Targeting of caries prevention at preschool children, a practice based study

Aim and design: To evaluate an oral health program directed to expecting families and their children. The intervention was carried out in one of the four health care areas of the city of Turku. Another area acted as a control. Subjects and methods: Children (n = 1217), born between January 1, 1998 and June 30, 1999, in the respective health care areas were screened for mutans streptococci bacteria (MS), and their caretakers were interviewed when the child was 18 months old. MScolonization was used as the child’s risk indicator. Intensified health education and the use of xylitol lozenges targeted at the children at risk were the main elements of the program. Controls and the non-MS-colonized children received routine prevention –examination and education at the ages of three and five years. Altogether 794 subjects were followed for 42 months after receiving consent from their caretakers. Associations of oral-health-related factors with MS colonization and caries increment were studied inside the control group. Results: MS colonization associated with the occupation of the caretaker and ethnicity. The program was effective in white-collar families; prevented fraction being 67 %. In blue-collar families no effect was achieved. At the age of five years, caries increment was strongly related to the occupation of the caretaker, MS at 18 months, child’s sugar use, night feeding, use of thirst quencher at the age of 18 months, and father’s reported oral health. Conclusions: Programs targeted at MS-colonized children can reduce caries in whitecollar families. A program mainly based on activity at home seems to favor white-collar families, whereas different kind of support is needed for the blue-collar families.

How (not) to interview children : interviews with young children in sexual abuse investigations in Finland

The present thesis had two main objectives: The first was to assess how child sexual abuse (CSA) interviews in Finland are conducted through analysing the interviewing techniques applied and the language used by the interviewers, as well as to suggest ways to improve interviews if they were found to have deficiencies. The second main aim was to contribute to the growing research corpus concerning CSA interviews, in particular, by addressing how interviewers follow up information provided by the child, by analysing whether child health care professionals would use childadapted language, and by studying the kind of modifications in the verbal behaviour of interviewers and children that were associated with a) repeated interviews, b) a support person’s presence at the interview, and c) the use of anatomically detailed dolls. Two complementary samples of CSA interviews were analysed. The first one was composed of child interviews with 3-12-year-old children (N = 27) that had been considered problematic by lawyers or other involved professionals (Studies I and IV). The second sample consisted of unselected interviews (N = 43) with children aged 3 to 8 years conducted in a number of hospitals in different parts of the country (Studies II and III). Study I: The verbal interaction between interviewer and child was analysed in a sample of interviews that had been considered to be problematic by involved professionals. Results showed that interviewers used inappropriate questioning techniques, relying on option-posing, specific suggestive and unspecific suggestive questions to a significant extent, these comprising around 50% of all interviewer utterances. The proportion of invitations, which the research community recommends interviewers to rely on, was strikingly low. Invitations and directive utterances were associated with an increase in informative responses by the child in terms of response type, number of new details reported, as well as length of response. The opposite was true for option-posing and suggestive utterances. Longer questions by the interviewer (in number of words) often rendered no reply from the child, whereas shorter questions were followed by descriptive answers. Even after the child had provided an informative answer, interviewers failed to follow up the information in an adequate way and instead continued to rely on focused and leading questions. Study II: Due to the possible bias of the sample analysed in Study I, the most important analyses were rerun with the unselected sample and reported separately. Results were quite similar between the two studies, indicating that the problems observed in Study I, with interviewers relying on option-posing and suggestive questions to a significant extent, are likely to be general and not specific for those interviews. Even if suggestive questions were slightly less and invitations slightly more common in this sample than in the previous study, almost half of the interviewer questions were still optionposing or suggestive, and also in this sample, interviewers failed to follow up information by the child in a facilitating manner. Differentiating between judicial and contextual details showed that while facilitators, invitations, and directive utterances elicited more contextual than judicial details, the opposite was true for specific suggestive utterances. These results might be explained by the reluctance of children to describe sexual details related to the abuse events. Alternatively, they may also be due to children describing incorrect sexual details as a result of suggestive interviewing techniques. Study III: This study examined features of the language used by the interviewers. Interviewer utterances included multiple questions, long statements, complicated grammar and concepts, as well as unclear references to persons and situations. More than a fifth of the interviewer utterances were coded as belonging to at least one of these categories. The results suggest that even professionals who are experienced in interacting with children may have difficulties in using a child-sensitive language, adding to the pool of studies showing similar problems to occur in legal hearings with children conducted by lawyers. As children rarely comment on, or even recognise, their lack of comprehension, the use of a language that is too complex can have detrimental consequences for the outcomes of investigative interviews. Interviewers used different approaches to introduce the topic of abuse. While 15% of the children spontaneously addressed the topic of abuse, probably indicating that they felt confident with the interviewer and the situation, in almost 50% of the cases, the interviewer introduced the topic of abuse in a way that can be considered leading. Interviews were characterised by a lack of structure, apparent in frequent rapid switches of topic by the interviewer. This manner was associated with a decrease in the number of new details provided by the children. Study IV: This study analysed possible changes in the interview dynamics associated with repeated interviewing, the presence of a support person (related to the child), and the use of anatomically detailed (AD) dolls. Repeated interviewing, in combination with suggestive questions, has previously been found to seriously contaminate children’s accounts. In the present material, interviewers used significantly more suggestive utterances in the repeated condition, thus endangering the reliability of the children’s reports. Few studies have investigated the effects of a support person’s presence at the interview. The results of the present study showed that interviewers talked more and children provided less information when a support person was present. Supporting some earlier findings regarding the use of AD dolls, the present results showed that using AD dolls was associated with longer interviewer utterances and shorter, less responsive, and less detailed child responses. Interviewers used up to five times more unspecific suggestive utterances when dolls were used, for instance through repeatedly asking the child to show “what really happened” with the dolls. Conclusion: The results indicate that CSA interviews in Finland are not conducted in a manner that follows best practice as defined by the research community and as stated in a number of guidelines. When comparing these questioning strategies with the recommendations, which have been predominant in the field for more than ten years now, it can be concluded that the interviews analysed were conducted in a manner that undermines the possibility to elicit an uncontaminated and accurate narrative from the children. A particularly worrying finding was the fact that interviewers did not follow up relevant information by the children in an adequate way. A number of clinical implications can be drawn from the results, particularly concerning the need for improvement in the quality of CSA interviews. There is convincing research regarding how to improve CSA interviews, notably through training forensic child interviewers to use a structured interviewing protocol, and providing them with continuous supervision and feedback. Allocating appropriate resources to improve the quality of forensic child interviews is a matter of protecting the rights of all persons involved in CSA investigations, in particular those of the children.

