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MSc, Child Health Neurodevelopment, Faculty of Health Sciences, University of the Witwatersrand / Background: Prematurely born very low birth weight (VLBW) infants are at high risk for neurodevelopmental problems and require regular follow up. Within the South African context, one needs a reliable and user-friendly screening tool to identify those who require intervention. The Molteno Adapted Scale (MAS) is used for this purpose in many clinics, but it has never been validated. Aim: To assess if the MAS performed on young prematurely born infants reliably predicts the neurodevelopmental outcome at 2 years of age as determined by the Griffiths Mental Development Scales (GMDS). Methods: A retrospective study of records of VLBW infants between 1998 and 2006, from the Panorama Medi-Clinic Neonatal Intensive Care Unit follow up clinic. Infants with birth weights < 1500g and accurately assessed gestation < 34 weeks were included. Those who suffered brain insults e.g. meningitis, between the early assessments and the GMDS were excluded. For each child, quotients obtained from the MAS at early assessments were compared to quotients obtained on the GMDS after 2 years of age using Spearman correlations. Results: Fifty-two (27 boys) VLBW infants were included in the study, with a mean birth weight of 981.2 ± 225.5 g and mean gestation of 27.7 ± 1.9 weeks. Thirteen (25%) infants had cerebral palsy and two had visual impairment. MAS assessments were performed at mean ages of 5.1, 10.1 and 16.8 months and the GMDS at a mean age of 28.8 months. Correlations between the MAS and the GMDS ranged from 0.1 - 0.43 at the first assessment, 0.29 - 0.46 at the second assessment and 0.52 - 0.63 at the third assessment. Correlations were statistically significant for the Fine Motor quotient on the MAS at the first assessment, the General quotient and Personal Social quotient at the second assessment, and all quotients except Personal Social at the third assessment. Conclusion: Developmental quotients on the MAS at 5.1 and 10.1 months have a weak positive correlation with the GMDS at 28 months. The MAS at 16.8 months significantly correlated with the developmental outcome as assessed on the GMDS at a mean age of 28 months in prematurely born VLBW infants.

Com o objetivo de analisar dados de 697 comportamentos observados em cerca de 30 bebês considerados clinicamente normais, na faixa etária de O a 6 meses, provenientes de dois estudos, da cidade de Ribeirão Preto, SP, foi realizada neste trabalho a exploração detalhada das informações consideradas relevantes para a compreensão de alguns aspectos do processo de desenvolvimento infantil, através da construção e emprego de técnicas estatísticas adequadas à natureza dos dados em questão, em um trabalho cuja diretriz foi determinada pela integração entre profissionais, particularmente das áreas de Estatística e Neurodesenvolvimento. Os resultados da aplicação das técnicas propiciaram a melhoria na compreensão do processo de desenvolvimento desses bebês, através de: a) levantamento das tendências das freqüências comportamentais; b) comprovação da igualdade entre os grupos de bebês dos dois estudos na idade de um mês; c) determinação dos grupos de comportamentos com freqüências semelhantes na faixa etária considerada; d) constatação de que os objetos estimuladores não apresentam efeitos diferentes; e) verificação de que as situações de estimulação podem ser simplificadas; f) redução substancial do número de comportamentos avaliados e, g) constmção de um indicador (IPC) visando a avaliação de padrões de comportamentos de bebês na faixa etária considerada. / This thesis analyses data based on 697 behaviors of about 30 clinically normal babies, from zero to six months old, in two studies conducted in Ribeirão Preto, SP. The work explores in detail information relevant to the comprehension of certain aspects of infant development processes and required the elaboration and use of statistical techniques appropriate to the nature of the data. Collaboration of professionals in many areas, particularly Statistics and Neuro-Development, was necessary. The results of the applications of these techniques increase comprehension of developmental process, taking into account: a) trend analysis of frequency of behaviors; b) corroboration of hypothesis of equality between two groups of one month-old babies; c) determination of behavioral groups with similar frequencies at give ages; d) conclusion that stimulation objects did not have different effects; e) verifications that stimulation situations can be simplified; f) conclusion that number of evaluated behaviors should be reduced, and g) construction of a statistical formula (IPC (\"Indicator of Behavior Pattern\")) to analyse standard behaviors of babies.

