High Children Research Articles

Gender Land Rights as Factor for Households' Sustainable Development in Rwanda

This study was to analyse Gender Land Rights as Factor of Households’ Sustainable Development in Rwanda. The emphasis was put on land tenure reform theories developed in Africa for securing women's land rights through policies and laws issued in order to find out whether women land titling is really applied and if they enable the women to play their effective socio-economic role for the households’ sustainable development in Rwanda. The conclusion is that women’s titling rooted in land reform through policies and laws in Rwanda present significant positive benefits such as improved well-being for women and their families, women having a greater say in household decisions, access to loans, and higher children’s school enrollment especially girls, sustainable stability of marriage between couples, sustainable land management. However, some challenges such low level of education, cultural practises maintain women in subornation status vis-a-vis of their husbands and society in general. Thus, the study recommended to promoting awareness and education under all forms, in order to breakdown the cultural barriers avoiding women access to socio-economic capacity building for their real empowering.

Longitudinal trajectory and predictors of change in family accommodation during exposure therapy for pediatric OCD

Family accommodation (FA) is key in the maintenance of OCD. However, most studies are cross-sectional, and have not identified long-term trajectories and correlates of FA changes over treatment. This study investigated changes in clinician-rated FA over 10 sessions of cognitive behavioral therapy (CBT) for 142 children with OCD, as well as several key predictors/correlates: (a) clinician-rated OCD symptom severity, (b) child- and parent-rated functional impairment, (c) parent-rated treatment expectancies, and (d) child- and parent-rated therapeutic alliance. Multi-level models indicated that FA changed significantly during treatment, with gains maintained over 6-months. Baseline clinician-rated OCD severity did not predict changes in FA. Significant interactions indicated that children with higher child- and parent-rated impairment exhibited greater FA improvements over treatment (versus children with lower impairment). Child- and parent-rated therapeutic alliance and parent-rated expectancies did not predict FA changes. Finally, FA mediated the relationship between OCD severity and parent- (but not child-) rated impairment. Reverse mediation models were also significant. Findings indicate that CBT can successfully reduce FA (a) even if children experience high OCD severity and interference in school, relationships, and family life, and (b) regardless of non-specific factors like treatment expectancies and alliance. FA reductions are an important mechanism mediating treatment response.

Seroprevalence of diphtheria toxoid IgG antibodies in the Malaysian population

BackgroundDespite high childhood immunization coverage, sporadic cases of diphtheria have been reported in Malaysia in recent years. This study aims to evaluate the seroprevalence of diphtheria among the Malaysian population.MethodsA total of 3317 respondents age 2 years old to 60 years old were recruited in this study from August to November 2017. Enzyme-linked immunosorbent assay (ELISA) was used to measure the level of IgG antibody against the toxoid of C. diphtheriae in the blood samples of respondents. We classified respondent antibody levels based on WHO definition, as protective (≥0.1 IU/mL) and susceptible (< 0.1 IU/mL) to C. diphtheriae infection.ResultsAmong the 3317 respondents, 57% were susceptible (38.1% of children and 65.4% of adults) and 43% (61.9% of children and 34.6% of adults) had protective antibody levels against diphtheria. The mean antibody level peaked among individuals aged 1–2 years old (0.59 IU/mL) and 6–7 years old (0.64 IU/mL) but generally decreased with age, falling below 0.1 IU/mL at around 4–6 years old and after age 20 years old. There was a significant association between age [Children: χ2 = 43.22(df = 2),p < 0.001)], gender [Adults: χ2 = 5.58(df = 1),p = 0.018] and ethnicity [Adults: χ2 = 21.49(df = 5),p = 0.001] with diphtheria toxoid IgG antibody level.ConclusionsAbout 57% of the Malaysian population have inadequate immunity against diphtheria infection. This is apparently due to waning immunity following childhood vaccination without repeated booster vaccination in adults. Children at age 5–6 years old are particularly vulnerable to diphtheria infection. The booster vaccination dose normally given at 7 years should be given earlier, and an additional booster dose is recommended for high-risk adults.

Patients with HIV and cirrhosis: the risk for hepatocellular carcinoma after direct-acting antivirals for hepatitis C virus.

