Implicações da prática profissional no acolhimento institucional de crianças: perspectiva de cuidadoras / Implications of professional practice in children's institutional sheltering: caregivers' perspective / Implicaciones de la práctica profesional en el alojamiento institucional de niños: perspectiva de cuidadoras

Este estudo qualitativo teve como objetivo compreender, a partir da teoria de bioecológica de desenvolvimento, as implicações da prática profissional no processo de acolhimento de crianças em uma casa-abrigo, na perspectiva de cuidadoras. As participantes foram 10 profissionais de uma casa-abrigo localizada na região sul do Brasil. Utilizou-se a entrevista semiestruturada e a organização e análise dos dados sustentou-se na Grounded Theory, com auxílio do software Atlas.ti 8.4.14. Os resultados evidenciaram uma centralização das ações de acolhimento e atenção em torno dos cuidados físicos das crianças. As ações para promover suporte e cuidados emocionais dentro da casa-abrigo eram delegadas às profissionais da equipe técnica da instituição. Observou-se que as dificuldades encontradas pelas cuidadoras diziam respeito à falta de segurança e preparação para responder e acolher as demandas emocionais das crianças, as quais estão presentes em diversos momentos do processo de acolhimento. Percebeu-se que as práticas institucionais afetaram decisivamente tanto as ações de acolhimento das participantes e o suporte emocional oferecido às crianças na passagem pela casa-abrigo quanto as cuidadoras, no sentido de vivenciarem no trabalho sentimentos de insegurança. Os resultados tensionam ecologicamente a interação nos processos proximais presentes no desenvolvimento humano. Advoga-se pela reflexão sobre as implicações das práticas institucionais de uma casa-abrigo e o desenvolvimento infantil, visando o cuidado integral dos acolhidos.(AU)

Based on the developmental bioecological theory, this study analyzes the implications of professional practice in children's user embracement at a shelter from the caregivers' perspective. Semi-structured interviews were conducted with 10 professionals from a shelter located in southern Brazil. Data organization and analysis was performed based on Grounded Theory using the Atlas.ti 8.4.14 software. Results showed that embracement and attention focus on the physical care of children. Support and emotional care activities were delegated to the institution's technical team. Caregivers faced difficulties regarding the lack of security and preparation to respond to and accept the children's emotional demands, which arise at different moments in the embracement process. The institutional practices decisively affected both user embracement actions and the emotional support offered to the children, as well as the caregivers, in the sense of experiencing feelings of insecurity. These findings ecologically tension the interaction in the proximal processes present in human development. Further reflections on the implications of institutional shelter-based practices for child development are needed to provide comprehensive care.(AU)

Este estudio cualitativo tuvo como objetivo comprender, desde la perspectiva de la teoría bioecológica del desarrollo, las implicaciones de la práctica profesional en el proceso de acogida de niños en una institución infantil desde la perspectiva de las cuidadoras. Las participantes fueron 10 profesionales de una institución de acogida infantil ubicada en la región Sur de Brasil. Se utilizó la entrevista semiestructurada, y para la organización y análisis de datos se aplicó Grounded Theory, con el uso del software Atlas.ti 8.4.14. Los resultados mostraron que las acciones de recepción y atención se centran en el cuidado físico de los niños. Las acciones de promoción de apoyo y cuidado emocional dentro del alojamiento se asignaron a los profesionales del equipo técnico de la institución. Se observó que las dificultades encontradas por las cuidadoras estaban relacionadas con la falta de seguridad y preparación para responder y aceptar las demandas emocionales de los niños, las cuales se encuentran presentes en diferentes momentos del proceso de acogida. Se notó que las prácticas institucionales afectaron decisivamente tanto las acciones de acogida de las participantes como el apoyo emocional que la institución brinda a los niños durante su paso, así como a las cuidadoras en el sentido de experimentar sentimientos de inseguridad en el trabajo. Estos resultados tensan ecológicamente la interacción en los procesos proximales presentes en el desarrollo humano. Se aboga por reflexionar sobre las implicaciones de las prácticas institucionales en los alojamientos institucionales y el desarrollo infantil, apuntando a la atención integral de los acogidos.(AU)

Serum Fat-Soluble Vitamin Levels of 6,082 Minors in Zhuzhou City.

