Includes bibliographical references (leaves 106-112). / Measures of the severity of metabolic acidosis (base excess) and of the severity of the underlying acid-base derangements (levels of lactate, chloride, albumin, and strong ion gap) have been used to differentiate survivors from nonsurvivors in various types of adult critical illness, including states of severe hamodynamic compromise following cardiac surgery on cardiopulmonary bypass (CPB) and in septic shock. prognostic studies of acid-base data for critically ill children in the settings of post-operative cardiogenci shock and septic shock are relatively scarce. It has been suggested that hyperchloraemia migh be a benign phenomenon that should not prompt escalation of therapy. Although it is recognised that hypoalbuminaemia is associated with adverse outcome, and obscrues the extent of underlying metabolic acidosis, the significance of 'unmeasured' anions estimated from the strong ion gap remains controversial. It has been suggested that the admission lactate level is strongly predictive of paediatric intensive care unit (PICU) outcome in both shock states, but it is not known whether calculation of the lactate: pyruvate ratio would add prognostic value in children with either post-operative cardiogenic, or septic shock.

No description available.

Collecting and aggregating timely and rigorous data for sexual, reproductive, maternal, newborn, child, and adolescent health (SRMNCAH) services and outcomes evaluation in humanitarian settings is essential for accountability and transparency. However, reliable SRMCNAH data are scarce in such settings, and the quality of available data often varies across different humanitarian settings. Establishing a core set of SRMNCAH indicators that are feasible to collect in all humanitarian settings is the first step in developing and implementing a common core framework for monitoring SRMNCAH programs in such settings. Led by the World Health Organization, in 2018 a group of global experts in the SRMNCAH field proposed a core list of indicators for inclusion in routine data collection systems. In 2019-2022, a team at the University of Ottawa in partnership with local investigators led multi-method feasibility assessments in Afghanistan, Bangladesh, the Democratic Republic of Congo, and Jordan to understand the feasibility, relevance, and acceptability of the proposed core indictors. In this thesis I report on the results from the multi-methods assessment in Afghanistan. Based on a desk review, key informant interviews, facility assessments, facility observation sessions, and focus group discussions in three provinces, we explored national stakeholders’ perspectives on SRMNCAH data collection, in general, and the proposed indicator list, in particular. The findings of this assessment and the results from the other three countries will help stakeholders reach a consensus on the final list of SRMNCAH indicators that are feasible for collection in all humanitarian settings.

The consequences of childhood bereavement are two-fold, in the pain he/ she suffers at the time of the death, and in future psychiatric disorders which can follow unresolved mourning. The bereaved child needs a familiar and responsible adult outside the family to help him/her cope with his/her grief, because parents are sometimes emotionally absent from him/her due to their own grief or they seek to "protect" the child from the pain of the loss. This study presents a programme given to 164 primary school teachers from nine schools in Cape Town to educate them in how to help the bereaved child in the classroom situation, so that they can fill the role of an outside responsible adult in the life of the bereaved child. 78 bereavements occurred in the nine schools in the year of the study. It was found that the teachers responded positively to the training programme and that they perceived it to be helpful in dealing with a bereaved child.

Introduction: Maternal antenatal depression is associated with increased risk of adverse offspring outcomes, which manifest in approximately 20% of infants. However, the mechanisms by which risk is transferred from mother to infant, and the factors determining susceptibility to antenatal mood disturbance, remain poorly understood. Objectives: The primary objectives of this thesis are to investigate whether: (i) Antenatal depression is associated with alterations of the maternal and infant Hypothalamic-Pituitary-Adrenal (HPA) axis. (ii) The infant serotonin transporter genotype (5-HTTLPR) confers susceptibility to antenatal mood disturbance. Methods: This thesis is an analysis of two different cohorts. First, 103 pregnant women were recruited in Oxford, UK. Participants’ self-reported antenatal mood, and salivary cortisol was assessed in response to a stressor and diurnally. 88 participants were visited two months post-birth. Mothers reported postnatal mood and infant temperament. Infant cortisol responses to inoculation were assessed, as was infant DNA methylation. Analysis of this cohort addresses the first objective of this thesis. Next, data from the ALSPAC cohort was analysed to address the second objective. Maternal-reported antenatal mood and infant behaviour up to 7 years was available, as was 5-HTTLPR genotype data for over 4,000 infants. Results: Antenatal depression was not associated with increased maternal cortisol during pregnancy. Neither antenatal depression nor cortisol was associated with infant cortisol reactivity or temperament. Antenatal depression predicted increased NR3C1 DNA methylation in males, and decreased BDNF DNA methylation in male and female infants. Infant 5-HTTLPR genotype did not moderate associations between antenatal mood disturbance and behavioural difficulties. Conclusions: This thesis does not support the theory that antenatal depression exerts influence on infant development via increased activity of the maternal and infant HPA axis; however, changes in infant DNA methylation may be a mediating mechanism. Further, susceptibility to antenatal mood may be more complex than previously thought.

