lymphadenitis and splenomegaly are non-specific ultrasound findings in infected with Bh, although they were usually described pathological changes in abdominal ultrasound. This is to conclude that the subject usually had colitis and IBD changes in endoscopic and histopathological changes in the colon. Metronidazole has beem proved safe and effective, at 15-50 mg/ kg/day for 10 days in the treatment of infections in children with Bh. CONCLUSION: Children infected with Bh colitis usually have pathological changes in the large intestine, with no significant difference between the non-specific colitis and inflammatory bowel disease. Significantly less infected with Bh has a normal colonoscopy findings. Confirmed the importance of Bh in the development of chronic colitis and inflammatory bowel disease in children, increase public acceptance Blastocistisa hominis as pathogens and points to the necessity of treatment.</p>

<p>Istraživanje prikazano ovim radom imalo je za cilj da opi&scaron;e mentalno zdravlje<br />dece na hraniteljstvu ranog &scaron;kolskog uzrasta i da sagleda kakvu ulogu u aktuelnom<br />stepenu njihovog psihosocijalnog funkcionisanja ima kvalitet brige koji im je pružen u<br />hraniteljskoj porodici. Kvaliteta staranja o detetu je konceptualizovan iz okvira teorije<br />afektivne vezanosti kao posvećenost hranitelja detetu na sme&scaron;taju i podrazumeva nivo<br />emocionalne investiranosti i motivisanosti hranitelja da sa detetom uspostavi emotivno<br />blizak, stabilan i trajan odnos.<br />U uzorak istraživanja je uključeno 82 dece na sme&scaron;taju u hraniteljskim<br />porodicama, uzrasta od 5 do 11 godina, koji su &scaron;tićenici Centra za socijalni rad Grada<br />Novog Sada i vi&scaron;e op&scaron;tinskih centara na teritoriji Vojvodine (Novi Bečej, Bačka<br />Topola, Mali Iđo&scaron; i Vrbas), bez ozbiljnijih smetnji u psihomotornom razvoju i koja u<br />aktuelnoj hraniteljskoj porodici borave najmanje dva meseca. U uzorku je podjednak<br />broj dečaka i devojčica, pri čemu dominiraju deca koja su na sme&scaron;taju u standardnim<br />(nesrodničkim) hraniteljskim porodicama (90.2 %), u odnosu na srodničke.<br />Podaci o mentalnom zdravlju dece su prikupljani uz pomoć dve skale za procenu<br />dečije psihopatologije koje su popunjavale hraniteljice: Liste provere dečijeg pona&scaron;anja<br />za decu od 6-18 godina (Child Behavior Checklist for ages 6-18, CBCL/6-18,<br />Achenbah &amp; Reskorla, 2001) i Liste za procenu dece u socijalnoj za&scaron;titi uzrasta od 4-11<br />godina (Assessment Checklist for Children for ages 4-11, ACC, Tarren-Sweeney,<br />2007). Podaci o mentalnom zdravlju su prikupljani i za kontrolni uzorak dece koja<br />odrastaju u biolo&scaron;kim porodicama, ujednačenom po broju, polnoj i uzrasnoj strukturi sa<br />uzorkom dece na hraniteljstvu, kao i u odnosu na pol roditelja koji pruža podatke<br />(majke). Za operacionalizovanje i procenjivanje kvaliteta staranja o detetu od strane<br />hranitelja je kori&scaron;ćen polustrukturirani intervju &ldquo;To je moje čedo&rdquo; (&ldquo;This Is My Baby&rdquo;<br />interview&rdquo;, TIMB, Bates &amp; Dozier, 1998) koji se sastoji od standardizovanih pitanja u<br />vezi hraniteljicinih osećanja prema detetu i njihovog međusobnog odnosa i daje uvid u<br />tri dimenzije: prihvatanja deteta na sme&scaron;taju kao svog (eng. acceptance), posvećenosti u<br />podsticanju njegovog rasta i razvoja bez emotivne &ldquo;zadr&scaron;ke&rdquo; (eng. commitment) i<br />svesnosti o uticaju uspostavljenog odnosa sa detetom na detetov emocionalni i socijalni<br />razvoj, aktuelno i u budućnosti (eng. awareness of influence).