Esta pesquisa de abordagem qualitativa teve por objetivo investigar como os Centros para Crianças e Adolescentes (CCAs) vêm tratando a questão da inclusão do público com deficiência em seus espaços. Nas suas ações, a educação não formal figura como perspectiva educativa subjacente às ações de proteção social, visando à promoção do desenvolvimento de competências sociais, cognitivas e afetivas, marcadas por valores de inclusão e protagonismo social, complementando, assim, o processo educacional escolar num conceito ampliado de educação. Nessa lógica, os CCAs podem ser considerados potencialmente qualificados como instituições aptas a desenvolver ações socioeducativas com crianças e adolescentes com deficiência, inclusive em complementaridade à educação escolar, indicando oportunidades para que a abordagem da deficiência seja refletida e reedificada em ambos os espaços. Os procedimentos metodológicos para a coleta de dados foram: entrevistas semiestruturadas com doze profissionais de três CCAs eleitos como campo de pesquisa, análise de documentos e observação participante; ainda, a análise dos dados das entrevistas referenciou-se na análise de conteúdo. A presente pesquisa revelou que a concepção dos profissionais acerca do trabalho que desenvolvem vem acompanhando o deslocamento do eixo assistencialista para o eixo socioeducativo das ações, em consonância com o novo modelo de atuação proposto pela vigente política de assistência social. No entanto, algumas inconsistências práticas foram identificadas no que concerne à tarefa educativa desses serviços e a ideia de complementaridade entre CCAs e escolas, educação formal e não formal e ações intersetoriais, seja para o público com ou sem deficiência. Foi identificado um incipiente avanço gradual, no âmbito da Secretaria Municipal de Assistência Social, ao indicar a inclusão de público com deficiência nos CCAs, porém sem a correspondência de adoção de medidas de acompanhamento técnico junto aos serviços para que esse atendimento seja implementado sob bases inclusivas. Em contrapartida, os CCAs reconhecem a importância e exibem predisposição para empreender tal ação, mas apresentam fragilidade discursiva e prática, a partir de concepções muito difusas e parciais que detêm sobre os temas inclusão e deficiência, evidenciando a necessidade de suporte técnico e formativo aos seus profissionais. / This qualitative approach research had for objective to investigate as the Centers for Children and Adolescents (CCAs) are treating the subject on the inclusion of the public with deficiency in their spaces. In their actions, the not formal education appears as educational perspective underlying to the social protection actions, seeking to the promotion of the development of social, cognitive and affectionate competences, marked by inclusion values and social protagonism, complementing, like this, the school education process in an enlarged concept of education. In that logic, CCAs can be considered potentially qualified as institutions capable to develop social-educational actions with children and adolescents with deficiency, besides in complementarity to the school education, indicating opportunities so that the approach of the deficiency is contemplated and rebuilt in both spaces. The methodological procedures for the data collection were: semi-structured interviews with twelve professionals of three CCAs elected as research field, analysis of documents and participant observation; besides, the analysis of the data interviews based on the content analysis. This research revealed that the professionals\' conception concerning the work that they develop is accompanying the displacement from the assistential axis to the social-educational axis of the actions, in consonance with the new model of performance proposed by the effective social welfare politics. However, some practical inconsistencies were identified in what concerns to the educational task of those services and the complementarity idea between CCAs and schools, formal and not formal education and inter-sectorial actions, so much for the public with as without deficiency. It was identified an incipient gradual progress in the extent of the Municipal General Office of Social Welfare, when indicating the inclusion of public with deficiency in CCAs, however without the correspondence of adoption of technical attendance measures close to the services so that it is implemented under inclusive bases. In compensation, CCAs recognize the importance and exhibit predisposition to undertake such action, but they present discursive and practical fragility, starting from very diffuse and partial conceptions that they have on the inclusion and deficiency themes, evidencing the need of technical and formative support to their professionals.

