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BACKGROUND: The discontinuation of "Mother-Baby Friendly" accreditation, coupled with the impact of the COVID-19 pandemic, has contributed to reduced breastfeeding rates observed in parts of South Africa. Consequently, the Child, Youth and School Health cluster of the National Department of Health, with support from the World Health Organization and United Nations Children's Fund, organised a Mother-Baby Friendly initiative revitalisation workshop. METHODS: Held in Johannesburg, South Africa, on June 29-30, 2022, the workshop brought together local and international breastfeeding promotion experts to engage on issues related to the revitalisation of the Mother-Baby Friendly Initiative. The workshop included presentations and group sessions aimed at setting expectations, evaluating the Ten Steps to Successful Breastfeeding, and developing actionable revitalisation strategies. RESULTS: Inadequate monitoring of the Mother-Baby Friendly Initiative implementation and adherence to the Ten Steps was identified as a major implementation bottleneck. Participants identified steps ten (coordinating discharge so that parents and their infants have timely access to ongoing support and care), five (supporting mothers to initiate and maintain breastfeeding and manage common difficulties), and two (ensuring that staff have sufficient knowledge, competence, and skills to support breastfeeding) of the Baby-Friendly Hospital Initiative as the most difficult to implement. Step seven (enabling mothers and their infants to remain together and to practise rooming-in 24 h a day) was the least difficult to implement. Workshop participants identified the following proposed solutions to revitalise breastfeeding promotion: strengthening capacity building and mentorship, improving monitoring and accountability measures, and certification of facilities meeting the initiative's standards. CONCLUSION: Current breastfeeding policies and practices must be evaluated by the National Department of Health in collaboration with provincial and private representatives of the initiative to effectively revitalise the Mother-Baby Friendly Initiative. Moreover, an integrative monitoring framework must be developed through stakeholder engagement, role clarification, and ownership. While collaboration between the private and public sectors is required to promote training and communication within healthcare facilities and communities.
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Aleitamento Materno , Promoção da Saúde , Melhoria de Qualidade , Humanos , Aleitamento Materno/psicologia , África do Sul , Feminino , Recém-Nascido , Lactente , Mães/psicologia , COVID-19/prevenção & controle , COVID-19/epidemiologiaRESUMO
BACKGROUND/AIM: Picky eating is a common childhood phenomenon that impacts many families' occupations surrounding mealtimes. Evidence of the effectiveness of Occupational Performance Coaching (OPC) for caregivers of children suggests it may represent a useful occupation-focused intervention for parents of picky eaters. Using an OPC-targeted intervention, this study aims to report preliminary effectiveness, explore the experience of parents' participation, and investigate factors that influence the OPC intervention. METHODS: This study used an explanatory mixed-method design. Parent participants (n = 8) were recruited via purposive sampling and engaged in three sessions of OPC delivered via an online platform between October and December 2022. Standardised assessments were completed before and after OPC and a qualitative semi-structured interview two weeks after the final OPC session. Variables were analysed descriptively, and independent t tests were performed to compare scores on each standardised assessment pre- and post-intervention. Pearson's correlation analyses were conducted to consider associations between resistance to change and the extent of change in each outcome measure. Reflexive thematic analysis was conducted on postintervention interview transcripts. CONSUMER AND COMMUNITY INVOLVEMENT: Consumer invovlement was limited to parents feedback on their experiences of the intervention. RESULTS: Improvements in occupational performance as measured by the COPM change score were statistically significant (p = <0.001). Child eating behaviours, as measured by the CEBQ Food Fussiness subscale change score (p = 0.01) and BPFAS change score (p = 0.02), demonstrated significant improvements. The extent to which parents viewed these behaviours as problematic as measured by the BPFAS problem change score, showed a significant reduction (p = <0.001). Three themes emerged from interviews with parents: small changes beyond nutrition, parents supported as the experts, and what parents value within an intervention. CONCLUSION: Targeted OPC intervention delivered online by an occupational therapist may be an effective intervention for parents of picky eaters. Future studies using randomised controls are required before OPC can be routinely recommended in a clinical setting for the management of picky eating in children.
