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1.
Pediatrics ; 136(2): 272-80, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26148947

RESUMO

OBJECTIVE: More than 200 million children globally do not attain their developmental potential. We hypothesized that a parent training program could be integrated into primary health center visits and benefit child development. METHODS: We conducted a cluster randomized trial in the Caribbean (Jamaica, Antigua, and St Lucia). Fifteen centers were randomly assigned to the control (n = 250 mother-child pairs) and 14 to the intervention (n = 251 mother-child pairs) groups. Participants were recruited at the 6- to 8-week child health visit. The intervention used group delivery at 5 routine visits from age 3 to 18 months and comprised short films of child development messages, which were shown in the waiting area; discussion and demonstration led by community health workers; and mothers' practice of activities. Nurses distributed message cards and a few play materials. Primary outcomes were child cognition, language, and hand-eye coordination and secondary outcomes were caregiver knowledge, practices, maternal depression, and child growth, measured after the 18-month visit. RESULTS: Eight-five percent of enrolled children were tested (control = 210, intervention = 216). Loss did not differ by group. Multilevel analyses showed significant benefits for cognitive development (3.09 points; 95% confidence interval: 1.31 to 4.87 points; effect size: 0.3 SDs). There were no other child benefits. There was a significant benefit to parenting knowledge (treatment effect: 1.59; 95% confidence interval: 1.01 to 2.17; effect size: 0.4). CONCLUSIONS: An innovative parenting intervention, requiring no additional clinic staff or mothers' time, was integrated into health services, with benefits to child cognitive development and parent knowledge. This is a promising strategy that merits further evaluation at scale.


Assuntos
Desenvolvimento Infantil , Intervenção Educacional Precoce , Poder Familiar , Atenção Primária à Saúde , Feminino , Humanos , Lactente , Jamaica , Masculino , Mães
2.
JAMA Neurol ; 71(5): 575-80, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24590389

RESUMO

IMPORTANCE: Juvenile myasthenia gravis (MG) is a relatively rare autoimmune disorder. The comparative efficacy of plasmapheresis (PLEX) vs immunoglobulin as maintenance therapy is unclear for this childhood disease. OBJECTIVE: To determine whether PLEX or intravenous immunoglobulin (IVIG) therapy is more effective as maintenance therapy in this disease. DESIGN, SETTING, AND PARTICIPANTS: This retrospective analysis over a 33-year period involved 54 children and adolescents with juvenile MG at a specialized neuromuscular clinic and electromyography laboratory at a tertiary care academic pediatric hospital. INTERVENTIONS: Plasmapheresis and IVIG. MAIN OUTCOMES AND MEASURES: Response to treatment was measured by both improvement in objective physical examination findings and the patients' reported improvement in symptoms and functional abilities. RESULTS: Subjective and objective outcomes correlated well. Both PLEX and IVIG had high response rates. Of the 27 patients with generalized juvenile MG receiving PLEX, IVIG, or both treatments, 7 of 7 patients treated with PLEX alone responded, 5 of 10 patients treated with IVIG alone responded, and 9 of 10 patients who received both responded. There was a significant difference in response rates between patients who received PLEX vs IVIG (P = .04). The youngest age at which PLEX was initiated via peripheral venous access was 9 years, while the youngest child who received IVIG was 9 months old. Thymectomy was performed in 17 children, of whom 11 experienced significant postoperative improvement. CONCLUSIONS AND RELEVANCE: This study provides class III evidence that PLEX and IVIG both have high response rates as maintenance therapies and are reasonable therapeutic options for juvenile MG. Plasmapheresis may have a more consistent response rate than IVIG in this setting. These findings will provide some guidance regarding the approach to therapy for juvenile MG, especially as the results differ somewhat from those of studies focusing on adult MG.