<br />Rezultati istraživanja ukazuju da deca na hraniteljstvu u poređenju sa svojim<br />vr&scaron;njacima koji odrastaju u biolo&scaron;kim porodicama, ispoljavaju značajno vi&scaron;e problema<br />mentalnog zdravlja, pri čemu prednjače problemi sa pažnjom, smetnje afektivne<br />vezanosti u vidu nediskriminativnog, pseudozrelog i nesigurnog pona&scaron;anja u<br />5<br />interpersonalnim relacijama, eksternalizujući problemi (agresivno pona&scaron;anje, kr&scaron;enje<br />pravila), abnormalni obrasci ishrane (čuvanje, skladi&scaron;tenje i krađa hrane) i<br />samopovređivanje. Mentalno zdravlje dece je determinisano nepovoljnim razvojnim<br />okolnostima koje prethode sme&scaron;taju ali i kvalitetom brige koja im je pružena u<br />hraniteljskoj porodici, pa se kod dece o kojima brinu hraniteljice visokog nivoa<br />prihvatanja i posvećenosti beleži manje emocionalnih problema, problema u pona&scaron;anju i<br />odnosu sa drugima. Rezultati ukazuju i na moderirajuće efekte kvaliteta staranja, u<br />smislu da je stepen prihvatanja i posvećenosti od strane hraniteljica posebno značajan za<br />decu koja su pre sme&scaron;taja u hraniteljsku porodicu imala visoko rizično iskustvo, čineći<br />ih znatno vulnerabilnijim u okolnostima niskog kvaliteta brige, kao &scaron;to i okolnosti<br />visokog kvaliteta staranja u ovoj grupi dece ostvaruju najintenzivniji protektivni i<br />kompenzatorni efekat.<br />Rezultati su diskutovani u svetlu teorije afektivne vezanosti, u smislu potvrde<br />kvaliteta staranja kao protektivnog činioca koji podstiče rezilijentnost dece i implikacija<br />relevantnih za praksu socijalnog rada u oblasti hraniteljstva.</p> / <p>The purpose of the research presented in this paper is to describe the mental<br />health of children in foster care at early school-age and to analyse the role that the<br />quality of care they receive in foster family plays in the current level of their<br />psychosocial functioning. The quality of child care has been conceptualized from the<br />framework of the attachment theory as the commitment of foster carers to the foster<br />children and it implies a level of emotional investment and motivation of the foster<br />carers to establish an emotionally close, stable and permanent relationship with the<br />child.<br />The research sample involved 82 foster children, aged 5 to 11, who are in the<br />care of the Centre for Social Work of the City of Novi Sad and several municipal<br />centres in the territory of Vojvodina (Novi Bečej, Bačka Topola, Mali Iđo&scaron; and Vrbas),<br />who are without serious difficulties in psychomotor development and who have been<br />with the current foster family for at least two months. The sample included the same<br />number of boys and girls, and the majority were children in standard (non-kinship)<br />foster families (90.2 %), as opposed to kinship foster families.<br />Information about the mental health of the children was collected using two<br />scales for the assessment of psychopathology in children, which were filled out by<br />foster mothers: Child Behaviour Checklist for ages 6-18 (CBCL/6-18, Achenbah &amp;<br />Reskorla, 2001) and Assessment Checklist for Children for ages 4-11 (ACC, Tarren-<br />Sweeney, 2007). Information about the mental health was also collected for the control<br />sample of children who live with biological families, identical in number, gender and<br />age structure with the sample of children in foster care, as well as in relation to the<br />gender of the parent providing the information (mother). In order to operationalize and<br />assess the quality of child care, the research used the semi structured interview &ldquo;This Is<br />My Baby&rdquo; (TIMB, Bates &amp; Dozier, 1998) which contains standardized questions in<br />relation to the foster mother&rsquo;s feelings towards the child and their mutual relationship<br />and it also provides insight into three dimensions: acceptance of foster child as her own,<br />commitment in encouraging their growth and development without emotional<br />&ldquo;reservations&rdquo; and the awareness of influence of the established relationship with the<br />child on the child&#39;s emotional and social development, now and in the future.