Research Doctorate - Doctor of Philosophy (PhD) / Families with serious and/or chronic child protection risks often have complex personal and social issues. Statutory child protection services must manage escalating child protection reports with limited resources. Addressing families at immediate risk often takes precedence over comprehensive family assessment and planned intervention, so the child protection issues in the lower priority families persist, and child protection reports continue. The Montrose Home-Based Family Assessment Program assesses Department of Community Services registered families who are at risk of child removal because of chronic and/or severe child protection issues. Using an ecological perspective, the Montrose team conducts a five day comprehensive assessment in the family's home and community, and develops a caseplan to address child protection risks and family support needs. The assessment is voluntary, and the family is encouraged to participate in identifying the child protection issues and developing solutions. The primary goal of this study is to compare child protection outcomes, three years after referral, for 100 families who participated in a Montrose Assessment, and 100 Comparison Group families. The research questions also explore the relationship between demographic, family, parent, child and child protection service factors and child protection outcome. Outcome is measured by Family Outcome, Children's Outcome, Legal Status, Children's Placement, subsequent Child Protection Reports and Substantiated Child Protection Reports, and Type of Abuse. The results suggest that home-based family assessment is a cost-effective model that can measurably reduce the likelihood of further abuse, court intervention and out of home care even for complex, high risk families. The study also identifies specific child, parent and child protection service related variables that are significantly associated with child protection outcome. These findings have major relevance for current child protection policy and practice, and also for broader social policy that impacts on high risk families.

<p>Breast cancer is the most common malignancy among females in Sweden. Axillary lymph-node dissection is a standard procedure in the management of breast cancer, aiming at obtaining prognostic information for adjuvant therapy decisions. Axillary dissection entails considerable morbidity. The aims of this study were to establish more selective surgical approaches and to investigate angiogenesis, a potential predictor for lymph-node metastases and prognosis.</p><p>Clinical nodal status, tumour size and S-phase were associated with nodal metastases in cohort of 1145 women. The proportion of nodal metastases was 13% in the subgroup with the lowest risk.</p><p>In a study from two registries, 675 and 1035 breast cancers ≤10 mm diagnosed by screening mammography had nodal metastases in 6,5% and 7%, respectively. Clinically detected cancers had a risk of 16% and 14%, respectively.</p><p>In a study on 415 women, a 5-node biopsy of the axilla had a sensitivity of 97,3% and a false negative rate of 2,7% in comparison with axillary dissection.</p><p>Six sections from 21 breast cancers were analysed for microvessel density (MVD). The inter-section variation contributed more to the total variance than inter-tumour variation, 45,0% and 37,3%, respectively.</p><p>In a cohort of 315 women, breast cancers with high MVD more frequently had p53 mutations (27,1%) compared with cases with low MVD (18,4%). This difference was not statistically significant (p=0,075). p53 mutations were associated with a worse outcome, whereas MVD was not.</p><p>In conclusion, women with screening detected ≤10 mm breast cancers have a low risk of lymph node metastases and some may not need axillary dissection in the future. The 5-node biopsy could be an alternative to axillary dissection. MVD is associated with methodological weaknesses and routine use is not recommended.</p>

Breast cancer is the most common malignancy among females in Sweden. Axillary lymph-node dissection is a standard procedure in the management of breast cancer, aiming at obtaining prognostic information for adjuvant therapy decisions. Axillary dissection entails considerable morbidity. The aims of this study were to establish more selective surgical approaches and to investigate angiogenesis, a potential predictor for lymph-node metastases and prognosis. Clinical nodal status, tumour size and S-phase were associated with nodal metastases in cohort of 1145 women. The proportion of nodal metastases was 13% in the subgroup with the lowest risk. In a study from two registries, 675 and 1035 breast cancers ≤10 mm diagnosed by screening mammography had nodal metastases in 6,5% and 7%, respectively. Clinically detected cancers had a risk of 16% and 14%, respectively. In a study on 415 women, a 5-node biopsy of the axilla had a sensitivity of 97,3% and a false negative rate of 2,7% in comparison with axillary dissection. Six sections from 21 breast cancers were analysed for microvessel density (MVD). The inter-section variation contributed more to the total variance than inter-tumour variation, 45,0% and 37,3%, respectively. In a cohort of 315 women, breast cancers with high MVD more frequently had p53 mutations (27,1%) compared with cases with low MVD (18,4%). This difference was not statistically significant (p=0,075). p53 mutations were associated with a worse outcome, whereas MVD was not. In conclusion, women with screening detected ≤10 mm breast cancers have a low risk of lymph node metastases and some may not need axillary dissection in the future. The 5-node biopsy could be an alternative to axillary dissection. MVD is associated with methodological weaknesses and routine use is not recommended.

