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- Khoo, Evelyn Grace, 1964-
(författare)
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Protecting Our Children : A comparative study of the dynamics of structure, intervention and their interplay in Swedish child welfare and Canadian child protection
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This dissertation is a case study of how two agencies in Umeå, Sweden and Barrie, Canada protect children found in need of child welfare services. The project's purposes are to describe how children are protected from harm in these two contexts, to illuminate the similarities and differences in the child welfare systems reflected at the local level, and explicate the significance of uncovered similarities and differences. The research project is grounded in three complementary theoretical approaches: i) social constructionism, ii) critical program evaluation theory, and iii) institutional ethnography. Using a model I developed to guide cross-national comaprisons, the research project explores three dimensions in the organization and delivery of services: i)Structure (service contexts and features), ii) Intervention (intervention process, and documentation and gatekeeping as two central aspects of intervention), and iii) the interplay between structure and intervention. The project combines methods including focus groups, qualitative application of the vignette technique, and analyses of assessment summaries extracted from case files at each agency. Finding from this investgation are reported in four papers. We identified differences in gatekeeping, use of social work skills, identification of clients, decision-making, and use of compulsory measures and the availability of other measures for clients. The documentation study showed that in Canada documentation is increasingly structured whereas in Sweden documentation is systematically varied but with narrative forms dominating. The different documentation trajectories in these nations are coupled to the paths they have taken with regard to the care and protection of children. We then focus on the "best interests of the child" principle. In Canada, the best interests principle is paramount but intimately connected to "need of protection" and risk assessment. In Sweden, the best interests principle is contibutory to the Social Service Act's emphasis on a solidaristic response to need. When data from this study are taken in context with other research in the field, it appears to give meaning to description of two models of state service for children in need because of abuse or neglect. Umeå is representative of some of the key elements in Swedish child welfare whereas Barrie is representative of some of the key elements in Canadian child protection.
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- Nygren, Anders, et al.
(författare)
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Rapid Cardiovascular Effects of Growth Hormone treatment in short prepubertal children. Impact of treatment duration.
- 2012
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Ingår i: Clinical Endocrinology. - : Wiley. - 0300-0664 .- 1365-2265. ; 77:6, s. 877-884
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Previous studies show that growth hormone (GH) treatment increases cardiac dimensions in short children with GH deficiency (GHD) and has diverse cardiac effects in children with idiopathic short stature (ISS). This study was performed to assess the effect of GH on the cardiovascular system in short children with a broad range of GH secretion and GH sensitivity/responsiveness. DESIGN AND PATIENTS: In this prospective, multicentre study, short prepubertal children diagnosed with isolated GHD (89) or ISS (38) were followed during two years of GH treatment. They were randomized to receive either a standard (43 μg/kg/d) or individualized GH dose (range 17-100 μg/kg/d) based on GH responsiveness estimated by a prediction model and distance to target height. Echocardiography, blood pressure and electrocardiography were performed at baseline, 3, 12 and 24 months. RESULTS: Left ventricular mass (LVM) indexed to body surface area increased significantly during two years of GH treatment in both GHD and ISS irrespective of randomized dose. This change was already apparent at three months, when standard deviation scores (SDS) of wall thickness and diameter were increased. At 24 months, left ventricular diameter SDS remained increased whereas myocardial thickness SDS returned to baseline values. There was no impairment of systolic or diastolic function. There was no correlation with treatment dose and LVM SDS at 24 months. CONCLUSIONS: Irrespective of GH status, there was a rapid increase in LVM during GH treatment in short children. At 3 months, wall thickness and diameter were increased whereas only diameter remained increased at 24 months. © 2012 Blackwell Publishing Ltd.
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