The present study examined psychological factors associated with individual variation in children's adjustment following minor surgery, and focused specifically on the process of coping with postoperative pain. Sixty children and adolescents (7 to 16 yrs) were interviewed on the day following surgery. They provided ratings and descriptions of their postoperative pain experience, perceived capacity for pain control, spontaneous coping strategies, and emotional distress. Parents also provided information about their efforts (both historical and present) to facilitate their child's coping, their own emotional distress, and perceptions of their child's distress following surgery. Thirdly, nurses rated children's pain behaviours displayed on the ward. Finally, information about analgesic medications and physical complications following surgery was recorded from children's medical charts. Qualitative data concerning the process of coping with postoperative pain and specific parental influences on children's coping were presented within a conceptual model adapted from the adult stress and coping literature. The data were also analyzed for age/developmental differences between older children (10 to 16 yrs) and younger children (7 to 9 yrs). Finally the predictive role of demographic, child coping process, and parental influence variables, in accounting for variations in child coping outcome, was analyzed. Results indicated that children and adolescents experienced moderate to severe pain following minor surgery. They reportedly tried a number of different cognitive and behavioural methods to deal with postoperative pain. Also, parents took an active role in facilitating children's coping. Age group differences were revealed in children's descriptions of postoperative pain, their reported ways of coping with pain, and their perceptions of control over pain and recovery. Age effects were interpreted with caution, however, since age and sex were confounded in this sample. Children who reported the most pain and emotional distress following surgery also reported more catastrophizing cognitions, felt less in control of their recovery, and reported having tried a greater number of behavioral coping strategies to manage pain. These results emphasize the role of children's appraisal processes in predicting coping effectiveness, and demonstrate that more coping does not imply better outcome. Future research directions and potential clinical appplications that follow from these findings were discussed. / Arts, Faculty of / Psychology, Department of / Graduate

Memory and metamemory were examined in 30 hyperactive and 30 nonhyperactive children matched on age, grade, and IQ (as measured by the Vocabulary and the Block Design subtests of the WISC-R), within the context of a broad range of tasks. The five tasks investigated in this study were: (a) a prospective memory task, (b) a feeling-of-knowing task, a visual retention task, (c) a word generation task, (d) and (e) an object span and recall task. Previous research has demonstrated considerable variability in the performance of hyperactive children on memory tasks. They have been shown to perform as well as normal children on tasks of cued recall, paired associates for meaningful words, and on tests of recognition memory. They are distinguished from normal children by their poor performance on tasks of uncued recall, paired associates learning for semantically unrelated words, and in addition, often display performance decrements when task demands increase. The results of this study suggest that hyperactive children are less efficient in metamemory knowledge and skills than normal children. These findings are consistent with the proposal that the difficulties hyperactive children demonstrate on memory tasks may result from a deficiency in their ability to efficiently engage in metamemory processes. The hyperactive children in this study generally had more difficulty than the control children with recall on all the tasks. These included tests of both verbal and nonverbal memory, short and long-term memory, and prospective remembering. Further, they did not derive a memorial benefit, as the control subjects did, when generating their own recall items, or when recalling visual stimuli that could be more easily verbally encoded than others. The hyperactive subjects demonstrated their recall abilities by performing as well as the normal subjects on the recall of read words in the word generation task, and on the recall of the low and medium level of labelability items in the visual retention task. Also, the recall performance of the hyperactive subjects differed significantly between a no-strategy and a provided strategy condition on the prospective memory task. Moreover, there were no group differences on the recognition memory test of the feeling-of-knowing task. The results of this study are consistent with the previous investigations of memory performance in hyperactive children. The present findings further extend the past research by demonstrating selective memory deficits in the hyperactive