Syfte: Syftet med studien var att undersöka arbetsterapeuters erfarenheter av att arbeta med fritidsaktiviteter för barn och ungdomar som lever med funktionsnedsättningar inom barn- och ungdomspsykiatrin och habiliteringen. Metod: Studien genomfördes som en kvalitativ intervjustudie. Sju semistrukturerade intervjuer utfördes via telefon och Skype med yrkesverksamma arbetsterapeuter med erfarenheter av att arbeta med barn och ungdomar med funktionsnedsättningar inom barn- och ungdomshabiliteringen (HAB) samt barn- och ungdomspsykiatrin (BUP). Vid analys av intervjuerna användes en kvalitativ innehållsanalys. Resultat: Det framgick i resultatet att fritidsaktiviteter inte är prioriterat enligt vårdriktlinjer och att det även fanns andra hindrande faktorer som begränsar arbetsterapeuterna att arbeta med fritidsaktiviteter. Det framgick även att det fanns stöttande faktorer som gör det möjligt för arbetsterapeuterna att hitta lösningar på hur de kan arbeta med fritidsaktiviteter och att de upplever att det har positiv påverkan på klienterna som väger över de annars negativa konsekvenser som kan uppstå vid brist av en meningsfull fritid. Resultatet visar att arbetsterapeuterna inkluderar fritidsaktiviteter vid kartläggningen, ger tips och råd kring fritidsaktiviteter samt har möjlighet att sätta in interventioner som kan gynna både vardagliga aktiviteter och fritidsaktiviteter. Arbetsterapeuterna upplever att klientens efterfrågan av hjälp varierar beroende på vilken diagnos klienten har. Slutsats: Arbetsterapeuterna som arbetade med fritidsaktiviteter upplevde att det hade en positiv effekt för barn- och ungdomar med funktionsnedsättning. Fritidsaktiviteter är ett område som bör inkluderas mer i arbetsterapin eftersom det främjar självständighet och delaktighet i vården men även i klienternas liv. Arbetsterapeuter besitter den kunskap som behövs för att arbeta och anpassa fritidsaktiviteter i olika miljöer och behov. / Purpose: The aim of this study was to examine occupational therapists' experience of working with leisure activities for children and adolescents who live with functional impairments in pediatric facilities in Sweden. Method: The study was conducted with a qualitative data collection method with semi-instructed interviews through phone or skype with seven occupational therapists with experience and that are working in a pediatric facility with children and adolescents who live with functional impairments. In the analysis of the interviews a qualitative content analysis was used. Result: The results showed that leisure activities are not a prioritization according to health guidelines and that there are also other factors that prevent occupational therapists from working with leisure activities. It also appears that there are supporting factors that enable occupational therapists to find solutions of how they can work with leisure activities and that their experience is that leisure activities have a positive impact on clients weighing over the otherwise negative consequences that can arise from lack of meaningful leisure. The result showed that occupational therapists include leisure activities in information gathering, provide tips and advice and have the opportunity to use intervention that benefit both activities of daily living and leisure activities. The occupational therapists find that the clients demand for help vary depending on the diagnosis the client has. Conclusion: The Occupational therapists that are working with leisure activities experience that they have a positive effect on children and adolescents with functional impairments. And that is a topic that should be included more in occupational therapy because it promotes independence and participation in care but also in the client’s life. Occupational therapists possess the knowledge needed to be able to work and adapt leisure activities in different environments and needs.

Introduction: Cerebral palsy (CP) is a CNS related permanent disorder following a lesion on the developing brain. Spasticity and muscle weakness are the most commonly reported impairments. Aim: To describe spasticity measured instrumentally as the muscle resistance and muscle strength in children with CP and in typically developing children (TD), and explore the relationship between muscle resistance, muscle strength and functional mobility. Method: Measurements of the muscle resistance in plantarflexors with Neuroflexor®. Muscle strength measurements in the lower leg with a rig-fixed dynamometry in n= 4 children with CP and in n = 11 TD children. Timed Up and Go (TUG) test measured in seconds in 4 children with CP. Results: Mann- Whitney U test showed a significant increased muscle resistance in plantarflexors during a fast movement between children with CP and TD children (p = 0.044). It was significantly shown that the children with CP were weaker in their dorsiflexors compared to the group of TD children (p = 0,001). Analysis for muscle resistance and TUG was collected for 2 children with CP and therefore no correlation analysis could be made. Conclusion: This pilot study indicates that the children with CP were weaker in their dorsiflexors compared to TD children and that muscle resistance measured during a passive elongation was higher, but no statistically significant conclusion can be made due to few included numbers of participants.

