Core Problem Research Articles

Carter, Porter, Herrera: Overcoming Mythology to Achieve Agency (Sometimes) Effectively

ABSTRACT This article explores the work of three fiction authors examining how they allow protagonists to bring originality to their use of stable mythological content to form new ways of organizing social relations. Across the three, the protagonist is led toward a pivotal moment, confronted by symbolic objects and figures that pose a real danger, from which some improvise, escape and form a more satisfying life. Fiction demonstrates how agency is possible, that humans can play with any given identities and roles and establish a different social order, at least sometimes effectively. Given the constraining power of mythology, this article builds on three core problems identified by Barthes to show how these writers can: first, undermine the naturalization of figures; second, challenge the notion that since order is largely given, then intentionality and agency are futile; and third, overcome how facts or veracity in myth-driven meaning lack any historical specificity by instead portraying direct experiences that produce their own identities, categories and relations. These findings are significant because the writers step outside politics to develop ideas about how political relations can be made differently through will, ability to experiment and enjoy experiments’ outcomes, and by living with greater multiplexity of perspectives.

Health-related quality of life and its association with socioeconomic status and mental health in 5- to 7-year-old children: a cross-sectional study.

Assessing socioeconomic status (SES), mental health, and health-related quality of life (HRQoL) in young children is crucial for making informed health care decisions and identifying areas of intervention. The present study aimed to investigate potential associations between SES, mental health, and HRQoL in 5-7-year-old children. The present study included mother-reported health assessments for 621 children aged 5-7years in Grade 1 collected between 2019 and 2023 as part of the Starting Right™ project. Online questionnaires were used to support public health nurses in assessing children's health status. HRQoL (KIDSCREEN-27, 5 subscales) and mental health [Strength and Difficulties Questionnaire (SDQ), 4 subscales] were assessed. Sociodemographic characteristics, sex, maternal education, and income were obtained from Statistics Norway. The data were analyzed using multiple robust regression. Mother-reported mean scores for the KIDSCREEN-27 were within the normal range compared with European norms (8-11years). However, for each KIDSCREEN-27 dimension, there were individuals whose mothers reported scores that were substantially lower than average. Having mental health problems, defined as being in the 80th and 90th percentiles of the SDQ Total problem score, was associated with 2.1-10.7-point lower KIDSCREEN-27 scores (p < 0.001-0.021), which was most noticeable in the KIDSCREEN-27 school environment subscale. Weak but significant positive associations were found between SES and HRQoL. Our results provide important insights into the associations between SES, mental health, and HRQoL in young children. Given the strong association between mental health problems and HRQoL in Grade 1 children, the assessment of both is essential, so that early interventions, an improved caring environment, and nurturing support can be initiated.

Effects of dog ownership on children's social-emotional development: findings from the PLAYCE cohort study.

Dog ownership is common in families with children and could play a role in children's social-emotional development. This study used longitudinal data on dog ownership and changing dog ownership to investigate their effects on young children's social-emotional development. Parents reported family dog ownership when their child was aged 2-5 years and at 5-7 years. Children (n = 591) were assigned to a dog ownership group by combining their current and prior dog ownership status. The parent-report Strengths and Difficulties Questionnaire (SDQ) measured children's social-emotional development at 5-7 years. Analyses included linear, Poisson, and logistic regression and adjusted for socio-demographic factors. Girls who acquired a dog had significantly higher peer problems scores than non-dog owner girls (exp(β) = 1.8; 95% CI 1.3, 2.6). Boys who acquired a dog had significantly lower peer problems scores than continuing non-dog owner boys (exp(β) = 0.5; 95% CI 0.3, 0.8). There were no other significant effects observed between dog ownership group and SDQ scores or the odds of having abnormal scores. Overall, changing or continuing dog ownership status had minimal impact on young children's social-emotional development. Future longitudinal research should examine the effects of dog ownership on child development by family characteristics and attachment to the dog. Dog acquisition was associated with higher peer problems for girls and lower peer problems for boys, but not the odds of having abnormal peer problems scores. Dog acquisition, dog loss, and continuing dog ownership status were not associated with other measure of social-emotional development. This study used longitudinal data to examine effects of dog ownership on child development. Overall, changing or continuing dog ownership status had minimal impact on young children's social-emotional development. Since dog ownership is selected into, longitudinal research is needed to confirm if changes in children's social-emotional development occur following changes in dog ownership.

