This thesis examines the cognitive-psychological theory of autism, specifically the "theory of mind" account. According to this theory, autistic people lack the ability to attribute mental states to other people and this underlies their social communication difficulties. In the introductory chapters, autism is described, followed by a consideration of different theoretical accounts of the normal child's theory of mind and empirical evidence on the autistic child's theory of mind. Finally, the introduction discusses whether the different theoretical accounts can explain autism. A series of experiments are then described which investigated normal and autistic children's ability to understand knowledge as a mental state. Experiment 1 established a baseline for the subsequent experiments and included three groups of normal children with mean ages of four years nine months, five years nine months and six years nine months. In this experiment the children's ability to differentiate the cognitive mental terms "know" and "guess" with reference to their own and another person's mental states was examined. Results of this experiment indicated that all three groups of children could differentiate "know" and "guess" in reference to their own and another person's mental state. Experiments 2 and 3 compared the ability to differentiate "know" from "guess" with reference to their own and another persons mental state of high language level autistic children, low language level autistic children, children with Down's syndrome, four-year- old and five-year-old normal children. Results of these experiments showed that the high language level autistic children were able to refer to their and another person's mental state of knowledge. In addition the results were related to a number of measures of language ability. Experiment 4 compared the ability to attribute knowledge and ignorance to themselves and another person of high language level autistic children, low language level autistic children, four-year-old and five-year-old normal children. In one task the experimental question involved the mental term "know", in another task, the term "could help" was used. Results of this experiment showed that all four groups of children performed significantly better in the "know" task than in the "help" task. Performances on the tasks was again related to the children's language skills. The thesis reaches two main conclusions. First that autistic children do not totally lack a theory of mind, since high language level autistic children were able to refer to their and another person's knowledge state. Second, autistic children's language level is a strong predictor of their performance on theory of mind tasks. The thesis concludes by discussing a number of issues involved in autism research and indicating future directions for research.

abstract: During the nineteenth century, children's physical health became a dominant theme in France and Great Britain, two of Europe's pediatric pioneers. This dissertation examines how British and French doctors, legislators, hospital administrators, and social reformers came to see the preservation of children's physical health as an object of national and international concern. Medical knowledge and practice shaped, and was shaped by, nineteenth-century child preservation activities in France and Great Britain, linking medicine, public health, and national public and private efforts to improve the health of nations, especially that of their future members. Children's hospitals played a significant role in this process by promoting child health; preventing and combating childhood diseases; fostering pediatric professionalization and specialization; and diffusing medical-based justifications for child welfare reforms in the second half of the century. This deeply contextualized tale of two hospitals, Great Ormond Street Hospital for Children in London (1852) and Sainte-Eugénie in Paris (1855), traces a crescendo in the interest, provision, and advocacy for children's medical care over time: from foundling homes and dispensaries to specialized hospitals with convalescent branches and large outpatient clinics. As a comparative study of the medicalization of children's bodies between 1820 and 1890, this dissertation also investigates the transnational exchange of medical ideas, institutions, and practices pertaining to child health between France and Great Britain during a period of nation-building. Specialized pediatric institutions in Paris and London built upon and solidified local, national, and international interests in improving and preserving child health. Despite great differences in their hospital systems, French and British children's hospital administrators and doctors looked to one another as partners, models, and competitors. Nineteenth-century French and British concerns for national public health, and child health in particular, had important distinctions and parallels, but medical, institutional, and legislative developments related to these concerns were not isolated activities, but rather, tied to transnational communication, cooperation, and competition. / Dissertation/Thesis / Doctoral Dissertation History 2014