Objective: To explore the nutritional status of serum fat-soluble vitamins such as vitamin A, 25-hydroxyvitamin D, and vitamin E of minors in the Zhuzhou area to provide a scientific basis for clinical guidance to supplement fat-soluble vitamins reasonably. Method: A total of 6,082 minors who underwent physical examination from January 2017 to February 2019 in the Children's Health Department of Zhuzhou Hospital affiliated with XiangYa School of Medicine of Central South University were selected as the subjects to measure the levels of serum fat-soluble vitamins A, D, and E. Results: (1) Their average levels of serum vitamin A, 25-hydroxyvitamin D, and vitamin E were (0.34 ± 0.08) mg/mL, (34.65 ± 10.24) ng/mL, and (10.11 ± 2.65) mg/mL, respectively. (2) Serum vitamin E showed a gender difference (P < 0.001). (3) The average levels of serum 25-hydroxyvitamin D and vitamin E in infancy, early childhood, preschool age, school age, and adolescence decreased gradually (P < 0.05). In contrast, the average level of serum vitamin A ranged between 0.32 mg/mL and 0.37 mg/mL. (4) The age was negatively correlated with serum 25-hydroxyvitamin D (r = -0.517, P < 0.001) and weakly negatively correlated with vitamin E (r = -0.366, P < 0.001), but weakly positively correlated with vitamin A (r = 0.269, P < 0.001). Conclusion: Minors from infancy to adolescence in Zhuzhou should strengthen their supplementation of fat-soluble vitamins.

Estudio de la actividad antimicrobiana de Xenophyllum poposum sobre microorganismos de la cavidad bucal por el método de difusión radial / Study of the antimicrobial activity of Xenophyllum poposum on microorganisms of the oral cavity by the radial diffusion method

Resumen En este estudio se evaluó la actividad antimicrobiana in vitro de extractos de Xenophyllum poposum sobre microorganismos bucales como Streptococcus mutans, Streptococcus sobrinus, Lactobacillus casei, Actinomyces naeslundii, Actinomyces odontolyticus, Candida albicans y Veillonella sp. Se empleó el método de difusión radial en agar y como controles negativo y positivo de inhibición se emplearon etanol y clorhexidina al 0,12% (Plac out NF®) respectivamente. Los extractos con mayor actividad antimicrobiana fueron el etanólico y el clorofórmico. La diferencia entre ambos no fue estadísticamente significativa (p≥0,05). Tampoco se observó diferencia significativa con respecto a la clorhexidina, excepto sobre Veillonella sp., ya que el extracto etanólico presentó halos de inhibición significativamente menores sobre este microorganismo. Esto es importante ya que Veillonella se considera indicador de salud en relación a la caries dental. En base a esto, el extracto etanólico de Xenophyllum poposum podría ser usado como control químico de la biopelícula dental.

Abstract In this study, the in vitro antimicrobial activity of Xenophyllum poposum extracts on oral microorganisms such as Streptococcus mutans, Streptococcus sobrinus, Lactobacillus casei, Actinomyces naeslundii, Actinomyces odontolyticus, Candida albicans, Veillonella sp. was evaluated. The radial diffusion method in agar was used and 0.12% ethanol and chlorhexidine (Plac out NF®) were used as negative and positive inhibition controls, respectively. The extracts with the highest antimicrobial activity were the ethanolic and chloroform extracts. The difference between the two was not statistically significant (p≥0.05). No significant difference was observed with respect to chlorhexidine, except on Veillonella sp., since the ethanolic extract presented significantly lower inhibition halos on this microorganism. This is important as Veillonella is considered an indicator of health in relation to dental caries. Based on this, the ethanolic extract of Xenophyllum poposum could be used as chemical control of dental biofilm.

Resumo Neste estudo, a atividade antimicrobiana de extratos de Xenophyllum poposum sobre microrganismos orais como Streptococcus mutans, Streptococcus sobrinus, Lactobacillus casei, Actinomyces naeslundii, Actinomyces odontolyticus, Candida albicans e Veillonella sp. Foi utilizado o método de difusão radial em ágar e etanol 0,12% e clorexidina (Plac out NF®) como controles de inibição negativa e positiva, respectivamente. Os extratos com maior atividade antimicrobiana foram os extratos etanólico e clorofórmio. A diferença entre os dois não foi estatisticamente significativa (p≥0,05). Não foi observada diferença significativa em relação à clorexidina 0,12%, exceto em Veillonella sp., uma vez que o extrato etanólico apresentou halos de inibição significativamente menores neste microrganismo. Isso é importante, pois a Veillonella é considerada um indicador de saúde em relação à cárie dentária. Com base nisso, o extrato etanólico de Xenophyllum poposum pode ser utilizado como controle químico do biofilme dental.

