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Item Acceptance of Behavior Guidance Techniques Used in Pediatric Dentistry by Parents From Diverse Backgrounds(Sage, 2019-08) Martinez Mier, E. Angeles; Walsh, Christopher R.; Farah, Christopher C.; Vinson, LaQuia A.; Soto-Rojas, Armando E.; Jones, James E.; Cariology, Operative Dentistry and Dental Public Health, School of DentistryObjective. To investigate if parental background affects acceptance of behavior guidance techniques. Background. Behavior guidance techniques are used for the safe and effective treatment of pediatric patients. Acceptance of these techniques may vary by racial and ethnic background. Methods. A total of 142 parents were recruited and asked to rate videos showing: active restraint/protective stabilization (AR), general anesthesia (GA), nitrous oxide sedation (N2O), oral premedication/sedation (OP), passive restraint/protective stabilization (PR), tell-show-do (TSD), and voice control (VC) techniques. Results. Hispanic parents rated VC most acceptable, followed by TSD, PR, and pharmacologic techniques. Black and white parents rated TSD, followed by N2O, as most acceptable, and AR and PR as least favorable. Hispanics found GA significantly less acceptable than whites or blacks. Hispanics were less accepting of AR than blacks; but more accepting of PR than whites. TSD was highly rated among all 3 cohorts. Parental background affected acceptance of the techniques in this study.Item Advocacy as an Environmental Modification: Occupational Therapy’s Role in Stigma Reduction to Increase Occupational Performance in Children with Learning Disabilities(2022-05) Klukken, Angela; Petrenchik, Terry; Department of Occupational Therapy, School of Health and Human Sciences; Petrenchik, TerryOccupational therapists have a pivotal role in advocating for their clientele across various settings. The present study adds direction and suggestion for enhancing occupational therapy’s role in client advocacy, through the use of therapeutic skills utilized in teacher training to reduce the harmful effects of disability-based stigma for children with learning disabilities in a public elementary school setting. The author suggests that stigma reduction may serve as a powerful environmental modification; as disability accommodations and self-advocacy alone do not always permit equitable occupational participation. Teacher training in the area of pediatric learning disabilities with an emphasis on bias reduction, information, empathy, self-reflection and interpretation of anonymous student school experiences was implemented in a public elementary school by an occupational therapy doctoral capstone student. Medium effect sizes were found among some aspects of psychological flexibility with regard to stigmatizing thoughts among teachers. Significant results were found among students answering questions in class, and teachers’ awareness and ability to identify learning disabilities in their students. Results suggest that teachers were overall satisfied with training and have implemented changes in support of learning disability accessibility in their classrooms following intervention.Item Analysis of INSPPIRE-2 Cohort: Risk Factors and Disease Burden in Children with Acute Recurrent or Chronic Pancreatitis(Wiley, 2022-11) Uc, Aliye; Cress, Gretchen A.; Wang, Fuchenchu; Abu-El-Haija, Maisam; Ellery, Kate M.; Fishman, Douglas S.; Gariepy, Cheryl E.; Gonska, Tanja; Lin, Tom K.; Liu, Quin Y.; Mehta, Megha; Maqbool, Asim; McFerron, Brian A.; Morinville, Veronique D.; Ooi, Chee Y.; Perito, Emily R.; Schwarzenberg, Sarah Jane; Sellers, Zachary M.; Serrano, Jose; Shah, Uzma; Troendle, David M.; Wilschanski, Michael; Zheng, Yuhua; Yuan, Ying; Lowe, Mark E.; Consortium for the Study of Chronic Pancreatitis, Diabetes and Pancreatic Cancer; Pediatrics, School of MedicineObjectives: To investigate risk factors and disease burden in pediatric acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP). Methods: Data were obtained from INternational Study group of Pediatric Pancreatitis: In search for a cuRE-2 (INSPPIRE-2), the largest multi-center prospective cohort study in pediatric patients with ARP or CP. Results: Of 689 children, 365 had ARP (53%), 324 CP (47%). CP was more commonly associated with female sex, younger age at first acute pancreatitis (AP) attack, Asian race, family history of CP, lower BMI%, genetic and