The quality of caregiver–child interactions in infant classrooms in Portugal: the role of caregiver education

Recent research has shown that caregiver education and training can be important in determining levels of quality in early childhood, but has mainly considered the education and training of the lead teacher. In infant child care, however, classrooms have more than one caregiver with varying levels of education and in Portugal it is less common to have a qualified teacher exclusively assigned to infant classrooms. This study examines the quality of caregiver–child interactions in infant classrooms and its association with caregiver qualifications and training, specifically the level of pre-service education and in-service training of the lead caregiver, whether she is exclusively assigned to an infant classroom or to more classrooms, and the pre-service education of the multiple caregivers in the classroom. Participants were 90 infant classrooms from Porto, Portugal. The CLASS–Infant was used to measure quality of caregiver–infant interactions. Classrooms with one lead caregiver holding at least a bachelor’s degree, whether exclusively assigned to the infant classroom or not, showed higher levels of quality. Few effects were found for in-service training. Results suggest that lead teachers with pre-service education in early childhood are likely to play an important role not only directly by interacting with children but also indirectly through team work.info:eu-repo/semantics/publishedVersio

Stability and change in teacher-infant interaction quality over time

Given that an increasing number of infants spend part of the day in center-based childcare in many countries, understanding infants’ education and care experiences in these settings is essential. The aims of this study are to examine change in teacher-infant interaction quality over time, and to determine the extent to which teacher and classroom structural characteristics are associated with change in teacherinfantinteraction quality. Ninety infant childcare classrooms from the greater metropolitan area of Porto, Portugal, participated in this study. Each classroom was observed twice (6-month interval between Time 1 and Time 2) by trained and reliable observers using the Infant/Toddler Environment Rating Scale – Revised (ITERS-R; Harms et al., 2006), the Classroom Assessment Scoring System – Infant (CLASS-Infant; Hamre et al., 2014), and the Caregiver Interaction Scale (CIS; Arnett, 1989). Additionally, teachers provided demographic information aboutthemselves and structural characteristics ofthe classroom. Overall results indicated that the quality of teacher-infant interactions changed over time, with a general trend toward lower quality at Time 2. The increase in infant:adult ratio from Time 1 to Time 2 was an important predictor of process quality levels at Time 2, after controlling for prior quality and other structural characteristics. These findings can be informative for policymaking as group size and number of adults per classroom are regulated features of childcare in many countries, including Portugalinfo:eu-repo/semantics/publishedVersio

Predictors of parent-teacher communication during infant transition to childcare in Portugal

Although literature reports associations between parent-teacher communication and childcare quality, little is known about how such communications are related to family, child and childcare characteristics. This study examines whether child, family and childcare experience characteristics predict the level of parent-teacher communication, and differences between parents’ and teachers’ reports of communication. Participants were mothers of 90 infants and their teachers in childcare in Portugal. Results show that both parents and teachers report higher levels of communication in higher-quality programmes. Teachers reported more frequent communication than parents. Teachers, but not parents, reported more frequent communication when children spent fewer hours in childcare. Discussion highlights the relevance of monitoring the quality of childcare contexts, especially in early ages, and to increase parent-teacher communication when children spend more time in childcare. The importance of promoting high-quality childcare and accounting for variables at the mesosystemic level of development in teacher training are also discussed.info:eu-repo/semantics/publishedVersio

The COMET (Comparison of Operative versus Monitoring and Endocrine Therapy) trial: a phase III randomised controlled clinical trial for low-risk ductal carcinoma in situ (DCIS)

