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To study the agreement between three tests for aspiration, barium videofluoroscopy, salivagram, and milk scan we studied 63 children with severe non-ambulant spastic quadriplegic cerebral palsy (CP) aged 14 months to 16 years (32 males, 31 females). The salivagram was most frequently positive (56%, 95% confidence interval 43 to 68%); the next most frequently positive was barium videofluoroscopy when aspiration was defined as the presence of either laryngeal penetration of material or frank aspiration (39%, 95% confidence interval 26 to 53%). The milk scan was rarely positive (6%, 95% confidence interval 2 to 16%). Agreement between the tests of aspiration was poor. The maximum agreement (kappa=0.20) was between aspiration as diagnosed with the salivagram and by barium videofluoroscopy. Positive tests for aspiration are frequent in children with severe CP. Frequency varies widely depending on the investigation used. There is poor agreement between tests used for the diagnosis of aspiration. This information is of importance in assessing the significance of test results. [ABSTRACT FROM AUTHOR]

Many children in developing countries survive on a nutritionally inadequate diet. Dietary inadequacies during the complementary feeding period can be prevented by using complementary food supplements (CFSs) such as water dispersible or crushable micronutrient tablets, micronutrient sprinkles added to food just before feeding, or fortified spreads added to food just before feeding or fed as a snacks. A meeting was convened to discuss technical and operational issues related to the development of these new approaches and to identify knowledge gaps. The technical issues covered: what micronutrients to include, tolerable upper intake limits, bioavailability, micronutrient and macronutrient stability, package systems and amounts, encapsulation technologies, methods to limit or eliminate allergens, bacterial and chemical contamination, interactions between CFSs and complementary foods, and flavoring agents. Operational issues included: identifying the market positioning of CFSs, cost positioning of CFSs, regulatory requirements, CFS production and technology transfer, quality assurance, and public-private sector partnership and coordination. Intervention trials are needed to determine the efficacy of CFSs in preventing micronutrient deficiencies. Other important knowledge gaps relate to technical and operational issues. Sprinkles and tablets are produced using well-known technologies, but further research is needed to modify them for use as CFSs. Spread development is not as advanced as sprinkle and tablet development, and further research is needed to improve the technology. Although none of the products is ready for widespread use, enough information is available to set research priorities and accelerate product development and implementation. [ABSTRACT FROM AUTHOR]

Introducing commercial milk formula (CMF) as prelacteal feeds can disturb exclusive breastfeeding and shorten breastfeeding duration. However, the prelacteal feeding of CMF has been growing alongside its increasing sales in Indonesia. This study examined predictors of the CMF feeding in the Malang and Sidoarjo districts of Indonesia. This analysis used post-delivery data collected from 676 mothers in a cohort evaluation of a cluster randomised controlled trial (Baduta study). Multivariate random effects logistic models were employed to assess factors associated with the CMF feeding. A total of 467 (69.1%) respondents reported giving CMF to their infants during the first 3 days after delivery. Mothers with low breastfeeding self-efficacy (BFSE) were at a higher risk of providing CMF within 3 days of birth compared to those with medium or high BFSE (adjusted odds ratio (aOR) 8.12; 95% confidence interval (CI) (4.26-15.48). Receiving explanations to solve breastfeeding problems from health professionals (aOR: 1.87; 97% CI: 1.12-3.11) and primipara parity (aOR: 1.71; 95% CI: 1.12-3.04) were positively associated with the CMF feeding. Early initiation of breastfeeding (EIBF) was protective against CMF feeding (aOR: 0.40; 95% CI: 0.22-0.58). There was an interaction between EIBF and BFSE. EIBF was protective among mothers with high or medium BFSE, but had no effect among those with low BFSE. CMF feeding was prevalent in Indonesia. Future strategies should focus on improving health-staff capacity to strengthen BFSE during pregnancy and provide adequate counselling for mothers with breastfeeding problems., (© 2024 The Author(s). Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

To address high rates of malnutrition among children from vulnerable households in Rwanda, the government initiated a national food supplementation programme. A before and after evaluation, using repeat cross-sectional surveys in randomly selected villages was conducted; aimed at assessing the effectiveness of providing fortified blended food (FBF) to children 18-23 months of age, pregnant and lactating women in the lowest tier of Rwanda's social support system. Data were collected in 2017, 2018 and 2021 through interviews with caregivers; anthropometric measurements and a capillary blood sample were obtained from children. The primary statistical analysis compared the nutritional status of children before and after the introduction of FBF. We enroled 724 children during each survey. The prevalence of stunting declined from 47% to 35% between 2017 and 2021; in 2018, the prevalence of stunting was 43%. Children had a 42% reduction in the odds of being stunted (adjusted odds ratio [AOR]: 0.58, 95% confidence interval [CI]: 0.47-0.74, p < 0.001) from 2017 to 2021 even after adjusting for inherent, distal, proximal, and intermediate covariates. The reduction in stunting observed within the first year of the programme was not statistically significant (AOR: 0.83, 95% CI: 0.67-1.03, p < 0.091). We observed meaningful reductions in the prevalence of stunting among children which coincided with the introduction of Government-led initiative to reduce malnutrition. The Rwandan Government has committed to improving the living conditions of vulnerable households and has made strong investments in reducing malnutrition. The impact of these investments can be seen in the overall trend towards improved nutritional status highlighted in this evaluation., (© 2024 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

