<p>Infant and young child feeding practices are suboptimal in Tanzania, but optimal nutrition during the first two years of life is critical for development. At this age, behaviors of caregivers determine children’s diets, but few studies quantify how fathers or couples jointly influence child feeding. We investigate how men and women shape the family food environment to determine children’s diets in rural Mara, Tanzania. This mixed methods study used quantitative baseline data from the Engaging Fathers for Effective Child Nutrition and Development in Tanzania (EFFECTS) trial (ClinicalTrials.gov Identifier: NCT03759821), including 960 rural households with both parents and a young child. Logistic and linear mixed effects regressions examined associations between parental determinants and exclusive breastfeeding (n=189) and child dietary diversity over one day and one week (n=764 children 6-23 months; n=597 children 9-23 months). Parental determinants measured knowledge of breastfeeding and complementary feeding, self-efficacy on provision of diverse or nutritious diets, workload away from home, social support, household savings, and couples’ communication and decision-making, indicating women’s empowerment. Qualitative data drew from formative research (July-August 2018) conducted with parents of children aged 0-36 months, including eight focus group discussions (FGDs) with mothers and fathers (four FGDs each, 31 and 30 participants, respectively). FGDs were transcribed, translated, quality checked, and coded to identify key themes. The odds of exclusive breastfeeding decreased with mothers’ higher workload away from home and increased with mothers’ reports of more frequent couples’ communication over household decisions. Higher child dietary diversity was linked to mothers’ reports of higher knowledge of nutritious foods, higher social support, and higher couples’ communication frequency and quality. Generally, fathers’ determinants were not associated with children’s diets. Qualitative findings indicated that knowledge of exclusive breastfeeding was common, but challenges of perceived breastmilk insufficiency, women’s workload, and concerns about breastmilk quality led to early introduction of complementary foods. Affordability was a common challenge to appropriate complementary feeding, while couples’ decision-making dynamics and attitudes and beliefs about foods had the potential to be both enablers and barriers. Interventions must improve nutrition knowledge and social support, and they must empower women through joint decision-making and more gender-equitable workloads between parents to enable optimal child diets. </p>

Solicitud de embargo por publicación en revista indexada. / INTRODUCCIÓN: La lactancia materna exclusiva (LME) es la nutrición primordial del infante. El tipo de parto puede impactar en los conocimientos, actitudes y prácticas (CAP) de la LME. OBJETIVO: Evaluar la relación entre tipo de parto y CAP de LME de mujeres en edad fértil con hijos menores de 6 meses de edad en un hospital de Perú. MATERIALES Y MÉTODOS: Este estudio transversal analítico estuvo conformado por 126 mujeres con antecedente de parto vaginal (PV) y parto por cesárea (PC) que acudieron a cuatro consultorios externos del hospital. El instrumento consistió en un extracto del cuestionario nacional para datos sociodemográficos y un extracto del Manual CAP relacionado a la LME. RESULTADOS: El 61.9% tuvo PC. No se encontró relación significativa entre tipo de parto con conocimientos (p=0.574), actitudes (p =0.068) y prácticas (p=0.574) de LME. Las madres de 31 a 49 años (58.8%, p=0.032), casadas (63.6%, p=0.028) y universitarias (49.3%, p=0.026) tuvieron mayor nivel de conocimientos sobre LME. Los recién nacidos recibieron en su mayoría LME (71.2%, p=0.047). CONCLUSIÓN: No hubo diferencias de CAP según tipo de parto; esto podría deberse a una buena estrategia de salud en el cuidado postnatal hospitalario. La edad materna, el nivel de instrucción y el estado civil se encuentran relacionados al nivel de conocimiento de LME. Además, la edad del infante se encuentra relacionada a las prácticas exclusivas de lactancia materna. / INTRODUCTION: Exclusive breastfeeding (EBF) is the primordial nutrition of the infant. The type of delivery can impact knowledge, attitudes and practices (KAP) of EBF. OBJECTIVE: To assess the relationship between type of delivery and KAP of EBF in fertile women with children under 6 months of age in a hospital in Peru. MATERIALS AND METHODS: This analytical cross-sectional study consisted of 126 women with a history of vaginal delivery (VD) and cesarean delivery (CD) who attended to four outpatient offices of the hospital. The instrument consisted of an extract from the National Demographic and Family Health Survey (ENDES) and an extract from the KAP Manual related to EBF. RESULTS: Between the women, 61.9% had CD. No significant relationship was found between type of delivery with knowledge (p = 0.574), attitudes (p = 0.068) and practices (p = 0.574) of EBF. Mothers from 31 to 49 years old (58.8%, p = 0.032), married (63.6%, p = 0.028) and university students (49.3%, p = 0.026) had a higher level of knowledge about EBF. Most of the newborns received EBF (71.2%, p = 0.047). CONCLUSIONS: There were no differences in KAP according to type of delivery; this could be due to a good health strategy in the hospital postnatal care. Maternal age, educational level and marital status are related to the level of knowledge of EBF. In addition, the age of the infant is related to the exclusive practices of breastfeeding. / Tesis

