RESUMO
Children with special health care needs (SHCN) have or are at increased risk for a chronic condition that necessitates more health and related supports than their peers. While it is generally accepted that these children are at risk for school failure, the mechanisms through which SHCN impact on children's experiences (and therefore opportunities to intervene) at school are still relatively poorly understood. Based on the current literature, this paper provides a conceptual framework to guide further discussion of this issue in research, policy and practice. Evidence from the literature was reviewed and existing frameworks examined. We propose that SHCN impact on four interrelated domains of children's functioning: (1) body functions and structures; (2) activities of daily living; (3) social participation; and (4) educational participation. Children's functioning is further influenced by risk and protective factors that can be identified at the level of the child, family and service systems. Together, these processes contribute to shaping either positive or negative trajectories of school functioning. The mechanisms influencing school experiences for children with special health care needs are complex, with opportunities for positive interventions at a range of levels. The proposed conceptual model provides an accessible tool for guiding discussion of the support needs of this vulnerable population.
Assuntos
Atividades Cotidianas , Crianças com Deficiência/educação , Educação Inclusiva/normas , Instituições Acadêmicas/normas , Participação Social , Criança , Doença Crônica , Crianças com Deficiência/psicologia , Crianças com Deficiência/reabilitação , Educação Inclusiva/economia , Educação Inclusiva/métodos , Escolaridade , Relações Familiares , Humanos , Classificação Internacional de Funcionalidade, Incapacidade e Saúde , Instituições Acadêmicas/economia , Instituições Acadêmicas/organização & administraçãoRESUMO
Pneumocystis carinii infection is rare in infants, and raises strong concerns of immune deficiency. This report describes the unusual case of a male infant with concurrent chest infections caused by P carinii and cytomegalovirus. Investigation was complicated by the strong suspicion of non-accidental injury, including subdural haematomas. The case illustrates how to investigate for possible immunodeficiency. Low immune function tests at presentation slowly improved and have remained normal on longterm follow up. Possible explanations for the transient severe clinical immunodeficiency in this case are discussed.
Assuntos
Infecções por Citomegalovirus/congênito , Infecções por Citomegalovirus/complicações , Hospedeiro Imunocomprometido , Pneumonia por Pneumocystis/complicações , Antibacterianos/uso terapêutico , Antivirais/uso terapêutico , Maus-Tratos Infantis , Infecções por Citomegalovirus/tratamento farmacológico , Ganciclovir/uso terapêutico , Hematoma Subdural/complicações , Hematoma Subdural/cirurgia , Humanos , Lactente , Transmissão Vertical de Doenças Infecciosas , Masculino , Pneumonia por Pneumocystis/tratamento farmacológico , Fraturas das Costelas/complicações , Combinação Trimetoprima e Sulfametoxazol/uso terapêuticoRESUMO
This review describes the mechanisms of the immune response to meningococcal disease, examining the extent to which individual variation of the immune response can determine susceptibility. It concludes by summarising the difficulties encountered by recent efforts to develop new immunomodulatory treatments.