5-year Olds Research Articles

Analysis of multiple organ involvement in Kawasaki disease

This study aimed to explore the incidence and clinical characteristics of multiple complications in children with Kawasaki disease (KD). All patients were diagnosed in our hospital between January 2016 and December 2020. A total of 640 cases were included, 43 patients had coronary artery aneurysm, 51 patients had coronary artery dilation, and 546 patients had no coronary artery damage. The patients were divided into three subgroups based on age: < 1year old, 1-5years old, and > 5years old. The multiple complications of all the KD children and the correlation between extracardiac complications and cardiovascular complications were analyzed. Among the 640 KD children, most were 1-5years old (415/640, 64.8%). Children < 1year old (31.6%) and > 5years old (28.3%) were more likely to have cardiovascular complications. The incidence of respiratory complications was highest in 1-5year olds (57.1%). Involvement of the digestive and the hematological systems gradually decreased with age, whereas involvement of the nervous system, the urinary system, and the joints gradually increased with age. The incidence of cardiovascular injury with extracardiac complications (22.3%) was higher than that without extracardiac complications (16.3%), although the difference was not statistically significant (p > 0.05).Conclusions: KD can be complicated by multiple-organ injury but there was no significant relationship between the occurrence of extracardiac complications and cardiovascular complications. What is Known: • Cardiovascular disease is generally believed to be the most common and serious complication of Kawasaki disease (KD). • Over recent years, we have found that extracardiovascular complications of KD are more common than generally supposed and, because they have some effect on prognosis, we believe that more attention should be paid to these complications. What is New: • There was no significant relationship between the occurrence of extracardiac complications and cardiovascular complications.

Feasibility of Remote Performance Assessment Using the Free Research Executive Evaluation Test Battery in Adolescents.

Lockdowns and other preventive measures taken to curb the spread of diseases such as COVID-19 have restricted the use of face-to-face cognitive assessment. Remote testing may be an alternative, but it should first be shown to be comparable to in-person assessment before being used more widely, during and after the pandemic. Our aim was to evaluate the suitability of online, examiner-mediated administration of an open-access battery of executive function tests (the Free Research Executive Evaluation battery, or FREE) that can be adapted considering various characteristics of diverse populations and therefore used worldwide. A total of 96 9–15-year olds (42 girls) were tested, half of whom online through video calls mediated by an examiner. Their performance was compared to that of the other 48 individuals tested face-to-face, who were matched against the online-tested participants for age, pubertal status, sex, and parental schooling. The battery consists of two tests of the following executive domains: Updating (2-Back and Number Memory tests), Inhibition (Stroop Victoria and Stroop Happy-Sad), and Switching (Color Shape and Category Switch). Answers were vocal and self-paced, and the examiner recorded accuracy and time taken to complete in-person and online tasks. Only free software is needed for the assessment. Executive measures obtained from the tasks did not differ statistically between online and in-person tested participants and effects sizes of group effects were small, thus showing that the FREE test battery holds promise for online cognitive assessment, pending confirmation in different samples and further validation studies.

Verbally Highlighting Extrinsic Causes of Novel Social Disparities Helps Children View Low-Status Groups as Structurally Disadvantaged Rather Than Personally Inferior.

As part of their “essentialist” intuitions, young children tend to form personal attributions for observed intergroup differences – attributing them to groups’ intrinsic natures or inborn characteristics. Much research has linked this essentialist view of social groups with prejudiced attitudes. However, less research has explored children’s capacity to form structural attributions for observed intergroup differences – attributing them to groups’ extrinsic circumstances or access to opportunities – or how structural attributions relate to social attitudes. Structural attributions could enable children to view low-status groups as extrinsically disadvantaged rather than intrinsically inferior. We were interested in whether verbally highlighting the extrinsic causes of novel social status disparities could support young children in forming structural attributions for them, thereby mitigating the formation of prejudice toward novel low-status groups. To investigate, we introduced participants (n=106 5- and 6-year olds) to novel social status disparities that could be attributed to either intrinsic or extrinsic causes, and we framed the disparities in either intrinsic, neutral, or extrinsic terms. We then assessed children’s attributions for the disparities (through two measures: explanations and interventions) and their social attitudes toward the groups (through two measures: friendship preferences and prize allocations). Results indicated that participants tended to provide mostly personal attributions overall but that extrinsic framing led them to provide significantly more structural attributions. Extrinsic framing did not significantly impact social attitudes overall, but exploratory analyses revealed that it impacted participants’ friendship preferences in particular. Together, results suggest that verbally highlighting extrinsic causes can disrupt children’s intuitive tendency toward personal attributions, with promising implications for their views of low-status groups.

