5 Abstract This thesis is focused on the research of adult day care centers. Its aim is to answer the question how the the day care centers define the care from the point of view of different stakeholders; how are the centers specific to other social services and what are the possible problems and obstacles. Theoretical part describes the current situation of elderly care and deals with topics such as the demographic development of the Czech Republic, the media image of the elderly, new trends in the area of care, active aging, social services etc. Empirical research deals with two day care centers from the points of view of different stakeholders. The research, which results in two case studies and their comparisons, is carried out using qualitative methods - semi-structured interviews, analysis of documents and survey. Data analysis shows that the main function of day care centers is "relief service" for families who provide care to the frail seniors. The distinctive feature of day care centers is emphasizing differnces with other social services for elderly, especially the residential ones. This is why the great emphasis is placed on individual care in a small environment and on intergenerational encounters. The analysis also shows the day care centers as a female environment. Women prevail among...

Bakgrund: Den vanligaste anledningen att personer med psykiatriska funktionshinder lämnar hemmet är för att besöka en dagverksamhet. Samtidigt kritiseras dagverksamheter för att vara stigmatiserande. Forskning inom området återger en i stora drag homogen bild av dagverksamheters betydelse för individen där positiva aspekter lyfts fram. Emellertid återfinns kontrasterande bilder där dessa verksamheter kan tänkas påverka besökarna negativt. Syfte: Syftet med denna studie är att utifrån tidigare forskning ge kunskap om vad dagverksamheter för personer med psykiatriska funktionshinder betyder för dess besökare. Vi ämnar kartlägga kunskapsläget samt med efterföljande analys skapa en djupare förståelse för dagverksamheters betydelse för individen. Metod och teori: Studien är i form av en allmän litteraturstudie där tolv utvalda artiklar utgör empirin. För att förstå betydelsen av dagverksamheter har vi satt ihop ett teoretiskt ramverk av stigma, självstigma och empowerment. Resultat:Studien utmynnar i tre huvudteman: betydelsen av dagverksamheten som socialt sammanhang, betydelsen av dagverksamheten som sysselsättning, olika aspekter av dagverksamhetens betydelse för måendet. Slutsatser: Vi fann att dagverksamheter är av stor vikt för besökarna genom att erbjuda en trygg plats för social gemenskap, en del i ett socialt sammanhang, erbjuda meningsfull sysselsättning och en motivation till att lämna hemmet. Vi ser i resultatet att målgruppen har svårt att ta sig in på arbetsmarknaden. Det är därför viktigt att dagverksamheter finns så besökarna kan komma dit och delta i olika typer av aktiviteter, samt för att ge vardagen en struktur. En annan slutsats är att i de positiva aspekter som lyfts i empirin kan vi skönja problematiska sidor av dagverksamhetens betydelse, även i det som framhävs som positivt. Detta kan röra sig om slutenheten som präglar dessa institutioner, deltagarnas beroende av dagverksamheterna samt verksamheternas svårigheter att vara en brygga till nya utvecklingsmöjligheter. / Title: Left out together? A general literature study on the meaning of daycare centers to individuals with psychiatric disabilities. Background: The most common reason why people with psychiatric disabilities leave home is to visit a daycare center. At the same time, daycare centers are criticized for being stigmatizing. The research in the area provides a fairly homogeneous picture of what daycare centers mean to the individual where positive aspects are highlighted. However, contrasting images are found in which daycare centers may have a negative impact on its visitors. Aim: The aim of this study is to provide knowledge of what daycare centers for people with psychiatric disabilities mean to their visitors based on previous research. We intend to map the state of knowledge and, with subsequent anlays, create a deeper understanding of what daycare centers mean for the individual. Method and theory: This study is a general literature study in which twelve selected articles constitute the empiric. To understand the meaning of daycare centers, we have put together a theoretical framework of stigma, self-stigma and empowerment. Findings: The study generates three main themes: the meaning of daycare centers as a social context, the meaning of daycare centers as occupation, different aspects of what daycare centers mean for well-being. Conclusion: We found that daycare centers are of great importance to visitors in providing a safe place for social community, part of a social context, offering meaningful occupation and a motivation to leave home. We see in the result that the target group has difficulty in entering the labor market. It is therefore important that daycare centers exist so that visitors can come there and participate in different types of activities, as well as to provide structure to everyday life . Another conclusion is that in the positive aspects highlighted in the empiricism, we can discern problematic aspects of the importance of daycare centers, even in what is emphasized as positive. This may concern the introversion that characterizes these institutions, the participants' dependence on daycare centers and the difficulties of the centers to be a bridge to new development opportunities.