<br />The results of the research indicate that the children in foster care, as compared<br />to their peers growing up with biological families, display significantly more mental<br />health problems, and the most frequent ones are attention problems, attachment related<br />difficulties in the form of indiscriminate, pseudo mature and insecure interpersonal<br />8<br />behaviours, externalising problems, aggressive and rule-breaking behaviour, eating<br />problems, food maintenance behaviour and self-injury. The mental health of the<br />children is determined by the unfavourable development circumstances prior to<br />placement in foster care, but also by the quality of care that they receive in foster<br />family, and so the children in the care of foster mothers with a high level of acceptance<br />and commitment display fewer emotional, behavioural and interpersonal problems. The<br />results also indicate the moderation effects of the quality of care, in the sense that the<br />level of acceptance and commitment by the foster mothers is of particular significance<br />for the children who had high-risk experience before they were placed in foster family,<br />which made them significantly more vulnerable in the circumstances of low-quality<br />care, just like the circumstances of high-quality care with this group of children<br />produced a more intensive protective and compensatory effect.<br />Results are discussed in the light of the attachment theory, in terms of<br />confirmation of the quality of care as a protective factor which encourages the resilience<br />of children, as well as the implications relevant to the social work practice in the field of<br />foster care.</p>

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Ce mémoire traite des Discours sur la Première Décade de Tite-Live de Nicolas Machiavel. Notre problématique est de savoir pourquoi Machiavel s'est intéressé à l'Histoire Romaine de Tite-Live, dans quelle optique il la lit, la commente et comment il en tire des leçons pour la vie politique de Florence. Dans un premier chapitre, nous présentons notre méthode qui s'inspire de l'école contextualiste de Cambridge. Nous replaçons ensuite Machiavel dans son époque à travers une brève biographie puis nous présentons l'Histoire Romaine de Tite-Live, ainsi que son auteur. Dans un second chapitre nous présentons les Discours sur la Première Décade de Tite-Live et le contexte de leur rédaction. Nous démontrons pourquoi cette œuvre de Machiavel est à la fois en continuité et en rupture avec leur époque (la Renaissance). Nous étudions les liens possibles entre l'antique Rome et Florence au XVIe siècle. Nous commentons ensuite certains chapitres des Discours à titre d'exemple. Dans un troisième chapitre, nous traitons des enjeux philosophiques des Discours: la vision de l'Histoire qui en ressort, le rôle des concepts de virtù et de fortuna et enfin, la possibilité d'actualiser l'approche de Machiavel, c'est-à-dire prendre en compte - ou non - les exemples de l'Histoire pour décider aujourd'hui des modes de l'agir politique. / This master thesis is about Niccolò Machiavelli's Discourses on Livy. Our main issue is to know why did Machiavelli interest in Livy's History of Rome, from which point of view did he read and comment on it, and the political lessons he taught Florence from it. In chapter one, we present our method inspired from the Cambridge contextualist school. Next, we put Machiavelli back in his time through a short biography; then we present Livy's History of Rome, and the author himself. In chapter two, we present the Discourses on Livy and the background in which Machiavellli wrote it. We demonstrate how this work follows on from the Renaissance litterature and at the same time breaks with it. Then we study the possible connections between the ancient Rome and the 16th century Florence. Afterwards, we comment some chapters of the Discourses, as an exemple. The last chapter deals with the philosophical issues in the Discourses: which view on History reveals through it, which part do play the concepts of virtù and fortuna and finally, the possibility of updating Machiavelli's approach, that is to say taking - or not - into account the historical exemples as a guide for today's political action.