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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.
Identifying dietary patterns in different environments attended by children is relevant to guide public politics. The aim of this study was to analyse the factors associated with dietary patterns of children under 2 years of age in childcare centres and at homes. This transversal study was enrolled in municipal childcare centres of Guaratuba, Paraná, Brazil. Food consumption data from 256 children were obtained by the food record method. From the consumption data, four dietary patterns were identified by factor analysis using the principal component method in each environment. ‘Traditional’ patterns were observed in both environments; the ‘less healthy’ pattern was found only at homes. Other patterns identified in childcare centres include ‘snacks’, ‘nutritive’ and ‘pasta and meats’; at homes, it was possible to identify patterns such as ‘milk and cereals’ and ‘mixed’. Children over 12 months presented higher scores for all the patterns in both environments. Obese children had lower scores for all the patterns in childcare centres. There was an association between maternal age below 21 years and higher adherence to a ‘less healthy’ pattern, maternal level of education less than 8 years and lower adherence to the ‘mixed’ pattern and lower familiar income per capita and higher adherence to the ‘snacks’ and ‘traditional’ patterns in childcare centres. In conclusion, adherence to dietary patterns was associated with socio-economic, demographic variables and nutritional status and further studies are needed, especially those with a longitudinal design, enabling the monitoring of dietary patterns.
Chest tube drainage placement, a standard procedure in video-assisted thoracoscopic surgery, was reported to cause perioperative complications like pain and increased risk of infection. The present study was designed to evaluate the necessity of chest tube drainage inpaediatric thoracoscopic surgery.
Thirty children admitted to our hospital from April 2018 to April 2020 were included in the current study and were grouped as the tube group (children receiving video-assisted thoracoscopic surgery with chest tube drainage) and the non-tube group (children receiving video-assisted thoracoscopic surgery without chest tube drainage). Laboratory hemogram index, length of hospitalisation, post-operative performance of involved children, and psychological acceptance of indicated therapy by guardians of the involved children were investigated.
Laboratory examination revealed that the mean corpuscular haemoglobin concentration in the non-tube group was significantly higher than that in the tube group on post-operative day 1 (p < 0.05). Children in the non-tube group had a shorter length of hospitalisation (7–9 days) than that of patients from the tube group. Additionally, the frequency of crying of children was decreased and psychological acceptance by patients’ guardians was improved in the non-tube group when compared with the tube group.
This study showed that chest tube drainage placement may not be necessary in several cases of paediatric video-assisted thoracoscopic surgery. Rapid recovery with decreased perioperative complications in children operated by video-assisted thoracoscopic surgery without tube placement could also reduce the burden of the family and society both economically and psychologically.
The present study aimed to assess the relative validity and reliability of a modified Food and Nutrition Literacy (M-FNLIT) questionnaire in primary school children in the city of Mashhad. The study was conducted in four phases. In the first step, the content and face validity of the questionnaire was evaluated by Delphi consensus as well as interviewing the students. Then, construct validity was examined using Confirmatory Factor Analyses (CFA). The internal consistency and reliability of the questionnaire were also assessed using Cronbach α and Intraclass Correlation Coefficient (ICC), respectively. Finally, a Receiver Operating Characteristic (ROC) analysis was performed to detect the cut-off scores of the M-FNLIT scale. Findings of two rounds of Delphi showed satisfactory levels of Content Validity Ratio (CVR): 0.72 and 0.92, Content Validity Index (CVI): 0.92 and 0.98, respectively. The results of CFA for domains and subscales of M-FNLIT questionnaire including cognitive domain (understanding food and nutrition information and nutritional health knowledge) and skill domain (functional, food choice, interactive, and critical skills) indicated acceptable fit indices. M-FNLIT subscale-specific Cronbach α values ranged between 0.68 to 0.8 and ICC was 0.95 (CI: 0.93-96). The Final questionnaire included 40 items (36 Likert-type and 4 true-false items). FNLIT scores were categorized as low (≤58), medium (>58-<81), and high (≥81). The M-FNLIT questionnaire has a good level of validity and reliability to measure food and nutrition literacy in primary school children. The questionnaire can be applied in the evaluation of nutritional interventions in this age group.
