Flexibility in young people with autism spectrum disorders on a card sort task.

Adults with autism spectrum disorders (ASD) have shown deficits in switching between rules governing their behaviour, as have high-functioning children with ASD. However, there are few studies of flexibility in lower-functioning children with ASD. The current study investigated this phenomenon with a group of low-functioning children with ASD compared to a mental-age-matched comparison group. The ASD group learned an initial discrimination task as quickly as the matched comparison group, but when the rule governing the discrimination was shifted, the comparison group learned the task with fewer errors, and made the discrimination more quickly than the groups with ASD. These findings suggest that low-functioning children with ASD do display the predicted deficits in extra-dimensional shift.

Contrasting causal pathways contribute to poorer health and nutrition outcomes in orphans in Zimbabwe.

Orphaned children have been found to be at greater risk of poor health and malnutrition compared to non-orphans in sub-Saharan African countries. However, levels of disadvantage vary by location and little is known about the causal pathways that lead from orphanhood to poorer health and malnutrition. Aggregate data from recent Demographic and Health Surveys in 22 countries were used to compare overall levels of ill-health and malnutrition by orphan status. Data from the Manicaland Child Cohort Study in Zimbabwe - a closed cohort study with detailed longitudinal information on orphan's experience - were used to describe how patterns of ill-health and malnutrition alter over the child's life-course and to test causal pathways between orphanhood and ill-health and malnutrition, hypothesized in a previously published theoretical frame-work. Modest increases in ill-health and malnutrition were found in orphans in the Demographic and Health Surveys data, with maternal and double orphans being worst affected. Non-significant associations were found between orphanhood and ill-health in the Manicaland Child Cohort Study data, but no associations with malnutrition were found. None the less, smaller increases in body mass index with age were seen among orphans (ologit test for difference: adjusted odds ratio = 0.68; p = 0.07) and maternal orphans (ologit test for difference: adjusted odds ratio = 0.67; p = 0.03) than among non-orphans. Stigma and discrimination contributed to poor diet, malnutrition and ill-health in children whose mothers had died, while heightened poverty was a more important factor for paternal orphans. These results suggest social and psychological support for orphans and their families could be as important as material support in preventing malnutrition and ill-health.

HIV-associated orphanhood and children's psychosocial distress: theoretical framework tested with data from Zimbabwe.

OBJECTIVES: We measured the psychosocial effect of orphanhood in a sub-Saharan African population and evaluated a new framework for understanding the causes and consequences of psychosocial distress among orphans and other vulnerable children. METHODS: The framework was evaluated using data from 5321 children aged 12 to 17 years who were interviewed in a 2004 national survey in Zimbabwe. We constructed a measure of psychosocial distress using principle components analysis. We used regression analyses to obtain standardized parameter estimates of psychosocial distress and odds ratios of early sexual activity. RESULTS: Orphans had more psychosocial distress than did nonorphans. For both genders, paternal, maternal, and double orphans exhibited more-severe distress than did nonorphaned, nonvulnerable children. Orphanhood remained associated with psychosocial distress after we controlled for differences in more-proximate determinants. Maternal and paternal orphans were significantly more likely than were nonorphaned, nonvulnerable children to have engaged in sexual activity. These differences were reduced after we controlled for psychosocial distress. CONCLUSIONS: Orphaned adolescents in Zimbabwe suffer greater psychosocial distress than do nonorphaned, nonvulnerable children, which may lead to increased likelihood of early onset of sexual intercourse and HIV infection. The effect of strategies to provide psychosocial support should be evaluated scientifically.

Poorer health and nutritional outcomes in orphans and vulnerable young children not explained by greater exposure to extreme poverty in Zimbabwe.

OBJECTIVE: To describe patterns of association between different groups of young orphans and vulnerable children (OVC) and their nutritional and health outcomes; and to develop a theoretical framework to analyse the determinants of child malnutrition and ill-health, and identify the different mechanisms which contribute to these outcomes in such children. METHODS: We developed and tested a theoretical framework to explain why orphans and vulnerable children experience more ill-health and malnutrition based on statistical analysis of data on 31 672 children aged 0-17 years (6753 aged under 5 years) selected from the Zimbabwe OVC Baseline Survey 2004. RESULTS: 28% of children aged 0-4 years at last birthday were either orphans or vulnerable children. They were more likely than non-vulnerable children to have suffered recently from diarrhoeal illness (age- and sex-adjusted odds ratio, AOR, 1.27; 95% CI 1.09-1.48) and acute respiratory infection (1.27; 1.01-1.59) and to be stunted (1.24; 1.09-1.41) and underweight (1.18; 1.02-1.36). After further adjustment for exposure to extreme poverty, OVC remained at greater risk of diarrhoeal disease (AOR 1.25; 1.07-1.46) and chronic malnutrition (1.21; 1.07-1.38). In 0-17-year-olds, OVC with acute respiratory infection were more likely not to have received any treatment even after adjusting for poverty (AOR 1.29; 95% CI 1.16-1.43). CONCLUSION: Differences in exposure to extreme poverty among young children by OVC status were relatively small and did not explain the greater malnutrition and ill-health seen in OVC.

Internationally qualified midwives: developing a pathway to adaptation.

Midwives who have gained their qualifications abroad are a valuable asset to the NHS, but they require training in some areas to enable them to adapt to practice in the U.K. With a view to developing such a programme, research was undertaken into the communication skills and learning needs of internationally qualified midwives.

Rising incidence and prevalence of orphanhood in Manicaland, Zimbabwe, 1998 to 2003.

OBJECTIVE: To quantify and describe orphan incidence in Manicaland, eastern Zimbabwe. DESIGN: Open cohort study. METHODS: Statistical analysis of data on 13,740 and 10,308 children, aged 0-14 years, enumerated in household censuses in four socio-economic strata, 1998-2000 and 2001-2003, and 10,184 children seen in both censuses (74% follow-up). RESULTS: Prevalence of all forms of orphanhood increased. The overall rate of losing a parent amongst non-orphans was 27.5 per 1000 person-years (py). Paternal orphan incidence (20.2 per 1000 py) was higher than maternal orphan incidence (9.1 per 1000 py) and maternal orphans lost their fathers at a faster rate than paternal orphans lost their mothers. Paternal and maternal orphan incidence increased with age. Incidence of maternal orphanhood and double orphanhood amongst paternal orphans rose at 20% per annum [incidence rate ratio (IRR) = 1.20; 95% CI, 1.06-1.35] and 71% per annum (IRR = 1.71; 95% CI, 1.25-2.33), respectively, 1998-2003, but incidence of paternal orphanhood and double orphanhood amongst maternal orphans were unchanged. For 82% of children with a parent who died, the parent was HIV-positive at baseline. More new paternal and double orphans--but not new maternal orphans--than non-orphans had left their baseline household. Mortality was higher in orphans than non-orphans with the highest death rates observed amongst maternal orphans. CONCLUSIONS: Orphan incidence and prevalence are high and increasing due to HIV in eastern Zimbabwe. Orphan incidence patterns differ from orphan prevalence patterns and need to be understood if support programmes are to assist children during periods of high vulnerability.