Search results for: maternal and child health

Authors: Karen L. Lindsay, Sonja Entringer, Claudia Buss, Pathik D. Wadhwa

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Maternal nutrition and stress are independently recognized as among the most important factors that influence prenatal biology, with implications for fetal development and poor pregnancy outcomes. While there is substantial evidence from non-pregnancy human and animal studies that a complex, bi-directional relationship exists between nutrition and stress, to the author’s best knowledge, their interaction in the context of pregnancy has been significantly understudied. The aim of this study is to assess the interaction between maternal psychological stress and diet quality across pregnancy and its effects on biomarkers of prenatal insulin resistance and inflammation. This is a prospective longitudinal study of N=235 women carrying a healthy, singleton pregnancy, recruited from prenatal clinics of the University of California, Irvine Medical Center. Participants completed a 4-day ambulatory assessment in early, middle and late pregnancy, which included multiple daily electronic diary entries using Ecological Momentary Assessment (EMA) technology on a dedicated study smartphone. The EMA diaries gathered moment-level data on maternal perceived stress, negative mood, positive mood and quality of social interactions. The numerical scores for these variables were averaged across each study time-point and converted to Z-scores. A single composite variable for 'STRESS' was computed as follows: (Negative mood+Perceived stress)–(Positive mood+Social interaction quality). Dietary intakes were assessed by three 24-hour dietary recalls conducted within two weeks of each 4-day assessment. Daily nutrient and food group intakes were averaged across each study time-point. The Alternative Healthy Eating Index adapted for pregnancy (AHEI-P) was computed for early, middle and late pregnancy as a validated summary measure of diet quality. At the end of each 4-day ambulatory assessment, women provided a fasting blood sample, which was assayed for levels of glucose, insulin, Interleukin (IL)-6 and Tumor Necrosis Factor (TNF)-α. Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) was computed. Pearson’s correlation was used to explore the relationship between maternal STRESS and AHEI-P within and between each study time-point. Linear regression was employed to test the association of the stress-diet interaction (STRESS*AHEI-P) with the biological markers HOMA-IR, IL-6 and TNF-α at each study time-point, adjusting for key covariates (pre-pregnancy body mass index, maternal education level, race/ethnicity). Maternal STRESS and AHEI-P were significantly inversely correlated in early (r=-0.164, p=0.018) and mid-pregnancy (-0.160, p=0.019), and AHEI-P from earlier gestational time-points correlated with later STRESS (early AHEI-P x mid STRESS: r=-0.168, p=0.017; mid AHEI-P x late STRESS: r=-0.142, p=0.041). In regression models, the interaction term was not associated with HOMA-IR or IL-6 at any gestational time-point. The stress-diet interaction term was significantly associated with TNF-α according to the following patterns: early AHEI-P*early STRESS vs early TNF-α (p=0.005); early AHEI-P*early STRESS vs mid TNF-α (p=0.002); early AHEI-P*mid STRESS vs mid TNF-α (p=0.005); mid AHEI-P*mid STRESS vs mid TNF-α (p=0.070); mid AHEI-P*late STRESS vs late TNF-α (p=0.011). Poor diet quality is significantly related to higher psychosocial stress levels in pregnant women across gestation, which may promote inflammation via TNF-α. Future prenatal studies should consider the combined effects of maternal stress and diet when evaluating either one of these factors on pregnancy or infant outcomes.

Keywords: diet quality, inflammation, insulin resistance, nutrition, pregnancy, stress, tumor necrosis factor-alpha

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Authors: Chrysoula Mangafa

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Autism is a lifelong condition that affects how individuals interact with others and make sense of the world around them. The two core difficulties associated with autism are difficulties in social communication and interaction, and the manifestation of restricted, repetitive patterns of behaviour. However, children with autism may also have many talents and special interests among which is their affinity with digital technologies. Despite the increasing use of mobile tablets in schools and homes and the children’s motivation in using them, there is limited guidance on how to use the tablets to teach children with autism-specific skills. This study aims to fill this gap in knowledge by providing guidelines about the ways in which iPads and other tablets can be used by parents/carers and their child at home to support the development of social communication skills. Semi-structured interviews with 10 parents of primary school aged children with autism were conducted with the aim to explore their experiences in using mobile devices, such as iPads and Android tablets, and social activities with their children to create opportunities for social communication development. The interview involved questions about the parents’ knowledge and experience in autism, their understanding of social communication skills, the use of technology at home, and their links with the child’s school. Qualitative analysis of the interviews showed that parents used a variety of strategies to boost their child’s social communication skills. Among these strategies were a) the use of communication symbols, b) the use of the child’s special interest as motivator to gain their attention, and c) allowing time to their child to respond. It was also found that parents engaged their child in joint activities such as cooking, role play and creating social stories together on the device. Seven out of ten parents mentioned that the tablet is a motivating tool that can be used to teach social communication skills, nonetheless all parents raised concerns over screen time and their child’s sharing difficulties. The need for training and advice as well as building stronger links with their child’s school was highlighted. In particular, it was mentioned that recommendations would be welcomed about how parents can address their child’s difficulties in initiating or sustaining a conversation, taking turns and sharing, understanding other people’s feelings and facial expressions, and showing interest to other people. The findings of this study resulted in the development of a parents’ guide based on evidence-based practice and the participants’ experiences and concerns. The proposed guidelines aim to urge parents to feel more confident in using the tablet with their child in more collaborative ways. In particular, the guide offers recommendations about how to develop verbal and non-verbal communication, gives examples of tablet-based activities to interact and create things together, as well as it offers suggestions on how to provide a worry-free tablet experience and how to connect with the school.

Keywords: families, perception and cognition in early development, school-age intervention, social development

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Authors: Meng Wang

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Historically, young members (children) in the society have been oppressed by adults through direct violent acts. Direct violence was evident in rampant child labor and child maltreatment cases. After acknowledging the rights of children from the United Nations, it is believed in public that children have been protected against direct physical violence. Nevertheless, at present, this paper argues from Foucauldian and disability study standpoints that similar to the old times, children are oppressed objects in the context of child play, which is constructed by adults to substitute direct violence in regulating children. Particularly, this paper suggests that on the one hand, preschool play is a new way that adults adopt to oppress preschoolers and regulate the society as a whole; on the other hand, preschoolers are taught how to play as an acquired skill and master self-regulation through play. There is a line of contemporary research that centers on child play from social constructivism perspective. Yet, current teaching practices pertaining to child play including guided child play and free play, in fact, serve the interest of adults and society at large. By acknowledging and deconstructing the prevalence of 'evidence-based best practice' in early childhood education field within western society, reconstruction of child-adult power relation could be achieved and alternative truth could be found in early childhood education. To support the argument of this paper, an on-going observational case study is conducted in a preschool setting in the United States. Age range of children is 2.5 to 4 years old. Approximately 10 children (5 boys) are participating in this case study. Observation is conducted throughout the weekdays as children follow through the classroom routine with a lead and an assistant teacher. Classroom teachers are interviewed pertaining to their classroom management strategies. Preliminary research finding of this case study suggested that preschool teachers tended to utilize scenarios from preschoolers’ dramatic play to impart core cultural values to young children. These values were pre-determined by adults. In addition, if young children have failed to follow teachers' guidance in terms of playing in a correct way, children ran the risk of being excluded from the play scenario by peers and adults. Furthermore, this study tended to indicate that through child play, preschoolers are obliged to develop an internal violence system, that is self-regulation skill to regulate their own behavior; and if this internal system is unestablished based on various assessments by adults, then potentially there will be consequences of negative labeling and disabling toward young children intended by adults. In conclusion, this paper applies Foucauldian analysis into the context of child play. At present, within preschool, child play is not free as it seems to be. Young children are expected to perform cultural tasks through their play activities designed by adults. Adults utilize child play as technologies of governmentality to further predict and regulate future society at large.

