The effectiveness of short-term literacy skills intervention on children at risk of reading and writing difficulties in Tanzania : a study of grade one children with dynamic assessment approach

The aim of the study was to create and evaluate an intervention programme for Tanzanian children from a low-income area who are at risk of reading and writing difficulties. The learning difficulties, including reading and writing difficulties, are likely to be behind many of the common school problems in Tanzania, but they are not well understood, and research is needed. The design of the study included an identification and intervention phase with follow-up. A group based dynamic assessment approach was used in identifying children at risk of difficulties in reading and writing. The same approach was used in the intervention. The study was a randomized experiment with one experimental and two control groups. For the experimental and the control groups, a total of 96 (46 girls and 50 boys) children from grade one were screened out of 301 children from two schools in a low income urban area of Dar-es-Salaam. One third of the children, the experimental group, participated in an intensive training programme in literacy skills for five weeks, six hours per week, aimed at promoting reading and writing ability, while the children in the control groups had a mathematics and art programme. Follow-up was performed five months after the intervention. The intervention programme and the tests were based on the Zambian BASAT (Basic Skill Assessment Tool, Ketonen & Mulenga, 2003), but the content was drawn from the Kiswahili school curriculum in Tanzania. The main components of the training and testing programme were the same, only differing in content. The training process was different from traditional training in Tanzanian schools in that principles of teaching and training in dynamic assessment were followed. Feedback was the cornerstone of the training and the focus was on supporting the children in exploring knowledge and strategies in performing the tasks. The experimental group improved significantly more (p = .000) than the control groups during the intervention from pre-test to follow-up (repeated measures ANOVA). No differences between the control groups were noticed. The effect was significant on all the measures: phonological awareness, reading skills, writing skills and overall literacy skills. A transfer effect on school marks in Kiswahili and English was found. Following a discussion of the results, suggestions for further research and adaptation of the programme are presented.

Influenza in children – Diagnosis, treatment and prevention

Background: The burden of influenza on children is substantial. Although mortality rates are low, the incidence of influenza is highest in children, among whom also complications are frequent. A more accurate recognition of influenza in children could enable the rational use of antiviral drugs and help to avoid unnecessary courses of antibiotics. Limited data exists on the efficacy of oseltamivir treatment and the trivalent inactivated influenza vaccine (TIV) in children. Aims and methods: We sought for signs and symptoms that could help clinicians to diagnose influenza on clinical grounds in a case-control study in children <13 years of age. We further assessed the feasibility of different diagnostics methods during the early stage of the illness in children aged 1-3 years. The efficacy of early oseltamivir treatment (started <24h from the onset of symptoms) was evaluated in a randomized controlled trial (RCT) conducted in children 1-3 years of age, and the effectiveness of TIV to prevent laboratory-confirmed influenza was determined in a prospective, observational cohort study conducted among children aged 9 months to 3 years of age. Results: Fever was the only symptom predicting influenza in children. The sensitivity of conventionally used laboratory methods to detect influenza during the first 24h of illness was 92%. The sensitivity of the influenza rapid test in the same setting was 90% for influenza A and 25% for influenza B. Early oseltamivir treatment shortened the duration of the illness in children with influenza A by 3.5-4.0 days, but no efficacy was observed against influenza B. The effectiveness of TIV was 84% against the wellmatched influenza A, while no effectiveness against the mismatched influenza B was observed. Conclusions: Laboratory diagnostics are needed for a reliable diagnosis of influenza in children and were found sensitive already during the early stage of the illness. Early oseltamivir treatment was highly effective against influenza A, but no efficacy was seen against influenza B. TIV is effective also in young children if a good match between the vaccine and circulating strain is achieved.

Spontaneous Focusing on Numerosity in the Development of Early Mathematical Skills