Suboptimal infant young child feeding practices are frequently reported globally, including in Indonesia. This analysis examined the impact of a package of behaviour change interventions on breastfeeding practices in Malang and Sidoarjo Districts, East Java Province, Indonesia. The BADUTA study (which in the Indonesian Language is an acronym for BAwah DUa TAhun, or children aged less than 2 years) was an impact evaluation using a cluster-randomized controlled trial with two parallel treatment arms. We conducted household surveys in 12 subdistricts from Malang and Sidoarjo. We collected information from 5175 mothers of children aged 0-23 months: 2435 mothers at baseline (February 2015) and 2740 mothers at endline (January to February 2017). This analysis used two indicators for fever and diarrhoea and seven breastfeeding indicators (early initiation of breastfeeding, prelacteal feeding, exclusive breastfeeding under 6 months, predominant breastfeeding, continued breastfeeding, age-appropriate breastfeeding and bottle-feeding). We used multilevel logistic regression analysis to assess the effect of the intervention. After 2 years of implementation of interventions, we observed an increased odds of exclusive breastfeeding under 6 months (adjusted odds ratio [aOR] = 1.85; 95% confidence interval [CI]: 1.35-2.53) and age-appropriate breastfeeding (aOR = 1.39; 95% CI: 1.07-1.79) in the intervention group than in the comparison group, at the endline survey. We found significantly lower odds for prelacteal feeding (aOR = 0.52; 95% CI: 0.41-0.65) in the intervention than in the comparison group. Our findings confirmed the benefits of integrated, multilayer behaviour change interventions to promote breastfeeding practices. Further research is required to develop effective interventions to reduce bottle use and improve other breastfeeding indicators that did not change with the BADUTA intervention., (© 2022 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

Background For patients with hypoplastic left heart syndrome, digoxin has been associated with reduced interstage mortality after the Norwood operation, but the mechanism of this benefit remains unclear. Preservation of right ventricular (RV) echocardiographic indices has been associated with better outcomes in hypoplastic left heart syndrome. Therefore, we sought to determine whether digoxin use is associated with preservation of the RV indices in the interstage period. Methods and Results We conducted a retrospective cohort study of prospectively collected data using the public use data set from the Pediatric Heart Network Single Ventricle Reconstruction trial, conducted in 15 North American centers between 2005 and 2008. We included all patients who survived the interstage period and had echocardiographic data post-Norwood and pre-Glenn operations. We used multivariable linear regression to compare changes in RV parameters, adjusting for relevant covariates. Of 289 patients, 94 received digoxin at discharge post-Norwood. There were no significant differences in baseline clinical characteristics or post-Norwood echocardiographic RV indices (RV end-diastolic volume indexed, RV end-systolic volume indexed, ejection fraction) in the digoxin versus no-digoxin groups. At the end of the interstage period and after adjustment for relevant covariates, patients on digoxin had better preserved RV indices compared with those not on digoxin for the ΔRV end-diastolic volume (11 versus 15 mL, P =0.026) and the ΔRV end-systolic volume (6 versus 9 mL, P =0.009) with the indexed ΔRV end-systolic volume (11 versus 20 mL/BSA 1.3 , P =0.034). The change in the RV ejection fraction during the interstage period between the 2 groups did not meet statistical significance (-2 versus -5, P =0.056); however, the trend continued to be favorable for the digoxin group. Conclusions Digoxin use during the interstage period is associated with better preservation of the RV volume and tricuspid valve measurements leading to less adverse remodeling of the single ventricle. These findings suggest a possible mechanism of action explaining digoxin's survival benefit during the interstage period.

Purpose: To examine the interplay between pain and disability in arthritis when adjusting for patient heterogeneity in pain progression. There is consistent evidence to suggest that people experience osteoarthritis heterogeneously, with subgroups of people having different trajectories of pain. However, at present it is unclear how these pain trajectories are related to functional disability. We ask the question: Do levels of disability track changes in pain across different pain trajectories?, Methods: Secondary analysis of a subset (n = 889) from a cohort of older English adults, representative of the general population (the English Longitudinal Study of Ageing). The relationship between pain and functional disability was compared in three domains of disability: mobility, activities of daily living (ADL) and instrumental ADL. These represent increasingly complex forms of self-care required for independent living. Data analysis compared the heterogeneous analysis of pain (different trajectories) and disability compared to treating pain as a simpler homogenous construct., Results: On a population level, pain was significantly positively correlated with increased disability in all three domains, and the relationship remained stable over time. However, when heterogeneity was examined respondents whose pain improved did not show a corresponding improvement in disability in two domains (ADL and mobility)., Conclusions: These findings highlight how, for some people, alleviating pain, the main symptom of arthritis, might not prevent the persistence or progression of disability. Even when pain improves, further interventions that improve disability are likely to be required. Statement of contribution What is already known on this subject? Pain and functional limitation in daily living are common symptoms of arthritis. Arthritis pain is heterogeneous - there are trajectories of people whose pain gets better or worse. However, to date no study has looked at the relationship between trajectories of arthritis pain and functional disability outside of the minority of people with rheumatoid arthritis. What does this study add? Treating pain as heterogeneous explained disability better than treating pain as a single entity. Respondents in a trajectory of worsening pain reported functional disability in two domains (mobility and activities of daily living) also got worse over time. People in a trajectory of decreasing pain over time did not experience a reduction in disability, despite pain being the most common reason for why people limit their daily functioning. This suggests further intervention is required for people with arthritis, even when the most visible symptoms have been alleviated., (© 2019 The Authors. British Journal of Health Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.)

