FluMum : a prospective cohort study of mother-infant pairs assessing the effectiveness of maternal influenza vaccination in prevention of influenza in early infancy

INTRODUCTION Influenza vaccination in pregnancy is recommended for all women in Australia, particularly those who will be in their second or third trimester during the influenza season. However, there has been no systematic monitoring of influenza vaccine uptake among pregnant women in Australia. Evidence is emerging of benefit to the infant with respect to preventing influenza infection in the first 6 months of life. The FluMum study aims to systematically monitor influenza vaccine uptake during pregnancy in Australia and determine the effectiveness of maternal vaccination in preventing laboratory-confirmed influenza in their offspring up to 6 months of age. METHODS AND ANALYSIS A prospective cohort study of 10 106 mother-infant pairs recruited between 38 weeks gestation and 55 days postdelivery in six Australian capital cities. Detailed maternal and infant information is collected at enrolment, including influenza illness and vaccination history with a follow-up data collection time point at infant age 6 months. The primary outcome is laboratory-confirmed influenza in the infant. Case ascertainment occurs through searches of Australian notifiable diseases data sets once the infant turns 6 months of age (with parental consent). The primary analysis involves calculating vaccine effectiveness against laboratory-confirmed influenza by comparing the incidence of influenza in infants of vaccinated mothers to the incidence in infants of unvaccinated mothers. Secondary analyses include annual and pooled estimates of the proportion of mothers vaccinated during pregnancy, the effectiveness of maternal vaccination in preventing hospitalisation for acute respiratory illness and modelling to assess the determinants of vaccination. ETHICS AND DISSEMINATION The study was approved by all institutional Human Research Ethics Committees responsible for participating sites. Study findings will be published in peer review journals and presented at national and international conferences. TRIAL REGISTRATION NUMBER The study is registered with the Australia and New Zealand Clinical Trials Registry (ANZCTR) number: 12612000175875.

Treatment for gender dysphoria in children : the new legal, ethical and clinical landscape

- Gender dysphoria is a condition in which a child's subjectively felt identity and gender are not congruent with her or his biological sex. Because of this, the child suffers clinically significant distress or impairment in social functioning. - The Family Court of Australia has recently received an increasing number of applications seeking authorisation for the provision of hormones to treat gender dysphoria in children. - Some medical procedures and interventions performed on children are of such a grave nature that court authorisation must be obtained to render them lawful. These procedures are referred to as special medical procedures. - Hormonal therapy for the treatment of gender dysphoria in children is provided in two stages occurring years apart. Until recently, both stages of treatment were regarded by courts as special medical treatments, meaning court authorisation had to be provided for both stages. - In a significant recent development, courts have drawn a distinction between the two stages of treatment, permitting parents to consent to the first stage. In addition, it has been held that a child who is determined by a court to be Gillick competent can consent to stage 2 treatment. - The new legal developments concerning treatment for gender dysphoria are of ethical, clinical and practical importance to children and their families, and to medical practitioners treating children with gender dysphoria. Medical practitioners should benefit from an understanding of the recent developments in legal principles. This will ensure that they have up-to-date information about the circumstances under which treatment may be conducted with parental consent, and those in which they must seek court authorisation.

Simpatía y conducta prosocial en niños de 6 y 7 años

Resumen: El presente estudio analiza el rol de la simpatía en la conducta prosocial infantil, determinando posibles diferencias en función del sexo y la edad. La muestra estuvo constituida por 275 niños de ambos sexos, escolarizados, de 6 y 7 años de edad de las provincias de Chaco y Corrientes, Argentina. Previo consentimiento informado de los padres, se administró la Escala de simpatía para niños de 6 y 7 años de edad, de Oros (2006), el Prosocial BehaviorScale de Caprara y Pastorelli (1993) traducido y adaptado al español por Del Barrio, Moreno y López, (2001), y el Cuestionario de Conducta Prosocial (PBQ) de Weiner y Duveen (1981).En función de los objetivos propuestos, se realizó un análisis univariado de varianza (ANOVA) y análisis multivariados de variancia (MANOVAs). Los diferentes resultados obtenidos, se discuten en función de los desarrollos teóricos y empíricos encontrados hasta el momento, hallando una consistencia general entre los mismos

