Bakgrund: Små barn spenderar allt mer tid framför digitala skärmar. Enligt WHO:s riktlinjer rekommenderas ingen skärmtid för barn under två år. Folkhälsomyndigheten saknar riktlinjer angående skärmtid, de anser att samtida forskning inte uppnått tillräckligt tydliga slutsatser. Barnhälsovården har som uppdrag att följa barn från födsel till skolstart. Barnhälsovården följer barns utveckling, arbetar hälsofrämjande och fungerar som stöd för familjen. Syfte: Studiens syfte var att beskriva Barnhälsovårdssjuksköterskorserfarenhet av digitala levnadsvanors påverkan på barns utveckling. Metod: En kvalitativ innehållsanalys med induktiv ansats användes. En skriftlig datainsamling gjordes genom frågeformulär med öppen karaktär. Informanterna var elva Barnhälsovårdssjuksköterskor. Resultat: Flera tydliga mönster framträdde hur skärmtid påverkade barnen ur ett utvecklingsperspektiv som bildade resultatets åtta underkategorier samt dessa fem kategorier; Skapar ett beteende som är att likna vid beroende, svårighet att föra dialog och samspela, påverkan på ordförrådet, stödjer anpassning till det digitala samhället och lär sig att hantera och sätta ord på känslor. Konklusion: Barnhälsovårdssjuksköterskornas erfarenhet beskriver att skärmtid kan ha en påverkan på barns utveckling. Barnhälsovårdssjuksköterskorna bör uppmärksamma signaler på beroende, anknytningsproblematik, språkförsening och samspelssvårigheter för att kunna ge råd om hur skärmtid disponeras för barn. / Background: Young children spend more and more time in front of digital screens. According to WHO guidelines, no screen time is recommended for children under two years of age. Folkhälsomyndigheten lacks guidelines regarding screen time, they believe that contemporary research has not reached sufficiently clear conclusions. Child health care is tasked with following children from birth to the start of school. They follow children`s development, work to promote health and act as support for the family. Aim: The aim of the study was to describe child health care nurses' experience of the impact of digital living habits on children's development. Method: A qualitative content analysis with an inductive approach was used. A written data collection was done through open-ended questionnaires. The informants were eleven child health care nurses´. Results: Several clear patterns emerged in how screen time affected children from a developmental perspective that formed the results´ eight subcategories as well as these five categories; Creates behavior that is similar to addiction, difficulty in dialogue and interaction, impact on vocabulary, supports adaptation to the digital society and learns to manage and put emotions into words. Conclusion: The child health nurses' experience describes that screen time can have an impact on childrens´ development. The child health nurses´ should pay attention to signs of addiction, attachment problems, language delay and interaction difficulties in order to be able to give advice on how screen time is allocated for children.

