The purpose of this paper is to create an understanding of the negotiation process behind the decision of who will stay at home with a sick child and to develop the knowledge of the mechanisms considered to affect the negotiation process, in particular, the mechanisms likely to contribute to an uneven use of care leave. In the study six interviews were conducted with three sets of parents. These interviews were then analysed with Janet Finch’s (1989) definition of negotiation of family responsibilities. The study finds that the negotiation on care leave is a result of the negotiation of the shared view of reality. This image is in turn influenced by a number of institutional aspects such as job design, relative resources, and the couple's ideological points. Previous studies that found that relative resources, converted to salary, affects the distribution greatest. Instead the results of this study points out that the nature of work is most important for how parents divide their care leave. If one parent have work that easier can be pushed forward or to be away from, the latter tend to be the one who stays at home. This arrangement, however, is affected by a number of other factors. For example, the ideas of a fair distribution of care leave counteract this tendency.

D.Litt.et Phil. (Psychology) / According to Cunningham (1978) there is a fair amount of controversy that surrounds the possible causes of auto-immune diseases. According to him there are two conflicting categories of causes of which psycho-social causes is one and abnormalities of the immune system is the other. Although a substantial amount of studies concerning the relationship between psychological factors and immune functioning have been done, the results have been inconclusive. The reason for this seems to be that there is a vast amount of mediating factors. A further aspect that needs to be taken into account is that psychoneuroimmunological research has focused mainly on adults. Schleifer, Scott, Stein and Keller (1986) is of the opinion that extensive research is required to study the effects of the central nervous system and behaviour during the early development of a person. The study attempted to identify possible psycho-social factors that could contribute to pediatric diseases such as rheumatoid arthritis. In order to identify factors that are unique to auto-immune diseases four groups were compared i.e, emotional disorders, behavioral disorders, auto-immune diseases and a "normal" group.

This non-experimental, descriptive, quantitative survey attempted to evaluate IMCI implementation in the eThekwini district of KwaZulu -Natal. The study focused on IMCI implementation by IMCI trained registered nurses, health facility support and follow-up and supervision. The research population comprised of all IMCI trained registered nurses working in health facilities in the eThekwini district. The convenient sample consisted of 40 research subjects. Data was collected by means of an interview schedule and a checklist, and analysed using Microsoft Excel 2007. Findings of the study revealed that many of the IMCI trained registered nurses were unable to assess, classify and treat the sick child comprehensively and consistently. The recommended follow-up visit at six weeks after completion of IMCI training, and lack of on-going supervision remains an area of concern. Recommendations were that district or clinic supervisors can enhance the skills of IMCI trained registered nurses through recommended follow-up visits and on-going supervision and the provision of updated IMCI chart booklets. / Health Studies / M.A. (Health Studies)

Thesis (M.Phil. (Social Work))--University of Stellenbosch, 1984. / 367 leaves printed on single pages,preliminary pages i - xiv and numberd pages 1-351. Includes bibliography and 3 figures. Digitized at 600 dpi grayscale to pdf format (OCR), using a Bizhub 250 Konica Minolta Scanner. / Please refer to full text.

