<p>Background: The Baby Friendly Hospital Initiative (BFHI) is considered one of the most successful international efforts to protect, promote and support breastfeeding. The initiative has proven impact, increasing the likelihood of babies being exclusively breastfed for six months. Official designation as Baby Friendly requires careful assessment completed by a trained external team to confirm that the institution is truly carrying out all Ten Steps of successful breastfeeding and conforming to the International Code of Marketing of Breastmilk Substitutes (BMS).The implementation of these principles are however challenging for facilities as it requires &ldquo / strategic planning, implementation and maintaining change&rdquo / within the facilities. Aim: To assess the factors influencing the implementation of BFHI principles in non accredited MOU` s in the Metropole region of the Western Cape.</p>

Este trabalho tem o objetivo de discutir o surgimento e desenvolvimento da noção de qualidade de vida como uma estratégia de avaliação em saúde, a partir da trajetória do instrumento de qualidade de vida da Organização Mundial de Saúde, WHOQOL. Através de uma perspectiva construcionista foi realizada uma pesquisa bibliográfica e documental identificando os usos da noção de qualidade de vida nas políticas de saúde internacionais e na literatura médica. A discussão proposta pelo trabalho aponta para as relações entre os processos de globalização e o campo da saúde como a matriz política e cognitiva para o surgimento dos instrumentos de avaliação de qualidade de vida, principalmente a partir de sua perspectiva transcultural. A criação e uso do WHOQOL em seus diversos centros de pesquisa distribuídos em 40 países visam produzir consensos técnicos e políticos para a construção de sistemas de informação em saúde baseada em critérios universais, possibilitando às agências internacionais, como a OMS, influir globalmente sobre as políticas nacionais de saúde. / This work aims to discuss the emergence and development of the concept of quality of life as an strategy to assess health, based on the WHOQOL, an instrument developed by the World Health Organization to assess quality of life. Through a constructionist perspective, a bibliographical and documental research has been carried out, in order to identify uses of the concept of quality of life in international health policies and in medical literature. The discussion provided by this work points to the relations between globalization processes and the health area as political and cognitive matrix for the emergence of tools to assess quality of life mainly from their transcultural perspective. The creation and use of the WHOQOL in research centers in 40 countries aim to produce technical and political consensus to build health information systems based on universal systems, and afford international agencies, like WHO, worldwide influence on national health politics.

Este trabalho tem o objetivo de discutir o surgimento e desenvolvimento da noção de qualidade de vida como uma estratégia de avaliação em saúde, a partir da trajetória do instrumento de qualidade de vida da Organização Mundial de Saúde, WHOQOL. Através de uma perspectiva construcionista foi realizada uma pesquisa bibliográfica e documental identificando os usos da noção de qualidade de vida nas políticas de saúde internacionais e na literatura médica. A discussão proposta pelo trabalho aponta para as relações entre os processos de globalização e o campo da saúde como a matriz política e cognitiva para o surgimento dos instrumentos de avaliação de qualidade de vida, principalmente a partir de sua perspectiva transcultural. A criação e uso do WHOQOL em seus diversos centros de pesquisa distribuídos em 40 países visam produzir consensos técnicos e políticos para a construção de sistemas de informação em saúde baseada em critérios universais, possibilitando às agências internacionais, como a OMS, influir globalmente sobre as políticas nacionais de saúde. / This work aims to discuss the emergence and development of the concept of quality of life as an strategy to assess health, based on the WHOQOL, an instrument developed by the World Health Organization to assess quality of life. Through a constructionist perspective, a bibliographical and documental research has been carried out, in order to identify uses of the concept of quality of life in international health policies and in medical literature. The discussion provided by this work points to the relations between globalization processes and the health area as political and cognitive matrix for the emergence of tools to assess quality of life mainly from their transcultural perspective. The creation and use of the WHOQOL in research centers in 40 countries aim to produce technical and political consensus to build health information systems based on universal systems, and afford international agencies, like WHO, worldwide influence on national health politics.

