Miedo e inseguridad de la gestante durante el trabajo de parto como motivos para la demanda de internación precoz

Objective. To identify reasons why women look for early health care attention at the end of pregnancy. Methodology. Qualitative study based in socio-existential phenomenology proposed by Alfred Schütz. Nine pregnant women who consulted to the maternity service without being in real labor were interviewed. Results. The following analysis categories emerged: Having different symptoms or signals from the ones they had felt or been informed about, not being able to identify real labor, fear to fetal complications for being close to the probable labor date, feeling calmer when being seen by professionals of the institution, lack of problem solving by other services of the health institution, fearing out of hospital delivery, imitating real labor, looking for tranquility in the idealization of labor and modifying behaviors to guarantee attention. Conclusion. Women are insecure and fear because of a fragmented health care, where they do not perceive themselves linked to the prenatal control program anymore, and at the same time they don’t find the health care assistance they want.

Inclusão escolar na percepção de professores do município de Dois Córregos, São Paulo

This paper aims to make a survey about the inclusion of children in need of special care in all schools and day nurseries (publics and privates) in ?Dois Córregos? city, in São Paulo. We interviewed 144 teachers and 14 school principals in 14 educational establishments ? 5 private schools, 5 state-owned schools, 2 municipal schools, 1 municipal nursery and 1 philanthropic nursery. The research aimed to investigate possible prejudices against the children in need of special care; verify if the schools have adequate infrastructure to receive the students in need of special care; and verify if the professionals who work in the schools are receiving (or received) specific training to work on this inclusion process. The results indicated that teachers who don?t work with children in need of special care are very insecure in receiving them. It?s evident that there are a lot of doubts and uncertainties about the inclusion system. In general, schools don?t have adequate infrastructure and most of the time the included students are those who have internal deficits, which are not evident.

Tropical, de Anita Malfatti

A partir da análise de Tropical, tela pintada por Anita Malfatti em 1917, este artigo propõe que a artista procedia a uma mudança em sua linguagem pictórica, afastando-se das concepções de vanguarda que adotara até então para, aderindo ao clima de retorno à ordem internacional, aproximar-se das discussões sobre o nacionalismo na arte, presentes na cena paulistana. Assim, a imagem de mulher insegura que mudou sua perspectiva por causa da crítica de Monteiro Lobato adquire outra conotação. Os modernistas teriam preferido essa interpretação a efetuar uma análise da obra de Anita Malfatti, por meio da qual se poderia desvelar uma deserção do programa vanguardista feita de forma consciente pela artista

Trends, drivers and impacts of changes in swidden cultivation in tropical forest-agriculture frontiers: A global assessment

This meta-analysis of land-cover transformations of the past 10-15 years in tropical forest-agriculture frontiers world-wide shows that swidden agriculture decreases in landscapes with access to local, national and international markets that encourage cattle production and cash cropping, including biofuels. Conservation policies and practices also accelerate changes in swidden by restricting forest clearing and encouraging commercial agriculture. However, swidden remains important in many frontier areas where farmers have unequal or insecure access to investment and market opportunities, or where multi-functionality of land uses has been preserved as a strategy to adapt to current ecological, economic and political circumstances. In some areas swidden remains important simply because intensification is not a viable choice, for example when population densities and/or food market demands are low. The transformation of swidden landscapes into more intensive land uses has generally increased household incomes, but has also led to negative effects on the social and human capital of local communities to varying degrees. From an environmental perspective, the transition from swidden to other land uses often contributes to permanent deforestation, loss of biodiversity, increased weed pressure, declines in soil fertility, and accelerated soil erosion. Our prognosis is that, despite the global trend towards land use intensification, in many areas swidden will remain part of rural landscapes as the safety component of diversified systems, particularly in response to risks and uncertainties associated with more intensive land use systems. (C) 2011 Elsevier Ltd. All rights reserved.

