Due to its limiting effects on the independency of life, the Alzheimer's disease has a radical impact on a diseased person. Their dependency on others influences all their family members, though especially those ones, who are taking immediate part in the caregiving for their relatives. The new changes in the family caregivers' lifestyle have an extensive influence on their health and the care about the diseased itself. In this empirical study we intended to examine the presence and the intensity of a burden, an anxiety and a depression among the family caregivers, who are being provided with psychosocial and other professional help. It's a transverse survey among the 102 family caregivers caring for their relatives with diagnosed Alzheimer's disease or some other form of dementia. The caregivers were tested for the level of subjective burden by Zarit Burden Inventory (ZBI) and for the anxiety and the depression by Beck Depression Inventory (BDI II), Geriatric Depression Scale (GDS) and Beck Anxiety Inventory (BAI), the results were processed with the statistical analysis and Pearson correlation coefficient. In the study sample there were 83 % of women and 62 % of the caregivers were older than 50 years. According to our findings 86 % of people caring for less than 2 years and 89 % of people caring...

Submitted by Ana Maria Fiscina Sampaio (fiscina@bahia.fiocruz.br) on 2012-09-04T18:27:25Z No. of bitstreams: 1 Wildo Navegantes Aspectos epidemiologicos da leptospirose....pdf: 1357912 bytes, checksum: 01380ce81c921e78d62f63cce2d77036 (MD5) / Made available in DSpace on 2012-09-04T18:27:25Z (GMT). No. of bitstreams: 1 Wildo Navegantes Aspectos epidemiologicos da leptospirose....pdf: 1357912 bytes, checksum: 01380ce81c921e78d62f63cce2d77036 (MD5) Previous issue date: 2010 / Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, Bahia, Brasil / A leptospirose é a principal doença infecciosa zoonótica em áreas urbanas nos países em desenvolvimento, porém subnotificada. O conhecimento e as atitudes sobre a leptospirose é desconhecida nas comunidades brasileiras onde a doença é prevalente. Objetivos: 1) Descrever os casos notificados de leptospirose, fatores de risco para óbito, influência das chuvas em cidades metropolitanas e parte da carga da leptospirose no Brasil, 2000-2009. 2) Descrever o conhecimento e as atitudes sobre leptospirose dos moradores de uma favela na cidade de Salvador. Métodos:1) Foram descritos os casos notificados de leptospirose no Sistema Nacional de Vigilância de 2000 a 2009. Foi analisada a influência das chuvas e a ocorrência de casos de leptospirose em cinco metrópoles brasileiras. Foram calculadas as taxas de incidência, hospitalização, mortalidade e letalidade por leptospirose e foram avaliados os fatores de risco para óbito a partir das variáveis demográficas entre os casos confirmados. 2) Foi conduzido um estudo transversal sobre o conhecimento e atitudes sobre leptospirose na comunidade de Pau da Lima, Salvador – Bahia. Resultados: 1) A doença acomete populações vulneráveis socialmente que vivem em áreas urbanas. As taxas de incidência, hospitalização, mortalidade e letalidade foram 1,48, 1.04, 0,12 por 100.000 habitantes e 9%, respectivamente. A partir de 15 anos de idade (OR=1,88; IC95% 1,39-2,55), baixo nível educacional (OR=1,35; IC95% 1,17-1,56), viver em área urbana (OR=2,19; IC95% 1,80-2,69) foram detectados como fatores de risco para óbito entre os casos confirmados. As chuvas tiveram forte relação com a ocorrência de surtos sazonais da doença em cinco cidades metropolitanas. 