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BACKGROUND: Increasingly, health services are adopting short-term consultative therapy models, such as single session therapy, to cope with increased service demands, finite budgets and changing consumer expectations. Within the paediatric sub-specialty of child development and behaviour, allied health clinicians are central to supporting families to understand their children, provide therapeutic interventions and help achieve optimal developmental and health outcomes. This study aimed to describe parents'/caregivers' engagement during advanced allied health consultations utilizing a single session therapy framework for managing neurodevelopmental and behavioural concerns in children. METHODS: Between March to June 2021, 14 parents participated in a qualitative study involving focus groups. Reflexive thematic analysis was used to code and interpret the data to understand and explore families' engagement in single session therapy. RESULTS: Three overarching themes relating to parents' engagement during consultations emerged from the data: connection with the clinician, parental attributes and organizational influences. Clinician connection was the prominent construct that enhanced parent attributes and the positive perception of the organization in an ongoing manner. There was a complex interplay between the behavioural and affective components of the clinician, parents and the organization to create mutual presence, valued time, understanding and action. CONCLUSIONS: This study demonstrates the importance of clinician connection, parental attributes and organizational influences to enhance engagement in therapeutic consultations. These factors are interrelated and are a complex blend of behaviour and internal states and highly individualized for each family. Understanding how services can continue to engage families is integral to ongoing sustainability and overall health and well-being.
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Desenvolvimento Infantil , Pais , Criança , Humanos , Pais/psicologia , Pesquisa Qualitativa , Grupos Focais , CuidadoresRESUMO
INTRODUCTION: Transition from primary school to high school can be a time of significant stress for young people. Social connection may mitigate the stress experienced by young people, yet their play activities, which are a key source of connection and friendship, have not been examined. The aim of the study was to capture the play behaviours of children in outdoor school environments. METHODS: Children's play behaviours in their final year of primary school and those in their first year of high school were captured using a standardised tool (Tool for Observing Play Outdoors). Observations occurred in school outdoor environments during break times in the South Australian autumn of 2021. Frequencies and types of play were compared between year levels using descriptive statistics and contingency tables. Data were collected from four schools (two metropolitan and two regional), which were all from a similar level on the Index of Educational Disadvantage. Four observation sessions were held at each school. RESULTS: Parents of 42 (16 girls) primary school students and 85 (33 girls) high school students gave permission for their children to participate. Physical play was the most frequent activity observed in both primary school and high school followed by expressive play. Year level was significantly associated with the type of play engaged in. CONCLUSION: Findings demonstrate children in the first year of high school continue to engage in physical and social play albeit less than those in the final year of primary school. Further research is needed to determine whether the physical and social environment or onset of puberty is more influential on changes in children's play.
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Exercício Físico , Terapia Ocupacional , Criança , Feminino , Humanos , Adolescente , Austrália , Instituições Acadêmicas , Pais , Jogos e BrinquedosRESUMO
BACKGROUND/AIM: Picky eating is a common childhood phenomenon in younger children, impacting family relationships and mealtimes. Limited qualitative studies have explored parents' experiences of parenting an extremely picky eater. This study aimed to address this gap. METHODS: This exploratory qualitative research design included participants who were Australian-based parents (n = 10) of children aged 2-6 years with a minimum picky eating score of 3.33, indicating extreme picky eating, on the Food Fussiness subscale of the Child Eating Behavior Questionnaire (CEBQ). Parents were interviewed online via Zoom using semi-structured interviews focused on their experiences of having a child who is a picky eater. Reflexive thematic analysis was used to analyze the data. RESULTS: Five themes were identified: 1: The picky eating journey for parents. 2: Picky eating impacts families and mealtimes. 3: Parents have attempted multiple strategies to manage picky eating. 4: Emotions associated with parenting an extremely picky eater. 5: Parents of extremely picky eaters have a positive outlook for the future. CONCLUSION: This qualitative study demonstrates that parents' experiences of parenting an extremely picky eater are varied. Parents desire health professionals who listen to their concerns and provide evidence-based knowledge around parent feeding practices to positively impact picky eating.