Photofixierung von Lipidmembranen aus Glykolipopolymeren auf Goldoberflächen

Ziel war Herstellung und Charakterisierung festkörperunterstützter Membransysteme aus Glykolipopolymeren auf Goldoberflächen, mit elektrischen Eigenschaften, die denen der Schwarzfilmmembranen entsprechen. Um diese Eigenschaften mit impedanzspektroskopischen Techniken messen zu können, ist die Präparation der Membranen auf Goldfilmen notwendig. Eine direkte Verankerung der Glykolipopolymermoleküle (GLP) auf der Goldoberfläche ist nicht möglich, daher werden die untersuchten GLP mit Hilfe von photoreaktiven Molekülen kovalent auf der Goldoberfläche immobilisiert. Untersuchten Abstandhalter waren Thio-Polyethylenglykol und eine Mischung zweier Alkanthiole, bestehend aus 1-Thiohexanol und Bis-(Aminododecyl)-disulfid. Thio-PEG-Monoschichten zeigten sehr unterschiedliche Schichtdicken, weil die Moleküle auf der Oberfläche sehr unterschiedliche Konformationen annehmen können, die eine regelmässige Anordnung erschweren. Langmuir-Blodgett Übertrag sowie die durchgeführte photochemische Fixierung der GLP-Moleküle auf Thio-PEG Schichten führte zu Eigenschaften, die auf den Aufbau einer Lipidmonolage hinweisen. Diese stellte jedoch im Bereich der Lipidmoleküle keine geschlossene Schicht dar. Es kommen als Abstandhaltermoleküle für die Photofunktionalisierung nur Moleküle in Frage, die aufgrund ihrer Eigenschaften eine regelmässige Anordnung auf der Goldoberfläche anstreben. Diese Voraussetzung erfüllt am besten die Gruppe der Alkanthiole. Terminal funktionalisierte Alkanthiole müssen jedoch mit nicht oder anderweitig funktionalisierten Alkanthiolen verdünnt assembliert werden, um weitergehende Funktionalisierungen einzugehen. Die untersuchten GLP lassen sich aufgrund ihrer amphiphilen Struktur an der Wasser-Luft Grenzfläche vororientieren. In allen Fällen gelingt auch der Langmuir-Blodgett Übertrag der komprimierten Schicht, sowie, nach der für die Anbindung notwendigen Trocknung, die photochemisch kovalente Fixierung der Monoschicht durch Bestrahlung mit UV-Licht. Damit konnte erstmals die photochemisch kovalente Fixierung von GLPs auf der Goldoberfläche gezeigt werden. Untersuchungen erfolgten an einem Copolymer sowie zwei unterschiedlichen Homopolymermolekülen. Der unterschiedliche molekulare Aufbau der GLP spiegelt sich in ihrem Verhalten an der Wasser-Luft Grenzfläche sowie in den Eigenschaften der gebildeten Monoschichten wieder. Die Copolymer-Schichten zeigten sehr unterschiedliche Schichtdicken. Auch die EIS-Daten sind schlecht reproduzierbar. Dies ist auf die molekulare Struktur des Copolymers zurückzuführen. Gänzlich unterschiedlich verhalten sich die Homopolymere. Aufgrund ihrer Struktur lassen sie sich zu dichten Schichten komprimieren. Messungen der Fluoreszenzerholung nach Photobleichung (FRAP) zeigen homogene aber nicht fluide Schichten. Die photochemisch kovalente Fixierung des Moleküls auf der Goldoberfläche konnte durch SPR- sowie EIS-Messungen nachgewiesen werden. Die EIS-Messungen zeigen Werte, die sich in Bereichen der idealen Modellmembran bewegen. Der erfolgreiche Einbau von Valinomycin konnte bestätigt werden. FRAP Untersuchungen zeigten die Bildung homogener Schichten. Diese sind jedoch im Bereich der proximalen Lipidschicht nicht fluide. Um die Fluidität in Anlehnung an die Eigenschaften der natürlichen Membranen zu erhöhen, wurden die photochemisch kovalent fixierten Anker-Glykolipopolymer-Moleküle durch Mischung mit freien Lipiden lateral verdünnt. Auch die kovalente Fixierung der GLP-Bausteine innerhalb gemischten Schichten konnte erfolgreich demonstriert werden. Die Schichten zeigten sich jedoch, mit Ausnahme der Schichten aus 50mol% Homopolymer und 50mol% Lipid, inhomogen. Nach Photobleichung durch den Laserblitz kam es nur bei den 50mol%:50mol% -Schichten (Ho: Lipid) zur Erholung der Fluoreszenz, was auf das Vorliegen von beweglichen Lipidmolekülen innerhalb der Membran schliessen lässt. Der Versuch der Inkorporation von Valinomycin gelang ebenfalls. Alle genannten Ergebnisse deuten darauf hin, dass die molekulare Architektur der hergestellten Schichten durch die unterschiedlichen Längendimensionen des Homopolymer-Moleküls einerseits, sowie des Lipids andererseits nicht für alle Mischungsverhältnisse ausreichend stabil ist. Die für die kovalente Fixierung erforderliche Trocknung der Schicht führt zu einer deutlichen Verminderung des Wassergehaltes des Systems und einer daraus resultierenden starken Destabilisierung der aufgebauten Schichten. Insgesamt gesehen stellt somit die photochemische Fixierung der glykosidischen Homopolymer-Membranen ein vielversprechendes Modellsystem dar.