Com o objetivo de analisar dados de 697 comportamentos observados em cerca de 30 bebês considerados clinicamente normais, na faixa etária de O a 6 meses, provenientes de dois estudos, da cidade de Ribeirão Preto, SP, foi realizada neste trabalho a exploração detalhada das informações consideradas relevantes para a compreensão de alguns aspectos do processo de desenvolvimento infantil, através da construção e emprego de técnicas estatísticas adequadas à natureza dos dados em questão, em um trabalho cuja diretriz foi determinada pela integração entre profissionais, particularmente das áreas de Estatística e Neurodesenvolvimento. Os resultados da aplicação das técnicas propiciaram a melhoria na compreensão do processo de desenvolvimento desses bebês, através de: a) levantamento das tendências das freqüências comportamentais; b) comprovação da igualdade entre os grupos de bebês dos dois estudos na idade de um mês; c) determinação dos grupos de comportamentos com freqüências semelhantes na faixa etária considerada; d) constatação de que os objetos estimuladores não apresentam efeitos diferentes; e) verificação de que as situações de estimulação podem ser simplificadas; f) redução substancial do número de comportamentos avaliados e, g) constmção de um indicador (IPC) visando a avaliação de padrões de comportamentos de bebês na faixa etária considerada. / This thesis analyses data based on 697 behaviors of about 30 clinically normal babies, from zero to six months old, in two studies conducted in Ribeirão Preto, SP. The work explores in detail information relevant to the comprehension of certain aspects of infant development processes and required the elaboration and use of statistical techniques appropriate to the nature of the data. Collaboration of professionals in many areas, particularly Statistics and Neuro-Development, was necessary. The results of the applications of these techniques increase comprehension of developmental process, taking into account: a) trend analysis of frequency of behaviors; b) corroboration of hypothesis of equality between two groups of one month-old babies; c) determination of behavioral groups with similar frequencies at give ages; d) conclusion that stimulation objects did not have different effects; e) verifications that stimulation situations can be simplified; f) conclusion that number of evaluated behaviors should be reduced, and g) construction of a statistical formula (IPC (\"Indicator of Behavior Pattern\")) to analyse standard behaviors of babies.

Este trabalho de pesquisa consiste num esforço teórico com foco de interesse na dinâmica subjetiva vivenciada por bebês em processo de estruturação psíquica ao serem defrontados com a primeira experiência escolar, tendo como referencial a conexão psicanálise e educação. O motivo que inspirou a investigação foi a busca por um pouco de entendimento em relação aos impasses vivenciados nessa passagem. O choro e a dificuldade experimentada pela mãe em confiar seu bebê a alguém desconhecido conferem à entrada da criança na creche um caráter traumático, pois representam uma separação, no discurso corriqueiramente utilizado. Para isso, encontrou-se suporte nas noções de constituição psíquica e de campo do Outro e nas operações lacanianas de alienação e separação que permitiram estabelecer um contraponto entre estruturação subjetiva e noção de desenvolvimento infantil. A partir dessa abordagem e da noção lacaniana de separação como uma operação fundante do psiquismo, foi possível propor uma leitura dos impasses que permeiam a inserção da criança no mundo público como mais uma vicissitude do vir a ser um sujeito. / This research is a theoretical effort focused in the subjective dynamics experienced by infants in psychic structuring process when faced with the first school experience, taking as referential the psychoanalysis and education connection. The reason that inspired the investigation was the search for some understanding about the impasses experienced in this passage. The crying and the difficulty experienced by the mother to trust her baby to someone unknown give a traumatic nature to the entry of the child in the daycare, as it represents a separation, in the routinely used speech. For this, we found support in the notions of psychic constitution and field of the Other and in the Lacanian operations of alienation and separation that allowed establishing a counterpoint between subjective structuring and the concept of child development. Based on this approach and the Lacanian notion of separation as a foundational operation of the psyche, it was possible to propose a reading of the impasses that permeate the inclusion of children in the public world as another vicissitude of becoming a subject.

