Influencia del bajo peso al nacer en el cumplimiento del esquema de vacunación en Colombia

INTRODUCCION. En Colombia y a nivel mundial la vacunación es una estrategia que ha reducido la mortalidad infantil, sin embargo existen bajas coberturas en algunas zonas del país, dentro de las causas de la no vacunación se encuentra el bajo peso al nacer, tema de gran importancia y poco estudiado, encontrándose como una causa controlable y que permitiría a la población acceder a la protección frente a enfermedades inmunoprevenibles. MATERIALES Y METODOS. Se realizó un estudio de tipo observacional de corte trasversal, la muestra fue tomada de la ENDS realizada por Profamilia en el año 2010, se tomó el número total de los encuestados que cumplían con los criterios de inclusión, en total fueron 9694 registros a los que se les realizo; análisis descriptivo, bivariado y multivariado. RESULTADOS. Los niños con bajo peso al nacer tienen menor probabilidad de estar vacunados con el esquema completo con respecto a los niños con peso normal, OR 0762 (IC 95% 0,650; 0,895), se observó que las vacunas en forma individual tienen un comportamiento similar al esquema completo, específicamente en la aplicación en el tiempo indicado para su aplicación, exceptuando triple viral donde no se encontró asociación. CONCLUSION. El bajo peso es un factor determinante en la vacunación a tiempo de los menores y del cumplimiento posterior del esquema, se encontraron variables asociadas al no cumplimiento como el lugar del parto, el índice de pobreza y pertenecer a la etnia afrodescendiente.

Plant variety protection in developing countries: A view from the private seed industry in India

Many developing countries are currently engaged in designing and implementing plant variety protection systems. Encouraging private investment in plant breeding is the key rationale for extending intellectual property rights to plant varieties. However, the design of plant variety protection systems in developing countries has been dominated by concerns regarding the inequities of a plant variety protection system, especially the imbalance in the reward structure between plant breeders and farmers. The private seed industry, a key stakeholder in plant variety protection, appears to be playing only a peripheral role in the design of the intellectual property rights regime. This paper explores the potential response of the private seed industry in India to plant variety protection legislation based on a survey of major plant breeding companies. The survey finds that the private seed industry in India is generally unenthusiastic about the legislation and plant variety protection is likely to have only a very limited impact on their research profile and expenditures on plant breeding. Measures designed to curb the 'excessive' profits of breeders, farmers' rights provisions and poor prospects for enforcement of rights are seen to be seriously diluting breeders' rights, leaving few incentives for innovation. If the fundamental objective of plant variety protection is to stimulate private investment in plant breeding, then developing countries need to seriously address the question of improving appropriability of returns from investment.

Improving quality of mother-infant relationship and infant attachment in socioeconomically deprived community in South Africa: randomised controlled trial

Objective To assess the efficacy of an intervention designed to improve the mother-infant relationship and security of infant attachment in a South African peri-urban settlement with marked adverse socioeconomic circumstances. Design Randomised controlled trial. Setting Khayelitsha, a peri-urban settlement in South Africa. Participants 449 pregnant women. Interventions The intervention was delivered from late pregnancy and for six months postpartum. Women were visited in their homes by previously untrained lay community workers who provided support and guidance in parenting. The purpose of the intervention was to promote sensitive and responsive parenting and secure infant attachment to the mother. Women in the control group received no therapeutic input from the research team. Main outcome measures Primary outcomes: quality of mother-infant interactions at six and 12 months postpartum; infant attachment security at 18 months. Secondary outcome: maternal depression at six and 12 months. Results The intervention was associated with significant benefit to the mother-infant relationship. At both six and 12 months, compared with control mothers, mothers in the intervention group were significantly more sensitive (6 months: mean difference=0.77 (SD 0.37), t=2.10, P<0.05, d=0.24; 12 months: mean difference=0.42 (0.18), t=-2.04, P<0.05, d=0.26) and less intrusive (6 months: mean difference=0.68 (0.36), t=2.28, P<0.05, d=0.26; 12 months: mean difference=-1.76 (0.86), t=2.28, P<0.05, d=0.24) in their interactions with their infants. The intervention was also associated with a higher rate of secure infant attachments at 18 months (116/156 (74%) v 102/162 (63%); Wald=4.74, odds ratio=1.70, P<0.05). Although the prevalence of maternal depressive disorder was not significantly reduced, the intervention had a benefit in terms of maternal depressed mood at six months (z=2.05, P=0.04) on the Edinburgh postnatal depression scale). Conclusions The intervention, delivered by local lay women, had a significant positive impact on the quality of the mother-infant relationship and on security of infant attachment, factors known to predict favourable child development. If these effects persist, and if they are replicated, this intervention holds considerable promise for use in the developing world. Trial registration Current Controlled Trials ISRCTN25664149.

