Journal articles on the topic 'School attendance. [from old catalog]'

School refusal (SR) can have several negative consequences, but effective treatments are available. When chronic, school absence requires comprehensive treatment. This study evaluates an intervention for SR based on a Cognitive Behavioral Therapy (CBT) model, Hemmasittarprogrammet (HSP). Attendance, anxiety, depression, quality of life, and emotional and behavioral symptoms were measured at pre-treatment, post-treatment, and follow-up. The participants (n = 84; 69% male) were SR students between 10 and 17 years old and their parents. School attendance increased after treatment and at follow-up. The proportion of students totally absent from school decreased and the number of students with an acceptable level of school attendance increased. Levels of anxiety and depression were lower both post-treatment and at follow-up for the youths and their parents. HSP, a promising treatment program for school refusal, builds on the literature of CBT-based programs, which has been shown to be effective for SR treatment. However, more research about the effectiveness of the program is needed. Future studies should have a stronger research design, include a measure of fidelity, and be evaluated independent of the founders of the program under investigation.

The objective of this study is to examine the factors influencing school attendance among the secondary school population between the ages of 15 and 17 in Ecuador, by means of a descriptive and multidimensional analysis of statistical data principally from the 2015 National Survey of Employment, Unemployment and Underemployment of Ecuador (ENEMDU). The descriptive analysis demonstrates the frequency and percentages of the variables used in the investigation, while comparing the social characteristics of student attendees and absentees in this age group. This descriptive analysis was conducted in order to provide a more enlightening profile of attendance and truancy regarding this sector of the student population whereas the method of multidimensional statistical analysis used was the hierarchical analysis which classifies the students in clusters according to their common traits.

Several months ago I was asked by a neighbour-friend, ‘Mrs James’, to help her get her eleven year-old son, ‘Stephen’ and eight year-old daughter, ‘Katherine’, back to school. Mrs James was in hospital in Sydney at the time, recovering from a serious operation, while Mr James, an invalid pensioner, was trying to look after the two remaining children at home. (An older son is with foster parents).Stephen had missed more than 100 days of school in 1988 and had not returned to school in 1989. Katherine had a somewhat better attendance record but had stopped going to school when her mother went off to Sydney. Stephen’s and Katherine’s absences had been drawn to the attention of the home-school liaison officers.

We examined the associations between preschool attendance and academic school readiness at kindergarten entry among 5-year-old children of immigrant mothers in the United States using data from a US nationally representative sample (Early Childhood Longitudinal Study—Birth Cohort, N = 1650). Comparing children who were in preschool (Head Start, prekindergarten, or other center-based preschool) to children being cared for exclusively at home, analyses using both ordinary least squares regressions with rich controls and with propensity score weighting consistently showed that attending preschool was associated with higher reading and math skills. Analyses focused on specific type of preschool revealed that children attending prekindergarten (but not Head Start and other center-based preschool) had higher reading and math skills than those in parental care. Analyses focused on hours of preschool attendance indicated that children’s reading skills benefited from attending more than 20 hours per week of Head Start or prekindergarten. Attending preschool, especially for full days, increases the school readiness of children of immigrants.

Background:After-school programs (ASPs) across the nation have been asked to increase the amount of activity children accumulate during such programs. Policies/standards that benchmark the amount of total activity (light-to-vigorous physical activity, LVPA) and moderate-to-vigorous physical activity (MVPA) accumulated in an ASP have been developed. Little is known about the prevalence of children meeting these goals.Methods:Children (N = 812, 6 to 12 y old) attending 19 ASPs wore accelerometers for 4 days while attending an ASP. LVPA and MVPA were dichotomized according to existing ASP policies/standards. Data on whether a policy/standard was met were compared between gender, age, BMI, race/ethnicity, and ASP-type (faith-, school-, community-based) using mixed-model logistic-regression.Results:The prevalence of meeting an LVPA policy/standard ranged from 75.4% (National Afterschool Association [NAA], 20% of program time spent in LVPA) to 97.8% (NAA, 20% of time in attendance spent in LVPA), and meeting an MVPA policy/standard ranged from 0.3% (California, 60 min MVPA/d) to 26.9% (North Carolina, 20% of attendance spent in MVPA). Boys, younger children, nonwhites, and children attending faithor community-based ASPs were more likely to meet any policy/standard.Conclusion:Current practice in ASPs is sufficient to meet LVPA policies/standards but insufficient to meet MVPA policy/standards. Efforts must be directed toward identifying the most appropriate policy/standard and strategies to meet it.

Reduced school attendance is a recognised risk factor for poorer outcomes both educationally and across a wide range of social, economic and personal indicators throughout life. Children and young people with chronic health conditions often have poor or disrupted records of school attendance due to periods of hospitalisation and time spent recuperating at home. Keeping students with health conditions connected to school and learning is critical to avoid a trajectory of school absence, disengagement from schoolwork and peers, reduced achievement in education and early school leaving. This paper reports on a research project conducted in Victoria, Australia, to connect 7–12 year old hospitalised children with their school using a specially designed Presence App run on a mobile tablet computer. Nine hospitalised students, their families and schools participated in the trial. Results indicate that the Presence App helped to create and maintain a social presence for the absent child in the classroom and keep students at risk of disengagement connected to school. Our research also showed that while the ‘Presence’ App complemented existing information and communication technology such as videoconferencing and email by connecting hospitalised student and school, it had added advantages over these modes of communication such as creating an on-going classroom presence for the hospitalised child while respecting privacy and attempting to minimise disruption in the hospital and classroom settings.

The Mediterranean diet (MD), despite its multiple benefits, presents low levels of adherence among children. Moreover, childhood is a key stage in the acquisition of healthy habits. The aim of this study was to describe adherence to MD in school-age children from Asturias, Spain, and to evaluate the association with weight status and several lifestyle behaviors. A cross-sectional study was conducted on 309 children aged between 8 and 13 years old. The level of adherence to MD was evaluated through the KIDMED questionnaire. Descriptive analysis and logistic regression models were used to analyze the association between adherence to MD and weight status, frequency of out-of-school exercise, frequency of school canteen attendance, and sleep habits. We found that 54.4% of children had optimal adherence to MD and 29.9% of the sample was overweight or obese. Frequency of exercise practice was positively associated with optimal adherence to MD (95% CI: 1.02, 1.33). A positive association was found between some KIDMED items and frequency of out-of-school exercise practice and attendance at the school canteen. This study shows the need for an improvement in the adherence to MD in youth considering the concomitant occurrence of other related healthy behaviors.

Objective. This study assessed the impact of toothache on school attendance among secondary school students in the Ha’il Region, Saudi Arabia. Methods. A cross-sectional, paper based survey was conducted among 16–18-year-old students of public sector secondary schools in the Ha’il Region, Saudi Arabia. Results. Of the 510 students selected from the participating schools, 480 were analyzed (94.1%). Of the sample, 50.4% were boys. Among the participants in the study, 86 students reported school absence due to toothache in the six months prior to the survey. Consequently, the prevalence of absenteeism due to toothache in this study was of 18%. Conclusion. The prevalence of school absenteeism due to toothache among students in the Ha’il Region was low. Yet, still, missed school days due to toothache may have implications for students also in the Ha’il Region, Saudi Arabia, as school absenteeism leads to missed opportunities for learning and academic advancement.

Our aim is to explore (1) whether gestational medication use, mode of delivery, and early postnatal exposure correlate with childhood asthma, (2) the dose responsiveness of such exposure, and (3) their links to early- and late-onset asthma. We conducted a matched case-control study based on the Taiwan Children Health Study, which was a nationwide survey that recruited 12-to-14-year-old school children in 14 communities. 579 mothers of the participants were interviewed by telephone. Exclusive breastfeeding protected children from asthma. Notably, childhood asthma was significantly associated with maternal medication use during pregnancy, vacuum use during vaginal delivery, recurrent respiratory tract infections, hospitalization, main caregiver cared for other children, and early daycare attendance. Exposure to these factors led to dose responsiveness in relationships to asthma. Most of the exposures revealed a greater impact on early-onset asthma, except for vacuum use and daycare attendance.

PurposeThis study explores how menstruation is perceived, experienced and navigated by school-going adolescent girls living in low-to-middle income settings in South Africa. Existing research from developing countries suggest that the onset of menstruation has implications for school attendance and academic performance. There is evidence that menstrual cycle–related symptoms (primarily physical) lead to difficulties in, or interference with, and disengagement from school, social relations, and physical activities (van Iersel et al., 2016; Steiner et al., 2011; Kiesner and Pastore, 2010; Taras, 2005). The onset of menstruation can be shame-inducing and has been associated with anxiety and confusion. Few studies have been conducted on menstruation in countries with a history of sectarian violence and characterised by substantial socio-economic disparities and high levels of gender-based violence. Understanding the experiences of girls in these contexts is important in generating contextually-grounded knowledge and appropriate interventions.Design/methodology/approachA qualitative, exploratory, descriptive and contextual research design was used to collect data from 48 adolescent girls aged 13–16 year-old. A total of six focus group discussions (FGDs) were conducted using a semi-structured questionnaire among a purposive sampling method. Data collected were transcribed verbatim and thematically analysed. Written parental consent was obtained for participants under 18 years old.FindingsThe findings illustrated complex psychological experiences in response to menarche and menstruation. Experiences of shame in relation to menstruation were aggravated by unsupportive responses from school teachers. Challenges such as scarcity of sanitary products were experienced as creating a barrier for girls' school attendance.Research limitations/implicationsExisting research from developing countries suggests that the onset of menstruation has implications for school attendance and academic performance. The research data includes the views of adolescent learners and their negative reactions and positive experiences towards menstruation within the school environment.Practical implicationsGiven the comparative paucity of research emerging from developing countries in sub-Saharan Africa, this paper addresses an important gap in the literature by providing contextually-nuanced information about the menstrual experiences of adolescent girls. The study can further provide information for efforts made by the Department of Education and Department of Health regarding the impact of menstruation on adolescent girls' school attendance.Social implicationsThis study provides important insights regarding the experiences of South African school girls in relation to menstruation. Although dominant feelings of shame, confusion and disgust may surround menstruation, the study also highlighted potential positive experiences associated with menstruation. Teachers and school administrators need to be oriented towards the needs of adolescent girls if issues regarding poor school attendance are to be addressed.Originality/valueTo reduce absenteeism in schools and ensure learners are provided with improved allocation of sanitary products in schools, there is a need for the advocacy regarding sexuality education and resources to promote the psychological health of adolescent girls.

Dental recordings of 0 to 15-year-old patients assisted at Urgency Dental Service (UDS) from Bauru Dental School, University of São Paulo, in 2001 and 2002, were assessed in order to quantify the number of patients that used the service, to determine attendance patterns, and to record the frequency of different types of dental emergencies and their performed treatment. Data were plotted and submitted to a descriptive statistical analysis. Among the total of patients attended at UDS (6020), 1166 (19.37%) were children, with mean age of 9.24 years. Trauma was the cause for 199 (17.06%) of the recorded urgency visits. It occurred more frequently in children between 0 and 3 years of age (34.42%), and between 7 and 12 years of age (18.12%). The main treatments performed were temporary restoration (33.33%) for coronal fracture, and orientation (24.44%) for luxation. Nontraumatic events were the etiology for 967 (82.92%) of the total urgency diagnosis. The most commonly found nontraumatic diagnosis was dental caries lesions (61.75%), followed by problems of eruption or root resorption (14.27%) and bone or soft tissue lesions (6.51%), among others (17.47%). The most frequent treatments performed for caries lesions were: excavation and temporary restoration (39.39%) when there was no abscess, and coronal opening and dressing (40.95%) for caries lesions with abscess. There was an increasing trend in caries lesions prevalence according to the rising of the age, in contrast to trauma prevalence. Treatment for both situations was done according to the indicated protocol for each case.