A investigação, aqui apresentada, buscou conhecer e analisar o cuidado institucional à criança e adolescente em situação de risco social, sob a visão de seus familiares e da equipe de profissionais que atua no abrigo da cidade de Jardinópolis, SP. A metodologia adotada é de abordagem qualitativa e utilizou-se como instrumentos de coleta de dados o mapa censitário, a observação livre e a entrevista semiestruturada, aplicada aos funcionários do abrigo e aos pais das crianças e adolescentes ali institucionalizados. Quanto à análise desses dados, escolhe-se a análise de conteúdo, modalidade temática. Identificou-se, a partir da caracterização do espaço pesquisado e dos atores estudados que as crianças e adolescentes institucionalizados são em sua maioria meninos, negros e pobres e o motivo pelo qual foram institucionalizados se destaca a negligência. Destacou-se ainda, que as famílias dessas crianças e adolescentes institucionalizados, são, em sua maioria, desempregados, possuem situação financeira desfavorável o que se relaciona ao baixo grau de escolaridade o que por sua vez diminuem as chances dessas famílias de se inserir no mercado de trabalho. A partir das falas dos entrevistados, emergiram três temáticas: o cuidado enquanto contexto de análise, a violência enquanto (re)construção dos espaços e a instituição como espaço de trabalho. Em relação à primeira temática, apreendeu-se que o cuidado se apresenta a partir de ações relacionadas com a alimentação, higiene pessoal, ambiental e cuidados relativos à saúde, sem incluir a prevenção de doenças. Além disso, os cuidadores ressaltam que realizam tais cuidados baseados em suas experiências como pais. Afirmam, também, que não utilizam o conhecimento técnico ao oferecer cuidados às crianças e adolescentes abrigados e que se sentem inseguros para tais prática. Dessa forma, evidencia-se a fragilidade da função cuidadora no arcabouço da construção do papel profissional. Em relação à segunda temática, verificou-se a violência simbólica, psicológica e até física praticada por esses cuidadores, aparecendo de uma forma naturalizada, necessária e integrante das relações de poder perpetradas no contexto institucional. Assim, pode-se pensar o cuidado institucional como mecanismo de controle disciplinar que a partir de Foucault abre-nos a possibilidade de maior compreensão dessa dinâmica de forças, sendo elas indefinidas, mutáveis e transitórias, de acordo com o contexto à qual se inserem. E, por fim, na terceira temática, apreendeu-se que a falta de políticas públicas adequadas e a fragilidade no modelo vigente de atenção à criança e adolescente exercem significativa influência no atendimento dentro das instituições de abrigo. De forma geral, percebese que há muita lacuna na sistematização do cuidado, dificultando que ele possa ser objetivado, mediante planejamento, com definição de objetivos, estratégias e avaliação permitindo que ele seja visto como produção de um trabalho profissional, estruturado nas reais necessidades dessa população. Pensar a criança e o adolescente como atores sociais ativos, envolvidos no cuidado da própria saúde, permite compreender que o cuidado dispensado nessas instituições de abrigamento pode e deve ser entendido como um processo dialético de mútua interação e construção. Os resultados obtidos na presente pesquisa levam a refletir, dialogar e intervir nessa realidade tão pouco conhecida. Acredita-se que a elucidação de tais significados na perspectiva dos atores sociais estudados proporcionará melhor entendimento e aproximação entre quem cuida e quem é cuidado, bem como oferecerá ao profissional subsídios que fundamentem suas ações para o atendimento das necessidades de cuidado institucionalizado manifestadas por essas crianças e adolescentes / The investigation, here presented, looked for to know and to analyze the institutional care to the child and adolescent in situation of social risk, under your relatives\' vision and of the professionals\' team that acts in the shelter of the city of Jardinópolis, SP. The adopted methodology is of qualitative approach and it was used as instruments of collection of data the map censitário, the free observation and the interview, applied to the employees of the shelter and the children\'s parents and adolescents there institutionalized. With relationship to the analysis of those data, it is chosen the content analysis, thematic modality. Identified, starting from the characterization of the researched space and of the actors studied that the children and institutionalized adolescents are in your majority boys, blacks and poor and the reason for which were institutionalized if it detaches the negligence. Still stood out, that those children\'s families and institutionalized adolescents, they are, in your majority, unemployed, possess unfavorable financial situation what he/she links to the bass of education degree that you/they reduce the chances of those families of interfering in the job market for your time. Starting from the interviewees\' speeches, three emerged thematic: \" the care while analysis \" context, the violence while (re)construction of the spaces \" and \" the institution as work space. In relation to the first thematic, it was apprehended that the care comes starting from actions related with the feeding, hygiene personal, environmental and relative cares to the health, without including the prevention of diseases. Besides, the caretakers point out that accomplish such cares based on your experiences as parents. They affirm, also, that don\'t use the technical knowledge when offering cares to the children and sheltered adolescents and that feel insecure for such practice. In that way, the fragility of the function caretaker\'s insert is evidenced in the context of the construction of the professional paper. In relation to thematic second, the violence symbolic, psychological was verified and even physics practiced by those caretakers, appearing in a naturalized way, necessary and integral of the relationships of power perpetrated in the institutional context. Like this, it can be thought the institutional care as control mechanism to discipline that starting from Foucault these he/she opens us the possibility of larger understanding of that dynamics of forces, being them indefinite, changeable and transitory, in agreement with the context to which you/they interfere. And, finally, in the thematic third, it was apprehended that the lack of appropriate public politics and the fragility in the effective model of attention to the child and adolescent exercise significant influence inside in the attendance of the shelter institutions. In a general way, it is noticed that there is a lot of gap in the sistematização of the care, hindering that he can be aimed at, by planning, with definition of objectives, strategies and evaluation allowing him to be seen as production of a professional work, structured in the real needs of that population. To think the child and the adolescent as active social actors, involved in the care of the own health, he/she allows to understand that the care released in those shelter institutions it can and it should be understood as a process dialogue of mutual interaction and construction. The results obtained in the present he/she researches they take to contemplate, to dialogue and to intervene in such little known reality. It is believed that the elucidation of such meanings in the studied social actors\' perspective will provide better understanding and approach among who he/she takes care and who is taken care, as well as he/she will offer to the professional subsidies that base your actions for the attendance of the needs of institutionalized care manifested by those children and adolescents