subjects that are consistent with deficits in metamemory abilities. The proposition that metamemory skills are implicated in the difficulties that the hyperactive children demonstrated in this study is further supported by the difficulty they experienced in describing how they remembered the task items. The hyperactive subjects had more difficulty than the control subjects when attempting to describe a strategy that they used to aid recall. The strategies they described, relative to the control subjects, tended to be vague and poorly defined. These findings suggest that there may be both qualitative and quantitative differences in the way in which hyperactive and normal children use strategies. In summary, the findings of this study suggest that hyperactive children, relative to normal children, seem to be deficient in both their metamemory knowledge and the ability to monitor and control their memory performance. Questions addressing whether these children cannot or do not employ these skills were introduced. The clinical implications of the findings were considered and recommendations were made for future research. / Arts, Faculty of / Psychology, Department of / Graduate

The present study examined stimulus control in autistic children. A matching-to-sample procedure was employed in all experiments. In the first part of Experiment I, autistic and control subjects were trained to discriminate between a vertical line and a line tilted at an angle of 33 degrees from vertical. Following training, subjects were given a generalization test to determine the degree of dimensional control by line tilt. In the second part of Experiment I, subjects were trained to discriminate between a vertical line and lines tilted progressively closer to vertical. Experiment II was also a test for the degree of dimensional control by the line tilt. In Experiment I, the autistic subjects took a greater number of trials than the controls to reach the criterion of 24 consecutive correct trials. However, the difference in the number of trials taken by the two groups was not large. There was also little difference between the autistic and control subjects in part two of Experiment I. All of the autistic subjects successfully discriminated between a vertical line and a 2 degree line tilt to a criterion of eight consecutive correct trials. In the generalization tests in Experiments I and II, there was little difference between the autistic and control subjects in dimensional stimulus control. In Experiment III, the autistic subjects were examined for acquisition of a multidimensional discrimination. Both autistic and control subjects were trained to match a standard stimulus with one of four comparison stimuli that were varied in shape and in the presence and absence of a star within the shape. The autistic subjects took a greater number of trials than the controls to reach the criterion of eight consecutive correct trials. However, the difference between the autistic and control subjects in the number of trials taken to reach criterion was not large. In summary, the study found little difference between autistic and control subjects in the acquisition of simple or multidimensional discrimination. As well, there was little difference between the autistics and the controls in dimensional stimulus control. The results of the study suggest that the autistic child's problem is not one of stimulus selectivity. / Arts, Faculty of / Psychology, Department of / Graduate

Three experiments examined auditory-visual integration of temporal relations by infants. In the first experiment infants of 3, 6 and 10 months of age were placed midway between two flashing visual displays. Tones, temporally synchronized to one of the visual displays, emanated from concealed speakers placed midway between the visual displays directly in front of the infants. The visual displays, and corresponding tones differed in temporal rate by a factor of four. No evidence was found for differential looking to the sound-specified visual pattern in any of the three age levels tested. The 3-month-olds showed a strong right-looking bias regardless of visual pattern or temporal rate of the tone, while the 10-month-olds preferred to look at the fast visual pattern regardless of position or tone rate. Both of these biases impaired the effectiveness of the simultaneous presentation paradigm to detect differential looking related to auditory-visual synchrony. Experiments II and III used an habituation methodology which eliminated any effects of position and rate bias. Only 4-month-old infants were tested. In each experiment, one group of infants was first presented with temporally synchronous auditory and visual signals during habituation trials and then nonsynchronous signals during recovery trials. Two other groups of infants, one in each experiment, received the opposite sequence. In Experiment II the auditory and visual signals were spatially congruous, but they were separated by 90° in Experiment III. Since the pulse rate of the visual stimuli was changed for the nonsynchronous trials, a control group was tested which received only the light during habituation and recovery trials. Both groups initially presented with synchronous signals showed habituation and recovery. Neither group presented with nonsynchronous stimuli during habituation trials demonstrated recovery and only the group with the spatially separated sources habituated. The results suggest that 4-month-old infants are able to coordinate the temporal relations between auditory and visual signals. / Arts, Faculty of / Psychology, Department of / Graduate

