An Infant with Food Allergy and Eczema in the Family – The Mental and Economic Burden of Caring

Allergic diseases including food allergy and eczema in an infant in combination with the everyday activities of caring for a family will pose challenges to parents. Only fragments of these challenges are revealed to health care professionals. Families have varying mental, social and economic resources to help them care for an allergic infant, and all such resources are important in determining how families succeed in meeting these challenges and the quality of the infant’s care. This study evaluated the whole burden to the family caused by an infant's allergic disease during the first 24 months of life. As the primary caregiver during this period is usually the mother, her perspective was considered important. Ecocultural theory, which considers families as capable of modifying the positive and negative forces facing them, was taken as the frame of reference. Data were collected as part of an ongoing prospective mother-infant study, and the methods included severity scoring of atopic dermatitis, dietary records, health-related quality of life measurements and assessments of the use of health care services and medications for treating the infant’s eczema, food allergy and asthma. Interviews with mothers were analysed by deductive content analysis on the basis of ecocultural theory and the family empowerment model. The theme “Living an ordinary family life” guided the organization of family activities essential for treating the infant's food allergy and eczema. These activities were sources of both strain and support for the mothers, the allergy-related supporting factors being the mother’s own knowledge of the allergy, hopes for an improvement in the infant’s condition, social support and work. An infant’s food allergy at the age of one year caused considerable strain for the mother in cases where the introduction of new foods into the child’s diet was delayed. This delay was still causing the mother additional strain when the child was 24 months of age. The infants waking at night at the ages of 12 and 24 months because of itching related to eczema caused strain for the mothers. The infants’ health-related quality of life was impaired at ages of 6 and 12 months compared with healthy infants. The principal reasons for impairments were itching, scratching and sleep disturbances at 6 and 12 months and treatment difficulties at 6 months. Problems with getting to sleep were reported at all stages irrespective of eczema and were also present in healthy infants. The economic impact of the treatment of allergic diseases on families during the first 24 months was 131 EUR (2006 value) in cases of eczema and 525 EUR in cases of food allergy. From the societal perspective, the costs of food allergy were a median of 3183 EUR (range 628–11 560 EUR) and of eczema a median of 275 EUR (range 94–1306 EUR). These large variations in costs in food allergy and eczema indicate that disease varies greatly . In conclusion, food allergy and eczema cause extra activities and costs to families which arrange these disease-related activities in such a way that they support the leading family theme “Living an ordinary family life”. Health care professionals should consider this thematic character of family life and disease-related activities in order to ensure that new treatments are sustainable, meaningful and tailored to daily activities. In addition, those mothers who are experiencing difficulties with food allergic infants or infants with eczema should be recognized early and provided with individual encouragement and support from health clinics. In the light of the present results, early detection of symptoms and effective parental guidance can contribute to the well-being and health-related quality of life of the child and family.

Developmental norms for the Gardner Steadiness Test and the Purdue Pegboard: a study with children of a metropolitan school in Brazil

Norms for the Gardner Steadiness Test and the Purdue Pegboard were developed for the neuropsychological assessment of children in the metropolitan area of Rio de Janeiro. A computer-generated unbiased sample of 346 children with a mean age of 9.4 years (SD = 2.76), who were attending a large normal public school in this urban area, was the subject of this study. Two boys were removed from the study, one for refusing to participate and the other due to severe strabismus. Therefore, the final sample contained 344 children (173 boys and 171 girls). Sex and age of the child and hand preferred for writing, but not ethnic membership or social class, had significant effects on performance in the Gardner Steadiness Test and the Purdue Pegboard. Girls outperformed boys. Older children performed better than younger children. However, the predictive relationship between age of the child and neuropsychological performance included linear and curvilinear components. Comparison of the present results to data gathered in the United States revealed that the performance of this group of Brazilian children is equivalent to that of US children after Bonferroni's correction of the alpha level of significance. It is concluded that sex and age of the child and hand preferred for writing should be taken into account when using the normative data for the two instruments evaluated in the present study. Furthermore, the relevance of neurobehavioral antidotes for the obliteration of some of the probable neuropsychological effects of cultural deprivation in Brazilian public school children is hypothesized.

