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Item Open Access Advancing successful implementation of task-shifted mental health care in low-resource settings (BASIC): protocol for a stepped wedge cluster randomized trial.(BMC psychiatry, 2020-01-08) Dorsey, Shannon; Gray, Christine L; Wasonga, Augustine I; Amanya, Cyrilla; Weiner, Bryan J; Belden, C Micha; Martin, Prerna; Meza, Rosemary D; Weinhold, Andrew K; Soi, Caroline; Murray, Laura K; Lucid, Leah; Turner, Elizabeth L; Mildon, Robyn; Whetten, KathrynBACKGROUND:The mental health treatment gap-the difference between those with mental health need and those who receive treatment-is high in low- and middle-income countries. Task-shifting has been used to address the shortage of mental health professionals, with a growing body of research demonstrating the effectiveness of mental health interventions delivered through task-shifting. However, very little research has focused on how to embed, support, and sustain task-shifting in government-funded systems with potential for scale up. The goal of the Building and Sustaining Interventions for Children (BASIC) study is to examine implementation policies and practices that predict adoption, fidelity, and sustainment of a mental health intervention in the education sector via teacher delivery and the health sector via community health volunteer delivery. METHODS:BASIC is a Hybrid Type II Implementation-Effectiveness trial. The study design is a stepped wedge, cluster randomized trial involving 7 sequences of 40 schools and 40 communities surrounding the schools. Enrollment consists of 120 teachers, 120 community health volunteers, up to 80 site leaders, and up to 1280 youth and one of their primary guardians. The evidence-based mental health intervention is a locally adapted version of Trauma-focused Cognitive Behavioral Therapy, called Pamoja Tunaweza. Lay counselors are trained and supervised in Pamoja Tunaweza by local trainers who are experienced in delivering the intervention and who participated in a Train-the-Trainer model of skills transfer. After the first sequence completes implementation, in-depth interviews are conducted with initial implementing sites' counselors and leaders. Findings are used to inform delivery of implementation facilitation for subsequent sequences' sites. We use a mixed methods approach including qualitative comparative analysis to identify necessary and sufficient implementation policies and practices that predict 3 implementation outcomes of interest: adoption, fidelity, and sustainment. We also examine child mental health outcomes and cost of the intervention in both the education and health sectors. DISCUSSION:The BASIC study will provide knowledge about how implementation of task-shifted mental health care can be supported in government systems that already serve children and adolescents. Knowledge about implementation policies and practices from BASIC can advance the science of implementation in low-resource contexts. TRIAL REGISTRATION:Trial Registration: ClinicalTrials.gov Identifier: NCT03243396. Registered 9th August 2017, https://clinicaltrials.gov/ct2/show/NCT03243396.Item Open Access Assessing the Suitability of a Mobile Phone-Based Case Management System for Children in Adversity in Battambang, Cambodia(2015) Mangale, Dorothy ImbukaAbstract
There are over 250 million children in adversity (CIA) globally; however, insufficient information on prevalence of CIA and their daily needs limits case management of this group by social welfare systems. Recently, mobile technology-based (mHealth) systems have been used successfully to extend health services and information to clients in hard-to-reach, under resourced areas. This study aimed to determine the suitability of mHealth systems for improving case management of CIA in Battambang Province, Cambodia.
Methods used included focus group discussions (FGDs), in depth interview and direct observation with government and NGO social workers, their supervisors and street-based CIA (10-17 years). Data on daily workflows, roles, responsibilities and case management activities of social workers were documented. Mobile phone ownership, use and attitudes among social workers were used to assess suitability of an mHealth tool in the Cambodian context. Daily life experiences and case management needs of CIA were documented.
Our data suggests that routine case management of CIA is limited by low capacity of social workers, logistical constraints, a burdensome paper-based data collection system, scanty resources and poor supportive supervision. All social workers participating in the study owned and used mobile phones, and enthusiasm for further incorporation of these devices into daily work activities was high. Street children came from different situations of adversity, were under-served and had diverse case management needs such as referral to vocational programs, early intervention to prevent violence in the home and continuous follow-up.
An mHealth system could be developed to overcome constraints in case management of CIA by streamlining social worker workflows, facilitating timely data collection, and enabling continuous training of social workers. Such a system, implemented in conjunction with other initiatives to strengthen the social welfare system, could promote better case management for CIA in Cambodia, and globally.