Three Problems of Business Addressed by Stakeholder Theory: Insights from the Institutional Economics of John R. Commons

AbstractStakeholder theory is traditionally motivated by the need to reconceptualize three core problems of business: value creation and trade, the ethics of capitalism, and managerial mindsets. We argue that the need for this reconceptualization arises, in part, from the limitations of mainstream economic theory in grasping the evolving business environment. The original institutional economics of John R. Commons offers an alternative body of economic thought that addresses these limitations by replacing the atomistic individualism of mainstream economics with an ontology grounded in collective action. Drawing on Commons’ insights, we demonstrate how the problem of value creation and trade takes on a new meaning of promoting security of expectations through conflict resolution and the maintenance of order. We further reconstruct the problem of the ethics of capitalism by drawing on Commons’ concept of reasonableness, rooted in evolving community standards of morality. Finally, we trace the problem of managerial mindsets to Commons’ category of industrial goodwill, which suggests that managers can deliberately pursue policies that maximize stakeholders’ collaborative attitudes. We conclude that reconstructing these three problems of business through Commons’ categories reveals the deeper institutional economics content embedded within contemporary stakeholder theory.

Mixed data augmentation and osprey search strategy for enhancing YOLO in tomato disease, pest, and weed detection

Diseases, pests, and weeds are the core problem that restricts crop growth. Effective detection of biotic stress information plays an important role in crop growth and management. This paper proposes a mixed data augmentation method and the osprey search strategy for tomato biotic stress detection. Firstly, the channel attention mechanism is used to capture the channel correlation of the convolutional neural network and build an optimized object detection model YOLO_SE. Secondly, in the face of scarce and unbalanced classes, the feature transfer of “diseased leaves” based on CycleGAN and the mixed data augmentation method based on small target oversampling augmentation are used for image processing. Thirdly, a fast response osprey search strategy is proposed to optimize hyperparameters. The algorithm simulates the osprey's predatory behavior. Tent chaotic map, Lévy flight strategy, and data driven evolutionary optimization strategy are respectively used to ensure population position diversity, global optimization ability, and fast response ability. Experiments prove that the optimal validation mAP of the YOLO_SE in this paper is 2.61 % higher than that of the original model YOLOv4, and the optimal validation mAP of the expanded training set is 5.05 % higher than that of the original YOLO_SE. The optimal learning rate obtained using the osprey search strategy is 0.0011426948, and the best verification mAP of YOLO_SE trained by this learning rate is 88.42%, reaching the optimal effect.

Adrenal Crisis and Adrenal Insufficiency Admissions in Patients 30-59 Years: Contribution of Psychosocial Factors.

Adrenal crises (AC) occur in middle aged adults with adrenal insufficiency (AI). Psychosocial difficulties may impede effective self-management in some cases. This study aimed to investigate associations between psychosocial problems and hospital admissions for AI/AC in middle aged adults. Data on all hospitalisations among patients aged 30-59 years with a diagnosis of AI were extracted from a regional database for the years 2005-2020. Trends in hospitalisations and associations between admissions and comorbid psychosocial problems were assessed. Of the 3948 admissions for AI between 2005 and 2020, 63.4% were in women. Admissions increased by 91.4%, from 61.89 to 118.44/million (p < 0.0001), while AC admission rates increased by 176.5% (from 7.71 to 21.33/million, p=NS). Secondary AI (SAI) admissions rose by 133.0%, from 27.98/million to 65.20/million (p < 0.001). Admissions increased in women in each decade but only in males aged 50-59 years. Comorbid infection was identified in 28.1% of admissions and at least one comorbid contributory psychological problem was found in 25.6%. Males, patients with SAI and those not living in a domestic partnership had a higher combined psychosocial problem burden. Females admitted with at least one sign of an AC had significantly higher psychosocial problem scores than those with less severe presentations. These results suggest that psychosocial factors may play a role in some admissions for AI/AC in adults aged between 30 and 59 years, possibly contributing to the otherwise unexplained rise in hospitalisations for AI.

The Impact of Slight to Mild Hearing Loss on Academic Performance and Behavior of 9-15-Year-Olds.