The aim of the present set of longitudinal studies was to explore 3-7-year-old children.s Spontaneous FOcusing on Numerosity (SFON) and its relation to early mathematical development. The specific goals were to capture in method and theory the distinct process by which children focus on numerosity as a part of their activities involving exact number recognition, and individual differences in this process that may be informative in the development of more complex number skills. Over the course of conducting the five studies, fifteen novel tasks were progressively developed for the SFON assessments. In the tasks, confounding effects of insufficient number recognition, verbal comprehension, other procedural skills as well as working memory capacity were aimed to be controlled. Furthermore, how children.s individual differences in SFON are related to their development of number sequence, subitizing-based enumeration, object counting and basic arithmetic skills was explored. The effect of social interaction on SFON was tested. Study I captured the first phase of the 3-year longitudinal study with 39 children. It was investigated whether there were differences in 3-year-old children.s tendency to focus on numerosity, and whether these differences were related to the children.s development of cardinality recognition skills from the age of 3 to 4 years. It was found that the two groups of children formed on the basis of their amount of SFON tendency at the age of 3 years differed in their development of recognising and producing small numbers. The children whose SFON tendency was very predominant developed faster in cardinality related skills from the age of 3 to 4 years than the children whose SFON tendency was not as predominant. Thus, children.s development in cardinality recognition skills is related to their SFON tendency. Studies II and III were conducted to investigate, firstly, children.s individual differences in SFON, and, secondly, whether children.s SFON is related to their counting development. Altogether nine tasks were designed for the assessments of spontaneous and guided focusing on numerosity. The longitudinal data of 39 children in Study II from the age of 3.5 to 6 years showed individual differences in SFON at the ages of 4, 5 and 6 years, as well as stability in children.s SFON across tasks used at different ages. The counting skills were assessed at the ages of 3.5, 5 and 6 years. Path analyses indicated a reciprocal tendency in the relationship between SFON and counting development. In Study III, these results on the individual differences in SFON tendency, the stability of SFON across different tasks and the relationship of SFON and mathematical skills were confirmed by a larger-scale cross-sectional study of 183 on average 6.5-year-old children (range 6;0-7;0 years). The significant amount of unique variance that SFON accounted for number sequence elaboration, object counting and basic arithmetic skills stayed statistically significant (partial correlations varying from .27 to .37) when the effects of non-verbal IQ and verbal comprehension were controlled. In addition, to confirm that the SFON tasks assess SFON tendency independently from enumeration skills, guided focusing tasks were used for children who had failed in SFON tasks. It was explored whether these children were able to proceed in similar tasks to SFON tasks once they were guided to focus on number. The results showed that these children.s poor performance in the SFON tasks was not caused by their deficiency in executing the tasks but on lacking focusing on numerosity. The longitudinal Study IV of 39 children aimed at increasing the knowledge of associations between children.s long-term SFON tendency, subitizing-based enumeration and verbal counting skills. Children were tested twice at the age of 4-5 years on their SFON, and once at the age of 5 on their subitizing-based enumeration, number sequence production, as well as on their skills for counting of objects. Results showed considerable stability in SFON tendency measured at different ages, and that there is a positive direct association between SFON and number sequence production. The association between SFON and object counting skills was significantly mediated by subitizing-based enumeration. These results indicate that the associations between the child.s SFON and sub-skills of verbal counting may differ on the basis of how significant a role understanding the cardinal meanings of number words plays in learning these skills. The specific goal of Study V was to investigate whether it is possible to enhance 3-year old children.s SFON tendency, and thus start children.s deliberate practice in early mathematical skills. Participants were 3-year-old children in Finnish day care. The SFON scores and cardinality-related skills of the experimental group of 17 children were compared to the corresponding results of the 17 children in the control group. The results show an experimental effect on SFON tendency and subsequent development in cardinality-related skills during the 6-month period from pretest to delayed posttest in the children with some initial SFON tendency in the experimental group. Social interaction has an effect on children.s SFON tendency. The results of the five studies assert that within a child.s existing mathematical competence, it is possible to distinguish a separate process, which refers to the child.s tendency to spontaneously focus on numerosity. Moreover, there are significant individual differences in children.s SFON at the age of 3-7 years. Moderate stability was found in this tendency across different tasks assessed both at the same and at different ages. Furthermore, SFON tendency is related to the development of early mathematical skills. Educational implications of the findings emphasise, first, the importance of regarding focusing on numerosity as a separate, essential process in the assessments of young children.s mathematical skills. Second, the substantial individual differences in SFON tendency during the childhood years suggest that uncovering and modeling this kind of mathematically meaningful perceiving of the surroundings and tasks could be an efficient tool for promoting young children.s mathematical development, and thus prevent later failures in learning mathematical skills. It is proposed to consider focusing on numerosity as one potential sub-process of activities involving exact number recognition in future studies.