Engaging in the Crooked Timbre of Humanity: Value Pluralism and Social work

The field of social work ethics is changing. While more established positions, such as utilitarianism and deontology, continue to influence social work thinking and practice, emergent approaches are taking hold, leading to a radical examination of social work as an ethical discipline. To contribute to this unfolding debate, this article examines Isaiah Berlin's notion of value pluralism and its contribution to social work. The argument proceeds by summarising and categorising some of the traditional and emergent theories shaping social work according to metaphors of the ‘head’ (the justice-oriented, rational approaches) and the ‘heart’ (the grounded, particularistic and care-focused approaches). Berlin's value pluralism is then adopted to contend that social work needs to hold both ‘head’ and ‘heart’ ethics in a vital equilibrium to generate the ethics of the ‘hand’ (i.e. the practical response to contested areas of need) and the ‘feet’ (the commitment to change and well-being). These metaphors are then mapped on to a decision-making process and applied to the fraught area of adoption without parental consent

Population density and refractive error among Chinese children.

PURPOSE: China is urbanizing rapidly, and the prevalence of myopia is high. This study was conducted to identify the reasons for observed differences in the prevalence of myopia among urban versus rural Chinese children. METHODS: All children with uncorrected acuity of 6/12 or worse and a 50% random sample of children with vision better than 6/12 at all secondary schools in mixed rural-urban Liangying Township, Guangdong, underwent cycloplegic refraction, and provided data on age, gender, parental education, weekly near work and time outdoors, and urban development level of respondents' neighborhoods (12-item questionnaire). Population density of 32 villages and urban zones in Liangying was calculated from census figures (mean population density, 217 persons/km(2); range, 94-957; mean for Guangdong, 486). RESULTS: Among 5844 eligible children, 4612 (78.9%) had parental consent and completed examinations; 2957 were refracted per protocol, and 2480 (83.9%) of these had questionnaire data. Those with completed examinations were more likely to be girls (P < 0.001), and questionnaire respondents were more myopic (P = 0.02), but otherwise did not differ significantly from nonrespondents. In multivariate models, older age (P < 0.001), more near work (P = 0.02), and higher population density (P = 0.003), but not development index, parental education, or time outdoors were significantly associated with more myopic refractive error. CONCLUSIONS: Higher population density appears to be associated with myopia risk, independent of academic activity, time spent outdoors, familial educational level, or economic development, factors that have been thought to explain higher myopia prevalence among urban children. Mechanisms for this apparent association should be sought.

Liderazgo y Clima Organizacional en un Colegio de Cundinamarca. Lineamientos Básicos para su Intervención

El propósito de este estudio fue describir y analizar el liderazgo de los directivos y el clima organizacional presentes en un Colegio de Cundinamarca y con base en ello, plantear algunos lineamientos para su intervención. Para tal fin se desarrolló un estudio descriptivo, donde el liderazgo y el clima organizacional se midieron a través de dos instrumentos: el Test de Adjetivos de Pitcher (PAT) (Pitcher, 1997) y la Escala del Clima Organizacional (ECO) (Fernándes, 2008), respectivamente. La aplicación de estos instrumentos se realizó de forma colectiva, para lo cual se trabajó con los directivos, los docentes y los estudiantes de los grados noveno, décimo y undécimo del Colegio, que constituyeron el grupo estudiado. Para el caso de los educandos, los test se aplicaron con previo consentimiento de los padres. De acuerdo con los resultados, el Colegio estudiado denota ciertas dificultades respecto al liderazgo y algunos problemas de Clima Organizacional que deben ser intervenidos de manera prioritaria. La comunidad educativa estudiada registra una inconformidad mayoritaria en la forma en que se ejerce el liderazgo, bien sea por ausencia del mismo, o por ejercerse de formas no deseadas a la luz de las teorías y de la práctica.

