The U.N. convention on the rights of the child: Relevance and application to pediatric clinical bioethics

This article provides an overview of the relevance and import of the U.N. Convention on the Rights of the Child (CRC) to child health practice and pediatric bioethics. We discuss the four general principles of the CRC that apply to the implementation of all rights contained in the document, the right to health articulated in Article 24, and the important position ascribed to parents in fulfilling the rights of their children. We then examine how the CRC is implemented and monitored in law and practice. The CRC and associated principles of child rights provide strategies for rights-based approaches to clinical practice and health systems, as well as to policy design, professional training, and health services research. In light of the relevance of the CRC and principles of child rights to children’s health and child health practice, it follows that there is an intersection between child rights and pediatric bioethics. Pediatric bioethicists and child rights advocates should work together to define this intersection in all domains of pediatric practice.

A Qualidade da Vinculação e o Comportamento Social em Jovens Institucionalizados

A qualidade da vinculação é fundamental para o desenvolvimento das crianças e adolescentes e tem uma enorme importância tanto a nível social como a nível emocional O presente estudo teve como objetivo averiguar a associação entre a qualidade da vinculação e os comportamentos sociais entre adolescentes institucionalizados que constituíram a sua amostra (34 jovens, de ambos os sexos e com idades compreendidas entre os 11 e os 18 anos). O protocolo de investigação incluiu um questionário sociodemográfico e a versão portuguesa do Inventory of parent and peer attachment (IPPA, Armsden & Greenberg, 1987). Os resultados dão conta da perceção normativa dos comportamentos sociais, a despeito de se tratar de uma população de adolescentes institucionalizados. Relativamente à qualidade da vinculação, este estudo dá conta que, apesar da aparente instabilidade da retaguarda familiar, uma parte destes adolescentes tem, ainda assim, a perceção de uma vinculação segura aos pais. / The quality of attachment is essential for the healthy development of children and adolescents, both socially and emotionally. The goal of this study was to analyze the eventual association between the quality of attachment and social behaviors among the institutionalized adolescents in study (34 adolescents from both genders aged 11 to 18 years-old). The research protocol included a social-demographic questionnaire and the Portuguese language version of "Inventory of parent and peer attachment (IPPA, Armsden & Greenberg, 1987). The results show that the perception of social behavior among these adolescents is normative, despite their institutionalization. In what relates to attachment data shows that, regardless of the apparent disorganization of the familial background, these adolescents have the perception of a secure attachment to their parents.

Processus décisionnel des parents concernant la vaccination de leur nourrisson, selon leur génération d’appartenance

Résumé : Malgré le fait que la vaccination soit reconnue comme l’une des mesures de santé publique les plus efficaces, elle est perçue comme non sécuritaire et non nécessaire par un nombre grandissant de parents. Dans ce contexte, la compréhension du processus décisionnel des parents par rapport à la vaccination de leur enfant serait aidante. Le but de cette étude est d’explorer le processus décisionnel des parents concernant la vaccination de leur nourrisson, selon leur génération d’appartenance, soit la génération X ou Y. Une étude de cas descriptive et comparative a été réalisée avec des entrevues semi-structurées ainsi qu’une analyse des sources d’informations consultées par les participantes. Les mères ont été sélectionnées selon leur intention de vaccination pour leur enfant. Les données ont été codifiées et analysées de façon systématique et rigoureuse au niveau intra-cas et inter-cas, co-analysées et ensuite validées avec les participantes. Quatre mères dans chaque génération ont été interviewées, dont trois participantes par génération à deux reprises. Le processus décisionnel est similaire d’une génération à l’autre. Les composantes du processus sont l’attitude initiale envers la vaccination, le processus cognitif, la recherche d’information, la décision, l’acte et l’évaluation rétrospective de l’expérience vécue. Toutes ces composantes sont influencées par des facteurs intrinsèques et extrinsèques. Certaines trouvailles de cette étude ont peu été documentées dans la littérature telles que la perception positive envers la vaccination, l’inconscience du processus, l’importance du déclencheur et le fait de saisir le moment opportun. Malgré la rigueur de cette étude, la principale limite est la saturation des données qui n’a possiblement pas été atteinte pour tous les aspects du processus décisionnel. Même si la norme sociale est favorable à la vaccination, aucune participante n’avait consciemment réfléchi à l’immunisation de son enfant jusqu’à ce qu’un déclencheur soit introduit. Ceci soulève l’enjeu et l’impact de la transmission de l’information adéquate, au moment opportun, et du soutien donné aux parents qui naviguent dans ce processus.