In August 1919, a settlement house worker in Columbus, Ohio, filed a complaint in juvenile court against a seven-year-old girl whom I will call “Marie.” The complaint read, “Marie runs the streets continually. She is very irregular in her attendance at school, and is as dirty as a pig. She has been found in a lumber yard with a negro, and it was alleged by her associates that he raped her there. She goes into stores and begs.” According to the surviving records, Marie's “truancies from home” alerted settlement workers to the case. As a young child she reportedly began staying out late at night and loitering in the company of men and boys, and was threatened with being put out of the house when she was found alone with the African American man. By 1928, after Marie became an unwed mother at the age of sixteen, and had spent nine years in and out of child welfare institutions, a summary report contained the interesting typographical error that Marie's young life had strayed a distance of “six blacks from home.” As incidental as slipping “blocks” into “blacks” may have been in one sense, it captured a powerful truth. Marie violated key boundaries of sexual, gender, and racial purity that made a woman a candidate for respectable motherhood, and she paid dearly for these transgressions.

The older population in the 21th century usually live a longer and healthier life. This pinpoint the necessary and sufficient factors for their empowerment and sustainability. Therefore, this study aims at investigating possible antecedents of social support giving behavior of elderly and its relation to Buddhist type of happiness. A group of 395 older adults with ages range from 59 to 90 years old responded to a set of questionnaires. Multiple regression analysis reveals that having role models, Buddhist belief and practice, elderly school attendance, and generativity trait were the important predictors of social support giving behavior. Predictive power in the total sample was 39.74%, and between 33.66% to 53.82% in subgroups. In addition, social support giving behavior is related to greater Buddhist happiness, and higher core self-evaluation. Suggestions for enhancing empowerment and sustainability living of the older rural population are offered.

This study compared cross-sectional data from online surveys describing the sleep behavior of infants and caregivers in March 2020 (the school closure period during the early stages of the COVID-19 pandemic; n = 295, 23.8 ± 3.8 months old) and March 2019 (before the pandemic; n = 2017, 24.2 ± 3.8 months old). In comparing those two points in time, no significant differences were found in wake-up times (2019: 7:19 ± 0:46 am vs. 2020: 7:18 ± 0:47 am, p = 0.289), bedtimes (21:01 ± 0:48 pm vs. 21:04 ± 0:53 pm, p = 0.144), or nocturnal sleep times (593.7 ± 43.9 min vs. 588.1 ± 50.3 min, p = 0.613). Regarding the caregivers, in 2020, wake-up times (2019: 6:46 ± 0:50 am vs. 2020: 6:39 ± 0:50 am, p = 0.017) and bedtimes (22:53 ± 1:17 pm vs. 22:42 ± 1:04 pm, p = 0.016) became significantly earlier compared to 2019. Among infants staying at home, total sleep time and percentage of outdoor play decreased significantly, and media use increased significantly in 2020. Lower levels of exercise and more frequent media viewing may have caused prolonged sleep latency in these children. The percentage of caregivers responding with “negative childcare feelings” was significantly higher in the group with less than three nursery school attendance days. Caregivers and infants staying at home are a high-risk group during the pandemic.

Background: Thirdhand smoke (THS) exposure is linked to lung cancer, asthma, and chronic diseases, especially in children. The parental risk perception of THS exposure in children has rarely been reported. The objective of this study was to test the association between sociodemographic factors and parental risk perceptions of child exposure to thirdhand smoke (PRPCETS) in residential homes with a child or children aged from one to five years old. Methods: This study used secondary data from the Smoke Free Home intervention trial. 336 participants were included and analyzed. PRPCETS was assessed by self-administered questionnaire. Multiple logistic regression was used to test the factors related to parental risk perception to the harm of thirdhand smoke. Results: The overall prevalence of disagreement that THS might be harmful to children was 22.02% (95% CI: 17.59%, 26.45%). Factors associated with PRPCETS were being over 50-years-old (OR: 2.15; 95%CI: 1.05, 4.41); attending school for more than six years (OR: 2.08; 95%CI: 1.07, 4.08); being unemployed (OR: 6.98; 95% CI, 1.41, 34.71); and the number of smokers in the home ≥2 persons (OR: 2.48; 95%CI: 1.41, 4.36). Conclusions: Our findings show the factors related to PRPCETS as follows; aged over 50, duration of school attendance less than six years, no job status, and having ≥2 smokers in the home. Further studies should investigate parental knowledge of and attitude towards thirdhand smoke exposure.

This cross-sectional study investigated the bilingual lexical skills of 175 US school-age children (5 to18 years old) with Cantonese, Mandarin, or Korean as their heritage language (HL), and English as their dominant language. Primary study goals were to identify potential patterns of development in bilingual lexical skills over the elementary to high school time span and to examine the relation of environmental factors to lexical skills. HL and English productive lexical skills were assessed with a Picture Naming and a Verbal Fluency task. English receptive lexical skills were assessed with Peabody Picture Vocabulary Test. A survey obtained information about participants’ language use in six environmental contexts. There were age-related significant increases in both HL and English skills. However, English proficiency already had a significant lead over HL proficiency at the youngest age. English receptive lexical skills reached monolingual expectations from age 8, whereas for HL, high school age participants on average only reached the level of early elementary school monolinguals. Although more English use at home at younger ages was associated with stronger English skills, the relation did not exist for older participants. Instead, among older participants, more English use at home was associated with weaker HL skills. Children’s attendance at HL programs and visits to home countries bore little relation to HL proficiency.

This qualitative study explores the factors contributed to 13 older teen mothers’ academic success as very young mothers. The participants were older teen mothers who were pregnant and gave birth at the age of 16 years old or younger, and who have achieved a college degree from an accredited college or university while they raised their child(ren). In depth interviews were employed to document and analyze older teen mother experiences. One-on-one interviews with the participants revealed multiple factors assisted older teen mothers’ academic success, including family and other individuals support, teachers, early school attendance, personal drive, and responsibilities. While further research is needed, these findings suggest that developing holistic services for teen mothers is needed to assist in developing future academic success. A holistic approach includes mind, body and spirit (Arsenian, n.d.). These recommended services could be developed within existing programs and should include activities to promote self-awareness, health and some form of exploration of values, faith and family.

Background/Aims: Suicidal ideations (SI) indicate and predict psychological distress. We examined the prevalence of SI among early adolescents and its association with parental war participation, personal, behavioral, and sociodemographic characteristics. Methods: We performed a cross-sectional questionnaire study on 803 12-year-old adolescents. Data were collected using a sociodemographic questionnaire, the Junior Eysenck Personality Questionnaire and Children Depression Inventory. Unintentional injuries, physical fighting, and involvement in bullying behavior were assessed using questions from the World Health Organization (WHO) survey Health Behavior in School-aged Children. Suicidal ideations were assessed with three dichotomous items. Results: There were no gender differences in SI prevalence. SI in males were associated with lower maternal education, crowded families, birth order, parental war participation, physical fighting, being bullied, and substance use. In females, we found associations with lower parental educational level, number of brothers, lower perception of the relationship with parents, parental relationship, family cohesion and parental control, negative attitude toward school, rare church attendance, fighting, and being bully or bullied. Depressive symptoms and SI were associated in both genders. Conclusions: SI showed gender-specific associations that may partially be explained with parental war involvement. These findings may have potentially important clinical and preventive implications.

Formal schooling frequently lacks both democratic learning culture and effective climate change education (CCE). This study analyzes the effects of the participatory CCE initiative k.i.d.Z.21 and the impacts of the current Fridays For Future (FFF) climate protests on teenagers’ climate change awareness. The mixed-methods approach comprises online pre-and post-tests, and personal interviews with selected students. k.i.d.Z.21 follows moderate constructivist, inquiry-based learning approaches and addresses 14-year old students from secondary schools in Austria and southern Germany. Considering the effectiveness of the CCE intervention of school year 2018/2019 (N = 169), quantitative findings reveal an increased mean of major components of climate change awareness, including climate-friendly behavior. When separating participants and non-participants in Fridays For Future, personal concern and refusing meat have both increased significantly only among protest participants. A closer examination of this group identifies an enhanced feeling of self-efficacy that might be triggered by perceived collective efficacy. Besides, more climate-friendly consumption behavior, as well as enhanced multiplicative action, are detected. The interviewed students also clearly assigned increased action-related components of climate change awareness to the attendance of FFF. From the findings, we conclude that democratic learning in and out of school can enhance action-related components of climate change awareness, and a combination of both can have an even stronger effect.

<em>The purpose of this study was to investigate child rape in Nigeria, its implications on the education of the child. Descriptive survey design was adopted. Three research questions guided the study. The population of the study was all the young parents in Nigeria whose female children are between 0-12 years old. Disproportionate random sampling was used to select 100 respondents each from 8 states out of 36 states in the country, making it 800 respondents. Structured questionnaire and interview were used to collect data from the respondents. Frequency, percentage and rank order were used to analyze the data collected for research question one. Mean, standard deviations and rank order were used to analyze data for research questions two and three. The findings revealed a high prevalence of child rape in Nigeria. The findings also identified in rank order; lack of reports on rape cases, mishandling of rape cases, child labour, children being left alone without care, men raping children for ritual purposes, indecent dressing as the causes of child rape. According to the findings, the effects of child rape in rank order include; emotional traumas, social stigma, sexual transmitted infections, termination of child’ life, low academic performance, physical pains and injuries, school dropout, poor attendance to school. Recommendations and implications were also made.</em>

Background.Helicobacter pyloriinfection affects more than half of the world’s population. The infection is generally acquired during childhood but can remain asymptomatic, with long-term clinical sequelae including gastritis, peptic ulcer disease, and stomach cancer.Methods. The study was approved by Institutional Review Committee of Mbarara University of Science and Technology. After obtaining informed consent from parents/legal guardians, illegible children who presented with gastrointestinal complaints at Holy Innocents Children’s Hospital were recruited; structured questionnaires were administered to the parents/guardians to collect information on sociodemographic data and risk factors ofH. pyloriinfection. Four (4) millilitres of blood was collected from each child and tested forH.pyloriblood Antibody test and stool specimens were used forH. pyloriantigen test.Results. The prevalence ofH. pyloriinfection among the study participants was 24.3%. The infection rate increased with increase in age of the participants, from 16.2% among 1to 5 years old to 27.2% among 6 to 10 years. Infections were higher among school going children (68/74, p=0.003, OR 3.9; CI: 1.5 to 10.6) and children from crowded households (59/74, p<0.001, OR 2.6, and CI 1.3 to 5.0), unsafe source of drinking water at schools (46/74, p=0.003), and lack of sanitary facility at homes (57/74, p=0.001, and OR 1.6 CI 0.7 to 3.6).Conclusion. The prevalence ofH. pyloriinfection among children aged 1 to 15 years at Holy Innocents Children’s Hospital was high and increases with age. School attendance, lack of sanitary facility, lack of safe drinking water, and overcrowding were the risk factors associated withH. pyloriinfection.