Patient-Therapeut-Bindung bei Drogenabhängigen: Instrumentenvalidierung und Therapieevaluation

In der vorliegenden Arbeit wird zum einen ein Instrument zur Erfassung der Patient-Therapeut-Bindung validiert (Client Attachment to Therapist Scale, CATS; Mallinckrodt, Coble & Gantt, 1995), zum anderen werden Hypothesen zu den Zusammenhängen zwischen Selbstwirksamkeitserwartung, allgemeinem Bindungsstil, therapeutischer Beziehung (bzw. Therapiezufriedenheit), Patient-Therapeut-Bindung und Therapieerfolg bei Drogen-abhängigen in stationärer Postakutbehandlung überprüft. In die Instrumentenvalidierung (einwöchiger Retest) wurden 119 Patienten aus 2 Kliniken und 13 Experten einbezogen. Die Gütekriterien des Instrumentes fallen sehr zufriedenstellend aus. An der naturalistischen Therapieevaluationsstudie (Prä-, Prozess-, Post-Messung: T0, T1, T2) nahmen 365 Patienten und 27 Therapeuten aus 4 Kliniken teil. Insgesamt beendeten 44,1% der Patienten ihren stationären Aufenthalt planmäßig. Auf Patientenseite erweisen sich Alter und Hauptdiagnose, auf Therapeutenseite die praktizierte Therapierichtung als Therapieerfolgsprädiktoren. Selbstwirksamkeitserwartung, allgemeiner Bindungsstil, Patient-Therapeut-Bindung und Therapiezufriedenheit eignen sich nicht zur Prognose des Therapieerfolgs. Die zu T0 stark unterdurchschnittlich ausgeprägte Selbstwirksamkeits-erwartung steigert sich über den Interventionszeitraum, wobei sich ein Moderatoreffekt der Patient-Therapeut-Bindung beobachten lässt. Es liegt eine hohe Prävalenz unsicherer allgemeiner Bindungsstile vor, welche sich über den Therapiezeitraum nicht verändern. Die patientenseitige Zufriedenheit mit der Therapie steigt von T1 zu T2 an. Die Interrater-Konkordanz (Patient/Therapeut) zur Einschätzung der Patient-Therapeut-Bindung erhöht sich leicht von T1 zu T2. Im Gegensatz dazu wird die Therapiezufriedenheit von Patienten und Therapeuten zu beiden Messzeitpunkten sehr unterschiedlich beurteilt. Die guten Testgütekriterien der CATS sprechen für eine Überlegenheit dieses Instrumentes gegenüber der Skala zur Erfassung der Therapiezufriedenheit. Deshalb sollte die Patient-Therapeut-Bindung anhand dieses Instrumentes in weiteren Forschungsarbeiten an anderen Patientenkollektiven untersucht werden, um generalisierbare Aussagen zur Validität treffen zu können.

