844 resultados para Child-parent relationship


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Objective: premature infants are at increased risk of developmental disability. Early identification of problems allows intervention to ameliorate or attenuate problems. A reliable screening tool allows triage of children in this high-risk population by identifying those unlikely to need full developmental assessment. To explore the test characteristics of an established parent-completed developmental assessment questionnaire 'Ages and Stages Questionnaire' (ASQ) in follow up of an Australian population of premature infants. Methodology: One hundred and sixty-seven children born prematurely with corrected ages 12- to 48-months attending the Growth and Development Clinic at the Mater Children's Hospital in Brisbane, Queensland, Australia; 136 questionnaires 'ASQ' were returned completed (81%) and were compared to formal psychometric assessment (Griffith Mental Development Scales for 12- and 24-months, Bayley Mental Development Intelligence Scale for 18-months, McCarthy General Cognitive Intelligence Scale for 18-months). Developmental delay was considered to be present if any of the above psychometric assessments fell below 1.0 standard deviations (SD). The ASQ cut-off used was 2.0 SD (US data derived means and SD). Results: Aggregate results for all age groups comparing ASQ to psychometric assessments as 'gold standards' found the ASQ to have the following test characteristics: sensitivity (90%); specificity (77%); positive predictive value (40%); negative predictive value (98%): % over-referred (20%); % under-referred (1%); % agreement (79%). likelihood ratio for children failing the ASQ was 3.8 and for passing the ASQ was 0.13. Twenty-one children with known disabilities were included in the study and in 14 of these, the ASQ overall score agreed with the psychometric assessment (67%). Conclusion: The high negative predictive value of the ASQ supports its use as a screening tool for cognitive and motor delays in the follow up of ex-premature infants. This would need to be combined with other strategies as part of a comprehensive follow up program for ex-premature infants.

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Background/Aims: Patients with chronic liver disease undergoing liver transplantation have reduced body fat and muscle mass. The extent to which nutritional indicators and Child-Pugh class are predictive of postoperative outcome in adults is unclear. The aims of this study were to determine in adult patients undergoing transplant 1) the influence of preoperative Child-Pugh class and nutritional indicators on early transplant outcomes and one-year survival, 2) the relationship between nutritional indicators and Child-Pugh class and disease type. This study included 80 patients (1990-1994). Methodology: The nutritional indicators utilized were grip strength, triceps skinfold thickness and uncorrected mid-arm muscle area. Measured outcomes were ventilator time, intensive care stay, postoperative hospital stay and one-year survival. Results: Early morbidity was determined in survivors. Child-Pugh class C patients required longer ventilation and spent more time in the intensive care unit than Child-Pugh classes A and B. No significant relationships were found length of hospital stay. Relationships between the nutritional indicators (when controlled for Child-Pugh class) and early morbidity could not be determined due;to insufficient data. No relationship was established between one-year survival and Child-Pugh class or the nutritional indicators. Grip strength and mid-arm muscle area were lower in the patients in Child-Pugh:classes B and C. Parenchymal liver disease was associated with lower grip strength and mid-arm muscle area when compared to cholestatic disease. Conclusions: Child-Pugh class C is associated with greater early postoperative morbidity. Advanced Child-Pugh class is also associated with diminished muscle status and parenchymal disease.

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The relationship between asymptomatic shedding of bacterial enteropathogens and the hygiene habits of families who have had a child with typhoid fever (TF) are investigated. The sample was made up of 80 families: 40 families in which one child had had TF (Group A) and 40 in which no children or either of the parents had had a history of TF (Group B). In each group 20 families belonged to a low socieconomic status (SES) and 20 to a high SES. A structured interview was used to evaluate the SES and the hygiene habits of the child; observations were made to measure the hygiene habits of the family (toilet, kitchen and food preparation) and bacteriological studies (fecal samples and hand markers). Results show that carriers were more frequent in Group A than in Group B. The bacterial species found were significantly more numerous in Group A than in Group B (fecal samples: E. coli, the classic serotypes, Shigella ssp, and hand markers: E. coli). Families of Group A had higher carriage rates than those of Group B. Finally there exists a significantly higher association between inadequate hygiene habits and carrier families. These results show the need to teach specific habits of proper hygiene to the entire population, because the fact of belonging to the high SES does not in itself preclude inadequate hygiene habits.