Context. Bullying among schoolchildren is a serious phenomenon and a leading health concern. Aim. To determine the prevalence of bullying, its forms, and its effect on academic abilities and school attendance, as well as associated sociodemographic, physical, and dentofacial features among Saudi schoolchildren. Methods. This cross-sectional study recruited a sample of 1131 parents of schoolchildren 8-18 years old and requested them to complete internationally accepted questionnaires for their children. Chi-squared test and logistic regression analysis were used to analyze the data (p<0.05). Results. A majority (89.2%) of schoolchildren were bully victims. Physical bullying (48.9%) was the most common form of bullying. The youngest schoolchildren (8-11 years) and those who disliked school classes or neither liked nor hated them, as well as those who were truant from school, were more likely to be victims. In addition, those who had worse grades because of bullying and those who were very often bullied because of good grades or because they showed an interest in school were more likely to be victims. With regard to targeted physical features, teeth were the number one target, followed by the shape of the lips and strength, while tooth shape and color were the most common dentofacial targets, followed by anterior open bite and protruded anterior teeth. Boys and the youngest schoolchildren were more often subjected to bullying because of these features (p<0.05). Conclusions. The prevalence of bullying, mainly in a physical form, was high among Saudi schoolchildren, with a negative influence on students’ academic abilities. Problems related to teeth, in particular, which can be treated, were targets, mainly for boys and the youngest schoolchildren. More studies are required in Saudi Arabia to explore the issue further among schoolchildren themselves.

BackgroundMany children do not meet UK physical activity (PA) guidelines. Girls are less active than boys, and the age-related decline in activity is steeper for girls. Dance is the favourite form of PA among adolescent girls in the UK. Participation in after-school dance classes could significantly contribute to girls’ PA. Therefore, after-school dance may be effective for increasing PA levels.ObjectivesTo determine the effectiveness and cost-effectiveness of a dance-based intervention to increase the objectively assessed mean weekday minutes of moderate- to vigorous-intensity physical activity (MVPA) of Year 7 girls (11- and 12-year olds) 1 year after baseline measurement.DesignTwo-arm cluster randomised controlled trial and economic evaluation. Year 7 girls in participant schools received a ‘taster’ session and were invited to participate. Up to 33 girls per school were able to participate. Schools were randomly assigned (equal numbers) to intervention or control arms.SettingA total of 18 mainstream secondary schools across greater Bristol.ParticipantsYear 7 girls in participating schools who could participate in physical education.InterventionNine intervention schools received an after-school dance intervention (40 × 75-minute sessions) underpinned by self-determination theory, which attempts to improve intrinsic motivation for being active, and delivered by external dance instructors. Control schools continued as normal.Main outcome measuresThe main outcome was accelerometer-assessed mean minutes of MVPA at T2. Measures were assessed at baseline (T0), the end of the intervention (T1) and at T0 + 52 weeks (T2).ResultsBaseline MVPA levels were high. A total of 508 girls were included in the primary analysis, which found no difference in weekday MVPA between trial arms. There was no effect on secondary accelerometer outcomes. Data were subjected to a per-protocol analysis and no effect was found. However, at T1, girls who attended dance classes had 4.61 minutes more of MVPA and 14.27 minutes more of light-intensity activity between 15.00 and 17.00 on the days on which they attended intervention sessions. The intervention was inexpensive at £73 per participant (£63 when excluding dance instructor travel) but was not cost-effective owing to the ineffectiveness of the intervention. The European Quality of Life-5 Dimensions Youth survey data were unresponsive to changes in the sample. The process evaluation reported that girls in attendance enjoyed the sessions, that exertion levels were low during sessions and that attendance was low and declined. Fidelity to the session-plan manual was low but theoretical fidelity (to self-determination theory) was good. Qualitative information provides information for improving future interventions.ConclusionsThe intervention was enjoyed by participants. However, there was no difference in the MVPA levels (which were high at baseline) of girls allocated to receive dance compared with girls receiving the control. High baseline MVPA levels indicate that the study appealed to an already active cohort and, therefore, may not have targeted those most in need of an intervention. Dance is an enjoyable activity for adolescent girls and could be further trialled as a means by which to increase PA. Research might consider the impact of dividing the intervention period into smaller blocks.Trial RegistrationCurrent Controlled Trials ISRCTN52882523.FundingThe National Institute for Health Research Public Health Research programme. The work was also undertaken with the support of the Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), a UK Clinical Research Collaboration (UKCRC) PHR Centre of Excellence. Joint funding (MR/KO232331/1) from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the Welsh Government and the Wellcome Trust, under the auspices of the UKCRC, is gratefully acknowledged. This study was designed and delivered in collaboration with the Bristol Randomised Trials Collaboration, a UKCRC Registered Clinical Trials Unit in receipt of NIHR Clinical Trials Unit support funding. All intervention costs were funded by the respective councils to which the participant schools were affiliated, namely North Somerset Council, Bristol City Council, and Bath and North East Somerset Council.

BACKGROUND: Adolescent pregnancy, defined as a pregnancy in girls aged 10 to 19 years. Adolescent mothers are at high risk for maternal and neonatal complications.
 AIM: To compare maternal, perinatal and neonatal outcomes in adolescents and adult women aged 20-24 years.
 MATERIAL AND METHODS: This retrospective cohort study included all singleton pregnancies during a three-year period (January 2016-December 2018) who gave birth in a Clinical Hospital in Tetovo, Republic of Macedonia. After exclusion criteria, a total of 932 cases were reviewed and divided into two groups: one of the teenage mothers (< 19 years old) (115 women) and the other of adult mothers (20-24 years old) (817 women).
 RESULTS: Of the total number of 5643 births, 128 (2.27%) were from adolescent pregnancies. Of them, nulliparous adolescent women were 115 (2.04%). Adolescents compare to adult mothers had a higher rate of urinary tract infections (33% vs. 22%), increased rate of maternal anemia (26% vs. 15%), preterm birth, small for gestational age newborns (25.2% vs. 17.1%), lower high school attendance (0 vs. 21.9%) and inadequate prenatal care. Spontaneous labour was more common in adolescents (73% vs 63.5%), while Caesarean sections were less common than in women aged 20-24 years (25.2% vs 33.5%). The rate of other perinatal outcomes was not significantly different between the 2 groups.
 CONCLUSIONS: The results of the study showed that the frequencies of some maternal, perinatal and neonatal complications were considerably higher in adolescent mothers.
 nal and perinatal complications were considerably higher in adolescent mothers.

ObjectivesWe evaluated the feasibility of conducting a 9-week long sexually transmitted infection (STI) prevention intervention, Angels in Action, within an alternative disciplinary school for adolescent girls.MethodsAll girls who were 16–18 years old, enrolled in the school and did not have plans to transfer from the school were eligible to participate. We measured process feasibility with recruitment, retention and participant enjoyment. Using a pretest-post-test design with a double post-test, we used χ² tests to estimate the intervention effect on participants’ sexual partner risk knowledge, intentions to reduce partner risk and sexual activities in the past 60 days with three behavioural surveys: prior to, immediately following and 3 months after the intervention.ResultsAmong the 20 girls who were eligible, 95% (19/20) of parents consented and all girls (19/19) agreed to participate. Survey participation was 100% (19/19) prior to, 76% (13/17) immediately following and 53% (9/17) 3 months after the intervention. The intervention was administered twice and a total 17 girls participated. Session attendance was high (89%) and most participants (80%) reported enjoying the intervention. The intervention increased the percentage of girls who could identify partner characteristics associated with increased STI risk: 38% before, 92% immediately following and 100% 3 months after the intervention (p=0.01). Girls also increased their intentions to find out four of the most highly associated partner characteristics (partner’s age, recent sexual activity and STI or jail history): 32% before to 75% immediately following (p=0.02) and 67% 3 months after the intervention (p=0.09).ConclusionsThis pilot study suggests girls at alternative disciplinary schools participated in and enjoyed a 9-week STI preventive intervention. Within alternative disciplinary schools, it is potentially feasible to increase girls’ consideration of partner risk characteristics as a means to enhance their STI prevention skills.

Purpose: To evaluate the effect of a 17-week intervention, including an after-school physical activity (PA) club 3 d/wk, on moderate-to-vigorous physical activity (MVPA), body mass index (BMI) z score, percentage body fat (%BF), and cardiorespiratory fitness (CRF) among fifth to eighth grade girls having a BMI z score ≥0, and explore whether intervention outcomes varied by club attendance (1 vs 2 vs 3 d/wk). Design: Secondary analysis of data from a group randomized controlled trial (N = 1519, 10- to 15-year-old girls: n = 753 intervention; n = 766 control). Setting: Twenty-four Midwestern US schools (n = 12 intervention; n = 12 control). Sample: Subsample (n = 1194 girls) from trial’s intervention (n = 593 girls) and control (n = 601 girls) groups having BMI z scores ≥0. Measures: Moderate-to-vigorous physical activity (min/h), BMI z score, %BF, and CRF ([Formula: see text]: mL/kg/min) were estimated at baseline and postintervention. Analysis: Linear mixed-effect models. Results: Intervention group gained less %BF ( B = −0.35, P = .016), and their CRF decreased less ( B = 0.22, P = .010) than the control. Marginally significant findings showed girls attending the club an average of 1 d/wk had greater increases in %BF ( B = 0.33, P = .087) and MVPA ( B = 0.20, P = .083) and a greater decrease in CRF ( B = −0.20, P = .061) than girls attending 3 d/wk. No differences occurred between girls who attended 2 versus 3 d/wk for any outcomes. Conclusions: The intervention attenuated an increase in %BF and a decrease in CRF among girls at risk for obesity from baseline to postintervention. Offering the after-school PA club 2 d/wk may be adequate for achieving outcomes.

IntroductionRotavirus vaccines were introduced into the Australian National Immunisation Program in 2007. Despite this, Northern Territory Indigenous children continue to be hospitalised with rotavirus at a rate more than 20 times higher than non-Indigenous children in other Australian jurisdictions, with evidence of waning protection in the second year of life. We hypothesised that scheduling an additional (third) dose of oral human rotavirus vaccine (Rotarix, GlaxoSmithKline) for children aged 6 to <12 months would improve protection against clinically significant all-cause gastroenteritis.Methods and analysisThis Bayesian adaptive clinical trial will investigate whether routinely scheduling an additional dose of Rotarix for Australian Indigenous children aged 6 to <12 months old confers significantly better protection against clinically important all-cause gastroenteritis than the current two-dose schedule at 2 and 4 months old. There are two coprimary endpoints: (1) seroconversion from baseline serum anti-rotavirus immunoglobulin A (IgA) titre <20 U/mL prior to an additional dose of Rotarix/placebo to serum anti-rotavirus IgA titre >20 U/mL following the administration of the additional dose of Rotarix/placebo and (2) time from randomisation to medical attendance (up to age 36 months old) for which the primary reason is acute gastroenteritis/diarrhoea. Secondary endpoints include the change in anti-rotavirus IgA log titre, time to hospitalisation for all-cause diarrhoea and for rotavirus-confirmed gastroenteritis/diarrhoea, and rotavirus notification. Analysis will be based on Bayesian inference with adaptive sample size.Ethics, registration and disseminationEthics approval has been granted by Central Australian Human Research Ethics Committee (HREC-16-426) and Human Research Ethics Committee of the Northern Territory Department of Health and Menzies School of Health Research (HREC-2016-2658). Study investigators will ensure the trial is conducted in accordance with the principles of the Declaration of Helsinki and with the ICH Guidelines for Good Clinical Practice. Individual participant consent will be obtained. Results will be disseminated via peer-reviewed publication. The trial is registered with Clinicaltrials.gov (NCT02941107) and important modifications to this protocol will be updated.Trial registration numberNCT02941107; Pre-results.