The relation between visual orienting functions, daily visual behaviour and visuoperceptual performance in children with (suspected) cerebral visual impairment

BackgroundChildren with cerebral visual impairment (CVI) present heterogeneous visual orienting functions (VOF) and higher-order perception. Multiple assessment methods evaluate CVI, but the relations between them remain unclear. AimTo investigate the relations between VOF and (1) daily life behaviour and (2) visuoperceptual tests in children with (suspected) CVI. Methods and proceduresVOF were tested with a validated eye tracking-based paradigm. Visual perception was assessed using the children’s visual impairment test for 3- to 6-year olds (CVIT 3-6) and (retrospective) visuoperceptual dimension results. Caregivers completed the Flemish cerebral visual impairment questionnaire (FCVIQ) and an expert panel scored relations between VOF and the other methods. We compared experts’ survey responses with data-based results (linear mixed models and correlations). Outcomes and resultsFourty-four children (23 boys, 21 girls; median age = 7y11mo, SD = 2y7mo) participated. Twenty-one experts completed the survey. Slower VOF was significantly associated with (1) object and face processing impairments, (2) visual (dis)interest, (3) worse visual spatial perception (to local motion and form stimuli), and (4) worse CVIT 3-6 object and scene recognition (to cartoon stimuli). Conclusions and implicationsIntegration of VOF with existing visual assessments provides a better clinical picture of CVI and can prevent misdiagnosing children as inattentive, incapable, or unmotivated.

Social inequality in alternative sanctions: A register data study on all adolescent drug offenders in Norway 2005–2015

The penal repertoire for young offenders in Europe encompasses an increasing variety of alternative sanctions. Research indicates that the availability and implementation of these sanctions vary within jurisdictions, raising issues of unequal treatment for equal offences. Among possible factors associated with intra-jurisdictional disparities in alternative sentencing outcomes is the socioeconomic status of young offenders. This study investigates the social profile of diverted youth, thereby addressing social inequalities in alternative sanctioning. Register data on all 15- to 17-year olds charged with minor drug offences in Norway between 2005 and 2015 ( N = 3209) were compared to a randomly drawn sample of non-offenders ( N = 69,201). Offenders who were diverted from a fine to a conditional waiver of prosecution, either with or without rehabilitative measures, were classified with an alternative sanction. Socioeconomic status was measured by an indicator combining register data on household income and parental education. Probit regressions with sample selection were used to identify social gradients in alternative sanctioning. By extensive register linkages, we were able to control for a range of well-known confounders such as gender, immigrant status, family composition, parental crime, and geographical centrality. We found that the probability of receiving a conditional waiver of prosecution was around 5% points higher for youth from a medium-high socioeconomic status background and 8% points higher for youth from a high socioeconomic status background compared with their low socioeconomic status counterparts. The positive social gradient pertained to sanctioning with rehabilitative elements and not to minimal interventions. Social inequality in desistance-oriented sanctions, which may consolidate pre-existing inequalities in criminal charges, is likely influenced by the resources parents have at their disposal to get involved in their children’s legal processes.

Study Protocol of the Ten Years Up Project: Mapping the Development of Self-Regulation Strategies in Young Adults Over Time.