Improving quality of mother-infant relationship and infant attachment in socioeconomically deprived community in South Africa: randomised controlled trail

Objective To assess the efficacy of an intervention designed to improve the mother-infant relationship and security of infant attachment in a South African peri-urban settlement with marked adverse socioeconomic circumstances. Design Randomised controlled trial. Setting Khayelitsha, a peri-urban settlement in South Africa. Participants 449 pregnant women. Interventions The intervention was delivered from late pregnancy and for six months postpartum. Women were visited in their homes by previously untrained lay community workers who provided support and guidance in parenting. The purpose of the intervention was to promote sensitive and responsive parenting and secure infant attachment to the mother. Women in the control group received no therapeutic input from the research team. Main outcome measures Primary outcomes: quality of mother-infant interactions at six and 12 months postpartum; infant attachment security at 18 months. Secondary outcome: maternal depression at six and 12 months. Results The intervention was associated with significant benefit to the mother-infant relationship. At both six and 12 months, compared with control mothers, mothers in the intervention group were significantly more sensitive (6 months: mean difference=0.77 (SD 0.37), t=2.10, P<0.05, d=0.24; 12 months: mean difference=0.42 (0.18), t=−2.04 , P<0.05, d=0.26) and less intrusive (6 months: mean difference=0.68 (0.36), t=2.28, P<0.05, d=0.26; 12 months: mean difference=−1.76 (0.86), t=2.28 , P<0.05, d=0.24) in their interactions with their infants. The intervention was also associated with a higher rate of secure infant attachments at 18 months (116/156 (74%) v 102/162 (63%); Wald=4.74, odds ratio=1.70, P<0.05). Although the prevalence of maternal depressive disorder was not significantly reduced, the intervention had a benefit in terms of maternal depressed mood at six months (z=2.05, P=0.04) on the Edinburgh postnatal depression scale). Conclusions The intervention, delivered by local lay women, had a significant positive impact on the quality of the mother-infant relationship and on security of infant attachment, factors known to predict favourable child development. If these effects persist, and if they are replicated, this intervention holds considerable promise for use in the developing world.

Faith and protection: the construction of hope by parents of children with leukemia and their oncologists

Background. Oncologists are criticized for fostering unrealistic hope in patients and families, but criticisms reflect a perspective that is oversimplified and “expert” guidance that is ambiguous or impractical. Our aim was to understand how pediatric oncologists manage parents' hope in practice and to evaluate how they address parents' needs. Methods. Participants were 53 parents and 12 oncologists whom they consulted across six U.K. centers. We audio recorded consultations approximately 1–2, 6, and 12 months after diagnosis. Parents were interviewed after each consultation to elicit their perspectives on the consultation and clinical relationship. Transcripts of consultations and interviews were analyzed qualitatively. Results. Parents needed hope in order to function effectively in the face of despair, and all wanted the oncologists to help them be hopeful. Most parents focused hope on the short term. They therefore needed oncologists to be authoritative in taking responsibility for the child's long-term survival while cushioning parents from information about longer-term uncertainties and being positive in providing information about short-term progress. A few parents who could not fully trust their oncologist were unable to hope. Conclusion. Oncologists' pivotal role in sustaining hope was one that parents gave them. Most parents' “faith” in the oncologist allowed them to set aside, rather than deny, their fears about survival while investing their hopes in short-term milestones. Oncologists' behavior generally matched parents' needs, contradicting common criticisms of oncologists. Nevertheless, oncologists need to identify and address the difficulty that some parents have in fully trusting the oncologist and, consequently, being hopeful.

