The quality of different types of child care at 10 and 18 months. A comparison between types and factors related to quality.

The quality of care offered in four different types of non-parental child care to 307 infants at 10 months old and 331 infants at 18 months old was compared and factors associated with higher quality were identified. Observed quality was lowest in nurseries at each age point, except that at 18 months they offered more learning activities. There were few differences in the observed quality of care by child-minders, grandparents and nannies, although grandparents had somewhat lower safety and health scores and offered children fewer activities. Cost was largely unrelated to quality of care except in child-minding, where higher cost was associated with higher quality. Observed ratios of children to adults had a significant impact on quality of nursery care; the more infants or toddlers each adult had to care for, the lower the quality of the care she gave them. Mothers' overall satisfaction with their child's care was positively associated with its quality for home-based care but not for nursery settings

Clarifying Differences Between Reading Skills and Reading Strategies

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/88049/1/RT.61.5.1.pd

Maternal Feeding Practices Become More Controlling After and Not Before Excessive Rates of Weight Gain

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/93708/1/oby.2009.54.pd

Use of antenatal corticosteroids prior to preterm birth in four South East Asian countries within the SEA-ORCHID project

BackgroundThere is strong evidence supporting the use of antenatal corticosteroids in women at risk of preterm birth to promote fetal lung maturation and reduce neonatal mortality and morbidity. This audit aimed to assess the use of antenatal corticosteroids prior to preterm birth in the nine hospitals in four South East Asian countries participating in the South East Asia Optimising Reproductive Health in Developing Countries (SEA-ORCHID) Project.MethodWe reviewed the medical records of 9550 women (9665 infants including 111 twins and two triplets) admitted to the labour wards of nine hospitals in four South East Asian countries during 2005. For women who gave birth before 34 weeks gestation we collected information on women's demographic and pregnancy background, the type, dose and use of corticosteroids, and key birth and infant outcomes.ResultsAdministration of antenatal corticosteroids to women who gave birth before 34 weeks gestation varied widely between countries (9% to 73%) and also between hospitals within countries (0% to 86%). Antenatal corticosteroids were most commonly given when women were between 28 and 34 weeks gestation (80%). Overall 6% of women received repeat doses of corticosteroids. Dexamethasone was the only type of antenatal corticosteroid used. Women receiving antenatal corticosteroids compared with those not given antenatal corticosteroids were less likely to have had a previous pregnancy and to be booked for birth at the hospital and almost three times as likely to have a current multiple pregnancy. Exposed women were less likely to be induced and almost twice as likely to have a caesarean section, a primary postpartum haemorrhage and postpartum pyrexia. Infants exposed to antenatal corticosteroids compared with infants not exposed were less likely to die. Live born exposed infants were less likely to have Apgar scores of ConclusionIn this survey the use of antenatal corticosteroids prior to preterm birth varied between countries and hospitals. Evaluation of the enablers and barriers to the uptake of this effective antenatal intervention at individual hospitals is needed.Pattanittum P, Ewens MR, Laopaiboon M, Lumbiganon P, McDonald SJ, Crowther CA and The SEA-ORCHID Study Grou

Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people: systematic review and economic evaluation

