A temática da pedofilia é complexa, polêmica e emergente. A pedofilia, no entanto, não implica necessariamente no cometimento de atos abusivos contra as crianças, sendo possível que as fantasias sexuais do pedófilo jamais saiam de sua mente. Por outro lado, caso referido distúrbio sexual ultrapasse os limites do imaginário do indivíduo que dele é portador, estará configurado o abuso sexual infantil. Relevante observar que não apenas o indivíduo portador de pedofilia pratica atos que caracterizam abuso sexual infantil, mas também os denominados abusadores oportunistas ou ocasionais. Na relação pedófilo-criança, a opção pelo estudo da criança neste trabalho justifica-se, sobretudo, porque é ela quem ocupa a posição de vítima e, como tal, não se duvida que seus prejuízos sejam maiores em decorrência dos atos abusivos praticados. De fato, relevante assumir um olhar benevolente para aquela que, subjugada pelo abuso, necessita, de alguma forma, encontrar amparo que a possa resgatar dessa situação. Menciona-se, nesta dissertação, que historicamente as crianças sempre foram vítimas de atos de violência e que a temática do abuso sexual infantil compreende outras noções igualmente polêmicas, dentre as quais se podem destacar a sexualidade infantil e o incesto. Nesse passo, é dito que a existência de uma sexualidade infantil saudável constitui aspecto relevante para o pleno desenvolvimento da criança. Demonstra-se que o abuso sexual infantil tem a peculiaridade de se revestir da característica do segredo, ou seja, de um silêncio que encobre as práticas abusivas perpetradas contra a criança, de forma que fica garantida a perpetuação do abuso ao longo do tempo, sendo notável a cifra negra relativamente a essas práticas. Com relação ao estudo do abuso sexual infantil praticado por portadores de pedofilia, justifica-se o enfoque em virtude das circunstâncias de sedução e engodo que envolvem a atuação pedofílica e que potencializam o trauma vivenciado pela vítima. Nesse contexto, retrospectivamente ao abuso, verifica-se a existência de fatores de risco para sua ocorrência, bem como se mencionam teorias sobre a vítima. Ressalta-se que a criança e o abusador ocupam posições nitidamente distintas na relação de poder que se estabelece entre eles e se enfatiza a necessidade de investigar quais dessas crianças, que já são vulneráveis por si só, apresentam-se no grupo de risco para a vitimização. São apontados fatores de risco para a vitimização, dentre os quais, sexo, idade, isolamento social e relações conflituosas com os pais ou entre eles. Descreve-se o processo de aproximação entre o pedófilo e a vítima, bem como se analisam os danos sofridos pela criança vitimada. São fornecidos critérios para o diagnóstico do abuso sexual infantil e elencados fatores capazes de potencializar o trauma da vitimização. Descrevem-se os efeitos iniciais e a longo prazo do abuso e, por fim, refletindo-se sobre os fatores de risco, anteriores ao abuso e, sobre os danos, a ele posteriores, salienta-se a importância da tomada de atitudes preventivas e reparatórias do abuso sexual infantil, todas pautadas em ações multissetoriais e interdisciplinares. / Pedophilia is a complex, emergent and polemic theme. However, pedophilia does not imply committing abusive acts against children; once it is possible the pedophile sexual fantasy never emerges out of his mind. On the other hand, in case such sexual deviance exceed the limits of the persons imagination, then the child sex abuse is configured. It is relevant to observe that not only the pedophile practices acts which can be qualified as childs sex abuse, but also those acts practiced by opportunists or occasional abusers. Within the pedophile-childs relationship, the option for a study of the child is justifiable, mainly because it holds the position of victim and, as such, there cannot be any doubt that the damages are larger as a result of the abuse acts. In fact, a benevolent eye is set upon the child who suffered the abuse and needs, somehow, to receive the necessary support to rescue it from this situation. It is mentioned, in this paper, that historically children have always been victims of violence acts, and that the theme of child sex abuse comprises other aspects equally polemic, among which we can detach infantile sexuality and incest. In this connection, it is said that the existence of a healthy infantile childhood is relevant for the full development of children. It is pointed out that the child sex abuse has the peculiarity of being involved in a climate of secrecy, i.e. the silence covering abusive practices against children, so that the maintenance of the abuse is kept for a long time, the black cipher on this context being notable. With reference to the study of child sex abuse practiced by pedophilists, this focus is justifiable, in view of the seduction and deception involving pedophilic activities, which contribute to potentiate the trauma experienced by the victim. In this sense, it is said there are risk factors which precede the abuse, as well as theories about the victim are mentioned. It is noteworthy that the child and the abuser occupy distinct positions in the power relationship between them, and we must emphasize the need for investigation about which of the children, vulnerable by themselves, are on the victimization risk group. Risk factors for victimization are pointed out, such as, sex, age, social isolation and conflict relations with parents or between them. The process of approximation between the pedophile and the victim is indicated, as well as de damages suffered by the victim child. Criteria are supplied for the diagnosis of infant sex abuse, and factors capable of potentiating the victimization trauma are indicated. The initial and long-term abuse effects are described and, finally, considering the reflections on the risk factors prior to the abuse and on the damages after it, emphasizing the importance of taking preventive and remedial actions on infantile sex abuse, all of them based on multi-sector and multidisciplinary actions.