Made available in DSpace on 2014-07-29T15:29:12Z (GMT). No. of bitstreams: 1 Dissertacao Maria Nice A M Rocha.pdf: 1650606 bytes, checksum: 21927985ce6a9e6db6a183351003574b (MD5) Previous issue date: 2011-12-06 / There are few studies of epidemiological research in of Ophthalmology with the population of center-western Brazil. In order to identify the prevalence of the of eye diseases in the region, and specifically in Goiania and Goiás, that impact on blindness and visual impairment, this study analyzed 10,060 records randomly selected from patients seen at the Reference Center for Ophthalmology School of Medicine Federal University of Goiás ((CEROF/UFG), in From April 2009 to March 2010. There was a profile analysis of ocular morbidity in the target population in relation to disease group, acuity, age, sex and region of origin. The study also covered the distribution of queries in the four quarters of the year, elective and urgent, and the degree of visual impairment in the bands visual impairment and blindness. The predominant diseases in elective care in relation to the total sample of 10,060 patients were cataract (7.24%), pterygium (6.77%), allergic conjunctivitis (3.70%), dry eye (3,36%) , diseases of the retina and vitreous (3.23%), strabismus (2.64%) and glaucoma (1.94%). In urgent care were the most prevalent extraocular foreign body (25.5%), infectious conjunctivitis (23.6%), keratitis and and corneal ulcer (11.3%), pterygium and pingueculite (5.3%) and sub conjuntival hemorrhage (4.0%). There was higher prevalence of sex female (63.1%) and ages between 0-14 (26,8%) years and 40 to 49 (20,8%) years in elective consultations. In urgency consultations there was more prevalent of male (64.84%) and ages between 15 and 39 (51.06%) years in clinical urgency. Refractive errors were recorded in 43.08% of queries being found more astigmatism (40.02%) followed by hyperopia (36.54%). Were determined rates of low vision within the parameters of World Health Organization (WHO). The results were compared with other studies in Brazil and abroad, aiming to define the reality of the regional profile of eye health, as an aid to prevention strategies, recovery and treatment through health policies and government's own guidance service studied, the CEROF/UFG. It follows that both elective care and emergency at CEROF/UFG is similar to that found in southern and southeastern Brazil and in most developed countries of the world. / Há escassez de trabalhos de pesquisa epidemiológica em Oftalmologia com a população do centro-oeste brasileiro. Com o objetivo de identificar a prevalência dessas doenças na região, especificamente em Goiás e Goiânia, que repercutem em cegueira e em deficiência visual, este trabalho analisou 10.060 prontuários de pacientes atendidos no Centro de Referência em Oftalmologia da Faculdade de Medicina da Universidade Federal de Goiás (CEROF/UFG), selecionados aleatòriamente. Foi feita uma análise do perfil de morbidade ocular na população alvo com relação aos grupos de doenças, acuidade visual, idade, sexo e região de procedência. O estudo também abrangeu a distribuição de consultas nos quatro trimestres do ano, eletivas e na urgência, e o grau de comprometimento visual nas faixas de deficiência visual e cegueira. As doenças predominantes no atendimento eletivo, em relação à amostra total de 10.060 pacientes, foram: catarata (7,24%), pterígio (6,77%), conjuntivite alérgica (3,70%), olho seco (3,36%), doenças de retina e vítreo (3,23%), estrabismo (2,64% e glaucoma (1,94%). No atendimento de urgência as mais prevalentes foram: corpo estranho extraocular (25,5%), conjuntivite infecciosa (23,6%), ceratite e úlcera de córnea (11,3%), pterígio e pingueculite (5,3%) e hemorragia subconjuntival (4,0%). Houve maior prevalência do sexo feminino (63,1%) e das faixas etárias de 0 a 14 (26,8%) anos e de 40 a 49 (20,8%) anos nas consultas eletivas. Nas consultas de urgência predominou o sexo masculino (64,84%) e a faixa etária entre 15 a 39 (51,06%) anos. Os erros de refração foram registrados em 43,08% das consultas sendo astigmatismo o mais encontrado (40,02%) seguido por hipermetropia (36,54%). Foram determinados os índices de baixa visão regional segundo parâmetros da Organização Mundial de Saúde (OMS). Os resultados foram comparados com outros estudos realizados no Brasil e no exterior, visando definir a realidade do perfil da saúde ocular regional, como subsídio para estratégias de prevenção, recuperação e tratamento através de políticas de saúde governamentais e orientação do próprio serviço estudado, o CEROF. Conclui-se que o atendimento tanto eletivo quanto de urgência feito no CEROF é similar ao encontrado nas regiões sul e sudeste do Brasil e em países mais desenvolvidos.