SUMMARYDientamoeba fragilis is an inhabitant of human gastrointestinal tract with a worldwide distribution. The first description considered this protozoan a rare and harmless commensal, since then it has struggled to gain recognition as a pathogen. Commercial multiplex real-time PCR was used to detect D. fragilis in fecal samples from hospitalized children (⩽18 years) with acute gastrointestinal disease, admitted to two hospitals of Lisbon area, with different demographic characteristics. A total of 176 children were studied, 103 (58·5%) male, 144 (81·8%) children between 0 and 5 years and 32 (18·2%) above 6 years old. The overall protozoa frequency considering the four tested microorganisms were 8·5% (15/176), and the most frequently found protozoan was D. fragilis, 6·3% (11/176). Dientamoeba fragilis frequency was higher among older children (21·9%), than younger children (2·8%), and greater in boys (6·8%) than in girls (5·5%). All positive children presented with diarrhoea associated with vomiting, fever and abdominal pain. Infection was associated with the age of children (P < 0·001), school attendance (P = 0·002) and consumption of certain foods (P = 0·014), e.g. cakes with crème and ham. The frequency of diantamoebiasis found in a cohort of hospitalized Portuguese children, with acute gastrointestinal disease, could be considered a very high value when compared with the protozoan frequency normally associated with this pathology.

Background: Globally, the poor activity level of adolescent girls is a public health concern. Little research has involved adolescents in the design of interventions. This study assessed the feasibility of involving girls in the co-creation of an activity programme. Methods: Thirty-one students (15–17 years old) were recruited from a post-primary school. The Behaviour Change Wheel guided intervention design, providing insights into participants’ capability, opportunity and motivation for change. Step counts and self-reported physical activity levels were recorded pre- and post-intervention. Feasibility benchmarks assessed recruitment, data collection, acceptability and adherence. Results: Activity and educational sessions were delivered for six weeks during physical education class. Average attendance was 87% (benchmark = 80%). Eligibility was 61% (benchmark = 60%). There was a 100% retention rate (benchmark = 90%). All participants ( n = 31) completed baseline measures and 71% ( n = 22) completed post-measures. 54% ( n = 17) of students completed pedometer measurements, with 32% ( n = 10) having complete data. Average daily steps were 13,121 pre-intervention and 14,128 post-intervention ( p > 0.05). Data collection was feasible, receiving a mean score > 4/5 (benchmark > 3.5/5). Conclusions: The Behaviour Change Wheel can be used to co-create an activity programme with adolescent girls. Predetermined benchmarks, except for pedometer recordings, were reached or exceeded, providing evidence for the need of a randomised controlled trial to test effectiveness.

Questionnaire is one of the possible ways of research in organized children's groups, which allows us to identify socio-hygienic factors of caries occurrence. Proper oral hygiene, awareness of children about this, regular preventive visits to a dentist, knowledge about the possibility of caries prevention play an important role in caries prevention. Lately, a great attention is paid to the psycho-emotional state of adult patients and especially of children due to the impact school strain and the formation of behavioral responses on them.
 The aim of our research was to study the correlation interrelation between the psycho-emotional state of children from 6 to 16-year-old with the socio-hygienic factors of dental caries occurrence.
 Dental survey, analysis of the emotional state and interrogation of children and their parents were performed in 295 children from 6 to 16-year-old. Children and their parents were interviewed in order to study the influence of socio-hygienic factors on the possibility of caries occurence. Psycho-emotional state was studied by the following methods: method of definition of school fears, kinetic image of the family, Spielberg's self-esteem scale of personal anxiety level.
 Definition of school fears has revealed that 13.2% of the surveyed children had signs of general school fear, 15.6% had a fear of social contacts with peers, 10.2% had a fear of social contact with teachers, 17.0% had a fear of self-expression, 10.2% had a fear of knowledge test situations, 38.6% had a fear of not meeting the expectations of others, 14.6% had low physiological resistance to school fears. Anxiety (by Spielberg`s method) was found in 80.3% of surveyed. Only general school fear (rs = 0.17, p <0.005) correlated with the children age. Its frequency increases in 2.6 times after 12 years age.
 Only 36.1% of children did not experience psychological distress inside of their families. However, tensed relationship inside of families was not determined in 51.4% of children without caries and only in 22.1% of children with caries (pMU <0.001). There are correlation interelationships between caries development and tensed relationships inside of families and general school fear, less pronounced correlation between carious process activity and tension inside of families and general school fear.
 Children with low physiological resistance to school fears have the least complaints about the condition of tooth hard tissues. However, complaints do not have significant interrelation with caries presence. Children with caries do not have complaints about the presence of carious cavities in teeth, rarely complain on discoloration, misalignment or irregular shape teeth, equaly as children without caries. Children with a fear of knowledge testing are the most likely to complain about the presence of carious cavities.
 Children who can better resist to school fears are more likely to visit a dentist for a preventive purpose. Children who have a fear of social contact with teachers or fear of unsettled meeting the expectations of others are less likely to seek a preventative meeting with a dentist. Increasing anxiety (according to Spielberg`s method) contributes to preventive treatment. Low physiological resistance to school fears indicates the risk that, even if there is pain in a tooth, children do not seek for a dental support.
 During the questionnaire of children the dependence of general school fear presence with the age of the child was found, which frequency increases in 2.6 times after 12 years age.
 There is a correlation interrelationship between the frequency of attendance of a dentist and the presence of a common school fear, ie, greater the fear, less attendences of a dentist. Greater the children`s general school fear is observed, greater the anxiety during the dentist appointment is noted. The results are improved according to work with children and their parents on the regulation of the emotional state of children.

Aims: We examine the characteristics of participants entering Norwegian Healthy Life Centres, their reasons for attending and whether socio-economic status, motivation, self-efficacy and social support relate to physical activity and sedentary behaviour. Methods: This cross-sectional study is part of a randomised controlled trial. Inclusion criteria are that participants should be ≥ 18 years old and able to take part in a physical activity group intervention. Exclusion criteria are severe mental illness and general learning disability. We analysed data using simple and multiple linear regression analyses. Results: We recruited 118 participants from eight Norwegian municipalities between June 2014 and September 2015. Of these, 77% were female, mean (standard deviation) age 48.6 (13.4) years, body mass index 34.0 (5.8) kg/m2 and mean gross family income €61,000. The proportion of participants with upper-secondary school or less as their highest level of education was 55%. The most frequent reasons given for attendance at Healthy Life Centres were being overweight, increasing physical activity, improving diet and having musculoskeletal health challenges. Participants had high levels of autonomous motivation and 79% achieved national recommendations for physical activity. Respect and appreciation in childhood, self-esteem and self-rated health were associated with self-efficacy and social support for physical activity. Conclusions: Participants were predominantly obese, physically active, female and motivated for change. A high proportion had low educational attainment and low incomes. The trial will reveal whether interventions succeed in increasing physical activity further, or in decreasing sedentary behaviour, and whether health inequalities narrow or widen across groups.

Street life is a challenge for survival, even for adults, and is yet more difficult for children. They live within the city but are unable to take advantage of the comforts of urban life. This study focused primarily on access to health and education in street children from 6 to 18 years old in the Indian metropolises of Mumbai and Kolkata. The study also aimed to assess the role of social work interventions in ensuring the rights of street children. A combination of quantitative and qualitative research methodologies was used. Convenience sampling was used to recruit 100 children. Data were collected on a one-to-one basis through semi-structured interview schedules and by non-participant observation. Findings revealed that extreme poverty was the primary cause for the increasing numbers of street children. Lack of awareness among illiterate parents regarding educational opportunities kept most children away from school attendance. Factors such as lack of an educational ambience at home made it difficult for the children to work on their lessons outside the premises of the institution. It was evident that those living with their parents had better access to health care facilities than did those living on their own; however, nongovernmental organizations made significant efforts to redress this imbalance, setting up health check-up camps at regular intervals. Although exposure to harsh reality at an early age had resulted in a premature loss of innocence in most, making them sometimes difficult to work with, the nongovernmental organizations were striving to ensure child participation and the growth of individual identity. The interventionists therefore focused on developing a rights-based approach, rather than a charitable one.

A Review of: Curry, A. (2005). If I ask, will they answer? Evaluating public library reference service to gay and lesbian youth. Reference & User Services Quarterly, 45(1), 65-75. Retrieved from https://www.jstor.org/journal/refuseserq
 Abstract 
 Objective - To assess the quality of service provided by reference staff in public libraries when presented with a request for LGBTQ information by a young person.
 Design - Unobtrusive observation without informed consent. Setting - Public library branches in the greater Vancouver area, British Columbia, Canada.
 Subjects - Reference librarians.
 Methods - A 19-year-old posing as a high school student approached reference desk staff at 20 public library branches. The student proxy, “Angela”, was instructed to ask for books on forming a gay-straight alliance at her school and, if there was a full reference interview, to also ask for recommendations of novels that the group might read. She recorded the reactions, both verbal and nonverbal, using Reference and User Services Association guidelines as a template. Library administrators were aware of the potential visits and permitted the research, but the reference desk staff were not aware of a potential visit by the student proxy. The researcher claimed that her method, while deceptive, was necessary to obtain authentic reactions from the library staff.
 Main Results - Most reference librarians approached by Angela made adequate attempts to assist her, although a few library staff reacted negatively to her query. Half of the librarians reacted positively to the patron’s request, with most of the others providing neutral responses. Very few of the librarians actually taught the patron how to use the library’s catalog to search for materials, and most of the librarians were unable to find appropriate materials due to not knowing the appropriate search terms. Only three library staff showed overt disapproval of the search topic, such as frowning or rushing to finish the reference interview quickly, with most remaining objective or supportive. Because of the service she received, Angela stated that eight of the 20 libraries were welcoming enough that she thought she would return.
 Conclusion - The wide range of responses received by Angela indicated that there was room for improvement in educating public library staff on gay and lesbian issues and materials, especially for gay and lesbian youth.

Abstract Introduction: Obesity and type 2 diabetes mellitus (T2DM) are growing health concerns. A ten-fold increase of T2DM was noted in the Hong Kong paediatric population from 1997 to 2007. T2DM is often asymptomatic at presentation, but complications can emerge rapidly, especially in youngsters. Experience in Japan, Korea and Taiwan suggests that urine glucose screening is a practical and non-invasive screening tool for identification of T2DM. The Hong Kong Student Health Service (SHS) offers yearly health checks for students and is a good platform for screening of T2DM since attendance rate is over 90% for primary school students and over 70% for secondary school students. Method: In 2005, SHS and the Hong Kong Paediatric Society formulated a protocol on urine glucose screening for early diagnosis of T2DM in students with obesity. Students between the ages of 10–18 years old with age- and sex- specific body mass index (BMI) >97th percentile were recruited. Those screened positive for glycosuria were referred to paediatric departments for workup under a standardized protocol, whilst those who screened positive for both glucose and ketones were referred to the emergency departments. Students enrolled from school year 2005–2006 to 2017–2018 were included. Demographic data, clinical presentation, investigatory results and co-morbidities were captured using a structured reply letter. Results: A total of 219,276 eligible students attended SHS in the years specified and 216,528 students (99%) completed urine glucose screening. 381 (0.18%) students were tested positive for urine glucose; 18 (4.7%) had concomitant urine ketones. In total 120 students had T2DM, 41 had pre-diabetes [impaired fasting glucose and /or impaired glucose tolerance] and 126 turned out normal. 43 students defaulted the referrals and 51 students had known diabetes. 21 students (17.5%) were started on insulin therapy upon diagnosis. A significant proportion of students with T2DM had co-morbidities including raised alanine amino-transferase (57%), hypercholesterolaemia (59%), and hypertension (13%). Five students (4.2%) had microalbuminuria at presentation. Of those with ketonuria, two students had serum glucose of over 20mmol/L and required fluid resuscitation ± insulin infusion in high dependency unit. Conclusion: Our pick up rate for T2DM from students with obesity aged 10–18 years using urine glucose is 0.05% (120/216,528). According to the Hong Kong Childhood Diabetes Registry, the crude incidence of T2DM for this age group was 6.16 /100,000/year over the study period, which equates to 506 new cases of T2DM. Thus 24% of the new T2DM cases were diagnosed by this program and many had associated co-morbidities at diagnosis. Our study shows that urine glucose testing is an inexpensive and simple test that allows for early diagnosis and treatment of T2DM in the primary care setting in this at risk population.