A temática da pedofilia é complexa, polêmica e emergente. A pedofilia, no entanto, não implica necessariamente no cometimento de atos abusivos contra as crianças, sendo possível que as fantasias sexuais do pedófilo jamais saiam de sua mente. Por outro lado, caso referido distúrbio sexual ultrapasse os limites do imaginário do indivíduo que dele é portador, estará configurado o abuso sexual infantil. Relevante observar que não apenas o indivíduo portador de pedofilia pratica atos que caracterizam abuso sexual infantil, mas também os denominados abusadores oportunistas ou ocasionais. Na relação pedófilo-criança, a opção pelo estudo da criança neste trabalho justifica-se, sobretudo, porque é ela quem ocupa a posição de vítima e, como tal, não se duvida que seus prejuízos sejam maiores em decorrência dos atos abusivos praticados. De fato, relevante assumir um olhar benevolente para aquela que, subjugada pelo abuso, necessita, de alguma forma, encontrar amparo que a possa resgatar dessa situação. Menciona-se, nesta dissertação, que historicamente as crianças sempre foram vítimas de atos de violência e que a temática do abuso sexual infantil compreende outras noções igualmente polêmicas, dentre as quais se podem destacar a sexualidade infantil e o incesto. Nesse passo, é dito que a existência de uma sexualidade infantil saudável constitui aspecto relevante para o pleno desenvolvimento da criança. Demonstra-se que o abuso sexual infantil tem a peculiaridade de se revestir da característica do segredo, ou seja, de um silêncio que encobre as práticas abusivas perpetradas contra a criança, de forma que fica garantida a perpetuação do abuso ao longo do tempo, sendo notável a cifra negra relativamente a essas práticas. Com relação ao estudo do abuso sexual infantil praticado por portadores de pedofilia, justifica-se o enfoque em virtude das circunstâncias de sedução e engodo que envolvem a atuação pedofílica e que potencializam o trauma vivenciado pela vítima. Nesse contexto, retrospectivamente ao abuso, verifica-se a existência de fatores de risco para sua ocorrência, bem como se mencionam teorias sobre a vítima. Ressalta-se que a criança e o abusador ocupam posições nitidamente distintas na relação de poder que se estabelece entre eles e se enfatiza a necessidade de investigar quais dessas crianças, que já são vulneráveis por si só, apresentam-se no grupo de risco para a vitimização. São apontados fatores de risco para a vitimização, dentre os quais, sexo, idade, isolamento social e relações conflituosas com os pais ou entre eles. Descreve-se o processo de aproximação entre o pedófilo e a vítima, bem como se analisam os danos sofridos pela criança vitimada. São fornecidos critérios para o diagnóstico do abuso sexual infantil e elencados fatores capazes de potencializar o trauma da vitimização. Descrevem-se os efeitos iniciais e a longo prazo do abuso e, por fim, refletindo-se sobre os fatores de risco, anteriores ao abuso e, sobre os danos, a ele posteriores, salienta-se a importância da tomada de atitudes preventivas e reparatórias do abuso sexual infantil, todas pautadas em ações multissetoriais e interdisciplinares. / Pedophilia is a complex, emergent and polemic theme. However, pedophilia does not imply committing abusive acts against children; once it is possible the pedophile sexual fantasy never emerges out of his mind. On the other hand, in case such sexual deviance exceed the limits of the persons imagination, then the child sex abuse is configured. It is relevant to observe that not only the pedophile practices acts which can be qualified as childs sex abuse, but also those acts practiced by opportunists or occasional abusers. Within the pedophile-childs relationship, the option for a study of the child is justifiable, mainly because it holds the position of victim and, as such, there cannot be any doubt that the damages are larger as a result of the abuse acts. In fact, a benevolent eye is set upon the child who suffered the abuse and needs, somehow, to receive the necessary support to rescue it from this situation. It is mentioned, in this paper, that historically children have always been victims of violence acts, and that the theme of child sex abuse comprises other aspects equally polemic, among which we can detach infantile sexuality and incest. In this connection, it is said that the existence of a healthy infantile childhood is relevant for the full