Self-regulation is an important predictor of many outcomes relating to health and well-being. Research thus far has not systematically addressed the development of self-regulation strategies during young adulthood, but instead has focused on the predictive value of childhood self-regulation competence for outcomes later in life. The present study protocol describes the Ten Years Up (10YUP) project, a longitudinal cohort of young adults who will be followed for Ten years. By adopting a dynamic approach, we aim to examine how the nature and frequency of self-regulation strategies develop over time, document to what extent the use of strategies is affected by contextual and personal factors, and determine how these strategies affect health and well-being over the course of ten years. The 10YUP project employs a prospective longitudinal design to map the development of self-regulation strategies over time. A sample of 3,000 participants will be recruited by random selection from the general population of 16-year olds to retain a final sample of 1,000 participants after Ten years (accounting for an estimated drop-out rate of 10% each year). A mobile app will be used to collect data every 3 months. Self-regulation strategies will be assessed by means of the Goal Setting and Striving Inventory that asks participants to list their personal goals and then choose their most important goal to answer items about goal perception and strategy use. The resulting composite self-regulation index will be related to a wide range of contextual and personal factors that may act as either antecedents or consequences of self-regulation, depending on their specific time of assessment (either prior to or following self-regulation assessment) by means of cross-lagged panel analyses and other analyses allowing for establishing causal relationships over time. The 10YUP project is likely to generate novel insights into the development of self-regulation in young adulthood, how this development is affected by personal and contextual factors, and how these in turn may be influenced by how young people self-regulate—which is important for public policies aimed at guiding young people's choices and how they affect their health and well-being.

Educational outcomes of political participation? Young first-time voters 3 years after the Scottish Independence Referendum

ABSTRACT After the enfranchisement of 16- and 17-year olds in the 2014 Scottish Independence Referendum, much research continued to prioritise questions of how education influences young people's political engagement. By contrast, this paper advances an original focus on educational outcomes of youth political participation and investigates how political engagement might have educational consequences. Shortly after the referendum, we interviewed a strategic sample of first-time voters aged 16–20, who had voted ‘yes’ to Scottish independence. We re-interviewed a sub-sample 3 years on, facilitating longitudinal analysis and novel qualitative data. Our analysis demonstrates how, from the perspective of remarkably engaged participants, referendum engagement has three kinds of educational consequences. First, participants describe learning about politics through referendum participation and their subsequent reflection on it. Second, participants understood their political engagements as informing their trajectories into and through post-compulsory education, including subject choices. Third, participants discussed learning about themselves and their career aspirations, ‘growing up’ and developing ‘mature’ political attitudes, via ongoing, shifting political engagement. This article contributes significant new insights about youth political engagement and lowering the voting age, by showing how young people understand their political participation as influencing their formal educational pathways and informal learning, about politics and themselves.

Reliability of an automated gaze-controlled paradigm for capturing neural responses during visual and face processing in toddlerhood.

Electroencephalography (EEG) has substantial potential value for examining individual differences during early development. Current challenges in developmental EEG research include high dropout rates and low trial numbers, which may in part be due to passive stimulus presentation. Comparability is challenged by idiosyncratic processing pipelines. We present a novel toolbox (“Braintools”) that uses gaze‐contingent stimulus presentation and an automated processing pipeline suitable for measuring visual processing through low‐density EEG recordings in the field. We tested the feasibility of this toolbox in 61 2.5‐ to 4‐year olds, and computed test–retest reliability (1‐ to 2‐week interval) of event‐related potentials (ERP) associated with visual (P1) and face processing (N290, P400). Feasibility was good, with 52 toddlers providing some EEG data at the first session. Reliability values for ERP features were moderate when derived from 20 trials; this would allow inclusion of 79% of the 61 toddlers for the P1 and 82% for the N290 and P400. P1 amplitude/latency were more reliable across sessions than for the N290 and P400. Amplitudes were generally more reliable than latencies. Automated and standardized solutions to collection and analysis of event‐related EEG data would allow efficient application in large‐scale global health studies, opening significant potential for examining individual differences in development.

Social inequalities in obesity and overweight: secular changes in Poland between 1983 and 2020.

Human development is strongly influenced by environmental factors, including the socioeconomic status (SES) of the family. The aim of this study is to analyze the prevalence of excess body weight among Polish children and adolescents from families of varying SES examined in 1983 and 2020. The study group included 3-15-year olds from two cross-sectional surveys (1983 and 2020) conducted in kindergartens and schools. The 1983 cohort consisted of 3394 individuals and the one from 2020-of 1253 children and adolescents. Body height and weight were measured and body mass index was calculated. Inclusion into underweight, normal weight and overweight/obese categories was based on Cole's cutoff points. SES was established based on the place of the parents' birth, parents', education status and the number of children in the family, which were self-reported in a questionary by the parents of the examined individuals. The mean overall SES was higher in the 2020 cohort, in comparison to the one examined in 1983. This change was also reflected by the changing prevalence of excess body weight, which, in 1983 was the greatest in the high socioeconomic category. On the other hand, in 2020 overweight/obesity was the most prevalent among individuals from families of low SES. The present results confirm the findings obtained in other countries, which suggest that changing the level of socioeconomic development modifies the changes regarding the prevalence of excess body weight. It is an important observation because a study of this type has not yet been conducted in the Polish population.