Keywords: child play, developmentally appropriate practice, DAP, poststructuralism, technologies of governmentality

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Authors: Priscilla Akua Agyapong

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Background: In a country of nearly 34 million people, Ghana suffers from rapidly growing pediatric CHD cases and not enough pediatric specialists to attend to the burgeoning needs of these children. Most of the cases are either missed or diagnosed late, resulting in increased mortality. According to the National Cardiothoracic Centre, 1 in every 100,000 births in Ghana has CHD; however, there is limited data on the clinical presentation and its management, one of the many reasons I decided to do this case study coupled with the loss my 2 month old niece to multiple Ventricular Septal Defect 3 years ago due late diagnoses. Method: A retrospective cohort study was performed at the child health clinic of one of Ghana’s public tertiary Institutions using data from their electronic health record (EHR) from February 2021 to April 2022. All suspected or provisionally diagnosed cases were included in the analysis. Results: Records of over 3000 children were reviewed with an approximate male to female ratio of 1:1.53 cases diagnosed during the period of study, most of whom were less than 5 years of age. 25 cases had complete clinical records, with acyanotic septal defects being the most diagnosed. 62.5% of the cases were ventricular septal defects, followed by Patent Ductus Arteriosus (23%) and Atrial Septal Defects (4.5%). Tetralogy of Fallot was the most predominant and complex cyanotic CHD with 10%. Conclusion: The indeterminate coronary anatomy of infants makes it difficult to use only echocardiography and other conventional clinical methods in screening for CHDs. There are rising modernizations and new innovative ways that can be employed in Ghana for early detection, hence preventing the delay of a potential surgical repair. It is, therefore, imperative to create the needed awareness about these “SILENT CRISES” and help save the Ghanaian child’s life.

Keywords: congenital heart defect(CHD), ventricular septal defect(VSD), atrial septal defect(ASD), patent ductus arteriosus(PDA)

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Authors: F. Nur Baran Aksakal, Özge Dinç, H. Tanju Besler, Begüm Mutuş, Özlem Üliç Çatar, Orhan Aydoğdu, Serhat Ünal

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Healthy eating habits are associated not only with the newborn, child, and maternal health but also with longer life expectancy by acting as a protective factor against non-communicable diseases such as obesity, diabetes, cardiovascular diseases, and cancer. The role of nutrition in medical education is to provide information about the relationship between healthy nutrition and malnutrition as well as diet-related non-communicable diseases. Considering the information pollution experienced in the field of nutrition and health in the society, it is seen that more than half of the population receives information from family physicians as the closest counseling unit. However, postgraduate nutrition education programs for physicians and other health professionals who wish to improve their current knowledge of the role of nutrition communication in the prevention and management of chronic diseases are limited worldwide. However, nutrition courses are either not included in the undergraduate medical education curriculum of physicians or they are insufficient. Based on this need, the main aim of the study group was to develop a "Nutrition and Nutrition Communication Training for Physicians" program that would be conducted in cooperation with the Sabri Ülker Foundation and the Federation of Family Physicians Associations (AHEF). This program is the first online nutrition and nutrition communication information platform for physicians in Turkey. This program aims to present the concept of adequate and balanced nutrition to physicians, the importance of nutrition in diseases with scientific data, and to gain communication skills that may be necessary while transferring scientific information to the public. A needs assessment questionnaire was applied to identify pre-program training needs. A study plan was made to allow the participation of all family physicians in the population, and a complete inventory was targeted. In other words, we aimed to reach the whole source without taking a section of the population. Participation in the training is based on volunteerism. The needs assessment study is conducted using 25,102 family physicians for whom email addresses are available. The online questionnaire was sent to all the family physicians with a reminder email one week after the first one, and 1308 responded. Considering the topics determined, a training program was prepared for family physicians under eight online training titles, starting in March 2022, and conducted once every two weeks. The number of audience members present at each session was between 1217 and 1673, and a minimum of 17 and a maximum of 53 questions were received in each session. We strongly believe that to prevent individuals' health problems and to have better control over chronic diseases, the information level of physicians should be increased via these kinds of interventions, and better collaboration between family physicians and dieticians should be established.

Keywords: nutrition communication, nutrition training, communication, nutrition

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Authors: Dejene Ermias Mekango, Mussie Alemayehu, Gebremedhin Berhe Gebregergs, Araya Abrha Medhanye, Gelila Goba

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Background: Maternal near miss (MNM) can be used as a proxy indicator of maternal mortality ratio. There is a huge gap in life time risk between Sub-Saharan Africa and developed countries. In Ethiopia, a significant number of women die each year from complications during pregnancy, childbirth and the post-partum period. Besides, a few studies have been performed on MNM, and little is known regarding determinant factors. This study aims to identify determinants of MNM among women in Tigray region, Northern Ethiopia. Methods: a case-control study in hospital found in Tigray region, Ethiopia was conducted from January 30 - March 30, 2016. The sample included 103 cases and 205 controls recruited from women seeking obstetric care at six public hospitals. Clients having a life-threatening obstetric complication including haemorrhage, hypertensive diseases of pregnancy, dystocia, infections, and anemia or clinical signs of severe anemia in women without haemorrhage were taken as cases and those with normal obstetric outcomes were considered as controls. Cases were selected based on proportional to size allocation while systematic sampling was employed for controls. Data were analyzed using SPSS version 20.0. Binary and multiple variable logistic regression (odds ratio) analyses were calculated with 95% CI. Results: The largest proportion of cases and controls was among the ages of20–29 years, accounting for37.9 %( 39) of cases and 31.7 %( 65) of controls. Roughly 90% of cases and controls were married. About two-thirds of controls and 45.6 %( 47) of cases had gestational age between 37-41 weeks. History of chronic medical conditions was reported in 55.3 %(57) of cases and 33.2%(68) of controls. Women with no formal education [AOR=3.2;95%CI:1.24, 8.12],being less than 16 years old at first pregnancy [AOR=2.5; 95%CI:1.12,5.63],induced labor[AOR=3; 95%CI:1.44, 6.17], history of Cesarean section (C-section) [AOR=4.6; 95%CI: 1.98, 7.61] or chronic medical disorder[AOR=3.5;95%CI:1.78, 6.93], and women who traveled more than 60 minutes before reaching their final place of care[AOR=2.8;95% CI: 1.19,6.35] all had higher odds of experiencing MNM. Conclusions: The Government of Ethiopia should continue its effort to address the lack of road and health facility access as well as education, which will help reduce MNM. Work should also be continued to educate women and providers about common predictors of MNM like the history of C-section, chronic illness, and teenage pregnancy. These efforts should be carried out at the facility, community, and individual levels. The targeted follow-up to women with a history of chronic disease and C-section could also be a practical way to reduce MNM.

