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The novel since the nineteenth century has displayed a thorny ambivalence toward the question of having children. In its representation of human vitality it can seem to promote the giving of life, but again and again it betrays a nagging doubt about the moral implications of procreation. The Novel and the Problem of New Life identifies this tension as a defining quality of the modern British and European novel. Beginning with the procreative-skeptical writings of Flaubert, Butler, and Hardy, then turning to the high modernist work of Lawrence, Woolf, and Huxley, and culminating in the postwar fiction of Lessing and others, this book chronicles the history of the novel as it came to accommodate greater misgivings about the morality of reproduction. This is the first study to examine in literature a problem that has long troubled philosophers, environmental thinkers, and so many people in everyday life.
This study aimed to investigate the impact of COVID-19 on time spent cooking and parental inclusion of children in cooking. A secondary aim was to investigate differences between those who frequently included their children in cooking activities during the COVID-19 pandemic and those that included their children less, on a number of factors such as working from home, parents’ diet quality and cooking skills confidence.
Cross-continental survey with Wilcoxon signed ranks, Independent t-tests, Mann Whitney-U, Chi2, and a binomial logistic regression used for assessment.
A convenience sample of parents over 18 years from the island of Ireland (N=180), Great Britain (N=312), United States of America (N=120), New Zealand (N=166)
In three regions, parents’ time spent cooking and inclusion of children in everyday cooking activities increased (p<0.001). Country (OR=3.6, 95% CI=1.7–7.6), education (OR=1.6, 95% CI =1.1–2.4), cooking skills confidence (OR=1.02, 95% CI=1.009-1.032) and a parental higher intake of vegetables (OR=1.3, 95% CI=1.1-1.5) were significant predictors of a more frequent inclusion of children in cooking activities.
While there a number of key benefits to including children in cooking for the children such as providing life skills and increases in diet quality, this study highlighted a higher intake of vegetables by parents who included children more frequently in cooking activities. With continued lockdowns due to COVID-19 and perhaps more flexibility in working from home in the future, including children in cooking activities should be a key public health message for both children and parents.
To prioritise and refine a set of evidence-informed statements into advice messages to promote vegetable liking in early childhood, and to determine applicability for dissemination of advice to relevant audiences.
A nominal group technique (NGT) workshop and a Delphi survey were conducted to prioritise and achieve consensus (≥70% agreement) on 30 evidence-informed maternal (perinatal and lactation stage), infant (complementary feeding stage) and early years (family diet stage) vegetable-related advice messages. Messages were validated via triangulation analysis against the strength of evidence from an Umbrella review of strategies to increase children’s vegetable liking, and gaps in advice from a Desktop review of vegetable feeding advice.
A purposeful sample of key stakeholders (NGT workshop, n=8 experts; Delphi survey, n=23 end-users).
Participant consensus identified the most highly ranked priority messages associated with the strategies of: ‘in-utero exposure’ (perinatal and lactation, n=56 points); and ‘vegetable variety’ (complementary feeding, n=97 points; family diet, n=139 points). Triangulation revealed two strategies (‘repeated exposure’ and ‘variety’) and their associated advice messages suitable for policy and practice, 12 for research and four for food industry.
Supported by national and state feeding guideline documents and resources, the advice messages relating to ‘repeated exposure’ and ‘variety’ to increase vegetable liking can be communicated to families and caregivers by healthcare practitioners. The food industry provides a vehicle for advice promotion and product development. Further research, where stronger evidence is needed, could further inform strategies for policy and practice, and food industry application.
The health status of children in the United States varies by racial and ethnic, shaped by an interrelated set of systems that disadvantage children of color in the United States. In this article, we argue for a broad view of resilience, in both research and policy, that views resilience not just as a property of individuals but also as a characteristic of social contexts and policies. Accordingly, we describe the empirical evidence for policies and contexts as factors that can improve health among children and families that are deprived of equal opportunities and resources due to structural racism. We discuss the evidence and opportunities for policies and interventions across a variety of societal systems, including programs to promote economic and food security, early education, health care, and the neighborhood and community context. Based on this evidence and other research on racism and resilience, we conclude by outlining some directions for future research.
