Randomised controlled trials in child health in developing countries: trends and lessons over 11 years.

Using a uniform systematic approach annually, we reviewed 1553 publications from randomised controlled trials in child health in developing countries published between July 2002 and June 2013. There were annual increases in such publications, from 38 in the 12 months to July 2003 to over 200 in each of 2012 and 2013. These trials involved children in 76 developing countries. Studies of nutrition (366 publications, 23.6%) and malaria (336 publications, 21%) predominated. 79% of nutrition trials have been of micronutrients (288 publications), with comparatively few publications related to macronutrient interventions or complimentary feeding (48 publications) or measures to improve breast feeding (20 publications). Trials of malaria have involved a comprehensive range of treatment and preventive strategies and have heralded the implementation of new interventions as routine health strategies, and reductions in malaria in each affected country in the world in the last decade. There have been a relatively small number of trials of interventions for treatment or prevention of acute respiratory infection (98 publications, 6.3%), neonatal health (64 publications, 4.1%) and tuberculosis in children (26 publications, 1.7%). In the last 5 years there has been increasing focus on non-communicable diseases such as asthma and allergy, obesity, diabetes and cardiac disease, and behavioural-developmental disorders. Mental health conditions have received little attention (21 publications, 1.4% of publications). There is increasing research activity and capacity in child health in developing countries. Some areas have been the subject of a large amount of research, and have led to the design and implementation of effective public health interventions and reduced disease burdens, while in other areas comprehensive approaches and the systematic application of research findings have been lacking.

Trends in child and adolescent obesity prevalence in economically advanced countries according to socioeconomic position: a systematic review

Recent obesity trends in children and adolescents suggest a plateau. However, it is unclear whether such trends have been experienced across socioeconomic groups. We analysed whether recent trends in child and adolescent overweight and obesity differ by socioeconomic position (SEP) across economically advanced countries. Eligible studies reported overweight and obesity prevalence in children and/or adolescents (2-18 years), for at least two time points since 1990, stratified by SEP. Socioeconomic differences in trends in child and adolescent overweight and obesity over time were analysed. Differences in trends between SEP groups were observed across a majority of studies. Over half the studies indicated increasing prevalence among low SEP children and adolescents compared to a third of studies among children and adolescents with a high SEP. Around half the studies indicated widening socioeconomic inequalities in overweight and obesity. Since 2000 a majority of studies demonstrated no change or a decrease in prevalence among both high and low SEP groups. However around 40% of studies indicated widening of socioeconomic inequalities post-2000. While our study provides grounds for optimism, socioeconomic inequalities in overweight and obesity continue to widen. These findings highlight the need for greater consideration of different population groups when implementing obesity interventions. © 2015 World Obesity.

Trends in child and adolescent obesity prevalence according to socioeconomic position: protocol for a systematic review

BACKGROUND: Obesity is a significant public health issue and is socially patterned, with greater prevalence of obesity observed in the most socioeconomically disadvantaged groups. Recent evidence suggests that the prevalence of childhood obesity is levelling off in some countries. However, this may not be the case across all socioeconomic strata. The aim of this review is to examine whether trends in child and adolescent obesity prevalence since 1990 differ according to socioeconomic position in developed countries.

METHODS: An electronic search will be conducted via Ovid Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, Scopus and Cochrane Collaboration to identify articles that report trends in obesity prevalence in children and adolescents according to socioeconomic position. We will also search grey literature databases including the Virtual Library for Public Health and the System for Information on Grey Literature, as well as websites from relevant organisations. Articles that report on a series of cross sectional studies; describe one or more measure of obesity with data recorded at two or more time points since 1990; and report trends by at least one indicator of socioeconomic position will be included. Quality of included studies will be evaluated according to criteria that consider both internal and external validity. Descriptive analysis will be performed to examine trends since 1990 in childhood obesity prevalence according to socioeconomic position.

DISCUSSION: The review will provide a picture of change over time in developed countries of childhood obesity prevalence across socioeconomic strata and identify whether changes in childhood obesity prevalence are experienced equally across socioeconomic groups.

Investigative interviewers' perceptions of their difficulty in adhering to open-ended questions with child witnesses

Best practice guidelines for conducting investigative interviews of children emphasise the importance of obtaining free narrative accounts with the use of open-ended questions. However, research indicates that most investigative interviewers underutilise open-ended questions, even following intensive training in their use. The aim of the current study was to explore investigative interviewers' perceptions of their difficulty in asking open-ended questions. During a training course on how to use open-ended questions, eight child abuse investigators were individually interviewed about why they had asked specific questions in a 10-minute mock interview conducted immediately earlier with a school child. Overall, three reasons were identified. These related to: 1. the specificity of the information required from children; 2. the unfamiliar nature of the open-ended discourse style; and 3. the complex distinction between open-ended versus specific questions. Each of these themes is discussed, along with the implications for trainers and researchers in child investigative interviewing.

Prosecutors’ perceptions on improving child witness interviews about abuse

This edited volume reviews the latest research on investigative interviewing in order to provide insights on the psychological processes of the person being interviewed as well as to offer guidelines for conducting credible and useful ...

A guide to clarifying evidence in Australian child forensic interviews

Purpose – Interviewing victims of child sex abuse requires considerable care in order to minimise error. Due to children’s heightened suggestibility any question asked of a child could potentially incite error that could undermine the witness’s credibility. A focus group was conducted in order to facilitate the development of guidance for interviewers around the circumstances in which it is necessary to ask children follow-up questions in an interview. The paper aims to discuss these issues.

Design/methodology/approach – Seven Crown prosecutors representing every Australian state and territory (with the exception of one small state) were issued with 25 hypothetical narrative accounts of child abuse and asked to indicate what information, if any, required follow-up in the child’s narrative. Their responses and rationale for requiring following up in some cases and not others were discussed.

