Typescript (photocopy). / Digitized by Kansas Correctional Industries

Attention deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder diagnosed in childhood. It is largely accepted that ADHD is a product of gene-environment interactions and method of infant feeding has been proposed as a factor influencing the expression and/or severity of ADHD. The objectives of this study were to determine the relationship between infant feeding (i.e. formula feeding or breast feeding) and subsequent hyperactive/inattentive (H/I) behaviours and ADHD diagnosis and if the relationship between infant feeding and academic performance is moderated by H/I scale score. This study used data from the 2000/1, 2002/3, 2006/7 and 2008/9 cycles of the National Longitudinal Survey of Children and Youth (NLSCY) (n= 3,895) to follow children longitudinally from the age of 0 to 1 years old to 6 to 7 years old. Infant feeding at 0 to 1 years old, and child H/I score, ADHD diagnosis and academic performance scores at 6 to 7 years old were reported by the biological mother. Multivariable logistic and linear regression were used to determine the relationship between infant feeding and H/I score, ADHD and academic performance adjusting for a range of sociodemographic, birth and home environment factors. Breastfeeding for more than 12 months was found to be significantly associated with decreased H/I scale scores in the most adjusted model (OR=0.3; 95% CI 0.2-0.8, p<0.01). Infant feeding was not associated with ADHD diagnosis and there was no moderating effect of the H/I score on the relationship between breastfeeding and academic performance. A small proportion of mothers breastfeed beyond one year in Canada and this study shows that there might be important child benefits incurred by breastfeeding for longer than 12 months. / May 2016

No description available.

No description available.

No description available.

The aims were to critically assess methodologies relevant to PK studies tailored to the needs of children. In view of the significant challenges associated with pain control in children paracetamol and ketorolac were selected for the study. Methods: Two bioanalytical methods were developed to measure paracetamol and enantiomers of ketorolac in paediatric samples, to support PK studies of IV paracetamol and ketorolac in children less than 16 years old. All studies had ethical approval and clinical trial authorisation. Results: The developed bioanalytical methods were reliable, requiring only 30 μl of blood for paracetamol, and 50 μl of plasma for ketorolac. Paracetamol concentrations from finger-prick samples in the first hour post dose were greater than from venous samples (349% at 15, 72% at 30, and 9.3% at 60minutes). There were no differences in median CL (0.41, 0.31 and 0.37 1h^-1kg^-1), V_d (0.90, 0.95 and 0.90 1/kg) and t_1/2 (1.7, 2.2 and 1.6 h) among the respective age groups 2-5, 6-10 and 11-15 years. All PK parameters were different for R- and S- ketorolac, with V_d and CL of R- being lower than those of S- (0.12 vs. 0.17 1/kg; 0.017 vs. 0.049 1/h/kg). The median half-life of R- was longer than that of S- (5.0 vs. 3.1 h, <i>P =</i> 0.043). Conclusions: Bioanalytical method did not limit PK trials in children. Sampling method affected PK parameter estimation, and prolonging cannula patency was the most challenging procedure during blood sampling. The PK of IV paracetamol was similar in children 2-15 years old, and the enantiomers of ketorolac were found to have different PKs in children.

The unprecedented scale of health sector reform in the course of radical political transformation in post-apartheid South Africa is well-documented. This thesis examines child health policy reform as a crucial part of this process. The goals of broader health sector reform were to improve the overall health status of citizens, in particular those most vulnerable, and eliminate inequities in health service provision and health status outcomes. Although children were accorded explicit prioritisation during this time, child health indicators remain poor and some have worsened. Amidst the documented explanations for the poor progress with child health indicators, the specific role and contribution of child health policies had not been interrogated. The thesis examines the development, design and implementation of national child health policies, with particular focus on equity. The National School Health Policy serves as a case-study for the analysis. Three complementary policy analysis frameworks guide the enquiry. Findings are based on a documentary analysis of key policies and 81 qualitative interviews with national policy makers and managers, provincial and district managers, and service providers in three socioeconomically different provinces of South Africa. The common assertion by South African health system analysts, that "policies are good, but implementation is poor", is refuted by this research. The findings show that child health policies have many deficiencies in their design and development. These "poor policies" contribute to inadequate child health service provision, which in turn have a bearing on poor child health outcomes. In particular the failure in clearly defining and conceptualising equity in policy development and design contributed to the absence of equity considerations in the implementation phase. The explanations for these policy failures include: lack of strategic direction for child health services; poor policy making capacity; a lack of clear policy translation; and the diverse politics, power and passion of policy actors. Broader health system factors, such as an immature and poorly functioning district health system, compound these policy failures. The thesis deepens the understanding of child health policy reform through a retrospective policy analysis and so contributes to the body of knowledge on policy reform in South Africa and in low- and middle-income countries more generally.