The child's understanding of open systems, as exemplified by an ecosystem and a socio-economic system, was assessed in a Piagetian type interview with 8 males and 8 females in each of grades 3, 5, 7, 9, 11 and first year post-secondary (n=96). Since Piagetian theory has been based on tasks using mainly inanimate, physical content, the generalizability of Piagetian stages and sequences to the two open systems content domains was tested. Tasks assessing the four concrete operations examined were repeated in each of the physical, the bio-ecological and the societal domains. Typical stage and sequence patterns were observed in all three domains. Post-concrete operations were represented by three formal operations in the physical domain and four systemic operations in each of the open systems domains. Logical and philosophical arguments for the qualitative difference between formal and systemic logic were presented. Three blind judges reached spontaneous agreement on 84.6% of the scores assigned for the systemic task protocols. A scalogram analysis and comparisons of the differences between pass/fail proportions indicated that the systemic operations of systems synthesis and transitive recycling were more difficult than the formal operational tasks by a Guttman step of the same size as that between the formal and concrete stages. A cluster analysis showed those most difficult systemic tasks to be grouped as if they were a part of a separate structure d'ensemble. Further analyses indicated that the greater difficulty of these two systemic operations could not be attributed to the greater un-familiarity of the task contents. Systemic task success rates were zero for respondents below grade 9 (14 years) and consistently fell far below formal task success rates for same aged peers'. The most difficult systemic operations satisfied the criteria for membership in a fifth stage as well as any other Piagetian operations do for their imputed stage membership. Nevertheless, an alternative interpretation construing systemic operations as post-concrete developments parallel and complementary to formal operations could not be ruled out. The implications of the findings for the areas of cognitive development, social development and social psychology were discussed. / Arts, Faculty of / Psychology, Department of / Graduate

This study describes ways that parents attempt to help their preschool children with asthma meet their basic human needs. Information about such parental guidance is lacking in the literature and yet parents need assistance from health professionals about how to accomplish the task of rearing their chronically ill children. Ten couples with asthmatic preschool children from the Lower Mainland region of British Columbia were identified and interviewed in their homes. The couples were asked about the actions they took to help their preschool children with asthma meet their basic human needs and the ways they perceived asthma and its treatment affecting their efforts to help these children. An Interview Guide was developed based on the University of British Columbia's Model for Nursing. It is a model with a basic human needs and systems theory framework. All interviews with the couples were audiotaped and later analyzed for content of their communications. The analysis revealed 17 specific helpful actions common to all of the couples, and additional emotions, decisions, and physical efforts to normalize their asthmatic children's and family's daily lives. It was concluded that the couples in this study assumed the responsibilities of helping their preschool children, sick or well, meet their needs to grow and develop according to parental tasks. The intensity of the helping behaviours tended to increase during the children's asthmatic attacks. There are implications for health professionals for developing programs to assist parents to acquire the knowledge, skills and attitudes: to facilitate the growth and development of their children with a chronic disease such as asthma. / Applied Science, Faculty of / Nursing, School of / Graduate

