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Globally, gastrointestinal (GI) infections by enteric pathogens are the second leading cause of morbidity and mortality in children under the age of five (≤5). While GI pathogen exposure in households has been rigorously examined, there is little data about young children’s exposure in public domains. Public areas in low-income settings are often used for waste disposal practices beyond human feces disposal, including trash dumping in open drainage canals and unused lots. If young children play in public domains unattended, they might be exposed to interrelated and highly concentrated microbial, chemical, and physical hazards. This study performed structured observations at 36 public areas in a transitioning internally displaced persons community in Haiti, to document how often young children play in public areas and to quantify behaviors that might lead to illness and injury. Children ≤5 yrs played at all public sites, including toddlers (92%/sites) and infants (44%/sites). Children touched and mouthed trash (metal, glass, plastic), food and other objects from the ground, ate soil (geophagia), drank surface water; as well as touched latrines, animals, animal feces, and open drainage canals. Hand-to-mouth contact was frequent and significantly different among developmental stages (infants: 18/hr, toddlers: 11/hr, and young children: 9/hr), providing evidence that children could ingest trace amounts of GI pathogens and other contaminants on hands. These findings demonstrate that water, sanitation, and hygiene interventions need to consider the unique risks posed by public domains that contribute to GI infection in young children. Furthermore, this highlights the need for waste related interventions to address the broader set of civil conditions that create unsafe, toxic, and contaminated public environments where young children play.

Darbo tikslas: atlikti pritaikyto maitinimo paslaugos prieinamumo Šiaulių miesto ikimokyklinio ugdymo įstaigose įvertinimą. Uždaviniai: įvertinti tėvų požiūrį į maitinimo organizavimą Šiaulių miesto ikimokyklinio ugdymo įstaigose; išanalizuoti pritaikyto maitinimo poreikį ir dažniausias jo priežastis ikimokyklinio ugdymo įstaigose; įvertinti įstaigų vadovų bei slaugytojų pasirengimą užtikrinant pritaikytą maitinimą ikimokyklinio ugdymo įstaigose; įvertinti pritaikyto maitinimo organizavimą specializuotoje vaikų ikimokyklinio ugdymo įstaigoje „Pušelė“. Tyrimo metodika: kiekybinis momentinis tyrimas; tyrimo dalyvių tikimybinė atranka: ikimokyklinio ugdymo įstaiga – grupė. Analizuojamosios imties dydis = 865 ikimokyklinio amžiaus vaikų tėvai. Atsako dažnis 73,7 proc. Papildoma imtis – 56 respondentai (28 ikimokyklinių ugdymo įstaigų vadovai bei 28 slaugytojos). Atsako dažnis 100 proc. Gautiems duomenims apdoroti naudotos SPSS 17.0, Microsoft Excel of Windows programos. Rezultatai: aukštąjį universitetinį išsilavinimą buvo įgiję daugiau nei 1/3 vaikų mamų ir 1/4 tėčių. Didžiąją dalį vaikų valgiaraščio sudaro grūdiniai/ankštiniai, pieno bei mėsos produktai. Ikimokyklinio ugdymo įstaigos teikiamą maitinimo paslaugų kokybę 59,9 proc. tėvų vertina gerai arba vidutiniškai. Tėvai, kurie blogai vertina ugdymo įstaigos teikiamą maitinimo paslaugų kokybę nuolat domisi vaiko dienos meniu (p<0,05).Vaikų, kurių sveikata yra puiki/labai gera ir gera/vidutiniška, tėvai nepasigenda jokių... [toliau žr. visą tekstą] / The aim of the work: to evaluate the accessability of the applied nutrition service in preschool institutions of Šiauliai city. Objectives: to evaluate parents’ attitude towards the organization of nutrition in the preschool institutions of Šiauliai city; to analyze the demand for the applied nutrition and its most frequent reasons in preschool institutions; to evaluate the preparation of the institution heads and nurses ensuring the applied nutrition in the preschool institutions; to evaluate the organization of the applied nutrition in the specialized preschool institution “Pušelė”.

