Psychotherapeutic work with Families with Life-threatening Maternal Illness

This exploratory research study describes a child and adolescent psychotherapeutic clinical service offered to children/adolescents and their families with mothers with a life-threatening illness. The clinical service itself was also exploratory in nature. The research objectives of the study were (i) to explore whether this form of clinical work could be beneficial for such families in relieving distress and supporting their development; (ii) to discover the factors at play within and between the family members using an adaptation of Grounded Theory research methodology; and (iii) to add to the knowledge base for adults – family members and professionals – relating to, and dealing with, such children and adolescents. Descriptions and discussion of the therapeutic input and research study are given. Symptoms, which included emotional, behavioural, psychological, learning, and interpersonal difficulties, decreased in all the children/adolescents who were offered clinical treatment within an outpatient multidisciplinary Tier 3 Child and Adolescent Service (CAMHS). Six Themes were identified across the cases and these were named: Engagement, Parental Concern, Impact of Mother’s Illness, Defences, Sustaining Factors and Feeling Different. These Themes are discussed in the light of relevant published research. A literature review was undertaken and focuses on: epidemiological context; children’s understanding of death; impact of parental bereavement in childhood; the mourning process; anticipatory grief; psychoanalysis: mourning and trauma; children’s play and drawings as communication; and psychosocial therapeutic services. The thesis has particular relevance for child and adolescent psychotherapists and other mental health professionals who work within hospital and hospice settings.

Psychotherapeutic work with Families with Life-threatening Maternal Illness

This exploratory research study describes a child and adolescent psychotherapeutic clinical service offered to children/adolescents and their families with mothers with a life-threatening illness. The clinical service itself was also exploratory in nature. The research objectives of the study were (i) to explore whether this form of clinical work could be beneficial for such families in relieving distress and supporting their development; (ii) to discover the factors at play within and between the family members using an adaptation of Grounded Theory research methodology; and (iii) to add to the knowledge base for adults – family members and professionals – relating to, and dealing with, such children and adolescents. Descriptions and discussion of the therapeutic input and research study are given. Symptoms, which included emotional, behavioural, psychological, learning, and interpersonal difficulties, decreased in all the children/adolescents who were offered clinical treatment within an outpatient multidisciplinary Tier 3 Child and Adolescent Service (CAMHS). Six Themes were identified across the cases and these were named: Engagement, Parental Concern, Impact of Mother’s Illness, Defences, Sustaining Factors and Feeling Different. These Themes are discussed in the light of relevant published research. A literature review was undertaken and focuses on: epidemiological context; children’s understanding of death; impact of parental bereavement in childhood; the mourning process; anticipatory grief; psychoanalysis: mourning and trauma; children’s play and drawings as communication; and psychosocial therapeutic services. The thesis has particular relevance for child and adolescent psychotherapists and other mental health professionals who work within hospital and hospice settings.

Early Years Teachers and young children’s rights: the need for critical dialogue

The absence of knowledge about children’s rights is frequently associated with ineffective implementation of the United Nations Convention on the Rights of the Child (UNCRC); this directly impacts on children’s lives and the ways they are viewed by adults (Freeman 1998; Pugh 2015). Recent research (Jerome et al. 2015) has highlighted the lack of focus on children’s rights in the initial training of teachers and other education practitioners. In this paper I analyse the status of children’s rights in the standards for Early Years Teachers (EYTs) introduced in 2013 in England. Informed by the findings from research in sites of early years practice, I suggest possibilities for a critical dialogue that repositions the UNCRC as a visible and explicit framework of reference for EYTs’ work with young children.

Patient Characteristics Associated with Differences in Admission Frequency for Diabetic Ketoacidosis in U.S. Children’s Hospitals

Thesis (Master's)--University of Washington, 2016-08

My Ideal School: A Personal Construct Psychology Approach to Understanding the School Constructs of Children Described as Anxious

This research explores the school constructs of children described as anxious. Little research exists that looks at understanding children’s school-related anxiety through the lens of Personal Construct Psychology (PCP). This qualitative research design includes semi-structured interviews that followed a PCP theoretical framework. The interviews were carried out with five children aged between 7 and 11, who attended state schools in Malta, and who were experiencing school-related anxiety. Participants were asked to comment and produce drawings about the kind of school they would like to attend (their ideal school), and the kind of school they would not like to attend. The children’s constructs were organised according to whether they related to adults in school, their peers, the school and classroom environment, and the participants themselves in each of these two imaginary schools. Participants were also asked to think of how the school they currently attend can become more like their ideal school. Findings indicate the importance of relationships between teachers and pupils, relationships amongst pupils themselves, a positive learning environment within the classroom and the belongingness to a common value system and school ethos to which anxious children can relate. This research aims to shed light on the responsibility of professionals working with children with school-related anxiety to look beyond within-child factors and understand possible stressors in the child’s environment as potentially contributing to heightening their anxiety.

Indirect Effects of Parental Coping on Children’s Psychosocial Adjustment in the Context of Pediatric Cancer

Thesis (Ph.D.)--University of Washington, 2016-08

Does a peer model’s task proficiency influence children’s solution choice and innovation?