Children at psychiatric risk and their families in Bucharest, in the context of 25 years of changes after December 89’ Romanian Revolution

The aim of the present dissertation was to capture a picture of child and adolescent mental health in Romania, in the context of almost 25 years of changes following the Romanian Revolution of December ’89. A three-part study was carried out in order to provide consistent answers to the pre-defined objectives: to appraise the development of child and adolescent mental health services in Romania (Part I), to explore the characteristics of clinically-referred patients in a Romanian child and adolescent psychiatry department (Part II), to examine the children’s mental health state and its connections with family functioning and associated risk factors (Part III). A multi-method research approach was used, comprising one qualitative analysis and two quantitative research studies. Part I consisted of a comparative qualitative analysis of the answers given by 10 mental health professionals at a 12-questions open ended interview about the current situation in child and adolescent mental health in Romania, on three topics: changes, challenges, solutions. Part II involved a descriptive quantitative analysis of certain variables (e.g. age, gender, primary diagnosis, co-morbidities, time of hospitalization) conducted on the patients who had been admitted to the Child and Adolescent Psychiatry Department at “Prof. Dr. Alexandru Obregia” Psychiatry Hospital, Bucharest in 1991 and in 2013. Part III was conducted on 342 subjects enrolled in two clinical groups and one school group, this study being performed through a cross-sectional analysis on multi-informant child and adolescent mental health problems and competencies (CBCL, YSR, SDQ P, SDQ SR) and their interrelation with household information (HQ) and family functioning (FAD). Outlining the results it can be stated that: 1) The CAMH System in Romania is definitely set on the path of reorganization, including a higher involvement of beneficiaries and of the community. 2) The characteristics of the admitted patients have changed significantly during the last almost 25 years since `89 December Revolution, under the influence of word wide trends in child psychiatry and of administrative aspects of the mental health network in Romania. 3) The rates of main diagnoses and co-morbidities confirm the reports in literature, with Autism Spectrum Disorder being the most frequent childhood psychiatric disorders in this study. 4) The children’s mental health problems in the psychiatry group are comparable to those reported for other clinical populations. 5) Significant score differences were observed according to various household features and also meaningful associations between a child’s clinical status and different aspects of family functioning. The Romanian Child and Adolescent Psychiatry has started to adopt the norms and standards of the European Union. In the 25 years that have elapsed after the 1989 Revolution, many changes have occurred in Romanian CAMH, but many unresolved issues have also risen. Therefore, the major contribution of this thesis is that it provides a coherent and updated overview of the present-day situation from three different perspectives- those of mental healthcare professionals, the one observed in clinical patients and the one reported by children’s families.

The Construction of ‘Disciplinary’ Violence Against Children — Social Workers’, Police Officers’ and Parents’ Rationales