Keywords: maternal near miss, severe obstetric hemorrhage, hypertensive disorder, c-section, Tigray, Ethiopia

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Authors: Lorenzo Ciletti, Ed Baines, Matt Somerville

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Internationally, supporting staff with limited training (Teaching Assistants (TA)) has played a critical role in the education of children with special educational needs and/or disabilities (SEND). Researchers have notably illustrated that TAs support the children’s classroom tasks while teachers manage the whole class. Rarely have researchers investigated the TAs’ support for children’s participation in whole-class or peer-group talk, despite this type of “social support” playing a significant role in children’s whole-class integration and engagement with the classroom curriculum and learning. Social support seems particularly crucial for a large proportion of children with SEND, namely those with communication and interaction difficulties (e.g., autism spectrum conditions and speech impairments). This study explored TA practice and, particularly, TA social support in a rarely examined context (Italy). The Italian case was also selected as it provides TAs, known nationally as “support teachers,” with the most comprehensive training worldwide, thus potentially echoing (effective) nuanced practice internationally. Twelve hours of video recordings of a single TA and a child with communication and interaction difficulties (CID) were made. Video data was converted into frequencies of TA multidimensional support strategies, including TA social support and pedagogical assistance. TA-pupil talk oriented to children’s participation in classroom talk was also analysed into thematic patterns. These multi-method analyses were informed by social scaffolding principles: in particular, the extent to which the TA designs instruction contingently to the child’s communication and interaction difficulties and how their social support fosters the child’s highest responsibility in dealing with whole-class or peer-group talk by supplying the least help. The findings showed that the TA rarely supported the group or whole class participation of the child with CID. When doing so, the TA seemed to highly control the content and the timing of the child’s contributions to the classroom talk by a) interrupting the teacher’s whole class or group conversation to start an interaction between themselves and the child and b) reassuring the child about the correctness of their talk in private conversations and prompting them to raise their hand and intervene in the whole-class talk or c) stopping the child from contributing to the whole-class or peer-group talk when incorrect. The findings are interpreted in terms of their theoretical relation to scaffolding. They have significant implications for promoting social scaffolding in TA training in Italy and elsewhere.

Keywords: children with communication and interaction difficulties, children with special educational needs and/or disabilities, social scaffolding, teaching assistants, teaching practice, whole-class talk participation

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Authors: Kavita Khoiwal, Vatsla Dadhwal, K. Aparna Sharma, Dipika Deka, Plabani Sarkar

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Introduction: About 2.4 million (1.93 - 3.04 million) people are living with HIV/AIDS in India. Of all HIV infections, 39% (9,30,000) are among women. 5.4% of infections are from mother to child transmission (MTCT), 25,000 infected children are born every year. Besides the risk of mother to child transmission of HIV, these women are at risk of the higher adverse pregnancy outcome. The objectives of the study were to compare the obstetric and neonatal outcome in women who are HIV positive with low-risk HIV negative women and effect of antiretroviral drugs on preterm birth and IUGR. Materials and Methods: This is a retrospective case record analysis of 212 HIV-positive women delivering between 2002 to 2015, in a tertiary health care centre which was compared with 238 HIV-negative controls. Women who underwent medical termination of pregnancy and abortion were excluded from the study. Obstetric outcome analyzed were pregnancy induced hypertension, HIV positive intrauterine growth restriction, preterm birth, anemia, gestational diabetes and intrahepatic cholestasis of pregnancy. Neonatal outcome analysed were birth weight, apgar score, NICU admission and perinatal transmission.HIV-positiveOut of 212 women, 204 received antiretroviral therapy (ART) to prevent MTCT, 27 women received single dose nevirapine (sdNVP) or sdNVP tailed with 7 days of zidovudine and lamivudine (ZDV + 3TC), 15 received ZDV, 82 women received duovir and 80 women received triple drug therapy depending upon the time period of presentation. Results: Mean age of 212 HIV positive women was 25.72+3.6 years, 101 women (47.6 %) were primigravida. HIV positive status was diagnosed during pregnancy in 200 women while 12 women were diagnosed prior to conception. Among 212 HIV positive women, 20 (9.4 %) women had preterm delivery (< 37 weeks), 194 women (91.5 %) delivered by cesarean section and 18 women (8.5 %) delivered vaginally. 178 neonates (83.9 %) received exclusive top feeding and 34 neonates (16.03 %) received exclusive breast feeding. When compared to low risk HIV negative women (n=238), HIV positive women were more likely to deliver preterm (OR 1.27), have anemia (OR 1.39) and intrauterine growth restriction (OR 2.07). Incidence of pregnancy induced hypertension, diabetes mellitus and ICP was not increased. Mean birth weight was significantly lower in HIV positive women (2593.60+499 gm) when compared to HIV negative women (2919+459 gm). Complete follow up is available for 148 neonates till date, rest are under evaluation. Out of these 7 neonates found to have HIV positive status. Risk of preterm birth (P value = 0.039) and IUGR (P value = 0.739) was higher in HIV positive women who did not receive any ART during pregnancy than women who received ART. Conclusion: HIV positive pregnant women are at increased risk of adverse pregnancy outcome. Multidisciplinary team approach and use of highly active antiretroviral therapy can optimize the maternal and perinatal outcome.

Keywords: antiretroviral therapy, HIV infection, IUGR, preterm birth

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Authors: Khulud Alhussain, Anna Gavine, Stephen Macgillivray, Sushila Chowdhry

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Background: Estimates show that by the year 2030, mental illness will account for more than half of the global economic burden, second to non-communicable diseases. Often, the perinatal period is characterised by psychological ambivalence and a mixed anxiety-depressive condition. Maternal mental disorder is associated with perinatal anxiety and depression and affects breastfeeding behaviors. Studies also indicate that maternal mental health can considerably influence a baby's health in numerous aspects and impact the newborn health due to lack of adequate breastfeeding. However, studies reporting factors associated with breastfeeding behaviors are predominantly quantitative. Therefore, it is not clear what literature is available to understand the factors affecting breastfeeding and perinatal women’s perspectives and experiences. Aim: This review aimed to explore the perceptions and experiences of women with perinatal anxiety and depression, as well as how these experiences influence their breastfeeding behaviours. Methods: A systematic literature review of qualitative studies in line with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ). Four electronic databases (CINAHL, PsycINFO, Embase, and Google Scholar) were explored for relevant studies using a search strategy. The search was restricted to studies published in the English language between 2000 and 2022. Findings from the literature were screened using a pre-defined screening criterion and the quality of eligible studies was appraised using the Walsh and Downe (2006) checklist. Findings were extracted and synthesised based on Braun and Clark. The review protocol was registered on PROSPERO (Ref: CRD42022319609). Result: A total of 4947 studies were identified from the four databases. Following duplicate removal and screening 16 studies met the inclusion criteria. The studies included 87 pregnant and 302 post-partum women from 12 countries. The participants were from a variety of economic, regional, and religious backgrounds, mainly from the age of 18 to 45 years old. Three main themes were identified: Barriers to breastfeeding, breastfeeding facilitators, emotional disturbance, and breastfeeding. Seven subthemes emerged from the data: expectation versus reality, uncertainly about maternal competencies, body image and breastfeeding, lack of sufficient breastfeeding support for family and caregivers’ support, influences positive breastfeeding practices, breastfeeding education, and causes of mental strain among breastfeeding women. Breastfeeding duration is affected in women with mental health disorders, irrespective of their desire to breastfeed. Conclusion: There is significant empirical evidence that breastfeeding behaviour and perinatal mental disturbance are linked. However, there is a lack of evidence to apply the findings to Saudi women due to lack of empirical qualitative information. To improve the psychological well-being of mothers, it is crucial to explore and recognise any concerns with their mental, physical, and emotional well-being. Therefore, robust research is needed so that breastfeeding intervention researchers and policymakers can focus on specifically what needs to be done to help mentally distressed perinatal women and their new-born.