Understanding the ways in which practitioners can identify and manage undernutrition is important within developing world countries. There is still much uncertainty when it comes to understanding which measures of undernutrition are the most effective predictors of adverse outcomes. This thesis explores how children grow and applies statistical methodology to three longitudinal growth datasets with frequent measurements in the first two years, seeking new insights into how measures of undernutrition can be used to predict future adverse outcomes. The three datasets are diverse - from Malawi, South Africa and Pakistan, the latter of which contains 4 subsets of different socioeconomic groups. The large number of children within the sets made it possible to test several different hypotheses. Growth charts (or reference charts) are charts which allow practitioners to compare a given infant’s anthropometric measurements with a reference population. We developed growth charts from the available datasets using Generalised Additive Models for Location Scale and Shape (GAMLSS), a method which allows users to flexibly model distributions of measurements over time. The reference charts we developed describe the growth of samples of children, many of whom will not have grown at a healthy rate. It is preferable to compare children with healthy infants from a composite external standard. The World Health Organization (WHO) growth standard was developed from a variety of populations from across the globe which describes the growth of a ‘healthy’ population. This suggests an aspirational model, as opposed to a reference, which describes how a sample of children actually grow. In this thesis GAMLSS was used to determine whether real populations of pre-school children from the developing world fit this international standard. We found that relatively affluent populations fit the standard well, or even outperform it, while more deprived populations fall away to varying degrees, then mainly track parallel to the WHO mean beyond 6 months. This suggests that after the first 6 months children from the developing world have rates of weight gain roughly on par with the standard, although the children are much lighter. Plotting measurements on growth charts identifies those whose weight Z score or centile is falling relative to the reference. However, children initially at the extremes tend to regress toward the mean. Conditional weight gain (CWG) takes this expected movement into account, but can only be used within the population in which the child originates, due to certain statistical assumptions. We developed a generalised measure of CWG for use with the WHO external standard. This measure requires the correlation between pairs of groups of measurements at different time points, as the amount of regression to the mean is synonymous with this correlation. If data are not available at these time points, they can be interpolated by firstly computing correlations between all available data, then modelling the resulting matrix. We found that these correlation matrices are heterogeneous within the developing world. Therefore, constructing a generalised correlation model was not possible. This makes the use of the new generalised measure of CWG impractical without access to correlation models computed from local data. However, the measure may be useful within the developed world, where correlation matrices may be less variable. The analysis then explored the ways that children move between different nutritional states, defined as healthy, thin (wasted) and/or short (stunted), over 3-6 month (m), 6-9m and 9-12m timeframes, and the probability these states will lead to death. We used stochastic models to explore the probability of moving state conditional on previous state, exploring the pathways children take through different states over time. Within all timeframes, children who were wasted as well as stunted were more likely to die than wasted children, who were in turn more likely to die than stunted children. Furthermore, as children age, the conditional risk of death in the next time period decreases. However, relative to healthy children, all children were less vulnerable within the middle period (6-9m) regardless of state. Children who were wasted were at significantly higher risk than healthy children of later wasting, or becoming stunted as well as wasted, over all timeframes. However, wasting alone significantly increased the risk of later stunting only in the 3-6m timeframe. Across the 3-6-9m timeframes children were much more likely to move from either healthy to healthy to stunted, or healthy to stunted to stunted, than from healthy to wasted to stunted. This indicates children are more likely to move directly into a stunted state than from healthy to stunted via wasted. Change in weight (growth) has been shown to be a predictor of mortality in populations of children, but it is not clear if this measure is more predictive than the latest weight (size). Using weighted Cox proportional hazards models, we determined which of these measures is the most valuable predictor of mortality for the majority of children within each individual dataset, conducting analyses using variable levels of weightings for children at the extremes. We included weight-for-age and height-for-age as predictors within our models to determine what combination of predictors best predict mortality. In all unweighted analyses, size was the best predictor of time until death. However, as the weighting increased, growth entered as the best predictor in populations with low rates of undernutrition. In contrast, size always remained the strongest predictor within populations with high rates of undernutrition, since in these populations, such a high proportion of children fall away from within the centre of the normal range, making growth pattern non-discriminating. This programme of work applied statistical techniques to three diverse longitudinal datasets, gaining insights into how children grow between different socio-economic backgrounds. We investigated measures of size and measures of growth, utilising methods that control for the inevitable fact that healthy children at the centre of the population distribution tend to dominate analyses. Furthermore, these methods were both multidimensional and time dependant, providing us with a useful framework to assess child growth while controlling for influential factors. The results should improve understanding of both the aetiology of undernutrition and its clinical management.

No description available.

