Made available in DSpace on 2016-04-18T21:31:46Z (GMT). No. of bitstreams: 4 Ana Cristina Medeiros Moreira1.pdf: 86814 bytes, checksum: 45364eada4d323c3b88223d4d2010595 (MD5) Ana Cristina Medeiros Moreira2.pdf: 477418 bytes, checksum: c0c3f53cd7f795fdd30d68e2cb029106 (MD5) Ana Cristina Medeiros Moreira3.pdf: 769917 bytes, checksum: 80bc96a991d0a6acb2196d19d4ecb708 (MD5) Ana Cristina Medeiros Moreira4.pdf: 3240134 bytes, checksum: 603494a4692126e11b7c1b137cd21cc4 (MD5) Previous issue date: 2006-08-15 / Fundo Mackenzie de Pesquisa / The changes in alimentary behavior that are occurring in our society have been promoting a deep impact on the health outlook of the brazilian people, causing a representative increase of non transmissible chronic diseases that are associated to the more common death causes nowadays. These changes have equally affected children. The incidence of infantile obesity has triplicated in last three decades. School has been presented as an outstanding space for promoting health, including formation of healthy alimentary habits. The study aims to know the performance of the Municipal School of Infantile Education (São Paulo) facing the challenge of nutritional education, considering the infantile obesity issue from the observation of school lunch, educational school projects, and teachers' knowledge degree and effective actions on the matter. The paper was characterized by an exploratory and participative study, with a methodological approach of qualitative research. The target population was a sample of approximately 400 students and 14 teachers. Diaries with personal registers, interview with pedagogic coordinator, field observation, questionnaire applied to teachers, photographies and videos were all used. An analysis of anthropometric data of children was conducted, by using the Epiinfo applicable. In the school lunch, the matter of lack of variety in the provided menu was stressed. From qualitative and sensory aspect (taste and appearance) viewpoint, the meal presented greater adequacy than the lunch. School agents and school lunch cooks were not oriented to contribute in the nutritional education of children. It was verified that the school has an ongoing educational project (Projeto Horta) related to nutritional education actions. It can be stated that educators feel the importance of nutritional education being inserted in the school activities, but this has not still been transformed in effective actions by all teaching body. The obesity percentile encountered among chidren was of 14%, being greater among girls. The lecture conducted in the school was well-succeeded in the attainment of its objectives. Because of the interdisciplinary bias of the current research, it could be observed that the professional interaction between nutritionist and teachers is not only possible, but is also extremely necessary in nutritional education actions. It could be observed that there is little communication between the organs that take part in the school food system. Health centers have not been integrated to the nutritional education activities in school environment. It is recommended that there is a nutritionist professional in charge of the follow-up of nutritional education actions, coordinating, articulating, and following the phases up to the end of processes. It is also suggested a periodical conduction of nutritional orientation lectures for parents and capacitation courses for teachers, school lunch cooks, and teaching agents. / As mudanças de comportamento alimentar que estão ocorrendo na sociedade estão promovendo grande impacto no panorama da saúde do povo brasileiro, provocando um representativo aumento das doenças crônicas não-transmissíveis, associadas às causas mais comuns de morte na atualidade. Essas alterações têm, igualmente, afetado as crianças. A incidência da obesidade infantil triplicou nas últimas três décadas. A escola tem sido apresentada como um espaço privilegiado para promover saúde, incluindo a formação de hábitos alimentares saudáveis. O estudo visa conhecer a atuação de uma Escola de Educação Infantil do Município de São Paulo, frente ao desafio da educação nutricional, considerando a problemática da obesidade infantil, partindo da observação da merenda escolar, dos projetos educacionais da escola, do grau de conscientização e das ações efetivas dos professores nesse sentido. O trabalho caracterizou-se por um estudo exploratório e participante, com uma abordagem metodológica de pesquisa qualitativa. A população alvo constituiu-se de uma amostra de aproximadamente 400 alunos e de 14 professoras. Foram utilizados diários com registros pessoais, entrevista com a coordenadora pedagógica, observação de campo, questionário aplicado aos professores, fotos e vídeos. Foi efetuada uma análise dos dados antropométricos das crianças, por meio da utilização do aplicativo Epiinfo. Na merenda escolar, destacou-se a falta de variedade do cardápio oferecido. Do ponto de vista qualitativo e dos aspectos sensoriais (sabor e aparência), a refeição era mais adequada do que o lanche. Os agentes escolares e as merendeiras não eram orientados a contribuir com a educação nutricional das crianças. Verificou-se que a escola possui em andamento um projeto educacional (Projeto Horta) relacionado com as ações de educação nutricional. Pode-se afirmar que os educadores percebem a importância desse tema estar inserido nas atividades da escola, mas que ainda não foi transformado em ações efetivas por parte de todos. O percentual de obesidade encontrado entre as crianças foi de 14%, sendo maior entre as meninas. A palestra realizada na escola foi bem sucedida na consecução de seus objetivos. O caráter interdisciplinar da pesquisa permitiu concluir que a interação profissional entre o nutricionista e os educadores é possível e extremamente necessária para as ações de educação nutricional. Pôde-se observar que há pouca comunicação entre os órgãos do governo que integram o sistema de alimentação escolar, incluindo também os Centros de Saúde, os quais não estão inseridos nas atividades de educação nutricional no ambiente escolar. Recomenda-se que haja um profissional nutricionista responsável pelo acompanhamento das ações de educação nutricional, coordenando, articulando e acompanhando as diferentes fases dos processos. Recomenda-se também a realização periódica, não só de palestras orientadoras aos pais, como ainda cursos de capacitação aos professores, merendeiras e agentes de ensino.