Item Open Access Child Valuation in Contemporary China: Abandonment, Institutional Care, and Transnational Adoption(2020-04-17) Marlow, JessicaIn this thesis, I contend that orphaned and relinquished children’s positionality in Chinese society reveals a complex entanglement between changing domestic and international policies and popular Western perceptions of China. Initially inspired by my personal experiences evaluating the mental health of children in institutional care centers in Delhi, India, this thesis focuses on socio-political and economic factors which influence how children in institutional care are valued on the state and individual level. The orphaned child’s value within economic, moral, and political spheres is not objective or easily quantifiable; rather it is determined in relation to factors which extend far beyond the reach of the individual. Nevertheless, these value-decisions have tangible effects on children’s lived experiences. Key questions I will address in subsequent chapters are as follows: (1) To what extent do adult economic concerns and expectations influence the abandonment and/or adoption of children and their status in alternative care?; (2) What are the moral considerations of care in alternative care environments and how do these differ for domestic workers, international volunteers, and potential adoptees?; and (3) How do international perceptions of the China’s orphan care influence transnational adoption narratives and transnational adoption, and how do these perceptions intersect with the China’s political development of soft power overseas? This thesis foregrounds the complex, intercultural nature of institutional care in the contemporary period which are influenced by socio-historical and political changes in China and beyond.Item Open Access Children or Citizens: Civic Education in Liberal Political Thought(2017) Oprea, AlexandraMy contention in this dissertation is that the history of liberal political thought contains two incompatible models of children's political status, which in turn produce two incompatible answers to the question "Is liberalism compatible with civic education?" The first model, which I describe as "the apolitical child", emerges out of the social contract tradition in liberal political thought dominant during the 17th and 18th centuries. This radical departure from previous conceptions of children's place within political communities served to weaken the authority of absolutist monarchs over subjects born within their territories. In making political obligations voluntary, this tradition justified either exclusive parental authority over children's education or a program of education concerned with preserving children's capacity to voluntarily choose their political obligations upon coming of age. The second model, which I describe as "the child as citizen", develops out of a later liberal tradition concerned with preserving then existing liberal regimes against the growing threats of illiberal populism, religious fanaticism and political violence. As the political power of the working classes grew during the 19th century, the risk of public support for illiberal policies became increasingly salient to liberal political thinkers. In abandoning consent as the ground of political obligations, these liberals also abandoned the model of the apolitical child. Instead, they saw children as citizens whose attachment to liberal political institutions would be decisive in whether those liberal institutions would survive.
Item Open Access Dietary Patterns, Nutritional Status, Prevalence and Risk Factors for Anemia among School Children in Naama Community, Uganda(2015) Zhao, YiBackground: The disease burden of malnutrition, anemia, malaria and helminth infections among school-aged children is rarely studied in low- and middle-income countries (LMICs) although these children are still at a high risk for these diseases compared with other more studied populations, such as pregnant women and children under 5 years old. Even in countries where the prevalence and trend of anemia and malnutrition are relatively well documented, few studies relate this to dietary factors, which are considered major contributors to anemia and malnutrition in most age groups. Aims: The aims of the study are (1) To determine the prevalence of anemia, malaria, helminth infections and malnutrition in a sample of 95 children, ages 6 to 14, attending primary schools in Naama Community, Uganda, and to observe and quantify school children's dietary patterns and daily nutrient intakes. (2) To find out the association between dietary factors and the risk of anemia and malnutrition. Methods: Measures included school-based, cross-sectional surveys, dietary assessments, anthropometric measurements and biological tests among school children. Photo-assisted 24-hour recall was used to collect daily nutrient intakes, combined with a Food Frequency Questionnaire (FFQ) to capture the dietary patterns. Anthropometrical and biochemical data was collected using standardized protocols. Socioeconomic data was obtained from parent surveys. Results: Ninety-five children in total were enrolled in all or some components of the study. The prevalence of anemia was low (3.2%), and all were mildly anemic. However, the prevalence of malaria and hookworm infections was relatively high, representing 12.9% and 24.4% of the studied population, respectively. In the studied children, 2.8% were underweight, 15.6% stunted and 1.3% thin, using criteria based on the WHO Growth reference. According to the WHO recommendations for nutrient intake, 80% of participants consumed inadequate energy from their daily diet, especially boys. Dietary fat intake was insufficient in 78% of the children. About 25% of the children had a low protein intake and 93% had low intakes of vitamin A. Calcium intake was low in school children's diet- 97.6% of children lacked of calcium. Inadequate vitamin C intake was less common, appearing in one out of three participants (29.1%). Matooke and posho, the most common local staple food, were the major sources for children's energy. Avocado, beans and matooke contributed to the highest fat, protein and vitamin A intake, respectively. Every participant reported consuming cereal/cereal products, roots/tubers/plantain, pulses/nuts, oil/oil-rich foods and fruits during the previous month, while almost one-fifth never consumed milk/dairy products. Vegetables were consumed by most of the respondents. Few (1.6%) of the respondents reported no animal source food in their diet. In general, children ate 3.81(SD: 0.99) out of all five meals in the area. Dinner was consumed by most of the participants (93.7%) while afternoon tea was the least consumed meal and was skipped by half of the childrenNo significant association between dietary factors and anemia were found, mainly due to the small sample size and low prevalence of disease. None of the dietary factors of primary interest were found to be associated with children's Hb concentration, but secondary analysis found the frequency of eating oranges was a protective factor for higher Hb concentration (P=0.015). The association between diet and stunting was not significant, except children who had low dietary fat intakes had a lower risk of being stunted compared with those had adequate fat consumption (OR=0.27, P=0.046). Conclusions: Malaria and helminth infections, but not anemia, in this cohort of school children is relatively high. Stunting was the most prevalent type of malnutrition. Most of the nutrients studied were not adequate in children's diets. The dietary pattern in this sample of children was primarily high in carbohydrates from staple foods and a minimal intake of fat and protein from animal sources. Children generally ate four meals per day. Dietary factors do not explain anemia and stunting in this population.
