Child Care Research Articles

Surgery and the first 8000 days of life: a review

Abstract The first 8000 days of life, from birth to adulthood, encompasses critical phases that shape a child's health and development. While global health efforts have focused on the first 1000 days, the next 7000 days (ages 2–21) are equally vital, especially concerning the unmet burden of surgical conditions in low- and middle-income countries (LMICs). Approximately 1.7 billion children globally lack access to essential surgical care, with LMICs accounting for 85% of these unmet needs. Common surgical conditions, including congenital anomalies, injuries, infections, and pediatric cancers, often go untreated, contributing to significant mortality and disability. Despite the substantial need, LMICs face severe workforce and infrastructure shortages, with most pediatric surgical conditions requiring specialized skills, equipment, and tailored healthcare systems. Economic analyses have shown that pediatric surgical interventions are cost-effective, with substantial societal benefits. Expanding surgical care for children in LMICs demands investments in workforce training, infrastructure, and health systems integration, complemented by innovative funding and equitable global partnerships. Prioritizing surgical care within national health policies and scaling up children's surgery through initiatives like the Optimal Resources for Children's Surgical Care can improve health outcomes, align with Sustainable Development Goals, and foster equity in global health. Addressing the surgical care gap in LMICs will reduce preventable mortality, enhance quality of life, and drive sustainable growth, emphasizing surgery as an essential component of universal health coverage for children.

Russian Immigrant Families’ Child Care Selection in the United States

AbstractResearch on immigrant populations shows that child care choices are dependent on the population’s region of origin. While the Russian immigrant population in the United States comprises the largest group of immigrants from Eastern Europe and is likely to increase in the future, there is virtually no research on Russian immigrant families’ child care search and selection criteria. This qualitative study applies the theoretical model of Pungello and Kurtz-Costes (1999), which illustrates how factors such as parental demographic characteristics, environmental context, child characteristics, and parental beliefs play into families’ child care selection. The study draws from semi-structured interviews with 11 Russian immigrant families residing in the Mid-Atlantic region of the United States to examine their child care search processes and selection criteria. Results revealed that most parents found child care through friends’ recommendations, Internet search, and online reviews. Nine themes describing child care criteria valued by Russian immigrant families emerged from the analysis. Specifically, parents mentioned culture and personal beliefs, child characteristics, convenience, cost and subsidy, education and learning, program features, facilities and environment, teacher characteristics, and rating and reputation as the major factors in selecting child care. Understanding Russian immigrant parents’ child care information sources and selection criteria will allow for early care and education (ECE) providers to accommodate the needs of Russian immigrant population and for policymakers to facilitate access to ECE programs for these families.

The Strategies to Improve Primary Health Care Services: A Scoping Review

Context: Evaluation of health policies and identification of their challenges are vital for improving and implementing reforms in the healthcare system. The present study was conducted to identify interventions aimed at improving primary healthcare (PHC) services in Iran. Evidence Acquisition: This research utilizes a scoping review to examine reform interventions in PHC services across 10 selected countries: Qatar, Oman, Turkey, Georgia, Armenia, United Arab Emirates, Saudi Arabia, Bahrain, Kazakhstan, and Kuwait. The study covers areas such as the PHC delivery system, human resource management, financial mechanisms, and the framework of community participation and intersectoral collaboration from 2010 to 2022. Results: The main reform strategies for PHC systems in the reviewed countries included the establishment of family medical centers with nurse support as a comprehensive strategy for service provision in public health centers; providing comprehensive and quality healthcare service packages including maternal and child health, infectious disease immunization, chronic disease monitoring, and dental care services; health education; access to essential medications; improvement of electronic health services; implementation of health promotion and continuous prevention programs; capacity enhancement; and a greater focus on health screening programs and grading of healthcare centers. Conclusions: The major findings from the reviewed countries indicate that healthcare policymakers focus on providing preventive care services, reducing maternal and child mortality, and increasing life expectancy. Programs such as referral systems, service grading, and the adoption of electronic health services are part of their reform agenda.