Assuntos
Imunoglobulinas Intravenosas/administração & dosagem , Miastenia Gravis/diagnóstico , Miastenia Gravis/terapia , Plasmaferese/métodos , Adolescente , Fatores Etários , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Masculino , Brometo de Piridostigmina/administração & dosagem , Estudos Retrospectivos
3.
Lancet ; 378(9799): 1325-38, 2011 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-21944375

RESUMO

Inequality between and within populations has origins in adverse early experiences. Developmental neuroscience shows how early biological and psychosocial experiences affect brain development. We previously identified inadequate cognitive stimulation, stunting, iodine deficiency, and iron-deficiency anaemia as key risks that prevent millions of young children from attaining their developmental potential. Recent research emphasises the importance of these risks, strengthens the evidence for other risk factors including intrauterine growth restriction, malaria, lead exposure, HIV infection, maternal depression, institutionalisation, and exposure to societal violence, and identifies protective factors such as breastfeeding and maternal education. Evidence on risks resulting from prenatal maternal nutrition, maternal stress, and families affected with HIV is emerging. Interventions are urgently needed to reduce children's risk exposure and to promote development in affected children. Our goal is to provide information to help the setting of priorities for early child development programmes and policies to benefit the world's poorest children and reduce persistent inequalities.


Assuntos
Desenvolvimento Infantil , Humanos
4.
Dev Med Child Neurol ; 52(9): 831-6, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20345956

RESUMO

AIM: The aim of this study was to determine the effects of early childhood stunting (height for age 2SD or more below reference values) and interventions on fine motor abilities at 11 to 12 years, and the relationship between fine motor abilities and school achievement and intelligence. METHOD: A cohort of stunted children who had participated in a randomized trial of psychosocial stimulation and/or nutritional supplementation in early childhood was compared with a group of non-stunted children. Fine motor abilities were assessed in 116 stunted (67 males, 49 females) and 80 non-stunted children (43 males, 37 females) at a mean age of 11 years 8 months (SD 4.3 mo) and 11 years 9 months (SD 3.8 mo) respectively. Testers were blind to the children's group assignment. RESULTS: Two fine motor factors were derived: rapid sequential continuous movements (RSCM) and dexterity. No effect of the early intervention was found. RSCM scores were lower in the stunted group than in the non-stunted group (p=0.01), but differences in dexterity were not significant (p=0.18) after adjusting for social background. Among stunted children, the RSCM score was significantly associated with IQ (p=0.04) and school achievement (all p<0.05). INTERPRETATION: Stunting in early childhood is associated with poor scores on tests of rapid sequential continuous hand movements in later childhood. Children with poorer scores are at greater risk for low IQs and low levels of school achievement.


Assuntos
Transtornos do Crescimento/complicações , Transtornos das Habilidades Motoras/complicações , Criança , Pré-Escolar , Estudos de Coortes , Escolaridade , Feminino , Seguimentos , Transtornos do Crescimento/dietoterapia , Transtornos do Crescimento/terapia , Mãos , Humanos , Lactente , Inteligência , Masculino , Destreza Motora , Índice de Gravidade de Doença , Resultado do Tratamento
5.
J Nutr ; 137(11): 2464-9, 2007 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17951486

RESUMO

Stunting is associated with deficits in cognition and school achievement from early childhood to late adolescence; however, there has been little investigation of emotional and behavioral outcomes. The objective of this study was to determine whether linear growth retardation (stunting) in early childhood is associated with poorer psychological functioning in late adolescence. The study was a prospective cohort study of stunted and nonstunted children. Participants were identified at age 9-24 mo by a survey of poor neighborhoods in Kingston, Jamaica, and a 2-y intervention trial of supplementation and stimulation was conducted in the stunted children. Psychological functioning was assessed at age 17 y in 103 of 129 stunted children enrolled and 64 of 84 nonstunted participants. Anxiety, depressive symptoms, self-esteem, and antisocial behavior were reported by participants using interviewer-administered questionnaires and attention deficit, hyperactivity, and oppositional behavior were reported by parent interviews. The stunted participants reported significantly more anxiety (regression coefficient = 3.03; 95% CI = 0.99, 5.08) and depressive symptoms (0.37; 95% CI = 0.01, 0.72) and lower self-esteem (-1.67; 95% CI = -0.38, -2.97) than nonstunted participants and were reported by their parents to be more hyperactive (1.29; 95% CI = 0.12, 2.46). Effect sizes were 0.4-0.5 SD. Participants who received stimulation in early childhood differed from the nonstunted group in hyperactivity only. Children stunted before age 2 y thus have poorer emotional and behavioral outcomes in late adolescence. The findings expand the range of disadvantages associated with early stunting, which affects 151 million children <5 y old in developing countries.