Crianças frequentemente realizam atividades físicas em ambientes quentes. O calor pode afetar o desempenho, conforto subjetivo, tolerância ao exercício e ser preocupante para a saúde. Além disso, parece que crianças obesas, comparadas com as magras, apresentam desvantagens ao se exercitarem no calor. Devido à importância do exercício aeróbio para o manejo da obesidade e promoção da saúde, essas diferenças merecem ser elucidadas, principalmente em meninas, devido à escassez de informações. Objetivo: Comparar as respostas termorregulatórias e perceptivas de meninas pré-púberes magras e obesas durante e após uma sessão de exercício, de similar intensidade relativa, em condição ambiental termoneutra e de calor. Métodos: Para a revisão da literatura, foram selecionados artigos com as palavras chaves: thermoregulation, obesity, children, girls, sweating, exercise, heat, hydration e acclimatization. No estudo experimental, vinte e sete meninas ativas e aclimatizadas, alocadas nos grupos magras e obesas conforme a adiposidade (≤ 25% para as magras e  30% para as obesas) medida pelo DXA, participaram do estudo. Elas pedalaram (carga de 55% do VO2pico) e recuperaram (sentadas) por 30 minutos numa condição termoneutra e outra de calor, com água disponível para ser ingerida à vontade. A temperatura retal (Tre), frequência cardíaca (FC), taxa de percepção de esforço (TPE), sensação térmica, conforto térmico e irritabilidade foram avaliados periodicamente. A sudorese foi avaliada, e durante o exercício no calor foi coletada uma amostra de suor para análise da concentração de eletrólitos (Na+, Cl- e K+). Resultados: Revisão — estudos com meninos indicam que os obesos parecem ser prejudicados nas respostas termorregulatórias durante exercício no calor relacionado: prejuízos na dissipação por convecção devido à menor área de superfície corporal (ASC) pela massa corporal; a menor taxa de sudorese, condicionamento físico, tolerância ao exercício e capacidade de aclimatação ao calor; ao maior custo metabólico para locomoção; e prejuízo na dissipação de calor pela maior gordura subcutânea. Não foram encontrados estudos comparando as respostas termorregulatórias de meninas magras e obesas no calor; e os estudos com o sexo feminino apresentam resultados parcialmente contraditórios ao masculino. Experimento — a Tre inicial foi maior nas obesas nas duas sessões (no calor 37,5 ± 0,3 vs. 37,3 ± 0,3 ºC, e na termoneutra 37,6 ± 0,3 vs. 37,3 ± 0,2 ºC; p = 0,03) e se manteve durante o exercício; e a magnitude do aumento foi maior nas magras, sendo que no calor a Tre final ultrapassou a das obesas (37,8 ± 0,2 vs. 38,0 ± 0,2 ºC; p = 0,04). As magras relataram diminuição do conforto térmico (p = 0,009) e aumento da irritação (p = 0,02) no decorrer do exercício. A FC, respostas perceptivas de TPE e sensação térmica foram semelhantes entre os grupos, assim como as respostas de sudorese. Observou-se maior concentração de Na+ no suor nas obesas (78,7 ± 47,5 vs. 50,5 ± 12,1 mEql-1; p = 0,04). Conclusão: Meninas obesas apresentaram maior Tre inicial, e as magras apresentaram uma maior magnitude de aumento na Tre, principalmente no calor, acompanhada de maior desconforto térmico e irritabilidade. / Children often perform physical activities in hot environments. The heat can affect performance, subjective comfort, exercise tolerance and cause concern for health. Moreover, it seems that obese children, compared with the lean, have disadvantages while exercising in the heat. Given the importance of aerobic exercise for obesity management and health promotion, these differences should be elucidated, especially in girls due to the information lack. Aim: To compare the thermoregulatory responses and perceptual between lean and obese pre-pubertal girls during and after an exercise session, at similar relative effort intensity in the thermoneutral environmental and heat. Methods: For the literature review, articles were selected using the keywords: thermoregulation, obesity, children, girls, sweating, exercise, heat, hydration and acclimatization. In the experimental trial, twenty-seven active and acclimatized girls, placed in groups lean and obese according to fat percentage (≤ 25% for lean and  30% for the obese) measured by DXA, participated in this study. They cycled (charge 55% of VO2peak) and recovered (seated) for 30 minutes in a thermoneutral condition and in the heat, with hydration ad libitum. Rectal temperature (Tre), heart rate (HR), rate of perceived exertion (RPE), thermal sensation, thermal comfort and irritability were assessed periodically. Sweating was evaluated, and during exercise in the heat a sample sweat was collected to electrolytes concentration (Na+, Cl- and K+) analysis. Results: Review — obese children appear to be impaired in thermoregulatory responses during exercise in the heat related to: the convection damage dissipation due to less body surface area (BSA) by body mass, the lower sweating rate, fitness, exercise tolerance and to heat acclimation ability, the higher locomotion metabolic cost, and heat dissipation loss for greater subcutaneous fat. Any study had compared the thermoregulatory responses between lean and obese girls in heat. Trial — the initial Tre was higher in obese in both sessions (in the heat 37.5 ± 0.3 vs 37.3 ± 0.3 ºC and in thermoneutral 37.6 ± 0.3 vs. 37.3 ± 0 2 º C, p = 0.03) and was maintained during exercise, and magnitude of the increase was greater in lean, mainly in the heat when the final Tre surpassed the obese (37.8 ± 0.2 vs. 38.0 ±0.2 ºC, p = 0.04). The thermal comfort has decreased (p = 0.009) and irritation has increased (p = 0.02) in the lean during the exercise. HR, sweating responses and perceptual responses of TPE and thermal sensation were similar between groups. A higher concentration of Na+ in sweat was observed in obese (78.7 ± 47.5 vs 50.5 ± 12.1 mEql-1, p = 0.04). Conclusion: Initial Tre were higher in obese group, and lean had a greater magnitude of increase in Tre, especially during exercise in the heat, accompanied by thermal discomfort and irritability increased.