The current study investigated whether 4- to 6-year-old children’s task solution choice was influenced by the past proficiency of familiar peer models and the children’s personal prior task experience. Peer past proficiency was established through behavioral assessments of interactions with novel tasks alongside peer and teacher predictions of each child’s proficiency. Based on these assessments, one peer model with high past proficiency and one age-, sex-, dominance-, and popularity-matched peer model with lower past proficiency were trained to remove a capsule using alternative solutions from a three-solution artificial fruit task. Video demonstrations of the models were shown to children after they had either a personal successful interaction or no interaction with the task. In general, there was not a strong bias toward the high past-proficiency model, perhaps due to a motivation to acquire multiple methods and the salience of other transmission biases. However, there was some evidence of a model-based past-proficiency bias; when the high past-proficiency peer matched the participants’ original solution, there was increased use of that solution, whereas if the high past-proficiency peer demonstrated an alternative solution, there was increased use of the alternative social solution and novel solutions. Thus, model proficiency influenced innovation.

Is there a health risk concerning the children´s consumption of cereal-based products? A cumulative mycotoxin risk assessment approach

Historically, the health risk of mycotoxins had been evaluated on the basis of single-chemical and single-exposure pathway scenarios. However, the co-contamination of foodstuffs with these compounds is being reported at an increasing rate and a multiple-exposure scenario for humans and vulnerable population groups as children is urgently needed. Cereals are among the first solid foods eaten by child and thus constitute an important food group of their diet. Few data are available relatively to early stages child´s exposure to mycotoxins through consumption of cereal-based foods. The present study aims to perform the cumulative risk assessment of mycotoxins present in a set of cereal-based foods including breakfast cereals (BC), processed cereal-based foods (PCBF) and biscuits (BT), consumed by children (1 to 3 years old, n=75) from Lisbon region, Portugal. Children food consumption and occurrence of 12 mycotoxins (aflatoxins, ochratoxin A, fumonisins and trichothecenes) in cereal-based foods were combined to estimate the mycotoxin daily intake, using deterministic and probabilistic approaches. Different strategies were used to treat the left censored data. For aflatoxins, as carcinogenic compounds, the margin of exposure (MoE) was calculated as a ratio of BMDL (benchmark dose lower confidence limit) and aflatoxin daily exposure. For the remaining mycotoxins, the output of exposure was compared to the dose reference values (TDI) in order to calculate the hazard quotients (HQ, ratio between exposure and a reference dose). The concentration addition (CA) concept was used for the cumulative risk assessment of multiple mycotoxins. The combined margin of exposure (MoET) and the hazard index (HI) were calculated for aflatoxins and the remaining mycotoxins, respectively. Main results revealed a significant health concern related to aflatoxins and especially aflatoxin M1 exposure according to the MoET and MoE values (below 10000), respectively. HQ and HI values for the remaining mycotoxins were below 1, revealing a low concern from a public health point of view. These are the first results on cumulative risk assessment of multiple mycotoxins present in cereal-based foods consumed by children. Considering the present results, more research studies are needed to provide the governmental regulatory bodies with data to develop an approach that contemplate the human exposure and, particularly, children, to multiple mycotoxins in food. The last issue is particularly important considering the potential synergistic effects that could occur between mycotoxins and its potential impact on human and, mainly, children health.

Factors Influencing Children’s Full Immunization in Ethiopia

Child morbidity and mortality in Ethiopia is mainly due to vaccine preventable diseases. Although numerous interventions have been made since the 1980’s to increase vaccination coverage, the level of full immunization is low in the country. This study examines factors influencing children’s full immunization based on data on 1927 children aged 12-23 months extracted from the 2011 Ethiopian Demographic and Health Survey. Multinomial logistic regression model was fitted to identify predictors of full immunization. The result shows that only 24.3% of the children were fully immunized. There was significant difference between regions in immunization coverage in which Tigray, Dire Dawa, and Addis Ababa performed well. In Oromia, Afar, Somali, Benishangul-Gumuz, and Gambela regions, the likelihood of children’s full immunization was significantly lower. Children born to mothers living in households with better socio-economic status, with frequent access to media, and who visit health facilities for antenatal care were more likely to be fully immunized. The results imply the importance of narrowing regional differences, improving women’s socio-economic status and utilization of antenatal care services, and strengthening culture-sensitive media campaign as a means of achieving full immunization of all children

Flexible bronchoscopy contribution in the approach of diagnosis and treatment of children’s respiratory diseases: the experience of a unique pediatric unit in Tunisia.