The experiences of children and adolescents undergoing forced separation from their parents during migration: A systematic review.

Globally, the migration of unaccompanied minors is increasing, however, the experiences of these children have not been examined. We systematically synthesised the existing qualitative literature to examine the experiences of children undergoing forced separation from their parents during migration. The review was structured based on the PRISMA statement. A systematic search of Ovid MEDLINE, EMBASE, PsychINFO and Scopus databases from inception to November 23, 2020 was conducted to retrieve eligible studies. Only qualitative studies of children aged ≤18 years were reviewed. The data analysis and synthesis were informed by the intersectionality framework. The search yielded 10,956 studies of which eight were included in this review. Thematic analysis identified the following themes: unaccompanied minors experience a deep sense of loss; anxiety over the uncertainty of the migration process; difficulty adjusting to their new life in the host country and adverse health effects. These experiences were heightened by children's exposure to violence during migration. The intersectionality framework suggests that unaccompanied minors experience separation from their parents during migration in ways that marginalise them and widen inequalities. Migration processes need to be streamlined to provide integrated health, emotional, legal and educational supports for unaccompanied children with particular attention given to treating the trauma of past violence. More research is needed to explore how to facilitate the integration of unaccompanied children into host communities in ways that are healing and empowering.

Valores de hemoglobina en niños y niñas de 2 a 5 años, que viven a una altura de 3073 m.s.n.m. y consumieron chispitas nutricionales en marzo 2018 / Hemoglobin values in infants 2-5 year olds, who got nutritional supplements chispitas, and live at a height of 3073 meters above sea level, march 2018

La anemia es la disminución de la concentración de la hemoglobina por debajo de los límites inferiores considerados como normales de acuerdo a la edad, sexo y el contexto de la altitud. La prevalencia de Anemia en menores de 5 años en Bolivia, departamento La Paz es de 60,3%, constituyéndose en la principal barrera para lograr el desarrollo social y económico. La presente investigación contribuye al cumplimiento de uno de los Objetivos de Desarrollo Sostenible para la trasformación de nuestro mundo, que es Poner fin al hambre, lograr la seguridad alimentaria y la mejora de la nutrición. OBJETIVO: determinar valores de hemoglobina en niños y niñas de 2 a 5 años, que viven a una altura de 3073 m.s.n.m. que consumieron Chispitas nutricionales en marzo 2018. METODOLOGÍA: fue un estudio cuantitativo, descriptivo de tipo trasversal, con una muestra de 43 entre niños y niñas que cumplieron los criterios de inclusión. MÉTODO: se utilizó el sistema portátil Fotómetro B Hemoglobin HemoCue, para procesar las muestras de sangre capilar y medir los niveles de concentración de hemoglobina. Para determinar el punto de corte de los niveles de hemoglobina a una altura de 3073 m.s.n.m. y se utilizó el factor de corrección para la altura de 1.9 g/dL Se considera 11.5 a 9.5 g/dL anemia leve; 9.5 a 7,5 g/dL anemia moderada y menor a 7,5 g/dL anemia severa. RESULTADOS: en niños y niñas menores de 5 años que viven a una altura de 3073 m.s.n.m. la prevalencia de anemia ferropénica es de 74%, los niveles de hemoglobina se incrementan según la edad (p < 0.05) y no se asocia al consumo de chispitas nutricionales con un (p > 0.05). CONCLUSIONES: los niveles de hemoglobina se incrementan según la edad y no así con el consumo de chispitas nutricionales. También se evidencia el promedio de hemoglobina no ajustada en ambos sexos, con una leve similitud entre los mismos, femenino 12,43 g/dL y masculino 12,46 g/dL; valores muy por debajo de umbrales óptimos para definir anemia a gran altitud.