Introduction Ductal carcinoma in situ (DCIS) is a noninvasive non-obligate precursor of invasive breast cancer. With guideline concordant care (GCC), DCIS outcomes are at least as favourable as some other early stage cancer types such as prostate cancer, for which active surveillance (AS) is a standard of care option. However, AS has not yet been tested in relation to DCIS. The goal of the COMET (Comparison of Operative versus Monitoring and Endocrine Therapy) trial for low-risk DCIS is to gather evidence to help future patients consider the range of treatment choices for low-risk DCIS, from standard therapies to AS. The trial will determine whether there may be some women who do not substantially benefit from current GCC and who could thus be safely managed with AS. This protocol is version 5 (11 July 2018). Any future protocol amendments will be submitted to Quorum Centralised Institutional Review Board/local institutional review boards for approval via the sponsor of the study (Alliance Foundation Trials). Methods and analysis COMET is a phase III, randomised controlled clinical trial for patients with low-risk DCIS. The primary outcome is ipsilateral invasive breast cancer rate in women undergoing GCC compared with AS. Secondary objectives will be to compare surgical, oncological and patient-reported outcomes. Patients randomised to the GCC group will undergo surgery as well as radiotherapy when appropriate; those in the AS group will be monitored closely with surgery only on identification of invasive breast cancer. Patients in both the GCC and AS groups will have the option of endocrine therapy. The total planned accrual goal is 1200 patients. Ethics and dissemination The COMET trial will be subject to biannual formal review at the Alliance Foundation Data Safety Monitoring Board meetings. Interim analyses for futility/safety will be completed annually, with reporting following Consolidated Standards of Reporting Trials (CONSORT) guidelines for noninferiority trials

Adaptation and qualitative evaluation of the BETTER intervention for chronic disease prevention and screening by public health nurses in low income neighbourhoods : views of community residents

The adaptation phase is one component of a study funded as a grant proposal entitled 'Advancing Cancer Prevention Among Deprived Neighbourhoods' by the Canadian Cancer Society Research Institute grant #704042 and by the Canadian Institutes of Health Research Institute of Cancer grant OCP #145450. Aisha Lofters is supported by a CIHR New Investigator Award, as a Clinician Scientist by the Department of Family and Community Medicine, University of Toronto, and as Chair in Implementation Science at the Peter Gilgan Centre for Women’s Cancers at Women’s College Hospital in partnership with the Canadian Cancer Society. Dr. Andrew Pinto holds a Canadian Institutes of Health Research Applied Public Health Chair and is supported as a Clinician-Scientist in the Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, and supported by the Department of Family and Community Medicine, St. Michael’s Hospital, and the Li Ka Shing Knowledge Institute, St. Michael’s Hospital. He is also the Associate Director for Clinical Research at the University of Toronto Practice-Based Research Network. Lawrence Paszat is supported by a Clinician Scientist award funded by the Ontario Ministry of Health and Long Term Care.Background The BETTER intervention is an effective comprehensive evidence-based program for chronic disease prevention and screening (CDPS) delivered by trained prevention practitioners (PPs), a new role in primary care. An adapted program, BETTER HEALTH, delivered by public health nurses as PPs for community residents in low income neighbourhoods, was recently shown to be effective in improving CDPS actions. To obtain a nuanced understanding about the CDPS needs of community residents and how the BETTER HEALTH intervention was perceived by residents, we studied how the intervention was adapted to a public health setting then conducted a post-visit qualitative evaluation by community residents through focus groups and interviews. Methods We first used the ADAPT-ITT model to adapt BETTER for a public health setting in Ontario, Canada. For the post-PP visit qualitative evaluation, we asked community residents who had received a PP visit, about steps they had taken to improve their physical and mental health and the BETTER HEALTH intervention. For both phases, we conducted focus groups and interviews; transcripts were analyzed using the constant comparative method. Results Thirty-eight community residents participated in either adaptation (n = 14, 64% female; average age 54 y) or evaluation (n = 24, 83% female; average age 60 y) phases. In both adaptation and evaluation, residents described significant challenges including poverty, social isolation, and daily stress, making chronic disease prevention a lower priority. Adaptation results indicated that residents valued learning about CDPS and would attend a confidential visit with a public health nurse who was viewed as trustworthy. Despite challenges, many recipients of BETTER HEALTH perceived they had achieved at least one personal CDPS goal post PP visit. Residents described key relational aspects of the visit including feeling valued, listened to and being understood by the PP. The PPs also provided practical suggestions to overcome barriers to meeting prevention goals. Conclusions Residents living in low income neighbourhoods faced daily stress that reduced their capacity to make preventive lifestyle changes. Key adapted features of BETTER HEALTH such as public health nurses as PPs were highly supported by residents. The intervention was perceived valuable for the community by providing access to disease prevention. Trial registration #NCT03052959, 10/02/2017.Peer reviewe

