Recommendations for a trans-European dietary assessment method in children between 4 and 14 years

Background/Objectives: The main objective of European Food Consumption Validation (EFCOVAL)-child Project is to define and evaluate a trans-European methodology for undertaking national representative dietary surveys among children in the age group of 4–14 years. In the process of identifying the best dietary assessment methodologies, experts were brought together at a workshop. The paper presents the discussion of the best available method and the final recommendations for a trans-European dietary assessment method among 4- to 14-year-old children.
Subjects/Methods: The starting point was to investigate whether the method (two non-consecutive 24-h dietary recalls (24-HDRs)) suggested for the adults in European Food Consumption Survey Method (EFCOSUM) would be usable for children in
the age group between 4 and 14 years. However, all available dietary assessment methods were included in the discussion to ensure that the final recommendation would be based on the best evidence. Six criteria were defined and used as additional
guidance in the process.
Results: The literature does not give a clear recommendation on the dietary assessment methods that are most suitable for children in the age group of 4–14 years. Nevertheless, on the basis of the literature, the recommendations were separated for preschoolers (4–6 years) and schoolchildren (7–14 years).
Conclusion: For preschoolers, two non-consecutive days of a structured food record are recommended, using a (for children adapted) picture booklet and household measures for portion-size estimation. For schoolchildren, repeated 24-HDRs are recommended, using a picture booklet and household measures for portion-size estimation. In addition, the child should bring a booklet to register what is eaten out of home. One parent should assist the schoolchild at the 24-HDR interview, and therefore face-to-face interviews are required.

Promoting Fundamental movement skill development and physical activity in early childhood settings : a cluster randomized controlled trial

The aim of this study was to assess the feasibility, acceptability and potential efficacy of a physical activity program for preschool children. A 20-week, 2-arm parallel cluster randomized controlled pilot trial was conducted. The intervention comprised structured activities for children and professional development for staff. The control group participated in usual care activities, which included designated inside and outside playtime. Primary outcomes were movement skill development and objectively measured physical activity. At follow-up, compared with children in the control group, children in the intervention group showed greater improvements in movement skill proficiency, with this improvement statically significant for overall movement skill development (adjust diff. = 2.08, 95% CI 0.76, 3.40; Cohen’s d = 0.47) and significantly greater increases in objectively measured physical activity (counts per minute) during the preschool day (adjust diff. = 110.5, 95% CI 33.6, 187.3; Cohen’s d = 0.46). This study demonstrates that a physical activity program implemented by staff within a preschool setting is feasible, acceptable and potentially efficacious.

Play, language and social skills of children attending a play-based curriculum school and a traditionally structured classroom curriculum school in low socioeconomic areas

Aim and method: A comparison study of four six-year-old children attending a school with a play-based curriculum and a school with a traditionally structured classroom from low socioeconomic areas was conducted in Victoria, Australia. Children’s play,
language and social skills were measured in February and again in August. At baseline assessment there was a combined sample of 31 children (mean age 5.5 years, SD 0.35 years; 13 females and 18 males). At follow-up there was a combined sample of 26
children (mean age 5.9 years, SD 0.35 years; 10 females, 16 males).
Results: There was no significant difference between the school groups in play, language, social skills, age and sex at baseline assessment. Compared to norms on a standardised assessment, all the children were beginning school with delayed play ability. At follow-up assessment, children at the play-based curriculum school had made significant gains in all areas assessed (p values ranged from 0.000 to 0.05). Children at the school with the traditional structured classroom had made significant positive gains in use of symbols in play (p < 0.05) and semantic language (p < 0.05). At follow-up, there were significant differences between schools in elaborate play (p < 0.000), semantic language (p < 0.000), narrative language (p < 0.01) and social connection (p < 0.01), with children in the play-based curriculum school having significantly higher scores in play, narrative language and language and lower scores in social disconnection.
Implications: Children from low SES areas begin school at risk of failure as skills in play, language and social skills are delayed. The school experience increases children’s skills, with children in the play-based curriculum showing significant improvements in all areas assessed. It is argued that a play-based curriculum meets children’s developmental and learning needs more effectively. More research is needed to replicate these results.

Improving outcomes of preschool language delay in the community : protocol for the Language for Learning randomised controlled trial

Background

Early language delay is a high-prevalence condition of concern to parents and professionals. It may result in lifelong deficits not only in language function, but also in social, emotional/behavioural, academic and economic well-being. Such delays can lead to considerable costs to the individual, the family and to society more widely. The Language for Learning trial tests a population-based intervention in 4 year olds with measured language delay, to determine (1) if it improves language and associated outcomes at ages 5 and 6 years and (2) its cost-effectiveness for families and the health care system.

