Articulação entre serviços públicos de saúde nos cuidados voltados à saúde mental infantojuvenil

O objetivo do estudo é descrever e analisar as articulações que se realizam entre as equipes da Estratégia Saúde da Família (ESF) e Centro de Atenção Psicossocial Infantojuvenil (CAPSI), tendo em vista as ações voltadas à saúde mental de crianças e adolescentes. Foram realizadas entrevistas semidirigidas com gerentes de cinco CAPSI e 13 Unidades Básicas de Saúde com ESF, de 5 regiões distintas no Município de São Paulo, Brasil, que foram transcritas e analisadas mediante perspectiva hermenêutica. A articulação entre as equipes da ESF e CAPSI se dá prioritariamente por encaminhamento de casos, apoio matricial ou parceria para casos considerados pertinentes ao CAPSI. Falta de recursos humanos, cobrança por produtividade e ausência de capacitação dos profissionais da ESF para trabalhar com saúde mental foram mencionadas como obstáculos para a efetiva articulação entre os serviços. A lógica do encaminhamento e da desresponsabilização, bem como a hegemonia do modelo biomédico e a consequente fragmentação dos cuidados se mostram vigentes no cotidiano dos serviços.

Measures of quality of life in children with cochlear implant: systematic review

The use of cochlear implant (CI) in children enables the development of listening and communication skills, allowing the child's progress in school and to be able to obtain, maintain and carry out an occupation. However, the progress after the CI has different results in some children, because many children are able to interact and participate in society, while others develop limited ability to communicate verbally. The need for a better understanding of CI outcomes, besides hearing and language benefits, has spurred the inclusion of quality of life measurements (QOL) to assess the impact of this technology. OBJECTIVE: Identify the key aspects of quality of life assessed in children with cochlear implant. METHOD: Through a systematic literature review, we considered publications from the period of 2000 to 2011. CONCLUSION: We concluded that QOL measurements in children include several concepts and methodologies. When referring to children using CI, results showed the challenges in broadly conceptualizing which quality of life domains are important to the child and how these areas can evolve during development, considering the wide variety of instruments and aspects evaluated.

Avaliação da qualidade de vida em crianças com implante coclear: revisão sistemática

The use of cochlear implant (CI) in children enables the development of listening and communication skills, allowing the child's progress in school and to be able to obtain, maintain and carry out an occupation. However, the progress after the CI has different results in some children, because many children are able to interact and participate in society, while others develop limited ability to communicate verbally. The need for a better understanding of CI outcomes, besides hearing and language benefits, has spurred the inclusion of quality of life measurements (QOL) to assess the impact of this technology. OBJECTIVE: Identify the key aspects of quality of life assessed in children with cochlear implant. METHOD: Through a systematic literature review, we considered publications from the period of 2000 to 2011. CONCLUSION: We concluded that QOL measurements in children include several concepts and methodologies. When referring to children using CI, results showed the challenges in broadly conceptualizing which quality of life domains are important to the child and how these areas can evolve during development, considering the wide variety of instruments and aspects evaluated.

Maus-tratos contra a criança e o adolescente no Estado de São Paulo, 2009

OBJETIVO: Descrever o perfil das notificações em crianças e adolescentes no Estado de São Paulo em 2009 e analisar possíveis fatores associados. MÉTODOS: Foram analisadas 4.085 notificações em menores de 15 anos, registradas no Sistema de Vigilância de Violências e Acidentes (VIVA); um teste de regressão logística foi utilizado. RESULTADOS: O sexo feminino foi 61,4% do total. A faixa etária mais frequente entre as meninas foi a de 10 a 14 anos (38,8%) e entre os meninos foi < 5 anos (35,8%). A violência física representou 43,3% dos casos em meninos e a sexual 41,7% em meninas. Os principais autores das agressões foram os pais (43,8% do total) e conhecidos (29,4%). Agressores homens representaram 72,0%. A residência foi o local de ocorrência de 72,9% dos casos; violência de repetição foi referida em 51,4% das notificações. Diferenças encontradas entre os casos de violência física e sexual: a) violência física - maioria meninos (50,9%), pais como autores (48,4%) e mulheres como autoras (42,8%); b) violência sexual - maioria meninas (77,2%), conhecidos como autores (48,4%) e homens como autores (96,1%). Variáveis associadas à violência física: sexo masculino (OR: 2,22), idade 10-14 anos (OR: 1,68) e pais como autores (OR: 2,50). A violência sexual foi associada ao sexo feminino (OR: 2,84), idade 5-9 anos (OR: 1,66) e desconhecidos como autores (OR: 1,53). CONCLUSÃO: As políticas públicas deveriam garantir o direito de toda criança ter uma vida saudável e livre de violência. A análise das notificações é importante instrumento para estabelecer estratégias de prevenção.