Carências nutricionais são ocorrências comuns em grande proporção de crianças do mundo e reconhecidamente um dos grandes problemas da saúde pública brasileira. Alguns estudos têm relatado que os escores mental e motor de crianças com carências nutricionais são mais baixos do que aqueles obtidos pelas crianças sem carências. As Escalas Bayley, publicadas pela primeira vez em 1969 e revisadas em 1993, constituem-se em instrumento adequado para a avaliação de crianças de um a quarenta e dois meses de idade, e são amplamente utilizadas em estudos que avaliam efeitos de carências nutricionais. Desta forma, o objetivo deste trabalho foi verificar a aplicabilidade da Escala de Avaliação do Comportamento Infantil (BRS), uma das três escalas que constituem as Escalas Bayley, na avaliação de crianças de creche com carência nutricional. A amostra foi constituída por 50 crianças de ambos os sexos, com idades que variaram entre 7 e 41 meses, provenientes de duas creches filantrópicas do município de Ribeirão Preto – SP. Um grupo de 23 crianças com deficiência proteico-calórica ou de ferro, consideradas de leve a moderada, segundo o Z-score < +1, proposto pela OMS e níveis de hemoglobina acima de 8 mg/dL, foi comparado a outro de 27 crianças sem estas deficiências. Através da avaliação do comportamento foram obtidos índices referentes ao comportamento geral, o controle emocional, a atenção/exitabilidade, a orientação/engajamento e a qualidade motora das crianças. Tais índices são apresentados em forma de percentil, sendo possível, segundo Bayley (1993), a classificação em: comportamento dentro dos limites normais (índice ? percentil 26), ou seja, esperado para sua idade; comportamento questionável (índice entre o percentil 11 e o 25), que sugere possível prejuízo e merece maior investigação; e comportamento não-ótimo (índice ? percentil 10), que evidencia atraso ou prejuízo em uma ou mais áreas importantes. Os resultados obtidos revelaram que o grupo controle era de maior faixa etária (30 meses) que o grupo carente nutricional (23 meses), e que as crianças do grupo controle apresentavam um comportamento geral frente a situação de teste melhor que do que as crianças do grupo carente nutricional (p=0.03), principalmente no fator Orientação/Engajamento (p=0.01): Afeto positivo (p=0.03), Energia (p=0.005), Entusiasmo acerca das tarefas (p=0.04), Engajamento social (p=0.03); e nos itens Afeto negativo (p=0.04) e Movimento lento e atrasado (p=0.005). Estes resultados são consistentes com aqueles já apresentados na literatura, nos quais as crianças com carências nutricionais são descritas como menos ativas, mais inibidas e tímidas, menos responsivas, atentas, vocalizando e movimentando-se menos. Concluiu-se que os itens relacionados à avaliação comportamental, aplicados e cotados como proposto originalmente, foram sensíveis para diferenciar grupos com e sem alterações nutricionais leves ou moderadas, embora as Escalas Bayley do Desenvolvimento Infantil requeiram ainda adaptação às condições sociais e culturais brasileiras. Tais resultados sugerem ainda que esta escala pode ser útil em outras condições clínicas, assim como para a avaliação do desempenho de grupos pós procedimentos de recuperação nutricional. / Nutritional deficiencies are common occurrences among a large proportion of children all over the world and are recognized to be one of the great public health problems in Brazil. Some studies have reported that the mental and motor scores of children with nutritional deficiencies are lower than those of children with no deficiencies. The Bayley Scales, first published in 1969 and revised in 1993, are an appropriate instrument for the evaluation of children aged one to forty months and are widely used in studies that evaluate the effects of nutritional deficiencies. Thus, the objective of the present study was to determine the applicability of the Behavioral Rating Scale (BRS), one of the three scales forming the Bayley Scales, for the evaluation of day-care center children with nutritional deficiencies. The sample consisted of 50 children of both sexes aged 7 to 41 months, from two philanthropic day-care centers in the municipality of Ribeirão Preto – SP. A group of 23 children with protein-calorie or iron deficiency considered to be mild to moderate according to a Z-score < +1 proposed by the WHO and with hemoglobin levels above 8 mg/dL, was compared to a group of children without these deficiencies. Indices referring to general behavior, emotional control, attention/excitability, orientation/engagement, and motor quality of the children were obtained by behavioral evaluation. These indices are presented in percentile form and, according to Bayley (1993), it is possible to classify them as behavior within normal limits (index ? 26th percentile), i.e., expected for age, questionable behavior (index between the 11th and 25th percentile), suggesting possible impairment and requiring more investigation, and non-optimal behavior (index ? 10th percentile), which demonstrates delay or impairment in one or more important areas. The results obtained revealed that the control group was in an older age range (30 months) than the group with nutritional deficiency (23 months), and that the children in the control group presented a better general behavior in the test situation than the children in the group with nutritional deficiency (p=0.03), especially regarding the Orientation/Engagement factor (p=0.01): Positive affect (p=0.03), Energy (p=0.005), Enthusiasm about tasks (p=0.04), Social engagement (p=0.03); and in the items Negative affect (p=0.04) and Slow and delayed movement (p=0.005). These results are consistent with those reported in literature studies in which children with nutritional deficiencies are described as less active, more inhibited and shy, less responsive and attentive, and vocalizing and moving less. We conclude that the items related to behavioral evaluation, applied and scored as originally proposed, were sensitive in differentiating between groups with and without mild or moderate nutritional alterations, although the Bayley Scales for Childhood Development still require adaptation to the Brazilian social and cultural conditions. These results also suggest that this scale can be useful for other clinical conditions and for the evaluation of performance of groups submitted to procedures or nutritional recovery.

