Crisis de reparación: brechas y gestión del cuidado en niños, niñas y adolescentes institucionalizados(as) / Reparation crisis: gaps and care management in institutionalized children and adolescents

INTRODUCCIÓN: La institucionalización de niños, niñas y adolescentes (NNA) es una medida frecuente en el país, pese a que la evidencia es contundente en señalar las graves consecuencias a nivel global en NNA bajo este régimen de cuidado, destacando el rezago en el desarrollo y problemas de salud mental. En este escenario, los enfermeros(as) de los equipos de Salud Mental comunitaria participan en su tratamiento y rehabilitación. OBJETIVO: Develar la gestión del cuidado en el trabajo con NNA pertenecientes a residencias Mejor Niñez, adscritos a Centros de Salud Mental, con enfoque comunitario. METODOLOGÍA: Se trabaja bajo el paradigma cualitativo, con análisis de contenido, en una población de enfermeros(as) adscritos a centros de Salud Mental, seleccionados por muestreo deliberado. Investigación autorizada por el Comité Ético-Científico de Valdivia (Chile). RESULTADOS: Se obtuvieron dos metacategorías: La gestión del cuidado de enfermeros(as) de Salud Mental en NNA institucionalizados(as), que engloba el actuar de enfermería según las realidades locales, y las brechas y nodos de las residencias Mejor Niñez: Crisis de reparación, que incluye narrativas de dilemas éticos y de coordinación. CONCLUSIONES: Existen falencias respecto del bienestar y seguridad de los niños(as) institucionalizados(as), lo cual puede generar consecuencias nocivas en el proceso de reparación. Se sugiere la incorporación de enfermeros(as) al staff de hogares institucionales, así como el empleo de protocolos de acción para el abordaje de enfermería en salud mental dirigido a esta población.

INTRODUCTION: Institutionalization of children and adolescents (NNA) is a frequent measure in the country, though the evidence is conclusive identifying the serious consequences at a general level in children and adolescents under this care regime, especially in evelopmental problems and terms of mental health conditions. In this scenario, nurses from community mental health teams participate in the treatment and rehabilitation of these users. The purpose is to generate knowledge about care management and the challenges related to this context. METHODOLOGY: The population consisted of nurses from Mental Health centers in the South of Chile, selected by means of a non-probabilistic deliberate sampling and snowball technique. This research was authorized by the Valdivia's Ethical-Scientific Committee(Chile). RESULTS: Two meta-categories were obtained: The care management of Mental Health nurses for institutionalized children and adolescents, which includes nursing actions according to the realities of each locality; and the second meta-category is called "Mejor Niñez" residencies Gaps and nodes: Crisis of reparation, which includes accounts of ethical and coordination dilemmas. CONCLUSIONES: There are still flaws regarding the safety and well-being of institutionalized children, which may generate harmful consequences in the reparation process. The incorporation of nurses to the staff of institutional homes is suggested, as well as the use of action protocols for the mental healthnursingapproach aimed at this population.

Habilidades sociais e acadêmicas de crianças e adolescentes em instituições de acolhimento / Social and academic skills of sheltered children and teenagers / Habilidades sociales y escolares de niños y adolescentes en instituciones de acogida

Considerando que habilidades sociais (HS) podem ser preditoras de bom desempenho escolar e que crianças e adolescentes com longo tempo de permanência em instituições tendem a apresentar dificuldades escolares, buscou-se, no presente estudo, comparar HS, problemas de comportamento e desempenho escolar entre crianças/adolescentes com e sem histórico de acolhimento institucional. Participaram do estudo 36 crianças/adolescentes divididas em dois grupos: G1, composto por 18 crianças/adolescentes de três instituições de acolhimento do interior do estado do Mato Grosso do Sul, e G2, composto por 18 crianças/adolescentes sem histórico de acolhimento e do mesmo contexto escolar; além de seus respectivos docentes. Todos os estudantes responderam a inventários de HS, conforme a idade e ao Teste de Desempenho Escolar (TDE). Os professores responderam a duas escalas: uma de HS e uma de problemas comportamentais. Para o G1, maiores índices de habilidades sociais foram correlacionados a bom desempenho em leitura e problemas de comportamento foram correlacionados a índices mais baixos nos escores totais do TDE. Para o G2, maiores índices de habilidades sociais correlacionaram-se a melhor desempenho em matemática no TDE. Os participantes do G2 perceberam-se mais habilidosos que os do G1, apesar de os professores terem percebido as habilidades sociais de ambos os grupos como semelhantes. Em relação aos problemas de comportamento, os professores indicaram diferenças significativas, com maiores índices para o G1. Os dados sugerem intervenções junto aos professores para que possam reforçar comportamentos habilidosos de seus alunos, favorecer o autoconceito e o desempenho escolar.

Considering that social skills (SS) may be predictors of good school performance and that children and adolescents institutionalized for a long time tend to present school difficulties, this study sought to compare SS, behavioral problems, and school performance in children/teenagers with and without institutional sheltering experiences. The study sample consisted of teachers and 36 children/teenagers that were divided into two groups: G1, which included 18 children and teens from three shelters in the countryside of Mato Grosso do Sul; and G2, including 18 children and teens without history of institutional sheltering and from the same school context as G1. All students answered social skills inventories according to their age and the School Performance Test (SPT). Teachers answered two scales: one for SS and one for behavioral problems. In G1, higher social skills scores were associated with good reading performances whereas behavioral problems were associated with lower total scores in the SPT. In G2, higher social skills scores were associated with better performance in SPT mathematics test. Although teachers reported similar social skills in both groups, G2 participants perceived themselves as more skilled than G1 participants. In turn, teachers assigned higher scores for behavioral problems in G1, significantly different than those found for G2. These findings indicate the need for interventions implemented with the help of teachers to reinforce skilled behaviors in their pupils, favoring self-esteem and school performance.