A-37 Interactions between in-Utero Stress Exposure, Externalizing Behavior, and Psychophysiology in Young Children

Abstract Objective The current study examines the associations between low resting heart rate (HR), low electrodermal activity (EDA), and externalizing behavior (EB) in children 1–5 years old through the following measures: baseline 1 (B1) HR, startle period HR, and recovery-stage HR HR, EDA amplitude and skin conductance responses (SCR). We also investigate whether in-utero stress (exposure to Hurricane Sandy) moderates these relationships. Method A subsample of 206 children was drawn from a NIMH longitudinal study, the Stress in Pregnancy Study, that follows offspring from in-utero to 6 years of age. HR and EDA data was collected during a startle-probe paradigm. Mean age of the participants was 3.89 years. Approximately 52% were female and 50.5% were Hispanic. Participants’ EB was assessed by the Behavioral Assessment Screening for Children Version-2 parent rating scales. Externalizing symptoms were trichotomized (high, medium, and low). Results One-way ANOVA showed that three EB groups differed in baseline-HR (p = 0.034), startle-HR (p = 0.006), and recovery-stage HR (p = 0.008) in 4-year olds. EDA was not significantly different between EB groups. Furthermore, Hurricane Sandy exposure significantly and marginally significantly moderates the relationship between EB and amplitude (b = 3.0344, p = 0.044) and EB and SCR (b = 1.5629, p = 0.056), respectively. Hurricane Sandy exposure did not moderate the relationship between EB and HR. Conclusion Externalizing problem symptom groups significantly differ in HR, but not EDA. Hurricane Sandy exposure moderates the relationship between EB and EDA, but not EB and HR. Results suggest that HR and EDA are differentially susceptible to environmental influence. Results can guide biologically informed treatments/screeners for EB in children.

Impact of the COVID-19 pandemic on incidence, time of diagnosis and delivery of healthcare among paediatric oncology patients in Germany in 2020: Evidence from the German Childhood Cancer Registry and a qualitative survey.

BackgroundThe indirect impact of the COVID-19 pandemic on cancer care and timely diagnosis is of increasing concern. We investigated the impact of the COVID-19 pandemic on incidence, time of diagnosis and delivery of healthcare among paediatric oncology patients in Germany in 2020.MethodsWe analysed incident paediatric cancer cases diagnosed in 0- to 17-year olds in Germany in 2020 using data of the German Childhood Cancer Registry. Absolute numbers and age-standardised incidence rates (ASR) in 2020 were compared to the previous five years (2015–2019). Moreover, we conducted a survey with open-ended questions, gathering perceptions of the diagnostic process and healthcare delivery for paediatric oncology patients during the COVID-19 pandemic.FindingsMore or similar numbers of paediatric cancer patients were newly diagnosed each month throughout 2020 in comparison to the previous five years. The estimated ASRs showed markedly higher incidence rates, overall and across diagnostic groups, in 2020 compared to 2015-2019. Results from the qualitative survey indicated that diagnostic processes, timeliness of diagnosis, and delivery of treatment were hardly affected during the COVID-19 pandemic. However, psychosocial supportive care and non-urgent appointments were considerably reduced during the lockdown periods.InterpretationWe found no indications of severe adverse effects of the COVID-19 pandemic on diagnosis and delivery of healthcare among children with cancer in Germany. The underlying reasons of the increase in incidence rates remain speculative. Continued close monitoring of incidence patterns may shed light on the underlying reasons of the present increase and contribute to understanding disease aetiology.FundingNone

Youth Encounters with Internet Pornography: A Survey of Youth, Caregiver, and Educator Perspectives

Despite international inquiry regarding young people’s encounters with Internet pornography (IP), there is a lack of knowledge about how their caregivers (parents or guardians) and educators perceive these encounters in comparison to young people. Such knowledge is critical to understanding the synergies and discrepancies that might exist between these key stakeholder groups (youth, caregivers and educators) and across genders, to subsequently inform how to best support youth in navigating IP. To this end, the present study describes youth (16–18-year olds) encounters with IP, as well as caregiver and educator perceptions of these encounters. An online survey was completed by 256 youth and 217 caregivers and educators recruited from nine schools with an existing investment in sexuality education in Aotearoa, New Zealand. Similar to global trends, this group of young New Zealanders were familiar with IP and patterns of encounters were gendered. However, there were varied understandings between stakeholder groups and across genders as to why and how these encounters occur. Understanding the ways youth encounter IP—and exploring how caregivers and educators perceive these encounters—serves as a springboard for future research that considers the broader socio-cultural context within which these perspectives are constructed.