Patient-centered medical homes and vision care for children: a cross-sectional analysis with data from the national survey of children's health 2018-2019.

Vision screening as part of well-child visits is recommended annually for US children 3 to 6 years. However, 63% of children do not get a vision screening in well-child visits. The Patient-Centered Medical Home (PCMH) improves the receipt of preventive care visits in other medical specialties but it is unknown if it improves receipt of vision screening. The objective of this study is to determine whether caregiver-reported receipt of care in a PCMH is associated with receiving a vision screening test in a well-child visit for children 3 to 6 years in a pediatrician/general doctor's office ('primary care'). Population-based data for US children aged 3 to 6 years was derived from the National Survey of Children's Health (2018-2019). Children were excluded if they did not have a well-child visit in the previous 12 months. The primary exposure was receipt of care in a PCMH ('PCMH care'), and the primary outcome was receipt of a vision screening in primary care. Adjusted odds ratios (aOR) and predicted probabilities were computed for children with and without PCMH care. Among 9,587 children with well-child visits, 4,984 (50.9%) were males. There were 1,107 (23.3%) Hispanic, 6704 (52.8%) White/Non-Hispanic and 545 (11.8%) Black/Non-Hispanic children. There were 5,482 (51.8%) children who received PCMH care. Of those with PCMH care, 2,629 (52.2%) received a vision screening in primary care. Those with PCMH care (52.2%) had a higher odds of receiving a vision screening (aOR, 1.31; 95% CI 1.11, 1.55) in primary care compared to children without PCMH care (42.8%). The predicted probability of vision screening in primary care was 50.8% (95% CI 48.2, 53.5) for children that received PCMH care, and 44.3% (95% CI 41.3, 47.3) without PCMH care. Caregiver-reported receipt of PCMH care was associated with a greater likelihood of vision screening for children 3 to 6 years in a well-child visit. Further studies are needed to understand the mechanisms through which PCMH care contributes to the greater odds of vision screening in primary care to inform the creation of strategic interventions to prevent vision loss and its long-term implications.

Unintentional drowning fatalities in Sweden between 2002 and 2021.

Despite declining over the past three decades, unintentional drownings still account for an estimated 236 000 annual deaths worldwide. Susceptibility persists amongst demographic groups and is influenced by sex, age, and socio-economic status, emphasizing the need for targeted interventions. Due to rapidly evolving population dynamics, particularly within Europe, there is a further responsibility to understand the impact of ethnicity on the risks of drowning to guide prevention. We conducted a national population-based retrospective study using data from the Swedish National Board of Forensic Medicine and Statistics Sweden for the years 2002 to 2021. The analysis includes variables such as age, sex, presence of alcohol and narcotics as well as activity undertaken at the time of drowning and type of water body. Furthermore, we considered ethnicity to identify subpopulations at greater risks. Results revealed a plateau in unintentional drowning rates in Sweden since 2012, despite an overall decrease from 2002 to 2021. Findings confirm the trend that males are overrepresented within drowning statistics across all age groups, and that individuals aged > 50 constitute over half of all unintentional drownings. Men aged between 40-69 years boating, and individuals of non-Swedish origin, particularly those < 20 years of age, face a notably greater risk of drowning, underscoring the need for subpopulation-targeted prevention strategies. The ten-year plateau in unintentional drowning signals the need for an official national prevention strategy with annual evaluations. Suggestions also include improved parental supervision of children, further avoidance of alcohol while swimming and boating, as well as targeted swimming lessons and water competency training for individuals of non-Swedish origin.

Equimolar oxygen-nitrous oxide (EMONO) in dental pediatric care: which patients achieve therapeutic effects? A French national exploratory prospective observational multicenter study.

