Age-related alterations of immunoreactive pancreatic cationic trypsinogen in sera from cystic fibrosis patients with and without pancreatic insufficiency

Serum immunoreactive cationic trypsinogen levels were determined in 99 control subjects and 381 cystic fibrosis (CF) patients. To evaluate the status of the exocrine pancreas all CF patients had previously undergone fecal fat balance studies and/or pancreatic stimulation tests. Three hundred fourteen CF patients had fat malabsorption and/or had inadequate pancreatic enzyme secretion (pancreatic insufficiency) requiring oral pancreatic enzyme supplements with meals. Sixty-seven CF patients did not have fat malabsorption and/or had adequate enzyme secretion (pancreatic sufficiency) and were not receiving pancreatic enzyme supplements with meals. Mean serum trypsinogen in 99 control subjects was 31.4 ± 14.8 /µg/hter (± 2 SD) and levels did not vary with age or sex. In CF infants (< 2 yr) with pancreatic insufficiency, mean serum trypsinogen was significantly above the non-CF values (p < 0.001). Ninety-one percent of the CF infants had elevated levels. Serum trypsinogen values in the pancreatic insuffi ient group declined steeply up to 5 years, reaching subnormal values by age 6. An equation was developed which described these age-related changes very accurately. Only six CF patients with pancreatic insufficiency had serum trypsinogen levels above the 95% confidence limits of this equation. In contrast, there was no age related decline in serum trypsinogen among the CF group with pancreatic sufficiency. Under 7 yr, serum trypsinogen failed to distinguish the two groups. In those over 7 yr of age, however, serum trypsinogen was significantly higher than the CF group with pancreatic insufficiency (p < 0.001), and 93% had values within or above the control range. In conclusion, serum trypsinogen appears to be a useful screening test for CF in infancy. Between 2 and 7 yr of age this test is of little diagnostic value. After 7 yr of age, serum trypsinogen can reliably distinguish between CF patients with and without pancreatic insufficiency.

The role of comfort in child restraint use practices

Suboptimal restraint use, particularly the incorrect use of restraints, is a significant and widespread problem among child vehicle occupants, and increases the risk of injury. Previous research has identified comfort as a potential factor influencing suboptimal restraint use. Both the real comfort experienced by the child and the parent’s perception of the child’s comfort are reported to influence the optimal use of restraints. Problems with real comfort may lead the child to misuse the restraint in their attempt to achieve better comfort whilst parent-perceived discomfort has been reported as a driver for premature graduation and inappropriate restraint choice. However, this work has largely been qualitative. There has been no research that objectively studies either the association between real and parent-perceived comfort, or any association between comfort and suboptimal restraint use. One barrier to such studies is the absence of validated tools for quantifying real comfort in children. We aimed to develop methods to examine both real and parent-perceived comfort and examine their effects on suboptimal restraint use. We conducted online parent surveys (n=470) to explore what drives parental perceptions of their child’s comfort in restraint systems (study 1) and used data from field observation studies (n=497) to examine parent-perceived comfort and its relationship with observed restraint use (study 2). We developed methods to measure comfort in children in a laboratory setting (n=14) using video analysis to estimate a Discomfort Avoidance Behaviour (DAB) score, pressure mapping and adapted survey tools to differentiate between comfortable and induced discomfort conditions (study 3). The DAB rate was then used to compare an integrated booster with an add-on booster (study 4) Preliminary analysis of our recent online survey of Australian parents (study 1) indicates that 23% of parents report comfort as a consideration when making a decision to change restraints. Logistic regression modelling of data collected during the field observation study (study 2) revealed that parent-perceived discomfort was not significantly associated with premature graduation. Contrary to expectation, children of parents who reported that their child was comfortable were almost twice as likely to have been incorrectly restrained (p<0.01, 95% CI 1.24 - 2.77).In the laboratory study (study 3) we found our adapted survey tools did not provide a reliable measurement of real comfort among children. However our DAB score was able to differentiate between comfortable and induced discomfort conditions and correlated well with pressure mapping. Preliminary results from the laboratory comparison study (study 4) indicate a positive correlation between DAB rate and use errors. In experiments conducted to date, we have seen a significantly higher DAB rate in the integrated booster compared to the add-on booster (p < 0.01). However, this needs to be confirmed in a naturalistic setting and in further experiments that take length of time under observation into account. Our results suggest that while some parents report concern about their child’s comfort, parent-reported comfort levels were not associated with restraint choice. If comfort is important for optimal restraint use, it is likely to be the real comfort of the child rather than that reported by the parent. The method we have developed for studying real comfort can be used in naturalistic studies involving child occupants to further understand this relationship. This work will be of interest to vehicle and child restraint manufacturers interested in improving restraint design for young occupants as well as researchers and other stakeholders interested in reducing the incidence of restraint misuse among children.