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Preferências Alimentares , Pais , Criança , Humanos , Preferências Alimentares/psicologia , Austrália , Pais/psicologia , Emoções , Pesquisa Qualitativa , Inquéritos e Questionários , Comportamento AlimentarRESUMO
BACKGROUND/AIM: Childhood picky eating occurs when there is limited intake or variety of food and/or unwillingness to try new foods. Within research settings, standardised assessments are used to describe picky eating behaviours in children. However, little is known about assessment practices of occupational therapists. Similarly, occupational therapy interventions for picky eating in the literature focus on; providing strategies for parents, and working with the child on self-feeding skills. Despite this, interventions and strategies utilised by occupational therapists in clinical practice within an Australian health-care context are unknown. This study examines Australian health professionals' observations of picky eating behaviours, the use of childhood picky eating assessments and interventions, and differences between occupational therapists and other professionals. METHODS: Health professionals (n = 179) were recruited through professional organisations, such as Occupational Therapy Australia. Participants completed an online survey between March and May 2021. Independent variables were reported using descriptive statistics, with logistic regression used to consider differences between occupational therapists and other health professionals. Conventional content analysis was used to analyse responses to open-ended questions. RESULTS: The final sample included 109 eligible participants, with an average of 8.5 years working with picky eaters. Results indicated picky eating behaviours aligned with those reported in the literature. Participants relied on clinical observations and workplace designed assessments. The most common interventions were education, coaching, and the sequential oral sensory approach to feeding. Occupational therapy participants were significantly more likely than other health professional participants to report always using coaching and education. CONCLUSION: Although few health professionals used standardised or validated assessments, the use of education and coaching by occupational therapists aligned with the literature. Results highlight the need for more rigorous investigation to determine the sensitivity of current assessments to differentiate between clinical and typical picky eating, and the effectiveness of interventions for childhood picky eating.
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Seletividade Alimentar , Terapia Ocupacional , Humanos , Criança , Preferências Alimentares , Austrália , Pais , Inquéritos e QuestionáriosRESUMO
Aim: Older adults represent a growing demographic in Australia who are at an increased risk of isolation, loneliness, and experiencing poorer overall health. Thus, the need for understanding factors that influence older adults' wellbeing is important. Emergent research into adult playfulness has shown positive associations with indicators of wellbeing, but limited research has been conducted in older adults (60+). This study investigated whether types of playfulness present in Australian older adults (60+) were predictive of their wellbeing.Method: An online survey was administered (n = 123) using the Other-directed, Light-hearted, Intellectual, Whimsical (OLIW) Playfulness Scale and the PERMA-Profiler wellbeing measure to explore playfulness types and its influence on self-reported wellbeing. Multiple linear regression analysis with bootstrapping was completed to determine if any significant relationships between OLIW and PERMA-Profiler subscales existed.Results: Playfulness was a significant predictor of wellbeing. The OLIW Other-directed subscale (enjoyment of others, using playfulness in tense situations) was the greatest predictor of PERMA-Profiler subscales with OLIW Intellectual and Whimsical subscales making smaller contributions.Conclusion/implications: Playfulness was shown to be a significant contributor to wellbeing in older adults and should be used as a part of occupational therapy intervention, especially when considering social activities.
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Solidão , Jogos e Brinquedos , Humanos , Idoso , Autorrelato , Austrália , AnsiedadeRESUMO
The health benefits and importance of family mealtimes have been extensively documented. Picky eating can impact this complex activity and has numerous extrinsic (or external) and intrinsic (or internal) features. Occupational therapists work with children and their families by looking at both intrinsic and extrinsic influences and are therefore well-placed to work within this context. This scoping review comprises a comprehensive search of key health industry databases using pre-determined search terms. A robust screening process took place using the authors pre-agreed inclusion and exclusion criteria. There were 80 studies that met the inclusion criteria, which were then mapped using content analysis. The most common assessments used to identify picky eating relied on parental reports and recall. Often additional assessments were included in studies to identify both the intrinsic and extrinsic features and presentation. The most common reported intrinsic features of the child who is a picky eater included increased sensitivity particularly to taste and smell and the child's personality. Extrinsic features which appear to increase the likelihood of picky eating are authoritarian parenting, rewards for eating, and pressuring the child to eat. Most commonly reported extrinsic features that decrease the likelihood of picky eating are family meals, responsive parents, and involving the child in the preparation of food. In conclusion, there is a lack of published papers addressing the role of occupational therapists in the assessment and identification of picky eating in children. There appears to be a complex interplay between intrinsic and extrinsic features which impact caregiver responses and therefore on the picky eater.