Item Open Access Economics of the Family: Marriage, Children and Human Capital(1976) KELLEY, ACNo Abstract availableItem Open Access Ensuring Healthy Children: The Effect of Health Insurance on Primary Health Care for Children(2010-12-10) Sanderson, AnthonyBackground Past studies have typically focused on the effect of health insurance on primary health care for children, but few have assessed the effect the type of health insurance coverage has on primary care. This research studied the effect of health insurance status—uninsured, private insurance, public coverage, or other insurance—on the accessibility, continuity, and comprehensiveness of primary health care for children. Methods This research analyzed a sample of 39,225 children under 18 years of age from the 2006-2009 National Health Interview Survey, a nationally representative sample of households in the United States. The response rate for children was 75.2 percent. Logistic regression models were used to analyze the effect of health insurance on health status and three aspects of primary care: accessibility (physician visit; usual source of care; time since health professional visit), continuity, (usual source and site of care), and comprehensiveness (physical). Excellent or very good health status was the final dependent variable. Results Compared to children with private health insurance, uninsured children and Medicaid or State Children’s Health Insurance Program (SCHIP) beneficiaries are 27% (p<0.001) and 89.4% (p<0.01) as likely, respectively, to have visited a physician within the last twelve months (LTM). Approximately 73% of uninsured children reported having a usual source of care, compared to 96% of children with private insurance and 98% of Medicaid/SCHIP beneficiaries. Children with private health insurance are at least twice as likely to report “excellent or very good” health as children with any other health insurance status (p<0.001). After controlling for the confounding effects of age, citizenship, mother’s education, father’s education, health status, poverty status, race/ethnicity, and region, Medicaid/SCHIP coverage is associated with similar, if not better, accessibility, continuity, and comprehensiveness of primary care compared to children with private insurance. Conclusions Although by many indicators Medicaid and SCHIP enrollees have worse primary care than children with private health insurance, Medicaid and SCHIP beneficiaries are more likely to have risk factors that are associated with poorer primary care and poorer child health status. Nevertheless, clear relationships cannot be established to conclude how government health insurance programs perform relative to private insurance. Health insurance status is an important predictor, but not the only predictor, of the accessibility, continuity, and comprehensiveness of primary care. Other important risk factors include adolescence, non-U.S. citizenship, low levels of mother’s education, poverty, and residence in the West or South.Item Open Access Evaluating morphometric body mass prediction equations with a juvenile human test sample: accuracy and applicability to small-bodied hominins.(Journal of human evolution, 2018-02) Walker, Christopher S; Yapuncich, Gabriel S; Sridhar, Shilpa; Cameron, Noël; Churchill, Steven EBody mass is an ecologically and biomechanically important variable in the study of hominin biology. Regression equations derived from recent human samples allow for the reasonable prediction of body mass of later, more human-like, and generally larger hominins from hip joint dimensions, but potential differences in hip biomechanics across hominin taxa render their use questionable with some earlier taxa (i.e., Australopithecus spp.). Morphometric prediction equations using stature and bi-iliac breadth avoid this problem, but their applicability to early hominins, some of which differ in both size and proportions from modern adult humans, has not been demonstrated. Here we use mean stature, bi-iliac breadth, and body mass from a global sample of human juveniles ranging in age from 6 to 12 years (n = 530 age- and sex-specific group annual means from 33 countries/regions) to evaluate the accuracy of several published morphometric prediction equations when applied to small humans. Though the body proportions of modern human juveniles likely differ from those of small-bodied early hominins, human juveniles (like fossil hominins) often differ in size and proportions from adult human reference samples and, accordingly, serve as a useful model for assessing the robustness of morphometric prediction equations. Morphometric equations based on adults systematically underpredict body mass in the youngest age groups and moderately overpredict body mass in the older groups, which fall in the body size range of adult Australopithecus (∼26-46 kg). Differences in body proportions, notably the ratio of lower limb length to stature, influence predictive accuracy. Ontogenetic changes in these body proportions likely influence the shift in prediction error (from under- to overprediction). However, because morphometric equations are reasonably accurate when applied to this juvenile test sample, we argue these equations may be used to predict body mass in small-bodied hominins, despite the potential for some error induced by differing body proportions and/or extrapolation beyond the original reference sample range.Item Open Access Family and Provider Perceptions of Barriers to NGO-Based Pediatric Surgical Care in Guatemala(2014) Silverberg, Benjamin AndrewBackground: Globally, there is often a gap between medical need and access to care, and this is particularly true for surgical care for children. In Guatemala, for instance, families frequently pursue care outside of the government health system. Using a structured anthropologic approach, we sought to explore the barriers to surgical care for children in Guatemala, suspecting both financial and cultural barriers were the primary obstacles families had to face.