Touchpoints: parents and nurses perceptions and satisfaction

O apoio prestado às famílias que vivenciam a parentalidade deve basear-se numa relação de confiança entre enfermeiros e pais. A satisfação dos clientes e dos enfermeiros durante a prestação de cuidados assume grande relevância e pode ser considerada um ganho em saúde. Objetivo: Compreender a experiência e o significado atribuído pelos pais de crianças entre os 11 e os 24 meses e dos enfermeiros que participaram na implementação da metodologia Touchpoints (TP), uma intervenção de enfermagem inovadora. Desenho do Estudo e Métodos: Estudo qualitativo de cariz fenomenológico. A recolha de dados foi efetuada através de (i) diários de itinerância dos enfermeiros que participaram na implementação da metodologia TP e da (ii) técnica de grupos focais realizada junto de 10 pais de crianças do grupo de intervenção. Resultados: os pais consideraram que as sessões TP, implementadas pelos enfermeiros, contribuíram para: Aquisição de conhecimentos e competências; Validação de práticas parentais; Melhoria do comportamento da criança; Confiança parental; Relacionamento interpessoal; Competências profissionais; Competências específicas; Satisfação. Os enfermeiros que participaram no estudo consideraram que a metodologia TP contribuiu para: Mobilização e aplicação dos princípios TP; Processo de aprendizagem; Interesse dos pais; Sentimentos/emoções; Satisfação. Implicações Clínicas: Os enfermeiros que cuidam de famílias devem implementar metodologias inovadoras que facilitem a adaptação à parentalidade, como os Touchpoints. A implementação da metodologia TP contribuiu para a satisfação dos pais e enfermeiros.

An exploration of parent ivolvement in Response to Intervention (RTI) in Title I schools

Research demonstrates that parental involvement positively impacts student achievement and enhances targeted instruction. Notably, however, little research currently exists on how schools involve parents in Response to Intervention (RTI), a framework for implementing targeted, tiered, research-based instruction. The purpose of this study was to interview selected parents, teachers, RTI specialists, and principals in three Title I elementary schools in one school district, plus one district-level administrator, in order to examine how elementary schools currently involve parents in RTI prereferral interventions, and to understand the factors that might facilitate or challenge such parent involvement. I employed a comparative case study qualitative design with each elementary school as the main unit of analysis. I conducted individual, in-depth interviews that lasted approximately 45-60 minutes with a total of 33 participants across the three school sites, including 11 parents, 12 teachers, and six RTI specialists, three principals, and one district-level administrator. I also analyzed documents related to RTI processes that are available through websites and participants. I used Strauss and Corbin’s (1998) three-step scheme for thematic/grounded theory analysis, and Atlas.ti as the electronic tool for management and analysis. Analyses of the data revealed that personnel across the sites largely agreed on how they explain RTI to parents and notify parents of student progress. Parents mostly disagreed with these accounts, stating instead that they learn about RTI and their child’s progress by approaching teachers or their own children with questions, or by examining report cards and student work that comes home. Personnel and parents cited various challenges for involving parents in RTI. However, they all also agreed that teachers are accessible and willing to reach out to parents, and that teachers already face considerable workloads. It appears that no district- or school-wide plan guides parent involvement practices in RTI at any of the three schools. Finally, I present a discussion of findings; implications for teachers, RTI implementation leaders, and Title school leaders; study limitations; and possibilities for future research.