Dental Health in Preschool and Schoolchildren in Relation to Dental Fear and Some Fear-Related Factors, and the Outcome of a Caries Prevention Program in Offspring of Fearful Mothers

Dental caries and dental fear and anxiety (DFA) are common interrelated problems but so far little is known about these problems in Estonia. The aim was to study dental health in relation to DFA, some fear-related factors, and to study the effect of a caries prevention program in children of fearful mothers. Dental health and DFA were assessed in two Estonian [2-4-year-olds (n=472) and 8-10-year-olds (n=344)], and the effect of some medical conditions on DFA in one Finnish child group [3-year-olds (n=148)]. 120 mother-child-pairs participated in the xylitol-based prevention program. Dental health was examined using the WHO or the ICDAS criteria and expressed as dmft/DMFT-indices. The modified children’s fear survey schedule dental subscale (MCFSS-DS) was used to assess DFA of schoolchildren, one single question to assess parental DFA, and the Corah’s dental anxiety scale (DAS) to assess DFA of mothers in the prevention study. Dentine caries was diagnosed in 42% of the 2-4-year-old and in 93% of the 8-10-year-old Estonian children. DFA of 8-10-year-olds (17%) was associated with experience of dental treatment, and maternal and paternal DFA. Dental apprehension at 9 years of age was associated with frequent exposure to invasive medical care. The xylitol-based prevention was successful irrespective of poor dental hygiene habits and maternal severe DFA. In conclusion, experience of operative dental treatment and DFA of Estonian children were closely associated. Invasive medical care and parental DFA were also linked to children’s DFA. Habitual use of xylitol by mothers was effective in preventing caries even in children of severely fearful mothers.