The anemy is the decrease of hemoglobine under the normal limits considered healthy acording to the age, gender and the sea level context. The prevalence of the anemia in children under 5 years in La Paz department in Bolivia is 60,3%, so, it is one of the main impediments to achieve the social and economic development. This research contributes to achieve one of the world's substantiable development objectives, which is to end hunger, to achieve the food security and improve nutrition. OBJECTIVE: to determine the values of hemoglobin in infants 2-5 years old who got nutritional supplements chispitas, and lived in a height of 3073 meters above sea level, March 2018. METODOLOGY: it was a quantitative descriptive cross sectional research, a sample of 43 infants who had all the requirements to the research. METHOD: it was used the photometric system B Hemoglobin HemoCue to process and to determine the hemoglobin levels of the capillary blood samples. At a height of 3073 meters above sea level, the cut-off point of hemoglobin with a cross-correlation figure of 1.9 is the following: from 11.5 to 9.5mg/dL mild anemia, from 9.5 to 7,5 mg/dL moderate anemia and less of 7,5mg/dL severe anemia. RESULTS: in infants under 5 year olds who lived at 3073 meters over sea level, the prevalence of iron deficiency anemia is 74%, the hemoglobin levels increases according to the age (p< 0,05) and not to the use of the nutritional supplements Chispitas (p > 0,05). CONCLUSIONS: the hemoglobin levels increase according to age and not to the use of nutritional supplements Chispitas. The average hemoglobin in both sexes is also evidenced, slightly similar between them, female 12.43 g/dL and male 12.46 g/dL; values below normal limits considered healthy in order to define anemia at high altitude.

Effectiveness and safety of 3 different traditional Chinese therapies for asthma in minors: A protocol for systematic review and network meta-analysis.

INTRODUCTION: Traditional Chinese medicine has been widely used in the treatment of asthma, but currently there has been no comprehensive evaluation on the efficacy and safety of different traditional Chinese medicine therapies, based on network meta-analysis (NMA). METHODS AND ANALYSIS: The retrieval strategy was strictly followed in the English databases PubMed, Embase, Cochrane Library, and Chinese databases: CNKI and Wanfang. The retrieval time was limited from the beginning of each database construction to September 12, 2020. Meanwhile, in order to prevent data missing, we compared the previous meta-analysis to determine the final inclusion results. The main indexes were Spirometry, the secondary indexes were Asthma Quality of Life Questionnaire and adverse events. Methodological quality of articles was assessed using the Cochrane Collaborative tool, and evidence quality was assessed using the Recommended Scoring, Development, and Evaluation tool. Completed The NMA using Stata statistical software (Version 14.0, Stata Corporation, College Station, TX). The Cochrane Collaboration's Tool was used to evaluate the methodological quality of articles, the Grading of Recommendations Assessment, Development, and Evaluation instrument was used to evaluate the quality of evidence. NMA was completed by using Stata Statistical Software (Version 14.0, Stata Corporation, College Station, TX). RESULTS: The study will rank 3 traditional Chinese medicine treatments for asthma. CONCLUSION: This study is the first time to use NMA to compare the efficacy and safety of traditional Chinese medicine for the treatment of asthma, which will provide ideas and methods for the clinical treatment for asthma. INPLASY REGISTRATION NUMBER: INPLASY202090052.

Valor nutricional del almuerzo ofrecido por una organización no gubernamental a niños(as) de 4 a 12 años de edad en zonas urbano marginales de San José, Costa Rica, 2017-2018 / Nutritional value of the lunch offered by a non-governmental organization to children between 4 and 12 years of age in marginal urban areas of San José, Costa Rica, 2017-2018