Copy Number Variations Associated With Obesity‐Related Traits in African Americans: A Joint Analysis Between GENOA and HyperGEN

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/95398/1/oby.2012.162.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/95398/2/oby_2790_sm_oby2012162_coi.pd

A multi-modal exploration of heterogeneous physico–chemical properties of DCIS breast microcalcifications

Ductal carcinoma in situ (DCIS) is frequently associated with breast calcification. This study combines multiple analytical techniques to investigate the heterogeneity of these calcifications at the micrometre scale. X-ray diffraction, scanning electron microscopy and Raman and Fourier-transform infrared spectroscopy were used to determine the physicochemical and crystallographic properties of type II breast calcifications located in formalin fixed paraffin embedded DCIS breast tissue samples. Multiple calcium phosphate phases were identified across the calcifications, distributed in different patterns. Hydroxyapatite was the dominant mineral, with magnesium whitlockite found at the calcification edge. Amorphous calcium phosphate and octacalcium phosphate were also identified close to the calcification edge at the apparent mineral/matrix barrier. Crystallographic features of hydroxyapatite also varied across the calcifications, with higher crystallinity centrally, and highest carbonate substitution at the calcification edge. Protein was also differentially distributed across the calcification and the surrounding soft tissue, with collagen and β-pleated protein features present to differing extents. Combination of analytical techniques in this study was essential to understand the heterogeneity of breast calcifications and how this may link crystallographic and physicochemical properties of calcifications to the surrounding tissue microenvironment.Cancer Research UK and by KWF Kankerbestrijding: C38317/A2404

Impact of an Online Decision Support tool for Ductal Carcinoma In Situ (DCIS) Using a Pre-Post Design (AFT-25)

BACKGROUND: The heterogeneous biology of ductal carcinoma in situ (DCIS), as well as the variable outcomes, in the setting of numerous treatment options have led to prognostic uncertainty. Consequently, making treatment decisions is challenging and necessitates involved communication between patient and provider about the risks and benefits. We developed and investigated an interactive decision support tool (DST) designed to improve communication of treatment options and related long-term risks for individuals diagnosed with DCIS. FINDINGS: The DST was developed for use by individuals aged \u3e 40 years with DCIS and is based on a disease simulation model that integrates empirical data and clinical characteristics to predict patient-specific impacts of six DCIS treatment choices. Personalized risk predictions for each treatment option were communicated using icon arrays and percentages for each outcome. Users of the DST were asked before and after interacting with the DST about: (1) awareness of DCIS treatment options, (2) willingness to consider these options, (3) knowledge of risks associated with DCIS, and (4) helpfulness of the DST. Data were collected from January 2019 to April 2022. Users\u27 median estimated risk of dying from DCIS in 10 years decreased from 9% pre-tool to 3% post-tool (p \u3c 0.0001). 76% (n = 101/132) found the tool helpful. CONCLUSIONS: Information about DCIS treatment options and related risk predictions was effectively communicated, and a large majority participants found the DST to be helpful. Successfully informing patients about their treatment options and how their individual risks affect those options is a critical step in the decision-making process. CLINICALTRIALS: gov Identifier NCT02926911

Peer support for type 2 diabetes management in Low- and Middle-Income Countries (LMICs): A scoping review

Background: Although there is evidence of peer support in high-income countries, the use of peer support as an intervention for cardiometabolic disease management, including type 2 diabetes (T2DM), in low- and middle-income countries (LMICs), is unclear. Methods: A scoping review methodology was used to search the databases MEDLINE, Embase, Emcare, PsycINFO, LILACS, CDSR, and CENTRAL. Results: Twenty-eight studies were included in this scoping review. Of these, 67% were developed in Asia, 22% in Africa, and 11% in the Americas. The definition of peer support varied; however, peer support offered a social and emotional dimension to help individuals cope with negative emotions and barriers while promoting disease management. Conclusions: Findings from this scoping review highlight a lack of consistency in defining peer support as a component of CMD management in LMICs. A clear definition of peer support and ongoing program evaluation is recommended for future research