Las habilidades sociales (HS) pueden ser predictoras de un buen rendimiento escolar. Considerando los indicativos de dificultades escolares de niños y adolescentes con largo tiempo de permanencia en instituciones de acogida, el presente estudio pretende comparar las habilidades sociales, los problemas de conducta y el rendimiento escolar entre niños/adolescentes con y sin histórico de acogida institucional. En el estudio, participaron 36 niños/adolescentes que fueron divididos en dos grupos: G1 - que consta de 18 niños/adolescentes de tres instituciones de acogida de la zona rural de estado de Mato Grosso do Sul (Brasil); y G2 - que se compone de 18 niños/adolescentes sin histórico de acogida y del mismo contexto escolar; además de sus respectivos maestros. Los participantes del G1 y del G2 respondieron a inventarios de habilidades sociales según la edad y al Test de Rendimiento Escolar (TRE). Los profesores respondieron a dos escalas: la de HS y la de problemas de conducta. Para el G1, los más altos índices de habilidades sociales se correlacionaron a un buen rendimiento en lectura; y los índices más bajos se correlacionaron a problemas de conducta en los puntajes totales del TRE. Para el G2, los más altos índices de habilidades sociales estuvieron correlacionados a un mejor rendimiento en matemáticas en el TRE. Los participantes del G2 fueron más hábiles que los del G1, pero los profesores percibieron las habilidades sociales de ambos grupos como semejantes. Con relación a los problemas de conducta, los profesores indicaron diferencias significativas, con altos índices para el G1. Los datos sugieren intervenciones junto con los profesores para que puedan reforzar conductas hábiles de sus alumnos, favorecer el autoconcepto y el rendimiento escolar de ellos.

Sistemas familiares conflituosos e cuidado feminino com crianças acolhidas / Conflicting family systems and female care with institutionalized children / Sistemas familiares conflictivos y cuidado femenino con niños acogidos

O estudo de famílias como um sistema permite desfocalizar sofrimentos e problemáticas em uma única pessoa. Essa compreensão facilita entender o cuidado realizado por mulheres com seus filhos, a partir das heranças transgeracionais que compõe a história de vida familiar. Em casos extremos no cuidado, a criança pode parar em uma instituição de acolhimento infantil. A presente pesquisa investigou a relação entre crianças institucionalizadas e a dinâmica de suas famílias num serviço de acolhimento para crianças de zero a seis anos. Trata-se de um estudo de caso com duas famílias e com os seguintes instrumentos: entrevistas semiestruturadas e o genograma. A discussão dos resultados evidenciou que a herança de abandono foi atualizada em até três gerações, a partir de uma história que se construiu a base de perdas emocionais e financeiras. Tais perdas foram somadas as dificuldades do núcleo, ao exteriorizarem conflitos que resultaram na posterior desagregação familiar e acolhimento infantil.

The understanding of families like systems allows defocus problems and sufferings on one single person. When this logic is used do compreheend female care, it is perceptive that the way women deal with their children is influenced bytransgenarational heritage whose shape the story of the group - which may be enriched or dreadful. In extreme cases, the child goes to a shelther care. This research aimed investigate how family system dynamic contributed to the stay of one of their children in a institutionalized space. The multiple case study was used as the method, whereby semi-estructured interview and genogram were the following instruments. As results' discussion, it was evidenced the abandonment's inheritance refreshed in three generations, based on a story of financial and emotional losses. These losses were added to the difficulties of the nucleus, when externalizing conflicts that resulted in the subsequent family disaggregation and child care.

El estudio de familias como un sistema, permite desfocalizar sufrimientos y problemáticas en una única persona. Esta visión, facilita entender el cuidado realizado por mujeres con sus hijos, el cual es influenciado por las herencias transgeneracionales que componen la historia de vida -las cuales pueden ser enriquecedoras o conflictivas. En casos extremos en el cuidado, el niño puede ir a parar a una institución de acogida infantil. La presente investigación indagó la relación entre niños institucionalizados y la dinámica de sus familias. Se trata de un estudio de casos múltiples desarrollada con entrevistas semiestructuradas y genograma. La discusión de los resultados evidenció que la herencia del abandono influyó en hasta tres generaciones, a partir de una historia que se construyó en pérdidas emocionales y financieras. Tales pérdidas se sumaron a las dificultades del núcleo, al exteriorizar conflictos que resultaron en la posterior disgregación familiar y en la institucionalización infantil.

Motor abilities, activities, and participation of institutionalized Brazilian children and adolescents with cerebral palsy

Abstract Aim: To assess motor abilities and functioning of institutionalized children and adolescents with cerebral palsy (CP) within a contextual model of development. Methods: Eleven institutionalized Brazilian children and adolescents aged 2-19 (14 ± 5) years, 5 males and 6 females, were evaluated through the Gross Motor Function Measure (GMFM-88 and 66) and the Functional Independence Measure (FIM), and classified according to the ICF core set. Results: The evaluated individuals have severe impairments as indicated by their GMFM scores and confirmed by their need for full assistance in basic activities of daily living according to the FIM assessment. The difficulties manifested reflected on the ICF body functions and activities and participation domains. Conclusion: Most institutionalized children and adolescents with CP had GMFM-66 scores comparable to those indicated in literature. The ICF-based assessment identified environmental barriers that might be considered for improvement in order to facilitate activities and participation.

Desafios da autonomização: estudo das transições segundo jovens adultos ex-institucionalizados / Empowerment challenges: study of transition by ex-institutionalized young adults / Desafíos de empoderamiento: estudio de las transiciones según jóvenes ex-institucionalizados

Este artigo dá conta de uma investigação centrada nas transições de jovens adultos que viveram um longo período das suas vidas em instituições de acolhimento para crianças e jovens - Lares de Infância e Juventude - e estão agora autonomizados. A estrutura pretende articular a teoria ecológica do desenvolvimento humano de Bronfenbrenner com modelos de transições (com especial incidência em Schlossberg), majorando a influência das vinculações criadas por crianças e jovens institucionalizados com cuidadores e entre os pares; visa fundamentar a metodologia utilizada na recolha e validação das entrevistas biográficas, enquadrando o trabalho em duas instituições da região Centro de Portugal, caracterizando o seu funcionamento; incide sobre a descrição, na perspetiva de adultos e jovens adultos ex-institucionalizados, das transições ao longo dos diversos espaços e tempos das suas vidas, nomeadamente através da sua perceção dos momentos de vida mais marcantes, das vinculações estabelecidas e da sua importância para aumentar a resiliência e competir para a sua integração social. Pretende-se assim compreender a perceção que os ex-utentes têm da relação entre o apoio e a formação que lhes foi proporcionada enquanto institucionalizados e o eventual contributo desses adquiridos na sua posterior integração nos diferentes contextos de vida.