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2017-03-29T12:27:58Z No. of bitstreams: 1 Izolda Maria Batista.pdf: 1882710 bytes, checksum: b10a88be349e822a01760930d60a211a (MD5) / Made available in DSpace on 2017-03-29T12:27:58Z (GMT). No. of bitstreams: 1 Izolda Maria Batista.pdf: 1882710 bytes, checksum: b10a88be349e822a01760930d60a211a (MD5) Previous issue date: 2017-03-22 / The main focus of this study is the practice of teachers who work in Early Childhood Education Centers (CEIs) serving groups of children from zero to three years within the São Paulo Municipal School System. This research questions the general policies of the system between 2012 and 2016. It has, therefore, the purpose of understanding how care practices have been implemented in early childhood education with this age group, guided by the following general question: how do CEIs use legislation and organize educational work with children from three to four years of age? The research was based on document analysis and observation of the teaching practices in classes of children from three to four years of age, seeking to ascertain, through actions in two units, how the enrollment legislation, organization of the unit, creation of class groups, and educational activities are implemented. The documents analyzed were considered external and internal, with the latter being composed of the political-pedagogical project, internal regulations, the school and teachers’ pedagogical projects. The study of these documents aims to provide information on their effectiveness, through both the teachers’ work and the school's actions, and to comprehend their changes in the daily work of the schools as observed during the middle months of the 2016 school year. Vygotsky and Falk’s theories give a historical-cultural perspective about the education of young children. The research also draws on Licínio Lima’s concept of normative infidelity as a sociological approach to analyzing the possible alterations from the legislation practiced by the schools. Rockwell (2009) also provided theoretical support. The methodological pathway is based on some principles of ethnographic research, making it possible to seek information in documents and from the observation of situations and experiencing certain facts. The results indicate several alterations in the schools’ actions when compared to the official definitions, many of them interfering in a negative way in the educational processes, confirming the hypothesis that there are changes to the general norms and the construction of individual norms in each unit / Este estudo tem como foco central o trabalho docente dos professores que atuam nos Centros de Educação Infantil (CEIs) atendendo agrupamentos de crianças de zero a três anos no âmbito da rede da Prefeitura Municipal de São Paulo. Problematiza-se esse trabalho em face das determinações gerais para toda a rede no período entre 2012 e 2016. Tem, portanto, a finalidade de entender como vem sendo implementado o atendimento nessa rede de ensino no que tange à educação infantil, nessa etapa de idade norteada pela seguinte questão geral: como os CEIs utilizam a legislação e organizam o trabalho educacional com as crianças de três anos até chegar aos 4 anos? A investigação se baseou em documentação e na observação do trabalho docente com turmas de crianças com idade entre 3 e 4 anos, buscando averiguar, por meio das ações em duas instituições, como se efetiva ou não a legislação explicitada nas portarias de matrícula, organização da unidade, formação dos agrupamentos e atividade educacional, entre outros documentos. Neste estudo os documentos analisados estão denominados externos e internos, sendo os últimos: projeto político-pedagógico, regimento interno, projetos pedagógicos da escola e de cada professor. O estudo desses documentos visa fornecer informações para se compreender sua efetivação por meio não só do trabalho do (a) professor (a), mas também das ações da escola no sentido mais amplo e suas alterações no cotidiano do trabalho das unidades observadas durante o ano de 2016 - parte no primeiro semestre e parte no segundo semestre. Esta pesquisa tem como base teórica Vigotsky e Falk, autores de abordagem histórico-cultural para análise de algumas questões relativas à educação das crianças dessa faixa etária, além do conceito de infidelidade normativa proposto por Licínio Lima com abordagem sociológica para análise das possíveis alterações da legislação em sua aplicação nas escolas. Com aporte teórico também de Rockwell (2009), o método tem algumas bases etnográficas que possibilitam a busca de informações também nos documentos, além da observação e vivência dos fatos. Foram obtidos resultados que permitem apontar várias alterações nas ações das escolas quando cotejadas com as definições oficiais, muitas delas interferindo de modo negativo nos processos educativos, confirmando a hipótese de que há alterações das normas gerais e construção de outras particulares a cada unidade