Estudo da perfusão pulmonar em crianças hospitalizadas com bronquite viral aguda por meio da cintilografia pulmonar perfusional quantitativa com 99mTC-MMA

Introdução: O conhecimento da distribuição da perfusão pulmonar pela cintilografia na bronquiolite viral aguda, pode auxiliar no entendimento das alterações no equilíbrio da ventilação - perfusão, peculiares a essa doença do lactente jovem. Objetivo: Avaliar o padrão de distribuição da perfusão pulmonar em pacientes hospitalizados com bronquiolite viral aguda por meio de cintilografia pulmonar perfusional quantitativa com macroagregado de albumina com tecnécio (99mTc-MAA), estabelecendo associação com as avaliações clínica e radiológica, bem como determinando o seu padrão evolutivo até a condição de normalidade. Tipo de estudo: Dois estudos prospectivos com enfoque diagnóstico: um transversal, comparativo, e um longitudinal, evolutivo, controlado. Pacientes e métodos: A amostra da pesquisa foi constituída por pacientes hospitalizados no Hospital de Clínicas de Porto Alegre com diagnóstico de bronquiolite viral aguda, no período de abril de 1998 a setembro de 2000, baseada em critérios clínicos de inclusão: idade entre 01 e 24 meses, com quadro respiratório obstrutivo de vias aéreas inferiores (primeiro episódio de sibilância expiratória de início súbito, com sinais de coriza, tosse irritativa, hipertermia, taquipnéia, tiragem, batimentos de asa de nariz, esforço expiratório), com gravidade suficiente para determinar a hospitalização e cujos pais aceitaram participar do estudo. Todos os pacientes da pesquisa foram submetidos à avaliação clínica, radiológica e da perfusão pulmonar com o radiofármaco. A cintilografia foi realizada na condição de crise (primeiras 24 horas da admissão) e na convalescência (depois de 7 dias da alta hospitalar). A quantificação do fluxo sangüíneo pulmonar, representada em valores percentuais, foi realizada em três áreas de interesse, nas projeções anterior e posterior, de ambos os pulmões. As comparações foram feitas entre ambos os pulmões e entre as condições de crise e controle, considerando as áreas de interesse e os gradientes entre elas e entre as projeções anterior e posterior das mesmas. Para análise comparativa das médias foi utilizado o teste t de Student para amostras pareadas, considerando o nível de significância de 0,05. Resultados: Iniciaram o estudo transversal 38 pacientes e permaneceram no estudo longitudinal 19 pacientes; da amostra total, 22 eram do sexo masculino. A idade variou de 1 a 8 meses (média 2,8 meses). A distribuição do fluxo sangüíneo pulmonar regional foi maior na região superior do pulmão esquerdo (PE) em relação ao pulmão direito (PD), na crise (P < 0,001), e maior na região média do PD, no controle. Os gradientes de distribuição do fluxo sangüíneo pulmonar entre as regiões superior e média e superior e inferior foi maior no PE, na crise e no controle (P < 0,05). O gradiente de distribuição do fluxo sangüíneo pulmonar entre as regiões média e inferior foi maior no PD, na crise e no controle. O gradiente de distribuição do fluxo sangüíneo pulmonar no eixo ântero-posterior na região superior foi > 1,0 em ambos os pulmões, na crise, e apenas no PE, no controle; na região média, foi > 1,0 em ambos os pulmões, na crise e no controle; na região inferior, foi > 1,0 apenas no PD, na crise e no controle (P < 0,05). A distribuição do fluxo sangüíneo pulmonar, comparada entre crise e controle, não mostrou diferença em quaisquer das regiões ou dos gradientes avaliados. Não houve associação entre o padrão de distribuição do fluxo sangüíneo pulmonar regional na crise com a avaliação clínica ou com a avaliação radiológica dos pacientes. Conclusão: não se evidenciou uma distribuição do fluxo sangüíneo pulmonar com caraterística de expressar o padrão da relação ventilação-perfusão em lactentes jovens hospitalizados com bronquiolite viral aguda. Ocorreu apenas uma tendência de redirecionamento da distribuição do fluxo sangüíneo pulmonar para as regiões superiores.