O-074 No methylome differences observed in IVF children born after embryo culture in different culture media

Abstract Study question Does human embryo culture in different IVF culture media lead to DNA methylation alterations in IVF offspring? Summary answer Genome-wide analyses identified no significant DNA methylation differences between culture medium groups in IVF children (neonates or 9-year olds) from two culture media studies. What is known already During in vitro fertilisation (IVF) treatments, embryos undergo preimplantation development in an artificial environment, while concurrently undergoing epigenetic reprogramming. Adversity during this period, such as peri-conception calorie restriction, has been linked to persistent DNA methylation aberrations and increased risk of cardiometabolic disease. Early environmental adversity is suspected in IVF offspring as they are born with lower birthweights and show increased risk of cardiometabolic dysfunction in adulthood as compared to their naturally-conceived counterparts. This is further supported by the observation from two culture media trials (MEDIUM0 and MEDIUM1) that embryo culture in different culture media leads to differences in birthweight. Study design, size, duration We recruited singleton offspring from two IVF culture media trials. The MEDIUM0 study, a pseudo-randomized trial comparing G3 (Vitrolife) and K-SICM (Cook), was conducted from 2003-2006. At the 9-year follow-up, saliva was collected (cohort-A). The MEDIUM1 study, a multi-center randomized controlled trial comparing G5 (Vitrolife) and HTF (Lonza), was conducted from 2010-2012. Umbilical cord blood (UCB) was collected at birth (cohort-B). Participants/materials, setting, methods DNA methylation was analysed in 120 saliva samples (65 G3, 55 Cook) and 106 UCB samples (47 HTF, 59 G5) using the Infinium MethylationEPIC array (Illumina). Mixed effects linear models, correcting for (gestational) age, sex, sample composition and batch effects alongside maternal age, pregnancy complications and IVF centre for cohort-B, were implemented at single or aggregated sites. Methylation outliers were defined as values over three interquartile ranges below or above 25th and 75th percentiles respectively. Main results and the role of chance 111 of the 120 saliva samples (60 G3, 51 Cook) and 105 of the 106 UCB samples (47 HTF, 58 G5) passed our quality control criteria. We filtered sites on sex chromosomes, and based on quality, proximity to single-nucleotide polymorphisms, and proportion of missing values, leaving 650,000-700,000 of the 850,000 sites included on the EPIC array for our analyses. To account for heterogeneity in the cellular composition of our samples we estimated their cell compositions using a reference-based approach. First, we investigated individual CpG sites, finding no differentially methylated sites in either cohort after correction for multiple testing (false discovery rate adjusted p. value threshold &amp;lt; 0.1). Sites were then aggregated into regions based on their allocations to genes, promoters and CpG islands. No differentially methylated regions were identified in either cohort. A targeted analysis of DNA methylation of imprinting genes showed no differentially methylated sites or regions. To examine the contribution of stochastic epigenetic alterations we quantified the number of methylation outliers per sample. Although this revealed a predominance of hypomethylation outliers, there was no difference in the total number or distribution of DNA methylation outliers between the two culture media groups of cohort-A and cohort-B. Limitations, reasons for caution This analysis is currently limited by the lack of comparison to a naturally-conceived control group. As such, we cannot yet conclude whether IVF embryo culture, in any medium, is associated with DNA methylation aberrations. Additionally, given the large number of comparisons, we may lack power to detect small differences. Wider implications of the findings Although there are disparities in birth weight and childhood growth after embryo culture in different media, we observed no DNA methylation alterations preserved postnatally. Whether DNA methylation of these individuals deviates from that of naturally-conceived individuals will be determined in the near future. Trial registration number MEDIUM1: NTR 1979 /NL1866 (Netherlands Trial Registry)

Outpatient Psychological Therapies in Children and Adolescents in Germany: Status Quo and Time Trends, 2009-2018