Equimolar oxygen-nitrous oxide mixture (EMONO) is considered as a reference for dental care in children. Completion of dental treatment has usually been used as a criterion to assess EMONO treatment. However, other patient-reported outcomes are needed. We sought to assess the prevalence of complete therapeutic effects (analgesia and anxiolysis) experienced by children during dental care under EMONO and identifying associated factors. A national prospective observational multicentric study was conducted between September 2018 and June 2020 in 13 French university hospitals. Participants were children between 3 and 15years of age requiring dental care under EMONO. 677 children were analyzed. Anxiolysis and analgesia were experienced by a large majority of patients (86.5% and 79.0%, respectively, and 73% experienced both effects). Several factors were associated with both analgesia and anxiolysis effects: the presence of expected effects (no loss of judgment and slight decrease in level of consciousness), the absence of agitation and distress, a positive perception of EMONO and ethnicity. Most patients benefit from the therapeutic effects (anxiolysis and analgesia) expected by EMONO during dental treatment. It is reassuring to observe that most sociodemographic characteristics and medical history do not seem to influence the effectiveness of care. The study was registered at www. gov under the reference number NCT03453411.

Lessons Learned From the Implementation of an Integrated Health and Social Care Child and Family Hub &amp;ndash; a Case Study

Introduction: Childhood adversity is associated with poor physical and mental health outcomes across the lifespan. Integration of health and social care may provide a solution to childhood adversity through practices of better detection and response. There is growing interest in the creation of child and family hubs that integrate health and social care but little literature that describes the development process. Description: We aimed to evaluate and describe the implementation of a co-designed health and social care child and family hub in Victoria, Australia. Rapid ethnographic methodology was used to iterate the hub components. Practitioners and researchers co-created solutions to barriers identified during implementation. Discussion: There were five key learnings: (i) Practice change takes time and intensive coaching, (ii) Lived experience is a powerful motivator for practice change, (iii) Integration of services requires more than co-location to break down silos, (iv) Reflective practice is a key driver of practice change, and (v) Using real time data enabled rapid implementation change and directly informed the development of solutions. Conclusions: Maintaining and developing practice change during implementation requires time and access to a broad range of data to enable iteration and the development of solutions.

Teachers' knowledge about the principles of dealing with a student with type 1 diabetes mellitus.

A proper self-management and therapy process, and the involvement of patients and their carers in this process, influences the effectiveness of T1DM therapy. The responsibility for the self-management process lies with children and adolescents with T1DM, as well as their parents and other carers. The aim of this study was to assess the level of teachers' knowledge of the principles of the treatment and self-management of T1DM in children and to demonstrate the influence of various factors influencing teachers' knowledge. A cross-sectional survey was conducted among the teachers in the Pomeranian Voivodeship. The first part of the survey contained questions on sociodemographic data, the second part contained questions on personal attitudes towards a student with T1DM, and the third part contained twenty-nine questions assessing the basic knowledge of the self-management and treatment principles of T1DM. Tests were conducted with 698 (86.4%) female teachers and 110 (13.6%) male teachers. The median (25thQ ÷ 75thQ) score of the test on the teachers' knowledge was 20 (18 ÷ 21) points, with a maximum of 29 and a minimum of 0 points. Male teachers, aged between 26-40years, with 6-10years of seniority, working in rural areas, having a person with T1DM in their immediate environment or having a student with T1DM in their class had a higher knowledge level. Teachers who worked in schools where no nurse was employed and those who had not completed specific training on the principles of caring for a child with T1DM at school had a lower level of knowledge. 1. Knowledge of teachers is insufficient to ensure safe stay at school for a child with T1DM. 2. The ongoing training of teachers on the principles of the self-management and treatment of T1DM is necessary to improve and increase the safety of children and adolescents with T1DM in school units. 3. There is a need to improve the quality of health care for children with T1DM in the learning environment by increasing the number of school nurses and improving their knowledge, and by the ongoing training of teachers and other staff in school units. 4. Detailed care plans should be developed for children with T1DM, adapted to the school conditions.

