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Use of personal child health records in the UK: findings from the millennium cohort study.

OBJECTIVES: The personal child health record (PCHR) is a record of a child's growth, development, and uptake of preventive health services, designed to enhance communication between parents and health professionals. We examined its use throughout the United Kingdom with respect to recording children's weight and measures of social disadvantage and infant health. DESIGN: Cross sectional survey within a cohort study. SETTING: UK. PARTICIPANTS: Mothers of 18,503 children born between 2000 and 2002, living in the UK at 9 months of age. MAIN OUTCOME MEASURES: Proportion of mothers able to produce their child's PCHR; proportion of PCHRs consulted containing record of child's last weight; effective use of the PCHR (defined as production, consultation, and child's last weight recorded). RESULTS: In all, 16,917 (93%) mothers produced their child's PCHR and 15,138 (85%) mothers showed effective use of their child's PCHR. Last weight was recorded in 97% of PCHRs consulted. Effective use was less in children previously admitted to hospital, and, in association with factors reflecting social disadvantage, including residence in disadvantaged communities, young maternal age, large family size (four or more children; incidence rate ratio 0.87; 95% confidence interval 0.83 to 0.91), and lone parent status (0.88; 0.86 to 0.91). CONCLUSIONS: Use of the PCHR is lower by women living in disadvantaged circumstances, but overall the record is retained and used by a high proportion of all mothers throughout the UK in their child's first year of life. PCHR use is endorsed in the National Service Framework for Children and has potential benefits which extend beyond the direct care of individual children

An ecological systems approach to examining risk factors for early childhood overweight: findings from the UK Millennium Cohort Study

Objective: To use an ecological systems approach to examine individual-, family-, community- and area-level risk factors for overweight (including obesity) in 3-year-old children. Methods: A prospective nationally representative cohort study conducted in England, Wales, Scotland, Northern Ireland. Participants included 13 188 singleton children aged 3 years in the Millennium Cohort Study, born between 2000 and 2002, who had complete height/weight data. The main outcome measure was childhood overweight (including obesity) defined by the International Obesity TaskForce cut-offs for body mass index. Results: 23.0% of 3-year-old children were overweight or obese. In the fully adjusted model, primarily individual- and family-level factors were associated with early childhood overweight: birthweight z-score (adjusted odds ratio, 1.36, 95% CI 1.30 to 1.42), black ethnicity (1.41, 1.11 to 1.80) (compared with white), introduction to solid foods or =21 hours/week (1.23, 1.10 to 1.37) (compared with never worked). Breastfeeding > or =4 months (0.86, 0.76 to 0.97) (compared with none) and Indian ethnicity (0.63, 0.42 to 0.94) were associated with a decreased risk of early childhood overweight. Children from Wales were also more likely to be overweight than children from England. Conclusions: Most risk factors for early childhood overweight are modifiable or would allow at-risk groups to be identified. Policies and interventions should focus on parents and providing them with an environment to support healthy behaviours for themselves and their children

Maternal employment and early childhood overweight: findings from the UK Millennium Cohort Study

Background: In most developed countries, maternal employment has increased rapidly. Changing patterns of family life have been suggested to be contributing to the rising prevalence of childhood obesity. Objectives: Our primary objective was to examine the relationship between maternal and partner employment and overweight in children aged 3 years. Our secondary objective was to investigate factors related to early childhood overweight only among mothers in employment. Design: Cohort study. Subjects: A total of 13 113 singleton children aged 3 years in the Millennium Cohort Study, born between 2000 and 2002 in the United Kingdom, who had complete height/weight data and parental employment histories. Measurements: Parents were interviewed when the child was aged 9 months and 3 years, and the child's height and weight were measured at 3 years. Overweight (including obesity) was defined by the International Obesity Task Force cut-offs. Results: A total of 23% (3085) of children were overweight at 3 years. Any maternal employment after the child's birth was associated with early childhood overweight (odds ratio (OR) [95% confidence interval (CI)]; 1.14 [1.00, 1.29]), after adjustment for potential confounding and mediating factors. Children were more likely to be overweight for every 10 h a mother worked per week (OR [95% CI]; 1.10 [1.04, 1.17]), after adjustment. An interaction with household income revealed that this relationship was only significant for children from households with an annual income of pound33 000 ($57 750) or higher. There was no evidence for an association between early childhood overweight and whether or for how many hours the partner worked, or with mothers' or partners' duration of employment. These relationships were also evident among mothers in employment. Independent risk factors for early childhood overweight were consistent with the published literature. Conclusions: Long hours of maternal employment, rather than lack of money may impede young children's access to healthy foods and physical activity. Policies supporting work-life balance may help parents reduce potential barriers

Linking natural product producer & processor organisations to natural product enterprises: a discussion of past, present and future models