Orientador: Regina Helena Garcia Martins / Resumo: Introdução: A sífilis congênita é citada como indicador de risco para deficiência auditiva e apesar de ter sido erradicada após a era da penicilina, nos últimos anos houve um progressivo aumento de sua incidência no Brasil, no entanto poucos casos acarretam com o desfecho de deficiência auditiva, em decorrência da identificação precoce da sífilis materna, ainda no pré-natal, o que possibilita o tratamento precoce, evitando-se ao máximo a contaminação do feto pelo Treponema pallidum. Ainda assim, a literatura recomenda o acompanhamento do desenvolvimento auditivo dessas crianças, inclusive as que foram apenas expostas a sífilis materna na gestação. Objetivo: Analisar as respostas auditivas de recém-nascidos expostos à sífilis materna, por meio de exames eletroacústicos e eletrofisiológicos. Método: Participaram do estudo 90 recém-nascidos a termo, divididos em dois grupos: Grupo exposto à sífilis materna, composto por 41 recém-nascidos e Grupo controle, composto por 49 recém-nascidos sem indicadores de risco para deficiência auditiva. Os recém-nascidos foram atendidos no programa de triagem auditiva neonatal universal, do Hospital das Clínicas da Faculdade de Medicina de Botucatu, por meio do exame de emissões otoacústicas por estímulo transiente (EOE-t), com resultado “passa”, em ambas as orelhas, e potencial evocado auditivo de tronco encefálico (PEATE) com diferentes taxas de repetição do estímulo clique sendo: 21.1 c/s, 51.1 c/s e 91.1c/s. Resultados: Mesmo apresentando re... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Congenital syphilis is reported as a risk indicator for hearing loss and although it has been eradicated after the penicillin era, in recent years there has been a progressive increase in its incidence in Brazil; however, few cases lead to hearing loss due to early identification of maternal syphilis during prenatal care, which enables early treatment, and avoids, as much as possible, the contamination of the fetus by Treponema pallidum. Nevertheless, the literature recommends monitoring the auditory development of these children, including those who were only exposed to maternal syphilis during pregnancy. Objective: To analyze the auditory responses of newborns exposed to maternal syphilis through electroacoustic and electrophysiological assessments. Method: Ninety full term newborns participated in the study, divided into two groups: Group exposed to maternal syphilis, composed of 41 infants and Control group, composed of 49 newborns without risk indicators for hearing loss. The newborns were treated in the universal neonatal hearing screening program of Botucatu Medical School General Hospital through transient-evoked otoacoustic emission (TEOAE), with “pass” results, in both ears, and brainstem auditory evoked potential (BAEP) with different click stimuli repetition rates: 21.1 c/s, 51.1 c/s and 91.1c/s. Results: Even with the “pass” result, TEOAE amplitudes of the group exposed to syphilis presented lower values when compared to control group, especially at... (Complete abstract click electronic access below) / Doutor

The major physiological function of the carotid body is to respond to a low partial pressure of oxygen in the systemic arterial blood. The structure and functions of the adult carotid body have been extensively investigated over the past fifteen years. However, the carotid body in children has been relatively neglected with only a handful of studies being performed. To date, no study has been undertaken to investigate the effects of intrauterine hypoxia on the carotid body of foetuses. Clinically, intrauterine growth retardation has been ascribed, amongst other causes, to placental insufficiency that results in chronic hypoxia in the fetus. Intrauterine growth retardation can be divided into two types: - Type I (symmetrical) and type II (asymmetrical). In Type II intrauterine growth retardation, growth retardation does not become clinically evident until the third trimester. There is relative brain sparing with a greater deprivation in the size of abdominal organs, such as the liver and the kidneys. Previous studies have shown that there is no correlation between volume of the carotid body and hypoxia in children. However, Heath et al. made the observation that there are three variants of chief cells (progenitor, light and dark) within the carotid body and that an increase in the relative percentage of the dark subtype is an indicator of hypoxia. Using this observation, the present study set out to test two hypotheses: Firstly, whether the carotid body is functional in utero; and secondly whether there are any objective morphological changes in the carotid bodies of fetuses that have been subjected to intrauterine growth retardation. The carotid bodies from 72 fetuses with a gestational age between thirty and forty weeks were removed from the archived autopsy material, and differential cell counts were performed of the various cells present within the carotid bodies, using haematoxylin and eosin stained sections of the carotid bodies. The cases were assigned to three groups: - I) cases that had clinical and pathological evidence of intrauterine growth retardation, 2) negative controls and 3) positive controls. The three main groups were categorised as follows: -: (1) Intrauterine growth retardation (all cases with a weight for gestational age that is below the tenth centile and a brain to liver ratio of greater than four.) (2) Negative controls (all cases in whom there is a normal