Methods/Design

A large-scale randomised trial of a year-long intervention targeting preschoolers with language delay, nested within a well-documented, prospective, population-based cohort of 1464 children in Melbourne, Australia. All children received a 1.25-1.5 hour formal language assessment at their 4th birthday. The 200 children with expressive and/or receptive language scores more than 1.25 standard deviations below the mean were randomised into intervention or ‘usual care’ control arms. The 20-session intervention program comprises 18 one-hour home-based therapeutic sessions in three 6-week blocks, an outcome assessment, and a final feed-back/forward planning session. The therapy utilises a ‘step up-step down’ therapeutic approach depending on the child’s language profile, severity and progress, with standardised, manualised activities covering the four language development domains of: vocabulary and grammar; narrative skills; comprehension monitoring; and phonological awareness/pre-literacy skills. Blinded follow-up assessments at ages 5 and 6 years measure the primary outcome of receptive and expressive language, and secondary outcomes of vocabulary, narrative, and phonological skills.

Discussion

A key strength of this robust study is the implementation of a therapeutic framework that provides a standardised yet tailored approach for each child, with a focus on specific language domains known to be associated with later language and literacy. The trial responds to identified evidence gaps, has outcomes of direct relevance to families and the community, includes a well-developed economic analysis, and has the potential to improve long-term consequences of early language delay within a public health framework.

Children and university architecture students working together : a pedagogical model of children’s participation in architectural design

Increasing efforts have been made to engage children in the design of the built environment, and several participatory models have been developed. The aim of this paper is to propose a pedagogical model for children's genuine participation in architectural design, developed in an architectural education context. According to this pedagogical model, children (primary school students) and youth (university architecture students) work in teams to develop the architectural design proposals. This model was developed through a joint educational project between Deakin University and Wales Street Primary School (both institutions are based in Victoria, Australia). In the four-week duration of the project, first year architecture students worked with Grade 3 and 4 primary school children to design a school playground. The final product of the project was a 1:20 scale model of a playground, which was installed and presented at the end of the fourth week. The project received positive feedback from all the participants, including children, architecture students, university lecturers, primary school teachers and architects. In addition, it achieved a high level of children's genuine participation. This model can be refined and applied in new situations, and potentially with other primary schools working with Deakin University.

Kids in design : designing creative schools with children

There is a consensus that children should be involved in the planning and design process of their schools, and attempts have been made throughout the world. This paper introduces a ‘Kids in Design’ project, through which primary school children worked with university architecture students to design a school playground. The aim of the project was to encourage the full potential of children’s creativity and generate creative school design outcomes. From October to December 2011, the ‘Kids in Design’ project was conducted in Roslyn Road Primary School (Geelong, Australia). Through eight weeks of workshops, children in Year 5 & 6 worked with architecture students from Deakin University (Geelong, Australia) to design a school playground. Assessing the design outcomes of this project, assertions are made that creative design outcomes have been achieved. Deakin University is currently working with another primary school to replicate the ‘Kids in Design’ project in 2012.

An analysis of potential barriers and enablers to regulating the television marketing of unhealthy foods to children at the state government level in Australia

Background In Australia there have been many calls for government action to halt the effects of unhealthy food marketing on children's health, yet implementation has not occurred. The attitudes of those involved in the policy-making process towards regulatory intervention governing unhealthy food marketing are not well understood. The objective of this research was to understand the perceptions of senior representatives from Australian state and territory governments, statutory authorities and non-government organisations regarding the feasibility of state-level government regulation of television marketing of unhealthy food to children in Australia.

Method Data from in-depth semi-structured interviews with senior representatives from state and territory government departments, statutory authorities and non-government organisations (n=22) were analysed to determine participants' views about regulation of television marketing of unhealthy food to children at the state government level. Data were analysed using content and thematic analyses.

Results Regulation of television marketing of unhealthy food to children was supported as a strategy for obesity prevention. Barriers to implementing regulation at the state level were: the perception that regulation of television advertising is a Commonwealth, not state/territory, responsibility; the power of the food industry and; the need for clear evidence that demonstrates the effectiveness of regulation. Evidence of community support for regulation was also cited as an important factor in determining feasibility.

Conclusions The regulation of unhealthy food marketing to children is perceived to be a feasible strategy for obesity prevention however barriers to implementation at the state level exist. Those involved in state-level policy making generally indicated a preference for Commonwealth-led regulation. This research suggests that implementation of regulation of the television marketing of unhealthy food to children should ideally occur under the direction of the Commonwealth government. However, given that regulation is technically feasible at the state level, in the absence of Commonwealth action, states/territories could act independently. The relevance of our findings is likely to extend beyond Australia as unhealthy food marketing to children is a global issue.

