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PubMed2003

Latin American social medicine: roots, development during the 1990s, and current challenges.

Latin American social medicine arose during the 1950s and 1960s, drawing its inspiration from the social movements that emerged in France, Germany, and England in the mid-19th century. The Latin American movement of social medicine has clear ideological goals. It is organized around the Latin American Association of Social Medicine, which was founded in 1984 and is regarded as a social, political, and academic movement. This article takes a historical perspective and presents the reasons for the emergence and identity of the association, focusing on the main developments and contributions of this movement from the 1990s until the present time.

Consumer Advocacy↗
PubMed2004

Thirty years of hemophilia treatment in the Netherlands, 1972-2001.

Since the introduction of replacement therapy in the early 1960s by the infusion of plasma-derived factor VIII and IX preparations, important changes have occurred for hemophilia patients. We studied the medical and social developments over 30 years of hemophilia treatment. Since 1972, 5 cross-sectional national postal surveys among all hemophilia patients in the Netherlands were performed, the latest in 2001. The prestructured questionnaires included items on treatment, the presence of inhibitory antibodies against factor VIII or IX, the annual number of bleeding episodes, use of inpatient hospital care, and hepatitis C and HIV infections. Response rate in 2001 was 70%. Young patients (<16 years) with severe hemophilia showed the largest increase in use of prophylaxis, from 34% in 1972 to 86% in 2001. The occurrence of hemorrhages has gradually decreased. Hospital admissions decreased from 47% of all patients in 1972 to 18% in 2001. Our study shows that the treatment of patients with severe hemophilia in the Netherlands has focused on the use of prophylactic treatment, especially in children. This has resulted in a decrease in bleeding frequency and an improvement of the medical and social circumstances of patients.

Factor IX↗
PubMed1996

Adolescent decision making: a broadly based theory and its application to the prevention of early pregnancy.

The purpose of this paper is to present a broadly based theory of adolescent decision making including all the necessary components of the subject: cognitive development, social and psychological factors, and, perhaps most importantly, cultural and societal influences. Previous theories and applications have often focused on only one or two aspects. This theory is then applied to the problem of prevention of early pregnancy at an inner-city high school. Use of this theory, combined with an open-ended data-gathering format made possible some of the unexpected findings of this study: most of the young women at this school desire their pregnancies; many of them prefer single parenthood to traditional family structure; and low academic skills and poverty often result in pregnancy, rather than pregnancy causing high school dropouts and a life of poverty. Prevention programs will necessarily differ for sexually active adolescents who do and do not want pregnancy and for younger versus older adolescents. In designing such programs, we need to focus on pregnancy as the problem rather than on adolescent sexuality.

Adolescent↗
PubMed1999

Using social health insurance to meet policy goals.

Social health insurance, with contributions based on incomes and access to services on need is being considered as an option for health care finance in many countries. The argument in this paper starts from the premise that the choice of health care financing mechanisms should start with a clear focus on policy goals, with different options judged against the extent to which these are met. These are likely to include objectives of access to care for those in need, quality of care, incentives for efficient provision and cost control. Different systems will meet the objectives of mobilising resources, providing insurance against risk and redistribution resources to differing extents. It is argued that a particular problem in health care finance is shifting rights to resources over time. It is also important to be clear about the distinction between affordability of and payment mechanisms for health care. The choice of funding mechanisms may have little effect on other policy goals, such as economic development. However, they may differ in the degree to which they allow specific health policy goals to be met. Different mechanisms for collecting and managing funds, and for paying for services are discussed. The paper concludes with concerns that too much emphasis is placed on structures and not how they work, that a lack of cost control may be a serious risk in developing social health insurance and that it is important to have clear mechanisms for setting priorities if policy goals are to be met.

Cost Allocation↗
PubMed2002

[A world tailored for children and the young. The children and the young around us and the child and the adolescent within each of us].