Keywords: pregnancy, perinatal period, anxiety, depression, emotional disturbance, breastfeeding

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Authors: Yogesh Karunakar, Praveen Kandaswamy

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Mother’s milk provides the most superior source of nutrition to a child. There is no other substitute to the mother’s milk. Postpartum secretions like breast milk can be analyzed on the go for testing the presence of any harmful pathogen before a mother can feed the child or donate the milk for the milk bank. Since breast feeding is one of the main causes for transmission of diseases to the newborn, it is mandatory to test the secretions. In this paper, we describe the detection of pathogens like E-coli, Human Immunodeficiency Virus (HIV), Hepatitis B (HBV), Hepatitis C (HCV), Cytomegalovirus (CMV), Zika and Ebola virus through an innovative method, in which we are developing a unique chip for testing the mother’s milk sample. The chip will contain an antibody specific to the target pathogen that will show a color change if there are enough pathogens present in the fluid that will be considered dangerous. A smart-phone camera will then be acquiring the image of the strip and using various image processing techniques we will detect the color development due to antigen antibody interaction within 5 minutes, thereby not adding to any delay, before the newborn is fed or prior to the collection of the milk for the milk bank. If the target pathogen comes positive through this method, then the health care provider can provide adequate treatment to bring down the number of pathogens. This will reduce the postpartum related mortality and morbidity which arises due to feeding infectious breast milk to own child.

Keywords: postpartum, fluids, camera, HIV, HCV, CMV, Zika, Ebola, smart-phones, breast milk, pathogens, image processing techniques

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Authors: Tianyu Chen

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The No Child Left Behind Act (NCLB) of 2001 was a major federal education policy that aimed to improve academic outcomes for all students in the United States. This study examines whether NCLB improved college readiness, measured by access to higher education, for different demographic groups. Using data from the Integrated Public Use Microdata Series (IPUMS) from 2003-2008, regression analyses explore the relationship between gender, race, family income, and region with occupational education score. The results indicate that NCLB implementation had a positive effect on college access for women and Asian students compared to other groups. Higher family income was also associated with an increased likelihood of pursuing higher education, especially for families in the South. While NCLB intended to close achievement gaps, disparities in college readiness remained five years after implementation. Further research could examine longer-term trends and additional factors influencing the policy's effectiveness across student subgroups. This study provides evidence that simply holding schools accountable for test scores may not sufficiently improve equitable educational outcomes. More targeted support of disadvantaged groups may be needed to fulfill the goal of "no child left behind."

Keywords: no child left behind act, college readiness, achievement gaps, educational equity

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Authors: Alan Collins

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This study explains how The People’s Tribunal empowered survivors of child abuse. It examines how People’s tribunals can be effective mean of empowerment; the challenges of empowerment – expectation v. reality; the findings and how they reflect other inquiry findings; and the importance of listening and learning from survivors. UKCSAPT “The People’s Tribunal” was established by survivors of child sex abuse and members of civil society to investigate historic cases of institutional sex abuse. The independent inquiry, led by a panel of four judges, listened to evidence spanning four decades from survivors and experts. A common theme throughout these accounts showed that a series of institutional failures prevented abuse from being reported; and that there are clear links between children being rendered vulnerable by these failures and predatory abuse on an organised scale. It made a series of recommendations including the establishment of a permanent and open forum for victims to share experiences and give evidence, better links between mental health services and police investigations, and training for police and judiciary professionals on the effects of undisclosed sexual abuse. The main findings of the UKCSAPT report were:-There are clear links between children rendered vulnerable by institutional failures and predatory abuse on an organised scale, even if these links often remain obscure. -UK governmental institutions have failed to provide survivors with meaningful opportunities for either healing or justice. -The vital mental health needs of survivors are not being met and this undermines both their psychological recovery and access to justice. -Police and other authorities often lack the training to understand the complex reasons for the inability of survivors to immediately disclose a history of abuse. -Without far-reaching changes in institutional culture and practices, the sexual abuse of children will continue to be a significant scourge in the UK. The report also outlined a series of recommendations for improving reporting and mental health provision, and access to justice for victims were made, including: -A permanent, government-funded popular tribunal should be established to enable survivors to come forward and tell their stories. -Survivors giving evidence should be assigned an advocate to assist their access to justice. -Mental health services should be linked to police investigations to help victims disclose abuse. -Victims who fear reprisals should be provided with a channel though which to give evidence anonymously.

Keywords: empowerment, survivors, sexual, abuse

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Authors: Xu Qian

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This abstract examines the concept of resilience in adolescents from both adolescent medicine and child psychology perspectives. It discusses the role of healthcare providers in fostering resilience among adolescents, encompassing physical, psychological, and social aspects. The paper highlights evidence-based interventions and practical strategies for promoting resilience in this population. Introduction: Resilience plays a crucial role in the healthy development of adolescents, enabling them to navigate through the challenges of this transitional period. This abstract explores the concept of resilience from the perspectives of adolescent medicine and child psychology, shedding light on the collective efforts of healthcare providers in fostering resilience. By integrating the principles and practices of these two disciplines, this abstract emphasizes the multidimensional nature of resilience and its significance in the overall well-being of adolescents. Methods: A comprehensive literature review was conducted, encompassing research articles, empirical studies, and expert opinions from both adolescent medicine and child psychology fields. The search included databases such as PubMed, PsycINFO, and Google Scholar, focusing on publications from the past decade. The review aimed to identify evidence-based interventions and practical strategies employed by healthcare providers to promote resilience among adolescents. Results: The review revealed several key findings regarding the promotion of resilience in adolescents. Firstly, resilience is a dynamic process influenced by individual characteristics, environmental factors, and the interaction between the two. Secondly, healthcare providers play a critical role in fostering resilience by addressing the physical, psychological, and social needs of adolescents. This entails comprehensive healthcare services that integrate medical care, mental health support, and social interventions. Thirdly, evidence-based interventions such as cognitive-behavioral therapy, social skills training, and positive youth development programs have shown promising outcomes in enhancing resilience. Discussion: The integration of adolescent medicine and child psychology perspectives provides a comprehensive framework for promoting resilience in adolescents. By acknowledging the interplay between physical health, psychological well-being, and social functioning, healthcare providers can tailor interventions to address the specific needs and challenges faced by adolescents. Collaborative efforts between medical professionals, psychologists, educators, and families are vital in creating a supportive environment that fosters resilience. Additionally, the findings highlight the importance of early identification and intervention, emphasizing the need for routine screening and assessment to identify adolescents at risk and provide timely support. Conclusion: Promoting resilience in adolescents requires a holistic approach that integrates adolescent medicine and child psychology perspectives. By recognizing the multifaceted nature of resilience, healthcare providers can implement evidence-based interventions and practical strategies to enhance the well-being of adolescents. The collaboration between healthcare professionals from different disciplines, alongside the involvement of families and communities, is crucial for creating a resilient support system. By investing in the promotion of resilience during adolescence, we can empower young individuals to overcome adversity and thrive in their journey toward adulthood.