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Seletividade Alimentar , Criança , Comportamento Infantil , Ingestão de Alimentos , Comportamento Alimentar , Preferências Alimentares , Humanos , Relações Pais-Filho , Poder FamiliarRESUMO
Intergenerational programs have long been identified as a way of promoting health and well-being for participants. Continuing such programs during pandemic restrictions is challenging and requires a novel approach. This community case study describes the use of co-design to create a high-level intergenerational program model, adapt it to specific community needs, and deliver it virtually with the aid of modern communication technology. Interviews conducted after the program had finished indicated that despite the challenges and limitations of the virtual environment, meaningful connections were achieved across three generations. The high-level program model may serve as a basis for other programs wanting to explore this area.
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COVID-19 , Pandemias , Humanos , Longevidade , Pandemias/prevenção & controle , SARS-CoV-2RESUMO
Playfulness is well researched in children; however, much less is known about its impact on the well-being of adults. To investigate the relationship between playfulness and well-being in Australian adults. Participants (N = 175) completed the Other-directed, Lighthearted, Intellectual, and Whimsical (OLIW) scale for playfulness and the Positive Emotion, Engagement, Relationship, Meaning, and Accomplishment (PERMA-Profiler) scale for well-being through an online survey. Multiple regression analyses with bootstrapping were completed to investigate whether playfulness predicted well-being. Six of the eight regression models analyzed contained significant predictors of well-being in adults. Adult playfulness exhibited the most robust positive relations with positive emotion, engagement while with others and during activities, relationships, finding meaning in one's life, and overall well-being. Playfulness was significantly related to several different indicators of well-being in adults. Therefore, incorporating elements of playfulness during occupational engagement could potentially nurture an individual's well-being.
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Jogos e Brinquedos , Adulto , Austrália , Criança , Humanos , Inquéritos e QuestionáriosRESUMO
AIM: This study investigated the impact of a transdisciplinary advanced allied health practitioner (AAHP) in a public hospital general paediatric outpatient department for children referred for concerns with neurodevelopment, learning and/or behaviour. It was hypothesised that time from referral to initial consultation and diagnosis was reduced for children initially assessed by AAHP. It was also hypothesised that children seen by AAHP were less likely to require a medical specialist appointment. METHODS: De-identifiable data were gathered from hospital records both retrospectively and prospectively for each group. Data were collected from: 75 children who attended a medical consultation only clinic in 2014; 75 children who attended an AAHP clinic and a medical officer in 2014 and 75 children who attended an AAHP clinic and a medical officer 2 years after establishment in 2016/2017. RESULTS: On average, 52% children were managed independently by the AAHP. Wait time from referral to consultation significantly decreased from 169 days to 48 days. Similarly, time from referral to diagnosis significantly reduced by almost a half, from 57.2 to 30.59 weeks. CONCLUSION: This study provides preliminary evidence that utilisation of transdisciplinary AAHPs in general paediatric outpatient departments may reduce waitlists, reduce amount of medical specialist appointments required and provide earlier diagnosis for children with neurodevelopmental, behavioural and/or learning difficulties.
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Pacientes Ambulatoriais , Encaminhamento e Consulta , Instituições de Assistência Ambulatorial , Agendamento de Consultas , Criança , Humanos , Estudos RetrospectivosRESUMO
INTRODUCTION: Toileting is a key activity of daily living and an important milestone in children's development. Difficulties with this process can cause stress to both child and parents and negatively affect their wellbeing. This study compared the perceived parental competence and child wellbeing of families attending a group-based workshop on toileting issues with families attending an individual appointment at a continence clinic. METHODS: All parents attending the workshops and attending the clinic between July 2016 and December 2017 were invited to participate in the study. The children were aged between 2 and 13 years. Three measures were used: 1) Parenting Sense of Competence Scale; (2) the Revised Quality of Life Questionnaire for Children (KINDLR) and (3) Parent self-assessment of information and support needs. Participants completed all measures at three points: prior to intervention, 1 week and 1 month post-intervention. RESULTS: Data were collected from 89 parents attending the workshops and 46 parents attending the clinic. Children were not assessed. Non-parametric tests were used to examine between group differences. Within group changes overtime were examined using Friedman's two-way analysis of variance. Parents who attended the workshop showed significant increases in parenting sense of competence and perceived child quality of life post-intervention. Although there were significant differences between and pre- and post-measures for workshop attendees, there were no significant differences found between the two groups indicating that both forms of intervention had beneficial results. CONCLUSION: These results suggest that group-based workshops can positively impact parents' perceived competence in managing their child's toileting issues and wellbeing. Further research is recommended to explore the relationship between parenting competence and child wellbeing and to determine which aspects of the workshops were most beneficial.