This dissertation examines parental disciplinary violence against children in authority records and in the criminal procedure in Finland. The main aim is to analyze disciplinary violence, how it is defined, and how it is constructed as a crime by social workers, the police, and parents. This dissertation consists of four sub-studies and a summary article. In the first sub-study, I examine how disciplinary violence appears in child welfare documents and analyze the decision-making processes and measures taken by the child welfare workers. The second sub-study, utilizing police interview data, examines police officers’ perceptions of disciplinary violence, its criminalization, and its investigation. In addition to this analysis of police officers’ own perceptions, in the third sub-study, I use reports of crime and pre-trial investigation documents to look at what a typical suspicion of disciplinary violence coming to the attention of the police is and examine the decision-making processes of the police. Utilizing authority data, the fourth sub-study analyzes how parents rationalize the use of disciplinary violence to the authorities investigating these suspicions. The research provides findings that are unprecedented in Finland. Firstly, it was shown that social workers’ decision-making processes in suspicions of disciplinary violence follow three pathways of reasoning, with many factors taken into consideration; and in less than one-third of the cases, a request for criminal investigation has been made to the police. Secondly, it was verified that police officers hold different perceptions of disciplinary violence, and these perceptions have multiple effects on the investigation of these cases and the construction of disciplinary violence as a crime. Thirdly, the analysis of the reports of crime and pre-trial investigation documents showed that almost two-thirds of the cases of disciplinary violence had been sent to a prosecutor by the police and, thus, defined as a crime. However, in many cases, acts of disciplinary violence were often seen as ‘educational, petty one-off incidents’ and a possible trial and punishment for the perpetrator were seen as unreasonable. Fourthly, it was found that parents often try to neutralize and rationalize the violence they have used against their children, for example, either by denying the victim, the criminal intent, or the entire act, or relying on the necessity of the forbidden act. The dissertation concludes that disciplinary violence is defined and constructed in authority policies and practices, first and foremost, by the severity of the act, the nature of the act as continuous or singular, the perceived harm caused by the act to a child, and the perceptions of authorities regarding physical punishment of children. The asymmetrical power setting present in disciplinary violence and parents’ legitimized right to raise and discipline their children partly seem to explain why criminal-law processing of these suspicions of violence and understanding these as crimes is difficult. Finally, this research calls for more coherent and consistent authority practices and policies, achieved by educating authorities and increasing awareness on disciplinary violence, questions the need for a concept like ‘disciplinary’ violence, and suggests more emphasis on unambiguous perceptions of a child’s best interest.

Bone properties and skeletal maturity in adolescent males, as assessed by quantitative ultrasound

ABSTRACT Background: Previous studies have implied that weight-bearing, intense and prolonged physical activities optimize bone accretion during the grow^ing years. The majority of past inquiries have used dual-energy X-ray absorptiometry (DXA) to examine bone strength and hand-wrist radiography to determine skeletal maturity in children. Recently, quantitative ultrasound (QUS) technologies have been developed to examine bone properties and skeletal maturity in a safe, noninvasive and cost-effective manner. Objective: The purpose of this study was to compare bone properties and skeletal maturity in competitive male child and adolescent athletes with minimallyactive, age-matched controls, using QUS technology. >. Methods: In total, 224 males were included in the study. The 115 pre-pubertal boys aged 10-12 years consisted of control, minimally-active children (n=34), soccer players (n=26), gymnasts (n=25) and hockey players (n=30). In addition, the 109 late-pubertal boys aged 14-16 years consisted of control, minimally-active adolescents (n=31), soccer players (n=30), gymnasts (n=17) and hockey players (n=31). The athletic groups were elite level players that predominantly trained year-round. Physical activity, nutrition and sports participation were assessed with various questionnaires. Anthropometries, such as height, weight and relative body fat percentage (BF%) were assessed using standard measures. Skeletal strength and age were evaluated using bone QUS. Lastly, salivary testosterone (sT) concentration was measured using Radioimmunoassay (RIA). Results: Within each age group, there were no significant differences between the activity groups in age and pubertal stage. An age effect was apparent in all variables, as expected. A sport effect was noted in all physical characteristics: the child and adolescent gymnasts were shorter and lighter than other sports groups. Adiposity was greater in the controls and in the hockey players. All child subjects were pubertal stage (fanner) I or II, while adolescent subjects were pubertal stage IV or V. There were no differences in daily energy and mineral intakes between sports groups. In both age groups, gymnasts had a higher training volume than other athletic groups. Bone speed of sound (50s) was higher in adolescents compared with the children. Gymnasts had signifieantly higher radial 50S than controls, hockey and soccer players in both age cohorts. Hockey athletes also had higher radial 50S than controls and soccer players in the child and adolescent groups, respectiyely. Child gymnasts and soccer players had greater tibial 50S compared with the hockey players and control groups. Likewise, adolescent gymnasts and soccer players had higher tibial SoS compared with the control group. No interaction was apparent between age and type of activity in any of the bone measures. » Lastly, maturity as assessed by sT and secondary sex characteristics (Tanner stage) was not different between sports group within each age group. Despite the similarity in chronological age, androgen levels and sexual maturity, differences between activity groups were noted in skeletal maturity. In the younger group, hockey players had the highest bone age while the soccer players had the lowest bone age. In the adolescent group, gymnasts and hockey players were characterized by higher skeletal maturity compared with controls. An interaction between the age and sport type effects was apparent in skeletal maturity, reflecting the fact that among the children, the soccer players were significantly less mature than the rest of the groups, while in the adolescents, the controls were the least skeletally mature. Summary and Conclusions: In summary, radial and tibial SOS are enhanced by the unique loading pattern in each sport (i.e, upper and lower extremities in gymnastics, lower extremities in soccer), with no cumulative effect between childhood and adolescence. That is, the effect of sport participation on bone SOS was apparent already among the young athletes. Enhanced bone properties among athletes of specific sports suggest that participation in these sports can improve bone strength and potential bone health.