Assuntos
Transtornos da Nutrição Infantil/psicologia , Transtornos do Crescimento/psicologia , Apoio Nutricional , Ludoterapia , Psicologia do Adolescente , Comportamento Social , Adolescente , Adulto , Criança , Estudos de Coortes , Suplementos Nutricionais , Emoções , Humanos , Estudos Prospectivos , Valores de Referência , Reprodutibilidade dos Testes , Autoimagem , Apoio Social , Inquéritos e Questionários
6.
BMJ ; 333(7566): 472, 2006 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-16877454

RESUMO

OBJECTIVE: To determine whether dietary supplementation or psychosocial stimulation given to growth retarded (stunted) children age 9-24 months has long term benefits for their psychosocial functioning in late adolescence. DESIGN: Sixteen year follow-up study of a randomised controlled trial. SETTING: Poor neighbourhoods in Kingston, Jamaica. PARTICIPANTS: Of 129 stunted children identified at age 9-24 months, 103 adolescents aged 17-18 were followed up. INTERVENTION: Supplementation with 1 kg milk based formula each week or psychosocial stimulation (weekly play sessions with mother and child), or both, for two years. MAIN OUTCOME MEASURES: Anxiety, depression, self esteem, and antisocial behaviour assessed by questionnaires administered by interviewers; attention deficit, hyperactivity, and oppositional behaviour assessed by interviews with parents. RESULTS: Primary analysis indicated that participants who received stimulation had significantly different overall scores from those who did not (F = 2.047, P = 0.049). Supplementation had no significant effect (F = 1.505, P = 0.17). Participants who received stimulation reported less anxiety (mean difference - 2.81, 95% confidence interval - 5.02 to - 0.61), less depression (- 0.43, - 0.78 to - 0.07), and higher self esteem (1.55, 0.08 to 3.02) and parents reported fewer attention problems (- 3.34, - 6.48 to - 0.19). These differences are equivalent to effect sizes of 0.40-0.49 standard deviations. CONCLUSIONS: Stimulation in early childhood has sustained benefits to stunted children's emotional outcomes and attention.


Assuntos
Suplementos Nutricionais , Transtornos do Crescimento/terapia , Transtornos Mentais/prevenção & controle , Ludoterapia/métodos , Adolescente , Estudos de Coortes , Seguimentos , Humanos , Lactente , Jamaica , Autoimagem , Comportamento Social
7.
J Allergy Clin Immunol ; 117(4): 909-15, 2006 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-16630951

RESUMO

BACKGROUND: In a cohort of children receiving highly active antiretroviral therapy (HAART) with sustained plasma HIV-1 RNA < 50 copies/mL, children who reached undetectable RNA after week 8 (slow responders, median: week 20) had higher HIV-1 intracellular DNA (HIV-1 DNA) and equal or greater CD4+ T-lymphocyte counts compared with children who reached undetectable plasma HIV-1 RNA by week 8 (rapid responders) throughout HAART. OBJECTIVE: To determine whether levels of T-cell receptor excision circles (TRECs) could explain the apparent inconsistency between the quantity of HIV-1 DNA and CD4+ T-lymphocyte counts in HIV-1-infected children receiving HAART with sustained virologic suppression. METHODS: T-cell receptor excision circles and HIV-1 DNA and plasma HIV-1 RNA were quantified longitudinally by PCR in 31 children (median age, 5.6 years) with sustained undetectable plasma HIV-1 RNA for >104 weeks of HAART. RESULTS: There was a positive correlation between TREC and HIV-1 DNA during HAART, notably at weeks 48 and 80 (P < .004). During the early stage of HAART, TREC levels positively correlated with CD4+ T-lymphocyte percentages (P < .02) and naive CD4+ T-lymphocyte counts (P < .001) and percentages (P = .05). Median TREC levels were consistently equal or higher in slow responders compared with rapid responders (P < .001) despite slow responders having consistently greater quantities of HIV-1 DNA. CONCLUSION: To maintain adequate levels of CD4+ T-lymphocytes, children with high HIV-1 DNA maintain high levels of TREC while receiving HAART. Thus, a thymic control mechanism is required to maintain new CD4+ T lymphocytes in the presence of persistent virus. CLINICAL IMPLICATIONS: The TREC level is a useful marker of thymic function in HIV-infected children.