This paper presents a research, focusing on transitions of young adults who lived in institutions for children and young people who are now independent. It which designed to articulate Bronfenbrenner's ecological theory of human development with models of transitions (particular focus on Schlossberg), subsequently adding the influence of the linkages created by institutionalized children and youth; which aims to support the methodology used in the collection and validation of biographical interviews, framing the work in monitoring and education and training activities carried out in two institutions in the region of Central Portugal; focuses on the description in perspective of ex-institutionalized adult and young adult transitions over the various spaces and times of their lives, particularly through their perception of the salient moments of life and established attachments.

Este artículo da a conocer una investigación aún en curso centrada en las transiciones de adultos e jóvenes que han vivido en instituciones de acogimiento de niños y jóvenes que están ahora a vivir de manera independiente. Su estructura pretende articular la teoría ecológica del desarrollo humano de Bronfenbrenner con modelos de transiciones (particular énfasis en Schlossberg) dando privilegio a la influencia de los vínculos creados por niños y jóvenes que viven en instituciones; pretende fundamentarse la metodología utilizada, en la recolección y validación de las entrevistas biográficas, encuadrando el trabajo en el acompañamiento y actividades de educación y formación desarrolladas en dos instituciones situadas en la región Central de Portugal; incide en la descripción en la perspectiva de los adultos y jóvenes adultos ex-institucionalizados, de las transiciones a lo largo de los diferentes espacios y tiempos de sus vidas, sobre todo a través de su percepción de los momentos de vida que sobresalen y de las vinculaciones establecidas. Para la consecución de este último nivel se realizaran entrevistas de cuño biográfico que visaran identificar las percepciones de los intervinientes acerca de la influencia de su institucionalización en su vida autónoma.

Estudo do "Ages and Stages Questionnaires" com cuidadores de crianças institucionalizadas / "Ages and Stages Questionnaires" study with caretakers of institutionalized children / Estudio del "Ages and Stages Questionnaires" con los cuidadores de los niños institucionalizados

Este estudo explorou o conhecimento de cuidadoras sobre o desenvolvimento de crianças em acolhimento institucional com um instrumento de triagem. Participaram deste estudo quatro crianças na faixa etária de 5 anos de idade e as cuidadoras responsáveis. O instrumento utilizado foi o Ages and Stages Questionnaires, que contém 21 questionários que envolvem seis áreas de desenvolvimento. Os resultados revelaram que a comunicação foi uma das áreas pouco pontuadas pelas crianças. Suas principais dificuldades estão em verbalizar e se concentrar nas tarefas propostas. A área da coordenação motora ampla, que envolve, entre outras coisas, o correr e pular, incentivada pelo próprio ambiente da instituição, foi considerada dentro das expectativas para o desenvolvimento e recebeu pontuação máxima de acordo com o ASQ-3. As cuidadoras como pessoas de referência para as crianças, foram essenciais para aplicação do ASQ-3, que se mostrou sensível na identificação dos problemas do desenvolvimento...

This study discussed the knowledge caretakers have on the development of children who live in institutional shelter, using a triage instrument. Took part of this study four five-year old children and the caretakers. The Ages and Stages Questionnaires were used, they are composed by 21 questionnaires which comprise six areas of development. The results demonstrated that communication was an area poorly scored by the children, their main difficulties are in verbalizing and focusing on the proposed task. The gross motor coordination field which gathers among other things jumping and running, all motivated by the environment of the institution, fit the expectations, hence received the maximum score according to ASQ-3. The caretakers, considered key people for the children, were essential for the application of ASQ-3, which had a major role in identifying developmental problems...

Este estudio ha explotado el conocimiento de cuidadoras sobre el desarrollo de niños en abrigo institucional con un instrumento de selección. Participaron de este estudio cuatro niños con edad mediana de 5 años de edad y las cuidadoras responsables. El instrumento utilizado fue el Ages and Stages Questionnaires que contiene 21 cuestionarios que abarcan seis áreas de desarrollo. Los resultados han revelado que la comunicación fue una de las áreas poco puntuadas por los niños, sus principales dificultades están en verbalizar y concentrarse en las tareas propuestas. El área de la coordinación motora amplia, que abarca entre otras cosas, el correr y saltar, está incentivada por el propio ambiente de la institución, fue considerada dentro de las expectativas para el desarrollo y ha recibido máxima puntuación de acuerdo con el ASQ-3. Las educadoras como personas de referencia para los niños fueron esenciales para la aplicación del ASQ-3 que se ha mostrado sencillo en la identificación de los problemas del desarrollo...

Estudo de aspectos adaptativos e psicológicos de mães de crianças acolhidas em abrigos / Study of psychological and adaptive aspects of mothers of children in shelters

O acolhimento de crianças em abrigos mostra uma realidade de violência intrafamiliar, negligência e abandono parental. Interessada na compreensão desse tema, a presente pesquisa teve por objetivo geral delinear os aspectos adaptativos e psicológicos de mães de crianças abrigadas. Participaram deste estudo sete mães, cujos filhos com idade entre 0 a 10 anos e 11 meses estavam acolhidos e recebiam visitas regulares delas. Os instrumentos utilizados foram: entrevista preventiva; Escala Diagnóstica Adaptativa Operacionalizada (EDAO) e Teste do Desenho da Figura Humana. Os resultados obtidos com a Escala Diagnóstica Adaptativa Operacionalizada (EDAO) revelaram: três mães com adaptação ineficaz grave; três mães com adaptação ineficaz severa; e uma mãe com adaptação ineficaz moderada. Os setores afetivo-relacionais, a produtividade e o aspecto sociocultural mostraram-se mais comprometidos. Revelaram ainda a transmissão transgeracional da violência e do abandono vivenciados pelas mães na própria infância e o empobrecimento do papel materno. No Teste do Desenho da Figura Humana, predominaram o autoconceito e a autoimagem acentuadamente negativos. Verificou-se, assim, que os fatores psicológicos e adaptativos evidenciados na pesquisa apresentavam forte associação com o abrigamento dos filhos.