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Tendo em conta o aumento do número de estruturas de apoio à primeira infância, particularmente, a expansão da creche, a investigação tem-se debruçado sobre as questões da qualidade. A generalidade dos estudos centra-se na discriminação das dimensões de qualidade e o seu impacto no desenvolvimento das crianças. Contudo, raramente a representação dos pais tem sido alvo de estudo. Partindo do pressuposto que a discussão sobre a qualidade da creche deve ser baseado na evidência empírica mas é, também, um conceito social baseado nos valores e representações dos seus atores, fomos ouvir os pais. Assim, quisemos conhecer: Como escolhiam a creche do seu filho(a)? Qual o seu conceito de qualidade? Que valor atribuem às experiências vividas pelo seus filhos ou filhas na creche? Que representação têm do papel do profissional de educação? Para o efeito, planificámos uma investigação em duas fases correspondendo a dois estudos empíricos. O primeiro estudo tinha como objetivo aferir livremente as Representações dos Pais acerca da Creche numa abordagem qualitativa, com recurso a entrevistas. Das entrevistas procurámos conhecer a opinião de um pequeno grupo de 20 pais com objetivo de aferir indicadores para a construção de um questionário que daria lugar ao segundo estudo - quantitativo. O primeiro estudo daria-nos a noção da opinião e o segundo estudo a noção da sua representação numa amostra de 180 participantes. Tanto quanto conhecemos (pesquisando as bases nacionais) estudos desta natureza sobre as representação dos pais sobre a creche, ainda, não tinham sido realizados em Portugal. De modo geral, os dois estudos revelaram que os pais valorizam a creche como espaço de promoção do desenvolvimento da criança; valorizam a dimensão afetiva do trabalho em creche; as educadoras como profissionais qualificados de educação e o desejo de uma relação estreita, aberta e respeitosa entre a creche e a família. Estes resultados abrem caminho para uma reflexão mais aprofundada acerca das representações, convicções e valores da família em relação à creche. - ABSTRACT Associated with an increased number of support structures for early childhood, we have witnessed a growing interest in studying the quality of these listed structures due to the impact that this will have on the quality development of children. Parents, as primary educators and educational agents privileged child, assume a key role in this regard. Through this study is to evaluate which representations and concept of parents about the quality of daycare. We performed a literature search in order to fit theoretically the main concepts covered in this study. We analyzed investigations already carried out on Nursery and Regulations and Guidelines for National Nursery. In terms of empirical studies we conducted two studies on the Representations about the Parent Nursery: A Qualitative Analysis using interviews with 20 parents and a Quantitative Study applying questionnaires to 180 parents. The main results of both studies revealed that parents value the nursery as a space to promote child development; value the affective dimension of work in nursery; qualified educators and desire for a good and respectful relationship between nursery and the family. These results pave the way for a deeper reflection about the representations, beliefs and values from the family about nursery.

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Introdução: Nas crianças/jovens com Paralisia Cerebral (PC), as limitações motoras repercutem-se em limitações funcionais e, consequentemente, na diminuição da participação em ocupações. Sendo as manifestações da PC diferentes de indivíduo para indivíduo, estas vão refletir, dependendo da gravidade, quadro motor, ambiente físico e social, diferentes níveis de participação. Objetivo: O objetivo deste estudo foi avaliar a relação entre a idade, sexo e grau de comprometimento motor e a participação em crianças/jovens com diagnóstico de paralisia cerebral com idades compreendidas entre os 5 e os 18 anos na ilha de São Miguel. Amostra e Métodos: 25 crianças de ambos os sexos (5- 18 anos), sinalizadas em instituições especializadas de reabilitação e em Centros de Atividades Ocupações (CAO’s) na Ilha de São Miguel – Açores. Foram aplicados dois instrumentos de avaliação às crianças/jovens, Gross Motor Function Measure e Quality of Upper Extremity Skills Test, e foram entregues aos pais os outros dois instrumentos para autopreenchimento, Assessment of Life Habits e Child Health Questionnaire – Parent- Form 50. Na análise estatística, recorreu-se a testes como o Kolmogorov-Smirnov, Tstudent ou Mann-Whitney, teste de Fisher, teste de Spearman e ANOVA. Resultados: Não foram encontradas relações significativas entre a idade e o sexo e o nível de participação das crianças/jovens com PC. Contrariamente, ao avaliarmos a relação entre o grau de participação e o grau de afetação verificamos que esta é significativa (p=0,004). Conclusão: Na nossa amostra não se encontrou uma influência da idade e do sexo com a frequência da participação (relações não foram significativas). Contudo, pode-se concluir que as crianças/jovens que apresentam menos limitações motoras, como as que se enquadram no nível I/II da Gross Motor Function Classification System, apresentam níveis de participação maiores do que as que apresentam níveis de afetação motora maiores (Nível V)