Social Work as Laboratory for Normative Professionalisation

In most Western countries, the professional status of social workers is instable and insecure. Of course, most Western countries are themselves instable, ridden with feelings of insecurity and in search of reassurance and promises of control. But social work hardly lends itself as a projection screen for visions of professional control and efficiency in the face of insecurity. On the contrary: within the present cultural and political climate, social work connotes primarily with unpopular social problems, with people unable to cope adequately with the competitiveness and the rate of change of post-industrial societies, that is to say: it connotes more with dependency and helplessness then with autonomy and control. Moreover, whereas public discourse in most Western country is dominated by a neo-liberal perspective and the intricate network of economic, managerial, consumerist and military metaphors connected with it, social work still carries with it a legacy of 'progressive politics' increasingly labeled as outdated and inadequate. Although the values of solidarity and social justice connected with this 'progressive heritage' certainly have not faded away completely, the loudest and most popular voices on the level of public discourse keep underscoring the necessity to adapt to the 'realities' of present-day postindustrial societies and their dependence on economic growth, technological innovation and the dynamics of an ever more competitive world-market. This 'unavoidable' adaptation involves both the 'modernization' and progressive diminishment of 'costly' welfare-state arrangements and a radical reorientation of social work as a profession. Instead of furthering the dependency of clients in the name of solidarity, social workers should stimulate them to face their own responsibilities and help them to function more adequately in a world where individual autonomy and economic progress are dominant values. This shift has far-reaching consequences for the organization of the work itself. Efficiency and transparency are the new code words, professional autonomy is dramatically limited and interventions of social workers are increasingly bound to 'objective' standards of success and cost-effectiveness.

How Insecurity impacts on school attendance and school drop out among urban slum children in Nairobi

This paper discusses how perceptions of personal security can impact on school enrolment and attendance. It mainly focuses on threats to physical harm, crime, community and domestic violence. These security fears can include insecurity that children suffer from as they go to school, maybe through the use of unsafe routes; insecurity that children feel at school; and the insecurity they suffer from in their homes. Although poverty is an indicator of insecurity, this paper does not focus solely on poverty as it is well covered elsewhere in the literature. The paper relies on qualitative data collected in Korogocho and Viwandani slum areas in Nairobi, Kenya between October and November 2004. The paper analyses data from individual interviews and focus group interviews and focuses on the narrative of slum dwellers on how insecurity impacts on educational attainment. The conclusion in this paper is that insecure neighbourhoods may have a negative impact on schooling. As a result policies that address insecurity in slum neighbourhoods can also improve school attendance and performance.

Evaluating watershed service availability under future management and climate change scenarios in the Pangani Basin

Watershed services are the benefits people obtain from the flow of water through a watershed. While demand for such services is increasing in most parts of the world, supply is getting more insecure due to human impacts on ecosystems such as climate or land use change. Population and water management authorities therefore require information on the potential availability of watershed services in the future and the trade-offs involved. In this study, the Soil and Water Assessment Tool (SWAT) is used to model watershed service availability for future management and climate change scenarios in the East African Pangani Basin. In order to quantify actual “benefits”, SWAT2005 was slightly modified, calibrated and configured at the required spatial and temporal resolution so that simulated water resources and processes could be characterized based on their valuation by stakeholders and their accessibility. The calibrated model was then used to evaluate three management and three climate scenarios. The results show that by the year 2025, not primarily the physical availability of water, but access to water resources and efficiency of use represent the greatest challenges. Water to cover basic human needs is available at least 95% of time but must be made accessible to the population through investments in distribution infrastructure. Concerning the trade-off between agricultural use and hydropower production, there is virtually no potential for an increase in hydropower even if it is given priority. Agriculture will necessarily expand spatially as a result of population growth, and can even benefit from higher irrigation water availability per area unit, given improved irrigation efficiency and enforced regulation to ensure equitable distribution of available water. The decline in services from natural terrestrial ecosystems (e.g. charcoal, food), due to the expansion of agriculture, increases the vulnerability of residents who depend on such services mostly in times of drought. The expected impacts of climate change may contribute to an increase or decrease in watershed service availability, but are only marginal and much lower than management impacts up to the year 2025.