obstructive factors, PRSS1 mutations and pancreas divisum. CFTR mutations, toxic-metabolic factors, medication use, hypertriglyceridemia, Crohn disease were more common in children with ARP. Constant or frequent abdominal pain, emergency room (ER) visits, hospitalizations, medical, endoscopic or surgical therapies were significantly more common in CP, episodic pain in ARP. 33.1% of children with CP had exocrine pancreatic insufficiency (EPI), 8.7% had diabetes mellitus. Compared to boys, girls were more likely to report pain impacting socialization and school, medical therapies, cholecystectomy, but no increased opioid use. There was no difference in race, ethnicity, age at first AP episode, age at CP diagnosis, duration of disease, risk factors, prevalence EPI or diabetes between boys and girls. Multivariate analysis revealed that family history of CP, constant pain, obstructive risk factors were predictors of CP. Conclusions: Children with family history of CP, constant pain or obstructive risk factors should raise suspicion for CP.Item The Association of Cerebral Palsy with Other Disability in Children with Perinatal Arterial Ischemic Stroke(2007-10) Golomb, Meredith R.; Saha, Chandan; Garg, Bhuwan P; Azzouz, Faouzi; Williams, Linda S.The association of cerebral palsy with other disabilities in children with perinatal stroke has not been well-studied. We examined this association in 111 children with perinatal stroke: 67 with neonatal presentation, and 44 with delayed presentation. Seventy-six children (68%) had cerebral palsy, which was hemiplegic in 66 and tri- or quadriplegic in 10. Fifty-five (72%) children with cerebral palsy had at least one other disability: 45 (59%) had a cognitive/speech impairment (moderate-severe in 20), and 36 (47%) had epilepsy (moderate-severe in 11). In children with neonatal presentation, cerebral palsy was associated with epilepsy (P = 0.0076) and cognitive impairment (P = 0.0001). These associations could not be tested in children with delayed presentation because almost all children in this group had cerebral palsy. In another analysis with multivariate logistic regression for children with cerebral palsy, children who had both neonatal presentation and history of cesarean-section delivery were more likely to have epilepsy (P = 0.001). Children with cerebral palsy after perinatal stroke who had neonatal presentation were more likely to have severe cognitive impairment (odds ratio, 7.78; 95% confidence interval, 1.80-47.32) or severe epilepsy (odds ratio, 6.64; 95% confidence interval, 1.21-69.21) than children with delayed presentation. Children with cerebral palsy after perinatal stroke are likely to have an additional disability; those with neonatal presentation are more likely to have a severe disability.Item The Best Interest Is the Child: A Historical Philosophy for Modern Issues(2013) Silva, Lahny R.; Robert H. McKinney School of LawA little over a century after the creation of the first juvenile court in America, the states and the federal government continue to try to find an effective and practical solution to juvenile delinquency. Beginning with the “Best Interest of the Child Standard” in 1899, juvenile justice policy has evolved into a mixed bag of philosophies. State statutes littered with “Best Interest” rhetoric, have interestingly resulted in state policies that are retributive in nature and disproportionately affect minority communities. The disconnect between theory and practice is the product of decades of socio-political influence on juvenile justice policy as well as a replacement of the “Best Interest” standard with staunch retributive ideals. This article puts forth a contemporary understanding of “Best Interest,” so as to unite theory and practice. This union may provide guidance for more effective policies in the realm of juvenile justice. America faces a costly and overburdened prison industrial complex that is fed by the juvenile justice system. Transfer provisions seamlessly transport juvenile offenders into adult court for criminal prosecution. Juveniles adjudicated in adult court face harsher penalties and diminished socio-economic opportunity than juveniles adjudged in juvenile court. While state lawmakers have recently recognized a decrease in violent crime among juveniles overall, many have refrained from advocating policies that promote true “Best Interest” ideals and instead have maintained