1,720,962 research outputs found
Symptoms suggestive of COVID-19 in households with and without children: a descriptive survey
No full textSystematic review of fruit and vegetable voucher interventions for pregnant women and families with young children
No full textObjective: this systematic review aimed to explore the impact of food voucher schemes during pregnancy and early life on fruit and vegetable (F&V) consumption and explore experiences of schemes.Design: six electronic databases and grey literature sources were searched. Interventional, observational, qualitative and mixed methods studies published from January 2000 to April 2024 in English were included.Setting: food voucher interventions targeting F&V intake.Participants: low-income pregnant women and families with young children (aged under 5 years).Results: 7,344 peer reviewed records, and 103 grey literature documents were screened. Sixteen peer reviewed studies (across eighteen reports) and eight grey literature documents met the inclusion criteria. All studies took place in the UK or the USA. There was a lack of consistency across primary quantitative outcomes. Overall, F&V voucher schemes did appear to increase fruit and/or vegetable consumption, but confidence in this finding was low. Qualitative data was more consistent. F&V vouchers were used in three main ways; as a financial benefit to subsidise food already being purchased, to increase the quantity or variety of F&V purchased, or as a safety net, to be used to ensure that the family had something to eat.Conclusions: F&V vouchers may increase F&V intake and are positively received by recipients. This review also highlights some of the difficulties that researchers face in evaluating the impact of public health measures to improve population health. It is clear that more high quality research is required to better understand the impacts of F&V vouchers on individual outcomes
Maternal weight change between successive pregnancies: an opportunity for lifecourse obesity prevention
No full textMaternal obesity is a major risk factor for adverse health outcomes for both the mother and the child, including the serious public health problem of childhood obesity which is globally on the rise. Given the relatively intensive contact with health/care professionals following birth, the interpregnancy period provides a golden opportunity to focus on preconception and family health, and to introduce interventions that support mothers to achieve or maintain a healthy weight in preparation for their next pregnancy. In this review, we summarise the evidence on the association between interpregnancy weight gain with birth and obesity outcomes in the offspring. Gaining weight between pregnancies is associated with an increased risk of large-for-gestational age (LGA) birth, a predictor of childhood obesity, and weight loss between pregnancies in women with overweight or obesity seems protective against recurrent LGA. Interpregnancy weight loss seems to be negatively associated with birthweight. There is some suggestion that interpregnancy weight change may be associated with preterm birth, but the mechanisms are unclear and the direction depends if it is spontaneous or indicated. There is limited evidence on the direct positive link between maternal interpregnancy weight gain with gestational diabetes, pre-eclampsia, gestational hypertension and obesity or overweight in childhood, with no studies using adult offspring adiposity outcomes. Improving preconception health and optimising weight before pregnancy could contribute to tackling the rise in childhood obesity. Research testing the feasibility, acceptability and effectiveness of interventions to optimise maternal weight and health during this period is needed, particularly in high-risk and disadvantaged groups.</p
Associations between mode of delivery and offspring overweight/obesity: findings from the studying lifecourse Obesity PrEdictors (SLOPE) population-based cohort
No full textBackground: Childhood obesity affects one in ten children in England by age 5, and one in five by age 11. Existing evidence suggests a possible relationship between caesarean section (CS) birth and higher risk of overweight/obesity in childhood, however maternal obesity is a strong confounder in this relationship. With CS rates rising by 4% globally per year, we aimed to examine the relationship between mode of delivery and overweight/obesity in childhood.
Methods: SLOPE is a linked population-based cohort of anonymised routine antenatal, birth and child healthcare records in Hampshire, UK (2003–2018). Delivery method was categorised into unassisted vaginal delivery, assisted vaginal delivery and CS (including elective and emergency). Child body mass index (BMI) was measured as part of the National Child Measurement Programme in England. Children were identified as overweight/obese if their age- and sex-adjusted BMI was above the 85th percentile. Generalised linear modelling for outcome at two time points; 4–5 years (n=30,229) and 10–11 years (n=14,305) was conducted, adjusting for clustering within families. Modelling was introduced in stages with the choice of covariates informed by a Directed Acyclic Graph, first adjusting for maternal BMI, then adding in confounders including maternal age, ethnicity, educational attainment, parity, smoking status at booking appointment, pre-eclampsia, and previous CS (model C) and then birthweight and gestational age at birth as potential mediators (model M). Analyses were also stratified by maternal BMI category (underweight: <18.5, normal weight: 18.5 to <25, overweight: 25 to <30, obese: ≥30 kg/m2) at booking.