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Aconselhamento/métodos , Poder Familiar/psicologia , Pais/educação , Psicoterapia de Grupo/métodos , Treinamento no Uso de Banheiro , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Relações Pais-Filho , Pais/psicologia , Qualidade de Vida , Apoio SocialRESUMO
BACKGROUND: Functional bladder and bowel problems are common in children and have a serious psychological as well as physical impact. The objective of this scoping review was to synthesise evidence on the impact of such conditions both on children's quality of life (QOL) and their parents. METHODS: The scoping review followed Arksey and O'Malley's framework. Relevant studies were identified by a comprehensive search of scientific databases. Inclusion criteria focused on children with bladder and bowel dysfunction, their QOL, and impact on parents. Studies were analysed for aims, study populations, measures, and results. RESULTS: A total of 783 records were retrieved with 30 meeting the criteria. Most studies found that QOL was reduced in children with nocturnal enuresis, day bladder dysfunction, bowel dysfunction, and combined bladder and bowel dysfunction. Parents' QOL and social-emotional functioning were also negatively affected. CONCLUSIONS: Functional bladder and bowel problems should be identified and treated as early as possible to minimise negative impacts on QOL of children and their carers. Future research should focus on how to best provide early and effective intervention in the most accessible manner.
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Constipação Intestinal/psicologia , Incontinência Fecal/psicologia , Pais/psicologia , Qualidade de Vida , Incontinência Urinária/psicologia , Adulto , Criança , Indicadores Básicos de Saúde , Humanos , Índice de Gravidade de Doença , Comportamento SocialRESUMO
Establishing fidelity processes and measures is an important step in the development of interventions. Accurate referencing, naming of interventions and robust discussion of deviations from the theories, methods or terminology underpinning interventions support the fidelity of future applications of interventions in research and clinical settings. This commentary clarifies the establishment of fidelity for Occupational Performance Coaching (OPC) in relation to a recent article on this topic by Dunn and colleagues. Fundamental flaws in the referencing, labelling, theoretical underpinnings and methods inaccurately described as OPC are outlined. Guidance in establishing fidelity for future applications of OPC is provided.
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Terapia Ocupacional/métodos , Projetos de Pesquisa/normas , Terminologia como Assunto , HumanosRESUMO
PURPOSE: This study explored collaborative goal setting with children, parents, and teachers, and children's reasons for their goals based on their perceived self-efficacy, using the Austrian-German Perceived Efficacy and Goal Setting System (AG-PEGS). METHOD: Thirty-eight children from age 5 to 10 years (referred to occupational therapists because of difficulties in performing everyday activities), their parents and teachers participated in this mixed methods study. Participants' goals were analyzed using descriptive statistics and content analysis. Data were grouped into thematic categories, and attributed to health factors according to the International Classification of Functioning, Disability, and Health-Children & Youth Version (ICF-CY). RESULTS: Children's responses underlined the significance of self-efficacy and participation for a child's health and well-being. They gave priority to their independence, competence, and joy in meaningful everyday activities and indicated social motives such as belonging to and being accepted by others for their mainly participation-oriented goals. Parents' main concerns were related to school task performance, whereas teachers mainly chose body functions and school activities to be the focus of occupational therapy intervention. CONCLUSIONS: Exploring clients' priorities, the meanings they attributed to activities in daily life, and their underlying motives for goals should be part of therapeutic intervention. Children and their caregivers are valid and important sources for therapeutic goal setting. Basic human needs, e.g., for relatedness, competence (self-efficacy), autonomy, and meaningful personal orientation, should be considered when prioritizing goals for intervention. Implications for Rehabilitation Children are a valid and important source for therapeutic goal setting. Children's goals focused on activities and participation in all life areas, and half of the parents' goals on activities as relevant for productivity (followed by self-care and leisure), while teachers tended to prioritize goals at the body functions and structures level. The experience of their task performance affecting participation, and the basic needs for independence, relatedness (belonging to and being accepted by others), competence (self-efficacy), and joy through engagement in personally meaningful activities are main motives for children with developmental disabilities to choose their goals for intervention. A client-centred approach in working with children with developmental disabilities requires time and attention for exploring meaning-attributed activities for children and their proxies when collaboratively setting goals.
