Health-related quality of life in school children: validation of instrument, child self assessment, parent-proxy assessment and school nursing documentation of health check-ups

The aims of this study were to validate an international Health-Related Quality of Life (HRQL) instrument, to describe child self and parent-proxy assessed HRQL at child age 10 to 12 and to compare child self assessments with parent-proxy assessments and school nursing documentation. The study is part of the Schools on the Move –research project. In phase one, a cross-cultural translation and validation process was performed to develop a Finnish version of Pediatric Quality of Life Inventory™ 4.0 (PedsQL™ 4.0). The process included a two-way translation, cognitive interviews (children n=7, parents n=5) and a survey (children n=1097, parents n=999). In phase two, baseline and follow-up surveys (children n=986, parents n=710) were conducted to describe and compare the child self and parent-proxy assessed HRQL in school children between the ages 10 and 12. Phase three included two separate data, school nurse documented patient records (children n=270) and a survey (children n=986). The relation between child self assessed HRQL and school nursing documentation was evaluated. Validity and reliability of the Finnish version of PedsQL™ 4.0 was good (Child Self Report α=0.91, Parent-Proxy Report α=0.88). Children reported lower HRQL scores at the emotional (mean 76/80) than the physical (mean 85/89) health domains and significantly lower scores at the age of 10 than 12 (dMean=4, p=<0.001). Agreement between child self and parent-proxy assessment was fragile (r=0,4, p=<0.001) but increased as the child grew from age 10 to 12 years. At health check-ups, school nurses documented frequently children’s physical health, such as growth (97%) and posture (98/99%) but seldom emotional issues, such as mood (2/7%). The PedsQLTM 4.0 is a valid instrument to assess HRQL in Finnish school children although future research is recommended. Children’s emotional wellbeing needs future attention. HRQL scores increase during ages between childhood and adolescence. Concordance between child self and parent-proxy assessed HRQL is low. School nursing documentation, related to child health check-ups, is not in line with child self assessed HRQL and emotional issues need more attention.

Growth and mineral nutrition Of Ipomoea quamoclit

A greenhouse experiment was carried out from November 2006 to April 2007 at FCAV/UNESP, Brazil, aiming to study the dry mass production and the accumulation and distribution of macronutrients in Ipomoea quamoclit, an important weed for annual and perennial crops in Brazil. The plants were grown in seven liter pots with sand substrate, daily irrigated with Hoagland & Arnon nutrient solution. The experimental design was completely randomized with four replicates. The treatments corresponded to evaluation times at 14 day intervals, beginning 21 days after emergence (DAE). In each evaluation, the plants of four pots were analyzed in function of dry mass production and macronutrient content. I. quamoclit had a small dry mass and macronutrient accumulation at the beginning of the experimental stage, increasing after 77 DAE and reaching the maximum theoretical value at 146, 143, 140, 149, 142, 153, and 124 DAE, for dry mass, N, P, K, Ca, Mg, and S, respectively. K and N were the macronutrients most accumulated by I. quamoclit plants.

Growth and mineral nutrition of Solanum americanum

A greenhouse trial was carried out from November 1995 to April 1996 at FCAV/UNESP, Brazil, aiming to study the dry matter production and the accumulation and distribution of macronutrients in Solanum americanum, an important weed for annual and perennial crops in Brazil. The plants were grown in seven liter pots with sand substrate, irrigated daily with Hoagland & Arnon nutrient solution. The experimental design was completely randomized with four replicates. The treatments corresponded to evaluation times at 14 day intervals, beginning 21 days after emergence (DAE). In each evaluation, the plants of four pots were analyzed for dry matter production and macronutrient content. S. americanum had a small dry matter and macronutrient accumulation at the beginning of the experimental stage, increasing after 77 DAE and reaching the maximum theoretical value at 142, 142, 164, 149, 140, 149 and 152 DAE, for dry matter, N, P, K, Ca, Mg, and S, respectively. K and N were the most accumulated macronutrients for S. americanum plants.

Prevalence of child malnutrition at a university hospital using the World Health Organization criteria and bioelectrical impedance data

