Better Outcomes For Children Research Articles

Postdivorce Father‐Adolescent Closeness

Research indicates that closeness of the father‐child bond following parental divorce is associated with better outcomes for children and adolescents. Unlike other investigations, this study takes a long‐term developmental approach to understanding stability and change in postdivorce father‐adolescent relationship closeness. Drawing on Add Health data (n = 483), we examine factors that explain (a) why some high‐quality father‐adolescent relationships remain the same after divorce whereas others decline, and (b) why some low‐quality relationships are stable following divorce whereas others improve. High mother‐offspring relationship quality and offspring feelings of well‐being prevented close father‐offspring relationships from deteriorating. Offspring’s childbearing and cohabitation following parental divorce increase closeness in father‐offspring relationships that were not close prior to divorce. Although a majority of offspring experienced a decline in closeness following divorce, results from this study show that some very close father‐offspring relationships are maintained and some poor relationships become closer.

L1 Is Associated With Favorable Outcome in Neuroblastomas in Contrast to Adult Tumors

Neuroblastoma is the most common solid tumor in childhood with unconventional clinical behavior. L1, a neuronal cell adhesion molecule, is associated with poor survival in malignant adult tumors. The aim of the current study was to determine expression of L1 in pediatric neuroblastoma. L1 expression was assessed on a tissue microarray with 66 surgically resected neuroblastoma samples by immunohistochemistry with a monoclonal antibody and peroxidase method. Additionally, mRNA expression was analyzed by reverse transcriptase-polymerase chain reaction with L1-specific primers. Data were correlated survival data by log rank test and Cox regression multivariate analysis. L1 was detected in 57 (86%) of 66 neuroblastomas, whereas 9 (14%) were L1 negative. Median survival of all children was 72 months. Analysis with Kaplan-Meier method revealed a surprising and contrary finding to adult tumor entities: an association of L1 positivity with better event-free and overall survival (P < .001 and P < .01 by log rank test). Multivariate Cox regression analysis showed an independent prognostic impact of L1 negativity for event-free and overall survival of the children (P < .05). In contrast to adult tumor entities, where L1 is associated with aggressive clinical behavior, our data show that L1 predicts good outcome in children with neuroblastoma. This novel finding suggests an inverse role of L1 in neuroblastoma. Future studies might focus on the molecular basis of the varying effect of L1 in different tumors.

Production of the HIV-Suppressive Chemokines CCL3/MIP-1α and CCL22/MDC Is Associated with More Effective Antiretroviral Therapy in HIV-Infected Children

Certain CC chemokines including ligands for the HIV-1 coreceptor CCR5 are associated with suppression of HIV-1 infection. Whether the release of these chemokines from lymphocytes influences treatment outcome in children receiving antiretroviral therapy is not known. A study of 175 HIV-infected children in Rio de Janeiro, Brazil was conducted to compare clinical measures and HIV-suppressive chemokine release. Clinical measures including %CD4 T cells, viral loads, and antiretroviral drug-resistant mutations were obtained. Chemokine release was measured in cultures of peripheral blood mononuclear cells collected from 135 children before or after receiving therapy. Chemokine levels were compared between subject groups stratified according to clinical measures and treatment regimen (1-2, 3-4, or no antiretrovirals) extant at the time of cell sample collection. Mean viral loads did not vary significantly between treatment groups although there were significant differences in %CD4 T cells. Virus from children taking 3-4 antiretrovirals had significantly more drug-resistant mutations than did virus from those receiving 1-2 drugs. Among antiretroviral-treated children, there was a significant direct relationship between %CD4 T cells and MIP-1alpha/CCL3 and macrophage-derived chemokine/CCL22 production. In addition, there was a significant inverse relationship between viral load and MIP-1alpha production in patients receiving 3-4 antiretrovirals. Greater recovery of %CD4 T cells after therapy was associated with higher MIP-1alpha and macrophage-derived chemokine production at baseline. The production of HIV-suppressive chemokines is associated with better outcome in children receiving antiretroviral regimens in settings where drug-resistant mutations are prevalent. Such information may provide insights for the design of treatment strategies for pediatric HIV infection under similar circumstances.

Intranasal desmopressin (OctimTM): a safe and efficacious treatment option for children with bleeding disorders

Desmopressin (1-deamino-8-D-arginine vasopressin (DDAVP)) has been shown to be an effective treatment option when administered both intravenously [1,2] and subcutaneously [3] to children with inherited bleeding disorders. We demonstrate here, both the efficacy and acceptability of a new intranasal DDAVP preparation, providing a cost effective treatment with good outcomes for children with bleed disorders.