There is limited data on the dietary patterns of 5-year-old children in Asia. The study examined childhood dietary patterns and their maternal and child correlates in a multi-ethnic Asian cohort. Based on caregiver-reported one-month quantitative food frequency questionnaires of 777 children from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort, cluster analysis identified two mutually exclusive clusters. Children in the “Unhealthy” cluster (43.9%) consumed more fries, processed meat, biscuits and ice cream, and less fish, fruits and vegetables compared to those in the “Healthy” cluster (56.1%). Children with mothers of lower educational attainment had twice the odds of being assigned to the “Unhealthy” cluster (adjusted OR (95% CI) = 2.19 (1.49-3.24)). Children of Malay and Indian ethnicities had higher odds of being assigned to the “Unhealthy” cluster (adjusted OR = 25.46 (15.40-42.10) and 4.03 (2.68-6.06)) respectively, relative to Chinese ethnicity. In conclusion, this study identified two dietary patterns in children, labelled as the “Unhealthy” and “Healthy” clusters. Mothers’ educational attainment and ethnicity were two correlates that were associated with the children’s assignments to the clusters. These findings can assist in informing health promotion programmes targeted at Asian children.
Cow’s milk is a naturally nutrient-dense foodstuff. A significant source of many essential nutrients, its inclusion as a component of a healthy balanced diet has been long recommended. Beyond milk’s nutritional value, an increasing body of evidence illustrates cow’s milk may confer numerous benefits related to health. Evidence from adult populations suggests that cow’s milk may have a role in overall dietary quality, appetite control, hydration and cognitive function. Although evidence is limited compared to the adult literature, these benefits may be echoed in recent paediatric studies. This article, therefore, reviews the scientific literature to provide an evidence-based evaluation of the associated health benefits of cow’s milk consumption in primary-school aged children (4-11 years). We focus on seven key areas related to nutrition and health comprising nutritional status, hydration, dental and bone health, physical stature, cognitive function, and appetite control. The evidence consistently demonstrates cow’s milk (plain and flavoured) improves nutritional status in primary-school aged children. With some confidence, cow’s milk also appears beneficial for hydration, dental and bone health and beneficial to neutral concerning physical stature and appetite. Due to conflicting studies, reaching a conclusion has proven difficult concerning cow’s milk and cognitive function therefore a level of caution should be exercised when interpreting these results. All areas, however, would benefit from further robust investigation, especially in free-living school settings, to verify conclusions. Nonetheless, when the nutritional-, physical- and health-related impact of cow’s milk avoidance is considered, the evidence highlights the importance of increasing cow’s milk consumption.
Cyanotic CHD is one of many disorders in paediatrics that influence the health of children in different clinical aspects. One of the fundamental aspects that may be affected is bone mineral density.
The aim of our study is to assess bone mineral density in children with congenital cyanotic heart disease of different anatomical diagnoses.
Cross-sectional, observational study included 39 patients (20 males) with congenital cyanotic heart disease of different anatomical diagnoses following with the cardiology clinic in Mansoura University children’s hospital. All patients were subjected to anthropometric measures, oxygen saturation assessment, and lumber bone mineral density using dual-energy X-ray absorptiometry.
Six patients (15.4%) out of the 39 included patients showed bone mineral density reduction, 13 patients (33.3%) showed bone mineral density with Z-score between −1 and −2, while 20 patients (51.3%) showed bone mineral density with Z-score more than −1.
Low bone mineral density can be found in children with cyanotic CHD, making it important to consider bone mineral density assessment and early treatment if needed to avoid further complications.