Children in shelter homes display a reality of interfamily violence, negligence and parental abandonment. Interested in understanding this subject, this research had the aim to investigate adaptive and psychological aspects of mothers of sheltered children. Seven mothers participated in this study, whose children are aged between 0 to 10 years and 11 months, and were in shelter and received regular visits. The instruments used were: preventive interview; Operational Adaptive Diagnostic Scale (EDAO) e Human Figure Drawing Test. The results achieved by the usage of Operational Adaptive Diagnostic Scale (EDAO) presented 3 mothers with serious ineffective adaptation; 3 mothers with severe ineffective adaptation; and 1 mother with moderate ineffective adaptation. Affective-relational sectors, productivity and socio-cultural aspect were even compromised. It was observed the transgenerational transmission of violence and abandonment suffered by mothers in their childhood, in addition of a decline of the maternal function. In Humans Figures Drawing, very negative self concept and self image were predominant. Adaptive and psychological factors of mothers were strongly correlated with sheltered children.

Toxocariasis: seroprevalence in abandoned-institutionalized children and infants / Toxocariosis: seroprevalencia en infantes expósitos, abandonados e institucionalizados

Toxocariasis is an infection that has worldwide distribution. Toxocara canis is the most relevant agent due to its frequent occurrence in humans. Soil contamination with embryonated eggs is the primary source of T. canis. This study aimed to determine the seroprevalence of toxocariasis in 10-month to 3 year-old abandoned infants, considered to be at high risk because of their orphanhood status and early age. Blood samples were collected from 120 children institutionalized in an orphanage in the city of La Plata. In this study, we observed 38.33% of seropositive cases for T. canis by ELISA and 45% by Western blot techniques; significant differences among groups A (<1 year), B (1-2 years) and C (>2 years) were also found. In research group A, children presented a seropositivity rate of 23.91%, in group B of 42.85% and in group C of 56%, which indicates an increase in frequency as age advances, probably because of greater chances of contact with infective forms of the parasite since canines and soil are frequently infected with T. canis eggs. Abandoned children come from poor households, under highly unsanitary conditions resulting from inadequate or lack of water supply and sewer networks, and frequent promiscuity with canines, which promotes the occurrence of parasitic diseases. These children are highly vulnerable due to their orphanhood status and age.

La toxocariosis es una enfermedad presente en todo el mundo. Como causa primaria de infección se cita la contaminación de los suelos con huevos embrionados de Toxocara canis. Nuestro objetivo fue determinar la seroprevalencia de toxocariosis en niños expósitos (abandonados) de 10 meses hasta 3 años, los que se consideran de alto riesgo por su condición de orfandad y escasa edad. Las muestras de sangre fueron recolectadas de 120 niños institucionalizados en un orfelinato de la ciudad de La Plata. En este estudio, se observó un porcentaje de seropositivos para T. canis de 38,33 % por la técnica de ELISA y de 45 % por la técnica de Western blot, con diferencias significativas entre los grupos etarios estudiados (A: < 1 año, B: 1-2 años, C: > 2 años). Los niños del grupo A presentaron una frecuencia de seropositividad de 23,91 %; los del grupo B, de 42,85 % y en los niños del grupo C fue del 56 %. Esto indica un incremento de la frecuencia de presentación a medida que aumentó la edad, debido probablemente a las mayores posibilidades de contactar con estados infectantes del parásito, ya que los caninos y el suelo se hallan frecuentemente infectados por huevos de T. canis. Los niños abandonados provienen de hogares carenciados, donde a las malas condiciones de higiene resultantes de la ausencia de red de agua y cloacal se le agrega la frecuente promiscuidad con caninos, lo cual propicia la presencia de parasitosis. Sumado a la condición de desamparo, esto produce un estado de máxima vulnerabilidad.

Interações entre avós e netos em instituição de acolhimento infantil / Interactions between grandparents and grandchildren in a shelter for children / Interacciones entre abuelos y nietos en centro de acogida infantil

Esta pesquisa teve por objetivo descrever aspectos das interações entre avós e netos em situação de acolhimento institucional e analisá-los na perspectiva da bioecologia do desenvolvimento humano. O estudo foi realizado em uma instituição de acolhimento infantil localizada na Região Metropolitana de Belém. Participaram 25 avós e 31 crianças. Foi utilizado o método de observação naturalística, e o registro das visitas se deu de forma cursiva, privilegiando-se a descrição das interações entre avós e netos durante o tempo de duração da visita. Os resultados demonstraram que a maioria dos avós interagia de maneira afetuosa e lúdica com o neto, aspecto que pode ser considerado positivo porque aumenta a chance de a criança ser reinserida no seio de sua família de origem de modo seguro. Sugere-se, assim, a realização de novos estudos que levem em consideração a importância dos avós no processo de reintegração familiar da criança...

This research aims to describe aspects of the interactions between grandparents and grandchildren in a situation of institutional care and analyze them from the perspective of bio-ecology of human development. The study was conducted in a child care institution located in the Metropolitan Region of Belém participated in 25 grandparents and 31 children. The method of naturalistic observation and recording of the visits was used occurred in a cursive form, privileging the description of interactions between grandparents and grandchildren during the duration of the visit. The results showed that most grandfathers interacted affectionate and playful with his grandson, an aspect that can be considered positive because it increases the chance of the child so be reinserted into the bosom of his family home safely. Thus, it is suggested that new studies that take into account the importance of grandparents in the process of family reintegration of the child...

Esta investigación pretende describir aspectos de las interacciones entre abuelos y nietos en una situación de atención institucional y analizarlos desde la perspectiva de la bio-ecología del desarrollo humano. El estudio se llevó a cabo en una institución de cuidado de niños ubicada en la Región Metropolitana de Belém (PA), Brasil, del que participaron 25 abuelos y 31 niños. Se utilizó el método de observación naturalista y el registro de las visitas se realizó de forma cursiva, privilegiando la descripción de las interacciones entre los abuelos y los nietos durante la visita. Los resultados mostraron que la mayoría de los abuelos interactuaban cariñosos y juguetones con sus nietos, un aspecto que puede considerarse positivo, ya que aumenta la posibilidad de que el niño se reinserte en el seno de su familia de origen con seguridad. Se sugiere, además, llevar a cabo nuevos estudios que tengan en cuenta la importancia de los abuelos en el proceso de reintegración familiar del niño...