Prognostic significance of WT1 gene expression in pediatric acute myeloid leukemia

The Wilms Tumor gene (WT1) encodes a transcription factor involved in kidney development and malignancy. WT1 expression in a subpopulation of early CD34+ cells has suggested its involvement in hematopoiesis. WT1 is aberrantly expressed in leukemias. High expression of WT1 at diagnosis has been associated with unfavorable prognosis in adult acute myeloid leukemia (AML). The prognostic relevance of WT1 expression in pediatric AML was evaluated in only one study, including 47 patients, which showed that very low levels of WT1 at presentation were associated with an excellent outcome. To test the validity of these findings we measured levels of WT1 in 41 newly diagnosed pediatric AML of the non-M3 FAB subtype. Patients were treated according to an AML-BFM 83-based protocol in a single institution. Mononucleated cells obtained from presentation BM aspirates were cryopreserved and later thawed and used for total RNA extraction and cDNA synthesis. The quantitative assessment of WT1 transcripts was made by real-time PCR (RQ-PCR). WT1 transcripts values were normalized with respect to the number of ABL transcripts. WT1 levels were significantly higher in patients bearing favorable chromosome abnormalities, t(8;21) and inv(16) (P = 0.002). Higher levels of WT1 expression were unexpectedly associated with a higher probability of overall survival by Cox regression analysis (P = 0.002). Multivariate regression analysis could not discriminate between the effects of WT1 and cytogenetics on survival. Higher WT1 expression was associated with favorable cytogenetics subtypes and accordingly with better outcome in children with AML in this study.

PR37 EVOLUTION OF SURGERY FOR CRANIOSYNOSTOSIS IN CHRISTCHURCH – A REVIEW OF 67 CHILDREN

Purpose The treatment of craniosynostosis has continued to evolve over the last few decades. Techniques from linear strip craniectomies through osteotomies, orbital bandeau fashioning, craniotomies and immediate calvarial remodelling to the latest spring‐mediated dynamic reshaping have been used to achieve ongoing improvements in facial and skull shape. This paper discusses the timing, long‐term results and recent advances of surgical techniques based on our experience. We also aim to identify factors which could affect the outcome.Methodology We performed a retrospective analysis of 67 patients surgically treated for craniosynostosis over a 24 year period in Christchurch Hospital. The craniofacial team consisted of a Plastic Surgeon and a Neurosurgeon. We analyzed results based on type of sutural involvement, cosmetic outcome, complications, blood transfusions and surgical technique.Results There were 20 females and 47 males. 62 had a non‐syndromic craniosynostosis and 5 had a syndromic craniosynostosis. The non‐syndromic cases comprised: sagittal (n = 30), metopic (n = 17), unilateral coronal (n = 9), bicoronal (n = 2) and multiple (N = 4). The 5 syndromic cases comprised: Crouzon’s/bilat coronal (n = 2), Apert’s (n = 2, 1 bilateral coronal, 1 unilateral coronal)) and Klippel‐Feil/unilateral lambdoid (n = 1). The median age at first operation was 8 months. Complications and outcomes will be presented and our conclusions will highlight the evolving surgical techniques and that a multidisciplinary approach (including neurosurgeon, plastic surgeons and paediatric team) provides the best outcome for children with craniosynostosis.

Networks, Connectedness and Resilience: Learning From the Children's Fund in Context

During the past decade, expectations placed on child welfare services in the UK have moved away from individualised provision geared to meeting the needs of specific children at risk, to consideration of the broader context for children. The introduction of a series of national programmes aimed at addressing social exclusion and tasked with stimulating new approaches to enabling better outcomes for children formed the background for the recent legislation and guidance for local children's services. The Children's Fund was one of a raft of New Labour social policies promoting partnerships between statutory and voluntary organisations in order to address the cross-cutting issue of social exclusion. It was announced following the UK 2000 Spending Review and drew from the Policy Action Team12 (PAT12) Report, ‘Young People at Risk’ (SEU, 2000). Funding started in January 2001 and continues until 2008 with a total allocation during this period of £960 million. Like most special policy initiatives instigated following 1997, the establishment of the Children's Fund was accompanied by both national and local evaluation requirements. The National Evaluation of the Children's Fund (NECF) was undertaken by a team from the Universities of Birmingham and London and this themed section draws on selected findings from that evaluation. Overall results are reported in Edwards et al., (2006).