Recent Trends in Maternal, Newborn, and Child Health in Brazil: Progress Toward Millennium Development Goals 4 and 5

We analyzed Brazil`s efforts in reducing child mortality, improving maternal and child health, and reducing socioeconomic and regional inequalities from 1990 through 2007. We compiled and reanalyzed data from several sources, including vital statistics and population-based surveys. We also explored the roles of broad socioeconomic and demographic changes and the introduction of health sector and other reform measures in explaining the improvements observed. Our findings provide compelling evidence that pro-active measures to reduce health disparities accompanied by socioeconomic progress can result in measurable improvements in the health of children and mothers in a relatively short interval. Our analysis of Brazil`s successes and remaining challenges to reach and surpass Millennium Development Goals 4 and 5 can provide important lessons for other low- and middle-income countries. (Am J Public Health. 2010;100:1877-1889. doi:10.2105/AJPH.2010.196816)

Improving children's recall of an occurrence of a repeated event: is it a matter of helping them to generate options?

Three experiments were conducted to explore whether children's recall of an occurrence of a repeated event could be improved by encouraging them to consider various details that occurred across a series of events prior to making a judgement about which details were included in the target (to-be-recalled) occurrence. Experiment 1 explored whether children's recall of the target occurrence was better after the interviewer presented all the items from the series prior to the child identifying the final item. Experiment 2 explored whether having the children generate all the items facilitated their subsequent recall of the target occurrence. Finally, Experiment 3 directly compared the effectiveness of the above 2 procedures. Regardless of the children's age, the retention interval, or the type of item, children's capacity to identify which details were included in a target occurrence was enhanced when they were initially provided with all the possible details from the series of events. However, without relying on the interviewer to generate the options, the benefit of the technique was directly contingent on the children's ability to generate content details; this was a distinct source of difficulty for the children. Indeed, having children generate options had no beneficial effect on decisions about the temporal position of items unless performance was made conditional on the children's ability to remember the relevant details in the first place. The implications of the findings for the legal setting and for future research are discussed.

Constructing the Australian musical child

This paper makes use of Foucauldian discourse analysis to examine some of the current directions in Arts education and Music Education, in particular, that are being promoted by education authorities in Australia. Foucault's concept of discourse, and analytical procedures developed from his ideas, have been much discussed recently but have not been applied very rigorously or very widely other than by Foucault himself. This paper will introduce some of the basic concepts and demonstrate how application of these concepts can identify, explain or elucidate basic misconceptions that are currently being promoted as the way forward in arts education.

Curriculum development and implementation has become an important focus for educational policy in the past ten years. Inspired by the work of the Federal Labour government between 1989 and 1994 which developed the national curriculum Statements and Profiles, many states have adopted a model of centralized curriculum development in which learning is mapped out for all students up to the age of eighteen. These learning "profiles" have been developed and disseminated at great expense in terms of time, money and effort. They represent a considerable investment of educational resources. Typically, however the resulting curriculum documents are complex, difficult to understand and use, and can appear unrelated to many of the normal practices in school. This has placed teachers in the position of having either to ignore them or to work against much of their own training and personal assumptions about what constitutes music education.

It will be suggested that there are some basic flaws in the way that many curriculum documents in Australia have conceived of music education and learning. With recent new developments in Victoria, South Australia and Western Australia, there is no indication that this process of profiling student development is really devoted to improving our understanding either of learning or of teaching. In fact, it would appear to be developing a life of it's own, oblivious to the practices and structures of our educational systems. It will be suggested that a more realistic assessment of our practices needs to form the basis of our frameworks and that they should not be developed as abstract theoretical models.