To examine the impact of slight to mild hearing loss in children by studying its association with academic performance and behavioral problems. This study was embedded within a prospective birth cohort in Rotterdam, the Netherlands. Participants underwent audiometric and behavioral evaluations between ages 9-11 (April 2012-October 2015) and 13-15 (May 2017-September 2019). At 13-15, a multiple linear regression was conducted to explore the relationship between hearing acuity and both academic and behavioral outcomes. A cross-lagged analysis using data from ages 9 to 11 investigated bidirectional associations between hearing loss and behavioral problems. The cross-sectional part of the study involved 4688 participants at the age of 13-15 years. The relative risk for children with slight to mild hearing loss of being placed in a lower educational level compared with the highest level was 1.52 (95% confidence interval (CI) [1.14, 2.02]). Among boys, elevated high-frequency pure-tone average (HPTA) was associated with a higher total problem score (per 1 dB HPTA: β = 0.01; 95% CI [0.00, 0.02]). For girls, elevated low-frequency pure-tone average (LPTA) was associated with a higher attention problem score (per 1 dB LPTA: β = 0.02; 95% CI [0.01, 0.02]). Cross-lagged effects showed that participants with increased pure-tone averages in low frequencies at 9-11 years had more social problems at ages 13-15 years (Z-score difference: 0.01; 95% CI [0.01, 0.02]). Elevated hearing thresholds in slight to mild hearing loss were linked to poorer academic performance and increased behavioral problems. 2 (prospective cohort study) Laryngoscope, 2024.

Dengue Outbreak Control and Prevention: A Case Study of Gampaha District, Sri Lanka

Dengue fever remains a persistent public health challenge in Gampaha District, Sri Lanka. Despite ongoing efforts by the Ministry of Healthcare, Nutrition &amp; Indigenous Medicine, the district reported 10,212 cases in 2022, with significant hospital admissions and deaths in high-risk areas like MC Negombo, Gampaha, and Minuwangoda. The study examines Dengue control and prevention strategies implemented from November 2022 to March 2023. Data was collected from existing records, interviews with key informants, and field observations. Major challenges were identified and prioritised using evidence-based methodologies, including the "Five Whys" root cause analysis. The analysis revealed significant challenges categorised into program-related and non-program-related issues. Key issues include inadequate use of existing data, insufficient evidence-based control measures, and operational inefficiencies. The root cause analysis identified core problems such as lack of funding, poor planning, and limited community engagement. The study highlights the critical need for data-driven decision-making and enhanced collaborative efforts. Establishing a technical body, develop context-specific programs, and improve community involvement. Resource mobilisation for research and forecasting epidemics was also emphasised. This case study provides valuable insights into the challenges and strategic interventions necessary for effective Dengue control in the Gampaha District. Emphasising evidence-based decision-making and a comprehensive action plan underscores the importance of collaborative efforts to combat Dengue in the region.

Bi-objective Optimization in Role Mining

Role mining is a technique that is used to derive a role-based authorization policy from an existing policy. Given a set of users U , a set of permissions P , and a user–permission authorization relation \(\mathit {UPA} \subseteq U \times P\) , a role mining algorithm seeks to compute a set of roles R , a user–role authorization relation \(\mathit {UA} \subseteq U \times R\) , and a permission–role authorization relation \(\mathit {PA} \subseteq R \times P\) , such that the composition of UA and PA is close (in some appropriate sense) to UPA . Role mining is therefore a core problem in the specification of role-based authorization policies. Role mining is known to be hard in general and exact solutions are often impossible to obtain, so there exists an extensive literature on variants of the role mining problem that seek to find approximate solutions and algorithms that use heuristics to find reasonable solutions efficiently. In this article, we first introduce the Generalized Noise Role Mining problem (GNRM)—a generalization of the MinNoise Role Mining problem—which we believe has considerable practical relevance. In particular, GNRM can produce “security-aware” or “availability-aware” solutions. Extending the work of Fomin et al., we show that GNRM is fixed parameter tractable, with parameter \(r + k\) , where \(r\) is the number of roles in the solution and \(k\) is the number of discrepancies between \(\mathit {UPA}\) and the relation defined by the composition of \(\mathit {UA}\) and \(\mathit {PA}\) . We further introduce a bi-objective optimization variant of GNRM, where we wish to minimize both \(r\) and \(k\) subject to upper bounds \(r \le \bar{r}\) and \(k\le \bar{k}\) , where \(\bar{r}\) and \(\bar{k}\) are constants. We show that the Pareto front of this bi-objective optimization problem (BO-GNRM) can be computed in fixed-parameter tractable time with parameter \(\bar{r} +\bar{k}\) . From a practical perspective, a solution to BO-GNRM gives security managers the opportunity to identify a mined policy offering the best tradeoff between the number of policy discrepancies and the number of roles. We then report the results of our experimental work using the integer programming solver Gurobi to solve instances of BO-GNRM. Our key findings are that (a) we obtained strong support that Gurobi’s performance is fixed-parameter tractable, and (b) our results suggest that our techniques may be useful for role mining in practice, based on our experiments in the context of three well-known real-world authorization policies. We observed that, in many cases, our solver is capable of obtaining optimal solutions when the values of either k or r are small.