Repeat chlamydia screening among adolescents: cohort study in a school-based programme in New Orleans

OBJECTIVES To describe uptake of chlamydia screening, determine rates of repeated yearly screening and investigate determinants of repeated participation in an organised school-based screening programme. METHODS The authors analysed data from 1995 to 2005 from female and male students in up to 13 schools in New Orleans, Louisiana, USA. The authors calculated proportions of students tested among all enrolled students and among those with parental consent and the percentage of positive chlamydia tests in each school year. The authors used random effects logistic regression to examine the effect of past screening history on subsequent participation. RESULTS 35 041 students were registered for at least one school year. Overall coverage was >30% in all school years. Among all students registered for 4 years, 10.6% (95% CI 9.3% to 12.0%) of women and 12.7% (95% CI 11.2% to 14.2%) of men had a test every year. Among students with parental consent for 4 years, 49.3% (95% CI 44.6% to 54.1%) of women and 59.3% (95% CI 54.5% to 64.0%) of men had a test every year. Among students registered for 2 or more years, those with a previous positive chlamydia test were less likely to have a subsequent test (female adjusted OR 0.77, 95% CI 0.67 to 0.88 and male adjusted OR 0.84, 95% CI 0.69 to 1.02). Chlamydia positivity increased over time. CONCLUSIONS High levels of uptake can be achieved in school-based chlamydia screening programmes, but repeated yearly screening is difficult to sustain over time.

Does Immediate Access to Birth Control Help Prevent Pregnancy? A Comparison of Onsite Provision Versus Off Campus Referral for Contraception at Two School-Based Clinics

PURPOSE: The purpose of this study was to assess the impact of different policies on access to hormonal contraception and pregnancy rates at two high school-based clinics. METHODS: Two clinics in high schools (Schools A and B), located in a large urban district in the southwest US, provide primary medical care to enrolled students with parental consent; the majority of whom have no health insurance coverage. The hormonal contraceptive dispensing policy of at School clinic A involves providing barrier, hormonal and emergency contraceptive services on site. School clinic B uses a referral policy that directs students to obtain contraception at an off-campus affiliated family planning clinic. Baseline data (age, race and history of prior pregnancy) on female students seeking hormonal contraception at the two clinics between 9/2008-12/2009 were extracted from an electronic administrative database (AHLERS Integrated System). Data on birth control use and pregnancy tests for each student was then tracked electronically through 3/31/2010. The outcomes measures were accessing hormonal contraception and positive pregnancy tests at any point during or after birth control use were started through 12/2009. The appointment keeping rate for contraceptive services and the overall pregnancy rates were compared between the two schools. In addition the pregnancy rates were compared between the two schools for students with and without a prior history of pregnancy. RESULTS: School clinic A: 79 students sought hormonal contraception; mean age 17.5 years; 68% were > 18 years; 77% were Hispanic; and 20% reported prior pregnancy. The mean duration of the observation period was 13 months (4-19 months). All 79 students received hormonal contraception (65% pill and 35% long acting progestin injection) onsite. During the observation period, the overall pregnancy rate was 6% (5/79); 4.7% (3/63) among students with no prior pregnancy. School clinic B: 40 students sought hormonal contraception; mean age 17.5 years; 52% > 18 years; 88 % were Hispanic; and 7.5% reported prior pregnancy. All 40 students were referred to the affiliated clinic. The mean duration of the observation period was 11.9 months (4-19 months). 50% (20) kept their appointment. Pills were dispensed to 85% (17/20) and 15% (3/20) received long acting progestin injection. The overall pregnancy rate was 20% (8/40); 21.6% (8/37) among students with no prior pregnancy. A significantly higher frequency of students seeking hormonal contraception kept their initial appointment for birth control at the school dispensing onsite contraception compared to the school with a referral policy for contraception (p<0.05). The pregnancy rate was significantly higher for the school with a referral policy for contraception compared to the school with onsite contraceptive services (p< 0.05). The pregnancy rate was also significantly higher for students without a prior history of pregnancy in the school with a referral policy for contraception (21.6%) versus the school with onsite contraceptive services (4.7%) (p< 0.05). CONCLUSION: This preliminary study showed that School clinic B with a referral policy had a lower appointment keeping rate for contraceptive services and a higher pregnancy rate than School clinic A with on-site contraceptive services. An on-site dispensing policy for hormonal contraceptives at high school-based health clinics may be a convenient and effective approach to prevent unintended first and repeat pregnancies among adolescents who seek hormonal contraception. This study has strong implications for reproductive health policy, especially as directed toward high-risk teenage populations.

