Dissertations / Theses on the topic 'Asthmatic children and adolescents'

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Asthma is a chronic inflammatory disease of the airways, such as children and adolescents. In this sense, active video games (VGA) and resistance exercise have been gaining prominence as a form of training in this age group, promoting adhesion, motivation, reduction of pulmonary inflammation, muscular strength gain and energy expenditure. Thus, the objective of this study was to evaluate whether the increase of aerobic (combined) exercise reduces a pulmonary inflammation and improves clinical control in children and adolescents as trainers more effectively than only aerobic training with VGA. This is a randomized, blinded clinical trial with no registry Clinical Trials.gov: NCT03014154, 30 children and adolescents were randomly assigned to a VGA group using XBOX 360 Kinect Adventure "Reflex Ridge" (VGA group) and unladen exercises and VGA group associated with resistance exercise (VGAR group) with intensity 3 sets of 15 repetitions, with 50% of 1 RM. The training period lasted 8 weeks and involved 2 weekly sessions of 1 hour and 10 minutes, 10 minutes. heating, 30 min. of VGA, 20 min. of exercises and 10 min. the elongation. Pulmonary inflammation, pulmonary function, peak flow, respiratory muscle strength, as anthropometric variables, clinical control questionnaires and quality of life, physical fitness and peripheral muscular strength of the participants before and after the training were evaluated. The results, involving 27 study participants (13 VGA and 14 VGAR) showed reduction in lung inflammation in both groups (clinically important) but the effect size (TE) for reduction of FeNO in the VGA group was 0 , 47 (small) and in the VGAR group was 0.68 (mean). In TCP it occurred in the test week, velocity, slope and distance traveled only in the VGA group. And in the VGAR group, improvement in physical fitness and rapid cardiovascular return to basal condition by HR recovery after the test (TE = 0.90) was higher in relation to the VGA group (TE = 0.41). Maximum load increase after 1RM test (MMSS from 2 kg to 4 kg (TE = 1,28) and MMII from 30 kg to 51 kg (TE = 1,09)) was also higher in the VGAR group. In both groups, there was improvement in quality of life and better clinical control of the disease, and no participants in both groups were not in exercise-induced bronchospasm during the sessions. These results allowed us to conclude that combined training is more effective in reducing pulmonary inflammation and allows an improvement in quality of life, clinical control of the disease, aerobic fitness, physical fitness and muscular strength in children and adolescents.
A asma é uma doença inflamatória crônica das vias aéreas, as crianças e os adolescentes asmáticos têm menor tolerância ao exercício físico. Neste sentido, os videogames ativos (VGA) e o exercício resistido vem ganhando destaque como forma de treinamento nesta faixa etária, promovendo adesão, motivação, redução da inflamação pulmonar, ganho de força muscular e gasto energético. Sendo assim, o objetivo deste estudo foi avaliar se o acréscimo do exercício resistido ao aeróbio (combinado) reduz a inflamação pulmonar e melhora o controle clínico em crianças e adolescentes asmáticos de forma mais eficaz do que apenas o treinamento aeróbio com VGA. Trata-se de um Ensaio clinico controlado, randomizado, cego, com registro no Clinical Trials.gov: NCT03014154, para tal, 30 crianças e adolescentes foram avaliados e alocados de forma randomizada, para um grupo de VGA utilizando o XBOX 360 Kinect Adventure “Reflex Ridge” (grupo VGA) e exercícios sem carga e um grupo de VGA associado a exercício resistido (grupo VGAR) com intensidade 3 séries de 15 repetições, com 50% de 1 RM. O período de treinamento durou 8 semanas e envolveu 2 sessões semanais de 1 hora e 10 minutos, sendo 10 min. de aquecimento, 30 min. de VGA, 20 min. de exercícios e 10 min. de alongamento. Foi avaliado a inflamação pulmonar, função pulmonar, peak flow, força muscular respiratória, as variáveis antropométricas, questionários de controle clinico e qualidade de vida, aptidão física e força muscular periférica dos participantes antes e após os treinamentos. Os resultados, provenientes de 27 participantes que completaram o estudo (13 VGA e 14 VGAR) mostraram redução na inflamação pulmonar em ambos os grupos (clinicamente importante) porém o tamanho do efeito (TE) para redução da FeNO no grupo VGA foi de 0,47 (pequeno) e no grupo VGAR foi de 0,68 (médio). No TCP houve aumento na duração do teste, velocidade, inclinação e distância percorrida apenas no grupo VGA. E no grupo VGAR, melhora do condicionamento físico e rápido retorno cardiovascular a condição basal pela recuperação da FC após o teste (TE=0,90) foi maior em relação ao grupo VGA (TE=0,41). O aumento da carga máxima após teste de 1RM (MMSS partindo de 2 kg para 4 kg (TE=1,28) e MMII de 30 kg para 51 kg (TE= 1,09)) também foi maior no grupo VGAR. Em ambos os grupos houve melhora da qualidade de vida e melhor controle clinico da doença, além de nenhum participante de ambos os grupos não apresentarem broncoespasmo induzido pelo exercício durante as sessões. Estes resultados permitiram concluir que o treinamento combinado é mais eficaz na redução da inflamação pulmonar e possibilita a melhora da qualidade de vida, controle clinico da doença, da aptidão aeróbia, condicionamento físico e aumenta da força muscular em crianças e adolescentes asmáticos.

Approximately 20 per cent of the Norwegian population has or has had asthma by the age of 10. Treating children for asthma is often a cumbersome and time-consuming task. Research has shown that tangible user interfaces and mobile applications in medical care have given positive effects in a number of different settings. The BLOPP project group has previously proved that distracting the child while he/she is taking his/her asthma medicine is positive for the child's experience. In our research we aimed to answer ``How can gamification be used to motivate children to take their asthma medicine?'' and ``How can tangible user interfaces be used to help children with asthma?''. To answer these questions, we have performed a literature study, conducted semi-structured interviews with domain experts and developed prototypes. A tangible user interface, AsthmaBuddy, and a smartphone application, AsthmAPP, was developed. These prototypes were then tested on children, as a validation test. During our research we have discovered several possibilities for how gamification can be used to motivate children with asthma, in addition to some ways gamification is not applicable to the situation. We have discovered several ways a TUI may help asthmatic children and their parents, such as keeping logs, informing, reminding and distracting the children during a treatment.

Thesis (PhD)-- Stellenbosch University, 2013.
ENGLISH ABSTRACT: Although the effect of inhaled corticosteroids (ICS) on the hypothalamic- pituitary-adrenal axis (HPA) has been regarded as a “benign physiological response”, a survey published in 2002 suggested that adrenal crisis is more common in asthmatic children on ICS than previously thought. Relying on clinical features to detect chronic adrenal insufficiency secondary to corticosteroids may not be wise, as these are non-specific and can therefore easily be missed. Accurate biochemical assessment of the whole axis to detect subclinical HPA suppression (HPAS) is thus desirable. A review of the literature indicates that basal adrenal function tests, including plasma cortisol profiles, do not identify which children can appropriately respond to stress. There is no evidence to suggest that the degree of the physiological adjustment of the HPA to ICS and/or nasal steroids (by reducing basal cortisol production), predicts HPAS. Cortisol profiles should therefore only be used to demonstrate differences in systemic activity of various ICS and delivery devices. Only two tests, considered as gold standard adrenal function tests [the insulin tolerance test (ITT) and the metyrapone test] can assess the integrity of the whole axis.
AFRIKAANSE OPSOMMING: Die outeurs van ´n opname wat in 2002 gepubliseer is stel voor dat ´n bynierkrisis meer algemeen by asmatiese kinders, wat inhalasie kortikosteroïede ontvang, voorkom as wat voorheen gedink is. Dit is strydig met die gevestigde opvatting dat die effek van IKS op die hipotalamiese-hipofise-bynier-as (HHB) ’n “goedaardige fisiologiese reaksie” is. Die kliniese kenmerke van kroniese bynierontoereikendheid sekondêr tot die gebruik van kortikosteroïede (KS) is nie-spesifiek en gevolglik onbetroubaar. ´n Akkurate biochemiese toets van subkliniese HBB onderdrukking (HHBO) sou gevolglik waardevol wees. ´n Literatuur oorsig toon dat toetse van basale bynierfunksie, insluitend plasma kortisol (K) profiele, nie kinders uitken wat toepaslik op stres sal reageer nie. Daar is geen bewyse dat die graad van fisiologiese aanpassing van die HHB, soos aangedui deur laer K-vlakke, na die gebruik van IKS en/of nasale steroïede (NS), HHBO voorspel nie. Serum K profiele is dus slegs van waarde om die sistemiese aktiwiteit van verskillende IKS en toedieningsstelsels te ondersoek. Slegs twee toetse, naamlik die insulien toleransie toets (ITT) en die metyrapone -(MTP)-toets (wat beide as die goue standaard van bynier funksie beskou word), kan die integriteit van die hele as meet.
Stellenbosch University
Medical Research Council
SA Thoracic Society
Harry Crossley Foundation
Red Cross Children’s Hospital.