Made available in DSpace on 2014-06-11T19:29:33Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-02-14Bitstream added on 2014-06-13T18:39:13Z : No. of bitstreams: 1 velo_ff_me_botfm.pdf: 1083035 bytes, checksum: 10ea31ff060419c2373a7f7f56465a68 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Com a implantação da Estratégia de Saúde da Família em âmbito nacional, várias ações foram propostas oficialmente, visando a promoção e atenção global à saúde da criança. Apesar de resultados ainda controversos, registrou-se um decréscimo no quadro geral da mortalidade infantil e resultados positivos de outros indicadores de saúde: aumento do aleitamento materno exclusivo e da cobertura vacinal, declínio das taxas de desnutrição infantil em menores de 2 anos, além do aumento da cobertura de consultas de pré-natal. Considerando que a organização das ações de saúde também deve contemplar a perspectiva do usuário, o presente trabalho pretendeu apreender as percepções das mães de crianças menores de cinco anos, usuárias de unidades de saúde da família de Botucatu-SP sobre a atenção à saúde infantil, contemplando aspectos organizacionais, profissionais e relacionais. Para tanto, foram selecionadas duas unidades de saúde da família, com diferentes tempos de implantação. Os dados foram coletados a partir de quatro grupos focais, abordando os temas acima referidos. Em cada uma das unidades foram compostos 2 grupos: um com mães de crianças de até 1 ano de idade e o outro por mães de crianças de 1 ano até 5 anos de idade. O tratamento dos dados, de natureza qualitativa, foi feito por meio de Análise de Conteúdo Temático. A partir da análise dos dados obtidos nos quatro grupos focais percebeu-se que o ideário do modelo tradicional, focado no atendimento às queixas dos usuários e em oferta de ações curativas, tendo o médico e suas especialidades como figura central do atendimento, ainda é muito prevalente para as mães. Desta forma, a maioria das demandas como dificuldade de conseguir consultas eventuais, grande espaçamento das consultas de rotina para crianças menores de 1 ano e longo tempo de espera foram relacionadas a ausência de... / Since the Family Health Strategy was implemented nationwide, several actions have been officially proposed in order to promote global healthcare for children. Although results remain surrounded by controversy, a decrease in overall child mortality and positive results regarding other health indicators such as increase in the rates of exclusive breastfeeding and vaccine coverage, decrease in malnutrition among children under two years, and increase in coverage of prenatal care have been reported. Considering that the organization of health actions should also take into account the user’s viewpoint, this study aimed at assessing the organizational, professional and relational aspects of child healthcare according to the perceptions of mothers of under-five children attending the family health units located in Botucatu-SP. Thus, two family healthcare units implemented at different times were selected. Study data were collected from four focal groups - two groups from each unit, one consisting of mothers of children at 0-1-years, and the other including mothers of children aged 1-5 years. Qualitative data were evaluated by theme-based content analysis. Analysis of the data obtained from all four focal groups revealed that the traditional model in which physicians in their specialties play the central role focusing on dealing with patients’ complaints and offering curative actions still prevails among the participating mothers. Therefore, most demands, such as difficulty in scheduling appointments, long intervals between routine visits for children under one year, and long waiting time, were related to absence of pediatricians in family health units, revealing poor acceptance of the nursing staff and limited understanding of the role of the health community agent. The referral/counter-referral system and medication supply were negatively rated, whereas the location of the units, ... (Complete abstract click electronic access below)