Keywords: psychology, clinical psychology, child psychology, adolescent psychology, adolescent

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Authors: Laleh Golamrej Eliasi

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Finland is the second most violent country for women in the European Union (EU). 47% of women in Finland claimed to have experienced domestic violence against women (DVAW), compared to an average of 33% in the EU. Although the statistics in Finland are transparent, to the author’s best knowledge, there are no statisticsonDV by nationality in Finland. On the other hand, being a Muslim woman in a non-Muslim-majority country represents a position of double vulnerability to violence. There are 10404 Afghan refugees in Finland who are Muslim. Barriers such as unfamiliarity with support services, fear of the police, racism, language, economic and practical dependence, social isolation, and family commitments all lead to a lack of reporting of DVAW among migrants. Although witnessing and experiencing DV have devastating effects on women’s and children’s health and well-being, there is a lack of studies about DVAW among Afghan families in Finland. To fill this knowledge gap, Afghan women living in Finland are selected as the target group to assess their views on DVAW and child protection. This study is implemented in the socio-ecological approach framework to assess the impacts of individual characteristics, interpersonal relationships, community, and society components on DVAW in Afghan families. Interviews with Afghan women and content analysis are used to find out participants' views on DVAW, its risk factors, and approaches and methods to improve protection for women and children. Main purpose is to obtain information about participants' views on the subject. The findings can be used to improve culturally safe social work knowledge and practices with a bottom-up approach to reduce DV and increase child protection. Therefore, this research can have important effects on the sustainable development of services and supports the welfare and inclusion of immigrant families. The expected results will contribute to sustainable gender equality, which is in line with the fifth goal of the Sustainable Development Goals.

Keywords: domestic violence, immigrant women, immigrant child protection, social work

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Authors: Beaudoin Marie-Joelle, Poirier Nathalie

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Introduction: Children with autism spectrum disorder (ASD) tend to lack socio-emotional skills (e.g., emotional regulation and theory of mind). Eisenberg’s theoretical model on emotion-related socialization behaviors suggests that mothers of children with ASD could play a central role in fostering the acquisition of socio-emotional skills by engaging in frequent educational conversations about emotions. Although, mothers’ perceptions of their own emotional skills and their child’s personality traits and social deficits could mitigate the benefit of their educative role. Objective: Our study aims to explore the association between mother-child conversations about emotions and the socio-emotional skills of their children when accounting for the moderating role of the mothers’ perceptions. Forty-nine mothers completed five questionnaires about emotionally related conversations, self-openness to emotions, and perceptions of personality and socio-emotional skills of their children with ASD. Results: Regression analyses showed that frequent mother-child conversations about emotions predicted better emotional regulation and theory of mind skills in children with ASD (p < 0.01). The children’s theory of mind was moderated by mothers’ perceptions of their own emotional openness (p < 0.05) and their perceptions of their children’s openness to experience (p < 0.01) and conscientiousness (p < 0.05). Conclusion: Mothers likely play an important role in the socio-emotional education of children with ASD. Further, mothers may be most helpful when they perceive that their interventions improve their child’s behaviors. Our findings corroborate those of the Eisenberg model, which claims that mother-child conversations about emotions predict socio-emotional development skills in children with ASD. Our results also help clarify the moderating role of mothers’ perceptions, which could mitigate their willingness to engage in educational conversations about emotions with their children. Therefore, in special needs' children education, school professionals could collaborate with mothers to increase the frequency of emotion-related conversations in ASD's students with emotion dysregulation or theory of mind problems.

Keywords: autism, parental socialization of emotion, emotional regulation, theory of mind

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Authors: Smriti Gour, Neelam Pandey

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The objective of this study was to describe and analyse the mutual relationship between the coping mechanisms used by the families of a child with Autism Spectrum Disorder (ASD) and family dynamics and the effect sibling interactions have on the dynamics and coping mechanisms in an urban setup. In-depth interviews were conducted for 25 families, with 4 members each in the Delhi NCR area in India. The families who were interviewed had a younger child who had received a diagnosis of ASD between the ages of 5-12. The in-depth questionnaires contained open-ended questions and the interviews were conducted separately for the mother, father and the typically developing sibling. The key findings of the study suggested that lack of communication was a common factor in most families (n=19) leading to other difficulties like stress and relationship dysfunction. It also fostered a fallacious perception of the relationship dynamics in the family in most of the interviewed families and changed depending on the family member being interviewed. In families where the typically developing elder sibling had a good relationship with the autistic child, the family dynamics were found to be more stable, and the overall family well-being was better maintained. The coping mechanisms employed by the families were also more positive and tended to work better if the typically developing sibling maintained a positive and interactive relationship with the parents and the autistic child. The type of coping mechanisms had a major impact on the relationship between the parents and in dictating the dynamics of the family of the child with ASD. Spirituality, professional help, family support and household help emerged to be the most effective coping mechanisms for the families, with spirituality emerging to be the most positive and effective coping mechanism in the families interviewed.

Keywords: autism spectrum disorder, coping mechanism, family dynamics, parental relationships, siblings

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Authors: Pierre Nicole Patriarca

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This study examined the attachment styles, parent-child relationship, and romantic relationship quality of five illegitimate emerging adults aged 18 to 23 years old. The researcher used self-report measures, inventory of parent and peer attachment, attachment style questionnaire, and network of relationship – relationship quality version in obtaining data. A semi-structured interview was also used to acquire qualitative data about the detailed perception and experiences on the attachment styles and parent-child relationship. Common themes of each variable were identified through thematic analysis. Results showed that four out of five participants depicted positive relationship to their fathers, while all of them reported to have positive relationship to their mothers. It was also found that four participants have preoccupied attachment style, while the other one has fearful attachment style. Common themes in describing their relationship with their mother include being close, influential to participants’ life, unbounded communication, favorable reason of trusting, and sometimes being inattentive. On the other hand, having distant relationship, limited communication about romantic relationship, uninfluential to participant’s life, and favorable reason of trusting were the common themes in describing relationship with father. Lastly, less trusting, being dependent, and emphasis on valuing intimacy were the common themes in describing their style of attachment.