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Die Arbeit geht der Frage nach, wie die meisten EU-Mitgliedstaaten eigenständige Regelungen für die Kontrolle ausländischer Direktinvestitionen haben können, obgleich ausländische Direktinvestitionen seit 2009 der gemeinsamen Handelspolitik der EU zuzuordnen sind. Die gemeinsame Handelspolitik ist eine ausschließliche Kompetenz der EU und schließt damit die Mitgliedstaaten von der Rechtsset-zung aus. Mit der Verordnung (EU) 2019/452 (Screening-Verordnung) werden den Mitgliedstaaten kaum Vorgaben gemacht, weshalb die Screening-Verordnung nicht als Ermächtigung der Mitgliedstaa-ten qualifiziert werden kann. Zunächst bestimmt die Arbeit die Weite der Kompetenzübertragung in Art. 207 AEUV im Bereich der autonomen Maßnahmen in Bezug auf ausländische Direktinvestitionen. Nachdem die Zuordnungskrite-rien der Rechtsprechung zur gemeinsamen Handelspolitik auf die neue Sachmaterie der ausländischen Direktinvestitionen übertragen wurde, werden verbreitete autonome Maßnahmen in Bezug auf auslän-dische Direktinvestitionen der gemeinsamen Handelspolitik zugeordnet. Unter Berücksichtigung des Art. 207 Abs. 2 AEUV stellt die Arbeit fest, dass die ausschließliche Kompetenz der EU im Bereich der autonomen Handelspolitik auf eine Rahmenrechtssetzungskompe-tenz beschränkt ist. Im Anschluss daran werden Kriterien für die Abgrenzung von Rahmenrechtsakten entwickelt. Sodann wird festgestellt, dass Art. 64 Abs. 2 AEUV eine geteilte Kompetenz für Vollrege-lungen für autonome Maßnahmen in Bezug auf ausländische Direktinvestitionen enthält und die aus-schließliche Rahmenrechtssetzungskompetenz der EU ergänzt. In Randbereichen kann sich ein Kompetenzvorbehalt zu Gunsten der Mitgliedstaaten ergeben. Die Arbeit untersucht daher die Regelungen zur nationalen Sicherheit in Art. 4 Abs. 2 EUV und Art. 346 Abs. 1 AEUV sowie den Eigentumsvorbehalt in Art. 345 AEUV. Abschließend stellt die Arbeit die Screening-Verordnung als Rahmenrechtsakt im Sinne des Art. 207 Abs. 2 AEUV dar. / The thesis examines the question of how most EU Member States can have independent regulations for the control of foreign direct investments, although foreign direct investments have become part of the EU's common commercial policy in 2009. The common commercial policy is an exclusive compe-tence of the EU and therefore excludes the member states from legislation in this field. Regulation (EU) 2019/452 (Screening Regulation) hardly sets any requirements for the member states, which is why the Screening Regulation cannot be qualified as an empowerment of the member states. First, the thesis determines the scope of the delegation of powers in Article 207 (1) TFEU in the area of autonomous measures in relation to foreign direct investments. After the classification criteria of the case law on the common commercial policy have been transferred to the new subject matter of foreign direct investments, widespread autonomous measures in relation to foreign direct investment are classified to the common commercial policy. Taking into account Article 207 (2) TFEU, the thesis establishes that the exclusive competence of the EU in the area of autonomous common commercial policy is limited to the competence to adopt framework regulations. Subsequently, criteria for framework regulations are developed. It is then es-tablished that Article 64 (2) TFEU contains a shared competence for regulations that goes beyond the scope of framework regulations for the autonomous regulation of foreign direct investment and supp-lements the EU's exclusive competence for framework regulations. In marginal areas, there may be a reservation of competence in favor of the member states. Therefo-re, the thesis examines the regulations on national security in Article 4 (2) TEU and Article 346 (1) TFEU as well as the reservation of ownership in Article 345 TFEU. Finally, the work presents the Screening Regulation as a framework regulation within the meaning of Article 207 (2) TFEU.