Il cinema in missione. La pratica cinematografica dei missionari italiani lungo il XX secolo tra apostolato e antropologia

The thesis reconstructs the cinema’s experience of Italian missionaries during the XX century in a historical-pragmatic key. Italian missionaries, who started producing movies around the Twenties, have used cinema as a helpful instrument for religious propaganda. They have considered the rules of the Catholic Church, the political and social context and the audience’s expectations. Each chapter (1-4) analyses the phenomenon inside the context constituted by the Italian colonial experiences, the relationship between Catholic Church and images during the Evangelization, the history of cinema and the history of missions. A specific chapter (chapter 5) is dedicated to the archives of missionary’s cinema and to the value to be assigned to this film production (in terms of social memory and archive’s memory). At the end of the first part, the thesis presents a proposal about the relationship between missionary’s cinema and visual anthropology. The second part of the thesis includes the film cards of the missionary’s movies preserved in Italy: 339 cards of Italian movies and 149 cards of foreign movies placed in different archives and bureaus.

Valutazione affettiva del setting odontoiatrico in età evolutiva

Lo studio si pone l'obiettivo di approfondire il tema della valutazione affettiva del setting odontoiatrico in età evolutiva indagando se possa essere modulata da fattori quali: differenze di genere, specifici quadri patologici (Displasia Ectodermica e Patologie Sistemiche Croniche) responsabili di pregresse esperienze odontoiatriche e/o ospedalizzazioni; stato affettivo del bambino, stato affettivo del genitore. Materiali e metodi Studio 1. 85 soggetti [39 (19 maschi e 20 femmine) affetti da PSC e 46 (26 maschi e 20 femmine) soggetti sani] (range di età: 5-14 anni). Sono stati somministrati: un compito di valutazione immagini con 36 immagini (12 a contenuto piacevole, 12 neutro e 12 spiacevole) dallo IAPS e 12 immagini a contenuto odontoiatrico e dei questionari (MCDASf, CFSS-DS, TAD). Studio 2. 45 soggetti (19 maschi affetti da EDs e 26 maschi sani) (range di età: 5-14 anni). Sono stati somministrati: il compito di valutazione immagini precedentemente descritto e i questionari (MCDASf, CFSS-DS, TAD). Studio 3. 104 bambini (64 maschi and 40 femmine) (range di età: 5-14 anni) e uno dei genitori (19 padri and 69 madri). Sono stati somministrati i questionari MCDASf, CFSS-DS, TAD ai bambini e FDPQ, STAI-Y1, Y2-BDI-II ai genitori. Risultati: il contesto odontoiatrico ha una caratterizzazione affettiva distinta rispetto a contesti piacevoli, spiacevoli o neutri; specifici quadri patologici (EDs e PSC) non sembrano modulare il tipo di valutazione affettiva del contesto odontoiatrico; le femmine, attribuiscono al contesto odontoiatrico una valenza significativamente più spiacevole e una maggiore attivazione emotiva rispetto ai maschi; la paura del dolore odontoiatrico del genitore ha una correlazione con l’ansia dei bambini. Conclusione: è importante che l’odontoiatra consideri che la risposta emotiva delle bambine può essere caratterizzata da vissuti di paura con tendenza a comportamenti di allontanamento e valuti se la figura genitoriale rappresenta una risorsa o un elemento disturbante nella corso della seduta stessa.

Altersabhängige Besonderheiten in der Entwicklung des Bedeutungsfeldes der binären Opposition von „Möglichkeit“ vs. „Unmöglichkeit“