Transparency and ‘uncomfortable knowledge’ in child protection

Australia's child protection systems and the provision of out-of-home care, in particular, have been subject to sustained criticism for decades from dozens of official inquiries and reviews. It is now well established that many children in state care are treated significantly less well than required by relevant legal frameworks and community standards. Much attention and significant resources have been directed toward trying to ameliorate this ‘wicked problem’ and yet it continues. This article focuses on one reason the problems persists, namely the secrecy and closed cultures that characterize relevant organizations which reinforce strategies of denial that avoid acknowledging or dealing with ‘uncomfortable knowledge’. It is a situation many people in child protection systems confront. It is, for example, when we know abuse is taking place, or when they see or are ourselves party to corrupt or negligent practices. It is knowing that important ethical principles are being abrogated. We draw on recent official reports and inquiries noting the repeated calls for greater transparency and independent oversight. An argument is made for a default position of total transparency subject to caveats that protect privacy and any investigation underway. An account of what this can look like is offered.

Liver transplantation in children: Experience with the development of an Australian pilot programme. The Queensland Liver Transplantation Programme

Children with end-stage liver disease now form a major sub-group of patients considered suitable for liver transplantation (ltp), and enjoy better survival statistics after transplantation than do adults. Since June 1984, a paediatric ltp programme has been developed in Brisbane with an initial working relationship and ongoing close links with two USA centres (Pittsburgh, and the UCLA Medical Center). Fourteen children with end-stage liver disease have been referred to the Queensland Liver Transplantation Programme for formal assessment. Following frank, informed discussion with their parents, 10 of these children were offered the option of ltp. During the transition stage, two infants with biliary atresia were referred to UCLA at their parents' request and, subsequently, eight children aged from 9 months to 6 years have been placed on a transplant candidacy list in Brisbane. A donor procurement team with access to a Queensland Government jet has been available to cover all mainland States except Western Australia. Six of the children have now had orthotopic ltp (two children at the UCLA Medical Center; four children at the Royal Children's Hospital, Brisbane). One UCLA patient died with a non-functioning graft, and one Brisbane patient died 5 weeks post-transplant with rejection, hepatic artery thrombosis and sepsis. The other four children are alive and well, three with normal liver function and one with unexplained intrahepatic cholestasis, during the 1-20 month follow-up to date. Three further children have died of their liver disease without a donor of an appropriate blood group and size being found, and one patient still awaits a suitable donor. The experience of these authors suggests that ltp is a major advance in the treatment of paediatric liver disease, and that the procedure can be carried out successfully in Australia with initial results comparable with leading overseas centres. The procedure requires the full array of services of a major paediatric tertiary care facility, an intensive team effort with awareness of the special needs of children, and a widespread procurement capability. A major problem for Australia is the procurement of sufficient numbers of optimal paediatric donor livers.

Serum immunoreactive pancreatic lipase and cationic trypsinogen for the assessment of exocrine pancreatic function in older patients with cystic fibrosis