Atopic asthma is characterized by excessive T helper 2 (Th2)-like immunity to allergens in the bronchial mucosa. The Th2-cytokine interleukin (IL)-4 induces IgE production, while the Th2-cytokine IL-5 promotes eosinophilic inflammation in the airways of asthmatics. Most asthmatics are atopic, but a subgroup is non-atopic. We hypothesize that allergen-induced Th2, particularly IL-5, responses can be observed in peripheral blood in both atopic and non-atopic asthmatic children but not in healthy control children. The aim of the present study was to determine IL-4, IL-5, IL-9, IL-10, IL-13 and IFN-γ secretion induced from peripheral blood mononuclear cells (PBMC) by a broad panel of inhalant allergens (timothy, cat, birch, dog and house dust mite) in asthmatic children with and without sensitization. The study included 13 atopic asthmatic, 5 non-atopic asthmatic, and 12 non-atopic non-asthmatic children. PBMC were stimulated with allergens and cytokine production was measured with enzyme-linked immunosorbent assay (ELISA). Higher levels of cat and dog antigen-induced IL-5 release were more commonly observed in both atopic and non-atopic asthmatics than in controls. Children with atopic, but not non-atopic, asthma produced higher levels of allergen-induced IL-4 and IL-9 than controls. Non-atopic asthmatics produced more IL-10 than atopic asthmatics after cat stimulation. High levels of eosinophilia-associated IL-5 responses are induced by cat and dog allergen in both atopic and non-atopic asthmatic children. The Th2 cytokines IL-4 and IL-9 were associated only with atopic asthma, probably due to their IgE-inducing properties.

Asthma is a common chronic disease for children and is a leading cause for their hospitalization. Despite its negative health impact, a local survey has shown that children with asthma as well as their parents have a lack of understanding for asthma management (Wong, Wong, Chung & Lau, 2001). However, to help asthmatic children to better cope with their condition, it is important for health care professional such as nurses to enhance their knowledge in asthma management. Recent empirical research has shown that education promoting knowledge of asthma management can improve health outcomes in asthmatic children. Therefore, it is important to develop an evidence-based asthma education guideline for them. This dissertation aims to evaluate the empirical evidence of the education program for asthmatic children, with the age ranging from 5 to 18, and their parents. The goal of the proposed program is to reduce their re-hospitalization rate by enhancing their knowledge of asthma care. A translational nursing research was conducted and 10 studies focusing on asthma education program for children and their parents were identified from electronic databases. Critical appraisal was performed using the recognized assessment tool, named the Scottish Intercollegiate Guidelines Network (SIGN) (2008). Recommendations were developed based on the data extracted from the review. Based on the literatures reviewed, it was found that a 45-to-60 minute one-to-one educational intervention conducted by nurses using self-management plan is the most effective method for improving the health outcomes for asthmatic children. A plan of translating the empirical information extracted from the review into practice was developed and the potential of implementation was assessed. Based on the assessment, it was found that there is high transferability of the findings from the review and the proposed innovation is feasible in the selected clinical setting. In addition, the benefits generated from the proposed innovation also outweigh its cost. An evidence-based guideline was then developed based on the high and medium level of evidence. The grades of the recommendation were stated as well. A comprehensive communication plan targeting on various stakeholders was prepared. A pilot study was designed to examine the feasibility of the proposed innovation before the full-scale implementation. The outcomes of the proposed innovation include the re-hospitalization rate of asthmatic children, the patients’ and nurses’ level of knowledge in asthma care, the satisfactory level of patients and nurses towards the innovation, the competency of nurses in conducting the innovation, and the utilization rate and the cost of the innovation. They would be evaluated using appropriate methodologies. The proposed innovation would be considered as effective if the primary outcome, the re-hospitalization rate of asthmatic children is reduced.
published_or_final_version
Nursing Studies
Master
Master of Nursing

One area of history that historians have ignored is that of children and their relationship to witchcraft and the witch trials. This thesis begins with a survey of historical done on the general theme of childhood, and moves on to review secondary literature about children and the continental witch trials. The thesis also reviews demonological theory relating to children and the roles children played in the minds of continental and English demonologists. Children played various roles: murder victims, victims of dedication to Satan, child-witches, witnesses for the prosecution, victims of bewitchment or possession, and victims of seduction into witchcraft. The final section of the thesis deals with children and English witchcraft. In England children tended to play the same roles as described by the demonologists.

Asthma is a serious respiratory disease that is affected by environmental and psychological variables. Asthma education programs are used to reduce the morbidity associated with asthma and to teach people how to better manage their illness so that they might have a higher quality of life. Although much research has examined the effectiveness of asthma education programs within the Caucasian community, no research has been done to see if asthma education programs are effective in the Hispanic community. This study examined the effects of an asthma education program directed towards three Spanish-speaking parents of children, 7–17 years old, who were diagnosed with asthma. Participants were recruited from local health clinics with written advertisements and were given a monetary reward for their participation in the study. This study was a series of AB designs with staggered baselines, as well as pre and post testing. The pretests and posttests include translated checklists that measure knowledge, self-efficacy, symptoms, problem behaviors, and quality of life of caretakers of children with asthma. Data were also collected on the number of doctor visits and asthma attacks. Treatment consisted of a 2-hr asthma education intervention in Spanish for the parents and caretakers of asthmatic children. It was expected that symptoms, number of doctor visits, number of asthma attacks, and problem behaviors would decline and that knowledge, self-efficacy and quality of life would increase for each of the participants. Only parent knowledge of asthma management techniques increased significantly after the implementation of the treatment. Implications of the study are discussed.

Aim: This thesis aims to describe perceived overall well-being, coping strategies, experiences of intimacy and sexuality, and global and dimension-specific self-esteem among children and adolescents with mobility impairment. Methods: The study included 141 children and adolescents aged 7–18 years with mobility impairment. Data was gathered by comprehensive semi-structured interviews and the self-report inventories “Children’s Coping Strategies Checklist” (CCSC) and “I Think I am”. Perceived overall well-being was measured by the nine-grade visual “Snoopy scale”. Motor function and pain were measured by the BL motor assessment, and independence or dependence by Katz Index of Independence in Activities of Daily Living. Results: The majority reported a favourable level of perceived overall well-being and positive global and dimension-specific self-esteem. Lower global self-esteem was significantly related to: greater age, being a first-generation immigrant, having an acquired disease or injury and experience of pain, while lower level of perceived overall well-being was significantly related to all of these in addition to not living with both parents. Generally, children and adolescents identified themselves as sexual beings and most expressed future aspirations as living together with partner having children. However, many had limited or no experience of partner-related intimacy and sexual activities, and socio-demographic and disability characteristics had a marginal influence. A history of sexual abuse was reported by 7% in the age cohort 13–18 years. A four-dimensional model of coping strategies including “active coping”, “distraction”, “avoidance” and “support seeking” strategies provided an adequate fit to the CCSC data. Three of the four strategies, all except “avoidance”, were significantly related to several demographic and disability features. Well-being was not significantly related to coping strategies, although the higher the trust in the strategies, the higher the estimation of well-being. Conclusion: The understanding of vulnerability factors as well as identification of coping strategies among children and adolescents with mobility impairment is essential for providing proper care, treatment and support during childhood and adolescence.

The 1980s mark the beginning of systematic research and theoretical advances in the field of psychic trauma in children. Posttraumatic stress disorder (PTSD) was a diagnosis for adults in the Diagnostic and Statistical Manual of Mental Disorders, DSM-III (American Psychiatric Association, 1980). In a later version, children and adolescents were partially included (American Psychiatric Association, 1987). Since 1980, a range of traumatic events have been identified as having the required stressor characteristics for posttraumatic stress reactions to manifest in children and adolescents.

In this study, the role of the stressor and peritraumatic reactions in PTSD of children and adolescents was studied. In addition, co-existing factors were assessed and related to the development and maintenance of PTSD reactions. A cascade of distressing events described the stressor in children who reported sexual abuse in daycare (paper I), and single-incident events were studied in adolescents (paper III). Subjective reactions during or immediately after the traumatic event, such as intense emotions, physiological arousal, dissociation and having thoughts of intervening, were strongly associated to the subsequent development of PTSD reactions in adolescents. The findings indicate that subjective responses to traumatic events play an important role in PTSD etiology. Objective features of the stressor, such as death or physical injury did not relate significantly to the levels of posttraumatic stress reactions. Half the children exposed to the cascade stressor in the case of alleged child sexual abuse, showed significant levels of PTSD reactions four years later. The objective features of the cascade stressor depended on the reported severity of child sexual abuse as well as media exposure, medical examinations, forensic interviews and the court trial. Children with high levels of PTSD reactions reported more severe CSA and were also more exposed to the media and the court trial, but the tendency was not significant.