Congenital syphilis (CS) is a systemic infect contagious disease, sexually transmitted, easily diagnosed, with effective and low cost treatment. Thus, the existence of a paradox is detached, once infectious diseases of greater complexity have already been controlled. In its congenital form, syphilis in Brazil constitutes a sentry event of high magnitude that presents unfavorable indicators in terms of its control. In the State of Pará, Marabá is the municipality with the highest number of cases in the past years. The aimed of this study was describing a clinical-epidemiological profile of congenital syphilis in Marabá, from 2006 to 2015. This was a descriptive, retrospective and documental study which analyzed secondary data from SINAN/SMS/SVS/DATASUS/Marabá/PA. Between 2006 and 2015, 323 cases of CS were notified in Marabá. The incidence of congenital syphilis of 6.5 cases per 1,000 live births from 2006-2015 is 6.5 the Ministry of Health goal; from 2012 to 2015 the rates were 8, 9.8, 26.3 and 11.3/1,000, respectively. Most pregnant women performed prenatal (88.6%), was between 20 and 24 years old (62.2%), 26.6% did not finish Middle School. Most partners, 67.5%, of the pregnants diagnosed with did not perform treatment; in 55% of cases, the maternal syphilis diagnosis happened during labor/curettage. Congenital syphilis in Marabá overcame the highest incidence in 2014, with 26.3 cases per 1,000 live births. This great value in 2014 may be a result of the campaign "It's possible to born without syphilis in Pará", released by the Secretary of State for Health of Pará at the end of 2013, since in periods of huge campaigns there is an increase of notifications, due to easier access to the diagnosis of the disease. In the year of 2015, an incidence of 11.3 cases per 1,000 live births was observed, this abrupt decrease, compared to 2014, corroborates with the influence of the campaigns in the detection of new cases. The cases of congenital syphilis notified in the Municipality of Marabá demonstrated failures in the prenatal service, particularly in the time of verification of gestational syphilis and in the treatment of the partners. However, most cases had a positive outcome, with a low number of pre and perinatal deaths due to CS. According to the section of Epidemiological Surveillance of Marabá, many factors are responsible for the high incidence of congenital syphilis in the municipality, among them the lack of clarification of the pregnants/mothers about syphilis, a low demand by the prenatal care and the low attendance of partners, what unfeasible the effective control of this disease, as well as the precarious training of health professionals, who give little importance to the disease and show difficulty to interpret lab results. The correct notification (if there is a higher quality in the reports, the number will be closer to the real), investigation of cases, appropriate treatment and implementation of measures to prevent new cases of congenital syphilis will contribute to the reduction of cases in Marabá.

Summary We present the first case of pigeon allergy causing severe haemolytic anaemia. Serology demonstrated very high titres of antibodies to avian proteins; in excess of those seen in the majority of cases of allergic lung disease1. Observation, immunosuppressive therapy and attempts at reducing antigen exposure were ineffective in controlling the disease. The only effective measure was culling the birds which resulted in a swift remission in the patient’s illness. Background Avian allergic diseases are well documented including extrinsic allergic alveolitis and asthma. However, from a review of the literature, haemolytic anaemia has not yet been described. Case Presentation An eight year old boy presented to accident and emergency with malaise, pallor and a sore throat. Haemoglobin was 53g/L. Further clinical examination revealed splenomegaly of 3.5cm below the costal margin. Investigations Full blood count demonstrated marked anaemia and a reticulocytosis (Hb 53g/L, WBC 2.2 x109/L, Neuts 1.3 x109/L, Lymphs 0.6 x109/L, Platelets 186 x109/L, Reticulocytes 375 x109/L). Blood film demonstrated increased polychromasia and microspherocytes. Direct coombes test was negative. Differential Diagnosis The patient’s haemoglobin stabilised following a short period of time in hospital. Red blood cell transfusion and immunosuppressive therapy were not required at this stage. Despite stable haemoglobin concentrations there continued to be evidence of haemolysis throughout the first year of follow-up. This was complicated by gallstone disease which required open cholecystectomy. School attendance was adversely affected. In view of the prolonged duration of the illness the patient was screened for congenital and acquired causes of haemolysis. No cause was found for the condition. Three years later the patient experienced decompensated haemolysis with a fall in his haemoglobin to 66g/L and symptoms of lethargy and malaise. His splenomegaly was more marked at 5.0cm. He was commenced on prednisolone (1mg/kg) which stabilised his blood count but was complicated by psychiatric disturbances. During a routine follow-up appointment the patient disclosed that he kept over 100 racing pigeons at his home. He was involved in their care on a daily basis and would regularly race the birds in competitions. Serological testing demonstrated high titres of antibodies to avian proteins (pigeon and budgie serum, feather and droppings >200x103 mg/L). These levels are in excess of those seen in the majority of cases of allergic lung disease1. Treatment Initial attempts to reduce exposure were ineffective. Following discussions with the family the birds were culled. There was an immediate and dramatic effect on reticulocytes and within a month it was possible to begin reducing the steroid dose. Over the following year there was a progressive rise in his haemoglobin associated with a continued fall in the reticulocytosis. Steroids were discontinued at four months. Three years following the removal of the causative agent the patient remains well and off treatment. Discussion Avian proteins are commonly cited as a cause for immune conditions, predominantly those affecting the respiratory system. This is the first case of avian allergic haemolytic anaemia. This case highlights the importance of consideration of unusual pathologies. Competing interests None Patient consent Not obtained. References 1) C I Baldwin, A Todd, J E Calvert. Pigeon fanciers' lung: effects of smoking on serum and salivary antibody responses to pigeon antigens. Clin Exp Immunol. 1998 Aug;113(2):166-72. Disclosures: No relevant conflicts of interest to declare.

Abstract Abstract 2485 Poster Board II-462 Introduction: Sickle cell disease (SCD) has a negative impact on education, career development, employment, and work history. Repeated painful crises and chronic complications (leg ulcers, retinopathy, etc.) can limit employment options and interfere with work attendance. Young adults frequently report that their health has interrupted educational plans and prevented their finding a full-time job. The purpose of this study is to examine employment patterns over time among SCD patients enrolled in the Multicenter Study of Hydroxyurea (MSH) in Sickle Cell Anemia, a randomized placebo-controlled double-blind study of whether hydroxyurea (HU) treatment could reduce the rate of painful crises in SCD. Patients and Methods: The N=299 adult patients in MSH were recruited from 21 sites across the U.S. and Canada, and were evenly distributed between males and females. Patients were at least 18 years old with a diagnosis of sickle cell anemia and at least 3 painful crises in the year prior to entry. The trial was terminated early due to a beneficial effect of HU on painful crises, but led to an observational follow-up and extension.Patients reported employment status at baseline and at 12, 24, and 36 months in the clinical trial; during the follow-up, employment data was collected in years 1-5 and 7-9. We categorized patients as ‘employed' (working full or part time) or ‘unemployed' (any other response, including unemployed, disabled, in school, retired, etc.). About 90% of all responses in this category were either unemployed or disabled, rather than other options such as in school.We examined employment history in 2 ways. First, changes from baseline to 24 months in the clinical trial (there was little data for 36 months due to the early termination) were categorized as continuous employment, continuous unemployment, shift from employment to unemployment, or from unemployment to employment; chi-square analyses were used to compare groups. Second, using all available data from the trial and follow-up, we calculated cumulative employment for each patient as the proportion of years employed out of all years of available data (up to the maximum possible of 12 years of data). This allowed us to obtain values for all patients despite missing data from some years. Linear regression models were used to compare groups.Employment history was compared between the placebo group and HU treatment responders and nonresponders (responders were defined as patients with % fetal hemoglobin < 15% before treatment and > 15% two years later). Many patients moved from placebo to HU following the clinical trial, but original group assignment was used for analyses because the HU group would have had the earliest and most consistent exposure to HU. Results: Descriptive data were suggestive of better employment outcomes for HU responders. During the clinical trial, 41% of responders and 29% of nonresponders were continuously employed or moved to employment. However, differences between responders, nonresponders and placebo patients were not statistically significant (p=.73). Across all years of data, responders were employed in 34% of years, versus about 30% for nonresponders and placebo patients. However, differences between groups were again not statistically significant (p=.71). Conclusions: Recurrent episodes of acute and chronic pain are characteristic of SCD. In MSH, HU treatment significantly reduced the rate of painful crises, the need for blood transfusion, and morbidity and mortality. Although some aspects of quality of life improved in this cohort of patients with moderate to severe SCD, employment patterns during the clinical trial and overall proportion of years in employment did not significantly differ. These findings point to two important aspects of HU treatment.First, employment effects may differ with more timely initiation of HU. MSH patients had moderate to severe SCD at enrollment, and some already had related disabilities (such as avascular necrosis) unaffected by HU. Earlier initiation of HU may prevent or delay onset of the most serious SCD complications that can negatively affect employment. Second, data such as those reported here may be of use in counseling young SCD patients regarding employment. The Americans with Disabilities Act defines rights of disabled/impaired persons in the workplace and awareness of this may lessen stress due to fear of losing a job or being unable to find employment. Disclosures: No relevant conflicts of interest to declare.