Assuntos
Terapia Antirretroviral de Alta Atividade , Contagem de Linfócito CD4 , Infecções por HIV/tratamento farmacológico , Infecções por HIV/imunologia , Timo/imunologia , Timo/patologia , Adolescente , Sequência de Bases , Criança , Pré-Escolar , Estudos de Coortes , DNA/genética , DNA Viral/sangue , Rearranjo Gênico do Linfócito T , Infecções por HIV/genética , HIV-1 , Humanos , RNA Viral/sangue
8.
Lancet ; 366(9499): 1804-7, 2005 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-16298218

RESUMO

Growth retardation affects about a third of children younger than age 5 years in developing countries and is associated with poor development. Previously, we did a trial of nutritional supplementation and psychosocial stimulation in stunted children aged 9-24 months. Non-stunted children were also assessed. Both types of intervention improved development. We now present the effects of early interventions on cognition and education in 103 of the 129 stunted children and compare them with 64 of the 84 non-stunted children now aged 17-18 years. We recorded no significant effects of nutritional supplementation. Compared with no intervention, stimulation resulted in higher full scale IQ scores (coefficient 0.38, 95% CI 0.06-0.71, p=0.02) and higher scores on the verbal subscale (0.37, 0.07-0.68, p=0.02), Peabody picture vocabulary test (7.84, 0.73-14.95, p=0.03), verbal analogies (0.26, 0.03-0.49, p=0.03), and reading tests (4.73, 1.31-8.14, p=0.007, and 2.7, 1.12-4.37, p=0.001). Overall, stunted non-stimulated participants had significantly poorer scores than the non-stunted group on 11 of 12 cognitive and educational tests. Stunting in early childhood is associated with cognitive and educational deficits in late adolescence, which are reduced by stimulation at a young age.


Assuntos
Logro , Cognição , Transtornos do Crescimento/terapia , Apoio Nutricional , Apoio Social , Adolescente , Criança , Pré-Escolar , Humanos , Lactente , Testes de Inteligência , Jamaica , Ensaios Clínicos Controlados Aleatórios como Assunto , Análise de Regressão
9.
Am J Clin Nutr ; 82(2): 399-405, 2005 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-16087985

RESUMO

BACKGROUND: Undernourished children have poor levels of development that benefit from stimulation. Zinc deficiency is prevalent in undernourished children and may contribute to their poor development. OBJECTIVE: We assessed the effects of zinc supplementation and psychosocial stimulation given together or separately on the psychomotor development of undernourished children. DESIGN: This was a randomized controlled trial with 4 groups: stimulation alone, zinc supplementation alone, both interventions, and control (routine care only). Subjects were 114 children aged 9-30 mo and below -1.5 z scores of the National Center for Health Statistics weight-for-age references who were recruited from 18 health clinics. Clinics were randomly assigned to receive stimulation or not; individual children were randomly assigned to receive zinc or placebo. The stimulation program comprised weekly home visits during which play was demonstrated and maternal-child interactions were encouraged. The supplementation was 10 mg Zn as sulfate daily or placebo. Development (assessed by use of the Griffiths Mental Development Scales), length, and weight were measured at baseline and 6 mo later. Weekly morbidity histories were taken. RESULTS: Significant interactions were found between zinc supplementation and stimulation. Zinc benefited the developmental quotient only in children who received stimulation, and benefits from zinc to hand and eye coordination were greater in stimulated children. Zinc supplementation alone improved hand and eye coordination, and stimulation alone benefited the developmental quotient, hearing and speech, and performance. Zinc supplementation also reduced diarrheal morbidity but did not significantly improve growth. CONCLUSION: Zinc supplementation benefits development in undernourished children, and the benefits are enhanced if stimulation is also provided.


Assuntos
Desenvolvimento Infantil , Transtornos da Nutrição Infantil/fisiopatologia , Relações Mãe-Filho , Zinco/administração & dosagem , Pré-Escolar , Suplementos Nutricionais , Feminino , Crescimento , Humanos , Lactente , Masculino
10.
AIDS ; 19(4): 371-80, 2005 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-15750390