Övervikt bland barn är ett växande problem. År 2016 bedömdes 340 miljoner barn falla inom ramen för övervikt och 2019 var andelen barn med övervikt i Sverige 20 procent. Problematikenfinns i alla samhällsklasser men är särskilt utpräglat i socioekonomiskt svagare hushåll. Övervikten medför risk för fysiskt, psykiskt och psykosocialt lidande med försämrade skolprestationer som följd. Skolsköterskan fyller en viktig funktion i arbetet med att förebygga och åtgärda övervikt. Skolsköterskan stöter inte sällan på motstånd från vårdnadshavare som förnekar övervikten och förbjuder skolsköterskan att lyfta frågan med barnet. Skolsköterskan måste därför ha strategier för hur hen ska arbeta förebyggande och åtgärdande, för att behålla fokus på barnets hälsa.  Syftet med studien är att beskriva skolsköterskans strategier i omvårdnadsarbetet med övervikt inom elevhälsan. Tio specialistutbildade sjuksköterskor deltog i semistrukturerade intervjuer. Utifrån intervjuerna gjordes en kvalitativ innehållsanalys med induktiv ansats med målet att lyfta fram skolsköterskans strategier. Intervjuerna skedde digitalt relaterat till pågående pandemi. Resultatet visar att skolsköterskor använder flertalet strategier i sitt arbete med övervikt inom ramen för elevhälsan. Kategorier som framkom i analysarbetet var bland annat Uppföljning, Samverkan och Vikten görs oviktig. De intervjuade skolsköterskorna beskriver att de vill göra barnet delaktigt i både det förebyggande och åtgärdade arbetet men att det inte är ovanligt att vårdnadshavare motsätter sig detta. Skolsköterskans arbete med övervikt är komplext och kräver utarbetade strategier för att nå fram till barnet och vårdnadshavarna. Framgångsreceptet framträder som motiverade och delaktiga barn med engagerade föräldrar samt att man som skolsköterska inte ger upp. / Overweight among children is a growing public health issue. In 2016, 340 million children worldwide were estimated to be overweight and in 2019 20 percent of all children in Sweden were overweight. Overweight appears in all parts of society but is more evident in socio-economic vulnerable environments. Being overweight is associated with increased risk of physical, mental and psychosocial suffering and affects study performance. School nurses have an important role in preventing and reducing overweight among children. The school nurse often encounters resistance from guardians that denies their children being overweight and prohibits the nurse to raise the issue with the child. With the child’s health in mind, the school nurse needs to find effective strategies.  The aim of this study was to describe the strategies of school nurses in addressing overweight among children in elementary schools.  Ten school nurses were recruited to take part in semi structured interviews. Qualitative content analysis with an inductive approach was used to extract school nurse strategies. School nurses uses a variety of strategies to address overweight among children. Categories resulting from the analysis were among others Follow-up, Cooperation and Weight made unimportant. All study participants expressed a desire to work more proactive and to involve the children but sometimes guardians oppose this approach.  School nurses need worked out strategies to engage with children and their caregivers. Success is believed to come with motivated and participating children and dedicated caregivers in addition to an attitude as a school nurse to never give up.

This project takes a look at the impacts of our built environment on obesity in children living in racial and ethnic communities in relation to city planning. The results of this project results in a comprehensive report to provide an in-depth look into understanding the important relationships between children’s health and the built environment and understanding the best practices and recommendations for improving health in Guadalupe. Located in the Santa Barbara County, the City of Guadalupe is mainly an agricultural town with over 85 percent of its residents who are of Hispanic Origin. With almost half of its Latino population under 17 years of age, Guadalupe is an ideal location to examine the number of complex social, economic, and environmental matters that can contribute to higher overweight and obesity rates among Latino children. The food environments and physical environments were examined using Community Assessments and outreach efforts with school children and the residents of Guadalupe. Current professional and academic literature on childhood obesity, the built environments, food environments, and schools were reviewed for this project. Responses from a multitude of methods were analyzed and compared to create a list of recommendations for improving children’s health in Guadalupe. These methods included Community of Excellence (CX3) field surveys, walkability surveys, and a Photovoice project with school children.