Assessing the impact of diabetes on the quality of life of older adults living in a care home : validation of the ADDQoL senior

Aims  Around a quarter of UK care-home residents have diabetes. Diabetes is known to impact quality of life but existing diabetes-specific quality of life measures are unsuitable for elderly care-home residents. We aimed to develop and evaluate a new measure for use with older adults, to be particularly suitable for use with care-home residents: the Audit of Diabetes-Dependent Quality of Life (ADDQoL) Senior†.

Methods  Content and format changes were made to the 19-domain ADDQoL, informed by related measures for people with visual impairments (12 domain-specific items were retained, four items were revised/added and three items were removed). This revision was modified further following cognitive debriefing interviews with three older adults living in a care home. Psychometric evaluation of the newly developed 17-domain ADDQoL Senior was conducted using data from 90 care-home residents with diabetes who took part in a broader intervention study.

Results  The life domains most impacted by diabetes were ‘independence’ and ‘freedom to eat as I wish’. The ADDQoL Senior demonstrated good factor structure and internal consistency (Cronbach’s alpha = 0.924). Domain scores were, as expected, significantly intercorrelated.

Conclusions  The ADDQoL Senior measures the perceived impact of diabetes on quality of life in older adults, and has been found to be suitable for those living in care homes if administered by interview. The scale has demonstrated acceptability and excellent psychometric properties. It is anticipated that the number of items may be reduced in the future if our current findings can be replicated.

Fictional inquiry : an alternative process to inspire creativity in children's co-design projects

Children's creativity is a valuable resource for architectural design, and attempts have been made throughout the world to involve children in the design process of their environments. Previous children's co-design projects often followed a problem solving process, however, this process has limitations in stimulating children's creativity. Research has found that children's creativity is different to adult's creativity: Instead of creative problem solving skills, children's creativity is most evident in their imagination and originality of thinking. Addressing this issue, an alternative process in children's co-design projects was experimented: Fictional Inquiry. In this paper, two case studies are used to illustrate how the fictional inquiry process is applied in children's co-design projects.* These two projects were both joint educational projects between Deakin University and schools in Geelong and Melbourne. Through several weeks' of workshops, children and university architecture students worked in small groups to develop architectural design solutions. It was observed that creative design outcomes have been achieved in these two projects, which suggested that Fictional Inquiry was an effective process to inspire children's creativity. Applying the Fictional Inquiry process, Deakin University is currently working with another school in the Geelong Region, with the aim of achieving creative architectural design outcomes.

Grandparents as educators and carers in China

Many grandparents play a significant role as educators and carers of children in the preschool years. Recently, this role has become the focus of much early childhood research as challenges facing grandparent carers and grandparent-headed households increasingly become an economic and social issue. Using survey data from China we explore the role of grandparents who have a primary care responsibility for a young child and discuss this contribution to the family in relation to quality of care and education. We argue that grandparents play a significant role in terms of home education of the young, workforce support for young parents, cultural identity within families and community capacity building. Grandparents are therefore deserving of more sustained attention from policy makers and educators when considering the young child's developmental environment.

Staff-focused interventions to increase referrals for depression in aged care facilities: a cluster randomized controlled trial

Objective: 

Recombinant human growth hormone for the treatment of growth disorders in children: a systematic review and economic evaluation