Professional learning within multi-agency children's services: researching into practice

Background This article is concerned with professional learning within multi-agency settings. Since the publication of the government document Every child matters in 2003, professionals involved in working with children and young people have been moving into newly organized services that are required to deliver improved services for vulnerable children and their families. Although new ways of professional working are described in the plethora of government guidance that has followed Every child matters, there has been little examination of how this is being achieved in different teams around the country. Purpose This paper describes a current national research project, ‘Learning in and for Inter-agency Working’, which is investigating new ways of learning that develop, while teams of professionals work together around children and young people who are at risk of social exclusion. Programme description The research project is theoretically based and draws upon sociocultural and activity theory research to understand the practices that develop within the different agencies involved. The paper describes the derivation of the theory and the particular aspects of activity theory that are central to the project. In particular, the use of developmental work research (DWR), as the method of intervention with a number of local education authorities, is described and explained. Sample Some of the early work undertaken within phases 3 and 4 of a five-stage project which began in 2004 and ends in 2007 is described. Five different inter-agency teams of professionals working as part of Children's Services, from different geographical locations in England are the participants in the study. Design and methods The research uses activity theory to structure a series of DWR workshops with members of the multi-agency teams. Ethnographic data, including observations and interviews, are collected and form the subject-matter of the workshops. Results The data gathered are used to facilitate workshops where participants discuss their developing working practices and plan changes. The reporting phase of the project, where the findings across all sites will be analysed and summarized is not until mid-2007. However, early themes emerging from the research are included in the paper. These themes include: issues around co-location and co-working, evolving of professional identities, discussion of divisions of labour and professional expertise. These are described and illustrated using data from the research project. Conclusions As this is still ‘work in progress’ no firm conclusions can be drawn. However, it has become clear that new ways of thinking about professional working with children and families is necessary as old ways of working do not necessarily provide better outcomes for children.

No Simple Answers to a Complex Question: A Response to Perry

The issue of whether professional social workers make better child welfare workers than nonsocial workers is a considerably complex one. Simply determining better is itself a difficult undertaking. For example, does better mean reduced turnover among professionally trained social worker child welfare specialists, or should it mean better outcomes for children served? Considerable prior work supports the contention that social workers can make better child welfare workers than non–social workers, research conducted using diverse methodologies and among different states. The performance evaluation process used by Perry may not be a valid method of assessing child welfare worker skills. However, his results certainly indicate the need for additional and more rigorous empirical research to answer the question he posed.

Costs and complications of hospitalizations for children with cerebral palsy

Although many children with cerebral palsy (CP) develop secondary conditions requiring hospitalization, in-patient hospital utilization by this population has not been characterized. To characterize hospitalizations in children with CP and to compare them with hospitalizations of those without CP using a large national data set. Analysis of the Healthcare Utilization Project Kid Inpatient Database, a weighted survey of paediatric discharges from US hospitals in 1997. In 1997, 37,000 children with CP were hospitalized, generating charges approaching 600 million dollars. Children with CP demonstrated longer lengths of stay (6.3 vs 4.1 days, p < 0.001), higher total charges (16,024 vs 9952 dollars, p < 0.001), more diagnoses (5.6 vs 3.0, p < 0.001) and more procedures (1.7 vs 1.1, p < 0.001) per admission. Five major diagnostic categories accounted for 83.2% of the discharge diagnoses for children with CP (48.6% for those without CP, p < 0.001). Children with CP were more often transferred to other facilities (p < 0.001) or prescribed home health care (p < 0.001) upon discharge. Hospitalization of children with CP represents a major expenditure for health care systems. Studies to improve the management of conditions associated with CP could result in better outcomes for children and families and potentially decrease costs associated with hospitalization.