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Optimal maternal nutritional status is required for development of a healthy infant. Drinking during pregnancy puts mothers at risk for nutrient deficiencies, endangering the health of the fetus and increasing the risk of Fetal Alcohol Spectrum Disorder (FASD). The current body of research has focused on interventions using nutrients important to fetal brain development (choline, DHA, folate, vitamin A, zinc) to reduce FASD in animal models. Whether mothers at risk for having a baby with FASD are consuming adequate amounts of these nutrients during pregnancy is unknown, due to a lack of sufficient research data. Therefore, this study aims to identify intake of nutrients important to fetal brain development in pregnant mothers. Through community engagement and partnerships with Mount Carmel Clinic and other prenatal programs located in Point Douglas and Downtown Winnipeg, 56 pregnant women were recruited and interviewed. Findings show that intake of certain nutrients important to fetal brain development are not being consumed in recommended amounts. While most participants met the Dietary Reference Intakes for zinc and vitamin A, only 44.6% met recommendations for folate, 48.2% for choline, and 16.1% for DHA. Dietary intake was not significantly different between women with alcohol exposure during pregnancy and those without. These results are important due to the high rate (46%) of women with prenatal alcohol exposure. Study outcomes may provide future nutrition interventions to enhance the health of mothers consuming alcohol during pregnancy and their infants, potentially reducing the effects of FASD. / October 2016

MPH, Faculty of Haelth Sciences, University of the Witwatersrand, 2009 / The Integrated Management of Childhood Illness (IMCI) strategy was introduced in Zimbabwe in 1996 to integrate vertical child health care programmes. It has since expanded to cover over 300 first level health facilities out of 897 in 23 districts out of a total of 59 districts in the country. This survey was conducted to measure the quality of care delivered to sick children aged 2 months up to 5 years at first level health facilities implementing IMCI. The management of sick children was observed for 226 children aged 2 months up to 5 years who were brought to primary level health facilities. 226 interviews with child caretakers were conducted, all children included in the survey were re-examined by an experienced IMCI practitioner to ascertain the classification (diagnosis) of child’s illness and the appropriate treatment needed. Finally facilities, services and supplies were assessed in the 35 facilities visited. Seventy one percent of cases were children under 2 years old. The majority of caretakers (88%) were mothers of the sick children. All children were systematically checked for the four main symptoms, 80% of children were checked for general danger signs. About 70% of cases classified as having pneumonia received correct treatment for pneumonia. Almost 50% of cases observed received correct treatment for malaria. Half of the children observed (50%) received their 1st dose at the facility. Just less than half (48%) of the children who needed vaccines left the health facilities with all the needed vaccines. Eighty five percent of caretakers were advised on drug treatment. As a result of the advice received, almost two third (65%) of the caretakers who had been prescribed an antibiotic/antimalarial were able to correctly describe how to give the antibiotic to the iv child. The large majority of caretakers (78%) were satisfied with the health services provided. Over half (54%) of facilities visited had at least 60% of health workers trained in IMCI; 88% of children were managed by health workers who had been trained in IMCI. Drugs were available with the exception with oral rehydration salts (ORS) or sugar salt solution (SSS). Most facilities had supplies and equipment for vaccination, and most had other basic supplies and materials; IMCI chart booklets were found in 91% of facilities. Health facilities which received at least one supervisory visit that included observation of -case management in the last 6 months was only 11% indicating that supervision is not carried out on a regular basis. The management of sick children seen by providers trained in IMCI followed a systematic approach in most cases but there is room for further improvement. Drugs were used rationally. Key supportive elements of the health system were in place in the facilities visited with the exception of regular supervision. However only 38% needing urgent referral were identified and prescribed urgent referral. Weaknesses were also observed in the management of diarrhea, fever and in counseling the caretaker. Only 15% of caretakers were given or shown the mothers card as a job aid and only 23% of caretakers were told on when to return immediately. The IMCI strategy has the potential to act as a powerful channel to improve the quality of services. As the survey was unable to determine reasons for poor performance observed, further research is required to investigate the factors leading to poor health worker performance.

We explored the role that exogenous and endogenous competitors for attention play in infants’ abilities to encode and retain information over a 6‐month period. Sixty‐six children visited the laboratory at 15 months, and 32 returned for a second visit at 21 months. Children observed models of conventional‐ relation and enabling‐relation action sequences. Half the children were distracted by a “Mister Monkey” mechanical toy during the conventional‐relation sequence, while the other half was distracted during the enabling‐relation sequence. The Early Childhood Behavior Questionnaire indexed endogenous factors at both ages. Immediate postmodel production of target actions indexed encoding efficiency, and 6‐month production of target actions indexed long‐term recall. The exogenous distracter impacted encoding efficiency (i.e., immediate recall), but not long‐term recall. Endogenous factors (i.e., temperament) were primarily associated with long‐term recall. Of special interest was our finding that endogenous factors, especially surgency, moderated the effect of the exogenous distracter. It appears that when learning conventional‐relation sequences in the presence of exogenous distracters, surgency mobilizes attentional resources toward the learning objective; however, when learning enabling‐relation sequences under the same conditions, surgency either boosts the saliency of the distracters or boosts children’s susceptibility to them.