Secondary analysis of effectivness of tinidazole-containing-quadruple eradication therapy in asymptomatic H. pylori infected children in El Paso

Helicobacter pylori infection is frequently acquired during childhood. This microorganism is known to cause gastritis, and duodenal ulcer in pediatric patients, however most children remain completely asymptomatic to the infection. Currently there is no consensus in favor of treatment of H. pylori infection in asymptomatic children. The firstline of treatment for this population is triple medication therapy including two antibacterial agents and one proton pump inhibitor for a 2 week duration course. Decreased eradication rate of less than 75% has been documented with the use of this first-line therapy but novel tinidazole-containing quadruple sequential therapies seem worth investigating. None of the previous studies on such therapy has been done in the United States of America. As part of an iron deficiency anemia study in asymptomatic H. pylori infected children of El Paso, Texas, we conducted a secondary data analysis of study data collected in this trial to assess the effectiveness of this tinidazole-containing sequential quadruple therapy compared to placebo on clearing the infection. Subjects were selected from a group of asymptomatic children identified through household visits to 11,365 randomly selected dwelling units. After obtaining parental consent and child assent a total of 1,821 children 3-10 years of age were screened and 235 were positive to a novel urine immunoglobulin class G antibodies test for H. pylori infection and confirmed as infected using a 13C urea breath test, using a hydrolysis urea rate >10 μg/min as cut-off value. Out of those, 119 study subjects had a complete physical exam and baseline blood work and were randomly allocated to four groups, two of which received active H. pylori eradication medication alone or in combination with iron, while the other two received iron only or placebo only. Follow up visits to their houses were done to assess compliance and occurrence of adverse events and at 45+ days post-treatment, a second urea breath test was performed to assess their infection status. The effectiveness was primarily assessed on intent to treat basis (i.e., according to their treatment allocation), and the proportion of those who cleared their infection using a cut-off value >10 μg/min of for urea hydrolysis rate, was the primary outcome. Also we conducted analysis on a per-protocol basis and according to the cytotoxin associated gene A product of the H. pylori infection status. Also we compared the rate of adverse events across the two arms. On intent-to-treat and per-protocol analyses, 44.3% and 52.9%, respectively, of the children receiving the novel quadruple sequential eradication cleared their infection compared to 12.2% and 15.4% in the arms receiving iron or placebo only, respectively. Such differences were statistically significant (p<0.001). The study medications were well accepted and safe. In conclusion, we found in this study population, of mostly asymptomatically H. pylori infected children, living in the US along the border with Mexico, that the quadruple sequential eradication therapy cleared the infection in only half of the children receiving this treatment. Research is needed to assess the antimicrobial susceptibility of the strains of H. pylori infecting this population to formulate more effective therapies. ^

Minors’ Access to Contraceptive Services

Over the past 30 years, states have expanded minors’ authority to consent to health care, including care related to sexual activity. This trend reflects U.S. Supreme Court rulings extending the constitutional right to privacy to a minor’s decision to obtain contraceptives and concluding that rights do not “come into being magically only when one attains the state-defined age of majority.” It also reflects the recognition that while parental involvement is desirable, many minors will remain sexually active but not seek services if they have to tell their parents. As a result, confidentiality is vital to ensuring minors’ access to contraceptive services. Even when a state has no relevant policy or case law, physicians may commonly provide medical care to a mature minor without parental consent, particularly if the state allows a minor to consent to related health services.