Keywords: illegitimate, emerging adult, attachment, parent-child relationship, relationship quality

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Authors: Kjellgren Maria, Lilliehorn Sara, Markström Urban

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This article describes the counselling practice of school social workers (SSWs) with individual children. SSWs work in the school system’s pupil health team, whose primary task is health promotion and prevention. The work of SSWs is about helping children and adolescents who, for various reasons, suffer from mental ill-health, school absenteeism, or stress that make them unable to achieve their intended goals. SSWs preferably meet these children in individual counselling sessions. The aim of this article is to describe and analyse SSWs’ experience of counselling with children and to examine the characteristics of counselling practice. The data collection was conducted through four semi-structured focus group interviews with a total of 22 SSWs in four different regions in Sweden. SSWs provide counselling to children in order to bring about improved feelings or behavioural changes. It can be noted that SSWs put emphasis on both the counselling process and the alliance with the child. The interviews showed a common practice among SSWs regarding the structure of the counselling sessions, with certain steps and approaches being employed. However, the specific interventions differed and were characterised by an eclectic standpoint in which SSWs utilise a broad repertoire of therapeutic schools and techniques. Furthermore, a relational perspective emerged as a most prominent focus for the SSWs by re-emerging throughout the material. We believe that SSWs could benefit from theoretical perspectives on ‘contextual model’ and ‘attachment theory’ as ‘models of the mind’. Being emotionally close to the child and being able to follow their development requires a lot from SSWs, as both professional caregivers and as “safe havens”.

Keywords: school social conselling, school social workers, contextual model, attachment thory

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Authors: Olufemi Samuel Shola, Oladapo Adenike Adesola

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Inadequate dietary intake has increased the susceptibility of under five children to malnutrition and infections. This study, therefore, assessed the feeding practices of children of 0-23 months of age among mothers in urban areas of Akure, Ondo State, Nigeria. Simple random sampling technique was used to select four hundred (400) mothers out of 710 mothers from 7 primary health care centres in Akure metropolis for the study. Data were collected using modified WHO 2003 Questionnaire on child feeding practices. Data were analyzed using descriptive statistics, while chi-square was used to determine the association between variables. Results showed that 52.0% of the children were males, with 47.5% in the 6-8 months age group. More than half (57.0%) of the mothers were between the ages of 20-29 years, and 45.0% had secondary education. Majority (94.3%) of the mothers breastfed their children in the last 24 hours preceding the survey. The feeding practices history of mothers showed that 28.0% and 53.7% of the mothers initiated breastfeeding less than 30 minutes and between 30 minutes to 1 hour after delivery, respectively. Also, 52.0% of mothers practiced exclusive breastfeeding for six months, while 26.2% breastfed from 6 months up to 2 years of age. Dietary diversity of the children age 6-23 months revealed that 68.7% of the children attained the minimum dietary diversity by consuming 4 or more food groups in the last 24 hours. There was a significant association (P < 0.05) between mothers’ education (n=180), occupation(n=41) and dietary diversity (n= 150) and meal frequency (n=209). Therefore, the study concluded that the duration of breastfeeding and time of introduction of complementary food did not meet WHO recommended guidelines. There is urgent need to launching more programmes.

Keywords: breastfeeding, mothers, child feeding, urban areas, ondo state, nigeria

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Authors: Sadhana Ghnayem

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This article examines the relationship between several socio-economic and background variables of Arab-Israeli families and their effect on the conflict management style of forcing, where teenage children are expected to obey their parents without questioning. The article explores the inter-generational gap and the desire of Arab-Israeli parents to force their teenage children to obey without questioning. The independent variables include: the sex of the parent, religion (Christian or Muslim), income of the parent, years of education of the parent, and the sex of the teenage child. We use the dependent variable of “Obedience Without Questioning” that is reported twice: by each of the parents as well as by the children. We circulated a questionnaire and collected data from a sample of 180 parents and their adolescent child living in the Galilee area during 2018. In this questionnaire we asked each of the parent and his/her teenage child about whether the latter is expected to follow the instructions of the former without questioning. The outcome of this article indicates, first, that Christian-Arab families are less authoritarian than Muslims families in demanding sheer obedience from their children. Second, female parents indicate more than male parents that their teenage child indeed obeys without questioning. Third, there is a negative correlation between the variable “Income” and “Obedience without Questioning.” Yet, the regression coefficient of this variable is close zero. Fourth, there is a positive correlation between years of education and obedience reported by the children. In other words, more educated parents are more likely to demand obedience from their children.  Finally, after running the regression, the study also found that the impact of the variables of religion as well as the sex of the child on the dependent variable of obedience is also significant at above 95 and 90%, respectively.

Keywords: conflict, religion, conflict management style, obedience

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Authors: Shabnam Dadparvar, Laijin Shen

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Undoubtedly, children are one of the biggest assets of any society and it is the duty of all officials to have a systematic plan to educate the next generation and make a better life for children so that they can progress and be effective for their communities. In an effort, Kurdistan Regional Government (KRG) has adopted standards to improve the condition for Izadis children; however, there are challenges that remain; such as: Izadis child abuse, Izadis child labor, Izadis children right’s law, orphans, Izadis street children and etc. In this paper, by a descriptive-analytical method the authors try to discuss the general situation of Izadis children in today s Iraqi Kurdistan and the issues such as drug abuse, Izadis child labor, orphans and Izadis street children. The questions are: How is the situation of Izadis children in Iraqi Kurdistan and what are their challenges? Also, what is the KRG’s strategy and through which ways, they can make a better life for minority children and change their current status? The authors believe that nowadays, the KRG is trying to crack down on problems against Izadis children; however, their effort is not adequate and some other activities should be performed; one of which is passing the Izadis children s law against violence.

Keywords: children right, Iraqi Kurdistan, Izadis children, Kurdistan Regional Government

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Authors: D. R. Apoorva

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Ichthyosis follicularis, alopecia, and photophobia (IFAP) syndrome is a rare oculocutaneous disorder of genetic origin. This disorder results from mutations in the membrane-bound transcription factor protease site, two genes that impair cholesterol homeostasis, and the ability to cope with endoplasmic reticulum stress. We report a rare case of IFAP syndrome with an atypical presentation, and it was interesting to note that the child had patchy non-scarring alopecia over the scalp along with unilateral madarosis. To our best knowledge, this unique presentation has not been described earlier. The child presented with photophobia and unilateral ptosis. The child also had short stature and intellectual disability. Skin histopathology was nonspecific and consisted of dilated hair follicles with keratin plugs extending above the skin surface. This rare oculocutaneous disorder requires proper documentation so that identification of its variants may be possible in the future. Early recognition of atypical presentations can help in preventing cardiovascular complications, which remain the major cause of death.