Hepatocellular carcinoma (HCC) has become a major issue in coinfected HIV/HCV patients with liver cirrhosis. We aimed to determine the rate of HCC occurrence after a direct-acting antiviral (DAA) treatment and to evaluate the factors associated with the risk of HCC in this population. We conducted a retrospective multicenter observational study including cirrhotic HIV/HCV-coinfected patients treated with DAAs, between October 2014 and January 2017. We collected demographics characteristics, data regarding HIV and HCV infections and treatment with DAAs. We investigated the rate and the time of occurrence of HCC. Statistical analysis explored the factors associated to development of liver cancer. During a median follow-up of 55 months, 24 out of 232 patients developed HCC, after a median of 22.5 months from starting DAAs. Factors associated with HCC were a higher Child--Pugh Turcotte (CPT) score (P = 0.002), HCV genotype 3 (P = 0.04), previous HCC (P < 0.001) and CD4+ cell count nadir greater than 350 cells/μl (P = 0.001), whereas antiretroviral therapy (ART) was associated to a lower rate of cancer (P = 0.02). At multivariable analysis CPT score and a history of HCC remained independently associated with HCC after DAAs (P = 0.003 and P < 0.001, respectively), and ART administration maintained its protective role (P = 0.047), regardless of HIV RNA at baseline. Our study highlights the importance of a long-lasting follow-up for HCC after HCV eradication, mostly in those patients with advanced cirrhosis and history of HCC. Furthermore, our data showed a potential role of ART itself (and not of undetectable HIV RNA) in reducing the risk for HCC development.

Leader-parent relationships in the early childhood education context: An exploration of testimonial and epistemic justice

Countries around the world have increased their focus on high quality early childhood programing. Recognizing the importance of parental and community engagement as a lever for improving child development and learning outcomes, and as a means of addressing social justice challenges, the Organization for Economic Cooperation and Development (OECD) (2018) has emphasized the need for more research on the complex dynamics between structure, process, learning, and development. Such research should consider the impacts of the dominant neo-managerial paradigm and its overemphasis on clearly defined linear cause and effect pathways between structure and student learning, which underrepresents the reciprocal role that parents, the community and the students themselves play in shaping the learning setting (Myran &amp; Sutherland, 2019a). Students’ and families’ senses of belonging to the community of knowers have major implications for their motivation, sense of ownership and buy-in (Davis, 2006; Goodenow &amp; Grady, 1993). This study explored the lived experiences of parents/guardians of young children with the leadership of their children’s early childhood education program and how these individual and social interactions shaped parents’ epistemic agency, and their access to rhetorical spaces that recognized them as credible knowers. Utilizing a phenomenological approach, we conducted in-depth interviews with 20 parents whose children attended publicly funded pre-school programs. Findings revealed limited communication with leadership and difficulty developing positive relationships. Moreover, these challenges limited their access to rhetorical spaces to be heard and recognized as credible knowers. This study offers one small window into the OECD’s (2018) call for more research on the dynamics between structure, process, learning and development, and the importance of the quality of parental and community engagement as a lever for enhancing healthy child development and learning, and as a means of more effectively addressing ongoing social justice challenges.

X-Linked Myotubular Myopathy: A Novel Mutation Expanding the Genotypic Spectrum of a Phenotypically Heterogeneous Myopathy.

X-linked myotubular myopathy (XLMTM), a centronuclear congenital myopathy secondary to pathogenic variants in the MTM1 gene encoding myotubularin, is typically recognized for its classic and severe phenotype which includes neonatal hypotonia, severe muscle weakness, long-term ventilator dependence, markedly delayed gross motor milestones with inability to independently ambulate, and a high neonatal and childhood mortality. However, milder congenital forms of the condition and other phenotypes are recognized. We describe a 6-year-old boy with a mild XLMTM phenotype with independent gait and no respiratory insufficiency even in the neonatal period. The child has a hemizygous novel splice site variant in the MTM1 gene (c.232-25A > T) whose pathogenicity was confirmed by cDNA studies (exon 5 skipping) and muscle biopsy findings. We also compared the phenotype of our patient with the few reported cases that presented a mild XLMTM phenotype and no respiratory distress at birth, and discussed the potential mechanisms underlying this phenotype such as the presence of residual expression of the normal myotubularin transcript.

Genetic Interactions with Intrauterine Diabetes Exposure in Relation to Obesity: The EPOCH and Project Viva Studies.