Background. Topicality of the theme. With the advent of the Internet, Internet journalism has appeared. In relating to theater, in essence, it is theatrical criticism, which has only undergone major changes. In recent years, there have been lively discussions in professional circles about the state and prospects of theater criticism as a profession, about the nature of theater criticism, its self-identification in the modern information space. Round tables with the participation of leading theater critics are devoted to the issues of the current state of theater criticism, a number of relevant materials have been published in specialized publications, often with indicative headings: “Who needs theater critics?” [1], “Theater criticism: final or transformation?” [9]; interviews of theater critics, in which they uphold the positions of the profession and, at the same time, speak about urgent problems and the need to update it taking into account rapidly changing realities: with S. Vasilyev [2], N. Pivovarova [5], Ya. Partola [6]; discussion articles on the status and prospects of the profession by M. Harbuziuk [3], M. Dmitrevskaya [4], N. Pesochinsky [7], I. Chuzhynova [10], S. Schagina, E. Strogaleva, E. Gorokhovskaya [11]. Thus, there are several points of view on this topic: that theatrical journalism has replaced theatrical criticism; that theatrical critics of the old school did not have time to adapt to the changing world and use new tools in this profession, and young critics just occupy their niches in the youth media and on the Internet; that the profession of a critic does not go beyond the framework of participation in expert councils, jury membership, attendance at theater festivals, and writing reviews on request. The question, however, is still open. The main goal of this article is to determine the degree and main character of the interaction of journalism and theatrical criticism in modern media. Results of the study. Those who are seriously engaged in theater studies and academic theater criticism feel the need for specialized publications, the number of which in Ukraine is reduced to a minimum. Therefore, those who had the opportunity to publish reviews in the socio-political periodicals, have to combine three professional areas in one, becoming a theater journalist. Academically trained theater critics can write and often write good books, but, as a rule, do not know how to write for newspapers and magazines. But graduates of journalistic departments who write about the theater are not familiar with professional terminology, which is able to give a correct assessment of the premiere performance. The question arises: how to combine those and these, that the theater journalism was both fascinating and acute, and moderately scandalous, but at the same time accurate and high-quality? To grow such specialists is a matter of work, there can be no conveyor system here. Modern theater criticism, gradually becoming obsolete, rather survives from the common theatrical space. The theater critic cannot be a free artist, and live on the money from the results of his work, because in non-capital cities the number of journals in which the theater specialist would have had time to publish his works has decreased by several times. In cities such as Poltava, Sumy, Chernigov, the issues relating to theatrical premieres are not covered by critics (they are simply not there), but by journalists who write on various topics and rarely specialize in one. The substitution of theatrical critique by journalism is quite natural, for example, for cities where there is no professional training of theater critics, however in Kiev, Kharkiv and Lviv theater studies continue, and a certain number of graduates hope for the viability of this profession. Theatrical criticism and theatrical journalism are in their own way demanded in certain circles. Criticism is closer to theaters, journalism – to the audience. It is difficult to debate with this statement that new epoch came with the Internet. Now, the spoken word has a completely different value. For example, а word thrown on Facebook can have the same effect on public opinion as a big, built, hard fought text. This does not mean that you do not need to write large texts and publish them on paper. You just need to understand and accept the new reality, its advantages and disadvantages, its danger and its benefits. It is a very important problem of our consciousness and the problem of our theater. The Internet has given a new push to the development of new type of media-translations, actively working in social networks. Sites appear on the network where online remote screenings of performances are held. They provide Internet audiences with the opportunity to be acquainted with the history of national and world theater art; they are introduced to modern avant-garde performances. Of course, this also brings the theater closer to a wide, as a rule, young audience and opens up new opportunities for a different kind of theater journalism. Сonclusions. Thus, the Internet becomes an active means of influencing the minds in the modern media space. The Internet influences everyone and everything, changing attitudes towards theatrical art, as well as contemporary theater criticism and theater journalism. However in this case, it is essential to remember that not the Internet, but only professional theater criticism that has been and remains the breeding ground for the scientific work of theater critics and art historians, while creating the history of dramatic, opera and ballet theater.

Abstract Background There is an evidence gap about whether levels of engagement with public services such as schools and health care affect people across the lifespan. Data on missed patient appointments from a nationally representative sample of Scottish general practices (GP) (2013–2016) were probabilistically linked to secondary school pupil data. We tested whether school attendance, exclusions (2007–2011) or lower educational attainment (2007–2016) was associated with an increased risk of missing general practice appointments. Methods School attendance data were classified into quartiles of possible days attended for years we had data. School exclusions were derived as a categorical variable of ‘ever excluded’. Attainment data were categorised via the Scottish Credit and Qualifications Framework (SCQF) level 3 or 6; a cumulative measure of attainment on leaving school. The associations between school attendance, exclusions and attainment and risk of missing medical appointments were investigated using negative binomial models, offset by number of GP appointments made and controlling for potential confounders. Results 112,534 patients (all aged under 35) had GP appointment and retrospective school attendance and exclusion data, and a subset of 66,967 also had attainment data available. Patients who had lower attendance, had been excluded from school or had lower educational attainment had an increased risk of missing GP appointments (all rate ratios > 1.40). Conclusions This study provides the first evidence from a population-representative sample in a high-income country that increased numbers of missed appointments in health care are associated with reduced school attendance, higher levels of school exclusion and lower educational attainment. Insights into the epidemiology of missingness across public services can support future research, policy and practice that aim to improve healthcare, health outcomes and engagement in services.

Abstract Background Managing school nonattendance is a priority worldwide. Frequent school nonattendance in early school years has immediate and long-term negative effects. Although strategies to address nonattendance are being developed and implemented, the number of students with school nonattendance issues is increasing. In this study, we explored students’ feelings and perceptions about attending school and the potential determinants of a positive attitude towards attending school. Methods We hypothesized that a positive perception towards attending school was influenced by relationships, perceptions of current circumstances, subjective health, and having someone to share experiences and thoughts with. For examining the hypothesized model, an original questionnaire with 14 items was developed, including perceptions towards school attendance (an item), relationships with friends and school teachers (5 items), current circumstances (4 items), subjective health (3 items), and the individuals available to share experiences and thoughts with (1 item). In total, 6860 children submitted the questionnaire (85.3% response rate) and 6841 responses were included to examine the model. Children were 10 or 11 years old, and selected from 111 state-run schools in 8 randomly selected school districts. Results The final model demonstrated good fit and showed that the latent variable of relationships with friends and school teachers directly impacted on how children felt about attending school. The latent variable of subjective health also directly impacted on how children felt about attending school but not strongly. Other latent variables were not significant. Conclusions The importance of positive relationships with friends and teachers in overcoming school nonattendance has been emphasized in previous studies. This study has provided evidence that these relationships impacted children’s positive perception about attending school in a large sample of students aged 10–11 years. The latent variable of subjective health may require more items to capture mental health.

While early childhood education has received increasing attention in the developing world in recent years, relatively little evidence is available from sub-Saharan Africa on its effects on child development and subsequent school enrolment. We use a prospective case-control design to evaluate the developmental impact of a community-based early childhood center in an urban area in Zambia. Comparing 40 children attending the center to 40 children not attending the center from the same community, we find that center attendance was associated with significantly better performance in an assessment of task orientation, and was also weakly associated with increased letter familiarity. We also observed higher performance among center students on tests of receptive language and pencil-related fine motor skills. These associations were, however, smaller and not statistically significant. We conducted a follow-up one year after the initial assessment, when children were seven years old and should have been in first grade. At follow-up, 27% of non-attendees were not yet enrolled in primary school, compared to just 11% of center students, suggesting that participation in early education encourages a timely transition into first grade.

This paper is an exploratory study investigating motivators of teenagers to both attend and not attend a climate change related protest event. Using open-ended surveys and focus groups, 16–19-year-old Australian students were asked about their motivators to attend and abstain from School Strike 4 Climate events. Through qualitative analysis and thematic coding, results show key motivators to attend a Strike include climate change and acts of political participation that provide youth with a public voice. Protest is positioned as a key part of teen political repertoires. Reasons for non-attendance included prioritizing schoolwork and low efficacy in protest or participatory action. However, low efficacy in climate change mitigation, or an outright rejection of climate science, was not evident in this sample. Overall, reasons for attendance and non-attendance at a Strike event were not direct mirror images of the other, and implications for inclusion of non-participants in further studies is discussed in this light.

Background: School absenteeism is a considerable problem generally related to higher dropout rates, poor academic achievement and school lag. This study determined the frequency and causes of overall and illness-related absenteeism of students in rural schools from two Colombian municipalities.
 Methods: A prospective and descriptive study was conducted in a population of 948 school children from 34 rural schools. Absenteeism data were collected for 2013 academic year consisted of the number of students registered and absent by grade, school, day and reason for absence. Absence rates (overall and illness-related absenteeism) were recorded, based on full or partial days absence, measured both as episodes, and accumulating the number of days.
 Results: From the students included in the study, 55.1% were male and 71.6% were between 5 and 9 years old. The overall absence rate was 5.7 episodes per child-year (95% confidence interval 5.5 to 5.8) and 8.6 days per child-year (8.4 to 8.9). The main reasons for non-attendance were illness (24.4%), medical or dental check-up (12.9%), travel (12.3%), lack of motivation to attend school (10.0%) and bad weather (9.3%). The illness-related absence rate was 1.4 episodes per child-year (95% confidence interval 1.3 to 1.5) and 2.5 days per child-year (2.4 to 2.6). The main reasons for illness-related absence were cold (37.0%), nonspecific fever (10.9%) and stomach pain or vomiting (8.4%).
 Conclusions: In this study, the most common reasons for non-attendance were illness-related. The importance of respiratory and gastrointestinal infections in absenteeism was evident, showing rates similar to other urban school studies. Then, the results of this study provide knowledge on the magnitude and reasons for absenteeism in rural schoolchildren.

AbstractIn several Latin American countries, conditional cash transfer programmes are a proven means of alleviating poverty in the short term and promoting education of children from disadvantaged families in the longer run. While the effectiveness of the Brazilian Bolsa Família for children’s education outcomes up to 15 years of age has been widely documented, its contribution to the promotion of students of secondary school age has not been fully explored in light of the programme’s expansion to 16-17 years olds in 2008. In this paper, I draw on Brazilian National Household Sample Survey data and use a difference-in-differences approach already applied in research in the context of Bolsa Família extension. Whereas these data were previously examined to detect intent-to-treat (ITT) effects due to insufficient information on treatment status, in this study I rely on a classifier method to additionally estimate average treatment effects on the treated who belong to families supposedly receiving Bolsa Família cash transfers. The results suggest that school attendance rates for 16-year-olds are particularly increased in the Brazilian Northeast, although the estimates are not significant when further time periods are taken into account. As comparably poor but non-recipient households have larger and consistently significant gains of school attendance, the effect on adolescent’s education directly caused by the expansion of Bolsa Família remains ambiguous and thus cast doubt on the specific parallel trend assumption. In addition, no long-run ITT effects of the programme’s expansion on school participation among 16 year old teenagers are found.

Abstract Issue/problem One of the duty of a State is to guarantee the protection of the health of all citizens, both safeguarding the sick individual needing care and protecting the healthy individual. An important objective of the vaccination prevention programs is to protect people most at risk of contracting infections because of their health conditions. Description of the problem In April 2019 the District 14 of Local Health Autority Roma 1 was asked by a father of an immunosuppressed child (6 years old), worried about infectious diseases, to verify the safeness of his child school attendance (the first class of primary school). First, a list of the class mates was asked to the school, in order to check their vaccination status by interrogating the web based regional vaccination register. Then, the District asked to the school to plan a meeting with classmates’ parents and teachers, in order to inform about the importance of a complete immunization both for the classmates and the immunosuppressed child protection. Results Preliminary results show that, among 18 classmates, 77.8% had full vaccination coverage for the second dose measles and fourth dose whooping cough (not mandatory for children aged less than 7 years), 22.2% were immunized for chicken pox. Among the parents attending the meeting, 15 agreed to complete their children vaccination cycle, all the teachers agreed to undergo whooping cough and chicken pox vaccination in order to allow a safe school attendance to the immunosuppressed child. Parents and teachers were given an appointment in a vaccination center for the week following the meeting. Lessons It is important to promote a real ’vaccination culture’ starting from the school, in order to develop greater citizenship awareness about the potential of vaccinations and to contrast fake news and ignorance leading to dangerous prejudices. Key messages The active collaboration between institutions (sanitary and school) allows, through the integration between different competences, to achieve health objectives to protect the community. Talking to pupils’ parents about infectious diseases and their prevention makes it possible to increase knowledge and therefore awareness of the importance of adult and children health protection.