2) 72,7% das pessoas sabem que a leptospirose é uma doença transmitida por ratos, 56,4% reconhecem que pegam a doença com o contato com urina de ratos, 17,8% referiram limpar esgotos ao redor da sua casa, 35,5% referiram usar luvas e 33,3% botas para se proteger. Conclusão: No Brasil, a doença acomete homens adultos, com baixa nível educacional que vivem em áreas urbanas, tais achados estão associados a óbitos. Muitos surtos sazonais ocorreram sob influência das chuvas nas cidades metropolitanas estudadas. Na comunidade de Pau da Lima, uma favela de Salvador, as pessoas conhecem a leptospirose e as principais atitudes detectadas estão relacionadas as contínuas exposições a água de chuvas e esgotos na comunidade. As conclusões deste trabalho apontam para a necessidade de estruturar serviços de saúde que antecedam as chuvas, e para obras de saneamento básico em regiões metropolitanas com maior incidência da doença. Recomendamos que sejam realizados outros estudos sobre o conhecimento em relação a leptospirose para entender os déficits de informação da população, assim como instruí-los para organizadamente cobrarem soluções como obras de saneamento básico que minimizem o impacto da leptospirose na população. / The leptospirosis is major zoonotic infectious disease in urban areas in the developing countries. However, the leptospirosis is underreported in the world. The knowledge and attitudes about leptospirosis of the communities which suffer due the leptospirosis is unavailable. Objectives 1) To describe the leptospirosis cases reported, risk factors for death, influence of the rainfalls in metropolitan cities and, part of the burden caused by the leptospirosis in Brazil from 2000 through 2009. 2) To describe the knowledge and attitudes about leptospirosis in slum area in metropolitan city of the Brazil. Methods: 1) Were described the leptospirosis cases reported in the National Surveillance System from 2000 to 2009. Were analyzed the influence of the rainfalls in metropolitan cities, were analyzed frequency measures and, were identified risk factors for death. 2) Was conducted a cross-section study about the knowledge and attitudes about leptospirosis in the community of “Pau da Lima”, Salvador- Bahia. Results: 1) The disease attacks adult men in economically active age with low educational level living in urban areas. Incidence, hospitalization, mortality and lethality rates were 1.48, 1.04, 0.12 per 100.000 inhabitants, and 9% respectively. Being aged 15 or above (OR=1.88; IC 95% 1.39-2.55), having low educational level (OR=1.35; IC 95% 1.17-1.56), and living in urban areas (OR=2.19; IC 95% 1.80-2.69) have been detected as risk factors for death among the confirmed cases. Rains were strongly related to the occurrence to seasonal outbreaks of the disease in five metropolitan cities studied. 2) In an urban slum in Salvador, 72.7% of the individuals know that leptospirosis is a disease transmitted by rats, 56.4% recognized that the disease can be contracted by getting in contact with the urine of rats, 17.8% clean the sewers surrounding their houses, 35.5% wear gloves and 33.3% wear boots to protect them. Conclusion: In Brazil, the disease attacks adult men with low educational level living in urban areas, these covariates are associated to death. Many seasonal outbreaks occur in the studied metropolitan cities under the influence of rain. In a slum area in Salvador, people know leptospirosis and the main attitudes detected are related to continuous exposition of the community to rainfalls and sewers. Health policies geared to structuring health services prior to rains and the implementation of basic sanitation infrastructure to be requirements for minimizing the occurrence of leptospirosis in mega cities. We also recommend the conduction of studies on the knowledge and attitudes in order to understand population’s information deficit, as well as to instruct them to demand solutions such as the construction of basic sanitation infrastructure in an orderly manner.