Submitted by Marlene Santos (marlene.bc.ufg@gmail.com) on 2018-06-29T16:39:56Z No. of bitstreams: 2 Dissertação - Lina Monteiro de Castro Lobo - 2013.pdf: 714186 bytes, checksum: 5d5c6b250a7a628a15bcfb47e33f1a3b (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2018-07-03T14:44:38Z (GMT) No. of bitstreams: 2 Dissertação - Lina Monteiro de Castro Lobo - 2013.pdf: 714186 bytes, checksum: 5d5c6b250a7a628a15bcfb47e33f1a3b (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2018-07-03T14:44:38Z (GMT). No. of bitstreams: 2 Dissertação - Lina Monteiro de Castro Lobo - 2013.pdf: 714186 bytes, checksum: 5d5c6b250a7a628a15bcfb47e33f1a3b (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2013-05-16 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / Introduction: Vitamin A deficiency can increase susceptibility to infection and reduce growth rate, besides it is an important cause of blindness in childhood. Infants and preschools are the most vulnerable groups to this deficiency. Objective: To evaluate the factors related to serum retinol in infants aged from six to 24 months who were attended at municipal daycare centers (CMEIs) in the city of Goiânia - Goiás State, Brasil. Methods: A cross-sectional study, undertaken between 2005 and 2006 in CMEIs located in Goiânia. A socioeconomic and demographic survey was performed as well as blood samples were drawn from 193 infants to analysis of complete blood count (CBC), serum retinol, ferritin and C-reactive protein (CRP). Retinol was determined by High Performance Liquid Chromatography (HPLC) being considered deficient retinol levels under 0,7 μmol/L. Data were analyzed by the softwares Stata/SE 12.0 and Statistical Package for the Social Sciences 18.0 (SPSS). T student test, Pearson’s or Spearman’s correlation and multiple linear regression were performed. Results: The mean serum of retinol level was of 1,00 ± 0,38 μmol/L and the prevalence of vitamin A deficiency was of 21,8%. The average levels of retinol did not differ significantly between gender, age, type of water consumed, prenatal assistance, breastfeeding (predominant or current), presence or absence of anemia and ferritin levels. There was no correlation between the mother’s schooling, birth weight and number of infants younger than five years of age with serum retinol. There was association between vitamin A deficiency and inflammation (p=0,04). For each CRP unit that increased there was a reduction of 0,133 e 0,115 mg/dL in serum retinol levels, according to two models of multiple linear regression, keeping other variables constant. Conclusion: Vitamin A deficiency in infants who were attended at a municipal daycare centers in Goiânia is high and the factor related to this deficiency was the inflammatory state of the child which is represented by the CRP serum levels, adjusted by sanitary sewage, habitation location and ferritin level. / Introdução: A deficiência de vitamina A pode aumentar a susceptibilidade à infecção e redução do crescimento, além de ser importante causa de cegueira na infância. Os grupos mais vulneráveis para esta deficiência são os lactentes e pré-escolares. Objetivo: avaliar os fatores relacionados ao retinol sérico em crianças de seis a 24 meses de idade que frequentavam Centros Municipais de Educação Infantil (CMEIs) no município de Goiânia-Goiás, Brasil. Métodos: Estudo transversal, realizado entre 2005 e 2006 em CMEIs da cidade de Goiânia. Realizou-se inquérito socioeconômico e demográfico e coleta de sangue de 193 crianças para análise do hemograma, retinol sérico, ferritina e proteína C-reativa (PCR). O retinol sérico foi determinado por Cromatografia Líquida de Alta Performance (HPLC) considerando como deficiência os níveis de retinol <0,7 μmol/L. Analisou-se os dados nos programas Stata/SE 12.0 e Statistical Package for the Social Sciences 18.0 (SPSS). Utilizou-se o teste t de Student, correlação de Pearson ou Spearman e regressão linear múltipla. Resultados: A média de retinol sérico foi de 1,00 ± 0,38 μmol/L e prevalência de deficiência de vitamina A de 21,8%. Os níveis médios de retinol sérico não apresentaram diferença estatística entre os sexos, idade da criança, tipo de água consumida, assistência pré-natal, aleitamento materno (predominante ou atual), presença ou não de anemia e níveis de ferritina. Não houve correlação entre escolaridade da mãe, peso ao nascer e número de crianças menor que cinco anos com o retinol sérico. Verificou-se associação entre deficiência de vitamina A e inflamação (p=0,04). Para cada unidade de aumento do PCR houve redução de 0,133 e 0,115 mg/dL nos níveis de retinol sérico, segundo dois modelos de regressão linear múltipla, mantendo as outras variáveis constantes. Conclusão: a deficiência de vitamina A nas crianças frequentadoras de CMEIs em Goiânia é alta e o fator relacionado à esta deficiência foi o estado inflamatório da criança representado pelos níveis séricos de PCR, ajustado pelo esgotamento sanitário, local de moradia e nível de ferritina.