Resilience can be a protective trait to promote mental health when implemented in the early years. This study explored the use of storytelling to foster children’s learning of resilience. A pedagogically appropriate storybook was used to facilitate and embed the skills of resilience in children at primary school. Teachers (n = 2) and community-based sports officers (n = 2) read the storybook to children enrolled in Kindergarten (first formal year of schooling) (n = 20), Year 1 (n = 20) and Year 2 (n = 20). The total number in the participant group was 60, aged 4–8 years old. Following the initial reading, teachers continued to deliver the storybook to children over a 4-week intervention period. All participants were interviewed about their perceptions of the storybook, and their responses were coded into key themes mapped by the Grotberg Resilience Framework. Results indicated that storytelling as a tool provided children with positive resilience-based behavioural intervention opportunities.
With increased survival, children with CHD are reaching adulthood, however, obesity amongst this cohort is an emerging problem. Making every contact count encourages clinicians to utilise contact to elicit behaviour change. The aim of this work was to identify whether the body habitus of children classified as obese was addressed during a clinical review.
A retrospective observational cohort study was completed using a cardiology outpatient dataset from 2010 to 2019. Inclusion criteria are all children with a body mass index z score classified as obese (≥ 2 z scores). Individual electronic patient records were reviewed to identify long-term anthropometric measures including (i) recognition of body habitus, (ii) prescription of physical activity or dietary intervention, and (iii) referral to a weight management programme or dietitian.
From the cohort of 95 patients, 285 “obese clinical encounters” were identified, at the time of a cardiology clinic attendance. Of those, obesity was acknowledged in 25 clinic letters (8.65%), but only 8 used the correct terms “obese” or “obesity” (2.77%). Action to tackle obesity was recorded in 9.3% of cases with a direct referral to a dietitian being made on 3 occasions (1.04%).
Body habitus is not being routinely addressed by cardiologists caring for paediatric and young adult cardiac patients. This study has recognised an alarmingly high incidence of missed opportunities to make every contact count, to manage those with obesity and associated risk factors.
Platelet indices are used to evaluate platelet activation and function which change in inflammatory diseases. We hypothesise that platelet indices such as plateletcrit, mean platelet volume, and platelet distribution width may be more useful as prognostic indicators for myopericarditis in children.
A total of 60 children were included in this study. Group 1 consists of children with myopericarditis, Group 2 is those with respiratory infections, and Group 3 consists of control group children of similar age and gender with the patient groups. Complete blood count parameters, C-reactive protein, and troponin values of the whole study group were recorded. Myopericarditis was diagnosed based on acute chest pain, dyspnea, palpitations, heart failure signs, arrhythmia symptoms and ST/T wave change, low voltage, supraventricular tachycardia/ventricular tachycardia on ECG, or elevated troponin T/troponin I levels or functional abnormalities on echocardiography. A comparison of the platelet indices made during diagnosis and 2 weeks after treatment was done for the myopericarditis patients.
There was no statistically significant difference in platelet indicies values. However, the increase in platelets and plateletcrit values after the treatment of myopericarditis was statistically significant. This study pointed out that there was a negative correlation between platelet–plateletcrit values and the troponin I–C-reactive protein.
We found that platelet count and plateletcrit values increased after treatment. This is important as it is the first study in children to investigate the possible role of platelet indications for myopericarditis in children.
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 who 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-year-old schoolchildren (n 1972) with complete data. This study applied the KIDMed score to determine ‘poor’ (≤3), ‘medium’ (4-7) 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 % CI 1·01, 1·73), hypertriglyceridaemia (OR 2·80; 95 % CI 1·05, 7·46) and IR (OR 1·31; 95 % CI 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, hypertriglyceridaemia 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.