1,721,061 research outputs found
A community-based responsive caregiving program improves neurodevelopment in two-year old children in a middle-income country, Grenada, West Indies. Psychosocial Intervention
No full textMany young children in low- and middle-income countries (LMICs) are at risk of developmental delays. Early child development (ECD) interventions have been shown to improve outcomes, but few interventions have targeted culturally normative violence such as corporal punishment (CP). We partnered with an existing community-based ECD organization in the LMIC of Grenada to implement a parallel controlled-trial single-blind responsive caregiving intervention that educates parents about the developing brain and teaches alternatives to corporal punishment while building parental self-regulation skills and strengthening social-emotional connections between parent and child. Parents and primary caregivers with children under age two were eligible. Allocation to the intervention and waitlist control arms was unblinded and determined by recruitment into the program. Neurodevelopment was assessed by blinded testers when each child turned age two. Primary comparison consisted of neurodevelopmental scores between the intervention and waitlist control groups (Clinicaltrials.gov registration xxx NCT04697134). Secondary comparison consisted of changes in maternal mental health, home environment, and attitudes towards CP. Children in the intervention group (n = 153) had significantly higher scores than children in the control group (n = 151) on measures of cognition (p = .022), fine motor (p < .0001), gross motor (p = .015), and language development (p = .013). No difference in secondary outcomes, including CP, was detected
Child developmental follow up in obstetric RCTs: a unique opportunity
No full textFor many obstetric-outcome focused randomised controlled trials (RCTs), the long-term developmental follow up of offspring is often not prioritised beyond the neonatal period. Obstetric RCTs, however, offer a unique opportunity to answer nuanced, hypothesis-focused questions about child development, in a manner in which observational birth cohorts, including those specific to child development, cannot. Often, by controlling for certain significant influences associated with adverse obstetric outcomes, such as maternal illness, and socio-economic status, in their design, these RCTs also inherently control for many factors evidenced to be associated with adverse child developmental outcomes.A good example of such an effort is provided in this issue’s paper by Ellingsen et al. (BJOG 2020;127:508–17). While the RCT's primary objective was to determine whether a regular, moderate intensity exercise intervention during pregnancy could prevent pregnancy complications such as gestational diabetes, the follow-up sample allowed the authors to test the effect of regular antenatal exercise on child developmental outcomes at 18 months and 7 years of age. Moreover, this follow up permitted the investigation of a question which, though nuanced, may not necessarily be considered as important as current priority topics in child development research such as child malnutrition, infectious diseases, and poverty (Richter et al. Lancet 2017;389:103–18). The public health message of such work cannot be underestimated and will, I hope, reassure pregnant women about the safety of regular, moderate intensity exercise during pregnancy in the context of their children’s developmental abilities.Well-conducted obstetric RCTs are more likely than non-randomised studies to produce similar comparison groups, and are therefore particularly suited to estimating the effects of antenatal interventions, including on the developing brain whose most sensitive period is during the first 1000 days of life. As a paediatrician and a researcher in international early child development, I am acutely aware of the technical and logistical challenges of comprehensive, standardised neurodevelopmental assessments. I commend the authors of this paper for assessing multiple dimensions of child development, including motor, language, and social skills, executive function and emotional/behavioural problems, in children aged 7 years. The authors chose to utilise the 90th percentile cut-off in their own control group to characterise problem scores, rather than using the Five to Fifteen’s scales' Swedish references (Trillingsgaard et al. Eur Child Adolesc Psychiatry 2004;13:39–63). It is unfortunate that there is a lack of international standards for child development testing. Although international standards exist to monitor growth in utero and during early childhood (Papageorghiou et al. Lancet 2014;384:869–79; WHO Multicentre Growth Reference Study, and deOnis. Acta Paediatr 2006;95:76–85), no comparable standards as yet exist for child development: researchers and clinicians must therefore select one among many region-specific references, or create their own set of norms. Such un-standardised practice results in a plethora of references with little cross-population applicability, confounding true comparisons between studies and raising questions about the validity of findings; a limitation that even well-conducted RCTs cannot overcome.Despite these challenges, the long-term developmental follow up of children enrolled in obstetric RCTs provides unique opportunities to answer nuanced questions of scientific, clinical, and public interest which may not otherwise be addressed, as elegantly demonstrated in this paper by Ellingsen et al
Does prenatal maternal depression predict foetal and infant development? A study of mothers and infants in rural South India