The present study aimed to determine the 3-month incidence of relapse and associated factors among children who recovered under the Optimising treatment for acute MAlnutrition (OptiMA) strategy, a MUAC-based protocol. A prospective cohort of children successfully treated for acute malnutrition was monitored between April 2017 and February 2018. Children were seen at home by community health workers (CHWs) every 2 weeks for 3 months. Relapse was defined as a child who had met OptiMA recovery criteria (MUAC ≥ 125 mm for two consecutive weeks) but subsequently had a MUAC < 125 mm at any home visit. Cumulative incidence and incidence rates per 100 child-months were estimated. Multivariable survival analysis was conducted using a shared frailty model with a random effect on health facilities to identify associated factors. Of the 640 children included, the overall 3-month cumulative incidence of relapse was 6⋅8 % (95 % CI 5⋅2, 8⋅8). Globally, the incidence rate of relapse was 2⋅5 (95 % CI 1⋅9, 3⋅3) per 100 child-months and 3⋅7 (95 % CI 1⋅9, 6⋅8) per 100 child-months among children admitted with a MUAC < 115 mm. Most (88⋅6 %) relapses were detected early when MUAC was between 120 and 124 mm. Relapse was positively associated with hospitalisation, with an adjusted hazard ratio (aHR) of 2⋅06 (95 % CI 1⋅01, 4⋅26) for children who had an inpatient stay at any point during treatment compared with children who did not. The incidence of relapse following recovery under OptiMA was relatively low in this context, but the lack of a standard relapse definition does not allow for comparison across settings Closer follow-up with caretakers whose children are admitted with MUAC < 115 mm or required hospitalisation during treatment should be considered in managing groups at high risk of relapse. Training caretakers to screen their children for relapse at home using MUAC could be more effective at detecting early relapse, and less costly, than home visits by CHWs.
To examine the associations between the level of adherence to the Mediterranean diet (MedDiet) with obesity, insulin resistance (IR), metabolic syndrome (MetS) and its components in schoolchildren.
The Healthy Growth Study was a large epidemiological cross-sectional study.
School children that were enrolled in primary schools in four counties covering the northern, southern, western and central part of Greece were invited to participate.
The study was conducted with a representative sample of 9-13 years old schoolchildren (n-1,972) with full data. This study applied the KIDMed score to determine “poor” (≤ 3), “medium” (4 to 7) and “high” (≥ 8) adherence of children to the MedDiet. The research hypothesis was examined using multivariate logistic regression models, controlling for potential confounders.
The percentage of children with “poor”, “medium” and “high” adherence to the MedDiet was 64.8%, 34.2% and 1% respectively. Furthermore, the prevalence of obesity, IR and MetS was 11.6%, 28.8% and 3.4% respectively. Logistic regression analyses revealed that “poor” adherence to the MedDiet was associated with an increased likelihood for central obesity (OR 1.31; 95% C.I 1.01-1.73), hypertriglyceridemia (OR 2.80; 95% C.I 1.05-7.46) and IR (OR 1.31; 95% C.I 1.05-1.64), even after adjusting for several potential confounders.
The present study showed that approximately two thirds of the examined sample of schoolchildren in Greece have “poor” adherence to the MedDiet, which also increases the likelihood for central obesity, hypertriglyceridemia and IR. Prospective studies are needed to confirm whether these are cause-effect associations.
In the first decade of life, children become bilingual in different language learning environments. Many children start learning two languages from birth (Bilingual First Language Acquisition). In early childhood hitherto monolingual children start hearing a second language through daycare or preschool (Early Second Language Acquisition). Yet other hitherto monolingual children in middle childhood may acquire a second language only after entering school (Second Language Acquisition). This Element explains how these different language learning settings dynamically affect bilingual children's language learning trajectories. All children eventually learn to speak the societal language, but they often do not learn to fluently speak their non-societal language and may even stop speaking it. Children's and families' harmonious bilingualism is threatened if bilingual children do not develop high proficiency in both languages. Educational institutions and parental conversational practices play a pivotal role in supporting harmonious bilingual development.
To quantify food/beverage advertising on television in Montreal (Quebec), to estimate and characterize children’s exposure, and to examine trends over time.