Background: The role of exercise stress echocardiography (ESE) in the pediatric population is less well defined as compared to adults. We aimed to determine the utility and impact of ESE on clinical decision-making in pediatric patients., Methods: We identified patients who underwent an ESE at our center from 2011 to 2015. Test indications were categorized into symptoms with exercise; sports/activity clearance; hypertrophic cardiomyopathy (HCM) or suspected HCM; coronary anomalies; or abnormal electrocardiogram (EKG). Change in clinical management was assessed by comparing pre- and post-test activity restrictions, which were categorized into unrestricted from exercise or activity; restricted from exercise or activity; and surgical referral., Results: During the study period, 353 ESEs met inclusion criteria. Of all ESEs performed, 263 (75%) were normal. Clinical management changed as a result of ESE in 144 (40%). Of the abnormal ESEs, 44 were restricted from activity, including 25 (56.8%) restricted from competitive or varsity athletics, 14 (31.8%) restricted from recreational sports, and 5 (11.4%) restricted from all activity. Surgical referrals included valve repair/replacement in 7 (50%), ICD placement in 5 (35.8%), coronary re-implantation in 1 (7.1%), and atrial septal defect repair in 1 (7.1%)., Conclusion: Exercise stress echocardiography provides the pediatric cardiologist with useful information that impacts management in a wide variety of cardiac disorders. Clinical management changed in nearly half the patients that were subjected to an ESE at our center. This supports the value of ESE for informing clinical decision-making. Future studies should aim to refine patient selection and examine its impact on patient outcomes., (© 2019 Wiley Periodicals, Inc.)

Objectives: The cortisol awakening response (CAR) and cortisol reactivity to an acute laboratory stressor both involve steep increases in cortisol secretion and are associated with preparing the body to deal with stressors ahead. Alterations in both have been linked to negative clinical and health outcomes. However, these two aspects of our biological stress response have rarely been directly compared, and the extant research focuses on state, rather than trait CAR. Given the similar roles of the CAR and cortisol reactivity, and their relationships to psychopathology, it is important to understand whether trait CAR and cortisol reactivity to acute stressors are related and whether a blunted CAR may be predictive of blunted cortisol reactivity across an acute laboratory stress task., Design: Cross-sectional. Participants completed the Trier Social Stress Test (TSST) the week after daily assessment of the CAR., Methods: Salivary cortisol secretion across the TSST was compared to the CAR, sampled across five weekdays at waking (S1) and 30 min past waking, for 54 female participants., Results: A smaller CAR, lower peak cortisol, and blunted CAR increase were all significantly related to a steep rise and flattened slope of recovery in cortisol secretion following the TSST. Additionally, lower S1 was predictive of a blunted rise in cortisol secretion from baseline to immediately post-task., Conclusion: There was a significant relationship between trait CAR and cortisol secretion across the TSST. The results provided mixed support for hypotheses. A blunted CAR was associated with impaired recovery in cortisol secretion following the TSST, but, surprisingly, a rapid rise in cortisol peaking immediately following the stress task. Statement of contribution What is already known on this subject? The CAR and cortisol reactivity to an acute laboratory stress task both are thought to marshal the body's resources to deal with stress. Both the CAR and cortisol reactivity have been related to psychosocial states and clinical and health outcomes in past research. State CAR has been linked to cortisol reactivity to stressors, and a greater CAR is thought to help an individual deal with stressors in the day ahead. What does this study add? The current study predicts trait CAR sampled across multiple days from the rise and recovery in cortisol secretion across an acute stress test. Comparison of trait CAR and cortisol reactivity may clarify both their relationship to each other and to clinical and health outcomes., (© 2019 The British Psychological Society.)

The adverse health impacts of early infant stunting can be partially ameliorated by early catch-up growth. Few studies have examined predictors of and barriers to catch-up growth to identify intervention points for improving linear growth during infancy. This study aimed to estimate the prevalence of, and factors associated with, catch-up growth among infants in Pakistan. A longitudinal study of mother-infant dyads (n = 1,161) was conducted in rural Sindh province, with enrolment between December 2015 and February 2016 (infants aged 0.5-3 months), and follow-up (n = 1035) between November 2016 and January 2017 (infants aged 9-15 months). The outcome was catch-up growth (change in conditional length-for-age z-scores >0.67 between baseline and endline). Associated factors were examined using multivariable logistic regression analyses. The prevalence of stunting was 45.3% at baseline and 60.7% at follow-up. 22.8% of infants exhibited catch-up growth over this period. Factors positively associated with catch-up growth included maternal height (odds ratio (OR) = 1.08 [1.05-1.11]), household wealth (OR = 3.61 [1.90-6.84]), maternal (OR = 2.43 [1.30-4.56]) or paternal (OR = 1.46 [1.05-2.03]) education, and households with two or more adult females (OR = 1.91 [1.26-2.88]). Factors negatively associated with catch-up growth were two (OR = 0.64 [0.45-0.89]) or three or more (OR = 0.44 [0.29-0.66]) preschool children in the household and the infant being currently breastfed (OR = 0.59 [0.41-0.88]). Catch-up growth was exhibited among approximately a quarter of infants despite living in challenging environments associated with extremely high rates of early infant stunting. Several modifiable factors were identified that might represent suitable programme intervention points to off-set early infant stunting in rural Pakistan., (© 2018 The Authors. Maternal and Child Nutrition Published by John Wiley & Sons, Ltd.)

In Nepal, more than one-third of children are stunted. Prior studies have shown that women's empowerment in agriculture is associated with child (<2 years) length-for-age z-scores (LAZ) in Nepal. This study tests whether child dietary diversity (DD) and household water, sanitation, and hygiene (WASH) facilities and practices mediate the associations between women's empowerment and LAZ. With a cross-sectional dataset of 4,080 households from 240 rural communities across 16 districts of Nepal, we used ordinary least squares regression models to first estimate the associations between women's empowerment and LAZ for children 6 to 24 months (n = 1,402; our previous published analysis included all children <24 months of age), using the Women's Empowerment in Agriculture Index's Five Domains of Empowerment subindex. We used standardized structural equation models to test whether child DD and/or household WASH mediated the association between women's empowerment and child LAZ. Overall, women's empowerment was positively associated with child LAZ (β = 0.24, P = 0.03), as found in our previous analyses. In the mediation analysis, women's empowerment was positively associated with WASH (β = 0.78, P < 0.001), and in turn child LAZ (β = 0.09, P < 0.001). Women's empowerment was not associated with DD, but DD was associated with LAZ (β = 0.06, P = 0.05). Empowered women had better WASH practices than nonempowered women, which translated into higher child LAZ. Child DD was not a mediating factor in the association between women's empowerment and child LAZ. More research is needed to explore other pathways by which women's empowerment may affect child nutrition outcomes., (© 2018 John Wiley & Sons Ltd.)