Submitted by Ana Maria Fiscina Sampaio (fiscina@bahia.fiocruz.br) on 2014-10-29T14:29:22Z No. of bitstreams: 1 Paulo Roberto Fontes Athanazio. Um método de contagem... 2014.pdf: 318362 bytes, checksum: 072e0651f6d0f2f5e3be2d66a40acc39 (MD5) / Made available in DSpace on 2014-10-29T14:29:22Z (GMT). No. of bitstreams: 1 Paulo Roberto Fontes Athanazio. Um método de contagem... 2014.pdf: 318362 bytes, checksum: 072e0651f6d0f2f5e3be2d66a40acc39 (MD5) Previous issue date: 2014 / Fundação Oswaldo Cruz. Centro de Pesquisa Gonçalo Moniz. Salvador, BA, Brasil / Introdução. É consenso que o laudo anatomopatológico de produtos de prostatectomia radical deve relatar de forma quantitativa a extensão do carcinoma prostático, mas qual o método a ser usado não é consensual. Objetivos. Relatar a experiência de um método de contagem de pontos adaptado em produtos de prostatectomias (n= 143) adaptado de Billis et al., Int Braz J Urol. 2003.29:113-120. Material e métodos. As margens basal e apical foram processadas pelo método do cone. O restante da próstata foi dividido em 12 regiões em forma de quadrantes: cada uma representada com duas secções. Em cada fragmento, oito pontos equidistantes foram marcados diretamente sobre a lamínula com caneta permanente. Os pontos presentes dentro da área do tumor foram contados e expressos na forma de percentagem de envolvimento por carcinoma (PEC) ou como volume do tumor (VT). Estes foram comparados com o método quantitativo mais usual de número de secções envolvidas (NSE). Resultados. Os três métodos apresentaram correlação moderada significante com níveis pré-operatórios de PSA, mas esta foi maior para os métodos baseados na contagem de pontos: NSE (r = 0.32), PEC (r = 0.39) e VT (r = 0.44). Quando estratificados em três categorias, os três métodos mostraram associação com escore de Gleason ≥7, Gleason primário ≥4, invasão angiolinfática e perineural, extensão extraprostática, envolvimento de vesículas seminais e margens positivas. Conclusão. Os três métodos quantitativos estão associados a marcadores morfológicos de progressão do carcinoma da próstata. Os métodos baseados na contagem de pontos proposta apresentam mais forte correlação com níveis pré-operatórios de PSA sérico. / Objective: To evaluate a modified point-count method for quantifying carcinoma in prostatectomy specimens (n=143), adapted from Billis et al., Int Braz J Urol. 2003.29:113-120. Methods: The basal/apical margins were sampled using the cone method. The remainder of the gland was divided into 12 quadrant-shaped regions which had two slices sampled. Eight equidistant points were marked directly on the coverslip over each fragment. The points inside the tumoral areas were counted and expressed as the percentage of prostate gland involvement by carcinoma (PGI) and as the tumor volume (TV). Results: A significant correlation between the preoperative PSA level and each of the three quantitative estimations was found, but it was higher for both values (PGI and TV) obtained using the point-count method, viz.: number of slices involved (NSI) (r = 0.32), PGI (r = 0.39) and TV (r = 0.44). When the data sets were stratified into three categories, all three methods correlated with Gleason scores ≥7, primary Gleason scores ≥4, perineural / angiolymphatic invasion, extraprostatic extension, seminal vesicle invasion and positive margins. Conclusion: All three quantitative methods were associated with morphologic features of tumor progression. The results obtained using the modified point-count method correlated better with the preoperative PSA levels.