This study examines the science/policy interactions in global health science and technology governance. It focuses on the institutional design of organizations that sit at the interface of science and policy, conceptualizing them as Boundary Organizations (BOs). The analysis considers how the institutional design of BOs affect boundary-work. The study examines two case studies, UNESCO’s International Bioethics Committee and the WHO’s Strategic Advisory Group of Experts on Immunization. The study examines the ways in which boundary-work is carried out and finds that the concept of a BO demonstrates an institutionalization of science/policy interactions and the analysis of these two cases show that there are different ways that boundary-work is practiced as a function of the design of BOs. / Doctorat en Sciences politiques et sociales / info:eu-repo/semantics/nonPublished

Magister Public Health - MPH / Background: The Baby Friendly Hospital Initiative (BFHI) is considered one of the most successful international efforts to protect, promote and support breastfeeding. The initiative has proven impact, increasing the likelihood of babies being exclusively breastfed for six months. Official designation as Baby Friendly requires careful assessment completed by a trained external team to confirm that the institution is truly carrying out all Ten Steps of successful breastfeeding and conforming to the International Code of Marketing of Breastmilk Substitutes (BMS).The implementation of these principles are however challenging for facilities as it requires "strategic planning, implementation and maintaining change" within the facilities. Aim: To assess the factors influencing the implementation of BFHI principles in non accredited MOU` s in the Metropole region of the Western Cape. / South Africa

Magister Scientiae (Physiotherapy) - MSc(Physio) / This study attests to the fact that disability is an issue in conflict-affected populations, in particular refugees. Refugees with disabilities living in Mayukwayukwa refugee camp also have poor HRQOL similar to other studies. Education was the only variable significantly correlated to the psychological and social domains of the HRQOL. The study highlighted that environmental and personal variables played a role in the determination of health related quality of life among refugees with disabilities. / South Africa

Masters of Science / There is evidence of the rising incidence and prevalence of chronic diseases of lifestyle in developing countries. It is estimated that by 2020 chronic diseases of lifestyle in Sub-Saharan Africa will be almost 50% of the burden of disease. Rapid urbanization with changes in lifestyle, such as physical activity patterns could explain at least partially the ongoing epidemiological transition. The purpose of this study was to assess levels of participation in physical activity among working Rwandan women in Kigali, in relation to socio-economic demographic characteristics. A cross-sectional study design using both quantitative and qualitative methods was used. Participants' level of participation in physical activity and influence of socio-economic demographic factors on questionnaire adapted from Sub-Saharan African Questionnaire. A focus group discussion assessed the need for a health promotion program related to physical activity participation among working women. Data analysis, using Statistical analysis version 8e, was used to obtain frequency tables and histograms. Chisquare tests and Fisher's exact tests were utilized to test for association between variables. Focus group discussion data were transcribed and translated into English. Data were then coded and put into themes and categories. There were 352 participants, with a mean age of 33.4 years. 71.9% of the participants were classified as sedentary and only 28.1 % of the participants were classified as physically active. Participation in physical activity decreased with age, and there were more participants classified as sedentary people in the married group (77%) than in non-married group (63.2%). A lower level of education and income of participants, the higher the level of participation in physical activity. Among the reported prevalence of chronic diseases, high blood pressure and diabetes were only reported by participants classified as sedentary. During the focus group discussion, participants reported facilitators and benefits of physical activity including, routine, relaxation, socialization and fitness, managing obesity and health purposes. Barriers limiting the participants' ability to engage in physical activity included lack of time, lack of knowledge, laziness, domestic helper, lack of motivation and culture. The main themes, which were identified as important in the development of a health promotion program were: The education and encouragement of girl children; education of women in the community, finding facilities and appropriate venues, a suitable environment and the contribution of physical activity program towards unity and reconciliation was emphasised. The findings of this study demonstrate a problem concerning sedentary lifestyle among the working women in Kigali/Rwanda. It is alarming that the participants who are already classified as sedentary and who will probably experience the consequences of sedentary lifestyle in the future are already reporting chronic diseases like high blood pressure and diabetes. There is therefore an urgent need to design, implement and evaluate a health promotion intervention aimed at promoting a physically active lifestyle in Rwanda.