The delivery process of the intravenous (IV) medication, one of the activities of greater responsibility of the nursing team, has a high incidence in child care in urgent and emergency situation. This process is considered highly complex and when not planned, controlled and monitored through indicators is exposed to unpredictable results affecting the quality of care. The objective was to evaluate the nursing practice in drug administration in child trough IV. Exploratory, descriptive, observational, quantitative study. It was developed in the urgency and emergency department in a pediatric referral hospital of the municipal sphere of Fortaleza. The study population consisted of 69 nurses whom participated in the drug administration via IV process that was in work schedules during the study period in the investigated unit. The sample of professionals was composed by 36 licensed practice nurses and 2 nurses. For the number of observations, it was considered the calculation for finite population with a total of 327 observations of intravenous medication delivery process. Interviews were carried out for data collection with the nursing staff and systematic observation of drug delivery process in children via IV. For data collection interviews were performed with the nursing staff and systematic observation by IV drug delivery process in children, considering seven stages, namely: medical prescription reading, hand hygiene, preparation of material and medication , guidance on the procedure, puncture technique and administration of the drug. Such steps have the total 47 shares. The data was stored in a database produced on the Windows Excel 2010 and analyzed according to the literature. The study was approved by the Ethics Committee under CAAE protocol 34651314.7.0000.5054. It was found that in 15% of the observations nursing professionals did not understand the prescription due to illegible handwriting professional. In 78.0% of the time there was no hand hygiene. It was found that all professionals used personal protective equipment (cap and mask), but none used gloves. Among the 327 observations included: peripheral intravenous device most commonly used was the scalp 21 (63.3%); selection of dorsal hand veins arc (83.9%); success on the first attempt of venipuncture (82.6%); explains the procedure for child and /or guardian (5.5%); calms the child (82.6%); performs antisepsis of the skin at the site to be punctured with a swab with 70% alcohol (100%); awaits antiseptic evaporation to then continue the procedure (45.6%); proper disposal of the materials used during the procedure (89.3%); checks the prescription immediately after drug administration (86.8%). It was found unsatisfactory performance in 23 actions by IV drug administration process. Therefore, we suggest the development of training for nursing professionals about medication delivery process. / O processo de administraÃÃo de medicamento por via intravenosa (IV), uma das atividades mais importante da equipe de Enfermagem, possui alta incidÃncia na assistÃncia à crianÃa em situaÃÃo de urgÃncia e emergÃncia. Tal processo à considerado de alta complexidade e, quando nÃo planejado, controlado e monitorado por meio de indicadores, fica exposto à imprevisibilidade de seus resultados, interferindo na qualidade da assistÃncia. Objetivou-se avaliar a prÃtica de enfermagem no processo de administraÃÃo de medicamento por via IV na crianÃa. Trata-se de um estudo exploratÃrio, descritivo, observacional, de natureza quantitativa, desenvolvido no setor de urgÃncia e emergÃncia de um hospital pediÃtrico de referÃncia da esfera municipal de Fortaleza-CE. A populaÃÃo do estudo foi constituÃda por 69 profissionais de enfermagem que participaram do processo de administraÃÃo de medicamento pela via IV e que estavam nas escalas de trabalho durante o perÃodo do estudo na unidade investigada. A amostra dos profissionais foi composta por 36 tÃcnicos de enfermagem e 2 enfermeiros. Para o nÃmero de observaÃÃes, considerou-se o cÃlculo para populaÃÃo finita, com um total de 327 observaÃÃes do processo de administraÃÃo de medicamento por via IV. Para a coleta de dados realizou-se entrevista com a equipe de enfermagem e observaÃÃo sistemÃtica do processo de administraÃÃo de medicamento por via IV na crianÃa, considerando sete etapas, quais sejam: leitura da prescriÃÃo mÃdica, higienizaÃÃo das mÃos, preparo do material e medicaÃÃo, orientaÃÃo acerca do procedimento, tÃcnica de punÃÃo e administraÃÃo do medicamento. Tais etapas possuem ao total 47 aÃÃes. Os dados foram armazenados em um banco de dados produzidos no Excel do Windows 2010, analisados estatisticamente e de acordo com a literatura pertinente. O estudo foi aprovado pelo Comità de Ãtica sob parecer N0 805.953. Constatou-se que em 15% das observaÃÃes o profissional de enfermagem nÃo compreendeu a prescriÃÃo mÃdica devido à letra ilegÃvel do profissional. Em 78,0% das observaÃÃes nÃo houve a higienizaÃÃo das mÃos. Identificou-se que todos os profissionais utilizaram equipamento de proteÃÃo individual (gorro e mÃscara), entretanto nenhum utilizou luvas. Dentre as 327 observaÃÃes destacaram-se como dispositivo intravenoso perifÃrico mais utilizado o scalp n 21 (63,3%); escolha das veias do arco dorsal da mÃo (83,9%); Ãxito na primeira tentativa da punÃÃo venosa (82,6%); orientaÃÃo sobre o procedimento para crianÃa e/ou responsÃvel (5,5%); acalma a crianÃa (82,6%); realizaÃÃo de antissepsia da pele no local a ser puncionado com algodÃo embebido com Ãlcool a 70% (100%); aguarda a evaporaÃÃo do antissÃptico para em seguida dar prosseguimento ao procedimento (45,6%); descarte adequado dos materiais utilizados durante o procedimento (89,3%); checou a prescriÃÃo imediatamente apÃs a administraÃÃo do medicamento (86,8%). Concluiu-se desempenho insatisfatÃrio em 23 aÃÃes do processo de administraÃÃo de medicamento por via IV. Portanto, sugere-se o desenvolvimento de capacitaÃÃo para os profissionais de enfermagem acerca do processo de administraÃÃo de medicamento.

