Mecanismos para elaboração de uma política pública visando à erradicação da exploração sexual de crianças e adolescentes no chamado turismo sexual na cidade do Rio de Janeiro

Esta dissertação tem por objetivo principal propor mecanismos para elaboração de uma política pública visando à erradicação da exploração sexual de crianças e adolescentes no chamado turismo sexual na cidade do Rio de Janeiro. Para tanto, faz-se reflexões teóricas sobre o tema, considerando a situação de vulnerabilidade social na qual se encontra grande parte da população. Além disso, define-se o significado de políticas públicas a fim de compreender como estas podem auxiliar na solução do problema proposto. Como procedimentos de coleta das informações, foram feitas entrevistas presenciais baseadas em roteiros não estruturados, que possibilitaram a construção de uma relação entre a revisão bibliográfica realizada e a percepção in loco das profissionais do sexo sobre o assunto. A partir disso, foi possível atingir ao objetivo final e propor temas para estudos futuros.

Spiritual dimension of children and adolescents with cancer: an integrative review

OBJECTIVE: To review scientific literature relating to the spiritual dimension of children and adolescents with cancer. METHODS: We conducted an integrative literature review in the LILACS, SciELO, PsycINFO and MEDLINE databases in the period between 1990 to 2011. RESULTS: Twenty-one studies were analyzed and grouped into thematic categories: quality of life and elements of spirituality; alternative and complementary therapies: spirituality as a therapeutic resource; spirituality as a coping strategy and spirituality as an attribute of existential transformations. It was found that spirituality is present at different stages of the disease experience and that its forms of expression may vary, according to age and cognitive development. CONCLUSION: There is a scarcity of specific scales for this age range and a need for scientific production relating to the spiritual dimension of children and adolescents with cancer. Descriptors: Neoplasms; Children; Adolescents; Spirituality

LMS tables for waist circumference and waist-to-height ratio among Colombian children and adolescents: The FUPRECOL study

Background: Indices predictive of central obesity include waist circumference (WC) and waist-to-height ratio (WHtR). The aims of this study were 1) to establish a Colombian youth smoothed centile charts and LMS tables for WC and WHtR and 2) to evaluate the utility of these parameters as predictors of overweight and obesity. Method: A cross-sectional study whose sample population comprised 7954 healthy Colombian schoolchildren [boys n=3460 and girls n=4494, mean (standard deviation) age 12.8 (2.3) years old]. Weight, height, body mass index (BMI), WC and WHtR and its percentiles were calculated. Appropriate cut-offs point of WC and WHtR for overweight and obesity, as defined by the International Obesity Task Force (IOTF) definitions, were selected using receiver operating characteristic (ROC) analysis. The discriminating power of WC and WHtR was expressed as area under the curve (AUC). Results: Reference values for WC and WHtR are presented. Mean WC increased and WHtR decreased with age for both genders. We found a moderate positive correlation between WC and BMI (r= 0.756, P < 0.01) and WHtR and BMI (r= 0.604, P < 0.01). The ROC analysis showed a high discrimination power in the identification of overweight and obesity for both measures in our sample population. Overall, WHtR was slightly a better predictor for overweight/obesity (AUC 95% CI 0.868-0.916) than the WC (AUC 95% CI 0.862-0.904). Conclusion: This paper presents the first sex- and age-specific WC and WHtR percentiles for both measures among Colombian children and adolescents aged 9–17.9 years. By providing LMS tables for Latin-American people based on Colombian reference data, we hope to provide quantitative tools for the study of obesity and its comorbidities.

Avaliação da implementação das ações de enfrentamento ao abuso sexual contra crianças e adolescentes em escolas públicas de ensino fundamental do bairro do Guamá – Belém- PA

