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WINDSOR, JENNIFER, ANA MORARU, CHARLES A. NELSON, NATHAN A. FOX e CHARLES H. ZEANAH. "Effect of foster care on language learning at eight years: Findings from the Bucharest Early Intervention Project". Journal of Child Language 40, n.º 3 (14 de maio de 2012): 605–27. http://dx.doi.org/10.1017/s0305000912000177.
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ABSTRACTThis study reports on language outcomes at eight years from the Bucharest Early Intervention Project, a randomized controlled study of foster care. We previously have shown that children placed in foster care by age two have substantially stronger preschool language outcomes than children placed later and children remaining in institutional care. One hundred and five children participated in the current study, fifty-four originally assigned to foster care and fifty-one to continued institutional care. Even though current placements varied, children originally in foster care had longer sentences and stronger sentence repetition and written word identification. Children placed in foster care by age two had significant advantages in word identification and nonword repetition; children placed by age 1 ; 3 performed equivalently to community peers. The results show the continuing adverse effects of early poor institutional care on later language development and the key importance of age of placement in a more optimal environment.
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Rohta, Sonam. "Children living in institutional care in northern India: A study". Developmental Child Welfare 2, n.º 4 (dezembro de 2020): 278–92. http://dx.doi.org/10.1177/2516103220985873.
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A very large number of children live without parental care in the entire world. Poverty is considered to be the main reason behind institutionalization of the children because 80% of children living in care have at least one parent alive. The present paper emphasizes on the trends of institutional care in India where the large population is poor. Keeping in view the socio-economic conditions of the country, it is an attempt to explore the challenges and living conditions of children in institutional care run by government and non-governmental organizations in the regions of Punjab and Chandigarh in northern India. The findings of the study are based on the empirical data that included around 177 institutionalized children both boys and girls between the age group of 5 and 18 years living in four different children’s institutions. The study also provides suitable recommendations for better alternative care in countries with large populations of vulnerable children.
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FERGUSON, HARRY. "Abused and Looked After Children as ‘Moral Dirt’: Child Abuse and Institutional Care in Historical Perspective". Journal of Social Policy 36, n.º 1 (21 de dezembro de 2006): 123–39. http://dx.doi.org/10.1017/s0047279406000407.
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This article argues that to provide adequate historical explanations for the maltreatment of children in institutional care it is necessary to ground the analysis fully in the context of the concept of child abuse and definition of childhood that existed at the time, something that many studies fail to do. Drawing primarily on the experience of the Irish industrial schools prior to the 1970s, while most commentators suggest that children were removed into care and treated cruelly because they were poor, there were also many children who entered the industrial schools who had been abused by their parents and welcomed being protected, and the community played a key role in supporting such actions. Children were treated harshly in the industrial schools not only due to their poverty but because they were victims of parental cruelty, which was perceived to have ‘contaminated’ their childhood ‘innocence’. They were treated as the moral dirt of a social order determined to prove its purity and subjected to ethnic cleansing. Prevention of such abuse today requires a radical reconstruction of the traditional status of children in care, while justice and healing for survivors necessitates full remembrance of the totality of the abuse they experienced, and that those responsible are made fully accountable.
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Beckett, Chris, e June Thoburn. "Family Placements from a Chinese Institution". Adoption & Fostering 26, n.º 3 (outubro de 2002): 19–27. http://dx.doi.org/10.1177/030857590202600305.
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In this article Chris Beckett and June Thoburn look at an innovative fostering project in Shanghai, which places children from a large children's institution. They consider placement outcomes for 220 children placed over a two-year period. A number of variables are discussed which might impact on placement outcomes, including age, gender, level of disability, length of time spent in the institution and age at time of placement. The length of time spent in institutional care and age at placement were found to be predictors of the placements breaking down during the first few years after placement. Younger children moved quickly into foster homes were most likely to settle there successfully. This finding is in accord with other studies that have found that early institutional care can have adverse long-term consequences for development. This pattern, it is suggested, does not necessarily reflect poor physical care within the institution. It may simply be a consequence of the fact that an environment of this kind cannot provide the kinds of relationships which are necessary for optimal development. The authors believe that looking at placement outcomes for projects of this kind provides a valuable opportunity to learn more about children's vulnerabilities and about the kinds of post-placement support which are needed.
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Ado, Uba Sabo. "Institutional Factors Affecting Retention of HIV Patient on Treatment at Wuse General Hospital, Abuja, Nigeria". TEXILA INTERNATIONAL JOURNAL OF PUBLIC HEALTH 9, n.º 2 (30 de junho de 2021): 23–34. http://dx.doi.org/10.21522/tijph.2013.09.02.art003.
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Retention On Treatment Is A Critical Factor In Reducing HIV-Related Morbidity And Mortality, The Incidence Of New Infections, And Development Of Drug Resistance Among Children And Adults. This Study Examined Institutional Factors Affecting Retention Of HIV Patients On Treatment, Care, And Support Services At Wuse General Hospital, Abuja. A Retrospective Cohort Study Was Used To Access Institutional Factors That Influence HIV Patient Retention On Treatment. About 4,564 HIV Patients Were Ever Enrolled On A Treatment Programme, And 2,791 Patients Are Currently Accessing Treatment. A Total Of 240 Clients Were Recruited For The Study, And A Pre-Tested Interviewer-Administered Semi-Structured Questionnaire Was Used For Data Collection. Data Were Entered Into Stata/MP 15.0 And Then Exported Into SPSS Version 23.0 For Statistical Analysis Of The 240 Respondents Interviewed, The Main Institutional Factor Affecting Retentions Were Long Waiting Time (61.7%), High Patient Load (46.9%), Inadequate Space For Clinics (48.3%), Poor Quality Of Services (40.8%), Difficulty In Accessing Health Facility (32.9%) And Inadequate Health Workers/Staff (31.3%). A Review Of Socio-Demographic Characteristics Of Respondents And Institutional Related Factors Affecting Retention In Treatment Showed An Association Between Marital Status (P=0.000), Religion (P=0.006), Employment Status (P=0.009), And Institutional Related Factors Affecting Retention In Care. Retention Of HIV Patients In Treatment And Care Support Services Is A Major Determinant In Achieving Sustained Viral Suppression And Reduced Community HIV Transmission. Therefore, Strategies To Mitigate Institutional Barriers To Treatment Retention Should Be Promoted To Optimize Retention Of HIV Patients In Care.
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Jesus, Maria Gorete Marques de, Giane Silvestre, Thais Lemos Duarte e Henrik Ronsbo. "Mothers, protection and care amongst communities affected by torture and state violence in Brazil". Journal of the British Academy 10s3 (2022): 97–116. http://dx.doi.org/10.5871/jba/010s3.097.
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This article examines the ways in which protection from torture and violence is understood and practiced by women in poor urban communities in Brazil. It demonstrates that despite a well-developed normative and institutional framework for the protection of survivors of torture and violence, such protection work grows from the notion of motherhood, which can be understood as an outlet for challenging various overlapping orders (race, class and gender) that legitimise torture and violence. Motherhood garners legitimacy in the fight for justice, for the truth and for restoring the positive memories related to the tortured, killed or imprisoned children and it generates moral and political capital that enable political participation for women. The article demonstrates that despite a well-developed institutional and normative framework for protection, everyday protection strategies respond to the perceptions and needs of survivors and their communities and can only be understood in the context of racial and gendered roles and performances of motherhood shaped by the historical enslavement of the Afro-Brazilian population.
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Asimina, Ralli, M., Schiza Melpomeni e Tsiatsiou Alexandra. "Language and Psychosocial Skills of Institutionalized Children in Greece". Open Family Studies Journal 9, n.º 1 (12 de agosto de 2017): 76–87. http://dx.doi.org/10.2174/1874922401709010076.
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Background: Institutionalization is increasingly acknowledged as a poor policy for the children. Every country has important responsibilities concerning the protection and promotion of children’s rights who are already in alternative care. Even a relatively short institutional placement may have long term negative consequences on children’s well-being and adult life. Aim: The aim of the present study was to investigate the language and psychosocial skills of Greek institutionalized children in comparison to family raised children. Method: 60 preschool children (30 institutionalized children and 30 children brought up in families) participated in the study. The children ranged in age from 4 to 5 years of age. Children’s language and psychosocial skills were assessed. Result: The results demonstrated that the institutionalized children had significantly lower scores in the expressive, receptive vocabulary, narrative skills and psychosocial adjustment in comparison to the children raised in families. These results are discussed in relation to their implications for policy makers in order to move towards the development of new policies, where children are taken care of in more supportive surroundings than an institution.
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Tamutienė, Ilona, e Vaida Auglytė. "Institutional Risk in Child Protection: Perspective of Professionals". Public Policy And Administration 17, n.º 3 (29 de outubro de 2018): 371–84. http://dx.doi.org/10.5755/j01.ppaa.17.3.21953.
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This article focuses on institutional risk factors that relate to the ability of child rights professionals to protect maltreated children. The aim of the article is to reveal the structural threats existing in the system of protection of the child’s rights, which create preconditions for the disclosure of institutional risks. Semi-structured qualitative interview method used. Ten interviews with children's rights protection specialists (CRPS) conducted during March-April 2018. According to the content analysis method, it has been established that the family assistance model for child protection is declarative in nature, due to the lack of services that meet the needs of children and families, and poor accessibility and quality, especially in rural areas, and social work orientation into control. The findings highlighted gaps in inter-agency cooperation in the protection of the child, the low level of involvement of health care, in particular – the treatment of paediatric and addictive diseases. In view of the internal field of the childʼs rights services, it has been highlighted that institutional problems are significantly contributing to the institutional risk: CRPS experienced inadequate methodological assistance and training which not corresponding to the problems encountering in everyday practice, lack of human resources, large workloads, low wages, lack of working methods, lack of stress management. In the context of the ongoing reform of the protection of the rights of the child, it is recommended to eliminate institutional risks, to strengthen services for children and families, and to improve inter-agency cooperation in the protection of the child.DOI: http://dx.doi.org/10.5755/j01.ppaa.17.3.21953
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Cloet, Eva, e Mark Leys. "An integrated, stepped care organizational model for diagnostic evaluations along the care trajectory of children with a developmental disorder." International Journal of Integrated Care 23, S1 (28 de dezembro de 2023): 70. http://dx.doi.org/10.5334/ijic.icic23337.
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Introduction: The field of multidisciplinary diagnostic evaluations for children with a developmental disorder in Flanders, Belgium, is heterogeneous and characterized by severe accessibility problems. However, children with a developmental disorder need timely and adequate diagnostics during their trajectory of care and support. This policy support research project develops an organizational model of integrated of care and networking adapted to diagnostic needs in different phases as well as the particularities of the Flemish institutional field.
Methods: Homogeneous focus groups were performed with stakeholders from six types of governmental regulated organizations offering specialized diagnostic evaluations in Flanders (Centres for Developmental Disorders, Centres for Ambulatory Rehabilitation, Autism Reference Centres, Mental Healthcare Centres, Pupil Guidance Centres, and Ambulatory Services for Paediatric Psychiatry). A topic list was developed, based on a literature review on relevant themes. Qualitative data was categorized and iteratively compared per theme between focus groups by researcher and data triangulation. A member check validation was organized.