Unauthorized reproduction of this 8 article is prohibited. Objective:To examine differences in bone mass between children and adolescents swimming competitively at nonelite levels (locally and regionally) and nonathletes and to assess changes in bone mass in these 2 groups over 24 months after taking into consideration several known confounders of bone mass.Design:Observational prospective study.Participants:White nonelite swimmers (n=128) and nonathletes (n=106) 8 to 18 years of age from Memphis, Tennessee, USA.Main Outcome Measures:Participants underwent dual-energy x-ray absorptiometry to assess total body and hip bone mineral content (BMC) at baseline and 12 and 24 months later.Results:At baseline, swimmers had 4.2% and 6.1% higher adjusted BMC for the total body and hip, respectively, compared with nonathletes (P values < 0.027). Averaging across assessment points, swimmers had 73.5 and 2.2 g higher BMC for the total body and hip, respectively, than nonathletes. Although there was a significant annual increase in total body and hip BMC in both groups (33.5 and 0.7 g, respectively), there was no difference in annualized bone accrual between swimmers and nonathletes for either total body BMC (swim by time effect; P=0.213) or hip BMC (P=0.265).Conclusions:Competitive swimming at nonelite levels during childhood and adolescence does not seem to compromise bone accrual.

Hintergrund: Bei der Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) handelt es sich um eine der häufigsten psychiatrischen Störungen im Kindes- und Jugendalter. Die Ätiologie der ADHS ist komplex und multifaktoriell bedingt und wird von genetischen und Umweltfaktoren beeinflusst. Hinsichtlich spezifischer Umweltfaktoren konnten einige pränatale, perinatale und postnatale Risikofaktoren identifiziert und in Studien mehrfach repliziert werden. Dennoch gilt die Ätiologie der ADHS bislang als nicht hinreichend geklärt. Kaum Studien haben sich mit dem potentiellen Einfluss bestimmter familiärer Strukturen sowie dem Einfluss visueller Beeinträchtigungen auf das Auftreten einer ADHS beschäftigt. Die wenigen durchgeführten Studien weisen zudem diskrepante Ergebnisse auf. Fragestellung: In zwei unabhängig voneinander durchgeführten Studien wurde untersucht, ob familiäre Faktoren wie die Geburtenreihenfolge und Anzahl von Geschwistern einen Einfluss auf die ADHS ausüben (Studie 1). Es wurde überprüft, ob erstgeborene Geschwisterkinder ein erhöhtes Risiko einer ADHS aufweisen und ob die Anzahl von Geschwistern ebenfalls einen Risikofaktor darstellt. Außerdem wurde die Hypothese überprüft, ob das Risiko von erstgeborenen Kindern hinsichtlich einer ADHS mit zunehmender Anzahl der jüngeren Geschwister steigt. In der zweiten Studie wurde untersucht, ob spezifische häufig auftretende visuelle Beeinträchtigungen wie die Hyperopie, Myopie, Astigmatismus und Strabismus eine ADHS beeinflussen (Studie 2). In beiden Studien wurden eine Vielzahl relevanter Kontrollvariablen inkludiert. Material und Methode: Die Hypothesen der beiden Studien wurden auf Basis einer nationalen repräsentativen epidemiologischen Gesundheitsstudie (KiGGS-Studie), die vom Robert-Koch-Institut durchgeführt wurde, erforscht. Innerhalb der Gesamtstichprobe (N=17.641) liegen bei insgesamt N=13.488 Kindern und Jugendlichen im Alter zwischen 3 und 17 Jahren Informationen zum Vorliegen einer ADHS Diagnose vor. Von den N=13.488 Kindern und Jugendlichen liegt bei N=660 (4,9%) eine ADHS Diagnose vor, N=12.828 (95.1%) der Teilnehmer haben nie eine ADHS-Diagnose erhalten und bilden die Kontrollgruppe der Analysen. Berechnet wurden sowohl deskriptive Analysen als auch univariate und multivariate logistische Regressionen. Die logistischen Regressionen wurden durchgeführt, um Assoziationen (ORs: odds ratios, mit einem 95% CI: 95% Konfidenzintervall) zwischen den jeweiligen Prädiktoren und der ADHS zu berechnen. Alle berücksichtigten Kontrollvariablen, die einen signifikanten Einfluss auf die ADHS aufwiesen, wurden in weiteren Analysen inkludiert. Ergebnisse: In der ersten Studie konnte