O cuidado em saúde mental infantil na perspectiva de profissionais, familiares e crianças

Introdução: A preocupação e a incorporação da problemática da saúde mental infantil nas políticas públicas de saúde são recentes, assim como o desenvolvimento de ações voltadas a esse cuidado. Preconiza-se que essa atenção se proceda a partir de uma rede composta por serviços atuando de modo articulado a outros setores. Objetivo: Analisar os processos e as condições de produção de cuidados em saúde mental de criança na perspectiva do modo psicossocial na Rede de Atenção Psicossocial. Método: Pesquisa qualitativa, com referencial teórico-metodológico oriundo da Análise Institucional, desenvolvida por meio de Observação Participante em (1) espaços de articulação entre serviços de saúde, (2) Unidade Básica de Saúde e (3) Centro de Atenção Psicossocial Infantojuvenil (CAPSi) no município de Mauá, São Paulo. A Observação Participante permitiu reconhecer os procedimentos de cuidados no cotidiano dos serviços. Para aprofundamento da investigação, foram realizados Grupos Focais com profissionais da Estratégia de Saúde da Família e do CAPSi, com familiares de crianças que frequentam o CAPSi e com crianças usuárias do serviço. Os dados foram analisados e interpretados a partir de conceitos advindos da psicanálise winnicottiana, do modo de atenção psicossocial e da análise institucional. Resultados e Discussão: O interesse, o investimento político e o direcionamento das ações e da organização dos serviços, coerentes com a lógica de atenção psicossocial, têm propiciado um terreno fértil para a construção de práticas transformadoras de cuidado em saúde mental. A incorporação desse cuidado na Atenção Básica, ainda que apresente desafios e tensões entre o modelo instituído (departamentalizado em especialidades) e instituinte (saúde mental integrante da saúde geral), levou a mudanças nas ações e concepções dos profissionais. Contudo, o desenvolvimento de ações intersetoriais e a construção de uma rede ampliada de atenção têm sido limitados pela escassez de serviços e profissionais da rede e por diferentes concepções que atravessam o campo. Os participantes da pesquisa expressam visão conflitante em relação à concepção acerca de problemas de saúde mental e das expectativas quanto ao cuidado, sendo observada forte presença de uma cultura psiquiátrica, que se acentua nas falas dos familiares e na articulação com outros serviços, e uma inclinação a favor da atenção psicossocial, mais presente nas expressões dos profissionais. Nos serviços de saúde, há movimentos instituintes que enfatizam a integralidade da atenção, a interdisciplinaridade do cuidado, a multideterminação do processo saúde-doença, alinhados ao modo de atenção psicossocial. O acolhimento, o vínculo, a escuta e a confiança, importantes elementos do cuidado estão presente nas ações dos serviços. As intervenções terapêuticas têm sido desenvolvidas a partir da singularidade dos casos por meio de Projetos Terapêuticos Individuais, embora sejam consideradas aquém das necessidades das crianças, limitações advindas da escassez de profissionais e serviços da rede. Considerações Finais: Embora os serviços de saúde atuem na direção do cuidado alicerçado no modo psicossocial, eles têm atuado de forma pouco articulada com outros setores. A hegemonia da cultura psiquiátrica é um desafio a ser enfrentado. São urgentes ações que possam promover mudanças nessa cultura predominante e no imaginário social no que toca aos problemas de saúde mental e aceitação das diferenças.

Advice to a mother on the management of her children : and on the treatment on the moment of some of [sic] their more pressing illnesses and accidents /

Includes index.

What is a good play school? Recommended standards for the group care of children of elementary school age.

Mode of access: Internet.

40 years of stewardship-- where are we headed? : a report on the 40th Anniversary Symposium of the Illinois Department of Children and Family Services, December 2004.

"December 2004."

Water-cure for ladies : a popular work on the health, diet, and regimen of females and children, and the prevention and cure of diseases : with a full account of the processes of water-cure, illustrated with various cases /

Tailpiece.

Care of Children Series

Mode of access: Internet.

Telepaediatrics and diabetic retinopathy screening of young people with diabetes in Queensland

We have examined the feasibility of a telemedicine-enabled screening service for children and adolescents with diabetes in Queensland. There are approximately 1400 young people with diabetes in Queensland and only about two-thirds of them are screened in accordance with international guidelines. A regional retinal screening service was established using a non-mydriatic digital retinal camera. Seven centres volunteered to participate in the study. During a five-month pilot trial, 83 of the young people with diabetes who attend these centres underwent digital retinal screening (3.7%). Retinal images were sent via email to a paediatric ophthalmologist for review and results were returned via email. A copy of each participant's results was forwarded by mail to the referring diabetes doctor and the participant and family. The majority of the image files (96%) were rated as excellent or good. Only one participant was identified as having an abnormal result. Participants and their families expressed satisfaction with the digital retinal screening process.