Optimizing Currency Circulation Forecasts in Indonesia: A Hybrid Prophet- Long Short Term Memory Model with Hyperparameter Tuning

The core problem for decision-makers lies in selecting an effective forecasting method, particularly when faced with the challenges of nonlinearity and nonstationarity in time series data. To address this, hybrid models are increasingly employed to enhance forecasting accuracy. In Indonesia and other Muslim countries, monthly economic and business time series data often include trends, seasonality, and calendar variations. This study compares the performance of the hybrid Prophet-Long Short-Term Memory (LSTM) model with their individual counterparts to forecast such patterned time series. The aim is to identify the best model through a hybrid approach for forecasting time series data exhibitingtrend, seasonality, and calendar variations, using the real-life case of currency circulation in South Sulawesi. The goodness of the models is evaluated using the smallest Mean Absolute Percentage Error (MAPE) and Root Mean Square Error (RMSE) values. The results indicate that the hybrid Prophet- LSTM model demonstrates superior accuracy, especially for predicting currency outflow, with lower MAPE and RMSE values than standalone models. The LSTM model shows excellent performance for currency inflow, while the Prophet model lags in inflow and outflow accuracy. This insight is valuable for Bank Indonesia’s strategic planning, aiding in better cash flow prediction and currency stock management.

Utilization of home-based care and its buffering effects between dementia caregiving intensity and caregiver burden in China.

Home-based care (HBC) services have gained global attention for their potential to reduce caregiver burden among informal caregivers of persons with dementia (PwDs), who experience high caregiving intensity. However, research on HBC and its effects on dementia caregiving in China remains limited. Data were collected from primary caregivers of PwDs in Jiangsu Province, China. Caregiving intensity and HBC utilization were measured using self-developed instruments. Caregiver burden was assessed by The Burden Scale for Family Caregivers-short. Factor analysis was employed to decompose HBC services. Hierarchical multiple regression analysed the moderating effects of HBC on the relationship between caregiving intensity and burden. A community sample of 318 caregiver and PwDs dyads was included. Caregivers averagely aged 62.16 years, with 61% being female, 84% not employed, and 66.2% having low income. PwDs aged 77.45 years averagely, with 52.8% being female and an average behavioural problems score of 42.27. Caregivers averaged 15.19 on response measures. The number and time spent on ADL-based tasks were positively associated with caregiver burden (β = 0.26, p < .001; β = 0.16, p < .01). However, attendance and time of supervision tasks were not significant predictors of burden. HBC services in China comprised four dimensions: Referral service, Household care, Skilled care, and Mental health service. While these did not directly predict caregiver burden, they moderated the associations between ADL-based tasks and caregiver burden (β=-0.25, p < .001; β=-0.24, p < .001; β=-0.23, p < .001; β=-0.20, p < .001), between time of ADL-based tasks and caregiver burden (β=-0.17, p < .001; β=-0.18, p < .001; β=-0.17, p < .001; β=-0.15, p < .01), and between the attendance at supervision tasks and caregiver burden (β=-0.11, p < .05; β=-0.20, p < .001; β=-0.17, p < .001; β=-0.17, p < .001). Only Referral service buffered the relationship between supervision time and caregiver burden (β = -0.13, p < .01). Informal caregivers of PwDs face high caregiving intensity and burden. HBC services may moderate this relationship, with different services playing varying roles. Further research is essential to explore the impact of supervision levels and develop effective strategies to enhance HBC services for dementia caregiving in China.