As perspectivas de crianças e adolescentes em situação de acolhimento sobre os cuidadores protetores / Las perspectivas de niños y adolescentes en situación de acogimiento a cerca de cuidadores protectores / The perceptions of children and adolescents in shelter institutions on the protective caretakers

O presente artigo apresenta pesquisa realizada em instituições de acolhimento (Inst. A e Inst. B) para crianças e adolescentes em município do interior do RS. A investigação buscou compreender a percepção de crianças e adolescentes institucionalizados acerca de suas relações com cuidadores. Foi considerado o entendimento que crianças e adolescentes têm de cuidado e as características destacadas nos trabalhadores apontadas como relevantes. Trata-se de um estudo exploratório, descritivo e qualitativo. O método utilizado foi a inserção ecológica com observações sistemáticas, diário de campo e entrevistas individuais com crianças e adolescentes. Na Inst. A foi evidenciado o apoio de interação positiva e emocional de cuidadores e valorização do diálogo. Na Inst. B o foco foi o apoio instrumental composto pelo auxilio nas atividades escolares, distribuição de guloseimas e brinquedos. Nas duas instituições as crianças/adolescentes entrevistados fizeram referências à importância de relações horizontais e afetivas com cuidadores percebidos como promotores de desenvolvimento.

This paper presents research conducted at shelter institutions (Inst. A and Inst. B) for children and adolescents in a city of RS. The study aimed to understand the perceptions of children and adolescents on their interactions with their caregivers. It was considered what children and adolescents think over care and what characteristics are perceived and pointed at the caregivers as relevant. It is an exploratory, descriptive and qualitative study. The method was the ecological engagement with systematic observations, field diary and interviews with children and adolescents. In the Inst. A the positive interaction and emotional support was evidenced in the caregivers who valued the dialogue. In the Inst. B the focus was on the instrumental support composed for help at the school activities, distribution of sweets and toys. In both institutions the respondents mentioned the importance of horizontal and affective interactions with caregivers which are perceived to promote development.

Este trabajo presenta una investigación realizada en instituciones de acogida (Inst. A y Inst. B) para niños y adolescentes en una ciudad del interior de RS. El estudio tuvo como objetivo comprender las perspectivas de niños y adolescentes acogidos a cerca de sus relaciones con cuidadores. Fue considerado el entendimiento de que los niños y adolescentes tienen sobre cuidado y qué características se destacan en los cuidadores como relevantes. Este es un estudio exploratorio, descriptivo y cualitativo. El método utilizado fue el inserción ecológica con la observación sistemática, diarios de campo y entrevistas con niños y adolescentes. En la Inst. A, el apoyo de interacción positiva y emocional fue evidente para los cuidadores que valoran el diálogo. En Inst. B, el objetivo era el apoyo instrumental compuesto por su ayuda en las actividades escolares, distribución de golosinas y juguetes. En ambas instituciones, los niños y adolescentes mencionaron la importancia de las relaciones afectivas y horizontales con los cuidadores que son percibidos como promotores del desarrollo.

Risk factors of renal scars in children with acute pyelonephritis

OBJECTIVE: The aim of this study was to determine the association between previously documented risk factors such as recurrent pyelonephritis with the incidence of renal scarring after acute pyelonephritis in children. MATERIAL AND METHODS: Children with acute pyelonephritis who were admitted to the Department of Pediatrics of a teaching hospital during 2007-2009 were enrolled in this study. DMSA scans were obtained 4-6 months after the last episode of pyelonephritis in all patients. RESULTS: A total of 80 children with acute pyelonephritis were enrolled in this study. Most of them were girls (77.5 percent), with a median age of 12 months. Nearly half of the children (n = 44; 55 percent) had one or more renal scars. The distribution of gender, CRP level and leukocytosis did not differ significantly regardingthe absence or presence of renal scars (p > 0.05). Most of the scars occurred in children who had presented with bilateral pyelonephritis (69.4 percent vs. 18.2 percent, p = 0.001). Most of the patients with renal scars had a positive history of vesicoureteral reflux (VUR) (75 percent vs.13.6 percent, p = 0.001). The significant roles of recurrent pyelonephritis and presence of VUR were further confirmed by multivariate analysis. CONCLUSIONS: According to our findings, presence of VUR and recurrent pyelonephritis are independently associated with a higher incidence of renal scarring.

Características clínicas e oftalmológicas de indivíduos com necessidades especiais institucionalizados no estado de Pernambuco, Brasil / Clinical and ophthalmological findings in subjects with special needs institutionalized in Pernambuco, Brazil

OBJETIVO: Descrever as características clínicas e oftalmológicas encontrados em indivíduos institucionalizados, com necessidades especiais no estado de Pernambuco. MÉTODOS: Realizou-se projeto multidisciplinar em 37 pacientes, com necessidades especiais, institucionalizados na Comunidade Rodolfo Aureliano (CRAUR), unidade da Fundação da Criança e do Adolescente (FUNDAC) em Recife-PE. A faixa etária dos indivíduos institucionalizados variou de seis a 30 anos, média de 18,8 ± 5,1 anos. O sexo masculino foi mais prevalente com 35 indivíduos (94,5 por cento). Consideraram-se como indivíduos institucionalizados, aqueles que vivem abrigados em instituições mantidas pelo Estado. Foi feito estudo de corte transversal, verificando-se os principais achados clínicos e oftalmológicos destes indivíduos. Realizou-se o exame oftalmológico completo nos casos, com boa colaboração e de acordo com protocolo pré-estabelecido. RESULTADOS: Uso de álcool na gravidez foi relatado por nove mães (24,3 por cento). Verificou-se a presença de retardo mental grave em 22 casos (59,4 por cento), paralisia cerebral e epilepsia em sete (18,9 por cento) indivíduos cada. Foi possível a realização do exame oftalmológico completo em 24 indivíduos (64,8 por cento). Detectou-se cegueira legal em dez casos (41,6 por cento). Os diagnósticos oftalmológicos mais encontrados foram ambliopia, erro refracional e phthisis bulbi em três casos (12,5 por cento) cada. Estrabismo foi encontrado em dois casos (8,3 por cento). CONCLUSÃO: Os achados oftalmológicos revelaram a importância do exame oftalmológico em indivíduos com necessidades especiais institucionalizados. A associação com múltiplas deficiências, tais como: doenças neuropsiquiátricas, contribuiu para o maior grau de dificuldade na avaliação e condução dos casos.

