23 research outputs found
Relationship between socioeconomic status and weight gain during infancy:The BeeBOFT study
Background Increased weight gain during infancy is a risk factor for obesity and related diseases in later life. The aim of the present study was to investigate the association between socioeconomic status (SES) and weight gain during infancy, and to identify the factors mediating the association between SES and infant weight gain. Methods Subjects were 2513 parent-child dyads participating in a cluster randomized controlled intervention study. Family SES was indexed by maternal education level. Weight gain in different time windows (infant age 0–3, 0–6, and 6–12 months) was calculated by subtracting the weight for age z-score (WAZ) between the two time-points. Path analysis was performed to examine the mediating pathways linking SES and infant weight gain. Results On average, infants of low-educated mothers had a lower birth weight and caught-up at approximately 6 months. In the period of 0–6 months, infants with low-educated mothers had an 0.42 (95% CI 0.27–0.57) higher gain in weight for age z-score compared to children with high-educated mothers. The association between maternal education level and increased infant weight gain in the period of 0–6 months can be explained by infant birth weight, gestational age at child birth, duration of breastfeeding, and age at introduction of complementary foods. After adjusting all the mediating factors, there was no association between maternal education level and infant weight gain. Conclusion Infants with lower SES had an increased weight gain during the first 6 months of infancy, and the effect can be explained by infant birth weight, gestational age at child birth, and infant feeding practices.</p
Spong3d: 3D printed facade system enabling movable fluid heat storage
Spong3D is an adaptive 3D printed facade system that integrates multiple functions to optimize thermal performances according to the different environmental conditions throughout the year. The proposed system incorporates air cavities to provide thermal insulation and a movable liquid (water plus additives) to provide heat storage where and whenever needed. The air cavities have various dimensions and are located in the inner part of the system. The movable liquid provides heat storage as it flows through channels located along the outer surfaces of the system (on the indoor and outdoor faces of the façade). Together, the composition of the channels and the cavities form a complex structure, integrating multiple functions into a singular component, which can only be produced by using an Additive Manufacturing (AM; like 3D printing) technology
Spong3d: 3D printed facade system enabling movable fluid heat storage
Spong3D is an adaptive 3D printed facade system that integrates multiple functions to optimize thermal performances according to the different environmental conditions throughout the year. The proposed system incorporates air cavities to provide thermal insulation and a movable liquid (water plus additives) to provide heat storage where and whenever needed. The air cavities have various dimensions and are located in the inner part of the system. The movable liquid provides heat storage as it flows through channels located along the outer surfaces of the system (on the indoor and outdoor faces of the façade). Together, the composition of the channels and the cavities form a complex structure, integrating multiple functions into a singular component, which can only be produced by using an Additive Manufacturing (AM; like 3D printing) technology
Work Package 9: A report containing consensus statements on most optimal models with guidance on potential benefits and how these might be achieved
Consensus statements of stakeholders on most optimal models of child primary healthcare with guidance on potential benefits and how these might be achieve
Parenting support to prevent overweight during regular well-child visits in 0-3 year old children (BBOFT+ program), a cluster randomized trial on the effectiveness on child BMI and health behaviors and parenting
Background Prevention of overweight during early childhood seems promising. Objective To evaluate the effectiveness of the parenting-based BBOFT+ overweight prevention program on child BMI, child health behavior and parenting behavior among 0–36 month old children. BBOFT+ is an acronym for the key healthy lifestyle behaviors that are targeted in the BBOFT+ intervention: breastfeeding (B), daily breakfast (B), daily going outdoors (O), limiting sweet beverages (in Dutch, F) and minimal TV or computer time (T), complemented with healthy sleep behavior and improvement of parenting skills (+). Methods A cluster randomized controlled trial in newborn children visiting well-baby clinics, comparing the BBOFT+ intervention (N = 901) with care as usual (CAU) (N = 1094). In both