Gender and East Asian Welfare States: from Confucianism to Gender Equality

How can we understand the gender logic underpinning the welfare states/systems of East Asia? Does the comparative literature, which has largely been concerned with western Welfare states, whether in The Three Worlds of Welfare Capitalism (Esping-Andersen 1990), or in gender-based analysis of the male breadwinner model (Lewis 1992, 2001, 2006), have anything to offer in understanding the gender assumptions underpinning East Asian welfare states? Are the welfare systems of East Asian countries distinctive, with Confucian assumptions hidden beneath the surface commitment to gender equality? We will use the (mainly western) comparative literature, but argue that Confucian influences remain important, with strong assumptions of family, market and voluntary sector responsibility rather than state responsibility, strong expectations of women’s obligations, without compensating rights, a hierarchy of gender and age, and a highly distinctive, vertical family structure, in which women are subject to parents-in-law. In rapidly changing economies, these social characteristics are changing too. But they still put powerful pressures on women to conform to expectations about care, while weakening their rights to security and support. Nowhere do welfare states’ promises bring gender equality in practice. Even in Scandinavian countries women earn less, care more, and have less power than men. We shall compare East Asian countries (Japan, Korea, Taiwan where possible) with some Western ones, to argue that some major comparative data (e.g. OECD) show the extreme situation of women in these countries. Some fine new qualitative studies give us a close insight into the experience of mothers, including lone and married mothers, which help us to understand how far the gender assumptions of welfare states are from Scandinavia’s dual earner model. There are signs of change in society as well as in economy, and room for optimism that women’s involvement in social movements and academic enquiry may be challenging Confucian gender hierarchies.

Vinculação em grávidas adolescentes e ligação emocional materna e paterna ao feto

Dissertação de Mestrado apresentada ao Instituto Superior de Psicologia Aplicada para obtenção de grau de Mestre na especialidade de Psicologia Clínica.

The Influence of Place Attachment, Aspirations, and Rapidly Changing Environments on Resettlement Decisions

Resettlement associated with development projects results in a variety of negative impacts. This dissertation uses the resettlement context to frame the dynamic relationships formed between peoples and places experiencing development. Two case studies contribute: (a) the border zone of Mozambique’s Limpopo National Park where residents contend with changes to land access and use; and (b) Bairro Chipanga in Moatize, Mozambique where a resettled population struggles to form place attachment and transform the post-resettlement site into a “good” place. Through analysis of data collected at these sites between 2009 and 2015, this dissertation investigates how changing environments impact person-place relationships before and after resettlement occurs. Changing environments create conditions leading to disemplacement—feeling like one no longer belongs—that reduces the environment’s ability to foster place attachment. Research findings indicate that responses taken by individuals living in the changing environment depend heavily upon whether resettlement has already occurred. In a pre-resettlement context, residents adjust their daily lives to diminish the effects of a changing environment and re-create the conditions to which they initially formed an attachment. They accept impoverishing conditions, including a narrowing of the spaces in which they live their daily lives, because it is preferred to the anxiety that accompanies being forced to resettle. In a post-resettlement context, resettlement disrupts the formation of place attachment and resettled peoples become a placeless population. When the resettlement has not resulted in anticipated outcomes, the aspiration for social justice—seeking conditions residents had reason to expect—negatively influences residents’ perspectives about the place. The post-resettlement site becomes a bad place with a future unchanged from the present. At best, this results in a population in which more members are willing to move away from the post-resettlement site, and, at worse, complete disengagement of other members from trying to improve the community. Resettlement thus has the potential to launch a cycle of movement- displacement-movement that prevents an entire generation from establishing place attachment and realizing its benefits. At the very least, resettlement impedes the formation of place attachment to new places. Thus, this dissertation draws attention to the unseen and uncompensated losses of resettlement.