Findings – Thematic analysis revealed three recommendations to guide questioning: whether the case involved identification or recognition evidence; the presence of contextual features that may influence the witness’s memory, or that should trigger a particular line of questioning; and whether the information can or should be sought at a later stage by the trial prosecutor, rather than by the interviewer. Practical implications – The recommendations are discussed within the context of their implications for interviewing, that is, how each recommendation could be implemented in practice.

Originality/value – The present study extends prior literature by elucidating principles to guide decision making across interview topic areas. The need for such guidance is highlighted by research suggesting that topics such as offender identity, offence time and place, and witnesses are a source of overzealous questioning in interviews.

Describing individual incidents of sexual abuse: a review of research on the effects of multiple sources of information on children's reports

Objective: For successful prosecution of child sexual abuse, children are often required to provide reports about individual, alleged incidents. Although verbally or mentally rehearsing memory of an incident can strengthen memories, children’s report of individual incidents can also be contaminated when they experience other events related to the individual incidents (e.g., informal interviews, dreams of the incident) and/or when they have similar, repeated experiences of an incident, as in cases of multiple abuse.

Method: Research is reviewed on the positive and negative effects of these related experiences on the length, accuracy, and structure of children’s reports of a particular incident.

Results: Children’s memories of a particular incident can be strengthened when exposed to information that does not contradict what they have experienced, thus promoting accurate recall and resistance to false, suggestive influences. When the encountered information differs from children’s experiences of the target incident, however, children can become confused between their experiences—they may remember the content but not the source of their experiences.

Conclusions: We discuss the implications of this research for interviewing children in sexual abuse investigations and provide a set of research-based recommendations for investigative interviewers.

Child testimony in custody cases: a review

The authors provide a brief historical review of judicial trends in child custody placement. In contrast to the start of the 19th century, by its end, courts took into consideration children's best interests, maternal rights, and prevailing sex role ideologies. Statutory changes began to reflect similar concerns by the end of that century. Modern practices, relying on the best interests of the child standard, also include consistent consideration of children's preferences in making custody determinations. An important factor in this context is the accuracy with which a child describes domestic relations, especially in contested cases with contradictory allegations by parents. Research dealing with children's report accuracy and techniques to enhance it are reviewed, and a description of various practical considerations when questioning children is provided.

Evaluation of the questions used to elicit evidence about abuse from child witnesses : Australian study

This study provides one of the first objective evaluations of the performance of a group of Australian police officers when conducting interviews about child abuse. The interviews included 136 videotaped child witness statements, conducted between 2001 and 2007 by police officers from two jurisdictions of Australia. The results indicated many positive aspects of the interviewers' performance, including the use of ground rules at the outset of the interview, commencement of the free-narrative account by seeking the children's understanding of the purpose of the interview, and avoidance of suggestive questions. But the interviewers tended to raise issues of contention when the child did not provide an initial disclosure, and the proportion of open-ended questions was low relative to specific cued-recall and closed questions. Further many closed questions raised specific details not yet mentioned by the child. These behaviours were exhibited irrespective of the recency of interview or time since training. The implications of these findings are discussed.

Importance of assessing family dysfunction in conjunction with standardised measures when treating substance abuse

In this thesis, the link between substance abuse and family dysfunction is examined, and an argument is made for the assessment of family dysfunction when treating clients with substance abuse issues. Family dysfunction has been associated with a broad range of problems in children (e.g., low self esteem, increased risk of child abuse) through to adolescence and adulthood (e.g., increased risk of mental disorders such as depressive disorders, substance abuse disorders, and personality disorders) (Kaplan & Sadock, 1998). It is not the purpose of this thesis to suggest that family dysfunction causes substance abuse but rather to highlight that family dysfunction can in some cases place the individual at greater risk of substance abuse. Therefore, in order to understand the reasons why substance abuse developed and how it is maintained in the present requires the assessment of family dysfunction. Further, the importance of assessing the role and impact that family dysfunction may have had on the client, may help to better understand the nature and extent of substance abuse so that relevant and appropriate treatment goals for change may be set, progress monitored, and risk of relapse reduced. Chapter 1 provides a brief introduction to this thesis, and Chapter 2 is a review of the literature on the impact of family dysfunction including poor parental attachment and supervision, neglect, physical and sexual abuse, in adolescence and adulthood. Four case studies are presented to illustrate how family dysfunction and substance abuse may be related, thus highlighting the importance of assessing family dysfunction when treating substance abuse clients. All of the case studies include an individual with a substance abuse disorder (namely heroin) but they are diverse in terms of the types and extent of family dysfunction. The final chapter discusses the case studies in relation to the literature reviewed. Lastly, it gives consideration to the implication of a history of family dysfunction, and how it may impact negatively on treatment and therefore prognosis.

Child-related information processing in step-parents : investigating the Cinderella effect

This thesis examined the over-representation of step-parents as perpetrators of child physical abuse. Results suggested a number of differences between step- and biological parents in attachment, information-processing, and disciplinary practices. Results were used to formulate a model of step-parental abuse, which has potential implications for the prevention of child physical abuse. The professional portfolio presents four cases from forensic practice in which predictions about further criminal behaviour are made. These cases are then used to discuss several practical questions that may be posed by psychologists who are considering which approach (clinical or actuarial) to use.

Relationship between childhood abuse and psychosexual adjustment in adult women

Study 1 found that poor attachment relationships, dysfunctional family environments, re-victimisation experiences and poor coping skills contibute towards mental health problems as well as the child abuse experiences. Study 2 implemented a therapy program that demonstrated an improvement in the sexual response of women who experienced childhood sexual assault.