groups, parents received regular well-child visits (±11 visits in the first 3 years). In the intervention group, care was supplemented with the BBOFT+ program, which focuses on improving parenting skills from birth onwards to increase healthy behavior. Questionnaires were filled in at child’s age 2–4 weeks, 6, 14 and 36 months. In multivariate analyses we corrected for child’s birthweight, age, ethnic background, mother’s educational level and BMI. Results No differences were found in weight status at 36 months between intervention and control group children. At 6 months, BBOFT+ parents reported their child drinking less sweet beverages than control parents (48% vs 54%;p = .027), and going outdoors daily with their child less often (57% vs 62%;p = .03). At 14 months, more BBOFT+ parents than control parents reported to have breastfed for six months or longer (32% vs 29%;p = .022). At 36 months, more BBOFT+ parents than control parents reported their child going outside daily (78% vs 72%;p = .011) and having less TV/computer time on week- (38% vs 46%;p = .001) and weekend days (48% vs 56%;p = .002). Also, BBOFT+ parents reported having more parental control than control parents (3.92 vs 3.89;p = .02). No significant differences were found for daily breakfast, sleep duration and parenting practices in adjusted analyses. Conclusion The BBOFT+ overweight prevention program showed small improvements in parent-reported child health behaviors, compared to care as usual; no effect was observed on child BMI. The identified modifiable elements are potentially relevant for interventions that aim to prevent overweight
Predictive validity of developmental milestones for detecting limited intellectual functioning.
Developmental milestones are commonly used in child health care, although from many milestones the predictive validity has not been adequately assessed. We aimed to determine the predictive validity of 75 developmental milestones for detecting limited intellectual functioning that can be obtained before the age of 4 years. We performed a case-control study with 148 children aged 5-10 years with limited intellectual functioning (IQ 50-69), who were in special education (cases) and a random sample of 300 children aged 5-10 years who were in regular elementary education (controls). Developmental milestones scores were retrieved from Child Healthcare files. We calculated sensitivity, specificity, positive likelihood ratios (LR+) and diagnostic odds ratios (DOR) for limited intellectual functioning. The LR+ determines whether a test result changes the probability that a condition exists. Given the prevalence of intellectual disability (1-3%), we considered that an LR+ > 10 would be clinically useful, as it increases the a priori probability of limited intellectual functioning from 2% to a posteriori probability of at least 17%. Out of 75 assessed milestones, 50 were included in the analysis. We found nine milestones to have a significant adjusted (for socio-economic status and prematurity) DOR > 1 and a significant LR+ > 10 (assessment age in months between brackets): 'says "dada-baba‴ (9), 'balances head well while sitting' (9), 'sits on buttocks while legs stretched' (9), 'babbles while playing' (12), 'sits in stable position without support' (12), 'walks well alone' (24), 'says "sentences" of 3 or more words' (36), 'places 3 forms in form-box' (36) and 'copies circle' (48). Sensitivities of these 9 milestones varied from 8-54%, specificities of these 9 milestones varied from 95-100%. Combining these milestones at 9, 12, and 36 months respectively resulted in sensitivities of 27-60% and specificities of 94-99%. These nine developmental milestones have substantial predictive validity for limited intellectual functioning
Primary care in five European countries: A citizens’ perspective on the quality of care for children
Objective As part of the Models of Child Health Appraised (MOCHA) project, this study aimed to answer the following research questions: 1) How do European citizens perceive the quality of primary health care provided for children? And 2) What are their priorities with respect to quality assessment of primary health care aimed at satisfying children’s needs? Methods Nine potential attributes of quality of primary care were operationalized in 40 quality aspects. An online survey was used to elicit opinions in a representative sample of citizens of Germany, the Netherlands, Poland, Spain, and the United Kingdom. Data collection comprised: background characteristics; perceived quality of primary health care for children; and priority setting of quality aspects. Descriptive analysis was performed and differences between groups were tested using Chi-Square test and ANOVA. Results Valid results were obtained from 2403 respondents. Mean satisfaction with quality of primary care ranged from 5.5 (Poland) to 7.2 (Spain). On average, between 56% (Poland) and 