Prevalence and Diagnosis of Latent Tuberculosis Infection in Young Children in the Absence of a Gold Standard

Introduction For adequate disease control the World Health Organization has proposed the diagnosis and treatment of latent tuberculous infection (LTBI) in groups of risk of developing the disease such as children. There is no gold standard (GS) test for the diagnosis of LTBI. The objective of this study was to estimate the prevalence of LTBI in young children in contact with a household case of tuberculosis (TB-HCC) and determine the accuracy and precision of the Tuberculin Skin Test (TST) and QuantiFERON-TB Gold in-tube (QFT) used in the absence of a GS. Methods We conducted a cross-sectional study in children up to 6 years of age in Manaus/Brazil during the years 2009-2010. All the children had been vaccinated with the BCG and were classified into two groups according to the presence of a TB-HCC or no known contact with tuberculosis (TB). The variables studied were: the TST and QFT results and the intensity and length of exposure to the index tuberculosis case. We used the latent class model to determine the prevalence of LTBI and the accuracy of the tests. Results Fifty percent of the children with TB-HCC had LTBI, with the prevalence depending on the intensity and length of exposure to the index case. The sensitivity and specificity of TST were 73% [95% confidence interval (CI): 53-91] and 97% (95%CI: 89-100), respectively, versus 53% (95%CI: 41-66) and 81% (95%CI:71-90) for QFT. The positive predictive value of TST in children with TB-HCC was 91% (95%CI: 61-99), being 74% for QFT (95%CI: 47-95). Conclusions This is one of the first studies to estimate the prevalence of LTBI in children and the parameters of the main diagnostic tests using a latent class model. Our results suggest that children in contact with an index case have a high risk of infection. The accuracy and the predictive value of the two tests did not significantly differ. Combined use of the two tests showed scarce improvement in the diagnosis of LTBI

Mycobacterium tuberculosis Infection in Young Children: Analyzing the Performance of the Diagnostic Tests

This study evaluated the performance of the Tuberculin Skin Test (TST) and Quantiferon-TB Gold in-Tube (QFT) and the possible association of factors which may modify their results in young children (0-6 years) with recent contact with an index tuberculosis case. Materials and Methods: A cross-sectional study including 135 children was conducted in Manaus, Amazonas-Brazil. The TST and QFT were performed and the tests results were analyzed in relation to the personal characteristics of the children studied and their relationship with the index case. Results: The rates of positivity were 34.8% (TST) and 26.7% (QFT), with 14.1% of indeterminations by the QFT. Concordance between tests was fair (Kappa = 0.35 P<0.001). Both the TST and QFT were associated with the intensity of exposure (Linear OR = 1.286, P = 0.005; Linear OR = 1.161, P = 0.035 respectively) with only the TST being associated with the time of exposure (Linear OR = 1.149, P = 0.009). The presence of intestinal helminths in the TST+ group was associated with negative QFT results (OR = 0.064, P = 0.049). In the TST- group lower levels of ferritin were associated with QFT+ results (Linear OR = 0.956, P = 0.036). Conclusions: Concordance between the TST and QFT was lower than expected. The factors associated with the discordant results were intestinal helminths, ferritin levels and exposure time to the index tuberculosis case. In TST+ group, helminths were associated with negative QFT results suggesting impaired cell-mediated immunity. The TST-&QFT+ group had a shorter exposure time and lower ferritin levels, suggesting that QFT is faster and ferritin may be a potential biomarker of early stages of tuberculosis infection

Policy and Practice in Language Support for Newly Arrived Migrant Children in Ireland and Spain

To cite this article: Rosa M Rodríguez-Izquierdo & Merike Darmody (2017): Policy and Practice in Language Support for Newly Arrived Migrant Children in Ireland and Spain, British Journal of Educational Studies, DOI: 10.1080/00071005.2017.1417973Over the last decades migration across Europe has continued to increase. Consequently, the issue of offering appropriate educational support for migrant students has been extensively debated across Europe and further afield, especially in countries with a history of immigration. However, less is known about how education systems in the ¿new¿ immigration countries have responded to the needs of newly arrived migrants (NAMs). While various research and policy documents have highlighted the importance of proficiency in the language of instruction for social and academic outcomes of migrant children and youth: how language support is provided varies significantly from one jurisdiction to another. This article focuses on language support measures set up for migrant students in statefunded schools in the Republic of Ireland and Spain ¿ both multilingual countries with more than one official language and with heterogeneous migrant population. In both countries, there is also a mismatch between an increasingly diverse student cohort and a homogenous teacher population.. Reviewing educational policy and practice in these jurisdictions in the areas of language support for migrants and how diversity is addressed in initial teacher education, the paper seeks to contribute to the debate on how to address the needs of migrant students in multi-lingual settings.Educación y Psicología SocialPreprin

A (re)estabilização identitária do professor no contexto do ensino de história na Espanha

Este trabalho discute situações interculturais no sistema educacional espanhol. Nesse contexto, o que interessa é a estabilidade identitária do professor que conta com a presença de estudantes de origem imigrante, em sala de aula. No artigo, analisamos diversas interações que aconteceram em sala, em um instituto madrilense de ensino fundamental (13-14 anos), durante o desenvolvimento de uma unidade temática relativa ao passado muçulmano em território espanhol. Na análise dos dados, observamos a emergência de situações conflitantes em que o professor pontuou a sua autoridade por meio de (re) ajustes discursivos. Isso aconteceu nos momentos em que o docente se viu envolvido em uma relação alteritária com o estrangeiro, suscitada, principalmente, por questões religiosas e étnico-nacionais. As (re)estabilizações identitárias do professor estiveram relacionadas, especificamente, com as formas de solucionar as rupturas provocadas pelo cenário de alteridade multicultural, levando em consideração sua condição de agente social necessariamente comprometido com a narração histórica produzida e com a cultura majoritária que a sustenta

"Organización, fragmentación y posibilidades de cambio: la brecha como vacío fértil"

En este trabajo buscamos comprender los complejos procesos de aprendizaje colectivo, y explorar y diseñar herramientas que posibiliten desarrollarlo. De este modo, observamos brechas y fragmentaciones en la red organizativa, que se enquistan en un vacío estéril que impide el flujo y tensión creativa que requieren los procesos de transformación y cambio. Primeramente se explicitan conceptos, seguido de ejemplos de brechas en torno a las cuales venimos trabajando. Finalmente concluimos con una síntesis integradora para abrir nuevos horizontes que nos conduzcan a una articulación compleja de dichas brechas