weight for age, a brain to liver ratio of less than three and no histological evidence of an episode of significant hypoxia before death). (3) Positive controls (all cases in whom there was clinically significant hypoxia present before death). The groups comprised of: 20 hypoxic positive controls, 15 negative controls, and 16 test cases which had suffered from intrauterine growth retardation. The remaining 21 cases were 7 dysmorphic infants, 3 congenital infection cases (congenital syphilis) and 11 cases that fitted the negative control criteria but had suffered significant hypoxia, thus excluding them from that category. The results showed that no significant difference was present in the percentage of sustentacular cells between any of the three groups. The results of the percentage of dark chief cells were as follows: l) mean percentage of dark chief cells in the intrauterine growth retardation group was 21.1 ±10.9%. 2) mean percentage of dark chief cells in the negative controls was 12.3 ±7.3%. 3) mean percentage of dark chief cells in the positive controls was 21.2 ±9.8%. A significant difference was present between the intrauterine growth retardation cases and the negative controls p=0.013, and between the positive and negative controls p=0.006. The dark chief cell count in the intrauterine growth retardation group showed no significant difference from the positive controls. No age-related difference appeared to be present in any of the groups. The conclusions reached are: a) Clinical hypoxia correlates with morphological changes in the carotid body, manifesting as an increase in the percentage of dark chief cells. b) intrauterine growth retardation cases show similar morphological changes in the carotid body to cases that have suffered from clinical hypoxia. c) therefore, by deduction intrauterine growth retardation fetuses have probably also been exposed to significant hypoxia while in utero. d) the fact that morphological changes in response to hypoxia are occurring in the carotid bodies of fetuses is an indication that the carotid body may be functional in utero. The results of the study indicate that a dark chief cell percentage of greater than 20% indicates that the fetus has been subjected to significant hypoxia, while a percentage of less than 10% indicates that it has not. A percentage of between 10 and 20% is unhelpful in determining whether hypoxia has taken place. The results of this study indicate that histological examination of the carotid bodies in neonates suspected of intrauterine growth retardation could be a useful additional means of assessment.

Background: Improvement in neonatal care has changed the features of severe hyperbilirubinemia and reduced the number of babies who need exchange transfusion (ET) to avoid bilirubin-induced neurological dysfunction. We conducted this study to determine the demographic and clinical characteristics of the exchanged babies, in order to identify their risk factors, and to determine the adverse effects and outcomes associated with ET. Methodology: This was a retrospective descriptive study, reviewing folders of infants who required ET at CMJAH from June 2006 to December 2011. Results: There were 63 patients who underwent 66 exchange transfusions. Patients exchanged in the neonatal unit accounted for 60.3%, with the rest of the patients (39.7%) being exchanged in the general ward. Preterm babies accounted for 45.7%, and the majority were inborn (44%). The majority were male (58.7%), term (54.3%), and the mean birth weight was 2.29 Kg (±0.89). The median age at exchange was 5 days (mean 4.5 days ±2.1 SD). The cause of jaundice was undetermined in most patients (84.1%), while ABO incompatibility and Rhesus disease accounted for 7.9% and 6.3%, respectively. Seven babies (11.1%) had an abnormal neurological examination before exchange and five (7.9%) were labelled as kernicterus. The mean bilirubin before exchange was 325 mmol/l ±118. The complications of ET were seen in 22.2% of patients. These were Necrotising Enterocolitis (NEC) (1.58%); seizure (1.58%); apnoea (4.76%); bleeding (3.1%); renal failure (3.1%); hypoglycaemia (4.76%); thrombocytopenia (67.6%); and hypercalcemia (85%). We had three deaths, of which two were due to neonatal sepsis acquired prior to exchange, with one case of perforated NEC in an infant with other comorbidities. Hence, the mortality associated with ET in our study was 1.5 percent. At discharge, three infants remained with signs of kernicterus (4.7%). Conclusion: Kernicterus remains a cause of concern in our settings, and mechanisms ought to be put in place to detect severe jaundice in discharged term babies who may benefit from early phototherapy (PTT) and ET; as this is shown to be a relatively safe procedure in our settings, especially in infants without other severe comorbidities. ACKNOWLEDGEMENTS I would like to take this opportunity to thank Prof Daynia Ballot, my research supervisor, who has been an inspiration for research and accepted the task of guiding me through the challenging journey of conducting and writing this review.