Atualmente um amplo processo de mobilização social contra a violência, nas famílias, tornou-se urgente. O serviço de saúde é um espaço privilegiado para se atuar sobre o campo da violência doméstica e são encontradas inúmeras dificuldades em lidar com o fenômeno por parte dos profissionais da área. Nesse sentido, acreditamos que a falta de uma compreensão mais ampla sobre o contexto familiar é uma das dificuldades que está relacionada à falta de conhecimento sobre o assunto. A investigação, aqui apresentada, buscou conhecer e analisar a compreensão de família para pais e filhos envolvidos no episódio da Violência Doméstica contra crianças e adolescentes institucionalizados no Centro de Atendimento à Criança e ao Adolescente Vitimizado (CACAV). A metodologia adotada é de abordagem qualitativa e utilizamos como instrumento de coleta de dados a entrevista semi-estruturada aplicada aos pais e às crianças que foram vitimizadas, totalizando seis famílias. Quanto à análise desses dados, escolhemos a análise de conteúdo, modalidade temática, proposta por Bardin (1979). O referencial teórico que subsidiou nossa análise de dados foi o modelo centrado na visão do contexto ecológico do desenvolvimento humano proposto por Urie Bronfenbrenner. Identificamos, a partir das falas dos entrevistados, duas temáticas: “contexto familiar" e “violência". Em relação à primeira temática, apreendeu-se que a visão dos pais sobre família é diferente da visão das crianças e adolescentes vitimizados, uma vez que a ótica dos pais favorece a compreensão da família como nuclear dentro de uma perspectiva que ainda permanece cultural e socialmente estabelecida pela sociedade. Já as crianças apontam que o vínculo de amor e afeição são mais significativos que laços consangüíneos, tal fato pode estar relacionado à vitimização, considerando que a violência doméstica contribui para o enfraquecimento do sentimento de família. Em relação à segunda temática, evidenciamos que o fato da criança e do adolescente testemunharem ou vivenciarem a violência doméstica tenderá a reproduzir, por sua vez, relacionamentos violentos em seu cotidiano, fazendo com que seja perpetuada a cadeia desse tipo de violência. Acreditamos que tais perspectivas apresentadas neste estudo, dentro de um contexto de significados, refletem a realidade pela qual passa a família, facilitando, assim, a prevenção desses eventos. Dessa forma, é importante considerar que a partir do conhecimento da dinâmica familiar e da forma como a violência é experienciada pelas suas vítimas e agressores é que podemos pensar em uma estratégia de intervenção capaz de romper o ciclo perverso das relações familiares violentas. / Nowadays, there is an urgent need for a broad social mobilization process against family violence. The health service is a privileged space to act in the field of domestic violence. Health professionals face countless difficulties to deal with this phenomenon. In this sense, we believe that one of these difficulties refers to the lack of a fuller understanding about the family approach, which is related to a lack of knowledge about the subject. This research aimed to get to know and analyze how parents and children involved in episodes of domestic violence against children and adolescents, institutionalized at the Care Center for Child and Adolescent Victims (CACAV). A qualitative methodology was adopted and data were collected by means of semi-structured interviews with parents and child victims, totaling 6 families. Content analysis was chosen to analyze these data, using the thematic mode proposed by Bardin (1979). The theoretical reference framework that guided our data analysis was the model centered on Urie Bronfenbrenner’s view of the ecological context of human development. Based on the interviewees’ discourse, we identified two themes: “family context" and “violence". With respect to the first theme, we observed that the parents’ view on family differs from that of the child and adolescent victims, since the parents’ point of view favors an understanding of family as the core, within a perspective that is still culturally and socially established by society. Children, on the other hand, indicate that bonds of love and affection are more important than blood relations. This fact may be related to victimization, since domestic violence contributes to the weakening of family feelings. What the second theme is concerned, we demonstrate that, due to the fact that children and adolescents witness or experience domestic violence, they will tend to reproduce violent relations, thus perpetuating the transmission chain of this kind of violence. We believe that, within a context of meanings, the perspectives presented in this study reflect the reality the family goes through, thus making it easier to prevent these events. Hence, it should be taken into account that it is on the basis of knowledge about the family dynamics and how violence is experienced by its victims and aggressors that we can think of an intervention strategy that is capable of breaking the perverse cycle of violent family relations.