In low-resource settings, such as rural Malawi, pregnant women are prone to energy and micronutrient deficiencies with the consequence of delivering low-birth weight infants with higher risks of morbidity and mortality. This study aimed to examine the association between maternal dietary intakes during pregnancy and infant birth size. Dietary intakes of 203 pregnant women were assessed between 28 and 35 weeks of gestation and their infants' (n = 132) birth size measured. Intakes of energy, macronutrients, and 11 micronutrients were estimated using a 3-day interactive 24-hr diet recall. Semiquantitative data on food intakes for four additional days were also collected to assess food patterns. Using multilevel linear regression modeling, maternal intakes of carbohydrate were negatively associated with neonate length (β: -0.1; 95% CI: -0.2, 0.0 cm/E%) and abdominal circumference (β: -0.1, 95% CI: -0.2, 0.0 cm/E%), whereas intakes of fat were positively associated with neonate length (β: 0.1; 95% CI: 0.0, 0.2 cm/E%) and abdominal circumference (β: 0.1; 95% CI: 0.0, 0.2 cm/E%). Vitamin C intakes were positively associated with birth weight (β: 1.4; 95% CI: 0.5, 2.3 g/mg). The frequency of milk intake was positively associated with birth weight (β: 75.3; 95% CI: 13.6, 137.0 g/day). These findings offer practical suggestions for food-based interventions in the study area to promote inclusion of fat, vitamin C-rich foods, and milk in pregnancy., (© 2017 John Wiley & Sons Ltd.)

Poor quality infant and young child (IYC) diets contribute to chronic under-nutrition. To design effective IYC nutrition interventions, an understanding of the extent to which realistic food-based strategies can improve dietary adequacy is required. We collected 24-h dietary recalls from children 6-23 months of age (n = 401) in two rural agro-ecological zones of Kenya to assess the nutrient adequacy of their diets. Linear programming analysis (LPA) was used to identify realistic food-based recommendations (FBRs) and to determine the extent to which they could ensure intake adequacy for 12 nutrients. Mean nutrient densities of the IYC diets were below the desired level for four to nine of the 10 nutrients analysed, depending on the age group. Mean dietary diversity scores ranged from 2.1 ± 1.0 among children 6-8 months old in Kitui County to 3.7 ± 1.1 food groups among children 12-23 months old in Vihiga County. LPA confirmed that dietary adequacy for iron, zinc and calcium will be difficult to ensure using only local foods as consumed. FBRs for breastfed children that promote the daily consumption of cows'/goats' milk (added to porridges), fortified cereals, green leafy vegetables, legumes, and meat, fish or eggs, 3-5 times per week can ensure dietary adequacy for nine and seven of 12 nutrients for children 6-11 and 12-23 months old, respectively. For these rural Kenyan children, even though dietary adequacy could be improved via realistic changes in habitual food consumption practices, alternative interventions are needed to ensure dietary adequacy at the population level., (© 2015 John Wiley & Sons Ltd.)

Women's disempowerment is hypothesised to contribute to high rates of undernutrition among South Asian children. However, evidence for this relationship has not been systematically reviewed. This review of empirical studies aims to: (1) synthesise the evidence linking women's empowerment and child nutritional status in South Asia and (2) suggest directions for future research. We systematically searched Global Health, Embase (classic and Ovid), MEDLINE, Campbell Collaboration, Popline, Eldis, Web of Science, EconLit and Scopus. We generated 1661 studies for abstract and title screening. We full-text screened 44 of these, plus 10 additional studies the authors were aware of. Only 12 studies fulfilled our inclusion criteria. We included English materials published between 1990 and 2012 that examined the relationship(s) of at least one women's empowerment domain and nutritional status among South Asian children. Data were extracted and synthesised within three domains of empowerment: control of resources and autonomy, workload and time, and social support. The results showed women's empowerment to be generally associated with child anthropometry, but the findings are mixed. Inter-study differences in population characteristics, settings or methods/conceptualisations of women's empowerment, and the specific domains studied, likely contributed to these inconsistencies. This review also highlights that different women's empowerment domains may relate differently to child nutritional status. Future research should aim to harmonise definitions of women's empowerment, which key domains it should include, and how it is measured. Rigorous evaluation work is also needed to establish which policies and programmes facilitate women's empowerment and in turn, foster child nutritional well-being., (© 2014 John Wiley & Sons Ltd.)

Background and Aims: Prenatal exposure to maternal cigarette smoking (PEMCS) is associated with a higher probability of substance use in adolescence. We explore if externalizing behavior mediates this relationship, while controlling for a number of potential covariates of this mediation process., Methods: We used data obtained in two geographically distinct community samples of adolescents. The first (cross-sectional) sample consisted of 996 adolescents (12-18 years of age) recruited from the Saguenay Youth Study (SYS) in Canada (47% with PEMCS). The second (longitudinal) sample consisted of 1141 adolescents (49% with PEMCS) from the Northern Finland Birth Cohort (NFBC1986). In both samples, externalizing behavior and substance use were assessed during adolescence. In the NFBC1986 cohort, externalizing behavior was also assessed in childhood., Results: In both populations, PEMCS is associated with a higher likelihood of adolescent drug experimentation. In the NFBC1986 cohort, exposed (versus non-exposed) adolescents experiment with an extra 1.27 [B = 0.24, 95% confidence intervals (CI) = 0.15, 0.33 P < 0.001] drugs. In the SYS cohort, a clear protective effect of not being exposed is shown: non-exposed (versus exposed) adolescents are 1.5 times [B = -0.42, 95% CI = -0.75, -0.09, P = 0.013] less likely to take drugs. These associations between PEMCS and drug experimentation remain in the multivariate and mediational analyses., Conclusions: Prenatal exposure to maternal cigarette smoking appears to be associated with a higher probability of experimenting with drugs during adolescence, both directly and indirectly via externalizing behavior and the number of peers reported as using drugs., (© 2014 Society for the Study of Addiction.)