Results: 59 experts participated in 6 focus groups. Because of poor participation, the focus group with stakeholders from paediatric psychiatry was cancelled. The focus groups learn that it currently lacks coordination of activities, there is no shared vision on the content and goals diagnostic evaluation, there is an unequal regional distribution of organizations. Interorganizational and interprofessional collaboration is restricted to referral, without integration of care. There is poor mutual trust in the quality of the diagnostic assessments between organizations. Mutual knowledge on activities and expertise, lacks. Regulations hamper interorganizational collaborations as well as different financing mechanisms between organizations. Current organization of the field focuses on organizations’ interests and do not take into account the specific children’s and context’s diagnostic needs during their trajectory.
Conclusion: A patient-centred, integrated, stepped care, network model integrating general specialized and highly specialized knowledge and expertise (for different developmental disorders) across organizations borders in a well thought regional approach, is expected by all stakeholders to improve accessibility to specialized diagnostic evaluations adapted to the care trajectory of the child with a developmental disorder.
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Choudhary, Payal, M. Asif e Suresh Goyal. "Clinical and biochemical profile among children admitted with diabetic ketoacidosis and their correlation in prognosis of children admitted in pediatric intensive care unit". International Journal of Contemporary Pediatrics 11, n.º 6 (27 de maio de 2024): 661–68. http://dx.doi.org/10.18203/2349-3291.ijcp20241345.
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Background: The present study aimed to analyse clinical and biochemical profile among children admitted with diabetic ketoacidosis (DKA) and their correlation in prognosis of children admitted in PICU. Methods: The prospective study was conducted in pediatric intensive care unit (PICU) of RNT medical college, Udaipur among 50 DKA children in the age group of (1 month-18 years) for a period of one year after approval of institutional ethics committee. In the study, HbA1c level was measured by automated analyzer method to find out the past 3-month duration of glycemic control. Pearson correlation coefficient was used to find the correlation between serum osmolality and GCS, serum osmolality and duration of hospital stay, correlation between HbA1c levels and GCS, HbA1c levels and duration of hospital stay. Result: The most common presenting complaint was respiratory distress (72%) followed by vomiting (54%), polyuria (34%), polydipsia (24%), pain in abdomen (24%), fever (24%) and polyphagia (4%). There was negative correlation between HbA1c and depressed sensorium, i.e. patients with higher HbA1c levels had poor GCS and it was statistically significant. Patients with higher HbA1c levels had longer duration of hospital stay, although this observation was not statistically significant. Conclusions: The present study concluded that patients presenting with DKA had severe derangement in acid-base parameters. The DKA patients who had higher serum osmolality and poor glycemic control had depressed sensorium at the time of hospital admission and a longer recovery time leading to a prolonged hospital stay, adding to the morbidity associated with the disease.
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Murmu, Nisha, Pushpa ., Anit Kujur, Vidya Sagar e Vivek Kashyap. "Epidemiological study on admission of infectious diseases in pediatrics department of a tertiary care hospital, Jharkhand, India". International Journal Of Community Medicine And Public Health 7, n.º 9 (28 de agosto de 2020): 3493. http://dx.doi.org/10.18203/2394-6040.ijcmph20203912.
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Background: Infectious diseases have a major contribution in the mortality and morbidity among children in India. The aim of our study was to assess the infectious diseases and the sociodemographic characteristics along with the assessment of awareness on mode of transmission of these diseases among the family members.Methods: This was a cross-sectional study done in Department of Pediatrics, RIMS, Ranchi, for a period of 6 months by consecutive sampling. Pre-tested, semi structured questionnaire was used for data collection and analysed in SPSS version 20.Results: A total of 220 children were included in the study. Majority of patients (60%) comprised of under 5 age group with male predominance (55%), with 84.1% children fully immunized, among which 54.1% were institutional deliveries and approx. 85.9% children were breast fed for more than 6 months. Malaria, being an endemic disease of Jharkhand affected maximum children (38.2%). Sanitation, (toilet facilities) was about 27% and hand hygiene was only 5% in the family members of the patients admitted. Thus lack of awareness and poor hand hygiene was an important finding in our result.Conclusions: Health education among the community should be the prime concern for the reduction of the diseases.
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Adhikari, Bhoj Raj, Mamata Shakya, Nisha Bhatta, Sumita Upadhya e Swagat Kumar Mahanta. "Dental Caries on Deciduous Molars among Children Visiting Dental Outpatient Department of a Tertiary Care Centre". Journal of Nepal Medical Association 61, n.º 268 (1 de dezembro de 2023): 919–22. http://dx.doi.org/10.31729/jnma.8360.
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Introduction: Dental caries is one of the most common, yet preventable childhood diseases. The aetiology of dental caries lies in the interplay between host, microorganism, substrate, and time. Risk factors for dental caries include physical, biological, environmental, behavioural, and lifestyle-related factors such as high numbers of cariogenic bacteria, inadequate salivary flow, insufficient fluoride exposure, poor oral hygiene, inappropriate methods of feeding infants, and poverty. Methods: This descriptive cross-sectional study was conducted on children who visited the dental outpatient department of Kathmandu University School of Medical Sciences, Dhulikhel Hospital from 15 June 2023 to 30 July 2023. Ethical approval was taken from the Institutional Review Committee of the same institute. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: The prevalence of dental caries on deciduous molars in children was 252 (93.33%)(90.35-96.30, 95% Confidence Interval). One-third of the children had visited dental clinics for the first time. Lack of topical fluoride application was seen in the majority of the children. Conclusions: The prevalence of dental caries on deciduous molars among pediatric patients was found to be higher than in other studies done in similar settings.
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Akinsete, Adeseye Michael, Michael R. DeBaun e Adetola A. Kassim. "Sickle Cell Disease Post-Transplant Care Challenges in Nigeria: Systematic Institutional Neglect of Medical Tourism". Blood 134, Supplement_1 (13 de novembro de 2019): 4568. http://dx.doi.org/10.1182/blood-2019-126120.
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Introduction: Allogeneic hematopoietic stem cell transplantation (Allo-HCT) is potentially curative in eligible patients with sickle cell disease (SCD). Long term survival remains a challenge following allo-HCT and factors that predict for longer term complications and late mortality include increased hospitalization within the first 100 days, low socioeconomic status and poor access to healthcare. A new cottage industry of medical tourism associated with allo-HCT has emerged where children and adults with SCD living in Africa are traveling to countries that provide allo-HCT. Recent advances in improved disease-free survival and overall survival has resulted in families seeking curative options outside of their low resource-setting. The decision for allo-HCT is heavily weighed to family preference without regards to post-transplant care in their local environment. Unfortunately, the long-term care required for many children following an allo-HCT transplant is usually not available in their home country. Thus, the family desiring an allo-HCT is put in an awkward situation where they may need to have follow-up care in their primary country at a medical facility where neither the expertise nor the resources are available to manage long-term complications of allo-HCT. To explore the relationship between transplant medical tourism and patients with SCD, we report a case series of children who received their allo-HCT in another country only to return back to Nigeria. Methods: We recently established a post-transplant care clinic at the Lagos University Teaching Hospital, Idi-Araba, Nigeria. This includes a multidisciplinary team of providers, physicians and nurses with expertise in transplant care, and collaboration from Vanderbilt University Medical Center, USA. All cases described received allo-HCT outside Nigeria and returned within 60-100 days post-transplant. Parental preference for curative option was main indication for seeking allo-HCT. Records were obtained through electronic and paper medical records. Results: All the four cases reported had sickle cell anemia (Hb SS). Cases 1-3 received reduced intensity haploidentical HCT with post-transplant cyclophosphamide (Haplo-HCT), using G-mobilized peripheral blood stem cell grafts from parental donors with sickle cell trait. They all received preconditioning with hydroxycarbamide, azacytidine, and hypertransfusion (Table). Case-1 was 2years old, initially evaluated at day +135 post-transplant, complications included grade-II acute GI graft-versus-host disease (GVHD) at day+37 post-transplant, febrile illness and pseudo-membranous colitis requiring repeat endoscopies and prolonged steroid therapy. Case 2 was 5-years-old, seen day+395 post-transplant self-discontinued immunosuppression and antimicrobial prophylaxis with no guidance (despite the original haplo-HCT required a minimum of 12 months of immunosuppression therapy). Similarly, Case 3 was 7-years-old, off immunosuppression prematurely, and yet to commence routine post-transplant immunizations. Case 4 was 5-year-old who received matched related myeloablative bone marrow transplant. He was seen at day +138 post-transplant. He had poor graft function, EBV reactivation requiring Rituximab chemotherapy. Other management challenges encountered by patient's post-transplant include timely monitoring of immunosuppression and graft function, provision of irradiated blood component transfusion support, provision of anti-malaria and anti-helminthic prophylaxis which are endemic locally. Further, no physician to physician contact was made to transfer the patient back to a hematologist or oncologist with knowledge about post-transplant medical care. Discussion: The argument for performing the allo-HCT in children moving back to a low-income country has to be weighed against the availability of a strategy for management of late complications of allo-HCT, such as chronic GVHD, infectious complications related to immune reconstitution, as well as endocrine and chronic metabolic syndromes. Ultimately, the decision to perform an allo-HCT in such situations must be done on a case-by-case basis with a clear contingency plan to manage transplant-related complications for at least 2 years after the procedure at a hospital with adequate transplant expertise and support measures. Disclosures No relevant conflicts of interest to declare.
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Atilola, Olayinka. "Where Lies the Risk? An Ecological Approach to Understanding Child Mental Health Risk and Vulnerabilities in Sub-Saharan Africa". Psychiatry Journal 2014 (2014): 1–11. http://dx.doi.org/10.1155/2014/698348.
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Efforts at improving child-health and development initiatives in sub-Saharan Africa had focused on the physical health of children due to the neglect of child and adolescent mental health (CAMH) policy initiatives. A thorough and broad-based understanding of the prevalent child mental-health risk and vulnerability factors is needed to successfully articulate CAMH policies. In this discourse, we present a narrative on the child mental-health risk and vulnerability factors in sub-Saharan Africa. Through an ecological point of view, we identified widespread family poverty, poor availability and uptake of childcare resources, inadequate community and institutional childcare systems, and inadequate framework for social protection for vulnerable children as among the risk and vulnerability factors for CAMH in the region. Others are poor workplace policy/practice that does not support work-family life balance, poor legislative framework for child protection, and some harmful traditional practices. We conclude that an ecological approach shows that child mental-health risks are diverse and cut across different layers of the care environment. The approach also provides a broad and holistic template from which appropriate CAMH policy direction in sub-Saharan Africa can be understood.