Bakgrund: Skärmtid har ökat i samhället och även barn använder sig mycket av skärm såsom mobil, surfplattor och tv. Forskningen om hur barn påverkas av skärmar fortgår och visar på både positiva och negativa effekter. Barnhälsovårdssjuksköterskans [BHV-sjuksköterskans] uppdrag är att arbeta hälsofrämjande för barnet och stötta familjer till god hälsa. Syfte: Syftet var att undersöka BHV-sjuksköterskans erfarenheter av att samtala med föräldrar om barns hälsa i relation till skärmtid. Metod: Studien baserades på en kvalitativ metod där semistrukturerade intervjuer genomfördes med sju BHV-sjuksköterskor. Resultatet analyserades genom kvalitativ innehållsanalys. Resultat: Intervjuerna resulterade i två kategorier “Att vara ett stöd” och “Att samtala om ett svårt men viktigt ämne” och sex subkategorier “Att skapa en tillitsfull relation”, “Ge information och råd”, “Ge föräldrar stöd till egen reflektion”, “Betydelsen av kunskap”, “Betydelsen av att ha rutiner” och “Ett ökat behov av att samtala om skärmtid”. Diskussion: BHV-sjuksköterskan har en viktig stödjande roll för att främja barns hälsa relaterat till skärmtid. En tillitsfull relation med föräldrarna ligger till grund för att kunna ge bra stöd och rådgivning som kan leda till bättre hälsa för barnet. Flera deltagare upplevde svårigheter i samtalet på grund av föräldrars reaktioner samt brist på mer djupgående kunskap inom ämnet. Slutsats: BHV-sjuksköterskor behöver få mer djupgående kunskap i hur skärmtid påverkar barns hälsa och hur samtalet om skärmtid kan föras med föräldrar. Mer forskning behövs kring BHV-sjuksköterskans roll i att främja barns hälsa genom att stötta familjer till att ha ett hälsosamt förhållningssätt till skärmtid. / Background: Screen time has increased in society and even young children spend much time in front of screens such as mobile phones, tablets and televisions. New research on how children are affected by the screens is being made with both positive and negative effects. The task of the child health nurse is to promote and support families to achieve good health for the child. Aim: The aim was to investigate the experience of the child health nurse when talking to parents about their children’s health in relation to screen time. Method: The study was based on a qualitative method with semi-constructed interviews conducted with seven child health nurses. The results were analyzed with a qualitative content analysis. Results: Two categories “To be a support” and “To talk about a difficult but important subject” and six subcategories “To create a trustworthy relationship”, “To give information and advice”, “Parents support to their own reflections”, “The value of knowledge”, “The value of routines” and “An increased need to talk about screen time” was found. Discussion: The child health nurse has an important role when it comes to supporting and promoting the children’s health in relation to screen time. A trusting relationship with the parents is the foundation to fulfill this role. Several participants experienced difficulties in their conversations based on the parents' reactions and their own lack of deeper knowledge on the subject. Conclusion: Child health nurses need more knowledge in how screen time affects children's health and how to deal with this subject with parents in general. More research is needed on how the child health nurse work support families to promote children’s health in the relationship to screen time. / <p>Datum för godkännande: 2021-11-01.</p>