To examine whether BMI-associated genetic risk variants modify the association of intrauterine diabetes exposure with childhood BMI z-scores, we assessed the interaction between 95 BMI-associated genetic variants and in utero exposure to maternal diabetes among 459 children in the Exploring Perinatal Outcomes among Children historical prospective cohort study (n = 86 exposed; 373 unexposed) in relation to age- and sex-standardized childhood BMI z-scores (mean age = 10.3 years, standard deviation = 1.5 years). For the genetic variants showing a nominally significant interaction, we assessed the relationship in an additional 621 children in Project Viva, which is an independent longitudinal cohort study, and used meta-analysis to combine the results for the two studies. Seven of the ninety-five genetic variants tested exhibited a nominally significant interaction with in utero exposure to maternal diabetes in relation to the offspring BMI z-score in EPOCH. Five of the seven variants exhibited a consistent direction of interaction effect across both EPOCH and Project Viva. While none achieved statistical significance in the meta-analysis after accounting for multiple testing, three variants exhibited a nominally significant interaction with in utero exposure to maternal diabetes in relation to offspring BMI z-score: rs10733682 near LMX1B (interaction β = 0.39; standard error (SE) = 0.17), rs17001654 near SCARB2 (β = 0.53; SE = 0.22), and rs16951275 near MAP2K5 (β = 0.37; SE = 0.17). BMI-associated genetic variants may enhance the association between exposure to in utero diabetes and higher childhood BMI, but larger studies of in utero exposures are necessary to confirm the observed nominally significant relationships.

189-LB: Using Genetics to Separate Childhood from Adult BMI Shows That Higher Childhood BMI Has No Direct Effect on Reduced Insulin Secretion or Sensitivity in Later Life

Higher BMI during childhood is associated with an increased likelihood of remaining overweight later in life, leading to higher risk of developing type 2 diabetes (T2D). Using a Mendelian randomisation approach, a recent study found no evidence that childhood BMI has a direct causal effect on T2D. However, the extent to which high BMI in childhood directly alters insulin secretion and sensitivity in later life requires further investigation. We aimed to use genetic variants associated with differential effects on childhood and adult BMI to test their separate effects on insulin secretion and insulin sensitivity. We first generated a measure of childhood BMI aged 10 using self-reported categories in the UK Biobank, which we approximated to a normal distribution. We then performed separate genome wide association studies (GWAS) of childhood and adult BMI. This approach increased the number of genetic instruments by a factor of two as compared to previous methods. We used a multivariable Mendelian Randomisation approach, with childhood and adult BMI as exposure variables, and 5 measures of insulin secretion and insulin sensitivity in nondiabetic adults from previous GWAS studies as outcome variables. We found no evidence (at p&amp;lt;0.05) that higher BMI in childhood has a direct adverse effect on type 2 diabetes (OR 0.94, 95%CI 0.82-1.08), fasting insulin (OR 1.00, 0.95 - 1.05), insulin sensitivity (OR 1.11, 0.97-1.27) or sensitivity-index adjusted acute insulin response (OR 1.11, 0.88-1.42) in adults. There was some evidence of a protective effect, with higher childhood BMI associated with lower fasting glucose (OR 0.96, 0.93 - 1.00) and insulin secretion (OR 1.30, 1.04 - 1.63). Crucially, our results are consistent with no adverse direct effect of higher childhood BMI on adult type 2 diabetes, insulin secretion or sensitivity. Disclosure G. Hawkes: None. T. G. Richardson: None. G. M. Power: None. G. Davey smith: None. T. M. Frayling: None. Funding Innovative Medicines Initiative 2 Joint Undertaking (875534)

Insight into the Stunting vis a vis Salmonella and Shigella Species among Children of Pakistan

