Identifying the participant characteristics that predict recruitment and retention of participants to RCTs involving children : a systematic review

Background: Randomised controlled trials (RCTs) are recommended as the gold standard in evaluating healthcare interventions. The conduct of RCTs is often impacted by difficulties surrounding recruitment and retention of participants in both adult and child populations. Factors influencing recruitment and retention of children to RCTs can be more complex than in adults. There is little synthesised evidence of what influences participation in research involving parents and children. Aim: To identify predictors of recruitment and retention in RCTs involving children. Methods/ Design: A systematic review of RCTs was conducted to synthesise the available evidence. An electronic search strategy was applied to four databases and restricted to English language publications. Quantitative studies reporting participant predictors of recruitment and retention in RCTs involving children aged 0-12 were identified. Data was extracted and synthesised narratively. Quality assessment of articles was conducted using a structured tool developed from two existing quality evaluation checklists. Results: 28 studies were included in the review. Of the 154 participant factors reported, 66 were found to be significant predictors of recruitment and retention in at least one study. These were classified as parent, child, family and neighbourhood characteristics. Parent characteristics (e.g. ethnicity, age, education, socio economic status) were the most commonly reported predictors of participation for both recruitment and retention. Being young, less educated, of an ethnic minority and low socio economic status (SES) appear to be barriers to participation in RCTs although there was little agreement between studies. When analysed according to setting and severity of the child’s illness there appeared to be little variation between groups. The quality of the studies varied. Articles adhered well to reporting guidelines around provision of a scientific rationale for the study and background information as well as displaying good internal consistency of results. However, few studies discussed the external validity of the results or provided recommendations for future research. Conclusion: Parent characteristics may predict participation of children and their families to RCTs, however, there was a lack of consensus. Whilst socio-demographics variables may be useful in identifying which groups are least likely to participate they do not provide insight into the processes and barriers to participation for children and families. Further studies that explore variables that can be influenced are warranted. Reporting of studies in this field need greater clarity as well as agreed definitions of what is meant by retention

Prevalence and trends in the childhood dual burden of malnutrition in low- and middle-income countries, 1990–2012

Abstract Objective To describe trends in country- and individual-level dual burden of malnutrition in children <5 years, and age-stratified (<2 years, ≥2 years) country-level trends, in thirty-six low- and middle-income countries (LMIC). Design Using repeated cross-sectional nationally representative data, we calculated the prevalence of malnutrition (stunting, wasting, overweight) at each survey wave, annualized rates of prevalence change for each country over time, and trends before and after 2000, for all children <5 years and separately for those </≥2 years. We examined country- (ratio of stunting to overweight) and individual-level (coexistence of stunting and overweight) dual burden in children <5 years. Setting Demographic and Health Surveys from thirty-six LMIC between 1990 and 2012. Subjects Children <5 years. Results Overall malnutrition prevalence decreased in children <5 years, driven by stunting decreases. Stunting rates decreased in 78 % of countries, wasting rates decreased in 58 % of countries and overweight rates increased in 36 % of countries. Rates of change differed for children </≥2 years, with children <2 years experiencing decreases in stunting in fewer countries yet increases in overweight in more countries. Countries with nearly equal prevalences of stunting and overweight in children <5 years increased from 2000 to the final year. Within a country, 0·3–10·9 % of children <5 years were stunted and overweight, and 0·6–37·8 % of stunted children <5 years were overweight. Conclusions The dual burden exists in children <5 years on both country and individual levels, indicating a shift is needed in policies and programmes to address both sides of malnutrition. Children <2 years should be identified as a high-risk demographic

Infant temperament contributes to early infant growth: A prospective cohort of African American infants

<p>Abstract</p> <p>Background</p> <p>Prospective studies linking infant temperament, or behavioral style, to infant body composition are lacking. In this longitudinal study (3 to 18 months), we seek to examine the associations between two dimensions of infant temperament (<it>distress to limitations </it>and <it>activity level</it>) and two anthropometric indicators (weight-for-length z-scores (WLZ) and skin fold (SF) measures) in a population at high risk of overweight.</p> <p>Methods</p> <p>Data are from the Infant Care and Risk of Obesity Project, a longitudinal study of North Carolina low income African American mother-infant dyads (n = 206). Two temperament dimensions were assessed using the Infant Behavior Questionnaire-Revised. A high <it>distress to limitations </it>score denotes an infant whose mother perceives that s/he often cries or fusses, and a high <it>activity level </it>score one who moves his/her limbs and squirms frequently. Cross-sectional analyses were conducted using ordinary least squares regression. Fixed effects longitudinal models were used to estimate anthropometric outcomes as a function of time varying infant temperament.</p> <p>Results</p> <p>In longitudinal models, increased <it>activity levels </it>were associated with later decreased fatness and WLZ. In contrast, high levels of <it>distress to limitations </it>were associated with later increased fatness at all time points and later increased WLZ at 12 months.</p> <p>Conclusion</p> <p>Infant temperament dimensions contribute to our understanding of the role of behavior in the development of the risk of overweight in the formative months of life. Identification of modifiable risk factors early in life may help target strategies for establishing healthy lifestyles prior to the onset of overweight.</p

