The Agency for Healthcare Research and Quality’s Children’s Health Research Portfolio

The objective of this work was to describe and assess the potential impact of the Agency for Healthcare Research and Quality’s, AHRQ’s, children’s health activities. Using AHRQ databases and publications lists and generic search engines, we developed a comprehensive list of AHRQ’s funded children’s health activities (1990–2005) and related publications (1996–2002). We conducted bibliometric analyses and used Stryer’s (2000) approach to categorize their potential impact. We found that AHRQ’s child health portfolio has changed over time with an increase in activities related to patient safety and health information technology, reflecting trends at AHRQ as a whole. Further, AHRQ has contributed a substantial body of new knowledge as a result of its funding for children’s health activities. The bibliometric analysis suggests that AHRQ’s children’s health activities have successfully disseminated research findings and new knowledge through the published literature. Most of the publications present research findings that can be building blocks early in the translation continuum rather than findings that directly inform policy or change clinical practice. Through its funding of children’s health activities, AHRQ has contributed new knowledge that has been disseminated effectively in the published literature. However, while AHRQ has successfully engaged the child health services research community, efforts to broaden into policy, practice and patient arenas have been less successful.     

Access to Obstetric Care and Children’s Health,Growth and Cognitive Development in Vietnam: Evidence from Young Lives

Background The impact of birth with poor access to skilled obstetric care such as home birth on children’s long term development is unknown. This study explores the health, growth and cognitive development of children surviving homebirth in the Vietnam Young Lives sample during early childhood. Methods The Young Lives longitudinal cohort study was conducted in Vietnam with 1812 children born in 2001/2 with follow-up at 1, 5, and 8 years. Data were collected on height/weight, health and cognitive development (Peabody Picture Vocabulary test). Statistical models adjusted for sociodemographic and pregnancy-related factors. Results Children surviving homebirth did not have significantly poorer long-term health, greater stunting after adjusting for sociodemographic/pregnancy-related factors. Rural location, lack of household education, ethnic minority status and lower wealth predicted greater stunting and poorer scores on Peabody Vocabulary test. Conclusions Social disadvantage rather than homebirth influenced children’s health, growth and development.     

The Indirect Effect of Family Cohesion on Children’s Weight Status Through Maternal Quality of Life and Children’s Internalizing and Externalizing Symptoms

Background

Obesity has serious psychosocial consequences for youth and family members and has reached epidemic levels in Portugal.

Objective

This study had two goals: (1) to investigate differences in family cohesion, mothers’ quality of life (QoL), and externalizing/internalizing symptoms between children/adolescents with healthy-weight and overweight/obesity; (2) to assess the mediating role of maternal QoL and children/adolescents’ externalizing/internalizing symptoms in the association between family cohesion and weight.

Methods

Children/adolescents with healthy-weight (n = 134) and with overweight/obesity (n = 163) and their mothers participated in the study. Mothers completed measures of family cohesion (FC) and QoL and children/adolescents completed measures of externalizing and internalizing symptoms. This study used a cross-sectional design.

Results

Children/adolescents with overweight/obesity reported higher levels of externalizing and internalizing symptoms than children/adolescents with healthy-weight. Mothers of children/adolescents with overweight/obesity reported lower levels of FC and QoL than mothers of children/adolescents with healthy-weight. Mothers’ QoL and children/adolescents’ externalizing symptoms sequentially mediated the relationship between FC and weight status. Specifically, an increase in FC and QoL resulted in a decreased likelihood of the child/adolescent reporting overweight or obesity, whereas an increase in externalizing symptoms resulted in a higher likelihood of the child/adolescent reporting overweight or obesity.

Conclusions

This study identifies mechanisms that might account for the link between FC and weight, suggesting the importance of mothers’ QoL and children’s externalizing symptoms. Moreover, it provides a better understanding of the psychosocial outcomes related to pediatric obesity, highlighting the relevance of working with the parents to promote weight reduction in youths.

     

Children’s Attendance Rates and Quality of Teacher-Child Interactions in At-Risk Preschool Classrooms: Contribution to Children’s Expressive Language Growth

The present research examines whether children’s daily attendance rates would be predictive of gains in expressive language within the context of high-quality preschool classrooms. The quality of preschool classrooms was assessed by measuring the quality of the teacher’s interactions with the children in his or her classroom. Hierarchical linear models, nesting children within classroom, were used to examine children’s growth in expressive language in two independent samples (n = 129 children in 14 classrooms; n = 160 children in 46 classrooms). Results showed positive relations between daily attendance and language gains for children enrolled in higher quality preschool classrooms. Findings suggest that at-risk children who are rarely absent from high-quality preschool classrooms show accelerated expressive language growth, thus indicating that preschool attendance is an important factor to consider in future research and policy decisions.     