Genetic, prenatal and postnatal determinants of weight gain and obesity in young children – The STEPS Study

Genetic, Prenatal and Postnatal Determinants of Weight Gain and Obesity in Young Children – The STEPS Study University of Turku, Faculty of Medicine, Department of Paediatrics, University of Turku Doctoral Program of Clinical Investigation (CLIPD), Turku Institute for Child and Youth Research. Conditions of being overweight and obese in childhood are common health problems with longlasting effects into adulthood. Currently 22% of Finnish boys and 12% of Finnish girls are overweight and 4% of Finnish boys and 2% of Finnish girls are obese. The foundation for later health is formed early, even before birth, and the importance of prenatal growth on later health outcomes is widely acknowledged. When the mother is overweight, had high gestational weight gain and disturbances in glucose metabolism during pregnancy, an increased risk of obesity in children is present. On the other hand, breastfeeding and later introduction of complementary foods are associated with a decreased obesity risk. In addition to these, many genetic and environmental factors have an effect on obesity risk, but the clustering of these factors is not extensively studied. The main objective of this thesis was to provide comprehensive information on prenatal and early postnatal factors associated with weight gain and obesity in infancy up to two years of age. The study was part of the STEPS Study (Steps to Healthy Development), which is a follow-up study consisting of 1797 families. This thesis focused on children up to 24 months of age. Altogether 26% of boys and 17% of girls were overweight and 5% of boys and 4% of girls were obese at 24 months of age according to New Finnish Growth references for Children BMI-for-age criteria. Compared to children who remained normal weight, the children who became overweight or obese showed different growth trajectories already at 13 months of age. The mother being overweight had an impact on children’s birth weight and early growth from birth to 24 months of age. The mean duration of breastfeeding was almost 2 months shorter in overweight women in comparison to normal weight women. A longer duration of breastfeeding was protective against excessive weight gain, high BMI, high body weight and high weight-for-length SDS during the first 24 months of life. Breast milk fatty acid composition differed between overweight and normal weight mothers, and overweight women had more saturated fatty acids and less n-3 fatty acids in breast milk. Overweight women also introduced complementary foods to their infants earlier than normal weight mothers. Genetic risk score calculated from 83 obesogenic- and adiposity-related single nucleotide polymorphisms (SNPs) showed that infants with a high genetic risk for being overweight and obese were heavier at 13 months and 24 months of age than infants with a low genetic risk, thus possibly predisposing to later obesity in obesogenic environment. Obesity Risk Score showed that children with highest number of risk factors had almost 6-fold risk of being overweight and obese at 24 months compared to children with lowest number of risk factors. The accuracy of the Obesity Risk Score in predicting overweight and obesity at 24 months was 82%. This study showed that many of the obesogenic risk factors tend to cluster within children and families and that children who later became overweight or obese show different growth trajectories already at a young age. These results highlight the importance of early detection of children with higher obesity risk as well as the importance of prevention measures focused on parents. Keywords: Breastfeeding, Child, Complementary Feeding, Genes, Glucose metabolism, Growth, Infant Nutrition Physiology, Nutrition, Obesity, Overweight, Programming

Författningsändring och problemlösning: en studie av kvalificerade majoriteter i 34 stater

Abstract: Constitutional amendment and problem-solving: supermajorities in 34 states.

Viable Health Games: Elements for Success

The main purpose of this study is to identify the elements of children's health games that have a positive impact on children’s health. The investigation is done by evaluating previous health game studies concentrating on children and five health affairs (such as asthma, cancer, diabetes, nutrition and obesity). In order to do so, firstly the topic of children’s health games is explained through its roots, as it is an interdisciplinary topic pertinent with many other fields. For this reason, the topics regarding the children’s health games as games, video games, children’s gameplay, and serious games along with health, relevant health affairs, and health promotion were covered. Secondly, the meta-study was conducted with the 56 articles on children’s health games. These 56 articles were analyzed with the coding technique defined by Charmaz’s Grounded Theory Method (Charmaz, 2006) for finding out which elements of children’s health games have a positive impact on children’s health promotion. The main result suggests that, although there are 24 different elements found and listed which all positive in their nature, their positive impact is a matter of how they are used or implemented through the consumption cycle of children’s health games and how all these elements interact with each other. In addition to this, a pragmatic proposal is formulated for possibly better or more successful health games. The study concludes with the declaration of the limitations encountered through the research and the recommendations for future research.