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Takele, Anduamlak Molla, Messay Gebremariam Kotecho e Philip Mendes. "The Poverty of Policy: Examining Care Leaving Policy in Ethiopia". Institutionalised Children Explorations and Beyond 8, n.º 2 (5 de janeiro de 2021): 260–71. http://dx.doi.org/10.1177/2349300320982399.
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International research consistently shows that young care leavers’ journey from care to emerging adulthood is characterised by adversities such as unemployment, poor academic performance, homelessness, involvement in criminal activities, mental illness and early parenthood. As research evidence points out, such negative outcomes are closely linked with the existence of multiple placements, lack of mentoring, limited connections with significant others, the absence of early preparation to leave care, and a dearth of or inadequate policy frameworks that entitle care leavers to use aftercare support schemes. In order to support care leavers’ transition from care to emerging adulthood, Global North countries have implemented an independent care leaving policy framework that serves as a scaffolding for challenges that would arise from care leavers’ exploration of the adult world upon leaving care. However, such experience in formulation of policy to empower care leavers to be an independent adult is not well developed in countries in Global South due to the infant nature of research on care leaving and a preference for addressing the issues of care leavers in the existing child policy frameworks rather than formulating a special policy that deals with care leaving. The status of Ethiopia in this regard is not different. Existing policy frameworks concerning children have failed to address the needs of Ethiopian care leavers despite the existence of over five million orphan and vulnerable children in the country most of whom are placed in institutional childcare centres. This article presents the case for an independent care leaving policy in Ethiopia to address the multifaceted needs of children in care and improve the care leaving service in the country. Thus, the study will shed light on the state of care leaving policy in the world and lessons for Ethiopia to support Ethiopia’s attempt to serve the most vulnerable children in care by developing its own care leaving policy.
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Acharya, Sharda, Bibechan Thapa, Rochak Kansakar, Henish Shakya, Ajaya Kumar Dhakal e Divya KC. "Stunting among Children Aged 6 to 59 Months Visiting the Outpatient Department of Pediatrics in a Tertiary Care Centre". Journal of Nepal Medical Association 61, n.º 264 (1 de agosto de 2023): 654–57. http://dx.doi.org/10.31729/jnma.8249.
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Introduction: Stunting refers to low height for age, resulting from chronic undernutrition, often linked to poor socio-economic conditions, maternal health, infant care, and nutrition. It hinders children's physical and cognitive development. In Nepal, over half of children under five suffer from malnutrition. Despite efforts, stunting remains high but has decreased from 57% in 1996 to 25% in 2022. The aim of the study was to find out the prevalence of stunting among children aged 6 to 59 months visiting the outpatient Department of Pediatrics in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among children aged 6 to 59 months visiting the outpatient Department of Pediatrics in a tertiary care centre after obtaining ethical approval from the Institutional Review Committee from 27 April 2023 to 15 July 2023. Anthropometric measurements were taken. World health organization standard growth charts for Z score was used appropriately for the completed age in months and gender of the child. A pre-designed questionnaire was used for face-to-face interviews. Convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Among 320 children, 46 (14.38%) (10.54-18.22, 95% Confidence Interval) children had stunting. Among those 46 children with stunting, 20 (43.47%) had severe stunting. Conclusions: The prevalence of stunting among children aged 6 to 59 months was found to be lower than other studies done in similar settings.
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DeBaun, Michael R., e Allison A. King. "Prevention of central nervous system sequelae in sickle cell disease without evidence from randomized controlled trials: the case for a team-based learning collaborative". Hematology 2016, n.º 1 (2 de dezembro de 2016): 632–39. http://dx.doi.org/10.1182/asheducation-2016.1.632.
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Abstract Since 1998, the National Institutes of Health has funded 5 randomized controlled trials (RCTs) for primary and secondary prevention of strokes in children with sickle cell anemia (SCA). In a systematic fashion, these trials have significantly advanced the care of children with SCA. In the absence of an RCT, clinicians are often compelled to make decisions at the bedside, based on experience, observational studies, and principles of hematology. We will provide an initial example that describes how a team-based, learning collaborative developed a multisite standard care protocol with a low budget (<$10 000 per year) to overcome the intrinsic limitations of advancing the care of neurologic complications in sickle cell disease (SCD). The critical components of this approach include: (1) regular meetings with the multidisciplinary team from multiple sites; (2) consensus regarding the best evidence-based neurologic management in multiple SCD centers; (3) an Institutional Review Board-approved protocol based on consensus standard care; (4) minimizing and ensuring accurate data collection; and most importantly, (5) a spirit of collaboration to improve the care of individuals with SCD. Four common neurologic problems and strategies for management in children and adults with SCD will be discussed: (1) secondary stroke prevention in high-income countries; (2) primary stroke prevention in low- and middle-income countries (LMICs); (3) poor academic performance in students; and (4) cognitive disability in adults. With a commitment to a team-based learning collaborative, incremental advances are possible for the neurologic care of children and adults with SCD.
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Ghoshal, Arunangshu, Mary Ann Muckaden, Chavi Garg, Jayanthi Iyengar, Anuja Damani e K. V. Ganpathy. "Child's Understanding of Cancer when Faced with Advancing Disease: A Retrospective Chart Review". Indian Journal of Medical and Paediatric Oncology 43, n.º 03 (junho de 2022): 262–69. http://dx.doi.org/10.1055/s-0042-1750208.
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Abstract Introduction It is difficult to comprehend a child's understanding of disease-related information as they might be unwilling to talk or feel inhibited about raising their concerns. Understanding children's perception is important to facilitate better communication in palliative care. Objectives To study child's understanding of advancing disease when referred to the Pediatric Palliative Care Services. Materials and Methods A retrospective chart review of 34 case record forms from March 2019 to March 2020 was conducted after obtaining a waiver of consent and Institutional Ethics Committee approval. The inclusion criteria were children having advanced cancer referred for palliative care, incomplete records were excluded. Data were analyzed using thematic analysis. Results Twenty-three were male, and 11 were female children, the mean age was 12 years. Five major themes were identified—the child's understanding of disease diagnosis and prognosis, nature of communication between parents and the child, barriers to communication, child's means of support, and interventions used during counseling. Conclusion Communication between children suffering from advanced cancer and their parents/caregivers is a sensitive issue, and noncommunication is often due to mutual effort to shield each other from the stress of difficult conversations. Lack of communication contributes to poor coping and forces children to seek comfort in other sources leaving parents distressed. Psychological interventions like resource building and psychoeducation are effective.
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Amiri, Mohamadreza. "Evaluation of Serum Vitamin D Levels in Foster's Children Care Center". Journal of Pediatric Health and Nutrition 1, n.º 2 (5 de janeiro de 2019): 1–8. http://dx.doi.org/10.14302/issn.2691-5014.jphn-18-2456.
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Vitamin D, the sunshine vitamin, is now recognized not only for its importance in promoting bone health in children and adults, but also for its other health benefits, including reducing the risk of chronic diseases such as autoimmune diseases, common cancer, and cardiovascular diseases. Ultraviolet radiation of the sun with wavelengths of 290-310 nm penetrates into the skin and converts 7-dehydrocholesterol to previtamin D3, which quickly transforms to vitamin D3. Vitamin D (D represents either D2 or D3) made in the skin or ingested through diet is biologically inert and requires two successive hydroxylations first in the liver on carbon 25 to form 25-hydroxyvitamin D 25(OH)D and then in the kidney for a hydroxylation on carbon 1 to form the biologically active form of vitamin D, 1,25-dihydroxyvitamin D (1,25(OH)2D) 1, 2, 14, 19. The concentration of the produced 25-hydroxy vitamin D in blood circulation is 1,000 times more than 1,25-dihydroxy vitamin D 4, and it is regarded as a standard indicator of vitamin D status in humans 3. 25-hydroxy vitamin D half-life is about 2-3 weeks and it is regulated by calcium (Ca), phosphorus (P), and serum parathyroid hormone (PTH) to some extent. 25-hydroxy vitamin D content also reflects the amount of vitamin D produced in the skin after exposure to sunlight or received through food intake 5, 6. Guidelines for vitamin D insufficiency/deficiency defined by serum 25(OH)D concentrations have been published from many countries and regions all over the world 7, 8, 9, 10, 11. Vitamin D deficiency is a pandemic problem. According to global estimations, more than one billion people around the world suffer from vitamin D deficiency. Among Iranian population, the incidence of vitamin D deficiency varies from 2.5 to 98.5% based on geographic area 12, 13. Various factors may give rise to vitamin D deficiency, including skin pigments, low levels of vitamin D in diet (insufficient fish oil and egg yolk intake), malnutrition, genetic factors, exclusive breast feeding, vitamin D deficiency of mother during pregnancy, prematurity, chronic use of drugs (e.g., anticonvulsants, aluminum-containing anti-acids, rifampcin, isoniazid, antifungal drugs, antiviral drugs, and glucocorticoids), winter and obesity 1, 13. Cultural habits, the need for full body coverage during outdoor activities and the lack of sunlight programs are the risk factors for low vitamin D levels in women 15, 16, 17. Children enter foster care due to early childhood adverse experiences such as poor prenatal and infant health care, food insecurity, chronic stress, and the effects of abuse and neglect. As a result, they are at higher risk for poor physical, psychological, neuroendocrine and neurocognitive outcomes compared to others. Foster children are at risk for growth and nutritional deficiencies due to their poor nutritional environment prior to placement in foster care. Insufficient caloric intake results in growth deficiencies. Evidence showed that the risk of stunting and underweight is high in this population 18. The risk of developing hypovitaminosis D was significantly higher in children living in foster homes. One reason is that they are at higher risk of child abuse, emotional deprivation and physical neglect than children living with their families. Moreover, these children most likely do not spend much time outdoors and they lack adequate sun exposure. Another reason is that as children grow up in institutional care, they shift from a diet of vitamin D–fortified formula milk to cooked food, which may not be fortified with vitamin D 1. Iranian government has made some efforts to apply efficient interventions to reduce the prevalence of vitamin D deficiency, and the country’s healthcare system should be managed through accurate planning. Yet, in this country, studies on vitamin D deficiency in children living in foster homes are very limited, and given that timely diagnosis and treatment of this deficiency is vital, this research is conducted in Ali Asghar foster home in Mashhad, Iran.
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Drobina, Liliia. "The Soviet system of institutional care and upbringing of children in the western regions of Ukraine after World War II". History Journal of Yuriy Fedkovych Chernivtsi National University, n.º 56 (30 de dezembro de 2022): 78–86. http://dx.doi.org/10.31861/hj2022.56.78-86.