Blackcurrant seed oil for prevention of atopic dermatitis

One hypothesis for the increased incidence of atopic diseases has been that it is associated with changing dietary habits, especially the changed intake of essential fatty acids (EFAs). The metabolism of EFAs produces eiconasoids, prostaglandins and leukotrienes, which are essential to organs and play a major role in regulation of inflammation and immune response. In some studies persons with atopic dermatitis have been found to have reduced levels of EFAs. The first year of infancy as well as the foetal period are crucial for the development of atopic immune response. The composition of blackcurrant seed oil (BCSO) corresponds to the recommended ratio of EFAs n-3 and n-6 in the diet (1/3-1/4) and as a dietary supplement could, even in small doses, modify the unbalance of EFAs in an efficient way. The purpose of this study was to find out whether atopic allergies can be prevented by supplementing the diet of pregnant mothers with blackcurrant seed oil and whether it could affect the immunological balance of a child. We also sought to find out whether a blackcurrant seed oil supplementation can affect the composition of breast milk to suppress the T helper 2 lymphocyte (Th2) responses in infants. 313 pregnant mothers were randomly assigned to receive BCSO (n=151) or olive oil as placebo (n=162). Supplementation was started at the 8th to 16th weeks of pregnancy, 6 capsules per day (dose of 3 g), and continued until the cessation of breastfeeding. It was thereafter followed by direct supplementation to infants of 1 ml (1 g) of oil per day until the age of two years. Atopic dermatitis and its severity (SCORAD index) were evaluated, serum total IgE was measured and skin prick tests were performed at the age of 3, 12 and 24 months. Peripheral blood mononuclear cell (PBMC) samples were taken at the age of 3 and 12 months and breast milk samples were collected during the first 3 months of breastfeeding. Parental atopy was common (81.7%) in the studied infants, making them infants with increased atopy risk. There was a significantly lower prevalence of atopic dermatitis in the BCSO group (33%) than in the olive oil group (47%) at the age of 12 months. Also, SCORAD was lower in the BCSO group than in the olive oil group. Dietary intervention with BCSO had immunomodulatory effects on breast milk, inducing cytokine production from Th2 to Th1 immunodeviation. It decreased the level of IL-4 and elevated the level of IFN-γ. BCSO intervention did not affect cytokines in the children’s PBMC. However, children of smoking parents in the combined BCSO and olive oil group had significantly elevated levels of Th2 type cytokines IL-4, IL-5 and the proinflammator cytokine TNF. Dietary supplementation with BCSO is safe. It is well tolerated and transiently reduces the prevalence of atopic dermatitis at the age of 12 months. It can possibly become a potential tool in prevention of atopic symptoms when used at the early stages of life.

Improving oral healthcare in Scotland with special reference to sustainability and caries prevention

Brett Duane Improving oral healthcare in Scotland with special reference to sustainability and caries prevention University of Turku, Faculty of Medicine, Institute of Dentistry, Community Dentistry, Finnish Doctoral Program in Oral Sciences (FINDOS-Turku), Turku, Finland Annales Universitatis Turkuensis, Sarja- Ser. D, Medica-Odontologica. Painosalama Oy, Turku, Finland, 2015. Dentistry must provide sustainable, evidence-based, and prevention-focused care. In Scotland oral health prevention is delivered through the Childsmile programme, with an increasing use of high concentration fluoride toothpaste (HCFT). Compared with other countries there is little knowledge of xylitol prevention. The UK government has set strict carbon emission limits with which all national health services (NHS) must comply. The purpose of these studies was firstly to describe the Scottish national oral health prevention programme Childsmile (CS), to determine if the additional maternal use of xylitol (CS+X) was more effective at affecting the early colonisation of mutans streptococci (MS) than this programme alone; secondly to analyse trends in the prescribing and management of HCFT by dentists; and thirdly to analyse data from a dental service in order to improve its sustainability. In all, 182 mother/child pairs were selected on the basis of high maternal MS levels. Motherswere randomly allocated to a CS or CS+X group, with both groups receiving Childsmile. Theintervention group consumed xylitol three times a day, from when the child was 3 months until 24 months. Children were examined at age two to assess MS levels. In order to understand patterns of HCFT prescribing, a retrospective secondary data analysis of routine prescribing data for the years 2006-2012 was performed. To understand the sustainability of dental services, carbon accounting combined a top-down approach and a process analysis approach, followed by the use of Pollard’s decision model (used in other healthcare areas) to analyse and support sustainable service reconfiguration. Of the CS children, 17% were colonised with MS, compared with 5% of the CS+X group. This difference was not statistically significant (P=0.1744). The cost of HCFT prescribing increased fourteen-fold over five years, with 4% of dentists prescribing 70% of the total product. Travel (45%), procurement (36%) and building energy (18%) all contributed to the 1800 tonnes of carbon emissions produced by the service, around 4% of total NHS emissions. Using the analytical model, clinic utilisation rates improved by 56% and patient travel halved significantly reducing carbon emissions. It can be concluded that the Childsmile programme was effective in reducing the risk for MS transmission. HCFT is increasing in Scotland and needs to be managed. Dentistry has similar carbon emissions proportionally as the overall NHS, and the use of an analytic tool can be useful in helping identify these emissions. Key words: Sustainability, carbon emissions, xylitol, mutans streptococci, fluoride toothpaste, caries prevention.