(1) Problem: Research on internalizing problems in young children is scarce despite evidence that children can have problematic internalizing symptoms as early as preschool years 1-3. In preschoolers, it is difficult to observe internalizing problems directly. While they are not overtly socially disruptive behaviors4, they have negative consequences in their daily lives, can continue in adolescence, and potentially develop into disorders in later years 5-7. Studying internalizing problems in preschoolers is of particular importance in Low- and Middle- Income Countries (LIMC) since there may be a higher prevalence of common risk factors (such as parental psychopathology, violence, and neglect) than in High-Income Countries. According to the World Health Organization, in 2015, Brazil (a LMIC) ranked first in the past-year prevalence of anxiety (9.3%) and fifth in the prevalence of depression (5.8%) 8,9 in people aged 15 years or older. Preschoolers in São Paulo, Brazil, have an estimated six-month prevalence of internalizing problems of 25.4%. There are few estimates in other regions of Brazil, partly due to the lack of validated scales to measure them. In addition, it is unknown if the disparate rates by sex (females have at least twice the rates of males) seen in adolescence and adulthood could be detected at an early age. This dissertation's primary goal is to advance our understanding of internalizing problems in preschoolers in Brazil, a LMIC that is highly affected by psychopathology and associated disability. (2) Methods: First, a systematic literature review on the topic in LMIC was conducted. Second, data from the Preschool Mental Health Survey (the PreK Survey), with a representative sample (n=1,292) of preschoolers aged 4 to 5 years old and their caregivers in the city of Embu das Artes, São Paulo, was used to: (a) do Confirmatory Factor Analysis (CFA) of the internalizing section of a worldwide known assessment tool for problem behaviors in preschoolers (the Child Behavioral Checklist CBCL 1.5-5); and (b) conduct multigroup CFA to examine differences by sex in the structure of internalizing problems. Finally, Generalized Linear Models for complex data were used to assess the risk of internalizing syndromes by parental depression, severe physical or verbal violence, and low-quality time with parents differentially by sex of the preschoolers. (3) Conclusions: From the literature review, a scarcity of research on internalizing problems of preschoolers was found in LMIC. Hence, (a) only a few risk factors, mainly parental psychopathology, have been explored in most LMIC; and (b) the large majority of studies in LMIC in the Americas use the CBCL 1.5-5 or other scales not validated for their study population. From the multigroup CFA, it was concluded that (a) the construct of internalizing problems in the CBCL 1.5-5 is valid in preschool boys and girls in São Paulo, Brazil, and in similar contexts, supporting previous and future studies on the topic; and (b) the main syndromes of internalization are "Anxiety/Depression" and "Emotionally Reactive." From the assessment of risk, it was concluded that (a) the main risk factor for internalizing problems in preschoolers in Brazil is parental depression; (b) externalizing problems are highly correlated with internalizing problems and are the main source of confounding; (c) there were no significant differences by sex in the prevalence of risky exposures, but they were all significantly associated with internalizing problems; (d) there were significant differences by sex in the mean scores of internalizing syndromes, and in the associations of risky exposures and internalizing problems, highlighting the need of a differential approach to primary prevention and treatment in preschool boys and girls.

Background. Swaziland adopted the World Health Organization’s (WHO) guidelines for the inpatient treatment of severely malnourished children in 2007 to reduce case -fatality rates for childhood malnutrition. However, no follow-up studies have been conducted to determine the reduction in the case -fatality rate post-implementation of the guidelines. Objectives. To determine the case -fatality rate for childhood malnutrition post-implementation of the WHO treatment guidelines and determine the level of adherence to the guidelines at Mbabane Government Hospital. Methods. A retrospective observational study was undertaken. All children under 5 years admitted for inpatient treatment of malnutrition between January 2010 and December 2011 had their demographic-, anthropometric- and clinical characteristics recorded and analysed, as well as the outcome of admission. Results. Of the 227 children admitted during the study period, 179 (64.6%) were severely malnourished and 98 (35.4%) had moderate malnutrition. One-hundred-and-eleven children died during admission, an overall case -fatality rate of 40.1%. Mortality was significantly higher among severely malnourished children compared to those with moderate malnutrition, (46.9% vs 27.6%, OR 3.0 (95% CI 1.7 to 5.3)). Comorbid pneumonia and gastroenteritis were significant predictors of mortality – , OR 2.0 (95% CI 1.2 to 3.4) and 1.9 (95% CI 1.1 to 3.2) respectively. Conclusion. Case -fatality rates for childhood malnutrition remain high, despite adoption of the WHO treatment guidelines. A need exists for improved adherence to the WHO guidelines and periodic clinical audits to reduce deaths from childhood malnutrition to meet the WHO mortality target of less than 5% and improve child survival. / Dissertation (MSc)--University of Pretoria, 2013. / gm2014 / Clinical Epidemiology / unrestricted