Realizou-se estudo retrospectivo, descritivo, com objetivo de identificar as características dos acidentes ocorridos com crianças e adolescentes, quando do exercício do trabalho, no período de 1º de junho de 2001 a 31 de maio de 2002. Após os procedimentos éticos e metodológicos necessários, realizou-se levantamento e revisão dos prontuários de crianças e adolescentes atendidos no Serviço de Saúde do Trabalhador do distrito central de saúde da cidade de Ribeirão Preto (SP). A coleta de dados foi realizada por meio de um protocolo, contendo informações relacionadas à criança e ao adolescente trabalhador, ao evento acidentário e à emissão da Comunicação de Acidente de Trabalho (CAT). As informações obtidas através da consulta ao prontuário dos acidentados do trabalho, foram codificadas, conforme a Classificação Estatística Internacional de Doenças (1993). No período, foram atendidos 1.589 crianças e adolescentes vítimas de acidentes em geral. Em 56 (3,6%) prontuários, havia descrição feita pelos trabalhadores da área de saúde que atenderam esses acidentados sobre o acidente como sendo Acidente de Trabalho (AT) ou havia uma cópia da CAT. Dentre esses 56 prontuários evidenciou-se que as crianças e adolescentes com AT eram auxiliares de padaria, zeladoria, oficina, entre outros (12,4%). Os AT aconteceram com substâncias e objetos diversos que corresponderam a 39,3% dos casos e entre os principais agentes causadores, a faca provocou o maior número de ocorrências. Os acidentes/atropelamentos tiveram percentual de 19,6 como causadores de fraturas, luxações e traumatismos, ocorridos no trajeto ao local de trabalho. O diagnóstico médico de maior freqüência foi o de ferimentos de punho e da mão (33,9%); houve também múltiplos diagnósticos (8,9%), de casos em que várias partes do corpo foram atingidas. As regiões mais lesadas foram os membros superiores (51,8%). Em 62,5% não foi percebida a CAT no prontuário do acidentado. Evidenciou-se que existe em Ribeirão Preto (SP), o trabalho realizado pelas crianças e adolescentes, possivelmente em decorrência da situação de pobreza, pois o fato de crianças e adolescentes trabalharem significa, em grande parte, a existência de uma complementação da renda familiar. Ações mais efetivas devem ser direcionadas para que o trabalho infantil e do adolescente seja erradicado no país, incluindo-se novas pesquisas acerca dos AT e através delas fundamentar-se medidas para que se essa meta não for alcançada, possa ao menos, ter seus efeitos deletérios minimizados. / The aim of this retrospective and descriptive study was to identify the characteristics of accidents occurred with children and adolescents while working, in the period from June 1, 2001 till May 31, 2002. After observing the necessary ethical and methodological procedures, a survey and review was realized in the health files of children and adolescents assisted at the Occupational Health Service of the a public health service in the Central health district of Ribeirão Preto (SP), Brazil. Data collection was realized by means of a protocol that contained information about the working child and adolescent, about the accident and the issuing of the Communication of Work Accident (CWA). The information obtained by consulting those accident victims' files was codified, according to the International Statistical Classification of Diseases (1993). During the period, 1,589 children and adolescent victims of accidents were assisted in general. In 56 (3.6%) files, the health workers who assisted these accident victims had given some description about the accident as being a Work Accident (WA) or a copy of the CWA had been included. Among the 56 files of children and adolescents accidented at work, 12.4% were bakery assistants, doormen, workshop assistants, among others. The WA happened with several substances and objects, which corresponded to 39.3% of the cases and, among the main causing agents, the knife was responsible for the largest number of occurrences. The accidents/runovers corresponded to 19.6% of the causes of fractures, dislocations and traumatisms, among others, which happened on the way to work. The most frequent medical diagnosis was fist and hand wounds (33.9%); there were also multiple diagnoses (8.9%), related to cases in which several parts of the body were affected. The most affected areas of the body were the superior limbs (51.8%). In 62.5% of the cases, the CWA was not observed in the accident victim's file. It was disclosed that children and adolescents’ work actually exists in Ribeirão Preto (SP), possibly due to poverty, because children and adolescents’ work mainly indicates the existence of a family income complement. More effective actions may be directed in order to eradicate children and adolescents’ work, including new research on WA and through them base measures to meet this goal or at least to diminish its negative effects.