Acknowledging mother's lived experience of raising a child with Autism : a phenomenological inquiry

Autism is one of those human ambiguities that forces vigilant open-mindednesssometimes this open-mindedness comes without choice, for example when you become the mother of a child with autism. Recent reports indicate that Pervasive Developmental Disorders affect 1 in 150 children (Centre for Disease Control and Prevention, 2007). This also means that there are many families caring for children with autism. The purpose of this research was to explore the day to day lived experiences of mothers caring for a child with autism. With a drastic increase in children diagnosed with autism, and very little research on mothers themselves, assisting in articulating lived experiences from mothers themselves seemed like an acceptable first step. Mothers were asked to journal for a period of one month, once a week, as well as participate in a focus group. Findings from both of these techniques were analyzed using underpinnings from Amelio Giorgi and Max van Manen. General findings indicate that mothers present poignant narratives about living with their child. It becomes clear that mothers are stressed, and live a complicated and often contradictory existence. Many days are fraught with struggle, anticipation, watchful eyes, judgment and guilt. There is a constant battle waging; the one within themselves, and the one with an uninformed and uncooperative public. Given that this research contributes to an extremely small body of qualitative research on mothers, future research should continue to gain insight from mothers, without classifying or categorizing their words. Their words speak volumes. Professionals may know autism, but mothers know their children.

Destigmatizing Child and Adolescent Mental Health through Group Chat: A Workshop to Support the Emotional and Social Needs of Youth

The purpose of this project was to raise awareness surrounding child and adolescent mental health in an effort to reduce preconceived stigmas in relation to this specialized field. This project presented a literature review of the current state of child and adolescent mental health in Canada today, including the prevalence and several treatment options for young people confronting mental health challenges. Consideration of the powerful role of the education system upon youth with mental health issues became evident, specifically regarding early identification and prevention. A needs assessment was conducted to gather feedback from the clinical practitioners of a Section 23 classroom within a Southern Ontario hospital. This assessment was used to develop an informational and pedagogical workshop resource to extend practitioner understanding of this pertinent issue and support the social and emotional needs of young people confronting mental heath challenges. Results of the assessment indicated the significant need for such a workshop resource, and these responses were used to guide the development of Group Chat: A Workshop to Support the Emotional and Social Needs of Youth. The latter was subsequently presented to participants, whereby evaluative questionnaires indicated the efficacy and usefulness of this workshop resource to both practitioners and students alike.

Les pratiques parentales maternelles et la symptomatologie des enfants victimes d’agression sexuelle d’âge préscolaire