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This research constitutes a relatively new area which has emerged from the previous study on the Soviet system of institutional care and upbringing of children, in particular, an established system of orphanages in the western regions of Ukraine after World War II. It should be noted that the issue of dealing with street children was of a significant political and ideological value and required considerable financial investments.Importantly, there is evidence that the problem of child homelessness has played a pivotal role for many years. Since, not every child in Ukraine had the opportunity to grow up in a favorable family environment as well as stabilize their family housing situations or home life. By and large, push-pull factors that contribute to child neglect and social orphanhood are multi-faceted; these factors include poverty of families, economic difficulties as well as deprivations from basic human needs. Therefore, the Soviet system of institutional care and upbringing of children established various education institutions, in particular, secondary boarding schools and orphanages.Overall, the social care system of the 40-50s of the twentieth century has much resemblance with the current situation in Ukraine (in the context of Russo-Ukrainian War), including a new wave of orphans. In those times, children who lost their parents or could not get in contact with them; children from low-income families; children from one-parent families were sent to orphanages. They were kept there until they received incomplete secondary or even comprehensive education. Moreover, it was noted that the category of special orphanages included boarding houses for disabled children – the blind, the deaf-and-dumb. Namely, since 1945 there were 4 such boarding houses in the western regions of Ukraine. The author’s focus revolves around the problem of the-then Soviet society’s education system, which facilitated both educational process management and developing labor skills in orphanages. Upon turning 16, children, when leaving orphanages, were given a referral for employment in state and public enterprises, institutions and organizations. At the same time, they were given a chance to continue their studies in educational institutions of the labor reserves system, they could proceed with their vocational education and training for craft apprentice and train engine drivers, vocational (plants and factories) schools, whilst disabled pupils were transferred to homes of disabled people. The entire system of vocational training in orphanages was primarily focused on unskilled workers.Noteworthy, the conveniences and facilities of post-war orphanages and boarding schools left much to be desired. Assessing orphanages’ amenities and quality of life, it is worth mentioning that in the post-war years of the twentieth century, children who were living outside the normal boundaries of family like the others, experienced a shortage in basic needs. Most people were malnourished, were living in poor conditions and were wearing out pre-war outfit and shoes. For children, who survived the famine and experienced occupation sufferings, vagrancy and begging, the orphanage served as a secured shelter.
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Kanter, Julie, Wally R. Smith, Payal C. Desai, Marsha Treadwell, Biree Andemariam, Jane Little, Diane Nugent et al. "Building access to care in adult sickle cell disease: defining models of care, essential components, and economic aspects". Blood Advances 4, n.º 16 (12 de agosto de 2020): 3804–13. http://dx.doi.org/10.1182/bloodadvances.2020001743.
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Abstract Sickle cell disease (SCD) is the most common inherited blood disorder in the United States. It is a medically and socially complex, multisystem illness that affects individuals throughout the lifespan. Given improvements in care, most children with SCD survive into adulthood. However, access to adult sickle cell care is poor in many parts of the United States, resulting in increased acute care utilization, disjointed care delivery, and early mortality for patients. A dearth of nonmalignant hematology providers, the lack of a national SCD registry, and the absence of a centralized infrastructure to facilitate comparative quality assessment compounds these issues. As part of a workshop designed to train health care professionals in the skills necessary to establish clinical centers focused on the management of adults living with SCD, we defined an SCD center, elucidated required elements of a comprehensive adult SCD center, and discussed different models of care. There are also important economic impacts of these centers at an institutional and health system level. As more clinicians are trained in providing adult-focused SCD care, center designation will enhance the ability to undertake quality improvement and compare outcomes between SCD centers. Activities will include an assessment of the clinical effectiveness of expanded access to care, the implementation of SCD guidelines, and the efficacy of newly approved targeted medications. Details of this effort are provided.
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Al Sofyani, Khouloud Abdulrhman. "Prevalence of burnout among the health team workers at paediatric intensive care unit". International Journal of Research in Medical Sciences 7, n.º 1 (26 de dezembro de 2018): 8. http://dx.doi.org/10.18203/2320-6012.ijrms20185354.
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Background: Paediatricians work in the ICU have to deal with babies who have serious or chronic conditions associated with multiple problems and they have to interact with their stressed and often fatigued parents. This makes them more exposed to developed burnout. This study aimed to estimate the prevalence of burnout among the paediatric health team at King Abdulaziz University Hospital and to determine the stress predictors among them.Methods: This cross-sectional study utilized the Maslach Burnout Inventory (MBI) that was distributed to the all the target group who filled it anonymously. The data were analysed using the Statistical Package of Social Science (SPSS) Version 16.Results: About 58 % of the participants had moderate grade burn out and 61 % of them had high grade of exhaustion. "Being single" and "being married with children" were significant predictors of burnout among the participants. The top five stressors for the participants were the poor work life balance, patient education, salary, volume of work and decision making in ICU. There was significant positive correlation between the degree of burnout and the lack of institutional resources (p=0.001), poor work life balance (p<0.001), volume of work (0.012), complexity of clinical work (p=0.009) and on call requirement (p=0.004).Conclusions: Large percent of pediatric ICU health team experienced high grade of emotional exhaustion compared to their national or international peers. There should be an interventional preventive plans to deal with such phenomenon.
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BUCHIGNANI, NORMAN, e CHRISTOPHER ARMSTRONG-ESTHER. "Informal care and older Native Canadians". Ageing and Society 19, n.º 1 (janeiro de 1999): 3–32. http://dx.doi.org/10.1017/s0144686x99007254.
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The number and relative proportion of older Native people in Canada are both increasing rapidly. So also is a social problems discourse asserting that informal care of older Native people by family and kin is traditional, and highly appropriate today. However, neither this discourse nor previous research satisfactorily address the informal care requirements of older Native people nor the gendered implications that high levels of informal care provision may have for Native caregivers. Informal care is provided to Canada's non-Native elderly people primarily by resident wives and non-resident daughters, and secondarily by husbands and sons. Data from the pan-provincial Alberta Native Seniors Study demonstrate that Native people aged 50 or more have comparatively high overall care requirements. Older Native Albertans are poor, and make extensive use of some government income support programmes. They also make moderate use of medical services. Extensive dependence on informal care, institutional barriers and local service unavailability lead Native seniors to under-utilise other formal programmes aimed generically at the older provincial population. Native seniors are much more likely to live with kin than are other Canadians. Informal care appears equally available to older women and men, and is provided chiefly by resident daughters, sons and spouses, and by non-resident daughters, sisters and sons. Extensive elderly caregiving requirements may impose a growing, double burden on many, who are also providing care for dependent children. Without further support, current and future requirements may significantly limit the options of caregiving women and men.
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Curley, Martha A. Q., R. Scott Watson, Elizabeth Y. Killien, Laura Beth Kalvas, Mallory A. Perry-Eaddy, Amy M. Cassidy, Erica B. Miller et al. "Design and rationale of the Post-Intensive Care Syndrome – paediatrics (PICS-p) Longitudinal Cohort Study". BMJ Open 14, n.º 2 (fevereiro de 2024): e084445. http://dx.doi.org/10.1136/bmjopen-2024-084445.
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IntroductionAs paediatric intensive care unit (PICU) mortality declines, there is growing recognition of the morbidity experienced by children surviving critical illness and their families. A comprehensive understanding of the adverse physical, cognitive, emotional and social sequelae common to PICU survivors is limited, however, and the trajectory of recovery and risk factors for morbidity remain unknown.Methods and analysisThe Post-Intensive Care Syndrome–paediatrics Longitudinal Cohort Study will evaluate child and family outcomes over 2 years following PICU discharge and identify child and clinical factors associated with impaired outcomes. We will enrol 750 children from 30 US PICUs during their first PICU hospitalisation, including 500 case participants experiencing ≥3 days of intensive care that include critical care therapies (eg, mechanical ventilation, vasoactive infusions) and 250 age-matched, sex-matched and medical complexity-matched control participants experiencing a single night in the PICU with no intensive care therapies. Children, parents and siblings will complete surveys about health-related quality of life, physical function, cognitive status, emotional health and peer and family relationships at multiple time points from baseline recall through 2 years post-PICU discharge. We will compare outcomes and recovery trajectories of case participants to control participants, identify risk factors associated with poor outcomes and determine the emotional and social health consequences of paediatric critical illness on parents and siblings.Ethics and disseminationThis study has received ethical approval from the University of Pennsylvania Institutional Review Board (protocol #843844). Our overall objective is to characterise the ongoing impact of paediatric critical illness to guide development of interventions that optimise outcomes among children surviving critical illness and their families. Findings will be presented at key disciplinary meetings and in peer-reviewed publications at fixed data points. Published manuscripts will be added to our public study website to ensure findings are available to families, clinicians and researchers.Trials registration numberNCT04967365.
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Tingo, Jennifer, Erika B. Rosenzweig, Steven Lobritto e Usha S. Krishnan. "Portopulmonary hypertension in children: a rare but potentially lethal and under-recognized disease". Pulmonary Circulation 7, n.º 3 (31 de julho de 2017): 712–18. http://dx.doi.org/10.1177/2045893217723594.
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Portopulmonary hypertension (PoPH) is defined by the combination of portal hypertension and precapillary pulmonary arterial hypertension (PAH). Very little is known about this process in pediatric patients but prognosis is generally poor. We review our institutional experience and report on five patients with pediatric PoPH. The median age of PoPH diagnosis was six years and PAH was 14 years. PAH diagnosis was made by echocardiogram in all patients, four of whom also had cardiac catheterization. The median mean pulmonary artery pressure (mPAP) was 48.5 mmHg (interquartile range [IQR] = 46–60) with a median pulmonary vascular resistance index (PVRi) of 9 WU*M2 (IQR = 8–22). All were acute pulmonary vasodilator testing non-responsive. All patients received targeted therapies. Three of five patients (60%) died despite an evidence-based approach to care. Of those who died, timing from the PoPH diagnosis to death ranged from three days to three years. Based upon our limited experience, PoPH is a disorder with significant mortality in childhood and challenges in treatment. Future research, focused on screening and early targeted treatment strategies, may alter the current dismal prognosis for these children.
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OA Enyuma, Callistus, Abdullah E Laher, Muhammed Moolla, Motara Feroza e Gbenga Olorunfemi. "A National survey describing the quality of care in Paediatric Emergency Departments of Tertiary Hospitals in Nigeria". African Health Sciences 24, n.º 2 (11 de julho de 2024): 328–47. http://dx.doi.org/10.4314/ahs.v24i2.35.
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Introduction: The outcome of paediatric emergency care is essential to the attainment of child-targeted sustainable development goals. We assessed the quality of paediatric emergency care among 34 tertiary Paediatric Emergency Departments (PED) in Nigeria. Methods: We conducted a cross-sectional process audit of recruited 34 PEDs in Nigeria. A paper questionnaire developed from the validated AAP/IFEM Guidelines for Care of Children in the ED was used to collect information on the PED settings, the processes of care and measurable patient outcome. Association between the regions, hospital volume category and other institutional attributes was conducted using chi-square, Results: The median (IQR) of paediatric visits and admissions to PEDs were 187.5 (120 - 300) and 107.5 (67 - 131) respectively. Over two-thirds (73.6 %,) of the PEDs had no set target Time-To-Physician consultation and the median (IQR) Length-of-Hospital Stay was 48 (0-72) hours.The majority of centres (90%) had patient safety tools but point-of-care-diagnostics (POCDs) were grossly deficient (23.5%). The mean protocol utilization score was 8.7 out of a maximum score of 34.The national crude death rate was 33.8 per 1000 children and there was no statistically significant relationship between the crude death rate and volume of hospital visits, (p-value=0.45) or geopolitical zones (p-value = 0.68). Conclusion: There was nationwide poor protocol utilization and non-availability of POCDs coupled with a high mortality rate at the PEDs. Development and utilization of locally relevant protocols and improvement in the availability of POCDs are essential. Keywords: Paediatrics; Emergency Department; Nigeria; quality of care; National survey.