Television food advertising data were licensed for 19 food categories and 18 stations for May 2011, 2016 and 2019. The frequency of advertisements and the average number viewed per child aged 2-11 years overall, by food category and by station type (i.e. youth-appealing (n=3) and generalist (n=15) stations) was determined. The percent change in advertising and exposure between May 2011 and 2019 was calculated.
Montreal, Quebec, Canada.
This study used media data and did not directly involve human participants.
The total number of television advertisements increased by 11% between May 2011 (n=41,084) and May 2019 (n=45,406) however exposure to food/beverage advertisements decreased by 53%, going from 226 ads/child in May 2011 to 107 ads/child in May 2019. Overall, the most advertised food categories in both May 2011 and 2019 were fast food (29.8% and 39.2%, respectively) followed by chocolate (14.2%) in 2011 and savory snacks (9.7%) in 2019. In May 2019, children were predominantly exposed to unhealthy food categories such as fast food (41.3% of exposure), savory snacks (7.5%), chocolate (5.0%) and regular soft drinks (4.5%), and most (89.3%) of their total exposure occurred on generalist television stations.
Despite Quebec’s restrictions on commercial advertising directed to children under 13 years, Quebecois children are still frequently exposed to unhealthy food advertising on television. Government should tighten restrictions to protect children from this exposure.
In 2019, California and Wilmington, Delaware‘ implemented policies requiring healthier default beverages with restaurant kids’ meals. The current study assessed restaurant beverage offerings and manager perceptions.
Pre-post menu observations were conducted in California and Wilmington. Observations of cashiers/servers during orders were conducted pre-post implementation in California and post-implementation in Wilmington. Changes in California were compared using multilevel logistic regression and paired t tests. Post-implementation, managers were interviewed.
Inside and drive-through ordering venues in a sample of quick-service restaurants in low-income California communities and all restaurants in Wilmington subject to the policy, the month before and 7–12 months after policy implementation.
Restaurant observations (California n 110; Wilmington n 14); managers (California n 75; Wilmington n 15).
Pre-implementation, the most common kids’ meal beverages on California menus were unflavoured milk and water (78·8 %, 52·0 %); in Wilmington, juice, milk and sugar-sweetened beverages were most common (81·8 %, 66·7 % and 46·2 %). Post-implementation, menus including only policy-consistent beverages significantly increased in California (9·7 % to 66·1 %, P < 0·0001), but remained constant in Wilmington (30·8 %). During orders, cashiers/servers offering only policy-consistent beverages significantly decreased post-implementation in California (5·0 % to 1·0 %, P = 0·002). Few managers (California 29·3 %; Wilmington 0 %) reported policy knowledge, although most expressed support. Most managers wanted additional information for customers and staff.
While the proportion of menus offering only policy-consistent kids’ meal default beverages increased in California, offerings did not change in Wilmington. In both jurisdictions, managers lacked policy knowledge, and few cashiers/servers offered only policy-consistent beverages. Additional efforts are needed to strengthen implementation of kids’ meal beverage policies.
This study aimed to analyze whether there are differences between bilingual (Brazilian Portuguese and Spanish) and monolingual (Brazilian Portuguese) school children regarding reading and writing learning achievement, in executive functions (EF) components and metalinguistic abilities. Twenty-three bilingual and 23 monolingual children, aged 6 to 8 years, were assessed in terms of their writing, reading, and metalinguistic abilities, and with verbal and non-verbal tasks testing EF. A bilingual advantage was observed in reading and writing abilities and in 16 of the 44 EF measures, including subcomponents of working memory, inhibition, cognitive flexibility, and executive attention, mainly in non-verbal paradigms, while monolingual children outperformed bilingual ones in three scores: counting errors (Five Digits Test), omission of bells (Bells test) and sequential trial B (Trail Making Test). There were moderate and weak effect sizes in metalinguistic subcomponents showing bilingual advantage. Literacy improvement seems to have the potential to increase linguistic and cognitive abilities.