UNLABELLED: Towards the end of the nineteenth century in America, a court that normally dealt with animal abuse found itself facing a very special problem: it had to discuss for the very first time a case of child abuse. It might seem a paradox to many that a matter of this nature should be discussed in a court set up for a quite different purpose, but it was not an error arising out of the lack of room in the civil court nor an error of competency: it happened to be the only place judged to be appropriate to discuss the rights of a child, mistreatment of whom was handled on a par with abuse of animals. In spite of the section expressly dedicated to children in the Universal Declaration of Human Rights of 1789, the world had to wait for the Geneva Convention of 1924 before the first declaration of children's rights was promulgated. There were five main principles: the right to a healthy psychophysical development, the right to be nourished, cared for, returned to a normal life if demoralised, looked after and aided in the case of orphans. But only with the international Convention of children's rights of New York in 1989 was it possible to draft a text for the full, more comprehensive protection of infancy, two centuries after the first pronouncement on the occasion of the universal declaration of human rights. Two centuries of struggles and growing awareness of the problem of children (and at the same time of women and mothers) in the world, two centuries that have produced all over the world the complete idea of the child as having rights and being an active part of contemporary society. But the examination of the current situation brings us to the main problem: if a virtuous circle is not established between rights, infant culture and duties of adults, then the declarations of this century will have to wait many years more before becoming a practical part of our society. What then should be done to make sure that the declarations and conventions on rights do not remain a mere expression of principles? There can be no evolution in children's living conditions, nor protection of their rights, if we do not create a culture of infancy based on two premises: the rights of children and the duties of adults with respect to children. Today an exact and comprehensive knowledge of the rights of children is necessary above all starting with their right to freedom, experience, opinion, equal opportunity for development and education, defence against all types of abuse, and their right to a family. But at the same time it is necessary to act in the area of the duties of parents and adults: the question is one of building up a cultural system that includes the rights whereby the prerogatives of children are matched with corresponding duties of adults, a culture of values that responsibilises adults by way of a process of personal awareness and parent training. The adult must find himself personally in harmony in his relationship with life so as not to compromise on child training: the idea of a vulnerable future must be avoided; a future that is insecure and defenceless for children and adolescents who are future adults. A third factor must cater for this, namely modern society whose task it is to build structures (interconnected by means of an interdisciplinary project and through the possibility that modern technology also offers them) to supply opportunities and laws that favour and protect the personality of both child and adult. In this case considerable value would be taken on by the drafting of a "Charter of Duties of adults with respect to children and adolescents" that favours the birth of new standards and national and international conventions aimed at a new conception of society understood as a set of several parts, children, adolescents, adults, each subject of rights. By this approach the commitment of individual associations, organisations and institutions would start a process of social development which as of today is the last and on]y real revolution possible to improve the conditions of life of the person as such, and not the person as such, and not only of the person as a citizen of one nation or another. IN CONCLUSION: no development is possible if we do not take steps as an international community to protect the first citizens of the world who are and always will bc children. 1n this sense, psychoanimation, which is a psychopedagogic-cultural intervention methodology based on a holistic approach and employs cognitive, creative, corporeal techniques to foster, in the individual and in the group, that ''growth'', that "awareness'', that "responsibility'' which have their "roots'' in self-awareness and in the possibility of acquiring cultural instruments that are scientifically and humanistically suitable to ''act'' individually and collectively, the "change'' in human societies sets itself the diffusion of a Culture of Infancy and of Adolescence as an objective. In fact for Psychoanimation that means: (''give soul to the soul'' employing all languages in interdisciplinary fashion for communication and social integration) in order to authentically permit knowledge, communication and exchange among human beings) the last ''possible revolution" is that connected with the success, all over the world, of a Culture of Infancy and of Adolescence. What is the possibility that this converts into: ''a world made to the measure of children'': the children around us and the chi]d within us!

Adolescent↗
PubMed1995

Longitudinal observations on 15 children with Wiedemann-Beckwith syndrome.

We conducted a follow-up study on 15 patients with Wiedemann-Beckwith syndrome (WBS) to further clarify major and minor diagnostic clinical characteristics and longterm expectations for growth and development. We found patients with WBS tended to have polyhydramnios with large placentas which were almost twice normal placental weight. The large fetal size and polyhydramnios often resulted in early delivery with occasional perinatal mortality (three cases). Increased placental size, with associated polyhydramnios resulting in excessive umbilical cord length, may be useful in suspecting WBS prior to delivery, thereby facilitating perinatal management. The presence of abdominal wall defects and/or macroglossia may help to confirm the diagnosis. At birth, patients were almost 2 standard deviations above the expected mean for gestational age, length, and weight. This trend continued through early childhood and then excessive size became less dramatic with increasing age. We detected no cytogenetic variations in nine patients who had studies done and, to date, no tumors have been detected other than a gastric teratoma that was evident in one infant at birth. Longitudinally, the children have not had an unusual incidence of medical problems, and long-term ultrasound monitoring was not burdensome to the families. In comparison, mental and social development to unaffected siblings and cousins appeared normal.

Beckwith-Wiedemann Syndrome↗
PubMed1989

[Increase of physical activity by improvement of the nutritional status].