READY FOR KINDERGARTEN: A TRAINING PROGRAM DESIGNED TO ENCOURAGE PARENT-CHILD CONVERSATION DURING THE PRESCHOOL YEARS

Many children in the United States begin kindergarten unprepared to converse in the academic language surrounding instruction, putting them at greater risk for later language and reading difficulties. Importantly, correlational research has shown there are certain experiences prior to kindergarten that foster the oral language skills needed to understand and produce academic language. The focus of this dissertation was on increasing one of these experiences: parent-child conversations about abstract and non-present concepts, known as decontextualized language (DL). Decontextualized language involves talking about non-present concepts such as events that happened in the past or future, or abstract discussions such as providing explanations or defining unknown words. As caregivers’ decontextualized language input to children aged three to five is consistently correlated with kindergarten oral language skills and later reading achievement, it is surprising no experimental research has been done to establish this relation causally. The study described in this dissertation filled this literature gap by designing, implementing, and evaluating a decontextualized language training program for parents of 4-year-old children (N=30). After obtaining an initial measure of decontextualized language, parents were randomly assigned to a control condition or training condition, the latter of which educated parents about decontextualized language and why it is important. All parents then audio-recorded four mealtime conversations over the next month, which were transcribed and reliably coded for decontextualized language. Results indicated that trained parents boosted their DL from roughly 17 percent of their total utterances at baseline to approximately 50 percent by the mid-point of the study, and remained at these boosted levels throughout the duration of the study. Children’s DL was also boosted by similar margins, but no improvement in children’s oral language skills was observed, measured prior to, and one month following training. Further, exploratory analyses pointed to parents’ initial use of DL and their theories of the malleability of intelligence (i.e., growth mindsets) as moderators of training gains. Altogether, these findings are a first step in establishing DL as a viable strategy for giving children the oral language skills needed to begin kindergarten ready to succeed in the classroom.

Validação da security scale para a população portuguesa: Análise fatorial confirmatória e estudo empírico davinculação na pré-adolescência

Dissertação de Mestrado apresentada no ISPA – Instituto Universitário para obtenção do grau de Mestre em Psicologia especialidade de Psicologia Clínica.

Recours aux services de soutien formel par les parents immigrants d’un enfant en situation de handicap

Les parents immigrants d’un enfant en situation de handicap présentent davantage de sources de vulnérabilité que d’autres parents. Cette situation peut diminuer le temps disponible et altérer leur implication dans le programme de réadaptation de leur enfant. L’objectif de cette thèse doctorale est de déterminer les attentes et les besoins en services de soutien formel de ces parents, afin de leur proposer une aide adaptée à leurs conditions de vie, et ceci, au fur et à mesure que l’enfant grandit. D’abord, une étude de la portée des écrits scientifiques est menée dans le but de mieux cerner les connaissances existantes en lien avec le recours aux services de soutien par les parents immigrants (chapitre 1). Les vingt publications sélectionnées indiquent que l’aide pour trouver de l’information s’avère la plus requise, que ce soit au sujet de la condition de l’enfant, du fonctionnement sociosanitaire et éducatif du pays d’accueil, ou encore des services de soutien. En outre, la transmission de ces informations peut se compliquer en cas de non-maîtrise de la langue du pays d’accueil ou lorsque des interculturelles apparaissent entre les parents immigrants et les différents intervenants rencontrés. Quant au non-recours aux aides formelles, il semble principalement dû à l’inadéquation entre l’aide concrète et les attentes des parents, au soutien informel reçu, à la méconnaissance des opportunités d’obtenir des services d’aide destinés aux parents, ou encore à un épuisement non ressenti. Compte tenu du nombre restreint d’écrits scientifiques recensés, des entrevues semi-dirigées sont conduites auprès de 28 parents immigrants d’un enfant en situation de handicap dans la province du Québec (Canada) dans le cadre d’une recherche de plus grande envergure portant sur la communication avec les intervenants en petite enfance (chapitre 2). Le but de cette deuxième étude est de mieux saisir l’utilisation des services de soutien formel par les parents immigrants et les facteurs influençant leurs choix. Il faut préciser que les propos recueillis restent très centrés sur les services destinés à l’enfant. Le soutien pour recevoir des informations et l’accompagnement à la décision apparaissent comme les aides formelles les plus utilisées par les participants, suivies du soutien à l’éducation, de l’écoute active et de l’aide financière. Cinq facteurs semblent guider le recours au soutien formel qui est destiné aux parents, soit : (1) leur perception de la condition de leur enfant, (2) l’accès à l’information, (3) leurs stratégies et leur capacité d’agir, (4) l’implication du réseau informel, et (5) leur perception de leur besoin de services de soutien. Suite à ces résultats, de nouvelles entrevues semi-dirigées sont menées auprès de huit parents immigrants d’enfants d’âges différents à Montréal et à Québec. Cette démarche permet d’approfondir le thème du recours au soutien formel destiné aux parents, et ce, au fur et à mesure que l’enfant grandit (chapitre 3). Le guide d’entretien conçu pour cette étude met l’emphase sur les attentes et les besoins des parents immigrants afin d’atteindre un équilibre dans toutes les sphères de leur vie. Suite à une analyse thématique exploratoire du discours des parents et par l’application d’un modèle de stress et de coping, sept principales sources de stress sont mises en évidence : (1) le parcours migratoire, (2) la condition de l’enfant, (3) l’organisation sociosanitaire du pays d’accueil, (4) l’insertion professionnelle, (5) la relation de couple, (6) le réseau social, et (7) l’état de santé du parent. Afin de faire face à ces circonstances difficiles, les parents immigrants recourent principalement à de l’aide financière, du soutien pour obtenir des informations, de l’accompagnement à la décision, de l’aide en éducation et pour le transport. La satisfaction exprimée varie, notamment en raison des divergences entre les attentes et les services obtenus (soutien en éducation, écoute active, services de garde), ainsi qu’en termes de quantité d’aide reçue (soutien financier, informations, accompagnement à la décision). Un modèle théorique original est proposé afin d’illustrer le contexte parental en termes d’attentes, de besoins et de recours au soutien. Si certains moments de la vie de l’enfant peuvent entraîner un stress supplémentaire pour les parents (annonce du diagnostic, arrivée à l’école, transition à l’âge adulte), le parcours migratoire semble davantage expliquer le recours aux aides formelles.