OBJECTIVES: This study compared mother, father, and child self-reported pain sensitivity and psychosocial functioning during an intensive pediatric pain rehabilitation treatment. METHODS: Twenty children with chronic pain and their parents were enrolled in an intensive pediatric pain rehabilitation center and completed measures of pain sensitivity, fear of pain, pain catastrophizing, functional disability, and current and usual pain ratings at admission and discharge. RESULTS: Bivariate correlations and one-way ANOVAs were used. Pain sensitivity and psychosocial variables for mother, father, and child decreased from admission to discharge. There was no correlation between pain sensitivity and psychosocial variables and no significant main effect for time. CONCLUSIONS: Results indicate a need for a larger sample to further explore the relationship between these variables.

Although mental disorders are common among children all over the world, information on the extent and types of child psychiatric disorders in Ethiopia is extremely limited. A study was conducted in an urban setting of Ethiopia to look at the prevalence of child psychiatric disorders and their correlates. A two-phase survey was performed. In the first phase, parents of 5000 children in Addis Ababa, the capital city of Ethiopia, were interviewed using the Reporting Questionnaire for Children (RQC). In the second phase, parents of all screen-positive children (n=864) and parents of 1537 screen-negative children were interviewed using the revised parent version of the Diagnostic Interview for Children and Adolescents (DICA-R), a semi-structured diagnostic instrument that is based on the third revised edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-III-R). This thesis discusses the results of that study in comparison with other child mental health studies in Ethiopia and elsewhere. At the recommended cut-off score of 1, the sensitivity, specificity, predictive values and likelihood ratios of the RQC to DICA-R diagnoses were acceptable. The RQC had high accuracy with a misclassification rate of 17%. The weighted prevalence for any DSM-III-R diagnosis was 17%. The most prevalent condition was enuresis (12.1%) followed by simple phobia (5.5%). The prevalence rates of all other identified conditions were below 1%. Children's age, severe economic problems, and single parenthood were found to be risk factors for any DSM-III-R diagnosis in children. Male sex, younger age, and lower achieved educational grade of the child were all independently associated with childhood enuresis. The odds of having enuresis were significantly higher for children in families with extreme poverty and in children from single-parent homes. The risk of having enuresis was significantly higher in children who had anxiety disorders (AD) and disruptive behaviour disorders (DBD). Sex was significantly associated with disruptive behaviour disorders while grade level, age, family size, ethnicity, poverty, and single parenthood were not. Anxiety disorders were significantly associated with sex, ethnicity, and extreme poverty but not with the other socio-demographic variables. The absence of mood disorders and somatoform disorders, of which symptoms are often encountered in both children and adults at clinical settings and the low prevalence rates of most identified conditions, were probably related to the lack of awareness or alternative explanations at the community level regarding the understanding of behaviour changes. Campaigns of public mental health education with the aim of providing scientific information to society are highly recommended. While Ethiopia works towards mainstreaming mental health into its health care system, training health care workers in applying simple screening tools like the RQC is recommended.

Thesis (Psy. D.)--Rutgers University, 2009. / "Graduate Program in School Psychology." Includes bibliographic references (p. 148-150).