Effects of a preschool parent enrichment programme on children and their parents /

This study evaluated a preschool parent enrichment programme to assess if child and parent involvement in the programme facilitated the children's subsequent school adjustment. Also examined were the programme's effects on parent-child relationships. Participants were 56 Junior-Senior Kindergarten and Grade One students from one elementary school. Parent participants were 12 parents from the preschool parent enrichment programme, 6 parents whose children had attended other preschool programmes, and 6 parents whose children had remained at home prior to school. Five elementary teachers and both nursery school teachers from the parent enrichment programme also participated. Measures used included the Florida Key to assess children's inferred self-concept as learner and four subscales (relating, asserting, coping and investing), and interviews to assess parent and teacher perceptions. Findings indicated that there was little difference between parent and teacher perceptions about children who had attended a preschool programme. Both groups showed improved social, emotional, and behavioural skill development, together with increased self-esteem, and the ability to cope with separation from their parents. This enabled children to make the transition from preschool to primary school more successful. Children from the parent enrichment programme were not readily identifiable in terms of the profile promulgated for disadvantaged children. The Florida Key showed a main effect for the coping subscale, indicating that children from the parent enrichment programme may show more confidence in their abilities, and seek assistance from teachers than children who had no preschool experience. The parent enrichment programme appeared to have the biggest impact on the parents. Parents reported improved relationships with their children, increased confidence and self-esteem, as well as improved parenting and general life skills. The implications for short-term gains for children from this type of programme are better readiness for school, more positive self-esteem, improved social behaviour, and a higher achievement motivation. The long-term gains for children are predicted to be fewer special education placements, less grade retention, and a lower dropout rate from school. The short-term gains for parents are better social support networks," greater self-confidence, better interactions with children, and improved parenting skills. The long-term benefits may be an increased motivation to continue education, gain employment, and less family breakdown and abuse.

Children's rights in rural Punjab : the story of a border-dweller

There is currently a disconnect between the universal and general children's rights as presented in the United Nation's Convention on the Rights of the Child and the lived experiences of children in various countries. This thesis uses the authors' struggle to exist between two cultures as a lens through which the disconnect is explored. The author returns to her village in Punjab and looks at spaces created for children through institutions such as the education system and spaces that children create on their own. Luhmann's social systems theory is used to critique anti-humanist institutions and systems. As an alternative to Luhmann, H~dt and Negri's concept of the multitude is explored to provide insight into the political spaces that children create for themselves.

Conflicting ideologies in early childhood education : an exploration of Reggio-inspired practice

Within the field of early childhood education, the ideologies of child development and its parent discipline, developmental psychology, dominate both theory and practice. In recent years, educators have attempted to reconceptualise early childhood education by adopting more progressive approaches to teaching and learning. The aim of this present research study was to critically examine the experiences of early childhood educators who have adopted a Reggioinspired approach to educating young children. To explore their experiences, an institutional ethnography was employed involving seven educators from a large child care organization in Hamilton, Ontario. In line with the intent ofthis study, qualitative data were collected through in-depth semi-structured interviews, participant-observations and textual analyses to explore the presence of developmental-psychological ideologies within early childhood education and Reggio-inspired practice. The present study also examined the challenges faced by educators who have adopted a Reggio-inspired approach. The results of this study indicate that ideologies associated with the developmental-psychological paradigm dominate the practice of early childhood educators and that the conflicting ideologies that surround Reggio educators may play a role in some of the challenges educators experience. The findings of this study thus demonstrate a need to adopt alternative approaches toward understanding both children and childhood, in both early childhood educational theory and practice.