gezeigt werden, dass Erstgeborene ein signifikant erhöhtes Risiko zur ADHS im Vergleich zu Einzelkindern (OR: 1.31, 95% CI: 1.03-1.68) und zu jüngsten Geschwisterkindern aufweisen (OR: 1.31, 95% CI: 1.09-1.58). Auch konnte gezeigt werden, dass das Risiko einer ADHS bei Erstgeborenen mit einer zunehmenden Anzahl jüngerer Geschwisterkinder steigt. Es konnte kein Zusammenhang zwischen Anzahl der Geschwister und einer ADHS festgestellt werden. Die Ergebnisse der zweiten Studie ergaben ein signifikant erhöhtes Risiko für die ADHS bei Kindern und Jugendlichen mit Myopie (OR: 1.29, 95% CI: 1.02-1.62), Hyperopie (OR: 1.67, 95% CI: 1.29-2.17), Astigmatismus (OR: 1.84, 95% CI: 1.39-2.43) und Strabismus (OR: 2.04, 95% CI: 1.49-2.79). Die Ergebnisse beider Studien blieben auch nach Berücksichtigung der Kontrollvariablen stabil, bis auf die Assoziation zwischen der Myopie und der ADHS, hier zeigte sich kein signifikantes Ergebnis mehr. Schlussfolgerungen: Die Ergebnisse beider Studien stellen einen wissenschaftlichen Erkenntnisgewinn hinsichtlich der aktuellen Forschung zu Risikofaktoren und der Ätiologie der ADHS dar. Die Ergebnisse legen nahe, dass die Geburtenreihenfolge und das Vorliegen bestimmter visueller Beeinträchtigungen (Hyperopie, Astigmatismus und Strabismus) einen Einfluss auf die ADHS ausüben. Die Ergebnisse liefern Implikationen für die Forschung und klinische Praxis. Für eine adäquate Versorgung der betroffenen Kinder und Jugendlichen sollen die vorliegenden Ergebnisse innerhalb des Diagnose- und Behandlungsprozess berücksichtigt werden.

[pt] O presente estudo busca compreender sentidos e significados que homens atribuem à prática do cuidado parental com crianças e adolescentes em âmbito familiar, a partir de pesquisa de campo realizada no Hospital Municipal Jesus, unidade pública de saúde, com atendimento a crianças e adolescentes, localizada na Zona Norte do Rio de Janeiro. Trata-se de pesquisa qualitativa, com realização de entrevistas semiestruturadas com dez homens presentes na unidade de saúde acompanhando crianças e adolescentes em consultas no setor ambulatorial, a fim de identificar suas concepções e práticas sobre o cuidado a esses sujeitos. Para análise dos dados empíricos, utilizou-se o método de interpretação de sentidos, baseado em princípios hermenêutico-dialéticos, em diálogo com estudos sobre a prática do cuidado e as organizações familiares, relações de gênero e papéis nas famílias, homens e masculinidades e inserção de homens no cuidado com crianças e adolescentes, tendo o exercício da paternidade como foco. Os resultados da pesquisa revelam que, apesar de ainda em número menor que as mulheres, homens têm participado de forma crescente de cuidados no âmbito da família, atribuindo ao exercício parental masculino sentidos e significados para além do papel de provedor. / [en] The present study seeks to understand the meanings that men attribute to the practice of parental care with children and adolescents within the family, based on field research carried out at the Municipal Hospital Jesus, a public health unit, with care for children and adolescents, located in the North Zone of Rio de Janeiro. The method used was qualitative research, with semi-structured interviews with ten men present in the health unit accompanying children and adolescents in consultations in the ambulatory sector, with the purpose of identifying their conceptions and practices about the care for these subjects. For the analysis of empirical data, the method of interpretation of meanings was used, based on hermeneutic-dialectic principles, in dialogue with studies on the practice of care and family organizations, gender relations and roles in families, men and masculinities and insertion of men in caring for children and adolescents, with the exercise of parenting as the focus. The results of the research reveal that, although still fewer in number than women, men have increasingly participated in care within the family, attributing meanings to the male parental exercise that are beyond the role of provider.