Study design: Twenty-nine parents/guardians of children receiving surgical care at two non-governmental organizations (NGOs) in Guatemala and 7 health care providers participated in semi-structured interviews to explore what they believed to be the impediments to care. Transcripts were analyzed using a grounded theory approach. Current models for barriers to care were critiqued and a novel Framework for Barriers to Pediatric Surgery in Guatemala (FBPSG) was developed, which highlights both the existence, and centrality, of fear and mistrust in families' experience.
Results: Families and providers identified financial costs, geography, and systems limitations as the primary barriers to care. Mistrust and fear were also voiced. In addition, health literacy and cultural issues were also thought to be relevant by providers.
Conclusions: Due to biases inherent in this sample, parents/guardians did not necessarily report the same perceived barriers as healthcare providers - e.g., education/health literacy and language - and may have represented a "best case" scenario compared to more disadvantaged populations in this specific Central American context. Nonetheless, financial concerns were some of the most salient barriers for families seeking pediatric surgical care in Guatemala, with systems limitations (waiting time) and geographic factors (distance/transit) also being highlighted. Fear and mistrust were found to be deeper barriers to care and warrant reevaluation of organizational heuristics to date. NGOs can address these worries by working with individuals and organizations already known by and trusted in target communities and by providing good quality medical treatment and interpersonal care.
Item Open Access Fixing the Form: Improving Individualized Education Programs in North Carolina(2013-04-17) Ireland, ElizabethExecutive Summary Policy Problem: Special education services for children in North Carolina schools are highly dependent upon the development of individualized education programs, or IEPs. In fact, without an IEP in place, a North Carolina student will not receive special education services. As the statewide agency tasked with providing special education, the Department of Public Instruction (DPI) publishes a model form for school districts (also known as local education agencies or LEAs) to use when they develop IEPs. This project considers how the form used to prepare IEPs, known as the DEC 4, can be changed to improve the substantive special education services that will be provided for North Carolina children. This project is premised on the notion that improved parental understanding of the form will help parents, as advocates for their children, ensure that children receive better services. Policy Question: How can the DEC 4, the form used to develop individualized education programs in North Carolina, be revised to better help parents understand the DEC 4? Policy Recommendations: There are two sets of recommendations in this project. First, I include recommendations for how to change the DEC 4, which are presented in order of feasibility. A more complete analysis of these recommendations can be found on pages 16 – 27 of this report. (1) Add instructions to the DEC 4. (2) Add numbers or letters before all items on the DEC 4. (3) Add legal citations to the DEC 4. (4) Add a text box and change the wording of the item on page 7. (5) Change the wording of all items on the DEC 4 so they are worded as questions, not statements. Next, I propose four strategies for changing the DEC 4. For maximum impact, these strategies should be implemented in the order in which they are presented in this report. A more complete analysis of these recommendations can be found on pages 25 - 30. (1) ACS must identify the best lead actor for this project, ideally a parent or group of parents. (2) The lead actor should reach out to three specific children’s rights organizations and DPI to garner support for the project. (3) Consider using one LEA as a pilot” for DEC 4 revisions. (4) When this project concludes, work next on the DEC 5. Summary of Methodology and Criteria for Analysis: To determine how the DEC 4 could be improved, I conducted three types of research: (1) legal research (2) research on survey design (3) qualitative interviews and surveys The legal research consisted of an analysis of state and federal statutes and regulations about special education. The survey design research focused on best practices in structuring or writing questions so that they are easily understandable. The qualitative interviews included phone or in-person interviews with five parents, two teachers, and one director of special education, as well as attorneys who represent parents and children in special education matters in North Carolina. Although this sample was small and selected by professional contacts, the conversations were consistent with findings from research on survey design and survey comprehensibility. I also sent an electronic survey to a variety of organizations and individuals in North Carolina that represent four critical groups: teachers, parents, school administrators, and school psychologists. 238 people completed the survey. The survey did not track respondents’ geographic region of North Carolina or income level; however, the respondents represented a range of North Carolinians who interact with children. To develop the recommendations for changes to the DEC 4, I considered four criteria: (1) whether the recommendation would be supported or approved by multiple groups of stakeholders (2) how responsive the recommendation was to parental concerns (3) the legality of the recommendation (4) how much the recommendation would cost DPI, the organization that creates the state model IEP form Explanation of Results: To make the DEC 4 more understandable, ACS should encourage DPI to modify the DEC 4 to make it more user-friendly. Parents, teachers, school personnel, and parent advocates all comment that the DEC 4 is confusing and lacks clarity, even for school administrators that use the form regularly. The five recommendations concerning the DEC 4 will all help ensure that the form is more easily understandable for parents, as the advocate for children in IEP meetings and the focal group for ACS. However, these recommendations are also supported by other groups of stakeholders, such as teachers and school personnel, which will help ACS make a stronger case than if the changes were supported by parents alone. Presumably, making the form more understandable will then improve the substance of services for North Carolina children. Since ACS is not DPI and does not control the DEC 4, this report also includes strategies to help ACS encourage DPI to change the form. These strategies are built on the assumption that a collaborative effort among a diverse group of organizations will encourage DPI to make these changes faster than if ACS acts alone.Item Open Access Food Advertising on Television Targeting Children in Honduras(2012) Gunderson, Matthew DonaldAbstract
Background: Rates of childhood overweight and obesity have increased dramatically across Latin America in recent years. In Honduras, the problem is more common among children of upper and middle socio-economic status (SES). Evidence suggests that television advertising of high-energy-density (HED) foods may be associated with increased rates of childhood overweight and obesity.