RESUMO

OBJECTIVE: The multidrug-resistance transporter gene (MDR1) encoding for P-glycoprotein (P-gp) and genes encoding for isoenzymes of cytochrome P450 (CYP) have an important role in transport and metabolism of antiretroviral agents. This research examined the impact of single nucleotide polymorphisms (SNP) of MDR1 and CYP genes on nelfinavir and efavirenz pharmacokinetics and the response to highly active antiretroviral therapy (HAART) in HIV-1 infected children. METHODS: Seventy-one HIV-1-infected children from PACTG 382 receiving nelfinavir, efavirenz and one or two nucleoside reverse transcriptase inhibitors had genomic DNA from PBMC evaluated for MDR1 and CYP SNP by real-time PCR. Plasma drug concentrations, CD4 lymphocyte counts and HIV-1 RNA were measured during HAART. RESULTS: The frequencies of C/C, C/T and T/T genotypes in the MDR1-3435-C-->T polymorphisms were 44% (n = 31), 46% (n = 33) and 10% (n = 7), respectively. Ninety-one percent of children with the C/T genotype reached plasma HIV-1 RNA < 400 copies/ml by week 8 compared to 59% of children with the C/C genotype (P = 0.01). Children with the C/T genotypes had higher 8 h postdose concentration (P = 0.02) and lower clearance rate (P = 0.04) for nelfinavir compared to those with the C/C genotype. The seven children with the T/T genotype had nelfinavir pharmacokinetics and virologic response similar to those with the C/C genotype. No compensatory polymorphisms were observed between MDR1 and CYP genotypes. CONCLUSIONS: HIV-1 infected children with the MDR1-3435-C/T genotype had more rapid virologic responses to HAART at week 8 with higher plasma nelfinavir concentrations compared to those with the C/C genotype. These findings suggest that P-gp may play an important role in the pharmacokinetics and virologic response to HAART containing nelfinavir.


Assuntos
Genes MDR/genética , Infecções por HIV/sangue , Inibidores da Protease de HIV/sangue , HIV-1/isolamento & purificação , Nelfinavir/sangue , Terapia Antirretroviral de Alta Atividade , Contagem de Linfócito CD4 , Criança , Pré-Escolar , Sistema Enzimático do Citocromo P-450/genética , Feminino , Genótipo , Infecções por HIV/tratamento farmacológico , Infecções por HIV/genética , Inibidores da Protease de HIV/uso terapêutico , Humanos , Masculino , Nelfinavir/uso terapêutico , Polimorfismo de Nucleotídeo Único , RNA Viral/sangue , Resultado do Tratamento
11.
J Nutr ; 134(6): 1417-23, 2004 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-15173406

RESUMO

It is estimated that 11% of births in developing counties are term low-birth-weight (LBW); however, there is limited information on the development of these infants. Our objectives were to determine the effect of psychosocial intervention on the development of LBW infants and to compare term LBW and normal-birth-weight (NBW) infants. Term LBW (n = 140) and NBW infants (n = 94) were enrolled from the main maternity hospital in Kingston, Jamaica. The LBW infants were randomly assigned to control or intervention comprising weekly home visits from birth to 8 wk and from 7 to 24 mo of age. Development was assessed at 15 and 24 mo with the Griffiths Scales. The intervention benefited the infants' developmental quotient (DQ, P < 0.05) and performance subscale at 15 mo (P < 0.02), the hand and eye (P < 0.05) and performance subscales (P < 0.02) at 24 mo, and home environment at 12 mo. The effect of the intervention on development was mediated in part by the improvement in the home environment. The control LBW infants had significantly lower scores than the NBW in DQ and several subscales, whereas there were no significant differences between the NBW and the LBW infants after intervention. In conclusion, term LBW was associated with developmental delays, which were reduced with psychosocial intervention.


Assuntos
Desenvolvimento Infantil , Visita Domiciliar , Recém-Nascido de Baixo Peso , Apoio Social , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Resultado do Tratamento
12.
J Infect Dis ; 189(7): 1216-20, 2004 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-15031790

RESUMO

The associations between human immunodeficiency virus type 1 (HIV-1) intracellular DNA and immunological markers were analyzed longitudinally for children with sustained, undetectable RNA levels while receiving highly active antiretroviral therapy (HAART) for >2 years. When DNA levels reached a plateau at week 104 of therapy, in contrast to findings for adults, there was no correlation between the CD4(+) : CD8(+) ratio and DNA levels (r=-0.02; P=.95), and naive CD4(+)CD45RA(+) lymphocytes predominated. These data suggest that the increased proportion of naive lymphocytes found in children are less susceptible to HIV-1 infection than are the memory lymphocytes that dominate immune reconstitution in adults.