Orientadores: Emílio Carlos Elias Baracat, André Moreno Morcillo / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-19T05:38:31Z (GMT). No. of bitstreams: 1 Romaneli_MarianaTresoldidasNeves_M.pdf: 5685752 bytes, checksum: bb58b36a9e0f1344d34b1120bc8b2e0b (MD5) Previous issue date: 2011 / Resumo: Introdução: Os ALTEs (eventos com aparente risco de morte) são episódios súbitos de alteração da coloração da pele (cianose ou palidez), da freqüência respiratória (apnéia) e do tônus muscular (hipotonia), e podem ser a primeira manifestação de inúmeras doenças congênitas ou adquiridas. Embora a história natural dos ALTEs seja benigna, existe risco de mortalidade subseqüente. Objetivos: Avaliar as características clínicas, epidemiológicas e os fatores associados ao óbito de lactentes atendidos na Unidade de Emergência Referenciada (UER) Pediátrica do Hospital de Clínicas (HC) da Universidade Estadual de Campinas (UNICAMP) com história de ALTE. Casuística e Métodos: Estudo transversal retrospectivo descritivo e analítico. Foram incluídos lactentes menores de 12 meses que apresentaram evento súbito de cianose, palidez, hipotonia e/ou apnéia e que foram atendidos na UER Pediátrica. Os dados foram coletados a partir dos Boletins de Atendimento de Urgência (BAUs), através de uma ficha previamente elaborada. Os dados obtidos foram processados com o software SPSS, versão 16.0, utilizando-se o teste de Mann-Whitney para comparação das idades. Para avaliar a associação do óbito com as variáveis independentes, determinou-se os valores de odds ratio bruto por regressão logística. Foram selecionadas para inclusão no modelo logístico multivariado não condicional aquelas que apresentavam associação na análise bivariada. Adotou-se o nível de significância de 5%. Resultados e Conclusão: O ALTE foi mais freqüente na faixa etária entre 9 e 15 semanas de vida, afetando igualmente ambos os gêneros. A manifestação mais comum de ALTE foi cianose, acompanhada ou não de outros sinais e sintomas. Os eventos únicos e de curta duração foram mais freqüentes, a maioria com melhora espontânea. Metade dos pacientes permaneceu internada por mais de 72 horas, em observação clínica e investigação etiológica do evento. O diagnóstico da doença que provocou o ALTE não foi esclarecido em 35,2% dos lactentes. Os demais foram elucidados e a maioria relacionada a doenças do trato respiratório. Durante a internação, a mortalidade dos lactentes com ALTE foi de 7,6%. O maior risco de óbito esteve presente na faixa etária acima dos 6 meses e quando os episódios não tiveram resolução rápida e espontânea, principalmente quando ocorreram como primeira manifestação de doenças do sistema cardiocirculatório / Abstract: Introduction: ALTEs (apparent life-threatening events) are sudden episodes of color change (paleness or cyanosis), apnea and marked change in the muscle tone (limpness), which may be the first sign of an underlying disease (congenital or acquired). Although the ALTE?s natural course is usually benign, there is a risk of subsequent death. Objectives: The aim of this study was to evaluate clinical and epidemiological characteristics, as well as the risk factors associated with mortality of infants who had presented an ALTE and were taken to the Emergency Pediatric Unit from the Clinical Hospital of the State University of Campinas (HC UNICAMP). Casuistic and Methods: Retrospective, transversal, descriptive and analytical study, There were included every infant younger than 12 months old, who had been taken to the Emergency Pediatric Unit after experienced a sudden episode of cyanosis, paleness, limpness and/or apnea. The data was collected from the Emergency care bulletin of each infant, using a previously elaborated card. The data obtained was processed with the software SPSS 16.0. To compare the ages, Mann-Whitney test was used. To evaluate the association among death with the independent variables, logistic regression was used to establish the odds ratio. The multivariate analysis included those variables with positive association in the bivariate analysis. The significance value used was 5%. Results and Conclusion: ALTE occurred more frequently around the ages of 9 and 15 weeks, achieving equally male and female infants. The most common sign observed during the event was cyanosis, with or without other signs and symptoms. The isolated events, with short duration were more frequent, mostly with spontaneous recovery. About 50% of the infants were hospitalized for more than 72 hours in observation and investigation of the underlying disease that caused the ALTE. The diagnosis couldn?t be established in 35.2% of the patients, and in the others, respiratory diseases were the most frequent ones. During the hospitalized investigation, 7.6% of the infants died. The risk factors associated with subsequent mortality were the age greater than 6 months and episodes with slow recovery, especially if the underlying disease affected the cardio-circulatory system / Mestrado / Pediatria / Mestre em Ciências