Keywords: alopecia, photophobia, ichthyosis follicularis, IFAP syndrome

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Authors: Nilam Bano, Uzma Iram

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Globally, the dilemma of undernutrition has become a notable concern for the researchers, academicians, and policymakers because of its severe consequences for many centuries. The nutritional deficiencies create hurdles for the people to achieve goals related to live a better lifestyle. Not only at micro level but also at the macro level, the consequences of undernutrition affect the economic progress of the country. The initial five years of a child’s life are considered critical for the physical growth and brain development. In this regard, children require special care and good quality food (nutrient intake) to fulfill their nutritional demand of the growing body. Having the sensitive stature and health, children specially under the age of 5 years are more vulnerable to the poor economic, housing, environmental and other social conditions. Beside confronting economic challenges and political upheavals, Pakistan is also going through from a rough patch in the context of social development. Majority of the children are facing serious health problems in the absence of required nutrition. The complexity of this issue is getting severe day by day and specially children are left behind with different type of immune problems and vitamins and mineral deficiencies. It is noted that children from the well-off background are less likely affected by the undernutrition. In order to underline this issue, the present study aims to highlight the existing nutritional inequalities among the children of under five years in Pakistan. Moreover, this study strives to decompose those factors that severely affect the existing nutritional inequality and standing in the queue to capture the consideration of concerned authorities. Pakistan Demographic and Health Survey 2012-13 was employed to assess the relevant indicators of undernutrition such as stunting, wasting, underweight and associated socioeconomic factors. The objectives were executed through the utilization of the relevant empirical techniques. Concentration indices were constructed to measure the nutritional inequalities by utilizing three measures of undernutrition; stunting, wasting and underweight. In addition to it, the decomposition analysis following the logistic regression was made to unfold the determinants that severely affect the nutritional inequalities. The negative values of concentration indices illustrate that children from the marginalized background are affected by the undernutrition more than their counterparts who belong from rich households. Furthermore, the result of decomposition analysis indicates that child age, size of a child at birth, wealth index, household size, parents’ education, mother’s health and place of residence are the most contributing factors in the prevalence of existing nutritional inequalities. Considering the result of the study, it is suggested to the policymakers to design policies in a way so that the health sector of Pakistan can stimulate in a productive manner. Increasing the number of effective health awareness programs for mothers would create a notable difference. Moreover, the education of the parents must be concerned by the policymakers as it has a significant association with the present research in terms of eradicating the nutritional inequalities among children.

Keywords: concentration index, decomposition analysis, inequalities, undernutrition, Pakistan

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Authors: Rachel Falconer

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Background: The United Nations Convention on the Rights of the Child sets out the duties placed on signatory nations to take measures to protect children from all forms of violence, abuse, neglect and maltreatment. The systems for ensuring this protection vary globally, shaped by national welfare policies. In England and Finland, past research has highlighted differences in how child protection issues are framed and how state agencies respond. However, less is known about how such differences impact processes of social work judgment and decision making in practice. Method: Data was collected as part of a wider PhD project in three stages. First, social workers in sites across England and Finland were asked to complete a short questionnaire. Participants were then asked to comment on two constructed case vignettes, and were interviewed about their experiences of child protection decision making at the point of referral. Interviews were analyzed using NVivo to draw out key themes. Findings: There were similarities in how the English and Finnish social workers responded to the case vignettes; for example, participants in both countries expressed concerns about similar risk factors and all felt further assessment was needed. Differences were observed, in particular, in regard to the sources of support and guidance participants referred to, with the English social workers appearing to rely more upon managerial input for their decisions than the Finnish social workers. These findings suggest evidence for two distinct decision making approaches: ‘supervised’ and ‘supported’ judgement. Implications for practice: The findings have relevance to the conference theme of research and evaluation of social work practice, and support the findings of previous studies that have emphasized the significance of organizational factors in child protection decision making. The comparative methodology has also helped to demonstrate how organizational factors can influence practice in different child protection system ‘orientations’. The presentation will discuss the potential practice implications of ‘supervised’, manager-led approaches to decision making as contrasted with ‘supported’, team-led approaches, inviting discussion about the relevance of these findings for social work in other countries.

Keywords: child protection, comparative research, decision making, social work, vignettes

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Authors: Mbuotidem Brendan, Nathanael Afolabi

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Teenage pregnancy is a major health concern because of its association with high morbidity and mortality for both mother and child. In 2013, 23% of women in Nigeria, aged 15 - 19 yr have begun childbearing: 17% have had a child and 5% are pregnant with their first child. Reported differences across locations have been attributed to factors such as educational attainment and exposure to mass media. This study therefore seeks to determine the difference in the level of exposure among teenage mothers and older women of reproductive age in Nigeria. Over 12,000 women of reproductive age (18 – 49 yr) were interviewed across 8 states from the Northern and Southern region of Nigeria. The women were further segregated into two groups of 0 (women aged 18 – 20 yr who had children of their own) and 1 (women of reproductive age excluding teenage mothers). Data was collected via structured questionnaires on mobile devices using the open data kit platform. Initial data formatting and recoding was done using STATA 13 package. Initial analysis was also conducted using SPSS version 21 and the data points were mapped on QuantumGIS package. From the results of analyzed data obtained from the studied states, there were various mean ages of first births across the supported states. Though Akwa Ibom had one of the oldest mean ages (21.2 yr) at first birth and the lowest fertility rate of 3.9 births/woman according to the National Demographic Health Survey 2013, Akwa Ibom had the highest rate of teenage pregnancy (18.2%) across the respondents. Based on education, the respondents that had completed secondary school education (56.9%) made up the greatest cohorts of the teenage parents. This is counter indicative of the initial thinking that there is an inverse relationship between level of education and teenage pregnancy. Akwa Ibom, Bauchi and Delta states are states where respondents felt that contraceptive use is dangerous to health and they were the top 4 states that had a large proportion of teenage mothers. Similarly, across the states examined, all the women of reproductive age felt they could convince their spouses to use contraceptives, as using family planning does not cause women to be promiscuous. This study thus reveals that across the states studied, there was no marked variation in the perception of family planning between teenage parents and women of reproductive age. The study also highlights the need for future planning and exposure to family planning messages at secondary school level.

Keywords: adolescent, family planning, mass media, teenage mothers

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Authors: Ghulam Zahra

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Parenting style affects the morality of their children. There is plenty of evidence to support the effect of parenting styles on the morality of their children. Therefore, this research is considered essential and suitable. Thus, the main objective of this study was to assess the correlation between the parenting style of mothers and the moral development of primary school students. The population consisted of all primary school students enrolled in the province of Punjab. The sample was comprised of twelve hundred thirty-nine primary school students. One questionnaire was adapted to explore the parenting styles of mothers and to assess the level of students’ level of morality; a moral development scale was adopted. The conclusions showed that there was a significant correlation exist among authoritarian parenting style, permissive parenting, and moral developments. Based on findings, it is recommended that parents should follow a warm style of parenting for the sake of the moral development of their children.