Observation of patients after cardiac surgery, surgical aspects for pediatricians

The article discusses the practical aspects of caring for children after heart surgery. It provides information on the timing of follow-ups, the frequency of pediatrician visits, and describes the most important aspects of patient management for different groups. The article identifies several groups of patients based on their postoperative risks and follow-up needs. Purpose of the article is to present the observation features of patients who have undergone surgery for congenital heart defects, from the perspectives of surgeons and pediatricians.

A comparison of assessment tools for childcare centers in high vs. low resource settings

Studies suggest issues may arise when using childcare setting assessment tools designed for high-resource settings in low-resource settings to assess and improve the quality of care, including placing disproportionate weight on features of the childcare environment that may not be available or culturally appropriate within the low-resource context. This study compares a novel assessment tool developed in and for low-income and low-resource settings with a standardized “gold standard” tool developed for use in high-resource settings. The study included a randomized sample of 34 childcare centers in a low-resource context that provided care for approximately 918. Results suggest that the WCI-QCUALS assessment tool performed better at differentiating among childcare settings that were consolidated into the lowest rating on the ECERS-R. Further, the WCI-QCUALS was found to be a feasible, appropriate stand-alone tool for assessing the quality of childcare centers in low-resource settings. Additional refinement and validity testing in other countries and contexts will improve the understanding of how the quality of childcare across different contexts can be measured, and improved assessment of childcare quality in low-resource settings will enhance the ability to identify low-quality care that can be remedied to ensure appropriate care for vulnerable children.

“The Source of All My Joy and All My Stress”: Children and Childcare as Underappreciated Sources of Stress That Affect Farm Women

ABSTRACT Objective Women have always played a crucial role in agriculture through their work on the farm, caring for the family and the household, and off-farm employment. Yet, like their essential contributions to agriculture, their mental health and well-being have largely been invisible since much of the focus of the mental health in agriculture research has been on older, male farmers. This paper seeks to address this knowledge gap by focusing on the emotional consequences stemming from the expectations of juggling childcare responsibilities, farm work and managing the household whilst keeping children safe. Methods The data were collected via focus groups and photovoice activity with, respectively, 68 and 33 farm women from Ohio, Wisconsin, and Vermont. Results The content thematic analysis first indicates that the juggling of multiple roles along with limited support deeply impacted farm women’s wellbeing. Worries that the children could get hurt was a major source of stress. Stress and mental health issues connected to children do not lessen as they age but rather shift and become more complex. Conclusion This article highlights the implications of the lack of investment in farm women’s mental wellbeing and their lived realities of caring for children on the farm. Future research should address supply chain and affordability issues, particularly for rural childcare provision.

Abstract IA024: Validation of liquid biopsy approaches for the care of children with cancer

Abstract Pediatric cancers are driven by a unique set of mutations, destinct from the variants that typically drive adult cancers. Therefore, widely available liquid biopsy assays are often not relevant for detection, quantificaiton, or profiling of circulating tumor DNA in childhood cancer. Custom liquid biopsy approaches have been developed by the Crompton lab and others and these assays demonstrate that ctDNA levels provide valuable prognostic information and can guide some therapeutic choices in pediatrics. Implementation of liquid biopsies into national phase 3 trials for children with cancer will require translation of these approaches into a clinical molecular laboratory environment. Citation Format: Brian Crompton. Validation of liquid biopsy approaches for the care of children with cancer [abstract]. In: Proceedings of the AACR Special Conference: Liquid Biopsy: From Discovery to Clinical Implementation; 2024 Nov 13-16; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2024;30(21_Suppl):Abstract nr IA024.