Rates of socio-emotional difficulties among deaf and hard of hearing children in Ireland

ABSTRACT Higher rates of socio-emotional difficulties for deaf and hard of hearing (DHH) children have been reported compared with their typical hearing (TH) peers. Nonetheless, there has to date been limited examination on this issue internationally and no such examination in the Republic of Ireland. In this study, data was collected from parents using an online survey which included the Strengths and Difficulties Questionnaire to examine the socio-emotional development of 113 DHH children aged 5–16 in the Republic of Ireland. The results were compared with data from typically hearing (TH) children obtained from a large longitudinal study of childhood in Ireland – the Growing Up in Ireland study. The findings demonstrate that the prevalence of socio-emotional difficulties among this cohort of children is over three times that of the general population of children in Ireland, with 42% of the sample demonstrating clinically significant problem scores. Furthermore, DHH children had elevated subscale scores for the four problem scales in the SDQ when compared against the TH sample. These differences were statistically significant and had a range of effect sizes from small to large. The subscale of most concern was the peer problems subscale where the DHH sample had mean scores that were roughly double those of the TH sample, with a large effect size found. Finally, bivariate analysis revealed that several background variables were associated with elevated difficulty scores for DHH children, namely male gender, poorer communicative competency, and presence of an additional educational need.

Against decolonial reductionism: The impact of Latin American thinking on the data decolonization project

This essay argues that Latin American scholarship and movement practice are key to understanding the dynamics of the datafied society and countering its inequities. Examining the sources of inspiration of a frontrunner seeking to decolonize the datafied society – the Big Data from the South Initiative ( BigDataSur) – we review Martín-Barbero's ontological shift from media to mediations, Freire's methodology centring individual agency and empowerment as a structural task of society, Mignolo's invite to take decoloniality as a praxis rather than merely an idea, Rodríguez's first-hand engagement with technology at the margins, Escobar's autonomous design for the pluriverse, and the critical ecology of eco-social movements. We engage with a new generation of Latin American thinkers who turn their gaze to core problems of today's systems of knowledge production, be they media or academia. Learning from these scholars, we warn against decolonial reductionism, namely the trend to evoke decolonial ideas and theories without fully committing to putting them into practice. We maintain that to decolonize datafication, we ought to also change how we generate knowledge about the datafied society. We outline three practical strategies that foster an open-ended dialogue on alternative approaches to datafication and scientific practice: multilingualism, public scholarship, and mentorship.

Behavioral feeding problems and parenting stress in toddlers with food protein–induced allergic proctocolitis

BackgroundFood protein–induced allergic proctocolitis (FPIAP) typically develops in infancy, a critical period for taste preference and feeding skill development. Eliminating culprit foods, along with limited food options and the child's distressing symptoms, can significantly impact the mothers' parenting roles. However, research on behavioral feeding problems and parenting stress in toddlers with FPIAP is lacking. ObjectiveTo assess feeding behaviors and parenting stress levels in toddlers with FPIAP compared with healthy controls. MethodsIn this case-control study, parents of toddlers with FPIAP (n = 89) and healthy controls (n = 93) completed a socio-demographic form, the Behavioral Pediatrics Feeding Assessment Scale (BPFAS), and the Parenting Stress Index–Short Form. ResultsThere were 75% percent of toddlers with FPIAP who had single food allergies, and cow's milk (95.5%) was the most common trigger. Children with FPIAP initiated complementary feeding later than controls (P = .001) and preferred vegetables (P < .001). They experienced more challenges during the transition to complementary foods (P < .001). Whereas BPFAS total and child-related frequency and restriction scores were similar between groups (P > .05), the FPIAP group had significantly higher parent-related frequency, total problem, child-related problem, parent-related problem, and poor strategies scores (P < .05). In addition, the FPIAP group exhibited higher levels of parental distress, parent-child dysfunctional interaction, difficult child, and total stress scores (P < .001). Multivariate logistic regression analysis revealed that increased maternal total stress scores were associated with higher BPFAS total frequency scores (≥85) (odds ratio [OR]: 1.065, 95% CI: 1.031-1.101, P < .001) and total problem scores (≥10) (OR: 1.049, 95% CI: 1.021-1.077, P < .001). In addition, following social media accounts related to allergic proctocolitis was negatively associated with having higher BPFAS total frequency scores (≥85) (OR: 0.253, 95% CI: 0.073-0.878, P = .030). ConclusionToddlers with FPIAP and their parents experience greater mealtime challenges compared with healthy controls, correlating with higher levels of parenting stress. Clinicians should recognize and address these challenges.