Objective: The purpose of this study was to characterize the advertising of foods during television programming that targets school-age children in Honduras.
Methods: Content analysis was performed on four different television stations accessible to children in Honduras, including one broadcast station and three cable networks. Programming for each station was observed and recorded for one complete week, during after-school hours (defined as 1:30 pm to 5:30 pm, Monday through Friday). Eighty hours of programming were recorded and analyzed. Foods were categorized as being high in energy density or not (HED or non-HED).
Results: A total of 2271 advertisements aired during the observation period; roughly half of these (49.3 percent) were product advertisements. Of the 1120 product advertisements, 397 marketed food-related products. Of these, 69.8 percent promoted HED foods. Children were targeted in the vast majority of advertisements for HED foods (92.1 percent). All of these foods were advertised on cable networks; none of the advertisements for HED foods were aired on broadcast television.
Conclusion: Cable television during after-school hours in Honduras included a high percentage of advertisements for HED foods. This may promote consumption of these foods by children, putting them at greater risk for overweight and obesity.
Item Open Access FUNCTIONAL STATUS OF CHILDREN WITH A CONGENITAL UPPER LIMB REDUCTION DEFICIENCY(2005) Buffart, Laurien M.; Pesch-Batenburg, Josemiek M.F.B.; van Heijningen, Vera G.; Roebroeck, Marij E.; Stam, Henk J.Congenital reduction deficiencies of the upper limb are rare. Nearly 50% of children with unilateral transverse upper limb reduction deficiencies (ULRD) wear a prosthetic device to enhance the ability to perform functional activities. Unfortunately, empirical evidence as to whether prostheses yield improved functional outcomes in these children is lacking. Assessment of arm and prosthetic functioning mostly relies on clinical observation of task performance. The purpose of this study was to assess the functional status of children with ULRD as measured by these standardized instruments. To adequately measure arm and prosthetic functioning in children with ULRD, standardized measures at activity level are required. The difference between what a child “can do” in a clinical setting and “does do” in daily life is well known, also recognized as capacity and performance of activities [1]. Therefore both aspects should be measured. Capacity can be measured with functional tests and to measure performance of activities, assessment of spontaneous arm use or self-reported or parent-reported questionnaires are options.Item Open Access Guaranteed Income in Durham, NC: Political Feasibility Prospective(2023-04-28) Stamper, ZachChild economic insecurity continues to be a prevalent issue in the United States, and in Durham, NC. Grown in Durham (GiD), the childcare initiative spawned from Durham County’s Early Childhood Action Plan, seeks to address this issue. GiD used a community-based approach to determine its priorities by including local parents and childcare experts in the planning process. One of the top priorities identified was a guaranteed income pilot program to provide supplemental cash assistance to Durham families facing economic insecurity. This policy solution was chosen because of the versatility of cash benefits and positive outcomes from other guaranteed income pilots across the country, including one already conducted in Durham. Given these pilot program successes, GiD anticipates their own guaranteed income pilot would have similarly positive outcomes. Thinking ahead of pilot success, this descriptive study seeks to understand the future of guaranteed income efforts in Durham. GiD asks “what is the political feasibility of a city or county-wide guaranteed income program serving families with children facing economic insecurity in Durham, NC?” Literature review of large-scale guaranteed income efforts, interviews with local elected officials and subject matter experts, and stakeholder analysis of local municipal government systems provide insights for this policy question. The multiple streams framework is employed to determine political feasibility as a function of cohesion in understanding of the problem of child economic insecurity and the policy of guaranteed income as a solution in the context of Durham politics. Review of relevant literature illuminated guaranteed income pilot program success in generating positive outcomes for participants facing economic insecurity and analyzed examples of similar policies that have been implemented at the state and national level. Regardless of overwhelmingly positive outcomes, individual support for guaranteed income and other social service provisions is ultimately dependent on one’s values, particularly the role of work in determining deservingness of support, and acknowledgment of systemic factors. These values do not exclusively fall along partisan lines, affording a more nuanced analysis of guaranteed income support. Policies closely resembling guaranteed income employed by Alaska, a traditionally conservative state, and at the national level demonstrate this nuance. Local elected officials and guaranteed income subject matter experts were interviewed to gauge the political feasibility of a scaled guaranteed income program in Durham. Elected officials included city council members and county commissioners, and subject matter experts included administrators of guaranteed income pilot (and related) policies in Durham. An interview guide was developed to gather data in the multiple streams framework and facilitate further conversation about anything that may dictate guaranteed income’s political feasibility in Durham. Interviews revealed the perception of