To determine the prevalence of outpatient psychological therapies (PT) in youths with statutory health insurance in Germany. Based on statutory health insurance funds data for 2009-2018, the prevalence of outpatient PT was assessed, stratified by sex, age, and federal state. Psychotherapeutic specialty, coded psychiatric diagnoses, and type of PT were also analysed. In 2018, 7.3 % received any form of PT (2009: 7.1 %). Of these, 18.4 % (2009: 12.8 %) received therapy according to the directives for psychotherapy (dPT), with CBT (since 2012) being most frequently used. PT prevalence was highest in 15- to 19-year olds, and only marginally differed by sex. Child psychiatrists delivered the majority of PTs. Main diagnoses were anxiety/emotional disorders, ADHD, and adjustment disorders. During the studied period, PT prevalence has not changed markedly. Yet, the share of dPT has increased, with CBT ranking top.

Understanding curriculum design in the perceptions and practices of classroom music teachers in the lower secondary school in England

AbstractCurriculum design is a domain that infrequently forms a discrete element of initial teacher training, or continuing professional development for music teachers in English secondary schools. Classroom music teachers, teaching Key Stage 3 (KS3) learners (11–14-year olds), are, however, required to design their own curriculum. Teachers are accountable to school leaders for curricula they implement, and the outcomes from their selected approaches. This article discusses classroom music curriculum practices and their significance in music education. The research project was conducted with music teachers from schools in the East and West Midlands of England, utilising questionnaires and semi-structured interviews. Research findings are conceptualised in a model of music curriculum activity. The research thereby facilitates discussion of unacknowledged complexities and tacit teacher planning practices in music curriculum design.

What happened? Do preschool children and capuchin monkeys spontaneously use visual traces to locate a reward?

The ability to infer unseen causes from evidence is argued to emerge early in development and to be uniquely human. We explored whether preschoolers and capuchin monkeys could locate a reward based on the physical traces left following a hidden event. Preschoolers and capuchin monkeys were presented with two cups covered with foil. Behind a barrier, an experimenter (E) punctured the foil coverings one at a time, revealing the cups with one cover broken after the first event and both covers broken after the second. One event involved hiding a reward, the other event was performed with a stick (order counterbalanced). Preschoolers and, with additional experience, monkeys could connect the traces to the objects used in the puncturing events to find the reward. Reversing the order of events perturbed the performance of 3-year olds and capuchins, while 4-year-old children performed above chance when the order of events was reversed from the first trial. Capuchins performed significantly better on the ripped foil task than they did on an arbitrary test in which the covers were not ripped but rather replaced with a differently patterned cover. We conclude that by 4 years of age children spontaneously reason backwards from evidence to deduce its cause.

Food and Nutrient Intakes of Nova Scotian Children in Home and Childcare Environments.

Purpose: To describe the energy (E), sodium, saturated fat, sugar, and fibre intakes of a sample of children attending regulated childcare (RCC) in Nova Scotia.Methods: Nutrient analyses from 79 food records were compiled and grouped by intakes in and outside of RCC, age, sex, location of the RCC (urban or rural), and nutrient intake data. Descriptive statistics and independent t tests were conducted.Results: Mean E and macronutrients were within recommended ranges and, for days attending RCC, 45%E was consumed in RCC. Saturated fat intake was 12%E on average. Mean sodium intake exceeded or approached the tolerable upper limit for 3-year olds (1726mg/day) and 4-5-year olds (1770mg/day), respectively. Total sugar was 27%E intake and significantly more sugar was consumed outside RCC and by boys compared to girls. Mean daily dietary fibre intake was below recommended levels (15 g/day).Conclusions: On average dietary intakes of children exceeded recommendations for sodium, saturated fat, and sugar with higher intakes outside RCC. The foods provided by RCC have a positive influence on children's intakes, but given the pervasiveness of sugar and sodium in the food environment and the challenges of feeding children, support is needed for both RCC and families to encourage healthy eating behaviours for positive growth and development.

Khuluma: Using Participatory, Peer-Led and Digital Methods to Deliver Psychosocial Support to Young People Living With HIV in South Africa.