A presença de doença crônica pode ser determinante de sobrecarga familiar e interferir no ambiente. Por outro lado, os aspectos familiares podem contribuir como um fator protetor ou de risco na evolução da doença. Estudos têm avaliado a sobrecarga familiar em transtornos mentais maiores, como a esquizofrenia, mas ainda não há estudos que avaliem a sobrecarga e o ambiente familiar em relação ao transtorno de pânico (TP). O objetivo deste estudo foi comparar a sobrecarga e o ambiente de familiares de pacientes com TP e de familiares de pacientes com doenças clínicas. Também pretendeu verificar a relação da sobrecarga e do ambiente familiar com as características sociodemográficas dos familiares e com a gravidade do TP. Trata-se de um estudo transversal com familiares e pacientes com TP e familiares de pacientes com doenças clínicas, como hipertensão arterial sistêmica (HAS), diabete melito tipo 2 (DM 2) e cardiopatias. A sobrecarga foi mensurada através do Family Burden Interview Schedule (FBIS-BR) e, para avaliar o ambiente familiar, foi utilizada a Family Environment Scale (FES). Para verificar a gravidade dos sintomas do TP, foi utilizada a Panic Disorder Severity Scale (PDSS). A pesquisa foi desenvolvida em ambulatório de hospital geral e aprovada pelo Comitê de Ética em Pesquisa do Hospital de Clínicas de Porto Alegre (nº 110109). Foram incluídos no grupo do TP 67 familiares com seus respectivos pacientes e 66 familiares de pacientes com doenças clínicas. Observou-se que existem diferenças significativas entre as características sociodemográficas dos grupos. Entre os familiares de pacientes com TP, predominam indivíduos do sexo masculino e com maior escolaridade do que no outro grupo. Em relação ao grau de parentesco, há um maior número de pais como familiares cuidadores de pacientes com TP e mais filhos(as) como cuidadores de pacientes com doença clínica. A sobrecarga objetiva “assistência à vida cotidiana”, “impacto nas rotinas diárias” e “geral” foi significativamente maior para familiares de pacientes com doenças clínicas (p=0,017; p=0,032 e p=0,024, respectivamente), enquanto a sobrecarga subjetiva “assistência na vida cotidiana” foi maior para familiares de pacientes com TP (p=0,025). O ambiente familiar foi diferente entre os grupos na dimensão “conflito”, sendo significativamente maior no grupo de familiares do TP. Após a análise multivariável com o Generalized Linear Models, permaneceu como variável independente de maior sobrecarga subjetiva quando o familiar é um dos pais em ambos os grupos (p=0,001). A sobrecarga objetiva manteve-se no grupo controle (p<0,05), sendo que a subescala “impacto nas rotinas diárias” e o escore geral permaneceram associados caso o familiar fosse um dos pais (p=0,017 e p=0,021, respectivamente). O ambiente na dimensão “conflito” foi maior quando o familiar era um dos pais (p=0,045) e a “organização” foi menor no grupo de familiares de pacientes com TP (p=0,034). Também foi analisado se pertencer a um dos grupos (controle ou do TP) e se o grau de parentesco determinava a sobrecarga familiar, porém não foi encontrada interação significativa. Observou-se correlação positiva significativa entre a gravidade do TP e sobrecarga familiar objetiva e subjetiva, que se manteve como variável independente após a análise multivariável. Os resultados indicaram que existem diferenças entre os grupos quanto à sobrecarga objetiva e subjetiva e que são determinadas pelo grau de parentesco, sendo maior principalmente quando o familiar é um dos pais. Os resultados também demonstraram queque a sobrecarga familiar está relacionada à gravidade dos sintomas do TP. Portanto, a avaliação de sobrecarga familiar pode ser útil no desenvolvimento de estratégias terapêuticas focadas na própria família e, assim, contribuir para melhorar os resultados dos pacientes. / The presence of chronic disease can be a determinant of family burden and impinge upon the family environment. On the other hand, family aspects can serve as a protective or risk factor in disease evolution. Studies have assessed the family burden associated with major mental disorders, such as schizophrenia, but there are no studies that assess the family burden and environment in relation to Panic Disorder (PD). The purpose of this study was to compare the burden and environment of family members of PD patients with family members of patients with clinical diseases. It also sought to examine the relationship between family burden and environment with the sociodemographic characteristics of family members and PD severity. This was a cross sectional study involving family members and PD patients and a control group of family members of patients with clinical diseases, such as systemic arterial hypertension (SAH), diabetes mellitus type 2 (DM2) or heart diseases. Burden was measured through the Family Burden Interview Schedule (FBIS-BR) and the family environment was assessed using the Family Environment Scale (FES). To check PD symptom severity, the