Pakistan is one of the leading countries where the high childhood mortality (under the age of 5 years) as well as is a country where &gt;33% of children are underweight and 38% show stunted growth. The current study investigated the presence or absence of Salmonella and Shigella sp. in stunted children under five years of age from the lower socioeconomic background of Pakistan. Besides, the antibiotics susceptibility patterns were studied along with the sociodemographic and clinical information demographic factors using a questionnaire. The stool samples from stunted children have processed following standard bacteriological protocols and presumptive colonies of Salmonella and Shigella species were identified and sub-cultured on selective media and confirmed by using the standard biochemical test as well as molecular tests. Antibiotics susceptibility of the isolates to 10 antibiotics was tested using disk diffusion assay. The results suggested that 10.5% and 5.7% of the stool samples were positive for Salmonella and Shigella sp. respectively. Moreover, the antibiotics susceptibility test results of the isolates showed that Salmonella sp., were showing higher resistance to amoxicillin whereas Shigella sp. were more resistant to gentamycin. All Salmonella and Shigella isolates were resistant to Rifampicin and 80% of isolates of both were susceptible to ciprofloxacin and cefotaxime. The study suggested that environmental enteric dysfunction (EED), is widespread among malnourished children and may result in stunted growth. The contributory factors such as unsafe farming practices or close association to poultry or livestock animals and prevailing sanitation &amp; hygiene conditions are the potential source of entero-pathogens.

Association between Hippocampal Volume and Working Memory in 10,000+ 9-10-Year-Old Children: Sex Differences.

Aim: This study tested sex differences in the association between hippocampal volume and working memory of a national sample of 9–10-year-old children in the US. As the hippocampus is functionally lateralized (especially in task-related activities), we explored the results for the right and the left hippocampus. Methods: This is a cross-sectional study using the Adolescent Brain Cognitive Development (ABCD) Study data. This analysis included baseline ABCD data (n = 10,093) of children between ages 9 and 10 years. The predictor variable was right and left hippocampal volume measured by structural magnetic resonance imaging (sMRI). The primary outcome, list sorting working memory, was measured using the NIH toolbox measure. Sex was the moderator. Age, race, ethnicity, household income, parental education, and family structure were the covariates. Results: In the overall sample, larger right (b = 0.0013; p < 0.001) and left (b = 0.0013; p < 0.001) hippocampal volumes were associated with higher children’s working memory. Sex had statistically significant interactions with the right (b = −0.0018; p = 0.001) and left (b = −0.0012; p = 0.022) hippocampal volumes on children’s working memory. These interactions indicated stronger positive associations between right and left hippocampal volume and working memory for females compared to males. Conclusion: While right and left hippocampal volumes are determinants of children’s list sorting working memory, these effects seem to be more salient for female than male children. Research is needed on the role of socialization, sex hormones, and brain functional connectivity as potential mechanisms that may explain the observed sex differences in the role of hippocampal volume as a correlate of working memory.

Death metal: Evidence for the impact of lead poisoning on childhood health within the Roman Empire

AbstractThe use of lead was ubiquitous throughout the Roman Empire, including material for water pipes, eating vessels, medicine, and even as a sweetener for wine. The toxicity of lead is well established today, resulting in long‐term psychological and neurological deficits as well as metabolic diseases. Children are particularly susceptible to the effects of lead, and it is likely that the widespread use of this deadly metal among Roman populations led to a range of adverse health effects. Indeed, lead poisoning has even been implicated in the downfall of the Roman Empire. This research examines, for the first time, the direct effect of lead poisoning on the inhabitants of the Empire. It explores whether the dramatic increase in lead during this period contributed to the failure to thrive evident within the skeletal remains of Roman children. Lead concentration and paleopathological analyses were used to explore the association between lead burdens and health during the Roman period. This study includes 173 individuals (66 adults and 107 non‐adults) from five sites, AD 1st–4th centuries, located throughout the Roman Empire. Results show a negative correlation between age‐at‐death and core tooth enamel lead concentrations. Furthermore, higher lead concentrations were observed in children with skeletal evidence of metabolic disease than those without. This study provides the first bioarcheological evidence that lead poisoning was a contributing factor to the high infant mortality and childhood morbidity rates seen within the Roman world.

The compounding effect of having HIV and a disability on child mortality among mothers in South Africa.