Asthma is the most common long-term condition in children in the United Kingdom (UK). Asthma-related hospitalisations and mortality are disproportionally higher in the UK, compared with other European countries, however the reasons for this disparity remain unclear. A putative explanation is that that prevalence of suboptimal asthma control in children in the UK is higher than in continental Europe. If this is indeed correct, then the drivers of suboptimal control, such as poor adherence to therapy resulting from poor understanding of the role of preventer medication (inhaled corticosteroids (ICS)) in UK children would be of significant clinical interest. Therefore, in this thesis, I sought to first identify the levels of asthma control and medication adherence in a non-random sample of London secondary school children. Then, I used focus groups to further highlight the barriers to good medication adherence, and generate insights into potential solutions. To achieve these aims, I developed and implemented an online questionnaire to be delivered in schools, which included the validated Asthma Control Test (ACT). Methods: This thesis is divided into three main sections. The first and second sections include original data from an observational research study, which collected data about asthma control, from 24 London secondary schools between December 2014 and March 2016. The aim of the first section was to assess current levels of asthma control and medication adherence among children with asthma in London secondary schools. Data were collected using an online questionnaire, which included the validated ACT to measure asthma control, as well as additional questions about knowledge, healthcare use, medication use, school attendance, lifestyle and emotion and behaviour, using the validated Me and My School (M&MS) questionnaire. The second section of this thesis includes data generated from six focus groups, conducted in four London secondary schools with 56 students. In order to generate data to inform future interventions, discussions focused on the barriers to medication adherence among teenagers, and how these barriers could be addressed. The third section comprises a systematic review of school-based self-management interventions for children with asthma. The review uses a mixed-methods approach, and includes both quantitative and qualitative study data. A process evaluation is also included, to identify intervention elements that are associated with implementation success. Results: 766 children with asthma from 24 schools were surveyed. Almost half of the students (45.7%; n = 350) had poor asthma control by ACT score. Adherence with asthma medication was low, regardless of asthma control (56.2% self-reported forgetting to use their ICS "preventer" inhaler; 29% self-reported not using their SABA "reliever" inhaler when they needed it, at least some of the time). Health care involvement was relatively high, with at least one unplanned GP visit, due to asthma in the previous four weeks, reported by 28.1% of students; at least one unplanned hospital visit was self-reported by 15.7% of students; and at least one unplanned school nurse visit due to asthma was self-reported by 16% of students. At least one whole school absence was reported by 20.9% of students. Unplanned medical care and school absences were higher among children with poor asthma control, according to the ACT. Themes from focus groups suggested that social stigma, fear of embarrassment, forgetfulness, and incorrect attitudes towards medication were all contributory factors to poor medication adherence. Communications with healthcare professionals were also identified as key unmet needs of teenagers with asthma. The findings from the meta-analyses, included in the systematic review of school-based self-management interventions, showed that such interventions were effective in improving several outcomes, largely related to healthcare use. These included hospitalisations, emergency department (ED) visits, and health-related quality of life. There was no evidence that school-based interventions improved school absences, experiences of day and night time symptoms, or the use of medication. The findings from the analysis of the process evaluation studies showed that a theoretical framework is important in the development of a successful intervention. Conclusions: First, in a large non-random sample of secondary school children with asthma, the proportion of children with suboptimal control is worryingly high, and this is associated with general poor adherence to prescribed therapy asthma. Second, focus groups identified practical and social barriers to good adherence, that should be addressed in future studies. Third, previous studies suggest that school based interventions are effective in reducing incidences of unplanned and urgent healthcare use. The systematic review included studies that included relatively hard-to-reach populations, suggesting that such interventions may be effective across diverse populations, including those considered hard-to-reach. The findings in this thesis informed the development of a school-based self-management intervention, to be piloted in London secondary schools, and an NIHR-funded global research group award on improving asthma control in African children.