Early identification and treatment fundamental for good outcome in children with toxic shock syndrome

Early identification and treatment fundamental for good outcome in children with toxic shock syndrome

From complexity to category: Responding to diagnostic uncertainties of autistic spectrum disorders

Recent data from Education Queensland has identified rising numbers of children receiving diagnoses of autistic spectrum disorder (ASD). Faced with funding diagnostic pressures, in clinical situations that are complex and inherently uncertain, it is possible that specialists err on the side of a positive diagnosis. This study examines the extent to which possible overinclusion of ASD diagnosis may exist in the presence of uncertainty and factors potentially related to this practice in Queensland. Using anonymous self-report, all Queensland child psychiatrists and paediatricians who see paediatric patients with development/behavioural problems were surveyed and asked whether they had ever specified an ASD diagnosis in the presence of diagnostic uncertainty. Using logistic regression, elicited responses to the diagnostic uncertainty questions were related to other clinical- and practice-related characteristics. Overall, 58% of surveyed psychiatrists and paediatricians indicated that, in the face of diagnostic uncertainty, they had erred on the side of providing an ASD diagnosis for educational ascertainment and 36% of clinicians had provided an autism diagnosis for Carer's Allowance when Centrelink diagnostic specifications had not been met. In the absence of definitive biological markers, ASD remains a behavioural diagnosis that is often complex and uncertain. In response to systems that demand a categorical diagnostic response, specialists are providing ASD diagnoses, even when uncertain. The motivation for this practice appears to be a clinical risk/benefit analysis of what will achieve the best outcomes for children. It is likely that these practices will continue unless systems change eligibility to funding based on functional impairment rather than medical diagnostic categories.

Effective Rehabilitation for Children and Adolescents With Brain Injury: Evaluating and Disseminating the Evidence

Teplicky R, Law M, Rosenbaum P, Stewart D, DeMatteo C, Rumney P. Effective rehabilitation for children and adolescents with brain injury: evaluating and disseminating the evidence. Objective To develop and evaluate literature reviews of the effectiveness of rehabilitation interventions for children with brain injury. Design We wrote 6 research summaries, which were evaluated by study participants. Setting Community. Participants A convenience sample that included 18 parents of children with brain injury, 18 service providers, and 12 insurance industry representatives. Interventions Not applicable. Main outcome measure Questionnaire designed for the evaluation of printed material. Results Few articles were found that focused on evaluation of rehabilitation interventions for children with brain injury. Study participants were representative of a broad range of educational and professional backgrounds. Before reading the research summaries, service providers reported greater familiarity with the topics than did parents and insurance representatives. Despite this finding, there were no significant between-group differences in the format, content, and impact ratings provided by the 3 participant groups. Conclusions Research summaries written in a clear, straightforward manner are appropriate for people with different educational and professional backgrounds. Further research into the effectiveness of rehabilitation interventions is needed to support informed decision-making that results in the best outcomes for children with brain injury.

THE COLLABORATIVE DIVORCE PROJECT: A Court‐Based Intervention for Separating Parents with Young Children

The role the legal process of separation and divorce plays in affecting outcomes for young children and their families was examined in the Collaborative Divorce Project (CDP), an intervention designed to assist the parents of children six years old or younger as they begin the separation/divorce process (married and unmarried couples). Evaluation and outcome data were collected from 161 couples, their attorneys, teachers, and court records. In addition to positive evaluations from both parents, intervention families benefited through lower conflict, greater father involvement, and better outcomes for children than the control group. Attorneys and court records indicate that intervention families were more cooperative and were less likely to need custody evaluations and other costly services. The CDP illustrates how prevention programs can be located within the courts, can be systematically evaluated, and can aid in helping the legal system function optimally for families with young children.

Providing for the best interests of the child?: The Adoption and Safe Families Act of 1997

The Adoption and Safe Families Act of 1997 (ASFA) was passed to increase rates of adoptions and other permanent placements for children in foster care. Through acceleration of timelines for terminating the rights of biological parents and for developing permanency plans, ASFA has the potential to reduce the length of time children spend in foster care as well as the number of disruptions in placements they experience there, yet still promotes reunification when this can be accomplished expeditiously and safely. Developmental research suggests that foster care often results in better outcomes for children than does reunification with their biological families but that adoption often leads to better outcomes than does foster care. These findings indicate that the overall goals outlined in ASFA are appropriate and likely serve the best interests of many children; however, a number of problems with the child welfare system remain.

Management of seizures in children with falciparum malaria.