A 12-year-old boy, with intermittent abdominal pain from 3 years of age, presented with increased frequency of right lower quadrant pain (at least three episodes per week over the past six months) and pain during micturition affecting school attendance. His family history included referred urolithiasis. An abdominal ultrasound performed 1 year before our visit showed a small stone of 4 mm in the right renal pelvis for which he did not receive any therapy. The patient brought 25 hard stones with irregular outline, 2–8 mm in diameter, of deep brown/grey colour that he claimed to have found in his underwear (figure 1). On examination, he looked well with normal vital signs and unremarkable cardiorespiratory and abdominal examinations. Plasma creatinine was 0.41 mg/dL (36.1 μmol/L), urinalysis and urine tests were all normal (including 24 hour calcium, phosphorus, oxalate, citrate, uric acid and cystine). Repeat kidney and urinary tract ultrasound showed no evidence of calculi.Figure 1Twenty-five hard formations brought along by the patient from home.Question 1Which is the most likely diagnosis?Cystinuria.Dent disease.Idiopathic urolithiasis.Factitious disorder imposed on self.Familial hypomagnesemia with hypercalciuria and nephrocalcinosis.Question 2How would you confirm your diagnostic suspicion?Reassurance and clinical follow-up.Mass spectrometry of stones.CT urography.Increase oral fluid intake and administration of potassium citrate.Question 3How would you manage this condition?Administration of placebo.Psychological consultation.Observed 24 hour urine collection.All of the above.Answers can be found on page 2.

Abstract Background Transition to college is characterized by change, ambiguity, and adjustment compared to the previous lifestyle before entering college. Our study aimed was to determine the pattern of students’ physical exercise practices in the Kingdom of Saudi Arabia in the period before and during college attendance. Methods A cross-sectional study was conducted among university students from fifteen universities in the Kingdom of Saudi Arabia on August 2017. The data were collected using an electronic questionnaire that was modified from questionnaires used in previous studies. Statistical analysis and data entry was performed with SPSS version 21. This study was approved by the Research Ethics Committee at King Abdulaziz University. Results 417 college students completed the questionnaire and 77.2% were female. Slightly more than half of the participants (55.9%) were from King Abdulaziz University, and 59.7% were from healthcare specialties from different institutions. The mean age of the participants was 21.80 years old (SD = 2.75). The pattern of practicing physical exercise showed a significant decrease after enrollment in college (p = 0.000). The most common reason for not practicing exercise was time restrictions, accounting for 18.5% of all the reasons, while the most common reason for practicing exercise was to improve body shape, accounting for 48% of all the reasons. Conclusions Our research found that there was a significant decrease in doing regular exercise during one’s college years in comparison to the school years prior to college. To address the decrease in physical exercise, we recommend organizing and promoting more awareness campaigns and providing suitable sports facilities and infrastructure.

We are now over four decades into digitally managing the names of Earth's species. As the number of federating (i.e., software that brings together previously disparate projects under a common infrastructure, for example TaxonWorks) and aggregating (e.g., International Plant Name Index, Catalog of Life (CoL)) efforts increase, there remains an unmet need for both the migration forward of old data, and for the production of new, precise and comprehensive nomenclatural catalogs. Given this context, we provide an overview of how TaxonWorks seeks to contribute to this effort, and where it might evolve in the future. In TaxonWorks, when we talk about governed names and relationships, we mean it in the sense of existing international codes of nomenclature (e.g., the International Code of Zoological Nomenclature (ICZN)). More technically, nomenclature is defined as a set of objective assertions that describe the relationships between the names given to biological taxa and the rules that determine how those names are governed. It is critical to note that this is not the same thing as the relationship between a name and a biological entity, but rather nomenclature in TaxonWorks represents the details of the (governed) relationships between names. Rather than thinking of nomenclature as changing (a verb commonly used to express frustration with biological nomenclature), it is useful to think of nomenclature as a set of data points, which grows over time. For example, when synonymy happens, we do not erase the past, but rather record a new context for the name(s) in question. The biological concept changes, but the nomenclature (names) simply keeps adding up. Behind the scenes, nomenclature in TaxonWorks is represented by a set of nodes and edges, i.e., a mathematical graph, or network (e.g., Fig. 1). Most names (i.e., nodes in the network) are what TaxonWorks calls "protonyms," monomial epithets that are used to construct, for example, bionomial names (not to be confused with "protonym" sensu the ICZN). Protonyms are linked to other protonyms via relationships defined in NOMEN, an ontology that encodes governed rules of nomenclature. Within the system, all data, nodes and edges, can be cited, i.e., linked to a source and therefore anchored in time and tied to authorship, and annotated with a variety of annotation types (e.g., notes, confidence levels, tags). The actual building of the graphs is greatly simplified by multiple user-interfaces that allow scientists to review (e.g. Fig. 2), create, filter, and add to (again, not "change") the nomenclatural history. As in any complex knowledge-representation model, there are outlying scenarios, or edge cases that emerge, making certain human tasks more complex than others. TaxonWorks is no exception, it has limitations in terms of what and how some things can be represented. While many complex representations are hidden by simplified user-interfaces, some, for example, the handling of the ICZN's Family-group name, batch-loading of invalid relationships, and comparative syncing against external resources need more work to simplify the processes presently required to meet catalogers' needs. The depth at which TaxonWorks can capture nomenclature is only really valuable if it can be used by others. This is facilitated by the application programming interface (API) serving its data (https://api.taxonworks.org), serving text files, and by exports to standards like the emerging Catalog of Life Data Package. With reference to real-world problems, we illustrate different ways in which the API can be used, for example, as integrated into spreadsheets, through the use of command line scripts, and serve in the generation of public-facing websites. Behind all this effort are an increasing number of people recording help videos, developing documentation, and troubleshooting software and technical issues. Major contributions have come from developers at many skill levels, from high school to senior software engineers, illustrating that TaxonWorks leads in enabling both technical and domain-based contributions. The health and growth of this community is a key factor in TaxonWork's potential long-term impact in the effort to unify the names of Earth's species.