Snoring and its association with asthma in Indigenous children living in the Torres Strait and Northern Peninsula Area

Objective: Respiratory health of Indigenous and minority ethnic groups in affluent countries is poorer than their non-minority counterparts and sleep disorders are no exception. In children, obstructive sleep apnoea has the potential to result in serious long-term consequences. In 1999, we studied 1650 children and adolescents living in the Torres Strait and the Northern Peninsula Area, Australia. Here we report prevalence of snoring in these communities and relate its association with asthma symptoms. Methods: A population-based cross-sectional study was conducted in the Torres Strait region. Five indigenous communities were randomly selected and information was collected using a structured face-to-face interview based on a standardized questionnaire. There was a 98% response rate, and 1650 children, 0-17 years of age, were included in the study. Results: Overall, the prevalence of snoring was 14.2% (95% CI 12.5-15.9); 3.6% (95% CI 2.7-4.6) reported snorting, and 6% (95% CI 4.9-7.2) reported restless sleep. The prevalence of snoring was significantly higher among males (17.1% for males and 10.8 for females, P = 0.005). Children were five times more likely to have experienced snoring and snorting if they reported wheezing in the last 12 months. Conclusion: We conclude that the prevalence of symptoms suggestive of obstructive sleep problems is relatively high in children of this region. This highlights the need for awareness among the community patients and physicians about the problem of obstructive sleep-disordered breathing, especially in children with asthma, and for the need for further studies to measure prevalence of sleep breathing disorders among Indigenous Australians.

Attentional bias toward fear-related stimuli: An investigation with nonselected children and adults and children with anxiety disorders

Research investigating anxiety-related attentional bias for emotional information in anxious and nonanxious children has been equivocal with regard to whether a bias for fear-related stimuli is unique to anxious children or is common to children in general. Moreover, recent cognitive theories have proposed that an attentional bias for objectively threatening stimuli may be common to all individuals, with this effect enhanced in anxious individuals. The current study investigated whether an attentional bias toward fear-related pictures could be found in nonselected children (n = 105) and adults (n = 47) and whether a sample of clinically anxious children (n = 23) displayed an attentional bias for fear-related pictures over and above that expected for nonselected children. Participants completed a dot-probe task that employed fear-related, neutral, and pleasant pictures. As expected, both adults and children showed a stronger attentional bias toward fear-related pictures than toward pleasant pictures. Consistent with some findings in the childhood domain, the extent of the attentional bias toward fear-related pictures did not differ significantly between anxious children and nonselected children. However, compared with nonselected children, anxious children showed a stronger attentional bias overall toward affective picture stimuli. (C) 2004 Elsevier Inc. All rights reserved.

Hospital care of children in four countries

Background. While perceptions of parents and staff about care of hospitalized children have been explored in developed countries, little research has examined these in developing countries. Assumptions about family-centred care are often based on Western values, with little evidence of how cultural constructs affect care delivery in developing nations. Aim. This paper reports a study to provide evidence from which culturally-appropriate hospital care for children can be delivered. Methods. Using a rigorously devised and trialed questionnaire, attitudes of staff and parents about the way children are cared for in children's hospitals in four countries were examined and subjected to a four way analysis: parents and staff within and between developed and developing countries. Results. There were no questions where all parents and staff in both developed and developing country groups were in complete agreement. However, there was some indication that, while culture plays a major role in paediatric care delivery, basic concepts of family-centred care are similar. Conclusions. The findings are limited by the sampling strategy. Nevertheless, while differences were found between parents' and staff's expectations of the delivery of care to children in hospitals, similarities existed and the influence of culture cannot be ignored. Education programmes for staff and parents should reflect these influences to ensure the optimum delivery of family-centred care, regardless of where the hospital is situated.

Prediction of total body water in infants and children

Background: In paediatric clinical practice treatment is often adjusted in relation to body size, for example the calculation of pharmacological and dialysis dosages. In addition to use of body weight, for some purposes total body water (TBW) and surface area are estimated from anthropometry using equations developed several decades previously. Whether such equations remain valid in contemporary populations is not known. Methods: Total body water was measured using deuterium dilution in 672 subjects (265 infants aged < 1 year; 407 children and adolescents aged 1-19 years) during the period 1990-2003. TBW was predicted (a) using published equations, and (b) directly from data on age, sex, weight, and height. Results: Previously published equations, based on data obtained before 1970, significantly overestimated TBW, with average biases ranging from 4% to 11%. For all equations, the overestimation of TBW was greatest in infancy. New equations were generated. The best equation, incorporating log weight, log height, age, and sex, had a standard error of the estimate of 7.8%. Conclusions: Secular trends in the nutritional status of infants and children are altering the relation between age or weight and TBW. Equations developed in previous decades significantly overestimate TBW in all age groups, especially infancy; however, the relation between TBW and weight may continue to change. This scenario is predicted to apply more generally to many aspects of paediatric clinical practice in which dosages are calculated on the basis of anthropometric data collected in previous decades.