Background: Psoriasis is a chronic inflammatory disease that predominantly affects the skin. Adalimumab (HUMIRA®, AbbVie, Maidenhead, UK), etanercept (Enbrel®, Pfizer, New York, NY, USA) and ustekinumab (STELARA®, Janssen Biotech, Inc., Titusville, NJ, USA) are the three biological treatments currently licensed for psoriasis in children. Objective: To determine the clinical effectiveness and cost-effectiveness of adalimumab, etanercept and ustekinumab within their respective licensed indications for the treatment of plaque psoriasis in children and young people. Data sources: Searches of the literature and regulatory sources, contact with European psoriasis registries, company submissions and clinical study reports from manufacturers, and previous National Institute for Health and Care Excellence (NICE) technology appraisal documentation. Review methods: Included studies were summarised and subjected to detailed critical appraisal. A network meta-analysis incorporating adult data was developed to connect the effectiveness data in children and young people and populate a de novo decision-analytic model. The model estimated the cost-effectiveness of adalimumab, etanercept and ustekinumab compared with each other and with either methotrexate or best supportive care (BSC), depending on the position of the intervention in the management pathway. Results: Of the 2386 non-duplicate records identified, nine studies (one randomised controlled trial for each drug plus six observational studies) were included in the review of clinical effectiveness and safety. Etanercept and ustekinumab resulted in significantly greater improvements in psoriasis symptoms than placebo at 12 weeks’ follow-up. The magnitude and persistence of the effects beyond 12 weeks is less certain. Adalimumab resulted in significantly greater improvements in psoriasis symptoms than methotrexate for some but not all measures at 16 weeks. Quality-of-life benefits were inconsistent across different measures. There was limited evidence of excess short-term adverse events; however, the possibility of rare events cannot be excluded. The majority of the incremental cost-effectiveness ratios for the use of biologics in children and young people exceeded NICE’s usual threshold for cost-effectiveness and were reduced significantly only when combined assumptions that align with those made in the management of psoriasis in adults were adopted. Limitations: The clinical evidence base for short- and long-term outcomes was limited in terms of total participant numbers, length of follow-up and the absence of young children. Conclusions: The paucity of clinical and economic evidence to inform the cost-effectiveness of biological treatments in children and young people imposed a number of strong assumptions and uncertainties. Health-related quality-of-life (HRQoL) gains associated with treatment and the number of hospitalisations in children and young people are areas of considerable uncertainty. The findings suggest that biological treatments may not be cost-effective for the management of psoriasis in children and young people at a willingness-to-pay threshold of £30,000 per quality-adjusted life-year, unless a number of strong assumptions about HRQoL and the costs of BSC are combined. Registry data on biological treatments would help determine safety, patterns of treatment switching, impact on comorbidities and long-term withdrawal rates. Further research is also needed into the resource use and costs associated with BSC. Adequately powered randomised controlled trials (including comparisons against placebo) could substantially reduce the uncertainty surrounding the effectiveness of biological treatments in biologic-experienced populations of children and young people, particularly in younger children. Such trials should establish the impact of biological therapies on HRQoL in this population, ideally by collecting direct estimates of EuroQol-5 Dimensions for Youth (EQ-5D-Y) utilities. Study registration: This study is registered as PROSPERO CRD42016039494. Funding: The National Institute for Health Research Health Technology Assessment programme

A Systematic Review of the Research on Vocabulary Instruction That Impacts Text Comprehension