Introdução: Estudos vêm demonstrando que o ambiente intrauterino influencia no crescimento fetal e extrauterino, repercutindo no perfil de saúde em longo prazo. Objetivo: Comparar a velocidade de crescimento durante os primeiros três meses de vida de crianças geradas em ambientes intrauterinos considerados adversos. Métodos: Trata-se de um estudo longitudinal prospectivo controlado desenvolvido com pares de mãe-filho residentes em Porto Alegre/RS. Cinco grupos de exposição foram estudados (diabetes, hipertensão arterial, tabaco e restrição do crescimento intrauterino) e um controle. O crescimento foi avaliado em cinco momentos (pós-parto, sete dias, quinze dias, um mês e três meses) utilizando os índices peso para idade (P/I), comprimento para idade (E/I) e Índice de Massa Corpórea para idade (IMC/I). A análise de regressão Equações de Estimativas Generalizadas foi utilizada para avaliar a relação entre o ambiente intrauterino e o crescimento. A velocidade de crescimento foi avaliada com um e três meses, utilizando a diferença entre as medidas de escore z (delta). Identificou-se a influência de fatores sociodemográficos, maternos e neonatais no peso ao nascer e na velocidade de crescimento. Resultados: Os fatores que influenciaram no peso ao nascer foram: paridade, IMC pré-gestacional, ganho de peso durante a gestação, tipo de parto e sexo. Ao utilizar o escore z de P/I, verificou-se que os grupos tabaco e restrito apresentaram médias significativamente menores do que o controle. De zero a um mês, a velocidade de ganho de peso entre os restritos foi significativamente maior do que os demais. De zero a três meses, só não foi significativamente maior do que o grupo hipertensão arterial. A velocidade de ganho de comprimento de zero a um e de zero a três meses foi significativamente maior no grupo restrito ao comparar com o controle. Ao utilizar o escore z de IMC/I, os grupos tabaco e restrito apresentaram médias significativamente menores do que o grupo controle. A velocidade de ganho de IMC de zero a um mês do grupo restrito só não foi significativamente maior do que o grupo hipertensão arterial. De zero a três meses, foi significativamente maior do que todos os demais. Os fatores que influenciaram na velocidade de crescimento foram: situação conjugal, IMC pré-gestacional, ganho de peso durante a gestação e internação hospitalar da criança. Conclusão: O presente estudo identificou que a velocidade de crescimento nos três primeiros meses de vida é influenciada por ambientes intrauterinos adversos e diferentes fatores gestacionais e neonatais estão envolvidos neste contexto. O grupo restrito foi o que apresentou os escores médios mais baixos e a maior recuperação. O grupo hipertensão arterial, que possuiu escores médios negativos, apresentou velocidade de ganho de peso positiva durante os primeiros três meses, sinalizando recuperação. Já o grupo tabaco, que apresentou escores médios negativos, não possuiu recuperação significativa. Os achados deste estudo poderão auxiliar na elaboração de estratégias de prevenção do crescimento acelerado em crianças expostas a fatores considerados de risco. Intervenções realizadas na infância inicial poderão refletir no perfil de saúde e na carga de doenças durante o curso da vida destas crianças. / Introduction: Studies has demonstrated that the intrauterine environment influences on fetal and extrauterine growth, reflecting the long-term health profile. Objective: To compare the growth velocity during the first three months of life among children born in intrauterine environments considered adverse. Methods: It is a prospective controlled longitudinal study developed with mother-infant pairs living in Porto Alegre/RS. Four exposure groups were studied (diabetes, hypertension, smoking and intrauterine growth restricted) and a control. Growth was evaluated in five moments (postpartum, seven days, fifteen days, one month and three months) using the weight for age (W/A), height for age (H/A) and Body Mass Index for age (BMI/A). Regression analysis with generalized estimating equations were used to evaluate the relationship between the intrauterine environment and growth. The growth velocity was performed with one and three months using the difference between the z-score measures (delta). Were identified the influence of sociodemographic factors on maternal and neonatal birth weight and growth velocity. Results: Factors that influence the birth weight were: parity, pre-pregnancy BMI, weight gain during pregnancy, type of delivery and sex. By using the z score for W/A, it was found that tobacco and intrauterine growth restricted groups had significantly lower average than the control. From