Indirect and qualitative tests of pancreatic function are commonly used to screen patients with cystic fibrosis for pancreatic insufficiency. In an attempt to develop a more quantitative assessment, we compared the usefulness of measuring serum pancreatic lipase using a newly developed enzyme-linked immunosorbent immunoassay with that of cationic trypsinogen using a radioimmunoassay in the assessment of exocrine pancreatic function in patients with cystic fibrosis. Previously, we have shown neither lipase nor trypsinogen to be of use in assessing pancreatic function prior to 5 years of age because the majority of patients with cystic fibrosis in early infancy have elevated serum levels regardless of pancreatic function. Therefore, we studied 77 patients with cystic fibrosis older than 5 years of age, 41 with steatorrhea and 36 without steatorrhea. In addition, 28 of 77 patients consented to undergo a quantitative pancreatic stimulation test. There was a significant difference between the steatorrheic and nonsteatorrheic patients with the steatorrheic group having lower lipase and trypsinogen values than the nonsteatorrheic group (P < .001). Sensitivities and specificities in detecting steatorrhea were 95% and 86%, respectively, for lipase and 93% and 92%, respectively, for trypsinogen. No correlations were found between the serum levels of lipase and trypsinogen and their respective duodenal concentrations because of abnormally high serum levels of both enzymes found in some nonsteatorrheic patients. We conclude from this study that both serum lipase and trypsinogen levels accurately detect steatorrhea in patients with cystic fibrosis who are older than 5 years but are imprecise indicators of specific pancreatic exocrine function above the level needed for normal fat absorption.

Age-related alterations in immunoreactive pancreatic lipase and cationic trypsinogen in young children with cystic fibrosis

Serum immunoreactive pancreatic lipase and cationic trypsinogen are elevated in young infants with cystic fibrosis (CF) and may be useful neonatal screening tests for CF. We compared lipase measured by a recently developed ELISA immunoassay with trypsinogen measured by radioimmunoassay in 70 children (ages 0.1 to 9.9 years) with CF who had various degrees of pancreatic dysfunction and in 79 similarly aged children without CF (controls). In the control children, lipase activity increased with advancing age, whereas trypsinogen showed no age-related trend. Lipase and trypsinogen were significantly elevated in the infants with CF who were younger than 1 year, irrespective of pancreatic function (trypsinogen, P<0.001; lipase, P<0.05). Sensitivities in detecting CF were 76% and 90% for lipase and trypsinogen, respectively. After the first year of life, lipase and trypsinogen values declined toward normal, the rate of decline of lipase being greater than that of trypsinogen; 67% of lipase values were within or below the normal range by 3 years, whereas 67% of trypsinogen values continued to be elevated. We conclude that trypsinogen is an excellent screening test for CF in young infants regardless of pancreatic function, and that the addition of a serum pancreatic lipase determination does not improve the accuracy of trypsinogen as a screening test for cystic fibrosis.

We need to support paedophiles to prevent child sex offending

The sexual abuse of children is, understandably, a key concern for the public. Child sexual abuse can cause long-lasting harms for victims, ranging from relationship difficulties to eating disorders. But misperceptions about those who perpetrate it abound in public debate. Although the terms “paedophile” and “child sex offender” are often used interchangeably, the two are distinct. Paedophiles are sexually attracted to young children. They have either acted on this attraction or fear they might. But not all paedophiles act on their attraction – and this is where support services can help reducing offending. Conversely, not everyone who offends sexually against a child is a paedophile. Some may have a sexual interest in and/or offend against both children and adults. Others do not have a sexual attraction to children but instead act opportunistically...

Sharism and social awareness of the Chinese One Child Generation: Urban youth and digital networks

This thesis is a study of Chinese One Child Generation's digital and social sharing. It examines urban youth grassroots communities, including an urban farmers' community and volunteers in educational camps. These case studies explain the emergence of 'sharism' in reaction to the growing risks in China, such as food safety and environmental degradation emanating from China's rapid economic development, and growing urbanism, globalisation, and consumerism. The new forms of 'sharism' are linked to guanxi (social relations) and connected youth communities, which are made possible by increasing accessibility to digital and networked technologies.