Previous research on the association between maternal HIV status and child mortality in sub-Saharan Africa was published between 2005-2011. Findings from these studies showed a higher child mortality risk among children born to HIV-positive mothers. While the population of women with disabilities is growing in developing countries, we found no research that examined the association between maternal disability in HIV-positive mothers, and child mortality in sub-Saharan Africa. This study examined the potential compounding effect of maternal disability and HIV status on child mortality in South Africa. We analyzed data for women age 15-49 years from South Africa, using the nationally representative 2016 South Africa Demographic and Health Survey. We estimated unadjusted and adjusted risk ratios of child mortality indicators by maternal disability and maternal HIV using modified Poisson regressions. Children born to disabled mothers compared to their peers born to non-disabled mothers were at a higher risk for neonatal mortality (RR = 1.80, 95% CI:1.31-2.49), infant mortality (RR = 1.69, 95% CI:1.19-2.41), and under-five mortality (RR = 1.78, 95% CI:1.05-3.01). The joint risk of maternal disability and HIV-positive status on the selected child mortality indicators is compounded such that it is more than the sum of the risks from maternal disability or maternal HIV-positive status alone (RR = 3.97 vs. joint RR = 3.67 for neonatal mortality; RR = 3.57 vs. joint RR = 3.25 for infant mortality; RR = 6.44 vs. joint RR = 3.75 for under-five mortality). The findings suggest that children born to HIV-positive women with disabilities are at an exceptionally high risk of premature mortality. Established inequalities faced by women with disabilities may account for this increased risk. Given that maternal HIV and disability amplify each other's impact on child mortality, addressing disabled women's HIV-related needs and understanding the pathways and mechanisms contributing to these disparities is crucial.

The Implementation and Five-Year Evolution of a Childhood Healthy Weight Program: Making a Health Care-Community Partnership Work.

Background: Sustained implementation of moderate to high-intensity interventions to treat childhood obesity meets many barriers. This report uses the Centers for Disease Control and Prevention's (CDC's) Replicating Effective Programs framework to describe and evaluate the implementation of a 5-year health care-community collaborative program. Methods: Interviews with program leadership provided information on setting, organizational culture, program creation and adaptation, and costs. Administrative data were used for number of sessions and their characteristics; referrals; and 2018-2019 participant enrollment, attendance, completion numbers, and completer outcomes. Results: Preconditions for this program were high childhood obesity prevalence, and the complementary strengths of the health care organization (primary care treatment referral stream, population health orientation, alternative Medicaid funding) and the community organization (accessible space and time, staffing model, and organization mission). Preimplementation steps included collaborative design of a curriculum and allocation of administrative tasks. Implementation led to simultaneous deployment in as many as 17 community locations, with sessions offered free to families weekday evenings or weekends, delivered in English or Spanish. From 2018 to 2019, 2746 children were referred from nearly 300 providers, 832 (30.3%) enrolled, and 553 (66.3%) attended at least once, with 392 (70.8% of attenders and 47.1% of enrolled) completing the program. Outcomes in completers included improvement in %BMIp95 [-2.34 (standard deviation, SD 4.19)] and Progressive Aerobic Cardiovascular Endurance Run (PACER) laps [2.46 (SD 4.74)], p < 0.0001 for both. Evolution, including in referral process, Spanish program material and delivery, and range of ages, occurred continuously rather than at discrete intervals. Major system disruptions also affected the implementation. Maintenance of the program relied on the health care organization's administrative team and the collaboration with the community organization. Conclusion: This program's collaboration across organizations and ongoing adaptation were necessary to build and sustain a program with broad reach and positive health outcomes. The lessons learned may be helpful for other programs.

The impact of maternal emotional intelligence on young children’s motor development

ABSTRACT This study examined the relationship between the mother’s emotional intelligence (EI) and children’s motor development. Iranian preschool children (N = 148) in the range of 4–6 years were selected from daycare centres using a multi-stage cluster sampling. The BarOn Emotional Quotient Inventory and Bruininks-Oseretsky Test of Motor Proficiency 2 Short-Form were used to assess EI and child motor development. Results indicated a significant relationship between family income, mother’s education, mother’s EI, and child motor development. Structural equation modelling (SEM) revealed a reliable goodness of fit for the relation between EI and motor development. Also, there was statistically significant association between EI and motor development with an effect size of 45%, thus suggesting that the mother’s EI could predict motor development. Whereas all EI dimensions had some positive influence on the child’s motor development, interpersonal skills highlighted the overall impact. Among the four scales of motor proficiency, the highest effect of EI was with fine-motor skills (55%). Overall, and arguably the most profound finding was that higher EI scores were significantly associated with higher child motor skill scores. In conclusion, these findings support the notion that a mother’s EI could have a significant impact on a child’s motor development.