Crianças frequentemente realizam atividades físicas em ambientes quentes. O calor pode afetar o desempenho, conforto subjetivo, tolerância ao exercício e ser preocupante para a saúde. Além disso, parece que crianças obesas, comparadas com as magras, apresentam desvantagens ao se exercitarem no calor. Devido à importância do exercício aeróbio para o manejo da obesidade e promoção da saúde, essas diferenças merecem ser elucidadas, principalmente em meninas, devido à escassez de informações. Objetivo: Comparar as respostas termorregulatórias e perceptivas de meninas pré-púberes magras e obesas durante e após uma sessão de exercício, de similar intensidade relativa, em condição ambiental termoneutra e de calor. Métodos: Para a revisão da literatura, foram selecionados artigos com as palavras chaves: thermoregulation, obesity, children, girls, sweating, exercise, heat, hydration e acclimatization. No estudo experimental, vinte e sete meninas ativas e aclimatizadas, alocadas nos grupos magras e obesas conforme a adiposidade (≤ 25% para as magras e  30% para as obesas) medida pelo DXA, participaram do estudo. Elas pedalaram (carga de 55% do VO2pico) e recuperaram (sentadas) por 30 minutos numa condição termoneutra e outra de calor, com água disponível para ser ingerida à vontade. A temperatura retal (Tre), frequência cardíaca (FC), taxa de percepção de esforço (TPE), sensação térmica, conforto térmico e irritabilidade foram avaliados periodicamente. A sudorese foi avaliada, e durante o exercício no calor foi coletada uma amostra de suor para análise da concentração de eletrólitos (Na+, Cl- e K+). Resultados: Revisão — estudos com meninos indicam que os obesos parecem ser prejudicados nas respostas termorregulatórias durante exercício no calor relacionado: prejuízos na dissipação por convecção devido à menor área de superfície corporal (ASC) pela massa corporal; a menor taxa de sudorese, condicionamento físico, tolerância ao exercício e capacidade de aclimatação ao calor; ao maior custo metabólico para locomoção; e prejuízo na dissipação de calor pela maior gordura subcutânea. Não foram encontrados estudos comparando as respostas termorregulatórias de meninas magras e obesas no calor; e os estudos com o sexo feminino apresentam resultados parcialmente contraditórios ao masculino. Experimento — a Tre inicial foi maior nas obesas nas duas sessões (no calor 37,5 ± 0,3 vs. 37,3 ± 0,3 ºC, e na termoneutra 37,6 ± 0,3 vs. 37,3 ± 0,2 ºC; p = 0,03) e se manteve durante o exercício; e a magnitude do aumento foi maior nas magras, sendo que no calor a Tre final ultrapassou a das obesas (37,8 ± 0,2 vs. 38,0 ± 0,2 ºC; p = 0,04). As magras relataram diminuição do conforto térmico (p = 0,009) e aumento da irritação (p = 0,02) no decorrer do exercício. A FC, respostas perceptivas de TPE e sensação térmica foram semelhantes entre os grupos, assim como as respostas de sudorese. Observou-se maior concentração de Na+ no suor nas obesas (78,7 ± 47,5 vs. 50,5 ± 12,1 mEql-1; p = 0,04). Conclusão: Meninas obesas apresentaram maior Tre inicial, e as magras apresentaram uma maior magnitude de aumento na Tre, principalmente no calor, acompanhada de maior desconforto térmico e irritabilidade. / Children often perform physical activities in hot environments. The heat can affect performance, subjective comfort, exercise tolerance and cause concern for health. Moreover, it seems that obese children, compared with the lean, have disadvantages while exercising in the heat. Given the importance of aerobic exercise for obesity management and health promotion, these differences should be elucidated, especially in girls due to the information lack. Aim: To compare the thermoregulatory responses and perceptual between lean and obese pre-pubertal girls during and after an exercise session, at similar relative effort intensity in the thermoneutral environmental and heat. Methods: For the literature review, articles were selected using the keywords: thermoregulation, obesity, children, girls, sweating, exercise, heat, hydration and acclimatization. In the experimental trial, twenty-seven active and acclimatized girls, placed in groups lean and obese according to fat percentage (≤ 25% for lean and  30% for the obese) measured by DXA, participated in this study. They cycled (charge 55% of VO2peak) and recovered (seated) for 30 minutes in a thermoneutral condition and in the heat, with hydration ad libitum. Rectal temperature (Tre), heart rate (HR), rate of perceived exertion (RPE), thermal sensation, thermal comfort and irritability were assessed periodically. Sweating was evaluated, and during exercise in the heat a sample sweat was collected to electrolytes concentration (Na+, Cl- and K+) analysis. Results: Review — obese children appear to be impaired in thermoregulatory responses during exercise in the heat related to: the convection damage dissipation due to less body surface area (BSA) by body mass, the lower sweating rate, fitness, exercise tolerance and to heat acclimation ability, the higher locomotion metabolic cost, and heat dissipation loss for greater subcutaneous fat. Any study had compared the thermoregulatory responses between lean and obese girls in heat. Trial — the initial Tre was higher in obese in both sessions (in the heat 37.5 ± 0.3 vs 37.3 ± 0.3 ºC and in thermoneutral 37.6 ± 0.3 vs. 37.3 ± 0 2 º C, p = 0.03) and was maintained during exercise, and magnitude of the increase was greater in lean, mainly in the heat when the final Tre surpassed the obese (37.8 ± 0.2 vs. 38.0 ±0.2 ºC, p = 0.04). The thermal comfort has decreased (p = 0.009) and irritation has increased (p = 0.02) in the lean during the exercise. HR, sweating responses and perceptual responses of TPE and thermal sensation were similar between groups. A higher concentration of Na+ in sweat was observed in obese (78.7 ± 47.5 vs 50.5 ± 12.1 mEql-1, p = 0.04). Conclusion: Initial Tre were higher in obese group, and lean had a greater magnitude of increase in Tre, especially during exercise in the heat, accompanied by thermal discomfort and irritability increased.