Moreover, co-existing factors not related to the traumatic event may play important roles in the development and maintenance of PTSD reactions. After alleged sexual abuse and subsequent distressing events, older children displayed more PTSD reactions than younger children, which may indicate that younger children were more protected from developing distress in this situation. On the other hand, five weeks after a tram car accident, age was negatively associated with the levels of PTSD reactions in a group of children (paper IV). The findings may be due to the diverse nature of the stressors and methodological issues.

Other co-existing factors to PTSD, such as behavior problems in children and adolescents, may represent considerable difficulties in a young person’s life. In the current study, children displayed significant levels of behavioral problems four years after alleged sexual abuse.

The impact on parents and the rest of the child’s family cannot be ignored in the assessment of posttraumatic stress reactions of children and adolescents. In this study, comprehensive assessments were made of the parents’ experiences and levels of distress after alleged sexual abuse of their children. The parents were exposed to a cascade of events, including hearing about the sexual abuse, being involved in the police investigation and the court trial and being exposed in media reports. Four years after the events, elements of the stressor were significantly associated to the level of posttraumatic stress reactions. The findings illustrate how child sexual abuse reports may involve the children’s parents and expose them to high levels of distress over a long period of time.

In addition, interactions in the family may contribute in the development and maintenance of posttraumatic stress reactions in children and adolescents, and impede the healing processes.

After traumatic events in childhood, researchers tend to prefer parental reports of the children’s reactions to spare the children. In this study, children reported significantly higher levels of distress than observed by their parents after a tram car accident (paper IV). These findings indicate that parents unintentionally may bring in a response bias in their reports, which future research and clinical practice should take into account.

The study illustrates that traumatic events are complex experiences involving cognitive and emotional reactions, physiological arousal and dissociation, and that these reactions may induce posttraumatic stress reactions in children and adolescents. The cascade stressor subsequent to alleged sexual abuse of children showed how different elements of the stressor may lead to distress over a long period of time. The distress involved both children and parents in this study.

Paper II reprinted with kind permission of Elsevier, www.sciencedirect.com

The primary purpose of this study was to identify resiliency factors evident in parentally bereaved children and adolescents identified as "holis-tically well." The population for this study consisted of 7 parentally bereaved children and adolescents between the ages of 5 and 18 who were referred by the Children to Children support program for grieving youth. The instruments used in this study were specifically developed to assess holistic wellness and evidence of resiliency factors. The most prevalent resiliency factors evident in parentally bereaved children and adolescents identified as holistically well were: Constitutional Resiliency Factors of: social competence, positive personality characteristics, sense of purpose and hope, problem-solving skills, and autonomy. Resiliency Factors within the Home Environment of: caring and support, high parental expectations, and encouragement of participation in family. Resiliency Factors within the School Environment of: high academic expectations and caring and support.

The role of guilt within the context of interpersonal relationships, the definitions of guilt, the origins of guilt, and whether or not outcomes associated with guilt tend to be negative or positive are the focus of this research paper. Four hundred and seventy-two (472) articles, covering a period of thirty-three years (33), were tabulated as to their perspective concerning the phenomenon of guilt. A determination was made as to whether each article leaned toward presenting guilt as a negative or positive influence pertaining to human behavior and/or interaction. It is hypothesized that the literature reflects significantly more negative outcomes associated with guilt than it does positive outcomes; that, overall, guilt can be said to have but little constructive use in human behavior and/or interaction. The findings of this study support the hypothesis.

Background: Studies in adults have shown physiological protection of a 'set-point' for weight, explaining why obese adults who diet eventually regain weight. Objective: We hypothesised that set-points for weight, and their physiological defence, are flexible in childhood but become fixed around puberty. We aimed to show that obese children who lost weight had less 'reflex' changes in satiety hormone profiles (that would drive weight regain), compared with adolescents who had experienced a similar degree of weight change. Method: Prospective cohort study. 41 subjects; 21 obese pre-pubertal children (age 3-7 years; 11 male) and 20 obese adolescents (age 14-18 years; 10 male). Obesity defined as BMI > 2.4 SDS. Subjects recruited as either 'reducers' (relative/absolute weight loss of ≥ 10% in the preceding 9-15 months) or 'maintainers' (controls). Measures: Resting Energy Expenditure (REE), bioelectrical impedance, and fasting and post-prandial (every 30 minutes for 3 hours) satiety hormone profiles. Results: Post-pubertal adolescents had 31% lower Ghrelin concentrations (4%-51%, p=0.03) and 50% higher Amylin concentrations than pre-pubertal children (18%-91%, p=0.001). The association between Ghrelin, Amylin and GIP concentration and weight change was similar for both pre and post-pubertal children (p=0.79, p=0.39, p=0.79 respectively). No associations were found for Peptide YY, Pancreatic Polypeptide, or active GLP-1. Regarding satiety, post-pubertal reducers reported less hunger and higher satiety than pre-pubertal children (p < 0.05). REE in pre-pubertal weight reducers and maintainers were similar (50kcal lower, -143 to 242, p=0.6) but post-pubertal reducers had 250kcal lower REE compared to post-pubertal maintainers (-68 to 572, p=0.1). Conclusion: Satiety hormone profiles were similar between pre and post-pubertal subjects, and contrast with adult data where weight reduction leads to sustained increases in Ghrelin and reductions in the other hormones. These findings indicate that the physiological mechanisms which act to protect against weight change in adults develop later than in the adolescent years.

Childhood aggression affects a significant number of children and represents the majority of referrals to child clinical services (Ford, Hamilton, Meltzer, & Goodman, 2007). There are substantial costs for the child, their family and society more generally if aggressive behaviour remains untreated (Shivram et al., 2009). Social-cognitive models of aggression have provided the theoretical framework for much of the research into childhood aggression over the past twenty years and formed the focus of clinical interventions (Crick & Dodge, 1994). A key finding from this research is that aggressive children have a tendency to attribute hostility to the intentions of others in ambiguous situations (Orobio de Castro, Veerman, Koops, Bosch and Monshouwer, 2002). The aim of literature review is to explore the factors that lead to the development of this bias. Limitations to extant literature and suggestions for future research are discussed. Although evidence from a number of studies demonstrates the effects of socialisation or peer contagion on children’s aggressive and anti-social behaviour (Prinstein & Dodge, 2008; Thornberry & Krohn, 1997), currently no studies have examined peer contagion effects on hostile attribution bias. The empirical paper describes a study investigating whether hostile attribution biases are contagious amongst adolescents in a community sample of boys and girls. Using a computerised ‘Chat-room’ experimental paradigm, contagion effects were demonstrated across two conditions (hostile and benign) with those exposed to hostile group norms showing greater contagion effects. Four possible moderators on the effects of peer contagion were explored; gender, dispositional levels of aggression, social anxiety and friendship style. The role of peers in the socialisation of hostile intent attribution styles and implications for preventative interventions are discussed.