Malnutrition constitutes a major public health concern worldwide and serves as an indicator of hospitalized patients’ prognosis. Although various methods with which to conduct nutritional assessments exist, large hospitals seldom employ them to diagnose malnutrition. The aim of this study was to understand the prevalence of child malnutrition at the University Hospital of the Ribeirão Preto Medical School, University of São, Brazil. A cross-sectional descriptive study was conducted to compare the nutritional status of 292 hospitalized children with that of a healthy control group (n=234). Information regarding patients’ weight, height, and bioelectrical impedance (i.e., bioelectrical impedance vector analysis) was obtained, and the phase angle was calculated. Using the World Health Organization (WHO) criteria, 35.27% of the patients presented with malnutrition; specifically, 16.10% had undernutrition and 19.17% were overweight. Classification according to the bioelectrical impedance results of nutritional status was more sensitive than the WHO criteria: of the 55.45% of patients with malnutrition, 51.25% exhibited undernutrition and 4.20% were overweight. After applying the WHO criteria in the unpaired control group (n=234), we observed that 100.00% of the subjects were eutrophic; however, 23.34% of the controls were malnourished according to impedance analysis. The phase angle was significantly lower in the hospitalized group than in the control group (P<0.05). Therefore, this study suggests that a protocol to obtain patients’ weight and height must be followed, and bioimpedance data must be examined upon hospital admission of all children.

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

Encapsulated specialty oils commercialized in São Paulo state, Brazil: evaluation of identity (fatty acid profile) and compliance of fatty acids and Vitamin E contents with nutrition labeling

Encapsulated specialty oils commercialized in São Paulo state, Brazil, were evaluated for their identity (fatty acids profile) and compliance with nutrition labeling (fatty acids and Vitamin E (alpha tocopherol) contents). Twenty one samples [flaxseed oil (6), evening primrose (5), safflower (8), borage (1), and black currant (1)] purchased from local markets or collected by the health surveillance agency were analyzed. The fatty acids and vitamin E contents were analyzed by gas chromatography with flame ionization detector and liquid chromatography with UV detector, respectively. Nine samples were adulterated (5 samples of safflower oil, 3 of flaxseed oil, and one of evening primrose). Among them, 3 flaxseed and 2 safflower oil samples were probably adulterated by the addition of soybean oil. Conjugated linoleic acid (CLA) was found in two safflower oils samples although the sale of oils with conjugated linoleic acid (CLA) is not permitted by the National Health Surveillance Agency in Brazil (ANVISA). Only two samples presented all values in compliance with nutrition labeling (one safflower oil sample and one borage oil sample). The results show that a continuous monitoring of encapsulated specialty oils commercialized in Brazil is necessary including a greater number of samples and sanitary surveillance.

Evaluation of hygienic-sanitary conditions of hospital nutrition and dietary services from the perspectives of internal and external auditors

The objective of this study was to evaluate the hygienic-sanitary conditions of hospital nutrition and dietary services using external and internal auditors. Eleven hospitals were evaluated for their nutrition and dietary services using an evaluation checklist based on food safety requirements in the current legislation. The checklist was applied by an internal auditor (a technical supervisor) and an external auditor (a professional with experience in food services) between August and October 2011. According to the number of items on the evaluation checklist that were considered adequate, the hospital facilities were ranked as excellent, good, regular, bad, or very bad. The results obtained by the auditors were compared. According to these results, it can be said that most of the hospital nutrition and dietary services were rated as good for overall quality by the internal auditor, while the external auditor classified them as Regular. There was a clear difference between the evaluations of the auditors, both in terms of the number of items considered adequate and the overall requirements' average score. It can be concluded that hospital nutrition and dietary services should meet safety requirements in order to provide food. These facilities should have external audits conducted as a way to prevent routine problems from being perpetuated.

Lipoprotein glomerulopathy: a case report of a rare disease in a brazilian child

Lipoprotein glomerulopathy (LPG) is a rare autosomal recessive glomerulopathy associated with the deposition of lipoprotein thrombi in the capillary lumina due to apoE gene mutations. Abnormal plasma lipoprotein profile and marked increase in serum apoliprotein E (apoE) are characteristic clinical data. The compromised patients can present nephrotic syndrome, hematuria, and progressive renal failure. Herein, the authors present the first described case of LPG in a Brazilian male patient, 11 years, who presented with a steroid-resistant nephrotic syndrome. Renal function was normal. Kidney biopsy showed markedly enlarged glomerulus, with dilated capillary loops and weak eosinophilic lipoprotein thrombi in the capillary lumina. Interstitium, tubules, arteries, and veins showed normal histologic aspect. Genotypic study for the apoE gene showed the presence of the alleles E3 and E4. The diagnosis of LPG was then performed. The patient received lipid-lowering treatment. After 2 years of follow-up, renal function is gradually decreasing, with persisting heavy proteinuria, despite a marked decrease in serum cholesterol and triglycerides levels.