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Deficiências do Desenvolvimento/reabilitação , Crianças com Deficiência/reabilitação , Objetivos , Terapia Ocupacional/métodos , Pais , Professores Escolares , Atividades Cotidianas , Adulto , Áustria , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Autocuidado , Autoeficácia , Comportamento SocialRESUMO
BACKGROUND: The Developmental Coordination Disorder Questionnaire 2007 (DCDQ'07) is widely used internationally and is a useful measure to assist in the diagnosis of developmental coordination disorder. The aim of this study was to translate the DCDQ'07 into German, test the psychometric properties, and establish cutoff scores for the 5.0 to 7.11 age group. MATERIALS AND METHODS: A six-stage cross-cultural adaptation process was used. The psychometric properties of the DCDQ-German (DCDQ-G) were tested with a clinic sample of 55 children (mean age: 6.1 years) and community sample of 67 children (mean age: 5.6 years). RESULTS: The internal consistency was high. Specificity and sensitivity for the total sample were 52.4 and 90%, respectively. Sensitivity for the clinic sample was 72.7% and specificity was 95%. The community sample had a sensitivity of 30% and a specificity of 86.7%. CONCLUSION: The DCDQ-G is a valid instrument for use with a clinic population in the 5.0 to 7.11 age group. Research into older age groups is ongoing.
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Transtornos das Habilidades Motoras/diagnóstico , Inquéritos e Questionários , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Psicometria , Sensibilidade e Especificidade , TraduçõesRESUMO
Play is commonly acknowledged as being important to children's development. School-aged children with developmental coordination disorder (DCD) are known to be less involved in play and more socially isolated than their typically developing peers, but little is known about play of preschool children with DCD. Using a quasi-experimental design, developmental play skills and frequency in engagement in play of two independent groups of preschool children aged 4 to 6 years with (n = 32) and without (n = 31) probable DCD were compared. Play skills were assessed using the Revised Knox Preschool Play Scales and the Play Observation Scale based on 30 minutes of videotape of free play at preschool. Preschool children with probable DCD had a lower developmental play age and engaged less frequently in play than their typically developing peers. Given the importance of play, children with DCD need to be identified and supported to enable them to play at preschool similarly to their peers. [OTJR: Occupation, Participation and Health 2013;33(4):198-208.].
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We conducted a study in order to confirm the eligibility of fosfomycin trometamol as an alternative treatment to quinolones for urinary tract infections. Among 102 quinolone-resistant Enterobacteriaceae strains, resistance rates to first line-prescribed antibiotics were above 77%. The resistance rate to fosfomycin was 2%.
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Antibacterianos/farmacologia , Enterobacteriaceae/efeitos dos fármacos , Fluoroquinolonas/farmacologia , Fosfomicina/farmacologia , Farmacorresistência Bacteriana , Infecções por Enterobacteriaceae/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Senegal , Infecções Urinárias/microbiologiaRESUMO
OBJECTIVES: To assess overall resistance rates and risk factors for resistance to ampicillin, co-amoxiclav, nalidixic acid, fluoroquinolones and trimethoprim/sulfamethoxazole in Escherichia coli strains isolated from outpatients with acute urinary tract infection in Dakar (Senegal). PATIENTS AND METHODS: From June 2001 to June 2003, a prospective study was performed among Senegalese outpatients consulting at the Institut Pasteur of Dakar for urine analysis. Evaluated risk factors were: age, gender, prior hospitalization, antibiotic exposure, urinary tract infection and urinary catheter. RESULTS: A total of 398 non-duplicate, consecutive, biologically significant E. coli were isolated. The levels of antibiotic resistance in Dakar appeared dramatic and worrisome with resistance rates ranging from 18.6% for fluoroquinolones to 73.6% for ampicillin. With the exception of the presence of urinary catheter, the risk factors identified were consistent with data previously reported in developed countries. CONCLUSIONS: We hope our results will assist medical authorities in the development of appropriate control strategies.