Objective Large quantities of epidemiological studies manifest that indoor and outdoor air pollutants may trigger and aggravate asthma symptoms, whose mechanism, however, has not been completely made clear yet. As shown by the result of the experiment in which in-vitro cells and animals are exposed to high-density air pollution, the triggering effect of air pollution on asthma is associated with inflammatory reaction, IgE expression and regulation pathways. However, there is a lack of evidence from population studies to support that association. This study plans to conduct continuous monitoring over indoor and outdoor air pollutants facing the asthmatic children from Beijing with a view to carry out an overall assessment of their exposure to air pollutants. Meanwhile, biomarkers which are directly reflecting airway inflammation as well as the signal molecules which are related to IgE expression and regulation are monitored. The next step is to establish an exposure-effect relationship to explore the trigger effect of air pollutants on childhood asthma. Methods 1. Questionnaires were used to collect general information (including age, drug use, indoor home decoration, passive smoking, diet during the study, indoor mildew, allergic history, history of diseases and family heredity history) in 60 asthmatic children (males, Han nationality, aged 5 to 14 years)from Beijing who were recruited into this study. 2. A comprehensive evaluation was conducted on their exposure levels of air pollutants by continuous monitoring of indoor PM2.5, black carbon, benzene, toluene, xylene and formaldehyde in their houses and collecting monitoring data with respect to PM2.5, PM10, NO2and SO2at air quality monitoring sites near their houses. Benzene, toluene and xylene were measured by two-stage thermal desorption-gas chromatography (GC), formaldehyde by AHMT spectrophotometry, mass concentration of PM2.5by gravimetric method, black carbon in PM2.5by multi-wavelength absorption spectroscopy. The concentration data of ambient outdoor air pollutants were available from the real-time air quality publishing platform of Beijing Municipal Environmental Monitoring Center. 3. Exhaled FeNO of asthmatic children were taken as biomarkers reflecting their airway inflammation. FeNO was measured by electrochemical method (off-line monitoring). 4. Trigger effect of air pollution on IgE signaling pathway of asthmatic children was investigated by determining signal molecules of two signaling pathways related to IgE expression and regulation in peripheral serum. Signal molecules were determined by ELISA. 5. Confounding factors were controlled by stratification analysis and multiple linear regression model, and a comprehensive analysis was conducted of the triggering effect of air pollution on children asthma. Results 1. During the research, as for subjects, concentrations of indoor PM2.5, BC, formaldehyde, benzene, toluene, m-, p-and o-xylenes were 55.3±29.9 μg/m3, 3.8±1.4 μg/m3,62.2±42.7 μg/m3, 13.1±15.9 μg/m3, 18.7±16.7 μg/m3, 7.9±7.9 μg/m3and 3.1±5.0 μg/m3, respectively. The7-day weighted average concentrations of outdoor PM2.5, PM10, SO2and NO2were 101.3±87.6μg/m3, 152.8±88.4μg/m3, 48.6±39.8 μg/m3and 63.1±27.7μg/m3, respectively. There was a significant correlation between 7-day weighted average concentrations of indoor and outdoor PM2.5 simultaneously (r=0.697, P<0.001), with a indoor/outdoor PM2.5concentration ratio (I/O ratio) of 0.86±0.39 (P25-P75ranging from 0.62 to 1.01). 2. After adjusting for such influencing factors as age, types of asthma, and season, analysis of all subjects found that FeNO was significantly positively correlated with either benzene in indoor air, or PM2.5, SO2and NO2 in ambient outdoor air. Separate analysis of subjects untreated with inhaled corticosteroids (ICSs) found that FeNO was significantly positively correlated with PM2.5, SO2and NO2 in ambient outdoor air, while this correlation was not significant in the ICS-treated group. 3. In serum, there was a significantly positive correlation between signal molecules in the two regulatory pathways of IgE expression. After adjusting for such influencing factors as age, types of asthma, and passive smoking. No effect of air pollutants on level of signaling molecule was observed in this study. Conclusion Monitoring results of indoor and outdoor air pollutants show that, at a high level of exposure to air pollutants, exposure of asthmatic children to indoor and outdoor air pollutants may cause or aggravate the airway inflammation. Administration of ICSs can control or attenuate the airway inflammation caused by air pollutants in asthmatic children, while the level of signaling molecule in the regulatory pathway of IgE expression in serum may not be an ideal marker for reflecting the trigger effect of air pollution on children asthma.
published_or_final_version
Public Health
Master
Master of Public Health

The purpose of this study was to determine if exercise-induced asthma (EIA) could be prevented in an outdoor environment in asthmatic children attending a summer camp 3 hours after their usual dose of medication. Most studies that test for ETA are done in a controlled environment which may make results not applicable to asthmatic children who spend a lot of their time outside. The relationship of aerobic fitness and level of activity to the severity of EIA were also examined. A total of 25 subjects (10.9+0.9 yrs, M±SD) were tested. Subjects were instructed to run around a grass field circular course (0.1 mile) for 5 minutes. The subjects could stop at any time. Baseline measurements of heart rate, respiratory rate and peak flow were determined before the test and at 1, 5, and 10 minutes following the end of the run. A fall in peak flow of >10% from baseline was considered positive for EIA. A total of 14 subjects experienced EIA following the run. There were no significant differences between the group who experienced EIA and those who did not in terms of heart rate, respiratory rate, or distance run. There was a significant difference between peak flow recordings as expected. Aerobic fitness and physical activity were not related to the severity of EIA. The results of this study suggests that additional medications may be needed to prevent EIA in these children in order to allow participation in activities which may produce EIA. Moreover, 3 hours may be beyond the protection time limit for some asthmatic children.
School of Physical Education

Orientador: Taís de Souza Barbosa
Texto em inglês e português
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba
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Resumo: Objetivo: Este estudo objetivou avaliar a presença de bruxismo do sono, maloclusões e disfunções orofaciais bem como os níveis salivares de cortisol e alfa-amilase em crianças asmáticas. Material e Métodos: A amostra consistiu de 108 crianças, de ambos os gêneros, com idade entre sete e nove anos, selecionados da Policlínica Santa Teresinha Doutor Antonio Haddad Dib (grupo com asma, n=53) e das escolas públicas (grupo controle, n=55), ambos do município de Piracicaba, SP, Brasil. O diagnóstico de bruxismo do sono foi confirmado pelo relato dos pais sobre ranger os dentes (pelo menos três vezes por semana) e pela presença de facetas de desgaste em incisivos e/ou molares permanentes. O Índice de Necessidade de Tratamento Ortodôntico ¿ Componente Dentário (IOTN-DHC) foi utilizado para avaliar a oclusão. As disfunções orofaciais foram avaliadas pela versão Brasileira do Nordic Orofacial Test-Screening (NOT-S). O cortisol salivar (?g/dl) e a alfa-amilase (U/ml) foram analisador por kit enzimaimunoensaio. Os dados foram expressos em "resposta ao acordar" (RA), calculada pela diferença entre os valores imediatamente ao acordar e 30 minutos após acordar, e "declínio diurno" (DD), calculado pela diferença entre os valores 30 minutos após acordar e antes de dormir. Os dados foram analisados utilizando os testes Shapiro Wilk/Kolmogorov-Smirnov, Qui-quadrado, teste t não pareado/Mann-Whitney e teste t pareado/Wilcoxon. Resultados: O bruxismo foi mais prevalente em crianças com asma do que controles (47,2% vs. 27,3%, p<0.05). Mais de metade das crianças com asma apresentaram gravidade intermitente (50,9%, p<0.001). O grupo com asma apresentou maiores escores do NOT-S total e entrevista do que o grupo controle (p<0.05). Sintomas de disfunções orais relacionados a (I) Função Sensorial e (IV) Mastigação e Deglutição foram mais frequentes em crianças com asma do que controles (p<0.05). A RA de cortisol salivar no final de semana foi significativamente maior no grupo com asma do que controles (p<0.05). No grupo controle, o DD de cortisol salivar foi significativamente maior em dia de semana do que no final de semana (p<0.05). Conclusões: A presença de asma em crianças esteve associada com sinais e sintomas de bruxismo do sono, percepção negativa das funções sensoriais, mastigação e deglutição e maior concentração de cortisol salivar no final de semana
Abstract: Objective: This study aimed to evaluate the presence sleep bruxism, malocclusions and orofacial dysfunctions as well as the salivary levels of cortisol and alpha-amylase in asthmatic children. Material and Methods: The sample consisted of 108 children of both genders in the age-range from seven to nine years, selected from Policlinic Santa Teresinha Doutor Antonio Haddad Dib (asthma group, n=53) and from public schools (control group, n=55), both of Piracicaba, SP, Brazil. Sleep bruxism diagnosis was confirmed by parental report of grinding sounds (at least three times a week) and the presence of shiny and polish facets on incisors and/or first permanent molars. The Index of Orthodontic Treatment Need ¿ Dental Health Component (IOTN-DHC) was used for occlusion evaluation. Orofacial dysfunctions were evaluated using the Brazilian Portuguese version of the Nordic Orofacial Test-Screening (NOT-S). Salivary cortisol (?g/dl) and alpha-amylase (U/ml) were assayed using enzyme immunoassay kit. These data were expressed as ``awakening response¿¿ (AR), calculated as the difference between levels immediately after awakening and 30 min after waking, and "diurnal decline" (DD), calculated as the difference between levels at 30 min after waking and at bedtime. Data were analyzed using Shapiro-Wilk/Kolmogorov-Smirnov, Chi-square, unpaired t test/Mann-Whitney and paired t/Wilcoxon tests. Results: Sleep bruxism was more prevalent in children with asthma than controls (47.2% vs. 27.3%, p<0.05). More than half of the asthmatic children had intermittent severity (50.9%, p<0.001). The asthma group had higher scores of NOT-S total and interview than control group (p<0.05). Symptoms of oral dysfunctions related to (I) Sensory Function and (IV) Chewing and Swallowing were more frequent in children with asthma than controls (p<0.05). Salivary cortisol AR on weekend was significantly higher for asthma group than controls (p<0.05). In control group, salivary cortisol DD was significantly higher on weekday than weekend (p<0.05). There were no significant differences in alpha-amylase values in and between groups. Conclusions: The presence of asthma in children was associated with signs and symptoms of sleep bruxism, negative perception of sensory, chewing and swallowing functions, and higher concentrations of salivary cortisol on weekend
Mestrado
Odontopediatria
Mestra em Odontologia

Social skills training is a need among autistic adolescents. This investigation examined a social skills training program involving several teaching strategies. Specific social skills were targeted for improvement. Attempts to decrease negative social behaviors were made. Five autistic adolescents participated in the program and five were selected for the no-treatment group. Two measures were used. A survey addressing the skills targeted in the program was completed by parents and teachers before and after the program. A test conversation with a stranger and a peer was conducted with each subject before and after the program. Anecdotal information was obtained from therapists, teachers, and parents. Results provided information on the effectiveness of this social skills program. The benefits and limitations of the program were discussed.