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Dissertação apresentada à Escola Superior de Educação de Lisboa para obtenção do grau de Mestre em Intervenção Precoce

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Dissertação apresentada na Escola Superior de Educação de Lisboa, para obtenção do grau de Mestre em Ciências da Educação - Especialidade Intervenção Precoce

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Dissertação apresentada na Escola Superior de Educação de Lisboa, para obtenção do grau de Mestre em Ciências da Educação Especialidade Intervenção Precoce

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Trabalho apresentado em XIII Congreso Internacional Galego-Portugués de Psicopedagoxía, Área 5 Familia, Escuela y Comunidad. Universidad da Coruña, 2 de Setembro de 2015.

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OBJECTIVE: To examine the relationship between social contextual factors and child and adolescent labor. METHODS: Population-based cohort study carried out with 2,512 families living in 23 subareas of a large urban city in Brazil from 2000 to 2002. A random one-stage cluster sampling was used to select families. Data were obtained through individual household interviews using questionnaires. The annual cumulative incidence of child and adolescent labor was estimated for each district. New child and adolescent labor cases were those who had their first job over the two-year follow-up. The annual cumulative incidence of child and adolescent labor was the response variable and predictors were contextual factors such as lack of social support, social deprivation, unstructured family, perceived violence, poor school quality, poor environment conditions, and poor public services. Pearson's correlation and multiple linear regression were used to assess the associations. RESULTS: There were selected 943 families corresponding to 1,326 non-working children and adolescents aged 8 to 17 years. Lack of social support, social deprivation, perceived violence were all positively and individually associated with the annual cumulative incidence of child and adolescent labor. In the multiple linear regression model, however, only lack of social support and perceived violence in the neighborhood were positively associated to child and adolescent labor. No effect was found for poor school quality, poor environment conditions, poor public services or unstructured family. CONCLUSIONS: Poverty reduction programs can reduce the contextual factors associated with child and adolescent labor. Violence reduction programs and strengthening social support at the community level may contribute to reduce CAL.