Influence of Childhood Trauma on Former Prisoners’ Attributional Style and Recidivism in Three Years

This study aimed to verify the mediating effects of attribution style, both external and internal, in the relationship between childhood trauma and former prisoners’ recidivism. In 2017, recidivism data on 235 former prisoners who had received Korea Rehabilitation Agency (KRA)’s housing support service in 2014, and had responded to the childhood traumatic questionnaire and surveys on external and internal attributions, were retrieved from the KRA. The analysis revealed that greater childhood trauma was correlated both with higher external and lower internal attribution. Although the relationship between high childhood trauma and recidivism was significant, no significant relationship appeared between internal/external attribution and recidivism. Further, the analysis did not confirm the mediating effect of attribution on the relationship between childhood trauma and recidivism. This indicates that traumatic experiences during childhood increase former prisoners’ external attribution, lower internal attribution, and lead to a higher probability of recidivism. These results demonstrate that interventions on childhood trauma may be effective in lowering recidivism because childhood trauma plays a key role in the former prisoners’ reoffending and attributions that may influence the interpretation of their criminal behavior.

Childhood stunting and associated factors among irrigation and non-irrigation user northwest, Ethiopia: a comparative cross-sectional study

BackgroundStunting is a critical public health problem of developing countries like Ethiopia. Different interventions like irrigation activity have been carried out by the government of Ethiopia to improve the nutritional status of the community. However, there is scanty of data on childhood stunting and its associated factors between irrigation user and non-irrigation user.ObjectiveTo assess the magnitude of childhood stunting and its associated factors between irrigation and non-irrigation user in North Mecha District, Northwest Ethiopia.MethodsA community-based comparative cross-sectional study design was employed from October to November 2019. A systematic sampling was used to draw mothers with children age 6–59 months (582 irrigated and 582 non- irrigated household users). Data were collected using questionnaire and anthropometric measurement tools. Multivariable logistic regression was used to identify the predictors of stunting. Adjusted odds ratios with 95% CI were used to determine the degree of association between independent and outcome variable. A-p-value < 0.05 was used as cutoff point to declare statistically significant variables with the outcome variable.ResultsThe prevalence of childhood stunting (6–59 months) among irrigation users [32.8% at 95%CI [29.1%-36.7%]] was slightly lower than non-users [40.2% at 95%CI [[36.3%-44.2%]]]. However, the difference did not show significant variation. The odds of childhood stunting were higher among a child from a mother had no antenatal visit, a child whose age was between 12 and 47 months, a child from a mother who did not use water and soap always for washing hands, and a child who had fever.ConclusionThe prevalence of childhood stunting was high and did not show significant variation between irrigation and non-irrigation users. A child from mother had no antenatal visit, whose age was between 12 and 47 months, a mother who did not use water and soap always for washing hands, and who had fever were factors associated with higher child stunting. Thus, the identified modifiable factors should be strengthened to reduce stunting.

Repeated introductions and intensive community transmission fueled a mumps virus outbreak in Washington State.

In 2016/2017, Washington State experienced a mumps outbreak despite high childhood vaccination rates, with cases more frequently detected among school-aged children and members of the Marshallese community. We sequenced 166 mumps virus genomes collected in Washington and other US states, and traced mumps introductions and transmission within Washington. We uncover that mumps was introduced into Washington approximately 13 times, primarily from Arkansas, sparking multiple co-circulating transmission chains. Although age and vaccination status may have impacted transmission, our data set could not quantify their precise effects. Instead, the outbreak in Washington was overwhelmingly sustained by transmission within the Marshallese community. Our findings underscore the utility of genomic data to clarify epidemiologic factors driving transmission and pinpoint contact networks as critical for mumps transmission. These results imply that contact structures and historic disparities may leave populations at increased risk for respiratory virus disease even when a vaccine is effective and widely used.

Making Partnerships Work: Proposing a Model to Support Parent-Practitioner Partnerships in the Early Years