a high amount of guaranteed income support from both Durham’s elected officials and general public. Interviews indicated a general consensus around the understanding of the problem of child economic insecurity, guaranteed income as a policy solution, and elected official and public support of such a policy. This stream alignment is encouraging for political feasibility. Funding was identified as the main logistical roadblock in implementing a city or county-wide guaranteed income for families with children experiencing economic insecurity. Municipal funding restrictions would need to be addressed to utilize this funding source at this crucial stage between pilot success and scaling beyond the municipal level by utilizing state or federal funding. A local stakeholder analysis provides political system context through which a municipally funded guaranteed income policy would have to pass. Interview respondents also corroborated the significance of personal values in dictating guaranteed income support. Interview and literature review insights prompted the following recommendations for GiD to implement to sustain guaranteed income’s political feasibility into the future: • Advocating for the resolution of municipal funding restrictions. • Developing clear and inclusive communication about what guaranteed income is, how it addresses economic insecurity, who it benefits, and destigmatizing welfare recipients. • Intentionally maintaining momentum around guaranteed income as a policy solution (e.g., strengthening a local advocate network, periodic communications, and informational programming). The future of guaranteed income in Durham is bright, and GiD can hold the light to lead the way.Item Open Access Investigating Flame Retardant Applications in Furniture and Impacts on Children's Exposure to Firemaster® 550(2023-04-28) Tang, XueningFlame retardants are chemicals that have been commonly added to furniture, electronics, and construction materials in order to prevent or reduce the spread of fire. 2-ethylhexyl-2,3,4,5-tetrabromobenzoate(EH-TBB) is a component in a flame retardant mixture known as Firemaster® 550, which is a replacement for PentaBDE that was phased out in 2004 due to health concerns. This study investigated whether FM550 treatment in furniture contributed to higher levels of exposure in children residing in NC. Results demonstrated that the presence of Firemaster® 550 in furniture was associated with significantly higher levels of EH-TBB in house dust, in personal measures of exposure (e.g. hand wipes) and higher urinary levels of tetrabromobenzoic acid, the metabolite of EH-TBB (p<0.05). These findings demonstrate that children experience exposure to EH-TBB from the application of Firemaster® 550 in residential furniture.Item Open Access No te dejes quitar a tu hijo: Operation Pedro Pan and The Cuban Children's Program(2008-04) Abreu, JeanFor most Cubans, Fidel Castro’s revolution was an enormous relief. Castro promised to bring democracy to a country that was only six decades old, to halt social corruption and to end economic dependence on the U.S. In particular, the middle class played a large role in participating in the underground and legitimizing the revolution. Cuban parents would never have guessed that less than two years later, they would be caught up in the turmoil of the Cold War, so desperate to get their families out of the country that they would send their young, unaccompanied children to the U.S., not knowing where they would stay, who would take care of them, or how long the separation would last. But as Cuba quickly became a battleground in the struggle between the U.S. and the Soviet Union, and the Central Intelligence Agency worked overtime to fuel hysteria and backlash against Castro, thousands of parents committed the unthinkable. In fear of their children becoming nationalized and indoctrinated in new president Fidel Castro’s militaristic education model, over 14,000 families sent their children to Miami between 1960 and 1962. This was later dubbed by a reporter in the U.S., “Operation Pedro Pan.” Though the U.S. government feigned support for Castro’s democratic promises through 1960, by September 1959 the CIA had already begun working on a covert mission to oust the new leader. December 1960 marked the first international airlift of children in the Western Hemisphere, when the combined powers of the Catholic Church, the U.S. government, the CIA, and several multinational corporations with interest in Cuba altered the lives of thousands of Cuban families that were caught in the middle of the political vortex. In this thesis the personal history of these 14,000 children is examined in light of the international political and religious tumult which continues to alter U.S.-Cuban relations today.Item Open Access PHTHALATE EXPOSURE AND CONSUMER PRODUCT USE AMONG CHILDREN IN A NORTH CAROLINA COHORT(2017-04-28) Killius, AllisonPhthalates, chemicals found in plastics and personal care products, are a ubiquitous class of chemical compounds that have been associated with adverse health effects. Mothers and their toddlers were recruited from a pregnancy cohort and completed a questionnaire that included demographic information and reports of children’s product use habits. Pooled urine samples (3 over 48 hours) were collected from 180 toddlers and analyzed for five major phthalate metabolites: mEHP, mEP2, mBP, miBP, and mBzP2. Statistical analysis compared the urinary metabolite concentrations with the children’s demographic information and average product use. Maternal education was inversely associated with urinary concentrations of all metabolites. After controlling for confounding by demographic variables, plastic bag, lotion, and nail polish use were significant predictors of urinary mEP2 levels. This study