RESUMEN Propósito: La inexistencia de datos a nivel nacional y regional sobre el valor nutricional (VN) de la alimentación ofrecida en comedores comunitarios dirigidos por Organizaciones No Gubernamentales (ONG), que atienden población infantil de zonas urbano marginales, junto con el incremento en la prevalencia de exceso de peso reportada por el Ministerio de Educación Pública de Costa Rica (MEP) en el 2016, justifican el estudio del VN del almuerzo servido a niños(as), que participan en programas de alimentación complementaria en zonas urbano marginales de San José, Costa Rica. Método: Se analizaron mediante muestreo aleatorio 321 platos de almuerzo, durante 12 días en dos comedores. Se reconstruyeron recetas y se determinaron tamaños de porción mediante pesaje directo y se calculó el VN promedio por plato. Resultados: El valor energético fue cercano a la recomendación nutricional. Sin embargo, valores de proteína, grasa total, grasa insaturada, fibra dietética, calcio y potasio fueron inferiores a las recomendaciones y por el contrario, carbohidratos totales, azúcar agregada, grasa saturada y sodio fueron superiores a la recomendación nacional. Conclusión: No es suficiente ofrecer un aporte adecuado de energía. Los excesos y deficiencias de nutrientes reflejan un patrón alimentario obesogénico que suma vulnerabilidad a la condición de pobreza y pobreza extrema de la población infantil de zonas urbano-marginales.

ABSTRACT Purpose: The lack of data at a national and regional level regarding the nutritional value (NV) of the food offered in community feeding programs run by Non-Governmental Organizations, which serve the population of marginal urban areas (an important indicator of infant health), along with the increase in the prevalence of excess weight reported in 2016 by the Ministry of Public Education of Costa Rica, justifies the study of the NV of the lunch served to preschool and school-aged children, who participate in complementary feeding programs in marginal urban areas of San José, Costa Rica. Method: 321 meals served were analyzed over 12 days, in 2 food services. Recipes were reconstructed, and portion sizes were determined by direct weighing of food served and the average NV per dish was calculated. Results: The energy value of the lunch served was similar to the nutritional recommendation. However, for the values of protein, total fat, unsaturated fat, dietary fiber, calcium and potassium which were lower than the nutritional recommendation and on the contrary, the content of total carbohydrates, added sugar, saturated fat and sodium was excessive. Conclusion: It is not enough to offer minors an adequate energy amount. Nutrient excesses and deficiencies reflect an obesogenic food pattern, which adds vulnerability to the condition of poverty and extreme poverty of the child population of marginalized urban areas.

What can we learn from unaccompanied refugee adolescents' perspectives on mental health care in exile?

Unaccompanied refugee adolescents who have fled war and persecution often have poor mental health. Yet, little is known about their own perspectives on what can relieve their mental health problems. The aim was to explore unaccompanied refugee adolescents' perspectives on healing and the mental healthcare offered to them when resettled. The study was based on methodical triangulation of participant observation in a Danish municipal institution for unaccompanied refugee minors, semi-structured individual interviews with experts, social workers and male refugee minors and a focus group interview with refugee minors. Results show that the refugee adolescents associated traditional conversational therapy with discussing negative and stigmatising aspects of their past and carrying risks of re-traumatisation. Instead, alternative activities were proposed, through which resources could be accumulated and they could be met without stereotype.Conclusion: To enhance the complex mental health needs of unaccompanied minors' mental healthcare, the perspective of the refugee adolescents should be taken into account. This calls for a holistic approach to mental healthcare in their daily lives, where they are met in a non-stigmatising manner in which their unique capabilities are the main focus. Moreover, a trusting relationship constitutes the fundament to support good mental health among refugee adolescents. What is Known: • Unaccompanied refugee adolescents are at risk of poor mental health outcomes, e.g., depression, anxiety, PTSD and psychosocial stress. • Stigma, lack of social support, stressful life events and lack of intercultural competency among mental health professionals are barriers to good mental health. What is New: • There is a need for informal and tailored health promotion initiatives in the refugee adolescents' everyday lives. • To treat the refugee adolescents as equal human beings through curiosity and receptiveness to their resources is important in order to build trust and address stigma.

A controlled early group intervention study for unaccompanied minors: Can Expressive Arts alleviate symptoms of trauma and enhance life satisfaction?

This is the first controlled study of an expressive arts group intervention with unaccompanied minor asylum seeking children. The aim of the study was to examine whether such an intervention may alleviate symptoms of trauma and enhance life satisfaction and hope. One hundred forty five unaccompanied minor refugee boys with their stated age between 15 and 18 were allocated into a 10 session 5 weeks manualized expressive arts intervention (EXIT) or a life as usual (LAU) control group. The participants were assessed at onset and 4 times over a period of 25 months with a battery of instruments measuring post-traumatic stress symptoms (PTSS), general psychological distress (HSCL-25A), current life satisfaction (CLS) and expected life satisfaction (ELS). The instruments were presented in the participants' native languages, using touch-screen laptops and the computer program Multilingual Computer Assisted Interview (MultiCASI). There were significant time by group interactions in favor of the EXIT group for PTSS and CLS. At the end of the follow up the EXIT group had higher life satisfaction and hope for the future than the LAU group. A manualized EXIT group intervention can have a beneficial effect on helping minor refugee boys to cope with symptoms of trauma, strengthen their life satisfaction and develop hope for the future. Our findings support previous studies showing that the arts may help people in reconstructing meaning and connection with others by focusing on resources and creativity.