The main research question for this paper was; does adolescent exercise predict happiness and positive moods in adult life? Data was collected through an online questionnaire (N = 438). The questionnaire included a measure of happiness (The Subjective Happiness Scale), moods (The Profile of Mood States) and questions on current and adolescent exercise. Adolescent exercise was a significant predictor for positive moods, even when controlling for current exercise. This is as far as we know the first study to find this connection. There is also a connection between adolescent exercise and happiness, although it appears to be that adolescent exercise predicts exercise in adult life, which in turn has a connection to happiness. Exercise was not a significant predictor of negative moods in adulthood.
This review examines the psychological benefits exercise lead to in healthy children and adolescents. Studies on the effect of exercise on cognition, self-esteem, emotions and mood, and academic performance were examined. Exercise seems to have a positive effect on several aspects of cognition and self-esteem in healthy children and adolescents. There is not sufficient evidence to conclude that there are benefits from exercise in emotions, mood and academic performance.

Dissertation (Ph.D.) -- The Institute for Clinical Social Work, 1990.
A dissertation submitted to the faculty of the Institute of Clinical Social Work in partial fulfillment for the degree of Doctor of Philosophy.

Thesis (M.S.)--University of North Carolina at Chapel Hill, 2007.
Title from electronic title page (viewed Mar. 26, 2008). "... in partial fulfillment of the requirements for the degree of Masters of Science in the School of Dentistry (Pediatrics)." Discipline: Pediatric Dentistry; Department/School: Dentistry.

The objectives of The Identification and Prevention of Dietary and Lifestyle Induced Health Effects in Children and Infants study (child sample) and the Kenya Adolescent Physical Activity study (adolescent sample) conducted in this thesis was firstly, to assess the impact of methodological and practical decisions such as the appropriate epoch length and cutpoints to use in accelerometry studies involving children and adolescents across the physical activity continuum and the reliability of these accelerometer outcomes in predicting habitual physical activity. Secondly, the performance of uniaxial ActiTrainer accelerometry with heart rate (HR) monitoring was compared to triaxial GT3X accelerometry against indirect calorimetry during structured activities in the predominantly active Kenyan adolescent cohort. Similarly, the performance of uniaxial ActiTrainer accelerometry with HR monitoring vs. triaxial 3DNX accelerometry was compared against DLW under free living conditions in both children and adolescent cohorts. Finally, the validated uniaxial ActiTrainer was used to assess the impact of physical activity and the environment on energy expenditure and indices of adiposity in the two cohorts. The main findings of the thesis were: (a) that 15 s epoch reports significantly higher engagement in physical activity compared to a 60 s epoch in both the children and adolescents cohorts (b) choice of cutpoints significantly affected classification of physical activity and sedentary behaviour in both cohorts (c) a minimum of 6 h for 7 - 9 days in the cohort involving children and a minimum of 6 h for 4 - 5 days in the adolescents were required to reliably measure physical activity (d) triaxial accelerometry reported better predictive validity compared to uniaxial accelerometry during structured activities. In addition, HR monitoring did not improve the predictive validity of either accelerometer during structured activities (e) during free living activities, however, uniaxial and triaxial accelerometry reported comparable predictive validity. The addition of HR monitoring improved the predictive validity of uniaxial accelerometry by approximately 4% in both cohorts (f) in both cohorts, total volume of physical activity and patterns (time engaged in light and moderate to vigorous physical activity) were significantly associated with energy expenditure (g) physical activity and sedentary behaviour were significantly related to indices of adiposity in both cohorts (h) the environment was a significant predictor of physical activity and indices of adiposity in the adolescents but not children. The findings of this thesis have important implications on strategies to standardise accelerometry field protocols and future studies on the validation of accelerometers and the association between physical activity, the environment and health.

This thesis examines and describes children's and adolescent's responses to burn injuries, with a specific focus on traumatic responses. Fifty five children, adolescents and their parents took part in this longitudinal study, a recruitment rate of 35% of the total population. All of the children had sustained accidental burn injuries of varying severity at least one month before their first assessment. Children were aged between three and eighteen years, and the mean age was seven years. Children under 6 years were not personally assessed. Parents reported on these children using the Child Behaviour Checklist (CBCL), and the Posttraumatic Stress Reaction Index- parent version (PTS-RI). Children over six years took part in the Diagnostic Interview for Children and Adolescents (DICA), and completed the Impact of Events Scale (IES), the Children's Posttraumatic Stress Reaction Index (C-PTS-RI), the Fear Survey Schedule (FSS) and the Depression Self-Rating Scale (DSRS). Parents of these children also completed DICA, the PTS-RI and the CBCL. At six months, all procedures were repeated. Generally, children and adolescents adjusted well following their burn injuries. Traumatic symptoms had been experienced by over half the children, with intrusive symptoms most common. 14% had a PTSD diagnosis at some time since their burn injury. A quarter of the children were reported to have general borderline or clinical behavioural problems using the CBCL. Over half the children reported symptoms of depression. The results are described with reference to the existing literature on children's traumatic responses and children's responses to burn injuries. It is suggested that there may be a "normal" acute trauma response following burn injury. Theory surrounding children's response to burn injury is examined and directions for a new theory encompassing trauma and injury in the context of development are proposed. The methodological limitations to the study are discussed and recommendations are made.