suggests plastic and personal care product use in toddlers influences phthalate exposure.Item Open Access Predictors of Poor Outcomes Among Infants with Respiratory Syncytial Virus-associated Acute Lower Respiratory Infection in Botswana(2020) Patel, Sweta MBackground: Acute lower respiratory infection (ALRI) is the leading infectious cause of death among children worldwide, and respiratory syncytial virus is the most common cause of ALRI. The majority of deaths occur in low- and middle-income countries, but there is a dearth of data on risk factors for poor outcomes in these settings. We endeavored to identify clinical and microbiome-related factors associated with poor outcomes among children hospitalized with RSV-ALRI in Gaborone, Botswana. Methods: Children 1-23 months of age presenting for care at Princess Marina Hospital who met the World Health Organization (WHO) definition of clinical pneumonia were enrolled in this prospective study and followed until hospital discharge or death. Nasopharyngeal swabs were collected for respiratory viral testing and microbiome analysis. Results: Young age (<6 months), household use of wood as a cooking fuel, moderate or severe malnutrition, and oxygen saturation <90% on room air were independent predictors of clinical nonresponse at 48 hours. Among HIV-uninfected infants 6 months of age or younger, HIV exposure was associated with a higher risk of in-hospital mortality. Nasopharyngeal microbiome composition and diversity were not associated with clinical nonresponse. Conclusions: We identified several risk factors for poor outcomes from RSV-ALRI among children in Botswana. These data could inform future use of RSV vaccines and therapeutics in these populations.
Item Open Access Public Childhoods: Street Labor, Family, and the Politics of Progress in Peru(2012) Campoamor, Leigh MThis dissertation focuses on the experiences of children who work the streets of Lima primarily as jugglers, musicians, and candy vendors. I explore how children's everyday lives are marked not only by the hardships typically associated with poverty, but also by their need to respond to the dominant notions of childhood, family roles, and urban order that make them into symbols of underdevelopment. In particular, I argue that transnational discourses about the perniciousness of child labor, articulated through development agencies, NGOs, the Peruvian state, the media, and everyday interpersonal exchanges, perpetuate an idea of childhood that not only fails to correspond to the realities of the children that I came to know, but that reinscribes a view of them and their families as impediments to progress and thus available for diverse forms of moral intervention. I ground my analysis in a notion that I call "public childhoods." This concept draws attention to the ways that subjectivities form through intersecting mechanisms of power, in this sense capturing nuances that common terms such as "street children" and "child laborer" gloss over. Children, I show, are a symbolic site for the articulation of the kinds of classed, raced and gendered differences that characterize Lima's contemporary urban imaginary. As they bear the embodied effects of such discourses, I argue, children who work the streets also participate - if in subtle ways - in these everyday ideological struggles into which they are drawn.
My dissertation is based on twenty-two months of fieldwork in Peru, in addition to several one- and two-month periods of preliminary and follow-up research. As an ethnographer, my research consisted primarily of accompanying children as they went about their daily routines. Beyond "hanging out" in their workspaces, which included a busy traffic intersection in an upper-middle class district and public buses, I also spent a great deal of time with the children's families, typically in their homes in Lima's shantytowns and working-class neighborhoods. I also attended meetings and otherwise participated in institutional spaces such as NGOs, social movements, Congressional hearings, and advocacy groups. Finally, in order to gain a more long-term perspective on discussions and policies involving childhood, I conducted research in Lima's historical archives.
Item Open Access Reaching the First 90: Examining Accuracy and Acceptability of an Oral Fluid HIV Test in Children in Harare, Zimbabwe(2018) Rainer, Crissi BondBackground: In 2016, 36.7 million people globally were living with HIV and approximately 70% knew their status. Novel HIV testing methods and strategies are needed to reach the first “90-90-90” target by 2020; that is 90% of people living with HIV know their status. Children and adolescents face additional barriers to HIV testing that stem from gaps in provider-initiated testing and counselling (PITC), parents’ concerns related to stigma and discrimination, and beliefs that children living with HIV cannot survive to adolescence. PITC barriers and the stigma and discrimination parents’ may face when seeking HIV testing and counselling (HTC) for their children could be reduced through a novel HIV testing strategy, which includes oral fluid tests (OFTs) and parents performing oral fluid HIV self-tests (O-HIVST) on their children. Therefore, the study aims of this thesis were: 1) to determine the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of an OFT for HIV in children aged 2-18 using the standard point of care rapid diagnostic test (RDT) as a reference, 2) to explore parents’/guardians’ and older adolescent’s knowledge of, and attitudes about, OFTs and O-HIVST, 3) to explore parents’/guardians’ and older adolescent’s preferences when undergoing O-HIVST. No studies to our knowledge have examined the diagnostic accuracy of OFTs in children or the facilitators of O-HIVST performed by a parent or guardian on their children.