Today our city cores are being transformed. Not only have they been transformed from a place of production to a place of consumption, but more recently also the city core as a place of work are being challenged by increasing land prices and the desire to live centrally and urban. An urban lifestyle has in some ways become an exclusive benefit for the most wealthy, and the tall residential towers symbolizes this new urban, transnational elite, that wants the qualities of a living city center but prefers to live high up in the sky. Though this elite sometimes never lives there, since they only see the apartments as investments, as a “money deposit”. These buildings increase gentrification and segregation since they push up the housing prices of the city cores and provide no public functions, we get excluding cities rather than including. In my thesis project I speculate how we can prevent our city centers from becoming an excluding and exclusive gated community, and I develop a general redesign strategy for the exclusive residential tower typology. I have searched for a collective rather than individualistic approach, that considers both environmental and social sustainability.

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The purpose of the study was to identify factors associated with the HIV transmission rate in 18 to 24 month-old children enrolled in the PMTCT programme at two selected City of Tshwane clinics. Mother-to-child transmission of HIV during labour and breastfeeding accounts for 40% of all HIV infection in children. The prevention of mother-to-child transmission of HIV programme is one effective strategy to reduce the rate of HIV infection in children. The HIV transmission rate was low at six weeks of age but increases at 18 to 24 months of age due to several factors. The researcher selected a descriptive retrospective correlational research design. A structured questionnaire was used to collect data from 60 mothers of children aged 18 to 24 months on the PMTCT programme and a data-collection form to collect data from 152 clinic records of children of the same age on the programme. The study found that the PMTCT guidelines were not properly adhered to by the nurses and the respondents. Prophylactic treatment was not provided as required and mixed feeding was prominent. The uptake of HIV test at 18 to 24 months was low compared to at 6 weeks. The transmission rate was high at 18 to 24 months compared to at 6 weeks. No factors were associated with the transmission rate / Health Studies / M.A. (Public Health)

Ghana subscribed to the global target of reaching at least 50% of exclusive breastfeeding in the first six months of birth by the year 2030. Policies and programmes to promote exclusive breastfeeding have been formulated and implemented in the country. In spite of these efforts, existing evidence showed that the rate of exclusive breastfeeding in the first six months post-delivery has been declining over the past decade. It was therefore important to understand behavioural factors that influence exclusive breastfeeding among teenage-mothers and propose a behavioural conceptual model based on the understanding of exclusive breastfeeding from the perspective of the teenage-mothers and their social environments. The study was conducted in three phases using multistrand mixed methods within the pragmatism philosophical framework. The Theory of Planned Behaviour and the six steps framework for developing models to address public health issues were used as frameworks in the study. In the first phase, the researcher used qualitative exploratory descriptive design to gain an understanding of the behavioural determinants of exclusive breastfeeding from the perspective of teenagers aged between 13 - 19 years attending antenatal care services at public facilities. Data were generated through focus group discussions and analysed using Group-level thematic and content analysis. In the second phase, longitudinal descriptive correlational designs were used to establish the relationships between the exclusive breastfeeding intentions during the prenatal period and actual breastfeeding practices at six months post-delivery. Structured questionnaires were used to collect data during the last visit of antenatal care visits and six months post-delivery. Data generated were analysed through descriptive inferential statistics. In the last phase, the researcher used meta-inferences to identify the key concepts of conceptual model from the integrated qualitative and quantitative results. Theoretical triangulations were used to define and establish relationships between the concepts and to structure the conceptual model. The integrated results of the two phases of the study showed that exclusive breastfeeding practices among teenage-mothers within the social context of Ghana are determined by certain personal and social related behavioural factors. The approval of the exclusive breastfeeding practice by the teenagers’ mothers and nurses/midwives’ capabilities to provide effective breastfeeding education were the strongest determinants of exclusive breastfeeding up to six months among teenage-mothers in Ghana. From these results, the researcher proposed an integrated behavioural conceptual model that provides an understanding of exclusive breastfeeding practice and the process of promoting exclusive breastfeeding among teenage-mothers in the social context of Ghana. The findings of this study have implications for public health policy-makers, health services managers, health sciences education and further research. / Health Studies / D. Lit. et Phil. (Health Studies)