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-01-12T11:24:27Z No. of bitstreams: 1 marcelamelquiadesdemelo.pdf: 1761396 bytes, checksum: 34590826f3bda12dcb62f9c1ce42fb58 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-01-25T17:14:38Z (GMT) No. of bitstreams: 1 marcelamelquiadesdemelo.pdf: 1761396 bytes, checksum: 34590826f3bda12dcb62f9c1ce42fb58 (MD5) / Made available in DSpace on 2016-01-25T17:14:38Z (GMT). No. of bitstreams: 1 marcelamelquiadesdemelo.pdf: 1761396 bytes, checksum: 34590826f3bda12dcb62f9c1ce42fb58 (MD5) Previous issue date: 2015-03-27 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Os sistemas de saúde orientados pela lógica da Atenção Primária à Saúde (APS) compreendem uma opção na organização da assistência à saúde que tem-se mostrado capaz de trazer ganhos na saúde da população. Nessa perspectiva, a Estratégia de Saúde da Família tem o propósito de organizar a prática da atenção à saúde no primeiro nível de atenção, ocupando papel central no Sistema Único de Saúde e representando a proposta de reorientação do modelo assistencial no Brasil. No entanto, compreende um grande desafio o processo de reestruturação do modelo, tornando-se relevante avaliar os resultados e impactos alcançados, assim como a qualidade dos serviços ofertados. Diante de tal contexto é que o estudo objetivou avaliar a efetividade e a qualidade da APS na população infantil de 0 a 9 anos no município de Juiz de Fora/MG. Trata-se de estudo transversal que avaliou a APS tomando como referência as Internações por Condições Sensíveis à Atenção Primária (ICSAP) no período de 2010 a 2012 e por meio da aplicação do PCATool em uma amostra. Ocorreram 12.412 internações na população infantil de 0 a 9 anos residente em Juiz de Fora, sendo 4.117 ICSAP. As Pneumonias Bacterianas (40,0%) foram as principais causas de tais internações seguidas por Bronquite Aguda (18,4%), das Gastroenterites Infecciosas (11,6%) e das Epilepsias (7,6%). O PCATool foi aplicado em 104 cuidadores, 54,8% apontaram vinculação com o nível primário de atenção à saúde (UAPS-SF e UAPS-Tradicional) e 45,2% com outros serviços, definindo três estratos de análise. Os atributos Longitudinalidade, Coordenação – Sistema de Informações e Orientação Familiar apresentaram forte presença e extensão entre os entrevistados vinculados APS. O componente Utilização do atributo Acesso de Primeiro Contato apresentou forte presença e extensão independente do serviço referenciado pelo cuidador. A Orientação Comunitária foi o atributo que obteve os piores resultados. O escore geral foi insatisfatório para os três estratos. Apesar dos estudos apontarem uma tendência de redução nas taxas de ICSAP a nível nacional, os resultados do presente estudo mostram um aumento dessas internações no município de Juiz de Fora. A forte orientação somente na APS de atributos como a Longitudinalidade e Orientação Familiar, compreende um aspecto positivo na avaliação da APS do município visto que esses são atributos característicos desse nível de atenção. No entanto, destaca-se a Orientação Comunitária, ponto fundamental da APS, apresentar resultado insatisfatório. Na análise bivariada, a única variável que se mostrou significativamente associada ao EEAPS foi a faixa etária do cuidador. Para o EGAPS, apresentaram associação significativa as variáveis situação conjugal e modelo de atenção - estrato da amostra. Tanto para o EEAPS como para o EGAPS, a variável Prevalência de ICSAP não se mostrou significativamente associada. Conclui-se a necessidade dos gestores de saúde direcionarem o olhar para APS, com ênfase em seus atributos, para melhor operacionalizar e potencializar a capacidade resolutiva desse nível de atenção, podendo refletir nas internações por CSAP, mesmo não apresentando associação estatística significativa no presente estudo, uma vez que essas são eventos que não deveriam acontecer na presença de uma APS resolutiva e oportuna. / The health systems oriented by the Primary Health Care (PHC) logic comprise option on the organization of the health assistance that has proved able to bring gains for the health of the population. With that in mind the Family Health (FH) strategy has the purpose to organize the practice of attention to health at the first level of attention, taking a central role at the Unified Health System and representing