Viable Health Games: Elements for Success

The main purpose of this study is to identify the elements of children's health games that have a positive impact on children’s health. The investigation is done by evaluating previous health game studies concentrating on children and five health affairs (such as asthma, cancer, diabetes, nutrition and obesity). In order to do so, firstly the topic of children’s health games is explained through its roots, as it is an interdisciplinary topic pertinent with many other fields. For this reason, the topics regarding the children’s health games as games, video games, children’s gameplay, and serious games along with health, relevant health affairs, and health promotion were covered. Secondly, the meta-study was conducted with the 56 articles on children’s health games. These 56 articles were analyzed with the coding technique defined by Charmaz’s Grounded Theory Method (Charmaz, 2006) for finding out which elements of children’s health games have a positive impact on children’s health promotion. The main result suggests that, although there are 24 different elements found and listed which all positive in their nature, their positive impact is a matter of how they are used or implemented through the consumption cycle of children’s health games and how all these elements interact with each other. In addition to this, a pragmatic proposal is formulated for possibly better or more successful health games. The study concludes with the declaration of the limitations encountered through the research and the recommendations for future research.

The family school : the impact of a group training programme on overactive hard-to-manage preschool children and their parents

Föräldraskap upplevs som en utmanande uppgift i dag och det påstås att föräldrar oftare än förr skulle var i behov av råd och stöd beträffande barnuppfostran. Denna uppgift kan ytterligare försvåras om det i familjen finns ett hyperaktivt okoncentrerat barn att uppfostra. Detta arbete undersökte effekterna av ett kortvarigt gruppbaserat interventionsprogram benämnt Familjeskolan POP (Preschool Overactivity Programme). Familjeskolan är avsedd för familjer med barn i lekåldern, som visar beteendesvårigheter såsom ADHD (Attention Deficit Hyperactivity Disorder), ODD (Oppositional Deficit Disorder) eller CD (Conduct Disorder). Målet för Familjeskolan är att öka föräldrarnas kunskaper och självförtroende då de har ett krävande svårhanterligt barn att uppfostra. Familjeskolan strävar också till att reducera barns icke-önskvärda beteenden genom att öka deras sociala färdigheter och koncentrationsförmåga. Familjeskolan verkställdes i Helsingfors vid ADHD- centrets lokaliteter. 45 mödrar och deras barn från huvudstadsregionen deltog i denna undersökning. Av dessa deltog 33 i Familjeskola-programmet medan de 12 övriga bildade den s.k. kontrollgruppen. Undersökningsresultaten tyder på förbättringar beträffande både moderns och faderns föräldrakunskaper efter Familjeskola-interventionen. Det är att lägga märke till att enbart mödrar deltog i interventionsprogrammet. Efter programmet klarade mödrar enligt egen utsaga vardagen bättre. Speciellt hade de blivit bättre på att hantera barnens beteendesvårigheter och hyperaktivt okoncentrerat beteende. Resultaten påvisade också att programmet var effektivast för de mödrar som före Familjeskolan upplevde sig besitta ringa föräldrakunskaper. Mödrarna rapporterade en signifikant minskning i barnens totala beteendesvårigheter. Efter interventionen ansåg mödrarna att deras barn var mindre olydiga, hyperaktiva samt att deras beteendesvårigheter var lindrigare. Enligt dagvårdspersonalen hade barnens totala beteendesvårigheter och problem med koncentration och hyperaktivitet också minskat. Motsvarande förbättringar uppnåddes inte i kontrollgruppen. Resultaten från uppföljningsintervjun, visade också att barnens beteendeförändringar var bestående både hemma och i daghemmet. Både föräldrar och dagvårdspersonalen rapporterade en signifikant minskning i barnens totala svårigheter jämfört med innan familjerna påbörjade interventionen. Föräldrarna rapporterade en marginell minskning i barnens ADHD-liknande beteende, beteendesvårigheter och i svårigheter med kamrater, dagvårdspersonalen däremot rapporterade en signifikant minskning i barnens beteendesvårigheter, hyperaktivt/okoncentrerat beteende samt i svårigheter med kamrater mellan innan familjerna påbörjade interventionen och uppföljningen ett år efter. Resultaten av denna undersökning stödjer hypotesen att kortvariga gruppbaserade interventionsprogram kan åstadkomma permanenta förbättringar i föräldrakunskaper och barns beteende. Detta gäller främst hyperaktivitet, koncentrationssvårigheter och trotsighet.