Feeding is a source of interaction and communication. It affects children's physical and psychological/emotional development. The present study aims to examine the association between caregiver and child characteristics and caregivers' feeding practices among preschools in Addis Ababa. We conducted a cross-sectional study among 542 caregivers of children aged between 3 and 6 years old in selected preschools. We used the Child Feeding Questionnaire (CFQ) to measure caregivers' feeding practices. Multiple linear regression was used for analysis. Caregivers who had higher levels of perceived feeding responsibility (β 0⋅20, P < 0⋅001), who were more concerned about their child being overweight (β 0⋅11, P < 0⋅001) and who had more depressive symptoms (β 0⋅23, P 0⋅05) were associated with food restriction practice. Caregivers who were less concerned about their child being overweight (β −0⋅10, P < 0⋅001) and who had higher levels of perceived feeding responsibility (β 0⋅25, P < 0⋅001) were associated with pressure to eat practice. Caregivers who had higher education (β 0⋅29, P < 0⋅05), who had higher levels of perceived feeding responsibility (β 0⋅47, P < 0⋅001), who were more concerned about their child being overweight (β 0⋅15, P < 0⋅001) and who were less concerned about their child underweight (β −0⋅06, P < 0⋅05) were associated with monitoring feeding practice. In addition, as the children have gotten older (β 0⋅08, P < 0⋅05), there is increased use of monitoring feeding practice. This study is one of few studies that show the association between caregiver and child characteristics and feeding practices in developing countries such as Ethiopia. It is essential to include responsive feeding components in national nutritional programmes to improve preschool children's nutritional status in Ethiopia.
Children with CHD carry an additional burden of pulmonary insufficiency, often necessitating prolonged ventilatory support, especially in the peri-operative phase. There has been an increase in the utilisation of non-invasive ventilatory support for these children. The objective of this study was to evaluate the utilisation, safety, and outcomes of RAM cannula as a tool for escalation and de-escalation of respiratory support in paediatric cardiac patients less than one year of age.
A single-centre retrospective cohort study of patients supported with RAM cannula.
A total of 275 instances of RAM use were included in the study, 81.1% being post-operative. Patients were stratified into escalation and de-escalation cohorts based on the indication of non-invasive ventilation. The success rate of using RAM cannula was 69.5% overall, 66.1% in the escalation group, and 72.8% in the de-escalation group. At baseline, age at cardiac ICU admission >30 days, FiO2 ≤ 40%, PaCO2 ≤ 50 mmHg; and after 12 hours of non-invasive ventilation support respiratory rate ≤ 60/min, PaO2 ≥ 50 mmHg, PaCO2 ≤ 50 mmHg; and absence of worsening on follow-up chest X-ray predicted the success with a sensitivity of 95% in the logistic regression model. Successful support was associated with a significantly shorter unit stay.
RAM cannula can be safely used to provide non-invasive support to infants in the cardiac ICU for escalation and de-escalation of respiratory support. Factors associated with success can be used to make decisions about candidacy and appropriate timing of non-invasive ventilation use to maximise effectiveness.
Schools have a significant role in disaster education to children. This study investigates the research works about school-based education programs in order to discover challenges and best practices. We conducted a systematic review of English language papers published in peer-review journals.
The search identified 2577 publications and 61 articles meeting selection criteria and included in the review. Reviewed studies indicated that disaster education in schools is effective but yet insufficient in many countries. Lack of equipment, financial resources, policy gaps, and teachers’ knowledge are common problems in programs. Main outcomes of this systematic review are showing methods used for health emergency preparedness of children of different ages and gender differences in school-based disaster preparedness, as well as the difference in their lifesaving skills in disasters.
This study shows that some disaster education programs reported in the papers reviewed were not high-quality enough, which may lead to insufficient preparedness of children in disasters and consequently may put their health at risk, considering the increasing number of natural hazards.