Mother's Experience of Caring for Children with Stunting in the Riverside of Banjar Regency

Introduction: Stunting is one of the most common impacts of chronic malnutrition in the world. Banjar Regency is one of the regencies in South Kalimantan that has experienced a significant increase in stunting cases. Mothers often act as the primary caregivers of children, thus all actions taken by mothers related to care including fulfilling nutritional needs can affect the health and nutritional status of their children. It is important for a mother to have good knowledge about fulfilling nutrition for children, fulfilling immunizations, maintaining sanitation and treating infectious diseases in children. One way to gain knowledge is from experience. Mothers with stunted children have experiences that can be lessons regarding the actions taken during treatment, the obstacles felt and how to prevent stunting in the next generation. Objective: This study aims to explore the experiences of mothers in caring for children with stunting in the riverside of ??Banjar Regency. Method: A qualitative approach with a phenomenological design was used in this study. Data were collected using the in-depth interview method and analyzed using the sequence: transcribing, categorizing, using N-Vivo 12. The population in this study were all mothers who had stunted children in the riverside of ??Banjar Regency. In this study, mothers who became participants were selected using a purposive sampling method, namely data was taken from information from health center officers in Banjar Regency with inclusion criteria having experience caring for children with stunting, being able to communicate well and being willing to be participants. Data saturation was obtained on the 16th participant. Result: The results of this study identified 5 themes, namely children's eating habits, children's conditions, mothers' efforts, mothers' difficulties and the role of fathers. Children's eating habits include incomplete menus, eating little, eating irregularly, eating without side dishes, and snacks before eating. The condition of stunted children in this study was slow development, frequent illness, and poor sleep quality. Mother’s efforts were to provide exclusive breastfeeding and routinely go to posyandu. The difficulties faced by mothers were difficulty in accessing health facilities, economic problems, children who did not want to be separated from their mothers, confusion in handling stunting and the presence of a closed mouth movement in children. The role of fathers included collaborating with mothers in parenting and being less involved in parenting. Conclusion: The conclusion obtained in this study was that 5 themes were obtained from the experience of mothers in caring for children with stunting in the riverside of Banjar Regency.

Surveying Child and Adolescent Inpatient Psychiatric Units: Demographics, Policies, and Practice

ABSTRACT Background The increasing demand for acute inpatient psychiatric unit (IPU) treatment for children and adolescents in recent years has put significant pressure on hospital systems to provide efficient and effective care. However, there is a gap in the literature regarding the characteristics of IPU care for children and adolescents in the US, making it difficult for institutions to benchmark their performance against nationwide standards or understand generalizability of existing research. Objective To address this gap in the literature by beginning to collect descriptive data on significant variables for youth care from a geographically and institutionally diverse group of on Child and Adolescent IPUs. Method A multi-institutional research team conducted a nationwide (US) survey of child and adolescent IPU clinicians using snowball sampling. Recruitment e-mails were sent to IPU groups in the American Psychological Association and the American Academy Child and Adolescent Psychiatry. Results The study yielded data from 12 institutions with a total of 20 IPUs, representing over 23,000 admissions in the years 2019 and 2020. The results of the survey show wide variability in institutional definitions of key variables (such as readmissions and safety events) as well as large ranges in length of stay, restraints, seclusions, and safety events. Conclusion This study reveals the importance of IPU clinical researchers taking steps to build a robust evidence base for IPU care, including developing consensus definitions of key variables and conceptualizing why high degrees of variability exist in important variables of IPU care. The survey results provide valuable insights for hospital systems, policymakers, and clinicians in the field of child and adolescent psychiatry.

Adaption of a trigger tool to identify harmful incidents, no harm incidents, and near misses in prehospital emergency care of children.