Full text linkIntroduction: Prenatal maternal depression is associated with an increased risk of psychopathology in childhood. The understanding of the mechanisms underlying this association is limited. Further, despite high rates of prenatal depression in the developing world, no research investigating this issue exists from these settings.Objectives: The primary objectives of this thesis are to study the association between prenatal maternal depression and the following early offspring outcomes in a non-smoking, non-alcohol consuming prenatal sample from rural, South India:i. Foetal stress responsivity, measured through foetal heart rate (FHR)ii. Infant stress responsivity, measured through infant cortisol response to immunisationiii. Infant temperament.Methods: 194 pregnant women from Solur, India were assessed for depression. The first 67 mothers with elevated symptoms of prenatal depression and the first 66 controls underwent FHR monitoring to study foetal stress responsivity. 58 mother-infant dyads returned at 1.5-3 months post birth. Infant salivary cortisol was measured before and after immunisation. Information on infant temperament and maternal postnatal depression (PND) was also collected.Results: Twenty nine mothers (14.9%) met a diagnosis of major depression during pregnancy while 67 (34.5%) had elevated symptoms of prenatal depression.Whilst there were no linear association between prenatal depression and foetal responsivity, a curvilinear (U shaped) association existed with the foetuses of mothers with very high and very low levels of prenatal depression having elevated stress responses compared to those with moderate levels of prenatal depression.Prenatal depression predicted infant cortisol responsivity independent of PND (B=13.08, p=0.02).The relationship between infant cortisol responsivity and prenatal depression was also U shaped.There was no association between prenatal depression and infant temperament.Conclusions: This is the first study from the developing world investigating the relationship between prenatal depression and offspring outcomes. It provides evidence suggestive of the programming influence of prenatal depression on the developing offspring
Neurodevelopmental outcomes of extremely preterm infants: theoretical and epidemiological perspectives to guide shared-care decision-making
No full textAlthough births below 28 completed weeks' of gestation contribute to less than 1% of all preterm births globally, the impact of extreme prematurity (EPT) on neurodevelopmental outcomes across the life-course is disproportionately large. Higher rates and increased severity of neurodevelopmental impairments (NDIs) are reported among extremely preterm infants (EPIs). Cognitive skills, motor skills (manifesting as cerebral palsy) and vision are most commonly affected, with effects pervasive throughout school, adolescence and early adulthood. In addition, poorer academic outcomes and higher rates of psychiatric morbidity are seen among EPTs. Consistent improvements in EPI survival in recent years has not been matched with improvements in neurodevelopmental outcomes, especially for those born at less than 25 gestational weeks. However, over the last 20 years, several national and cross-national cohort studies have helped advance our understanding of extreme prematurity's developmental and life-course consequences. Here we provide an overview of the key findings from 13 multi-centre cohorts measuring neurodevelopmental outcomes and discuss the theoretical and epidemiological perspectives of NDIs in the context of extreme prematurity to guide communication with families and shared care decision-making
Addressing racial inequities in neuropsychological assessment requires international prescriptive standards, not demographically adjusted norms.
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Family care indices and linear growth predict INTER-NDA scores for child development at age 2 years: findings from the “Women First” trial
No full textObjectives: nutrition during fetal and early postnatal life impacts brain development, however evidence from randomized trials from low-and-middle-income countries (LMIC) is limited. We evaluated effects of maternal nutrition supplementation before and during pregnancy on neurodevelopment and vision in children from 4 LMIC with high rates of stunting, using a simplified assessment tool.Methods: Women First was an individually randomized trial comparing the impact of maternal nutrition supplementation initiated preconception vs at ∼12 wk gestation vs no supplement; interventions were discontinued at delivery in trial sites in Democratic Republic of the Congo, Guatemala, India, and Pakistan. Neurodevelopment and visual acuity and visual contrast sensitivity were assessed at 24 mo using the INTER-NDA and the Cardiff tests, respectively, in a random sub-set, representing ∼1/3 of infants with valid birth measurements from the WF trial. Anthropometry and Family Care Indicators (FCI) were also obtained at 24 mo.Results: 667 and 634 children (91% and 86% of sub-set) were included in INTER-NDA and vision analyses. Arm-proportionate contribution was 32.2–32.8%. Overall, we observed the following percentage of children with delays: 66.6% cognitive; 87.4% fine motor; 91.3% gross motor; and 11.7% language; 25.9% had positive behavior problems; and 26.0% and 21.0% had low acuity and contrast sensitivity scores, respectively. WF intervention arm was not significant for INTER-NDA scores, rates of mild-to-moderate or severe delay (F = 0.004–1.518, p = 0.28–0.99; X2 = 3.81–5.92, p = 0.18–0.42; X2 = 3.81–6.33, p = 0.18–0.43); or for low acuity and contrast sensitivity (X2 = 0.91, p = 0.63 and X2 = 1.64, p = 0.44). LAZ24mo was significantly associated with cognitive, motor, language, and behavior scores; maternal education predicted cognitive, language, and vision; and FCI was significantly associated with fine motor, language, and behavior after adjusting for other covariates (R2 0.33 cognitive; 0.40 language; 0.12 motor; 0.05 positive and 0.11 negative behavior; and 0.31–0.34 for vision models).Conclusions: the findings highlight the association between child development, linear growth, and family environment
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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