the purpose of reorientation of the caring model in Brazil. However, the restructuring of the model comprises a major challenge, becoming relevant to evaluate the results reached and the quality of the offered services. Ahead of such context the study had as objective to evaluate the effectiveness and the PHC quality on the infantile population ranging from 0 to 9 years old in the municipality of Juiz de Fora/MG. This is about a cross-sectional study that assessed the PHC taking the Hospitalizations for Primary Care-Sensitive Conditions (HPCSC) in the period between 2010 to 2012 and through the application of the Primary Care Assesment Tool (PCATool) in a sample. 12.412 hospitalizations occurred amongst the infantile population ranging from 0 to 9 years old living in Juiz de Fora, being 4.117 HPCSC. The Bacterial Pneumonia (40,0%) were the main causes of such hospitalizations followed by Acute Bronchitis (18,4%), Infectious Gastroenteritis (11,6%), and by the Epilepsies (7,6%). The PCATool was applicated to 104 care takers, 54,8% indicated a link with the PHC (PHCU-FH and Traditional-PHCU) and 45,2% with Other Services, defining three layers of analysis. The atributes Longitudinality, Coordination – Information System and Family Guidance showed strong presence and extension amongst the interviewees linked to the PHC. The component Use of the attribute Primary Health Care showed strong presence and extention independently on the referenced service by the care taker. Community Guidance was the attribute having the worst results. The PHC Essential Score (PHCES) was unsatisfactory for the PHCU-FH and Other Services while the PHC General Score (PHCGS) for the three layers. Despite of the studies showed a national tendency of reduction of the HPCSC rates, the results of the present study show na increase of those hospitalizations in Juiz de Fora. The strong of orientation of attributes as Longitudinality and Family Guidance only on the primary level comprise positive aspects on the assessment of the PHC of the municipality since those attributes are charactecristic of this level of attention. However, Community Guidance stands out, fundamental point of the PHC, by presenting unsatisfactory result. On the bivariate analysis, the only variable that has proved itself importantly linked to the PHCES was the care taker’s age group. For the PHCGS, it has shown important association to the variables marital status and model of attention – sample layer. Both to the PHCES as to the PHCGS, the variable prevalence of HPCSC has not shown itself importantly linked. We can conclude the need of the health mangers for attracting the attention to the PHC, with emphasis in their attributes, to better operate and potencialize the response capacity of this level of attention, being possible to reflect on the HPCSC, once these events that should not happen at the presence of a resolutive and appropriate PHC.

This dissertation consists of three papers at the intersection of social policy and immigration. The first paper analyzes the impact of immigrant welfare exclusion on government social spending at both an aggregate and specific social program level, using cross-national social expenditure panel data from 21 Organization for Economic Co-operation and Development (OECD) countries between 1990 and 2015 and taking advantage of the significant variation in welfare exclusivity across OECD countries by year. The second paper utilizes the variation in states’ response to the Affordable Care Act’s Medicaid expansion to investigate its effects on low-income immigrants’ inter-state mobility, specifically in-migration, and out-migration. Finally, the third paper utilizes data from the National Survey of Children’s Health to examine the effect of the announcement of the Trump administration’s revised Public Charge rule on insurance coverage and other health outcomes for children of immigrant parents.