Ce mémoire examine le traitement politique des services de garde au Québec, dans son articulation à l'expansion de l'État néolibéral. Nous nous intéressons au rôle attribué à ces services dans la « régulation d'ensemble » de l'économie, à leurs effets sur l'organisation des rapports sociaux de genre et de classe, ainsi qu'aux discours légitimant l'intervention (ou non) de l'État dans ce secteur d'activité. Trois périodes sont examinées : 1) le moment providentiel (1945-1979) ; 2) la période de transition néolibérale (1980-2003) ; 3) le moment néolibéral (2004-2015). Par le biais d'une analyse des publications gouvernementales et de la « littérature grise », nous cherchons ainsi à comprendre les logiques guidant l'élaboration des politiques gouvernementales dans ce domaine. Les principes et les idées dégagées du corpus sont évalués au regard des concepts de défamilialisation, de démarchandisation et de collectivisation. Après avoir soutenu la familialisation des activités domestiques dans l'après-guerre, l'État québécois s'intéresse de plus en plus aux services de garde à partir des années 1980. L'investissement dans ce secteur d'activité connaît ensuite des avancées spectaculaires à la fin des années 1990 avec la création des centres de la petite enfance. Observons qu’au même moment, le gouvernement adopte une série de réformes visant le retour à l'équilibre des finances publiques et la « modernisation » de l'État québécois. On procède alors à des compressions budgétaires importantes dans la plupart des programmes sociaux. Enfin, après avoir rallié la faveur des élu.e.s, la politique de services de garde connaît plusieurs changements au cours des dernières décennies suivantes, menant progressivement à la privatisation de l'offre. Ce changement est principalement observé à travers les phénomènes de fiscalisation des subventions gouvernementales, c'est-à-dire l'investissement dans les programmes fiscaux et l'abandon progressif du principe de prix unique. Ce mémoire vise à contribuer à une meilleure compréhension des débats et des discours entourant les services de garde au Québec depuis l'après-guerre. En retraçant la sociohistoire des services de garde sur le temps long, nous montrons l'influence considérable des discours et des cibles économiques du gouvernement dans l'évolution des politiques publiques rattachées à la petite enfance. / This thesis examines the political treatment of childcare services in the province of Quebec, as it relates to the expansion of the neoliberal state. We focus our attention on the role attributed to these services in the "overall regulation" of the economy, their impact on gender and class relations’ organization, as well as on the rhetoric legitimizing, on the one hand, state intervention in this sector of activity and, on the other hand, its absence thereof. Three periods are examined: 1) the welfare period (1945-1979); 2) the neoliberal transition period (1980-2003); 3) the neoliberal period (2004-2015). Through an analysis of documents (both governmental and from the “grey literature”), we seek to understand the logic guiding the development of government policies in this field. The principles guiding state action in this matter that we have identified are evaluated through the lens of the following concepts: de-familialization, de-commodification and collectivization. After supporting the familialization of domestic activities in the post-war period, the Quebec government became increasingly interested in childcare services in the 1980s. Investment in this sector of activity then experienced spectacular growth at the end of the 1990s with the creation of early childhood centers. At the same time, the government adopted a series of reforms aimed at restoring balance to public finances and the "modernization" of the state. Significant cuts thus followed in most social programs. Finally, after gaining the favor of elected officials, daycare service policy underwent several changes over the following decades, gradually leading to the privatization of services. This change is mainly observed through the taxation of government subsidies, the investment in tax programs and the gradual abandoning of the unique price policy. This thesis contributes to a better understanding of the debates and discourses surrounding childcare services in Quebec, in a context of neoliberalization of the state. By studying the social history of childcare services over a long period, we show the influence of government discourse and economic targets on the choice of whether or not to invest in childcare services.