Closing the summer learning gap for vulnerable junior kindergarten students

Under current academic calendars across North America, summer vacation creates a significant gap in the learning cycle. I t has been argued that this gap actually decreases student achievement levels over the course of the summer. In a synthesis of 39 studies Cooper, Nye, Charlton, Lindsay, & Greathouse (1996) indicated that summer learning loss equaled at least one month of instruction as measured by grade level equivalents on standardized test scores whereby children's test scores were at least one month lower when they returned to school in the fall than scores were when students left in the summer. Specifically, Cooper et aI., (1996) found that the summer learning loss phenomena may be particularly troublesome for less advantaged children including those with speech and language delays, children at-risk for reading disabilities, children from lower socio-economic backgrounds, and children learning English as a second language. In general, research illustrated clearly that the summer learning gap can be particularly problematic for vulnerable children and furthermore, that literacy skills may be the area of achievement that is most affected. A foundational pillar to this research project is including primary caregivers as authentic partners in a summer literacy program designed to support their children's literacy needs. This pillar led the research team to use the Learning Begins at Home: A Research-Based Family Literacy Program Curriculum designed by Antoinette Doyle, Kathleen Hipfner-Boucher, and Janette Pelletier from the Ontario Institute for the Studies of Education. The LBH program is designed to be flexibly adapted to suit the needs of each individual participating family. As indicated by Timmons (2008) literacy interventions are most powerful when they include authentic family involvement. Based on this research, a requirement for participating in the summer literacy program was involvement of a child and one of their primary caregivers. The participating caregiver was integrally involved in the program, participating in workshop activities prior to and following hands-on literacy work with their child. By including primary caregivers as authentic partners, the research team encouraged a paradigmatic shift in the family whereby literacy activities become routine within their household. 5 Participants in this study were 14 children from junior kindergarten classrooms within the Niagara Catholic District School Board. As children were referred to the program, they were assessed by a trained emergent literacy specialist (from Speech Services Niagara) to identify whether they met the eligibility requirements for participation in the summer program. To be eligible to participate, children demonstrated significant literacy needs (i.e. below 25%ile on the Test of Preschool Early Literacy described below). Children with low incidence disabilities (i.e. profound sensory impairments, severe intellectual impairments, developmental disabilities, etc) were excluded as participants. The research team used a standard pre- and posttest design whereby all participating children were assessed with the Test of Preschool Early Literacy (Lonigan et aI., 2007), and a standard measure of letter names and sounds. Pretests were administered two weeks prior to the commencement of the program and the first set of posttests was administered immediately following the program. A second set of posttests was administered in December 2009 to measure the sustainability of the program. As a result of the program, all children scored statistically significantly higher on their literacy scores at the post-program assessment point immediately following the program and also at the Dec-post-program assessment point. These results in general indicated that the summer family literacy program made an immediate impact on the emergent literacy skills of participating children. All participating children demonstrated significant increases in print and phonological awareness as well as their letter sound understanding.

Mediated action, narratives of risk-taking, and identity formation in adolescents with a visual impairment

The purpose of this project was to discern the inherent tension present in narratives told by adolescents with a visual impairment as they attempted to make sense of their experiences, specifically those surrounding risk. Mediated action, based on the foundational work of Vygotsky and Bakhtin, was used as both a theoretical and methodological approach; it is the theory that there are two components that constitute any human action: the "agent," or the person who is doing the acting, and the "mediational means" that he or she is using to accomplish the action in question. Tension ensues as neither is able to fully explain human behaviour. Ten adolescents with a visual impairment participated in a narrative interview, revealing numerous counter-narratives surrounding risk-taking, including "experimentation undertaken using good judgment." Participants offered examples of how they engaged, appropriated, resisted and transformed the dominant narratives of disability and adolescence in their identity formation.