[Drawing, a tool to use with unaccompanied foreign minors]. / Le dessin, support de soins aux mineurs isolés étrangers.

Supporting unaccompanied foreign minors requires a different clinical approach. These youngsters must be given individualised support to help them make the transition from exile and loss, to an existence as an individual, yet still a son or daughter. The drawing, as a transcultural and atemporal imprint, constitutes a tool enabling these young people to bring to the surface their unconscious thought processes, to exist and to come into being with dignity.

[Stranger isolated minors and the french health care system: qualitative study]. / Les mineurs isolés étrangers et le système de soins français : étude qualitative.

OBJECTIVE: While waiting for health insurance coverage, unaccompanied foreign minors (UFM) can attend PASS healthcare access clinics in French hospitals. The aim of this study was to identify UFM's representations and perceptions of the French health care system. METHODS: This qualitative study was based on a series of individual, semi-structured interviews of UFMs attending a PASS clinic. The methodology was approved by the French data protection authority and an ethics committee. RESULTS: A total of 21 UFMs were interviewed. Participants expressed their satisfaction with health care, although the health care system was perceived as a complex system. The prescription is essential, as it enables the patient to obtain medications, the ultimate goal of health care access. Not all participants knew about the existence of national health insurance. They were unable to distinguish between PASS clinics and the hospital in general and the screening role of PASS clinics was often poorly understood. The general practitioner was not always identified and his role was poorly understood. Educators were perceived as playing a decisive role in health care access. Heath is essential for all UFMs. None of them referred to mental health issues. CONCLUSION: UFMs need better information about the health care system and their rights. The educators' health care support training, their knowledge of the rights of UFMs and the role of healthcare professionals need to be improved. Screening of mental illness needs to be developed.

Suplementação nutricional e ( in ) segurança alimentar em moçambique. programa de reabilitação nutricional, uma reflexão sobre estrutura de coordenação de sua implementação, o caso distrito de Marracuene ­ província de maputo / Nutritional supplementation and (in) food security in mozambique. Nutritional rehabilitation program, a reflection on the coordination structure of its implementation, the case of Marracuene district - maputo province

Moçambique faz parte dos países da zona subsaariana, onde segundo a Organização Mundial de Saúde (2013) os problemas de saúde relacionados à desnutrição atingiram cerca de 30% em 2011, na faixa etária menor de cinco anos. Prevenção e o tratamento da desnutrição são cruciais, exigindo sempre a definição e a implementação de medidas mais amplas e eficientes de combate à pobreza e à fome e políticas públicas de inclusão social. Nesta perspectiva, a pesquisa decorreu com o intuito de perceber qual é a percepção que se tem sobre o fenômeno da desnutrição e uso dos suplementos nutricionais administrados pelo Programa de Reabilitação Nutricional e, que medidas se podem incorporar para a coordenação das ações de reabilitação deste Programa. Perseguiu-se como objetivo global, identificar e discutir o processo de determinação social da desnutrição e suplementação nutricional nas comunidades do distrito de Marracuene, Província de Maputo - Moçambique. De fato, seguindo uma abordagem social qualitativa do tipo descritivo, os resultados do trabalho de campo mostraram que existe um aparente sentimento de desvalorização por parte dos potenciais praticantes da medicina tradicional das comunidades rurais estudadas face às autoridades de saúde convencional no país, o que configura necessidade urgente de encontrar mecanismos de coordenação com as autoridades locais para assegurar que os programas de assistências às crianças desnutridas produzam os efeitos desejados. No que tange ao conhecimento sobre a desnutrição e o processo de suplementação nutricional por parte dos participantes do estudo, constatou-se que a forma como o fenômeno de desnutrição é encarada pelas comunidades locais. Evocam-se elementos de índole sócio-cultural, com carácter tradicional, para a determinação da desnutrição como doença, denominando-a de xilala e o seu tratamento só pode ser possível seguindo vias tradicionais. No geral, ficou patente que a abordagem dos programas de assistência de saúde desenvolvidos para a comunidade, entre outros que visam o bem-estar da população em Moçambique, têm de ser desenvolvidos com a estrita observância dos fatores estruturais