Assuntos
Relação CD4-CD8 , Linfócitos T CD4-Positivos/imunologia , Linfócitos T CD8-Positivos/imunologia , DNA Viral/sangue , Infecções por HIV/imunologia , HIV-1/imunologia , Adolescente , Terapia Antirretroviral de Alta Atividade , Linfócitos T CD4-Positivos/virologia , Linfócitos T CD8-Positivos/virologia , Criança , Pré-Escolar , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , HIV-1/genética , Humanos , Estudos Longitudinais , Estudos Retrospectivos , Estatísticas não Paramétricas
13.
J Pediatr ; 143(5): 634-9, 2003 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-14615736

RESUMO

OBJECTIVES: To determine whether early psychosocial intervention with low birth weight term (LBW-T) infants improved cognition and behavior and to compare LBW-T with normal birth weight (NBW) infants. STUDY DESIGN: A randomized controlled trial was carried out in Kingston, Jamaica, with 140 LBW-T infants (weight<2500 g). The intervention comprised weekly home visits by paraprofessionals for the first 8 weeks of life aimed at improving maternal-child interaction. LBW-T and 94 matched NBW (weight 2500 to 4000 g) infants were recruited from the main maternity hospital. Main outcome measures were problem solving (2 means-end tests: cover and support) and 4 behavior ratings at 7 months. Analyses used were the t test for intervention effects and multiple regression to compare LBW and NBW infants. RESULTS: LBW-T intervened infants had higher scores than LBW-T control infants on the cover test (P<.05) and were more cooperative (P<.01) and happy (P<.05). LBW-T control infants had poorer scores on both the cover (P<.001) and support tests (P<.01), vocalized less (P<.02), and were less cooperative (P<.001), happy (P<.02), and active (P<.02) than NBW infants. LBW-T intervened infants had lower scores than NBW infants only on the support test (P<.05). CONCLUSIONS: Early low-cost intervention can improve cognition and behavior of LBW-T infants in developing countries.


Assuntos
Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/terapia , Deficiências do Desenvolvimento/epidemiologia , Deficiências do Desenvolvimento/terapia , Serviços de Assistência Domiciliar , Visita Domiciliar , Antropometria , Transtornos Cognitivos/diagnóstico , Deficiências do Desenvolvimento/diagnóstico , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Resolução de Problemas , Índice de Gravidade de Doença , Fatores Socioeconômicos
14.
Rev Panam Salud Publica ; 14(2): 97-103, 2003 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-14577932

RESUMO

OBJECTIVE: To obtain information on the perceptions and experiences of violence among secondary school students in Kingston, Jamaica, and its environs. METHODS: Data collection was carried out from September through December 1998. Two researchers administered questionnaires in 11 randomly selected secondary schools, to a total of 1 710 students who were in either grade 7 or grade 9 and who were aged 9-17 years old (mean of 13.2 years). Frequency distributions of the responses were compared by gender, age, grade level, socioeconomic status, and school type. RESULTS: Seventy-five percent of the students thought that someone who was reluctant to fight would be "picked on" more, 89% thought it generally wrong to hit other people, and 91% thought it wrong to insult other people. Eighty-four percent knew of students who carried knives or blades from such items as a scalpel or a utility knife to school, and 89% were worried about violence at school. Thirty-three percent had been victims of violence, and 60% had a family member who had been a victim of violence. Eighty-two percent thought that violent television shows could increase aggressive behavior. Factor analysis of selected responses was carried out, yielding five factors: neighborhood violence, school violence, perceptions of acceptable behaviors, level of concern about violence, and general experiences and perceptions of violence. The factors varied with gender, age, grade level, socioeconomic status, and school type. CONCLUSIONS: These results will help focus interventions aimed at reducing violence, provide a baseline for later comparisons of perceptions and experiences of violence, and offer a basis for comparing the experiences of young people in urban Jamaica with those of young persons elsewhere.