Research Doctorate - Doctor of Philosophy (PhD) / Families with serious and/or chronic child protection risks often have complex personal and social issues. Statutory child protection services must manage escalating child protection reports with limited resources. Addressing families at immediate risk often takes precedence over comprehensive family assessment and planned intervention, so the child protection issues in the lower priority families persist, and child protection reports continue. The Montrose Home-Based Family Assessment Program assesses Department of Community Services registered families who are at risk of child removal because of chronic and/or severe child protection issues. Using an ecological perspective, the Montrose team conducts a five day comprehensive assessment in the family's home and community, and develops a caseplan to address child protection risks and family support needs. The assessment is voluntary, and the family is encouraged to participate in identifying the child protection issues and developing solutions. The primary goal of this study is to compare child protection outcomes, three years after referral, for 100 families who participated in a Montrose Assessment, and 100 Comparison Group families. The research questions also explore the relationship between demographic, family, parent, child and child protection service factors and child protection outcome. Outcome is measured by Family Outcome, Children's Outcome, Legal Status, Children's Placement, subsequent Child Protection Reports and Substantiated Child Protection Reports, and Type of Abuse. The results suggest that home-based family assessment is a cost-effective model that can measurably reduce the likelihood of further abuse, court intervention and out of home care even for complex, high risk families. The study also identifies specific child, parent and child protection service related variables that are significantly associated with child protection outcome. These findings have major relevance for current child protection policy and practice, and also for broader social policy that impacts on high risk families.

Cette recherche de thèse porte sur les liens entre addiction à internet, facteurs prédisposant, et modalités d’utilisation d’internet. Sur la base d’une approche transactionnelle du stress, elle a pour objectif d’étudier la question de la gestion des émotions dans le rapport addictif des participants à ce média, ainsi que les liens entre l’addiction à internet et les différentes modalités d’utilisation d’internet selon le genre. Avec une approche quantitative, nos hypothèses visent tout d’abord à mettre en évidence que l’alexithymie, l’anhédonie, l’empathie, la dépression et anxiété, certains styles de coping, le stress, et les stresseurs sont des facteurs prédictifs de l’addiction à internet ; mais également que certaines modalités d’utilisation d’internet sont plus particulièrement associées à un usage addictif, et ce, différemment selon le genre. Dans une approche plus qualitative (approche des mondes lexicaux), nous étudierons ensuite les représentations que les sujets ont d’internet et du virtuel, selon qu’ils soient addictés à internet, non addictés, ou usagers à risque. La population étudiée est représentée par deux échantillons d’étudiants en première année d’université: un premier échantillon de 244 sujets (m=24.09 ans), et un second échantillon de 515 sujets (m=20 ans).Nos résultats montrent d’une part que l’alexithymie, l’empathie, la dépression, le coping « évitement avec pensée positive » et « autoaccusation », et le stress, sont des facteurs prédictifs de l’addiction à internet ; et d’autre part que si le chat, les sites sociaux, et le webmastering sont plus spécifiquement associés à l’addiction à internet, ces modalités d’utilisation diffèrent selon le genre. / The current study examines the association between internet addiction, predictive factors, and types of internet activities. Adopting transactional stress theory, our objectives are to study the question of emotions management in the participants’ addictive relationship to Internet, as well as links between internet addiction and the various modalities of internet use according to gender. With a quantitative approach, hypothesis aim first of all at bringing to light that alexithymia, anhédonia, empathy, depression and anxiety, some of coping styles, stress, and stressors are predictive factors of internet addiction ; but either than some of the internet use modalities are more particularly associated with an addictif usage, and this, differently according to gender. In a more qualitative approach (approach of the lexical worlds), we shall study then the subjects’ representations of internet and virtual, as they are internet addicts, non addicts, or potential addicts. The studied population is represented by two first-year university students' samples: the first sample is represented by 244 students (m=24.09 years old), and the second by 515 students (m=20 years old).Results support on one hand that alexithymia, empathy, depression, avoidant coping styles, and stress, are predictive factors of internet addiction ; and on the other hand that if chatting, networking sites, and webmastering are more specifically associated to the internet addiction, these modalities of use differ according to the gender.