Khuluma is a psychosocial and peer-to-peer mHealth intervention that uses text messaging to facilitate support groups for adolescents living with HIV (ALWH) with the aim of contributing toward positive health outcomes. Although use of mobile technology in the form of mHealth interventions has proliferated recently in the field of health, published literature describing methods and processes of its application are limited. We present a set of methods and processes utilised to develop and pilot the Khuluma mHealth intervention amongst young people (15–20 years) in South Africa. We recruited and enrolled 52 adolescents (15–20-year olds) from four clinics in Pretoria and Cape Town to participate in a 6-month pilot of Khuluma. Participants were ALWH, aware of their status, on antiretroviral therapy for more than 12 months, and not suffering from severe depression. We conducted four pre and post intervention focus group discussions (FGDs) with a proportion of ALWH (n = 36) enrolled in the pilot study using participatory methods. Several processes were utilised to then implement this pilot study. These included engaging ALWH for minor study implementation modifications; forming virtual groups; activating the mHealth platform; facilitating and delivering the Khuluma intervention. The acceptability of the intervention was informed by follow-up focus group discussions and text message data. The initial participatory processes helped to tailor the intervention design to participants' needs. The peer-led facilitation of the groups allowed for the provision of sensitive psychosocial support that allowed young people to express themselves freely, develop a sense of self-worth, and interact more. The nature of the mobile technology also allowed participants to build friendships beyond their geographic area and interact with their peers in real time. Within the evolving context of COVID-19, establishing evidence-based processes and methods for intervention design and curation in virtual spaces is critical.

How do lipids influence risk of violence, self-harm and suicidality in people with psychosis? A systematic review.

Objectives:Low cholesterol has been linked with violent and suicidal behaviour in people with schizophrenia. This association, if consistently present, may be a promising biological marker that could assist clinicians in decision making regarding risk and treatment. We conducted a systematic review to assess whether there is a reliable association between lipid profile (total cholesterol, high- and low-density lipoprotein cholesterol, and triglycerides) and aggression, self-harm or suicide in people with schizophrenia, and whether effects are similar in males and females.Method:Relevant databases were searched to identify primary research studies (up to November 2020) that (1) involved adults (some samples also included 16- to 18-year olds) with a confirmed diagnosis of schizophrenia, schizoaffective disorder or psychosis; and (2) included a standardised assessment of verbal aggression, physical aggression against objects, physical aggression against self (including suicide) or others. The search yielded 23 studies eligible for inclusion following a quality appraisal.Results:Suicidality was the most commonly assessed subtype of aggression (20 studies). For suicidality, about half the studies, including the study with the largest sample size, found a link with total cholesterol. An association between low total cholesterol and violence towards others was found in six of nine studies that investigated this. The evidence for a link with violence was the strongest for total cholesterol, followed by low-density lipoprotein cholesterol and high-density lipoprotein cholesterol, and the weakest for triglycerides. Only a few studies investigated sex differences and yielded mixed evidence. Studies focussed on self-harm as well as involving females in forensic settings were lacking.Conclusion:There is encouraging evidence of an association between low total cholesterol and aggression towards others as well as suicidality in schizophrenia. Future studies should systematically explore this association in people with schizophrenia who have a significant history of violence, suicidality and self-harm, both inpatients and community, and also investigate underlying mechanisms.

Correlates and mediators of geo-ethnic inequalities in child development in Cambodia

ABSTRACT The association between five indicators of inequality (geo-ethnicity, height-for-age, socioeconomic status (SES), gender, and preschool participation) and child development was examined among 1498 3- to 5-year olds from the Khmer and Phnong ethnic groups in Cambodia. Children were directly assessed using the East Asia-Pacific Early Child Development Scales (EAP-ECDS), and caregivers provided socio-demographic information. A series of multilevel regressions was run to examine associations between EAP-ECDS scores and each indicator of inequality. Structural equation models then examined whether geo-ethnic differences were mediated by other indicators of inequality. Results demonstrated significant differences between urban Khmer, rural Khmer and rural Phnong children. Increased height-for-age, higher SES background, gender (being a girl) and preschool participation all predicted higher developmental scores; and the combination of these indicators significantly mediated differences between rural and urban Khmer children, but not between Khmer and Phnong children. Findings suggest that Phnong children face substantial inequities in their early development that cannot be explained by other indicators of inequality. Appropriate nutritional and preschool interventions for rural children may be beneficial for reducing urban–rural disparities in the development of Khmer children.