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No description available.

The prevalence of children and adolescents who are considered overweight or obese has grown drastically in the United States. Childhood overweight and obesity is associated with serious long-term health consequences, including an increased risk for cardiovascular disease, type 2 diabetes, strokes, and different types of cancers. Added sugar intake (AS), in the form of sugar-sweetened beverages (SSB), may contribute to weight gain and obesity development in children and adolescents. Due to the negative health implications of SSB consumption, a valid and reliable brief beverage intake assessment tool is needed for children and adolescents to advance research in this area. The BEVQ-15 food frequency questionnaire has been validated as a tool to assess habitual beverage intake in adults. By validating this tool in youth, there will be a rapid, feasibly administered method to assess beverage intake in children and adolescents. The purpose of this investigation was to determine the comparative validity and test-retest reliability of the BEVQ-15 for assessing usual beverage intake in children and adolescents. Participants (n=326) completed four laboratory sessions, which included providing demographic information, assessment of height/weight, and four record-assisted 24 hour dietary recalls (24HR) from January 2014-September 2015. The BEVQ was completed at 2 sessions (BEVQ1, BEVQ2). Validity was assessed by comparing beverage intake from dietary recalls (24HR) to the BEVQ1; reliability was assessed by comparing BEVQ responses at two sessions (BEVQ1, BEVQ2). Data analysis included descriptive statistics, paired sample t-tests, independent sample t-tests, and chi-squared test, and one-way ANOVA tests. Comparisons of validity and reliability were also made within two subsets; children (aged 6-11) and adolescents (aged 12-18). In the full sample, self-reported water and total sugar-sweetened beverage intake (in fl oz and kcal) were not different between BEVQ1 and 24HR. Responses between BEVQ1 and BEVQ2 were not different in intake (fl oz) or energy (kcal) for water, milk, and total sugar-sweetened beverages. In children, milk and energy (kcal) for total beverages were not different between BEVQ1 and 24HR. No differences were reported between BEVQ1 and BEVQ2 across beverage categories. In adolescents, water and energy (kcal) for total-sugar sweetened beverages were not different between BEVQ1 and 24HR. No differences were reported between BEVQ1 and BEVQ2 with the exception of sweetened juice drinks and total beverages. Overall, these results demonstrate that the BEVQ-15 appears to be a valid and reliable tool to assess habitual water and total SSB intake in children and adolescents. This tool could further epidemiological and clinical research examining the impact of SSB intake, as well as intake of other beverages, on health. / Master of Science

Obesity is a public health concern and cardiometabolic consequences are severe when obesity develops during youth and continues into adulthood. Treatment prior to adulthood confers health benefits, but adolescent obesity rates have continually increased, reaching 20.6% in 2013-2014. Quality and quantity of dietary intake contribute to the development of obesity, but limitations of self-reported dietary intake are evident in overweight or obese adolescents, who frequently misreport nutrients of concern. Added sugar, sodium, and protein intake may indicate diet quality in this population. The 2015-2020 Dietary Guidelines recommend decreasing consumption of added sugars, sodium, and processed protein due to their known contributions to overweight and obesity. Objective dietary intake assessment measures are necessary for investigating the association between dietary intake and health outcomes. Added sugar, sodium, and protein intake could be assessed objectively with a panel of urinary biomarkers. Prior research indicates the potential of these urinary biomarkers to reflect dietary intake, but to date, no controlled feeding study has been conducted in adolescents. Using a controlled feeding design, the current study aims to evaluate the validity of urinary sucrose, fructose, sodium, and nitrogen as objective indicators of dietary intake. It is hypothesized that urinary sucrose and fructose will reflect dietary added sugar intake, while urinary sodium and nitrogen will correspond to dietary sodium and protein intake, respectively, in a healthy adolescent population. These biomarkers, if valid, could be used in clinical and epidemiological research to improve understanding of the associations between dietary intake and health outcomes. / Master of Science