Impact of Vegetable Preparation Method and Taste-Test on Vegetable Preference for First Grade Children in the United States

How children rate vegetables may be influenced by the preparation method. The primary objective of this study was for first grade students to be involved in a cooking demonstration and to taste and rate vegetables raw and cooked. First grade children of two classes (N= 52: 18 boys and 34 girls (approximately half Hispanic) that had assented and had signed parental consent participated in the study. The degree of liking a particular vegetable was recorded by the students using a hedonic scale of five commonly eaten vegetables tasted first raw (pre-demonstration) and then cooked (post-demonstration). A food habit questionnaire was filled out by parents to evaluate their mealtime practices and beliefs about their child’s eating habits. Paired sample t-tests revealed significant differences in preferences for vegetables in their raw and cooked states. Several mealtime characteristics were significantly associated with children’s vegetable preferences. Parents who reported being satisfied with how often the family eats evening meals together were more likely to report that their child eats adequate vegetables for their health (p=0.026). Parents who stated that they were satisfied with their child’s eating habits were more likely to report that their child was trying new foods (p<.001). Cooking demonstrations by nutrition professionals may be an important strategy that can be used by parents and teachers to promote vegetable intake. It is important that nutrition professionals provide guidance to encourage consumption of vegetables for parents so that they can model the behavior of healthy food consumption to their children.

Defining Fluid Restriction in the Management of Infants Following Cardiac Surgery and Understanding the Subsequent Impact on Nutrient Delivery and Growth Outcomes

Adequacy of nutritional intake during the postoperative period, as measured by a change in weight-for-age z-scores from surgery to the time of discharge, was evaluated in infants (n = 58) diagnosed with a congenital heart defect and admitted for surgical intervention at Miami Children’s Hospital using a prospective observational study design. Parental consent was obtained for all infants who participated in the study. Forty patients had a weight available at hospital discharge. The mean preoperative weight-for-age z-score was -1.3 ±1.43 and the mean weight-for-age z-score at hospital discharge was -1.89 ±1.35 with a mean difference of 0.58 ±0.5 (P Nutritional intake during the postoperative period was inadequate based on a decrease in weight-for-age z-scores from the time of surgery until discharged home. Our findings suggested that limited fluid volume for nutrition likely contributes to suboptimal nutritional delivery during the postoperative period; however, inadequate nutrition prescription may also be an important contributing factor. Development of a nutrition protocol for initiation and advancement of nutrition support may reduce the delay in achieving patient’s nutritional goals and may attenuate the observed decrease in z-scores during the postoperative period.

The +Contigo Project in the Voice of Eight-Grade Students

The +Contigo Project is a longitudinal research project based on a multilevel network intervention aimed at promoting mental health and well-being and preventing suicidal behaviors. Students participate in social skills training sessions on the stigma of mental disorders, adolescence, self-esteem, problem-solving skills, and wellbeing. Problem statement: To identify the qualitative impact of the +Contigo Project. Objectives: To identify the importance of the project for students, the problem situations which it helped to solve, and its impact on an individual level. Research methods: Content analysis (Bardin, 2009) with a posteriori categorical identification. Semi-structured interview guide with 5 questions. A convenience sample of 16 students, from three schools of one school cluster in the Center Region of Portugal, was used. The ethical aspects of parental consent, voluntary participation and data confidentiality were addressed. Findings: Fourteen categories emerged from the data analysis. The answers to Question 4 'How was this project important to you?' were particularly relevant. Students mentioned that it improved their self-esteem by increasing self-confidence and interpersonal skills, and that it increased their reflection and awareness on problems with which they learned how to cope during the sessions. Conclusions: All interviewees considered that the +Contigo project helped them to solve problems, improve their interpersonal skills and cope with the adolescence period. Students improved their self-esteem and self-knowledge, and were able to apply what they had learned in the sessions in their daily lives. We concluded that the project had a positive impact on the students' mental health.