Panic Disorder Severity Scale (PDSS) was used. The research was conducted in the general hospital outpatient clinic and approved by the Research Ethics Committee of Hospital de Clinicas de Porto Alegre (No. 110109). The groups were comprised of 67 family members with their respective PD patients and 66 family members of control group. It was noted that there are significant differences between the sociodemographic characteristics of the groups. The family members of PD patients are predominantly males with a higher level of education than the control group. As far as the parentage degree, there are a greater number of parents acting as family caregivers for PD patients and more sons or daughters as caregivers for patients with clinical diseases. The objective burden with respect to "assistance in everyday life", "impact on caregiver’s life " and "general" was significantly higher for family members of control group (p = .017; p = .032 and p = .024, respectively), whereas the subjective burden in terms of "assistance in everyday life" was higher for family members of patients with PD (p = .025). The family environment was different between the groups in regard to the "conflict" dimension, being significantly higher in the group of family members of PD patients. After the multivariate analysis using Generalized Linear Models, the independent variable with the highest subjective burden occurred when the family member is one of the parents regardless of the group (p = .001). The objective burden remained the same in the control group (p <.05), and the subscale of "impact on caregiver’s life" and overall score continued to be linked if the family member was one of the parents (p = .017 and p = .021, respectively). The "conflict" dimension of the environment was higher when the family member was one of the parents (p = .045) and "organization" was lower in the group of family members of PD patients (p = .034). It was also examined whether belonging to one of the groups (control or PD) and the parentage degree has a bearing on family burden, but no significant association was found. A significant positive correlation was noted between PD severity and objective and subjective family burden, which remained as an independent variable after the multivariate analysis. The results also demonstrated that family burden is related to PD symptom severity. Therefore, assessment of family burden may be useful in developing therapeutic strategies focused on family itself and thus contribute to improve patients outcomes.

The aim of this theses is analysis of the differences between the business companies in terms of accounting and taxes and evaluation of the tax burden of incomes of the partners. This work is devided into two parts. The theoretical part deals with economic result and incomes of partners in the business companies. These theoretical findings are used for processing of the practical part of the theses.

A pesquisa aferiu junto as operárias da empresa metalúrgica FAET sua percepção do significado do trabalho e da sobrecarga doméstica em suas vidas. A partir de uma fundamentação da centralidade do trabalho na sociedade capitalista, da importância do trabalho para a formação do ser social e da influência da divisão social do trabalho na manutenção das desigualdades no âmbito do trabalho e da família. / The research verified, among women workers in the metallurgic company FAET, their perception of the meaning of their work and of the domestic surcharge they carry in their lives. This research was built based on some fundaments: the centrality of work in capitalist society, the importance of work to build the social being, and the influence of the division of work to maintain the prevailing inequalities in work and in family

A presente dissertação toma como propósito compreender de que forma a ideia do peso do conhecimento é apresentada no Fausto de Fernando Pessoa. A expressão peso do conhecimento, cunhada pelo filósofo Stanley Cavell, surge como forma de apresentação da tragédia na modernidade. O Fausto de Fernando Pessoa, mediante a sua queda na mente, relata, no encontro com a Morte, a figuração máxima de todo e qualquer conhecimento; a afetação trágica que o consome. Esse trabalho, portanto, inaugura a perspectiva que visa explorar, como forma de compreensão da obra pessoana, a ideia de que a tragédia moderna é o peso do conhecimento. E, ao mesmo tempo, sustenta a hipótese de que o peso do conhecimento pressupõe o reconhecimento de que toda vida do conhecedor termina num tipo de tragédia shakespeariana. Assim, a obra de Fernando Pessoa se apropria de uma longa tradição que se inicia com Hamlet e, com ela, delineia, a partir do problema do peso do conhecimento, a teatralidade da escrita dos versos de Fausto, cuja apresentação do dilema entre a Vida e o Conhecimento pressupõe a cena imediata de uma figura, Fausto (ou Hamlet / The present thesis proposes to comprehend how the idea of burden of knowledge is presented in