a focus on law and order. Recent scientific research and psychosocial studies along with the past decade of United States Supreme Court precedent suggest that policymakers’ emphasis on retribution is misguided and anachronistic. Instead, legislators ought to be recognizing the real differences between juveniles and adults namely the “immaturity” of minors as well as their penchant for rehabilitation. This principle is already entrenched in other areas of law such as the minor abortion line of cases. This article advocates for a return to the “Best Interest of the Child” standard. Calling for an organic view of “Best Interest where contemporary contextual factors may be considered,” this article suggests that “Best Interest” calls for a focus on mitigation. This argument builds on Elizabeth S. Scott’s and Laurence Steinberg’s mitigation theory of juvenile justice. Scott and Steinberg argue that adolescents, because of their biological and psychosocial distinctions, possess a diminished capacity and are thereby less criminally blameworthy. Therefore, they argue, this diminished capacity ought to be recognized in the adult prosecution of juveniles. This article argues that Scott and Steinberg’s mitigation paradigm implicitly contains Best Interest principles that may help guide legislators in fashioning legal tools for which to adjudicate juvenile offenders in adult court. Beginning with a call for a “presumption of immaturity” in transfer decisions, this essay begins to examine practical solutions within a mitigation paradigm guided by Best Interest principles. Borrowing from minor abortion jurisprudence, it is contended that in those jurisdictions that have established automatic transfer provisions there ought to be a “presumption of immaturity” that the state must overcome prior to commencing an adult prosecution of a juvenile. Moreover, in the actual adjudication of a juvenile in adult court, defenses such as diminished capacity and extreme mental or emotional disturbance (“EMED”) may provide a vehicle for the admissibility of psychological and neurological evidence associated with adolescent immaturity and development thereby allowing the fact-finder to consider such evidence in its determination of criminal blameworthiness.Item Burosumab Therapy in Children with X-Linked Hypophosphatemia(Massachusetts Medical Society, 2018-05) Carpenter, Thomas O.; Whyte, Michael P.; Imel, Erik A.; Boot, Annemieke M.; Högler, Wolfgang; Linglart, Agnès; Padidela, Raja; van't Hoff, William; Mao, Meng; Chen, Chao-Yin; Skrinar, Alison; Kakkis, Emil; San Martin, Javier; Portale, Anthony A.; Medicine, School of MedicineBACKGROUND X-linked hypophosphatemia is characterized by increased secretion of fibroblast growth factor 23 (FGF-23), which leads to hypophosphatemia and consequently rickets, osteomalacia, and skeletal deformities. We investigated burosumab, a monoclonal antibody that targets FGF-23, in patients with X-linked hypophosphatemia. METHODS In an open-label, phase 2 trial, we randomly assigned 52 children with X-linked hypophosphatemia, in a 1:1 ratio, to receive subcutaneous burosumab either every 2 weeks or every 4 weeks; the dose was adjusted to achieve a serum phosphorus level at the low end of the normal range. The primary end point was the change from baseline to weeks 40 and 64 in the Thacher rickets severity total score (ranging from 0 to 10, with higher scores indicating greater disease severity). In addition, the Radiographic Global Impression of Change was used to evaluate rachitic changes from baseline to week 40 and to week 64. Additional end points were changes in pharmacodynamic markers, linear growth, physical ability, and patient-reported outcomes and the incidence of adverse events. RESULTS The mean Thacher rickets severity total score decreased from 1.9 at baseline to 0.8 at week 40 with every-2-week dosing and from 1.7 at baseline to 1.1 at week 40 with every-4-week dosing (P<0.001 for both comparisons); these improvements persisted at week 64. The mean serum phosphorus level increased after the first dose in both groups, and more than half the patients in both groups had levels within the normal range (3.2 to 6.1 mg per deciliter [1.0 to 2.0 mmol per liter]) by week 6. Stable serum phosphorus levels were maintained through week 64 with every-2-week dosing. Renal tubular phosphate reabsorption increased from baseline in both groups, with an overall