Attitudes toward mastectomy : the development of a measurement scale

The central purposes of this study were to develop a valid and reliable instrument to measure attitudes toward mastectomy and to determine the number and nature of the variables contained within the instrument. Based on a review of literature, personal interviews, and open-ended questionnaires, a 36-item Likert-type attitude instrument was formulated. Face and content validity were established by the interjudge agreement of three separate panels of judges. The rotated factor matrix in the factor analysis identified five underlying variables contained within the instrument, thereby supporting the construct validity of the instrument. Reliability of the instrument was established through the use of a test-retest method using women of a wide age range who had not had mastectomies. The scores calculated using a Pearson product-moment correlation coefficient showed high reliability coefficients on factors concerning general sexual functioning (r=+.91), fears associated with rejection or physical pain (r=+.83), and self-image (r=+.81). Moderate reliability coefficients on factors concerning feminine appearance (r=+.73), feelings of shame (r=+.79), and significance of breasts (r=+.67) were obtained

Impact of lipid-based nutrient supplementation (LNS) on children\u27s diet adequacy in Western Uganda

Lipid-based nutrient supplements (LNS) can help treat undernutrition; however, the dietary adequacy of children supplemented with LNS, and household utilisation patterns are not well understood. We assessed diet adequacy and the quality of complementary foods by conducting a diet assessment of 128 Ugandan children, ages 6-59 months, who participated in a 10-week programme for children with moderate acute malnutrition (MAM, defined as weight-for-age z-score \u3c -2). Caregivers were given a weekly ration of 650 kcal day (-1) (126 g day(-1)) of a peanut/ soy LNS. Two 24-h dietary recalls were administered per child. LNS was offered to 86% of targeted children at least once. Among non-breastfed children, over 90% met their estimated average requirement (EAR) cut-points for all examined nutrients. Over 90% of breastfed children met EAR cut-points for nutrient density for most nutrients, except for zinc where 11.7% met cut-points. A lower proportion of both breastfed and non-breastfed children met adjusted EARs for the specific nutritional needs of MAM. Fewer than 20% of breastfed children met EAR nutrient-density guidelines for MAM for zinc, vitamin C, vitamin A and folate. Underweight status, the presence of a father in the child\u27s home, and higher programme attendance were all associated with greater odds of feeding LNS to targeted children. Children in this community-based supplemental feeding programme who received a locally produced LNS exhibited substantial micronutrient deficiencies given the special dietary needs of this population. These results can help inform programme strategies to improve LNS targeting, and highlight potential nutrient inadequacies for consumers of LNS in community-based settings

“Whatever Average Is”: Understanding African American Mothers’ Perceptions of Infant Weight, Growth, and Health

Biomedical researchers have raised concerns that mothers’ inability to recognize infant and toddler overweight poses a barrier to stemming increasing rates of overweight and obesity, particularly among low-income or minority mothers. Little anthropological research has examined the sociocultural, economic or structural factors shaping maternal perceptions of infant and toddler size or addressed biomedical depictions of maternal misperception as a “socio-cultural problem.” We use qualitative and quantitative data from 237 low-income, African-American mothers to explore how they define ‘normal’ infant growth and infant overweight. Our quantitative results document that mothers’ perceptions of infant size change with infant age, are sensitive to the size of other infants in the community, and are associated with concerns over health and appetite. Qualitative analysis documents that mothers are concerned with their children’s weight status and assess size in relation to their infants’ cues, local and societal norms of appropriate size, interactions with biomedicine, and concerns about infant health and sufficiency. These findings suggest that mothers use multiple models to interpret and respond to child weight. An anthropological focus on the complex social and structural factors shaping what is considered ‘normal’ and ‘abnormal’ infant weight is critical for shaping appropriate and successful interventions

Pressuring and restrictive feeding styles influence infant feeding and size among a low-income African-American sample

The prevalence of overweight among infants and toddlers has increased dramatically in the past three decades, highlighting the importance of identifying factors contributing to early excess weight gain, particularly in high-risk groups. Parental feeding styles, the attitudes and behaviors that characterize parental approaches to maintaining or modifying children’s eating behavior, are an important behavioral component shaping early obesity risk. Using longitudinal data from the Infant Care and Risk of Obesity Study, a cohort study of 217 African-American mother-infant pairs with feeding styles, dietary recalls and anthropometry collected from 3-18 months of infant age, we examined the relationship between feeding styles, infant diet and weight–for-age and sum of skinfolds. Longitudinal mixed models indicated that higher pressuring and indulgent feeding style scores were positively associated with greater infant energy intake, reduced odds of breastfeeding and higher levels of age-inappropriate feeding of liquids and solids while restrictive feeding styles were associated with lower energy intake, higher odds of breastfeeding and reduced odds of inappropriate feeding. Pressuring and restriction were also oppositely related to infant size with pressuring associated with lower infant weight-for-age and restriction with higher weight-for-age and sum of skinfolds. Infant size also predicted maternal feeding styles in subsequent visits indicating that the relationship between size and feeding styles is likely bidirectional. Our results suggest that the degree to which parents are pressuring or restrictive during feeding shapes the early feeding environment and, consequently, may be an important environmental factor in the development of obesity