Results: Of children delivered by CS, 25.0% and 33.7% were overweight/obese by 4–5 years and 10–11 years respectively, compared to 21.9% and 31.0% respectively with vaginal births. In unadjusted analysis, CS was associated with increased risk of overweight/obesity at 4–5 years (relative risk (RR) 1.13, 95% Confidence Interval (95% CI) 1.08–1.19), and at 10–11 years (RR 1.08, 95% CI 1.02–1.14), however both were attenuated by adjusting for maternal BMI. In stratified analyses, CS delivery was associated with increased risk of childhood overweight/obesity at 4–5 years only in normal weight women (model C: RR 1.15, 95% CI 1.04–1.27, model M: RR 1.14, 95% CI 1.02–1.26), but not in 10–11 year models.
Conclusion: Maternal weight status at the start of pregnancy is a strong confounder in the relationship between mode of delivery and childhood overweight/obesity. In stratified analyses, this association was evident only for children of normal weight women. If this relationship is causal, the potential mechanisms need to be explored
Maternal interpregnancy weight change and premature birth: findings from an English population-based cohort study
No full textBackground
The relationship between maternal weight change between pregnancies and premature birth is unclear. This study aimed to investigate whether interpregnancy weight change between first and second, or second and third pregnancy is associated with premature birth.
Methods
Routinely collected data from 2003 to 2018 from one English maternity centre was used to produce two cohorts. The primary cohort (n = 14,961 women) consisted of first and second live-birth pregnancies. The secondary cohort (n = 5,108 women) consisted of second and third live-birth pregnancies. Logistic regression models were used to examine associations between interpregnancy BMI change and premature births adjusted for confounders. Subgroup analyses were carried out, stratifying by initial pregnancy BMI groups and analysing spontaneous and indicated premature births separately.
Results
In the primary cohort, 3.4% (n = 514) of births were premature compared to 4.2% (n = 212) in the secondary cohort, with fewer indicated than spontaneous premature births in both cohorts.
Primary cohort
Weight loss (>3kg/m2) was associated with increased odds of premature birth (adjusted odds ratio (aOR):3.50, 95% CI: 1.78–6.88), and spontaneous premature birth (aOR: 3.34, 95%CI: 1.60–6.98), in women who were normal weight (BMI 18.5-25kg/m2) at first pregnancy. Weight gain >1kg/m2 was not associated with premature birth regardless of starting BMI.
Secondary cohort
Losing >3kg/m2 was associated with increased odds of premature birth (aOR: 2.01, 95%CI: 1.05–3.87), when analysing the whole sample, but not when restricting the analysis to women who were overweight or obese at second pregnancy.
Conclusions
Normal-weight women who lose significant weight (>3kg/m2) between their first and second live pregnancies have greater odds of premature birth compared to normal-weight women who remain weight stable in the interpregnancy period. There was no evidence of association between weight change in women who were overweight or obese at the start of their first pregnancy and premature birth
P03: a novel childhood obesity risk estimation tool: findings from mixed methods feasibility testing within an enhanced health visiting service
No full textBackground: childhood obesity is a pressing public health issue. A Childhood Obesity Risk Estimation tool (SLOPE CORE) has been developed based on prediction models using routinely available maternity and early childhood data to estimate risk of childhood obesity at 4–5 years. This study aimed to test the feasibility, acceptability and usability of SLOPE CORE within an enhanced health visiting service for disadvantaged families.Methods: a mixed methods approach was used. Purposively sampled Health Visitors (HVs) working within an enhanced health visiting programme were trained to use the tool. HVs then recruited parents from their caseload into the study (convenience sampling), used the tool and HVs completed a system usability scale (SUS) questionnaire. HVs and parents were invited to take part in interviews or focus groups to explore their experiences of the tool. Qualitative data was analysed using thematic analysis (using NVivo software).Results: five HVs and seven parents took part in the study. HVs found the SLOPE CORE tool easy to use with a mean SUS of 84.4 (n=4, range 70–97.5), indicating excellent usability. Five HVs and three parents took part in qualitative work. The tool was acceptable and usable for both parents and HVs. Parents expressed a desire to know their child’s risk of obesity, provided this was accompanied by additional information, or support, to modify risk. HVs appreciated the health promotion opportunity presented by the tool, and felt it facilitated difficult conversations around weight, by providing ‘clinical evidence’ for risk, placing the focus of the conversation onto the tool result, rather than their professional judgement. HVs were concerned that using the tool may negatively impact their relationship with the parent. After using the tool HVs agreed that, for the majority of parents, a sensitive approach would mitigate any potential negative impacts from using the tool. Potential barriers to use of the tool included the need for internet access, and concerns around time needed to have a sensitive discussion around a conceptually difficult topic (risk).Conclusion: the SLOPE CORE tool was found to be feasible and user-friendly in this small sample. The tool has the potential to add value in clinical practice, and may support targeting limited resources towards families most at risk of childhood obesity. Further research is needed to explore how the tool might be efficiently incorporated into practice, and to evaluate the impact of the tool, and any subsequent interventions, on preventing childhood obesity
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
- …