Assuntos
Estudantes/psicologia , Violência/estatística & dados numéricos , Adolescente , Bem-Estar do Animal , Animais , Criança , Maus-Tratos Infantis/psicologia , Maus-Tratos Infantis/estatística & dados numéricos , Docentes , Feminino , Humanos , Jamaica/epidemiologia , Masculino , Distribuição Aleatória , Amostragem , Instituições Acadêmicas/classificação , Instituições Acadêmicas/estatística & dados numéricos , Fatores Socioeconômicos , Inquéritos e Questionários , População Urbana , Comportamento Verbal , Violência/psicologia
15.
Rev. panam. salud publica ; 14(2): 97-103, Aug. 2003. tab
Artigo em Inglês | MedCarib | ID: med-17004

RESUMO

Objective. To obtain information on the perceptions and experiences of violence among secondary school students in Kingston, Jamaica, and its environs. Methods. Data collection was carried out from September through December 1998. Two researchers administered questionnaires in 11 randomly selected secondary schools, to a total of 1,710 students who were in either grade 7 or grade 9 and who were aged 9-17 years old (mean of 13.2 years). Frequency distributions of the responses were compared by gender, age, grade level, socioeconomic status, and school type. Results. Seventy-five percent of the students thought that someone who was reluctant to fight would be "picked on" more, 89 percent thought it generally wrong to hit other people, and 91 percent thought it wrong to insult other people. Eighty-four percent knew of students who carried knives or blades from such items as a scalpel or a utility knife to school, and 89 percent were worried about violence at school. Thirty-three percent had been victims of violence, and 60 percent had a family member who had been a victim of violence. Eighty-two percent thought that violent television shows could increase aggressive behavior. Factor analysis of selected responses was carried out, yielding five factors: neighbourhood violence, school violence, perceptions of acceptable behaviors, level of concern about violence, school violence, and general experiences and perceptions of violence. The factors varied with gender, age, grade level, socioeconomic status, and school type. Conclusions. These results will help focus interventions aimed at reducing violence, provide a baseline for later comparisons of perceptions and experiences of violence, and offer a basis for comparing the experiences of young people in urban Jamaica with those of young persons elsewhere (AU)


Assuntos
Criança , Adolescente , Humanos , Estudantes , Violência/estatística & dados numéricos , Jamaica , Criança , Comportamento do Adolescente/psicologia
17.
Rev. panam. salud pública ; 14(2): 97-103, Aug. 2003. tab
Artigo em Inglês | LILACS | ID: lil-349606

RESUMO

OBJECTIVE: To obtain information on the perceptions and experiences of violence among secondary school students in Kingston, Jamaica, and its environs. METHODS: Data collection was carried out from September through December 1998. Two researchers administered questionnaires in 11 randomly selected secondary schools, to a total of 1 710 students who were in either grade 7 or grade 9 and who were aged 9-17 years old (mean of 13.2 years). Frequency distributions of the responses were compared by gender, age, grade level, socioeconomic status, and school type. RESULTS: Seventy-five percent of the students thought that someone who was reluctant to fight would be "picked on" more, 89 percent thought it generally wrong to hit other people, and 91 percent thought it wrong to insult other people. Eighty-four percent knew of students who carried knives or blades from such items as a scalpel or a utility knife to school, and 89 percent were worried about violence at school. Thirty-three percent had been victims of violence, and 60 percent had a family member who had been a victim of violence. Eighty-two percent thought that violent television shows could increase aggressive behavior. Factor analysis of selected responses was carried out, yielding five factors: neighborhood violence, school violence, perceptions of acceptable behaviors, level of concern about violence, and general experiences and perceptions of violence. The factors varied with gender, age, grade level, socioeconomic status, and school type. CONCLUSIONS: These results will help focus interventions aimed at reducing violence, provide a baseline for later comparisons of perceptions and experiences of violence, and offer a basis for comparing the experiences of young people in urban Jamaica with those of young persons elsewhere.