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ABSTRACT Background Mental health promotion is supported by a strong body of knowledge and is a matter of public health with the potential of a large impact on society. Mental health promotion programs should be implemented as soon as possible in life, preferably starting during pregnancy. Programs should focus on malleable determinants, introducing strategies to reduce risk factors or their impact on mother and child, and also on strengthening protective factors to increase resilience. The ambition of early detecting risk situations requires the development and use of tools to assess risk, and the creation of a responsive network of services based in primary health care, especially maternal consultation during pregnancy and the first months of the born child. The number of risk factors and the way they interact and are buffered by protective factors are relevant for the final impact. Maternal-fetal attachment (MFA) is not yet a totally understood and well operationalized concept. Methodological problems limit the comparison of data as many studies used small size samples, had an exploratory character or used different selection criteria and different measures. There is still a lack of studies in high risk populations evaluating the consequences of a weak MFA. Instead, the available studies are not very conclusive, but suggest that social support, anxiety and depression, self-esteem and self-control and sense of coherence are correlated with MFA. MFA is also correlated with health practices during pregnancy, that influence pregnancy and baby outcomes. MFA seems a relevant concept for the future mother baby interaction, but more studies are needed to clarify the concept and its operationalization. Attachment is a strong scientific concept with multiple implications for future child development, personality and relationship with others. Secure attachment is considered an essential basis of good mental health, and promoting mother-baby interaction offers an excellent opportunity to intervention programmes targeted at enhancing mental health and well-being. Understanding the process of attachment and intervening to improve attachment requires a comprehension of more proximal factors, but also a broader approach that assesses the impact of more distal social conditions on attachment and how this social impact is mediated by family functioning and mother-baby interaction. Finally, it is essential to understand how this knowledge could be translated in effective mental health promoting interventions and measures that could reach large populations of pregnant mothers and families. Strengthening emotional availability (EA) seems to be a relevant approach to improve the mother-baby relationship. In this review we have offered evidence suggesting a range of determinants of mother-infant relationship, including age, marital relationship, social disadvantages, migration, parental psychiatric disorders and the situations of abuse or neglect. Based on this theoretical background we constructed a theoretical model that included proximal and distal factors, risk and protective factors, including variables related to the mother, the father, their social support and mother baby interaction from early pregnancy until six months after birth. We selected the Antenatal Psychosocial Health Assessment (ALPHA) for use as an instrument to detect psychosocial risk during pregnancy. Method Ninety two pregnant women were recruited from the Maternal Health Consultation in Primary Health Care (PHC) at Amadora. They had three moments of assessment: at T1 (until 12 weeks of pregnancy) they filed out a questionnaire that included socio-demographic data, ALPHA, Edinburgh post-natal Depression Scale (EDPS), General Health Questionnaire (GHQ) and Sense of Coherence (SOC); at T2 (after the 20th weeks of pregnancy) they answered EDPS, SOC and MFA Scale (MFAS), and finally at T3 (6 months after birth), they repeated EDPS and SOC, and their interaction with their babies was videotaped and later evaluated using EA Scales. A statistical analysis has been done using descriptive statistics, correlation analysis, univariate logistic regression and multiple linear regression. Results The study has increased our knowledge on this particular population living in a multicultural, suburb community. It allow us to identify specific groups with a higher level of psychosocial risk, such as single or divorced women, young couples, mothers with a low level of education and those who are depressed or have a low SOC. The hypothesis that psychosocial risk is directly correlated with MFAS and that MFA is directly correlated with EA was not confirmed, neither the correlation between prenatal psychosocial risk and mother-baby EA. The study identified depression as a relevant risk factor in pregnancy and its higher prevalence in single or divorced women, immigrants and in those who have a higher global psychosocial risk. Depressed women have a poor MFA, and a lower structuring capacity and a higher hostility to their babies. In average, depression seems to reduce among pregnant women in the second part of their pregnancy. The children of immigrant mothers show a lower level of responsiveness to their mothers what could be transmitted through depression, as immigrant mothers have a higher risk of depression in the beginning of pregnancy and six months after birth. Young mothers have a low MFA and are more intrusive. Women who have a higher level of education are more sensitive and their babies showed to be more responsive. Women who are or have been submitted to abuse were found to have a higher level of MFA but their babies are less responsive to them. The study highlights the relevance of SOC as a potential protective factor while it is strongly and negatively related with a wide range of risk factors and mental health outcomes especially depression before, during and after pregnancy. Conclusions ALPHA proved to be a valid, feasible and reliable instrument to Primary Health Care (PHC) that can be used as a total sum score. We could not prove the association between psychosocial risk factors and MFA, neither between MFA and EA, or between psychosocial risk and EA. Depression and SOC seems to have a clear and opposite relevance on this process. Pregnancy can be considered as a maturational process and an opportunity to change, where adaptation processes occur, buffering risk, decreasing depression and increasing SOC. Further research is necessary to better understand interactions between variables and also to clarify a better operationalization of MFA. We recommend the use of ALPHA, SOC and EDPS in early pregnancy as a way of identifying more vulnerable women that will require additional interventions and support in order to decrease risk. At political level we recommend the reinforcement of Immigrant integration and the increment of education in women. We recommend more focus in health care and public health in mental health condition and psychosocial risk of specific groups at high risk. In PHC special attention should be paid to pregnant women who are single or divorced, very young, low educated and to immigrant mothers. This study provides the basis for an intervention programme for this population, that aims to reduce broad spectrum risk factors and to promote Mental Health in women who become pregnant. Health and mental health policies should facilitate the implementation of the suggested measures.