zero to one month, the weight gain velocity between intrauterine growth restricted was significantly higher than the others. From zero to three months, weight gain velocity of the intrauterine growth restricted group was significantly higher than the other groups, except hypertension. The length gain velocity from zero to one and three months was significantly higher in the intrauterine growth restricted vs. control. By using the BMI/A z score, tobacco and intrauterine growth restricted groups had significantly lower average than the control group. From zero to one month, only BMI gain speed intrauterine growth restricted group was not significantly higher than the hypertension group. From zero to three months, was significantly higher than the others. The factors that influenced the growth velocity were: marital status, pre-pregnancy BMI, weight gain during pregnancy and the child's hospitalization. Conclusion: The present study identified that the growth velocity in the first three months of life is influenced by adverse intrauterine environment and different gestational and neonatal factors are involved in this context. The intrauterine growth restricted group was the one with the lowest average scores and higher recovery. The hypertension group, which owned negative average scores showed positive weight gain velocity during the first three months, signaling recovery. Otherwise, the tobacco group, which showed negative average scores, did not possess significant recovery. The findings of this study will assist in developing prevention strategies in the accelerated growth in children exposed to the risk factors. Interventions in early childhood may reflect the health profile and burden of disease during the course of life of these children.

Visando contribuir para a avaliação dos serviços de saúde disponíveis em nossa cidade e sua relação com a saúde materno-infantil, realizamos esta investigação, que teve como objetivo: geral - estudar as condições de saúde, das crianças da zona urbana do município de Londrina; e específicos - estudar as famílias segundo as condições de moradia e saneamento básico; classe social, renda e escolaridade dos pais e; analisar a cobertura por serviços de assistência médica. Do ponto de vista metodológico, pode-se denominar este estudo de transversal ou de prevalência, pois avalia as condições de saúde de uma população definia em um determinado momento. A população de estudo corresponde a uma amostra populacional de 388 crianças com idades entre zero e 59 meses, representativas das cinco regiões urbanas da cidade de Londrina. As variáveis abordadas foram à escolaridade do chefe de família, a renda per capita e a classe social. Na descrição das moradias, foi observada uma regularidade na coleta de lixo em 99,7% das famílias entrevistadas, abastecimento de água de 99,2%, e rede pública de esgoto de apenas 40,5%. A relação do número de pessoas por domicilio foi 4,52. Na caracterização socioeconômica, destaca-se o alto grau de escolaridade dos chefes de família, que guarda uma relação direta com a renda per capita, havendo uma associação significativa também com as classes sociais. Na análise do pré-natal, em 82% dos casos, houve referência a seis ou mais consultas; com relação à precocidade do pré-natal em 81,6% dos casos a assistência foi iniciada no primeiro trimestre da gestação não havendo diferença significativa entre as variáveis estudadas. Em relação ao parto 55,4% foram cirúrgicos, freqüência inquestionavelmente excessiva, havendo uma associação positiva entre esta modalidade de parto e as variáveis selecionadas. A puericultura também foi iniciada precocemente em 79,4% das crianças (primeiro mês), sendo eu em relação ao numero de consultas no primeiro ano de vida a média foi de 10,8 consultas por criança. A vacinação mostrou uma cobertura elevada quanto ao esquema básico: BCG intradérmico, uma dose (98,4%); Sabin, três doses (97,6%); Tríplice, três doses (97,6%); Tríplice, três doses (97,6%); e Anti-sarampo, uma dose (98,0%). Parece não haver relação das variáveis escolhidas nas pequenas diferenças encontradas, entre as crianças maiores de doze meses. Conclui-se ser ampla e de boa qualidade a assistência materno-infantil prestada a população da zona urbana do município de Londrina, não foi evidenciada grandes desigualdades das crianças, quando separadas pelos diferentes estratos sociais da população. / This study was undertaken in order to analyse infant\'s health conditions in the urban área of Londrina aiming to contribute to the evaluation of Health Services available. This investigation was a transversal study on sanitation, socio-economical status health system and the