Falciparum malaria is the most common cause of convulsions in children admitted to hospital in malaria endemic areas. Detection of convulsions requires close monitoring and one should be on the look out for signs of subtle convulsions. About a third of acute seizures in children with cerebral malaria, do not manifest as convulsions, but as changes in eye deviation, salivation and/or eye deviation. It is important to terminate convulsions lasting more than 5 min, since prolonged convulsions are associated with neurological deficits in survivors of children with severe malaria. Initial management should include putting the child into the left lateral position, checking the blood glucose and administering oxygen if hypoxic. The benzodiazepines, particularly diazepam, are used as the initial anticonvulsants. Phenobarbital and phenytoin are used as second-line treatments. Prompt and effective management of falciparum malaria associated convulsions may contribute to a better outcome in children with severe malaria.

Cyclosporin A monitoring by 2-h levels: preliminary target levels in stable pediatric kidney transplant recipients.

Clinical trials in adults have shown that management of transplanted patients with cyclosporin A (CsA) 2-h levels (C2) lead to superior outcome compared with monitoring of 12-h trough levels (C0). In both adults and children, C2 levels enabled a better estimation of the area under the curve concentration than C0 levels. Therefore, it can be suspected that C2 monitoring might also lead to a better outcome in children. Until now C2 target levels for children have not been defined. We measured C2 levels in 101 stable pediatric kidney recipients with a minimum time of 1 yr after transplantation. C2 levels were compared with changes in glomerular filtration rate (GFR) 6 months later. Median C2 levels in children after renal transplantation were 714 ng/mL (95% confidence interval 654-774). Patients with C2 levels below 750 ng/mL had a significantly higher percentage of decline in GFR than patients with C2 levels above 750 ng/mL (p < 0.05). In children with C2 levels below 500 ng/mL three acute rejections occurred in comparison with no rejection in the remaining patients (p < 0.05). We conclude that the lower C2 target level should be above 750 ng/mL in stable pediatric transplant recipients. An upper target level above 1000 ng/mL should be avoided. The question, whether C2 monitoring in pediatric kidney recipients is superior to C0 monitoring, is yet to be answered.

Fertility and perinatal health among Finnish immigrants in sweden

Several studies have reported poorer infant outcome among immigrants, but contrary evidence also exists. Between 1940 and 1999 more than a half million Finns emigrated to Sweden, which made Finns the largest minority group in Sweden. Our aim was to investigate fertility trends, parturients’ background and pregnancy outcomes among Finns in Sweden, and to compare the findings with those obtained among Swedes in Sweden and Finns in Finland. The data came from the Finnish and Swedish Medical Birth Registers for the years 1987–1998. All deliveries by women born in Finland and having given birth in Sweden ( N=33 874) were compared with a 10% sample of all deliveries by Swedish parturients in Sweden ( N=108 549) and of all Finnish deliveries ( n=75 133). Among Finns in Sweden, the number of live births per 1000 women aged 15–49 years declined significantly in the late 1990s. The change in the total fertility rate was less dramatic: the rate for Finns in Sweden followed the total Swedish rate although it remained from 5% to 10% higher up to the mid-1990s. Finns who had given birth in Sweden were older, had a higher parity and a higher prevalence of previous miscarriages, and smoked more often than did Swedes in Sweden or Finns in Finland. The crude infant outcomes of Finns having given birth in Sweden were equal to those among Swedes in Sweden (except for the incidence of small for gestational age), but poorer than in Finland. Biological factors explained the differences between Finns in Sweden and Finland in being small for gestational age, and biological factors and smoking explained the difference in prematurity. The difference in low birth weight remained statistically significant (3.9% versus 3.6% among singletons). In conclusion, fertility trends followed the pattern prevailing in the resident country. The relatively good outcome of children whose mothers were born in Finland but who had given birth in Sweden can partly be explained by the healthy migrant effect.

Do You Believe In Magic?: What We Can Expect From Early Childhood Intervention Programs

Do You Believe In Magic?: What We Can Expect From Early Childhood Intervention Programs

Caring for children who care: Acknowledging the importance of the natural children of foster parents

In the arena of social welfare it is not unusual for practitioners to endeavour to give a voice to the disadvantaged by working to empower clients; placing value on each individual member in a family; helping communities care for each other; advocating for the rights of children and women. No doubt this is all familiar rhetoric to most welfare and social workers. However, in the area of foster care a voice that has seldom been heard is the voice of the ‘children who care’. The natural children of foster carers are valuable members of the caring team and whilst many foster parents are aware of their own children's contribution in caring for foster children, foster care agencies and social workers/caseworkers have not formally acknowledged them or accorded to them the support they deserve. Better outcomes for children in foster care and for families who care will be achieved if practitioners consult with, support, and acknowledge the ‘children who care’.