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RESUMO: Enquadramento: O sono é cada vez mais reconhecido como um fator determinante na Saúde Infantil porque, quando desadequado, pode ter consequências na regulação emocional e do comportamento, nas funções cognitivas, no rendimento académico, na regulação do peso e no risco de lesões acidentais. Os hábitos e problemas do sono das crianças portuguesas não se encontram ainda bem caracterizados. Este conhecimento é importante para o desenvolvimento da investigação e para a promoção da saúde nesta área. Objetivos: Adaptar e validar o Children's Sleep Habits Questionnaire (CSHQ) para a cultura portuguesa; Caracterizar os hábitos de sono de uma amostra de crianças dos 2 aos 10 anos tendo em vista a obtenção de dados de referência; Estimar a prevalência dos problemas do sono na perspetiva dos pais; Avaliar se existem diferenças nos hábitos e problemas do sono entre as regiões de média-alta e baixa densidade populacional; Identificar potenciais consequências dos problemas do sono. Métodos: Foi realizado um estudo transversal, descritivo e correlacional. A versão portuguesa do questionário (CSHQ-PT) foi desenvolvida de acordo com as orientações previamente publicadas e validada numa amostra de 315 crianças dos 2 aos 10 anos. Para o estudo dos hábitos e problemas do sono, o CSHQ-PT foi distribuído aos pais de 2257 crianças recrutadas em 17 zonas de agrupamentos escolares (15 escolhidos de forma aleatória) das áreas da Grande Lisboa, Península de Setúbal e Alentejo, compreendendo zonas litorais e do interior, e de alta, média e baixa densidade populacional. Foram obtidos 1450 (64%) questionários válidos. Resultados: O CSHQ-PT mostrou propriedades psicométricas semelhantes às das versões de outros países e adequadas para a investigação. A avaliação dos hábitos de sono nos dias de semana mostrou que as crianças se deitam, em média, pelas 21h 44m (DP 38 min.). A necessidade da companhia dos pais para adormecer diminui com a idade, ocorrendo em 49% das crianças aos 2-3 anos e 10% aos 9-10 anos. O hábito de adormecer a ver televisão foi descrito em 15,8% das crianças. O tempo total de sono diário diminui com a idade, com uma diferença mais marcada dos 2 para os 3 anos e dos 3 para os 4 anos, quando a sesta se torna menos frequente. No fim de semana, 25% das crianças dormia pelo menos mais uma hora. As diferenças nos hábitos de sono entre regiões de média-alta e de baixa densidade populacional foram reduzidas, sem reflexo na duração média do sono. Considerando valores de referência de outros países, verificou-se que 10% das crianças estudadas tinha uma duração do sono dois desvios-padrão abaixo da média esperada para a idade. A prevalência dos problemas do sono na perspetiva dos pais foi de 10,4%, sem diferenças significativas entre classes etárias, subgrupos de nível educacional dos pais, nem entre zonas de média-alta e baixa densidade populacional. Estes problemas do sono mostraram-se associados, sobretudo, à duração do sono insuficiente, resistência em ir para a cama, dificuldade em adormecer sozinho, despertares noturnos frequentes e ocorrência de parassónias. A baixa prevalência de problemas do sono identificados pelos pais contrasta com cotações elevadas no CSHQ-PT que traduzem comportamentos-problema mais frequentes, que são bem aceites por alguns pais. O Índice de Perturbação do Sono foi mais elevado nas famílias com menor nível educacional. Em análise multivariada mostraram valor preditivo para a sonolência diurna: o tempo total de sono diário, a diferença da duração do sono noturno durante a semana e no fim de semana, a frequência de algumas parassónias e o hábito de adormecer a ver televisão. O rendimento escolar mostrou associação com os problemas do sono, que são mais frequentes nas crianças com dificuldades escolares e hiperatividade/problemas de atenção. A relação entre estas variáveis é complexa. Conclusões: Este estudo mostrou que os problemas comportamentais do sono e a privação de sono são frequentes na população estudada. Estes problemas têm consequências, uma vez que correspondem a uma frequência mais elevada de sintomas de sonolência diurna, por comparação com outros países. Perante este cenário, é muito importante reforçar a promoção de hábitos de sono saudáveis e continuar a estudar as consequências do sono desadequado nas crianças portuguesas. -----------ABSTRACT:Framework: Sleep is increasingly being recognized as important to Child Health, for inadequate sleep may impact behavioral and emotional regulation, cognitive functions, academic performance, weight regulation and the risk of accidental injuries. The sleep habits and sleep problems of Portuguese children are not well characterized. This knowledge is important to support further studies and health promotion actions. Objectives: Develop and validate a Portuguese version of the Children's Sleep Habits Questionnaire (CSHQ-PT); Characterize the sleep habits and problems in a sample of Portuguese children from the ages of 2 to 10 for future reference; Estimate the prevalence of parent-defined sleep problems; Assess whether there are differences in sleep habits and problems between regions of medium-high and low population densities; Identify potential consequences of sleep problems. Methods: We conducted a cross-sectional, descriptive and correlational study. The Portuguese version of the questionnaire (CSHQ-PT) was developed according to published guidelines and validated in a sample of 315 children from 2 to 10 years old (y.o.). In order to study sleep habits and problems we delivered the CSHQ-PT to 2257 children recruited from 17 school districts (15 were chosen randomly) in areas with low, medium and high population densities, including coastline and inland regions. 1450 (64%) valid questionnaires were obtained. Results: The CSHQ-PT demonstrated psychometric properties that were similar to the versions from other countries and adequate for research. The evaluation of sleep habits showed that on schooldays children go to bed, on average, at 21h 44m (SD 38 min.). The need of having the parent in the room at bedtime decreases with the age of the child, occurring in 49% of children with 2-3 y.o. and 10% of children between 9 and 10 y.o. The habit of going asleep while watching TV was reported in 15,8% of the children. Total sleep time diminishes with the age of the child, having a major decrease from 2 to 3 y.o. and from 3 to 4 y.o., along with less frequent naps. During the weekend, 25% of the children sleep at least one extra hour. Considering reference values from other series, we found that 10% of the children had a sleep duration two standard deviations below the mean for the age. The differences in sleep habits between regions of medium-high and low population densities are few, and there are no differences in average sleep durations. The prevalence of parent-defined sleep problems was 10.4%. There were no significant differences between age classes, parent education subgroups or between regions of medium-high and low population densities. These sleep problems were associated with insufficient sleep duration, bedtime resistance, difficulty in falling asleep alone, frequent night awakenings and the occurrence of parasomnias. The low prevalence of parent-defined sleep problems contrasts with high CSHQ scores meaning that problematic behaviors are more frequent, but acceptable to some parents. The Sleep Disturbance Score was higher in families with a lower educational level. In multivariate analysis, the following factors predicted the daytime somnolence score: total sleep time, the difference in night sleep duration between the weekend and school days, the frequency of some parasomnias and the habit of falling asleep while watching TV. School achievement showed a negative correlation with the sleep problems, which are more frequent in children with school difficulties and hyperactivity/attention problems. The relationship between these variables is complex. Conclusions: This study evidenced that behavioral sleep problems and sleep deprivation are common in our population. These sleep problems have consequences as they correspond to more symptoms of excessive daytime somnolence comparing to other countries. Therefore, we reinforce the importance of promoting healthy sleep habits and further study the consequences of inadequate sleep in Portuguese children.