environment. The studied sample inclued 388 children from zero to 59 months,from all five urban areas of Londrina. There variables were selected: educational level of the head of the family, social class and montlhy income per person. The results found an average of 4,52 persons per house, 99,2% of the families presented adequate water supply, 99,7% had regular refuse disposal but only 46,5% had safe sanitation. The head of the family presented a high level of educationand we found an association between education,monthly income per person and social status. When analysing pre natal care 82% of mothers refered six or more regular check ups,the great majority (81,6%) started pre natal care in the first trimester and no significant statistical difference for the three variables was found. The results showed an extremely high percentage of ceasarian section (55,4%) with demonstrated a clear association with the selected variables. The results showed that 79,4% of the children were registered in the Well Baby Clinic during the first month of life with an average of 10,8 visits per child during the first year. In relation to the immunization schedule it was found that 98,4% were immunised against tuberculosis with BCG (one dose): 97,6% received three doses against poliomyelitis (Sabin); 97,6% were given three doses of DPT and 98,0% received one dose against measles. The results showed no statistical difference for children over one year old. Based on the results the author conclued that maternal and child health services in the urban area of Londrina are extensive and of very good quality. No significant difference was found when the children were divided according to the social status.

While Fetal Alcohol Syndrome Disorder is a recognized problem with alcohol ingestion during the formation of facial features, Fetal Alcohol Spectrum Disorders are not as widely recognized. These disorders result from exposure to alcohol throughout pregnancy when the brain and nervous system are developing. The resulting disorders include attention deficit disorders, social disorders, inappropriate behaviors, learning disorders, and intellectual disability. The incidence of children with alcohol-related disorders is increasing as evidenced by children needing special services in the educational systems. It is unknown how much alcohol ingestion is safe during pregnancy or how genetic factors are involved in the development of these disorders. Women often get conflicting information from the media and other resources about safe levels of alcohol consumption during pregnancy. Abstinence of alcohol ingestion is the only known prevention of such intellectual disorders. It is hypothesized that women of childbearing age may not be knowledgeable of the relationship between drinking and the implications of alcohol exposure on fetal development. The purpose of this research is to determine what women of childbearing age know about alcohol consumption during pregnancy and if there is a knowledge deficit that exists among women of a certain age or women that use specific resources for health information. The researcher surveyed 40 female students at East Tennessee State University by using true or false questions concerning alcohol consumption related to fetal development in order to determine if a knowledge deficit exists. Based on the findings, it may be determined if women of childbearing age need educational materials from a reliable source.

The objectives of this study were to determine whether there was an association between clinical nursing knowledge of four birthing positions and current evidence-based research of those same positions and also to identify possible areas where nursing knowledge of those birthing positions was inadequate. This pilot study used convenience sampling to survey registered nurses (RNs) and licensed practical nurses (LPNs) on labor and delivery units. The survey was distributed to three hospitals in the southeastern United States, and twenty-four RNs and LPNs participated. Participants’ knowledge did not reflect current clinical evidence in two key areas, (1) the best position to minimize blood loss and (2) the best position to decrease the likelihood anal sphincter tears. Respectively, only 13% and 27.3% of participants selected the correct position. Continuing education for maternity nurses regarding current evidence-based practice concerning various birthing positions remains a need, and incorporating this could include more frequent opportunities for education classes and unit inservices. Results from this study should not be generalized, and more research is needed in this area to validate these findings.