Assuntos
Adolescente , Animais , Criança , Feminino , Humanos , Masculino , Estudantes/psicologia , Violência/estatística & dados numéricos , Bem-Estar do Animal , Maus-Tratos Infantis/psicologia , Maus-Tratos Infantis/estatística & dados numéricos , Docentes , Jamaica/epidemiologia , Distribuição Aleatória , Amostragem , Fatores Socioeconômicos , Inquéritos e Questionários , Instituições Acadêmicas/classificação , Instituições Acadêmicas/estatística & dados numéricos , População Urbana , Comportamento Verbal , Violência/psicologia
19.
Public Health Nutr ; 5(3): 391-6, 2002 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-12003649

RESUMO

OBJECTIVE: To determine the effects of birth weight and early childhood stunting on body mass index (BMI), body fat and fat distribution at ages 7 and 11 years, and the change from 7 to 11 years. DESIGN: Prospective cohort study SETTING: Kingston, Jamaica. SUBJECTS: One hundred and sixteen stunted children (height-for-age below two standard deviations (<-2SD) of the National Center for Health Statistics (NCHS) references) and 190 non-stunted children (height-for-age > -1SD), identified at age 9-24 months. The stunted group was divided into a previously stunted group (height-for-age at 11 years >or= -1SD) and a chronically stunted group (height-for-age < -1SD). RESULTS: Birth weight was positively related to the children's BMI but not to measures of body fat. Birth weight was negatively associated with the subscapular/triceps skinfold (SSF/TSF) ratio at age 11 years, and to the change between 7 and 11 years. Controlling for birth weight, the chronically stunted group remained significantly smaller than the non-stunted children at both ages and increased less from 7 to 11 years in all measures except the SSF/TSF ratio, which was significantly greater at age 7 years. The previously stunted group had significantly lower BMI and percentage body fat at age 7 years than the non-stunted group. Change from 7 to 11 years was not significantly different from that of the non-stunted group except for a smaller increase in TSF. At age 11 years they had significantly lower TSF and percentage body fat. CONCLUSIONS: Children stunted in early childhood had less fat and lower BMI than non-stunted children but had a more central fat distribution that was partially explained by their lower birth weights. The association between birth weight and central fat distribution developed between 7 and 11 years.


Assuntos
Peso ao Nascer/fisiologia , Composição Corporal/fisiologia , Constituição Corporal/fisiologia , Índice de Massa Corporal , Transtornos do Crescimento/fisiopatologia , Obesidade/fisiopatologia , Antropometria , Criança , Estudos de Coortes , Feminino , Humanos , Jamaica , Masculino , Estudos Prospectivos , Puberdade/fisiologia , Análise de Regressão , Pregas Cutâneas , Classe Social
20.
J Infect Dis ; 185(10): 1409-16, 2002 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-11992275

RESUMO

Human immunodeficiency virus (HIV) type 1 DNA in peripheral blood mononuclear cells (PBMC) was quantified in 31 children who received efavirenz, nelfinavir, and 1 or 2 nucleoside reverse-transcriptase inhibitors for > or =2 years and in whom undetectable plasma HIV-1 RNA levels (< 50 copies/mL) were sustained, to determine the usefulness of HIV-1 DNA as a marker of virus suppression. The median baseline HIV-1 DNA level was 750 copies/10(6) PBMC. After initiation of highly active antiretroviral therapy (HAART), HIV-1 DNA levels decreased gradually, reaching a plateau from week 80 through week 104 (median HIV-1 DNA level, 263 copies/10(6) PBMC). Children who had plasma HIV-1 RNA levels < 50 copies/mL after receiving HAART for 8 weeks (n=16) had persistently lower quantities of intracellular HIV-1 DNA than children whose HIV-1 RNA levels reached < 50 copies/mL after 8 weeks of HAART (n=15). The median half-life for intracellular HIV-1 DNA was 60 weeks. Thus, despite prolonged maintenance of undetectable levels of plasma HIV-1 RNA, HIV-1 DNA remains detectable in PBMC of children and may be a useful marker of further virus suppression.


Assuntos
Fármacos Anti-HIV/uso terapêutico , DNA Viral/análise , Infecções por HIV/tratamento farmacológico , HIV-1/isolamento & purificação , Leucócitos Mononucleares/virologia , RNA Viral/sangue , Adolescente , Terapia Antirretroviral de Alta Atividade , Benzoxazinas , Biomarcadores/análise , Biomarcadores/sangue , Criança , Pré-Escolar , DNA Viral/sangue , Quimioterapia Combinada , Feminino , Infecções por HIV/sangue , Infecções por HIV/virologia , Inibidores da Protease de HIV/uso terapêutico , Meia-Vida , Humanos , Lactente , Masculino , Nelfinavir/uso terapêutico , Oxazinas/uso terapêutico , Inibidores da Transcriptase Reversa/uso terapêutico , Carga Viral
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