Orientadores: André Moreno Morcillo, José Dirceu Ribeiro / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-17T08:49:15Z (GMT). No. of bitstreams: 1 Cohen_MilenaAntonelli_M.pdf: 1391743 bytes, checksum: 7a98231a880dc5c3b6f1a7c69a4a3167 (MD5) Previous issue date: 2010 / Resumo: O objetivo desse estudo foi avaliar a qualidade de vida (QV) dos indivíduos com fibrose cística (FC) que são acompanhados no ambulatório de FC do departamento de pediatria do Hospital de Clínicas da Unicamp. Tratou-se de um estudo observacional, transversal e não randomizado, com aplicação das versões do "Cystic Fibrosis Questionnaire". Os modelos são específicos para diferentes faixas etárias dos pacientes e familiares e apresentam perguntas sobre as condições físicas, psicológicas e sociais dos pacientes. Os dados foram processados através do programa SPSS versão 16.0. Utilizou-se o Teste de Mann-Whitney e Kruskal-Wallis para a verificação das diferenças entre as distribuições dos escores de QV. O nível de significância adotado para os testes foi fixado em 0,05. Participaram 75 pacientes entre 6,1 e 26,4 anos (12,5+5,1), clinicamente estáveis. As pontuações mais altas foram as dos adolescentes e adultos (grupo III, n=24), referentes à alimentação (89,3+16,2) e sistema digestório (88,4+14,5), as mais baixas foram referentes à condição social (59,5+22,3) encontradas no grupo II (12 a 14 anos incompletos, n=12). O grupo III mostrou insatisfação em relação à rotina de tratamento, quando comparado com o grupo I (6 a 12 anos incompletos, n=39) (p=0,001). Esses dados indicam que os pacientes entre 6 a 14 anos incompletos apresentam QV satisfatória, enquanto os adolescentes e adultos relatam insatisfação em relação à rotina de tratamento. Nossos resultados mostram que as crianças entre 6 a 14 anos incompletos apresentam QV satisfatória, independente do volume expiratório forçado no primeiro segundo (VEF1) e capacidade vital forçada (CFV). Já, os adolescentes e adultos com VEF1, CVF abaixo da normalidade apresentam piores pontuações referente ao sistema respiratório, condição social e imagem corporal, sugerindo que auto-percepção de saúde está diretamente relacionada com o avanço da idade e do comprometimento pulmonar. Nosso estudo mostrou que os pacientes classificados em relação a gravidade como médios, moderados e graves (escore de Shwachman) do grupo I apresentam insatisfação em relação à condição social (p=0,045) e os do grupo II insatisfação em relação ao sistema respiratório (p=0,053) e digestório (p=0,042), quando comparados com indivíduos classificados como leves. Na população adolescente e adulta a gravidade da doença não se associou com a QV. A avaliação da QV dos indivíduos com FC é importante, pois corresponde à percepção do paciente sobre como é viver com uma doença grave, crônica e fatal. Além de fornecer informações para o planejamento econômico, ajudando na administração das finanças e na avaliação do impacto de novos tratamentos, contribuindo para uma melhor aderência aos mesmos / Abstract: The aim of this study was to evaluated the quality of life (QOL) of individuals with cystic fibrosis (CF) who are treated at department of pediatrics at UNICAMP. This was an observational study and nonrandomized, with application versions of "cystic fibrosis questionnaire". The models are specific to different age groups of patients and one for the parent's and were asked questions about the physical, psychological and social of the patients. The data were processed using SPSS version 16.0 and presented as mean standard deviation. For verification of the differences between the distributions of QOL scores employed the Mann-Whitney and Kruskal-Wallis test. The level of significance for the test was 0,05. The test was applied in 75 patients between 6.1 and 26.4 years (12,5+5,1). The highest scores were those of adolescents and adults (group III, n= 24), relating to eating (89,3+16,2) and digestive system (88,4+14,5), the lowest score was related to social condition (59,5+22,3) found in group II (12 to 14 years old, n=12). Group III showed dissatisfaction with routine treatment, when compared with group I (6 to 12 years old, n=39) (p=0,001). These data indicate that patients between 6-14 years of age have satisfactory QOL, while adolescents and adults report dissatisfaction with routine treatment. Our results show that children between 6-14 years of age have satisfactory QOL, independent of FEV1 (forced expiratory volume in one second) and FVC (forced vital capacity). On the other hand young people and adults with FEV1 e FVC, showed a worse score for the respiratory system, social conditions e body image, suggesting that self-perceived health is directly related to advancing age and pulmonary involvement. Our study showed that patients classified as average, moderate and severe (Shwachman score) in group I show dissatisfaction with social status (p=0,045) and group II dissatisfaction with the respiratory system (p=0,053) and digestive (p=0,042) when compared with individuals classified as light. In adolescents and adult disease severity was not associated with QOL. The assessment of QOL of individuals with CF is important because it matches the patient's perception about living with a serious illness, chronic and fatal. Besides providing information for economic planning, assisting in the administration of finances and in evaluating the impact of new treatments, contributing to a better adherence to them / Mestrado / Saude da Criança e do Adolescente / Mestre em Saude da Criança e do Adolescente