PURPOSE: To describe the main clinical and visual findings in special needs subjects institutionalized in Pernambuco State. METHODS: Thirty seven subjects with special needs, institutionalized in Rodolfo Aureliano Community (CRAUR), from Children and Adolescent Foundation (FUNDAC), in Recife PE, were evaluated by a multidiscipline team. The subjects aged 6 to 30 years, with mean of 18.8±5.1 years. Most of them were boys (94.5 percent). Institutionalized individuals were considered when they lived in institutions maintained by the State. It was made a cross-sectional study, verifying the main clinical and ophthalmic findings of these individuals. It was performed a complete ophthalmic examination in cases with good cooperation in accordance with pre-established protocol. RESULTS: Alcohol use in pregnancy was reported by nine mothers (24.3 percent). Severe mental retardation was seen in 22 subjects (59.4 percent), cerebral palsy and epilepsy in 7 (18.9 percent) subjects each. It was possible to perform the complete ophthalmic examination in 24 subjects (64.8 percent). Legal blindness was detected in 10 cases (41.6 percent). Main ophthalmologic findings found were amblyopia, refractive error and phthisis bulbi in 3 cases (12.5 percent) each. Strabismus was seen in two cases (8.3 percent). CONCLUSION: The ophthalmological findings detected revealed the importance of ophthalmic examination in institutionalized individuals with special needs. The association with multiple disabilities such as neuropsychiatric diseases contributed to the greatest degree of difficulty in the evaluation and conduct of cases.

Representaciones sociales acerca de la delincuencia que tienen las menores de edad institucionalizadas en un centro de reeducación de la ciudad de Bogotá / Social representations about the crime that minors are institutionalized in a re-education center of the city of Bogotá

La presente investigación tuvo como objetivo general conocer cuáles son las representaciones sociales que tienen las menores internas en una institución cerrada de reeducación en la ciudad de Bogotá, en la fase de ubicación. Como metodología se utilizó la técnica de discusión de grupo focal y a partir del análisis de discurso se plantearon las siguientes categorías: la conceptualización de la delincuencia, atribución de responsabilidad, legitimación de los actos delictivos y futuro. Los resultados analizados de acuerdo con dichas categorías muestran que las representaciones sociales sobre delincuencia reflejan que ésta se conceptualiza a partir de sus consecuencias, por su valoración, por su origen, por su instrumentación y por su conocimiento. La atribución de responsabilidad en la delincuencia se centra en sí misma, en relación con los demás, en la familia, en la sociedad y en la oportunidad que ésta brinda. La perspectiva de su futuro se ve influida en tres niveles: personal, institucional y social.

The general objective that this investigation had was to know the social representations that the underage boarders have in a closed institution of reeducation in Bogotá city, especially in the location stage. By the way, the methodology used was the discussion technique of the focal group and from the speech analysis it was set out the following categories of analysis: delinquency conceptualization, attribution of responsibility, legitimacy of criminal acts and future. The results that were analyzed according with those categories show that the social representations about delinquency are the result of its conceptualization from the consequences, assessment, origin, instrumentation and knowledge. The attribution of responsibility in delinquency focuses in itself in relationship with others in family, social life and the opportunities that society offers. The future prospect gets influenced in the levels: personal, institutional and social.

A criança com deficiência institucionalizada e o ensino de habilidades básicas: um estudo de caso / The institutionalized child with disabilities and the teaching of basic skills: a case study

Este trabalho teve como objetivo verificar as mudanças ocorridas no repertório de uma criança com deficiência, institucionalizada e em condição de abandono, ao passar por um procedimento focado no ensino de habilidades básicas. Participou da pesquisa uma menina de sete anos, com severo atraso no desenvolvimento, moradora de uma instituição residencial para pessoas com deficiência. Foi realizada uma avaliação inicial do repertório da criança (linha de base) por meio da aplicação de um protocolo de habilidades básicas, que possibilitou determinar as condutas que seriam ensinadas durante o desenvolvimento do programa de aquisição de habilidades básicas. Para verificar as mudanças no repertório comportamental da participante foram aplicadas avaliações quinzenais. Os resultados foram acompanhados por meio de um delineamento de linha de base múltipla entre comportamentos. Observou-se, a partir das avaliações quinzenais, que houve aumento na frequência dos comporta- mentos ensinados após início da implementação do programa de ensino. Tal aumento não foi observado nas demais habilidades podendo-se, portanto, afirmar que a modificação provavelmente foi devida à intervenção realizada. Pode-se concluir que a participante aprendeu as habilidades ensinadas ao passar pelo procedimento de ensino em questão, mesmo residindo em um ambiente institucional desfavorável para aprendizagem de novos comportamentos.

This case study was designed to verify changes on the behavioral repertoire occurred with a child with disability, abandoned and institutionalized, after undergoing a procedure focused on the teaching of new basic skills. The participant was a seven-year-old girl with severe developmental delay, who was living in an institution that houses people with disabilities. First, an evaluation of the initial repertoire of the child was done (baseline), by applying a protocol of basic skills, which allowed researchers to determine which conducts would be taught during the program for acquisition of basic skills. In order to verify any changes in the participant’s behavioral repertoire, evaluations were made every two weeks. The follow up of the results was done by a multiple baseline design across behaviors. The biweekly evaluations showed an increase on the frequency of the behaviors been taught through implementation of the teaching program. The increase was not observed on other behaviors, which indicates that the changes were probably a result of the intervention applied. The results showed that the participant was able to learn new basic skills, even though residing in an institutional environment which wasn’t favorable for the learning of new behaviors.