The big idea for sustainability for indigenous natural product (INP) harvesting is that communities have a reason to protect and manage their resources when those resources pay them a suitable regular income. Forming a long-term healthy commercial relationship between harvesting groups (Producing and Processing Organisations - PPO’s) and up-stream companies that develop and promote products from INPs is one of the essential steps along the pathway to proving this big idea works. Namibia has, arguably, one of the richest recent histories of developing such PPO/commercial INP enterprise models and there is much to learn from considering the range of approaches that have been adopted. In this Chapter the aim is to share the range of models and enterprise/PPO interactions tested during the MCA-Namibia INP Programme period, many of which build upon a much longer history of similar efforts going back to the Colonial times. We shall draw some conclusions about what models might be suitable to meet the current and future problems facing the INP sector in Namibia and what important lessons we have learned. Six main types of INP – SME relationships (sometimes called “models”) are identified. These are: the ‘Trader model’, the ‘NGO model’, the ‘Government model’, the local ‘SME led model’, the ‘PPO model’, and a ‘future model’. Considering the INP sector today, it could be said that all of these models are now present and working in parallel

Feasibility of collecting oral fluid samples in the home setting to determine seroprevalence of infections in a large-scale cohort of preschool-aged children

Oral fluid is a non-invasive biological sample, which can be returned by post, making it suitable for large-scale epidemiological studies in children. We report our experience of oral fluid collection from 14 373 preschool-aged children in the UK Millennium Cohort Study. Samples were collected by mothers in the home setting following the guidance of trained interviewers, and posted to the laboratory. Samples were received from 11698 children (81.4 %). Children whose mothers were of Black Caribbean ethnicity and who lived in non-English-speaking households were less likely to provide a sample, and those with a maternal history of asthma more likely to provide a sample [adjusted risk ratio (95 % CI) 0.85 (0.73-0.98), 0.87 (0.77-0.98) and 1.03 (1.00-1.05) respectively]. Collection of oral fluid samples is feasible and acceptable in large-scale child cohort studies. Formal interpreter support may be required to increase participation rates in surveys that collect biological samples from ethnic minorities

Regional differences in overweight: an effect of people or place?

Objective: To examine UK country and English regional differences in childhood overweight (including obesity) at 3 years and determine whether any differences persist after adjustment for individual risk factors. Design: Nationally representative prospective study. Setting: England, Wales, Scotland and Northern Ireland. Participants: 13 194 singleton children from the UK Millennium Cohort Study with height and weight data at age 3 years. Main outcome measure: Overweight (including obesity) was defined according to the International Obesity TaskForce cut-offs for body mass index, which are age and sex specific. Results: At 3 years of age, 23% (3102) of children were overweight or obese. In univariable analyses, children from Northern Ireland (odds ratio 1.30, 95% confidence interval 1.14 to 1.48) and Wales (1.26, 1.11 to 1.44) were more likely to be overweight than children from England. There were no differences in overweight between children from Scotland and England. Within England, children from the East (0.71, 0.57 to 0.88) and South East regions (0.82, 0.68 to 0.99) were less likely to be overweight than children from London. There were no differences in overweight between children from other English regions and children from London. These differences were maintained after adjustment for individual socio-demographic characteristics and other risk factors for overweight. Conclusions: UK country and English regional differences in early childhood overweight are independent of individual risk factors. This suggests a role for policies to support environmental changes that remove barriers to physical activity or healthy eating in young children

Manual para la promoción de la Inversión Extranjera Directa a nivel subnacional en mercados emergentes

Este manual está diseñado como una herramienta práctica destinada a asistir a aquellas ciudades con recursos escasos a incrementar el nivel de inversiones general y, en particular, a atraer Inversión Extranjera Directa (IED). Las recomendaciones hechas en este manual pueden ayudar a determinar las estrategias de desarrollo de una ciudad y a tomar decisiones de asignación presupuestaria. Por lo tanto, los funcionarios locales y nacionales responsables de la elaboración de políticas públicas pueden beneficiarse con su uso. Este manual está especialmente diseñado para ciudades medianas con recursos limitados y escasa experiencia en atraer inversiones y establecer una agencia dedicada a promocionarlas

Handbook for Promoting Foreign Direct Investment in Medium-size, Low-Budget Cities in Emerging Markets

In November 2009, the Vale Columbia Center on Sustainable International Investment and the Millennium Cities Initiative (MCI) released the Handbook for Promoting Foreign Direct Investment in Medium-size, Low-Budget Cities in Emerging Markets. With foreign direct investment (FDI) flows declining worldwide by an estimated 40-50% this year (following a decline of over 10% in 2008), investment promotion has become more important than ever: in a highly competitive world FDI market, promotion can make all the difference. Investment promotion is particularly important for cities other than capital cities, as investors in manufacturing and services often locate primarily in a country’s capital city. Hence, commercially viable investment opportunities need to be identified at the city level and in surrounding areas and brought to the attention of investors elsewhere in the country, in the region and internationally – and investors need to be assisted when they establish themselves. At the same time, effective investment promotion generally requires the development of an FDI promotion strategy, including a detailed sector competitiveness analysis that involves identifying key target markets and benchmarking against competitors, an exercise that may require in-depth groundwork and expertise. Therefore, the Handbook seeks to assist medium-size, low-budget cities in creating a capacity for investment promotion. It is a practical “how to” guide for city investment promotion based on the experience of different investment promotion agencies and experts from around the globe. .https://scholarship.law.columbia.edu/sustainable_investment_books/1004/thumbnail.jp