Orientador: Gil Guerra Junior / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-06T07:31:09Z (GMT). No. of bitstreams: 1 Castro_Lelma_M.pdf: 2684687 bytes, checksum: cb55c2a730aa505f713a68de763a3370 (MD5) Previous issue date: 2006 / Resumo: Introdução e objetivo: A cetoacidose diabética (CAD) é a principal causa de hospitalização e morte em crianças com diabetes mellitus tipo 1 (DM1). A mortalidade está principalmente relacionada ao edema cerebral, considerado uma complicação do tratamento. O objetivo desse estudo foi avaliar as características dos pacientes com CAD tratados na Pediatria do Hospital de Clínicas da UNICAMP. Métodos: Estudo retrospectivo e descritivo de variáveis clínicas e laboratoriais de 74 internações por CAD no período de janeiro de 1994 a dezembro de 2003. Resultados: As 74 internações corresponderam a 49 pacientes. Doze pacientes tiveram mais de uma internação, 27 (55%) eram do sexo feminino e a idade variou de 0,9 a 14,5 anos. O tempo médio de DM1 foi de 3 ± 3,1 anos, sendo em 20 casos a primeira manifestação do DM1. Quando comparados o número de internações de pacientes já com diagnóstico de DM1 com o de pacientes com primeira descompensação em relação ao ano de internação, houve diferença a partir do ano de 2000, quando houve predomínio de internações por primeira descompensação. Quando realizada a mesma comparação com relação à idade, houve predomínio de internações por primeira descompensação em pacientes menores de 9 anos. A CAD foi classificada em grave em 51% e moderada em 30%; 17 e 13 apresentaram, respectivamente, choque e coma na admissão. O tempo decorrido para a normalização da glicemia, do pH e do bicarbonato apresentou correlação significativa positiva com o valor inicial. O potássio sérico inicial variou de 3,1 a 5,9 mEq/l, sendo 8% com valores abaixo de 3,5 e 62% acima de 4,5. A hipoglicemia ocorreu em 10 internações e o edema cerebral com óbito em uma. O tempo total de tratamento correlacionou-se significativamente de forma positiva com tempo de fluidoterapia e tempo para normalização do pH, e negativamente com o Pronto Socorro como local de internação. Conclusões: Na amostra estudada houve predomínio de pacientes do sexo feminino, abaixo de 10 anos, com manifestação grave da doença. Cerca de 25% dos pacientes foram responsáveis por metade das internações. O tempo necessário para a normalização da glicemia variou de 1 a 24 horas e da acidose de 3 a 36 horas; o tempo total de tratamento variou de 6 a 80 horas. O bicarbonato foi utilizado em apenas 4% das internações. Edema cerebral ocorreu em apenas um caso, o qual evoluiu para óbito. Os dados encontrados são comparáveis aos da literatura mundial. Unitermos: acidose, cetose, diabetes mellitus, glicemia, pediatria, potássio / Abstract: Introduction and objective: Diabetic ketoacidosis (DKA) is the main cause of hospitalization and death in children with diabetes mellitus type 1 (DM1). The mortality is mainly related to cerebral edema, considered a treatment complication. The aim of this study was to evaluate the profile of patients with DKA treated in the Department of Pediatrics at Unicamp Clinical Hospital. Methods: Retrospective and descriptive study of clinical and laboratorial variables of 74 admissions due to DKA from January, 1994 to December, 2003. Results: The 74 admissions were related to 49 patients. Twelve patients were admitted more than once, 27 were females and the age ranged from 0.9 to 14.5 years. The mean time from DM1 diagnosis to admission was 3 ± 3.1 years and 20 cases presented DKA at the onset of DM1. When the number of admissions of patients with DM1 diagnosis was compared to those with new onset DM1 considering year of admission, there was a prevalence of the latter after year 2000. When the same comparison was performed considering age under or above nine, there was a prevalence of new onset DM1 admission under the age of nine. DKA was severe in 51% and moderate in 30%, 17 and 13 patients presented, respectively, shock and coma at admission. The time for normalization of glycemia, pH, and bicarbonate had a significant positive correlation with the initial value. Endovenous bicarbonate was used in only 3 admissions. The initial serum potassium value ranged from 3.1 to 5.9 mEq/l; in 8%, value was fewer than 3.5 and in 62%, greater than 4.5. Hypoglycemia occurred in 10 