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Joshi, Prakash, Bishnu Rath Giri, Najala Khatun, Bina Prajapati e Subhana Thapa Karki. "An audit of Pediatrics Inpatients in General Pediatrics Department of Tertiary Care Children’s Hospital". Nepal Medical Journal 2, n.º 1 (1 de agosto de 2019): 55–61. http://dx.doi.org/10.37080/nmj.41.
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Introduction: In Nepal currently there are very few reports about disease spectrum in pediatric inpatients. This study was conducted to determine the pattern of morbidity among pediatric inpatients aiming that the result thus obtained will help in proposing strategies for future healthcare planning and resource allocation.
Methods: This was a descriptive cross sectional study conducted at Kanti Children’s Hospital from January 2017 to December 2017, after taking ethical approval from Institutional Review Committee (Ref. no:14/075-076) of the hospital. Data on age, sex, diagnosis, date of admission and discharge was extracted from hospital record of 5,128 admitted children. Data were entered into MS Excel and analyzed using SPSS 16. The results were expressed as number, proportion and median.
Results: Out of 5,128 admitted patients 3,240 (63.18%) were male and 1,888 (36.81%) female. Children between 1 to 60 months were 3,225 (62.89%) of which infant constitute 1617 (50.13%). The leading causes of hospitalization were pneumonia, sepsis, enteric fever, bronchiolitis, congenital heart diseases and nephrotic syndrome constituting 898 (17.51%), 658 (12.83%), 274 (5.34%), 268 (5.22%), 227 (4.42%) and 221 (4.30%) of total admission respectively. System-wise, respiratory tract infection 1,308 (25.50%) was most common followed by ‘Other infectious diseases’ 1069 (20.85%), nephrology 607 (11.83%), gastro-intestinal tract 592 (11.54%), neurology 487 (9.49%), hematology 281 (5.47%) and cardiac system 278 (5.42%).
Conclusions: Majority of the children affected were under-five, residing outside the capital city. Respiratory infection and other infectious diseases were major cause of childhood morbidity. Programs like Integrated Management of Neonatal and Childhood Illness (IMNCI) needs to be strengthened, in resource poor country like ours.
Keywords: Inpatients; morbidity; neonate.
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Arvind Kumar Vimal e Pankaj Kumar. "Community Based Cross- Sectional Study to Assess the Utilization Pattern of Antenatal Health Care Services among Married Women of Reproductive Age Group in a Rural Area of Bihar". Asian Journal of Medical Research 9, n.º 1 (29 de abril de 2020): CM01—CM03. http://dx.doi.org/10.47009/ajmr.2020.9.1.cm1.
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Background: ANC services is important to ensure safe motherhood. The present study was conducted to assess the utilization of ANC services in rural area.Subjects and Methods:The present study was community based cross-sectional in nature conducted upon 180 currently married women having children of less than one year of age and living in the area covered by rural training center of the institute. Sociodemographic profile and details of utilization of ANC services were noted.Results:Most of the respondents belonged to the age group of 20-30 years. 37.2% of them were illiterate and 58.9% lived in nuclear family. 53.9% had institutional delivery and 42.2% had more than two children. 42.8% of mothers registered their pregnancy before 12 weeks. Only 17.2% mothers had four or more ANC visits. 87.2% of them were fully immunized against tetanus but only 11.1% consumed 100 or more IFA tablets. Lack of awareness was responsible in 28.2%, lack of transport in 16.8%, unwillingness in 34.2% and other reasons in 20.8% cases among the mothers not utilizing ANC services properly.Conclusion: Utilization of ANC services is poor in this area.
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Jose, Swetha E., Navya C. Joseph, Soorya Sheela e Vidhu M. Joshy. "Knowledge, attitude and practice of fathers about childhood immunization: a tertiary care hospital based cross sectional study". International Journal Of Community Medicine And Public Health 7, n.º 5 (24 de abril de 2020): 1932. http://dx.doi.org/10.18203/2394-6040.ijcmph20202008.
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Background: Immunization is globally recognized as one of the most powerful, safe, and cost-effective for the prevention/control of some childhood diseases. Father's involvement is essential for the successful immunization of the child, as man is the head of the family and he takes responsibility for all decision’s measures including health and financial issues. Fathers having good knowledge of RI are likely to encourage their children to assess immunization services. This study thus aimed at assessing the knowledge, attitude and practice of fathers, uptake of RI and its associated factors. To assess the knowledge, attitude and practice of fathers about childhood immunization.Methods: After obtaining institutional ethical clearance we interviewed 110 fathers who have children within the age group 9 months to 2 years who attended the pediatric OP and their knowledge, attitude and practice about immunization was analyzed.Results: Out of 110 fathers interviewed majority come from joint family (91.8%) and had secondary education only (42.7%). Majority were skilled workers (65.5%). Only 0.9% had child death in their family and only 2.7% had a history of vaccine preventable disease in their family. Only 10.9% had good knowledge, 99.09% had good attitude and only 32.7% had good practice.Conclusions: It was found that majority of fathers had poor knowledge and practice about childhood immunization. More awareness programs have to be done in order to improve the routine immunization.
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Mose, Ayenew, Merga Dheresa, Bezatu Mengistie, Biresaw Wassihun e Haimanot Abebe. "Colostrum avoidance practice and associated factors among mothers of children aged less than six months in Bure District, Amhara Region, North West, Ethiopia: A community-based cross-sectional study". PLOS ONE 16, n.º 1 (29 de janeiro de 2021): e0245233. http://dx.doi.org/10.1371/journal.pone.0245233.
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Introduction The World Health Organization and the United Nations International Children’s Emergency Fund jointly recommend colostrum feeding immediately following delivery of the newborn. Colostrum avoidance is the practice of discarding colostrum at least once within the first three days after delivery of the newborn. Colostrum contains antibodies that protect the newborn against disease. Despite this fact, many Ethiopian mothers see colostrum feeding as a cause of neonatal morbidity and mortality, and they believe colostrum should be discarded to alleviate its effects. However, the cause of this misconception about colostrum is not well researched in Ethiopia, particularly in the study area. Objective To assess the prevalence of colostrum avoidance and associated factors among mothers of children aged less than six months in Bure district, Amhara Region, North West, Ethiopia. Methods A community-based cross-sectional study was conducted from March 1st to 30th, 2019 in Bure district. Structured questionnaires and face to face interviews were used to collect data from 621 study participants. Multistage sampling technique was used to select study participants. Data were entered into Epi Data version 4.2.0 and then exported to Statistical Package for the Social Sciences version 23. Bivariate and multivariate logistic regression analyses were performed to identify predictors of colostrum avoidance practice. Results Six hundred twenty-one (621) mothers of children aged less than six months participated. The prevalence of colostrum avoidance was 14.5% (95%CI; 11.5–17.4). The multivariate analysis indicated that home delivery [AOR = 3.350, (95%CI; 2.517–14.847)], giving birth through cesarean section [AOR = 3.368, (95%CI; 1.339–8.471)], no participation in an antenatal care group [AOR = 1.889, (95%CI; 1.144–3.533)], poor knowledge of mothers about colostrum [AOR = 3.44, (95%CI; 2.45–4.977)], and poor attitude of mothers towards colostrum [AOR = 3.053, (95%CI; 1.157–8.054)] were important predictors of colostrum avoidance practice. Conclusion and recommendations Home delivery, giving birth through cesarean section, no participation in an antenatal care group, poor knowledge of mothers about colostrum, and poor attitude of mothers towards colostrum were significantly associated with colostrum avoidance practice. Therefore, health care workers in the district should promote institutional delivery, reduce the magnitude of cesarean section, encourage pregnant mothers to participate in an antenatal care group, and enhance maternal awareness about the merits of colostrum feeding. Moreover, health educations for mothers to have a positive attitude towards colostrum are important recommendations to be taken to prevent the further practice of colostrum avoidance.
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Sood, Mangla. "Institutional births analysis from labour room registries in North Indian hilly state". International Journal of Contemporary Pediatrics 7, n.º 4 (21 de março de 2020): 838. http://dx.doi.org/10.18203/2349-3291.ijcp20201140.
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Background: India is the second most populous country in the world contributing to one fifth of global deaths among under 5-year-old children. Of these under 5 deaths, Infant mortality contributes to more than 89% and neonatal mortality is responsible for 70% of IMR. Of the many proximal determinants of neonatal mortality, inadequate utilization of health services and poor skills of health care providers contribute significantly. The lack of data constrains targeted interventions for these. This study is an attempt to analyze the existing data quality along with gaps in the reporting system to initiate timely course correction for improved programmatic outcomes.Methods: The labour room birth registries from 12 District hospitals and two Government Medical Colleges in the state of Himachal Pradesh (India) were analyzed. The data was extracted from archives in the State Child health Nodal Officer for the year 2017-2018 and 2018-2019.Results: Over these two years the proportion of institutional delivery has improved. The number of newborns resuscitated remained constant at 4.5%. There was an improved coverage of birth dose immunization. Improvement in Antenatal Corticosteroids coverage among preterm laboring mothers was also observed.Conclusions: Continuous data analysis for improving its quality to take evidence informed decisions is needed. Hands on skill improvement for staff is need of the hour to ensure timely and maximum returns on investment in reproductive and Child Health program.
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Patel, Sachit A., Jeffrey S. DeMare, Edward J. Truemper e Joseph J. Deptula. "Successful Use of Venovenous Extracorporeal Membrane Oxygenation for Complicated H1N1 Pneumonia Refractory to Mechanical Ventilation". Journal of ExtraCorporeal Technology 43, n.º 2 (junho de 2011): 70–74. http://dx.doi.org/10.1051/ject/201143070.
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In April 2009, novel H1N1 influenza A pneumonia was initially identified in young adults by the Mexican Health Ministry. Previously healthy patients progressing to multisystem organ failure were common. Worldwide, hospitals reported surges in intensive care admissions during the initial phase of the pandemic. In patients with H1N1 pneumonia refractory to mechanical ventilation, centers were initially reporting low survival rates despite the use of extracorporeal membrane oxygenation (ECMO). The initial poor outcomes and protracted ECMO treatment epochs resulted in centers limiting or withholding the use of ECMO in this population. With respect to children with H1N1 infection there was uncertainty concerning optimal incorporation of ECMO as a therapeutic option. In children with rapidly progressive pneumonia and hypoxia refractory to mechanical ventilation, venovenous (VV) ECMO has been successfully used with survival ranging from 40–60% depending on the etiology. We report the successful use of VV ECMO in two children with confirmed novel H1N1 complicated by bacterial pneumonia or morbid obesity. Our Institutional Review Board waived the need for consent. Prompt initiation of VV ECMO resulted in rapid clinical improvement, radiographic resolution of diffuse consolidation, and return of full neurocognitive function. For children with rapidly progressive respiratory distress on conventional ventilation, VV ECMO can be used to improve outcomes when initiated early in the disease process even in children with a significant co-morbidity.