Physical activity is affected by nutritional modifications and, in turn, influences growth, cognition, social behavior, work performance and other functions. Studies in preschool children showed that: 1. A decrease in energy intake during four to seven days reduced the time allocated to energy-demanding activities and increased sedentary activities. 2. Children with mild weight deficit were more sedentary than well-nourished counterparts. 3. Children became more active when nutritional status improved. 4. A 10% reduction in energy intake reduced total energy expenditure by 15% without affecting weight gain nor basal metabolism. Studies of men working in non-mechanized agriculture showed that: 1. Dietary improvements led to faster salaried work, reduction of napping time and greater physical activity after work. 2. An increase in energy intake increased total daily energy expenditure, tending to maintain energy balance and relatively stable body weight within the cyclic variations of the agricultural year. 3. Food supplementation did not necessarily improve productivity. Other labor incentives without dietary improvements increased energy expenditure during working hours, which resulted in weight loss. In conclusion, good health and nutrition provide the biological basis for adequate physical activity that may improve cognitive development, social interactions, economic productivity and the quality of life of an individual or a population, but other incentives are required for the optimal expression of that biologic potential.

Adult↗
PubMed2007

Executive inhibitory control and cooperative behavior during early school years: a follow-up study.

Several links between aspects of executive functioning and the development of social competence have been established. The present study investigates the relation between executive inhibitory control and cooperative/non-cooperative behavior, in an ecological setting, and from a longitudinal perspective. Elementary school children (n=195) of three age groups (7, 9, 11 years, initially) were measured at two consecutive time points, at a one-year interval, with tasks tapping executive inhibitory control (the Stroop test), and social competence (a collaborative puzzle solving task). Executive inhibition was identified as the most influential stable predictor only in the case of non-cooperative behavior and presented strong concurrent relations with both cooperative and non-cooperative behavior at follow-up, even when controlling for previous level of the same behavior. The findings imply the need to consider the important role of executive inhibitory processes in multifactorial models of social competence development and in the refinement of present interventions.

Age Factors↗
PubMed2004

[Home nursing in the Netherlands since 1950].

This article describes home nursing in the Netherlands between 1950 and 2004. The developments in this period are described form the theoretical perspective on professions of Andrew Abbott: 'professions are exclusive occupational groups applying somewhat abstract knowledge to particular cases'. In 1950, home nursing was an all-round profession providing home nursing care and preventive care to all categories of patients, mainly in their own homes. It was - and still is - a profession situated in the 'periphery' of the health care system, where care and support to patients with pain, suffering and disabilities because of age or chronic illness are considered as belonging to a separate task domain, relatively independent of the mainly curative activities that are performed in the 'medical centre' of health care, especially in the academic hospitals. Typical compared to other countries is that an extensive network of private initiatives, in the form of Cross Organisations of different denominational signatures, existed in the Netherlands until 1990, covering the whole country with home nursing services. In that year, the provision of home nursing and home help were integrated and most home nursing organisations merged into large, regional home care organisations. In this article, six main social developments are described, that influenced the development of home nursing and resulted in the profession as it is now: a differentiated profession divided into different levels of care, working in an organisational, largely bureaucratic setting of home care organisations, where managers and external regional assessment organisations (RIO's) decide on the care to be provided. They now find themselves in a transmural setting, where boundaries between different forms of care no longer exist, and co-operation with other professionals, such as home helps, specialist nurses, GPs, and hospital physicians, is frequent. Currently, their professional autonomy and independent decision-making regarding diagnosis and therapy is affected, and elements of bureaucratisation and managementism (for example aspects such as time-writing) affect their daily work. However, home nursing can still be characterised as a relatively exclusive and independent profession, solving particular cases in the homes of patients by performing activities that are based on abstract, methodical knowledge.

History, 20th Century↗
PubMed1983

An application of the pictorial scale of perceived competence and acceptance within an epidemiological survey.

The Perceived Competence and Acceptance Scale for Younger Children (PCS) was examined in the course of an epidemiological survey of psychological disorders in children. Eighty-three children, aged 6 and 7 years, were administered several measures including the WISC-R, the WRAT, the Lie Scale for Children, and the PCS. Teachers provided ratings from a parallel version of the PCS and reported on the behavioral and social development of each child through the Child Behavior Checklist. Investigation of the psychometric characteristics of the PCS substantially replicates findings reported by its developers. The size and direction of correlations among the cognitive competence subscale of the PCS, achievement measures, and the Lie Scale indicate that children tend to more accurately report about this domain than others included in the PCS. Children who reported atypically high or low PCS levels were not found to differ from the remainder of the sample on two clinical indices. Children who tended to exaggerate PCS levels, as compared to teacher ratings, had significantly more behavior problems in school and were seen by two observers as more apt to be currently maladjusted.