Micro finance programs: caring for those missed by formal social protection mechanism

In line with the current global trend of economic and social restructuring, it has become essential to address the issue of poverty and social protection for the poorer segment of the population who are not covered by formal social protection mechanisms. Micro finance institutions (MFIs) in developing countries have been working towards poverty alleviation and enhancing social protection for the last few decades. MFI’s provision of financial assistance to the poor has been instrumental in improving the overall quality of the impoverished. Based on an in-depth qualitative study conducted across three different types of NGOs (Non Governmental Organization) in the Philippines, this study found a relationship between micro finance programs and improved social protection. The study reveals that MFIs have the ability to make a positive impact on areas such as entrepreneurship, education, housing, job security and income generation.

Improving infant sleep and maternal mental health: a cluster randomised trial

Objectives: To determine whether a community-delivered intervention targeting infant sleep problems improves infant sleep and maternal well-being and to report the costs of this approach to the healthcare system.

Design: Cluster randomised trial.

Setting: 49 Maternal and Child Health (MCH) centres (clusters) in Melbourne, Australia.

Participants: 328 mothers reporting an infant sleep problem at 7 months recruited during October–November 2003.

Intervention: Behavioural strategies delivered over individual structured MCH consultations versus usual care.

Main outcome measures: Maternal report of infant sleep problem, depression symptoms (Edinburgh Postnatal Depression Scale (EPDS)), and SF-12 mental and physical health scores when infants were 10 and 12 months old. Costs included MCH sleep consultations, other healthcare services and intervention costs.

Results: Prevalence of infant sleep problems was lower in the intervention than control group at 10 months (56% vs 68%; adjusted OR 0.58 (95% CI: 0.36 to 0.94)) and 12 months (39% vs 55%; adjusted OR 0.50 (0.31 to 0.80)). EPDS scores indicated less depression at 10 months (adjusted mean difference –1.4 (–2.3 to –0.4) and 12 months (–1.7 (–2.6 to –0.7)). SF-12 mental health scores indicated better health at 10 months (adjusted mean difference 3.7 (1.5 to 5.8)) and 12 months (3.9 (1.8 to 6.1)). Total mean costs including intervention design, delivery and use of non-MCH nurse services were £96.93 and £116.79 per intervention and control family, respectively.

Conclusions: Implementing this sleep intervention may lead to health gains for infants and mothers and resource savings for the healthcare system.

Who is responsible for the protection of children? Implicit and explicit interpretations of marketing messages

In this paper, we examine ethical issues related to advertising to children in light of evidence that people can hold ‘implicit’ as well as ‘explicit’ consumer attitudes. From a review of the important features of implicit versus explicit attitudes, we hypothesise three important features of implicit consumer attitudes in children. First, we suggest they are likely to be acquired automatically from, in part, exposure to marketing messages. Second, we predict that these attitudes will be resistant to change through reflection or reason by the child or other person. Third, we hypothesise that children’s implicit consumer attitudes will be powerful predictors of their consumer choices in many situations. We discuss the implications for the ethics of marketing to children, and propose a research framework to begin investigating this important issue.

Child labour and supply chain : profitability or (mis)management

Purpose – The purpose of this paper is to provide a realistic assessment, with an historical perspective, of the current practises and progress made by organisations towards elimination of child labour in global supply chains.

Design/methodology/approach – Literature review in the area of use of child labour within the global supply chain was combined with additional information obtained from the company searches of the GRI database, company ranking tables, and other sources.

Findings – Child labour is one of a number of areas of concern in global supply chains. Continued exploitation of child labour indicates an imbalanced state and consequently forces can be unleashed through standardization, collaboration and communication amongst all stakeholders to ensure protection of the vulnerable. This paper is part of the broader analysis informing incremental changes to supply chain management to preserve the rights and welfare of children in the present and future generations. Research/limitations/implications – The analysis is based on secondary data sources and further research is thus needed to verify the individual weightings of the criteria used in the primary ranking of the companies.