Introduction: Dental trauma is a frequent occurance in Dentistry. They often occur in early childhood, between 0 to 3 years old, when children begin to learn their first steps, to play and run, because their habilities are not refined. Objective: The purpose of this article is to verify the occurance of traumatic dental injury in primary teeth in a children population. Material and Method: seventy-eight child from 0 to 6 years old male and female were evaluated. The study was conducted in Regional Hospital of Presidente Prudente. Children were evaluated by a questionary about occurance of traumatic injury, cause and search for attendance. The data were collected and submited to Spearman correlation test. Results: Traumatic dental injury occurs in deciduous teeth in (44,8%) of the population, more common in males (68,5%), at two years old (28,5%) and in front superior region (91,5%) in the upper central incisors (48,5%). Conclusion: By the use of correlation test of Spearman, it was possible to verify that there is a positive correlation between the factors: darkness and mobility, darkness and search for treatment, early loss and satisfactory treatment and search for treatment and satisfactory treatment.Descriptors: Tooth Injuries; Dentition; Dental Care.ReferênciasAssunção LRS, Cunha RF, Ferelle A. Análise dos traumatismos e suas seqüelas na dentição decídua: uma revisão de literatura. Pesqui bras odontopediatria clín integr. B. Odontopediatria. Clin. Integr. 2007;7(2):173-79.Duarte DA, Bonecker MJS, Sant’anna GR, Suga SS. Caderno de odontopediatria: lesões traumáticas em dentes decíduos: tratamento e controle. Santos; 2001.Moss SJ, Macaro H. Examination, evaluation and behavior management following injury to primary incisors. NY State Dent J. 1985;51(2):87-92.Campos JADB, Zuanon ACC, Pansani CA. Traumatismo na dentição decídua e suas conseqüências na dentição permanente. 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Introduction I think the Privacy Act is a huge edifice to protect the minority of things that could go wrong. I’ve got a good example for you, I’m just trying to think … yeah the worst one I’ve ever seen was the Balga Youth Program where we took these students on a reward excursion all the way to Fremantle and suddenly this very alienated kid started to jump under a bus, a moving bus so the kid had to be restrained. The cops from Fremantle arrived because all the very good people in Fremantle were alarmed at these grown-ups manhandling a kid and what had happened is that DCD [Department of Community Development] had dropped him into the program but hadn’t told us that this kid had suicide tendencies. No, it’s just chronically bad. And there were caseworkers involved and … there is some information that we have to have that doesn’t get handed down. Rather than a blanket rule that everything’s confidential coming from them to us, and that was a real live situation, and you imagine how we’re trying to handle it, we had taxis going from Balga to Fremantle to get staff involved and we only had to know what to watch out for and we probably could have … well what you would have done is not gone on the excursion I suppose (School Principal, quoted in Balnaves and Luca 49). These comments are from a school principal in Perth, Western Australia in a school that is concerned with “at-risk” students, and in a context where the Commonwealth Privacy Act 1988 has imposed limitations on their work. Under this Act it is illegal to pass health, personal or sensitive information concerning an individual on to other people. In the story cited above the Department of Community Development personnel were apparently protecting the student’s “negative right”, that is, “freedom from” interference by others. On the other hand, the principal’s assertion that such information should be shared is potentially a “positive right” because it could cause something to be done in that person’s or society’s interests. Balnaves and Luca noted that positive and negative rights have complex philosophical underpinnings, and they inform much of how we operate in everyday life and of the dilemmas that arise (49). For example, a ban on euthanasia or the “assisted suicide” of a terminally ill person can be a “positive right” because it is considered to be in the best interests of society in general. However, physicians who tacitly approve a patient’s right to end their lives with a lethal dose by legally prescribed dose of medication could be perceived as protecting the patient’s “negative right” as a “freedom from” interference by others. While acknowledging the merits of collaboration between people who are working to improve the wellbeing of students “at-risk”, this paper examines some of the barriers to collaboration. Based on both primary and secondary sources, and particularly on oral testimonies, the paper highlights the tension between privacy as a negative right and collaborative helping as a positive right. It also points to other difficulties and dilemmas within and between the institutions engaged in this joint undertaking. The authors acknowledge Michel Foucault’s contention that discourse is power. The discourse on privacy and the sharing of information in modern societies suggests that privacy is a negative right that gives freedom from bureaucratic interference and protects the individual. However, arguably, collaboration between agencies that are working to support individuals “at-risk” requires a measured relaxation of the requirements of this negative right. Children and young people “at-risk” are a case in point. Towards Collaboration From a series of interviews conducted in 2004, the school authorities at Balga Senior High School and Midvale Primary School, people working for the Western Australian departments of Community Development, Justice, and Education and Training in Western Australia, and academics at the Edith Cowan and Curtin universities, who are working to improve the wellbeing of students “at-risk” as part of an Australian Research Council (ARC) project called Smart Communities, have identified students “at-risk” as individuals who have behavioural problems and little motivation, who are alienated and possibly violent or angry, who under-perform in the classroom and have begun to truant. They noted also that students “at-risk” often suffer from poor health, lack of food and medication, are victims of unwanted pregnancies, and are engaged in antisocial and illegal behaviour such as stealing cars and substance abuse. These students are also often subject to domestic violence (parents on drugs or alcohol), family separation, and homelessness. Some are depressed or suicidal. Sometimes cultural factors contribute to students being regarded as “at-risk”. For example, a social worker in the Smart Communities project stated: Cultural factors sometimes come into that as well … like with some Muslim families … they can flog their daughter or their son, usually the daughter … so cultural factors can create a risk. Research elsewhere has revealed that those children between the ages of 11-17 who have been subjected to bullying at school or physical or sexual abuse at home and who have threatened and/or harmed another person or suicidal are “high-risk” youths (Farmer 4). In an attempt to bring about a positive change in these alienated or “at-risk” adolescents, Balga Senior High School has developed several programs such as the Youth Parents Program, Swan Nyunger Sports Education program, Intensive English Centre, and lower secondary mainstream program. The Midvale Primary School has provided services such as counsellors, Aboriginal child protection workers, and Aboriginal police liaison officers for these “at-risk” students. On the other hand, the Department of Community Development (DCD) has provided services to parents and caregivers for children up to 18 years. Academics from Edith Cowan and Curtin universities are engaged in gathering the life stories of these “at-risk” students. One aspect of this research entails the students writing their life stories in a secured web portal that the universities have developed. The researchers believe that by engaging the students in these self-exploration activities, they (the students) would develop a more hopeful outlook on life. Though all agencies and educational institutions involved in this collaborative project are working for the well-being of the children “at-risk”, the Privacy Act forbids the authorities from sharing information about them. A school psychologist expressed concern over the Privacy Act: When the Juvenile Justice Department want to reintroduce a student into a school, we can’t find out anything about this student so we can’t do any preplanning. They want to give the student a fresh start, so there’s always that tension … eventually everyone overcomes [this] because you realise that the student has to come to the school and has to be engaged. Of course, the manner and consequences of a student’s engagement in school cannot be predicted. In the scenario described above students may have been given a fair chance to reform themselves, which is their positive right but if they turn out to be at “high risk” it would appear that the Juvenile Department protected the negative right of the students by supporting “freedom from” interference by others. Likewise, a school health nurse in the project considered confidentiality or the Privacy Act an important factor in the security of the student “at-risk”: I was trying to think about this kid who’s one of the children who has been sexually abused, who’s a client of DCD, and I guess if police got involved there and wanted to know details and DCD didn’t want to give that information out then I’d guess I’d say to the police “Well no, you’ll have to talk to the parents about getting further information.” I guess that way, recognising these students are minor and that they are very vulnerable, their information … where it’s going, where is it leading? Who wants to know? Where will it be stored? What will be the outcomes in the future for this kid? As a 14 year old, if they’re reckless and get into things, you know, do they get a black record against them by the time they’re 19? What will that information be used for if it’s disclosed? So I guess I become an advocate for the student in that way? Thus the nurse considers a sexually abused child should not be identified. It is a positive right in the interest of the person. Once again, though, if the student turns out to be at “high risk” or suicidal, then it would appear that the nurse was protecting the youth’s negative right—“freedom from” interference by others. Since collaboration is a positive right and aims at the students’ welfare, the workable solution to prevent the students from suicide would be to develop inter-agency trust and to share vital information about “high-risk” students. Dilemmas of Collaboration Some recent cases of the deaths of young non-Caucasian girls in Western countries, either because of the implications of the Privacy Act or due to a lack of efficient and effective communication and coordination amongst agencies, have raised debates on effective child protection. For example, the British Laming report (2003) found that Victoria Climbié, a young African girl, was sent by her parents to her aunt in Britain in order to obtain a good education and was murdered by her aunt and aunt’s boyfriend. However, the risk that she could be harmed was widely known. The girl’s problems were known to 6 local authorities, 3 housing authorities, 4 social services, 2 child protection teams, and the police, the local church, and the hospital, but not to the education authorities. According to the Laming Report, her death could have been prevented if there had been inter-agency sharing of information and appropriate evaluation (Balnaves and Luca 49). The agencies had supported the negative rights of the young girl’s “freedom from” interference by others, but at the cost of her life. Perhaps Victoria’s racial background may have contributed to the concealment of information and added to her disadvantaged position. Similarly, in Western Australia, the Gordon Inquiry into the death of Susan Taylor, a 15 year old girl Aboriginal girl at the Swan Nyungah Community, found that in her short life this girl had encountered sexual violation, violence, and the ravages of alcohol and substance abuse. The Gordon Inquiry reported: Although up to thirteen different agencies were involved in providing services to Susan Taylor and her family, the D[epartment] of C[ommunity] D[evelopment] stated they were unaware of “all the services being provided by each agency” and there was a lack of clarity as to a “lead coordinating agency” (Gordon et al. quoted in Scott 45). In this case too, multiple factors—domestic, racial, and the Privacy Act—may have led to Susan Taylor’s tragic end. In the United Kingdom, Harry Ferguson noted that when a child is reported to be “at-risk” from domestic incidents, they can suffer further harm because of their family’s concealment (204). Ferguson’s study showed that in 11 per cent of the 319 case sample, children were known to be re-harmed within a year of initial referral. Sometimes, the parents apply a veil of secrecy around themselves and their children by resisting or avoiding services. In such cases the collaborative efforts of the agencies and education may be thwarted. Lack of cultural education among teachers, youth workers, and agencies could also put the “at-risk” cultural minorities into a high risk category. For example, an “at-risk” Muslim student may not be willing to share personal experiences with the school or agencies because of religious sensitivities. This happened in the UK when Khadji Rouf was abused by her father, a Bangladeshi. Rouf’s mother, a white woman, and her female cousin from Bangladesh, both supported Rouf when she finally disclosed that she had been sexually abused for over eight years. After group therapy, Rouf stated that she was able to accept her identity and to call herself proudly “mixed race”, whereas she rejected the Asian part of herself because it represented her father. Other Asian girls and young women in this study reported that they could not disclose their abuse to white teachers or social workers because of the feeling that they would be “letting down their race or their Muslim culture” (Rouf 113). The marginalisation of many Muslim Australians both in the job market and in society is long standing. For example, in 1996 and again in 2001 the Muslim unemployment rate was three times higher than the national total (Australian Bureau of Statistics). But since the 9/11 tragedy and Bali bombings visible Muslims, such as women wearing hijabs (headscarves), have sometimes been verbally and physically abused and called ‘terrorists’ by some members of the wider community (Dreher 13). The Howard government’s new anti-terrorism legislation and the surveillance hotline ‘Be alert not alarmed’ has further marginalised some Muslims. Some politicians have also linked Muslim asylum seekers with terrorists (Kabir 303), which inevitably has led Muslim “at-risk” refugee students to withdraw from school support such as counselling. Under these circumstances, Muslim “at-risk” students and their parents may prefer to maintain a low profile rather than engage with agencies. In this case, arguably, federal government politics have exacerbated the barriers to collaboration. It appears that unfamiliarity with Muslim culture is not confined to mainstream Australians. For example, an Aboriginal liaison police officer engaged in the Smart Communities project in Western Australia had this to say about Muslim youths “at-risk”: Different laws and stuff from different countries and they’re coming in and sort of thinking that they can bring their own laws and religions and stuff … and when I say religions there’s laws within their religions as well that they don’t seem to understand that with Australia and our laws. Such generalised misperceptions of Muslim youths “at-risk” would further alienate them, thus causing a major hindrance to collaboration. The “at-risk” factors associated with Aboriginal youths have historical connections. Research findings have revealed that indigenous youths aged between 10-16 years constitute a vast majority in all Australian States’ juvenile detention centres. This over-representation is widely recognised as associated with the nature of European colonisation, and is inter-related with poverty, marginalisation and racial discrimination (Watson et al. 404). Like the Muslims, their unemployment rate was three times higher than the national total in 2001 (ABS). However, in 1998 it was estimated that suicide rates among Indigenous peoples were at least 40 per cent higher than national average (National Advisory Council for Youth Suicide Prevention, quoted in Elliot-Farrelly 2). Although the wider community’s unemployment rate is much lower than the Aboriginals and the Muslims, the “at-risk” factors of mainstream Australian youths are often associated with dysfunctional families, high conflict, low-cohesive families, high levels of harsh parental discipline, high levels of victimisation by peers, and high behavioural inhibition (Watson et al. 404). The Macquarie Fields riots in 2005 revealed the existence of “White” underclass and “at-risk” people in Sydney. Macquarie Fields’ unemployment rate was more than twice the national average. Children growing up in this suburb are at greater risk of being involved in crime (The Age). Thus small pockets of mainstream underclass youngsters also require collaborative attention. In Western Australia people working on the Smart Communities project identified that lack of resources can be a hindrance to collaboration for all sectors. As one social worker commented: “government agencies are hierarchical systems and lack resources”. They went on to say that in their department they can not give “at-risk” youngsters financial assistance in times of crisis: We had a petty cash box which has got about 40 bucks in it and sometimes in an emergency we might give a customer a couple of dollars but that’s all we can do, we can’t give them any larger amount. We have bus/metro rail passes, that’s the only thing that we’ve actually got. A youth worker in Smart Communities commented that a lot of uncertainty is involved with young people “at-risk”. They said that there are only a few paid workers in their field who are supported and assisted by “a pool of volunteers”. Because the latter give their time voluntarily they are under no obligation to be constant in their attendance, so the number of available helpers can easily fluctuate. Another youth worker identified a particularly important barrier to collaboration: because of workers’ relatively low remuneration and high levels of work stress, the turnover rates are high. The consequence of this is as follows: The other barrier from my point is that you’re talking to somebody about a student “at-risk”, and within 14 months or 18 months a new person comes in [to that position] then you’ve got to start again. This way you miss a lot of information [which could be beneficial for the youth]. Conclusion The Privacy Act creates a dilemma in that it can be either beneficial or counter-productive for a student’s security. To be blunt, a youth who has suicided might have had their privacy protected, but not their life. Lack of funding can also be a constraint on collaboration by undermining stability and autonomy in the workforce, and blocking inter-agency initiatives. Lack of awareness about cultural differences can also affect unity of action. The deepening inequality between the “haves” and “have-nots” in the Australian society, and the Howard government’s harshness on national security issues, can also pose barriers to collaboration on youth issues. Despite these exigencies and dilemmas, it would seem that collaboration is “the only game” when it comes to helping students “at-risk”. To enhance this collaboration, there needs to be a sensible modification of legal restrictions to information sharing, an increase in government funding and support for inter-agency cooperation and informal information sharing, and an increased awareness about the cultural needs of minority groups and knowledge of the mainstream underclass. Acknowledgments The research is part of a major Australian Research Council (ARC) funded project, Smart Communities. The authors very gratefully acknowledge the contribution of the interviewees, and thank *Donald E. Scott for conducting the interviews. References Australian Bureau of Statistics. 1996 and 2001. 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London: Palgrave Macmillan, 2004. Foucault, Michel. Power/Knowledge: Selected Interviews and Other Writings, 1972-1977. Ed. Colin Gordon, trans. Colin Gordon et al. New York: Pantheon, 1980. Kabir, Nahid. Muslims in Australia: Immigration, Race Relations and Cultural History. London: Kegan Paul, 2005. Rouf, Khadji. “Myself in Echoes. My Voice in Song.” Ed. A. Bannister, et al. Listening to Children. London: Longman, 1990. Scott E. Donald. “Exploring Communication Patterns within and across a School and Associated Agencies to Increase the Effectiveness of Service to At-Risk Individuals.” MS Thesis, Curtin University of Technology, August 2005. The Age. “Investing in People Means Investing in the Future.” The Age 5 March, 2005. 15 April 2006 http://www.theage.com.au>. Watson, Malcolm, et al. “Pathways to Aggression in Children and Adolescents.” Harvard Educational Review, 74.4 (Winter 2004): 404-428. Citation reference for this article MLA Style Kabir, Nahid, and Mark Balnaves. "Students “at Risk”: Dilemmas of Collaboration." M/C Journal 9.2 (2006). echo date('d M. Y'); ?> <http://journal.media-culture.org.au/0605/04-kabirbalnaves.php>. APA Style Kabir, N., and M. Balnaves. (May 2006) "Students “at Risk”: Dilemmas of Collaboration," M/C Journal, 9(2). Retrieved echo date('d M. Y'); ?> from <http://journal.media-culture.org.au/0605/04-kabirbalnaves.php>.