Food Insecurity in America: A Call to Action

When 1 in 6 people in the country is living in a food insecure household, that is an outrage. A country as wealthy as ours– wealthy enough to end hunger even in hard times like those we have been experiencing– should not countenance the moral blight of hunger. Those of us who work to reduce and eventually end hunger in this country cannot succeed, however, by making moral arguments alone. What is needed in addition to move voters, policymakers and institutions to act is a strong evidence base that establishes the causes of hunger, the consequences of hunger for individuals involved, the breadth of the population affected, and the practical strategies to address hunger. The articles in this journal illuminate many of these topics while exploring the impacts of federal nutrition programs and deepening the case that economic and nutrition supports for families reduce food insecurity and mediate the impacts of poverty and food insecurity, particularly for children.

Individual, Family, and Neighborhood Characteristics and Children's Food Insecurity

A growing body of work documents the influence of neighborhood environments on child health and well-being. Food insecurity is likely linked to neighborhood characteristics via mechanisms of social disadvantage, including access to and availability of healthy foods and the social cohesion of neighbors. In this paper, we utilize restricted, geo-coded data from the Early Childhood Longitudinal Study, which allows us to link individual children with their neighborhood's census characteristics, to assess how the neighborhoods of food secure and food insecure children differ at both the kindergarten level and in third grade. The average food insecure child lives in a neighborhood with a higher proportion of black and Hispanic residents, a higher proportion of residents living in poverty, and a higher proportion of foreign-born and linguistically isolated residents. After accounting for individual and household-level characteristics, children living in neighborhoods with a high proportion of Hispanic and foreign-born residents have a significantly increased risk of food insecurity compared to children living in neighborhoods which are predominantly white and have high socioeconomic status. We argue that interventions which take neighborhood context into account may be most efficacious for curbing child food insecurity.

Food Insecurity and the Behavioral and Intellectual Development of Children: A Review of the Evidence

Background: Given that an alarming 1 in 5 children in the USA are at risk of hunger (1 in 3 among black and Latino children), and that 3.9 million households with children are food insecure, it is crucial to understand how household food insecurity (HFI) affects the present and future well-being of our children. Purpose: The objectives of this review article are to: (i) examine the association between HFI and child intellectual, behavioral and psycho-emotional development, controlling for socio-economic indicators; (ii) review the hypothesis that HFI is indeed a mediator of the relationship between poverty and poor child development outcomes; (iii) examine if the potential impact of HFI on caregivers’ mental health well-being mediates the relationship between HFI and child development outcomes. Methods: Pubmed search using the key words “food insecurity children.” For articles to be included they had to: (i) be based on studies measuring HFI using an experience-based scale, (ii) be peer reviewed, and (iii) include child intellectual, behavioral and/or socio-emotional development outcomes. Studies were also selected based on backward and forward Pubmed searches, and from the authors’ files. After reviewing the abstracts based on inclusion criteria a total of 26 studies were selected. Results: HFI represents not only a biological but also a psycho-emotional and developmental challenge to children exposed to it. Children exposed to HFI are more likely to internalize or externalize problems, as compared to children not exposed to HFI. This in turn is likely to translate into poor academic/cognitive performance and intellectual achievement later on in life. A pathway through which HFI may affect child development is possibly mediated by caregivers’ mental health status, especially parental stress and depression. Thus, HFI is likely to foster dysfunctional family environments. Conclusion: Findings indicate that food insecure households may require continued food assistance and psycho-emotional support until they transition to a “stable” food secure situation. This approach will require a much better integration of social policies and access to programs offering food assistance and mental health services to those in need. Findings also fully justify increased access of vulnerable children to programs that promote early in life improved nutrition as well as early psycho-social and cognitive stimulation opportunities.