Achievement↗
PubMed2000

Aggression in childhood and long-term unemployment in adulthood: a cycle of maladaptation and some protective factors.

The present study was designed to shed light on specific risk mechanisms and protective factors in the relation between aggression in childhood and long-term unemployment in adulthood. Participants were drawn from the ongoing Jyväskylä Longitudinal Study of Personality and Social Development; data gathered at the ages of 8 (N = 369), 14, 27, and 36 years (n = 311) were used in the present study. Teacher-rated aggression at age 8 was related to subsequent long-term unemployment through a cycle of maladaptation. Specifically, childhood aggression predicted school maladjustment at age 14, which was both directly and indirectly (via problem drinking and lack of occupational alternatives at age 27) related to long-term unemployment. Child-centered parenting and prosocial tendencies in an aggressive child significantly lowered his or her probability of becoming long-term unemployed in adulthood.

Adolescent↗
PubMed2000

Attachment disorder behavior following early severe deprivation: extension and longitudinal follow-up. English and Romanian Adoptees Study Team.

OBJECTIVE: To examine attachment disturbances and disorder in a sample of children adopted into the U.K. following severe early privation and in a comparison sample of nondeprived, within-country, early-placed adoptees. METHOD: The subjects, 165 children adopted from Romania and 52 adoptees from the U.K., were assessed at age 6 years; longitudinal data (at ages 4 and 6 years) were available on the 111 Romanian adoptees placed in U.K. homes before 24 months of age and on all U.K. adoptees. Information on attachment disorder was derived from a semistructured interview with the parent; in addition, data on children's cognitive and social development were assessed using standardized assessments. RESULTS: Analyses revealed a close association between duration of deprivation and severity of attachment disorder behaviors. In addition, attachment disorder behaviors were correlated with attentional and conduct problems and cognitive level but nonetheless appeared to index a distinct set of symptoms/behaviors. Finally, there was marked stability in individual differences in attachment disorder behaviors and little evidence of a mean decrease over this 2-year period. CONCLUSIONS: The findings offer construct validation for the attachment disorder construct and highlight clinical and conceptual questions that require further research.

Adoption↗
PubMed2006

Middle childhood and adolescent contextual and personal predictors of adult educational and occupational outcomes: a mediational model in two countries.

The authors examined the prediction of occupational attainment by age 40 from contextual and personal variables assessed during childhood and adolescence in 2 participant samples: (a) the Columbia County Longitudinal Study, a study of 856 third graders in a semirural county in New York State that began in 1960, and (b) the Jyväskylä Longitudinal Study of Personality and Social Development, a study of 369 eight-year-olds in Jyväskylä, Finland, that began in 1968. Both samples were followed up during adolescence and early and middle adulthood. Structural modeling analyses revealed that in both countries, for both genders, children's age 8 cognitive-academic functioning and their parents' occupational status had independent positive long-term effects on the children's adult occupational attainment, even after other childhood and adolescent personal variables were controlled for. Further, childhood and adolescent aggressive behavior negatively affected educational status in early adulthood, which in turn predicted lower occupational status in middle adulthood.

Adolescent↗
PubMed1975

Effects of modification of the social environment on young monkey development.

Experiments and observations of the effects of modifications of the social environment on the young primate's relationship with its mother and its social-sexual development have begun to delineate the large number of variables that determine and affect the attachment relationship and that are contingent upon it. Attachment can occur to a number of mother substitutes, including a dog. Early experience has special importance but young monkeys are surprisingly responsive and adaptable to substitute maternal stimuli. The quality of developing social behavior is dependent on both the quantity and quality of an attachment. We have yet to learn what are the critical component stimuli which make up an adequate early social environment for young monkeys and apes.

Animals↗
PubMed2006

Semantic development in textual contexts during the school years: noun scale analyses.

The paper examines the nominal lexicon in later language acquisition as a window on linguistic knowledge and usage across childhood and adolescence. The paper presents a psycholinguistically motivated and cognitively grounded analysis of the distribution of ten semantic noun categories (the Noun Scale) across development, modality, and genre. Eighty Hebrew-speaking children (9;0 to 10;0), adolescents (12;0 to 13;0 and 16;0 to 17;0), and a group of adult university graduate students participated in the study. Each produced four different texts: a spoken and written narrative and a spoken and written expository, yielding a total of 320 texts. All lexical noun tokens in each of the 320 texts were analysed to determine their score on the Noun Scale. Results indicate that nominal density, which underlies much of the syntactic architecture of texts, increases dramatically in adolescence, towards adulthood. The paper analyses the developmental patterns of each of the ten Noun Scale categories, showing that the nominal lexicon of schoolaged children is already very different from that of young children in having only a small amount of genuinely concrete nouns, and these too only in narrative texts. The quantitative analysis shows that nouns grow more categorical and abstract with age and schooling, especially in adolescence. Written expository texts are the preferred habitat of abstract, categorical nouns from early on. The systematic qualitative analysis of noun tokens in their textual context demonstrates how the nominal lexicon undergoes fundamental changes that are affected by linguistic, cognitive and social development, in interaction with text genre and modality.