Revisiting the Jewish American princess : Jewish girls, the J.A.P. discursive stereotype, and negotiated identity

This qualitative exploratory research investigates how Canadian Jewish girls understand the discursive stereotype of the Jewish American Princess (JAP), and how they take up these understandings of the J AP in relation to their identities. Three focus groups and six interviews were conducted with girls attending Jewish high schools in Toronto, Canada to explore these questions. From a third wave Jewish feminist perspective, and taking a mediated action approach to identity, two analyses were conducted. A thematic analysis of peer relations, gender, community, and religious understandings demonstrates how aspects of individual identities mediate interpretations of the JAP. A series ofpor t rai t s of JAP-related identity were constructed to analyze how the JAP discursive stereotype also functions as a cultural tool that is taken up by the participants to mediate expressions of their identities. These findings establish the contradictory ways these Jewish girls describe, interpret, and utilize the JAP discursive stereotype, and the complex roles it plays in their social worlds.

An examination of the role of personality and self-regulation in the gambling behaviours of late adolescents and emerging adults

The purposes of this study were: a) to examine the role of personality and selfregulation in the gambling behaviour participation of late adolescents and emerging adults. In particular, the present study examined i f certain personality traits were more prevalent in high-risk gamblers than in young people considered low or at-risk gamblers; and, b) to examine i f the ability to self-regulate helped distinguish differences among the three groups of gamblers (low-risk, at-risk, and high-risk gamblers). A sample of late adolescents and emerging adults (N = 100) attending Brock University, completed a survey that assessed current gambling behaviour (both frequency and consequence experience), personality, self-esteem, and self-regulation. It was found that high-risk gamblers had lower scores on the personality dimensions Emotionality, Conscientiousness (especially on its Prudence facet), and Honesty-Humility (especially on its Fairness, Greed Avoidance, and Modesty facets) than at-risk or low-risk gamblers and higher scores on impulsive sensation seeking and impulsivity than at-risk or low-risk gamblers. Similarly, high-risk gamblers reported lower levels of self-regulation than both at-risk and low-risk gamblers. The findings from this study support past research which suggests that young people who gamble at problematic levels differ on many personality traits and often have more difficulty self-regulating than young people who do not participate at problematic levels. Findings may aid in the development of intervention and prevention programs that utilize specific self-regulation techniques with a young gambling population.

Provocative Innocence: Deconstructing Youth Sexuality through a Patriarchal & Immanent Framework

The purpose of this exploratory study is to deconstruct dominant discourses of youth’s sexuality through the exploration of a cultural text. Patriarchal and immanent frameworks form the theoretical basis for a deconstructive textual analysis and systematic mise en scène analysis of the chosen text, the film, Thirteen (Hardwicke, 2003). I intend to explore the portrayal of youth sexuality by deconstructing discourses of sexuality that are simultaneously reflected and interrogated in the above mentioned media text. I have chosen this approach in order to deconstruct socially constructed ways of knowing and experiencing sexuality in order to uncover a multitude of possibilities for sexuality. In other words, this project will use deconstruction in order to reconceptualize sexuality.

Deconstructing Evidence-Based Practice and Its Application in Children to with Mental Health Disorders

This is a mixed methodology study that uses an autoethnographic approach to combine both an autobiography and a survey of practitioners who work in children’s mental health. It is largely about the implementation of Evidence-Based Practice (EBP), and the questions, concerns, experiences that I have had, and compared them with those of my fellow practitioners. In addition, it is about my journey as a mental health professional, and how I have come to recognize that in order to achieve the goals I wanted to achieve, I needed to return to university to pursue a Master’s degree. Within the research, I identify and discuss different definitions of EBP and identify several themes. I deconstruct the implementation of EBPs through the lens of Foucault and his notions of governmentality. I offer policy and practice recommendations to improve the implementation of EBP and the services received by children facing mental health issues.