Management Practices and Productivity Level of Cebu City and Ozamiz City Eateries during COVID-19 Pandemic

The COVID-19 pandemic has made drastic changes in every country’s economy, affecting several businesses particularly in the restaurant industry and resulting in different obstacles that threaten the overall business productivity. Thus, the study is a quantitative non-experimental that aimed to determine if there is a significant relationship between the management practices and productivity among the 50 respondents from the randomly selected 10 eateries in Cebu City, Philippines through linear correlation analysis. Data were gathered online using an adapted and reliable questionnaire. Findings revealed that the management practices of the eateries have a very high average weighted mean and SD (x̄=3.34 SD=0.72). Meanwhile, the level of impact of the eateries’ overall productivity garnered a very high average weighted mean (x̄=3.50 SD=0.57). Therefore, the levels of management practices and the productivity of the eateries during the COVID-19 pandemic have significant relationship with a moderate positive correlation of 0.58 (r = 0.5846, = 0.00001, p &lt; 0.05). This implies the great need for businesses to establish appropriate management practices and for employees to systematically apply these practices for the betterment of both the productivity of the employees and the business as a whole. Additionally, with the problems of operations, regulations imposed by the government, and adjustments to competitors being faced, respondents suggested fostering open communication and utilizing online platforms, and promotions for the improvement of management practices and productivity

Public Health Nutrition: 5(1A)

Abstract Objective: The goal of this paper is to explore the hypothesis that the nutrition transition is related to households having an underweight and an overweight member simultaneously (under/over households and under/over pairs). Design: The 1993 China Health and Nutrition Survey (CHNS) was used to test the association between being an under/over household and household characteristics related to the nutrition transition. Sociodemographic and diet patterns were tested for the main age combinations of the under/over pairs. Setting: In China, 8.1% of all households were found to have underweight and overweight members within the same household. Subjects: Results are from the 1993 China Health and Nutrition Survey and are based on a sample of 13 814 persons from 3340 households. Results: The under/over household was more urban, had a higher income and was more likely to have assets such as a television, a motor vehicle and a washing machine, even after controlling for sociodemographic confounders. The under/over household had a diet that was higher in fat and protein compared with the underweight and normal weight households. There were no significant differences between the under/over and overweight households, with many of the associations near unity. Comparisons of the under/over subgroups by age of the under/over pairs showed some differences by income and occupation, but not for diet. Conclusions: It is imperative, as more individuals become exposed to the diet and lifestyle patterns of the nutrition transition, to find effective public health programmes that can simultaneously promote a healthy lifestyle, improve diet quality and address both undernutrition and chronic disease. Keywords China Diet Household food distribution Under/over Underweight Overweight A number of scholars have identified the presence of households with undernutrition and overweight coexisting in the same household. This finding has been regarded as a sign of the shift to the nutrition transition stage linked to diet-related non-communicable disease (NCD). Initial observations in South Africa found low-income, overweight women coexisting in communities with a high prevalence of child undernutrition 1,2 . Subsequent research has shown that this is a common condition in a wide range of countries 3 -5 . Garrett and Ruel 6 have also found obesity and overweight among women clustering with stunting among children. We have hypothesised these findings to be the result of diet and activity changes related to the rapid shift in the stage of the nutrition transition. Here and throughout this paper, the term nutrition transition is used to refer to the shift towards the diet-related NCD phase. Furthermore, emerging and rising obesity in many developing countries 7 indicate that this might be a broader global concern. However, few studies have considered households with underweight and overweight individuals of any age, simultaneously. These households, which are the focus of this paper, will be henceforth referred to as under/over households, and the underweight and overweight individuals within these households will be referred to as under/over pairs. The study by Doak et al. 5 found urban residence to be associated with the under/over households in Brazil, China and Russia. In China, the transitions in diet and activity related to overweight and chronic disease occurred first in the urban areas and among high-income households 8 -10 . These factors, as well as other sociodemographic variables such as household assets, may contribute to the likelihood of underweight and overweight clustering within households. The 1993 China Health and Nutrition Survey is used to test the association between household characteristics. Tests were made related to the nutrition transition and being an under/over household. This survey has in-depth anthropometric, dietary and socio-economic status (SES) data from all household members. It was expected that a common set of factors leads to increased overweight status, which are also related to the q The Authors 200