Telemedicine for rural and remote child and youth mental health services

The E-Child and Youth Mental Health Service was designed to provide children and adolescents in Queensland with access to specialist mental health consultations using telemedicine. A project officer provided a single point of contact for referral management and clinic coordination, thereby reducing barriers of access to the service. Over a six-month period from November 2004, 42 point-to-point videoconferences were conducted to nine sites in Queensland. Three multipoint conferences were also conducted. Eleven videoconferences (24%) were arranged for administrative purposes, and 34 (76%) were conducted for the delivery of clinical services (30 patients). The referral and consultation activity suggests an improvement in the capacity of rural and remote mental health service providers to deliver specialist services for children and adolescents.

Early intervention for children and their parents following paediatric accidental injury

This study was undertaken to develop and evaluate the efficacy of an early intervention for children who had been injured in an accident. The aim of the intervention was to prevent the development of longterm psychological consequences. Brochures were developed for children, adolescents, and their parents. These brochures detailed common responses to trauma (and normalized such responses), and suggestions for minimizing any post-trauma distress. Participants were children aged 7-15 admitted to hospital for traumatic injury. The intervention was delivered to one of two hospitals, within 72 hours of the trauma. 103 children and parents participated in the study. The parents and children completed structured interviews and questionnaires 2 weeks, 4-6 weeks and 6 months post-trauma. Outcome analyses also indicated that the intervention reduced parental distress at 4-6 weeks post-trauma. The intervention did not impact significantly on child adjustment over this time period. Results of the 6 month follow-up suggested that the intervention resulted in an amelioration of child anxiety from one to six months post-trauma, whereas the controls exhibited an increase in anxiety over this time period. Overall, it was concluded that the early intervention is a simple, practical, and cost-effective method of reducing child and parent distress post-trauma.

Exploring the experiences of nurses who care for children who have Acute Life Threatening Events (ALTE) in hospital

This thesis presents a program of work designed to explore and describe what the experience of caring for a child who has an Acute Life Threatening Event (ALTE) is like for the nurses. An ALTE may include a cardiac arrest, respiratory arrest or unplanned admission for a ward to the Paediatric Intensive Care unit. Using the MRC framework for the development of complex interventions, this information was then coupled with theory to develop the PREPARE and SUPPORT interventions. Given the wide-ranging and exploratory nature of this research, a pragmatic, mixed design approach was used to address the aims and objectives of the thesis. The mixed design approach included: a systematic literature review; international survey of practice; interviews with nurses and doctors using Interpretative Phenomenological Analysis; development, refinement and evaluation of interventions during a feasibility study. Two studies were identified through the systematic review which aimed to evaluate the effectiveness of debriefing. The studies did not provide evidence to support the use of these interventions within healthcare. The international survey of practice demonstrated hospitals were using interventions to both prepare and support nurses for these events. The preparatory interventions were clinically focused and the majority of the supportive interventions included a debrief. The interventions were not being evaluated for effectiveness. The interviews conducted with nurses and doctors provided insight into what that experience was like for the participants. Using the MRC framework, this evidence was coupled with theory to develop the PREPARE and SUPPORT interventions. A multidisciplinary working party used an iterative process to refine and evaluate the interventions and study procedures were explored through a feasibility study. The pragmatic, mixed design approach demonstrated how the empirical evidence was coupled with theory and clinical expertise to develop interventions for use within the healthcare environment.

Academic achievement orientation of West Indian American parents and adolescents

Literature addressing academic achievement orientation of Black adolescents in the United States often depicts poor school related attitudes and adaptation patterns, low academic achievement, and deficient family backgrounds. However, some researchers maintained that certain Black immigrant groups possessed positive academic achievement orientations and exemplary academic achievements (Ogbu, 1991; Gibson, 1991; Vernez, & Abrahamse, 1996). In this study, I attempted to combine qualitative data from multiple sources (surveys, interviews, observations, literature, and document analysis), using standard case study methodology and the constant comparative method of analysis to understand the relationship that existed between the academic achievement orientation of a select group of West Indian American parents and adolescents in Broward County, Florida. The sub-sample of 11 families, comprising 15 adolescents and 13 parents, was selected through maximum variation sampling from a pool of 23 families. The findings were presented as a single composite case study. The participants possessed specific, longstanding educational and career goals for the children. The parents were deeply involved and were knowledgeable of their children's schools and academic progress. While mothers were the parents most actively involved in the schools, fathers were strong authoritative figures. Families evidenced a strong moral religious base with set rules of behavior, firm parenting practices, and established chains of authority. Family members emphasized education over material things; reading over audiovisual or social activities; family cohesion over individual wishes; and academics over extracurricular activities. The parents' strong positive academic achievement orientation was communicated to the children and reinforced by relatives, family friends, and others. In turn, the adolescents possessed positive school-related attitudes and attributional styles. While they admitted their parents were somewhat strict, they voluntarily complied with the rules and were highly motivated to succeed because they believed their parents deeply cared for them and that education leads to success and upward mobility. Each adolescent was pursuing an academic track and planning for college and specific profession. The findings support Ogbu's cultural ecological model (1991). I recommend these findings to teachers, counselors, administrators, parents, and others working with West Indian American families. ^