Características emocionais e traços de personalidade em crianças institucionalizadas e não institucionalizadas / Emotional characteristics and personality traits among institutionalized and non-institutionalized children

Este estudo teve como objetivo comparar características psicológicas de crianças institucionalizadas e não institucionalizadas. Foram pesquisadas 36 crianças institucionalizadas e 36 crianças que viviam com suas famílias, de ambos os sexos e com idades entre 5 e 10 anos. Utilizou-se a Escala de Traços de Personalidade para Crianças e o Desenho da Figura Humana, avaliado segundo a escala de indicadores emocionais de Koppitz. Os resultados do Desenho da Figura Humana mostraram diferenças significantes em relação ao total de indicadores emocionais, sendo que as crianças institucionalizadas apresentaram em média dois indicadores a mais do que as crianças que viviam com suas famílias. Verificou-se também que as crianças institucionalizadas apresentaram mais traços de psicoticismo e de neuroticismo do que as do outro grupo. Concluiu-se sobre a importância da família como fator de saúde mental no desenvolvimento infantil.

This study intends to compare the psychological traits of institutionalized and non-institutionalized children. Participated 36 children from foster homes and 36 children who lived with their families, of both sexes, whose age ranged from 5 to 10 years-old. It was applied the Personality Traits Scale for Children and the Human Figure Drawing that were analyzed by the Koppitz emotional indicators. The Human Figure Drawing results showed significant differences when the total number of emotional indicators between the groups was compared, whereas children who had receive foster care presented in average two more indicators than the children who lived with their families. It was also seen that institutionalized children showed more traits of psychoticism and neuroticism than the children from the other group. It can be therefore concluded about the importance of family as a mental health factor in the child’s development.

A vinculação afetiva para crianças institucionalizadas à espera de adoção / Affective relations among institutionalized children who wait for adoption / La vinculación afectiva para niños institucionalizados a la espera de adopción

Este trabalho aborda a compreensão de vivências afetivas de crianças institucionalizadas à espera de adoção. Os sujeitos da pesquisa foram quatro crianças (duas meninas e dois meninos), com idade entre seis e nove anos. Buscaram-se informações sobre a sua história de vida nos prontuários da instituição, e as crianças foram entrevistadas individualmente. Observando-as em brincadeiras, em atividades na instituição e por meio do desenho livre, puderam ser percebidos modos e sentidos de alguns laços afetivos significativos para elas. Neles constatou-se que as percepções daquelas crianças no que se refere à instituição não eram tão problemáticas como se poderia supor à primeira vista. Entre elas e as cuidadoras, verificaram-se igualmente relações com certo nível de afetividade. Após análise qualitativa de dados, pôde-se perceber que as crianças se vinculam positivamente à instituição, entretanto, manifestam o desejo de ter um lar. Outras categorias emergentes acerca do vínculo afetivo, além da proximidade com as atendentes, foram o brincar, as amizades e a distinção entre o bem e o mal. Pode-se dizer que tais crianças, embora tenham estabelecido vínculos de afetividade com a instituição, ainda são agenciadas por um imaginário em que o desejo de ter uma família se revela muito intenso e com possibilidades de realização. conclui-se, com isso, que tais temáticas estão atreladas à possibilidade de a criança se relacionar com as demais pessoas de forma mais lúdica e simbólica....(AU)

The present research sought to understand the affective relations among institutionalized children who wait for adoption. Four children (two girls and two boys) aged from six to nine years old participated in the study. Their life histories were examined in the documents of the institution and the children were interviewed individually. They were observed at play, in routine activities and in drawing sessions which revealed their feelings and behavioral orientations in terms of their affective attitudes and the significance of these attitudes. It was found that their perceptions with reference to the institution were not as problematic as might be supposed at first. Between the children and their caretakers a certain level of affectivity was observed. Following a qualitative analysis of the data it could be perceived that the children were positively linked to the institution. They did, however, manifest the desire for a home. Other categories of behavior used to identify feelings of affection included their play activities, friendships and the distinctions they made between good and evil. It can be said that the children observed, in spite of having established affective relations within the institution, still remained captivated by their own imaginations, longed for families and hoped for their inclusion in family situations. It was concluded that the themes of the study are related to the possibility of the child to establish relations with others in informal and symbolic manners....(AU)

Este trabajo aborda la comprensión de vivencias afectivas de niños institucionalizados a la espera de adopción. Los sujetos de la pesquisa fueron cuatro niños (dos niñas y dos niños), con edad entre seis nueve años. Se buscaron informaciones sobre su historia de vida en los prontuarios de la institución, y los niños fueron entrevistados individualmente. Observándolos en juegos, en actividades en la institución y por medio del dibujo libre, pudieron ser percibidos modos y sentidos de algunos lazos afectivos significativos para ellos. En ellos se constató que las percepciones de aquellos niños en lo que se refiere a la institución no eran tan problemáticas como se podría suponer a la primera vista. Entre ellos y las cuidadoras, se verificaron igualmente relaciones con cierto nivel de afectividad. Después del análisis cualitativo de datos, se pudo percibir que los niños se vinculan positivamente a la institución, mientras, manifiestan el deseo de tener un hogar. Otras categorías emergentes acerca del vínculo afectivo, además de la proximidad con las auxiliares, fueron el jugar, las amistades y la distinción entre el bien y el mal. Se puede decir que tales niños, aunque hayan establecido vínculos de afectividad con la institución, aún son agenciados por un imaginario en que el deseo de tener una familia se revela muy intenso y con posibilidades de realización. Se concluye, con eso, que tales temáticas están relacionadas a la posibilidad de que el niño se relacione con las demás personas de forma más lúdica y simbólica....(AU)

The Effects of Iron Supplements and Cereal Intake on the Iron Nutritional Status in Children in Social Welfare Institutions