Estudiosos apontam a escola como local estratégico para o fortalecimento da ação de enfrentamento ao abuso sexual de crianças e adolescentes. A partir de 2000, com a elaboração do Plano Nacional de Enfrentamento à Violência Sexual Contra Crianças e Adolescentes, a política pública destinada ao tratamento desse problema ganhou maior visibilidade e organicidade no Brasil. O abuso sexual de crianças e adolescentes é a principal ocorrência registrada pelo Disque Direitos Humanos (2011) e pelos Conselhos Tutelares de Belém (2010). O bairro do Guamá – Belém/PA apresenta o maior índice de denúncias dessa natureza e as meninas são a maioria das vítimas. Esse contexto revela a relevância social do problema. A presente tese tem como objeto de estudo da avaliação da implementação da política pública de enfrentamento à violência sexual de crianças e adolescentes em escolas públicas de ensino fundamental do Guamá. Para conseguir imprimir uma análise contextual a pesquisa foi desenvolvida por meio de uma abordagem qualitativa apoiada nas técnicas de análise documental e entrevistas semiestruturadas. Os dados de pesquisa são documentos relativos aos planos, programas e projetos governamentais que tem em seu escopo o enfrentamento a esse tipo de violência e são voltados às escolas. Também foram realizadas entrevistas nas treze escolas públicas de ensino fundamental do bairro com diretores ou funcionários indicados por eles. A análise do material se deu por meio da técnica de análise de conteúdo dividida nas etapas da pré-análise, descrição analítica e a interpretação inferencial. A análise dos dados apontaram que: 1) as políticas formuladas em âmbito federal na área da formação dos profissionais da educação e dos materiais didáticos pedagógicos elaborados com a finalidade de subsidiá-los na apropriação da temática não chegaram às escolas pesquisadas; 2) planos/projetos que têm entre os seus objetivos o enfrentamento a esse tipo de violação devido a problemas de infraestrutura e de pessoal não foram executados como planejados; 3) nove entrevistados consideram que há a abordagem da temática no currículo das escolas, porém, não como conteúdo específico, mas como uma discussão pontual em meio a outras questões. Conclui-se dessa maneira, que pelas debilidades apresentadas a política pública de enfrentamento à violência sexual contra crianças e adolescentes não foi implementada nas escolas públicas de ensino fundamental do Guamá – Belém/PA. Crianças e adolescentes, em idade escolar obrigatória, são as principais vítimas de violência sexual. Por isso, a importância da inserção efetiva da escola na rede de enfrentamento com condições para identificar e notificar casos dessa natureza. Mas, para isso, é preciso fazer com que às políticas elaboradas com essa finalidade cheguem às unidades escolares, sobretudo a política de formação e que tenha intersecção com a política educacional.

Judiciary as the last resort to protect children and adolescents: intersectoral actions, investment in human resources, and structuring of services

This study aimed to identify the work developed by the Judiciary to prevent sexual violence against children and adolescents within the family. The approach to social representations in a cultural perspective was used. The field study consisted in the 1st and 2nd Court of Crimes against Children and Adolescents, at the State Supreme Court of Pernambuco, Brazil. Participant observation, semi-structured interviews, and focus group with 17 subjects were the techniques for data collection, analyzed through the interpretation of meanings, allowing the identification of the category "The Judiciary as the ultimate level" and the following subcategories: "The public policies to prevent violence" and "The structure and dynamics of Courts". This study allows the visualization of the Judiciary's limitations with regard to the full protection and absolute priority, and that the work along with the victims demands investments in structure and human resources.

A telephone survey to determine the experiences of children and their parents/carers, following the initiation of a new medicine

Objective: To determine what issues are experienced during the first few weeks of therapy by patients, and their parents/carers, when a child/young person has been prescribed a new medicine. Method: One hundred patients aged ≤18 years of age prescribed a new medicine for ≥6 weeks were recruited from a single UK National Health Service specialist paediatric hospital outpatient pharmacy. Six weeks after the first dispensing of their new medicine the patient or their parent/carer received telephone follow-up by a researcher and verbally completed a questionnaire containing both open and closed questions. Patient or parent/carer experiences were identified and analysed using thematic analysis and descriptive statistics. Results: Eighty-six participants were available for telephone follow-up. Six (7%) had not started their medicine. Paediatric patients and their parents/carers experienced a range of issues during the first few weeks after starting a new medicine. These included additional concerns/questions (24/80, 30%), administration issues (21/80, 26.3%), adverse effects (29/80, 36.3%) and obtaining repeat supplies (12/80, 15%). The Morisky Medication Adherence Scale indicated that 34/78 (43.6%) participants had a high adherence rating, 35/78 (44.9%) medium and 9/78 (11.5%) a low rating. Conclusions: Paediatric patients and their parents/carers experience a range of issues during the first few weeks after starting a new medicine. Further research is required to determine the type of interventions that may further support medicines use in this group of patients.

The contribution of physical activity and sedentary behaviours to the growth and development of children and adolescents : implications for overweight and obesity

The obesity epidemic is a global trend and is of particular concern in children. Recent reports have highlighted the severity of obesity in children by suggesting: “today's generation of children will be the first for over a century for whom life expectancy falls.” This review assesses the evidence that identifies the important role of physical activity in the growth, development and physical health of young people, owing to its numerous physical and psychological health benefits. Key issues, such as “does a sedentary lifestyle automatically lead to obesity” and “are levels of physical activity in today's children less than physical activity levels in children from previous generations?”, are also discussed. Today's environment enforces an inactive lifestyle that is likely to contribute to a positive energy balance and childhood obesity. Whether a child or adolescent, the evidence is conclusive that physical activity is conducive to a healthy lifestyle and prevention of disease. Habitual physical activity established during the early years may provide the greatest likelihood of impact on mortality and longevity. It is evident that environmental factors need to change if physical activity strategies are to have a significant impact on increasing habitual physical activity levels in children and adolescents. There is also a need for more evidence-based physical activity guidelines for children of all ages. Efforts should be concentrated on facilitating an active lifestyle for children in an attempt to put a stop to the increasing prevalence of obese children

Breathe easier online : evaluation of a randomized controlled pilot trial of an internet-based intervention to improve well-being in children and adolescents with a chronic respiratory condition