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Baker, John, Kathryn Berzins, Krysia Canvin, Sarah Kendal, Stella Branthonne-Foster, Judy Wright, Tim McDougall, Barry Goldson, Ian Kellar e Joy Duxbury. "Components of interventions to reduce restrictive practices with children and young people in institutional settings: the Contrast systematic mapping review". Health and Social Care Delivery Research 10, n.º 8 (maio de 2022): 1–180. http://dx.doi.org/10.3310/yvkt5692.
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Background Incidents in which children or young people experience severe distress or harm or cause distress or harm to others occur frequently in children and young people’s institutional settings. These incidents are often managed using restrictive practices, such as restraint, seclusion, sedation or constant observation; however, these also present significant risks of physical and psychological harm to children and young people as well as staff. Numerous interventions aim to reduce the use of restrictive techniques, but research is hampered by limited attention to specific intervention components. The behavior change technique taxonomy may improve reporting by providing a common language for specifying the content and mechanisms of behaviour change. This study aimed to identify, standardise and report the effectiveness of components of interventions to reduce restrictive practices in children and young people’s institutional settings. Objectives To map interventions aimed at reducing restrictive practices in children and young people’s institutional settings internationally, to conduct behaviour change technique analysis of intervention components, to identify process elements, and to explore effectiveness evidence to identify promising behaviour change techniques and compare the results with those found in adult psychiatric inpatient settings in a companion review. Design Systematic mapping review with programme content coding using the behavior change technique taxonomy. Review methods Eleven relevant English-language health and social care research databases 1989–2019 [including Applied Social Sciences Index (ASSIA), Criminal Justice Abstracts, Educational Resources Information Center (ERIC), MEDLINE and PsycInfo®], grey literature and social media were searched during 2019 (updated January 2020). Data extraction, guided by Workgroup for Intervention Development and Evaluation Research (WIDER), Cochrane Library and theory coding scheme recommendations, included intervention characteristics and study design and reporting. Screening and quality appraisal used the Mixed Methods Appraisal Tool. The behavior change technique taxonomy was applied systematically, and interventions were coded for behaviour change technique components. Outcomes data were then related back to these components. Results There were 121 records, including 76 evaluations. Eighty-two interventions, mostly multicomponent, were identified. Evaluation approaches commonly used a non-randomised design. There were no randomised controlled trials. Behaviour change techniques from 14 out of a possible 16 clusters were detected. Four clusters (i.e. goals and planning, antecedents, shaping knowledge, and feedback and monitoring) contained the majority of identified behaviour change techniques and were detected in over half of all interventions. Two clusters (i.e. self-belief and covert learning) contained no identified behaviour change techniques. The most common setting in which behaviour change techniques were found was ‘mental health’. The most common procedure focused on staff training. The two most common behaviour change techniques were instruction on how to perform the behaviour and restructuring the social environment. Promising behaviour change techniques included instruction on how to perform the behaviour, restructuring the social environment, feedback on outcomes of behaviour and problem-solving. Compared with the companion review, service user perspectives were more sparse and there was more interest in trauma-informed approaches. Effectiveness evidence, range of interventions and reporting were broadly similar. Limitations Poor reporting may have prevented detection of some behaviour change techniques. The finding that the evidence was weak restricted the feasibility of examining behaviour change technique effectiveness. Literature searches were restricted to English-language sources. Conclusions This study generated, to our knowledge, the first review of evidence on the content and effectiveness of interventions to reduce restrictive practices in children and young people’s institutional settings. Interventions tend to be complex, reporting is inconsistent and robust evaluation data are limited, but some behaviour change techniques seem promising. Future work Promising behaviour change techniques could be further explored. Better evidence could help address the urgent need for effective strategies. Study registration This study is registered as PROSPERO CRD42019124730. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 8. See the NIHR Journals Library website for further project information.
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Ghimire, Nirmala, Roshani Agrawal Khatry e Vivechana Shakya. "Maternal health services utilization among mothers in a rural municipality". Journal of Patan Academy of Health Sciences 8, n.º 1 (29 de abril de 2021): 121–31. http://dx.doi.org/10.3126/jpahs.v8i1.36861.
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Introduction: Maternal health is essential to ensure the good health of the mother as well as children and by extension, the whole family. Despite the various measures launched by the government to enhance maternal care services, the utilization remains at large.
Method: A community-based face to face interview was conducted using a pre-tested structured survey questionnaire to find out maternal health service utilization among mothers in Mahankal Rural Municipality, Lalitpur, Nepal, during Feb-Jun 2020. A probability simple random sampling was used to select mothers having children aged between 1 to 3 y. A score of ≥mean was considered good utilization and below it a poor utilization. The study was approved by the ethical committee. The SPSS 16 was used for descriptive (frequency, mean) and comparative analysis by chi square between demographics and health service utilization.
Result: There were a total of 178 mothers surveyed, the mean age of 25.9±4.4 y, 77(43.3%) had completed elementary school, and 147(82.6%) were farmers. Good utilization of maternal health service 98(55%) and poor utilization 80(45%). The majority 153(86%) had ≥4 Antenatal checkups, 55(30.9%) had delivered at home despite the government incentive for institutional delivery, 105(59%) had postnatal visits ≥1, and 18(10%) had 3 postnatal visits.
Conclusion: The study revealed that slightly more than half (55%) of mothers surveyed had good utilization of maternal health services.
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McPhillips, Kathleen. "Religion after the Royal Commission: Challenges to Religion–State Relations". Religions 11, n.º 1 (15 de janeiro de 2020): 44. http://dx.doi.org/10.3390/rel11010044.
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The findings and recommendations emanating from the Australian Royal Commission into Institutional Responses to Child Sexual Abuse (2012–2017) have advised religious organisations that they need to undertake significant changes to legal, governance and cultural/theological practices. The reason for urgency in enacting these changes is that religious organisations were the least child safe institutions across all Australian organisations, with poor practices of transparency, accountability and responsibility coupled with a tendency to protect the reputation of the institution above the safety of children in their care. In Australia, new state laws have been enacted and are impacting on the internal governance systems of religious organisations, including removing the secrecy of the Catholic confessional, instituting mandatory reporting of child abuse by clerics and criminalising the failure to report child sexual abuse. Religious organisations have moved to adopt many of the recommendations regarding their troubled governance including the professionalisation of religious ministry; adoption of professional standards; and appropriate redress for survivors and changes to religious laws. However, these changes signal significant challenges to current church–state relations, which have been characterised by positioning religious organisations as special institutions that enjoy exemptions from certain human rights legislation, on the basis of protecting religious freedom. This article examines and evaluates the nexus between state and religion in Australian public life as it is emerging in a post-Royal Commission environment, and in particular contested claims around the meaning and value of religious freedom versus the necessity of institutional reform to ensure that religious organisations can demonstrate safety for children and other vulnerable groups.
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RIMHANEN-FINNE, R., T. NISKANEN, S. HALLANVUO, P. MAKARY, K. HAUKKA, S. PAJUNEN, A. SIITONEN et al. "Yersinia pseudotuberculosiscausing a large outbreak associated with carrots in Finland, 2006". Epidemiology and Infection 137, n.º 3 (4 de janeiro de 2008): 342–47. http://dx.doi.org/10.1017/s0950268807000155.
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SUMMARYA large outbreak ofYersinia pseudotuberculosisO:1 infection affected over 400 children from 23 schools and 5 day-care centres in two municipalities in southern Finland in August–September, 2006. A retrospective cohort study conducted in a large school centre showed that the outbreak was strongly associated with the consumption of grated carrots served at a school lunch. The risk of illness increased with the amount of carrots eaten. Poor quality carrots grown the previous year had been delivered to the school kitchens in the two municipalities affected. In the patients' samples and in the environmental samples collected from the carrot distributor's storage facility, identical serotypes and genotypes ofY. pseudotuberculosiswere found, but the original source and the mechanism of the contamination of the carrots remained unclear. Outbreaks ofY. pseudotuberculosislinked to fresh produce have been detected repeatedly in Finland. To prevent future outbreaks, instructions in improved hygiene practices on the handling of raw carrots have been issued to farmers, vegetable-processing plants and institutional kitchens.
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Fuller, Bruce, Costanza Eggers-Piérola, Susan D. Holloway, Xiaoyan Liang e Marylee F. Rambaud. "Rich Culture, Poor Markets: Why Do Latino Parents Forgo Preschooling?" Teachers College Record: The Voice of Scholarship in Education 97, n.º 3 (março de 1996): 400–418. http://dx.doi.org/10.1177/016146819609700303.
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Debates rage in the K-12 sector over the probable effects of school-choice programs—often with scarce evidence of their institutional dynamics and local effects. Meanwhile, the preschool sector has become a lively and sizable mixed market of public and private organizations, financed by parental fees and over $6 billion in public funds each year. The sector offers an intriguing setting for studying the long-term access and equity effects that result from liberalized market conditions. This article focuses on the considerably lower proportion of Latino parents who select a formal preschool or child-care center for their three- to five-year-old youngsters. We empirically focus on the influence of ethnicity, maternal education, family structure, and preliteracy practices on parents’ propensity to select preschools and center-based programs. After controlling for the effects of maternal employment and household income, we find that children—across all ethnic groups—are less likely to enter preschools when they are younger (age three, not four-five years), when a father or a nonpatent adult resides in the household, when the mother has low school attainment, and when children's books are less evident in the household. Latino families are distinguished, in part, by these family characteristics; in addition, the negative relationship between Latino status and nonselection of a preschool persists after accounting for these effects. We then report initial qualitative evidence, revealing clear cultural conflicts that may discourage Latinos’ use of preschools. We discuss the importance of understanding how ethnic variation in family structure and cultural preferences regarding child rearing interact with secular conceptions of liberalized markets.
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Roy, Dipankar, Munmi Sarma, Joydeep Roy e Kinnor Das. "Determinants of immunisation of children under 2 years of age in Rural Barak Valley: An explorative study". IP International Journal of Medical Paediatrics and Oncology 8, n.º 1 (15 de março de 2022): 24–30. http://dx.doi.org/10.18231/j.ijmpo.2022.006.