In 1821, as the Wars of Independence drew to a close, officials of the newly created republic of Gran Colombia passed a national gradual emancipation law. At the center of it was a Free Womb law that declared legally free the children of enslaved women born after the law's promulgation, while bonding these children to their mothers’ masters until the age of 18. Yet, in addition to establishing a term limit on their legalized captivity, the law stipulated conditions for the commerce in Free Womb children, laying the groundwork for what I refer to as the Free Womb trade. This article presents the first detailed exploration of the origins, operations, and limitations of the Free Womb trade in Colombia, particularly at the level of one province: the northwestern Pacific coastal province of Chocó. I argue that the trade created distinctly bounded market geographies of Free Womb children, who were actively, if at times ambiguously, incorporated into Colombia's slave economy. As a general rule, the Free Womb trade placed captive families at the mercy of their masters; yet, as one extraordinary case reveals, the full extent of the local trade's legal power was not entirely secure.
We report a case of a pseudoaneurysm in the sinus of Valsalva, secondary to infective endocarditis in a child with trisomy 21. The patient had a history of subaortic stenosis, bicuspid aortic valve, and ventricular septal defect. Patch closure of the ostium of the pseudoaneurysm and aortic valve replacement was performed. The patient was discharged without severe complications.
Schools offer an ideal setting for childhood obesity interventions due to their access to children and adolescents. This review aimed to systematically review the impact of school-based intervention for the treatment of childhood obesity.
Eight databases were searched from inception till 30 May 2020. A revised Cochrane risk-of-bias tool and the Grading of Recommendations, Assessment, Development and Evaluations criteria were used to evaluate the risk of bias and overall evidence. Meta-analysis and meta-regression were performed on Stata software using the random effects model. Overall effect was evaluated using Hedges’ g, and heterogeneity was assessed using Cochran’s Q and I2.
Cluster randomised controlled trials (cluster-RCT) delivered in school.
Children and adolescents (6–18 years of age) with overweight and obesity.
Twelve cluster-RCT from seven countries with 1755 participants were included in the meta-analysis. School-based interventions for the treatment of childhood obesity reduced BMI and BMI z-scores with a medium effect (g = 0·52). Subgroup analyses showed greater effectiveness of brief school-based interventions and the interventions conducted in lower-middle to upper-middle economies. Meta-regression assessed the heterogeneity and the final model, with covariates of the type of economies and trial duration, accounted for 41·2 % of the variability. The overall quality of evidence was rated low because of the high risk of bias and inconsistency.
School-based interventions are a possible approach to provide universal healthcare for the treatment of childhood obesity, and further well-designed cluster-RCT with longer follow-up are needed. This study is registered with PROSPERO (CRD42020160735).
The relationship between different surrogates of insulin resistance and left ventricular geometry in obese children is still unclear.
We sought to explore the relationship between commonly used measures of insulin sensitivity/resistance (homeostatic model assessment index, serum uric acid, and triglycerides to high-density lipoprotein cholesterol ratio) and left ventricular geometry in normotensive obese children.
In this cross-sectional study, 32 normotensive obese children were examined. Transthoracic echocardiography was used to measure left ventricular mass index and relative wall thickness. Homeostasis model assessment index, serum uric acid level, and a ratio of triglycerides to high-density lipoprotein cholesterol were used as markers of the insulin resistance. Simple and partial correlation analyses (to control for the effects of body mass index) were conducted to explore relationship between studied variables and left ventricular mass index or relative wall thickness as outcome variables.
We found positive correlations between homeostasis model assessment index and relative wall thickness (r = 0.47, p = 0.03) which remained significant after controlling for the effect of body mass index, z-score (r = 0.48, p = 0.03). The cutoff level of homeostasis model assessment index with the optimum sensitivity (Sn) and specificity (Sp) derived from the receiver operating characteristic (ROC) curves for predicting concentric remodelling was ≥5.51 with Sn = 83.33 and Sp = 68.75.
There is a positive relationship between homeostasis model assessment index and relative wall thickness of obese normotensive children which may help to distinguish at risk obese normotensive children for the development of concentric left ventricular remodelling.