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Aravore Babies 天然高機能服裝：為啟動加州網路銷售之創業企劃 / NONE

As the capacity for saving smaller and smaller infants increases, the ethical dilemmas experienced by neonatal nurses who care for the smallest and most fragile of human beings will also increase. The current approaches to the resuscitation and management of extremely premature infants (24 weeks gestation and less) has resulted in the survival of infants with far less than optimal outcome. Neonatal nurses have begun to question saving the lives of extremely premature infants just because the technology exists to do so. This study explores the ethical issues faced by neonatal nurses caring for infants of 24 weeks gestation and less. The research question arose out of the need for neonatal nurses to articulate the ethical issues that they face in clinical practice when caring for extremely premature infants. The study design takes a dual approach to the research question, namely, a survey questionnaire and a qualitative analysis informed by phenomenology. Given the complexities of the issues within the topic, this combination of methods was deemed to be the most appropriate in gaining a convincing and authentic result. The results of this research are not generalisable to the experience of other nurses, or nurses caring for other groups of premature infants. In the first stage of the study neonatal nurses, members of the Australian Association of Neonatal Nurses (ANNA), were surveyed using a self-completion questionnaire. Then, in the qualitative component of this study fourteen (14) interviews with neonatal nurses were undertaken. These were either single or focus group interviews. In all, twenty four neonatal nurses from the state of New South Wales (NSW) and the Australian Capital Territory (ACT) were interviewed about their experiences of caring for infants of 24 weeks gestation and less. The questions asked during the interviews were based on findings from the questionnaire. The interview data was analysed using a qualitative approach informed by interpretative phenomenology. The qualitative analysis revealed that the ethical dilemmas faced by the nurses existed within four themes. The four themes are: • It’s all about this baby • Having a voice • Dealing with awfulness • Reflecting on the outcome. The qualitative description as given in the four themes reveals structures and meanings about what it is to be the neonatal nurse who experiences ethical dilemmas when caring for extremely premature infants. The study and its findings are a written account of the experiences of neonatal nurses and their ethical dilemmas in caring for infants of 24 weeks gestation and less. The meanings within the nurses’ experiences are offered and the final phenomenological description, Balancing hope with reality, is given. Hope has a buffering effect on the nurses. The nurses inspire and instil hope in themselves and a baby’s parents until the reality of a poor outcome dawns. Each time an extremely premature baby is born the nurses are hopeful for a good outcome, but the reality is that they have experienced many instances in which babies die or have a poor outcome. The neonatal nurses, affected by their experiences of ethical distress, attempted to find a pathway to achieve a balance between their emotions and caring for the baby. In doing so the nurses were able to remain productive the neonatal intensive care unit, and give high quality care to the baby and compassion to the parents. This study makes an important contribution to neonatal nursing knowledge and practice by exploring the ethical dilemmas and complexities associated with extremely premature infants. This study also makes a unique contribution to the body of literature on ethical dilemmas experienced by neonatal nurses.

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abstract: ABSTRACT Research suggests that there are benefits of early intervention and in focusing on mental health for infants and toddlers who have been maltreated. Court Teams for Infants and Toddlers is a model program designed to improve developmental outcomes using a systemic change approach. Multi-system collaboration between the courts, child welfare, health professionals, child advocates, and community partners are promoted to increase awareness and improve outcomes for infants and toddlers who have been removed from their parents. The Court Teams model in Arizona is known as Best for Babies. This study looks at implementation efforts of Best for Babies in two counties, Yavapai and Pima, and the unique perspectives of foster parents and attorneys representing the infants and toddlers while in the foster care system. It is important for purposes of effective program implementation to understand whether the Best for Babies program has impacted how these stakeholders address the unique needs of infants and toddlers. Findings reveal that most foster parents in this study were not familiar with the Best for Babies program; however, many of the comments shared are aligned with the values of the program. For example, all participants commented that collaboration among various stakeholders is necessary. Areas of opportunity were also illustrated in the findings regarding Best for Babies program implementation. For instance, the study found that even those foster parents familiar with the program could not attribute an impact on their care of infants and toddlers specifically to Best for Babies. / Dissertation/Thesis / M.S.W. Social Work 2011