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In 1978, India launched the "Expanded Programme on Immunisation" (EPI) to minimise the prevalence of "Vaccine-Preventable Diseases" (VPDs). Despite years of health and medical progress, children in India continue to suffer from VPDs, and significant disparities in immunisation coverage may be seen among regions, states, socioeconomic groups, and other factors. Barak Valley's socioeconomic and environmental characteristics reveal an overall underdevelopment pattern. Furthermore, in the valley, healthcare services such as comprehensive immunisation institutional delivery are underutilised, resulting in poor immunisation coverage. Despite this evidence, there have been limited studies to identify the factors that influence child immunisation. In this context, this article is a modest attempt to identify and quantify the inequality in socio-economic factors in explaining inequality in Child immunisation in rural Barak Valley. A multistage stratified random sampling was used to collect information on immunisation and related variables by using a pre-tested questionnaire from the universe of children aged between 12-23 months of rural Barak Valley. And, binary logistic regression model has been used to analyse the data and draw inferences. The immunisation coverage is the Barak Valley region is very poor. The highest immunisation coverage has been observed for the BCG vaccine, around 90%. And with 64% coverage, vaccination against measles stands at the bottom of the list. The extent of full immunisation in the valley is not satisfactory at all. Around 54% of children aged 12-23 months have received all the WHO recommended vaccines, implying half of the eligible children are left out. The study identifies religion, a strong cultural affiliation that significantly influences the immunisation coverage of the child. Furthermore, the gender of the child, unequal access to ante-natal care, and birth order of the child are the prime factors associated with inequality in child immunisation in the region.
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Sharma, Mohan Kumar, Shanti Prasad Khanal, Ramesh Adhikari e Jib Acharya. "Maternal health care services in Nepal: A qualitative perspective based on the socio-ecological model". Journal of Health Promotion 9, n.º 01 (30 de novembro de 2021): 42–54. http://dx.doi.org/10.3126/jhp.v9i01.40961.
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Nepal has a high Maternal Mortality Rates (MMR) in the South Asian region, partly due to the poor utilization of maternal and child healthcare services. The study aims to explore the influencing factors of maternal and child healthcare services among Nepalese women. Eighteen women, who had seven-days-old-children and those recently accessed maternal and child healthcare practices, were purposively selected. The face-to-face, In-depth-Interview (IDI) was applied to collect the information. The data were thematically analyzed, where Socio-Ecological Model (SEM) was applied as a theoretical framework. The study showed that the factors such as the knowledge of women, perception, and decision-making-autonomy at individual levels influenced maternal and child healthcare-seeking behaviors. Likewise, mothers-in-law and the role of husbands at intrapersonal levels, employment at institutional levels, peers and role of neighbors at community levels, and safe motherhood program at policy levels were significant factors for the utilization of maternal and child healthcare-seeking-behaviors. The negligence of women concerning pregnancy, inadequate health facilities, lack of specialist health workers with advanced equipment, and cultural taboos and beliefs were observed as score barriers for utilization of maternal and child health-seeking behaviors. The research strongly recommends that all women be aware of maternal and child healthcare and health-seeking behaviors at their initial ages.
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Gupta, Atul, e Har Ashish Jindal. "EPISTEMOLOGY IN MIGRANT COMMUNITY FOR BETTER HEALTH OUTCOMES IN PRIMARY HEALTH CARE OF NORTH INDIA - A CASE STUDY". International Journal of Advanced Research 10, n.º 09 (30 de setembro de 2022): 122–27. http://dx.doi.org/10.21474/ijar01/15332.
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The migrant community often lacks health care access due to poor health knowledge. Epistemology deals with the nature and scope of knowledge. Epistemology links the migrant community to health system with adequate knowledge to accept the health seeking behavior in lifestyle. Objective: To assess thesalutogenic health promotion model in primary health care for the migrant population. Methods: A qualitative analysis in the migrant community was conducted in a family with an antenatal case as the index case. The epistemological salutogenic health model of General Resistance Resources (GRR) and Sense of Coherence (SOC) was applied. A health promotion model was devised in accordance to the GRR and SOC. A health system intervention was also planned to improve health indicators. Results: The family had a better approach towards heath and preparedness towards the institutional delivery of the child. The children were immunized with appropriate documentation. The success story of the family turned the migrant community to act as a social support group for positive health. There were improvements in the health indicators of the urban slum improved. Conclusion: Usingepistemology aspects and salutogenic health promotion model bridged the gaps in the health system with the migrant community. The migrant community are often ignorant towards their health but with appropriate health promotion models their health needs can be addressed.
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M. V., Ramana Rao, e Naima Fathima. "A critical analysis of factors for delayed initiation of breast feeding in a district level hospital". International Journal of Reproduction, Contraception, Obstetrics and Gynecology 7, n.º 12 (26 de novembro de 2018): 4840. http://dx.doi.org/10.18203/2320-1770.ijrcog20184925.
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Background: Breastfeeding is the cornerstone for child survival. Poor breastfeeding practices contribute to 20 per cent of neonatal deaths and nearly 13 per cent of deaths in children below five years. In south Asia, 40% of the babies are initiated breastfeeding within one hour despite increase in institutional deliveries, 80%.Methods: This prospective study was conducted to critically analyse the factors for delayed initiation of breast feeding. A prospective study was carried out among randomly selected postnatal mothers in the postnatal ward of a district teaching hospital. Data was collected by face to face interviews using a pre-validated structured questionnaire.Results: Above 90% of the women did not know the importance of initiating breast feeding within one hour of delivery as none of them received antenatal counselling. Baby was not given to the mother in 90% of the cases. 70% believed that colostrum is not good for the baby. 60% gave pre-lacteal feeds and 60% reported pain of surgical site or perineum as the cause for delayed initiation of breast feeding.Conclusions: UNICEF estimates that if all children receive the benefits of breastfeeding – globally, 8,23,000 child deaths can be averted every year. All health care facilities should adopt Baby Friendly Hospital Initiative’s Ten successful steps for breast feeding to initiate early breast feeding within one hour to reduce morbidity and mortality of infants and under five children.
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Shin, Heeju. "A Study on the Effects of a Variety of Resources on Presenteeism of Single Parent Women". Korean Association of Health and Medical Sociology 65 (30 de abril de 2024): 5–34. http://dx.doi.org/10.37243/kahms.2024.65.5.
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The purpose of this study is to explore the factors pertinent to presenteeism, which has long-term effects on the quality of life of single- parent women and their children. Single-parent women are the most time-pressed and resource-poor group, as they are the sole breadwinners and caregivers in their households. This study analyzed data from the 6th Working Environment Survey conducted by the Korea Occupational Safety and Health Administration, and included 280 single-parent women and a total of 3,260 female workers living with children under the age of 18. The results are summarized as follows 1) Presenteeism among single-parent women living with children under 18 is higher than in other types of households; 2) Presenteeism among single-parent women is influenced by time pressures at work; 3) Adult family members living with single-parent women tend to lower presenteeism of single-parent women; and 4) Payment for time and effort at work is significantly associated with lower presenteeism of single-parent women. However, the problem of single-parent women's presenteeism cannot be solved at the individual level, such as formation of extended families, but requires institutional and policy alternatives to ensure that the right to care and the right to work are recognized as civil rights, while also addressing discriminatory and hierarchical labor market structures.
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Hamilton, Sharynne, Deborah Cleland e Valerie Braithwaite. "‘Why can’t we help protect children too?’ Stigma by association among community workers in child protection and its consequences". Community Development Journal 55, n.º 3 (6 de março de 2019): 452–72. http://dx.doi.org/10.1093/cdj/bsz004.
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Abstract Community workers provide critical support services to parents and families with children who may be placed in out-of-home care by child protection authorities. Drawing on in-depth interviews with fifteen community workers, who represent nine agencies assisting families with child protection issues in a small jurisdiction in Australia, we show how the stigma attached to ‘bad’ parents is passed on to the community workers who are supporting them. The ‘stigma by association’ directed at community workers by child protection authorities means they are stereotyped negatively, undermined professionally and socially excluded. In spite of such stigmatic treatment, community workers remained committed to their professional role. Although workers were frustrated and disappointed in the treatment they received, there was no open acknowledgment of stigma-induced poor mental health. The results are interpreted within a broader social context where child protection authorities are being constantly reviewed and criticized in Australia. The support that community workers give to each other as frontline defenders of families against a powerful and publicly criticized government authority may allow community workers to construe themselves as heroes rather than villains in this highly adversarial environment. The costs play out at the institutional level, however, because reduced trust limits opportunities for genuine collaboration between government and community organizations.
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Adhikari, Uma Rani, e Chandrima Paria. "Utilization of health services and its perceived barriers regarding infant care among tribal mothers in selected areas of West Bengal". International Journal Of Community Medicine And Public Health 9, n.º 4 (25 de março de 2022): 1766. http://dx.doi.org/10.18203/2394-6040.ijcmph20220852.
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Background: The tribal infant mortality rate in India was highest in the world among the indigenous populations. Utilization of child health services is poor in the tribal areas, due to presence of several barriers. The objective of the study was to assess the utilization of health services for infant, determining the perceived barriers of utilization of health services and finding the association between utilization of health services and selected socio-demographic characteristics.Methods: 100 mothers were selected by using purposive sampling technique. Self-developed tool was used for data collection after establishing validity and reliability. Data regarding participants’ profile was collected using a semi-structured interview schedule. To assess the utilization of health services, data were collected using record analysis proforma and semi structured interview schedule. A structured interview schedule was used to determine the perceived barriers of utilization of health services.Results: All mothers under the study utilized Institutional delivery and Immunization service for their children according to age. 65% of the mothers’ fully utilized health check-up service for their child during postnatal visit. Most of mothers (96%) received education for exclusive breast feeding for 6 months. Integrated Child Development Service was fully utilized by 74% mothers. Maximum (51%) of them fully utilized free treatment service for their children under JSSK. 63.46% mothers’ fully utilized Referral services. The study findings also show the presence of barriers among them like lack of awareness, lack of support person, financial barrier etc.Conclusions: Resolving the barriers to increase utilization of health services among tribal mothers is needed through improvement of their awareness.
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Joshi, Padam Raj, Saroj GC, Sushil Sah, Reshika Shrestha, Niharika Pathak, Sujata Maharjan e Pooja Paudyal. "Anaemia among Pregnant Women Visiting Obstetric Department of a Tertiary Care Centre: A Descriptive Cross-sectional Study". Journal of Nepal Medical Association 61, n.º 257 (1 de janeiro de 2023): 23–26. http://dx.doi.org/10.31729/jnma.7967.
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Introduction: Anaemia is one of the common health problems of pregnant women and children in developing countries. Anaemia in pregnancy is related to poor foetal and maternal outcomes contributing to significant morbidity and mortality. Anaemia is a treatable and preventable condition. The objective of this study was to find out the prevalence of anaemia in pregnant women visiting the Obstetric Department of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among the pregnant women visiting the Department of Obstetrics and Gynecology of a tertiary care centre for their antenatal checkup. The study was conducted from 2 November 2022 to 11 November 2022 after obtaining ethical approval from the Institutional Review Committee (Reference number: 11(6-11)E2/079/080). Pregnant women with a history of blood transfusion, anaemia of chronic disease like chronic kidney disease, history of recurrent bleeding, and referral cases from other centres were excluded from the study. Serum haemoglobin was used for diagnosing anaemia according to criteria given by the World Health Organization. Convenience sampling was used. Point estimate and 95% Confidence Interval were calculated. Results: Among 442 pregnant women, the prevalence of anaemia was 24 (5.43%) (3.32-7.54, 95% Confidence Interval). Conclusions: The prevalence of anaemia among pregnant women was lower in comparison to other studies done in similar settings.