Comme deux éléments qui ne peuvent coexister sans se nuire, les exceptions au droit d’auteur et les mesures techniques de protection sont dans un rapport d’opposition. On ne compte plus dans la littérature spécialisée le nombre d’articles dédiés à leur incompatibilité. Les exceptions au droit d’auteur sont des « dérogations légales » au monopole d’exploitation. Elles permettent d’écarter la mise en oeuvre du droit exclusif alors que les conditions d’application de ce dernier sont réunies. Les mesures techniques de protection sont destinées à empêcher les utilisations interdites par les titulaires de droits. La question est de savoir si ces dispositifs techniques peuvent restreindre l’exercice des exceptions au droit d’auteur. La réponse est positive puisque la directive 2001/29/CE du 22 mai 2001 interdit de contourner des mesures techniques quand bien même il s’agirait de mettre en oeuvre une dérogation au droit d’auteur. Cependant, l’instrument européen instaure un régime de sauvegarde en faveur de certaines exceptions. Aussi, le législateur français a créé une autorité administrative indépendante – la Haute Autorité pour la diffusion des oeuvres et la protection des droits sur Internet – chargée de garantir le bénéfice de ces exceptions. Il est permis de se demander si l’instauration d’un régime de sauvegarde n’est pas la reconnaissance implicite de la valeur impérative des dérogations au droit d’auteur. En tous les cas, cela donne à penser que les exceptions constituent bel et bien des intérêts juridiquement protégés susceptibles d’être portés devant l’autorité judiciaire contrairement à ce qu’a jugé la Cour de cassation. / Like two elements that cannot coexist without working against each other, exceptions to exclusive rights and technological protection measures are in opposition. There are countless articles in the specialised literature devoted to their incompatibility. Exceptions to exclusive rights are “legal exemptions” from the operating monopoly. They enable the implementation of exclusive rights to be neutralised even though the conditions for the application of the latter have been met. Technological protection measures are intended to prevent unauthorised use by rightholders. The question is whether these technological systems can restrict the use of exceptions to exclusive rights. The answer is affirmative, since the directive 2001/29/CE of 22 May 2001 prohibits the circumvention of technological measures even though it would be a case of implementing an exemption to exclusive rights. The European instrument, however, establishes a protection system in favour of certain exceptions. Consequently, French lawmakers have created an independent administrative authority – the High Authority for the dissemination of creative works and protection of rights on the Internet – in order to safeguard the benefits of these exceptions. It could be asked whether the establishment of a protection system implicitly acknowledges the crucial value of these exceptions. In any event, it suggests that they do indeed constitute legally protected interests liable to be brought before the legal authorities, contrary to the Court of Cassation’s assertions.

The purpose of the study was to identify factors associated with the HIV transmission rate in 18 to 24 month-old children enrolled in the PMTCT programme at two selected City of Tshwane clinics. Mother-to-child transmission of HIV during labour and breastfeeding accounts for 40% of all HIV infection in children. The prevention of mother-to-child transmission of HIV programme is one effective strategy to reduce the rate of HIV infection in children. The HIV transmission rate was low at six weeks of age but increases at 18 to 24 months of age due to several factors. The researcher selected a descriptive retrospective correlational research design. A structured questionnaire was used to collect data from 60 mothers of children aged 18 to 24 months on the PMTCT programme and a data-collection form to collect data from 152 clinic records of children of the same age on the programme. The study found that the PMTCT guidelines were not properly adhered to by the nurses and the respondents. Prophylactic treatment was not provided as required and mixed feeding was prominent. The uptake of HIV test at 18 to 24 months was low compared to at 6 weeks. The transmission rate was high at 18 to 24 months compared to at 6 weeks. No factors were associated with the transmission rate / Health Studies / M.A. (Public Health)