Fernando Pessoas Faust. The expression burden of knowledge by philosopher Stanley Cavell arises as a way of presenting tragedy in modernity. Fernando Pessoas Faust, due to the fall inside his mind, narrates, during his encounter with death, the most emblematic figure of all possible knowledge, a tragic affectation that has consumed him. The present work, therefore, launches the perspective that aims to explore, as a mean of understanding Pessoas literary work, the idea that modern tragedy is the burden of knowledge. Also, at the same time, it sustains the hypothesis that the burden of knowledge presumes the recognition that the knowers life ends up in some sort of Shakespeares tragedy. Thus, Fernando Pessoas work borrows a long tradition that has begun with Hamlet and with it, based on the question of the burden of knowledge, he outlines the theatricality found in Fausts verses, which presentation of the dilemma between Life and Knowledge presumes the immediate scene of a figure, Faust (or Hamlet)

Uma análise exegética do texto de Isaías 58.1-14 que tem como tema central o jejum, buscando conhecer quem é Iahweh para este profeta. A primeira parte aborda a origem do jejum e a sua prática até os dias contemporâneos no judaísmo. Compreende-se que a prática do jejum está presente no povo de Israel, desde antes da entrada na terra de Canaã e tem sua origem nos cultos funerários cananeus, onde se jejuava para evitar que o espírito dos mortos entrasse nos alimentos. Visam-se diferentes releituras em cada tempo histórico. O termo hebraico "tsôm" (jejum) abrange um conjunto de ritos, como por exemplo: colocar cinza na cabeça; deitar sobre pano de saco e cinza; sacrifícios de animais e orações de lamentação. Na época do primeiro e segundo templo, o jejum era realizado pelo povo no dia das expiações, isto é, o dia em que o sumo sacerdote entrava no santo dos santos para pedir a expiação de seus pecados e os do povo. O significado do jejum é um ato de auto-humilhação da pessoa ou da comunidade que reconhece suas próprias culpas e quer obter de Iahweh alguma concessão. No judaísmo atual, este dia das expiações é o Yom Kippur, dia de expiação dos pecados, dia de jejum por excelência. Na segunda parte, a tradução do hebraico mostra que o profeta coloca na boca do povo uma queixa: por que jejuamos e não vês? (Is 58.3a). O verdadeiro jejum é um dia agradável a Iahweh e não um dia de autossatisfação como estava acontecendo entre este povo. Esse povo era muito religioso e buscava aparentemente a justiça de Iahweh, mas praticava o rito do jejum vazio de compromisso com os desvalidos e com a transformação da sociedade. O verdadeiro jejum que Iahweh quer e aceita é desamarrar as algemas da maldade, soltar os laços da canga, despedir os esmagados livres, e toda canga despedaçar. No nível de relações interpessoais é partir o pão; fazer entrar em casa os desterrados; vestir o nu e não esconder-se daquele que é tua carne. Essas práticas são as prescrições do ano do jubileu, as quais são motivo de abundantes bênçãos de Iahweh para quem as pratica. Estas bênçãos são apresentadas com abundante e rica simbologia: a luz, a água e o alimento. O texto termina com a prescrição sobre o sábado, dia também de jejum. No texto emergem assuntos relevantes como o da salvação tão esperada ao retorno do exílio e que tarda a chegar; as pautas da nova comunidade proposta que ultrapassam a história e a inclusão universal ou cosmovisão cósmica. A última parte indica alguns apontamentos para nossa prática de fé atual como a renovação do compromisso social com os mais pobres e com a transformação das estruturas injustas da sociedade; uma revisão dos ritos e gestos litúrgicos; uma pregação que recorda a dimensão escatológica e a visão cósmica da salvação. / An exegetical analysis of Isaiah 58.1 to 14 which has as central theme the fasting, seeking to know who is Iahweh to this prophet. The first part discusses the origin of the fasting and practice to this day in Judaism. It is thought that the practice of fasting is present in the people of Israel, since before the entrance into the land of Canaan and has its origin in the Canaan funeral services, where the fasting were practiced in order to prevent the spirit of the dead to enter into the food. Different readings were made in each historical time. The Hebrew term "tsom" (fasting) comprises a set of rituals, for example, putting ashes on their heads, lying on sackcloth and ashes, animal sacrifices and prayers of lamentation. At the time of the conclusion of the first and second temple, fasting was done by people on the Day of Atonement, this is, the day the high priest entered the Holy of Holies to seek atonement for their sins and of the people. The significance of fasting is an act of self-humiliation of the person or community that recognizes its own guilt and wants to get some concession from Iahweh. Today this Day of Atonement is Yom Kippur, a day of atonement for sin in Judaism today, and day of fasting for excellence. The second part of the Hebrew translation tells us that the prophet puts in peoples mouth a complaint: Why do we fast and you dont see? (Is 58. 