Social inequalities in pregnancy outcomes and early childhood behaviour: the Generation R study

aim of this thesis was to extend the existing knowledge on the relation of social disadvantage with pregnancy outcomes and early childhood behaviour. More specifically, we aimed to identify the mechanisms underlying this association. In this thesis, several indicators of social disadvantage are examined, namely low educational level, low income, unemployment (these three indicators are also labeled ‘low socioeconomic status’), and ethnic minority status. This thesis indicated that a large social gradient exists in pregnancy outcomes in women living in Rotterdam, the Netherlands: women with a low socioeconomic background, as compared to women with a high socioeconomic status, had an elevated risk of adverse pregnancy outcomes, such as slower fetal growth, preterm birth, and low birth weight. The inequalities were largely explained by a combination of risk factors for pregnancy complications among women with a low socioeconomic background, such as young age, short stature, smoking during pregnancy, experience of stress and psychosocial problems. Equally, we found a large social gradient in behaviour early in life with infants of low socioeconomic status displaying more temperamental difficulties, and toddlers of non-Dutch origin having higher levels of parent-reported behavioural problems. The social gradient was also observed in parenting style with parents of low SES or non-Dutch origin being more likely to harshly discipline their 3-year old children. The social gradient in early childhood behaviour was mainly explained by sociodemographic risk factors (e.g. young parental age, single motherhood) and indicators of stress and psychosocial problems of the parents. We also showed that the reported behavioural problems of non-Dutch toddlers were more pronounced among those with unfavourable maternal immigration characteristics, such as poor Dutch language skills and not feeling accepted by Dutch natives

Seeking the roots of entrepreneurship: Childhood and adolescence extraversion predict entrepreneurial intention in adults

Entrepreneurial personality research has mostly used cross-sectional data, giving rise to the question of whether the results can be used to predict entrepreneurial outcomes. Using a unique longitudinal dataset, we investigate whether and from what age personality in childhood and adolescence predicts entrepreneurial intention in young adulthood. We cover a time span of 17 years by assessing personality at four different developmental phases (6–9, 9–12, 12–15, and 14–17 years of age) and one measurement of entrepreneurial intention in young adulthood (23–26 years of age). We employ a variable-oriented approach by studying the Big Five traits—imagination, conscientiousness, extraversion, benevolence, and emotional stability—individually and a person-oriented approach by studying the “entrepreneurial personality profile,” a configuration of these traits. Extraversion as measured at 9–12 years already predicts entrepreneurial intention in young adulthood. This relationship becomes stronger as the age at which extraversion is measured increases. Unlike earlier literature, we do not find clear prospective relationships regarding the other traits. Our study presents insights into the antecedents of entrepreneurial intention and highlights the importance of extraversion in childhood and adolescence. The difference between our results and those of previous cross-sectional research highlights the importance of using longitudinal data

Fine-grained access control framework for Igor, a unified access solution to the Internet of Things

With the growing popularity of the Internet of Things (IoT), devices in households and offices are becoming information sharing "smart" devices controlled via network connections. The growth of collection, handling and distribution of data generated by IoT devices presents ethical and privacy issues. Users have no control over what information is kept or revealed, the interpretation of data collected, data ownership and who can access specific information generated by their IoT devices. This paper describes an approach to data ethical/privacy issues related to IoT using a fine-grained access-control framework on Igor, a centralized home and office automation solution. We designed a capability-based access control framework on top of Igor that allows agents, either human or machine, to access and change only the data to which they are authorised. The applicability of this to the European General Data Protection Regulation (GDPR) should be obvious. The implementation, expert evaluation and performance measurement results demonstrate that this is a promising solution for securing access to data generated by IoT devices

Mental Health Care Professionals’ Appraisal of Patients’ Use of Web-Based Access to Their Electronic Health Record: Qualitative Study

BACKGROUND: Patients in a range of health care sectors can access their medical health records using a patient portal. In mental health care, the use of patient portals among mental health care professionals remains low. Mental health care professionals are concerned that patient access to electronic health records (EHRs) will negatively affect the patient’s well-being and privacy as well as the professional’s own workload. OBJECTIVE: This study aims to provide insights into the appraisal work of mental health care professionals to assess and understand patient access to their EHRs through a patient portal. METHODS: We conducted a qualitative study that included 10 semistructured interviews (n=11) and a focus group (n=10). Participants in both the interviews and the focus group were mental health care professionals from different professional backgrounds and staff employees (eg, team leaders and communication advisors). We collected data on their opinions and experiences with the recently implemented patient portal and their attempts to modify work practices. RESULTS: Our study provides insights into mental health care professionals’ appraisal work to assess and understand patient access to the EHR through a patient portal. A total of four topics emerged from our data analysis: appraising the effect on the patient-professional relationship, appraising the challenge of sharing and registering delicate information, appraising patient vulnerability, and redefining consultation routines and registration practices. CONCLUSIONS: Mental health care professionals struggle with the effects of web-based patient access and are searching for the best ways to modify their registration and consultation practices. Our participants seem to appraise the effects of web-based patient access individually. Our study signals the lack of systematization and communal appraisal. It also suggests various solutions to the challenges faced by mental health care professionals. To optimize the effects of web-based patient access to EHRs, mental health care professionals need to be involved in the process of developing, implementing, and embedding patient portals

Academic achievement of children with autistic symptoms compared to typically developing children