The study was designed to assess the effect of iron and cereal supplementation on children's iron nutritional status in social welfare institutions. Dietary survey was carried out methods of food weighing and record by interview (n = 74). A nutritional intervention study was carried out through supplementing iron supplements and cereal for 4 weeks in 4 - 12 years old children. Children received daily 40 mg elemental Fe as iron protein succinylate (n = 23) and 3.6 mg elemental Fe as 100 g cereal (n = 24), respectively. Blood samples were drawn before and after supplementation. Nutrients which children's intake was less than two-thirds of the RDA were vitamin A, vitamin B-1, vitamin B-2, calcium and iron. The mean daily intake of iron was 5.1 mg for male and 4.9 mg for female, and 52.3% for male and 45.4% for female of Korean RDA. The proportion of children with iron depletion assessed by TIBC (> 360 microgram/dl) and serum ferritin (< 20 ng/ml) were 56.6% and 58.7%, respectively. The proportion of children with the iron deficient erythropoiesis assessed by serum iron (< 70 microgram/dl), Hb (< 12 g/dl), Hct (< 36%) were 76.0%, 58.7%, 64.0%, respectively. After iron supplements treatment, Hb (p < 0.001), Hct (p < 0.001), serum iron (p < 0.001), transferrin saturation (p < 0.001) and serum ferritin (p < 0.01) increase significantly and only TIBC decreased slightly. After cereal supplementation, in anemic children, Hct (p < 0.001), serum iron (p < 0.001) and transferrin saturation (p < 0.001) were significantly increased. The effect of iron supplements and cereal supplementation in children with iron deficient erythropoiesis were more effective to improve the iron nutritional status than children with iron depletion. It was concluded that cereal supplementation program in anemic children was also effective to improve iron nutritional status.

Changing Social Background Pattern of Children in Adoption Institutions(the 4th Report)

PURPOSE: A study was undertaken to assess the social background of abandoning children at adoption institutions. The results were compared to those of three previous reports from the institution. METHODS: A total of 536 children who had been admitted to the institution during the period of 1993 to 1996 were subjected to the study. The medical records were reviewed retrospectively. RESULTS: The sex ratio of male to female was 1 : 0.9, which was opposite compared to previous studies. Mean birth weight was 2.76+/-0.58kg. The proportion of prematurity was 27.2% and their mean gestational age was 34.0+/-2.25 weeks. The academic background of the mother was mainly high school, comprising 58.4%. The highest rate of maternal age(75.9%) was between 16 to 25 years of age. Maternal age below 15 years was 2.8%, which showed increased in tendency compared to previous studies. Classifying the mother's occupation, they were unemployed(19.4%), office workers(16.8%), store clerks(15.9%), students(13.6%), factory workers(12.3%) and waitresses (5.6%) in this order of frequency. The order of birth showed that the first baby was 89.4%. The reasons for putting their baby up for adoption were they were unmarried(83.2%), poor(8.6%), extramarital birth(3.2%), divorce(2.9%) and death of parents(0.4%) in this order of frequency, showing a significant increased in the rate of unmarried mothers. Only 38.4% of mothers had taken antenatal care. Most of the children (90.8%) were adopted by parents in foreign countries. CONCLUSION: The main reason for adoption was the mothers were unmarried and the maternal age tended to be younger. The rate of foreign adoption was still high.

Changing Social Background Pattern of Children in Adoption Institutions(the 4th Report)

PURPOSE: A study was undertaken to assess the social background of abandoning children at adoption institutions. The results were compared to those of three previous reports from the institution. METHODS: A total of 536 children who had been admitted to the institution during the period of 1993 to 1996 were subjected to the study. The medical records were reviewed retrospectively. RESULTS: The sex ratio of male to female was 1 : 0.9, which was opposite compared to previous studies. Mean birth weight was 2.76+/-0.58kg. The proportion of prematurity was 27.2% and their mean gestational age was 34.0+/-2.25 weeks. The academic background of the mother was mainly high school, comprising 58.4%. The highest rate of maternal age(75.9%) was between 16 to 25 years of age. Maternal age below 15 years was 2.8%, which showed increased in tendency compared to previous studies. Classifying the mother's occupation, they were unemployed(19.4%), office workers(16.8%), store clerks(15.9%), students(13.6%), factory workers(12.3%) and waitresses (5.6%) in this order of frequency. The order of birth showed that the first baby was 89.4%. The reasons for putting their baby up for adoption were they were unmarried(83.2%), poor(8.6%), extramarital birth(3.2%), divorce(2.9%) and death of parents(0.4%) in this order of frequency, showing a significant increased in the rate of unmarried mothers. Only 38.4% of mothers had taken antenatal care. Most of the children (90.8%) were adopted by parents in foreign countries. CONCLUSION: The main reason for adoption was the mothers were unmarried and the maternal age tended to be younger. The rate of foreign adoption was still high.

Observation of Social Background and Disease Patterns of Children in an Institute for Adoption(the 3rd report)

OBJECTIVE: A Study was undertaken to assess the family background of abandonment and clinical and social aspects in an institute for foreign adoption. The results were compared to the previous two reports from the institute. METHOD: A sample of 1,728 children from 1987 to 1992 formed the subjects of the study by the medical records in the institution. RESULTS: 1) The unmber of girls were more than that of male and ratio of male to female was 1:1.1, which was reduced compared to previous study. 2) The distribution less than one month of age was most commonly and increased compared to previous study. 3) The Place at birth was hospital most commonly. 4) The type of delivery was full-term one(61.5%) and tend to be increased. 5) Age distribution of monthers was from 16 years to 25 years mainly, 1,081 of them(62.5%) were from unmarried one and 409(37.4%) were from married one. 6) By classifying the cause of adoption, unmarried mothers occupied main one(62.5%), poverty(13.4%) extramarital relations(5.2%), divorce(2.9%) and death of parents in the order of frequency, tend to increased in unmarried mothers. 7) Disease pattern showed respiratory disease, jaundice, acute gastroenteritis, pneumonia, urinary tract infection, conjunctivitis in order of frequency. By care of foster mother at private home since 1988, the incidence of the transmissible disease was reduced. 8) Congenital anomalies were cleft and palate, hydrocele, umbilical hernia and congenital heart disease in order frequency. 9) Three hundred and eighty two babies were admitted to general hospital. The main disease were bhaline membrane disease. Jaundice, pneumonia and urinary tract disease, sepsis in the order of frequency. CONCLUSIONS: The ratio of male to female in the institution showed no definite difference and the age was tend to be younger. The cause of adoption was unmarried mother mainly. Respiratory disease in the institution and hyaline membrane disease in the hospitalized was most common.