A Review of Family and Social Determinants of Children’s Eating Patterns and Diet Quality

With the growing problem of childhood obesity, recent research has begun to focus on family and social influences on children’s eating patterns. Research has demonstrated that children’s eating patterns are strongly influenced by characteristics of both the physical and social environment. With regard to the physical environment, children are more likely to eat foods that are available and easily accessible, and they tend to eat greater quantities when larger portions are provided. Additionally, characteristics of the social environment, including various socioeconomic and sociocultural factors such as parents’ education, time constraints, and ethnicity influence the types of foods children eat. Mealtime structure is also an important factor related to children’s eating patterns. Mealtime structure includes social and physical characteristics of mealtimes including whether families eat together, TV-viewing during meals, and the source of foods (e.g., restaurants, schools). Parents also play a direct role in children’s eating patterns through their behaviors, attitudes, and feeding styles. Interventions aimed at improving children’s nutrition need to address the variety of social and physical factors that influence children’s eating patterns.     

Children’s Gender and Parents’ Color Preferences

Gender differences in color preferences have been found in adults and children, but they remain unexplained. This study asks whether the gendered social environment in adulthood affects parents’ color preferences. The analysis used the gender of children to represent one aspect of the gendered social environment. Because having male versus female children in the U.S. is generally randomly distributed, it provides something of a natural experiment, offering evidence about the social construction of gender in adulthood. The participants were 749 adults with children who responded to an online survey invitation, asking “What’s your favorite color?” Men were more likely to prefer blue, while women were more likely to prefer red, purple, and pink, consistent with long-standing U.S. patterns. The effect of having only sons was to widen the existing gender differences between men and women, increasing the odds that men prefer blue while reducing the odds that women do; and a marginally significant effect showed women having higher odds of preferring pink when they have sons only. The results suggest that, in addition to any genetic, biological or child-socialization effects shaping adults’ tendency to segregate their color preferences by gender, the gender context of adulthood matters as well.     

Home Food Environment in Relation to Children’s Diet Quality and Weight Status

The objective of this cohort study was to explore relationships among the home food environment (HFE), child/parent characteristics, diet quality, and measured weight status among 699 child-parent pairs from King County, WA, and San Diego County, CA. HFE variables included parenting style/feeding practices, food rules, frequency of eating out, home food availability, and parents’ perceptions of food costs. Child dietary intake was measured by 3-day recall and diet quality indicators included fruits and vegetables, sweet/savory snacks, high-calorie beverages, and Dietary Approaches to Stop Hypertension (DASH) score. Individual linear regression models were run in which child BMI z score and child diet quality indicators were dependent variables and HFE variables and child/parent characteristics were independent variables of interest. Fruit and vegetable consumption was associated with parental encouragement/modeling (β=.68, P<0.001) and unhealthful food availability (−0.27, P<0.05); DASH score with food availability (healthful: 1.3, P<0.01; unhealthful: −2.25, P<0.001), food rules (0.45, P<0.01), and permissive feeding style (−1.04, P<0.05); high-calorie beverages with permissive feeding style (0.14, P<0.01) and unhealthful food availability (0.21, P<0.001); and sweet/savory snacks with healthful food availability (0.26, P<0.05; unexpectedly positive). Children's BMI z score was positively associated with parent's use of food restriction (0.21, P<0.001), permissive feeding style (0.16, P<0.05), and concern for healthy food costs (0.10, P<0.01), but negatively with verbal encouragement/modeling (−0.17, P<0.05), and pressure to eat (−0.34, P<0.001). Various HFE factors associated with parenting around eating and food availability are related to child diet quality and weight status. These factors should be considered when designing interventions for improving child health.     

Lead Content and Exposure from Children’s and Adult’s Jewelry Products

No abstract available.     

Change Trajectories: Children’s Patterns of Improvement in Acute-Stay Inpatient Care

This study estimated classes of children’s acute-stay psychiatric acuity trajectories in terms of shape (i.e., linear, quadratic, cubic) and rate of change (slope). A total of 788 children served on three child units (ages 4–12) were studied. The Children’s Acuity of Psychiatric Illness (CAPI) was completed each weekday by trained frontline staff on the milieu. Latent class growth analysis was applied to the data, and seven acuity trajectory classes provided the most parsimonious fit. Four classes evidenced a significant quadratic term, one class a significant linear term, and two classes did not evidence a significant change in acuity. The classes varied in survival time to rehospitalization, in pre-treatment community service use and rates of seclusion, restraint, and emergency medications during the episode. Overall, the results suggest that acute-stay patients may have distinct and identifiable psychiatric acuity change patterns during their episodes and that some may experience non-linear (i.e., quadratic) acuity trajectories.     