Objective: Our study aimed at assessing the role of flexible bronchoscopy (FB) in improving diagnosis and management of children’s respiratory conditions in the pediatric unit of FB, newly created and unique in Tunisia. Methods: Retrospective study including all the FB achieved in our pediatric unit from 2009 to 2014. Results: We performed 365 FB in 333 patients aged 46 months on average (1 month - 15 years), often under conscious anesthesia (81.6%). FB was performed for diagnostic purposes in 341 cases and for therapeutic purposes in 24 cases. Eight anatomical abnormalities were revealed in 22 patients. An intraluminal bronchial obstruction was found in 71 FB, mainly due to a foreign body (n=36). A vascular anomaly was responsible for nine cases out of 17 extraluminal obstructions. Airways malacia was observed in 60 FB. Bronchoalveolar lavage was performed in 196 cases. It was determinant in 43.9% of the cases. FB was of great diagnostic value in 74.8% of the cases. It influenced the management of the patients in 58% of the cases. The FB for therapeutic purposes was beneficial in all cases. Few complications occurred (5.5%). Conclusion: FB is a safe tool providing precious diagnostic and/or therapeutic help for the clinician. Keywords:

Hookworm-like eggs in children’s faecal samples from a rural area of Rwanda.

Background: Hookworm eggs identification and quantification is usually carried out by Kato-Katz method. However various structures present in the smear may be confused with eggs of such parasites. Objective: To document the presence of structures in Kato-Katz slides that could initially be misinterpreted as hookworm eggs. Method: 497 faecal samples were analysed by Kato-Katz technique, diphasic concentration technique, agar-plate coprocultive and larvae obtained were analysed by PCR and characterized by sequencing. Results: Hookworm-like eggs were found in 159 (32%) of the samples by Kato-Katz, finally identified as Caenorhabditis elegans by PCR technique. Conclusion: The diagnosis of human hookworm eggs, only by the use of Kato-Katz technique can lead to false positives because of similarities with eggs of other free-living worms, from wet soils like those of Rwanda that could contaminate stool samples.

Ethical aspects of children’s perceptions of information-giving in care

The aim of this study was to identify key aspects in the exchange of information and to determine how nurses communicate news to hospitalised children. For this study, we applied the critical incident technique with 30 children aged between 8 and 14 years. Data were collected in paediatric units in a hospital in Alicante (Spain) using participant observation and semi-structured interviews. The analysis yielded three main categories: the children’s reaction to the information, nursing staff behaviour as a key aspect in the exchange of information and communication of news as well as children’s experience. This article emphasises the need to promote children’s consent and participation in nursing interventions. An analysis of these aspects will verify whether children’s rights are being respected and taken into account in order to promote children’s well-being and adaptation to hospitalisation.

Establishing a children’s orthopaedic hospital for Malawi: A review after 10 years

Background BEIT CURE International Hospital (BCIH) opened in 2002 providing orthopaedic surgical services to children in Malawi. This study reviews the hospital’s progress 10 years after establishment of operational services. In addition we assess the impact of the hospital’s Malawi national clubfoot programme (MNCP) and influence on orthopaedic training. Methods All operative paediatric procedures performed by BCIH services in the 10th operative year were included. Data on clubfoot clinic locations and number of patients treated were obtained from the MNCP. BCIH records were reviewed to identify the number of healthcare professionals who have received training at the BCIH. Results 609 new patients were operated on in the 10th year of hospital service. Patients were treated from all regions; however 60% came from Southern regions compared with the 48% in the 5th year. Clubfoot, burn contracture and angular lower limb deformities were the three most common pathologies treated surgically. In total BCIH managed 9,842 patients surgically over a 10-year period. BCIH helped to establish and co-ordinate the MNCP since 2007. At present the program has a total of 29 clinics, which have treated 5748 patients. Furthermore, BCIH has overseen the full or partial training of 5 orthopaedic surgeons and 82 orthopaedic clinical officers in Malawi. Conclusion The BCIH has improved the care of paediatric patients in a country that prior to its establishment had no dedicated paediatric orthopaedic service, treating almost 10,000 patients surgically and 6,000 patients in the MNCP. This service has remained consistent over a 10-year period despite times of global austerity. Whilst the type of training placement offered at BCIH has changed in the last 10 years, the priority placed on training has remained paramount. The strategic impact of long-term training commitments are now being realised, in particular by the addition of Orthopaedic surgeons serving the nation.

(inter)FACE: A Study of Black Families Advocating for their Children’s Education

Black students are consistently overrepresented in categories of academic underachievement. Parent engagement has long been touted as an effective strategy for improving the educational outcomes of Black children. However, most parent engagement research reflects deficit based perspectives frame Black parents as problems that must be fixed or mitigated before they can positively contribute to their children’s education. Consequently, parent engagement research and frameworks ignore the perspectives of Black parents and the assets they use to participate effectively in parent engagement. In this case study, I draw on individual and focus group interview data, documents, and observations, to examine how fifteen Black families, collectively known as FACE: 1) define and participate in parental engagement, 2) experience barriers to and opportunities for engagement, and 3) experience benefits of engagement for their children and their own personal development. Guided by Black Feminist and Critical Race Theories, I show how Black families in this study used a myriad of engagement strategies to improve their children’s educational experiences which were invisible to schools and how they used school-sanctioned engagement activities to meet their own objectives. Ultimately, I argue that school-centered parent engagement frameworks and models are ineffective for empowering Black families and accounting for the essential ways that these families contribute to the well-being of their children. Based on my findings, I discuss implications for theory, practice and policy, and research, and make recommendations for a more family-centered approach to parent engagement.