development of children. It is pointed out that the child sex abuse has the peculiarity of being involved in a climate of secrecy, i.e. the silence covering abusive practices against children, so that the maintenance of the abuse is kept for a long time, the black cipher on this context being notable. With reference to the study of child sex abuse practiced by pedophilists, this focus is justifiable, in view of the seduction and deception involving pedophilic activities, which contribute to potentiate the trauma experienced by the victim. In this sense, it is said there are risk factors which precede the abuse, as well as theories about the victim are mentioned. It is noteworthy that the child and the abuser occupy distinct positions in the power relationship between them, and we must emphasize the need for investigation about which of the children, vulnerable by themselves, are on the victimization risk group. Risk factors for victimization are pointed out, such as, sex, age, social isolation and conflict relations with parents or between them. The process of approximation between the pedophile and the victim is indicated, as well as de damages suffered by the victim child. Criteria are supplied for the diagnosis of infant sex abuse, and factors capable of potentiating the victimization trauma are indicated. The initial and long-term abuse effects are described and, finally, considering the reflections on the risk factors prior to the abuse and on the damages after it, emphasizing the importance of taking preventive and remedial actions on infantile sex abuse, all of them based on multi-sector and multidisciplinary actions.

Diarrhea caused by rotavirus and Giardia is a major health problem among children attending day-care centers because of inadequate personnel hygiene. Epidemiological evidence suggesting person-to-person transmission of enteric pathogens has long been recognized. This study was initiated to investigate the effectiveness of handwashing for the removal of rotavirus and Giardia from contaminated hands. The palms of participant hands were innoculated with approximately 103 Giardia cysts or 105 plaque forming units of rotavirus and the effect of washing using tap water alone, a liquid soap or a bar soap on their removal was assessed. Handwashing with liquid soap was found to be very effective in the removal of rotavirus and Giardia cysts as compared to washing with bar soap or tap water alone. The overall recovery of viruses in both bar soap and liquid soap was low (0.03-22.5%), probably due to virus inactivation by the detergent.

Esta pesquisa teve como objetivo avaliar a evolução de crianças nascidas de mães positivas para o HIV ou com AIDS no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, durante o período compreendido entre 1986 e 2001. Foram levantadas informações relativas a profilaxia pré-natal e da criança ao nascer, assim como à reversão sorológica, soropositividade e sobrevida. Dos 680 participantes, 67 (9,8%) se infectaram, 520 (76,5%) não se infectaram e 93 (13,7%) ficaram sem informação devido ao abandono de seguimento. Profilaxia durante a gestação ocorreu em 144 mulheres com o uso de uma droga (21,2%) e em 77 com a utilização de duas ou mais drogas (11,3%), não tendo se verificado em 459 gestantes (67,5%). Entre os recém nascidos, 205 (30,1%) receberam apenas AZT, 134 (19,7%) foram medicados com AZT+SMX/TMP e 341 (50,1%) não foram tratados. Ocorreu óbito de 39 crianças (5,7%), com 559 (82,2%) tendo permanecido vivas e 82 (12,0%) cuja informação foi perdida. O percentual de óbito foi consideravelmente mais elevado entre os que não receberam profilaxia (9,7%), em relação aos que receberam apenas AZT (2,9%). Não se verificou nenhuma morte entre as 134 crianças em uso AZT+SMX/TMP. As proporções de óbitos variaram de acordo com o tempo, atingindo 9,5% no período pré-profilaxia (1986/1995) e caindo para 2,7% entre os anos de 1996 e 2001. Entre os 67 indivíduos infectados pelo HIV foram verificadas 22 mortes (33,8%), valor muito superior ao encontrado entre os 520 não infectados, nos quais ocorreram apenas 4 óbitos (0,8%). Os tempos medianos de reversão sorológica foram iguais a 589 dias para os nascidos de 1986 a 1995, e 451 dias, para os que nasceram no período 1996 a 2001. As curvas de sobrevivência demonstraram o evidente favorecimento dos indivíduos que foram submetidos a algum tipo de profilaxia, indicando que a intervenção