Why is Quality Improvement so Challenging? A Viable Systems Model Perspective to Understand the Frustrations of Healthcare Quality Improvement Managers

The challenges facing Quality Improvement Managers (QIMs) are often understood and addressed in isolation from wider healthcare organisation within which quality improvement initiatives are embedded. We draw on Stafford Beer's Viable System Model (VSM) to shed light on how the viability of quality improvement depends on the effective functioning of five critical quality improvement systems and the extent to which these systems are integrated within the healthcare organisation. These systems are System 1 (Operations), System 2 (Coordination), System 3 (Operational Control), System 4 (Development) and System 5 (Policy).Our analysis draws on interviews with 56 QIMs working in 15 of New Zealand's 20 District Health Boards. We use VSM to identify the sources of problems in QI implementation. These include changes in direction for QI initiatives; myopic behaviour resulting from fragmented systems of care; difficulties in managing and monitoring QI activities given variable staff engagement and inadequate resourcing; pressure for quick results rather developing QI capabilities; and a lack of strategic embeddedness.A viable QI system requires QI approaches that are (1) implemented at an organisation-wide level; (2) well-resourced and carefully monitored; (3) underpinned by a long-term vision; and (4) supported by QIMs with the necessary power and influence to integrate QI subsystem within the wider healthcare organisation.     

The NYU Children’s Health and Environment Study

European Journal of Epidemiology - The aims of the NYU Children’s Health and Environment Study (CHES) are to evaluate influences of prenatal non-persistent chemical exposures on fetal and...     

Children’s recognition of pictorial signs and symbols

This study aimed to examine children’s recognition of common signs. A group of 449 children ages 4–5 years old were recruited from preschools in three Jordanian cities. The children were presented with a collection of common signs found in public spaces and asked to identify the sign’s meaning. Results revealed a low frequency of correctly recognising a sign’s meaning, as reflected in the total score. Signs were categorised as guided, warning, or public. Results showed that the most frequently identified signs were guided signs, with the mosque sign in particular being mostly often correctly identified. Results also showed that the least recognised sign was the elevator sign. Additionally, findings revealed that sign recognition differed significantly depending on the child’s gender, age, and location. The results of this study highlight the lack of knowledge children have about common public signs.     

‘Critical Periods’ in Human Cognitive Development

Available evidence does not support the view that there are “critical periods” during which children must be exposed to a given learning opportunity or forever suffer some degree of intellectual deficit. Rather, this concept, a carry-over from studies that demonstrated “imprinting” in certain animal species, may hamper the development of a soundly based approach to the learning difficulties of deprived children.     

Community-Level Social Determinants and Children’s School Readiness

Prevention Science - The current study examined links between social determinants across communities and school readiness of children attending kindergarten in each community, in literacy, math,...     

Parental and Child Factors Associated With 2- to 6-Year-Old Children’s Diet Quality in Finland

BackgroundThere is limited evidence about diet quality and associated factors in a representative population-based sample of preschool-aged children in Finland.ObjectiveThe aims of this study were to investigate (1) the extent to which child diet quality and the consumption of health indicator foods (vegetables, fruits, berries, vegetable oil-based spread, nonfat milk) are in accordance with Finnish recommendations for preschool-aged children, (2) whether diet quality differs between children with underweight or normal weight compared with children with overweight or obesity, and (3) whether parental or child factors are related to children’s diet quality.DesignThis was a cross-sectional study.Participants/settingHealthy children aged 2 to 6 years (n = 766) were recruited from child health clinics across Finland from February to June 2016.Main outcome measuresDiet quality and consumption of the health indicator foods were assessed by the Children’s Index of Diet Quality (CIDQ, score 0-21, values < 10 indicate poor; 10-13.5, moderate; and ≥14, good diet quality). Parental information was collected with a self-administered questionnaire. Child weight and height were measured by child health clinic nurses.Statistical analysesThe overweight/obesity status and diet quality of the children were compared with 1-way analysis of variance. One-way analysis of variance was used as the preliminary analysis between child and parental factors and CIDQ scores, and linear mixed model analysis to further analyze the relationship between child and parental factors and CIDQ data.ResultsOnly a small minority (13.7%) of the children had a good diet quality, 55.4% had a moderate diet quality, and 30.9% had a poor diet quality. Only 1% of the children consumed the key health indicator foods, namely vegetables, fruits, and berries, as recommended. Diet quality did not differ between children with underweight/normal weight and overweight/obesity. Instead, the child’s younger age, parents’ higher education, and parents’ self-perceived healthy diet were related to good diet quality in the child.ConclusionsThe diet quality was moderate or poor in the majority of the children. Parental characteristics were the main factors related to the child’s diet quality. The results suggest that future efforts to improve preschool-aged children’s diet quality are needed including efforts to counsel families in pediatric care. Whether the findings from the current study also apply to Finnish school-aged children should be investigated further.