Child temperament and parental personality: continuity and transactional change

Studying the continuity and underlying mechanisms of temperament change from early childhood through adulthood is clinically and theoretically relevant. Knowledge of the continuity and change of temperament from infancy onwards, especially as perceived by both parents is, however, still scanty. Only in recent years have researchers become aware that personality, long considered as stable in adulthood, may also change. Further, studies that focus on the transactional change of child temperament and parental personality also seem to be lacking, as are studies focusing on transactions between child temperament and more transient parental characteristics, like parental stress. Therefore, this longitudinal study examined the degree of continuity of temperament over five years from the infant s age of six months to the child s age of five and a half years, as perceived by both biological parents, and also investigated the bidirectional effects between child temperament and parents personality traits and overall stress experienced during that time. First, moderate to high levels of continuity of temperament from infancy to middle childhood were shown, depicting the developmental links between affectively positive and well-adjusted temperament characteristics, and between characteristics of early and later negative affectivity. The continuity of temperament was quantitatively and qualitatively similar in both parents ratings. The findings also demonstrate that infant and childhood temperament characteristics cluster to form stable temperament types that resemble personality types shown in child and adult personality studies. Second, the parental personality traits of extraversion and neuroticism were shown to be highly stable over five years, but evidence of change in relation to parents views of their child s temperament was also shown: an infant s higher positive affectivity predicted an increase in parental extraversion, while the infant s higher activity level predicted a decrease in parental neuroticism over five years. Furthermore, initially higher parental extraversion predicted higher ratings of the child s effortful control, while initially higher parental neuroticism predicted the child s higher negative affectivity. In terms of changes in parental stress, the infant s higher activity level predicted a decrease in maternal overall stress, while initially higher maternal stress predicted a higher level of child negative affectivity in middle childhood. Together, the results demonstrate that the mother- and father-rated temperament of the child shows continuity during the early years of life, but also support the view that the development of these characteristics is sensitive to important contextual factors such as parental personality and overall stress. While parental personality and experienced stress were shown to have an effect on the child s developing temperament, the reverse was also true: the parents own personality traits and perceived stress seemed to be highly stable, but also susceptible to their experiences of their child s temperament.

Central America: Labor Reports and Child Labor Reports Pursuant to the Trade Act of 2002, Section 2102(c)(8)-(9)

[Excerpt] These comments are in response to the “Request for Information Concerning Labor Rights in Costa Rica, El Salvador, Guatemala, Honduras and Nicaragua and their Laws Governing Exploitative Child Labor” published at 68 Fed. Reg. 19580 (April 21, 2003). This Request for Information was issued pursuant to Section 2102(c)(8) and (9) of the Trade Act of 2002, Pub. L. 107-210, which requires the President, with respect to any proposed trade agreement, to submit to Congress a “meaningful labor rights report” and a “report describing the extent to which the country or countries that are parties to the agreement have in effect laws governing exploitative child labor.”

The Apparel Industry and Codes of Conduct: A Solution to the International Child Labor Problem?

This report is the third volume in ILAB’s international child labor series. It focuses on the use of child labor in the production of apparel for the U.S. market, and reviews the extent to which U.S. apparel importers have established and are implementing codes of conduct or other business guidelines prohibiting the use of child labor in the production of the clothing they sell. The report was mandated by the Omnibus Consolidated Rescissions and Appropriations Act of 1996, P.L. 104-134.

Uzbekistan Supplementary NGO Report on the Implementation of the Convention on the Rights of the Child in the Republic of Uzbekistan

[Excerpt] The Convention on the Rights of the Child (CRC) was one of the first international instruments to which the Republic of Uzbekistan acceded, and with parliamentary ratification on 9 December 1992, the Republic of Uzbekistan entered into a commitment to observe all the provisions of the CRC and to shoulder its responsibility before the international community. As a result various legislative, administrative and other steps have been taken by the government of the Republic of Uzbekistan with a view to bringing the State policy and legislation on children to be in line with the provisions as enshrined in the Convention on the Rights of the Child. The Constitution incorporates the fundamental provisions of the Universal Declaration of Human Rights. At the current stage in the restructuring of the country’s social and economic development, solid foundations have been laid for the conduct of significant democratic reforms based on a recognition of the innate worth of the individual (including the child) and of the unconditional respect of his or her rights and freedoms. Until recently, the State acted as the main guarantor of the provision of all social services, however the process of the transition (political/economic) to a market economy has entailed the development of new economic relations with a reduction in the allocation of state resources for the provision of social services to children. The efforts of the government made so far to bring the state policy and legislation on the child to be in line with the provisions enshrined in the convention on the rights of the child are commendable; never the less, the implementations of all these policies and laws into practice needs a lot to desire as there are a number of ongoing child rights violations. The National Report has fundamentally overlooked a number of child rights privileges enshrined in the CRC that have not yet been realised, or those rights that have been eroded since the independence. These shortcomings need to be noted for consideration so that the state steps up its efforts to enact new laws and/or to enforce the existing rules and regulations required for the protection and implementation of these child rights, and to improve the overall situation for children in the Republic of Uzbekistan.