Mestrado em Análises Clínicas
MSc in Clinical Analysis
PORTUGUÊS: A prevalência da obesidade está crescendo em todo o mundo, sendo este aumento particularmente notório na infância e adolescência. Os alimentos ricos em calorias e o estilo de vida sedentário são duas das características do estilo de vida moderno, que pode estar por de trás desta pandemia. A obesidade pediátrica é particularmente importante em nosso país: uma alta prevalência de sobrepeso / obesidade (30%) tem sido descrita em crianças e adolescentes portugueses, em comparação com seus pares de outros países europeus. A obesidade tem sido associada a várias outras doenças, como hipertensão, diabetes mellitus tipo 2, síndrome metabólica e doenças cardiovasculares. Além disso, a inflamação é conhecida por desempenhar um papel vital nessas doenças, ou seja, na iniciação e progressão da doença arteriosclerótica vascular, na resistência à insulina, e dislipidemia. Mais recentemente, a obesidade tem sido proposta como um estado de baixo grau inflamatório crónico. De fato, O tecido adiposo é uma importante fonte de várias substâncias que estão ligadas à resposta inflamatória e à imunidade - as adipoquinas. As dietas de indivíduos obesos são, geralmente, ricos em gorduras saturadas e ácidos gordos (AG) trans, e pobres em AG polinsaturados (AGPI), especialmente, em AGPI do tipo ω 3. Este tipo de hábitos alimentares causa alterações endógenas no metabolismo lipídico, e pode levar a mudanças na constituição em AG em diferentes tecidos do corpo. A composição lipídica das membranas celulares é importante para as propriedades reológicas e físico-químicas das células, influenciando a actividade dos canais protéicos e das bombas da membrana, assim como de transportadores e receptores membranares. Deste modo, o perfil lipídico da membrana é importante na modulação da sinalização celular e de várias funções biológicas da célula. Os lípidos da membrana dos glóbulos vermelhos estão em equilíbrio constante com lípidos e lipoproteínas plasmáticos. Apesar dos níveis dos lípidos plasmáticos serem altamente influenciados pelo estado de jejum, os níveis e tipo de lípidos da membrana eritrocitária reflectem o equilíbrio lipídico por períodos mais longos. Os glóbulos vermelhos (GV), por tratarem-se de células não-nucleadas, apresentam uma capacidade de biossíntese e mecanismos de defesa muito limitados. Portanto, quando expostos a stress físico e / ou químico, o eritrócito sofre e acumula o dano imposta por aquelas fontes durante sua vida em circulação. Em condições de stress oxidativo a membrana do eritrócito, pode sofrer danos em seus lípidos e proteínas. Deste modo, o eritrócito é um bom modelo para estudar os danos oxidativos dos lípidos e proteínas que ocorrem em estados pró-inflamatórios e oxidativas, e também pode fornecer um importante modelo para estudar o impacto dos hábitos alimentares na composição dos lípidos e proteínas das membranas celulares. O objectivo deste estudo foi analisar o impacto da obesidade no perfil lipídico, no metabolismo da glicose e na inflamação, bem como o impacto da obesidade, e das alterações a ela associadas, na composição da membrana do GV. Foram estudadas 34 crianças e adolescentes obesos [15 (44,1%), com idade média de 14,1 anos (8-17)] do Hospital S. João e do Hospital Infantil Maria Pia. O grupo total foi dividido de acordo com o percentil do índice de massa corporal (IMC) em 17 obesos, 8 sobre-pesos e 9 controles. Obesidade foi definida como um IMC superior ao percentil 95, ajustados para idade e sexo, segundo " gráficos de crescimento do Centro de Controle de Doenças de 2000". Sobrepeso foi considerado para os percentis de IMC igual ou superior a 85 e inferior a 95; e controles quando o IMC era inferior ao percentil 85, ajustado para sexo e idade. Os três grupos estavam equilibrados para a idade, sexo e estágio de maturação sexual de Tanner. Foram determinados os níveis circulantes de triglicerídeos, colesterol, colesterol de lipoproteína de alta densidade, colesterol de lipoproteína de baixa densidade, lipoproteína (a), apolipoproteína A, apolipoproteína B, proteína C-reativa, glicose e insulina. Um estudo hematológico básico foi realizado. A membrana eritrocitária foi estudada com a determinação de marcadores de lesão eritrocitária: hemoglobina ligada a membrana, carbonilação proteica, peroxidação lipídica e perfil de banda 3 – agregados de alto peso molecular, monómeros e fragmentos proteolíticos. O perfil de ácidos gordos da membrana foi também determinado. Os indivíduos obesos apresentaram, quando comparados com os controlos, alterações para um perfil lipídico mais aterogénico, um aumento da resistência à insulina e da inflamação. Assim, houve um aumento geral dos marcadores de risco de doença cardiovascular (DCV). Nenhuma diferença significativa foi encontrada no eritrograma ou nos marcadores de lesão eritrocitária. Quanto ao perfil de AG da membrana eritrocitária, os AG insaturados apresentaram uma tendência para o aumento, enquanto os AG saturados mostraram uma tendência para diminuir com a obesidade. Apesar disso, o AG beénico ácido (22:0) apresentou um aumento significativo nos obesos, em comparação com os controles. Uma proporção crescente de 20:0, 18:3n3, 20:3n6e 22:4n6 foram encontrados para indivíduos com sobrepeso e obesos, em relação aos controlos. Estes AG, que aumentaram com a obesidade, apresentaram as associações mais significativas com os marcadores de DVC estudados e que estão alterados com a obesidade na nossa população. Mais estudos são necessários para esclarecer as associações entre as alterações do perfil de AG da membrana eritrocitária e os marcadores de risco de DCV. Um estudo envolvendo mais participantes poderia ajudar a esclarecer algumas tendências observadas. Quanto à análise da membrana lipídica, algumas abordagens interessantes poderiam ser feitas, como analisar separadamente os AG ligados a fosfolípidos e ésteres de colesterol, ou analisar individualmente cada folheto da membrana plasmática (interno e externo). Além disso, a optimização da técnica de separação e identificação dos AG seria fundamental, pois no presente estudo não pudemos avaliar AG importante, como por exemplo o EPA (ácido eicosapentaenoico - 20:5n3) e GLA (ácido gama linolénico - 18:3 n6), devido a limitações técnicas.
ENGLISH: The prevalence of obesity is growing worldwide and in childhood the increase is particularly striking. The caloric rich foods and the reduced physical exercise practice are two of characteristics of the modern lifestyle that may underlie this pandemia. Childhood obesity is particularly important in our country, as a high prevalence of overweight/obesity (over 30%) has been reported for Portuguese children, as compared to other European countries. Obesity has been associated with several other diseases, such as hypertension, type 2 diabetes mellitus, metabolic syndrome and cardiovascular diseases. Moreover, inflammation is known to play a vital role in those diseases, namely, in the initiation and progression of the atherosclerotic vascular disease, in insulin resistance, and in dyslipidemia. More recently, obesity has been proposed as a chronic low grade inflammatory condition. The white adipose tissue is an important source of several substances that are linked to inflammatory response and to immunity - the adipokines. The diets of obese individuals are, usually, rich in saturated and trans fatty acids (FA), and poor in polyunsaturated FA (PUFA), especially, in ω 3 PUFA. These type of dietary habits, by leading to endogenous changes in FA and in lipid metabolism, may, ultimately, lead to changes in the proportions of the different FA in body tissues. The lipid composition of the cell membranes are important determinants in the rheological and physico-chemical properties of the cells, influencing the activity of membrane channels, pumps, transporters and receptors. Thus, it is important in the modulation of cell signalling and in several biological functions. The lipids of the red blood cell membrane are in constant equilibrium with plasmatic lipids and lipoproteins. While the levels of lipids in plasma are highly influenced by the fasting status, the levels and type of lipids of the erythrocyte membrane reflect the lipid balance of longer periods. The red blood cell (RBC), as a non-nucleated cell, exhibits a very limited biosynthesis capacity and poor repair mechanisms. Therefore, when exposed to physical and/or chemical stress, during their lifespan, the erythrocyte suffers and accumulates the damage imposed by such stress. In oxidative stress conditions the erythrocyte membrane, may suffer oxidative damage in membrane lipids and proteins. Thus, the erythrocyte is a good model to study the oxidative damage of lipids and proteins occurring in pro-inflammatory and oxidative conditions and may also provide an important model to study the impact of dietary habits in the lipid and protein composition of the cell membranes. The objective of this study was to analyse the impact of obesity in the lipid profile, glucose homeostasis and inflammation, as well as the impact of obesity and the associated changes in the RBC membrane composition. We studied 34 obese children and adolescents [15 (44.1%); mean age of 14.1 years (8-17)] from Hospital S. João and the Children’s Hospital Maria Pia. The total group was divided according to the body mass index (BMI) percentile in 17 obese, 8 overweight and 9 controls. Obesity was defined as a BMI higher than the 95th percentile, for age and gender, according to the “2000 Centre for Disease Control and Prevention (CDC) growth charts”. Overweight was considered for BMI percentiles equal or higher than 85 and lower than 95; and control subjects BMI were lower than the 85th percentile, adjusted for gender and age. The three groups were matched for age, gender and tanner stage. It were determined the circulating levels of triglycerides, cholesterol, high density lipoprotein cholesterol, Low density lipoprotein cholesterol, lipoprotein (a), apolipoprotein A, apolipoprotein B, C-reactive protein, glucose, and insulin. A basic hematologic study was also performed. The erythrocyte membrane was studied with the determination of erythrocyte damage markers: membrane bound haemoglobin, proteic carbonylation, lipid peroxidation and band 3 profile - high molecular weight aggregates, monomers and proteolytic fragments. The membrane fatty acid profile was determined. We found that the obese individuals, presented risk changes in the lipid profile, increased insulin resistance and inflammation, when compared to their lean counterparts. Thus, several changes in cardiovascular disease (CVD) risk markers were observed. No significant changes were found in the erythrogram and in the erythrocyte damage markers. Concerning the FA membrane profile, the unsaturated FA showed a trend to increase, while saturated FA showed a trend to decrease, with obesity. Despite that, behenic acid (22:0) presented a significantly increase in obese, in comparison with controls. An increasing proportion of 20:0, 18:3n3, 20:3n6 and 22:4n6 were found for overweight and obese individuals, as compared to control. These FA increased with growing obesity, and presented the most significant associations with the studied CVD markers associated with obesity. Further studies are needed to clarify the associations between membrane FA changes, and CVD risk markers. A larger study, with a higher number of individuals could also clarify some observed trends. Regarding the lipid membrane analysis, some interesting approaches could be made, such as to separate and analyze the different phospholipids and cholesterol ester and their associated FA, and to perform a separate study of inner and outer membrane sheets. Furthermore, optimization of the separation technique and consequent identification of FA would be crucial, as in this study we could not evaluate important FA, e.g. EPA (20:5n3) and GLA (18:3n6), due to technical limitations.

Rising prevalence of child and adolescent obesity worldwide poses a threat to the future health and wellbeing of individuals. A better understanding of the mechanisms involved in the regulation of energy balance and therefore energy intake should help devise dietary strategies conducive to the maintenance of a healthy bodyweight during growth. Indeed, eating habits established during childhood are powerful determinants of future food preferences and choices in adulthood. Appetite for food and calorie-containing drinks is an important driver of energy intake and is modulated by a variety of environmental, psychological and metabolic factors. For instance, macronutrient manipulation and particularly increasing the protein content of meals at the expense of carbohydrates has been previously shown to reduce appetite in adults. Less research has been carried out in children due to methodological limitations. The first study described in this thesis sought to establish whether salivary sampling could be a non-invasive alternative to intra-venous blood sampling for the quantification of an appetite inducing peptide called ghrelin. Chapter 4 describes the dietary habits of a cohort of children (8-10 years old) and adolescents (13-17 years old) with a specific focus on sugar consumption and a comparison of key dietary characteristics with the Scottish Dietary Goals and with data from national dietary surveillance programmes. Subsequently, chapter 5 assesses the effect of protein content and portion size of dairy breakfast drinks in children and adolescents on appetite and caloric intake at an ad libitum snack buffet in a randomised crossover design study. Differences between age groups, nutritional status and genders were examined. Chapter 6 examines the correlations between performance at cognitive tests of executive function and ad libitum snack intake and chapter 7 presents new avenues of research into appetite in children and adolescents.