Psychological well-being of the parents and child development, behavior, and quality of life in very low birth weight infants

The parents of premature infants, especially the mothers, are at increased risk for distress. Infants born prematurely are at risk for developmental problems. The aim of this study was to investigate whether the psychological well-being of both parents is associated with child development in very low birth weight (VLBW, ≤1500g) children. The burden of prematurity-related morbidity to the children and to the family was also assessed. A cohort of 201 VLBW infants born during 2001–2006 in the Turku University Hospital, Finland, and their parents were studied (I–IV). One study included a control group (n=166) of full-term infants (IV). The psychological well-being of the parents was evaluated by assessments of depressive symptoms, parenting stress, the sense of coherence and general family functioning. Cognitive, behavioral, and socio-emotional development, and the health-related quality of life (HRQoL) of the children were determined when the children were 2 to 8 years old. The psychological well-being of the parents was associated with the cognitive, behavioral and social development of the VLBW children. The VLBW infants with prematurity-related morbidities had a poorer HRQoL and the general functioning of the family was inferior compared to the control children and their families. 64.5% of the VLBW children survived without morbidities. Most of the VLBW children did not have significant behavior problems (93%), had normal social skills (63%), had no emotional problems (64%), and had no problems in executive functioning (62%). Only 3% of the surviving VLBW infants had significant cognitive delay. In conclusion, the depressive symptoms and stress of the parents can be risk factors for disadvantageous child development, while a strong sense of coherence can be protective. Parents of the premature children with developmental delays might also experience more depressive symptoms and stress than other parents. Prematurity-related morbidities were a burden to the VLBW child as well as to the family.

Ruumis, affekti ja tulemisen prosessi : feministinen, affektiivinen ja uusmaterialistinen näkökulma Heidi Tikan videoinstallaatioon Mother, Child (2011/2000)

Tutkielmassa tarkastellaan suomalaisen kuvataiteilija Heidi Tikan videoinstallaatiota Mother, Child (2011/2000). Tutkielmassa tutkitaan installaation uusinta, vuonna 2011 tehtyä versiota. Mother, Child on liikkuvan kuvan installaatio, jossa videokuva projisoidaan valkoiselle harsokankaalle, jota istuimelle asettunut katsoja pitää käsivarsillaan. Kankaalle heijastuu liikkuvaa kuvaa poikavauvasta, joka imee naisen rintaa. Installaatioon osallistuessaan katsojalle syntyy vaikutelma siitä, että hän pitää vauvaa sylissään, jolloin hän voi eläytyä lasta hoivaavan ja imettävän äidin asemaan. Lisäksi tutkielmassa huomioidaan, kuinka installaation tekniikan ansiosta videolla näkyvä vauva ja installaation katsoja voivat olla vuorovaikutuksessa keskenään. Tutkielma jakautuu kolmeen käsittelylukuun, joissa jokaisessa lähestytään Mother, Child -installaatiota eri näkökulmasta: ensimmäisessä käsittelyluvussa Mother, Child -installaatiota tarkastellaan feministisen taiteentutkimuksen lähtökohdista, toisessa käsittelyluvussa installaation analyysissä sovelletaan affektiteorioita ja kolmannen käsittelyluvun teoreettisen viitekehyksen muodostaa uusmaterialismi. Tutkimuskysymykset keskittyvät installaation katsojan ja videolla näkyvän naisen ruumiin tarkasteluun, installaation affekteihin sekä installaation materiaalisuuteen ja tulemisen prosessiin. Valittujen näkökulmien avulla sekä molekulaarisen taidehistorian metodia ja deleuze-guattarilaista filosofiaa soveltamalla tutkielmassa löydetään vaihtoehtoisia tapoja, joilla lähestyä Mother, Child -installaatiota jonakin muuna kuin representaationa: muotoutuvana, materiaalisena ja affektiivisena katsojan ja installaation ainutkertaisena kohtaamistapahtumana. Maailman representoimisen eli esittämisen tai samankaltaisten äitiyskuvien toisintoiston sijaan tutkielmassa korostuu ajatus Mother, Child -installaation olemassaolosta omana aktiivisesta materiasta muodostuvana itsenään ja osana todellista, materiaalista maailmaa. Tutkielmassa installaation olemassaolo ja jatkuva muotoutuminen määritellään tulemisen prosessiksi. Mother, Child edellyttää katsojansa ruumiillista ja affektiivista osallistumista tapahtuakseen eli tullakseen olevaksi. Tutkielmassa esitetään, että osallistavaa taidetta tutkittaisiin osallistuvan taiteentutkimuksen ja affektiivisen virittäytymisen keinoin, jolloin tutkija voi hyödyntää tunnereaktioitaan ja affektoitumisen kokemuksiaan tutkimuksessa. Tällöin tutkimuskohteeseen suhtaudutaan tutkimuksen objektin sijaan keskustelukumppanina ja tutkija asettuu samalle tasolle taiteen kanssa. Tutkijan on antauduttava taiteen molekulaarisen virran vietäväksi, mikä merkitsee herkkyyttä ja avoimuutta taiteen materian ja affektien liikkeelle sekä taiteen lähelle menemistä eli seuraamista.