Children in early childhood are still suffering from burdens of malaria-related morbidity and mortality. There have been insufficient studies on how family-level factors may predict the prevalence of malaria (PoM), and negatively impact the control of malaria in rural areas, especially among children. In this study, potential family factors were explored to address the challenges associated with the increase in PoM among the children in rural areas of Nsukka. Socioecological framework guided this study at the interpersonal level. The quantitative cross-sectional study used secondary data from Demographic and Health Surveys (DHS) of 2015 in Nsukka rural communities. Data were analyzed using chi-square analysis and multinomial logistic regression. The result showed a statistically significant relationship (P<0.05) between the age group susceptibility among children. There were statistically significant relationships between the family’s ownership of land for agricultural use, the family’s choice of a treatment facility and socioeconomic status. The couple’s extent of effective communication and whether the children in early childhood slept under the mosquito net showed statistically significant results. Positive social change implications depicted organizational level benefit that may help UNICEF and WHO by recruiting representatives in the distribution of preventive, control and treatment of malaria to the rural areas. Empowerment of women in the household to attend to their children during an emergency and standard housing policy initiative such as Family in Children (FIC) address both individual and societal levels, respectively.

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Orientador: Vera Therezinha Medeiros Borges / Resumo: Identificação: Devido ao aumento do número de mulheres submetidas à cesárea nos últimos anos, tornou-se fundamental a avaliação da assistência prestada à parturiente com cesárea anterior, considerando os riscos obstétricos e buscando reduzir a incidência de novas cesáreas nessa população. Objetivos: Identificar os fatores preditivos associados com o sucesso de parto vaginal em parturientes com cesárea anterior. Métodos: Trata-se de um estudo tipo caso controle, retrospectivo e analítico, baseado em revisão de prontuários médico eletrônico. Foram incluídas todas as parturientes com antecedente de uma cesárea anterior, que receberam assistência ao parto na maternidade do Hospital das Clínicas da Faculdade de Medicina de Botucatu – UNESP no período de janeiro de 2013 a dezembro de 2015, com gestação única, idade gestacional acima de 37 semanas, feto vivo e apresentação cefálica. As variáveis estudadas foram: idade materna, cor declarada, estado civil, escolaridade, profissão, idade gestacional, tabagismo, presença de doenças clínicas maternas, intercorrências clínicas durante a gestação atual, dilatação e índice de Bishop na admissão, indicação da cesárea prévia, número de partos vaginais anteriores a cesárea prévia, indução do parto, peso e sexo do recém-nascido. Para a análise estatística, utilizou-se o teste qui-quadrado e/ou Exato de Fisher, considerando o nível de significância de 5%. Resultados: Foram incluídas no estudo 653 parturientes, sendo que 324 evoluíram para parto... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Identification: Due to the increase in the number of women undergoing caesarean section in recent years, it has become essential to evaluate the care provided to women who have undergone a previous cesarean section, considering obstetric risks and aiming at reducing the incidence of new caesareans in this population. Objectives: To identify the predictive factors associated with successful vaginal delivery in parturients with previous cesarean section. Method: This is a case control study, based on the review of electronic medical charts. All parturients with a history of a previous cesarean section and who received delivery assistance in the maternity of the Clinical Hospital in Botucatu Medical School - UNESP from January 2013 to December 2015 were included in the study. These patients also featured single gestation, gestational age above 37 weeks, live fetus with cephalic presentation. The variables studied were: maternal age, declared color, marital status, education, occupation, gestational age, smoking, presence of clinical maternal diseases, clinical intercurrences during the current pregnancy, dilation and Bishop index at admission, previous cesarean indication, number of previous vaginal deliveries before previous cesarean section, labor induction, weight and gender of the newborn. For statistical analysis, chi-square test and/or Fisher's exact test, considering significance level of 5% were used. Results: A total of 653 parturients were included in the study, of whi... (Complete abstract click electronic access below) / Mestre

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