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There is an undeniable link between child support and scholarship, under article 1880 of the portuguese Civil Code. Of course, by being within family relationships, such link could not be out of controversy. At a time when the continuation of studies is more and more urgent, this link between the two, is often subject of disputes, especially resultant from the interpretation of the law, due to the wide extension that it is entitle to; and many times is also insufficient to the most interested people – the youngsters that want to study. Regardless of the imprecision that rules under article 1880 of the portuguese Civil Code, this article reveals a huge importance by enabling young adults and students to continue their studies, with the financial help from their parents - the responsibility of the parents with the support of their children should have ended by the time they have become legal adults, but it is extended by this article, once the criteria is filled, especially related to the reasonableness of what is required to the parents and the temporal duration of the education chosen. That is, considering that reaching adulthood does not cease the duty of support from the parents, it is important to know how much can parents provide to their children, bearing in mind their income and the child’s and his/her needs, behavior and the intellectual capacity of the child as a student and also the parent-child relationship; and, until when is such support due, taking in to account several circumstances of life and the difficulties inherent to the degree chosen and even the extension of the studies to a master or to a PhD degree that justifies the extension of the parent’s duty. Anyway, the application of article 1880 of the portuguese Civil Code is always based on a case by case analysis and on the economic insufficient of the youngsters to suffice themselves and the simultaneous desire to continue their studies.