Adolescent↗
PubMed2003

Infant mortality and low birth weight in cities of Northeastern and Southeastern Brazil.

OBJECTIVE: To compare estimates of low birth weight (LBW), preterm birth, small for gestational age (SGA), and infant mortality in two birth cohorts in Brazil. METHODS: The two cohorts were performed during the 1990s, in S o Lu s, located in a less developed area in Northeastern Brazil, and Ribeir o Preto, situated in a more developed region in Southeastern Brazil. Data from one-third of all live births in Ribeir o Preto in 1994 were collected (2,839 single deliveries). In S o Lu s, systematic sampling of deliveries stratified by maternity hospital was performed from 1997 to 1998 (2,439 single deliveries). The chi-squared (for categories and trends) and Student t tests were used in the statistical analyses. RESULTS: The LBW rate was lower in S o Lu s, thus presenting an epidemiological paradox. The preterm birth rates were similar, although expected to be higher in Ribeir o Preto because of the direct relationship between preterm birth and LBW. Dissociation between LBW and infant mortality was observed, since S o Lu s showed a lower LBW rate and higher infant mortality, while the opposite occurred in Ribeir o Preto. CONCLUSIONS: Higher prevalence of maternal smoking and better access to and quality of perinatal care, thereby leading to earlier medical interventions (cesarean section and induced preterm births) that resulted in more low weight live births than stillbirths in Ribeir o Preto, may explain these paradoxes. The ecological dissociation observed between LBW and infant mortality indicates that the LBW rate should no longer be systematically considered as an indicator of social development.

Brazil↗
PubMed1984

Functional outcome of closed head injury in children and young adults.

A comprehensive questionnaire which measured gross and fine motor function in the area of cognition, communication, and social development was completed by parents of children and young adults who had suffered severe closed head injuries between the years 1967 and 1978. The final sample included 42 returned questionnaires. Of these patients, 15 (37%) were considered independent, 20 (49%) dependent, and 6 (14%) had died. The area of cognition and communication dysfunction seemed to contribute most to dependency. The younger age group and the patients who were comatose for a shorter period of time tended to do the best functionally. While severe closed head injury can result in significant disability, many patients can achieve functional independence.

Adolescent↗
PubMed2000

"Development" is not essential to reduce infant mortality rate in India: experience from the Ballabgarh project.

BACKGROUND: India aims to reduce the infant mortality rate (IMR) to below 60 per 1000 live births by 2000. IMR is higher in northern India as compared with south Indian states like Kerala. Any further reduction in IMR needs identification of new strategies. The Ballabgarh project with an IMR of 36 in 1997 can help identify such strategies. OBJECTIVE: To see the trend in reduction of neonatal mortality rate (NNMR) and IMR at the Ballabgarh project, compare it with Kerala and rural India's trend and look at the causes of neonatal and infant mortality. DESIGN: The Comprehensive Rural Health Services Project, Ballabgarh, run by the All India Institute of Medical Sciences, covered an estimated population of 70,079 in 1997. The health care delivery system is on the national pattern. All the deaths are identified during the house visits by the male workers. The cause of death is ascertained by the health assistant based on the symptomatology at the time of death. RESULTS: The trends in reduction of IMR for Ballabgarh, Kerala and rural India are roughly parallel with the IMR of Ballabgarh lying somewhere in between the two. However, the NNMR of Ballabgarh (10.6 in 1996) was comparable to Kerala's NNMR (10.9 in 1992). The proportion of infant deaths occurring during the neonatal period had fallen from 50% in the early seventies to 30% during 1996-97. In 1992-1994, 33.8% of all neonatal deaths were attributable to low birth weight and 37.3% to infective causes. Acute respiratory infection and diarrhoea continue to be the chief cause of postneonatal mortality. CONCLUSION: It is possible to bring down neonatal mortality before postneonatal mortality. The Kerala model, which focuses on social development, may not apply to northern India for sociocultural reasons.

Acute Disease↗