Les travaux de recherche présentés dans ce manuscrit ont pour but de développer des procédés industriels pour la production de quatre ingrédients alimentaires infantiles ayant des propriétés hypoallergéniques et des teneurs réduites en phytoestrogènes. Les propriétés nutritionnelles des protéines de riz et de soja en font des sources intéressantes. Néanmoins, plusieurs problématiques liées aux caractéristiques des produits apparaissent aujourd’hui : la présence de phytoestrogènes (isoflavones) dans les isolats protéiques de soja ; la difficulté à solubiliser et isoler les protéines de riz et la forte allergénicité des protéines dans le cas du soja. Ces travaux présentent l’étude du fractionnement des protéines de soja et de riz pour le développement : d’isolat protéique à teneur réduite en isoflavones ; isolat protéique de riz ayant une teneur supérieure à 90% de protéines ; hydrolysats protéiques de soja et de riz dont le profil de poids moléculaire est maitrisé et potentiellement hypoallergénique. Afin d’y parvenir, la réduction de la taille des protéines par des processus enzymatiques puis le contrôle de leur poids moléculaire ont dû être étudiés. Concernant l’élimination des phytoestrogènes (isoflavones), deux méthodes ont permis d’atteindre de hauts rendements d’extractions. En premier lieu, l’étude de l’extraction par éthanol via une optimisation à petite échelle, suivie d’une mise à l’échelle industrielle ont permis de développer un premier produit à teneur résiduelle en isoflavones inférieure à 50 μg/g de produit sec représentant une réduction de près de 98% de la teneur en isoflavones. Le second procédé étudié a été la rétention des isoflavones sur résine d’adsorption à partir d’un hydrolysat protéique de soja préalablement mis au point, et ceci, par l’utilisation de solution aqueuse sans étape préalable d’extraction. Ce procédé a fait l’objet d’une mise à l’échelle industrielle et d’une étude du comportement chromatographique des isoflavones. L’extraction des isoflavones par eau subcritique et CO2 supercritique est aussi présentée dans cette thèse. Elle a permis de mettre en évidence l’influence de la polarité des différents composés et de la teneur en protéines des produits de soja utilisés. Ces travaux de thèse ont aussi permis de définir un nouveau procédé pour la production d’isolat protéique de riz par l’intermédiaire d’enzymes de types cellulolytiques et amylases, à partir de coproduits issus de l’industrie du sirop de glucose. Des études sur des matières moins transformées telles que le son de riz et la farine ont aussi été étudiées pour la concentration des protéines. L’étude de l’hydrolyse des protéines de soja et de riz a été possible par le suivi de différents indicateurs tels que le pH, la solubilité des protéines, le degré d’hydrolyse, le profil de poids moléculaire par électrophorèse et par chromatographie d’exclusion stérique. Ces procédés ont permis la production de quatre nouveaux ingrédients pouvant être testés pour leurs caractéristiques hypoallergéniques avant une éventuelle production industrielle / The objectives of these works were to develop industrial processes for the production of four infant food ingredients with hypoallergenic properties and reduced levels of phytoestrogens. For this purpose, the nutritional properties of the rice and soy protein are promising. However, due to the presence of phytoestrogens (isoflavones) the consumption of soy protein isolates is a big concern for infant food security because the high exposure to these compounds, known to be endocrine disruptors. Consequently, it was first intended to develop a soy protein isolate with reduced content of isoflavones below 50 μg/g following the recommendations of French and European health authorities. Rice protein isolates are either non-existent on the market, or extremely rare. Therefore, the development of rice protein isolate with a minimum content of 90 % protein was another objective. For the sensitive population, such as infants, the aim of this work was also to develop soy and rice protein hydrolysates conferring hypoallergenic properties. To achieve this goal, the reduction of the size of proteins and the control of their molecular weight was studied. Two methods were used to achieve high extractions yields. A study of ethanol extraction ranging from small-scale optimization to industrial scale was used for a final product with a residual content in isoflavones below 50 μg/g. The second method was to retain isoflavones on adsorption resin from a soy protein hydrolysate. This was possible without preliminary extraction step by solvent. This method was also tested in the industrial scale. The chromatographic behavior of different isoflavones was also studied. The extraction of isoflavones with subcritical water and supercritical CO2 is also presented in this thesis even though these methods were not retained. These pressurized extractions showed the influence of the polarity of isoflavones and the protein content of soy products onto the isoflavone extraction. These works also identified a novel process for the production of rice protein isolate by the hydrolysis of polysaccharides with cellulolytic enzymes and amylases from concentrated protein byproducts from the glucose syrup industry. Studies on less processed materials such as rice bran and flour were also studied for protein isolation. The study of the hydrolysis by proteases of soy and rice proteins were monitored by various indicators such as pH, protein solubility, the degree of hydrolysis, the molecular weight profile by electrophoresis, and size exclusion chromatography. These processes are enabled for the production of four new ingredients that will be tested for their hypoallergenic characteristics before a large scale production.