Growth failure is a major problem in children with chronic renal failure (CRF). A number of factors have been suggested as explanations for this impaired growth including renal osteodystrophy, age of onset of chronic renal failure, degree of azotemia and nutritional status. As children with CRF are frequently unable to maintain sufficient nutrient intakes for optimal growth, the nutritional status of these individuals must obviously have a major, if as yet poorly understood, role in the observed growth failure. Therefore, a nutritional, physical and biochemical study was conducted to assess the nutritional status of seven children undergoing maintenance hemodialysis. To evaluate the adequacy of dietary intake, fourteen day food records were obtained from each of the participants and average nutrient intakes were compared to the recommended daily nutrient intake of the Canadian Dietary Standard (CDS) (1975). To assess the physical status of the children, height, height velocity, weight, per cent body fat, and bone age were determined. As abnormalities of taste sensitivity are known to influence dietary patterns, salivary flow rates, salivary urea concentrations, and taste detection and recognition thresholds for sweet, sour, salt and bitter were determined pre and post dialysis. Biochemical investigations included the determination of pre and post dialysis plasma amino acid concentrations following a standardized fast of five hours, and the quantification of the amounts of amino acids lost into dialysate during a complete hemodialysis treatment. The mean caloric intake of 54% ±11 of the CDS is inadequate for optimal growth. The mean protein intake was 1.09 ±.16 grams of protein per kilogram of body weight. The first and second limiting amino acids were histidine and threonine, respectively. Nutritional deficiencies of certain water soluble vitamins (riboflavin, niacin and pyridoxine) existed for some of the children. The mean zinc, magnesium and copper intakes were 45% ±8, 51% ±19 and 54% ±32 of the CDS, respectively. Growth (as measured by body height and weight) was found to be retarded one to two standard deviations from normal in the children studied. Per cent body fat estimations were within normal limits, but bone age was frequently below chronological age. Taste sensitivity was impaired as shown by elevated pre dialysis sweet and bitter recognition thresholds (p<.01). This reduced taste acuity was improved post dialysis (p<.005), but did not reach normal values. Pre and post dialysis, salivary flow rates were reduced (p<.0005) and salivary urea concentrations elevated (p<.0005) when compared to normal. Pre dialysis, plasma concentrations of taurine, a-amino-butyric acid, valine, cystine, leucine, tyrosine and tryptophan were decreased from normal levels (p<.025), and aspartic acid, proline, glycine, citrulline, ornithine, histidine, arginine, asparagine, 3-methylhistidine and hydroxyproline were elevated above normal (p<.005). The presence of subclinical protein calorie malnutrition (PCM) was indicated by a depressed plasma essential to nonessential amino acid ratio, a depressed plasma valine to glycine ratio, and an elevated plasma phenylalanine to tyrosine ratio as compared to normal. The detection of 3-methylhistidine and hydroxyproline in plasma provides additional indications of PCM. The mean amount of total amino acid lost into dialysate was 4.7 ±.9 grams. Histidine, threonine, lysine and valine were the essential amino acids lost in the largest amounts. In conclusion, growth is retarded in children with CRF and may be due to the accumulation of metabolic end products which depress appetite and/or delay the natural rate of growth events Suboptimal nutriture, as evidenced by the presence of PCM, is a major factor in the growth retardation of these individuals. / Land and Food Systems, Faculty of / Graduate