Objectives: Higher conscientiousness (C) predicts better health outcomes. Recent research suggests that stress may play an important role in explaining this relationship. The current study aimed to establish whether C moderates the relationship between daily hassle appraisals, daily affect, and physical symptoms., Design and Methods: A daily diary design was used, where participants (N = 103) completed a baseline measure of C followed by a 14-day daily diary, providing daily details of hassles (primary and secondary appraisals) experienced as well as positive and negative affect and physical symptoms., Results: Hierarchical linear modelling revealed that Total C (as well as two facets of C: Order and Industriousness) moderated the relationship between stress appraisals and positive affect. Specifically, the negative association between the daily appraisal of hassles as stressful (i.e., where perceived demands outweighed perceived resources) and positive affect was stronger for lower and average levels of C, Order, and Industriousness. No significant moderated effects were found for negative affect or physical symptoms. The Order facet was also found to be an important factor predicting attrition., Conclusions: The current study provided evidence that C and two of its facets can moderate the relationship between hassle appraisal and positive affect. C may exert part of its influence on health by modifying the effects of daily stressors., Statement of Contribution: What is already known on this subject? Conscientiousness has a significant positive effect on longevity and health status. While the performance of health behaviours may partially account for this relationship, evidence suggests that it does not fully mediate the effect. Research has begun to look at stress as a possible additional explanatory variable, and there is evidence that Conscientiousness moderates the relationship between stress and health behaviours. What does this study add? Shows that Conscientiousness and two of its facets (Order and Industriousness) moderate the relationship between hassle appraisal and positive affect. Highlights the importance of studying lower order facets of personality in health research. Suggests that Conscientiousness may exert part of its influence on health by modifying the effects of daily stressors., (© 2013 The British Psychological Society.)

Suboptimal complementary feeding practices contribute to a rapid increase in the prevalence of stunting in young children from age 6 months. The design of effective programmes to improve infant and young child feeding requires a sound understanding of the local situation and a systematic process for prioritizing interventions, integrating them into existing delivery platforms and monitoring their implementation and impact. The identification of adequate food-based feeding recommendations that respect locally available foods and address gaps in nutrient availability is particularly challenging. We describe two tools that are now available to strengthen infant and young child-feeding programming at national and subnational levels. ProPAN is a set of research tools that guide users through a step-by-step process for identifying problems related to young child nutrition; defining the context in which these problems occur; formulating, testing, and selecting behaviour-change recommendations and nutritional recipes; developing the interventions to promote them; and designing a monitoring and evaluation system to measure progress towards intervention goals. Optifood is a computer-based platform based on linear programming analysis to develop nutrient-adequate feeding recommendations at lowest cost, based on locally available foods with the addition of fortified products or supplements when needed, or best recommendations when the latter are not available. The tools complement each other and a case study from Peru illustrates how they have been used. The readiness of both instruments will enable partners to invest in capacity development for their use in countries and strengthen programmes to address infant and young child feeding and prevent malnutrition., (© 2013 John Wiley & Sons Ltd.)

Objectives: There is increasing use of counter-normative health messages (i.e., evidence-based health information about cause-effect relationships that run counter to shared normative beliefs, e.g., stress can lead to personal growth). The current studies examine the effect of normative and counter-normative messages about stress on levels of symptom reporting. Predictions are derived from reactance, social comparison, and self-enhancement theories., Method and Design: Two studies focus on the development of the messages, and two experimental studies examine the effect of manipulating normative and counter-normative messages on symptom reports. The final study controls for mere-measurement effects and explores the role of stress process variables (appraisals and coping)., Results: Exposure to a normative message (stress causes ill health) results in reduced symptom reporting compared to a counter-normative message (stress provides challenge, growth, and development) and control groups. The results suggest that people may use symptom reporting strategically to indicate coping. Based on the argument that beliefs about stress and health are stored as mental models, the theoretical associations derived from stress theory are only observed when a normative message is presented., Conclusions: Counter-normative stress messages may carry no tangible benefits compared to normative messages. Some stress research may suffer from inherent methodological bias when normative information is provided in information and consent sheets. Statement of contribution What is already known on this subject? At present, nothing is known about counter-normative health messages, despite the fact that they are becoming widely used as a public intervention. What does this study add? A clear operational definition of counter-normative messages. A test of three competing theories for counter-normative messages that focus of the stress-symptom link. Demonstrating for the first time, that in the domain of stress and health, counter-normative messages are at best ineffective. Demonstrating for the first time that only when the stress-coping-symptom links are made explicit do the theoretical associations observed in the literature emerge. This may be a potential methodological artefact in stress research that needs to be controlled., (© 2013 The British Psychological Society.)