This study attempts to quantify the dissociative experiences reported by children and adolescents, and to determine whether the variance in degree of dissociation in children has useful diagnostic and treatment implications.

Hodgkin lymphoma (HL) is a heterogeneous condition varying from engaging one single lymph node site to a widespread condition. The prognosis with contemporary treatment is excellent for the vast majority. However, the treatment might cause severe late adverse effects in a proportion of the affected individuals. We evaluated all children and adolescents diagnosed in Sweden and registered in the Swedish Childhood Cancer Register over a period of 25 years. The incidence has been stable and the overall survival (OS) is very good, comparable to the best results in the world. Approximately ten percent encountered a relapse, but even after relapse the chances of survival were good. During the study period there were no detectable changes in survival estimates. The use of radiotherapy has decreased. Epstein Barr virus (EBV) and numbers of eosinophils, mast cells and macrophages in the tumors were investigated in 98 cases. Young children were more likely to express EBV. In patients with advanced disease the mast cell and macrophage counts were higher and they also had more affected laboratory parameters. Patients with Nodular Lymphocyte Predominant Hodgkin Lymphoma did not express EBV in the tumor, had significantly lower numbers of eosinophils, mast cells and macrophages and less affected laboratory parameters compared to classical HL. Outcome and clinical presentation were investigated in a cohort of children, adolescents and young adults in Sweden and Denmark and treatment in pediatric and adult departments was compared. OS and event-free survival (EFS) did not differ between the three age groups nor between pediatric and adult treatment. However, the Danish pediatric patients had lower EFS, which corresponded to less use of radiotherapy. Adolescents and young adults shared similar characteristics, while children presented differently with less advanced disease and male preponderance. Hospitalization rates and outpatient visits after end of treatment were evaluated to see whether the excess need of resources described in the literature is evenly distributed among the survivors or whether it is limited to a smaller group. Most of the patients had a low burden of health care use and the relapsing patients were the main drivers of the excess need.

The present study examined psychological factors associated with individual variation in children's adjustment following minor surgery, and focused specifically on the process of coping with postoperative pain. Sixty children and adolescents (7 to 16 yrs) were interviewed on the day following surgery. They provided ratings and descriptions of their postoperative pain experience, perceived capacity for pain control, spontaneous coping strategies, and emotional distress. Parents also provided information about their efforts (both historical and present) to facilitate their child's coping, their own emotional distress, and perceptions of their child's distress following surgery. Thirdly, nurses rated children's pain behaviours displayed on the ward. Finally, information about analgesic medications and physical complications following surgery was recorded from children's medical charts. Qualitative data concerning the process of coping with postoperative pain and specific parental influences on children's coping were presented within a conceptual model adapted from the adult stress and coping literature. The data were also analyzed for age/developmental differences between older children (10 to 16 yrs) and younger children (7 to 9 yrs). Finally the predictive role of demographic, child coping process, and parental influence variables, in accounting for variations in child coping outcome, was analyzed. Results indicated that children and adolescents experienced moderate to severe pain following minor surgery. They reportedly tried a number of different cognitive and behavioural methods to deal with postoperative pain. Also, parents took an active role in facilitating children's coping. Age group differences were revealed in children's descriptions of postoperative pain, their reported ways of coping with pain, and their perceptions of control over pain and recovery. Age effects were interpreted with caution, however, since age and sex were confounded in this sample. Children who reported the most pain and emotional distress following surgery also reported more catastrophizing cognitions, felt less in control of their recovery, and reported having tried a greater number of behavioral coping strategies to manage pain. These results emphasize the role of children's appraisal processes in predicting coping effectiveness, and demonstrate that more coping does not imply better outcome. Future research directions and potential clinical appplications that follow from these findings were discussed.
Arts, Faculty of
Psychology, Department of
Graduate

Research suggests that optimising affect during exercise may be key to exercise adherence (Van Landuyt, Ekkekakis, Hall & Petruzzello, 2000; Williams et al. 2008; 2012). Recent advances in this area have explored factors that contribute to affective responses in adult populations (Ekkekakis, 2003), but whilst it has been hypothesised that these factors are the same for children and adolescents they have not been explored systematically in the same way. As such, one aim of this thesis was to investigate the relationships between affect and physical activity in child and adolescent populations. Following on from this, a further aim was to explore the factors that contribute to affective responses. Given the research that suggests positive affect experienced during exercise may result in enhanced adherence to physical activity (Williams et al. 2012), the final aim of this study was to determine how to elicit the most positive affective responses during an acute exercise session. This thesis comprises a review of relevant literature, and six study chapters which were the result of three empirical studies; two acute exercise studies and one questionnaire based study. The findings of Study 1 demonstrated that, as with adults, affective responses declined after the onset of ventilatory threshold in both children and adolescents, indicating that to achieve optimum affective responses, particularly with younger children, exercise needs to be prescribed at an intensity below the ventilatory threshold. The findings from studies 2 - 4 highlighted specific factors that contribute to affective responses, reporting that preference for, and tolerance of, different exercise intensities may be an important factor to consider when prescribing exercise (studies 2 & 4). Results also showed that affective associations with physical activity played a significant role in determining overall physical activity behaviour (study 3). The findings from studies 4 and 5a and b revealed that encouraging adolescents to self-select their own exercise intensity may elicit a more positive affective response during the exercise session compared to the affective responses elicited during a prescribed exercise session. This thesis provides substantial evidence to support the link between affect and physical activity in children and adolescents. More specifically, it highlights several important factors that should be considered when attempting to enhance affective responses during an acute exercise session.