The emergency medical service (EMS) addresses all chief complaints across all ages in various contexts. Children in EMS present a particular challenge due to their unique anatomical and physical properties, which require specific training that EMS clinicians often report lacking. This combination exposes children to incidents threatening patient safety. The most common method to highlight incidents is the incident reporting system. Studies have shown underreporting of such incidents, highlighting the need for multiple methods to measure and enhance patient safety in EMS for children. Thus, the aim of this study was to modify and adapt the current Ambulance TT for road-based EMS (ATT) to a pediatric version (pATT) with a guide containing definitions of triggers. The adaption of the ambulance trigger tool to a version suitable for children followed a stepwise manner, including (1) a review of previous literature to pinpoint areas of risk regarding patient safety among children in EMS. (2) Three sessions of expert panel discussions via video meetings were held to evaluate each trigger of the ATT in terms of clinical relevance, comprehensibility, language and areas of risk regarding patient safety among children in EMS. (3) Clinical use of the pATT along with Retrospective Record Review (RRR). (4) Calculation of Item-level validity index and positive predictive value (PPV) for each trigger. (5) calculate inter-rater reliability between two independent record reviewers. The literature search revealed 422 respective 561 articles in Cinahl and Medline where headlines and abstracts were read to identify areas posing risks to patient safety in EMS for children. During the structured discussions, one trigger was added to the existing 19 derived from the ATT, and the trigger definitions were modified to suit children. The three most common triggers identified in the 900 randomly selected records were deviation from treatment guidelines (63.9%), incomplete documentation (48.3%), and the patient is non conveyed after EMS assessment (41.1%). The positive triggers were categorized into near miss (54.6%), no harm incident (5.8%), and harmful incident (0.4%). Inter-rater reliability testing showed excellent agreement. This study demonstrates the adaptation of an existing trigger tool (ATT) to one suitable for children. It also shows that the trigger tool, along with retrospective record review, is a feasible method to evaluate patient safety in EMS, thus complementing existing methods.

O PAPEL DO PROFISSIONAL DE ENFERMAGEM NA ATENÇÃO A CRIANÇAS E ADOLESCENTES COM TRANSTORNO DO ESPECTRO AUTISTA: UMA REVISÃO SISTEMÁTICA

Among the professionals involved in the health care of children with Autism Spectrum Disorder (ASD), nurses stand out as the first to establish contact, maintaining significant proximity with this patient. However, the theme of nursing care aimed at childhood autism is still little disseminated in the scientific community and in the practice of nursing professionals, especially when the focus is the mental health of children and adolescents with ASD. The objective of this study is to investigate the fundamental role of nursing professionals in the care of children and adolescents with Autism Spectrum Disorder (ASD), with an emphasis on promoting the mental health of both these individuals and those who live directly with them. To this end, a qualitative and descriptive research was carried out based on a systematic bibliographic review using the descriptors “Autism Spectrum Disorder”, “Nursing”, “Mental health”, "Child", "Adolescent" in the scientific platforms Google Scholar, PUBMED, LILACS, SCIELO and MEDLINE. A total of 1,098 articles were identified, of which 1,090 were obtained from the Google Scholar database, 4 from MEDLINE, 3 from SCIELO, 1 from PUBMED and none from LILACS. Of this total, 28 were considered eligible after applying the inclusion and exclusion criteria. A huge gap was found in Brazilian research regarding the promotion of mental health of children and adolescents with ASD by nursing professionals. Therefore, it is considered urgent to conduct scientific studies that offer nurses more knowledge about ASD, helping them to develop a critical, analytical and humanized perspective.

Financial strain and resilience: a qualitative exploration of parental perspectives on caring for children with sickle cell disease in Ghana.

In Ghana, nearly one in four (25%) of the population are sickle cell disease carriers. Furthermore, 2% of all babies born (20 for every 1000 live births) has sickle cell disease. However, little is known about how parents negotiate the financial challenges facing parents of a child with sickle cell disease. This study explores the financial difficulties of parents and children living with sickle cell disease. The study adopted a qualitative approach. Twenty-seven parents were purposively selected from a sickle cell clinic in Accra, Ghana. Data collection was through an in-depth, face-to-face interview, using an interview guide based on the research objectives, and analyzed using thematic analysis. The findings showed that parents faced multiple financial difficulties (both direct and indirect) as they met the direct cost of medications, routine laboratory investigations, and hospital admissions. The National Health Insurance scheme does not wholly cover these costs. Families also describe more indirect costs, such as those associated with maintaining their child's well-being alongside those connected to their caring responsibilities, including the impact of giving up work and reducing working hours. Findings highlight the most pressing challenge, including the lack of access to financial support and a more general lack of understanding of the difficulties they faced on the part of policymakers. Supporting sickle cell parents' financial needs would improve their emotional and social well-being, enabling them to be more effective family carers.