Mozambique is one of the countries in the sub-Saharan zone where, according to the World Health Organization (WHO) (2013), malnutrition-related health problems reached around 30% in 2011, under the age of five. Malnutrition is seen as a social disease, affecting thousands of children worldwide, victims of hunger and social inequality, "and may also be associated with other pathologies.Therefore, the prevention and treatment of malnutrition is crucial, always requiring the definition and implementation of broader and more efficient measures to combat poverty and hunger and public policies for social inclusion.In this perspective, this research was carried out with the intention of perceiving what is the perception about the phenomenon of malnutrition and the use of nutritional supplements administered by PRN and what measures can be incorporated to coordinate the rehabilitation actions under this program. Thus, among other aspects, it was pursued as a global objective, to identify and discuss the process of social determination of malnutrition and nutritional supplementation in the communities of Marracuene district, Maputo Province - Mozambique.In fact, following a qualitative social approach of the descriptive type, fieldwork results showed that there is an apparent feeling of devaluation by potential practitioners of traditional medicine in the rural communities compared to the conventional health authorities in the country, urgently need to find mechanisms of coordination with local authorities to ensure that malnourished child programs produce the desired effects.With regard to the knowledge about malnutrition and the nutritional supplementation process by the study participants, it was verified that the way the malnutrition phenomenon is faced by local communities contributes to the. In fact, elements of a socio-cultural nature, with a traditional character, are evoked for the determination of malnutrition as a disease, denominating it as xilala.Therefore, it is never believed that the economic causes related to poverty, lack of schooling, weak purchasing power, among others, are the main causes of the disease, and, therefore, their treatment can only be possible following traditional routes.In general, it was clear that the approach to health care programs developed for the community, the implementation the implementation of the Nutrition Rehabilitation Program, among others aimed at the well- being of the population in Mozambique, must be developed with strict observance of the population's structural factors, communities

[Unseen Suffering - Therapy for Traumatized Refugee Children]. / Unsichtbares Leiden ­ Therapie traumatisierter Kinder mit Fluchterfahrung.

Unseen Suffering - Therapy for Traumatized Refugee Children In March 2015 the psychological counselling service (Psychologische Familien- und Lebensberatung) of Caritas Ulm initiated a psychotherapy project for traumatized minor refugees. Besides individual and group therapy, networking and qualification of qualified personnel and volunteers, in autumn 2015 we started offering our services on-site in a large collective accommodation for asylum seekers in Ulm. This was mainly because - in contrast to unaccompanied, mostly adolescent, minor refugees - our services appeared to reach children only by chance. In our opinion this is mostly due to the fact that children's suffering is often far less noticed. This paper describes our first year's project work, followed by reports on the use of psychodrama groups with refugee children and on the therapeutic work in a collective accommodation for asylum seekers.

[Validated Instruments for the Psychological Assessment of Unaccompanied Refugee Minors - a Systematic Review]. / Validierte Verfahren zur psychologischen Diagnostik unbegleiteter minderjähriger Flüchtlinge - eine systematische Übersicht.

The German care system faces a growing number of unaccompanied refugee minors (URM). URM show high levels of traumatization, a variety of psychological symptoms and lack important resilience factors. Therefore an early and valid psychological assessment is important for intervention and service planning. Yet, no systematic review on validated instruments for the assessment of this group exists. Literature search revealed one study about translators in the assessment of URM and five validated instruments for proxy and self-report. These instruments are available in several languages and showed good psychometric properties. It has to be critically stated that all instruments have been validated by a single work group within a single population. Especially with regards to changing definitions of Posttraumatic Stress Disorder within the new (and upcoming) classification systems ICD-11 and DSM-5, increased awareness for diagnostic procedures is necessary. Additionally, more validated instruments for specific psychological disorders in multiple languages are needed. Under an economic perspective the use of open access questionnaires that are available in different languages seems useful, even if they are not especially validated for URM.