Mestrado em Análises Clínicas
MSc in Clinical Analysis
PORTUGUÊS: A prevalência da obesidade está crescendo em todo o mundo, sendo este aumento particularmente notório na infância e adolescência. Os alimentos ricos em calorias e o estilo de vida sedentário são duas das características do estilo de vida moderno, que pode estar por de trás desta pandemia. A obesidade pediátrica é particularmente importante em nosso país: uma alta prevalência de sobrepeso / obesidade (30%) tem sido descrita em crianças e adolescentes portugueses, em comparação com seus pares de outros países europeus. A obesidade tem sido associada a várias outras doenças, como hipertensão, diabetes mellitus tipo 2, síndrome metabólica e doenças cardiovasculares. Além disso, a inflamação é conhecida por desempenhar um papel vital nessas doenças, ou seja, na iniciação e progressão da doença arteriosclerótica vascular, na resistência à insulina, e dislipidemia. Mais recentemente, a obesidade tem sido proposta como um estado de baixo grau inflamatório crónico. De fato, O tecido adiposo é uma importante fonte de várias substâncias que estão ligadas à resposta inflamatória e à imunidade - as adipoquinas. As dietas de indivíduos obesos são, geralmente, ricos em gorduras saturadas e ácidos gordos (AG) trans, e pobres em AG polinsaturados (AGPI), especialmente, em AGPI do tipo ω 3. Este tipo de hábitos alimentares causa alterações endógenas no metabolismo lipídico, e pode levar a mudanças na constituição em AG em diferentes tecidos do corpo. A composição lipídica das membranas celulares é importante para as propriedades reológicas e físico-químicas das células, influenciando a actividade dos canais protéicos e das bombas da membrana, assim como de transportadores e receptores membranares. Deste modo, o perfil lipídico da membrana é importante na modulação da sinalização celular e de várias funções biológicas da célula. Os lípidos da membrana dos glóbulos vermelhos estão em equilíbrio constante com lípidos e lipoproteínas plasmáticos. Apesar dos níveis dos lípidos plasmáticos serem altamente influenciados pelo estado de jejum, os níveis e tipo de lípidos da membrana eritrocitária reflectem o equilíbrio lipídico por períodos mais longos. Os glóbulos vermelhos (GV), por tratarem-se de células não-nucleadas, apresentam uma capacidade de biossíntese e mecanismos de defesa muito limitados. Portanto, quando expostos a stress físico e / ou químico, o eritrócito sofre e acumula o dano imposta por aquelas fontes durante sua vida em circulação. Em condições de stress oxidativo a membrana do eritrócito, pode sofrer danos em seus lípidos e proteínas. Deste modo, o eritrócito é um bom modelo para estudar os danos oxidativos dos lípidos e proteínas que ocorrem em estados pró-inflamatórios e oxidativas, e também pode fornecer um importante modelo para estudar o impacto dos hábitos alimentares na composição dos lípidos e proteínas das membranas celulares. O objectivo deste estudo foi analisar o impacto da obesidade no perfil lipídico, no metabolismo da glicose e na inflamação, bem como o impacto da obesidade, e das alterações a ela associadas, na composição da membrana do GV. Foram estudadas 34 crianças e adolescentes obesos [15 (44,1%), com idade média de 14,1 anos (8-17)] do Hospital S. João e do Hospital Infantil Maria Pia. O grupo total foi dividido de acordo com o percentil do índice de massa corporal (IMC) em 17 obesos, 8 sobre-pesos e 9 controles. Obesidade foi definida como um IMC superior ao percentil 95, ajustados para idade e sexo, segundo " gráficos de crescimento do Centro de Controle de Doenças de 2000". Sobrepeso foi considerado para os percentis de IMC igual ou superior a 85 e inferior a 95; e controles quando o IMC era inferior ao percentil 85, ajustado para sexo e idade. Os três grupos estavam equilibrados para a idade, sexo e estágio de maturação sexual de Tanner. Foram determinados os níveis circulantes de triglicerídeos, colesterol, colesterol de lipoproteína de alta densidade, colesterol de lipoproteína de baixa densidade, lipoproteína (a), apolipoproteína A, apolipoproteína B, proteína C-reativa, glicose e insulina. Um estudo hematológico básico foi realizado. A membrana eritrocitária foi estudada com a determinação de marcadores de lesão eritrocitária: hemoglobina ligada a membrana, carbonilação proteica, peroxidação lipídica e perfil de banda 3 – agregados de alto peso molecular, monómeros e fragmentos proteolíticos. O perfil de ácidos gordos da membrana foi também determinado. Os indivíduos obesos apresentaram, quando comparados com os controlos, alterações para um perfil lipídico mais aterogénico, um aumento da resistência à insulina e da inflamação. Assim, houve um aumento geral dos marcadores de risco de doença cardiovascular (DCV). Nenhuma diferença significativa foi encontrada no eritrograma ou nos marcadores de lesão eritrocitária. Quanto ao perfil de AG da membrana eritrocitária, os AG insaturados apresentaram uma tendência para o aumento, enquanto os AG saturados mostraram uma tendência para diminuir com a obesidade. Apesar disso, o AG beénico ácido (22:0) apresentou um aumento significativo nos obesos, em comparação com os controles. Uma proporção crescente de 20:0, 18:3n3, 20:3n6e 22:4n6 foram encontrados para indivíduos com sobrepeso e obesos, em relação aos controlos. Estes AG, que aumentaram com a obesidade, apresentaram as associações mais significativas com os marcadores de DVC estudados e que estão alterados com a obesidade na nossa população. Mais estudos são necessários para esclarecer as associações entre as alterações do perfil de AG da membrana eritrocitária e os marcadores de risco de DCV. Um estudo envolvendo mais participantes poderia ajudar a esclarecer algumas tendências observadas. Quanto à análise da membrana lipídica, algumas abordagens interessantes poderiam ser feitas, como analisar separadamente os AG ligados a fosfolípidos e ésteres de colesterol, ou analisar individualmente cada folheto da membrana plasmática (interno e externo). Além disso, a optimização da técnica de separação e identificação dos AG seria fundamental, pois no presente estudo não pudemos avaliar AG importante, como por exemplo o EPA (ácido eicosapentaenoico - 20:5n3) e GLA (ácido gama linolénico - 18:3 n6), devido a limitações técnicas.
ENGLISH: The prevalence of obesity is growing worldwide and in childhood the increase is particularly striking. The caloric rich foods and the reduced physical exercise practice are two of characteristics of the modern lifestyle that may underlie this pandemia. Childhood obesity is particularly important in our country, as a high prevalence of overweight/obesity (over 30%) has been reported for Portuguese children, as compared to other European countries. Obesity has been associated with several other diseases, such as hypertension, type 2 diabetes mellitus, metabolic syndrome and cardiovascular diseases. Moreover, inflammation is known to play a vital role in those diseases, namely, in the initiation and progression of the atherosclerotic vascular disease, in insulin resistance, and in dyslipidemia. More recently, obesity has been proposed as a chronic low grade inflammatory condition. The white adipose tissue is an important source of several substances that are linked to inflammatory response and to immunity - the adipokines. The diets of obese individuals are, usually, rich in saturated and trans fatty acids (FA), and poor in polyunsaturated FA (PUFA), especially, in ω 3 PUFA. These type of dietary habits, by leading to endogenous changes in FA and in lipid metabolism, may, ultimately, lead to changes in the proportions of the different FA in body tissues. The lipid composition of the cell membranes are important determinants in the rheological and physico-chemical properties of the cells, influencing the activity of membrane channels, pumps, transporters and receptors. Thus, it is important in the modulation of cell signalling and in several biological functions. The lipids of the red blood cell membrane are in constant equilibrium with plasmatic lipids and lipoproteins. While the levels of lipids in plasma are highly influenced by the fasting status, the levels and type of lipids of the erythrocyte membrane reflect the lipid balance of longer periods. The red blood cell (RBC), as a non-nucleated cell, exhibits a very limited biosynthesis capacity and poor repair mechanisms. Therefore, when exposed to physical and/or chemical stress, during their lifespan, the erythrocyte suffers and accumulates the damage imposed by such stress. In oxidative stress conditions the erythrocyte membrane, may suffer oxidative damage in membrane lipids and proteins. Thus, the erythrocyte is a good model to study the oxidative damage of lipids and proteins occurring in pro-inflammatory and oxidative conditions and may also provide an important model to study the impact of dietary habits in the lipid and protein composition of the cell membranes. The objective of this study was to analyse the impact of obesity in the lipid profile, glucose homeostasis and inflammation, as well as the impact of obesity and the associated changes in the RBC membrane composition. We studied 34 obese children and adolescents [15 (44.1%); mean age of 14.1 years (8-17)] from Hospital S. João and the Children’s Hospital Maria Pia. The total group was divided according to the body mass index (BMI) percentile in 17 obese, 8 overweight and 9 controls. Obesity was defined as a BMI higher than the 95th percentile, for age and gender, according to the “2000 Centre for Disease Control and Prevention (CDC) growth charts”. Overweight was considered for BMI percentiles equal or higher than 85 and lower than 95; and control subjects BMI were lower than the 85th percentile, adjusted for gender and age. The three groups were matched for age, gender and tanner stage. It were determined the circulating levels of triglycerides, cholesterol, high density lipoprotein cholesterol, Low density lipoprotein cholesterol, lipoprotein (a), apolipoprotein A, apolipoprotein B, C-reactive protein, glucose, and insulin. A basic hematologic study was also performed. The erythrocyte membrane was studied with the determination of erythrocyte damage markers: membrane bound haemoglobin, proteic carbonylation, lipid peroxidation and band 3 profile - high molecular weight aggregates, monomers and proteolytic fragments. The membrane fatty acid profile was determined. We found that the obese individuals, presented risk changes in the lipid profile, increased insulin resistance and inflammation, when compared to their lean counterparts. Thus, several changes in cardiovascular disease (CVD) risk markers were observed. No significant changes were found in the erythrogram and in the erythrocyte damage markers. Concerning the FA membrane profile, the unsaturated FA showed a trend to increase, while saturated FA showed a trend to decrease, with obesity. Despite that, behenic acid (22:0) presented a significantly increase in obese, in comparison with controls. An increasing proportion of 20:0, 18:3n3, 20:3n6 and 22:4n6 were found for overweight and obese individuals, as compared to control. These FA increased with growing obesity, and presented the most significant associations with the studied CVD markers associated with obesity. Further studies are needed to clarify the associations between membrane FA changes, and CVD risk markers. A larger study, with a higher number of individuals could also clarify some observed trends. Regarding the lipid membrane analysis, some interesting approaches could be made, such as to separate and analyze the different phospholipids and cholesterol ester and their associated FA, and to perform a separate study of inner and outer membrane sheets. Furthermore, optimization of the separation technique and consequent identification of FA would be crucial, as in this study we could not evaluate important FA, e.g. EPA (20:5n3) and GLA (18:3n6), due to technical limitations.

PONTIFÍCIA UNIVERSIDADE CATÓLICA DO RIO DE JANEIRO
A presente pesquisa tem como objetivo discutir repercussões da violência conjugal como violência psicológica contra crianças e adolescentes, considerando a exposição da prole em espaços de convivência familiar onde a dinâmica de violência entre o (ex) casal parental é presente e frequente. Para tanto, foi realizada uma pesquisa qualitativa, através da análise de quatro casos atendidos em uma unidade de referência da rede de proteção a mulheres vítimas de violência doméstica no município do Rio de Janeiro. Os resultados demonstram a persistência de segmentação da rede de atendimento, desfavorecendo a abordagem da família em sua complexidade e dificultando a garantia, concomitante e integrada, dos direitos humanos de mulheres vítimas de violência conjugal e de seus filhos quanto às repercussões destes conflitos como expressão possível de violência psicológica.
The following research aims to discuss repercussions of domestic violence as well as psychological violence against children and adolescents, considering offspring exposure to family dynamics of frequent violence between parents. To do this, a qualitative study was conducted by analyzing four cases in a women s domestic violence treatment unit in Rio de Janeiro. The results demonstrate the continued segmentation of the service network, compromising the complexity of a family approach and making it difficult to guarantee the concurrent and integrated human rights of women domestic violence victims and their children on the impact of these conflicts as possible expressions of psychological violence.