L'infection congénitale par le cytomégalovirus (CMV) est l'infection congénitale la plus courante, survenant chez 0,2 à 2,0 % des naissances vivantes. Elle représente la principale cause non génétique de surdité neurosensorielle chez les nourrissons. Cette infection entraîne des séquelles neurodéveloppementales permanentes telles que des problèmes de vision, un retard cognitif et, dans certains cas, elle peut même entraîner la mort. Avoir une meilleure compréhension des caractéristiques épidémiologiques de l'infection maternelle par le CMV peut contribuer à améliorer notre compréhension de la transmission de ce virus au fœtus et, par conséquent, à prévenir l'infection congénitale. Cette thèse vise à étudier les aspects épidémiologiques de l'infection maternelle par le CMV et de l'exposition professionnelle au CMV. Le premier objectif consiste à estimer la séroprévalence, l'incidence et les facteurs de risque de l'infection maternelle à CMV pendant la grossesse. Le deuxième objectif examine l'association entre l'infection maternelle à CMV et certaines complications de la grossesse, telles que la prééclampsie et l'accouchement prématuré. Le troisième objectif est une revue systématique et une méta-analyse visant à déterminer la prévalence, l'incidence de l'infection primaire, les risques relatifs et les facteurs de risque au sein de deux groupes exposés professionnellement au CMV, à savoir les travailleurs en service de garde et le personnel de santé. Les données de deux importantes cohortes au Québec, comprenant un total de 6048 participantes (Grossesse en santé et 3D), ainsi que leurs échantillons biologiques, ont été utilisées pour atteindre les objectifs 1 et 2. Dans le cadre de l'objectif 3, une recherche bibliographique a été réalisée en consultant six bases de données électroniques (PubMed [NLM], Ovid MEDLINE, Ovid All EBM Reviews, Ovid Embase, ISI Web of Science et EBSCO CINAHL Complete). Les résultats de l'objectif 1 (article 1), basés sur les données d'une des deux cohortes, révèlent une séroprévalence de 23,4 % (IC à 95 %, 22,1-24,7 %) chez les femmes enceintes, ainsi qu'une incidence d'infection primaire de 1,8 pour 100 années-personnes pendant la grossesse (IC à 95 %, 1,2-2,6). Les facteurs de risque associés à la séropositivité maternelle sont la multiparité (avoir un ou plusieurs enfants), une ethnie autre que caucasienne et un lieu de naissance autre que le Canada et les États-Unis. Les résultats de l'objectif 2 (article 2) ont révélé deux associations importantes : (1) une association entre la séropositivité maternelle au CMV et la prééclampsie, et (2) une association entre la séropositivité maternelle au CMV et l'accouchement prématuré. L'analyse de médiation, en prenant en compte la prééclampsie comme facteur médiateur de l'association entre l'infection maternelle au CMV et l'accouchement prématuré, a montré que la quasi-totalité (96,8 %) de l'effet total de la séropositivité maternelle au CMV agit directement sur l'accouchement prématuré, sans passer par la prééclampsie. La revue systématique et méta-analyse, qui correspond à l'objectif 3 (article 3), souligne l'importance de l'exposition professionnelle au CMV. Dans le groupe des travailleurs en service de garde, la séroprévalence du CMV et l'incidence de l'infection primaire pour 100 personnes-années sont élevées, atteignant respectivement 59,3 % (IC à 95 % : 49,8-68,6) et 7,4 (IC à 95 % : 3,9-11,8). De même, dans le groupe du personnel de santé, ces valeurs s'élèvent à 49,5 % (IC à 95 % : 40,3-58,7) et 3,1 (IC à 95 % : 1,3-5,6) respectivement. La séropositivité au CMV et l'infection primaire sont significativement plus fréquentes chez les travailleurs en service de garde par rapport aux groupes témoins sans exposition professionnelle, avec un RC (Rapport des cotes) de 1,6 (IC à 95 % : 1,2-2,3) et un RR (Rapport des Risques) de 3,4 (IC à 95 % : 1,3-8,8) respectivement. Cependant, aucune différence significative n'a été observée chez le personnel de santé (RC : 1,3 [IC à 95 % : 0,6-2,7] et RR : 0,9 [IC à 95 % : 0,6-1,2]). Dans les deux groupes, la séropositivité au CMV était associée à la multiparité, l'état civil, l'ethnicité et l'âge. En conclusion, cette étude démontre que la séroprévalence du CMV chez les femmes enceintes varie. La parité, l'ethnicité, le lieu de naissance et l'exposition professionnelle sont des facteurs à prendre en compte lors de l'élaboration de mesures préventives contre l'infection maternelle par le CMV. Les résultats de l'article 2 