terapêutica trouxe ganhos inquestionáveis para os recém nascidos de gestantes positivas para o HIV ou com AIDS. / The objective of the present study was to evaluate the evolution of children born to HIV-positive mothers or mothers with AIDS at the University Hospital, Faculty of Medicine of Ribeirão Preto, during the period from 1986 to 2001. Information was obtained about prenatal prophylaxis and infant prophylaxis at birth, and about serologic reversal, seropositivity and survival. Of the 680 participants, 67 (9.8%) were infected, 520 (76.5%) were not infected, and no information was available for 93 (13.7%) infants who were lost to follow-up. Prophylaxis during pregnancy occurred in 144 women with the use of mono prophylaxis (21.2%) and in 77 with the use of two or more drugs (11.3%), and 459 (67.5%) received no prophylaxis. Among the newborns, 205 (30.1%) received only AZT, 134 (19.7%) were medicated with AZT+SMX/TMP, and 341 (50.1%) had not carried trough prophylaxis. Thirty-nine children died (5.7%), 559 (82.2%) continued to live, and for 82 (120%) the information was lost. The death rate was considerably more elevated among the children who did not receive prophylaxis (9.7%) compared to those who received only AZT (2.9%). No death occurred among the 134 children had prophylaxis with AZT+SMX/TMP. Death rates varied according to time, reaching 9.5% during the preprophylaxis period (1986/1995) and falling to 2.7% between 1996 and 2001 Twenty-two deaths occurred among the 67 HIV-infected individuals (33.8%), a much higher value than detected among the 520 non-infected individuals (4 deaths, 0.8%). The median times for serological reversal were 589 days for the infants born between 1986 and 1995 and 451 days for those born from 1996 to 2001. The survival curves demonstrated an evident favoring of individuals submitted to some type of prophylaxis, indicating that therapeutic intervention has brought unquestionable gains for infants born to HIV-positive mothers or mothers with AIDS.

Esta pesquisa teve como objetivo avaliar a evolução de crianças nascidas de mães positivas para o HIV ou com AIDS no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, durante o período compreendido entre 1986 e 2001. Foram levantadas informações relativas a profilaxia pré-natal e da criança ao nascer, assim como à reversão sorológica, soropositividade e sobrevida. Dos 680 participantes, 67 (9,8%) se infectaram, 520 (76,5%) não se infectaram e 93 (13,7%) ficaram sem informação devido ao abandono de seguimento. Profilaxia durante a gestação ocorreu em 144 mulheres com o uso de uma droga (21,2%) e em 77 com a utilização de duas ou mais drogas (11,3%), não tendo se verificado em 459 gestantes (67,5%). Entre os recém nascidos, 205 (30,1%) receberam apenas AZT, 134 (19,7%) foram medicados com AZT+SMX/TMP e 341 (50,1%) não foram tratados. Ocorreu óbito de 39 crianças (5,7%), com 559 (82,2%) tendo permanecido vivas e 82 (12,0%) cuja informação foi perdida. O percentual de óbito foi consideravelmente mais elevado entre os que não receberam profilaxia (9,7%), em relação aos que receberam apenas AZT (2,9%). Não se verificou nenhuma morte entre as 134 crianças em uso AZT+SMX/TMP. As proporções de óbitos variaram de acordo com o tempo, atingindo 9,5% no período pré-profilaxia (1986/1995) e caindo para 2,7% entre os anos de 1996 e 2001. Entre os 67 indivíduos infectados pelo HIV foram verificadas 22 mortes (33,8%), valor muito superior ao encontrado entre os 520 não infectados, nos quais ocorreram apenas 4 óbitos (0,8%). Os tempos medianos de reversão sorológica foram iguais a 589 dias para os nascidos de 1986 a 1995, e 451 dias, para os que nasceram no período 1996 a 2001. As curvas de sobrevivência demonstraram o evidente favorecimento dos indivíduos que foram submetidos a algum tipo de profilaxia, indicando que a intervenção terapêutica trouxe ganhos inquestionáveis para os recém nascidos de gestantes positivas para o HIV ou com AIDS. / The objective of the present study was to evaluate the evolution of children born to HIV-positive mothers or mothers with AIDS at the University Hospital, Faculty of Medicine of Ribeirão Preto, during the period from 1986 to 2001. Information was obtained about prenatal prophylaxis and infant prophylaxis at birth, and about serologic reversal, seropositivity and survival. Of the 680 participants, 67 (9.8%) were infected, 520 (76.5%) were not infected, and no