The Impact of Family and Society on Women’s Career in Bangladesh

This paper aims at understanding factors that may lead woman to work professionally and balance their family responsibilities in Bangladesh. The study reveals that factors related to self-interest, economic gain, parental and spouse support, peer status, and lenient schedules are crucial enough to create an appetite for promotion. However global studies on workforce participation and women are economic initiatives lack understanding of the particular socio-cultural factors of Bangladeshi women. This research therefore seeks to fill this gap by exploring how professional dreaming is shaped by family responsibilities, culture and organizational practices. This research forms part of a qualitative study and employed semi-structured questionnaires to capture data from 30 professional women in Dhaka. According to education, profession, marital status criteria, participants were selected and open coded to find themes. The work also finds out that wives and mothers are among the most critical sources of support to empower females for dual responsibilities. Nonetheless, flexibility, which includes offering fewer working hours and more telecommuting opportunities, was another major factor hubs relied on to serve the same purpose of improving the women’s quality of life at the cost of their work-life balance. Nonetheless, supportive cultural factors such as motivators also have their limitations in promoting work life balance due to societal pressures and absence of polices such as child care in organizations. A range of participants described financial security and job satisfaction as the key motivation that determines career success that contributes to personal and social self-actualization. In this regard, the study emphasize on the need to adopt family agenda related policies and encourage cultural change that may enhance women’s career paths. To adequately satisfy women’s career motivation it is crucial to have a strong family support and adequate flexibility at workplace.

PREVALÊNCIA DOS SINTOMAS DO TDAH EM CRIANÇAS COM BAIXO RENDIMENTO ESCOLAR SUBMETIDAS AO P.A.P.E. NO ANO 2022 EM PRESIDENTE PRUDENTE

Specific learning disorder impairs the brain's ability to process information, affecting around 30-40% of students. These disorders represent 35-45% of mental health visits and 35% of visits to pediatricians. In 2018, Presidente Prudente/SP launched the Specialized Pedagogical Support Program (PAPE) to offer support to students with learning difficulties in the Municipal Network. The study, including 136 students evaluated by MTA-SNAP IV, revealed that ADHD and ODD are common in the school age group, especially in elementary school and more frequent among boys, with inattention being the main characteristic. The research highlighted the effectiveness of the questionnaire in improving intervention and support methods, improving students' quality of life and academic performance. Greater involvement of the Municipal Health Department is recommended to enhance children's care and learning, preventing future problems such as school dropout and difficulties in adult life.

A WOMAN UNITED WITH THE SACRIFICE OF CHRIST – BLESSED KLEMENSA STASZEWSKA OSU (1890–1943)

The aim of this article is to examine the charism of Blessed Klemensa Staszewska, with which she was endowed by God, and its relevance to all believers. The sources of this study are her “spiritual notes”, written at the instruction of her spiritual director, and her letters. The first stage of the study examines how Blessed Klemensa, accepting her Ursuline vocation, experienced the desire for a spousal bond with Jesus and to give to Him alone all that she is and all that she possesses. In the second part of the article, a study is carried out on the spiritual desire expressed by Blessed Klemensa in her plan of life, written on the day of her perpetual vows to unite herself to the Sacrifice of Christ and to His intentions and the inner disposition with which He offered Himself on the Cross. Here it was important to examine how Blessed Klemensa experienced all the tribulations and difficulties of life in union with Jesus. This dimension of her spiritual life can be regarded as prophetic for both consecrated and lay persons, because it concerns the universal priesthood resulting from baptismal consecration, which seems to be underestimated in Christian spirituality today. In the fourth and final part of the article, it is shown how Blessed Klemensa combined a deep spiritual life with her ministry of caring for children and the formation of young people. She maintained this life amidst her duties and responsibility for the Ursuline community throughout the hardships of World War II and when, after helping with heroic courage those sought by the Gestapo, she endured the cruelty of the concentration camp.