Methods: We conducted the study in two large urban hospitals in Harare, Zimbabwe. The sample included children and adolescents aged 2-18 whose HIV status was unknown. We performed an OFT, followed by a finger-prick RDT to validate the OFT results. In addition, we conducted in-depth interviews (IDIs) with parents/guardians of children aged 2-15 and older adolescents aged 16-18. Quantitative analysis included tabulating descriptive statistics and calculating sensitivity, specificity, PPV, and NPV of the OraQuick ADVANCE® Rapid HIV-1/2 Antibody Test. Thematic qualitative analysis was conducted on the IDIs.
Results: Preliminary sensitivity results of the OFT showed high sensitivity at 100% (95% CI 83.89, 100.00) and high specificity at 99.77% (95% CI 99.17, 99.97) compared to the finger-prick RDT. In addition, PPV was 91.30% (95% CI 71.96, 98.93), and NPV was 100% (95% CI 99.57, 100.00). Qualitative findings showed low knowledge of OFTs and O-HIVST among parents and adolescents. However, participants reported favorable attitudes towards performing O-HIVST on themselves and their children and also reported a preference for a wide range of uptake mechanisms when asked about O-HIVST. Participants expressed concern about O-HIVST but felt that counselling could reduce unfavorable reactions to positive O-HIVST results.
Conclusions: The preliminary analysis confirmed the OFT has high sensitivity, but a larger sample size is needed to obtain a more accurate estimate of OFT sensitivity. If future findings confirm our preliminary results, we recommend OFTs as a method to increase HIV testing and uptake among children. Participants’ low knowledge of OFTs and O-HIVST indicate sensitization is needed before scale up of this new method. We also recommend O-HIVST implementation include a variety of strategies to increase O-HIVST uptake among children and adolescents who may face barriers to traditional HTC.
Item Open Access Responsiveness of the PROMIS® measures to changes in disease status among pediatric nephrotic syndrome patients: a Midwest pediatric nephrology consortium study.(Health Qual Life Outcomes, 2017-08-23) Selewski, David T; Troost, Jonathan P; Cummings, Danyelle; Massengill, Susan F; Gbadegesin, Rasheed A; Greenbaum, Larry A; Shatat, Ibrahim F; Cai, Yi; Kapur, Gaurav; Hebert, Diane; Somers, Michael J; Trachtman, Howard; Pais, Priya; Seifert, Michael E; Goebel, Jens; Sethna, Christine B; Mahan, John D; Gross, Heather E; Herreshoff, Emily; Liu, Yang; Carlozzi, Noelle E; Reeve, Bryce B; DeWalt, Darren A; Gipson, Debbie SBACKGROUND: Nephrotic syndrome represents a condition in pediatric nephrology typified by a relapsing and remitting course, proteinuria and the presence of edema. The PROMIS measures have previously been studied and validated in cross-sectional studies of children with nephrotic syndrome. This study was designed to longitudinally validate the PROMIS measures in pediatric nephrotic syndrome. METHODS: One hundred twenty seven children with nephrotic syndrome between the ages of 8 and 17 years participated in this prospective cohort study. Patients completed a baseline assessment while their nephrotic syndrome was active, a follow-up assessment at the time of their first complete proteinuria remission or study month 3 if no remission occurred, and a final assessment at study month 12. Participants completed six PROMIS measures (Mobility, Fatigue, Pain Interference, Depressive Symptoms, Anxiety, and Peer Relationships), the PedsQL version 4.0, and two global assessment of change items. RESULTS: Disease status was classified at each assessment: nephrotic syndrome active in 100% at baseline, 33% at month 3, and 46% at month 12. The PROMIS domains of Mobility, Fatigue, Pain Interference, Depressive Symptoms, and Anxiety each showed a significant overall improvement over time (p < 0.001). When the PROMIS measures were compared to the patients' global assessment of change, the domains of Mobility, Fatigue, Pain Interference, and Anxiety consistently changed in an expected fashion. With the exception of Pain Interference, change in PROMIS domain scores did not correlate with changes in disease activity. PROMIS domain scores were moderately correlated with analogous PedsQL domain scores. CONCLUSION: This study demonstrates that the PROMIS Mobility, Fatigue, Pain Interference, and Anxiety domains are sensitive to self-reported changes in disease and overall health status over time in children with nephrotic syndrome. The lack of significant anchoring to clinically defined nephrotic syndrome disease active and remission status may highlight an opportunity to improve the measurement of HRQOL in children with nephrotic syndrome through the development of a nephrotic syndrome disease-specific HRQOL measure.