Die vorliegende Arbeit zum kindlichen Erwerb der binären Opposition von „Möglichkeit“ und „Unmöglichkeit“ und ihrer modalen Ausdrucksweisen im Russischen ist in ihrem praktischen Teil eine Einzelfall- und Langzeitstudie, die eine Ergänzung zu den bisher veröffentlichten, durchgehend eher experimentell und statistisch orientierten Forschungsarbeiten darstellen soll.rnÜber dreieinhalb Jahre hinweg wurde kontinuierlich Sprachmaterial eines Kindes sowie einiger ungefährer Altersgenossen und Spielkameraden aufgezeichnet, geordnet und ausgewertet. Zu Beginn des Untersuchungszeitraums war die Hauptprobandin dreieinhalb Jahre alt, zum Schluß sieben Jahre. Dieses Verfahren wurde bisher für das Russische noch nicht angewandt und wird im theoretischen Teil sorgfältig begründet.rnDas Sammeln für die Fragestellung relevanten sprachlichen Materials erfordert naturgemäß einen hohen Zeit- und Arbeitsaufwand, liefert dafür aber Daten, die eine Beeinflussung durch einen vorgegebenen Versuchsaufbau ausschließen, der natürlichen, spontanen Kommunikation entspringende Äußerungen festhalten und es ermöglichen, unprovozierte Interaktion, situationsbedingte Einflüsse, das Diskursverhalten der Probanden und ähnliche, individuelle Faktoren bei der Interpretation des Sprachmaterials in angemessener Weise zu berücksichtigen.rnUm die Fülle modaler Ausdrucksweisen sinnvoll zu strukturieren, konzentriert sich die Analyse auf die kindliche Verwendung von Modalverben und Prädikative als zentrale Mittel innerhalb des „Möglichkeitsfeldes“ und richtet den Fokus dabei auf das Verb moč’. Aus diesem Grunde wurde das theoretische Fundament, das der Arbeit zugrunde liegt, zu einem nicht geringen Teil aus dem Ansatz I.V. Šatunovskijs entwickelt, der die differenzierteste Analyse der zahlreichen Bedeutungsschattierungen des Verbs moč’ vorgelegt hat. Für besonders bedeutungsvoll für die vorliegende Arbeit erweist sich die Unterscheidung von kontrollierbarer und unkontrollierbarer Möglichkeit.rnIm Rahmen der Untersuchung ließen sich die grundlegenden Entwicklungstendenzen verfolgen. Dabei wurde nicht nur versucht nachzuvollziehen, in welcher Weise sich bei einem Kind das Fundament des Sprachgebrauchs in Gestalt eines allgemeinen „Zitatenschatzes“ formiert, sondern es gelang mitunter sogar, erste Fälle der Verwendung des einen oder anderen kommunikativen Fragments mit der Bedeutung von „Möglichkeit“ / „Unmöglichkeit“ oder erste Fälle der Konfrontation des Kindes mit einer neuen Situation, die eine solche Bedeutung verlangte, und sein Sprachverhalten in diesem Moment zu fixieren.

Früherkennung von Psychosen bei Kindern und Adoleszenten - Sind entwicklungsbezogene Besonderheiten ausreichend berücksichtigt

The early detection and treatment of persons at risk for psychosis is currently regarded as a promising strategy in fighting the devastating consequences of psychotic disorders. The two current favored at-risk approaches, i.e., the «ultra high risk» and the «basic symptom» criteria, were developed mainly using adult samples. Initial evidence suggests, however, that they cannot simply be applied to children and adolescents. For «ultra-high risk» criteria, there is indication of some attenuated psychotic symptoms being potentially nonspecific in adolescents, and of brief limited intermittent symptoms being difficult to clinically classify in children when observable behavioral correlates are missing. For basic symptoms, too, only a preliminary indication of their usefulness in children and adolescents exists. Since developmental peculiarities in the assessment of basic symptoms should be considered, a child and youth version of the Schizophrenia Proneness Instrument (SPI-CY) was developed. In conclusion, research on the clinical-prognostic validity of the at-risk criteria and their potential adaption to the special needs of children and adolescents is needed. If a «Prodromal Risk Syndrome for Psychosis» or «Attenuated Psychotic Symptoms Syndrome» are included in the upcoming DSM-5, it should be highlighted that its suitability for children and adolescents is only insufficiently known.

Traumatic brain injury in children

The general practitioner has an important role in the acute management and during the rehabilitation process of children after a traumatic head injury. Latest research shows that sequelae may occur even after a mild head injury without loss of consciousness. Recognizing the warning signs and symptoms after a head injury allows the general practitioner to counsel the child and parents in secondary prevention, particularly in order to avoid any further head injury during the recovery phase. Under the supervision of the general practitioner, a gradual progressive return to the child's everyday activities optimizes the chances of a rapid and complete recovery.