Although numerous studies have identified a correlational relationship between vocabulary and comprehension, we know less about vocabulary interventions that impact reading comprehension. Therefore, this study is a systematic review of vocabulary interventions with comprehension outcomes. Analyses of 36 studies that met criteria are organized around (a) type of comprehension measure (i.e., comprehension of passages that included taught words or more generalized comprehension measures) and (b) type of intervention (i.e., direct teaching of word meanings or word‐learning strategies). The authors looked for patterns in characteristics of vocabulary instruction within these analyses. Their findings led to four major themes: (1) Teaching of word meanings supported comprehension of text containing the target words in almost all cases; (2) instruction that focused on some active processing was typically more impactful than a definition or a dictionary method for supporting comprehension of text containing the target words, but we do not know how much instruction is sufficient; (3) there is very limited evidence that direct teaching of word meanings, even long‐term, multifaceted interventions of large numbers of words, can improve generalized comprehension; and (4) there is currently no empirical evidence that instruction in one or two strategies for solving word meanings will impact generalized comprehension. However, studies that actively teach students to monitor their understanding of vocabulary and to use multiple, flexible strategies for solving word meanings are a promising area for future research. The authors discuss the implications of these themes, as well as critical avenues for future vocabulary research.Chinese虽然许多研究已经确定了词汇与阅读理解之间的相关关系,但在词汇干预教学对阅读理解的影响方面,我们所知道的则较少。因此,本研究针对词汇干预教学及其阅读理解学习成果,作一个系统性文献综述。符合标准的36个研究按其类别分两方面作分析:(a)阅读理解测验的类型(即,包含已教过的单字的文章阅读理解测验或较广义的阅读理解测验);(b)干预教学的类型(即,单字意义的直接教学或单字学习策略)。本文作者在这些分析中寻找词汇教学特点的模式,其分析结果带出四个主要主题︰(1)在几乎所有情况下,单字意义教学能支援含有目标单字的文本阅读理解;(2)就支援含有目标单字的文本阅读理解而言,侧重于一些主动性文本处理的教学,通常比单字定义教学或字典教学更有影响力,但本文作者不知道多少教学才足够; (3)单字意义的直接教学,甚至是长期性的,多方面的大量单字干预教学,均只有非常有限的证据证明可以提高广义的阅读理解; (4)目前还没有实证研究证据证明只教一两个解决单字义的学习策略就能对广义阅读理解产生影响。然而,在未来研究中,那些积极指导学生监控自己对词汇的理解和使用多样灵活的字义解决策略的研究,应是一个有希望的领域。本文作者最后讨论这四个主题的启示,以及未来词汇研究的关键途径。SpanishAunque numerosos estudios han mostrado una relación correlativa entre el vocabulario y la comprensión, no sabemos tanto sobre las intervenciones de vocabulario que impactan la comprensión lectora. Por ende, este estudio es una revisión sistemática de intervenciones de vocabulario que incluyen comprensión. Los análisis de 36 estudios que satisfacen dicho criterio fueron organizados de acuerdo a (a) la clase de comprensión medida (p. ej., la comprensión de pasajes que incluían palabras enseñadas o medidas de comprensión más generalizadas) y (b) la clase de intervención (p. ej., la enseñanza directa del significado de las palabras o estrategias para aprender palabras). Los autores buscaron patrones en las características de la instrucción de vocabulario dentro de estos análisis. Encontraron cuatro temas principales: (1) La enseñanza del significado de palabras apoya la comprensión de textos que incluyen dichas palabras en casi todos los casos; (2) la instrucción enfocada en algún procesamiento activo tiene típicamente un impacto mayor que una definición o el uso del diccionario para apoyar la comprensión del texto con las palabras indicadas, pero no sabemos cuánta instrucción se necesita; (3) hay poca evidencia de que la enseñanza directa del significado de las palabras, aún en intervenciones multifacéticas a largo plazo de muchas palabras, mejora la comprensión en general; y (4) actualmente no hay evidencia empírica alguna que la instrucción usando una o dos estrategias para resolver el significado de palabras impacta la comprensión general. Sin embargo, instrucción que les enseña activamente a los estudiantes a supervisar su propio entendimiento del vocabulario y a usar varias estrategias flexibles para encontrar el significado de las palabras prometen ser un área para investigaciones futuras. Los autores discuten las implicaciones de estos temas al igual que vías de vital importancia para futuras investigaciones sobre el vocabulario.Arabicعلى الرغم من أن العديد من الدراسات قد حددت العلاقة الارتباطية بين المفردات والفهم، لا تزال معرفتنا اقل بالنسبة لتدخلات المفردات التي تؤثر على القراءة والفهم. وبالتالي، فإن هذه الدراسة تراجع منهجية تدخل المفردات المؤثرة على الفهم. تم تنظيم التحاليل التي أجريت على 36 دراسة تلبي معايير (أ) نوع مقياس الفهم (أي: فهم المقاطع التي شملت الكلمات المدرسة أو تدابير الفهم الأكثر عمومية) (ب) نوع التدخل (أي التعليم المباشر لمعاني الكلمات أو استراتيجيات تعلم الكلمات). نظر المؤلفون عن أنماط خصائص تعليم المفردات ضمن هذه التحليلات. وأدت نتائجهم إلى أربعة محاور رئيسية هي: (1) تدريس معاني الكلمات التي تدعم فهم النص الذي يحتوي على الكلمات المستهدفة في جميع الحالات تقريبا، (2) التعليمات التي تركز على المعالجة الفعَّلة كانت عادة أكثر تأثيرا من تعريف الكلمة أو الأسلوب القاموسي لدعم فهم النص الذي يحتوي على الكلمات المستهدفة، لكننا لا نعرف ما هو الكافي من التعليمات. 3) هناك أدلة محدودة للغاية أن التعليم المباشر لمعاني الكلمات، وحتى على المدى الطويل، او التدخلات المتعددة الأوجه لأعداد كبيرة من الكلمات، يمكن أن يحسن الفهم العام. و (4) لا يوجد حاليا أي أدلة تجريبية أن التعليمات العملية في واحد أو اثنين من استراتيجيات تحليل معاني كلمة سيؤثر على الفهم العام. لكن، الدراسات التي تعلم الطلاب بنشاط مراقبة فهمهم للمفردات، واستخدام عدة استراتيجيات مرنة من أجل تحليل معاني الكلمات لها مبَشِّـرات للبحوث المستقبلية. يناقش المؤلفون الآثار المترتبة على هذه المحاور، وكذلك السبل الهامة في بحثوث المفردات المستقبلية.RussianМногочисленные исследования установили корреляцию между словарным запасом и пониманием текста, однако о лексических вмешательствах, которые дают положительный эффект для понимания прочитанного, известно немного. Поэтому был предпринят системный обзор подобных лексических интервенций. Анализ выбранных по определенному принципу 36 исследований сосредоточен на (a) критериях понимания (понимание абзацев, содержащих изученные слова, или критерии более общего характера) и (б) типе вмешательства (прямое обучение значениям слова или освоение стратегий работы с лексикой). В рамках данного обзора авторы пытались классифицировать полученные выводы. Выделены четыре лейтмотива: (1) почти всегда обучение значениям слова приводит к пониманию текста, содержащего целевую лексику; (2) обучение, связанное с активными лексическими упражнениями, как правило, более эффективно для понимания текста, содержащего целевую лексику, чем работа с определениями или словарями, но пока неясно, каков должен быть объем обучения; (3) существует совсем мало доказательств того, что прямое обучение значениям слова и даже долгосрочные, многогранные вмешательства, включающие большое количество лексики, улучшают общее понимание почитанного; (4) в настоящее время нет никаких эмпирических доказательств того, что обучение одной или двум стратегиям, позволяющим уловить смысл слова, положительно влияет на общее понимание прочитанного. Однако наиболее перспективным направлением для исследований представляется ситуация, когда школьников активно обучают самоконтролю при освоении лексики и дают им разнообразные гибкие стратегии для понимания смысла слов. В статье обсуждается значение полученных выводов, а также критически важные направления для будущих исследований.FrenchQuoique de nombreuses recherches aient mis en évidence une corrélation entre le vocabulaire et la compréhension, nous ne savons pas grand‐chose des interventions relatives au vocabulaire qui ont un impact sur la compréhension de la lecture. Cette étude est par conséquent une revue systématique des interventions en matière de vocabulaire et de leurs effets sur la compréhension. Les analyses des 36 études répondant aux critères sont organisées autour de (a) le type de mesure de la compréhension (i.e. la compréhension de passages qui incluent les mots enseignés ou des mesures plus générales de la compréhension) et (b) le type d’intervention (i.e. un enseignement direct de la signification des mots ou des stratégies d’apprentissage des mots). Les auteurs ont examiné les structures des caractéristiques de l’enseignement du vocabulaire au cours de ces analyses. Les résultats conduisent à quatre conclusions principales : (1) Enseigner la signification des mots est presque toujours bénéfique à la compréhension du texte contenant les mots cibles ; (2) un enseignement focalisé sur un processus actif a de façon typique un impact supérieur à une méthode qui donne la définition du vocabulaire pour améliorer la compréhension du texte contenant les mots cibles, mais sans pouvoir préciser quelle quantité d’enseignement est suffisante. (3) Il y a très peu de preuves qu’un enseignement direct de la signification des mots, et même que des interventions longues et multidimensionnelles d’un grand nombre de mots, puissent conduire à une compréhension générale ; et (4) on n’a actuellement pas de preuve empirique que l’une ou l’autre de ces deux stratégies de connaissance du sens des mots ait un impact sur la compréhension en général. Toutefois, les recherches qui enseignent aux élèves à diriger de façon active leur compréhension du vocabulaire et qui utilisent des stratégies multiples et souples de compréhension des mots sont un domaine prometteur pour les recherches à venir. Les auteurs discutent des implications de ces conclusions, ainsi que des voies pertinentes pour les futures recherches sur le vocabulaire.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/136457/1/rrq163_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136457/2/rrq163.pd