Keywords: maternal parenting style, moral development, authoritative parenting, authoritarian parenting, permissive parenting

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Authors: Rashed Shah, Jeanne Koepsell, Dixmer Rivera, Eric Swedberg, David Marsh

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Success of primary health care goals of health promotion and disease prevention may well be determined by community based health workers’ overall job satisfaction. It is also important to understand the ways community health workers perceive their jobs and the importance they give to the various factors influencing their job satisfaction, which is critical before making a decision for task-shifting and for expanding their scope of work. Although brigadistas are unpaid volunteers, they are formally recognized and receive support and supervision from the Ministry of Health in Nicaragua. Brigadistas are responsible for classifying and diagnosing illnesses, administering treatment, counseling mothers and care givers within the community, encouraging referral in case of serious illness and making follow-up visits at home. Some brigadistas provide more technically advanced services, including treatment for pneumonia, diarrhea, malaria and tuberculosis and/or distribution of contraceptives. Expanding brigadistas’ duties could threaten their heretofore ‘job satisfaction’. This study primarily aims to report on job satisfaction of brigadistas in Nicaragua before expanding the scope of their work by adding more responsibilities. The study was guided by the following research questions: 1) What aspects of their job made the brigadistas satisfied or dissatisfied? 2) What is the job satisfaction level of brigadistas in Nicaragua? This cross-sectional study was conducted during March – July 2014, to assess brigadistas’ job satisfaction, prior to deciding on inclusion of care for sick newborns and young infants (<2 months of age) to brigadistas’ existing service package of community case management for children of 2-59 months of age. Following stratified random sampling strategy, 15 brigadistas were randomly selected from each of the following four strata: [(1) females under 25 years of age, (2) females over 30 years of age, (3) males under 25 years of age, and (4) males over 30 years of age. Out of 45 completed in-person interview with eligible and available brigadistas, 20 (44.4%) were with female and 25 (55.6%) were with male respondents; the mean age (±sd) was found as 32.0 (±3.2) years. About 53% (24/45) brigadista mentioned “Training” as the most helpful for performing their job. Another 31% (14/45) mentioned that “feeling of doing good, supporting community, women and children” was helpful to perform their job well. When asked about difficulty, about 35.5% (16/45) brigadistas mentioned about “Lack of time” due to their responsibilities in family, farm, other work places, study and such time constraint made their job performance difficult. Measured on a 0-5 scale, estimated average job satisfaction was 4.2. Current trends in task-shifting and integrated program delivery require community health workers (like the brigadistas) to deliver several essential services, including maternal, newborn and child health, and family planning, and thereby increasing their responsibilities. Given the reported level of job satisfaction among brigadistas (4.2 out of 5), and the mentioned difficulty in performing their current job (as ‘Lack of Time’) in this study results, the policy makers and program managers in MOH should be cautious enough before making a decision to expand current scope of work for brigadistas in Nicaragua.

Keywords: Brigadisata, job satisfaction, Nicaragua, task-shifting

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Authors: Ş. Çiftcioğlu, E. Efe

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In recent years, cancer has been at the top of diseases that cause death in children. Adequate and balanced nutrition plays an important role in the treatment of cancer. Cancer and cancer treatment is affecting food intake, absorption and metabolism, causing nutritional disorders. Appropriate nutrition is very important for the cancerous child to feel well before, during and after the treatment. There are various difficulties in feeding children with cancer. These are the cancer-related factors. Other factors are environmental and behavioral. As health professionals who spend more time with children in the hospital, nurses should be able to support the children on nutrition and help them to have balanced nutrition. This study aimed to evaluate the importance of nursing approaches in the nutrition of children with cancer. This article is planned as a review article by searching the literature on this field. Anorexia may develop due to psychogenic causes or chemotherapeutic agents or accompanying infections and nutrient uptake may be reduced.  In addition, stomatitis, mucositis, taste and odor changes in the mouth, the feeling of nausea, vomiting and diarrhea can also reduce oral intake and result in significant losses in the energy deficit. In assessing the nutritional status of children with cancer, determining weight loss and good nutrition is essential anamnesis of a child.  Some anthropometric measurements and biochemical tests should be used to evaluate the nutrition of the child. The nutritional status of pediatric cancer patients has been studied for a long time and malnutrition, in particular under nutrition, in this population has long been recognized. Yet, its management remains variable with many malnourished children going unrecognized and consequently untreated. Nutritional support is important to pediatric cancer patients and should be integrated into the overall treatment of these children.

Keywords: cancer treatment, children, complication, nutrition, nursing approaches

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Authors: Muhamad N. Borhan, Nur S. Darus, Siti Z. Ishak, Rozmi Ismail, Siti F. M. Razali

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Children are at the greater risk to be involved in road traffic collisions due to the complex interaction of various elements in our transportation system. It encompasses interactions between the elements of children and driver behavior along with physical and social environment factors. The present study examined the effect between the collisions severity and physical environment factors on child pedestrian collisions. The severity of collisions is categorized into four injury outcomes: fatal, serious injury, slight injury, and damage. The sample size comprised of 2487 cases of child pedestrian-vehicle collisions in which children aged 7 to 12 years old was involved in Malaysia for the years 2006-2015. A multinomial logistic regression was applied to establish the effect between severity levels and physical environment factors. The results showed that eight contributing factors influence the probability of an injury road surface material, traffic system, road marking, control type, lighting condition, type of location, land use and road surface condition. Understanding the effect of physical environment factors may contribute to the improvement of physical environment design and decrease the collision involvement.

Keywords: child pedestrian, collisions, primary school, road injuries

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Authors: Masuma Novak, Daniel Novak

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Background: Sweden along with other Nordic countries has the highest incidence of type 1 diabetes mellitus (T1DM) worldwide. The trend is increasing globally. The diagnosis is often given at the emergency clinic when children arrive with cardinal symptom of T1DM. Children with T1DM are known to have an increased risk of microvascular- and macrovascular complications. A family history of cardiovascular complications may further increase their risk. Clinically evident diabetes-related vascular complications are however rarely visible in childhood and adolescence, whereby an intensive diabetes treatment and normoglycemic control is a goal for every child. This study is a risk evaluation of children with T1DM based on their family’s cardiovascular history. Method: Since 2005 the Better Diabetes Diagnosis (BDD) study is a nationwide Swedish prospective cohort study that recruits new-onset T1DM who are less than 18 years old at time of diagnosis. For each newly diagnosed child, blood samples are collected for specific HLA genotyping and islet autoantibody assays and their family’s cardiovascular history is evaluated. As part of the BDD study, during the years 2010-2013 all children diagnosed with T1DM at the Queen Silvia’s Children’s Hospital in Sweden were asked about their family’s cardiovascular history. Questions regarded maternal and paternal high blood pressure, stroke, and myocardial infarction before the age of 55 years, and hyperlipidemia were answered. A maximum risk score of eight was possible. All children are clinically observed prospectively for early functional and structural abnormalities such as protein uremia, blood pressure, and retinopathy. Results: A total of 275 children aged 0 to 18 years were diagnosed with T1DM at the Queen Silvia’s Children’s Hospital emergency clinic during this four year period. The participation rate was 99.7%. 26.4% of the children had no hereditary cardiovascular risk factors. 22.7 % had one risk factor and 18.8% had two risk factors. 14.8% had three risk factors. 9.7% had four risk factors and 7.5% had five risk factors or more. Conclusion: Among children with T1DM in Sweden there is a difference in hereditary cardiovascular risk factors. These results indicate that children with T1DM who also have increased hereditary cardiovascular risk factors should be monitored closely with early screening for functional and structural cardiovascular abnormalities. This is a very preliminary and ongoing study which will be complemented with the cardiovascular risk analysis among children without T1DM.

Keywords: children, type I diabetes, emergency clinic, CVD risk

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