Functional hoarseness in children: short-term play therapy with family dynamic counseling as therapy of choice

Children with nonorganic voice disorders (NVDs) are treated mainly using direct voice therapy techniques such as the accent method or glottal attack changes and indirect methods such as vocal hygiene and voice education. However, both approaches tackle only the symptoms and not etiological factors in the family dynamics and therefore often enjoy little success. The aim of the "Bernese Brief Dynamic Intervention" (BBDI) for children with NVD was to extend the effectiveness of pediatric voice therapies with a psychosomatic concept combining short-term play therapy with the child and family dynamic counseling of the parents. This study compares the therapeutic changes in three groups where different procedures were used, before intervention and 1 year afterward: counseling of parents (one to two consultations; n = 24), Brief Dynamic Intervention on the lines of the BBDI (three to five play therapy sessions with the child plus two to four sessions with the parents; n = 20), and traditional voice therapy (n = 22). A Voice Questionnaire for Parents developed by us with 59 questions to be answered on a four-point Likert scale was used to measure the change. According to the parents' assessment, a significant improvement in voice quality was achieved in all three methods. Counseling of parents (A) appears to have led parents to give their child more latitude, for example, they stopped nagging the child or demanding that he/she should behave strictly by the rules. After BBDI (B), the mothers were more responsive to their children's wishes and the children were more relaxed and their speech became livelier. At home, they called out to them less often at a distance, which probably improved parent-child dialog. Traditional voice therapy (C) seems to have had a positive effect on the children's social competence. BBDI seems to have the deepest, widest, and therefore probably the most enduring therapeutic effect on children with NVD.

Authorising History: Gestures of Authorship in Fourteenth-Century English Historiography

This book discusses the strategies and rhetorical means by which four authors of Middle English verse historiography seek to authorise their works and themselves. Paying careful attention to the texts, it traces the ways in which authors inscribe their fictional selves and seek to give authority to their constructions of history. It further investigates how the authors position themselves in relation to their task of writing history, their sources and their audiences. This study provides new insights into the processes of the appropriation of history around 1300 by social groups whose lack of the relevant languages, before this 'anglicising' of the dominant Latin and French history constructions, prevented their access to the history of the British isles.

An Examination of the Contextual Environment of Families with Sexually Abused Adolescents

This study examined the impact of the contextual environment of the family on post abuse adjustment of sexually abused adolescents. Bronfenbrenner’s ecological theory was used to investigate how the external influences of the family impact the capacity of families to foster the recovery of sexually abused adolescents. The results from this secondary analysis of data from the National Survey of Child and Adolescent Well-Being Wave I (NSCAW, Dowd et al., 2002) support contextually sensitive treatment planning for sexually abused adolescents and their families.

Evaluating Family Preservation in Nevada: A University-State Agency Collaboration

In this paper, concepts from the emerging family-centered paradigm in child welfare and mental health are applied to evaluative research in family preservation: the ecological perspective, enhancement of competence, a consumer orientation, and collaborative relationships. The experience of family preservation research collaborators from the School of Social Work at the University of Nevada, Reno and the Nevada Division of Child and Family Services illustrate these concepts. The researchers apply the theory of isomorphism to the research endeavor to produce eight principles of effective research partnerships derived from family-centered concepts and their own experiences.

Neurocognitive deficits in children with brain tumors at diagnosis

Survivors of brain tumors are faced with a high risk for a wide range of cognitive problems and learning difficulties. These problems are caused by the lesion itself and its surgical removal as well as by the treatments to follow (chemo- and/or radiation therapy). A few recent studies have indicated that children with brain tumors (BT) might exhibit cognitive problems already at diagnosis, i.e. before the start of any medical treatment. The aim of the present study was to investigate the "baseline" neuropsychological profile in children with BT in comparison to children with an oncological diagnosis not involving the central nervous system (CNS). 20 children with BT and 27 children with an oncological disease without involvement of the CNS (age range: 6.1 to 16.9 years) were evaluated with an extensive battery of neuropsychological tests tailored to the patient's age. Furthermore, the child and its parents completed self-report questionnaires about emotional functioning and quality of life. In both groups, tests were administered before any therapeutic intervention such as surgery, chemotherapy or irradiation. Groups were comparable regarding age, gender and social economic status. Compared to the CG, patients with BTs performed significantly worse in tests of working memory, verbal memory and attention. In contrast the areas of perceptual reasoning, processing speed and verbal comprehension were preserved at this time. Younger children with BT were especially disadvantaged. Compared to aged matched children with malignancies not involving the CNS and older BT patients the young BT patients showed deficits in attention, working memory and verbal memory measures. Our results highlight the need for cognitive assessments and interventions early in the treatment process in order to minimize or even prevent academic difficulties as patients return to school.