Recombinant human growth hormone (rhGH) is licensed for short stature associated with growth hormone deficiency (GHD), Turner syndrome (TS), Prader-Willi syndrome (PWS), chronic renal insufficiency (CRI), short stature homeobox-containing gene deficiency (SHOX-D) and being born small for gestational age (SGA). To assess the clinical effectiveness and cost-effectiveness of rhGH compared with treatment strategies without rhGH for children with GHD, TS, PWS, CRI, SHOX-D and those born SGA. The systematic review used a priori methods. Key databases were searched (e.g. MEDLINE, EMBASE, NHS Economic Evaluation Database and eight others) for relevant studies from their inception to June 2009. A decision-analytical model was developed to determine cost-effectiveness in the UK. Two reviewers assessed titles and abstracts of studies identified by the search strategy, obtained the full text of relevant papers, and screened them against inclusion criteria. Data from included studies were extracted by one reviewer and checked by a second. Quality of included studies was assessed using standard criteria, applied by one reviewer and checked by a second. Clinical effectiveness studies were synthesised through a narrative review. Twenty-eight randomised controlled trials (RCTs) in 34 publications were included in the systematic review. GHD: Children in the rhGH group grew 2.7 cm/year faster than untreated children and had a statistically significantly higher height standard deviation score (HtSDS) after 1 year: -2.3 ± 0.45 versus -2.8 ± 0.45. TS: In one study, treated girls grew 9.3 cm more than untreated girls. In a study of younger children, the difference was 7.6 cm after 2 years. HtSDS values were statistically significantly higher in treated girls. PWS: Infants receiving rhGH for 1 year grew significantly taller (6.2 cm more) than those untreated. Two studies reported a statistically significant difference in HtSDS in favour of rhGH. CRI: rhGH-treated children in a 1-year study grew an average of 3.6 cm more than untreated children. HtSDS was statistically significantly higher in treated children in two studies. SGA: Criteria were amended to include children of 3+ years with no catch-up growth, with no reference to mid-parental height. Only one of the RCTs used the licensed dose; the others used higher doses. Adult height (AH) was approximately 4 cm higher in rhGH-treated patients in the one study to report this outcome, and AH-gain SDS was also statistically significantly higher in this group. Mean HtSDS was higher in treated than untreated patients in four other studies (significant in two). SHOX-D: After 2 years' treatment, children were approximately 6 cm taller than the control group and HtSDS was statistically significantly higher in treated children. The incremental cost per quality adjusted life-year (QALY) estimates of rhGH compared with no treatment were: 23,196 pounds for GHD, 39,460 pounds for TS, 135,311 pounds for PWS, 39,273 pounds for CRI, 33,079 pounds for SGA and 40,531 pounds for SHOX-D. The probability of treatment of each of the conditions being cost-effective at 30,000 pounds was: 95% for GHD, 19% for TS, 1% for PWS, 16% for CRI, 38% for SGA and 15% for SHOX-D.

Medication errors in hospitalised children

This study aims to explore the characteristics of reported medication errors occurring among children in an Australian children's hospital, and to examine the types, causes and contributing factors of medication errors.

'Kids in design': designing creative schools with children

There is a consensus that children should be involved in the planning and design process of their schools, and attempts have been made throughout the world. This paper introduces a 'Kids in Design' project, through which primary school children worked with university architecture students to design a school playground. The aim of the project was to encourage the full potential of children's creativity and generate creative school design outcomes. From October to December 2011, the 'Kids in Design' project was conducted in Roslyn Road Primary School (Geelong, Australia). Through eight weeks of workshops, children in Year 5 & 6 worked with architecture students from Deakin University (Geelong, Australia) to design a school playground. Assessing the design outcomes of this project, assertions are made that creative design outcomes have been achieved. Deakin University is currently working with another primary school to replicate the 'Kids in Design' project in 2012.

Simulated astigmatism impairs academic-related performance in children

Purpose: Astigmatism is an important refractive condition in children. However, the functional impact of uncorrected astigmatism in this population is not well established, particularly with regard to academic performance. This study investigated the impact of simulated bilateral astigmatism on academic-related tasks before and after sustained near work in children. Methods: Twenty visually normal children (mean age: 10.8 ± 0.7 years; six males and 14 females) completed a range of standardised academic-related tests with and without 1.50 D of simulated bilateral astigmatism (with both academic-related tests and the visual condition administered in a randomised order). The simulated astigmatism was induced using a positive cylindrical lens while maintaining a plano spherical equivalent. Performance was assessed before and after 20 min of sustained near work, during two separate testing sessions. Academic-related measures included a standardised reading test (the Neale Analysis of Reading Ability), visual information processing tests (Coding and Symbol Search subtests from the Wechsler Intelligence Scale for Children) and a reading-related eye movement test (the Developmental Eye Movement test). Each participant was systematically assigned either with-the-rule (WTR, axis 180°) or against-the-rule (ATR, axis 90°) simulated astigmatism to evaluate the influence of axis orientation on any decrements in performance. Results: Reading, visual information processing and reading-related eye movement performance were all significantly impaired by both simulated bilateral astigmatism (p < 0.001) and sustained near work (p < 0.001), however, there was no significant interaction between these factors (p > 0.05). Simulated astigmatism led to a reduction of between 5% and 12% in performance across the academic-related outcome measures, but there was no significant effect of the axis (WTR or ATR) of astigmatism (p > 0.05). Conclusion: Simulated bilateral astigmatism impaired children's performance on a range of academic-related outcome measures irrespective of the orientation of the astigmatism. These findings have implications for the clinical management of non-amblyogenic levels of astigmatism in relation to academic performance in children. Correction of low to moderate levels of astigmatism may improve the functional performance of children in the classroom.