Made available in DSpace on 2017-06-01T18:08:37Z (GMT). No. of bitstreams: 1 Helenita Meyer.pdf: 5018681 bytes, checksum: 3daec4b23b46d6999430c05a71022240 (MD5) Previous issue date: 2004-02-27 / The objective of this work is to understand the dynamics of families whose children have learning difficulties, during the period of literacy. In theoretical grounding, we adopt a systemic approach, as much to define family dynamics as to discuss difficulties of learning. To get our objective, during the investigation, we count on five mothers, one father, one (that shows up for interwiew next to his wife), two teachers and two school coordinatiors from two schools where the children study; and five children, this way consisting of five cases or five family sistems. To the children, we use the technique of Drawings of the Family with Estory (DF-E). To the fathers, the teachers and the school coordinatiors, we use the semi- strutured interwiew. Our analysis occur on two different moments: one analysis case by case and, on second moment, the general analysis of the cases. The results indicate a family dynamics that focus itself in children, with concern to get their well-being and it values the study as to achieve success in life. By other side, we check the difficult on differentiation/individual process that concerns the children, translated though mechanisms like a superprotection, excess of care, fragile tough excess of control and strict tough, identifications and comparisons. Our study show also the false knowledge that are behind the secrecies and myths, the double messages, the family commands, that become structural elements of family dynamics. This way, these elements of family dynamics. This way these elements work like something that inhibits the character in his own exploration, taking ourselves to reflect about its influence on learning. The purpose of this study is to offer subsidies to parents and profissional workers that deal with children that have learning difficulties and their families, emphasizing the importance of family context on full development of individual / Este trabalho tem como objetivo compreender a dinâmica de famílias com crianças que apresentam dificuldades de aprendizagem, em fase de alfabetização. Na fundamentação teórica, adotamos um enfoque sistêmico, tanto para definir dinâmica familiar, quanto para tratar das dificuldades de aprendizagem. Para alcançar nosso objetivo, tomamos, para investigação, cinco mães, um pai (que compareceu à entrevista, junto com a esposa), duas professoras e duas coordenadoras pedagógicas dos dois colégios onde as crianças estudam; e cinco crianças, formando, no total, cinco casos ou cinco sistemas familiares. Com as referidas crianças, usamos a técnica de Desenhos da Família com Estória (DF-E). Com os pais, as professoras e as coordenadoras, usamos a entrevista semi-estruturada. Nossa análise deu-se em dois momentos distintos: uma análise caso a caso e, no segundo momento, a análise geral dos casos. Os resultados apontam para uma dinâmica familiar que se centraliza nos filhos, com a preocupação de promover o seu bem-estar e valoriza o estudo como meio de alcançar sucesso na vida. Por outro lado, verificamos a dificuldade no processo de diferenciação/individuação com relação aos filhos, traduzida através de mecanismos, como a superproteção, excesso de zelo, fragilização, excesso de controle e rigidez, identificações e comparações. Nosso estudo aponta também para os falsos conhecimentos que estão por trás dos segredos e mitos, as duplas mensagens, os mandatos familiares, que se tornam elementos estruturantes das dinâmicas familiares. Estes fatores acabam por funcionar como inibidores do sujeito na sua exploração autônoma, fazendo-nos refletir sobre a sua influência na aprendizagem. O propósito deste estudo é oferecer subsídios aos pais e profissionais que lidam com crianças que têm dificuldades de aprendizagem e suas famílias, ressaltando a importância do contexto familiar no desenvolvimento integral do indivíduo

Resumo: Nas últimas décadas a transição nutricional vem ocorrendo em países desenvolvidos e em desenvolvimento, com uma prevalência maior de indivíduos sobrepesos e obesos. Devido à situação agravante do estado nutricional da população infantil brasileira, às doenças acarretadas pela má alimentação e sedentarismo, além da construção do hábito alimentar ser realizado nessa fase de desenvolvimento e este adotado para a vida adulta do indivíduo, podese notar a necessidade de educar essas crianças, em relação à nutrição. A creche é o local considerado apropriado para o ensino dessa população e, segundo as Diretrizes Curriculares Nacionais para Educação Infantil, a alimentação deveria estar inserida em todos os projetos político-pedagógicos, na área da Educação em Saúde, mas ainda existe um erro na concepção dos significados de cuidar e educar nessas instituições, principalmente entre a faixa etária de 0 a 3 anos. Contudo, o objetivo do presente trabalho foi identificar os conhecimentos e as práticas, relacionados à alimentação de crianças de 0 a 3 anos a fim de verificar a formação dos profissionais que trabalham com crianças dessa faixa etária, na área da Educação Nutricional. Para isso, o procedimento metodológico seguiu as orientações do estudo de caso, com abordagem qualitativa, que englobou a fase exploratória, a observação, a entrevista semiestruturada e a análise, visando a caracterização das participantes da pesquisa, do local onde foi realizado o estudo e das crianças da faixa etária estudada. Os saberes e práticas das agentes educacionais e professoras de Ensino Infantil do Centro de Educação e Recreação, em estudo, foram analisados por meio de questões abertas e fechadas e das observações dos tópicos relacionados à nutrição infantil, juntamente com os dados sobre a formação dessas profissionais... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: In the last decades, nutritional transition has been occurring in developed and in-progress countries, focusing overweight and obese people. The necessity of providing children nutritional education/knowledge has increased due to the aggravating nutrition situation of the Brazilian infantile population, diseases caused by bad eating habits and lack of physical exercises, yonder the acquirement of eating habits that will be lifetime followed. Day care centers are the appropriate places for teaching this population, and according to National Curricular Guide for Infantile, nourishment should be inserted in all political-pedagogic projects in the Health Education field, but these institutions still misunderstand the meaning of caring and educating, specially among children from 0 to 3 years old. Yet, the aim of this current work was to identify the knowledge and practices that people have regarding 0 to 3 year-old children in order to add information to professionals who work with this age group children in the Nutrition Education field. Thus, the methodological procedure followed the guidance of the studied case using a qualitative approaching that comprised the exploiting stage, the examination, the semi-structured interview and the analysis aiming the characterization of the interview participants, the place where the study was carried out and the age group of the children studied. The educational agents and teachers of infantile education from the Recreation and Education Center studied were analyzed through questions, and examinations of topics related to infantile nutrition along with data about the degree of these professionals. It can be concluded that both educational agents and Infantile Education teachers have a significant knowledge about infantile nutrition. However their biggest concern was to supply the children's nutritional necessities through a healthy meal... (Complete abstract click electronic access below) / Orientador: Rodolfo Telarolli Junior / Coorientador: Maria Iolanda Monteiro / Banca: Maria Rita Marques de Oliveira / Banca: Marilda da Silva / Mestre

[pt] Esta dissertação faz uma análise da transposição da narrativa oral de pessoas da terceira idade para os desenhos infantis por um processo empírico onde observamos a produção de 453 desenhos de alunos em escolas municipais do Rio de Janeiro. Configurados a partir de histórias da infância dos idosos, esses desenhos foram objeto de estudo em relação à criatividade, à narratividade e à memória que possibilitaram a representação dos elementos dessas histórias. A idéia é averiguar a influência do tempo entre a escuta e o desenho, a interferência do processo de ensino e aprendizagem no espaço escolar e a relação do sujeito com os materiais desta transposição, levando em conta a cultura, o contexto e o nível de expertise dos sujeitos. / [en] This dissertation analyses the process of transposition of aged peoples oral narrative to childrens drawings, by an empirical work where we were able to analyse 453 drawings made by pupils from Rio de Janeiro schools.Inpired by the childhood stories of the aged collaborators, these drawings show narrative capacities, creative qualities and the memory of these stories. The intention is to understand time influences between the period listening to the stories and the transposed drawing. The interference of the teaching and learning process on the drawings, made in a school enviroment and, finally, the relation between the individual and the materials available for this transposition, taking into account the culture, the environment and the level of expertise.

PhD (Microbiology) / Department of Microbiology / Background: Diarrheal diseases have a major effect on human health, Globally; it is second only to pneumonia as a leading cause of death among children under five. They are due to a variety of infectious and non-infectious agents; including Entamoeba spp. Entamoeba histolytica is an invasive enteric protozoan parasite that causes amebiasis. Amebiasis is frequent in communities without clean water and poor sanitation, which include low-income South African populations in Giyani and Pretoria. In these populations, the amount of diarrhea caused by Entamoeba histolytica inclusive of all ages, sexes and HIV status is uncertain. Diagnosis of the parasite is usually by microscopy. However, microscopy lacks sensitivity and specificity, therefore it is not reliable. Fortunately, molecular diagnostic tests have been developed to detect different Entamoeba species in humans. It is known that the parasite E. histolytica causes asymptomatic and symptomatic diseases. However, the transition from colonization to disease is still unclear. While parasite and host factors, as well as environmental conditions influence the infection outcome, there is currently no clear explanation of wide variation in the presentation of the disease. This could suggest that there are other factors affecting the disease outcome. A better understanding of these factors as well as their role in disease remains target objectives of modern scientists and it will definitely help in the fight against the disease. In spite of the emerging evidence that the host microbiome, parasite burden and the inflammatory response contribute to the virulence of E. histolytica, their roles have never been defined in developing regions such as Giyani and Pretoria. In addition, the present study hypothesized that co-infections with E. histolytica and secretion of extracellular vesicles/exosomes have a significant impact on the virulence of E. histolytica. Little has been explored or elucidated about responses triggered by other enteropathogens/ameba interplay that could be important in the induction of tissue invasion and disease and also how E. histolytica/enteropathogens interplay in these infections has not been determined. Therefore, the knowledge of this interplay could help in understanding how this modifies disease manifestations by modulating pathogen virulence and the host response. The use of secretion systems is an essential biological process exploited by pathogenic microorganisms to promote survival and spread of the pathogen, which in turn exacerbate the infection. The study of extracellular vesicles (EVs) released by pathogens is a new and exciting field that may realistically contribute to a better understanding of the pathogenic process of E. histolytica and provide alternate control strategies. Aim and objective of the study: The overall aim of the study was to determine the impact of enteric pathogens and secreted extracellular vesicles on amebic virulence and the outcome of infection. This aim was addressed in through a series of six primary objectives, which were: a. To investigate the distribution and prevalence of protozoan parasites in South Africa. b. To investigate novel species of Entamoeba circulating in the South African population. ix c. To elucidate the impact of gut microbiota and immune response during amebic infection. d. To determine the role of Entamoeba histolytica macrophage inhibitory factor (EhMIF) during amebic infection. e. To investigate the impact of co-infections on the outcome of amebiasis. f. To determine the presence of secreted extracellular vesicles/exosomes in Entamoeba histolytica. Brief methodology and results: A modified and validated Taqman qPCR assay (with taqman probes and genus specific primers) was used for amplification and target