3a). True fasting is a nice day to Iahweh and not a day of self-satisfaction like was happening among people who were very religious and they apparently sought the righteousness of Iahweh, but they practiced the rite of fasting void of commitment to the underprivileged and the transformation of society. True fasting that Iahweh wants and accepts is to untie the bonds of wickedness, to lose the cords of the yoke, to dismiss the crushed free, and to waste all yoke. At the level of interpersonal relationships is the breaking of bread; to come home the exiles, clothe the naked and not hide themselves from their own flesh. These practices are the requirements of the jubilee, which are the reasons of Iahweh's abundant blessings to those who practice. These blessings are presented with rich and abundant symbols: light, water and food. The text ends with a prescription on Saturday, a day for fasting as well. In the text, relevant issues emerge as the salvation of the long-awaited return from exile and so long to arrive, the guidelines of the proposed new community beyond the story and the inclusion of universal or cosmic worldview. In the last part some notes for our current practice of faith as the renewal of the social commitment with the poor and the transformation of unjust structures of society, a revision of the rites and liturgical gestures, preaching that recalls the eschatological and cosmic vision of the salvation.

Doctor of Philosophy / Human Nutrition / Richard R. Rosenkranz / Child stunting refers to a condition where the child is relatively shorter in height, in comparison to their age group. Child stunting is a public health nutrition problem that hinders the development of future generations, not only physiologically but also potentially deprives their cognitive function and productivity. The demographic transition, conjoined with the epidemiological and nutrition transitions, has resulted in the coexistence of an over- and under-nutrition problem known as double burden of malnutrition, and child stunting has been a persistent part of the problem. In 2014, the World Health Organization (WHO) reported that one-fourth of the children in the developing countries have been suffering from child stunting. The objective of this research was to apply the behavioral epidemiology approach to tackle child stunting in households with double burden of malnutrition. It was hypothesized that unlike any other households with problem of child stunting, households with double burden of malnutrition possess some degree of capacity that, with proper support and direction, might enable them to help themselves reduce or prevent this nutrition-related debacle. Results from a secondary data analysis revealed that child stunting was associated with lower dietary diversity as an indication of poor food choice in the household, related to children’s nutrient requirements. Another cross-sectional study in this dissertation was conducted in an urban setting in Indonesia, and found that households with child stunting alone was associated with extreme food insecurity, while households with double burden of malnutrition ─ in the form of stunted child and overweight/obese mother (SCOWT) ─ was associated with even a mild degree of food insecurity. These results support our hypothesis that households with double burden of malnutrition lack the capacity to direct their resources properly to prevent child stunting. Most notably, we expected that the role of the mothers to manage healthy food choices through indirect measure of dietary diversity, availability and distribution within the household was lacking. In order to equip mothers with necessary components to be able to overcome these problems, we conducted a behaviorally based intervention that targeted mothers in the households experiencing the problem of double burden of malnutrition. The intervention provided the potential to achieve participant self-administered goal setting to improve diet, as well as child feeding behavior, by means of improved self-efficacy, nutrition literacy and dietary diversity. Maternal self-efficacy may be potentially enhanced by vicarious experience and active mastery experience gained during 6 sessions of behavioral intervention and verbal motivation by community health workers during 6 additional home visits. These studies, collectively comprising the present dissertation, present a message for policy makers in developing countries: nutrition literacy and behaviors for choosing healthy foods are lacking in mothers that affect both maternal and child food intake, but efforts such as improving vicarious and mastery experience on child feeding practices and healthy food choices can boost mother’s self-efficacy to engage in appropriate behaviors and improve their child’s nutrition.

No description available.