Practical implications – The findings provide encouragement for policy and decision makers to implement incremental changes to global supply chains in order to protect the rights and welfare of children, according to the standards of Social Accountability (SA) 8000, the International Labour Organisation (ILO), and other world trade stakeholders.

Originality/value – This paper questions the view that child labour incidences have diminished proportional to economic development. A swinging fulcrum with hidden traps for developed and developing nations in light of cross border transactions through supply chains has been proposed.

The effect of intra- versus post-interview feedback during simulated practice interviews about child abuse

Objective
This study compared the effectiveness of two types of instructor feedback (relative to no feedback) on investigative interviewers’ ability to adhere to open-ended questions in simulated practice interviews about child abuse.
Method
In one condition, feedback was provided at the end of each practice interview. In the other, the instructor stopped the interviewer at various stages during the practice interviews to provide feedback. The relative effect of these conditions was examined by measuring interviewers’ performance in a standardized mock interview paradigm immediately prior to, immediately after, and 12 weeks after the practice and feedback sessions.
Results
Prior to and 12 weeks after the practice sessions were administered, there was no significant difference in participants’ adherence to open-ended questions irrespective of the nature of the feedback, or whether feedback was received. At the immediate post-practice assessment interval, however, the participants who received feedback during the practice interviews performed better (M proportion of open-ended questions = .85, SD = .13) than the other participants (post-interview feedback M = .67, SD = .18, p < .001; no feedback M = .56, SD = .16, p < .001). This heightened use of open-ended questions was associated with a greater tendency among the interviewees to provide abuse-related details in response to open-ended questions (M = .91, SD = .11) compared to the other participants (post-interview feedback M = .77, SD = .15, p < .05; no feedback M = .69, SD = .16, p = .001).
Conclusions
Different types of feedback can be differentially effective in training child abuse investigators to adhere to open-ended questions. The benefits of any training program, however, are likely to be short-lived without ongoing practice.
Practice implications
A single study compared the relative effectiveness of two types of instructor feedback (relative to no feedback) on investigative interviewers’ ability to adhere to open-ended questions in simulated practice interviews about child abuse. This research is relevant to trainers of investigative interviewers because there is currently large variability in the type of feedback employed in training programs. This study is one of the first to empirically demonstrate that different types of feedback may be differentially effective in improving the performance of investigative interviewers.

Reconstructing child welfare through participatory and child-centred professional practice : a conceptual approach

The 'child' in child welfare/protection is seen as a dependent waif and an object of interest, on whose behalf adults speak and act. An alternative perspective has argued for child-centredness, and includes concepts of child liberation, rights and citizenship. Policymakers and practitioners who may accept the underlying principles may be concerned about the appropriateness and applicability of such principles in relation to practice with children and their parents in child welfare/protection cases. This paper discusses a conceptual framework for research that aims to explore participatory and child-centred professional practice by critically evaluating and developing, for professional practice, the practical meanings of 'participatory' and 'children as citizens'. We do not present research outcomes based on empirical data; instead, we present our conceptual framework as the first stage of research in progress into participatory and child-centred professional practice.

Domestic violence and the exemption from seeking child support : providing safety or legitimizing ongoing poverty and fear

This article examines the experience of low-income women on welfare in Australia and the process of seeking child support from a violent ex-partner, contrasting this with research from the United States and the United Kingdom. Women in Australia who fear ongoing or renewed abuse as a result of seeking child support are eligible for an exemption. However, the exemption policy does not necessarily provide the intended protection of women and children from ongoing abuse and poverty. The exemption policy route also produces an unintended outcome whereby the perpetrators of violence are financially rewarded as they do not have to pay child support. These outcomes are shaped by a complex interaction of personal, cultural and structural forces that make the process of seeking child support for women who have experienced violence extremely problematic. The article demonstrates how in Australia, as in the US and UK policy contexts, the needs of women and their children are compromised by the details of policy specification and the way policies are implemented within the different systems.