Objectives: To test the prediction that Openness to Experience (O) is a protective factor with respect to all-cause mortality. To provide a method of calculating a standard effect size estimate (r(equivalent) ) from relative risk (RR) and odds ratios (OR)., Methods: A meta-analysis of 11 (N= 19, 941) studies linking O to all-cause mortality is reported. Analyses are conducted on the total sample and on sub-samples with and without other mortality risk factors (e.g., age, social class) controlled. The same analyses are also conducted on the studies that used indices of O based on standard measures of the five-factor model (FFM: NEO and Goldberg's adjective markers). This paper also provides a means of calculating an r(equivalent) from RR and OR., Results: The results show that for all studies O is a protective factor (r= .051) and this effect is slightly higher (r= .064) when only FFM measures are used. When risk factors are not controlled, the protective effect for O is .091 for all studies and .097 for FFM indices. However, a predicted attenuation is observed when standard mortality risk factors are controlled to .028 for all measures and .036 for FFM measures., Conclusions: While O is protective with respect to all-cause mortality, the effect is attenuated by other mortality risk factors and future work needs to explore the complex independent, moderating, and mediating processes linking O to all-cause mortality., (©2011 The British Psychological Society.)

Altruistic behaviour raises major questions for psychology and biology. One hypothesis proposes that human altruistic behaviour evolved as a result of sexual selection. Mechanisms that seek to explain how sexual selection works suggest genetic influence acting on both the mate preference for the trait and the preferred trait itself. We used a twin study to estimate whether genetic effects influenced responses to psychometric scales measuring mate preference towards altruistic traits (MPAT) and the preferred trait (i.e., 'altruistic personality'). As predicted, we found significant genetic effects influencing variation in both. We also predicted that individuals expressing stronger MPAT and 'altruistic personality' would have mated at a greater frequency in ancestral populations. We found evidence for this in that 67% of the covariance in the phenotypic correlation between the two scales was associated with significant genetic effects. Both sets of findings are thus consistent with the hypothesized link between sexual selection and human altruism towards non-kin. We discuss how this study contributes to our understanding of altruistic behaviour and how further work might extend this understanding.

Objective: Modern postgraduate medical training requires both accurate and reliable selection procedures. An essential first step is to conduct detailed job analysis studies. This paper reports data on a series of job analyses to develop a competency model for three secondary care specialties (anaesthesia, obstetrics and gynaecology, and paediatrics)., Methods: Three independent job analysis studies were conducted. The content validity of the resulting competency domains was tested using a questionnaire-based study with specialty trainees (specialist registrars [SpRs]) and consultants drawn from the three specialties. Job analysis was carried out in the Yorkshire and the Humber region in the UK. The validation study was administered with additional participants from the West Midlands and Trent regions in the UK. This was an exploratory study. The outcome is a set of competency domains with data on their importance at senior house officer, SpR and consultant grade in each specialty., Results: The study produced a model comprising 14 general competency domains that were common to all the three specialties. However, there were significant between-specialty differences in both definitions of domains and the ratings of importance attached to them., Conclusions: The results indicate that a wide range of attributes beyond clinical knowledge and academic achievement need to be considered in order to ensure doctors train and work within a specialty for which they have a particular aptitude. This has significant implications for developing selection criteria for specialty training. Future research should explore the content validity of these competency domains in other secondary care specialties.

Humans are often seen as unusual in displaying altruistic behaviour towards non-relatives. Here we outline and test a hypothesis that human altruistic traits evolved as a result of sexual selection. We develop a psychometric scale to measure mate preference towards altruistic traits (the MPAT scale). We then seek evidence of whether mate choice on the basis of altruistic traits is present and find it in one study (N=170 couples). We also predict that a stronger female MPAT, as measured by responses to the MPAT scale, will be expressed - a result found in all three studies (Ns=380, 340, and 398). Both sets of results are consistent with the hypothesized link between human altruism towards non-relatives and sexual selection.

Objective: This study aimed to examine whether a graduate entry course widens access to medicine., Methods: We carried out a retrospective study at the University of Nottingham Medical School of socio-demographic and academic data collected by the Universities and Colleges Admission Service (UCAS). Study participants comprised all applicants to the 5-year (mainly school-leavers) and 4-year (graduates only) medical courses for admission in October 2003., Results: In 2002-03, there were 2392 applicants for the 5-year course and 1235 applicants for the 4-year course. Significantly, applicants for the 4-year course comprised more males, were more socio-economically deprived and had lower UCAS tariff point scores compared with applicants for the 5-year course. These differences were preserved in those students who eventually started on either of the 2 courses in October 2003 (254 and 94 students for the 5- and 4-year courses, respectively). Comparing entrants with non-entrants (mainly rejected students), those joining the 5-year course were younger, were less socio-economically deprived, were more likely to be White and had higher UCAS tariff point scores than non-entrants, but there were no significant gender differences. Those joining the 4-year course were more likely to be White and had higher UCAS tariff point scores than non-entrants. By contrast with entrants to the 5-year course, entrants to the 4-year course were significantly older than non-entrants., Conclusions: Graduate entrants to medicine widen academic and socio-demographic diversity in the medical school student population.

People respond differently when information is framed either positively or negatively (frame valence). Two prominent models propose that the effects of valence are moderated by (1) the method of framing (attributes vs. goals: Levin, Schneider, & Gaeth, 1998) and (2) perceived risk (Rothman & Salovey, 1997). This experiment (N=200) explores the joint influence of both of these moderators with respect to decisions about a flu vaccination. The study extends previous work by integrating these two models and exploring the moderating effects of two different aspects of perceived risk (personal outcome effectiveness and procedural risk). The results show that personal outcome effectiveness indirectly links frames to intentions. Procedural risk moderates the relationship between valence and method in a manner consistent with predictions from Levin et al.. Partial support for the model proposed by Rothman and Salovey are observed for goal frames only.