Background Chronic respiratory illnesses are the most common group of childhood chronic health conditions and are overrepresented in socially isolated groups. Objective To conduct a randomized controlled pilot trial to evaluate the efficacy of Breathe Easier Online (BEO), an Internet-based problem-solving program with minimal facilitator involvement to improve psychosocial well-being in children and adolescents with a chronic respiratory condition. Methods We randomly assigned 42 socially isolated children and adolescents (18 males), aged between 10 and 17 years to either a BEO (final n = 19) or a wait-list control (final n = 20) condition. In total, 3 participants (2 from BEO and 1 from control) did not complete the intervention. Psychosocial well-being was operationalized through self-reported scores on depression symptoms and social problem solving. Secondary outcome measures included self-reported attitudes toward their illness and spirometry results. Paper-and-pencil questionnaires were completed at the hospital when participants attended a briefing session at baseline (time 1) and in their homes after the intervention for the BEO group or a matched 9-week time period for the wait-list group (time 2). Results The two groups were comparable at baseline across all demographic measures (all F < 1). For the primary outcome measures, there were no significant group differences on depression (P = .17) or social problem solving (P = .61). However, following the online intervention, those in the BEO group reported significantly lower depression (P = .04), less impulsive/careless problem solving (P = .01), and an improvement in positive attitude toward their illness (P = .04) compared with baseline. The wait-list group did not show these differences. Children in the BEO group and their parents rated the online modules very favorably. Conclusions Although there were no significant group differences on primary outcome measures, our pilot data provide tentative support for the feasibility (acceptability and user satisfaction) and initial efficacy of an Internet-based intervention for improving well-being in children and adolescents with a chronic respiratory condition. Trial registration Australian New Zealand Clinical Trials Registry number: ACTRN12610000214033;

A systematic review of interventions to enhance medication adherence in children and adolescents with chronic illness

Introduction Poor medication adherence is common in children and adolescents with chronic illness, but there is uncertainty about the best way to enhance medication adherence in this group. The authors conducted a systematic review of controlled trials examining interventions that aim to improve medication adherence. Method A comprehensive literature search was undertaken to locate controlled trials that described specific interventions aiming to improve adherence to long-term medication, where participants were aged 18 years and under, medication adherence was reported as an outcome measure, and which could be implemented by individual health practitioners. Studies were reviewed for quality and outcome. Results 17 studies met inclusion criteria: seven studies examined educational strategies, seven studies examined behavioural interventions and three studies examined educational intervention combined with other forms of psychological therapies. Only two of seven studies reported a clear benefit for education on medication adherence, whereas four of seven trials indicated a benefit of behavioural approaches on medication adherence. One trial reported that combining education with behavioural management may be more effective than education alone. Studies which combined education with other non-medication specific psychological interventions failed to demonstrate a beneficial effect on medication adherence. Only two studies examined adherence-promoting interventions in young people with established adherence problems. Conclusion These findings suggest that education interventions alone are insufficient to promote adherence in children and adolescents, and that incorporating a behavioural component to adherence interventions may increase potential efficacy. Future research should examine interventions in high-risk groups.

EDSS-maintenance prototype: an environmental decision support system to assess the definition of operation and maintenance protocols for horizontal subsurface constructed wetlands

Els Sistemes d'Aiguamolls Construïts (SAC) de Flux Subsuperficial Horitzontal (FSH) és una tecnologia apropiada pel sanejament d'aigües residuals procedents de nuclis de població petits. No obstant els SAC de FSH són considerats una tecnologia natural, l'operació i manteniment d'aquestes depuradores és crucial per a garantir el seu correcte funcionament. Aquestes necessitats d'operació i manteniment varien entre depuradores segons (1) les característiques de la comunitat, (2) la configuració de la depuradora i el disseny del SAC de FSH i (3) les característiques del medi receptor. En aquest sentit, en aquesta tesi es presenta el desenvolupament d'un Sistema d'Ajuda a la Decisió (SAD) per a la definició de protocols d'operació i manteniment per a SAC de FSH tenint en compte els factors que causen variabilitat entre aquest tipus de depuradores (1, 2 i 3).

Zinc for treating of children and adolescents with attention-deficit hyperactivity disorder : a systematic review of randomized controlled clinical trials

This study systematically reviews the randomized clinical trials examining the effect of zinc on attention-deficit hyperactivity disorder (ADHD), searching the PubMed/Medline and Scholar Google databases. All randomized controlled trials that examined zinc as the intervention, and ADHD as the primary outcome were included. Only three randomized controlled trials, one which included a community sample and two that included clinical samples, met inclusion criteria. The only trial that was well controlled and randomized according to the baseline zinc level showed that using zinc, either alone or in combination with stimulants, did not improve ADHD. Considering the lack of clear evidence for the effect of zinc on ADHD and the possible effect of zinc on the nervous system, more clinical studies are needed to prove or disprove the effect of zinc as a monotherapy or adjuvant therapy.

La familia frente a las necesidades de los niños y adolescentes en el desarrollo nacional = The family vis-a-vis the needs of children and adolescents in national development

Incluye Bibliografía