detection. This assay was used to investigate the distribution and prevalence of protozoan parasites (Cryptosporidium spp and Giardia lamblia) in South Africa, the assay was considered superior for this project because it is more sensitive than conventional PCR and it can be used to detect multiple infection targets. This assay allows fast, accurate, and quantitative detection of a broad spectrum of enteropathogens and is well suited for surveillance or clinical purposes. A total of 484 stool samples collected from diarrheal and non-diarrheal patients from rural and urban communities of South Africa were studied. The overall prevalence of parasites (Giardia lamblia and Cryptosporidium spp) in rural and urban patients were found to be 49% (112/227) and 21% (54/257) respectively (p= < 0.0001). The distribution of specific pathogens in rural areas was Cryptosporidium spp (20%) and Giardia lamblia (14%). Our findings showed no significant difference in parasitic infections between gender and the age of the participants (Chapter 3). The discovery of novel species is of great importance to human health. We have recently discovered stools positive for Entamoeba organisms by microscopy but PCR negative for known Entamoeba species. This led to the hypothesis that novel species of Entamoeba are present in the South African population. A comprehensive assay was used which included probes to identify Entamoeba bangladeshi from diarrheal and non-diarrheal participants. A sensitive qPCR assays and amplicon sequencing was used to detect Entamoeba spp, Prevotella copri and Enterobacteriaceae. Interestingly, E. bangladeshi was identified in the South African population. Entamoeba was present in 27% (E. histolytica 8.5% (41/484), E. dispar 8% (38/484), and E. bangladeshi 4.75% (23/484) E. moshkovskii was not detected in the present study. We were also able to observe changes in the host microbiome and the parasite burden associated with E. histolytica infections in S. African diarrhea cases versus asymptomatic controls but not with E. bangladeshi or E. dispar. In E. histolytica positive samples the level of both parasite and P. copri were lower in non-diarrheal samples (p=0.0034) (Chapter 4). There is accumulating evidence that the inflammatory response contributes to injury. Little is known about the key parasite mediators of host mucosal immunopathology. This study hypothesized that migration inhibitory factor (MIF) mediates the destructive host inflammatory response seen in amebic colitis. To determine the role of EhMIF during amebic infection, we used a genetic approach to test the effect of EhMIF on mucosal inflammation. We found that EhMIF induces IL-8 secretion from intestinal epithelial cells. Mice treated with antibodies that specifically block EhMIF had reduced chemokine expression and neutrophil infiltration in the mucosa. In addition to antibody-mediated neutralization, mice infected with parasites overexpressing EhMIF had increased chemokine expression, neutrophil influx and mucosal damage. We also found that the concentration of EhMIF correlated with the level of intestinal inflammation in persons with intestinal amebiasis. Together, our results reveal a novel parasite mediator of mucosal inflammation and support MIF homologs as potential immunomodulatory targets (Chapter 5). To investigate the impact of co-infections on the outcome of amebiasis, we analyzed the co-occurence of E. histolytica with other enteropathogens known to cause diarrheal infections, such as Shigella/EIEC (IpaH), Campylobacter (cadf), Enterotoxigenic E. coli (STh), Norovirus GII and Adenovirus (Hexon). The results were compared with those obtained with E. histolytica that were not interacted with enteropathogens and with E. histolytica interacted with enteropathogens. The impact of multiple infections on the outcome of the infection was compared between nondiarrheal and diarrheal stool samples. It was found that co-infections with two pathogens were associated with diarrhea compared to single infections. Moreover, Norovirus GII, Campylobacter (Cadf) and co-infections were associated with diarrhea in the study population. This study did not show any significant impact of pathogens co-infecting with E. histolytica on the outcome of amebic infection (Chapter 6). The presence of secreted extracellular vesicles/Exosomes in Entamoeba histolytica was determined by using the Pathogenic ameba strains (HM-1:IMSS or HM-1:IMSS (Sub-strain-US) from petri’s lab to purify exosomes using the commercially available kit to isolate exosomes (total exosomes isolation kit). Our study for the first time revealed that E. histolytica does secrete Evs. This finding increases the appreciation that all organisms are likely to secrete these EVs (Chapter 7). However, the impact of these EVs on the pathogenesis of E. histolytica needs further investigations. Conclusion: This study has contributed significantly to our knowledge on infectious diarrhea and the diversity of Entamoeba species by providing new data on the rate and prevalence of Entamoeba diarrheal infections and their distribution in the South African population. Our study describes for the first time the presence of E. bangladeshi in the South African population. Furthermore, our results reveal a novel parasite mediator of mucosal inflammation and support MIF homologs as potential immunomodulatory targets. This study also, for the first time revealed that E. histolytica does secrete EVs. The results from this work will undoubtedly open an exciting research to establish a deeper understanding of the function and role of these vesicles in amebic infection. We encourage public health interventions like health education programs and improvement of sanitation and hygiene in these populations. Molecular diagnostics should be used for specific diagnostic in clinical settings. / NRF

This thesis looks at the social, political, and military effects of epidemic polio on America's war effort during World War II. The primary sources consulted include newspapers, military medical reports, photographs, memoirs, speeches, and archival collections. It looks at the effects of polio on the home front, more specifically how epidemics and the rising rates of polio were a detriment to the civilian war effort. It also focuses on the American military's preparation for and response to polio outbreaks among troops both at home and abroad. Finally, it discusses the experiences of the servicemen who contracted polio during the war. This work fills a major hole in the historiography of the disease and highlights the overlapping interests of the public, the medical community, and the military during a time of war.