Toward a Theory of Child Well-Being

Assuring the well-being of children has emerged over the past several decades as an important goal for health and social policymakers. Although the concept of child well-being has been operationalized and measured in different ways by different child-serving entities, there are few unifying theories that could undergird and inform these various conceptual and measurement efforts. In this paper, we attempt to construct a theory of child well-being. We first review the social and policy history of the concept of child well-being, and briefly review its measurement based on these conceptualizations. We then examine three types of theories of well-being extant in philosophy - mental states theories, desire-based theories and needs-based theories - and investigate their suitability to serve as prototypes of a theory of child well-being. We develop a constraint that child well-being is important in and of itself and not merely as a way station to future adult well-being (we call this a non-reduction constraint). Using this constraint, we identify the limitations of each of the three sets of theories to serve as a basis for a theory of child well-being. Based on a developmentalist approach, we then articulate a theory of child well-being that contains two conditions. First, a child's stage-appropriate capacities that equip her for successful adulthood, given her environment; and, second, an engagement with the world in child-appropriate ways. We conclude by reviewing seven implications of this theoretical approach for the measurement of child well-being. Key Words Child well-being, philosophy, social policy, child developmentNoneThis is the author accepted manuscript. The final version is available from Springer via http://dx.doi.org/10.1007/s11205-014-0665-

Antiretroviral Therapy for Asymptomatic Adults and Adolescents with HIV-1 Infection and CD4+ T-cell Counts ≥500 cells/μL: a Meta-Analysis.

The article of record as published may be found at http://dx.doi.org/10.Background: World Health Organization (WHO) antiretroviral therapy (ART) guidelines are regularly updated with the most current evidence on when to initiate ART. Methods: We performed a systematic review and meta-analysis and identified published literature and conference abstracts for randomised controlled trials (RCT) and cohort studies that compared HIV-infected patients starting ART at ≥ 500 CD4 cells/µL with those with <500 CD4 cells/µL. Results: We identified 24 articles. Studies found a decreased hazard of HIV disease progression with initiation at >500 CD4 cells/µL (2 RCTs: relative risk [RR]=0·38, 95% CI 0·20-0·74; 1 cohort: hazard ratio [HR]=0·20, 95% CI 0·10-0·42). One RCT found a reduced risk of HIV transmission (RR=0·11, 95% CI 0·06- 0·19), although this was not supported in two cohorts (RR=1·17, 95% CI 0·46-2·98). There was no increased risk of most Grade 3/4 adverse events identified in RCTs, but there was evidence of increased risk of laboratory adverse events for earlier initiation (RR=1·43; 95% CI 1·13-1·81) from one cohort study. Conclusion: We found moderate quality evidence that the ART initiation at CD4 ≥500 cells/µL leads to reduced risk of disease progression. The risk of adverse events for early initiators is not yet well understood and needs further investigation