Children with autistic symptoms experience challenges in school settings, yet little is known about their academic profiles and the mechanisms underlying the association between autistic symptoms and academic achievement. This study examined the association between autistic symptoms and academic achievement in a population-based sample of children with and without (sub)clinical autism spectrum disorder (ASD). We also investigated potential sex differences and assessed if the association is mediated by vocabulary skills and behavior problems. Information was available for 2038 participants (48.3% boys), and autistic symptoms were assessed using the Social Responsiveness Scale (M = 6.8 years). Diagnosis of ASD was clinically confirmed in 28 children. Academic achievement was determined by a nationwide, standardized test assessed at the end of primary school (M = 11.8 years). Children with more autistic symptoms in early childhood had lower achievement scores in language, mathematics, and world orientation by the end of primary education. There were no sex differences. Furthermore, vocabulary skills and behavior problems partly mediated the association between autistic symptoms and academic achievement. Then, by using propensity matching technique, we compared 140 matched typically developing peers with 28 children diagnosed with ASD. These results indicated no differences in academic achievement between children diagnosed with ASD and their matched typically developing peers. We conclude that autistic symptoms associate with lower academic achievement but by carefully matching on background variables and potential confounders, the academic achievement of children with clinical ASD might not differ from that of their typically developing peers.</p

Children's Attention-Deficit/Hyperactivity Disorder Symptoms Predict Lower Diet Quality but Not Vice Versa:Results from Bidirectional Analyses in a Population-Based Cohort

BACKGROUND: As an adjuvant for medication, dietary changes focused on specific nutrients have been proposed to prevent or reduce attention-deficit/hyperactivity disorder (ADHD) symptoms. However, whether an overall healthy dietary pattern is associated with ADHD symptom severity during childhood remains unclear. Furthermore, it is not clear what the direction of this association is. OBJECTIVES: We aimed to examine the association between dietary patterns and ADHD symptoms in school-aged children. In addition, we aimed to identify the temporal direction of this association-that is, whether dietary patterns predict ADHD symptoms or vice versa. METHODS: We analyzed data from 3680 children participating in the Generation R Study, a prospective cohort in Rotterdam, Netherlands. ADHD symptoms were assessed with parent-report questionnaires at ages 6 and 10 y using the Child Behavior Checklist. Dietary intake was assessed at the age of 8 y with a validated food-frequency questionnaire. We computed a diet quality score reflecting adherence to dietary guidelines. We examined bidirectional associations of diet quality with ADHD symptom scores using multivariable linear regression analysis and cross-lagged modeling. RESULTS: Linear regressions showed that more ADHD symptoms at age 6 y were associated with a lower diet quality score at age 8 y (SD score = -0.08; 95% CI: -0.11, -0.05) but that diet quality at age 8 y was not associated with ADHD symptoms at age 10 y. Cross-lagged models confirmed a unidirectional relation from ADHD symptoms to diet quality but not vice versa. Associations did not differ by overweight status or between boys and girls. CONCLUSION: Our study suggests that children with more ADHD symptoms may be at higher risk of an unhealthy diet but that overall diet quality does not affect ADHD risk

Impaired subjective self-control in alcohol use: An ecological momentary assessment study

Background: While both theory and empirical findings have supported impaired self-control as a crucial factor in understanding problem drinking, little is known about the relationship of self-control and drinking in naturalistic settings. The present study uses Ecological Momentary Assessment (EMA) to examine the predictive relationships between impaired subjective self-control, craving and alcohol use in everyday life. Methods: A sample of 172 regular drinkers responded on their smartphone to three random prompts each day for seven days in which amount of perceived self-control and craving were measured with self-report. In the meantime, participants were instructed to initiate an EMA report when they started drinking alcohol. Results: Findings supported the hypotheses that impaired self-control and higher craving levels were prospectively related to the likelihood that people will drink. That is, on random assessments that preceded drinking (i.e., were within two hours of drinking), perceived self-control was lower and craving was higher compared to random assessments that were not followed by drinking. Additionally, during drink consumption, impaired self-control and craving were associated with a higher amount of expected alcohol consumption. Findings further indicated that subjective self-control acted as a moderator of the relationship between craving and alcohol consumption during drinking occasions. Conclusions: By using a smartphone mobile application, this study showed that impaired subjective self-control and cravin

Television viewing through ages 2-5 years and bullying involvement in early elementary school

BACKGROUND: High television exposure time at young age has been described as a potential risk factor for developing behavioral problems. However, less is known about the effects of preschool television on subsequent bullying involvement. We examined the association between television viewing time through ages 2-5 and bullying involvement in the first grades of elementary school. We hypothesized that high television exposure increases the risk of bullying involvement. METHOD: TV viewing time was assessed repeatedly in early childhood using parental report. To combine these repeated assessments we used latent class analysis. Four exposure classes were identified and labeled “low”, “mid-low”, “mid-high” and “high”. Bullying involvement was assessed by teacher questionnaire (n = 3423, mean age 6.8 years). Additionally, peer/self-report of bullying involvement was obtained using a peer nomination procedure (n = 1176, mean age 7.6 years). We examined child risk of being a bully, victim or a bully-victim (compared to being uninvolved in bullying). RESULTS: High television exposure class was associated with elevated risks of bullying and victimization. Also, in both teacher- and child-reported data, children in the high television exposure class were more likely to be a bully-victim (OR = 2.11, 95% CI: 1.42-3.13 and OR = 3.68, 95% CI: 1.75-7.74 respectively). However, all univariate effect estimates attenuated and were no longer statistically significant once adjusted for maternal and child covariates. CONCLUSIONS: The association between television viewing time through ages 2-5 and bullying involvement in early elementary school is confounded by maternal and child socio-demographic characteristics

Prevalence and Characterization of Avoidant Restrictive Food Intake Disorder in a Paediatric Population

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