Anatomy of the mouthparts and digestive tract during feeding in larvae of the parasitoid wasp Trichogramma australicum Girault (Hymenoptera : Trichogrammatidae)

To aid in the development of artificial diets for mass rearing parasitioids, we investigated the anatomical changes in the digestive tract during feeding behaviour of larval Trichogramma australicum (Hymenoptera: Trichogrammatidae). Larvae begin to feed immediately upon eclosion and feed continuously for 4 h until replete. Feeding is characterised by rhythmic muscle contractions (ca 1 per s) of the pharynx. Contractions of the pharyngeal dilator muscles lift the roof of the lobe-shaped pharynx away from the floor of the chamber, opening the mouth and pumping food into the pharyngeal cavity. Another muscle contraction occurs about 0.5 s later, forcing the bolus of food through the oesophagus and into the midgut. The junction of fore- and midgut is marked by a cardiac valve. The midgut occupies most of the body cavity and is lined with highly vacuolated, flattened cells and a dispersed layer of muscle cells. In the centre of the midgut, food has the appearance of host egg contents. Food near the midgut epithelial cells has a finer, more homogeneous appearance. This change in the physical properties of the gut contents is indicative of the digestion process. In the prepupa, where digestion is complete, the entire gut contents have this appearance. After eclosion, the vitelline membrane remains attached to the posterior end of the larva. We believe this attachment to be adaptive in two ways: (1) to anchor the larva against the movements of its anterior portion, thereby increasing the efficiency of foraging within the egg, and (2) to prevent a free-floating membrane from clogging the mouthparts during ingestion. 1998 Elsevier Science Ltd. All rights reserved.

Complex distal insertions of the tibialis posterior tendon: detailed anatomic and MR imaging investigation in cadavers