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Jalali, Rakesh, Anupam Rishi, Jayant S. Goda, Epari Sridhar, Mamta Gurav, Pravin Sharma, Aliasgar Moiyadi, Prakash Shetty e Tejpal Gupta. "Clinical outcome and molecular characterization of pediatric glioblastoma treated with postoperative radiotherapy with concurrent and adjuvant temozolomide: a single institutional study of 66 children". Neuro-Oncology Practice 3, n.º 1 (6 de agosto de 2015): 39–47. http://dx.doi.org/10.1093/nop/npv024.
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Abstract Background Glioblastoma (GBM) in children is rare. Pediatric GBM have a distinct molecular profile as compared to adult GBM. There are relatively few studies of pediatric GBMs and no standard of care on adjuvant therapy. We aimed to evaluate the clinical outcome and molecular profile of pediatric GBM. Methods and Materials Between 2004 and 2013, 66 consecutive children with histologically proven GBM were identified from our database. The majority of the children underwent maximal safe resection followed by focal radiotherapy with concurrent and adjuvant temozolomide. Immunohistochemical staining was performed for p53, MIB-1 labeling index, MGMT overexpression, and EGFR amplification and isocitrate dehydrogenase (IDH1) R132H point mutation. Survival and impact of possible prognostic factors on outcomes were analyzed. Result Median survival was 15 months. The overall survival rate at 1 year was 62%, at 2 years was 30%, and at 3 years was 27%. Patients with thalamic tumors (P < .001), incompletely resected tumors (P < .00001), and tumors with MIB-1 labeling index >25% (P < .002) had poor overall survival rates. p53 was overexpressed in 74% of patients, MGMT promoter methylation was seen in 37% of patients, IDH1 mutation was seen in 4% of patients, and no patients had EGFR amplification. MGMT methylation and p53 overexpression did not impact survival. Conclusions Clinical outcome of pediatric GBM is similar to that reported for adult GBM. The frequency of p53 overexpression is higher than in adult GBM, while MGMT methylation, IDH1 mutations and EGFR amplification is lower than in adult GBM. MGMT methylation and p53 expression status do not have any prognostic significance.
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Alekhin, Igor N., Nadezhda S. Apkhanova, Ekaterina V. Dushina e Maria L. Prokopyeva. "Regional features of the incidence of mental disorders in the population (on the example of the Irkutsk region): a retrospective study". Kuban Scientific Medical Bulletin 28, n.º 5 (30 de outubro de 2021): 79–97. http://dx.doi.org/10.25207/1608-6228-2021-28-5-79-97.
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Background. Mental and behavioural disorders pose a pressing challenge in healthcare as pertaining to socially significant diseases. The significance is conditioned by high morbidity rates, including temporary and permanent disability, high fi nancial burden of medical care andregular social subsidy to target groups. According to the World Health Organisation, mental burden currently aggravates to entail serious social, human-rights and economic impact around the globe.Objectives. A study of regional dynamics of mental and behavioural morbidity in the Irkutsk Region over a seven-year period.Methods. A retrospective descriptive study used statistics data on primary and overall morbidity of definitely diagnosed mental and behavioural disorders (other than substance use disorders; F00–F09, F20–F99). The analysis of mental and behavioural illness incidence was based on statistical reports over the period of 2013–2019. The inclusion criterion was definite diagnosis of a mental and behavioural disorder (other than substance use disorder; F00–F09, F20–F99) in children, adolescents and adults. The main study indicators were the regional mental morbidity rate and prevalence, mental and behavioural morbidity rates among “dispensary care” and “medical counselling” outpatients, and primary morbidity rates by mental and behavioural nosology groups.Results. The article reports the regional traits of mental morbidity dynamics exhibiting a growing trend in Irkutsk Region. The morbidity traits of primary diagnoses have been analysed in dispensary care and medical counselling outpatients. Growing psychoneurologic visits are observed along with the institutional redirection of fi rst diagnoses towards decreasing the numbers of dispensary care vs. medical counselling outpatients. Thus, the structure of fi rst mental diagnoses changed towards prevailed medical counselling. Primary morbidity rate in male population is higher almost 1.5-fold in the study period. Primary morbidity elevated in both men and women. A primary morbidity analysis in different age cohorts reveals its growth in ages 0–14, 40–59 and >60 years.Conclusion. Our analyses reveal a lowering primary morbidity rate of mental disorders in outpatients taken for dispensary care, given the overall higher incidence. This may occur due to an institutional and instructional change in medical care provided to this patient category, including ineffective diagnosis, poor aid access and visit rate, statistical reporting design and possible changes in the criteria of taking for dispensary care. This fact requires improvements in the legal regulation of outpatient management of mental and behavioural illness at psychoneurologic institutions and the development of clear criteria of registering for dispensary care.
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Pollock, Allyson M., e Louisa Harding-Edgar. "Covid-19 and public health". Theory & Struggle 122, n.º 1 (1 de junho de 2021): 92–111. http://dx.doi.org/10.3828/ts.2021.10.
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The UK has the highest death rate from Covid-19 in the world, and it is vulnerable groups who have suffered the most. This article describes the multiple failures of government that led to this tragedy. The depletion of and disinvestment in public health services, communicable disease control and community health services over decades meant those reliant on these services were failed. The fundamental tenets of public health were set aside, and public health expertise ignored, in favour of establishing a parallel, privatised system for epidemic control which failed expensively and spectacularly. Long-established principles of infectious disease control and rules and standards for scientific evaluation were not followed, and our ‘world-class scientists’ fatally departed from World Health Organisation advice. Covid has been used as a cover for more privatisation and less scrutiny and accountability. It has exposed the gap between rich and poor and erosion in our public services. However, rather than ameliorating inequalities, the government has presided over enormous inter- and intra-generational transfers of harms and risks from rich to poor and to those in institutional settings, and from older prosperous people to children. Above all, Covid has been a cover for enormous transfers of wealth from the public purse and public services to private interests — notably in health services. There is a political solution to the undermining of public health, commercial conflicts and lack of public accountability: the government must bring forward legislation to reinstate a publicly funded, publicly operated and fully integrated National Health and Care Service, and set out clear plans for reinvestment and restoring and rebuilding health and care services.
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Dorris, Kathleen, Melissa Widener, Vladimir Amani, Andrew Donson, Debra Schissel, Jessica Carson, Ashley Mettetal et al. "EPCT-18. PHASE 0/I STUDY OF GM-CSF AND INTRATHECAL TRASTUZUMAB IN CHILDREN WITH RECURRENT POSTERIOR FOSSA EPENDYMOMA". Neuro-Oncology 22, Supplement_3 (1 de dezembro de 2020): iii307. http://dx.doi.org/10.1093/neuonc/noaa222.140.
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Abstract BACKGROUND Posterior fossa ependymoma (PF EPN) is a pediatric central nervous system malignancy that has a poor outcome to standard therapeutic approaches. The majority of PF EPN tumors have increased HER2 expression. Trastuzumab is a monoclonal antibody that targets HER2, and sargramostim (GM-CSF) stimulates hematopoietic progenitor cell proliferation. The combination of trastuzumab and GM-CSF has been shown to trigger antibody-dependent cell cytotoxicity in vitro in PF EPN cell lines. METHODS Children aged 1–21 years with relapsed PF EPN and no ventriculoperitoneal shunt or CSF obstruction are eligible for the Phase 0/I institutional trial at Children’s Hospital Colorado. Stratum 1 involves IT trastuzumab and subcutaneous (subQ) GM-CSF prior to standard-of-care surgical resection. Stratum 2 involves a 3 + 3 phase I design with serial IT trastuzumab doses, each preceded by three days of GM-CSF, to establish the MTD for IT trastuzumab. RESULTS Trastuzumab was detected in a sufficient number of tumors after presurgical IT delivery in Stratum 1 to open Stratum 2. Four patients (75% female) have been enrolled in Stratum 2 at trastuzumab Dose Level 1. Median age at enrollment is 9.8 years (range, 3.5–20.2 years). Preliminary CSF pharmacokinetic analysis demonstrated detectable trastuzumab up to 14 days after IT doses. No dose-limiting toxicities have occurred. Two patients progressed on therapy (median, 4 cycles). One patient is progression-free at 18 months off therapy. One patient remains on study therapy. CONCLUSIONS IT trastuzumab penetrates PF EPN tumor tissue. Stratum 2 remains open to accrual at Dose Level 2.
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Singh, Nishmeet, Phuong Nguyen, Samuel Scott, Sunny Kim, Sumanta Neupane, Zivai Murira, Rebecca Heidkamp, Zulfiqar Bhutta, Purnima Menon e Harriet Torlesse. "South Asia Is Far from Achieving Universal Coverage of Essential Nutrition Interventions: Examining Coverage, Trends, and Inequities, 2005 to 2018". Current Developments in Nutrition 4, Supplement_2 (29 de maio de 2020): 907. http://dx.doi.org/10.1093/cdn/nzaa053_112.
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Abstract Objectives South Asia carries the largest burden of malnutrition globally. Tracking coverage of nutrition interventions is a critical step in designing effective nutrition policies and monitoring progress in the region. This paper examines coverage, trends, and inequities in nutrition interventions in South Asia. Methods Data were from Demographic and Health Surveys in Afghanistan (2015), Bangladesh (2011, 2014), India (2006, 2015), Maldives (2009, 2017), Nepal (2011, 2016) and Pakistan (2013, 2018). We examined essential interventions spanning the continuum of care: 2 in the pre-conception period, 7 in pregnancy, 4 in postpartum and 9 in childhood. We calculated absolute changes, average annual change rates, and concentration indices to examine trends and inequalities in coverage and composite coverage index (CCI) over time by residence and wealth quintiles. Results Coverage of nutrition interventions has generally improved since 2005 but coverage levels remain low and varied. Improvements have occurred for consumption of iodized salt, institutional births, antenatal care, weight monitoring during pregnancy, zinc and ORS supplementation (16 to 34 percentage points, pp). However, coverage of some child-level interventions has decreased: full immunization, preventive deworming, vitamin A supplementation and postnatal care (−9 to −13 pp). Median regional coverage was below 75% for 17 of 22 interventions. Extremely low coverage persists for preventive deworming during pregnancy (10%) and daily Iron supplementation for children (5%), while high coverage (>80%) exists for consumption of iodized salt, attendance by a trained provider during pregnancy and weight monitoring during pregnancy. Large coverage gaps were found for CCI by wealth (10–45pp higher in rich, except Maldives) and residence (3–22pp higher in urban), with the gap decreasing over time in most countries. Conclusions Despite improvements in nutrition intervention coverage since 2005, universal coverage is still far from optimal and unequally affects poor, rural women and children in South Asia. More work is needed to close coverage gaps and measure the quality of nutrition interventions. Funding Sources BMGF through DataDENT.