information was available for 93 (13.7%) infants who were lost to follow-up. Prophylaxis during pregnancy occurred in 144 women with the use of mono prophylaxis (21.2%) and in 77 with the use of two or more drugs (11.3%), and 459 (67.5%) received no prophylaxis. Among the newborns, 205 (30.1%) received only AZT, 134 (19.7%) were medicated with AZT+SMX/TMP, and 341 (50.1%) had not carried trough prophylaxis. Thirty-nine children died (5.7%), 559 (82.2%) continued to live, and for 82 (120%) the information was lost. The death rate was considerably more elevated among the children who did not receive prophylaxis (9.7%) compared to those who received only AZT (2.9%). No death occurred among the 134 children had prophylaxis with AZT+SMX/TMP. Death rates varied according to time, reaching 9.5% during the preprophylaxis period (1986/1995) and falling to 2.7% between 1996 and 2001 Twenty-two deaths occurred among the 67 HIV-infected individuals (33.8%), a much higher value than detected among the 520 non-infected individuals (4 deaths, 0.8%). The median times for serological reversal were 589 days for the infants born between 1986 and 1995 and 451 days for those born from 1996 to 2001. The survival curves demonstrated an evident favoring of individuals submitted to some type of prophylaxis, indicating that therapeutic intervention has brought unquestionable gains for infants born to HIV-positive mothers or mothers with AIDS.

Infantile hemangiomas (IHs), benign vascular lesions present on the surface of the skin of children, are treated with systemic or topical beta-adrenergic antagonists (known as “beta-blockers”). However, systemic beta-blocker therapy is associated with serious adverse events in pediatric patients, and there are currently no topical formulations optimized for the skin. The objectives of this work were to 1) evaluate the local skin concentrations and drug permeation through the skin using novel beta-blocker formulations, and 2) characterize the epidermal properties and skin surface inflammatory mediators of IH skin. Skin concentrations and drug permeation through the skin from current topical treatment options were quantified in vitro; these data served as benchmarks to which other treatment paradigms in later studies were compared. Microneedle (MN)-mediated delivery of two beta-blockers, propranolol and timolol, was evaluated in vitro using solid MNs and two dissolving MN array formulations. Solid MNs increased skin concentrations of timolol compared to intact skin, while producing similar skin concentrations of propranolol. Drug permeation through the skin was increased for both drugs after MN pretreatment. Both formulations of dissolving MN arrays were ineffective at increasing local skin concentrations compared to intact skin. This was likely due to the small loading capacity of drug into the array. Drug-loaded microemulsions (ME) of varying composition were formulated and characterized. All ME formulations had solubilization properties, and water rich MEs had the greatest cumulative release through a homogenous membrane compared to surfactant rich MEs. Drug-loaded MEs did not increase local skin concentrations in vitro compared to a drug solution; however, water rich ME formulations produced greater skin-to-receiver ratio of drug concentration, indicating their potential for skin accumulation. MN pretreatment increased the skin-to-receiver ratios for surfactant rich formulations but not for water rich formulations, indicating this enhancement in skin retention after MN pretreatment is formulation dependent. These results demonstrate the potential for topical treatment of IHs upon further optimization of delivery and formulation parameters. The epidermal properties and skin surface mediators of IH skin were compared to normal, unaffected skin. Significant differences in barrier function and color, as well as chemokine and growth factor concentrations, were observed between the two sites. These results provide a greater understanding of the IH properties that have previously not been quantified. Similar changes in lesion color, which correlate to efficacy, were observed after beginning treatment with oral propranolol or topical timolol, while changes in barrier function were similar between the two treatment groups. These results indicate topical timolol may be a safe alternative for systemic treatment for superficial IHs without a loss of efficacy.