[What is allowed? - Aesthetic Surgery in Children and Adolescents]. / Was ist erlaubt? - Ästhetische Eingriffe bei Kindern und Jugendlichen.

More and more children, and even more so adolescents, undergo procedures pertaining to the category of aesthetic surgery and mainly aiming to improve the patient's physical appearance. There is a broad spectrum of possible operations ranging from purely cosmetic procedures to operations with a medical indication.

Descrição das Características Clínico-Patológicas e de Expressão do HHV-8 em Pacientes com Sarcoma de Kaposi Atendidos no Serviço de Dermatologia do Hospital Central de Maputo, Moçambique / Description of the Clinical-Pathological and Expression Characteristics of HHV-8 in Kaposi Sarcoma Patients Served at the Dermatology Service of Maputo Central Hospital, Mozambique

O Sarcoma de Kaposi (SK) é um tumor vascular de baixo grau do sangue e dos vasos linfáticos, com evolução clínica muito variável, que frequentemente se apresenta na forma de lesões cutâneas; Histologicamente caracteriza-se por proliferação de vasos sanguíneos, de células fusiformes, inflamação e edema.A incidência deste tumor está aumentada em indivíduos HIV positivos. Nestes doentes, o HIV tem mudado a forma de apresentação do SK, tornando numa doença agressiva que se caracteriza por disseminação, mudanças de apresentação histológicas das lesões, aumento da carga viral do HHV-8 e progressão rápida. Com a descoberta do HHV-8, o genoma viral tem sido detectado em todas as formas de SK. O antígeno associado a latência (LANA) é usada como marcador de infecção pelo HHV-8, e a sua presença é demonstrada nas biópsias das lesões do SK. No nosso estudo utilizamos a técnica de imuno - histoquímica para caracterizar e quantificar o HHV-8 nas lesões, de forma a caracterizar a agressividade clínica e morfológica do SK. Os doentes incluídos no estudo apresentaram na sua maioria Sarcoma de Kaposi associado ao HIV (n=109; 94,8%) e sem TARV (n=88; 80.7%), apesar de estarem imunologicamente comprometidos. A imunodeficiência verificada foi caracterizada pela diminuição no número de células TCD4+ (mediana - 284.5 células/mm3) e carga viral do HIV (mediana - 7741.73cópias /ml). As lesões de SK foram maioritariamente observadas nos membros inferiores (n=105; 91.3%) e com disseminação múltipla pelo corpo. O diagnóstico histológico foi marcado pelos estágios precoces, com maior representação de lesões em placa (n=56; 48.7%). A expressão imunohistoquímica do LANA/HHV-8 nestas lesões foi aumentada nos estágios tumorais (nódulo), quando comparadas com outros estágios. No entanto, a expressão do HHV-8 não se correlacionou com estado de imunodeficiência, mas está inversamente relacionada com a agressividade clínica observada, o que sugere que uma pequena quantidade de vírus no tecido possa ser suficiente para fazer com que o SK tome características agressivas em indivíduos co - infectados com HIV e com grau de imunodeficiência grave. O nosso estudo mostra que apesar da agressividade clínica dada pelo número de lesões do SK se relacionar com a menor densidade do vírus no tecido com lesão, esta está associada com o tempo de aparecimento das lesões em relação ao tempo de diagnóstico ou inclusão no estudo.

Frontline ethical issues in pediatric clinical research: ethical and regulatory aspects of seven current bottlenecks in pediatric clinical research.

In the course of the past decades, considerable effort has been expended on the ethical guidance and legal regulation of pediatric clinical trials in Europe. Nonetheless, the conduct of clinical research in the population of minors continues to generate myriad ethical and regulatory issues. This paper explores seven bottlenecks in the ethical guidance and legal regulation that currently govern pediatric clinical research: (1) the integration of research in therapy, (2) the education of clinicians, (3) the empowerment of families, (4) the harmonization of protocol review, (5) the assessment non-clinical research objectives, (6) the control of placebo use, and (7) the provision of fair incentives for pediatric research conduct. For all of these issues, a clear view on the way forward is largely lacking, either because these issues have not been discussed in depth to date or because the existing debates have failed to generate a generally supported consensus.