Background: In the United Kingdom medical students are selected predominantly on their academic merit. Their academic achievement marks are equated via the tariff point score structure administered by the Universities and Colleges Admissions Service (UCAS). We studied the applicant databases for 1998-2003 for one English medical school to determine the factors that predict high tariff point scores., Methods: Complete demographic data and relative socio-economic status, educational institution attended and tariff point score was available for 8997 UK applicants aged 21 years or younger to the 5-year Bachelor of Medicine/Bachelor of Surgery (BM BS) course at Nottingham University medical school (and partially complete data for a further 1891 applicants). The data were subjected to standard univariate and multivariate analyses and to path analysis., Results: In these samples, the independent predictors of a high tariff point score were being younger and male. The effect sizes were small, although significant. Higher tariff point scores were achieved by those from households less materially disadvantaged. Ethnicity was also a predictor with white, Chinese and those of mixed ethnic origin achieving higher tariff point scores than those from other groups. Finally, the type of school attended predicted academic achievement with applicants from further education colleges, independent schools and grant-maintained schools achieving higher tariff point scores., Conclusion: Notwithstanding the relatively homogeneous (predominantly young, white, high academic achievers) applicant pool to a single UK medical school we identified consistent significant predictors of high tariff point scores. As high tariff point scores are still the major entry criterion to UK medical schools, our findings will be of value in informing policy decisions concerning 'widening access' schemes being established at government request.

Maternal alcohol or tobacco consumption may negatively impact the fetus and breastfeeding infants. Maternal tobacco consumption is also known to negatively affect exposed young children. The current study therefore aimed to assess the prevalence of these lifestyle behaviours in a sample of 6-24-months post-partum women and to elucidate socio-demographic and maternal factors associated with these behaviours. A community-based cross-sectional survey was conducted on 6-24-months post-partum women (n = 318) in three cities in the South Island of New Zealand. Self-reported data on current alcohol and tobacco consumption were collected from these women using a self-administered questionnaire. The results showed that nearly 72% and 23% of these women consumed alcohol and tobacco, respectively. Being Caucasian, having a higher level of education and higher household income were significant factors for alcohol consumption, while being of younger age and of lower educational status were significant factors for tobacco consumption. Pregnancy was associated with lower odds for alcohol consumption (0.07; P < 0.001), but not with lower odds for tobacco consumption. In contrast, breastfeeding was not associated with lower odds of alcohol consumption (0.08; P = 0.075). In conclusion, younger women with lower levels of education and household income must be targeted for public health education on the negative effects of tobacco consumption on their own health and on the health of their children.

Two studies are reported. Study one (N = 104) explored the extent to which male hormonal contraception is perceived as risky compared to other prevention behaviours. Study two examined the effects of message framing on intentions to use hormonal male contraception and investigated whether attitude moderates message framing effects. Three hundred and four participants read either a loss frame or gain frame message and then completed questionnaires assessing their intentions to use hormonal male contraception, stress appraisals and the theory of planned behaviour (TPB) variables. Exposure to a loss frame influenced intention to use the daily male pill in men with a more positive attitude. This suggests that attitude, but not other TPB variables or stress appraisals have the capacity to moderate framing effects. Stress appraisals, in addition to TPB variables, significantly predicted variance in behavioural intentions in men and women. These findings are discussed within the context of Prospect Theory, perceived risk and prevention/detection behaviours.

Objectives: Personality factors were used to explore aspects of blood donor behaviour (a form of prosocial volunteer behaviour). Based on the Big 5 model of personality, a number of mediation (via perceived control) and moderation hypotheses linking personality to aspects of blood donor behaviour (frequency, recency, rate and years of past behaviour) were explored., Design: A cross-section quasi-experimental survey of 630 blood donors., Method: Prior to donation, 630 donors completed measures of the Big 5 personality domains and donor history (frequency, recency, rate and years of past behaviour); after donation, they indicated levels of perceived procedural and emotional control., Results: There was no evidence that perceived control mediates the relationship between personality and behaviour. However, donors were able to express control in a low control context. For males, the relationship between years as a donor and both the frequency and the rate of donation were stronger for those higher in conscientiousness (C), whereas for females, emotional stability (ES) acted as the moderator. Recency and frequency of past behaviour were orthogonal., Discussion: The results extend previous work by showing that C (for males) and ES (for females) help to sustain behaviour over time. The recency and frequency of past behaviour assess qualitatively different aspects of past behaviour and this should be explored in future studies. These results have important practical implications for designing donor recruitment and retention interventions.

Theory: Non-specific or medically unexplained symptoms account for up to 35% of outpatient referrals. In contrast to the literature on affect, little is known about how people frame daily symptoms and how these patterns are influenced by individual differences., Method: Three fixed occasion diary studies over an 8-day period (one on ill veterans of the Gulf War and two on healthy undergraduates) and a single cross-sectional survey (on ill Gulf War veterans) were conducted. The severity and frequency of daily symptoms were assessed in all daily diary samples, together with the Big 5 personality domains in one of the undergraduate samples and in the survey of veterans. The data were analysed using auto-correlations and hierarchical multivariate linear modelling., Results: In all the chronically ill and healthy samples, the data suggested potential cyclical patterns for symptom severity reporting. With regard to the frequency of symptom reporting, the veterans showed a pattern of constant symptom reporting. Finally, the relationship between the reported severity of symptoms was attenuated by intellect and surgency., Discussion: There is evidence that daily experiences of symptom severity are framed relative to each other and this relationship is influenced by personality. The practical implications of these findings are discussed.