admissions and cerebral edema and death occurred in one. The total length of treatment had significant positive correlation with the time for fluid replacement and pH normalization and negative correlation with Emergency Room as admission place. Conclusions: The analyzed sample showed a predominance of female patients, under the age of ten, with severe manifestation of the disease. The time for glycemia normalization ranged from 1 to 24 hours and for acidosis normalization from 3 to 36 hours. Total treatment lasted from 6 to 80 hours. Bicarbonate was administered in only 4% of admissions. Death occurred in one case only, due to cerebral edema. Twenty-five percent of patients accounted for 50% of admissions / Mestrado / Pediatria / Mestre em Saude da Criança

FundaÃÃo de Amparo à Pesquisa do Estado do Cearà / CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A escassez de medicamentos adequados ao uso pediÃtrico obriga os prescritores a extrapolarem informaÃÃes obtidas atravÃs de testes com indivÃduos adultos para crianÃas, bem como a adaptarem formulaÃÃes desenvolvidas para adultos. Os riscos sÃo elevados podendo comprometer a eficÃcia e a seguranÃa dos tratamentos.Conhecer a problemÃtica da carÃncia de formulaÃÃes farmacÃuticas adequadas ao uso em crianÃas e suas repercussÃes prÃticas em um hospital pediÃtrico do SUS. Estudo descritivo transversal, envolvendo: busca na literatura internacional de medicamentos cuja forma ou formulaÃÃo representam um problema para o uso em crianÃas (MP, medicamentos problema) e identificaÃÃo desses medicamentos no mercado farmacÃutico brasileiro; inquÃrito com mÃdicos de um hospital pediÃtrico (N=48, 98% do total) sobre quais sÃo os MP em sua prÃtica clÃnica e seguimento da prescriÃÃo e preparo de MP sÃlidos na instituiÃÃo. Foi empregada a ClassificaÃÃo AnatÃmica TerapÃutica e QuÃmica de medicamentos e cÃlculo de freqÃÃncias das variÃveis. O projeto foi aprovado pela comissÃo de Ãtica da instituiÃÃo. Foram identificados 131 MPI (medicamentos problema internacionais), 105 destes sÃo comercializados no Brasil, sendo 85 de uso pediÃtrico. Os princÃpios ativos mais freqÃentes foram: salbutamol, furosemida, paracetamol, cisaprida e morfina. Os MP mais citados pelos mÃdicos foram captopril, furosemida, digoxina, espironolactona, hidroclorotiazida e prednisona. A carÃncia de preparaÃÃes orais, parenterais e em baixas doses foram os problemas mais citados. Foi acompanhada a adaptaÃÃo de 24 distintos MP sÃlidos (89 prescriÃÃes). Todas as prescriÃÃes apresentavam inconformidades, bem como todos os procedimentos de preparo. As doses administradas foram 3,47 a 1.125% do preconizado (22,7% inferiores e 39.5% superiores); somente em 37,8% dos casos foi administrada a dose preconizada. A carÃncia de preparaÃÃes apropriadas para uso em crianÃas à um problema em todo o mundo. No Brasil isso à agravado pela falta de condiÃÃes adequadas para a adaptaÃÃo de formulaÃÃes em hospitais, bem como pela inobservÃncia de procedimentos padronizados. / The scarcity of medicines developed to be used in children creates the need of to extrapolate information obtained by tests in adults and of to adapt adult formulations to this age group. The risks are great and can compromise the efficacy and safety of treatments.To know the problem of lack of formulations apropriated to be used in children and its practical repercussions in a SUS pediatric hospital.A cross-sectional, descriptive study, involving: literature search for medicaments whose formulations represents a problem for use in children (Medicine Problem â MP) and the identification of these medicines on the Brazilian market; a survey applied to doctors in a pediatric hospital to know which are the PM in their clinical practice; follow up of prescription and adaptation of solid PM in this institution. The Anatomic Therapeutic Chemical classification of medicines was adopted; the frequencies of variables were calculated; the project was approved by the hospital Ethics Committee.A total of 131 IPM (International Problem Medicine) were identified, 105 of these are marketed in Brazil, including 85 pediatric preparations. The most frequent MP were salbutamol, furosemide, paracetamol, cisaprida and morphine; The doctors (N=48, 98% of total) referred mainly captopril, furosemide, digoxine, espironolactone, hidroclorotiazide e prednisone as PM. Lack of oral, parenteral, or lower doses formulations were the more frequent problems. The preparation of 89 solid PM was followed up; there were inadequacies in all prescriptions and preparing procedures. The final dosis administered were 3,47 to 1.125% of expected (22,7% under and 39 over); only 37,8 of children received the standardized dosis. The lack of appropriate preparations to be used in children is a problem all over the world. In Brazil this problem is aggravated by the lack of adequate conditions in hospitals to adapt formulations and poor compliance with standard procedures.