Purpose The purpose of this report was to demonstrate the normal complex insertional anatomy of the tibialis posterior tendon (TPT) in cadavers using magnetic resonance (MR) imaging with anatomic and histologic correlation. Material and methods Ten cadaveric ankles were used according to institutional guidelines. MR T1-weighted spin echo imaging was performed to demonstrate aspects of the complex anatomic distal insertions of the TPT in cadaveric specimens. Findings on MR imaging were correlated with those derived from anatomic and histologic study. Reults Generally, the TPT revealed a low signal in all MR images, except near the level of the medial malleolus, where the TPT suddenly changed direction and ""magic angle"" artifact could be observed. In five out of ten specimens (50%), a type I accessory navicular bone was found in the TPT. In all cases with a type I accessory navicular bone, the TPT had an altered signal in this area. Axial and coronal planes on MR imaging were the best in identifying the distal insertions of the TPT. A normal division of the TPT was observed just proximal to the insertion into the navicular bone in five specimens (100%) occurring at a maximum proximal distance from its attachment to the navicular bone of approximately 1.5 to 2 cm. In the other five specimens, in which a type I accessory navicular bone was present, the TPT directly inserted into the accessory bone and a slip less than 1.5 mm in thickness could be observed attaching to the medial aspect of the navicular bone (100%). Anatomic inspection confirmed the sites of the distal insertions of the components of the TPT. Conclusion MR imaging enabled detailed analysis of the complex distal insertions of the TPT as well as a better understanding of those features of its insertion that can simulate a lesion.

Family environment patterns in families with bipolar children

Background: We studied the characteristics of family functioning in bipolar children and healthy comparison children. We hypothesized that the family environment of bipolar children would show greater levels of dysfunction as measured by the Family Environment Scale (FES). Methods: We compared the family functioning of 36 families that included a child with DSM-IV bipolar disorder versus 29 comparison families that included only healthy children. All subjects and their parents were assessed with the K-SADS-PL interview. The parents completed the FES to assess their current family functioning. Multivariate analysis of variance was used to compare the family environment of families with and without offspring with bipolar disorder. Results: Parents of bipolar children reported lower levels of family cohesion (p<0.001), expressiveness (p=0.005), active-recreational orientation (p<0.001), intellectual-cultural orientation (p=0.04) and higher levels of conflict (p<0.001) compared to parents with no bipolar children. Secondary analyses within the bipolar group revealed lower levels of organization (p=0.03 1) and cohesion (p=0.014) in families where a parent had a history of mood disorders compared to families where parents had no history of mood disorders. Length of illness in the affected child was inversely associated with family cohesion (r=-0.47, p=0.004). Limitations: Due to the case-control design of the study, we cannot comment on the development of these family problems or attribute their cause specifically to child bipolar disorder. Conclusion: Families with bipolar children show dysfunctional patterns related to interpersonal interactions and personal growth. A distressed family environment should be addressed when treating children with bipolar disorder. (C) 2007 Elsevier B.V. All rights reserved.

Lsa63, a newly identified surface protein of Leptospira interrogans binds laminin and collagen IV

Leptospira interrogans is the etiological agent of leptospirosis, a zoonotic disease that affects populations worldwide. We have identified in proteomic studies a protein that is encoded by the gene LIC10314 and expressed in virulent strain of L. interrogans serovar Pomona. This protein was predicted to be surface exposed by PSORT program and contains a p83/100 domain identified by BLAST analysis that is conserved in protein antigens of several strains of Borrelia and Treponema spp. The proteins containing this domain have been claimed antigen candidates for serodiagnosis of Lyme borreliosis. Thus, we have cloned the LIC10314 and expressed the protein in Escherichia coli BL21-SI strain by using the expression vector pAE. The recombinant protein tagged with N-terminal hexahistidine was purified by metal-charged chromatography and characterized by circular dichroism spectroscopy. This protein is conserved among several species of pathogenic Leptospira and absent in the saprophytic strain L. biflexa. We confirm by liquid-phase immunofluorescence assays with living organisms that this protein is most likely a new surface leptospiral protein. The ability of the protein to mediate attachment to ECM components was evaluated by binding assays. The leptospiral protein encoded by LIC10314, named Lsa63 (Leptospiral surface adhesin of 63 kDa), binds strongly to laminin and collagen IV in a dose-dependent and saturable fashion. In addition, Lsa63 is probably expressed during infection since it was recognized by antibodies of serum samples of confirmed-leptospirosis patients in convalescent phase of the disease. Altogether, the data suggests that this novel identified surface protein may be involved in leptospiral pathogenesis. (C) 2009 The British Infection Society. Published by Elsevier Ltd. All rights reserved.