A cohort study of in utero polychlorinated biphenyl (PCB) exposures in relation to secondary sex ratio

Abstract: Background: Polychlorinated biphenyls (PCBs) are ubiquitous industrial chemicals that persist in the environment and in human fatty tissue. PCBs are related to a class of compounds known as dioxins, specifically 2,3,7,8-TCDD (tetrachloro-dibenzodioxin), which has been implicated as a cause of altered sex ratio, especially in relation to paternal exposures. Methods: In the 1960's, serum specimens were collected from pregnant women participating in the Child Health and Development Study in the San Francisco Bay Area. The women were interviewed and their serum samples stored at -20°C. For this study, samples were thawed and a total of eleven PCBs were determined in 399 specimens. Secondary sex ratio, or sex ratio at birth, was evaluated as a function of maternal serum concentrations using log-binomial and logistic regression, controlling for hormonally active medications taken during pregnancy. Results: The relative risk of a male birth decreased by 33% comparing women at the 90th percentile of total PCBs with women at the 10th percentile (RR = 0.67; 95% CI, 0.48–0.94; p = 0.02), or by approximately 7% for each 1 μg/L increase in total PCB concentration. Although some congener-specific associations with sex ratio were only marginally statistically significant, all nine PCB congeners with < 30% of samples below the LOQ showed the same direction of association, an improbable finding under the null hypothesis. Conclusion: Maternal exposure to PCBs may be detrimental to the success of male sperm or to the survival of male embryos. Findings could be due to contaminants, metabolites or PCBs themselves