Monikulttuurisuuskasvatus päiväkodin monikulttuurisessa esiopetusryhmässä

This study reports on the realisation of multicultural education in a multicultural pre-school group of one kindergarten. The research questions were: 1) what multicultural goals and contents did the kindergarten´s own pre-school curriculum contain? and 2) how did the pre-school educators´ views on multicultural education appear in their actions in a multicultural pre-school group? The research was conducted by analysing the curricula, interviewing the educators, and observing of the preschool groups. Pre-school education is seen as part of institutionalised education which is defined through culture. Education is considered from the point of view of critical multicultural education, paying special attention to the role of society in the definition of education. The research is a case study, and it concentrates on the interpretation of the working philosophy of one preschool group with respect to its implementation. The target group consisted of 20 6-year-old pre-school pupils in a kindergarten and their four pre-school educators. The research results showed that the kindergarten´s own pre-school curriculum (1997) was in structure and form consistent with the structure and form of the National Core Curriculum for Pre-School Education from 1996. The only difference was in the classification of the various subject fields and objectives. The contents of the two curricula showed hardly any variation, and both of them contained only few goals and contents for multicultural education. According to the interviews, the educational views and learning philosophy of the pre-school educators represented a child-centred point of view that takes into consideration the individual pupil´s needs and skills. This is also one of the basic principles of multicultural education. The principle was not, however, realised in the directed activities of the pre-school group. The heterogeneity of the pre-school group was dealt with by dividing the children into smaller groups, but the contents of the tuition were not differentiated. All children were provided with the same goals and contents. Multicultural education was seen as remote and separate from the overall educational philosophy. The contents of multicultural education were interpreted by the educators as teaching Finnish as a second language and teaching the children their own mother tongue and religion. After the evaluation of the state of the kindergarten´s multicultural education using four different models, I determined that the kindergarten emerged as a representative of the model where multicultural education is seen as something meant for immigrants only. The aim of the model is a rapid integration of the immigrant children with the majority population. Keywords: education, pre-school education, multicultural education, critical multicultural education, language, culture

Lapsi, lapsuus ja perhe varhaiskasvatusasiakirjoissa 1967-1999

The aim of this study is to describe and interpret discourses in Finnish national early childhood education and care (ECEC) documents concerning the child, childhood and family, including preschool education of six-year-old children. The study begins with preparation phase of the Act on Children s Day Care (1967) and concludes with the definition of ECEC policy (1999). The research data consists of committee memoranda and national ECEC curriculum guidelines. The total number of documents studied was 20, comprising some 1700 pages. The research data was examined with qualitative text analysis and employed a discursive approach. A semiotic square (Greimas rectangle) served as a tool for clarifying the discourses and constructions reflected in the research data. The theoretical framework of the study consists of the theories of childhood and family studies. The main concepts from childhood studies used in this study were childhood as a cultural construct and child-centred pedagogy in ECEC. The theoretical approaches from family studies used were the formation of modern and late-modern parenthood and family, as well as the concept of familism. Two main discursive lines were constructed from the ECEC documents. The notion of universalistic childhood suggests that early education and care aim to create the same good childhood for all children, regardless of their family background or living area. The second discursive line followed in the documents is the familistic discourse. This discourse contains emphasis on the priority of parental care. The construct of the competent child was found in the research data as early as in the mid-1970s. On the other hand, the construct of the weak family is distinguishable throughout almost the entire research period. This raises the question of whether Finnish ECEC system has been developed for the competent and self-sufficient child of a weak family which needs constant support and guidance of welfare experts. According to the study, it appears that within the Finnish ECEC system the relatively heavy emphasis on social work rather than on early education has been legitimised by the construct of the weak family. This study also shows that a more thorough analysis should be given to what we mean when we say that the main task of ECEC system is to support families in the upbringing of their children. The study was completed during the period when historical decisions concerning the administration in Finland were in the making (i.e. the potential transfer of ECEC services from the Ministry of Social Affairs and Health to the Ministry of Education). Also, over the past decade, a major reformation of the Act on Children s Daycare has been on the agenda, but no concrete measures have been implemented. Based on the findings of this study, we can ask for what kind of child and family we are preparing the ECEc reforms of the new millennium. Key words: ECEC policy Finland, childhood, family, familism, discourse analysis, semiotic square