It is widely known that HIV and ARV drugs trigger mitochondrial impairment in adults. However, their effects in perinatally-infected children have been poorly explored. For this reason, the main hypothesis of the present Thesis was to demonstrate that mitochondrial abnormalities are present in HIV-infected pediatric patients treated with ARV. It is expected to find mitochondrial alterations in asymptomatic perinatally HIV-infected children. This mitochondrial lesion, manifested in a depletion of the mitochondrial genome, would lead to a reduction of the mitochondrial protein synthesis or to a mitochondrial dysfunction and, as a last resort, compromising the cellular viability. However, it is also possible that the presence of homeostatic mechanisms in mitochondria entails a proper function of some complexes, even in the presence of mitochondrial genome depletion. Rather than a localized mitochondrial alteration in a specific enzymatic activity, it is possible that HIV and ARV cause a diffuse damage in the organelle which may be observed in a general assessment of the respiratory chain. In case of a mitochondrial alteration, either in asymptomatic or symptomatic patients, it would be expected a more evident presentation of mitochondrial toxicity in case of the latter. If our hypothesis of an evidence of mitochondrial toxicity derived from HIV and ARV in children is confirmed, we believe that, once the detrimental agent is withdrawn, a recover of the mitochondrial affectation is possible. Mitochondrial impairment may change depending on the type of HAART regimen, leading us to use mitochondrial parameters as a biomarker or a trail to find the best therapeutic options in the choice of different HAART schedules. In this context, the intensity of mitochondrial impairment over time would be higher in children receiving first generation NRTI which, in turn, have been demonstrated to present a higher mitochondrial toxicity in vitro, than those under second generation NRTI. In order to study and test our hypothesis, the main objectives of the present Thesis are: A) General Objective To test if HIV and ARV mechanisms of mitochondrial toxicity found in adults are present in perinatally HIV-infected children. B) Specific Objectives - Objective 1: To elucidate whether ARV treatment or HIV infection were exerting a mitochondrial toxic effect in asymptomatic perinatally HIV-infected pediatric patients receiving HAART. - Objective 2: To investigate if hypothetic alterations in the mitochondrial genome of asymptomatic HIV-infected children receiving ARV are downstream reflected at transcriptional, translational and functional levels. In case of mitochondrial dysfunction was present, to test whether MRC alterations are focalized or diffuse. - Objective 3: To determine mitochondrial status in lipodystrophic HIV-children and compare them to a group of asymptomatic children and to a group of uninfected controls. - Objective 4: To evaluate whether a 12-month interruption of ARV is able to improve or revert these hypothetic mitochondrial alterations at molecular and/or clinical level. - Objective 5: To compare mitochondrial toxicity derived from different HAART schedules in a longitudinal 2-year follow-up assessment of immunovirological and mitochondrial status under first or second generation NRTI. To elucidate whether those NRTI demonstrated to present high mitochondrial toxicity in vitro present a major toxicity in vivo as well.

Family Meetings occur frequently in the Paediatric Intensive Care Unit (PICU) yet little data existed to guide clinicians in the conduct of these meetings. The medical team is required to deliver complex medical information and navigate complex decision-making with a traumatised family during a meeting. The objectives of this study were to describe the content and process of 15 whanau/family meetings in the PICU, identify family meeting characteristics and patient and family attributes that influence family satisfaction and recommend guidelines for health professionals working in the PICU. The study was conducted in a PICU in a university-affiliated children’s hospital in New Zealand (NZ). The process and content of 15 family meetings were analysed using a coding framework previously developed through a qualitative study of family meetings in the adult intensive care unit (Curtis, 2002a). A questionnaire providing a quantitative assessment of family satisfaction drawn from the same study was administered to 30 family members. Demographic data for the study were collected from the patient’s hospital record and these were combined with data relating to the meeting recording and transcript to identify family meeting characteristics and attributes that might influence family satisfaction. The content and process of family meetings in the PICU were described using a framework detailing 28 codes from the six domains: introductions, informational exchange, discussions of the future, decisions, discussions about death and dying, and closings. A comparison of family meeting characteristics and patient and family attributes revealed that longer meetings (40 minutes plus) were associated with lower family satisfaction and should therefore prompt clinicians to consider whether there are unresolved conflicts, difficulties or misunderstandings between the medical team and the family. Recommendations are proposed to guide health professionals in family meetings in the PICU. This is the first study to record and code the content of family meetings in the PICU. The findings from this study will assist clinicians in their meetings with families. The description of the family meeting content will also provide a foundation for future communication training and research in the health environment.

published_or_final_version / Community Medicine / Doctoral / Doctor of Philosophy