70% (Netherlands) of respondents had a positive perception of the primary health care system for children in their country. The ability of a child to limit their parents’ access to the child’s medical records was judged most negatively in all countries (average agreement score 28%, range 12–36%). The right of a child to a confidential consultation was judged most differently between countries (average agreement score 61%, range 40–75%). Overall top-10 priorities in ensuring high quality primary care were: timeliness (accessibility); skills/ competences, management, facilities (appropriateness); no costs (affordability); information, dignity/respect (continuity); and swift referrals, collaboration (coordination). Discussion Between countries, significant differences exist in the perceived quality of primary care and priorities with regard to quality assessment. Taking into account the citizens’ perspective in decision-making means that aspects with low perceived quality that are highly prioritized warrant further action
Determinants of adherence to wrap-around care in child and family services
BACKGROUND: The aim of this study is to understand the determinants of adherence to wrap-around care (WAC) by professional care providers working in child and family services. WAC is a care coordination method targeting families with complex needs. The core components of WAC involve activating family members and the social network, integrating the care provider network, and assessing, planning and evaluating the care process. WAC was introduced in the Netherlands using two approaches: the network approach (NA) and the team approach (TA). METHODS: A cross-sectional study was conducted using a digital questionnaire targeted at care providers. After imputation of missing data, univariate and multilevel regression analyses were conducted to study the associations between adherence to the core components of WAC, the determinants of adherence and background characteristics. RESULTS: In total 145 out of 275 care providers (52.7%) responded to the questionnaire. Multilevel regression analysis showed that self-efficacy of the care providers and the way WAC is organised (NA versus TA region) were significantly associated with adherence to core components of WAC. Self-efficacy was significantly associated with all WAC core components (activating family members and the social network: β (95% confidence interval, CI) = .27(.04-.50), integrating the network of care providers: β (95% CI) = .27(.05-.50) and assessing, planning and evaluating the care process: β (95% CI) = .30(.08-.52)). The way WAC is organised was significantly associated to two core components (activating family members and the social network: β (95% CI) = .18(0.1-.37) and integrating the network of care providers: β (95% CI) = .25(.09-.42)). CONCLUSION: The way WAC is organised and the self-efficacy of care providers who use WAC are factors that are relevant for the redesign of the strategy for introducing WAC. Longitudinal research into the predictive value of determinants of adherence to WAC is advised
Sleep and body mass index in infancy and early childhood (6-36 mo): a longitudinal study
Background: Relatively, few longitudinal studies have evaluated the association between sleep and body mass index (BMI) among younger children. In addition, few studies have evaluated the bidirectional longitudinal association between sleep duration and child BMI. Objective: The objective of the study is to determine in children aged 6 to 36 months (1) the cross-sectional association of sleep duration and sleep problems with child BMI z score, (2) whether sleep duration predicts changes in child BMI z score, and (3) and whether BMI z score can predict changes in child sleep duration. Methods: This study used longitudinal data from the BeeBOFT study (N = 2308). Child sleep duration and sleep problems (indicated by night awakenings and sleep-onset latency) were parent reported, and child BMI was measured using a standardized protocol by trained healthcare professionals at approximately 6, 14, and 36 months of age. Linear mixed models and linear regression models were applied to assess the cross-sectional and bidirectional longitudinal associations between sleep and BMI z scores. Results: Cross sectionally, shorter sleep duration was associated with higher BMI z scores at 14 (β = −0.034, P < 0.05) and 36 months (β = −0.045, P < 0.05). Sleep duration at 6 or 14 months did not predict BMI z score at either 14 or 36 months. Higher BMI z scores at 6 months predicted shorter sleep duration (hours) at 14 months (β = −0.129, P < 0.001). No association was found between sleep problems and child BMI z scores. Conclusions: Cross-sectional associations between shorter sleep duration and higher BMI z score emerged in early childhood (age 14 and 36 mo). Higher BMI z scores may precede shorter sleep duration but not vice versa