Exploring the Association Between Household Food Insecurity, Parental Self-Efficacy, and Fruit and Vegetable Parenting Practices Among Parents of 5- to 8-Year-Old Overweight Children

Background: Food insecurity may negatively impact children’s nutritional status by affecting parenting quality. Because parents have a strong influence on their children’s eating and food choices, examining the effects of food insecurity on parenting may provide important insights into obesity prevention efforts. Objectives: This study explored whether food insecurity was associated with parental self-efficacy and parenting practices related to fruit and vegetable consumption. Methods: Secondary analysis was performed using baseline data from 31 mothers of 5-8 year old overweight or obese children who had participated in a pilot obesity treatment program. Household food security status, fruit and vegetable parental self-efficacy (modeling/socialization, planning/encouraging and availability/accessibility) and fruit and vegetable parenting practices (structure, responsiveness, non-directive control, and external control) were assessed using validated measures. Students' t-test investigated differences in subscales by food security status. Results: There were no significant differences in fruit and vegetable parenting practices and parental self-efficacy between food secure and insecure groups. There was a trend towards a decrease in parental self-efficacy for making fruit and vegetables available in the home among food insecure parents (p=.06). Conclusions: In this small sample no significant associations were found between food insecurity and fruit and vegetable parenting practices and parental self-efficacy. However, the trend observed in this exploratory analysis supports further hypothesis-driven research with a larger sample size able to detect more subtle differences.

Consequences of insecurity in emergency telephone consultations: an experimental study in medical students.

QUESTION UNDER STUDY Handling emergency telephone consultations (ETCs) is a challenging and very important task for doctors. The aims of the study were to document insecurity in medical students during ETCs and to identify the reasons for that insecurity. We hypothesised that insecurity is associated with advising more urgent action (e.g. advice to call for an ambulance) in ETCs. METHODS We used ETCs with simulated patients (SPs), with each student randomly allocated two of four possible cases. After the training, 137 students reported on any insecurity that they had in the various ETC phases. We analysed the reasons for insecurity using descriptive statistics. The association between the students' advice that urgent action was needed and their insecurity was analysed with Spearman rank correlation. RESULTS Overall, 95% of the students felt insecure in at least one phase of their ETC. History taking was the phase in which students felt most insecure (63.1%), followed by the phase of analysing the information given by the patient (44.9%). Perceived insecurity was associated with more urgent advice in one case scenario (abdominal pain; correlation r = 0.46; p <0.01). The other two cases (child with fever; chest pain) also had a positive, but not statistically significant, correlation trend (p <0.12; p <0.08). CONCLUSIONS Insecurity is highly prevalent among medical students in their ETC decision-making. ETC training in medical schools, with a focus on structured history taking and formulating discriminating questions, might help decrease insecurity in ETCs. Medical education should also teach management of insecurity.

Ethiopia's Food Reserve Policies and Practice

Ethiopia has for a long time been one of the world’s most food-insecure countries. Efforts by the government and a multitude of sponsors including NGOs have developed an array of institutions and instruments to mitigate the negative impact of production and supply disruptions. Public stockpiles are one such tool, the use of which is rapidly increasing worldwide. This brief field study examines the Ethiopian policies and practice in context, including various instruments operated by farmers, processors and traders. The study finds that the multiple objectives assigned to food reserves as well as the present management structure may not be well-suited at a time of high world market prices and when international food aid is dwindling, and as the international regulatory trade and investment environment remains a matter of unfinished business from a global food security perspective. A comprehensive study of various options for improvements would lay out policy alternatives for public authorities and stakeholders.