Identifying childhood pesticide exposure trajectories and critical window associated with behavioral problems at 10 years of age: Findings from SMBCS

BackgroundPesticides may impact children’s neurodevelopment. As children’s metabolic function and neural plasticity change throughout their growth and development, the effects of pesticide exposure may also vary. ObjectivesWe aimed to identify the trajectories of combined pesticide exposure during childhood, and examine the associations of the exposure trajectories with children’s neurobehavior at the age of 10. MethodsWe involved repeated measurements of three pesticide metabolites [Pentachlorophenol (PCP), 3,5,6-Trichloro-2-pyridinol (TCPy), and Carbofuran phenol (CFP)], in urine samples collected from children in a cohort study at ages 1, 2, 3, 6, 7, 8, 9, and 10 years. The group-based multi-trajectory model (GBMT) and latent class analysis (LCA) were separately utilized to describe the distinct trajectories and patterns of pesticide mixture exposure during childhood. Meanwhile, the Strengths and Difficulties Questionnaire (SDQ) and attention deficit hyperactivity disorder (ADHD) Criteria of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) list were applied to assess behavioral disorders in children. The associations between exposure trajectories and behavioral problem scores were then examined. ResultsThe GBMT model delineated three distinct trajectories of combined pesticide exposure among children: consistently low, higher levels in early childhood transitioning to lower levels during pre-school age, and lower levels in early childhood followed by higher levels in the middle childhood. The LCA model identified three similar longitudinal exposure patterns. Further, the children in the second trajectory group identified by GBMT, characterized by higher early childhood exposure levels, exhibited significantly elevated hyperactivity/inattention scores of the SDQ compared to the other two groups (β = 0.46, 95 %CI: 0.11, 0.81; β = 0.44, 95 %CI: 0.02, 0.86). ConclusionsOur study revealed that exposure to pesticides during early childhood (especially before the age of two), rather than other age periods, was linked to hyperactivity/inattention problems in children aged 10 years. We also provided a novel perspective on characterizing the fluctuation in repeated measurements of multiple environmental chemicals and identifying the potential critical windows.

Analysis of the cause, harm and optimization of “too much democracy”

“Too much democracy” refers to an excess of political procedures, institutions, and information. It has a historical background, but it actually leads to worse governance and poses significant challenges to global democratic systems. The reasons for excessive democracy include the inherent nature of democracy itself and the impure political motives of politicians participating in democratic activities. While excessive democracy can improve transparency and accountability, it can lead to inefficient decision-making, political gridlock and economic losses. Political apathy, which contributes to populism and political polarization, can also be attributed to excessive democracy. Deliberate democracy, as a new trend in numerous democratic countries, does not address the core problems of “too much democracy” and is not a long-term solution. This paper believes that the direction of efforts should be to continuously improve the clarity and efficiency of democratic principles.

Estimated lifetime impact of a school-based intervention for mental health: A microsimulation study

Abstract Background The prevalence of childhood mental health problems is increasing. School-based interventions have the potential to reduce poor mental health and mental health inequalities. Our aim was to estimate the long-term costs and benefits of the Incredible Years Teacher® Classroom Management (IY-TCM) intervention in primary schools compared to no intervention. Methods LifeSim, an existing microsimulation model, was used to estimate the lifetime costs and benefits of IY-TCM by linking short-term changes in SDQ based on a previous trial in primary schools (Cluster RCT: 2075 children aged 4-9 years with a 30-month follow-up) to long-term health, social, economic and wellbeing outcomes. Benefits were measured in quality adjusted life years and wellbeing adjusted life years. We examined subgroup based on deprivation, conduct scores and parental depression. Results Microsimulation modelling estimated small gains in lifetime outcomes including reduced conduct disorder in adolescence and depression in adulthood. Estimates indicate IY-TCM could be cost-effective with a large amount of uncertainty (Net monetary benefit (NMB)=£21, Estimated CI = -£195, £240). IY-TCM was estimated to be more cost-effective for those with high deprivation (NMB = £231, Estimation CI - -£99, £231) and high conduct problem scores (NMB=£315, Estimated CI = £45, £483). Total net social benefit for a typical year size group was estimated to be £111m. Conclusions IY-TCM could be cost-effective compared to no intervention with a large estimated social benefit supporting wider implementation of IY-TCM, but results indicate a large amount of uncertainty. Greater benefits and higher certainty of cost-effectiveness for children with conduct problems and those living in a deprived area suggest IY-TCM has the potential to reduce mental health inequalities and may be more cost-effective for schools with higher deprivation and/or a high prevalence of conduct problems. Key messages • The Incredible Years Teacher Classroom Management intervention for mental health in primary schools could be considered cost-effective but there is a large amount of uncertainty. • Greater benefits for children with conduct problems and those living in a deprived area indicates the intervention has the potential to reduce mental health inequalities.