Les enfants victimes d’agression sexuelle (AS) peuvent présenter divers problèmes psychologiques (Beitchman, Zucker, Hood, DaCosta et al., 1991; Briere & Elliott, 1994). Ces difficultés peuvent d’ailleurs perdurer jusqu’à l’âge adulte (Putnam, 2003). Afin de favoriser le rétablissement de ces enfants et prévenir le cycle intergénérationnel de la maltraitance sexuelle, il est important de s’intéresser aux facteurs de protection pouvant diminuer leurs séquelles. Les pratiques parentales représentent un facteur clé dans le développement de l’enfant de façon générale (Campbell, 1995) et peuvent jouer un rôle important dans la capacité des victimes à s’adapter à l’AS qu’elles ont subie (Ullman, 2003; Yancey & Hansen, 2010). Des pratiques parentales moins étudiées dans ce domaine de recherche ont été examinées dans la présente étude, soit le contrôle psychologique (CP), le contrôle limitatif (CL) et le soutien de l’autonomie (SA). Par ailleurs, l’évaluation des variables pouvant être liées à la conduite parentale et des impacts de celle-ci sur le développement de l’enfant permettra de mieux comprendre les difficultés que peuvent présenter ces familles et d’intevenir adéquatement auprès de celles-ci. Les objectifs de cette thèse étaient : 1) de valider une grille de codification des comportements parentaux auprès d’enfants d’âge préscolaire, 2) de documenter le lien entre le CP, le CL, un concept que nous avons proposé dans la présente étude, et le SA afin de clarifier des incohérences conceptuelles et des failles méthodologiques notées dans les études passées, 3) de comparer les pratiques parentales de mères d’enfants victimes d’AS avec celles de mères dont l’enfant n’a pas vécu d’AS, 4) d’examiner le lien entre les mauvais traitements et les événements traumatiques subis par les mères, leur détresse psychologique et leurs pratiques parentales et 5) d’évaluer la relation entre les pratiques parentales et l’adaptation psychologique des enfants de l’échantillon. Un échantillon formé de 22 enfants d’âge préscolaire victimes d’AS recrutés au Centre d’expertise Marie-Vincent (CEMV) et de 79 enfants n’ayant pas vécu un tel événement recrutés dans des Centres de la petite enfance (CPE) de milieux défavorisés de Montréal, de même que leurs mères, a participé à l’étude. La détresse psychologique des mères, les mauvais traitements subis dans leur l’enfance, les expériences traumatiques vécues avant et après 18 ans et les comportements inductifs et coercitifs ont été mesurés à l’aide de questionnaires auto-rapportés par la mère. Les mères et les éducateurs-trices de garderie ont aussi complété un questionnaire sur la symptomatologie de l’enfant. Finalement, une grille de codification des comportements parentaux a permis de mesurer les pratiques des mères et ce, lors d’une procédure d’observation. Les résultats démontrent que la grille élaborée présente des qualités psychométriques satisfaisantes. Par ailleurs, les corrélations entre les échelles principales de la grille de même que les résultats de l’analyse factorielle révèlent que le CP, le CL et le SA constituent des construits indépendants, tel que prévu. La comparaison des comportements maternels montre que les mères d’enfants victimes d’AS présentent des pratiques similaires à celles des mères dont l’enfant n’a pas subi d’AS. De plus, des liens ont été obtenus entre les expériences traumatiques et les mauvais traitements passés de la mère, sa détresse psychologique et les pratiques qu’elle adopte envers son enfant. Finalement, l’utilisation de stratégies inductives est associée marginalement à moins de troubles extériorisés chez l’enfant alors que l’utilisation de stratégies coercitives est reliée à plus de troubles intériorisés, selon l’éducateur-trice de l’enfant. Afin d’augmenter les possibilités que l’enfant se développe de façon optimale et de prévenir la transmission intergénérationnelle des mauvais traitements sexuels, il est important de comprendre le fonctionnement et les pratiques parentales des mères non-agresseurs. Les résultats de cette étude ont permis de mieux documenter la conduite des mères d’enfants victimes d’AS. Par ailleurs, des explications sont proposées concernant les facteurs distincts associés à l’utilisation d’une conduite centrée sur l’enfant (inductive) versus sur le parent (coercitive). L’identification de ceux-ci peut permettre une prévention et une intervention plus adéquate auprès de ces familles et est d’autant plus cruciale compte tenu de l’impact négatif de certaines pratiques sur l’adaptation de l’enfant, tel que démontré dans la présente recherche.

Child labour in India

This thesis entitled “Child labour in india”Children are "supremely important assets" of the nation, India proudly asserts in the National Policy for Children (1974) gracefully acknowledging that they are future citizens on whose shoulders the destiny of our nation rests.Childhood is a time of discovery as the world and all it contains are new to children. It is a time of excitement and anticipation. lt is a time of dreams and fantasies. And it is a time of receiving love and appreciation. Paradoxically, a picture of contrast is a common experience in India as a vast majority of children who are starved of basic needs of nutrition, health and education are made to work at an early age in exploitative conditions. The specter of child labour is a glaring anomaly in a country graciously adorning human right. In an exposition of the problem involving human rights abuse, Chapters from Two to Five of this study have shot into focus the human rights jurisprudence with special reference to the rights of children. Children have a particular identity as children and they also have a universal identity as human beings.The concern for mankind expressed unequivocally and transcending the globe will be real and moving and not mere rhetoric and ritual if and only when it begins with children, as, to quote the words of Nehru, the human being counts much more as a child than as a grown up.The first three of these rights namely right to health, right to nutritive food and right to education are dealt with in Chapter Four. Finally, the positive effects of education have been sketched in that chapter to impress upon its significance in the development of human capitals.legitimization. The theme of legitimacy was rationalised on the ground of poverty as a strategy for achieving eradication of child labour ultimately by enforcing minimum wages, shorter working hours, leave compensation, non-formal education etc., as the employer would soon discover that child labour is not cheap and would be obliged to substitute adult labour. However, humanising the work life is only a promise to the detriment of children as the Act of 1986 enacted as a part of the new strategy is nearingcompletion of a decade of existence but nowhere near the fulfilment of the mission.As similar urge is more necessary and overdue, it has been suggested that a special body be established with all powers for cognisance of human rights abuse of children.It is proposed to conclude this study with a brief summary of the inferences drawn from the foregoing chapters along with a few suggestions emerging out of those inferences