Building on Froebelian principles that highlight the importance of family and community, this study explored the importance of collaboration and communication as part of a two-way dialogue. The aim was to identify the key characteristics of a model that would encourage interest and commitment to partnerships from both parents and practitioners. The idea of such partnerships has a solid theoretical background and is supported both rhetorically and by legislation by the Department of Education. However, research has shown that practice often falls short of the ideal, due to reasons such as the managerial discourse that constructs parents as potential consumers and the challenges faced when performance is prioritised over creativity. As part of the study, we employed a mixed methods approach and encouraged parents and practitioners to work together by participating at two sessions with families and children. The sessions provided parents and practitioners with space and time to explore the issue of working in ‘partnership’. After careful consideration of ethical issues, data were collected using pre and post-session questionnaires with all participants, as well as face to face interviews with some of them. Findings indicate that both parties need to invest time and recognise that ‘effective partnership’ is a two way process which requires engagement and dialogue to be able to develop meaningful relationships of trust. The findings were used to develop the ‘CAFE' partnership model which incorporates those elements considered important to facilitate the development of partnerships between practitioners and parents. The CAFE model addresses the gap in the literature in terms of unpicking the key features of a partnership approach, as captured through the lived experience of both parents and practitioners. It also contributes to deepening the understanding of the applications of Froebelian principles in contemporary contexts and the ways in which they can encourage high quality early childhood development and education. Future research should explore how this model could be used to evaluate existing practice and guide the development of current partnership policies and approaches.

The PRKAR1B p.R115K Variant is Associated with Lipoprotein Profile in African American Youth with Metabolic Challenges.

High childhood obesity rates coincide with increased incidence of nonalcoholic fatty liver disease (NAFLD) and other comorbidities. Understanding the genetics of susceptibility to obesity and its comorbidities could guide intervention. The cyclic adenosine monophosphate (cAMP)-dependent protein kinase (PKA) signaling pathway regulates energy balance, glucose homeostasis, and lipid metabolism. We hypothesized that PKA-related gene variants may be associated with obesity or associated metabolic conditions. We included 457 youths from the Yale Obesity Clinic into the Pathogenesis of Youth-Onset Diabetes cohort (NCT01967849); a variety of clinical tests were performed to characterize NAFLD. Exon sequencing of 54 PKA pathway genes was performed. Variants were confirmed by Sanger sequencing. Clinical data were analyzed, correcting for NAFLD status and body mass index z-score with adjustments for multiple comparisons. Fluorescence resonance energy transfer (FRET) and PKA enzymatic assays were performed in HEK293 cells transfected with the PRKAR1B p.R115K construct. In silico structural analysis for this variant was done. We identified the variant PRKAR1B p.R115K in 4 unrelated, African American patients. Analyses compared this variant group to other African American patients in the cohort. PRKAR1B p.R115K was associated with favorable circulating lipoprotein levels. Analysis of FRET and PKA enzymatic assay showed stronger interaction between the R1β mutant and PKA catalytic subunit Cα and decreased basal PKA activity compared with the wildtype (P < .0001). Structural analysis revealed that p.R115K may hinder conformational changes resulting from cAMP binding at cAMP binding domain A. Data suggest PRKAR1B p.R115K affects cAMP signaling and may favorably modulate lipoprotein profile in African American youth, protecting them from some adverse metabolic outcomes.

Within-visit SBP variability from childhood to adulthood and markers of cardiovascular end-organ damage in mid-life.

Within-visit SBP variability is associated with age and SBP, but its long-term clinical significance is unknown. We examined the association between child, adult, and life-time within-visit SBP variability with markers of end-organ damage using data from a 31-year longitudinal study. Within-visit SBP variability was calculated as the standard deviation of three sitting SBP readings among up to 3010 participants aged 6-18 years (childhood) who were re-measured up to seven times to mid-adulthood. Markers of cardiovascular end-organ damage in adulthood were carotid intima--media thickness, brachial flow-mediated dilatation, carotid distensibility, pulse wave velocity, left ventricular mass index, carotid plaque, and coronary artery calcification. The mean (standard deviation) cumulative within-visit SBP variability was 2.7 (1.5) mmHg in childhood, 3.9 (1.9) mmHg in adulthood and 3.7 (1.5) mmHg across the observed life-time. Childhood within-visit SBP variability was not correlated with its subsequent values measured from 3 to 31 years later. With adjustment for age, sex, cumulative SBP, BMI and serum lipids, neither child, adult, or life-time cumulative within-visit SBP variability associated with markers of cardiovascular end-organ damage. However, higher child, adult, and life-time cumulative SBP significantly associated with higher carotid intima--media thickness, higher pulse wave velocity, lower brachial flow-mediated dilatation, lower carotid distensibility in adulthood. Within-visit SBP variability from childhood to adulthood does not provide additional predictive utility over SBP over the same period of the life course.