mean increase of 0.98 mg per deciliter (0.32 mmol per liter). The mean dose of burosumab at week 40 was 0.98 mg per kilogram of body weight with every-2-week dosing and 1.50 mg per kilogram with every-4-week dosing. Across both groups, the mean serum alkaline phosphatase level decreased from 459 U per liter at baseline to 369 U per liter at week 64. The mean standing-height z score increased in both groups, with greater improvement seen at all time points with every-2-week dosing (an increase from baseline of 0.19 at week 64) than with every-4-week dosing (an increase from baseline of 0.12 at week 64). Physical ability improved and pain decreased. Nearly all the adverse events were mild or moderate in severity. CONCLUSIONS In children with X-linked hypophosphatemia, treatment with burosumab improved renal tubular phosphate reabsorption, serum phosphorus levels, linear growth, and physical function and reduced pain and the severity of rickets.Item Caregivers and community perceptions of blood transfusion for children with severe anaemia in Uganda(Wiley, 2019-02) Dhabangi, Aggrey; Idro, Richard; John, Chandy C.; Dzik, Walter H.; Opoka, Robert; Siu, Godfrey E.; Ayebare, Florence; van Hensbroek, Michael B.; Pediatrics, School of MedicineObjective To describe local perceptions of blood transfusion for children with severe anaemia in Uganda. Background Blood transfusion is a common emergency treatment for children with severe anaemia and saves millions of lives of African children. However, the perceptions of transfusion recipients have not been well studied. A better understanding of the perceived risk may improve transfusion care. Methods A qualitative study based on 16 in‐depth interviews of caregivers of transfused children, and six focus group discussions with community members was conducted in three regions of Uganda between October and November 2017. Results Caregivers of children and community members held blood transfusion in high regard and valued it as life‐saving. However, there were widespread perceived transfusion risks, including: Human immunodeficiency virus (HIV) transmission, too rapid blood infusion and blood incompatibility. Other concerns were: fatality, changes in behaviour, donor blood being ‘too strong’ and use of animal blood. In contrast, recent transfusion, older age, knowledge of HIV screening of blood for transfusion, faith in God and having a critically ill child were associated with less fear about transfusion. Respondents also emphasised challenges to transfusion services access including distance to hospitals, scarcity of blood and health workers' attitudes. Conclusion Perceptions of the community and caregivers of transfused children in Uganda about blood transfusion were complex: transfusion is considered life‐saving but there were strong perceived transfusion risks of HIV transmission and blood incompatibility. Addressing community perceptions and facilitating access to blood transfusion represent important strategies to improve paediatric transfusion care.Item Childhood Obesity(Oxford University Press, 2005-03-01) Speiser, Phyllis W.; Rudolf, Mary C. J.; Anhalt, Henry; Camacho-Hubner, Cecilia; Chiarelli, Francesco; Eliakim, Alon; Freemark, Michael; Gruters, Annette; Hershkovitz, Eli; Iughetti, Lorenzo; Krude, Heiko; Latzer, Yael; Lustig, Robert H.; Hirsch Pescovitz, Ora; Pinhas-Hamiel, Orit; Rogol, Alan D.; Shalitin, Shlomit; Sultan, Charles; Stein, Daniel; Vardi, Pnina; Werther, George A.; Zadik, Zvi; Zuckerman-Levin, Nehama; Hochberg, Zeev; Medicine, School of MedicineIn March 2004 a group of 65 physicians and other health professionals representing nine countries on four continents convened in Israel to discuss the widespread public health crisis in childhood obesity. Their aim was to explore the available evidence and develop a consensus on the way forward. The process was rigorous, although time and resources did not permit the development of formal evidence-based guidelines. In the months before meeting, participants were allocated to seven groups covering prevalence, causes, risks, prevention, diagnosis, treatment, and psychology. Through electronic communication each group selected the key issues for their area, searched the literature, and developed a draft document. Over the 3-d meeting, these papers were debated and finalized by each group before presenting to the full group for further discussion and agreement. In