Diseño de un modelo de intervención del suicidio en niños y adolescentes

Resumen El objetivo de este estudio fue el de diseñar un modelo de intervención para la prevención del suicidio en la población escolar de niños y adolescentes, con 72 participantes de un colegio público y un colegio privado de la ciudad de Bogotá. Se caracterizó el suicidio en la ciudad de Bogotá en los últimos nueve años, los aspectos legales, se analizaron algunos modelos de prevención, se identificaron los principales factores de riesgo y factores protectores y se propusieron estrategias para su prevención. Este modelo está basado en la administración social del riesgo y los factores protectores y de riesgo, susceptibles de modificación. Se realizó una prueba de tamizaje y fueron utilizados: el Inventario de depresión infantil (CDI de Kovacs), la escala de desesperanza de Beck y la escala de ansiedad para niños y adolescentes de Spence, validadas a nivel internacional. Se observó una correlación positiva (0.490) mediante el coeficiente de rangos de Spearman, con una significación de 0,01 (bilateral) para los tres factores de riesgo. Se hace entrega de un manual de instrucción para la intervención temprana del suicidio en esta población y un folleto informativo dirigido a padres de familia sobre los factores de riesgo y factores protectores. A partir de esto se plantean implicaciones futuras.

Interdisciplinary Pedagogical Experience for Health Human Resources Focused on the Holistic Promotion of Health and the Prevention of the Disease

The object of this experience is to offer the students the opportunity to take part in the construction of a pedagogic strategy centred on the ludic, for the promotion of the integral health and the prevention of the disease with an educational community; directed to supporting and qualifying the well-being so much individually as group. The project is designed to five years, about interdisciplinary character (Speech Therapy, Medicine, Psychology, Nursery, Occupational Therapy), interinstitutional (Universidad del Rosario, Universidad de San Buenaventura y Universidad de Cundinamarca) and intersectorial (Education and Health). It considers the different actors of the educational community and school and the home as propitious scenes for the strengthening potential, beside being the fundamental spaces for the construction of knowledges and learnings concerning the integral health. To achieve the target, one has come constructing from the second semester of 2003, one pedagogic strategy centred on the ludic and the creativity, from which they are planned, they develop and evaluate the actions of promotion of skills, values, behaviors and attitudes in the care of the health and the prevention of disease, orientated to the early, opportune and effective detection of risk factors and problematic of the development that they affect the integral health. The above mentioned strategy raises a so called scene Bienestarópolis: A healthy world for conquering, centred on prominent figures, spaces and elements that alternate between the fantasy and the reality to facilitate the approximation, the interiorización and the appropriation of the integral health. Across this one, the children motivated by the adults enter an imaginary world in that theirs desires, knowledges and attitudes are the axis of his development. Since Vigotsky raises it, in the game the child realizes actions in order to adapt to the world that surrounds it acquiring skills for the learning. The actions of the project have involved 410 children and 25 teachers, of the degrees Zero, The First and The Second of basic primary; 90 parents of family, and an average of 40 students and 8 teachers of the already mentioned disciplines.