Associations of fetal and infant growth patterns with behavior and cognitive outcomes in early adolescence

AbstractBackgroundFetal life and infancy might be critical periods for brain development leading to increased risks of neurocognitive disorders and psychopathology later in life. We examined the associations of fetal and infant weight growth patterns and birth characteristics with behavior and cognitive outcomes at the age of 13 years.MethodsPopulation‐based prospective cohort study from fetal life until adolescence. Pregnant women with a delivery date between April 2002 and January 2006 were eligible. Follow‐up measurements were available for 4716 children. Fetal weight was estimated in the second and third trimesters of pregnancy by ultrasonography. Infant weight was measured at birth and at 6, 12, and 24 months. Fetal and infant weight acceleration or deceleration were defined as a change in SD greater than 0.67 between time points. Total, internalizing and externalizing problems and attention‐deficit hyperactivity disorder (ADHD) symptoms were measured using Child Behavior Checklist (CBCL/6–18), autistic traits by the Social Responsiveness Scale (SRS) and intelligence quotient (IQ) by the Wechsler Intelligence Scale for Children‐Fifth Edition (WISC‐V).ResultsOne week longer gestational age at birth was associated with a −0.03 SDS (95% Confidence Interval (CI): −0.04, −0.01) lower total behavior problems score, a −0.02 SDS (95% CI: −0.04, −0.01) lower ADHD symptoms score. Also an increase in birth weight of 500 g was associated with a lower odds of having high externalizing problems (OR 0.92 (95% CI: 0.86, 0.98) and of having a low IQ score (OR 0.79 (95% CI: 0.71, 0.88). Compared to children with normal fetal and infant growth, those with accelerated fetal and infant growth had a 0.27 SDS higher IQ (95% Confidence Interval 0.11, 0.44).ConclusionsBoth fetal and infant weight development are associated with behavioral and cognitive outcomes in early adolescence. Follow‐up studies are needed to assess whether these associations link to later life mental health outcomes.

Revolutionizing bone defect healing: the power of mesenchymal stem cells as seeds.

Bone defects can arise from trauma or pathological factors, resulting in compromised bone integrity and the loss or absence of bone tissue. As we are all aware, repairing bone defects is a core problem in bone tissue engineering. While minor bone defects can self-repair if the periosteum remains intact and normal osteogenesis occurs, significant defects or conditions such as congenital osteogenesis imperfecta present substantial challenges to self-healing. As research on mesenchymal stem cell (MSC) advances, new fields of application have emerged; however, their application in orthopedics remains one of the most established and clinically valuable directions. This review aims to provide a comprehensive overview of the research progress regarding MSCs in the treatment of diverse bone defects. MSCs, as multipotent stem cells, offer significant advantages due to their immunomodulatory properties and ability to undergo osteogenic differentiation. The review will encompass the characteristics of MSCs within the osteogenic microenvironment and summarize the research progress of MSCs in different types of bone defects, ranging from their fundamental characteristics and animal studies to clinical applications.

Language barriers and mental health problems of preschool children born very preterm in Germany.

We assessed whether behavioural and emotional problems of 5- to 6-year-old preschool children born very preterm (<32 weeks' gestation) are associated with an immigrant background and linguistic distance of their first language to the host country's official language, German. This is an observational longitudinal cohort study. Data are from the national multicentre German Neonatal Network cohort, including all very preterm births from 2009 onwards. A total of 3220 (n = 1570 female) children were followed up at preschool age; 629 (n = 324 female) of these had an immigrant background. Behavioural and emotional problems were assessed using the parent-reported Strengths and Difficulties Questionnaire (SDQ). Mixed-effects models showed that immigrant status alone was not associated with children's behavioural and emotional problems. However, a higher linguistic distance of the children's first language to German was associated with higher SDQ total problem scores (coefficient = 0.008, 95% confidence interval 0.002, 0.015), after adjusting for known confounders. Language barriers in the form of linguistic distance between the first language of children born very preterm and countries' official languages are associated with increased risk for behavioural and emotional problems. More research is needed on how language barriers affect long-term developmental outcomes of immigrant children born very preterm.