Background: Studies of causal attributions for difficult pupil behaviour in schools have tended to focus on the perspectives of teachers., Aims: The present study examines the causal attributions made by parents for difficult behaviour in classrooms. It reveals the structure of these attributions and serves as a direct comparison to a previous study of pupils' attributions (Miller, Ferguson, & Byrne, 2000) and, more indirectly, with the teacher studies., Sample: The participants were 144 parents (106 mothers and 38 fathers) whose children all attended the same inner city school., Method: A questionnaire was constructed following three initial small group interviews with parents to identify the wide range of factors they viewed as potential causes of difficult classroom behaviour. This was then administered to all the parents of children attending the same inner-city primary school., Results: Factor analysis indicated that parents' attributions for misbehaviour were best represented by three factors: (1) 'fairness of teachers' actions', (2) 'pupil vulnerability to peer influences and adverse family circumstances', and (3) 'differentiation of classroom demands and expectations'. While there were no differences between parents in terms of gender or ethnicity, they did see the first two factors as more significant contributors to pupil misbehaviour than the third., Conclusion: There is both agreement and conflict between parents' attributions and those made by pupils and by teachers. The implementation of policy initiatives, such as home-school agreements and Pastoral Support Programmes, risk exacerbating tensions and difficulties if these differences in attributions are not acknowledged and acted upon.

OBJECTIVES: The main objective of this paper is to explore the structural similarities between Eysenck's model of personality and the dimensions of the dispositional COPE. Costa et al. {Costa P., Somerfield, M., & McCrae, R. (1996). Personality and coping: A reconceptualisation. In (pp. 44-61) Handbook of coping: Theory, research and applications. New York: Wiley} suggest that personality and coping behaviour are part of a continuum based on adaptation. If this is the case, there should be structural similarities between measures of personality and coping behaviour. This is tested using a joint factor analysis of personality and coping measures. DESIGN: Cross-sectional survey. METHODS: The EPQ-R and the dispositional COPE were administered to 154 participants, and the data were analysed using joint factor analysis and bivariate associations. RESULTS: The joint factor analysis indicated that these data were best explained by a four-factor model. One factor was primarily unrelated to personality. There was a COPE-neurotic-introvert factor (NI-COPE) containing coping behaviours such as denial, a COPE-extroversion (E-COPE) factor containing behaviours such as seeking social support and a COPE-psychoticism factor (P-COPE) containing behaviours such as alcohol use. This factor pattern, especially for NI- and E-COPE, was interpreted in terms of Gray's model of personality {Gray, J. A. (1987) The psychology of fear and stress. Cambridge: Cambridge University Press}. NI-, E-, and P-COPE were shown to be related, in a theoretically consistent manner, to perceived coping success and perceived coping functions. CONCLUSIONS: The results indicate that there are indeed conceptual links between models of personality and coping. It is argued that future research should focus on identifying coping 'trait complexes'. Implications for practice are discussed.

Objectives: The main objective of this paper was to explore the associations between life-events and primary appraisals (threat, challenge and loss) controlling for depression. It was predicted that specific associations between life-events and primary appraisals would remain once depression had been partialled. A subgoal of this paper was to develop a content analytic coding frame for student life-events., Design: This study was a retrospective survey in which participants provided accounts of recent stressful encounters, and completed indices of primary appraisals and depression., Method: The participants were 979 undergraduates who provided descriptions of life-events. A subsample of 391 provided additional information on primary appraisals and depression. The primary outcomes were the partial correlations between life-events and primary appraisals., Results: There were significant associations between life-events and primary appraisals above and beyond variance explained by depression. Results also indicated that the definition of loss appraisals could be extended to include events that were related to anticipated future loss, especially if the event was also perceived as threatening. Also certain self-defined negative life-events were appraised as positive. Life-events were shown to vary systematically as a function of external constraints (e.g. stage of the academic year)., Conclusions: A variety of events were associated with loss appraisals and this may have implications for risk factors in depression.

Background: Studies of causal attributions within educational contexts have tended to concentrate on academic performance. There have been a smaller number of investigations of teachers' attributions for pupils' behaviour in school., Aims: The present study examines the causal attribution made by pupils for difficult behaviour in classrooms. It reveals the structure of these attributions and serves as a comparison with the teacher studies., Sample: The participants were 105 pupils (52 males and 53 females) in the first year of secondary schooling, all drawn from the same inner city school., Method: Four initial small group interviews were used to identify a wide range of factors that pupils viewed as being causes of difficult classroom behaviour in the 18 primary schools they had previously attended. A questionnaire was then constructed incorporating items from these discussions and administered to the whole of the year group of pupils, but omitting the participants in the initial group discussions., Results: The results of a factor analysis indicated that pupils' attributions for misbehaviour at school were best represented by four factors: (1) 'fairness of teacher's actions', (2) 'pupil vulnerability', (3) 'adverse family circumstances' and (4) 'strictness of classroom regime'. While there were no gender differences, pupils saw the 'fairness of teacher's actions' and 'pupil vulnerability' as more significant contributors to pupil misbehaviour than either 'adverse family circumstances' or 'strictness of classroom regime'., Conclusion: The attributions by pupils for difficult classroom behaviour differ markedly from those obtained in studies of teachers. Policy and practice initiatives which do not attend to conflicting attributional styles are unlikely to succeed in improving levels of pupil behaviour in schools.

The symptoms of Gulf War Syndrome (GWS) closely correspond to the physiological and behavioural sequelae of an interleukin-1 (IL-1) mediated sickness response. We propose that this response can account for the variability in its symptomatology. Furthermore, the persistence of GWS can be accounted for by an associative process, whereby the smells/tastes of war become linked with the physiological reaction to environmental stressors encountered in the Gulf and/or the 'cocktail' of drugs given to the soldiers. As required, the IL-1 response is conditionable.

Making a blood donation, especially for first-time donors, can be a stressful experience. These feelings of stress may inhibit donors from returning. This paper applies stress theory to this particular problem. The effects of a stress management intervention (the provision of music) and previous donor experience were examined in relation to pre- and post-donation mood, environmental appraisals and coping behaviour. Results indicated that the provision of music had detrimental effects on environmental appraisals for those who have donated up to two times previously, but beneficial effects for those who had donated three times before. These effects were, to an extent, moderated by coping processes but not perceived control. It is recommended that the provision of music is not used as a stress management technique in the context of blood donation.