mettent en évidence que la séropositivité maternelle au CMV pourrait être un facteur de risque de prééclampsie et d'accouchement prématuré. Mots clés : cytomégalovirus, prévalence, incidence, séroconversion, grossesse, sérologie, prééclampsie, accouchement prématuré, exposition professionnelle, travailleur en service de garde, garderie, personnel de santé. / Cytomegalovirus infection is the most common congenital infection occurring in 0.2% to 2.0% of all live births. Congenital CMV infection is the most common non-genetic cause of sensorineural hearing loss. It results in permanent neurodevelopmental sequelae such as visual impairment, cognitive delay and in some cases, death. Knowing the epidemiological characteristics of maternal CMV infection could contribute to improve the understanding of the transmission of this virus to the fetus, and then, contribute to the prevention of congenital infection. The present thesis aims to study some epidemiological aspects of maternal CMV infection and occupational exposure to CMV. The first objective sought to estimate the seroprevalence, incidence, and risk factors of CMV infection during pregnancy. The second objective studied the association between maternal CMV infection and some adverse pregnancy outcomes, including preeclampsia and preterm delivery. The third objective was a systematic review and meta-analysis to determine the prevalence, incidence of primary infection, relative risks, and risk factors in the two groups occupationally exposed to CMV, namely childcare workers and healthcare workers. Data from two large Quebec cohorts with 6048 women (“Grossesse en santé” and “3D” cohorts), and their biobanks, were used to address objectives 1 and 2. For objective 3, a literature search was conducted in 6 electronic databases along with a meta-analysis (PubMed (NLM), Ovid MEDLINE, Ovid All EBM Reviews, Ovid Embase, ISI Web of Science, et EBSCO CINAHL complete). The results for objective 1 (article 1) on the data of one of the two cohorts show a seroprevalence of 23,4% among pregnant women (95% CI, 22.1–24.7%), an incidence of primary infection of 1,8 per 100 person-years during pregnancy (95% CI, 1.2–2.6). During the 5 years of the study, seroprevalence was stable and no seasonality was observed. Risk factors associated with maternal seropositivity were multiparity, i.e., having one or more children, non-Caucasian ethnicity, and place of birth other than Canada and the United States. The results for objective 2 (article 2) highlighted on the one hand the association between maternal CMV seropositivity and preterm birth, and on the other hand the association between maternal CMV seropositivity and preeclampsia. The mediation analysis considering preeclampsia as a mediating factor of the association between maternal CMV infection and preterm delivery showed that almost all the total effect of maternal CMV seropositivity i.e., 96,8%, acts directly on preterm delivery without passing through preeclampsia. The systematic review and meta-analysis (objective 3) noted the importance of occupational exposure to CMV. CMV seroprevalence and incidence of primary infection per 100 person-years remained high in the childcare worker group (59.3% [95% CI: 49.8-68.6] and 7.4 [95% CI: 3.9-11.8], respectively) and the healthcare worker group (49.5% [95% CI: 40.3-58.7] and 3.1 [95% CI: 1.3-5.6], respectively). CMV seropositivity and primary infection are significantly more prevalent among childcare workers compared to the comparison groups without occupational exposure. The Odds ratio (OR) for this difference is 1.6 (95% CI: 1.2-2.3), with a risk ratio (RR) of 3.4 (95% CI: 1.3-8.8). However, these differences are not observed in healthcare workers, where the OR is 1.3 (95% CI: 0.6-2.7) and the RR is 0.9 (95% CI: 0.6-1.2). In both groups, CMV seropositivity shows an association with factors such as multiparity, civil status, ethnicity, and age. In conclusion, this thesis shows that maternal CMV seroprevalence is variable. Parity, ethnicity, place of birth and occupational exposure would be the identified risk factors to consider when defining preventive measures for maternal CMV infection. The results of article 2 highlighted that maternal CMV seropositivity could be a risk factor for preeclampsia and preterm delivery. Keywords: cytomegalovirus, prevalence, incidence, seroconversion, pregnancy, serology, preeclampsia, preterm birth, occupational exposure, daycare worker, daycare center, healthcare workers.