developing a consensus statement, this international group has presented the evidence, developed recommendations, and provided a platform aimed toward future corrective action and ongoing debate in the international community.Item Children’s conceptions of peace in two Ugandan primary schools: Insights for peace curriculum(Sage, 2017-03) Kagaari, James; Nakasiita, Kirabo; Ntare, Edward; Atuhaire, Richard; Baguwemu, Ali; Ojok, Gerald; Okumu, Auma S.; Kaahwa, Goretti; Byamugisha, Gastone; Semakula, Paul; Namusoke, Jane; Mayengo, Nathan; Thompson, Chalmer E.; School of EducationOppenheimer urged communities all over the world to study how children come to understand peace, conflict, and war. Set in various countries, their review of studies, as well as more recent examinations reveal trends in how children view these phenomena, often differing by gender, age, and extent to which they were exposed to highly dangerous and traumatizing situations, like being forced to be child soldiers or sex slaves. No such research has been published in the contemporary post-war Uganda context. Using focus group methodology, we asked: How might Ugandan primary school children’s stories about peace (traditional and otherwise) help them navigate conflict? What sorts of conflicts do these children observe in their home, school, and community, and how do they describe peace as being resolved by themselves or others? The purpose of our study was to contribute to the knowledge base on peace education in Uganda and to ultimately develop written materials that students can use as part of their learning in their respective schools. Local studies like this one are relevant to the global situation because racial and economic conditions are global phenomena. The local manifestations can speak to those racial and economic conditions as perspectives not often used to put the global situation in relief. This paper explores the findings related to the children’s overarching conceptions of peace and their ideas of peacebuilding, including activities that both hinder and encourage peace. The voices of the children speak strongly of the connection between peace and access to basic necessities in the community.Item Chronic Illness in Children and Adolescents: Research on the Impact on Their Siblings(Office of the Vice Chancellor for Research, 2014-04-11) Richardson, Elizabeth A; Parker, Katherine MChronic illness affects over 7 million children and adolescents (i.e., children) in the United States with significant stress to their family members. Although a great deal of research has described the impact of chronic illness on family members, these studies focused on mothers. Siblings of children with chronic illness have received less attention. Before interventions can be developed to address the stress on siblings, we must first understand their experiences and needs related to living with children with chronic illness. The purpose of this project is to evaluate current research on the impact of children’s chronic illness on their siblings. We conducted a search of the literature using: Key words, siblings and children combined with chronic illness, physical illness, developmental disorder, or mental disorder to search articles in PsychINFO, CINAHL, and Web of Science databases. We did not limit searches by date but excluded dissertations and non-English language publications. We analyzed the total number of articles, purpose, and findings regarding impact of chronic illness on siblings. Results of the search yielded 431 on chronic illness. Of these 152, 119, and 44 articles were on physical illness, developmental disorder, and mental disorder respectively. Analyses led to inclusion of 97 articles on chronic illness, 53 articles on physical illness, 15 articles on developmental disorders, and four articles on mental disorder. Impact on siblings is mostly negative and includes emotional problems such as envy, fear, anxiety, anger, resentment, loneliness, and sadness; behaviors problems such as physical aggression, poor school performance and peer relationships. These factors as well as poor communication and knowledge deficits about the illness impact the siblings’ adjustment to chronic illness in children. Further, mental disorders are underrepresented in the literature on chronic illness and the impact on siblings. Research is needed to understand how children’s mental disorders impact their siblings.