South Africa experienced a major measles outbreak from 2009 to 2011. This study was done to describe the patient profile of children admitted with measles for a period during the outbreak. It includes patient demographics, clinical presentation, management and outcomes. An audit of the notification system was also performed.

No description available.

Introduction: Despite the method existing for centuries, uses of crowdsourcing have been rising rapidly since the term was coined a decade ago. Crowdsourcing refers to ‘outsourcing’ a problem or task to a large group of people (i.e., a crowd) rapidly and cheaply. Researchers debate over definitions of crowdsourcing, and it is often conflated with mHealth, web 2.0, or data mining. Due to the inexpensive and rapid nature of crowdsourcing, it may be particularly amenable to health research and practice, especially in a global health context, where health systems, human resources, and finances are often scarce. Indeed, one of the dominant methods of health research prioritization uses crowdsourcing, and in particular, wisdom of the crowds. This method, called the Child Health and Nutrition Research Initiative (CHNRI) method, employs researchers to generate and rank research options which are scored against pre-set criteria. Their scores are combined with weights for each criterion, set by a larger, diverse group of stakeholders, to create a ranked list of research options. Unfortunately, due to difficulties in defining and assembling a group of stakeholders that would be appropriate to each exercise, 75% of CHNRI exercises to-date did not involve stakeholders, and therefore presented unweighted ranks. Methods: First, a crowdsourcing was defined through a literature review. Benefits and challenges of crowdsourcing were explored, in addition to ethical issues with crowdsourcing. A second literature review was conducted to explore ways in which crowdsourcing has been already used in health and global health. As crowdsourcing could be a potential solution to data scarcity or act as a platform for intervention in global health settings, but its potential has never been systematically assessed, a CHNRI exercise was conducted to explore potential uses of crowdsourcing in global health and conflict. Experts from both global health and crowdsourcing participated in generation and scoring ideas. This CHNRI exercise was conducted in-line with previously described steps of the CHNRI method for setting health research priorities. As three quarters of CHNRI exercises have not utilized a larger reference group (LRG) of stakeholders, and the public was cited as the most difficult stakeholder group to involve, we conducted a survey using Amazon Mechanical Turk, an online crowdsourcing platform, that involved an international group of predominantly laypersons who, in essence, formed a public stakeholder group, scoring the most common CHNRI criteria using a 5-point Likert scale. The resulting means were converted to weights that can be used in upcoming exercises. Differences in geographic location, and whether the respondents were health stakeholders were assessed through the Fisher exact test and Wilcoxon rank-sum test, respectively. The influence of other demographic characteristics was explored through random-intercept modelling and logistic regression. Finally, an example of a national-level CHNRI exercise, which is the largest CHNRI conducted to-date, exploring research priorities in child health in India is described. Results: A comprehensive definition of crowdsourcing is given, along with its benefits, challenges, and ethical considerations for using crowdsourcing, based on a literature review. An overview of uses of crowdsourcing in health are discussed, and potential challenges and techniques for improving accuracy, such as introducing thresholds, qualifiers, introducing modular tasks and gamification. Crowdsourcing was frequently used as a diagnostics or surveillance tool. The CHNRI method was not identified in the second literature review. In re-weighting the CHNRI criteria using a public stakeholder group, we identified differences in relative importance of the criteria driven by geographic location and health status. When using random-intercept modelling to control for geographic location, we found differences due to health status in many criteria (n = 11), followed by gender (n = 10), ethnicity (n = 9), and religion (n = 8). We used the CHNRI method to explore potential uses of crowdsourcing in global health, and found that the majority of ideas were problem solving or data generation in nature. The top-ranked idea was to use crowdsourcing to generate more timely reports of future epidemics (such as in the case of Ebola), and other ideas relating to using crowdsourcing for the surveillance or control of communicable disease scored highly. Many ideas were related to the United Nations’ Sustainable Development Goals (SDGs). Finally, a national-level exercise to set research priorities in child health in India identified differential priorities for three regions (Empowered Action Group and North Eastern States, Northern States and Union Territories, and the Southern and Western States). The results will be very useful in developing targeted programmes for each region, enabling India to make progress towards SDG 3.2. Conclusion: Crowdsourcing has grown exponentially in the past decade. Integrating gamification, machine learning, simplifying tasks and introducing thresholds or trustworthiness scores increases accuracy of results. This research provides recommendations for improvements in the CHNRI method itself, and for crowdsourcing, generally. Crowdsourcing is a rapid, inexpensive tool for research, and thus, is a promising data collection method or intervention for health and global health.