Texte remanié de: Proefschrift--Wageningen universiteit, 2003. / N° de : "A.A.G. Bijdragen", ISSN 0511-0726, 42. Bibliogr. p. 323-336.

Mémoire d'orthophonie : Médecine : Université de Nantes : 2007. / Bibliogr.

Mémoire d'orthophonie : Médecine : Université de Nantes : 2007. / Bibliogr.

Le présent travail vise à évaluer le processus de changement intrapsychique chez un enfant après une année de psychothérapie psychanalytique. Historiquement, la recherche sur le changement a suscité peu d'intérêt du côté des psychanalystes d'enfants, ce qui désavantage grandement la psychanalyse en regard des approches cognitivo-comportementales, dont les bienfaits ont été démontrés à maintes reprises. Un des principaux problèmes rencontrés en abordant ce domaine d'étude est relié à la méthodologie traditionnellement utilisée par les psychanalystes, soit l'étude de cas clinique. Malgré les avantages indéniables de ce modèle d' acquisition des connaissances, celui-ci connaît néanmoins d'importantes lacunes, notamment au niveau de sa validité interne. Par conséquent, sa valeur sur le plan scientifique s'en trouve considérablement affaiblie. Dans le but de remédier à ce problème, nous avons développé une méthodologie qualitative d'étude de cas systématisée. Ainsi, tout en conservant les avantages des études de cas (c'est-à-dire accès à la singularité et profondeur des analyses), nous avons tenté d'accroître la validité interne de ce type de démarche en systématisant les étapes rattachées à la collecte et à l'analyse des données. Par la mise au point d'une méthodologie qualitative d'étude de cas systématisée, nous répondons à notre premier objectif de recherche. Afin de demeurer fidèle aux enseignements de la psychanalyse, notre second objectif consiste à évaluer le changement en termes de fonctionnement intrapsychique. Étonnamment, même s'il constitue la visée du travail psychanalytique, nous savons peu de choses sur l'évolution de ce type de fonctionnement à travers le temps. Plus précisément, il s'agit pour nous de voir comment évoluent chez un enfant suivi en psychothérapie psychanalytique les deux composantes intrapsychiques suivantes: les angoisses et les mécanismes de défense. Ces deux composantes sont évaluées à partir de trois épreuves projectives (Rorschach, test d'aperception thématique et épreuves graphiques) administrées en deux temps avec un intervalle de douze mois qui sépare le temps I et le temps II. Le modèle théorique qui a servi de toile de fond pour définir les différents concepts à l'étude est le modèle kleinien. Brièvement, nos résultats montrent que d'importantes modifications se sont produites entre le temps I et le temps II. L'évolution la plus marquée est sans aucun doute dans le registre de la position schizo-paranoïde où l'angoisse persécutive connaît les remaniements les plus importants. Nous notons également une diminution de l'utilisation de certains mécanismes de défense (dont la défense maniaque) et l'émergence d'un bon objet secourable qui, au temps l, était totalement défaillant lorsque l'enfant avait besoin d'être rassuré et protégé. En fin de parcours, nous avons tenté d'établir un pont entre les résultats obtenus et la théorie psychanalytique. Spécifiquement, à partir des notions d'intégration de Klein et de fonction contenante de Bion, nous voulions voir comment la théorie éclaire les données cliniques et inversement comment les données cliniques, à leur tour, éclairent certains points théoriques. Cet aller-retour entre clinique et théorie a pour but d'enrichir et d'approfondir la réflexion sur la notion de changement en psychanalyse. ______________________________________________________________________________ MOTS-CLÉS DE L’AUTEUR : Changement intrapsychique, Évolution, Étude de cas, Singularité, Psychothérapie psychanalytique, Angoisse, Mécanisme de défense, Épreuves projectives, Intégration, Fonction contenante.