This non-experimental, descriptive, quantitative survey attempted to evaluate IMCI implementation in the eThekwini district of KwaZulu -Natal. The study focused on IMCI implementation by IMCI trained registered nurses, health facility support and follow-up and supervision. The research population comprised of all IMCI trained registered nurses working in health facilities in the eThekwini district. The convenient sample consisted of 40 research subjects. Data was collected by means of an interview schedule and a checklist, and analysed using Microsoft Excel 2007. Findings of the study revealed that many of the IMCI trained registered nurses were unable to assess, classify and treat the sick child comprehensively and consistently. The recommended follow-up visit at six weeks after completion of IMCI training, and lack of on-going supervision remains an area of concern. Recommendations were that district or clinic supervisors can enhance the skills of IMCI trained registered nurses through recommended follow-up visits and on-going supervision and the provision of updated IMCI chart booklets. / Health Studies / M.A. (Public Health)

Esta pesquisa resulta do estudo realizado com professores do Atendimento Pedagógico Domiciliar na cidade de Curitiba - PR e suas concepções quanto a utilização de jogos didáticos no ensino e aprendizagem de conceitos científicos das disciplinas de Ciências e Biologia, Física, Matemática e Química. Apresenta os conceitos de Educação Inclusiva e Especial ressaltando o conceito de Atendimento Pedagógico Hospitalar e Domiciliar. Ainda destaca a estratégia da utilização dos jogos didáticos como fator de contribuição para o desenvolvimento de habilidades cognitivas e da autoestima seriamente comprometida em função da doença do aluno atendido por esse programa da Secretaria de Educação do Estado do Paraná. Os jogos foram selecionados na internet sendo que já haviam sido testados e com resultados já registrados. A produção foi artesanal. Para o levantamento de dados foram utilizadas perguntas semiestruturadas por meio de questionário e posterior entrevista com os professores do APD. A metodologia utilizada para a análise de dados foi a de estudo de caso com enfoque qualitativo. Segundo os professores entrevistados, os jogos didáticos confirmaram ser excelente estratégia de ensino e aprendizagem enriquecendo as aulas e proporcionando aos alunos a oportunidade de aquisição do conhecimento de forma leve e divertida. / This research is the result of a study conducted with teachers Pedagogical Household Care in Curitiba - PR and conceptions about the use of educational games in teaching and learning of scientific disciplines of science and biology, physics, mathematics and chemistry concepts. Introduces the concepts of Inclusive Education and Special highlighting the concept of Hospital and Home Teaching Service. Also highlights the strategy of using educational games as a contributing factor for the development of cognitive skills and self-esteem seriously compromised because of the student served by this program the Department of Education of the State of Paraná disease. The games were selected on the internet of which had already been tested and results have already registered. The production was handmade. Semi- structured questions were used by a questionnaire and subsequent interviews with the teachers of the DPA for data collection. The methodology used for the data analysis was a case study with qualitative approach. . According to the interviewed teachers, educational games confirmed to be excellent strategy for teaching and learning enriching classes and giving students the opportunity to acquire the knowledge of light and fun way. / 5000

Indiana University-Purdue University Indianapolis (IUPUI) / On October 18, 1982, the Ronald McDonald House of Indiana (RMHI) opened near downtown Indianapolis on the campus of Indiana University Purdue University at Indianapolis (IUPUI), located within walking distance of the prestigious Riley Children's Hospital. The Ronald McDonald House (RMH) concept represented an almost perfect intersection between philanthropy and families in need. Creating the RMHI offered the opportunity for individuals, corporations, and benevolent organizations to come together and build a "home-away-from-home" for the families of sick children. When the RMH idea arrived in Indianapolis in the late 1970s, a group of collaborators representing the McDonald's corporation and restaurant owners, Riley Hospital, IUPUI, and the Indianapolis community banded together to make it a reality. On October 18, 1982, after nearly three years planning, fundraising, and construction, the RMHI's advocates and their supporters celebrated the successful opening of Indiana's only RMH. After this momentous occasion, the RMHI's board of directors and their community and corporate partners worked throughout the 1980s and 1990s to sustain, operate, and expand the home they created for the families of seriously ill children receiving treatment at Riley.