Análisis económico de las vacunas 10-valente y 13-valente contra neumococo: revisión sistemática

Introducción: Las vacunas clásicamente han representado un método económico y eficaz para el control y prevención de múltiples enfermedades infecciosas. En los últimos años se han introducido nuevas vacunas contra neumococo a precios elevados, y los diferentes análisis económicos a nivel mundial de estas vacunas no muestran tendencias. El objetivo de este trabajo era resumir la evidencia existente a través de los diferentes estudios económicos evaluando las dos vacunas de segunda generación contra neumococo en la población a riesgo. Metodología: En este trabajo se realizo una revisión sistemática de la literatura en 8 bases de datos localizadas en diferentes partes del mundo y también que tuvieran literatura gris. Los artículos fueron inicialmente evaluados acorde a su titulo y resumen, posteriormente los elegidos se analizaron en su totalidad. Resultados: Se encontraron 404 artículos, de los cuales 20 fueron incluidos en el análisis final. Se encontró que la mayoría de los estudios se realizaron en áreas donde la enfermedad tiene una carga baja, como es Norte América y Europa, mientras que en los lugares del mundo donde la carga es mas alta, se realizaron pocos estudios. De igual manera se observo que la mayoría de los estudios mostraron por los menos ser costo efectivos respecto a la no vacunación, y en su totalidad las dos vacunas de segunda generación mostraron costo efectividad respecto a la vacunación con PCV-7. Los resultados de los estudios son muy heterogéneos, hasta dentro del mismo país, señalando la necesidad de guías para la conducción de este tipo de estudios. De igual manera, la mayoría de los estudios fueron financiados por farmacéuticas, mientras en un numero muy reducido por entes gubernamentales. Conclusiones: La mayoría de los estudios económicos sobre las vacunas de segunda generación contra neumococo han sido realizados en países con un alto índice de desarrollo económico y patrocinados por farmacéuticas. Dado que la mayoría de la carga de la enfermedad se encuentran en regiones con un menor nivel de desarrollo económico se deberían realizar mas en estas zonas. De igual manera, al ser la vacunación un asunto de salud publica y con un importante impacto económico los gobiernos deberían estar mas involucrados en los mismos.

Análisis bibliométrico de depresión infantil

El objetivo de este estudio fue identificar las tendencias en la investigación de la depresión infantil mediante un análisis bibliométrico de artículos publicados entre enero de 2010 y enero de 2015, en las bases de datos EBSCO, Scopus y Scielo. Se incluyeron 146 artículos, escritos en inglés, español y portugués. En el trabajo se identifican los autores más productivos y las tendencias de los autores con respecto al sexo, profesión y producción; así como los países, instituciones y revistas que más publicaron sobre dicho trastorno. La edad y la ansiedad son las variables que con más frecuencia se asocian al tema; de igual forma, se identificó el Children Depression Inventory (CDI) como el instrumento más común para medir la depresión infantil. En este periodo de tiempo destacan los artículos centrados en investigaciones sobre poblaciones con diferentes estados de salud, diseños correlacionales, de corte transversal y escritos por múltiples autores. Al analizar los resultados obtenidos se observa un creciente interés y preocupación de los investigadores por conocer la frecuencia de los trastornos del estado de ánimo y más específicamente de la depresión en niños, y la asociación e influencia que esta puede tener para su desarrollo.

Is participation prevention? A blurring of discourses in children's preventative initiatives in the UK

This article explores the relationships between two key concepts that have defined recent social policy initiatives for children in the UK: participation and prevention from social exclusion. Drawing on the Children's Fund initiative as an example, the article traces the diverse and sometimes contradictory discourses of childhood and social inclusion/ exclusion in stakeholders' differing rationales for supporting children's participation and prevention. The authors argue that the blurring of the rationales for participation and prevention has implications for the strategies and practices that agencies adopt and raises questions about which groups benefit and whose agendas are served by participation and prevention activities.

A experiência da criança com a droga :características do uso e circunstâncias familiares

The study is a reflexion of the use of drugs among children, pointing that as one of the most serious social problem nowadays. Customize the abuse of drugs reflecting on the childhood and the family s influence of the problem of the children that use drugs, is the main objective of this thesis. Choosing the qualitative method of research, the investigation starts with the reports of the children and mothers assisted at Centro de Referência e Apoio à Criança e ao Adolescente Usuários de Drogas, program of specialized assistance of 1ª Vara da Infância e da Juventude de Natal/RN. The research was done through semi-structured interviews, in a total of six subjects: three children and their respective mothers. Through the reports of the subjects, it is brought theorical reflexions that illustrates their perceptions and conceptions about topics like the usage of drugs, the circumstances the usage of drugs was started, the family s structure and dynamic, the situation on the streets, and other factors that affect the development of a child in her/his environment. It is proved that the usage of drugs in Brazil, problem that has been increasing the number of children affected by, is a multi faceted and complex phenomenon but some factors of social and family risks deserve to be pointed out like the manner of support future actions in the prevention area